Implementing adaptive e-learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains
Introduction To improve healthcare provider knowledge of Tanzanian newborn care guidelines, we developed adaptive Essential and Sick Newborn Care (aESNC), an adaptive e-learning environment. The objectives of this study were to (1) assess implementation success with use of in-person support and nudg...
| Main Authors: | , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2024-02-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/2/e077834.full |
| _version_ | 1797269385773056000 |
|---|---|
| author | Peter Andrew Meaney Christine Lynn Joyce Ambrose Agweyu Joseph R Mwanga Marc Berg Adolfine Hokororo Hanston Ndosi Alex Dahlen Theopista Jacob Florence Salvatory Kalabamu Rishi Mediratta Boris Rozenfeld Zachary Haines Smith Neema Chami Namala Mkopi Castory Mwanga Enock Diocles |
| author_facet | Peter Andrew Meaney Christine Lynn Joyce Ambrose Agweyu Joseph R Mwanga Marc Berg Adolfine Hokororo Hanston Ndosi Alex Dahlen Theopista Jacob Florence Salvatory Kalabamu Rishi Mediratta Boris Rozenfeld Zachary Haines Smith Neema Chami Namala Mkopi Castory Mwanga Enock Diocles |
| author_sort | Peter Andrew Meaney |
| collection | DOAJ |
| description | Introduction To improve healthcare provider knowledge of Tanzanian newborn care guidelines, we developed adaptive Essential and Sick Newborn Care (aESNC), an adaptive e-learning environment. The objectives of this study were to (1) assess implementation success with use of in-person support and nudging strategy and (2) describe baseline provider knowledge and metacognition.Methods 6-month observational study at one zonal hospital and three health centres in Mwanza, Tanzania. To assess implementation success, we used the Reach, Efficacy, Adoption, Implementation and Maintenance framework and to describe baseline provider knowledge and metacognition we used Howell’s conscious-competence model. Additionally, we explored provider characteristics associated with initial learning completion or persistent activity.Results aESNC reached 85% (195/231) of providers: 75 medical, 53 nursing and 21 clinical officers; 110 (56%) were at the zonal hospital and 85 (44%) at health centres. Median clinical experience was 4 years (IQR 1–9) and 45 (23%) had previous in-service training for both newborn essential and sick newborn care. Efficacy was 42% (SD ±17%). Providers averaged 78% (SD ±31%) completion of initial learning and 7% (SD ±11%) of refresher assignments. 130 (67%) providers had ≥1 episode of inactivity >30 day, no episodes were due to lack of internet access. Baseline conscious-competence was 53% (IQR: 38%–63%), unconscious-incompetence 32% (IQR: 23%–42%), conscious-incompetence 7% (IQR: 2%–15%), and unconscious-competence 2% (IQR: 0%–3%). Higher baseline conscious-competence (OR 31.6 (95% CI 5.8 to 183.5)) and being a nursing officer (aOR: 5.6 (95% CI 1.8 to 18.1)), compared with medical officer, were associated with initial learning completion or persistent activity.Conclusion aESNC reach was high in a population of frontline providers across diverse levels of care in Tanzania. Use of in-person support and nudging increased reach, initial learning and refresher assignment completion, but refresher assignment completion remains low. Providers were often unaware of knowledge gaps, and lower baseline knowledge may decrease initial learning completion or activity. Further study to identify barriers to adaptive e-learning normalisation is needed. |
| first_indexed | 2024-03-08T06:49:59Z |
| format | Article |
| id | doaj.art-518d8f0aa1cd40788a7cf31392c6bdf5 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-25T01:47:32Z |
| publishDate | 2024-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-518d8f0aa1cd40788a7cf31392c6bdf52024-03-07T20:35:08ZengBMJ Publishing GroupBMJ Open2044-60552024-02-0114210.1136/bmjopen-2023-077834Implementing adaptive e-learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gainsPeter Andrew Meaney0Christine Lynn Joyce1Ambrose Agweyu2Joseph R Mwanga3Marc Berg4Adolfine Hokororo5Hanston Ndosi6Alex Dahlen7Theopista Jacob8Florence Salvatory Kalabamu9Rishi Mediratta10Boris Rozenfeld11Zachary Haines Smith12Neema Chami13Namala Mkopi14Castory Mwanga15Enock Diocles16Critical Care, Lucile Salter Packard Children`s Hospital at Stanford, Palo Alto, California, USACritical Care, Cornell University Department of Pediatrics, New York, New York, USAEpidemiology and Demography, KEMRI—Wellcome Trust Research Institute, Nairobi, KenyaEpidemiology, Biostatistics, and Behavioural Sciences School of Public Health, Catholic University of Health and Allied Sciences Bugando, Mwanza, TanzaniaDepartment of Pediatrics, Stanford University School of Medicine, Stanford, California, USAPediatrics and Child Health, Bugando Consultant and Referral Hospital, Mwanza, TanzaniaPediatrics and Child Health, Catholic University of Health and Allied Sciences Bugando, Mwanza, TanzaniaNew York University Division of Biostatistics, New York, New York, USAPediatric Association of Tanzania, Dar es Salaam, TanzaniaPaediatrics and Child Health, Hubert Kairuki Memorial University, Dar es Salaam, TanzaniaDepartment of Pediatrics, Stanford University School of Medicine, Stanford, California, USAArea9 Lyceum, Boston, Massachusetts, USADepartment of Pediatrics, Stanford University School of Medicine, Stanford, California, USAPediatrics and Child Health, Bugando Consultant and Referral Hospital, Mwanza, TanzaniaPediatric Critical Care, Muhimbili National Hospital, Dar es Salaam, TanzaniaPediatrics, Simiyu District Hospital, Simiyu, TanzaniaNursing, Mwanza College of Health and Allied Sciences, Mwanza, TanzaniaIntroduction To improve healthcare provider knowledge of Tanzanian newborn care guidelines, we developed adaptive Essential and Sick Newborn Care (aESNC), an adaptive e-learning environment. The objectives of this study were to (1) assess implementation success with use of in-person support and nudging strategy and (2) describe baseline provider knowledge and metacognition.Methods 6-month observational study at one zonal hospital and three health centres in Mwanza, Tanzania. To assess implementation success, we used the Reach, Efficacy, Adoption, Implementation and Maintenance framework and to describe baseline provider knowledge and metacognition we used Howell’s conscious-competence model. Additionally, we explored provider characteristics associated with initial learning completion or persistent activity.Results aESNC reached 85% (195/231) of providers: 75 medical, 53 nursing and 21 clinical officers; 110 (56%) were at the zonal hospital and 85 (44%) at health centres. Median clinical experience was 4 years (IQR 1–9) and 45 (23%) had previous in-service training for both newborn essential and sick newborn care. Efficacy was 42% (SD ±17%). Providers averaged 78% (SD ±31%) completion of initial learning and 7% (SD ±11%) of refresher assignments. 130 (67%) providers had ≥1 episode of inactivity >30 day, no episodes were due to lack of internet access. Baseline conscious-competence was 53% (IQR: 38%–63%), unconscious-incompetence 32% (IQR: 23%–42%), conscious-incompetence 7% (IQR: 2%–15%), and unconscious-competence 2% (IQR: 0%–3%). Higher baseline conscious-competence (OR 31.6 (95% CI 5.8 to 183.5)) and being a nursing officer (aOR: 5.6 (95% CI 1.8 to 18.1)), compared with medical officer, were associated with initial learning completion or persistent activity.Conclusion aESNC reach was high in a population of frontline providers across diverse levels of care in Tanzania. Use of in-person support and nudging increased reach, initial learning and refresher assignment completion, but refresher assignment completion remains low. Providers were often unaware of knowledge gaps, and lower baseline knowledge may decrease initial learning completion or activity. Further study to identify barriers to adaptive e-learning normalisation is needed.https://bmjopen.bmj.com/content/14/2/e077834.full |
| spellingShingle | Peter Andrew Meaney Christine Lynn Joyce Ambrose Agweyu Joseph R Mwanga Marc Berg Adolfine Hokororo Hanston Ndosi Alex Dahlen Theopista Jacob Florence Salvatory Kalabamu Rishi Mediratta Boris Rozenfeld Zachary Haines Smith Neema Chami Namala Mkopi Castory Mwanga Enock Diocles Implementing adaptive e-learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains BMJ Open |
| title | Implementing adaptive e-learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains |
| title_full | Implementing adaptive e-learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains |
| title_fullStr | Implementing adaptive e-learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains |
| title_full_unstemmed | Implementing adaptive e-learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains |
| title_short | Implementing adaptive e-learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains |
| title_sort | implementing adaptive e learning for newborn care in tanzania an observational study of provider engagement and knowledge gains |
| url | https://bmjopen.bmj.com/content/14/2/e077834.full |
| work_keys_str_mv | AT peterandrewmeaney implementingadaptiveelearningfornewborncareintanzaniaanobservationalstudyofproviderengagementandknowledgegains AT christinelynnjoyce implementingadaptiveelearningfornewborncareintanzaniaanobservationalstudyofproviderengagementandknowledgegains AT ambroseagweyu implementingadaptiveelearningfornewborncareintanzaniaanobservationalstudyofproviderengagementandknowledgegains AT josephrmwanga implementingadaptiveelearningfornewborncareintanzaniaanobservationalstudyofproviderengagementandknowledgegains AT marcberg implementingadaptiveelearningfornewborncareintanzaniaanobservationalstudyofproviderengagementandknowledgegains AT adolfinehokororo implementingadaptiveelearningfornewborncareintanzaniaanobservationalstudyofproviderengagementandknowledgegains AT hanstonndosi implementingadaptiveelearningfornewborncareintanzaniaanobservationalstudyofproviderengagementandknowledgegains AT alexdahlen implementingadaptiveelearningfornewborncareintanzaniaanobservationalstudyofproviderengagementandknowledgegains AT theopistajacob implementingadaptiveelearningfornewborncareintanzaniaanobservationalstudyofproviderengagementandknowledgegains AT florencesalvatorykalabamu implementingadaptiveelearningfornewborncareintanzaniaanobservationalstudyofproviderengagementandknowledgegains AT rishimediratta implementingadaptiveelearningfornewborncareintanzaniaanobservationalstudyofproviderengagementandknowledgegains AT borisrozenfeld implementingadaptiveelearningfornewborncareintanzaniaanobservationalstudyofproviderengagementandknowledgegains AT zacharyhainessmith implementingadaptiveelearningfornewborncareintanzaniaanobservationalstudyofproviderengagementandknowledgegains AT neemachami implementingadaptiveelearningfornewborncareintanzaniaanobservationalstudyofproviderengagementandknowledgegains AT namalamkopi implementingadaptiveelearningfornewborncareintanzaniaanobservationalstudyofproviderengagementandknowledgegains AT castorymwanga implementingadaptiveelearningfornewborncareintanzaniaanobservationalstudyofproviderengagementandknowledgegains AT enockdiocles implementingadaptiveelearningfornewborncareintanzaniaanobservationalstudyofproviderengagementandknowledgegains |