TY - JOUR
T1 - Remote Consulting in Primary Health Care in Low- And Middle-Income Countries
T2 - Feasibility Study of an Online Training Program to Support Care Delivery during the COVID-19 Pandemic
AU - Downie, Andrew
AU - Mashanya, Titus
AU - Chipwaza, Beatrice
AU - Griffiths, Frances
AU - Harris, Bronwyn
AU - Kalolo, Albino
AU - Ndegese, Sylvester
AU - Sturt, Jackie
AU - De Valliere, Nicole
AU - Pemba, Senga
N1 - Funding Information:
We are deeply grateful to the health care workers who participated in the training and its evaluation. We thank the journal editors and 2 anonymous reviewers for the constructive, thoughtful comments on our manuscript. We also thank our colleagues in the Digital Innovation for Development in Africa (DIDA) project for the collegiality and shared insights into remote consulting. This study was supported by funding from the UK Research and Innovation (UKRI) Global Challenges Research Fund for Digital Innovation for Development in Africa: Engineering and Physical Sciences Research Council (Grant EP/T030240/1) and the King’s Together Fund: “How Can Remote Consulting Training for health workers in Rural Tanzania Be Optimised to Support Upscaling to Remote and Marginalised Communities of East and West Africa?”
Funding Information:
The facilitator is supported by a facilitator’s guide incorporating pedagogical principles underpinning the course, logistics, expectations, and tips to optimize trainee engagement. The
Publisher Copyright:
©Andrew Downie, Titus Mashanya, Beatrice Chipwaza, Frances Griffiths, Bronwyn Harris, Albino Kalolo, Sylvester Ndegese, Jackie Sturt, Nicole De Valliere, Senga Pemba.
PY - 2022/6/1
Y1 - 2022/6/1
N2 - Background: Despite acceleration of remote consulting throughout the COVID-19 pandemic, many health care professionals are practicing without training to offer teleconsultation to their patients. This is especially challenging in resource-poor countries, where the telephone has not previously been widely used for health care. Objective: As the COVID-19 pandemic dawned, we designed a modular online training program for REmote Consulting in primary Health care (REaCH). To optimize upscaling of knowledge and skills, we employed a train-the-trainer approach, training health workers (tier 1) to cascade the training to others (tier 2) in their locality. We aimed to determine whether REaCH training was acceptable and feasible to health workers in rural Tanzania to support their health care delivery during the pandemic. Methods: We developed and pretested the REaCH training program in July 2020 and created 8 key modules. The program was then taught remotely via Moodle and WhatsApp (Meta Platforms) to 12 tier 1 trainees and cascaded to 63 tier 2 trainees working in Tanzania’s rural Ulanga District (August-September 2020). We evaluated the program using a survey (informed by Kirkpatrick's model of evaluation) to capture trainee satisfaction with REaCH, the knowledge gained, and perceived behavior change; qualitative interviews to explore training experiences and views of remote consulting; and documentary analysis of emails, WhatsApp texts, and training reports generated through the program. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed thematically. Findings were triangulated and integrated during interpretation. Results: Of the 12 tier 1 trainees enrolled in the program, all completed the training; however, 2 (17%) encountered internet difficulties and failed to complete the evaluation. In addition, 1 (8%) opted out of the cascading process. Of the 63 tier 2 trainees, 61 (97%) completed the cascaded training. Of the 10 (83%) tier 1 trainees who completed the survey, 9 (90%) would recommend the program to others, reported receiving relevant skills and applying their learning to their daily work, demonstrating satisfaction, learning, and perceived behavior change. In qualitative interviews, tier 1 and 2 trainees identified several barriers to implementation of remote consulting, including lacking digital infrastructure, few resources, inflexible billing and record-keeping systems, and limited community awareness. The costs of data or airtime emerged as the greatest immediate barrier to supporting both the upscaling of REaCH training and subsequently the delivery of safe and trustworthy remote health care. Conclusions: The REaCH training program is feasible, acceptable, and effective in changing trainees’ behavior. However, government and organizational support is required to facilitate the expansion of the program and remote consulting in Tanzania and other low-resource settings.
AB - Background: Despite acceleration of remote consulting throughout the COVID-19 pandemic, many health care professionals are practicing without training to offer teleconsultation to their patients. This is especially challenging in resource-poor countries, where the telephone has not previously been widely used for health care. Objective: As the COVID-19 pandemic dawned, we designed a modular online training program for REmote Consulting in primary Health care (REaCH). To optimize upscaling of knowledge and skills, we employed a train-the-trainer approach, training health workers (tier 1) to cascade the training to others (tier 2) in their locality. We aimed to determine whether REaCH training was acceptable and feasible to health workers in rural Tanzania to support their health care delivery during the pandemic. Methods: We developed and pretested the REaCH training program in July 2020 and created 8 key modules. The program was then taught remotely via Moodle and WhatsApp (Meta Platforms) to 12 tier 1 trainees and cascaded to 63 tier 2 trainees working in Tanzania’s rural Ulanga District (August-September 2020). We evaluated the program using a survey (informed by Kirkpatrick's model of evaluation) to capture trainee satisfaction with REaCH, the knowledge gained, and perceived behavior change; qualitative interviews to explore training experiences and views of remote consulting; and documentary analysis of emails, WhatsApp texts, and training reports generated through the program. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed thematically. Findings were triangulated and integrated during interpretation. Results: Of the 12 tier 1 trainees enrolled in the program, all completed the training; however, 2 (17%) encountered internet difficulties and failed to complete the evaluation. In addition, 1 (8%) opted out of the cascading process. Of the 63 tier 2 trainees, 61 (97%) completed the cascaded training. Of the 10 (83%) tier 1 trainees who completed the survey, 9 (90%) would recommend the program to others, reported receiving relevant skills and applying their learning to their daily work, demonstrating satisfaction, learning, and perceived behavior change. In qualitative interviews, tier 1 and 2 trainees identified several barriers to implementation of remote consulting, including lacking digital infrastructure, few resources, inflexible billing and record-keeping systems, and limited community awareness. The costs of data or airtime emerged as the greatest immediate barrier to supporting both the upscaling of REaCH training and subsequently the delivery of safe and trustworthy remote health care. Conclusions: The REaCH training program is feasible, acceptable, and effective in changing trainees’ behavior. However, government and organizational support is required to facilitate the expansion of the program and remote consulting in Tanzania and other low-resource settings.
KW - cascade
KW - consultation
KW - COVID-19
KW - digital health
KW - eHealth
KW - health care
KW - Kirkpatrick
KW - low- and middle-income
KW - low- and middle-income countries
KW - mHealth
KW - mobile consulting
KW - mobile health
KW - remote consultation
KW - rural
KW - rural areas
KW - Tanzania
KW - telehealth
KW - train the trainer
KW - training
UR - http://www.scopus.com/inward/record.url?scp=85133538523&partnerID=8YFLogxK
U2 - 10.2196/32964
DO - 10.2196/32964
M3 - Article
AN - SCOPUS:85133538523
SN - 2561-326X
VL - 6
JO - JMIR Formative Research
JF - JMIR Formative Research
IS - 6
M1 - e32964
ER -