Implementing adaptive e- learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains
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Date
2024-01-14
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ open
Abstract
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.
Description
Keywords
E- learning for newborn care, knowledge gains, Newborn care in Tanzania
Citation
Meaney, P.A., Hokororo, A., Ndosi, H., Dahlen, A., Jacob, T., Mwanga, J.R., Kalabamu, F.S., Joyce, C.L., Mediratta, R., Rozenfeld, B. and Berg, M., 2024. Implementing adaptive e-learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains. BMJ open, 14(2), p.e077834.