Implementing adaptive e- learning for  newborn care in Tanzania: an  observational study of provider  engagement and knowledge gains

Kalabamu, Florence S.

Implementing adaptive e- learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains

dc.contributor.author	Kalabamu, Florence S.
dc.date.accessioned	2024-04-05T11:23:43Z
dc.date.available	2024-04-05T11:23:43Z
dc.date.issued	2024-01-14
dc.description.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.	en_US
dc.identifier.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.	en_US
dc.identifier.other	https://doi.org/10.1136/bmjopen-2023-077834
dc.identifier.uri	http://hdl.handle.net/123456789/1331
dc.language.iso	en	en_US
dc.publisher	BMJ open	en_US
dc.subject	E- learning for newborn care	en_US
dc.subject	knowledge gains	en_US
dc.subject	Newborn care in Tanzania	en_US
dc.title	Implementing adaptive e- learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains	en_US
dc.type	Article	en_US