Feasibility of an adaptive e-learning environment to improve provider proficiency in essential and sick newborn care in Mwanza, Tanzania
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Date
2023-07-13
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MedRxiv
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
(AEE). 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 1 zonal hospital and 3 health centers in Mwanza, Tanzania.
To assess implementation success, we used the RE-AIM 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 centers. 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, 183.5) and being a nursing officer (aOR: 5.6 [95%CI:1.8, 18.1]), compared to 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 normalization is needed.
Description
Keywords
Newborn Care in Mwanza, Tanzania, Feasibility of Adaptive Essential
Citation
Meaney, P.A., Hokororo, A., Ndosi, H., Dahlen, A., Jacob, T., Mwanga, J.R., Kalabamu, F.S., Joyce, C., Mediratta, R., Rozenfeld, B. and Berg, M., 2023. Feasibility of an Adaptive E-Learning Environment to Improve Provider Proficiency in Essential and Sick Newborn Care in Mwanza, Tanzania. medRxiv, pp.2023-07.