Web-based training for primary healthcare workers in rural China: a qualitative exploration of stakeholders' perceptions

Outcomes of cancer survivorship education and training for primary care providers: a systematic review

Purpose

To identify published literature regarding cancer survivorship education programs for primary care providers (PCPs) and assess their outcomes.

Methods

PubMed, Embase, and CINAHL databases were searched between January 2005 and September 2020. The Quality of Cancer Survivorship Care Framework and Kirkpatrick’s 4-level evaluation model were used to summarize program content and outcomes, respectively. Data extraction and critical appraisal were conducted by two authors.

Results

Twenty-one studies were included, describing self-directed online courses (n=4), presentations (n=2), workshops and training sessions (n=6), placement programs (n=3), a live webinar, a fellowship program, a referral program, a survivorship conference, a dual in-person workshop and webinar, and an in-person seminar and online webinar series. Eight studies described the use of a learner framework or theory to guide program development. All 21 programs were generally beneficial to PCP learners (e.g., increased confidence, knowledge, behavior change); however, methodological bias suggests caution in accepting claims. Three studies reported positive outcomes at the patient level (i.e., satisfaction with care) and organizational level (i.e., increased screening referrals, changes to institution practice standards).

Conclusions

A range of cancer survivorship PCP education programs exist. Evidence for clinical effectiveness was rarely reported. Future educational programs should be tailored to PCPs, utilize an evidence-based survivorship framework, and evaluate patient- and system-level outcomes.

Implications for Cancer Survivors

PCPs have an important role in addressing the diverse health care needs of cancer survivors. Improving the content, approach, and evaluation of PCP-focused cancer survivorship education programs could have a positive impact on health outcomes among cancer survivors.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11764-021-01018-6.

The effect of a web-based training for improving primary health care providers' knowledge about diabetes mellitus management in rural China: A pre-post intervention study

Background

The performance of primary health care providers regarding DM management is poor in rural China, and effective training methods for providers are urgently needed. This study aimed to evaluate the effect of web-based training for improving knowledge about DM management among primary health care providers in rural China and to further compare the effects of the training effect between primary health care providers with different backgrounds.

Methods

A pre-post intervention study was conducted from April to August 2014. In this study, a total of 901 primary health care workers were recruited from six counties in Hubei province. To evaluate the effect of the web-based training, the knowledge achievement of participants was measured with multiple choice questions (MCQ) at baseline, at the end of two weeks of training and at three months after training. A mixed linear model (MLM) was used to measure group differences in the mean scores at baseline and follow-up.

Results

After the web-based training, the knowledge scores of the village doctors increased from 73.58 at baseline to 89.98 at posttest and to 84.57 three months after the training. For township health workers, we observed an upward trend in scores from 78.87 at the pre-test to 91.72 at the second test, and at the three months after the training, the scores increased to 94.91. For village doctors, greater knowledge achievement was observed between the scores at baseline and after two weeks of training(adjusted difference: 3.55, P = 0.03) compared to that observed for the township health workers, while decreased their knowledge achievement between baseline and the third-test compared with that of township health workers (adjusted difference: 5.05, P = 0.01).

Conclusions

This study suggested that web-based training was an effective method for improving the knowledge of primary health care providers about management of DM in remote areas. Compared with the effect of the training on village doctors, the training had a poor short-term effect on township health workers but a better long-term effect.

Exploring the needs and possibilities of physicians' continuing professional development - An explorative qualitative study in a Chinese primary care context

BACKGROUND

One component of the 2009 Chinese health care reform plan is to train general practitioners to improve the delivery of primary care services. This continuing professional development is expected to further improve the physicians' competencies to be general practitioners in primary care. Augmented reality-a combination of virtual information and the real environment-may enhance general practitioners' continuing professional development by allowing their learning experiences to overlap with their workplace practice.

OBJECTIVE

To explore the needs, opportunities, and challenges involved in continuing professional development for Chinese physicians becoming competent general practitioners within primary care, with a special focus on the possibilities of applying augmented reality.

METHODS

This study used a qualitative approach with semi-structured face-to-face interviews. Two managers and thirteen physicians (from four community health centers and stations) participated. The data were analyzed using a thematic inductive analysis approach.

RESULTS

Based on our interviews, most of the physicians were not fully trained as general practitioners but still assumed the duties of that position; they were supposed to eventually become fully trained in line with the reforms of the Chinese primary care system. However, they reported a lack of in-service training opportunities to fulfill this goal. Even those who said that they had such opportunities perceived the efficacy of that training as being poor. The managers and most of the physicians reacted positively to the idea of using augmented reality in continuing professional development, and they suggested antibiotics treatment, surgery, and emergency care as learning areas in which augmented reality could be applied.

CONCLUSIONS

Due to the Chinese reforms of the primary care system, both managers and the physicians themselves expect general practitioners to become qualified by engaging in continuing professional development. Both groups also regarded augmented reality as a potentially useful tool.

Does exam-targeted training help village doctors pass the certified (assistant) physician exam and improve their practical skills? A cross-sectional analysis of village doctors' perspectives in Changzhou in Eastern China

BACKGROUND

Quality of health care needs to be improved in rural China. The Chinese government, based on the 1999 Law on Physicians, started implementing the Rural Doctor Practice Regulation in 2004 to increase the percentage of certified physicians among village doctors. Special exam-targeted training for rural doctors therefore was launched as a national initiative. This study examined these rural doctors' perceptions of whether that training helps them pass the exam and whether it improves their skills.

METHODS

Three counties were selected from the 4 counties in Changzhou City in eastern China, and 844 village doctors were surveyed by a questionnaire in July 2012. Chi-square test and Fisher exact test were used to identify differences of attitudes about the exam and training between the rural doctors and certified (assistant) doctors. Longitudinal annual statistics (1980-2014) of village doctors were further analyzed.

RESULTS

Eight hundred and forty-four village doctors were asked to participate, and 837 (99.17%) responded. Only 14.93% of the respondents had received physician (assistant) certification. Only 49.45% of the village doctors thought that the areas tested by the certification exam were closely related to the healthcare needs of rural populations. The majority (86.19%) felt that the training program was "very helpful" or "helpful" for preparing for the exam. More than half the village doctors (61.46%) attended the "weekly school". The village doctors considered the most effective method of learning was "continuous training (40.36%)" . The majority of the rural doctors (89.91%) said they would be willing to participate in the training and 96.87% stated that they could afford to pay up to 2000 yuan for it.

CONCLUSIONS

The majority of village doctors in Changzhou City perceived that neither the certification exam nor the training for it are closely related to the actual healthcare needs of rural residents. Policies and programs should focus on providing exam-preparation training for selected rural doctors, reducing training expenditures, and utilizing web-based methods. The training focused on rural practice should be provided to all village doctors, even certified physicians. The government should also adjust the local licensing requirements to attract and recruit new village doctors.

Effects of Improving Primary Health Care Workers' Knowledge About Public Health Services in Rural China: A Comparative Study of Blended Learning and Pure E-Learning

Background

Primary health care workers (PHCWs) are a major force in delivering basic public health services (BPHS) in rural China. It is necessary to take effective training approaches to improve PHCWs’ competency on BPHS. Both electronic learning (e-learning) and blended learning have been widely used in the health workers’ education. However, there is limited evidence on the effects of blended learning in comparison with pure e-learning.

Objective

The aim of this study was to evaluate the effects of a blended-learning approach for rural PHCWs in improving their knowledge about BPHS as well as training satisfaction in comparison with a pure e-learning approach.

Methods

The study was conducted among PHCWs in 6 rural counties of Hubei Province, China, between August 2013 and April 2014. Three counties were randomly allocated blended-learning courses (29 township centers or 612 PHCWs—the experimental group), and three counties were allocated pure e-learning courses (31 township centers or 625 PHCWs—the control group). Three course modules were administered for 5 weeks, with assessments at baseline and postcourse. Primary outcomes were score changes in courses’ knowledge. Secondary outcome was participant satisfaction (5-point Likert scale anchored between 1 [strongly agree] and 5 [strongly disagree]).

Results

The experimental group had higher mean scores than the control group in knowledge achievement in three course modules: (1) module 1: 93.21 (95% CI 92.49-93.93) in experimental group versus 88.29 (95% CI 87.19-89.40) in the control group; adjusted difference, 4.92 (95% CI 2.61-7.24; P<.001); (2) module 2: 94.05 (95% CI 93.37-94.73) in the experimental group vs 90.22 (95% CI 89.12-91.31) in the control group; adjusted difference, 3.67 (95% CI 1.17-6.18; P=.004); (3) module 3: 93.88 (95% CI 93.08-94.68) in the experimental group versus 89.09 (95% CI 87.89-90.30) in control group; adjusted difference, 4.63 (95% CI 2.12-7.14; P<.001). The participants in the experimental learning group gave more positive responses with the four issues than control group participants: (1) the increase of interest in learning, 1.85 (95% CI 1.22-2.80; P=.003); (2) the increase of interaction with others, 1.77 (95% CI 1.20-2.60; P=.004); (3) the satisfaction with learning experience, 1.78 (95% CI 1.11-2.88; P=.02); and (4) achievement of learning objectives, 1.63 (95% CI 1.08-2.48; P=.02).

Conclusions

Among PHCWs in rural China, a blended-learning approach to BPHS training could result in a higher knowledge achievement and satisfaction level compared with a pure e-learning approach. The findings of the study will contribute knowledge to improve the competency of PHCWs in similar settings.

The attitudes of primary healthcare providers towards web-based training on public health services in rural China: a cross-sectional study

OBJECTIVES

To explore the attitudes of primary healthcare workers, including township public health workers (TPHWs) and village doctors (ViDs), towards web-based training on basic public health services (BPHS) and to examine the factors influencing their attitudes.

STUDY DESIGN

Cross-sectional study.

METHODS

Questionnaires addressing training status, needs, and attitudes towards web-based public health training were administered to 2768 primary healthcare workers from May to September 2013. Multivariate logistic regression models were used to identify the factors that were significantly associated with a positive attitude towards web-based public health training.

RESULTS

Among the 2768 participants, 90.6% of the TPHWs and 86.9% of the ViDs expressed a positive attitude towards web-based BPHS training. TPHWs who had a positive attitude towards previous public health training (odds ratio [OR] = 2.75, 95% confidence interval [CI] = 1.28-5.93) and better computer skills (OR = 2.59, 95% CI = 1.03-6.48) were more likely to adopt web-based training on BPHS, as were ViDs who had better computer skills (OR = 2.54, 95% CI = 1.58-4.11) and better Internet speeds (neutral: OR = 2.81, 95% CI = 1.58-5.01; satisfied: OR = 2.53, 95% CI = 1.28-5.01). TPHWs who tended to read papers (OR = 0.24, 95% CI = 0.11-0.50) and were aged 50 years or older (OR = 0.34, 95% CI = 0.14-0.87), as were ViDs who tended to read papers (OR = 0.48, 95% CI = 0.29-0.77), expressed a more negative attitude towards web-based BPHS training.

CONCLUSIONS

The findings indicated that most primary healthcare workers have a positive attitude towards web-based BPHS training. More priority measures, such as conducting computer training, improving Internet quality and integrating mobile technology, are recommended and will further improve the implementation of web-based public health training programs.

Antibiotic prescribing of village doctors for children under 15 years with upper respiratory tract infections in rural China: A qualitative study

The aim of this study was to explore the knowledge, attitudes, and practices of village doctors regarding the prescribing of antibiotics for children under 15 years with upper respiratory tract infections (URTIs) in rural China. Twelve focus group discussions (FGDs) were conducted in Xianning, a prefecture-level city in rural China, during December 2014. We conducted 6 FGDs with 35 village doctors, 3 with 13 primary caregivers (11 parents), and 3 with 17 directors of township hospitals, county-level health bureaus, county-level Centers for Disease Control and Prevention, or county-level Chinese Food and Drug Administration offices. Audio records of the interviews were transcribed verbatim and analyzed using the thematic analysis approach. Participants believed that unnecessary antibiotic prescribing for children under 15 years with The occurrence of URTIs was a problem in village clinics in rural China. The discussions revealed that most of the village doctors had inadequate knowledge and misconceptions about antibiotic use, which was an important factor in the unnecessary prescribing. Village doctors and directors reported that the doctors' fear of complications, the primary caregivers' pressure for antibiotic treatment, and the financial considerations of patient retention were the main factors influencing the decision to prescribe antibiotics. Most of the primary caregivers insisted on antibiotics, even when the village doctors were reluctant to prescribe them, and they preferred to go to see those village doctors who prescribed antibiotics. The interviewees also gave their opinions on what would be the most effective measures for optimizing antibiotic prescriptions; these included educational/training campaigns, strict regulations on antibiotic prescription, and improved supervision. Findings emphasized the need to improve the dissemination of information and training/education, and implement legislation on the rational use of antibiotics. And it also provided helpful information to guide the design of more effective interventions to promote prudent antibiotic use and good antimicrobial stewardship.

Determinants of basic public health services provision by village doctors in China: using non-communicable diseases management as an example

BACKGROUND

To ensure equity and accessibility of public health care in rural areas, the Chinese central government has launched a series of policies to motivate village doctors to provide basic public health services. Using chronic disease management and prevention as an example, this study aims to identify factors associated with village doctors' basic public health services provision and to formulate targeted interventions in rural China.

METHODS

Data was obtained from a survey of village doctors in three provinces in China in 2014. Using a multistage sampling process, data was collected through the self-administered questionnaire. The data was then analyzed using multilevel logistic regression models.

RESULTS

The high-level basic public health services for chronic diseases (BPHS) provision rate was 85.2% among the 1149 village doctors whom were included in the analysis. Among individual level variables, more education, more training opportunities, receiving more public health care subsidy (OR = 3.856, 95 % CI: 1.937-7.678, and OR = 4.027, 95% CI: 1.722-9.420), being under integrated management (OR = 1.978, 95% CI: 1.132-3.458), and being a New Cooperative Medical Scheme insurance program-contracted provider (OR = 2.099, 95% CI: 1.187-3.712) were associated with the higher BPHS provision by village doctors. Among county level factors, Foreign Direct Investment Index showed a significant negative correlation with BPHS provision, while the government funding for BPHS showed no correlation (P > 0.100).

CONCLUSION

Increasing public health care subsidies received by individual village doctors, availability and attendance of training opportunities, and integrated management and NCMS contracting of village clinics are important factors in increasing BPHS provision in rural areas.