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Little KM, Nwala AA, Demise E, Archie S, Nwokoma EI, Onyezobi C, Anyasi H, Afolabi K, OlaOlorun FM, Rademacher KH, Danna K, Lorenzetti L, Anyanti J, Plotkin M. Use of a hybrid digital training approach for hormonal IUD providers in Nigeria: results from a mixed method study. BMC Health Serv Res 2023; 23:1316. [PMID: 38031098 PMCID: PMC10685471 DOI: 10.1186/s12913-023-10211-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND In Nigeria, in-service trainings for new family planning (FP) methods have typically been conducted using a combination of classroom-based learning, skills labs, and supervised practicums. This mixed-methods study evaluated the feasibility, acceptability, provider competency, and costs associated with a hybrid digital and in-person training model for the hormonal intrauterine device (IUD). METHODS The study was conducted in Enugu, Kano, and Oyo states, Nigeria, and enrolled FP providers previously trained on non-hormonal IUDs. Participants completed a digital didactic training, an in-person model-based practicum with an Objective Structured Clinical Examination (OSCE), followed by supervised provision of service to clients. Provider knowledge gains and clinical competency were assessed and described descriptively. Data on the feasibility, acceptability, and scalability of the approach were gathered from participating providers, clinical supervisors, and key stakeholders. Training costs were captured using an activity-based approach and used to calculate a cost per provider trained. All analyses were descriptive. RESULTS Sixty-two providers took the hybrid digital training, of whom 60 (91%) were included in the study (n = 36 from public sector, n = 15 from private sector, and n = 9 both public/private). The average knowledge score increased from 62 to 86% pre- and post-training. Clinical competency was overall very high (mean: 94%), and all providers achieved certification. Providers liked that the digital training could be done at the time/place of their choosing (84%), was self-paced (79%), and reduced risk of COVID-19 exposure (75%). Clinical supervisors and Ministry of Health stakeholders also had positive impressions of the training and its scalability. The hybrid training package cost $316 per provider trained. CONCLUSIONS We found that a hybrid digital training approach to hormonal IUD service provision in Nigeria was acceptable and feasible. Providers demonstrated increases in knowledge following the training and achieved high levels of clinical competency. Both providers and clinical supervisors felt that the digital training content was of high quality and an acceptable (sometimes preferable) alternative to classroom-based, in-person training. This study provided insights into a hybrid digital training model for a long-acting contraceptive, relevant to scale-up in Nigeria and similar settings.
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Affiliation(s)
- Kristen M Little
- Population Services International (PSI), Strategy and Insights Department, 1120 19th, Street NW, Suite 600, Washington, DC, 20020, USA.
| | - Anthony A Nwala
- Society for Family Health (SFH) Nigeria, RH/FP Division, Abuja, Nigeria
| | - Eden Demise
- Population Services International (PSI), Strategy and Insights Department, 1120 19th, Street NW, Suite 600, Washington, DC, 20020, USA
| | - Samantha Archie
- FHI 360, Health Services Research Department, Durham, NC, USA
| | | | - Chinedu Onyezobi
- Society for Family Health (SFH) Nigeria, RH/FP Division, Abuja, Nigeria
| | - Helen Anyasi
- FHI 360, Product Development and Introduction Department, Abuja, Nigeria
| | - Kayode Afolabi
- Nigeria Federal Ministry of Health, Reproductive Health Division, Abuja, Nigeria
| | - Funmilola M OlaOlorun
- Evidence for Sustainable Human Development Systems in Africa and the Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Kate H Rademacher
- FHI 360, Product Development and Introduction Department, Abuja, Nigeria
| | - Kendal Danna
- PSI, Sexual and Reproductive Health Department, Washington, DC, USA
| | - Lara Lorenzetti
- FHI 360, Behavioral, Epidemiological, and Clinical Sciences Division, Durham, NC, USA
| | - Jennifer Anyanti
- Society for Family Health (SFH) Nigeria, RH/FP Division, Abuja, Nigeria
| | - Marya Plotkin
- FHI 360, Reproductive, Maternal, Newborn, and Child Health Department, Durham, NC, USA
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Dougherty K, Hobensack M, Bakken S. Scoping review of health information technology usability methods leveraged in Africa. J Am Med Inform Assoc 2023; 30:726-737. [PMID: 36458941 PMCID: PMC10018268 DOI: 10.1093/jamia/ocac236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/14/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore the state of health information technology (HIT) usability evaluation in Africa. MATERIALS AND METHODS We searched three electronic databases: PubMed, Embase, and Association for Computing Machinery. We categorized the stage of evaluations, the type of interactions assessed, and methods applied using Stead's System Development Life Cycle (SDLC) and Bennett and Shackel's usability models. RESULTS Analysis of 73 of 1002 articles that met inclusion criteria reveals that HIT usability evaluations in Africa have increased in recent years and mainly focused on later SDLC stage (stages 4 and 5) evaluations in sub-Saharan Africa. Forty percent of the articles examined system-user-task-environment (type 4) interactions. Most articles used mixed methods to measure usability. Interviews and surveys were often used at each development stage, while other methods, such as quality-adjusted life year analysis, were only found at stage 5. Sixty percent of articles did not include a theoretical model or framework. DISCUSSION The use of multistage evaluation and mixed methods approaches to obtain a comprehensive understanding HIT usability is critical to ensure that HIT meets user needs. CONCLUSIONS Developing and enhancing usable HIT is critical to promoting equitable health service delivery and high-quality care in Africa. Early-stage evaluations (stages 1 and 2) and interactions (types 0 and 1) should receive special attention to ensure HIT usability prior to implementing HIT in the field.
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Affiliation(s)
- Kylie Dougherty
- School of Nursing, Columbia University, New York, New York, USA
| | | | - Suzanne Bakken
- School of Nursing, Columbia University, New York, New York, USA
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McGushin A, de Barros EF, Floss M, Mohammad Y, Ndikum AE, Ngendahayo C, Oduor PA, Sultana S, Wong R, Abelsohn A. The World Organization of Family Doctors Air Health Train the Trainer Program: lessons learned and implications for planetary health education. Lancet Planet Health 2023; 7:e55-e63. [PMID: 36608949 DOI: 10.1016/s2542-5196(22)00218-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 08/23/2022] [Accepted: 09/07/2022] [Indexed: 06/17/2023]
Abstract
The World Organization of Family Doctors (WONCA) Air Health Train the Trainer Program was a pilot educational programme that focused on a key aspect of planetary health: the intersection of air pollution, human health, and climate change. In this Viewpoint, we-the coordinators of the training programme and some of the most active trainers-briefly describe the programme and discuss implementation successes, challenges, and lessons learned, which relate to the creation and use of training materials appropriate for health professionals in low-income and middle-income countries, strategies to improve the retention of trainers to deliver activities in their communities, and the development of stronger networks and further tools to support trainers. These findings could be applied to future education and training programmes.
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Affiliation(s)
- Alice McGushin
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK.
| | - Enrique Falceto de Barros
- Instituto de Ciências Básicas da Saúde-Programa de Pós Graduação de Educação em Ciências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mayara Floss
- Department of Pathology, University of São Paulo, São Paulo, Brazil
| | - Yousser Mohammad
- GARD-WHO Collaborating Center for Research and Training for Chronic Respiratory Diseases and Comorbidities, Tishreen University, Lattakia, Syria; School of Medicine and Pharmacy, Al-Sham Private University, Damascus, Syria
| | - Achiri E Ndikum
- Department of Animal Biology, The University of Yaoundé 1, Yaounde, Cameroon
| | | | - Peter A Oduor
- School of Public Health, Great Lakes University of Kisumu, Kisumu, Kenya
| | - Sadia Sultana
- Department of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, BSM Medical University, Dhaka, Bangladesh
| | - Rachel Wong
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Alan Abelsohn
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Udenigwe O, Okonofua FE, Ntoimo LF, Yaya S. Enablers and barriers to the acceptability of mHealth for maternal healthcare in rural Edo, Nigeria. DIALOGUES IN HEALTH 2022; 1:100067. [PMID: 38515913 PMCID: PMC10953930 DOI: 10.1016/j.dialog.2022.100067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 03/23/2024]
Abstract
Objective Acceptability has become a key consideration in designing, implementing and evaluating digital health interventions. Current evidence points to acceptability as a crucial factor in sustaining mobile health programs for maternal health across sub-Saharan Africa particularly in Nigeria where the burden of maternal mortality is high. This paper describes the enablers and barriers to the acceptance of Text4Life, a mobile phone-based health intervention that extends maternal healthcare services to rural areas of Edo State Nigeria. Method This is a cross-sectional qualitative study of women who used Text4Life, their spouses who were all men and Ward Development Committee chairpersons who oversaw the implementation of Text4Life. This study was set in Etsako East and Esan Central Local Government Areas of Edo State, Nigeria. Between September 2021 and January 2022, eight focus groups were conducted with 64 participants: 39 women and 25 men. Two in-depth interviews were conducted with Ward Development Committee chairpersons. Data collection was conducted in English and Pidgin English. Discussions and interviews were digitally recorded and translated to English from Pidgin English where necessary. Data analysis followed a mainly deductive approach to thematic analysis, however, emergent information from the data was also considered and reported. Results The results show that participants' positive attitudes towards the intervention, the involvement of the community, participants' understanding of the intervention, and perceived effectiveness of the Text4Life program were enablers to women's acceptance of Text4Life and enablers to Ward Development Committee chairpersons' assistance with the program. On the other hand, limited resources and a clash with the community's value system presented barriers to the acceptability of the Text4Life program. Conclusion Our findings demonstrate the importance of alleviating the burdens associated with participating in mobile health interventions while noting that the risk of obstructing the gains from mobile health interventions is high if plans for sustaining it are not incorporated early enough in the design phase.
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Affiliation(s)
- Ogochukwu Udenigwe
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada
| | - Friday E. Okonofua
- Women's Health and Action Research Centre, KM 11 Lagos-Benin Expressway, Igue-Iyeha, Benin City, Edo State, Nigeria
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria
| | - Lorretta F.C. Ntoimo
- Federal University Oye-Ekiti, P. M. B. 373, Km 3 Oye-Are Road, Oye-Ekiti, Ekiti State, Nigeria
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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Okuzu O, Malaga R, Okereafor K, Amos U, Dosunmu A, Oyeneyin A, Adeoye V, Sambo MN, Ebenso B. Role of digital health insurance management systems in scaling health insurance coverage in low- and Middle-Income Countries: A case study from Nigeria. Front Digit Health 2022; 4:1008458. [PMID: 36204711 PMCID: PMC9530809 DOI: 10.3389/fdgth.2022.1008458] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundIncreasing global commitment to Universal Health Coverage (UHC) in the past decade has triggered UHC-inspired reforms and investments to expand health service coverage in many Low- and Middle-Income Countries (LMICs). UHC aims to ensure that all people can access quality health services, safeguard them from public health risks and impoverishment from out-of-pocket payments for healthcare when household members are sickAimThis paper reviews the role of health insurance as a policy tool to address health financing as a contributory mechanism for accelerating the achievement of UHC in LMICs. We focus on Nigeria's legal framework for health insurance coverage for its whole population and the role of technology in facilitating enrollment to health insurance schemes.MethodsFrom May to July 2022, we adopted a cross-sectional case study design combining: (i) a literature review of the effects of UHC with (ii) document analysis of health insurance systems in Nigeria, and (iii) secondary analysis of health insurance datasets to understand experiences of deploying MedStrat, a locally-developed digital health insurance management system, and its features that support the administration of health insurance schemes in multiple states of Nigeria. We drew on contemporary technology adoption models to triangulate diverse data analyzed from literature and documents reviews and from health insurance datasets to identify: (i) enablers of adoption of digital insurance schemes, (ii) the contribution of digital technology to expanding access to health insurance, and (iii) further scalability of digital insurance intervention.ResultsPreliminary findings suggests that digital insurance management systems can help to increase the number of enrollees for insurance especially among poor households. Three contextual enablers of adoption of digital insurance schemes were a favourable policy environment, public-private-partnerships, and sustained stakeholder engagement and training.Discussion and conclusionKey elements for successful scaling of digital health insurance schemes across Nigeria and similar contexts include: (i) ease of use, (ii) existing digital infrastructure to support electronic insurance systems, and (iii) trust manifested via data encryption, maintaining audit trails for all data, and in-built fraud prevention processes. Our findings affirm that digital health technology can play a role in the attainment of UHC in LMICs.
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Affiliation(s)
- Okey Okuzu
- Instrat Global Health Solutions, Abuja, Nigeria
- Correspondence: Okey Okuzu
| | - Ross Malaga
- School of Business, Montclair State University, Montclair, NJ, United States
| | - Kenneth Okereafor
- Department of Information / Communications Technology, National Health Insurance Authority, Abuja, Nigeria
| | - Ujulu Amos
- Adamawa State Contributory Health Management Agency, Yola, Adamawa State, Nigeria
| | - Afolabi Dosunmu
- Ogun State Contributory Health Insurance Agency, Abeokuta, Ogun State, Nigeria
| | - Abiodun Oyeneyin
- Ondo State Contributory Health Commission, Akure, Ondo State, Nigeria
| | | | - Mohammed Nasir Sambo
- Department of Information / Communications Technology, National Health Insurance Authority, Abuja, Nigeria
| | - Bassey Ebenso
- Leeds Institute for Health Sciences, University of Leeds, Leeds, United Kingdom
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Owoyemi A, Osuchukwu JI, Azubuike C, Ikpe RK, Nwachukwu BC, Akinde CB, Biokoro GW, Ajose AB, Nwokoma EI, Mfon NE, Benson TO, Ehimare A, Irowa-Omoregie D, Olaniran S. Digital Solutions for Community and Primary Health Workers: Lessons From Implementations in Africa. Front Digit Health 2022; 4:876957. [PMID: 35754461 PMCID: PMC9215204 DOI: 10.3389/fdgth.2022.876957] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
The agenda for Universal Health Coverage has driven the exploration of various innovative approaches to expanding health services to the general population. As more African countries have adopted digital health tools as part of the strategic approach to expanding health services, there is a need for defining a standard framework for implementation across board. Therefore, there is a need to review and employ an evidence-based approach to inform managing challenges, adopting best approaches, and implement informed recommendations. We reviewed a variety of digital health tools applied to different health conditions in primary care settings and highlighted the challenges faced, approaches that worked and relevant recommendations. These include limited coverage and network connectivity, lack of technological competence, lack of power supply, limited mobile phone usage and application design challenges. Despite these challenges, this review suggests that mHealth solutions could attain effective usage when healthcare workers receive adequate onsite training, deploying applications designed in an intuitive and easy to understand approach in a manner that fits into the users existing workflows, and involvement of the stakeholders at all levels in the design, planning, and implementation stages of the interventions.
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Affiliation(s)
- Ayomide Owoyemi
- Department of Biomedical and Health Information Sciences, Chicago, IL, United States
- *Correspondence: Ayomide Owoyemi
| | | | - Clark Azubuike
- Social and Behavioral Sciences Department, T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | | | - Blessing C. Nwachukwu
- Department of Biomedical and Health Information Sciences, Chicago, IL, United States
| | | | - Grace W. Biokoro
- Department of Human and Health Sciences, Northern Illinois University, DeKalb, IL, United States
| | - Abisoye B. Ajose
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Nehemiah E. Mfon
- Department of Obstetrics and Gynecology, National Hospital, Abuja, Nigeria
| | - Temitope O. Benson
- Institute for Computational and Data Sciences, University at Buffalo, State University of New York, Albany, NY, United States
| | - Anthony Ehimare
- Department of Health Informatics, Swansea University, Wales, United Kingdom
| | | | - Seun Olaniran
- Department of Integrated Information Technology, College of Engineering and Computing, University of South Carolina, Columbia, SC, United States
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