JMIR Publications

ABSTRACT

Background:

Despite uptake of remote consulting accelerating throughout the COVID-19 pandemic, many healthcare professionals are practising without training. This is especially challenging in resource-poor countries, where telephone has not previously been widely used for healthcare.

Objective:

As the COVID 19 pandemic dawned, we designed a modular online training program for REmote Consulting in primary Healthcare (REaCH). To optimise upscaling of knowledge and skills, we employed a train the trainer approach, training health workers (tier 1) to cascade the training to others (tier 2) in their locality. We aimed to determine if REaCH training was acceptable and feasible to health workers in rural Tanzania to support their healthcare delivery during the pandemic.

Methods:

Twelve tier 1 trainees and 63 tier 2 trainees from the Ulanga district of rural Tanzania participated between August and September 2020. A survey informed by Kirkpatrick's model of evaluation was used to capture trainee demographics, their satisfaction with REaCH, knowledge gained and perceived and actual behaviour change. The survey was analysed using descriptive statistics. Interviews of trainees and facilitators were undertaken and analysed thematically. Documentary analysis of emails, WhatsApp texts and training reports was completed.

Results:

We developed the REaCH training program in July 2020 and created eight key modules. The program was then taught, across two rounds of evaluation, via Moodle and WhatsApp to twelve tier 1 trainees, ten of whom completed the training. Nine tier 1 trainees cascaded to 63 tier 2 trainees. All tier 1 trainees who completed the program would recommend the training to other healthcare workers, received relevant skills, and reported applying their learning to their daily work demonstrating satisfaction, learning and perceived behaviour change. Trainees identified several barriers to implementation of their training into routine practice, including lacking technological infrastructure and support, and limited community awareness.

Conclusions:

We successfully designed, implemented and evaluated an online-based remote consulting training program. The REaCH training program is feasible, acceptable and effective in changing trainees’ behaviour. Government and organisational support are required to facilitate the expansion of the program and remote consulting in other low resource settings.