Application And Effect Evaluation Of Blended Training On Public Health For Primary Healthcare Workers In Rural Areas,China

Objectives1. To explore primary healthcare workers'(PHCWs') capability on basic public health services (BPHS) and their training needs, and to evaluate the hardware and software conditions of primary healthcare units in rural areas, so as to provide scientific evidences for training development and implementation.2. To establish an interactive distance Moodle training platform, and to evaluate the effectiveness of blended training and traditional face-to-face training method, so as to explore the feasibility of blended training used in rural areas.3. To analyze the short-term and long-term effects of two blended training methods, for exploring a suitable and effective blended training mode for public health capacity building of PHCWs'in rural China.Methods1. PHCWs and stakeholders of three prefecture-level cities in rural areas of Hubei province were evaluated using both quantitative (questionnaire survey) and qualitative methods (focus group discussions). Aims of the study were to explore PHCWs' capability on BPHS and their training needs, and to evaluate the hardware and software conditions of primary healthcare institutions in rural areas.2. Based on literature review and expert consultation, we established an interactive distance Moodle training platform and developed the practical skills-oriented and case-based training materials. Two county-level cities (Zhijiang and Yiling) in Yichang prefecture-level city were selected as pilot study areas, and a quasi-experimental study was conducted in these two rural areas. In this study, triangulation methods (combination of quantitative and qualitative methods) was used to evaluate PHCWs'satisfaction toward blended training method, and to compare training effectiveness between blended training (experimental group) and traditional face-to-face methods (control group).3. Based on literature review and expert consultation, a quasi-experimental empirical study was conducted in three prefecture-level cities (Xianning, Ezhou, and Yichang city) in Hubei province. PHCWs in these three rural areas were divided into three different groups, one was blank control group and the other two groups were experimental groups. The PHCWs in two experimental groups received two different blended training methods on BPHS. In this empirical study, Kirkpatrick training evaluation model and triangulation method were used to evaluate the short-term and long-term training effects between the two different blended training methods.Results1. Among all of the 2123 PHCWs,39.7% were between 41 and 50 years of age, and 42.1% were 51 above years of age; 41.5% PHCWs were from township hospitals or community health service centers, and 58.5% were from village health clinics or community health service stations; 68.1% PHCWs had high school or technical secondary school educational background.2. The competency of PHCWs in China was relatively poor (especially the village doctors) and some BPHS delivery was at a lower level of quality than expected. The existing training program for PHCWs were held in traditional face-to-face method and commonly held in regular training seminar format and concentrated in conference sessions in rural China. The training on BPHS was remained inadequate.3. Results showed that most of the primary healthcare institutions (both township hospitals and village clinics) were equipped with at least one computer, PHCWs in these primary healthcare institutions can easily access to an internet and most of the PHCWs grasped basic computer skills. Web-based training on BPHS is a promising option in rural China. Meanwhile, some barriers were posed for utilization of the web-based training method, such as lack of personal interaction (web-based training) and lack of time and motivation (PHCWs).4. The number of trainers in experimental group, who completed both of the two tests in two training topics, were more than trainers in control group, and completion rate of the two training topics were 86.4% vs 82.5%(elderly health management) and 88.0% vs 64.0% (health education), respectively. Post-test scores (the two training topics) in each group, compared with pre-test, were statistic significantly improved respectively (elderly health management:7.8% vs 11.7%; health education:23.2% vs 20.0%)." There was not statistic significantly difference in Post-test scores of two training methods in training topic "elderly health management" (F=0.045, P>0.05).While, There was a statistic significantly difference in Post-test scores of two training methods in training topic "health education" (F=12.301, P<0.05). Effect size (Cohen'd) of the two training methods in two training topics were 0.09 (elderly health management) and 0.74 (health education).5. More than 80% PHCWs in experimental group showed high satisfaction toward the training effect, training teachers and training contents of blended training method in pilot study. The interactive Moodle training platform was proved to be stable and could be used in later research, and it was feasible to carry out training using the blended training methods in rural China.6. For both of the two experimental groups, there was a statistic significantly increase in post-test and 3 months of follow-up knowledge scores (all of the training topics), compared to pre-test, (P<0.05). PCHWs in two experimental groups had a much higher achievements in post-test and 3 months of follow-up knowledge scores (all of the training topics), than those in blank group (P< 0.05). In addition, training effects of two blended training methods varied in different training topics.7.80% above PCHWs in two experimental groups showed high satisfaction and effectiveness toward two blended training method. PCHWs who received on-site training from township-level teachers, showed a statistic significantly increase in training objectives achievement than whose received training from city-level teachers (P<0.05); and PCHWs who received on-site training from township-level teachers, showed a lower satisfaction toward the on-site training organization forms than whose received training from city-level teachers (P<0.05).Conclusions1. Health human resource allocation was not unreasonable in rural areas. The construction of age and knowledge of PHCWs in rural areas are gradually ageing, and it is necessary to develop high-quality training programs on BPHS to improve the PHCW's knowledge and the efficacy of the existing program. The establishment of information construction in primary medical institutions in rural areas provide software and hardware conditions for development of web-based training.2. Effect of blended training method was equal to or even better than traditional face-to-face training method. The interactive Moodle training platform was proved to be stable and could be used in the later research, and it was feasible to carry out training using the blended training methods in rural China.3. PHCWs in two experimental groups showed high satisfaction and effectiveness toward two blended training method and they showed a statistic significantly increase in knowledge and skill level. And both of this two blended training methods were proved to be used to support health workforce capacity building in rural primary healthcare settings.4. Development of enthusiasm and initialization of the township-level teachers and strict quality control of training are crucial to a successful training implementation.