Jhpiego-Ethiopia, P.O.Box: 201748/1000, Addis Ababa, Ethiopia.
JSI Research and Training Institute Inc, Addis Ababa, Ethiopia.
Midwifery. 2019 Nov;78:42-49. doi: 10.1016/j.midw.2019.07.014. Epub 2019 Jul 16.
Lack of trained personnel is a major obstacle to providing the full package of emergency obstetric and newborn care (EmONC) services in Ethiopia and other low-income countries. The aim of this study was to evaluate whether a blended learning approach to in-service EmONC training could be as effective as a conventional learning approach while reducing costs.
A quasi-experimental study design assigned providers in need of EmONC training to blended learning (12 days of offsite training followed by daily SMS and weekly phone calls) or conventional learning (18 days of offsite training followed by a facility visit to mentor participants). A self-administered questionnaire measured provider knowledge before training and three months afterwards. Provider skills were assessed three months post-training with an Objective Structured Clinical Examination (OSCE). Independent sample t-test and multiple linear regression analysis were used to assess differences in mean percentage knowledge and skills scores between learning groups. The direct costs and cost-effectiveness of each learning approach were calculated.
Knowledge scores were similar for the blended and conventional learning groups before training (58.5% vs 61.5%, p = 0.358) and three months post-training (74.7% vs 75.5% = 0.720), with no significant difference in gains made. Post-training skills scores were significantly higher for conventional than blended learning (85.8% vs 75.3%, p < 0.001). After controlling for other factors in the multiple linear regression analysis, providers with a university degree had significantly higher skills scores than those with a diploma (p < 0.001). Training costs were lower for blended learning than conventional learning (1032 USD vs 1648 USD per trainee).
Blended learning approach using SMS and phone calls was as effective as conventional one to increase providers' knowledge with substantially lower costs. Further study is warranted to examine the effect of blended learning on providers' skills.
缺乏训练有素的人员是在埃塞俄比亚和其他低收入国家提供全面紧急产科和新生儿保健（EmONC）服务的主要障碍。本研究旨在评估混合学习方法对在职 EmONC 培训的效果是否与传统学习方法一样有效，同时降低成本。
采用准实验设计，将需要 EmONC 培训的提供者分配到混合学习（12 天的场外培训，随后每天发送短信和每周电话）或传统学习（18 天的场外培训，随后到医疗机构访问以指导参与者）中。自我管理的问卷在培训前和三个月后测量提供者的知识。培训三个月后，使用客观结构化临床考试（OSCE）评估提供者的技能。使用独立样本 t 检验和多元线性回归分析评估学习组之间知识和技能得分的平均百分比差异。计算了每种学习方法的直接成本和成本效益。
培训前（58.5%对 61.5%，p=0.358）和三个月后（74.7%对 75.5%，p=0.720），混合学习和传统学习组的知识得分相似，且在取得的收益方面没有显著差异。培训后，传统学习组的技能得分明显高于混合学习组（85.8%对 75.3%，p<0.001）。多元线性回归分析控制了其他因素后，具有大学学历的提供者的技能得分明显高于具有文凭的提供者（p<0.001）。混合学习的培训成本低于传统学习（每名学员 1032 美元对 1648 美元）。
使用短信和电话的混合学习方法与传统方法一样有效，可以提高提供者的知识水平，同时成本大大降低。需要进一步研究混合学习对提供者技能的影响。
