Effects Evaluation Of Web-based Training On Public Health Services In Rural Areas Based On CIPP And Kirkpatrick Models

Objectives:1.To assess primary healthcare workers'(PHCWs)ability on basic public health services(BPHS)and their training needs,and to evaluate the hardware and software conditions of primary healthcare institutions in rural areas by using the context evaluation in the CIPP model.To explore the attitudes of township public health workers(TPHWs.township health centers)and village doctors(ViDs,village clinics)toward web-based training and its influencing factors,so as to provide scientific evidences for training development and implentation.2.To evaluate the effectiveness of web-based training compared with traditional face-to-face training,and to explore the feasibility and acceptability of the web-based training in rural China.3.To compare the short-term and long-term effects of web-based training between TPHWs and ViDs respectively,so as to provide theoretical evidences for the training strategy of public health capacity building among PHCWs in rural China.Methods:1.PHCWs' ability and their training needs as well as the hardware and software conditions of primary health institutions were investigated by a structured questionnaire.Multivariate logistic regression models were used to identify the factors that were significantly associated with a positive attitude towards web-based training among TPHWs and ViDs.2.Based on literature review and expert consultation,a Moodle-based interactive training platform was established for the study.Two county-level cities(Zhijiang and Yiling)iin Yichang prefecture-level city were selected as pilot study areas,and a quasi-experimental study was conducted in these two rural areas.Difference in difference analysis(DID)was used to compare the effects of web-based training and traditional face-to-face learning.Tri angulation methods(the combination of quantitative and qualitative research)were used to evaluate the feasibility and acceptability of Moodle-based training in rural China.3.According to the results in the pilot study.the Moodle-based interactive training platform and web-based training mode were further improved.And a quasi-experimental study was conducted in three prefecture-level cities(Xianning,Ezhou,and Yichang city)in Hubei province.Based on CIPP and Kirkpatrick models,the web-based public health training was carried out among PHCWs.Liner Mixed-effects model for Repeated Measurements was performed to compare the short-term and long-term training effects of the web-based learning between TPHWs and ViDs,respectively.The combination of quantitative and qualitative methods was used to assess the TPHWs and ViDs' satisfaction toward the training platform,training contents and training effect.The factors influencing the training effect and completion rate among TPHWs and Vids were also explored.Results:PHCWs' ability on public health services and training needsAmong the 2768 PHCWs,62.6%were over 40 years old;69.7%PHCWs have an education background of high school or technical secondary school(TPHWs:62.8%;ViDs:72.3%).The ViDs(45.11 ±9.97)were older than TPHWs(38.55±9.75);ViDs were predominantly male(72.7%vs 40.3%)and had less education than the TPHWs(P<0.001).94.7%of PHCWs agreed with the necessity of pursuing public health training.The computer and internet accessibility,and the factors influencing PHCWs' attitude toward web-based trainingMore than 85%primary health institutions were equipped with computers and had the access to Internet(township hospital centers:95.3%;village clinics:86.3%).More than 60%PHCWs grasped basic computer skills(TPHWs:86.5%;ViDs:69.8%).Prior web-based training was mainly on clinical knowledge and skills(72.1%).Most of the TPHWs(90.6%)and ViDs(86.9%)were willing to adopt web-based BPHS learning.According to the results of multivariate logistic regression models,there were four factors influencing TPHWs ' positive attitude toward web-based public health training:being aged 50 years or older(OR[Odds ratio]=0.34,95%CI[Confidence Interval]=0.14-0.87),satisfication with previous public health training(OR=2.75,95%CI= 1.28-5.93),better computer skills(OR = 2.59,95%CI=1.03-6.48),and paper reading preference(OR=0.24.95%CI=0.11-0.50);and three factors for ViDs:better computer skills(OR=2.54,95%CI=1.58-4.11),better Internet speed(neutral:OR=2.81.95%CI=1.58-5.01;satisfied:OR=2.53,95%CI=1.28-5.01),and paper reading preference(OR=0.48,95%CI=0.29-0.77).The effectiveness of web-based training compared with traditional face-to-face trainingIn the pilot study,the completion rate in the experimental group was higher than that of the control group:88.4%vs 82.5%(elderly health management)and 74.4%vs 62.6%(health education).The score difference between pre-and post-training in the experimental group was higher than that in the control group in both the two training topics(elderly health management:5.67;health education:9.29,P<0.05,DID value).More than 80%PHCWs showed a high level of satisfaction with the training effects,training contents of web-based training in the pilot study.The interactive Moodle training platform was proved to be stable and operable,and it was feasible and acceptable to conduct the web-based training among PHCWs in rural China.It was suggested to further optimize the training mode and expand the sample size to explore the training effects among TPHWs and ViDs.The effects of web-based training between TPHWs and ViDsFor both TPHWs and ViDs,there was a significant increase in post-test and 3 months of follow-up knowledge scores(all of the training topics),compared with pre-test(P<0.05).After the adjustment by the liner mixed-effects model for repeated measures,the short-term effect among ViDs was higher than that among TPHWs,and the three training topics were statiscally significant(Health management of patients with diabetes,vaccinations,the reporting and handling of infectious disease outbreaks and public health incident,P<0.05).The long-term effect among TPHWs was higher than that among ViDs,and two training topics were statistically significant(Health management for patients with diabetes and hypertension,P<0.05).Based on the quantitative and qualitative research,more than 80%TPHWs and ViDs showed a high level of satisfaction with training effects,training contents,training platform and training method.TPHWs had a higher level of satisfaction than ViDs in the following three issues:the overall speed of the training platform,the speed of watching flash and case-videos,and the overall satisfaction with the training.More ViDs than TPHWs agreed that the web-based training was helpful to improve their computer skills(OR=1.52,95%CI=1.10-2.12,P=0.014).Less ViDs than TPHWs expressed a willingness to continue web-based training in the future(OR =0.47,95%CI=0.27-0.82,P=0.0007).The professional training needs,active and effective supervision,and the flexibility of web-based training mode were the positive factors associated with PHCWs' training effects and completion rates.Other barriers for ViDs included the incompatibility of inner net and outer net,the low quality of Internet speed,and the low learning motivation.Conclusions:1.As the capacity of PHCWs was generally poor,the age and knowledge structure of PHCWs were aging,and therefore there was a shortage of highly-educated public health workers in rural China.It was an urgent need to make the advantage of novel Interent technology for strengthing the capacity building of public health services among PHCWs.At present,the construction of IT infrastructure in primay healthcare institutions and the PHCWs' positivie attitude toward web-based training provide the possibility of developing and implementing the training.2.Moodle-based public health web-based learning was superior to the traditional face-to-face training in our study.Moodle-based Interactive training platform run stability,and be operable with good interaction.The novel web-based training mode with the combination of theroretical knowledge and case-based videos was feasible,acceptable and can be promoted among PHCWs in rural China.3.Both the short-term and long-term knowledge achievement in the web-based training of public health services were improved among TPHWs and ViDs.TPHWs and ViDs expressed a high level of satisfaction with the training mode and training effects,thus,web-based public health training method can be used to strength the capacity building of public health services among PHCWs.4.It was necessary to establish an effective supervision system and take incentive measures for promoting ViDs'learning ehthusiasm and self-discipline learning ability in order to improve long-term training effects of ViDs.The training content should be further optimized and improved based on the requirements and interests of TPHWs and ViDs,and stratificatcd and classificatcd training were needed.