Background Access to continuing professional development (CPD) for health care workers in low- and middle-income countries (LMICs) is severely limited. Digital technology serves as a promising platform for supporting CPD for health care workers by providing educational content virtually and enabling virtual peer-to-peer and mentor interaction for enhanced learning. Digital strategies for CPD that foster virtual interaction can increase workforce retention and bolster the health workforce in LMICs. Objective The objective of this integrative review was to evaluate the evidence on which digital platforms were used to provide CPD to health care workers and clinical students in LMICs, which was complemented with virtual peer-to-peer or mentor interaction. We phrased this intersection of virtual learning and virtual interaction as mobile-social learning. Methods A comprehensive database and gray literature search was conducted to identify qualitative, quantitative, and mixed methods studies, along with empirical evidence, that used digital technology to provide CPD and virtual interaction with peers or mentors. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Eligible articles were written in English, conducted in an LMIC, and used a mobile device to provide CPD and facilitate virtual peer-to-peer or mentor interaction. Titles, abstracts, and full texts were screened, followed by an assessment of the quality of evidence and an appraisal of the articles. A content analysis was then used to deductively code the data into emerging themes. Results A total of 750 articles were identified, and 31 (4.1%) were included in the review. SMS text messaging and mobile instant messaging were the most common methods used to provide continuing education and virtual interaction between peers and mentors (25/31, 81%). Across the included articles, participants had high acceptability for using digital platforms for learning and interaction. Virtual peer interaction and mentorship were found to contribute to positive learning outcomes in most studies (27/31, 87%) through increased knowledge sharing, knowledge gains, improved clinical skills, and improved service delivery. Peer-to-peer and mentor interaction were found to improve social support and reduce feelings of isolation (9/31, 29%). There were several challenges in the implementation and use of digital technology for mobile-social learning, including limited access to resources (eg, internet coverage and stable electricity), flexibility in scheduling to participate in CPD, and sociobehavioral challenges among students. Conclusions The summary suggests that mobile-social learning is a useful modality for curriculum dissemination and skill training and that the interface of mobile and social learning serves as a catalyst for improved learning outcomes coupled with increased social capital.

Aim This manuscript offers a set of practical recommendations to the nursing and digital health communities in order to achieve a common vision of nurses fully engaged with and leading digital health solutions for universal health coverage. Background Nurses comprise the largest occupation of health workers in the world and play a central role in efforts to achieve Sustainable Development Goals. Nevertheless, though they are essential to delivering health care, nursing voices are too often absent in the design and implementation of new technology and digital health advances. The World Health Organization recognizes digital health as a critical catalyst for advancing universal health coverage and the aims of the Sustainable Development Goals. Therefore, the use of digital health by nurses is globally recommended as a channel of practice to strengthen nursing services and allow practitioners to significantly improve health outcomes. Sources of Evidence Websites of the World Health Organization, United Nations, peer‐reviewed research search engines, as well as the experiences of both authors. Discussion Digital health is transforming the entirety of the healthcare provision system and these systemic changes require engagement, leadership and championing from nurses. Conclusion and Implications for Nursing Practice and Policy Both the nursing and digital health communities have much to gain from each other and can be stronger together. The authors offer a set of practical recommendations for both the nursing and digital health communities to implement to optimize mutual efforts towards achieving universal health coverage.

The global vision for primary health care (PHC) is defined by regular access to quality care for comprehensive services throughout the course of life. However, this is not what typically happens, especially in low-and middle-income countries, where many people access the formal health system only for emergent needs. Yet, even episodic care is nearly impossible to attain due to infrastructure barriers, critical shortages of health care providers, and low-quality care. Artificial intelligence and machine learning (AI/ML) can help us revolutionize the current reality of health care into the vision of continuous health care that promotes individuals to maintain a constant healthy state. AI/ML can deliver precise recommendations to the individual, transforming patients from a passive receiver of health services into an active participant of their own care. By accounting for each individual, AI/ML can also ensure equitable coverage for entire populations with an ongoing data exchange between personal health, genomic data, public health, and environmental factors. The greatest challenge to enlisting AI/ML in the quest toward the PHC vision will be instilling a sense of responsibility with global citizens to recognize health data for the global good while prioritizing protected, individually owned data sets. Only when individuals start taking a collective approach to health data, shifting the mindset toward the goal of prevention, will the potential of AI/ML for PHC be realized. Until we overcome this challenge, the paradigm shift of the global community away from our ad hoc, reactive health system culture will not be achieved.

We share recommendations on 3 important pivots away from longstanding approaches to continued professional development and in-service training programs that have demonstrated a measurable benefit across a diversity of health-related applications and projects.nThe first pivot involves shifting from focusing on using data primarily for reporting purposes. Encouraging team members within facilities to regularly use their own data to track, review, and measure priority quality indicators promotes the quality improvement process and can improve service delivery outcomes.nThe second pivot involves shifting from focusing on repeated, external, quality assurance assessments, often from the district or subnational level, to using facility team-based internal service delivery indicator data reviews to implement quality improvement efforts based on these data. n These pivots toward health care provider and facility manager ownership of the quality improvement process also lead to the third pivot, which involves shifting from one-time, groupbased training toward workplace-based educational interventions. Team involvement in interpreting their facility data can lead to identifying targeted team-based learning needs and the potential need for individual mentoring.

BACKGROUND Access to continuing professional development (CPD) for health care workers in low-and-middle- income countries (LMICs) is severely limited. Digital technology serves as a promising platform in supporting CPD for health care workers through providing educational content virtually, along with enabling virtual peer-to-peer and mentor interaction for enhanced learning. Digital strategies for CPD that foster virtual interaction can increase workforce retention and bolster the health workforce in LMICs. OBJECTIVE The objective of this integrative review was to evaluate evidence in which digital platforms were utilized to provide CPD to health care workers and clinical students in LMICs which was complemented with virtual peer-to-peer and/or mentor interaction. We have phrased this intersection of virtual learning and virtual interaction as mobile-social learning. METHODS A comprehensive database and grey literature search was conducted to identify qualitative, quantitative, and mixed-methods studies, along with empirical evidence employing digital technology to provide CPD and virtual interaction with peers and/or mentors. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Eligible articles were written in English, took place in a low-and-middle-income country, and utilized a mobile device to provide CPD and facilitated virtual peer-to-peer and/or mentor interaction. Titles, abstracts, and full texts were screened, followed by assessment of the quality of evidence and appraisal of articles. Content analysis was then used to deductively code data into emerging themes. RESULTS A total of 750 articles were identified, and 31 articles were included in the review. Text messaging, mobile instant messaging (MIM), and short-message services (SMS) was the most common method used to provide continuing education and virtual interaction between peers and mentors (n=25). Across included articles, participants had high acceptability of using digital platforms for learning and interaction. Virtual peer interaction and mentorship was found to contribute to positive learning outcomes across the majority of studies (n=27) through increased knowledge sharing, knowledge gains, improved clinical skills, and improved service delivery. Peer-to-peer and mentor interaction was found to improve social support and reduce feelings of isolation (n=9). Several challenges existed in the implementation and utilization of digital technology for mobile-social learning which included limited access to resources (e.g. internet coverage and stable electricity), flexibility in scheduling to participate in CPD, and sociobehavioral challenges among students. CONCLUSIONS This integrative review demonstrates that digital platforms that foster mobile-social learning can serve as an innovative method in providing health care providers and clinical students in LMICs with CPD while simultaneously enabling supportive interaction among peers and mentors. This evidence synthesis demonstrates the added value of social learning networks in enhancing the utility and effectiveness of digital learning platforms, whether as independent dissemination strategies, or as part of blended-learning approach. CLINICALTRIAL N/A