Background: The Ministry of Health in Sierra Leone has developed and operationalized the national Digital Health Strategy to guide integrated roll out of e-health/mobile health solutions. The goal is that "by 2023 an effective and efficient ICT enabled system supports delivery of quality, accessible, affordable, equitable, and timely healthcare services and moves Sierra Leone closer to achieving universal health coverage". Investing in digital platforms for the education of community health workers (CHWs) in Sierra Leone is a critical strategic approach to strengthening the country's readiness for future Ebola outbreaks. A new national curriculum for this target group is being implemented that is based upon classroom training approaches. In a country where many CHWs are remotely located, the use of technology can be an enabler to reach such individuals with key training content to repeat the most important messages. Here we describe the piloting of a mobile training and support (MOTS) service for CHWs using interactive voice response (IVR) technology in Bo district of Sierra Leone. This training platform delivers voice recorded training content in local languages on the topics of Vaccines and (Ebola) Disease Surveillance & Outbreak Response. Methods: MOTS was developed in collaboration with the Sierra Leone Ministry of Health & Sanitation. Training content was customized in line with the national training curriculum and case reporting requirements. Local ethical approval was achieved and a test protocol involving recruitment of 125 consenting CHWs was implemented in Bo district of Sierra Leone. Two training modules-one covering vaccination and one covering outbreak response and disease surveillance were delivered to the mobile phones of participants as audio messages in the preferred local language. Knowledge change was assessed largely through pre-and post-quiz assessments also implemented through IVR. Results: Knowledge acquisition was observed in the 123 CHWs completing this pilot assessment. The extent of knowledge acquired was higher with the Vaccine training module when compared to the (Ebola) Disease Surveillance & Outbreak Response module. The technology was readily accepted by this population and their engagement was such that they also provided important elements to be improved prior to further implementation. The order in which training modules are delivered as well as general fatigue of the IVR methodology for participating in the quiz assessments may be of importance and requires further investigation. Conclusions: Technology should be considered when planning delivery of training to CHWs and can be positioned as a vehicle by which repetitive aspects of important training content can be reinforced without the need for additional classroom presence of the CHW community. Sustainability of such solutions requires cost containment and subsequent software accessibility for authorities in resource limited settings.
Introduction: The Ebola vaccine Deployment, Acceptance, and Compliance (EBODAC) project was established to develop a communication and community engagement strategy, including the development of appropriate technology, to maximize Ebola vaccination impact in the targeted population both in support of clinical trials and in the broader vaccination program beyond the clinical trial. EBODAC supported the EBOVAC-Salone trial in Kambia district in Sierra Leone to ensure that the novel prime-boost vaccine regimen is well accepted and successfully used in the context of clinical trials; while also preparing to maximize the impact of the potential deployment of a future Ebola vaccination program. The Mobile Technology for Community Health (MOTECH) platform was utilized and customized to help ensure compliance with the prime-boost vaccination regimen. Its main role was to support the communications and reminders surrounding the Ebola vaccine trial through an automated message service to participants' mobile phones as Interactive Voice Responses (IVR) and SMS (Short Message Service) messages. Methods: The study was cross-sectional and adopted qualitative and quantitative research methods. The design was constructed to provide a representation of different user segments. The sample size was not constructed to provide statistical differences or detect differences in impact among groups but was simply designed to provide insights into how study participants interacted with the technology. Eligibility criteria involved randomly selecting participants from those that: a) received IVR and SMS and didn't miss an appointment (booster compliant), b) received IVR and SMS and missed an appointment (booster non-compliant), c) received no IVR and SMS and didn't miss or missed an appointment (MOTECH non-user). Quantitative information was entered in well-designed data entry templates. All participants' names were anonymized for data analysis. Results: All the respondents, (n=81) revealed liking both the IVRS and SMS messages and majority of these, 80.2% (n=65) reported that IVR was very easy to understand. Respondents 47.5% (n=45) were comfortable receiving IVR, as opposed to 35.8% (n=29) preferred both text and voice messages. It was also found that 74.1% (n=60) of the respondents who were sent visit reminder messages never missed clinic appointment and 81.5% of those that received information preferred to know how to protect themselves from the disease. Conclusion: The EBOVAC-Salone automated voice messages contributed to valuable learning about areas of improvement for the MOTECH that will be of great importance for future outbreaks and medical interventions.
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