Achieving and Sustaining Change Through Capacity Building Train-the-Trainer Health Initiatives in Low- and Middle-Income Countries: A Systematic Review

Abstract

Introduction:Given the anticipated health challenges, forecasted deficiencies in the global health workforce, and steady demands to work through resource constraints, effective and efficient training approaches to build capacity are direly needed. Although train-the-trainer (T3) is not a new approach, there has been considerable interest in using it to develop and sustain capacity, particularly in low- and middle-income countries. This systematic review aimed to better understand the factors to achieve and sustain change across multiple countries and levels through T3 approaches.Methods:A literature search was conducted of six scholarly, peer-reviewed, and gray literature databases. Data were extracted for the study method, design, characteristics, and implicit or explicit factors related to maximizing the likelihood of achieving and sustaining change. An existing conceptual framework for T3 interventions in global health guided the thematic analysis. The framework consisted of five factors pertinent to capacity building T3 initiatives: Talent, Resources, Alignment, Implementation, and Nurture and Development.Results:Twenty-two studies met the inclusion criteria. The T3 training spanned all geographical regions, but interventions were most prevalent in sub-Saharan Africa (46%). Nearly all studies (68%) quantitatively examined change at the individual level (95%), but some studies also explored change at the organizational (77%) and institutional (23%) levels. Implementation and Nurture/Development were the two most salient factors in achieving and sustaining change. The greatest hindrances involved Resources and Context, an additional theme that the data identified.Discussion:The findings and recommendations from this first systematic review exploring antecedents influencing change through health-related T3 interventions can inform training and capacity-building investments, improve existing T3 initiatives, and steer planning for future approaches.

From Teacher to Teacher-Trainer: A Qualitative Study Exploring Factors Contributing to a Successful Train-the-Trainer Digital Education Program

“…Snowden and his collegues (2022) added the Context factor after a recent systematic review. In the next paragraphs we explicit the sustainability factors behind Mormina and Pinder's framework (2018) (completed by the context factor of Snowden, Lahiri, Dutton, & Morton, 2022) using the process model of Lane and Mitchell (2013) to temporally structure the explanation (see Fig. 1).…”

“…The talent factor in the conceptual framework of Mormina and Pinder (2018) first consists in the selection by a group of experts of teachers with the desired characteristics. Trainer with a) motivation, self-efficacy and legitimacy feeling to engage in the professional development of their own colleagues (Engelbrecht & Ankiewicz, 2016, Dichaba, 2012, b) technical and training skills (Snowden et al, 2022), c) interpersonal skills (honesty, patience, listening, credibility, etc.) (Kandiller & Özler, 2015), d) organizational skills (Chatziefstathiou & Phillips, 2011) and d) content and pedagogical knowledge (Ngeze, Khwaja, & Iyer, 2018) must be selected and retained.…”

“…Indeed, to prevent attrition, being a trainer should be seen as a career path rather than an extra task. At the organizational level, this career path should be aligned with policies and process (Snowden et al, 2022) This factor is also linked to the need of trainee-perceived credibility identified by Bax (2002).…”

“…The second phase is where the future TTs start receiving a specific training from the group of experts. The implementation factor is reported by the systemic review of Snowden et al (2022) as the most impactful factor to achieve and sustain change and represents the delivering of a solid TTT training that transfers ownership of the program (Coburn, 2003) and sustains the cascade effect. This ownership process must be carfefully monitored to avoid instructional content dilution (Demarle--Meusel et al, 2020;Hayes, 2000), curriculum misunderstanding (Suzuki, 2011) and adaptations that should not be made (Van Daele, Van Audenhove, Hermans, Van den Bergh, & Van den Broucke, 2014).…”

“…In particular, the findings focus on specific considerations relevant to the implementation of digital education programs using TTs. To facilitate the replication of such programs, it is recommended to integrate these findings with existing frameworks, such as the TRAIN framework by Mormina and Pinder (2018) and the systematic review conducted by Snowden et al (2022), to ensure effective implementation.…”