Telehealth to Expand Community Health Nurse Education in Rural Guatemala: A Pilot Feasibility and Acceptability Evaluation

Abstract

Telehealth education has the potential to serve as an important, low-cost method of expanding healthcare worker education and support, especially in rural settings of low- and middle-income countries. We describe an innovative educational strategy to strengthen a long-term health professional capacity building partnership between Guatemalan and US-based partners. In this pilot evaluation, community health nurses in rural Guatemala received customized, interactive education via telehealth from faculty at the supporting US-based institution. Program evaluation of this 10 lecture series demonstrated high levels of satisfaction among learners and instructors as well as knowledge gain by learners. An average of 5.5 learners and 2 instructors attended the 10 lectures and completed surveys using a Likert scale to rate statements regarding lecture content, technology, and personal connection. Positive statements about lecture content and the applicability to daily work had 98% or greater agreement as did statements regarding ease of technology and convenience. The learners agreed with feeling connected to the instructors 100% of the time, while instructors had 86.4% agreement with connection related statements. Instructors, joining at their respective work locations, rated convenience statements at 100% agreement. This evaluation also demonstrated effectiveness with an average 10.7% increase in pre- to posttest knowledge scores by learners. As the global health community considers efficiency in time, money, and our environment, telehealth education is a critical method to consider and develop for health worker education. Our pilot program evaluation shows that telehealth may be an effective method of delivering education to frontline health workers in rural Guatemala. While larger studies are needed to quantify the duration and benefits of specific knowledge gains and to perform a cost-effectiveness analysis of the program, our initial pilot results are encouraging and show that a telehealth program between a US-based university and a rural community health program in a low- and middle-income country is both feasible and acceptable.

Telemonitoring and Team-Based Management of Glycemic Control on People with Type 2 Diabetes: a Cluster-Randomized Controlled Trial

“…In our cost analysis, we found that the setup and implementation cost contributed to 77% of our total direct cost, mainly driven by equipment cost as well as personnel cost for telemedicine implementation. This concurs with other similar studies conducted in many other low-middle-income countries, [23][24][25] where cost of medical services is minimal compared with many high-income countries. Nevertheless, we believe that this situation will change in the foreseeable future as technology becomes cheaper which will make telemedicine a cost-effective alternative irrespective of setting.…”

Evaluation of global health capacity building initiatives in low-and middle-income countries: A systematic review

“…Of those, blended approaches that still include a face-to-face component are more prevalent than purely online modalities, potentially because such a transition is complex and may require more time, technological literacy, adequate infrastructure and cultural acceptance [ 86 , 87 ]. Nevertheless, such a shift may offer increased practicality and accessibility for the delivery and evaluation of GHCB initiatives given the potential of technology in overcoming barriers associated with traditional capacity building delivery methods [ 88 ]. For example, LMICs tend to have limited access to global health education, and technology has the potential to address this problem by allowing the transfer of knowledge from developed to developing countries in an easier, more accessible and cost-effective manner [ 88 , 89 ].…”

“…Nevertheless, such a shift may offer increased practicality and accessibility for the delivery and evaluation of GHCB initiatives given the potential of technology in overcoming barriers associated with traditional capacity building delivery methods [ 88 ]. For example, LMICs tend to have limited access to global health education, and technology has the potential to address this problem by allowing the transfer of knowledge from developed to developing countries in an easier, more accessible and cost-effective manner [ 88 , 89 ]. Our results indicate that clinically related GHCB initiatives included a face-to-face component, whereby purely online initiatives were didactic and did not include a hands-on approach.…”

“…As a result, we were not able to draw further conclusions regarding blended and online modalities beyond the individual-level assessment of reaction, knowledge, attitudes, and practices, or their long-term efficacy. This is especially important since blended and online approaches were effective and accepted by the participants, which means that a shift toward technology-assisted GHCB may be promising [ 67 , 88 ]. There is thus an urgent need to refine evaluation approaches used in initiatives delivered through technology-assisted modalities in order to better assess their wider and longer-term impact.…”

Examining the reach and exposure of a mobile phone-based training programme for frontline health workers (ASHAs) in 13 states across India

“… 15 In rural Guatemala, nurses’ mobile phones were used to support tele-care. 26 In Malawi 13 and Bangladesh, 27 mobile phones have been used to foster digital skills development. Mobile phones have also been used to train midwives in the management of pre-eclampsia in Iran 28 and support the management of viral infections in China.…”