TY  - JOUR
AU  - Downie, Andrew
AU  - Mashanya, Titus
AU  - Chipwaza, Beatrice
AU  - Griffiths, Frances
AU  - Harris, Bronwyn
AU  - Kalolo, Albino
AU  - Ndegese, Sylvester
AU  - Sturt, Jackie
AU  - De Valliere, Nicole
AU  - Pemba, Senga
PY  - 2022
DA  - 2022/6/14
TI  - Remote Consulting in Primary Health Care in Low- and Middle-Income Countries: Feasibility Study of an Online Training Program to Support Care Delivery During the COVID-19 Pandemic
JO  - JMIR Form Res
SP  - e32964
VL  - 6
IS  - 6
KW  - remote consultation
KW  - mobile consulting
KW  - digital health
KW  - telehealth
KW  - mHealth
KW  - eHealth
KW  - mobile health
KW  - health care
KW  - cascade
KW  - train the trainer
KW  - low- and middle-income countries
KW  - rural areas
KW  - Tanzania
KW  - Kirkpatrick
KW  - consultation
KW  - training
KW  - low- and middle-income
KW  - rural
KW  - COVID-19
AB  - Background: Despite acceleration of remote consulting throughout the COVID-19 pandemic, many health care professionals are practicing without training to offer teleconsultation to their patients. This is especially challenging in resource-poor countries, where the telephone has not previously been widely used for health care. Objective: As the COVID-19 pandemic dawned, we designed a modular online training program for REmote Consulting in primary Health care (REaCH). To optimize upscaling of knowledge and skills, we employed a train-the-trainer approach, training health workers (tier 1) to cascade the training to others (tier 2) in their locality. We aimed to determine whether REaCH training was acceptable and feasible to health workers in rural Tanzania to support their health care delivery during the pandemic. Methods: We developed and pretested the REaCH training program in July 2020 and created 8 key modules. The program was then taught remotely via Moodle and WhatsApp (Meta Platforms) to 12 tier 1 trainees and cascaded to 63 tier 2 trainees working in Tanzania’s rural Ulanga District (August-September 2020). We evaluated the program using a survey (informed by Kirkpatrick's model of evaluation) to capture trainee satisfaction with REaCH, the knowledge gained, and perceived behavior change; qualitative interviews to explore training experiences and views of remote consulting; and documentary analysis of emails, WhatsApp texts, and training reports generated through the program. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed thematically. Findings were triangulated and integrated during interpretation. Results: Of the 12 tier 1 trainees enrolled in the program, all completed the training; however, 2 (17%) encountered internet difficulties and failed to complete the evaluation. In addition, 1 (8%) opted out of the cascading process. Of the 63 tier 2 trainees, 61 (97%) completed the cascaded training. Of the 10 (83%) tier 1 trainees who completed the survey, 9 (90%) would recommend the program to others, reported receiving relevant skills and applying their learning to their daily work, demonstrating satisfaction, learning, and perceived behavior change. In qualitative interviews, tier 1 and 2 trainees identified several barriers to implementation of remote consulting, including lacking digital infrastructure, few resources, inflexible billing and record-keeping systems, and limited community awareness. The costs of data or airtime emerged as the greatest immediate barrier to supporting both the upscaling of REaCH training and subsequently the delivery of safe and trustworthy remote health care. Conclusions: The REaCH training program is feasible, acceptable, and effective in changing trainees’ behavior. However, government and organizational support is required to facilitate the expansion of the program and remote consulting in Tanzania and other low-resource settings. 
SN  - 2561-326X
UR  - https://formative.jmir.org/2022/6/e32964
UR  - https://doi.org/10.2196/32964
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35507772
DO  - 10.2196/32964
ID  - info:doi/10.2196/32964
ER  -