Investigating the design,implementation and impacts of an mHealth based educational video training program for Community Health Workers(CHWs)in Uganda

我的研究将集中在教育，社会文化和健康的影响，教学社区卫生工作者（CHW）在乌干达通过移动的技术平台。根据世界卫生组织（世卫组织）发布的数据，到2035年，全球将短缺1290万卫生工作者。(1)这种短缺在低收入和中等收入国家更为严重。为了弥补这一差距，世卫组织强调了培训社区卫生工作者（CHW）的重要性，以确保满足基本医疗保健需求。(1)社区卫生工作者被定义为几乎没有受过正规教育的非专业人员，他们在社区工作，宣传重要的公共卫生信息，提供基本的医疗保健。(2)2016年一份题为《通过社区卫生工作者加强初级卫生保健：投资案例和融资建议》的报告（3）强调，各国对社区卫生工作者的培训时间长短差异很大。在尼泊尔，女性社区保健工作者接受18天的培训，而在赞比亚，她们接受12个月的培训。(3)社区卫生工作者可以在监测和管理患病儿童方面发挥重要作用。2014年，乌干达五岁以下儿童死亡中有52%是由于腹泻、疟疾和肺炎（DM&P），这一数字令人震惊和不可接受，因为这三种疾病都是可以治疗和预防的。(4)一个旨在降低DM&P儿童死亡率的具体培训计划是综合社区病例管理（ICCM），传统上由CHW提供。(5)ICCM的目的是帮助加强DM&P的识别和基本社区治疗，同时也为社区卫生工作者提供培训手册和监督，并鼓励社区一级的行为改变作为疾病预防工具。(5)虽然它已被证明是成功的，该计划的共同批评，包括不一致的风格和教学时间，CHW参加长期培训日的困难往往在不方便的时间在遥远的地点举行，以及培训后监督的能力很小。(6)提高社区卫生工作培训质量和普及率的一个解决方案是使用移动的技术作为培训工具。这一概念福尔斯mHealth的范畴，mHealth被定义为使用“移动的计算、医疗传感器和通信技术进行医疗保健”。“（7）它有许多潜在的应用，包括但不限于培训和教育、疾病管理、护理点文件和患者沟通。(7)鉴于东非蜂窝网络的普及和目前移动的电话的大量使用，在扩大使用移动的技术方面有很大的潜力。(8)通过设计一个文化上合适的基于视频的培训计划加载到低成本的android平板设备上，我希望探索mHealth在乌干达教育400名CHW的潜力。我进行的研究将有助于确定使用移动健康工具的视频培训的教育效果，探索实施移动健康培训计划的社会文化和财务影响，并有助于更好地了解计划设计中的挑战和解决方案。这一点很重要，因为很少有研究探讨了移动健康作为中低收入国家社区卫生工作者培训工具的教育价值，更少的工作是探索实施此类计划的社会文化和道德影响。这不仅对在这一领域工作的研究人员、非政府组织和政府具有巨大的重要性，而且还对公共卫生产生重大影响，可能影响到社区卫生工作者所负责的数千名儿童的健康。

My research will focus on the educational, socio-cultural and health impacts of teaching Community Health Workers (CHWs) in Uganda via a mobile technology platform. According to figures released by the World Health Organization (WHO) there will be a worldwide shortage of 12.9 million health workers by 2035.(1) This shortage is magnified in low- and middle-income countries (LMICs). In order to bridge this gap, the WHO has emphasised the importance of training Community Health Workers (CHWs) to ensure basic healthcare needs are met.(1) CHWs are defined as lay people with little formal education, working in their communities to promote important public health messages and provide basic healthcare.(2) A 2016 report entitled "Strengthening Primary Health Care through Community Health Workers: Investment Case and Financing Recommendations,"(3) highlighted the length of training for CHWs varies enormously from country-tocountry. In Nepal, female CHWs are trained for 18 days, whereas in Zambia, they receive 12 months of training.(3) CHWs can play a vital role in the monitoring and management of sick children. 52 percent of under-five deaths in Uganda in 2014 were due to diahorrea, malaria and pneumonia (DM&P) a figure that is both shocking and unacceptable given that all three diseases are treatable and preventable.(4) One specific training program aimed at reducing childhood mortality from DM&P is Integrated Community Case Management (ICCM), which is traditionally delivered by CHWs.(5) The aim of ICCM is to help strengthen the identification and basic community level treatment of DM&P, whilst also providing CHWs with training manuals and supervision and encouraging behaviour change at a community level as a disease prevention tool.(5) Although it has been shown to have success, common criticisms of the program, include inconsistent styles and duration of teaching, difficulties for CHWs to attend long training days often held at inconvenient times in distant locations, and little ability for post-training supervision.(6) One solution to increase the quality and prevalence of CHW training has been the use of mobile technology as a training tool. This concept falls under the umbrella of mHealth which is defined as using "mobile computing, medical sensor, and communications technologies for healthcare." (7) It has many potential applications including, but not limited to, training and education, disease management, point of care documentation and patient communication.(7) There is great potential for the expanded use of mobile technology in East Africa given widespread cellular network availability and existing high use of mobile phones.(8) By designing a culturally appropriate video-based training program loaded onto low-cost android tabletdevices, I hope to explore the potential of mHealth in educating a cohort of 400 CHWs in Uganda. The research I carry out will help to ascertain the educational effectiveness of video based training using mHealth tools, explore the socio-cultural and financial impacts of implementing an mHealth based training program, and help to better understand the challenges and solutions in program design. This is important since very few studies have explored the educational value of mHealth as a training tool for CHWs in LMICs and even less work has been done to explore the socio-cultural, and ethical impacts of implementing such programs. Not only does this carry enormous importance for researchers, NGOs and governments working in this field, but it also has significant public health impacts that are likely to affect the health of thousands of children for whom CHWs are responsible.