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

我的研究将集中在通过移动技术平台教授乌干达社区卫生工作者(CHW)的教育、社会文化和健康影响。根据世界卫生组织(WHO)发布的数据，到2035年，全球卫生工作者将短缺1290万人。(1)这种短缺在低收入和中等收入国家(LMIC)更加严重。为了弥合这一差距，世卫组织强调了培训社区卫生工作者(CHW)以确保基本医疗需求得到满足的重要性。(1)社区卫生工作者被定义为受过很少正规教育的非专业人员，他们在所在社区工作，宣传重要的公共卫生信息并提供基本卫生保健。(2)2016年的一份题为《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)强调了社区卫生工作者的培训期限因国家而异。在尼泊尔，女性妇女妇女接受18天的培训，而在赞比亚，她们接受12个月的培训。(3)妇女妇女在监测和管理患病儿童方面可以发挥重要作用。2014年乌干达5岁以下儿童死亡中有52%是由糖尿病、疟疾和肺炎(DM&P)造成的，这一数字既令人震惊又不可接受，因为所有这三种疾病都是可以治疗和预防的。(4)旨在降低儿童因DM&P死亡的一个具体培训计划是综合社区病例管理(ICCM)，这是传统上由CHW提供的。(5)ICCM的目的是帮助加强DM&P的识别和基本社区层面的治疗，同时也为CHW提供培训手册和监督，并鼓励在社区一级改变行为，作为疾病预防工具。(5)尽管已被证明是成功的，对该计划的常见批评包括教学风格和持续时间不一致，社区卫生工作者难以参加长时间的培训，通常在偏远地区的不便时间举行，以及缺乏培训后监督能力。(6)提高社区卫生工作者培训质量和普及率的一个解决方案是使用移动技术作为培训工具。这个概念属于mHealth的范畴，mHealth的定义是“将移动计算、医疗传感器和通信技术用于医疗保健”。(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、护理点记录和患者交流。(7)鉴于广泛的蜂窝网络可用性和现有的高移动电话使用率，移动技术在东非的扩大使用潜力巨大。(8)通过设计一个加载到低成本Android平板设备上的适合文化的基于视频的培训计划，我希望探索mHealth在乌干达教育400名CHW队列的潜力。我开展的研究将有助于确定使用mHealth工具进行基于视频的培训的教育效果，探索实施基于mHealth的培训计划的社会文化和财务影响，并帮助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移动健康作为低收入中等收入国家社区卫生工作者的培训工具的教育价值，而探索实施此类计划的社会文化和伦理影响的工作更少。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，而且还具有重大的公共卫生影响，可能会影响社区卫生组织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.