Figures & Tables
Figures
- FIGURE
Logic Model of Lateral Learning for the mCME Intervention in Vietnam
Abbreviations: HMU, Hanoi Medical University; mCME, mobile continuing medical education; SMS, short message service.
The mCME intervention implemented in Vietnam was hypothesized to function as a pedagogical analog to the Health Belief Model. In the intervention, the stimuli were the daily text messages and the desired initial outputs were a change in self-study behaviors, which were also a hypothesized mediator of acquired medical knowledge. As in the Health Belief Model, the potency of the stimuli were contingent on the willingness of a given individual to respond by investing their time and energy to self-study.
Tables
Value Female, % 56.0 Age, years, mean (SD) 41.2 (9.5) Highest clinical degree, No. (%) CBPA 3 (2.8) CK1 57 (53.8) CK2 1 (0.9) MD 45 (42.5) Years of experience providing HIV care to patients, mean (SD) 4.2 (4.9) Number of patients typically seen each daily, No. (%) 1–2 62 (58.5) 3–4 13 (12.3) 5–7 12 (11.3) 8–11 8 (7.6) 12+ 11 (10.4) Baseline scores, mean (SD) 46.4 (11.9) Intervention group 44.6 (12.4) Control group 48.2 (11.2) Endline scores,a mean (SD) 54.2 (12.1) Intervention group 55.0 (11.7) Control group 53.4 (12.5) % change in scores between baseline and endline,a mean (SD) 19.6 (30.9) Intervention group 25.6 (32.4) Control group 13.5 (28.2) Abbreviations: CBPA, community-based physician's assistants; CK1, first-level specialization/specialist; CK2, second-level specialization/specialist, SD, standard deviation.
↵a Sample size at endline consisted of 95 individuals (n=48 in the intervention group, n=47 in the control group).
- TABLE 2.
HIV Clinicians' Participation in Intervention-Prompted and Independent Study Behaviors
Value Intervention-Prompted Study Behaviors Among Intervention Group (n=53) % of SMS quizzes answered, mean (SD) 81.9 (23.1) % of SMS quizzes correctly answered, mean (SD) 52.0 (20.5) % of daily hyperlinks accessed, mean (SD) 18.1 (21.8) Ever accessed online CME courses,a % (SD) 60.4 (49.4) Independent Study Behaviors Among Intervention and Control Groups Combinedb Used medical textbooks (ref: 1–3 times/month or <1 time/month) 61.7 (48.9) Consulted with colleagues (ref: 1–3 times/month or <1 time/month) 44.7 (50.0) Researched online (ref: 1–3 times/month or <1 time/month) 56.8 (49.8) Researched website for medical professionals (ref: 1–3 times/month or <1 time/month) 55.3 (50.0) Reviewed HIV guidelines (ref: 1–3 times/month or <1 time/month) 61.1 (49.0) Reviewed scientific papers (ref: 1–3 times/month or <1 time/month) 42.6 (49.7) More use of medical textbooks than before (ref: the same or less) 62.8 (48.6) More consultation with colleagues than before (ref: the same or less) 43.2 (49.8) More research online than before (ref: the same or less) 60.2 (49.2) More visits to researched medical websites than before (ref: the same or less) 56.8 (49.8) More frequent review of HIV guidelines than before (ref: the same or less) 62.4 (48.7) More frequent reviews of scientific papers than before (ref: the same or less) 50.5 (50.3) Total number of study resources used 1–3 or 4 or more times/week, mean (SD) 3.6 (2.7) Abbreviations: CME, continuing medical education; SD, standard deviation; SMS, short message service.
↵a Among the entire study group (intervention and control group combined), 43.4% (SD=49.8) ever accessed the online CME courses.
↵b Sample size for the intervention and control group varied slightly for each indicator, from 93 to 95 individuals, depending on how many respondents answered each question.
- TABLE 3.
Correlation Coefficients for Intervention-Prompted Study Behaviors and Baseline and Endline Test Scores (n=48)
(1) (2) (3) (4) (5) (6) (7) (8) (9) Endline Test Scores Baseline Test Scores Average % of SMS Quizzes Answered Average % of SMS Quizzes Correctly Answered Average % of Daily Readings Accessed Ever Accessed Online CME Courses Years of Experience in HIV Care Provision Age Male r P r P r P r P r P r P r P r P r P (1) Endline test scores 1.00 (2) Baseline test scores 0.59 <.001 1.00 (3) Average % of SMS quizzes answered 0.17 .26 0.04 .81 1.00 (4) Average % of SMS quizzes correctly answered 0.36 .01 0.11 .47 0.83 <.001 1.00 (5) Average % of daily readings accessed 0.20 .18 −0.004 .98 0.38 .01 0.56 <.001 1.00 (6) Ever accessed online CME courses 0.04 .81 −0.08 .57 0.45 .002 0.35 .01 0.30 .04 1.00 (7) Years of experience in HIV care provision 0.16 .28 −0.07 .65 −0.16 .28 -0.09 .56 −0.002 .99 −0.19 .20 1.00 (8) Age −0.13 .39 -0.09 .53 0.13 .36 0.26 .08 0.14 .36 0.07 .63 0.33 .02 1.00 (9) Male −0.12 .41 -0.11 .45 0.19 .20 0.16 .27 -0.17 .26 0.06 .66 0.15 .30 0.23 .11 1.00 Abbreviations: CME, continuing medical education; SMS, short message service.
- TABLE 4.
Associations Between Intervention-Prompted Study Behaviors and Total Endline Test Scores (n=48)
Model 1: Predictor, Quiz Participation Model 2: Predictor, Quiz Performance Model 3: Predictor, Daily Readings Model 4: Predictor, Online CME Courses Model 5: All Predictors Except Quiz Performancea Model 6: All Predictors Except Quiz Participationa ß (SE) P ß (SE) P ß (SE) P ß (SE) P ß (SE) P ß (SE) P Average % of SMS quizzes answered 0.24 (0.06) .05 0.16 (0.07) .27 Average % of SMS quizzes correctly answered 0.42 (0.06) .004 0.43 (0.08) .005 Average % of daily readings accessed 0.22 (0.06) .06 0.14 (0.07) .28 −0.03 (0.07) .81 Accessed online CME courses (ref: never) 0.16 (2.89) .19 0.05 (3.16) .71 0.03 (2.78) .79 Male (ref: female) −0.11 (2.81) .38 −0.12 (2.51) .28 −0.01 (2.83) .92 −0.07 (2.84) .57 −0.06 (2.97) 0.62 −0.13 (2.74) .28 Age −0.18 (0.16) .15 −0.27 (0.15) .02 −0.19 (0.17) .14 −0.16 (0.17) .21 −0.20 (0.17) 0.11 −0.27 (0.16) .03 Years of HIV care provision 0.31 (0.30) .02 0.34 (0.27) .004 0.26 (0.29) .04 0.29 (0.31) .03 0.31 (0.31) .02 0.34 (0.28) .005 Baseline test score 0.57 (0.11) <.001 0.53 (0.10) <.001 0.59 (0.11) <.001 0.60 (0.12) <.001 0.58 (0.11) <.001 0.53 (0.11) <.001 Adjusted R2 0.40 0.51 0.40 0.37 0.39 0.49 Abbreviations: CME, continuing medical education; SE, standard error; SMS, short message service.
↵a Model 5 includes Quiz Participation, Daily Readings, Online CME Courses, and controls while Model 6 includes Quiz Performance, Daily Readings, Online CME Courses, and controls. Quiz Participation and Quiz Performance were not included in the same model together due to high collinearity.
Model 1 Predictor, Intervention Status (n=95) Model 2 Independent Study Behaviors as Potential Mediators of Intervention Effect (n=91) Model 3 Independent Study Behaviors as Predictors of Endline Scores Among Intervention Group (n=47) Model 4 Independent Study Behaviors as Predictors of Endline Scores Among Control Group (n=44) ß (SE) P ß (SE) P ß (SE) P ß (SE) P Treatment status (ref: control) 0.11 (2.08) .22 0.15 (2.09) .11 Used medical textbooks (ref: 1–3 times/month or <1 time/month) −0.11 (3.11) .41 0.07 (3.95) .69 −0.35 (5.47) .16 Consulted with colleagues (ref: 1–3 times/month or <1 time/month) −0.12 (2.57) .28 −0.23 (3.18) .11 0.18 (4.56) .35 Researched online (ref: 1–3 times/month or <1 time/month) 0.20 (3.32) .19 0.26 (3.89) .11 0.12 (6.56) .69 Researched website for medical professionals (ref: 1–3 times/month or <1 time/month) −0.04 (3.11) .80 −0.14 (3.84) .41 0.40 (6.07) .14 Reviewed HIV guidelines (ref: 1–3 times/month or <1 time/month) −0.09 (2.70) .45 −0.002 (3.81) .99 −0.15 (4.37) .45 Reviewed scientific papers (ref: 1–3 times/month or <1 time/month) 0.17 (2.46) .12 0.21 (3.13) .15 −0.03 (4.56) .89 Male (ref: female) −0.25 (2.12) .01 −0.28 (2.16) .005 −0.15 (2.71) .23 −0.55 (4.67) .01 Age −0.02 (0.12) .86 0.11 (0.13) .32 −0.07 (0.19) .66 0.23 (0.19) .19 Years of HIV care provision 0.15 (0.24) .12 0.12 (0.23) .24 0.23 (0.33) .11 0.04 (0.37) .83 Baseline test score 0.50 (0.09) <.001 0.55 (0.09) <.001 0.62 (0.12) <.001 0.47 (0.16) .01 Adjusted R2 0.31 0.34 0.42 0.26 Abbreviation: SE, standard error.
- TABLE 6.
Associations of Interactions Between Quiz Performance and Study Behaviors With Total Endline Scores
Model 1 (n=48) Model 2 (n=48) ß (SE) P ß (SE) P % of SMS quizzes correctly answered 0.18 (0.08) .04 0.11 (0.09) .24 % of daily readings accessed −0.64 (0.37) .09 Accessed online CME courses (ref: never) −13.81 (8.06) .09 % of SMS quizzes correctly answered * % of daily readings accessed 0.87 (0.48) .08 % of SMS quizzes correctly answered * accessed online CME courses 0.25 (0.15) .09 Age −1.88 (2.85) .51 −0.92 (2.76) .74 Years of HIV care provision −0.28 (0.16) .09 −0.30 (0.16) .08 Baseline test score 0.49 (0.11) <.001 0.52 (0.11) <.001 Intercept 36.67 (9.15) <.001 37.69 (9.51) <.001 Adjusted R2 0.44 0.43 Abbreviations: CME, continuing medical education; SE, standard error; SMS, short message service.
- TABLE 7.
Percentage of Total Explained Variances Attributable to Intervention-Prompted Study Behaviors (n=48)
Adjusted R2 % of Adjusted R2 Attributable to: % of SMS Quizzes Correctly Answered % of Daily Readings Accessed Accessed Online CME Courses Model 1. Gender, age, years of HIV care provision, baseline test scores 0.36 Model 2. % of SMS quizzes correctly answered, gender, age, years of HIV care provision, baseline test scores 0.51 43 Model 3. % of daily readings accessed, gender, age, years of HIV care provision, baseline test scores 0.40 10 Model 4. Accessed online CME courses, gender, age, years of HIV care provision, baseline test scores 0.37 3 Abbreviations: CME, continuing medical education; SMS, short message service.
