TY - JOUR T1 - Applying Adult Learning Best Practices to Design Immunization Training for Health Care Workers in Ghana JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT SP - 487 LP - 497 DO - 10.9745/GHSP-D-21-00090 VL - 9 IS - 3 AU - Denise Traicoff AU - Dieula Delissaint Tchoualeu AU - Joseph Opare AU - Melissa Wardle AU - Pamela Quaye AU - Hardeep S. Sandhu AU - George Bonsu Y1 - 2021/09/30 UR - http://www.ghspjournal.org/content/9/3/487.abstract N2 - Key FindingsThe published literature regarding adult learning and training of trainers provides practical guidance for developing performance-based training of trainers, such as for the Ghana Health Service immunization workforce.Training of trainers (TOT), while a common capacity-building strategy, presents several risks that must be carefully mitigated.The Ghana 2YL TOT was designed with a systems approach, including audience selection, class activities, evaluation methods, and postworkshop action planning.Performance-focused class activities, including practice teaching, increased participants’ confidence as technicians and trainers.Key ImplicationsProgram managers should consider the risks involved in TOTs and be prepared to support the cascade with human and financial resources.Technical experts can take practical steps to ensure TOTs follow adult learning and TOT best practices.TOT designers should include opportunities for practice teaching and feedback to prepare participants for their training role.Program managers and designers should develop reporting tools and processes and monitor trainers’ field activities.Introduction:A 2016 assessment of frontline health care workers (HCWs) in Ghana identified knowledge, skill, and attitude gaps related to immunization during the second year of life (2YL). The U.S. Centers for Disease Control and Prevention subsequently supported the Ghana Health Service Immunization Program to apply best practices of adult learning and training of trainers (TOT) for a cascade training program for 2YL.Methods:Five districts from each of the 3 regions (Greater Accra, Northern, and Volta) were selected for the TOT based on key measles and rubella vaccination coverage indicators. The design incorporated best practices of adult learning and TOT. The curriculum integrated 3 major topical themes: technical (immunization topics), operational, and training adults. The technical and operational content was based on HCW tasks most directly affecting 2YL objectives. A cross-functional team developed all classroom, field activity, and training evaluation materials.Results:Seventy-four participants attended TOT workshops in 2017. Based on a rubric defined by the course designers, 99% of the participants reported an acceptable level of confidence to apply and teach the course content. After the TOTs, participants conducted 65 workshops, 43 field visits, and 4 review meetings, reaching 1,378 HCWs within 7 months. Fifty-four percent of HCWs who received training from TOT participants reported an acceptable level of confidence in using the skills, and 92% reported they would prioritize applying the skills acquired during the training.Discussion:The success factors for effective adult learning and TOT can be applied to design and implement high-quality TOT even in resource-limited settings. The factors include using a variety of approaches, spending enough class time to prepare TOT participants for their training role, setting specific expectations for cascading the training, and following up through mentorship and reporting. Strong collaboration across the administrative levels of the Ghana Health Service enabled cascade training. ER -