Qualitative Interview Results With Key Stakeholders (n=10)

DomainsIllustrative Quotes
Knowledge“Trainings are theoretical via lectures. They teach too many things at the same time and they rush through the material. Learners have trouble prioritizing and leave with confusion; meanwhile the essential notions aren't mastered and they aren't able to apply the knowledge to a case. Providers have been trained before but it's as if they have never been trained. It would be better to have more practical training.”
“CE should incorporate adult learning principles, and it should be continuous/regular.”
“Hospital/workers are often 'subjected' to trainings that they haven't planned … should be included in planning in response to priority gaps/needs.”
“Must present things that are relevant to what they [health workers] do–where they get practical info and can see the gestures.”
“SDA renders learning operational.”
Skills“There is a weak development of competence of personnel.”
“Care has become mechanized and based on memorized protocols, so they [health workers] have a difficult time analyzing situations.”
“Providers were able to put into practice new things learned [from the SDA] such as using the side of the hand for manual extraction [of the placenta] and bimanual compression for PPH.”
“Should be conducted in real work conditions to combat the gap between what one knows and what one does.”
“mLearning also teaches people how to use technology.”
Social/professional role and identity“[Health workers] use what they have to treat patients, but they are not going to look something up or get additional info.”
“Must create a way for people to share information. Maybe form a club (to discuss with an animator/trainer). If the program is personalized, even better–get points, get certificate [must be linked to the employer].”
Beliefs about capabilities“Imposing CE is only of limited value, when the boss isn't there … they won't do it.”
“Inspiring them to the benefits of CE would be more motivating then sanctions.”
Beliefs about consequences“No accountability related to malpractice.”
“CE regulations/requirements are where the country needs to go to make a change.”
“[Employers or] Ministry should have tracking capability related to CE to be able to identify persons in need of training and needed training.”
“Must assure career path for health workers based on regular evaluation.”
“Must lead to a change in employment status/have a concrete change.”
Reinforcement“mLearning is interesting to reinforce learning since the tool is available at all times and the provider can view the information many times.”
“Ideal if someone [trainer] follows the process to enrich the application [give retro-information and ensure that needs are covered in the app], and to answer questions.”
“SDA should be made available in all health zones with post-training supervision … would decrease maternal and neonatal mortality.”
Intentions“For remote settings, eLearning is interesting–self-directed learning, and should measure if they acquire competencies/can be certified, and put in place a system for them to be encouraged to do this.”
Memory, attention, and decision processes“The images allow people to learn with more stimulation and attention. The visual memory can fix the memory of the information for longer.”
“When time passes after a training, you forget.”
“If people are motivated they may retain info better.”
Environmental context and resources“Better working conditions [salaries, supervision, environment] would push people.”
“Poor distribution of opportunity to get CE training. Limited training for hard-to-reach areas and for lower health worker cadres (A3, A2).”
“For CE, programs/partners decide subject, may repeat subjects already covered, same people always go to the trainings and are missing from work.”
“No clear CE policy. Who chooses the subjects? And must be defined who participates and what one gets from it. Needs a clear policy, training should be programmed and budgeted … so that employers recognize the training and has it planned/budgeted for their facility.”
“eLearning can train more people at lower cost.”
Emotion“Seeing the images is more interesting than just talking theoretically.”
“Approaches must change from written info to interactive self-learning options.”
“New technology fascinates/attracts people and they want to try it; it responds to a need.”
  • Abbreviations: CE, continuing education; PPH, postpartum hemorrhage; SDA, Safe Delivery App.