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Distance Education

Interactive Distance Education Application (iDEA)

NURHI launched a Distance Education tool in November 2013 to provide a platform from which providers can access relevant educational content and resources from Android based smart phones or tablets.The NURHI iDEA was developed in response to the need for re-enforcement of skills post-training. NURHI has been training family planning providers in the clinical and non-clinical elements of family planning provision, including medical eligibility, interpersonal communication, counseling and method-specific clinical skills.  The training is followed up by supportive supervision because the skills learned in training are not always fully utilized without consistent practice, refreshing and reinforcement for example, issues such as provider bias can be difficult to change, and can still persist even after training.

The NURHI midterm data revealed provider bias towards clients assessing FP due to age, parity, marital status and religion were still apparent.  In response, NURHI developed an interactive distance education application(iDEA) to address the need for the re-enforcement of skills post-training. The tool is intended to supplement existing forms and curriculum of OJT training and supportive supervision.The application is designed to be a refresher of the three key components of the NURHI On the Job Training (OJT) curriculum:

  1. Counseling;
  2. Clinical Service Provision; and
  3. Contraceptive Logistics Management Systems (CLMS)

The NURHI DE App can be uploaded to any android smart phone. The Distance Education application is available for free download on Google Play.

Development Process

Content development was guided by findings from the NURHI Midterm Assessment that revealed a high prevalence of myths; misconceptions and provider biases still existed among providers.  NURHI held content development workshops, script writing meetings and reviews to aid in the design of the tool and content. NURHI team held a workshop with creative consultants and partners. After much discussion and consultations, NURHI opted to create a series of case studies and quizzes, where the user is asked a series of questions about key content covered in the videos to test their knowledge.  In addition, the application includes a library of relevant reference FP materials including FMOH protocols and job aids currently used in Nigeria into a library; providing easy access to the user should they wish to refresh their knowledge.

NURHI issued an RFP for a company that could do both the creative development and production of the videos. The African Radio Drama Association (ARDA), a NURHI collaborating partner that also worked on the NURHI radio drama magazine program, was engaged to develop and produce the scripts. The technical team reviewed all scripts and the videos pretested with providers prior to final production.

The entire layout of the DE application is designed to be entertaining, interactive and user-friendly.  The initial NURHI DE application modules included introductory videos, scenario based counseling videos, pre and post tests (Click here to view DE videos) and a library function were strategically designed and developed to:

  • Decrease provider bias based on age, parity, religion, and other factors;
  • Increase understanding and use of medical eligibility for FP provision; and
  • Improve client counseling and responsiveness.

In addition NURHI equipped all the phones with ACE, the Application for Contraceptive Eligibility, developed by USAID K4Health Project. This app is a resource that providers can use to help with determining patient eligibility for various FP clinic methods. The application can also be downloaded from Google Play.

Selection of data plans and mobile phone providers

Mobile phone suitability tests were conducted and phone models selected. The project sought to find an android phone with at least 5 inches screen and other specific features. Most major telecommunications companies in Nigeria were considered for the provision of data plan for the DE initiative, however, only two providers (Globacom and Etisalat) responded to the requests for collaboration. Globacom Nigeria was selected to provide the service because Etisalat has limited coverage in some areas of Ilorin (Irepodun and Offa).  Globacom provided free SIM cards for the data plan on monthly subscription, which was modified to suit NURHI’s demand.

Field/Pilot Testing

Two NURHI project cities (Ibadan in the south and Kaduna in the North) were selected for pilot testing.  20 service providers were selected in each city, these were trained and given the DE phones.

A one-day orientation was conducted in each city and the selected providers were taken through the registration process and use of the phone.  Providers were then left to operate the phones independently for a week after which a Focused Discussion Group (FDG) was conducted to get feedback on the use of the phones and applications and based on these feedbacks, the DE applications were refined. The DE application program was launched thereafter.

Roll out in the four NURHI cities

400 participants were selected from the NURHI training database to partake in the Phase I DE program. Providers were oriented on use of phone in groups in each the four cities. A total of 348 mobile phones were procured and 285 were distributed.

Each of the 285 providers was registered with the DE program system. NURHI was able to monitor providers’ usage and access to the DE platform. Initial data showed that usage remained consistent months after the phones were distributed indicating that providers continued consistently to utilize and access the DE application.

Revision and Expansion

After the positive response of the initial Distance Education application and module on counseling by the providers, NURHI expanded the content to include the other two OJT components of Clinical Service Provision and CLMS and also worked to improve the functionality of the library.

The additional modules to the NURHI mobile distance education application focus on the areas of the Clinical Service Provision Training and Contraceptive Logistics and Management Training. The modules were designed in the similar style and format as the Counseling module, consisting of short videos and quizzes aimed to:

  • Motivate providers on the importance of clinical counseling procedures
  • Provide information to and build confidence of providers to manage and counsel on Side Effects- with a focus on Bleeding – the most common side effect
  • Re-enforce and refresh skills on proper Contraceptive Logistics Management System (CLMS)

Impact Evaluation

NURHI plans to conduct an evaluation of the Distance Education Application to assess its impact on quality care and knowledge of providers for FP service provision. The evaluation will take place in early 2015.