Medical Doctors' Offline Computer-Assisted Digital Education: Systematic Review by the Digital Health Education Collaboration.

BACKGROUND: The widening gap between innovations in the medical field and the dissemination of such information to doctors may affect the quality of care. Offline computer-based digital education (OCDE) may be a potential solution to overcoming the geographical, financial, and temporal obstacles faced by doctors. OBJECTIVE: The objectives of this systematic review were to evaluate the effectiveness of OCDE compared with face-to-face learning, no intervention, or other types of digital learning for improving medical doctors' knowledge, cognitive skills, and patient-related outcomes. Secondary objectives were to assess the cost-effectiveness (CE) of OCDE and any adverse effects. METHODS: We searched major bibliographic databases from 1990 to August 2017 to identify relevant articles and followed the Cochrane methodology for systematic reviews of intervention. RESULTS: Overall, 27 randomized controlled trials (RCTs), 1 cluster RCT (cRCT), and 1 quasi-RCT were included in this review. The total number of participants was 1690 in addition to the cRCT, which included 24 practices. Due to the heterogeneity of the participants, interventions, and outcomes, meta-analysis was not feasible, and the results were presented as narrative summary. Compared with face-to-face learning, the effect of OCDE on knowledge gain is uncertain (ratio of the means [RM] range 0.95-1.17; 8 studies, 495 participants; very low grade of evidence). From the same comparison, the effect of OCDE on cognitive skill gain is uncertain (RM range 0.1-0.9; 8 studies, 375 participants; very low grade of evidence). OCDE may have little or no effect on patients' outcome compared with face-to-face education (2 studies, 62 participants; low grade of evidence). Compared with no intervention, OCDE may improve knowledge gain (RM range 1.36-0.98; 4 studies, 401 participants; low grade of evidence). From the same comparison, the effect of OCDE on cognitive skill gain is uncertain (RM range 1.1-1.15; 4 trials, 495 participants; very low grade of evidence). One cRCT, involving 24 practices, investigated patients' outcome in this comparison and showed no difference between the 2 groups with low-grade evidence. Compared with text-based learning, the effect of OCDE on cognitive skills gain is uncertain (RM range 0.91-1.46; 3 trials with 4 interventions; 68 participants; very low-grade evidence). No study in this comparison investigated knowledge gain or patients' outcomes. One study assessed the CE and showed that OCDE was cost-effective when compared with face-to-face learning if the cost is less than or equal to Can $200. No trial evaluated the adverse effect of OCDE. CONCLUSIONS: The effect of OCDE compared with other methods of education on medical doctors' knowledge and cognitive skill gain is uncertain. OCDE may improve doctors' knowledge compared with no intervention but its effect on doctors' cognitive skills is uncertain. OCDE may have little or no effect in improving patients' outcome.

Digital Education of Health Professionals on the Management of Domestic Violence: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration.

BACKGROUND: The World Health Organization states that 35% of women experience domestic violence at least once during their lifetimes. However, approximately 80% of health professionals have never received any training on management of this major public health concern. OBJECTIVE: The objective of this study was to evaluate the effectiveness of health professions digital education on domestic violence compared to that of traditional ways or no intervention. METHODS: Seven electronic databases were searched for randomized controlled trials from January 1990 to August 2017. The Cochrane Handbook guideline was followed, and studies reporting the use of digital education interventions to educate health professionals on domestic violence management were included. RESULTS: Six studies with 631 participants met our inclusion criteria. Meta-analysis of 5 studies showed that as compared to control conditions, digital education may improve knowledge (510 participants and 5 studies; standardized mean difference [SMD] 0.67, 95% CI 0.38-0.95; I2=59%; low certainty evidence), attitudes (339 participants and 3 studies; SMD 0.67, 95% CI 0.25-1.09; I2=68%; low certainty evidence), and self-efficacy (174 participants and 3 studies; SMD 0.47, 95% CI 0.16-0.77; I2=0%; moderate certainty evidence). CONCLUSIONS: Evidence of the effectiveness of digital education on health professionals' understanding of domestic violence is promising. However, the certainty of the evidence is predominantly low and merits further research. Given the opportunity of scaled transformative digital education, both further research and implementation within an evaluative context should be prioritized.

Opening the doors for school health-An exploration of public health nurses' capacities to engage in comprehensive school health programs.

OBJECTIVES: Public health nurses (PHNs) have a significant role in engaging the voice and actions of school communities in promoting the health of children and youth. School nursing was one of the early 20th century public health nursing foci and specialties in Canada, however over several decades, there has been a gap in actualizing PHNs' full potential in schools. At the same time, intersectoral and interdisciplinary comprehensive school health (CSH) models have emerged as exemplars of partnerships between schools and communities to advance health promotion and ultimately chronic disease prevention with school populations (Pan-Canadian Joint Consortium for School Health, ; World Health Organization, ). DESIGN AND MEASUREMENT: Using a participatory action research methodology we explored the role of PHNs in CSH, drawing on the concept of engagement in intersectoral healthy school teams. RESULTS AND CONCLUSIONS: The three themes that emerged from the data analysis were: facilitators of public health nursing engagement, barriers to public health nursing engagement, and the influences of community context on engagement. Overall, findings indicate that the PHN role in CSH must be developed and supported so that PHNs remain a vital link between school health communities, programs, and policies in the promotion of health.

Sharing Histories-a transformative learning/teaching method to empower community health workers to support health behavior change of mothers.

BACKGROUND: One of the keys to improving health globally is promoting mothers' adoption of healthy home practices for improved nutrition and illness prevention in the first 1000 days of life from conception. Customarily, mothers are taught health messages which, even if simplified, are hard to remember. The challenge is how to promote learning and behavior change of mothers more effectively in low-resource settings where access to health information is poor, educational levels are low, and traditional beliefs are strong. METHODS: In addressing that challenge, a new learning/teaching method called "Sharing Histories" is in development to improve the performance of female community health workers (CHWs) in promoting mothers' behaviors for maternal, neonatal and child health (MNCH). RESULTS: This method builds self-confidence and empowerment of CHWs in learning sessions that are built on guided sharing of their own memories of childbearing and child care. CHWs can later share histories with the mother, building her trust and empowerment to change. For professional primary health care staff who are not educators, Sharing Histories is simple to learn and use so that the method can be easily incorporated into government health systems and ongoing CHW programs. CONCLUSIONS: I present here the Sharing Histories method, describe how it differs from other social and behavior change methods, and discuss selected literature from psychology, communications, and neuroscience that helps to explain how and why this method works as a transformative tool to engage, teach, transform, and empower CHWs to be more effective change agents with other mothers in their communities, thereby contributing to the attainment of the Sustainable Development Goals.

Transferable Training Modules: Building Environmental Education Opportunities With and for Mexican Community Health Workers (Promotores de Salud).

Community health workers (promotores de salud) have the ability to empower communities to mitigate negative health outcomes. Current training efforts in environmental topics are lacking. This project addressed this gap by developing 4 transferable training modules on environmental health. By applying a series of surveys, interviews, and trainings, we evaluated their relevance. Partners provided favorable feedback for 3 of the 4 modules. It was also learned that the development method could be improved by engaging technically trained promotores de salud in the role of co-creators. This project has implications for environmental justice communities as it can lessen information disparities.

A time-use study of community health worker service activities in three rural districts of Tanzania (Rufiji, Ulanga and Kilombero).

BACKGROUND: Despite expanding international commitment to community health worker (CHW) deployment, little is known about how such workers actually use their time. This paper investigates this issue for paid CHWs named "Community Health Agents," which in Swahili is "Wawezeshaji wa Afya ya Jamii" ("WAJA"), trained for 9 months in primary health care service delivery and deployed to villages as subjects of a randomized trial of their impact on childhood survival in three rural districts of Tanzania. METHODS: To capture information about time allocation, 30 WAJA were observed during conventional working hours by research assistants for 5 days each over a period of 4 weeks. Results were presented in term of percentage time allocation for direct client treatment, documentation activities, health education, health promotion non-work-related activities and personal activities. RESULTS: During routine 8-h workdays, 59.5 % of WAJA time was spent on the provision of health services and other work-related activities. Overall, WAJA spent 27.8 % of their work on traveling from home to home, 33.1 % on health education, 9.9 % of health promotion and only 12.3 % on direct patient care. Other activities related to documentation (7.8 %) and supervision (2.5 %). CONCLUSIONS: Results reflect the pressing obligations of WAJA to engage in activities other than direct work responsibilities during routine work hours. Time spent on work activities is primarily used for health education, promotion, moving between households, and direct patient care. However, greater effort should be directed to strengthening supervisory systems and follow-up of challenges WAJAs facing in order to increase proportion of working hours.

[The educational work of nurses in the Family Health Strategy: difficulties and perspectives on change]. / Trabalho educativo do enfermeiro na Estratégia Saúde da Família: dificuldades e perspectivas de mudanças.

The objective of this study was to understand the difficulties and perspectives on change that nurses have identified in developing educational interventions in the Family Health Strategy (FHS). This is a qualitative, descriptive-exploratory study. The data were collected with 20 nurses working in the FHS of the 10th Regional Health District of Paraná, by means of semi-structured interviews carried out in April 2010, which were subjected to content analysis. The results demonstrated that nurses face difficulties in developing health education strategies with the clients, healthcare team, and administrators, especially in regards to the lack of physical, material and financial resources. However, based on the difficulties they encounter, they seek alternatives to overcome them and suggest changes aimed at improving the delivery of primary health care to the population, particularly regarding educational practices.

A Nurse-Led Population-Based Health Education Project to Improve Infant Care Knowledge for an Old Order Mennonite Community.

Population health is changing the focus of nursing practice as nurses are challenged to focus on health promotion and education for communities rather than limiting their practice to restorative care for individual acute care patients. This new focus is necessary to improve knowledge of maternal and infant health among vulnerable populations. One particularly vulnerable population is members of Old Order Mennonite communities, who frequently rely on self-trained local midwives in the community for home births and home remedies when caring for their infants. Providing evidence-based education to members of this isolated population can be a challenge because they do not typically access information outside of the community. The purpose of this article is to share the process of developing, publishing, and disseminating a culturally sensitive infant care manual for an Old Order Mennonite community using a community-based participatory model and to highlight the impact nursing outreach can have on improving health knowledge.

Comparing the Effectiveness of Brief Versus In-Depth Gatekeeper Training on Behavioral Outcomes for Trainees.

BACKGROUND: A common suicide prevention strategy is training gatekeepers to identify at-risk individuals and refer them to services. AIMS: The study aimed to examine whether differences in training outcomes were observed for brief versus in-depth gatekeeper trainings for trainees from varied professional settings while controlling for differences in trainee characteristics and community context. METHOD: Trainees' identification and referral behavior 3 months after gatekeeper training was compared with a sample of respondents matched on individual- and community-level variables using propensity score-based techniques. The value was estimated, in terms of additional identification and associated costs, of adopting in-depth training. RESULTS: A higher proportion of trainees who participated in in-depth trainings from K-12 and community settings identified at-risk youth, and a higher proportion of in-depth trainees from mental health settings referred youth to services compared with participants of brief trainings from the same setting and with similar characteristics. The effect of training type on outcomes varied by professional role and community context. LIMITATIONS: Self-report measures were used to assess outcomes. Similar measures are used in other studies; their validity has not been conclusively established. CONCLUSION: Findings suggest certain individuals may benefit from in-depth training more than others, which favors targeting this intervention to particular gatekeepers.

Effectiveness of computer-aided learning in oral health among patients and caregivers: a systematic review.

Computer-aided learning (CAL) offers enormous potential in disseminating oral health care information to patients and caregivers. The effectiveness of CAL, however, remains unclear. OBJECTIVES: The purpose of this study was to systematically review published evidence on the effectiveness of CAL in disseminating oral health care information to patients and caregivers. MATERIALS AND METHODS: A structured comprehensive search was undertaken among 7 electronic databases (PUBMED, CINAHL Plus, EMBASE, SCOPUS, WEB of SCIENCE, the Cochrane Library, and PsycINFO) to identify relevant studies. Randomized controlled trials (RCTs) and observational studies were included in this review. Papers were screened by 2 independent reviewers, and studies that met the inclusion criteria were selected for further assessment. RESULTS: A total of 2915 papers were screened, and full texts of 53 potentially relevant papers (κ = 0.885) were retrieved. A total of 5 studies that met the inclusion criteria (1 RCT, 1 quasi-experimental study, and 3 post-intervention studies) were identified. Outcome measures included knowledge, attitude, behavior, and oral health. Significant improvements in clinical oral health parameters (P < .05) and knowledge/attitudes (P < .001) were reported in 2 of the studies. The 3 remaining studies reported improved oral health behaviors and confidence. CONCLUSION: There is a limited number of studies which have examined the effectiveness of CAL interventions for oral health care among patients and caregivers. Synthesis of the data suggests that CAL has positive impacts on knowledge, attitude, behavior, and oral health. Further high- quality studies on the effectiveness of CAL in promoting oral health are warranted.

The health educator network as a nutrition education strategy: the example of the EDALNU programme (1963-1994) / La red de promotores de salud como estrategia de educación alimentaria: el ejemplo del Programa EDALNU (1963-1994).

Food and nutrition education is an essential tool to ensure public health. The year 1961 saw the launch of the Food and Nutrition Education Programme (EDALNU), which helped Spanish population to complete their nutrition transition. The aim of this study was to analyze the characteristics of the health education network which was created as part of the program. A total of 46,752 people, 94% of whom were women, received training on food and nutrition. Of these, 89.54% obtained the basic certificate, and 8.80% were awarded the diploma. Some 1,407 courses were given, reaching a peak in 1979 with 131 courses and 4,029 students. The most active provinces were Madrid, with 26.65% of the courses; Valencia, with 7.60%; Murcia, with 7.53%, and Malaga, with 6.75%. The Spanish Ministry of Culture and Education organized the largest number of courses (26.23%), followed by the Women's Section (11.16%) and Catholic Action (5.12%). Diploma courses were taught for 160 hours, while basic courses lasted 40 hours. The training delivered was affected by changes in the EDALNU program and the Spanish administrative and political structure. Our research revealed that the development and gender balance of the network of trainers presented regional inequalities, and that a wide range of institutions were involved in delivering the courses

La educación en alimentación y nutrición es una herramienta fundamental para garantizar la salud. En 1961, se puso en marcha el Programa de Educación en Alimentación y Nutrición (EDALNU), que ayudó a la población española a completar su transición alimentaria y nutricional. El objetivo de este trabajo es analizar las características de la red de promotores de salud que se desarrolló en el marco del programa. Recibieron formación relacionada con alimentación y nutrición 46.752 personas, el 94% de ellas mujeres. El 89,54% obtuvo el título de iniciado y el 8,80%, el de diplomado. Se realizaron 1.407 acciones y en 1979 se alcanzó el momento más álgido, con 131 cursos y 4.029 alumnos. Madrid, con el 26,65% de cursos; Valencia, con el 7,60%; Murcia, con el 7,53%, y Málaga, con el 6,75%, fueron las provincias más activas. El Ministerio de Cultura y Educación fue el encargado de organizar el mayor número de cursos (26,23%), seguido de Sección Femenina (11,16%) y Acción Católica (5,12%). La duración y los contenidos formativos de los cursos eran de 160 horas para los diplomados y 40 para los iniciados. La acción formativa desarrollada estuvo sometida a los cambios que experimentó el Programa y a los que afectaron a la estructura administrativa y política española. La investigación ha mostrado las desigualdades territoriales que acompañaron el desarrollo de la red de formadores, su componente de género y el carácter plural de las instituciones que organizaron los cursos.

What Does Evidence-Based Mean for Nutrition Educators? Best Practices for Choosing Nutrition Education Interventions Based on the Strength of the Evidence.

Funding agencies and professional organizations are increasingly requiring community-based nutrition education programs to be evidence-based. However, few nutrition education interventions have demonstrated efficacy, particularly for interventions that address the outer layers of the socioecological model (ie, organizational, community, and public policy). This article reviews the types of evidence available to assess the likelihood that a given intervention will deliver the desired outcomes and how these types of evidence might be applied to nutrition education, and then suggests an approach for nutrition educators to evaluate the evidence and adapt interventions if necessary.

The work of the community health worker from the perspective of popular health education: possibilities and challenges. / O trabalho do agente comunitário de saúde na perspectiva da educação popular em saúde: possibilidades e desafios.

This article addresses the possibilities and challenges in the performance of the community health worker (CHW) from the perspective of the National Policy of Popular Health Education. It is based on the analysis of findings from a research-intervention carried out at a Family Health Center in a small city in the southern region of Brazil. The data analyzed was produced in meetings with the research team, in activities with the CHWs (individual interviews and workshops), and in feedback sessions with the team regarding the intervention. Among the results, the intertwined role of the CHW within the team was emphasized. In situating themselves between technical and popular forms of knowledge, the work of the CHW potentializes the actions of the Popular Health Education program, as it points to the need for training, agreement of the developed practices, and professional valorization. From these findings we were able to approach and understand the results in terms of the National Policy of Popular Health Education. Based on the analyses, we recommend the establishment of practices associated with the broader concept of health sustained in holistic teamwork that valorizes the knowledge/action of CHW and of the community, inspired in the guiding principles of PNEP-SUS.

Let's see action on Willis' framework for education.

I don't suppose many of you will have ploughed through the 72 pages that make up the Shape of Caring review, which sets out a framework for the future of nursing education. It is not the first such report, and won't be the last. This one contains many noble sentiments and sensible ideas on how nurses and care assistants should be trained and developed throughout their careers, but it fails to deliver a coherent strategy that everyone can get behind.

Influência das práticas de educação em saúde nas responsabilidades de enfermeiros, agentes de saúde e cuidadores familiares no cuidado a idosos dependentes / Influencia de las prácticas educativas de salud sobre responsabilidades de enfermeras, agentes de salud y cuidadores familiares para el cuidado de ancianos dependientes / Influence of health education practices on the responsibilities of nurses, health agents and family caregivers for the care of dependent elderly people

Introdução: As práticas educativas em saúde tem potencial transformador no cotidiano das pessoas e os profissionais de saúde têm responsabilidades para com a sua concretização. Objetivo: Avaliar a influência de práticas educativas em saúde nas responsabilidades de enfermeiros, agentes comunitários de saúde e cuidadores familiares pelo cuidado do idoso dependente. Métodos: Estudo qualitativo, descritivo e exploratório, realizado em município da Bahia, com dois enfermeiros, oito agentes comunitários de saúde e seis cuidadores familiares de idosos que participaram de práticas educativas em saúde. Utilizou-se para coleta de dados questionário e roteiro de entrevista semiestruturados e análise a partir da Técnica da Configuração Triádica, Humanista-existencial-personalista. Resultados: As práticas educativas possibilitaram mudanças nas responsabilidades dos profissionais como na abordagem dos idosos, na atenção à saúde, na cobrança dos familiares pelo cuidado e na compreensão das dificuldades dos idosos e de suas famílias. Entre os cuidadores, houve modificações no cuidado, na aceitabilidade da condição de dependência do idoso e na busca de assistência à saúde. Conclusão: As práticas educativas favoreceram entre os participantes a aquisição de conhecimentos, empoderamento e influenciaram positivamente nas responsabilidades pelo cuidado do idoso, evidenciadas na realização de visitas domiciliares dos profissionais e na cobrança de cuidadores por atendimento domiciliar(AU)

Introducción: Las prácticas de educación en salud tienen un potencial transformador en la vida cotidiana de las personas, y los profesionales de salud tienen la responsabilidad de su implementación. Objetivo: Evaluar la influencia de las prácticas de educación sanitaria en las responsabilidades de enfermeras, agentes de salud comunitarios y cuidadores familiares para el cuidado de los ancianos dependientes. Métodos: Estudio cualitativo, descriptivo y exploratorio, realizado en municipio del interior de Bahía, con 2 enfermeras, 8 agentes comunitarios de salud y 6 cuidadores familiares de ancianos que participaron en prácticas de educación sanitaria. Se utilizó para el cuestionario de recopilación de datos y el guion de entrevista semiestructurada, con producción de datos en 2016, con análisis de la Técnica de Configuración Triádica, humanista-existencial-personalista. Resultados: Las prácticas educativas permitieron cambios en las responsabilidades de los profesionales, como acercarse a los ancianos, la atención médica, la recuperación de los miembros de la familia para el cuidado y la comprensión de las dificultades de los ancianos y sus familias. Entre los cuidadores, hubo cambios en la atención, la aceptabilidad de la condición de dependencia de los ancianos y la búsqueda de atención médica. Conclusión: Las prácticas educativas favorecieron la adquisición de conocimiento entre los participantes, el empoderamiento e influyeron positivamente en las responsabilidades para el cuidado de los ancianos, evidenciado en las visitas domiciliarias de profesionales y la colección de cuidadores para el cuidado domiciliario(AU)

Introduction: health education practices have the potential to transformer into people's daily lives and health professionals have responsibilities for their implementation. Objective: to evaluate the influence of health education practices on the responsibilities of nurses, community health agents and family caregivers for the care of the dependent elderly. Methods: qualitative, descriptive and exploratory study, conducted in a municipality in the interior of Bahia, with two nurses, eight community health agents and six family caregivers of elderly who participated in health education practices. It was used for data collection questionnaire and semi-structured interview script, production of data in 2016, analysis from Triadic Configuration Technique, humanist-existential-personalist. Results: educational practices allowed changes in responsibilities of professionals such approaching the elderly, health care, recovery of family members for care and understanding of difficulties of elderly and their families. Among the caregivers, there were changes in care, acceptability of dependency condition of elderly and in the search for health care. Conclusion: educational practices favored among the participants acquisition of knowledge, empowerment and positively influenced the responsibilities for the care of elderly, evidenced in home visits of professionals and collection caregivers for home care(AU)

Homebound Learning Opportunities: reaching out to older shut-ins and their caregivers.

Homebound Learning Opportunities (HLO) represents an innovative health promotion and educational outreach service for homebound older adults and their caregivers. It provides over 125 topics for individualized learning programs delivered to participants in their own places of residence, an audiovisual lending library, educational television programming, and a peer counseling service. Shut-ins are recruited as instructors and as participants in service projects that benefit the greater community. Preliminary assessments reveal high levels of participation and satisfaction with the program.

[What can family physicians contribute to health promotion in schools?]. / Welchen Beitrag können niedergelassene Arzte zur Gesundheitsförderung an Schulen leisten?

Although several German schools have developed and tested concepts of a goal-directed health education, a stable and continuous implementation is missing. In this field free-practising physicians can support public health efforts. In the area Bruchsal/Ostringen it is demonstrated, that especially those primary care physicians, who work according to the "Three-Level-Concept of Free-Practising Physicians", can successfully use their geographical and social proximity to schools in their neighbourhood for a log-lasting implementation of recurring health-related activities. Within ten years 1389 students in schools, further ca. 500 outside schools, were directly included in interactive learning in the framework of preventive measures, e.g. during school health days. 10 physicians (4 of them continuously) cooperated in these activities, which had been planned in close collaboration with teachers and parents, considering the different age groups. From the very beginning--although sometimes limited in scale--each activity was evaluated. Pupils in the age group 10-12 years generally showed the highest interest in health-related diet, 17-26% were physically more active. Promising are the results with respect to smoking: one fifth of the smoking students intended to quit as a consequence of the health activities in their schools.

A statewide institute to deliver professional development programs to school health personnel in Massachusetts.

Schoolchildren suffer from health problems ranging from chronic medical and developmental problems to new morbidities related to drugs, violence, and sexual behavior. To help administrators, teachers, and health personnel meet the new challenges in schools, nursing educators from the University of Massachusetts and Simmons College developed the UMass-Simmons School Health Institute. The Institute delivers a series of professional development programs in all regions of the commonwealth to: 1) devise innovative strategies to remove health barriers to learning and to promote the health of children and adolescents, and 2) enhance the design, implementation, integration, and management of comprehensive school health programs, including those mandated and regulated by the Commonwealth of Massachusetts. This article describes a statewide model to prepare school health personnel for delivery of comprehensive school health services.

[Health education in the French school system: principles and practical applications]. / L'éducation à la santé dans le système scolaire français: discours et pratiques du discours.

Various methods, values and practices have been used for a long time in French schools in order to promote health education. The authors discusses her analysis on the didactic aspect of health education which appears as a complex phenomenon with methodological difficulties and ethical aspects.