EXPANDING COMMUNITY HEALTH NURSE EDUCATION & SUPPORT IN RURAL GUATEMALA THROUGH TELEHEALTH

KELLY MCCONNELL, MD, LYNDSAY KRISHER, MPH, MAUREEN LENSSEN, MSN, PNP, MAYA BUNIK, MD, MSPH, SASKIA BUNGE MONTES, MD, MPH, GRETCHEN DOMEK, MD, PHIL

PRESENTER DISCLOSURE

▸ Presenter: Kelly McConnell

▸ Nothing to declare

▸ Potential for conflict(s) of interest: Not Applicable

▸ Work as a postdoctoral fellow at the Colorado School of Public Health

▸ Current Employment: Carson Medical Group (Nevada, USA)

Presenter

Presentation Notes

Background - We have a partnership between the University of Colorado and a local agricultural company - AgroAmerica- who requested assistance for their community in rural SW Guatemala known as the Trifinio. The health care center provides a clinic, pharmacy, labratory, birth center, community health programs performed by community health nurse

TO MAKE SURE THAT EVERYONE HAS ACCESS TO A SUITABLE, TRAINED AND MOTIVATED HEALTH WORKER AS PART OF A FUNCTIONING HEALTH SYSTEM

World Health Organization & Global Health Workforce Alliance

HEALTH WORKERS FOR ALL AND ALL FOR HEALTH WORKERS (2008)

INITIATION▸ Summer

2015

PROGRESSION

▸ CHNs requested child health topics

▸ To meet the need of families asking for advice at care groups or home visits

▸ To improve referral appropriateness

▸ Summer & Fall 2015: Regular rotation of topics

▸ Evaluate? Improve? Share?

PROGRAM EVALUATION

AIMS

‣Prove knowledge gains in child health topics

‣Assess satisfaction and convenience

‣Demonstrate connection between learners and instructors

‣Identify challenges in delivery

METHODS▸ One instructor (myself) provided 2 blocks of 5 lectures

▸ Regular Schedule

▸ Topics: per CHN request / instructor ability / applicability to the site

▸ ~ 30 min teaching, 15 min discussion / questions (15 min to deal with tech)

▸ Lecture shared via Google Drive

PROGRAM EVALUATION

PROGRAM EVALUATION

▸ Colorado Multiple Institutional Review Board: Exempt / Program Evaluation

▸ No identification of survey / test responses from the learners

▸ Google Forms for surveys & tests (pre & post)

▸ Survey responses on 4 point Likert scale

▸ Averaged on scale & dichotomized for agree v. disagree

▸ Tests 20pts per topic x 5 topics = 100

▸ Averaged as a groups per topic & compared pre v. post

GOOGLE FORMS: EVALUATION OF QUALITY & UTILITY

GOOGLE FORMS: EVALUATION OF QUALITY & UTILITY

GOOGLE FORMS: EVALUATION OF QUALITY & UTILITY

GOOGLE FORMS: INSTRUCTOR EVALUATION

▸ What was your role? (lead, assisting, observer)

▸ How long did it take to connect?

▸ I felt connected to the learners. *

▸ I could see the learners well. *

▸ I could hear the learners well. *

▸ The system is easy to use. *

▸ This format was convenient for me. *

* Indicates 4 point Likert scale

KNOWLEDGE GAIN

▸ % Increase Range

▸ 1.4 (Anemia)

▸ 19.9 (Injury Prevention)

▸ Avg % Increase

▸ 10.7%

Block 2 (n=7) Block 1 (n=6/7)

PROGRAM EVALUATION

SURVEY RESPONSES: LEARNERS

▸ Lecture Content: 98% Agreement

▸ Technology: Ease of Use / Convenience: 98% Agreement

▸ Technology: Hear (94.5%) > See (87.3%) the instructor

▸ Connection to the Instructor / Felt the instructor cared: 100% Agreement

PROGRAM EVALUATION

SURVEY RESPONSES: INSTRUCTORS

▸ Average of 2 per lecture; n = 10

▸ Technology: Hear (86.4%) > See (59.1%) the instructor

▸ Ease & Convenience: 100% Agreement

▸ Felt connected to the learners: 86.4% Agreement

CONCLUSIONS

ISSUES ENCOUNTERED >>> LESSONS LEARNED

▸ Failure / Delay to connect >>> Be flexible, establish internet connection for site, use system designed for these issues

▸ 2 rescheduled to different days

▸ 2 delayed

▸ Difficulty of connecting to learners / silence >>> Adaptations in teaching methods, screen displays, pausing for connection (bad jokes?), mixing didactic with questions / cases

CONCLUSIONS

LIMITATIONS / LOOKING FORWARD

▸ Small number of participants for analysis

▸ No adjustment for attendance (anonymous)

▸ No linkage to clinic or hospital referrals or health outcomes

▸ Anecdotes only

▸ No economic evaluation

▸ No bandwidth measurements

CONCLUSIONS

STRENGTHS

▸ Fellow with salary & time

▸ Telehealth team for licensing & support

▸ Established partnership for this healthcare system

▸ All team members were familiar with the site & the program

CONCLUSIONS

TAKE HOME POINTS

▸ Telehealth is a feasible, effective & convenient educational conduit for rural community health workers, especially from distant faculty.

▸ Reduce costs (time & money) for faculty travel

▸ Alternative engagement when travel is limited (health / safety)

▸ Planetary Health

▸ Maintain partner relationships with increased contact frequency

AUTHORS▸ Kelly McConnell, MD - McConnell.Kelly@gmail.com

▸ Lyndsay Krisher, MPH

▸ Maureen Lenssen, MSN, PNP

▸ Maya Bunik, MD, MSPH

▸ Saskia Bunge-Montes, MD

▸ Gretchen Domek, MD, Phil

SPECIAL THANKS▸ Claudia Rivera - CHN manager

▸ FSIGCU / Bolaños Foundation

▸ CHCO Telehealth Department

REFERENCES

▸ Asturias E, Heinrichs G, Domek G, Brett J, Shick E, Cunningham M, et al. The center for human development in Guatemala. Advances in Pediatrics. 2016; 63: 357 - 387.

▸ World Health Organization, Global Health Workforce Alliance. Health Workers for All and All for Health Workers. World Health Organization. 2008. Available from http://www.who.int/workforcealliance/knowledge/resources/aga_meetingdeclaration/en

Presenter

Presentation Notes

We used documents, slides, photos and videos as well as interactive websites

INSTRUCTORS

LEARNERS