Effects of improving primary health care workers' knowledge about public health services in rural China: A comparative study of blended learning and pure E-Learning

Background: primary health care workers (phcws) are a major force in delivering basic public health services (bphs) in rural china. it is necessary to take effective training approaches to improve phcws' competency on bphs. both electronic learning (e-learning) and blended learning have been widely used in the health workers' education. however,there is limited evidence on the effects of blended learning in comparison with pure e-learning. objective: the aim of this study was to evaluate the effects of a blended-learning approach for rural phcws in improving their knowledge about bphs as well as training satisfaction in comparison with a pure e-learning approach. methods: the study was conducted among phcws in 6 rural counties of hubei province,china,between august 2013 and april 2014. three counties were randomly allocated blended-learning courses (29 township centers or 612 phcws-the experimental group),and three counties were allocated pure e-learning courses (31 township centers or 625 phcws-the control group). three course modules were administered for 5 weeks,with assessments at baseline and postcourse. primary outcomes were score changes in courses' knowledge. secondary outcome was participant satisfaction (5-point likert scale anchored between 1 [strongly agree] and 5 [strongly disagree]). results: the experimental group had higher mean scores than the control group in knowledge achievement in three course modules: (1) module 1: 93.21 (95% ci 92.49-93.93) in experimental group versus 88.29 (95% ci 87.19-89.40) in the control group; adjusted difference,4.92 (95% ci 2.61-7.24; p<.001); (2) module 2: 94.05 (95% ci 93.37-94.73) in the experimental group vs 90.22 (95% ci 89.12-91.31) in the control group; adjusted difference,3.67 (95% ci 1.17-6.18; p=.004); (3) module 3: 93.88 (95% ci 93.08-94.68) in the experimental group versus 89.09 (95% ci 87.89-90.30) in control group; adjusted difference,4.63 (95% ci 2.12-7.14; p<.001). the participants in the experimental learning group gave more positive responses with the four issues than control group participants: (1) the increase of interest in learning,1.85 (95% ci 1.22-2.80; p=.003); (2) the increase of interaction with others,1.77 (95% ci 1.20-2.60; p=.004); (3) the satisfaction with learning experience,1.78 (95% ci 1.11-2.88; p=.02); and (4) achievement of learning objectives,1.63 (95% ci 1.08-2.48; p=.02). conclusions: among phcws in rural china,a blended-learning approach to bphs training could result in a higher knowledge achievement and satisfaction level compared with a pure e-learning approach. the findings of the study will contribute knowledge to improve the competency of phcws in similar settings. © 2017 adrian aguilera,emma bruehlman-senecal,orianna demasi,patricia avila.