Abstract：
BACKGROUND: Despite acceleration of remote consulting throughout the COVID-19 pandemic, many health care professionals are practicing without training to offer teleconsultation to their patients. This is especially challenging in resource-poor countries, where the telephone has not previously been widely used for health care.
OBJECTIVE: As the COVID-19 pandemic dawned, we designed a modular online training program for REmote Consulting in primary Health care (REaCH). To optimize upscaling of knowledge and skills, we employed a train-the-trainer approach, training health workers (tier 1) to cascade the training to others (tier 2) in their locality. We aimed to determine whether REaCH training was acceptable and feasible to health workers in rural Tanzania to support their health care delivery during the pandemic.
METHODS: We developed and pretested the REaCH training program in July 2020 and created 8 key modules. The program was then taught remotely via Moodle and WhatsApp (Meta Platforms) to 12 tier 1 trainees and cascaded to 63 tier 2 trainees working in Tanzania\'s rural Ulanga District (August-September 2020). We evaluated the program using a survey (informed by Kirkpatrick\'s model of evaluation) to capture trainee satisfaction with REaCH, the knowledge gained, and perceived behavior change; qualitative interviews to explore training experiences and views of remote consulting; and documentary analysis of emails, WhatsApp texts, and training reports generated through the program. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed thematically. Findings were triangulated and integrated during interpretation.
RESULTS: Of the 12 tier 1 trainees enrolled in the program, all completed the training; however, 2 (17%) encountered internet difficulties and failed to complete the evaluation. In addition, 1 (8%) opted out of the cascading process. Of the 63 tier 2 trainees, 61 (97%) completed the cascaded training. Of the 10 (83%) tier 1 trainees who completed the survey, 9 (90%) would recommend the program to others, reported receiving relevant skills and applying their learning to their daily work, demonstrating satisfaction, learning, and perceived behavior change. In qualitative interviews, tier 1 and 2 trainees identified several barriers to implementation of remote consulting, including lacking digital infrastructure, few resources, inflexible billing and record-keeping systems, and limited community awareness. The costs of data or airtime emerged as the greatest immediate barrier to supporting both the upscaling of REaCH training and subsequently the delivery of safe and trustworthy remote health care.
CONCLUSIONS: The REaCH training program is feasible, acceptable, and effective in changing trainees\' behavior. However, government and organizational support is required to facilitate the expansion of the program and remote consulting in Tanzania and other low-resource settings.
OBJECTIVE: As the COVID-19 pandemic dawned, we designed a modular online training program for REmote Consulting in primary Health care (REaCH). To optimize upscaling of knowledge and skills, we employed a train-the-trainer approach, training health workers (tier 1) to cascade the training to others (tier 2) in their locality. We aimed to determine whether REaCH training was acceptable and feasible to health workers in rural Tanzania to support their health care delivery during the pandemic.
METHODS: We developed and pretested the REaCH training program in July 2020 and created 8 key modules. The program was then taught remotely via Moodle and WhatsApp (Meta Platforms) to 12 tier 1 trainees and cascaded to 63 tier 2 trainees working in Tanzania\'s rural Ulanga District (August-September 2020). We evaluated the program using a survey (informed by Kirkpatrick\'s model of evaluation) to capture trainee satisfaction with REaCH, the knowledge gained, and perceived behavior change; qualitative interviews to explore training experiences and views of remote consulting; and documentary analysis of emails, WhatsApp texts, and training reports generated through the program. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed thematically. Findings were triangulated and integrated during interpretation.
RESULTS: Of the 12 tier 1 trainees enrolled in the program, all completed the training; however, 2 (17%) encountered internet difficulties and failed to complete the evaluation. In addition, 1 (8%) opted out of the cascading process. Of the 63 tier 2 trainees, 61 (97%) completed the cascaded training. Of the 10 (83%) tier 1 trainees who completed the survey, 9 (90%) would recommend the program to others, reported receiving relevant skills and applying their learning to their daily work, demonstrating satisfaction, learning, and perceived behavior change. In qualitative interviews, tier 1 and 2 trainees identified several barriers to implementation of remote consulting, including lacking digital infrastructure, few resources, inflexible billing and record-keeping systems, and limited community awareness. The costs of data or airtime emerged as the greatest immediate barrier to supporting both the upscaling of REaCH training and subsequently the delivery of safe and trustworthy remote health care.
CONCLUSIONS: The REaCH training program is feasible, acceptable, and effective in changing trainees\' behavior. However, government and organizational support is required to facilitate the expansion of the program and remote consulting in Tanzania and other low-resource settings.
摘要：
背景：尽管在整个COVID-19大流行期间远程咨询加速，许多卫生保健专业人员在没有培训的情况下练习为他们的病人提供远程会诊。这在资源匮乏的国家尤其具有挑战性，电话以前没有被广泛用于医疗保健。
目标：随着COVID-19大流行的到来，我们为初级卫生保健中的REmote咨询（REaCH）设计了模块化在线培训计划。为了优化知识和技能的升级，我们采用了训练教练的方法，培训卫生工作者(第1层)将培训与当地的其他人(第2层)进行级联。我们旨在确定在大流行期间，坦桑尼亚农村地区的卫生工作者是否可以接受REaCH培训，以支持他们的医疗保健服务。
方法：我们于2020年7月开发并预先测试了REaCH培训计划，并创建了8个关键模块。然后，该计划通过Moodle和WhatsApp（元平台）远程教授给12名1级学员，并与在坦桑尼亚乌兰加农村地区（2020年8月至9月）工作的63名2级学员进行级联。我们使用一项调查（由Kirkpatrick的评估模型提供信息）来评估该计划，以获取受训者对REaCH的满意度，获得的知识，和感知的行为变化；定性访谈，以探索远程咨询的培训经验和观点；以及电子邮件的文献分析，WhatsApp文本，以及通过该计划生成的培训报告。采用描述性统计分析定量数据。定性数据进行了主题分析。在解释过程中对发现进行了三角测量和整合。
结果：在参加该计划的12名一级学员中，全部完成培训；然而，2（17％）遇到互联网困难，未能完成评估。此外,1(8%)选择退出级联进程。在63名二级学员中，61(97%)完成了级联训练。在完成调查的10名(83%)一级受训人员中，9（90％）会向其他人推荐该程序，报告接受相关技能并将他们的学习应用于日常工作，展示满意度，学习,和感知的行为改变。在定性采访中，一级和二级学员确定了实施远程咨询的几个障碍，包括缺乏数字基础设施，资源少,不灵活的计费和记录保存系统，和有限的社区意识。数据或通话时间的成本成为支持扩大REaCH培训以及随后提供安全和值得信赖的远程医疗保健的最大直接障碍。
结论：REaCH培训计划是可行的，可接受,并有效地改变受训者的行为。然而,需要政府和组织支持，以促进该计划的扩展以及在坦桑尼亚和其他低资源环境中的远程咨询。
目标：随着COVID-19大流行的到来，我们为初级卫生保健中的REmote咨询（REaCH）设计了模块化在线培训计划。为了优化知识和技能的升级，我们采用了训练教练的方法，培训卫生工作者(第1层)将培训与当地的其他人(第2层)进行级联。我们旨在确定在大流行期间，坦桑尼亚农村地区的卫生工作者是否可以接受REaCH培训，以支持他们的医疗保健服务。
方法：我们于2020年7月开发并预先测试了REaCH培训计划，并创建了8个关键模块。然后，该计划通过Moodle和WhatsApp（元平台）远程教授给12名1级学员，并与在坦桑尼亚乌兰加农村地区（2020年8月至9月）工作的63名2级学员进行级联。我们使用一项调查（由Kirkpatrick的评估模型提供信息）来评估该计划，以获取受训者对REaCH的满意度，获得的知识，和感知的行为变化；定性访谈，以探索远程咨询的培训经验和观点；以及电子邮件的文献分析，WhatsApp文本，以及通过该计划生成的培训报告。采用描述性统计分析定量数据。定性数据进行了主题分析。在解释过程中对发现进行了三角测量和整合。
结果：在参加该计划的12名一级学员中，全部完成培训；然而，2（17％）遇到互联网困难，未能完成评估。此外,1(8%)选择退出级联进程。在63名二级学员中，61(97%)完成了级联训练。在完成调查的10名(83%)一级受训人员中，9（90％）会向其他人推荐该程序，报告接受相关技能并将他们的学习应用于日常工作，展示满意度，学习,和感知的行为改变。在定性采访中，一级和二级学员确定了实施远程咨询的几个障碍，包括缺乏数字基础设施，资源少,不灵活的计费和记录保存系统，和有限的社区意识。数据或通话时间的成本成为支持扩大REaCH培训以及随后提供安全和值得信赖的远程医疗保健的最大直接障碍。
结论：REaCH培训计划是可行的，可接受,并有效地改变受训者的行为。然而,需要政府和组织支持，以促进该计划的扩展以及在坦桑尼亚和其他低资源环境中的远程咨询。
