Using Mobile Devices to Support Training of Community-Based Rehabilitation Workers in India Who Provide Services to Children With Cerebral Palsy

PURPOSE: In low- and middle-income countries (LMICs), people with disabilities often have poor access to health care professionals. LMICs frequently use community-based rehabilitation (CBR) workers to provide services. The skills of CBR workers hinge on their training (Adams et al., 2011). Increasingly, occupational therapists provide continuing education to CBR workers as a supplement to the brief initial job training they receive (Suarez-Balcazar et al., 2015).

In response to a training need identified by the Indian Institute of Cerebral Palsy (IICP), a series of 5-min video modules were created to demonstrate adaptive mealtime strategies for children with cerebral palsy who struggle with feeding. The current study evaluated the effectiveness of mobile devices as a tool to support implementation of the video techniques by CBR workers in West Bengal, India. In LMICs, everyday use of mobile devices is increasing. Although mobile health (mHealth) strategies are increasingly popular in high-income countries, little research has assessed the feasibility of mHealth-supported training in LMICs (Hall et al., 2014).

METHOD: A mixed methods approach was used. In collaboration with the IICP, a convenience sample of 21 CBR workers were recruited from rural and urban areas. Participants were randomly assigned to intervention (smartphone + training) and control (training-only) groups. At the conclusion of a 4-wk period, each group participated in a focus group, during which both quantitative and qualitative data were collected.

At baseline, both groups were given a 1-hr training session in which they viewed, practiced, and asked questions about the adaptive feeding techniques featured in the video modules. The control group was then encouraged to use the adaptive feeding strategies as appropriate with families on their caseload over a 4-wk period. The intervention group received smartphones preloaded with the video modules and were encouraged to share the adaptive feeding strategies and the videos with appropriate families over the same period. After 4 wk, all participants completed a short survey and a focus group discussion of their experiences sharing the adaptive feeding strategies with families. Quantitative survey ratings were descriptively summarized, and focus group transcripts were qualitatively analyzed for common discussion themes.

RESULTS: Over 80% of the intervention group strongly agreed that the feeding strategies were easy to share using the videos and strongly agreed they would be using the techniques in the future. In contrast, 10% of the control group strongly agreed that the strategies were easy to share from memory, and 50% strongly agreed that they would continue sharing the adaptive strategies in the future. The intervention group reported improved confidence, enthusiasm, and credibility with families when using the videos to teach the adaptive feeding strategies. The control group expressed trepidation sharing some of the strategies solely on the basis of their memories from baseline training.

CONCLUSION: The data indicate that ongoing smartphone access to video modules enabled CBR workers to review the videos at their convenience and confidently share the strategies with families. The results suggest that mobile phones are a promising medium for disseminating education and training content for CBR workers.

IMPACT STATEMENT: Ongoing access to the video module content resulted in better long-term learning and application of the skills that had been taught during the initial training. This approach suggests an opportunity to increase the long-term deployment of occupational therapy practice skills in resource-poor regions of the world that have few trained occupational therapists.

References

Adams, M. S., Khan, N. Z., Begum, S. A., Wirz, S. L., Hesketh, T., & Pring, T. R. (2011). Feeding difficulties in children with cerebral palsy: Low-cost caregiver training in Dhaka, Bangladesh. Child: Care, Health and Development, 38, 878–888. https://doi.org/10.1111/j.1365-2214.2011.01327.x

Hall, C. S., Fottrell, E., Wilkinson, S., & Byass, P. (2014). Assessing the impact of mHealth interventions in low- and-middle-income countries: What has been shown to work? Global Health Action, 7, 25606. https://doi.org/10.3402/gha.v7.25606

Suarez-Balcazar, Y., Hansen, A. M. W., & Munoz, J. P. (2015). Transformative nature of global partnerships. Occupational Therapy International, 22, 117–120. https://doi.org/10.1002/oti.1406