title: Successful mLearning Pilot in Senegal: Delivering Family Planning Refresher Training Using Interactive Voice Response and SMS.
abstract: BACKGROUND
  In-service training of health workers plays a pivotal role in improving service quality. However, it is often expensive and requires providers to leave their posts. We developed and assessed a prototype mLearning system that used interactive voice response (IVR) and text messaging on simple mobile phones to provide in-service training without interrupting health services. IVR allows trainees to respond to audio recordings using their telephone keypad.
  
  
  METHODS
  In 2013, the CapacityPlus project tested the mobile delivery of an 8-week refresher training course on management of contraceptive side effects and misconceptions to 20 public-sector nurses and midwives working in Mékhé and Tivaouane districts in the Thiès region of Senegal. The course used a spaced-education approach in which questions and detailed explanations are spaced and repeated over time. We assessed the feasibility through the system's administrative data, examined participants' experiences using an endline survey, and employed a pre- and post-test survey to assess changes in provider knowledge.
  
  
  RESULTS
  All participants completed the course within 9 weeks. The majority of participant prompts to interact with the mobile course were made outside normal working hours (median time, 5:16 pm); average call duration was about 13 minutes. Participants reported positive experiences: 60% liked the ability to determine the pace of the course and 55% liked the convenience. The largest criticism (35% of participants) was poor network reception, and 30% reported dropped IVR calls. Most (90%) participants thought they learned the same or more compared with a conventional course. Knowledge of contraceptive side effects increased significantly, from an average of 12.6/20 questions correct before training to 16.0/20 after, and remained significantly higher 10 months after the end of training than at baseline, at 14.8/20, without any further reinforcement.
  
  
  CONCLUSIONS
  The mLearning system proved appropriate, feasible, and acceptable to trainees, and it was associated with sustained knowledge gains. IVR mLearning has potential to improve quality of care without disrupting routine service delivery. Monitoring and evaluation of larger-scale implementation could provide evidence of system effectiveness at scale.
authors.affiliation: IntraHealth International Senegal, Dakar, Senegal.
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Diedhiou
authors.affiliation: IntraHealth International, CapacityPlus project, Washington, DC, USA.
authors.forename: Kate E
authors.initials: KE
authors.lastname: Gilroy
authors.affiliation: St. Catherine University, St. Paul, Minnesota, USA.
authors.forename: Carie Muntifering
authors.initials: CM
authors.lastname: Cox
authors.affiliation: IntraHealth International, CapacityPlus project, Washington, DC, USA.
authors.forename: Luke
authors.initials: L
authors.lastname: Duncan
authors.affiliation: IntraHealth International Senegal, Dakar, Senegal.
authors.forename: Djimadoum
authors.initials: D
authors.lastname: Koumtingue
authors.affiliation: University Research Company, LLC, Bethesda, MD, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Pacqué-Margolis
authors.affiliation: IntraHealth International, CapacityPlus project, Washington, DC, USA.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Fort
authors.affiliation: IntraHealth International, CapacityPlus project, Washington, DC, USA.
authors.forename: Dykki
authors.initials: D
authors.lastname: Settle
authors.affiliation: IntraHealth International, CapacityPlus project, Washington, DC, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Bailey
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D040421:Cell Phone; D002983:Clinical Competence; D003270:Contraceptive Agents / Q000009:adverse effects*; D004521:Educational Measurement; D005193:Family Planning Services / Q000193:education*; D005260:Female; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D007858:Learning; D008297:Male; D008568:Memory; D008875:Middle Aged; D009726:Nurses; D012054:Reinforcement, Psychology; D017010:Reminder Systems; D012675:Senegal; D011795:Surveys and Questionnaires; D060145:Text Messaging; D014831:Voice
chemical_list: D003270:Contraceptive Agents