title: Using a mHealth tutorial application to change knowledge and attitude of frontline health workers to Ebola virus disease in Nigeria: a before-and-after study.
abstract: BACKGROUND
  The Ebola epidemic exposed the weak state of health systems in West Africa and their devastating effect on frontline health workers and the health of populations. Fortunately, recent reviews of mobile technology demonstrate that mHealth innovations can help alleviate some health system constraints such as balancing multiple priorities, lack of appropriate tools to provide services and collect data, and limited access to training in health fields such as mother and child health, HIV/AIDS and sexual and reproductive health. However, there is little empirical evidence of mHealth improving health system functions during the Ebola epidemic in West Africa.
  
  
  METHODS
  We conducted quantitative cross-sectional surveys in 14 health facilities in Ondo State, Nigeria, to assess the effect of using a tablet computer tutorial application for changing the knowledge and attitude of health workers regarding Ebola virus disease.
  
  
  RESULTS
  Of 203 participants who completed pre- and post-intervention surveys, 185 people (or 91%) were female, 94 participants (or 46.3%) were community health officers, 26 people (13 %) were nurses/midwives, 8 people (or 4%) were laboratory scientists and 75 people (37%) belonged to a group called others. Regarding knowledge of Ebola: 178 participants (or 87.7%) had foreknowledge of Ebola before the study. Further analysis showed an 11% improvement in average knowledge levels between pre- and post-intervention scores with statistically significant differences (P < 0.05) recorded for questions concerning the transmission of the Ebola virus among humans, common symptoms of Ebola fever and whether Ebola fever was preventable. Additionally, there was reinforcement of positive attitudes of avoiding the following: contact with Ebola patients, eating bush meat and risky burial practices as indicated by increases between pre- and post-intervention scores from 83 to 92%, 57 to 64% and 67 to 79%, respectively. Moreover, more participants (from 95 to 97%) reported a willingness to practice frequent hand washing and disinfecting surfaces and equipment following the intervention, and more health workers were willing (from 94 to 97%) to use personal protective equipment to prevent the transmission of Ebola.
  
  
  CONCLUSIONS
  The modest improvements in knowledge and reported attitudinal change toward Ebola virus disease suggests mHealth tutorial applications could hold promise for training health workers and building resilient health systems to respond to epidemics in West Africa.
authors.affiliation: Department of Internal Medicine, College of Medical Sciences, University of Calabar, P.M.B. 11115, Calabar, Cross River State, Nigeria. akanotu@yahoo.com.
authors.forename: Akaninyene
authors.initials: A
authors.lastname: Otu
authors.affiliation: Nuffield Centre for International Health and Development, Leeds Institute for Health Sciences, University of Leeds, Leeds, UK.
authors.forename: Bassey
authors.initials: B
authors.lastname: Ebenso
authors.affiliation: Instrat Global Health Solutions, New Jersey, USA.|Instrat Global Health Solutions, Abuja, Nigeria.
authors.forename: Okey
authors.initials: O
authors.lastname: Okuzu
authors.affiliation: Anadach Group, Azusa, CA, USA.
authors.forename: Egbe
authors.initials: E
authors.lastname: Osifo-Dawodu
mesh_terms: D002983:Clinical Competence; D003430:Cross-Sectional Studies; D058872:Epidemics; D006268:Health Facilities; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology; D006801:Humans; D063731:Mobile Applications; D009549:Nigeria / Q000453:epidemiology; D011795:Surveys and Questionnaires; D017216:Telemedicine