title: The mCME Project: A Randomized Controlled Trial of an SMS-Based Continuing Medical Education Intervention for Improving Medical Knowledge among Vietnamese Community Based Physicians' Assistants.
abstract: BACKGROUND
  Community health workers (CHWs) provide critical services to underserved populations in low and middle-income countries, but maintaining CHW's clinical knowledge through formal continuing medical education (CME) activities is challenging and rarely occurs. We tested whether a Short Message Service (SMS)-based mobile CME (mCME) intervention could improve medical knowledge among a cadre of Vietnamese CHWs (Community Based Physician's Assistants-CBPAs) who are the leading providers of primary medical care for rural underserved populations.
  
  
  METHODS
  The mCME Project was a three arm randomized controlled trial. Group 1 served as controls while Groups 2 and 3 experienced two models of the mCME intervention. Group 2 (passive model) participants received a daily SMS bullet point, and were required to reply to the text to acknowledge receipt; Group 3 (interactive model) participants received an SMS in multiple choice question format addressing the same thematic area as Group 2, entering an answer (A, B, C or D) in their response. The server provided feedback immediately informing the participant whether the answer was correct. Effectiveness was based on standardized examination scores measured at baseline and endline (six months later). Secondary outcomes included job satisfaction and self-efficacy.
  
  
  RESULTS
  638 CBPAs were enrolled, randomized, and tested at baseline, with 592 returning at endline (93.7%). Baseline scores were similar across all three groups. Over the next six months, participation of Groups 2 and 3 remained high; they responded to >75% of messages. Group 3 participants answered 43% of the daily SMS questions correctly, but their performance did not improve over time. At endline, the CBPAs reported high satisfaction with the mCME intervention, and deemed the SMS messages highly relevant. However, endline exam scores did not increase over baseline, and did not differ between the three groups. Job satisfaction and self-efficacy scores also did not improve. Average times spent on self-study per week did not increase, and the kinds of knowledge resources used by the CBPAs did not differ between the three groups; textbooks, while widely available, were seldom used.
  
  
  CONCLUSIONS
  The SMS-based mCME intervention, while feasible and acceptable, did not result in increased medical knowledge. We hypothesize that this was because the intervention failed to stimulate lateral learning. For an intervention of this kind to be effective, it will be essential to find more effective ways to couple SMS as a stimulus to promote increased self-study behaviors.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02381743.
authors.affiliation: Center for Global Health and Development, Boston University, Boston, MA, United States of America.|Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gill
authors.affiliation: Pathfinder International in Vietnam, Hanoi, Vietnam.
authors.forename: Bao
authors.initials: B
authors.lastname: Le Ngoc
authors.affiliation: Center for Global Health and Development, Boston University, Boston, MA, United States of America.|Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America.
authors.forename: Nafisa
authors.initials: N
authors.lastname: Halim
authors.affiliation: Center for Population Research Information and Databases (CPRID), Ministry of Health, Hanoi, Vietnam.
authors.forename: Ha
authors.initials: H
authors.lastname: Nguyen Viet
authors.affiliation: Center for Global Health and Development, Boston University, Boston, MA, United States of America.
authors.forename: Anna
authors.initials: A
authors.lastname: Larson Williams
authors.affiliation: General Office for Population and Family Planning (GOPFP), Ministry of Health, Hanoi, Vietnam.
authors.forename: Tan
authors.initials: T
authors.lastname: Nguyen Van
authors.affiliation: Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America.|Pathfinder International, Watertown, MA, United States of America.
authors.forename: Marion
authors.initials: M
authors.lastname: McNabb
authors.affiliation: Thái Nguyên Provincial Department of Public Health, Thái Nguyên City, Vietnam.
authors.forename: Lien
authors.initials: L
authors.lastname: Tran Thi Ngoc
authors.affiliation: Center for Global Health and Development, Boston University, Boston, MA, United States of America.
authors.forename: Ariel
authors.initials: A
authors.lastname: Falconer
authors.affiliation: Hanoi Medical University, Hanoi, Vietnam.
authors.forename: Hai
authors.initials: H
authors.lastname: An Phan Ha
authors.affiliation: Center for Global Health and Development, Boston University, Boston, MA, United States of America.|Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America.
authors.forename: Julia
authors.initials: J
authors.lastname: Rohr
authors.affiliation: Thái Nguyên Provincial Department of Public Health, Thái Nguyên City, Vietnam.
authors.forename: Hai
authors.initials: H
authors.lastname: Hoang
authors.affiliation: Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America.
authors.forename: James
authors.initials: J
authors.lastname: Michiel
authors.affiliation: Center for Population Research Information and Databases (CPRID), Ministry of Health, Hanoi, Vietnam.
authors.forename: Tam
authors.initials: T
authors.lastname: Nguyen Thi Thanh
authors.affiliation: Boston University School of Medicine, Boston, MA, United States of America.
authors.forename: Liat
authors.initials: L
authors.lastname: Bird
authors.affiliation: Center for Population Research Information and Databases (CPRID), Ministry of Health, Hanoi, Vietnam.
authors.forename: Hoang
authors.initials: H
authors.lastname: Pham Vu
authors.affiliation: Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America.
authors.forename: Mahlet
authors.initials: M
authors.lastname: Yeshitla
authors.affiliation: Hanoi School of Public Health, Hanoi, Vietnam.
authors.forename: Nhu
authors.initials: N
authors.lastname: Ha Van
authors.affiliation: Center for Global Health and Development, Boston University, Boston, MA, United States of America.|Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America.
authors.forename: Lora
authors.initials: L
authors.lastname: Sabin
mesh_terms: D000328:Adult; D003153:Community Health Services; D003150:Community Health Workers; D004502:Education, Medical, Continuing / Q000379:methods; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010823:Physician Assistants; D060145:Text Messaging; D014744:Vietnam; D055815:Young Adult