A community health nurse shows the “CHN on the Go” app on her phone. Photo: Stephen Morrison

Repackaging eLearning Content as a Mobile App for Community Health Workers in Ghana

The following post is part of an ongoing series on content adaptation. To read from the beginning, check out Part 1.

In 2014, the Grameen Foundation in Ghana reached out to The Knowledge for Health (K4Health) Project. They were working on the Care Community Hub (CCH) Project led by Concern Worldwide. Their work focused on leveraging mobile technology to improve job satisfaction, motivation, and, ultimately, retention of community health nurses in rural areas in Ghana. Community health nurses in Ghana are the frontline health workers of the Ghana Health Service and are often the primary providers of family planning and maternal, newborn, and child health counseling and services in rural communities. As the lowest credentialed nurses, however, they are at the bottom of the Ghana Health Service hierarchy and have limited opportunities for career advancement. Community health nurses in rural Ghana report isolation, lack of opportunities for professional advancement and career development, and inadequate resources to do their jobs. In response, CCH developed an Android app that provided, among other services, a Learning Center for community health nurses to access up-to-date technical health information.

Instead of developing health material for the app from scratch, CCH reached out to its professional network for leads on high quality learning content related to family planning and maternal, newborn, and child health. One of the project partners, John Snow, Inc., had recently worked with K4Health to develop an eLearning course for the Global Health eLearning (GHeL) Center and recommended K4Health as a possible content provider. The projects found common ground in their commitment to open-source technology and open education, and they formed a mutually beneficial partnership.

Open education is a collective term to describe institutional practices and programmatic initiatives that broaden access to the learning and training traditionally offered through formal education systems.

Content Adaptation Is a Team Effort

For the CCH project, Grameen conducted user research and worked closely with Ghana Health Service to identify relevant and useful health content that adhered to community health nurses’ terms of reference and protocols for service provision. They shared their content needs and specifications with K4Health.

K4Health then proposed to Grameen which GHeL courses would be the most appropriate for adaptation. After Grameen selected courses from the proposed list, K4Health pulled out provider-specific content from the selected GHeL courses, removed irrelevant details, such as global statistics, and rewrote some of the content to simplify concepts for easy comprehension.

Finally, Grameen reviewed the content with Ghana Health Service to:

  • Ensure the content was relevant and aligned with local health protocols
  • Replace photos and graphics with Ghana-specific images
  • Provide additional text to illustrate key concepts within the Ghana health system

The adaptation process revealed that 80% of the global GHeL content was relevant as is.

The app and the content were rolled out in a phased approach, starting with the family planning courses for Phase I. This approach made it easier for Grameen to train community health nurses on the app and collect user feedback to make improvements for the Phase II roll-out of adapted maternal, newborn, and child health courses.

Consider Audience Motivation

When designing and delivering content (described in the K4Health content adaptation guide and Part 1 of this series), it’s important to not only think about where and how to reach your intended audience but what motivates them.

The Design and Deliver phase from the Making Content Meaningful: A Guide to Adapting Existing Global Health Content for Different Audiences.

During user research, community health nurses told Grameen that the lack of opportunities for career development dampened their motivation. Therefore, Grameen engaged Ghana’s Nursing and Midwifery Council to accredit the adapted courses so that they would count toward continuing professional development credits for re-licensing. To obtain accreditation, Grameen and K4Health needed to add a secondary skills assessment to ensure that community health nurses who passed a course on the app truly understood and could apply the material.

Working with the Nursing and Midwifery Council and Ghana Health Service, we developed scenario-based practical questions that the community health nurses’ supervisors administer in person at the district or sub-district level. A district or sub-district supervisor such as the District Public Health Nurse or head of the Reproductive and Child Health unit of the sub-district health center asks questions that ensure that the learner understands how to apply the concepts in practical, varied situations. These scenario-based questions also provide community health nurses’ supervisors with an opportunity to provide focused coaching and feedback.

Lessons Learned

Three key ingredients made this a successful collaboration between K4Health and Grameen:

  1. Partnering with organizations and projects with similar missions and a high regard for open-source technology and open education
  2. Engaging in a collaborative and iterative content adaptation process with key stakeholders familiar with community health nurses’ terms of references and training needs
  3. Adapting the rollout of the assessment to include a face-to-face component to supplement the mobile learning component

The full case study and guidance on replicating the content adaptation process are available in K4Health’s Making Content Meaningful: A Guide to Adapting Existing Global Health Content for Different Audiences. Additionally, this partnership and process are documented in the journal article, Leveraging open-source technology and adapting open eLearning content to improve the knowledge and motivation of Ghana’s rural nurses.

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The Exchange is a K4Health publication. The Knowledge for Health (K4Health) Project is supported by the United States Agency for International Development (USAID) Office of Population and Reproductive Health, Bureau for Global Health, under Cooperative Agreement #AID-OAA-A-13–00068 with the Johns Hopkins University.

The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the U.S. Government.