Skilled Delivery Research Articles

Assessing Clinical Skills of Nursing Students: A Triangulation Study to Explore Faculty Experiences and Feedback in Objective Structured Clinical Examination (OSCE)

Background and aim: Developing clinical skills and its assessment is one of the most important components in nursing education which prepares the student for the reality of practice. Objective structured clinical examination (OSCE) is extensively used and widely accepted by nurse educators across the globe to assess the competency skills of nursing students. The present study aimed at identifying the attitude and perceptions of faculty, and exploring their feedback and experience in conducting OSCE as an assessment tool. Methods: A triangulation research approach was used with convenience sampling. Data collection was carried out using questionnaires and semi-structured interviews. Participants were ten faculty members who were involved in conducting OSCE for students. Results and conclusion: Most of the faculty felt that OSCE reflected the skills of delivery of safe patient care, and the structure reflected mastery of knowledge and skills, which are related to course objectives. OSCE was regarded by the faculty as a consistent, reliable, valid, and objective measure to assess students’ performance and to improve students’ confidence in clinical skills. Concerns were raised about a high level of stress in students, the time required for the proper performance of tasks, OSCE scenarios lacking real-life situations in assessment, and the need for repeated practice and intensive mock training sessions. The applicability of OSCE in terms of limitations in human and material resources with a large number of students would necessitate rethinking in developing other assessment strategies to improve the overall process. Key words: Clinical examination, nursing education, nursing competencies, clinical skills assessment, clinical evaluation

Possibilities of practicing the skills of operative delivery in the context of simulation training

Caesarean section (CS) is one of the most common surgical procedures in the world, and its frequency continues to rise, especially in high- and middle-income countries. A technically correct CS determines the successful course of the intra- and postoperative period, promotes favorable healing of the postoperative wound.

Telehealth Behavioral Intervention for Diabetes Management in Adults With Physical Disabilities: Intervention Fidelity Protocol for a Randomized Controlled Trial

BackgroundDiabetes mellitus is a major health problem among people with physical disabilities. Health coaching has been proven to be an effective approach in terms of behavioral changes, patient self-efficacy, adherence to treatment, health service use, and health outcomes. Telehealth systems combined with health coaching have the potential to improve the quality of health care by increasing access to services. Treatment fidelity is particularly important for behavior change studies; however, fidelity protocols are inadequately administered and reported in the literature.ObjectiveThe aim of this study is to outline all the intervention fidelity strategies and procedures of a telecoaching intervention—artificial intelligence for diabetes management (AI4DM)—which is a randomized controlled trial to evaluate the feasibility, acceptability, and preliminary efficacy of a telehealth platform in adults with type 2 diabetes and permanent impaired mobility. AI4DM aims to create a web-based disability-inclusive diabetes self-management program. We selected the National Institutes of Health Behavior Change Consortium (NIH BCC) fidelity framework to describe strategies to ensure intervention fidelity in our research.MethodsWe have developed fidelity strategies based on the five fidelity domains outlined by the NIH BCC—focusing on study design, provider training, treatment delivery, treatment receipt, and enactment of treatment skills. The design of the study is grounded in the social cognitive theory and is intended to ensure that both arms would receive the same amount of attention from the intervention. All providers will receive standardized training to deliver consistent health coaching to the participants. The intervention will be delivered through various controlling and monitoring strategies to reduce differences within and between treatment groups. The content and structure of the study are delivered to ensure comprehension and participation among individuals with low health literacy. By constantly reviewing and monitoring participant progress and protocol adherence, we intend to ensure that participants use cognitive and behavioral skills in real-world settings to engage in health behavior.ResultsEnrollment for AI4DM will begin in October 2021 and end in October 2022. The results of this study will be reported in late 2022.ConclusionsDeveloping and using fidelity protocols in behavior change studies is essential to ensure the internal and external validity of interventions. This study incorporates NIH BCC recommendations into an artificial intelligence embedded telecoaching platform for diabetes management designed for people with physical disabilities. The developed fidelity protocol can provide guidance for other researchers conducting telehealth interventions within behavioral health settings to present more consistent and reproducible research.Trial RegistrationClinicalTrials.gov NCT04927377; http://clinicaltrials.gov/ct2/show/NCT04927377.International Registered Report Identifier (IRRID)PRR1-10.2196/31695

Magnitude, trends and determinants of skilled delivery from Kilite-Awlaelo Health Demographic Surveillance System, Northern Ethiopia, 2009- 2017.

The fundamental approach to improve maternal and neonatal health is increasing skilled delivery rate. Women giving birth at health institutions can prevent maternal and neonatal deaths by getting skilled birth attendance. In Ethiopia, despite a significant decrease in maternal mortality over the past decade, still a significant number of women give birth at home. Moreover, evidence from population-based longitudinal studies on skilled delivery is limited. Therefore, this study aims to investigate the magnitude, trend, and determinants of skilled delivery in Kilite-Awlaelo Health Demographic Surveillance System (KA-HDSS), Northern Ethiopia. Population-based longitudinal study design was conducted by extracting data for nine consecutive years (2009-2017) from KA-HDSS database. In order to measure the trends of skilled delivery, KA-HDSS data sets were analyzed (2009-2017). Bivariate and multivariate analyses were performed using STATA version 16. A multivariable binary logistic regression model was fitted to assess determinants of skilled delivery and odds ratio with 95% CI was used to assess presence of associations at a 0.05 level of significance. The skilled delivery rate have continuously increased among reproductive age women from 15.12% (95% CI: 13.30% - 17.09%) in 2010 to 95.85% (95% CI: 94.58% - 96.895%) in 2017. The skilled delivery rate becomes high (> = 82) in the period of 2014-2017. Education, residence, marital status, occupation and antenatal care (ANC) visits were the most important determinants for skilled delivery among reproductive age women during the period of high skilled delivery rate (2014-2017). Women urban dwellers had about 28 times (AOR = 27.66; 95% CI: 3.86-196.97) higher odds to deliver by skilled birth attendants than rural dwellers. Unmarried women who gave birth were 2.18 (AOR: 2.18; 95% CI: 1.30-3.64) times more likely to have skilled delivery service compared to those married. Likewise, women with four or more ANC visits were 3.2 times more likely to undergo skilled delivery service than those having no ANC visits (AOR: 3.16; 95% CI: 2.33-4.28). Moreover, women having at least a secondary education were 2 times more likely to have skilled delivery service compared to those women with no formal education (AOR = 2.10, 95% CI: 1.18-3.74). Regardless of the importance of health facility delivery, a significant number of women still deliver at home attended by unskilled birth attendants. There has been a substantial increase in use of health facilities for delivery among women in the reproductive age. The factors affecting skilled delivery among reproductive age women were educational level, residence, marital status, occupation and use of ANC service. Maternal health related interventions are needed to change women's attitudes towards skilled delivery. Moreover, ANC coverage should be increased to improve skilled delivery service.

Effectiveness of maternity waiting homes in increasing utilization of facility-based delivery: A systematic review

To reduce the second delay contributing to maternal mortality, maternity waiting homes have been recommended for implementation especially in remote areas to help improve access to facility-based skilled delivery. Evidence of its effectiveness, however, is limited. This systematic review, therefore, aims to assess the effectiveness of the Maternity waiting home strategy in increasing utilization of facility delivery. Search for relevant articles was conducted on PubMed, Scopus, Google Scholar, Ebscohost, and Science Direct from database inception to March 30, 2021. Two reviewers independently screened the articles and assessed the quality of the studies. The identified maternity waiting home interventions and their effectiveness in improving facility-based delivery uptake were narratively synthesized and reported following the preferred reporting items for systematic reviews and meta-analysis reporting guidelines. The search yielded 670 articles of which five studies fulfilled the inclusion criteria. The three of five studies revealed that there is a significant association between Maternity waiting home use and utilization of facility-based delivery. The quality of the Maternity waiting homes significantly improved facility-based delivery uptake. Maternity Waiting Homes appear to be promising in decreasing barriers to skilled delivery attendance however the quality of evidence is low. More interventional studies of robust design are needed to clearly demonstrate its effectiveness.

Women Farmers Perception of Information Dissemination Skills among Agricultural Extension Workers in North Eastern Nigeria

This study examined the perception of rural women farmers on information dissemination skills of agricultural extension workers. Using multistage sampling procedure 378 respondents were randomly selected from the population of 6758 women farmers. Questionnaire was administered to the sampled farmers. Data were analysed using mean, and standard deviation. Findings reveals that women farmers participated moderately in agricultural practices with overall mean value of 2.65. Also, agricultural extension workers had a lower level of information dissemination skill in dealing with women farmers with overall mean value of 2.25. There is the need for training and retraining of extension workers to boost their skills for information delivery to women farmers. Extension programme for rural women should be designed to ensure extension workers are well informed and knowledgeable enough to work with them.

The Impact of Training Ministry Coordinators and Facilitators on their Performance: An Analysis of the Training of Theological Education by Extension.

The purpose of the study was to determine how the level of training of theological education by extension (TEE) coordinators/facilitators affect its performance in the Anglican church of Kenya. The study adopted 360- degree feedback by Ward (1995), social learning theory by Albert Bandura (1977) and the theory by Maslow’s (1954). A survey was done and inferential statistics were obtained using SPSP. The respondents were 4 people from the sampled 10 dioceses out of the 32 dioceses in the A.C.K. The researcher adopted stratified simple random sampling technique which was most appropriate for the intended purpose of the research. The study conclude that it was evident from the respondents that, although training has a great impact on the performance of the T.E.E department and the organization as a whole, most of the T.E.E coordinators are not trained on T.E.E delivery skills, Majority of the respondents asserted that there is an assumption that the theological training attained by coordinators is adequate for them to coordinate T.E.E. The study recommended that the A.C.K should consider organizing training programme on TE.E delivery skills for the T.E.E coordinators. The purpose of training is basically to improve knowledge and skills and change attitudes at work as the coordinators run the T.E.E programme.
 
 

School Administrators' Instructional Supervision, Psychosocial Assistance, and Professional Support as Determinants of Teacher Job Performance in Elementary Schools

Previous studies have assessed the relative effect of instructional supervision, psycho-social and professional support on teacher’s job performance in secondary or higher education. Little or nothing is yet to be known about the effect of these variables on teacher’s job performance at the primary education level. This study is the first to show the relative and cumulative effect of instructional supervision, psycho-social and professional support on teacher’s job performance in primary education. An ex-post facto research design was adopted for the study, with a sample of 965 teachers selected through the proportionate stratified sampling technique. Two instruments – the “Improvement Strategies Questionnaire (ISQ)” and the Teachers’ Effectiveness Scale (TES) were used for data collection. Findings showed a significant effect of all the independent variables partially and jointly on the job performance of primary education teachers. Based on this conclusion, policy implications are discussed, while it is recommended amongst others, that headteachers in primary school should ensure that they visit classrooms regularly to monitor the teaching activities of teachers. This would enable them (headteachers) to identify teachers with sound, average or weak pedagogical skills for service delivery; professional counsellors should be recruited and deployed to all primary schools to cater for the psychological and social needs of teachers and pupils; regular retraining programmes on the ethics of teaching should be organised for teachers from time to time to enable primary education teachers to acquire skills in line with the changing society.

The implementation and embedding of digital skills and digital literacy into the curriculum considering the Covid-19 pandemic and the new SQE

This paper focuses on the introduction of a new model of digital teaching and resource provision for the University of Law (ULaw) Library Service, during the Covid-19 pandemic. It details the processes and steps we took to achieve the three core aims of: a new mode of online skills delivery, the creation of self-directed, independent learners in the various student cohorts at the university and the creation of a flexible self-assessment platform to provide an incremental learning journey for both students and staff. This paper also highlights some of the challenges and difficulties we faced, arising from a project of this size and nature.

Competencies possessed by the training professionals of agricultural training institutes in Punjab, Pakistan

Professional competencies are considered as key to perform job responsibilities. Training professionals of Agricultural Training Institutes (ATIs) are engaged in imparting various skills and expertise to extension field staff in the form of training so that they would perform their tasks and responsibilities in a better way to disseminate advanced agricultural knowledge. In this scenario, the present study was designed to investigate various competencies possessed by the training professionals of ATIs in the Punjab province of Pakistan. For this purpose, data was collected from all training professionals working in all ATIs of Punjab Province in Pakistan. A well-structured questionnaire was developed as an instrument of the study. Descriptive statistics including frequencies, means and standard deviations were applied through Statistical Packages for Social Sciences. Results reveal that training professional of ATIs possess computer skill especially MS word and email skills. Motivational skills, lecture delivery skills and communication skills were ranked at top, which are being possessed by training professionals. Moreover, the results recommend that the government should launch capacity building programs to develop professional competencies of training professionals on regular basis.

Experience of a Final Year Medical Student: Pre- and Post-COVID-19 Era.

Medical education provides both knowledge and clinical skills to students. Clinical skills program including bedside teaching is considered an irreplaceable part of the undergraduate medical curriculum. COVID-19 pandemic has halted the delivery of effective clinical skills to medical students which has especially affected the final year students. So, we need to find an alternate approach to teach clinical skills to medical students in this era of COVID-19. This public health crisis has also demonstrated the significance of resilience and adaptability in the medical education system and the need to inculcate these values in our generation of medical students. This will help the students to complete their transition from a 'student' to a 'doctor'. This article highlights the experience of a final year medical student in the pre- and post-COVID-19 period, problems faced by final year medical students during this crisis, and effective ways to cope up with them.

Assessment of impact of obstetric factors on use of skilled delivery service by pregnant women at health facilities in Ghana

Pregnancy and delivery complications account for greater proportion of deaths and disability among women in reproductive age than any other reproductive health problems. The purpose of the study was to assess the Assessment of Influence of Obstetric Variables n he Use of Skilled Delivery Service by Pregnant Women at Health Facilities in Ghana. A cross-sectional design was utilised to achieve the overall objective of the study. The study covered pregnant women between the ages of 15-49 years in Central Region of Ghana. Questionnaire was designed and used as the main instrument for the study. Data collected were processed by the use of SPSS version 21 and analysed using descriptive and inferential statistics. Women with no history of miscarriage are 1.9 times more likely to use SDS compared to those who have had the experience of miscarriage in life (OR = 1.94, 95% CI = 1.34-2.83, p = <0.0001). Skilled birth attendants should educate the pregnant women about the complications associated with pregnancy to enable them seek timely care at health facilities.

Towards a better understanding of self-management interventions in type 2 diabetes: A meta-regression analysis

AimsAttributes that operationally conceptualize diabetes self-management education (DSME) interventions have never been studied previously to assess their impact on relevant outcomes of interest in people with type 2 diabetes (T2D). The aim of this study was to determine the impact of existing interventions classified by their delivery of skills or information related attributes on immediate (knowledge), intermediate (physical activity), post-intermediate (HbA1c), and long-term (quality of life) outcomes in people with T2D. MethodsPubMed, Embase, PsycINFO, and Cochrane Library/Cochrane CENTRAL as well as the grey literature were searched to identify interventional studies that examined the impact of DSME interventions on the four different outcomes. Eligible studies were selected and appraised independently by two reviewers. A meta-regression analysis was performed to determine the impact of delivery of the skills- and information-related attributes on the chosen outcomes. Results142 studies (n = 25,511 participants) provided data, of which 39 studies (n = 5278) reported on knowledge, 39 studies (n = 8323) on physical activity, 99 studies (n = 17,178) on HbA1c and 24 studies (n = 5147) on quality of life outcomes. Meta-regression analyses demonstrated that skills-related attributes had an estimated effect suggesting improvement in knowledge (SMD [standardized mean difference] increase of 0.80; P = 0.025) and that information-related attributes had an estimated effect suggesting improvement in quality of life (SMD increase of 0.96; P = 0.405). Skill- and information-related attributes did not have an estimated effect suggesting improvement in physical activity or in HbA1c. ConclusionsThe study findings demonstrate that the skills and information related attributes contribute to different outcomes for people with T2D. This study provides, for the first time, preliminary evidence for differential association of the individual DSME attributes with different levels of outcome.

Utilization of health facility delivery services in the Jomoro District of the Western Region of Ghana

Background: In the year 2000, member states of the United Nations pledged to work towards a three-quarters reduction in the 1990 maternal mortality ratio by 2015 in line with Millenium. Development Goal 5, but this could not be achieved. This pledge became imperative given the high maternal mortality being recorded, especially among developing countries. The high maternal deaths in developing countries have been attributed partly to the lack of access to skilled birth attendants during delivery. Objective: This study aimed to investigate factors that influence the utilization of health facility delivery services among pregnant women in the Jomoro District of the Western Region of Ghana. Methods: The study used data from a cross-sectional survey among women aged 18 - 49 yr. living in the Jomoro District of Ghana and had given birth between 2012 and 2016 (n = 374). The study participants were randomly selected from women who attended child welfare clinics on clinic days with their babies in eighteen communities. The study used a structured questionnaire to solicit for information about the women’s demographic and socio-economic characteristics, community characteristics and health systems factors likely to influence their decision to seek skilled delivery care as well as their experiences relating to their last delivery. Bivariate analyses were performed between the primary dependent variable and background characteristics of the respondents. Factors influencing the choice of place of delivery were estimated by multiple logistic regression analysis. Data analysis was performed using STATA Statistical Software, Release 14. Results: About 61.0% (n= 228/374) of the women had their last delivery at a health facility while the remaining 38.8% (n= 145/374) delivered at home without skilled assistance. In multivariate analysis, women aged 25 – 29 yr. were less likely to have a skilled delivery (aOR, 0.40; 95% CI: 0.17 - 0.93). Also, professional women had 4.77 odds of having skilled delivery (aOR, 4.77; 95% CI: 1.53 - 14.93). Distance to the nearest health facility also had a statistically significant association with skilled delivery. Women living at 10 – 19 km to a health facility were less likely to have a skilled delivery (aOR, 0.56; 95% CI: 0.32 - 0.97). In addition, the presence of a midwife at a health facility increased the odds of skilled delivery among women (aOR, 4.59; 95% CI: 2.47 - 8.55). Conclusion: Interventions aimed at increasing the uptake of delivery care services to achieve the SDG’s target on maternal mortality must consider improving the socio-economic wellbeing of women in addition to removing the physical and health system barriers impeding access and utilisation of delivery care services.

The need of the hour: Adapting the delivery of clinical skills teaching remotely

As the World Health Organization (WHO) announced the prevailing COVID-19 pandemic, the South African government enforced a nationwide lockdown in March 2020. The resulting closure of medical schools necessitated the provision of clinical skills teaching on remote platforms. This presented numerous challenges especially for skills that require face-to-face interaction and hands-on instruction. The Nelson R Mandela School of Medicine, University of KwaZulu-Natal modified George’s (2001) five stage process and devised a framework for online small group skills teaching with the help of videos. The adapted method retained as close as possible the significant concepts and frameworks of conventional face-to-face programmes allowing for continuation of teaching under the current constraints.

The health response to the Rohingya refugee crisis post August 2017: Reflections from two years of health sector coordination in Cox's Bazar, Bangladesh.

On August 25 2017, an unprecedented influx of Rohingya refugees began from Rakhine State in Myanmar into Bangladesh’s district of Cox’s Bazar. The scale and acuteness of this humanitarian crisis was unprecedented and unique globally, requiring strong coordination of a multitude of actors. This paper reflects on the health sector coordination from August 2017 to October 2019, focusing on selected achievements and persisting challenges of the health sector strategic advisory group (HSSAG), and the health sector working groups including epidemiology and case management, sexual and reproductive health, community health, mental health and psychosocial support, and emergency preparedness. In the early days of the response, minimum service standards for primary health care were established, a fundamental initial step which enabled the standardization of services based on critical needs. Similarly, establishing standards for community health outreach was the backbone for capitalizing on this important health workforce. Novel approaches were adopted for infectious disease responses for acute watery diarrhoea and varicella, drawing on inter-sectoral collaborations. Sexual and reproductive health services were prioritized from the initial onset of the crisis and improvements in skilled delivery attendance, gender-based violence services, abortion care and family planning were recorded. Mental health service provision was strengthened through community-based approaches although integration of mental health programmes into primary health care has been limited by availability of specialist psychiatrists. Strong, collaborative and legitimate leadership by the health sector strategic advisory group, drawing on inter-sectoral collaborations and the technical expertise of the different technical working groups, were critical in the response and proved effective, despite the remaining challenges to be addressed. Anticipated reductions in funding as the crisis moves into protracted status threatens the achievements of the health sector in provision of health services to the Rohingya refugees.

Influence of information, education and communication on prenatal and skilled delivery in the Tano North District, Ghana: A cross-sectional study

Skilled birth attendance is considered an effective intervention to reduce maternal and early neonatal morbidity and mortality. Yet in Ghana, skilled birth attendance is said to be relatively low despite high antenatal attendance. In this study, we specifically assessed the influence of information, education and communication on prenatal and skilled delivery in the Tano North District of Ghana. A descriptive cross-sectional quantitative survey involving both closed and open-ended questionnaires were conducted among 393 women at three health facilities. The results showed skilled health personnel attended 94.1% of deliveries, which is higher than what has been reported in previous studies. Mothers with Senior High School Education were found to be 11.46 times more likely to be delivered by skilled birth attendant than those without formal education COR = 11.46, 95% (2.01–65.19) and this was statistically significant p = 0.006. There was also a significant association between information received by pregnant women and place of delivery (X2 = 20.85, P = 0.000 α = 0.05) in that the usefulness of information to mothers influenced their choice of health facility delivery. Marital status was also strongly correlated to being attended by skilled birth attendant (χ2 = 14.73, p = 0.005) as 0.4 times of mothers who were married were more likely to be attended by skilled birth attendants as compared to those that are single. COR = 0.005, 95% CI (0.00–0.36) and this was statistically significant p = 0.002. This study suggests the incorporation of IE&C into nursing training curriculum to orient students on the importance of IE&C so as to improve ANCs and skilled birth attendance further.

Rural-urban differences in utilization of antenatal and delivery services in Ebonyi State, Nigeria.

The high maternal death burden in developing countries when compared to the developed could be attributed to differences in use of antenatal and skilled delivery care. To assess the differences in utilization of antenatal and delivery services in urban and rural communities of Ebonyi state, Nigeria. A cross-sectional comparative study design was used. Two stage (cluster) sampling technique was used to select 660 women in 4 of 13 local government areas in the state. The respondents were women who were permanent residents of communities and have delivered in last one year. Outcome measure was good utilization of antenatal and delivery services and was assessed by proportion of respondents who obtained antenatal and delivery from a skilled provider and also made at least four antenatal visits. The mean age of respondents was urban, 29.6 ± 6.2 and rural, 28.6 ± 5.1 years. Majority in urban, 51.8% utilized tertiary health facility for antenatal care while in rural, 77.9% used primary health centers (P < 0.001). Comparable proportions in urban, (77.3%) and rural, (79.1%) had good use of antenatal and delivery services (P = 0.572). Predictors of good use of antenatal and delivery services in urban included having one child (AOR = 4.8; 95%C1: 1.4--17.0), having attained tertiary education, (AOR = 2.6; 95%C1: 1.2--5.5), being in low socioeconomic class, (AOR = 0.4; 95%C1: 0.2--0.7), and having good knowledge of danger signs, (AOR = 2.6; 95%C1: 1.3--5.4). In rural, predictors included having one child, (AOR = 2.8; 95%C1:1.1--7.1), being unmarried, (AOR = 0.3; 95%C1: 0.1--0.9), and having good knowledge of danger signs (AOR = 3.7; 95%C1: 1.8--7.5). Utilization of antenatal and delivery services in health facilities in study area was high but there is room for improvement. There is need to plan specific interventions aimed at improving utilization of maternal health services by some groups like urban poor and unmarried mothers, especially teenagers. Emphasis should also be placed on improving community understanding of danger signs of pregnancy.

How Academic Medical Centers Can Navigate the Pandemic and Its Aftermath: Solutions for 3 Major Issues.

The COVID-19 crisis has seriously affected academic medical centers (AMCs) on multiple levels. Combined with many trends that were already under way pre pandemic, the current situation has generated significant disruption and underscored the need for change within and across AMCs. In this article, the authors explore some of the major issues and propose actionable solutions in 3 areas of concentration. First, the impact on medical students is considered, particularly the trade-offs associated with online learning and the need to place greater pedagogical emphasis on virtual care delivery and other skills that will be increasingly in demand. Solutions described include greater utilization of technology, building more public health knowledge into the curriculum, and partnering with a wide range of academic disciplines. Second, leadership recruiting, vital to long-term success for AMCs, has been complicated by the crisis. Pressures discussed include adapting to the dynamics of competitive physician labor markets as well as attracting candidates with the skill sets to meet the requirements of a shifting AMC leadership landscape. Solutions proposed in this domain include making search processes more focused and streamlined, prioritizing creativity and flexibility as core management capabilities to be sought, and enhancing efforts with assistance from outside advisors. Finally, attention is devoted to the severe financial impact wrought by the pandemic, creating challenges whose resolution is central to planning future AMC directions. Specific challenges include recovery of lost clinical revenue and cash flow, determining how to deal with research funding, and the precarious economic balancing act engendered by the need to continue distance education. A full embrace of telehealth, collaborative policy-making among the many AMC constituencies, and committing fully to being in the vanguard of the transition to value-based care form the solution set offered.

Employing User-Centered Design and Learning Science Theory to Enhance Remote Delivery of Diabetes Education and Survival Skills at Hospital Discharge

Learning diabetes mellitus (DM) survival skills is critically important, especially for those newly diagnosed upon discharge. COVID-19 has created new educational challenges, as DM self-management education and support is difficult to deliver remotely and can be time intensive. Content and format have not been re-designed for remote delivery; however, learning sciences research can help us create effective remote education strategies. We conducted interviews with users to identify critical needs in assuming immediate DM self-care at discharge from the hospital. We then mapped these user needs to relevant learning science theories to inform potential re-designs for remote delivery of DM education and survival skills at discharge.We conducted 12 semi-structured interviews with “users,” which included 18 participants (8 minority; 6>65 years): patients newly diagnosed with DM at discharge (N=6 [33%]), their caregivers (N=4 [22%]), and laypersons new to DM (N=8 [45%]). Users were asked about their discharge needs, laypersons about perceived needs. Three investigators performed iterative rounds of inductive coding of the transcripts (using MAXQDA software), utilizing a constant comparative method to identify codes describing dominant user needs. Learning science theory was applied to identify potential re-designs for remote delivery.Dominant user needs during hospitalization included being overwhelmed with DM self-care information (6/12 sessions) and difficulty organizing self-care equipment (5/12 sessions). Dominant user needs at home included remembering DM self-care steps (6/12 sessions), understanding correct insulin dosing (9/12 sessions), feeling fearful injecting insulin (9/12 sessions), with some noting difficulty in tracking glucose (4/12 sessions) and confusing insulin types (4/12 sessions). When learning science theory was applied, analysis mapped to three discrete educational strategies, most dominant of which is the spiral design approach—cycles of teaching the same topic but with increasing complexity. This design follows the pre-teaching principle—curriculum-based conceptual overview of self-care. Self-care at home mapped to the need for segmented learning and goal directed practice and feedback, with the potential need for behavioral therapies to reduce fear.Learning sciences has demonstrated that learning complex procedures and concepts, such as DM self-care, requires time, repetition, and continued support. With short hospital stays and the complexity of learning DM self-care, patients cannot gain needed knowledge structures to organize the information received during hospitalization. This study suggests specific learning science strategies for the design of an effective remote delivery of DM education and skills.