Motivating HIV Providers in Vietnam to Learn: A Mixed-Methods Analysis of a Mobile Health Continuing Medical Education Intervention

Abstract

Background: The Mobile Continuing Medical Education Project (mCME V.2.0) was a randomized controlled trial designed to test the efficacy of a text messaging (short message service [SMS])-based distance learning program in Vietnam that included daily quiz questions, links to readings and online courses, and performance feedback. The trial resulted in significant increases in self-study behaviors and higher examination scores for intervention versus control participants.

Objective: The objective of this mixed-methods study was to conduct qualitative and quantitative investigations to understand participants' views of the intervention. We also developed an explanatory framework for future trial replication.

Methods: At the endline examination, all intervention participants completed a survey on their perspectives of mCME and self-study behaviors. We convened focus group discussions to assess their experiences with the intervention and attitudes toward continuing medical education.

Results: A total of 48 HIV specialists in the intervention group completed the endline survey, and 30 participated in the focus group discussions. Survey and focus group data suggested that most clinicians liked the daily quizzes, citing them as convenient mechanisms to convey information in a relevant manner. A total of 43 of the 48 (90%) participants reported that the daily quizzes provided motivation to study for continuing medical education purposes. Additionally, 83% (40/48) of intervention participants expressed that they were better prepared to care for patients with HIV in their communities, compared with 67% (32/48) at baseline. Participation in the online coursework component was low (only 32/48, 67% of intervention participants ever accessed the courses), but most of those who did participate thought the lectures were engaging (26/32, 81%) and relevant (29/32, 91%). Focus group discussions revealed that various factors influenced the clinicians' decision to engage in higher learning, or "lateral learning," including the participant's availability to study, professional relevance of the topic area, and feedback. These variables serve as modifying factors that fit within an adapted version of the health belief model, which can explain behavior change in this context.

Conclusions: Qualitative and quantitative endline data suggested that mCME V.2.0 was highly acceptable. Participant behaviors during the trial fit within the health belief model and can explain the intervention's impact on improving self-study behaviors. The mCME platform is an evidence-based approach with the potential for adoption at a national scale as a method for promoting continuing medical education.

Trial registration: ClinicalTrials.gov NCT02381743; https://clinicaltrials.gov/ct2/show/NCT02381743.

Keywords: HIV/AIDS; SMS intervention; Vietnam; continuing medical education; health education; mHealth; telemedicine; text messaging.

Figure 1

Framework for the decision to engage in lateral learning. Elements of the Mobile Continuing Medical Education Project are analogous to the health belief model. The figure illustrates the underlying behavioral mechanisms that lead a clinician to decide whether to engage in lateral learning, defined as accessing and using high-quality educational materials beyond daily short message service (SMS) text messages. CME: continuing medical education; HMU: Hanoi Medical University.

Figure 2

Sample of Likert-scale responses from Mobile Continuing Medical Education Project (mCME V.2.0) trial intervention participants in the endline survey showing the proportion of those who agreed or strongly agreed with the statements shown (standard error bars with 95% CI). Importantly, for questions pertaining to the daily readings and the Hanoi Medical University (HMU) courses, we excluded the responses from participants who never accessed those intervention components. CME: continuing medical education; SMS: short message service.