Knowledge Translation of Healthcare Information to Low And Middle Income Countries: A Case Study Involving Mhealth Intervention for Community Based Rehabilitation Workers and Parents of Children with Cerebral Palsy in West Bengal, India
MetadataShow full item record
In low and middle income countries (LMICs), individuals with disabilities in rural communities and slum areas have poor access to health care professionals. Community based rehabilitation (CBR) workers are often enlisted to provide health and rehabilitation services to these communities. Evidence-based practices are infrequently used in these contexts due to CBR workers’ lack of formal professional training. Knowledge translation of healthcare information bridges the gap between evidence-based knowledge and clinical practice. Knowledge translation is most effective when knowledge is tailored to the local context, especially if the information is being translated to a different cultural context. The Knowledge to Action framework provides guidelines to create and disseminate knowledge to local contexts. Mobile health technology, or mHealth, is an emerging medium for knowledge translation that has been used for public health programs involving training and consultation, health education, and remote health surveillance. The aim of this study was to create and effectively disseminate video-based training modules on mealtime management strategies for CBR workers and parents of children with cerebral palsy in West Bengal, India. This study was conducted in three phases: (a) developing the video-based training modules; (b) evaluating the content and presentation of the modules; and (c) assessing the medium of dissemination. The Mealtime Management Videos were developed in Phase I based on current research literature and best practices. Five prototype video modules were evaluated in Phase II using focus groups with CBR workers and caregivers of children with cerebral palsy who assessed the clarity, comprehensiveness and cultural relevance of the video modules. In addition, a series of in-home observations were conducted in urban, rural, and suburban homes in West Bengal to verify the appropriateness of the content and environmental contexts depicted in the videos. The data from Phase II indicated that the videos were easy to understand, applicable to day-to-day life, and beneficial for both CBR workers and families with children with cerebral palsy. The data also identified three content areas requiring modification: chewing, positioning, and brushing teeth. The effectiveness of the mHealth delivery medium was assessed in Phase III using focus groups and survey questions based on the Technology Acceptance Model (TAM). Twenty-four CBR workers from rural and urban locations were divided into two groups: (a) the mobile device group, and (b) the control group. Both groups were exposed to the training videos during a 1-hour introductory session that occurred at baseline. The mobile device group members were then given smartphones and encouraged to share the Mealtime Management Videos to caregivers on an as needed basis over a 4-week period. The control group members, who did not have access to the mobile videos, were encouraged to share the feeding intervention strategies using traditional demonstration methods with families over the same 4-week period. Upon conclusion of the 4-week period, the mobile device group participants reported improved knowledge and practice skills from having access to the mobile videos. Caregiver knowledge about mealtime and parent engagement in the intervention process were also reported to be greater among those families who received services from the mobile device group. The findings from this study indicated that the Knowledge to Action framework provided an effective structure for knowledge translation of a rehabilitation-related patient education program to an LMIC. The findings also indicated that mobile phones are an effective medium for dissemination of patient education content in an LMIC.