A Blended Learning Approach for Basic Emergency Obstetric and Newborn Care (BEmONC) Training in Ethiopia

The study, conducted from November 2015 to June 2016, aimed to assess the knowledge, skills, and overall competency of health care providers in both approaches. The study design was a quasi-experimental study, comparing blended learning and conventional learning groups on overall BEmONC competency, knowledge, and skills. A total of 80 providers were invited to each study arm, with 78 and 75 participating in the intervention and control arms, respectively. The study was conducted in the Amhara, Oromia, and Southern Nations Nationalities & Peoples (SNNP) regions of Ethiopia. The blended learning approach included eight days of clinical simulation and practice, with theoretical content delivered in advance for four days, followed by use of short messaging service (SMS) and phone for post-training follow-up. In contrast, the conventional approach dedicated more time to theory, with the same emphasis on clinical practice, followed by post-training on-site mentoring. The study outcomes were measured using a self-administered questionnaire to assess provider knowledge, a structured questionnaire to collect socio-demographic data, and an observation checklist to document provider skills. The results showed that there was no difference in knowledge retention between the two approaches, with both groups retaining approximately 75% of their knowledge three months post-training. However, the study found a small but statistically significant difference in skill retention between the conventional and blended learning groups. The conventional learning group retained a higher percentage of skills, with a mean percentage skill score of 85.8% compared to 75.3% for the blended learning group. This difference was observed in both intention-to-treat and per-protocol analyses. The study also found that the blended learning approach was more cost-effective, with a 38% reduction in per-trainee costs compared to the conventional approach. Additionally, the blended approach minimized the amount of time health care providers must spend away from their facilities, saving an average of six days per trainee. The overall competency score, which combined knowledge and skills, was higher in the conventional learning group compared to the blended learning group. However, the difference was small and statistically significant only in the per-protocol analysis. The study's findings suggest that while the blended learning approach may not be as effective as the conventional approach in terms of skill retention, it offers significant cost savings and minimizes the disruption to health service delivery. Further study is needed to improve the blended learning approach in the Ethiopian context and to determine its long-term effectiveness in improving BEmONC competency among health care providers.