A Virtual Childhood Obesity Collaborative
A Virtual Childhood Obesity Collaborative
The learning collaborative model for QI developed by the Institute for Healthcare Improvement to increase clinician adherence to guidelines and engage in QI processes has established positive outcomes for in-person training (Bordley et al., 2001, Institute for Healthcare Improvement, 2004, Margolis et al., 2004, Wilson et al., 2003). Providers, including nurses and nurse practitioners, could implement the findings of this study by starting with a baseline chart audit in their practice and using the PDSA worksheet to develop a plan for practice change.
This study used the unique, Web-based collaborative approach that is emerging to reach a broader audience (John et al., 2014). Web-based training is a cost-efficient and flexible alternative to educating providers using in-person trainings. Web-based training also expands the reach to include rural providers and those who serve vulnerable populations with limited access to resources for formal training programs. One major goal of this project was to support and provide better access for rural and underserved areas, specifically those providing care to members of ethnic minority groups. The intention was to reach practitioners who cannot easily access training.
In the current study, provider satisfaction with Web-based training was high. These results are consistent with other Web-based training studies measuring satisfaction, as shown in a recent synthesis article (Militello et al., 2014). Participants also reported intention to change their practice based on the training. Research indicates that intention to change correlates with behavior change (Ajzen and Fishbein, 1980, Madden et al., 1992).
Providers in the current study were selected from a nationally representative sample including both urban and rural SBHC providers distributed across the United States. Because the sample size of the current study was small, it may be difficult to generalize to a larger population. Additionally, providers in the current study chose to participate in the virtual eLearning obesity collaborative and may have higher satisfaction because of interest in the topic. The attrition rate may also have influenced the high satisfaction scores because those who chose not to complete the training may not have been as satisfied with the training.
The following significant changes occurred in the practice sites that limited completion of the final learning sessions: two providers retired, two providers changed jobs, two providers had the hours at their center reduced, and two providers started the project late and did not participate in the final round of data collection. Although up to four people per site were encouraged to participant in the collaborative, many SBHCs are run by single providers, with limited support staff. Therefore, many sites did not have extra team members to participate. Even in the sites with additional team members participating, many of these participants only completed some of the training modules. Because of limited technology at many sites, as well as difficulty fitting training into an already busy schedule, additional team members may have chosen modules that were of most interest to them or their site. Also, multiple people at a site could have watched a module together or providers may have presented information to additional team members after participating in the training.
Overall, participant satisfaction was high, reaching 24 SBHCs in diverse sites from remote rural communities to large urban centers, and many providers reported intentions to change practice. Challenges to Web-based training in the current study were the lack of computer literacy of providers and the lack of agency support for Web-based interventions. Some sites had difficulty with Web access, some had outdated computers that would not allow them to view the Web-based presentations or video vignettes, and some had minimal information technology support for on-site assistance with Internet and technology questions
Discussion
The learning collaborative model for QI developed by the Institute for Healthcare Improvement to increase clinician adherence to guidelines and engage in QI processes has established positive outcomes for in-person training (Bordley et al., 2001, Institute for Healthcare Improvement, 2004, Margolis et al., 2004, Wilson et al., 2003). Providers, including nurses and nurse practitioners, could implement the findings of this study by starting with a baseline chart audit in their practice and using the PDSA worksheet to develop a plan for practice change.
This study used the unique, Web-based collaborative approach that is emerging to reach a broader audience (John et al., 2014). Web-based training is a cost-efficient and flexible alternative to educating providers using in-person trainings. Web-based training also expands the reach to include rural providers and those who serve vulnerable populations with limited access to resources for formal training programs. One major goal of this project was to support and provide better access for rural and underserved areas, specifically those providing care to members of ethnic minority groups. The intention was to reach practitioners who cannot easily access training.
In the current study, provider satisfaction with Web-based training was high. These results are consistent with other Web-based training studies measuring satisfaction, as shown in a recent synthesis article (Militello et al., 2014). Participants also reported intention to change their practice based on the training. Research indicates that intention to change correlates with behavior change (Ajzen and Fishbein, 1980, Madden et al., 1992).
Strengths and Weaknesses
Providers in the current study were selected from a nationally representative sample including both urban and rural SBHC providers distributed across the United States. Because the sample size of the current study was small, it may be difficult to generalize to a larger population. Additionally, providers in the current study chose to participate in the virtual eLearning obesity collaborative and may have higher satisfaction because of interest in the topic. The attrition rate may also have influenced the high satisfaction scores because those who chose not to complete the training may not have been as satisfied with the training.
The following significant changes occurred in the practice sites that limited completion of the final learning sessions: two providers retired, two providers changed jobs, two providers had the hours at their center reduced, and two providers started the project late and did not participate in the final round of data collection. Although up to four people per site were encouraged to participant in the collaborative, many SBHCs are run by single providers, with limited support staff. Therefore, many sites did not have extra team members to participate. Even in the sites with additional team members participating, many of these participants only completed some of the training modules. Because of limited technology at many sites, as well as difficulty fitting training into an already busy schedule, additional team members may have chosen modules that were of most interest to them or their site. Also, multiple people at a site could have watched a module together or providers may have presented information to additional team members after participating in the training.
Overall, participant satisfaction was high, reaching 24 SBHCs in diverse sites from remote rural communities to large urban centers, and many providers reported intentions to change practice. Challenges to Web-based training in the current study were the lack of computer literacy of providers and the lack of agency support for Web-based interventions. Some sites had difficulty with Web access, some had outdated computers that would not allow them to view the Web-based presentations or video vignettes, and some had minimal information technology support for on-site assistance with Internet and technology questions
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