Description
Introduction: With the ever-increasing demand for Community Healthcare Workers (CHWs) in India, there is also the need to provide them with healthcare training for initial learning and refresher training for reinforcement learning. Current teaching pedagogy of classroom training is ineffective in imparting adequate knowledge and skills required. Proper knowledge will render positive healthcare outcomes like reduced mortality of infants, neonatal, and mothers during delivery. Almost 20% of deaths of children before their fifth birthday in the world happen in India, and more than 50% of them are preventable by immunization. The shortage of well-trained CHWs and immunization awareness in society adds to the problem.
Objective: A self-paced and gamified refresher training game for Android phones, designed by us, can bridge the knowledge gap of CHWs. The objective is to check for a significant knowledge gain before and after playing five rounds of the gamified application, followed by knowledge retention testing done after six months.
Methodology: We conducted a pre-post and long-post test of knowledge and retention based on the immunization schedule (Sample size: n=84 No exclusion criteria) CHWs. The sample was almost equally divided into (n=28) as control group (CG), (n=28) as intervention group-1 (IG-1), and another (n=28) as intervention group-2 (IG-2). The CG was trained through regular classroom training pedagogy. At the same time, the IG-1 was encouraged to play the immunization card game through physical cards and the IG-2 through the same game but digitally on their own Android smartphone as the game app version. The knowledge test was conducted by a questionnaire survey containing 30 questions on immunization. The order of questions was shuffled in each round. Paired t-tests analyzed the collected data to find significant differences between pre-post and long-post tests. Repeated Measure ANOVA was conducted to check for significant overall differences in knowledge through different stages.
Results and Discussion: Comparing pre and post-test group values, through t-test, the p-value < 0.05 suggests a significant difference in learning through card gameplay over regular classroom training. The f-statistics value of Repeated measure ANOVA (F < 0.05) confirms the same for knowledge retention. A significant difference was found in comparing the physical and the digital modes of playing card games. The initial knowledge gain was more in physical card games, but knowledge retention was more in digital card games (p<0.05). Among all participant demographics, young and recently recruited CHWs (25- 30 years) had the maximum increase and retention of knowledge. Players who previously played the physical card game version of the game, felt it more uncomplicated to check out and transition to the digital game version.
Conclusion: The pedagogy of digital and physical card games proves to be an effective tool for knowledge gain and retention compared to classroom training. This method of refresher training will not only reduce the travel cost and hassle of the CHWs coming to the district centre and make the training scalable by reaching their pockets. Multiplayer group play also improves cohesion among the groups of CHWs through interactions and strategy-making during gameplay.
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