User:Gurmit/Distance Learning for Health Workers

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Accepted for Poster Presentation at First global symposium on Health Systems Research, Montreux, Switzerland on 16 - 19 November 2010.


Distance learning for health professional development in resource-limited settings: A review of evaluation approaches and outcomes


With the increasing availability and adaptability of technology, distance learning has emerged as a cost-effective method to overcome time and distance barriers and provide continuous learning opportunities for health professional development in resource-limited settings.

Despite growing investment in such programs, there is insufficient evidence regarding their effectiveness in improving patient health outcomes. Therefore, we aimed to analyse how distance learning programs are currently evaluated.


In December 2009, an abstract search on PubMed for published peer-review journal articles after 2000 was conducted using the terms: distance education, program evaluation, outcomes assessments, and resource limited settings (World Bank definition). For this study, blended-learning programs, that combine distance-learning programs with traditional classroom instruction, were included alongside strictly distance-learning programs. The initial review of 66 papers was narrowed to 43; of these, 19 profiled specific evaluation strategies, and were further categorized to understand how distance learning programs evaluated their outcomes.


Five broad approaches to distance learning program evaluation emerged: learner satisfaction surveys (n=12), changes in knowledge (n=14), changes in attitudes (n=3), changes in practice (n=2), and changes in patient health outcomes (n=1). Ten programs overlapped several categories because they used multiple evaluation approaches; for example, learner satisfaction surveys were paired with post-tests that measured changes in knowledge in six programs. Only one study found that health professionals who participated in a distance learning program demonstrated improved patient health outcomes, as compared to those health professionals that participated in traditional classroom learning. No study provided any pedagogic or theoretical rationale for their distance learning program development, including evaluation.


While this review shows that there are perceived benefits of distance learning in transferring knowledge, the implementation of new evidence and changes to professional practice are poorly addressed during evaluation. Also, there is no research evidence that distance learning for capacity building in resource-limited settings has led to any tangible improvements in patient health outcomes. Hence, there is an urgent need to better evaluate the health outcome impact of distance learning programs, especially in the present economic environment.