An Outcome Evaluation of the Health Information Management and Applied Epidemiology (HIMAE) course in South Africa

Abstract

Background: Health Information Systems (HIS) can provide accurate and reliable data for patient monitoring, disease surveillance, program evaluation, and resource allocation at varying levels of a national health system. South Africa has been making poor progress on meeting targets for HIV epidemic control due to a lack of data capturers at the facility-level and poor data quality. Blended learning has been identified as one feasible option to address this gap. This paper evaluates the Health Information Management and Applied Epidemiology (HIMAE) course designed to train frontline healthcare workers in South Africa. Methods: The ten module HIMAE course was disseminated through a Demonstration Programme (DP) and Open Choice Programme (OCP). Participants had access to e-learning, USB, and workbook modalities. Pre- and post-test scores were used to evaluate change in knowledge over the first five modules of the course which was defined as course completion. Completer and non-completer interviews were conducted to assess participant attitudes towards course delivery and uptake and measure translation into daily practice. Descriptive statistics, t-tests, and linear regressions were calculated to determine differences within and across dissemination groups. Interviews were coded and analyzed for common themes based on findings from the quantitative analysis. Results: A total of 331 participants took part in the study. 39 participants were enrolled in the DP and 292 were enrolled in the OCP. DP participants were 3.9 (95% CI: 2.2-6.7, p <0.001) times more likely to complete the first five modules than those in the OCP. On average, DP participants’ test-scores improved by 24.2 percentage-points and the OCP improved by 21.0 percentage-points. There were no significant differences in mean post-test scores across dissemination groups or mean score differences among cadres. The DP model increased motivation to complete the course but did not change the types of uptake barriers faced by participants. Conclusion: Overall, the course significantly improved participant knowledge in data literacy. Interview participants also indicated several ways they applied knowledge gained from the course into their daily practice. Based on these findings, the HIMAE course can provide an approach to remove barriers of poor data quality and large frontline health worker knowledge gaps as well as assist South Africa to make improved progress to meeting targets for HIV control.