What drives participation? A look at personal influences on Tanzanian nurses in project ECHO

The Project Extension for Community Health Care Outcomes (Project ECHO) is a renowned collaborative model of medical education and care management. This model enhances the capabilities of primary care providers through telementoring, providing a promising and cost-effective approach to augmenting healthcare professionals' knowledge. Participation in weekly ECHO sessions often falls short of expectations despite its benefits. This study examined the personal factors that influence Tanzanian nurses' engagement with Project ECHO.

We conducted a cross-sectional study involving 450 nurses from 42 primary healthcare facilities in Dar es Salaam, Tanzania. A standardised questionnaire served as the data collection tool. Descriptive analysis was performed to calculate means, frequencies and percentages for socio-demographic variables and the level of participation of nurses. Bivariate and multivariate logistic regression were used to test the association between the level of participation of nurses in ECHO sessions and their socio-demographic factors.

Only 36% (n = 162) of 450 nurses attended at least two ECHO sessions (median 2, IQR 1-2). Paediatric ECHO sessions had the highest attendance (43.8%, n = 71). Ease of computer use (AOR = 1.95, p = 0.015) and ICT self-motivation (AOR = 2.08, p = 0.003) significantly increased attendance. A majority (58%) lacked personal computers. Surprisingly, adequate ICT skills lowered the likelihood of attending at least two sessions (AOR = 0.37, p < 0.001).

The study found low participation of nurses in ECHO sessions, with paediatric ECHO sessions showing the highest engagement. Comfort with online format and ease of instructions motivated attendance, while computer proficiency and ICT motivation were positive predictors. Surprisingly, adequate ICT skills correlated with lower participation. Enhancing basic computer literacy and ICT motivation is crucial for improved engagement. Future research should explore reasons for lower participation among digitally skilled nurses and tailor session content accordingly.