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Unpacking the black box of training effectiveness: a structural equation modelling analysis.
Ayako Masu1, Tomoka Takano2, Hirotsugu Aiga3
1Bureau of Global Health Cooperation, Japan Institute for Health Security, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan. masu.a@jihs.go.jp.
Tropical Medicine and Health
|June 9, 2026
Summary
A feasible action plan is key to effective health worker training in low- and middle-income countries (LMICs). Supportive work environments enhance training transfer, improving health workforce capacity and population health outcomes.
Area of Science:
- Global Health
- Health Workforce Development
- Capacity Building
Background:
- Health workforce shortages in low- and middle-income countries (LMICs) impact population health.
- Evaluating training programs for LMIC health workers is crucial but rarely done.
- Limited evidence exists on factors influencing training outcomes in LMICs.
Purpose of the Study:
- Evaluate Japan's Official Development Assistance (ODA) capacity-building training for LMIC health workforces.
- Identify structural factors influencing training effectiveness to guide future strategies.
- Assess the impact of ODA training on health personnel quality in LMICs.
Main Methods:
- Cross-sectional questionnaire study (Jan-June 2023) in Laos and Mongolia.
- 148 health professionals who participated in ODA training (2013-2020) were surveyed.
- Exploratory factor analysis (EFA) and structural equation modeling (SEM) were used.
Main Results:
- EFA identified six factors influencing training effectiveness.
- Feasible Action Plan, Collaborative Work Environment, Job-aligned Training, and Readiness were significant predictors.
- Feasible Action Plan had the strongest direct effect (β=0.72, p<0.001); Collaborative Work Environment had indirect effects.
Conclusions:
- Training effectiveness depends on factors before, during, and after training.
- A Feasible Action Plan is the strongest predictor of applying new knowledge and skills.
- Holistic, process-oriented approaches are vital for effective ODA capacity-building training in LMICs.
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