Blended learning approaches for community health education in tuberculosis control

Tuberculosis (TB) is a major health concern in the entire world, and community health workers (CHWs) are the main frontline staff in disease control initiatives. Conventional approaches of training CHWs are usually limited in their ability to scale, to standardization as well as knowledge retention. The research examined the efficacy of the blended learning method that is the digital module with practical learning face-to-face sessions in the area of TB-related community health education. A quasi-experimental, three-arm comparative study was conducted among 248 CHWs, with training modality assigned by district to minimize contamination (blended learning n = 84; traditional n = 82; e-learning n = 82). The main outcomes were TB knowledge scores, competency of skills in practice, knowledge retention after 6 months and satisfaction of the participants. Given district-level allocation, sensitivity analyses accounting for clustering were performed. E-learning-only exposure time (12h) was shorter than the 20h blended/traditional formats; findings are interpreted accordingly. The findings showed that the blended learning group had significantly higher knowledge scores of post-training (82.4 ± 8.7) than traditional (74.6 ± 9.2) and e-learning groups (71.8 ± 10.1) (p < 0.001). The knowledge retention of blended learning was 78.2% and traditional was 62.4% and e-learning was 58.7%. The greatest rates of practical skill competencies were observed in the group of blended learning (88.1) than in the traditional (79.3) and e-learning (64.6) groups. The level of satisfaction among participants was also higher in the blended learning group (4.32 ± 0.51 on a 5-point scale). The blended learning model proves to be more effective to CHW training in TB control programs, and it provides a scalable and efficient framework of community health education in variable resource environments.