{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T06:48:18Z","timestamp":1774594098862,"version":"3.50.1"},"reference-count":71,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2024,2,3]],"date-time":"2024-02-03T00:00:00Z","timestamp":1706918400000},"content-version":"unspecified","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Stanford University School of Medicine Maternal and Child Health Research Institute","award":["Not Applicable"],"award-info":[{"award-number":["Not Applicable"]}]},{"DOI":"10.13039\/501100004102","name":"Laerdal Foundation for Acute Medicine","doi-asserted-by":"publisher","award":["Not Applicable"],"award-info":[{"award-number":["Not Applicable"]}],"id":[{"id":"10.13039\/501100004102","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006521","name":"Stanford School of Medicine","doi-asserted-by":"crossref","award":["Not Applicable"],"award-info":[{"award-number":["Not Applicable"]}],"id":[{"id":"10.13039\/100006521","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,1,9]]},"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>To improve healthcare provider knowledge of Tanzanian newborn care guidelines, we developed adaptive Essential and Sick Newborn Care (aESNC), an adaptive e-learning environment. The objectives of this study were to (1) assess implementation success with use of in-person support and nudging strategy and (2) describe baseline provider knowledge and metacognition.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>6-month observational study at one zonal hospital and three health centres in Mwanza, Tanzania. To assess implementation success, we used the Reach, Efficacy, Adoption, Implementation and Maintenance framework and to describe baseline provider knowledge and metacognition we used Howell\u2019s conscious-competence model. Additionally, we explored provider characteristics associated with initial learning completion or persistent activity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>aESNC reached 85% (195\/231) of providers: 75 medical, 53 nursing and 21 clinical officers; 110 (56%) were at the zonal hospital and 85 (44%) at health centres. Median clinical experience was 4 years (IQR 1\u20139) and 45 (23%) had previous in-service training for both newborn essential and sick newborn care. Efficacy was 42% (SD \u00b117%). Providers averaged 78% (SD \u00b131%) completion of initial learning and 7% (SD \u00b111%) of refresher assignments. 130 (67%) providers had \u22651 episode of inactivity &gt;30\u2009day, no episodes were due to lack of internet access. Baseline conscious-competence was 53% (IQR: 38%\u201363%), unconscious-incompetence 32% (IQR: 23%\u201342%), conscious-incompetence 7% (IQR: 2%\u201315%), and unconscious-competence 2% (IQR: 0%\u20133%). Higher baseline conscious-competence (OR 31.6 (95% CI 5.8 to 183.5)) and being a nursing officer (aOR: 5.6 (95% CI 1.8 to 18.1)), compared with medical officer, were associated with initial learning completion or persistent activity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>aESNC reach was high in a population of frontline providers across diverse levels of care in Tanzania. Use of in-person support and nudging increased reach, initial learning and refresher assignment completion, but refresher assignment completion remains low. Providers were often unaware of knowledge gaps, and lower baseline knowledge may decrease initial learning completion or activity. Further study to identify barriers to adaptive e-learning normalisation is needed.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-077834","type":"journal-article","created":{"date-parts":[[2024,2,3]],"date-time":"2024-02-03T01:27:40Z","timestamp":1706923660000},"page":"e077834","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Implementing adaptive e-learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9898-6928","authenticated-orcid":false,"given":"Peter Andrew","family":"Meaney","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA"},{"name":"Critical Care, Lucile Salter Packard Children's Hospital at Stanford, Palo Alto, California, 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Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph R","family":"Mwanga","sequence":"additional","affiliation":[{"name":"Epidemiology, Biostatistics, and Behavioural Sciences School of Public Health, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2983-6632","authenticated-orcid":false,"given":"Florence Salvatory","family":"Kalabamu","sequence":"additional","affiliation":[{"name":"Paediatrics and Child Health, Hubert Kairuki Memorial University, Dar es Salaam, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine Lynn","family":"Joyce","sequence":"additional","affiliation":[{"name":"Critical Care, Cornell University Department of Pediatrics, New York, New York, 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