{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T05:40:27Z","timestamp":1777873227036,"version":"3.51.4"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Gates Foundation","award":["Opportunity ID: OPP1195232"],"award-info":[{"award-number":["Opportunity ID: OPP1195232"]}]},{"name":"Gates Foundation","award":["Opportunity ID: OPP1195232"],"award-info":[{"award-number":["Opportunity ID: OPP1195232"]}]},{"name":"Gates Foundation","award":["Opportunity ID: OPP1195232"],"award-info":[{"award-number":["Opportunity ID: OPP1195232"]}]},{"name":"Gates Foundation","award":["Opportunity ID: OPP1195232"],"award-info":[{"award-number":["Opportunity ID: OPP1195232"]}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Subcutaneous depot medroxyprogesterone acetate, or DMPA-SC, is an injectable contraceptive that can be administered by any trained person, including for self-injection. When scaling in-service healthcare worker training on DMPA-SC between 2019 and 2021, Ghana Health Service tasked a cohort of formally-trained healthcare workers to transfer their training \u2018on-the-job\u2019 to colleagues at their facilities, to save costs while improving training coverage. This cross-sectional mixed-methods implementation study explored the consistency of this approach in practice and how healthcare worker knowledge of DMPA-SC differed between healthcare workers receiving formal and on-the-job training. The study, conducted in 2021, included a structured survey of healthcare workers (N\u2009=\u2009192) across trained facilities in four regions in Ghana, plus key informant interviews with regional resource team members (n\u2009=\u20098), facility in-charges (n\u2009=\u20098), and formally-trained or on-the-job trained healthcare workers (n\u2009=\u200916). Descriptive statistics, equality-of-proportions tests, and logistic regressions (adjusting for clustering by facility) were used to compare quantitative outcomes between formally-trained and on-the-job trained healthcare workers. Qualitative results were analysed thematically and triangulated with quantitative results. Only 62% of eligible healthcare workers surveyed reported receiving any on-the-job training on DMPA-SC from a formally-trained colleague. Where implemented, on-the-job training was reported to vary in length and depth, with on-the-job trained healthcare workers typically reporting fewer training components and lower satisfaction with training than formally-trained counterparts. Both cohorts scored comparably in injectables counselling role-plays and demonstrated comparable attitudes towards injectables. However, formally-trained healthcare workers scored better in overall correct knowledge of DMPA-SC (59.6% versus 26.4%, aOR: 4.68, 95%CI: 1.98-11.07, p\u2009&lt;\u20090.01) and recall of all five critical self-injection steps (65.4% versus 37.9%, aOR 3.52, 95%CI: 1.53-8.10 p\u2009&lt;\u20090.01). This study found that on-the-job training had been inconsistently implemented, seemingly leading to incomplete knowledge transfer on DMPA-SC between healthcare workers. The authors recommended standardising on-the-job training and increasing supportive supervision to strengthen the approach.<\/jats:p>","DOI":"10.1371\/journal.pgph.0004799","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T17:51:54Z","timestamp":1777571514000},"page":"e0004799","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Consistency of on-the-job training implementation for subcutaneous depot medroxyprogesterone acetate in Ghana and associated healthcare worker knowledge transfer: A cross-sectional mixed-methods study"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7588-0565","authenticated-orcid":true,"given":"Chelsey","family":"Porter 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Ahliba","family":"Diogo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8387-3292","authenticated-orcid":true,"given":"Kofi","family":"Issah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"pgph.0004799.ref001","year":"2024"},{"issue":"1","key":"pgph.0004799.ref002","doi-asserted-by":"crossref","first-page":"55","DOI":"10.9745\/GHSP-D-17-00250","article-title":"Expanding access to injectable contraception: results from pilot introduction of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) in 4 African Countries","volume":"6","author":"A Stout","year":"2018","journal-title":"Glob Health Sci Pract"},{"issue":"5","key":"pgph.0004799.ref003","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(18)30061-5","article-title":"Effect of self-administration versus 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