Replay, Revise, and Refresh: Smartphone-based Refresher Training for Community Healthcare Workers in India

In India, community healthcare workers are the primary touchpoints between the state and the beneficiaries, such as pregnant mothers and children. Their healthcare knowledge directly impacts the quality of care they provide through home visits and community activities. Classroom in-person or traditional ways of training are found ineffective in imparting knowledge and render poor knowledge retention, which needs reinforcements through short, frequent revisions. Smartphone games on healthcare topics could be a promising solution as a refresher, as they can be scaled and tailored as per players' requirements. This study aims to check the differences in knowledge gain, pre and post-intervention, and, secondly, to check knowledge retention after six months. 270 CHWs or participants were recruited to evaluate different modes of refresher training and assigned into three equal groups of 90 each. The control group (CG) (n=90) was trained using the standard classroom method, which is usually followed. Intervention Group-1 (IG1)(n=90) was trained in a physical card game format, and Intervention Group-2 (IG2)(n=90) was trained in a smartphone game format. 4 sets of questionnaires were made by shuffling 45 questions based on immunization of equal weightage. The questionnaires were filled out by CHWs by hand and collected, evaluated, and analyzed. Paired t-tests were conducted to compare pre-post knowledge increments and repeated measure ANOVA to check for differences in knowledge retention. Results suggest a significant difference in scores in all three groups. A significant difference was observed between the physical and digital gameplay modes. Pre-post knowledge increment was higher in the digital mode (p<0.05), but knowledge retained was not significantly different (p=.4) in digital and physical card versions.