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Abstract

The COVID-19 pandemic required an efficient uplift of health professional competencies. Accordingly, the Sri Lankan Ministry of Health implemented novel online training for 50 hospitals in COVID-19 management. This study aimed to evaluate the impact of these online training programs to enable refinements for future implementation. Cluster sampling selected seven hospitals for the descriptive cross-sectional study. An interviewer-administered questionnaire was provided to 840 randomly selected health staff who participated in the training programs, and 637 responded. The most useful, satisfied, and effective training was ‘Use of Personal Protective Equipment’. The highest-ranked advantages of online training were time and cost savings, while more interaction and effectiveness were for face-to-face training. Most participants (>75%) preferred online training during the pandemic, but approximately 33% preferred face-to-face training under normal conditions. Hospital, age, gender, staff, educational, and healthcare experience categories were significantly associated with the perceived effectiveness and preference for online training versus face-to-face training in different circumstances. While these novel online training programs were considered effective and preferred during the pandemic, future utilization for professional development programs in non-pandemic environments needs to account for health professional preferences varying with contextual factors, integration with strategies for interaction, and provision of required resources.

Keywords

COVID-19 pandemic online training continuous professional development andragogy social learning theory Sri Lanka

Introduction

The COVID-19 pandemic posed multiple challenges to the routine processes of health systems in almost every country, including Sri Lanka. The World Health Organization (WHO) reported these challenges as being due to increased demand for COVID-19 patient care and also the considerable restrictions placed on freedom of movement, which disrupted normal delivery of care (World Health Organization, 2020). The lessons learned through the pandemic need to be used to inform the design of more resilient health systems, services, and workforces in the future in preparation for future infectious disease outbreaks.

The main challenge posed by the pandemic in Sri Lanka was the need to efficiently uplift the capacity of all categories of health staff in COVID-19 management amidst the restrictions imposed by the mandatory requirements for social distancing, curfews, and movement restrictions. In this context, the Sri Lankan Ministry of Health (MoH) developed and implemented a series of online training programs on COVID-19 management under the Medical Services Branch with the COVID Coordinating Cell (Figure 1) to uplift the competencies of Sri Lankan health staff as of the previous experiences with similar programs (Beane et al., 2016; Dharmagunawardene & Samaraweera, 2019). This approach aligned with the recommendation of WHO to utilize online learning platforms and mobile technology to provide key training to strengthen workforce competencies amidst the pandemic (World Health Organization, 2020).

Figure 1.

Process of training session development.

During the curriculum design and implementation phases, core principles of adult learning theories were incorporated into the training programs, as COVID-19 management was associated with work-related, life-related, and community-related experiences of health staff (Conner et al., 2018; Knowles, 1978). Adult learning theories emerged from the concept of andragogy by Malcolm Knowles (Knowles, 1978), who concluded that adults learn differently from children. Subsequent critiques posit that, instead, learning occurs in a life-long continuum with variations in problems, focus, and strategies (Hartree, 1984; Taylor & Hamdy, 2013). For example, the acquisition of the required behaviours for effective COVID-19 management mainly occurred through observation and was influenced by context and the community, as opposed to being rather reflective, experiential, and self-directed. Accordingly, social learning theories were deemed more suitable approaches to guide the design and delivery of these training programs, out of several categories of adult learning theories outlined by Taylor and Hamdy (2013).

Due to the characteristics of COVID-19 infection (rapid transmission, novelty) and its management (new infection prevention and control tools including social distancing) (World Health Organization, 2020), there was an urgent and rapid need to instil multiple behavioural changes in relation to the use of infection prevention control and online training practices among health staff. Accordingly, more opportunity was created for employing social learning theories based on context and community (Taylor & Hamdy, 2013). The introduction and use of specific and novel situational tools for healthcare settings were expected to be facilitated by experts and peers within the same healthcare community, involving the sharing of associated experiences and observations providing community encouragement for learning (Bandura & Walters, 1977).

The process was initiated with rapid and informal training needs assessment (Supplemental File-I) (Piskurich, 2009; Rossett, 1987) to gather the learning needs of health staff associated with their work-related problems. This needs assessment was conducted through the institutional in-service Training Focal Points to be aligned with adult learning theories and to be suitable for professional improvement as work-related training (Conner et al., 2018; Grant, 2002; Knowles, 1978). Based on the prioritized needs identified, nine training programs were formulated with the involvement of experts from Infectious Diseases Hospital (IDH), Medical Research Institute (MRI), and WHO. Involvement of experts facilitated the effectiveness of training sessions, as they knew about the competencies, tools, and settings required for the management of real-life COVID-19 situations. These training sessions were based on discussions and real-life, practical demonstrations to engage and improve participants’ behaviours, utilizing the virtual platform of Google Classroom® (Iftakhar, 2016; Kaiser et al., 2023). The process of training session development is depicted in Figure 1, and the details of the nine training sessions are illustrated in Table 1.

Table 1.

Details of nine online training sessions conducted by Sri Lankan MoH on COVID-19 management.

	Training session	Objectives	Resource person	Training strategy
1	Introduction to online training using Google Classroom ®	To be able to explain the applications of Google Classroom ®	Industry experts from Google ® Local Agents, Sri Lanka	Practical demonstration
2	Proper use of personal protective equipment (PPE)	To be able to demonstrate the use of PPE in COVID management settings	Chief nurse (special grade nursing officer) of the Infectious Diseases Hospital, Sri Lanka	Lecture and practical demonstration of use of PPE
3	Setting up of COVID treatment centre – journey through Infectious Diseases Hospital	To be able to design or create standardized COVID treatment centres, as per the guidelines	Consultant physicians from Infectious Diseases Hospital and National Hospital, Sri Lanka	Lecture discussion and practical demonstration
4	Setting up of COVID screening centre	To be able to design or create standardized COVID screening centres, as per the guidelines	Consultant physicians from Infectious Diseases Hospital and National Hospital, Sri Lanka	Lecture discussion and practical demonstration
5	Infection prevention and control	To be able to apply standardized infection prevention and control practices in COVID patient management settings, as per the guidelines	Consultant microbiologists from Infectious Diseases Hospital and College of Microbiologists, Sri Lanka	Lecture discussion and practical demonstration
6	Psycho-social support for healthcare workers	To be able to appraise and apply strategies to enhance psycho-social well-being	Psychologist from World Health Organization, Sri Lanka	Lecture discussion
7	Sample collection and transport	To be able to perform standardized sample collection procedures from COVID patients and transport to assigned laboratories as per the guidelines	Senior medical laboratory technologist from Medical Research Institute, Sri Lanka	Practical demonstration
8	E-learning on COVID-19	To be able to effectively operate and use available e-learning methodologies for COVID	Medical informatics experts from Ministry of Health, Sri Lanka	Lecture, demonstration, and discussion
9	Q&A session with experts	To be able recognize and solve any queries in relation to the conducted training sessions on COVID	All resource personnel who conducted the COVID online training sessions	Lecture discussion

While this offered a reasonable solution to the immediate challenge, it was vital to critically reflect upon and evaluate the training programs and processes that were utilized, to inform future policy and training program decisions (Morewedge et al., 2015; Schalock, 2001). Accordingly, learning outcomes of the training programs were evaluated using Kirkpatrick Training Evaluation Model (Kirkpatrick & Kirkpatrick, 2006). The Kirkpatrick Training Evaluation Model was developed in 1959 by Donald Kirkpatrick for evaluating workplace learning initiatives and has four levels of evaluation, that is, reaction, learning, behaviour, and results (Kirkpatrick, 1994). This model is widely used due to practicability and simplicity, despite criticisms of focusing on end-results and lesser ability for influencing ongoing training (Reio et al., 2017). However, due to constraints, the Kirkpatrick Model was only used up to the third level in this study (i.e. learners’ immediate reaction to the training program – reaction, what are the competencies gained by the learners due to the training program – learning, and the changes instilled in performing the workplace activities as a result of the training – behaviour) (Kirkpatrick & Kirkpatrick, 2006; Reio et al., 2017). We could not evaluate the last level of learning outcome, which is the results (changes in results of the hospital settings) due to constraints and limitations imposed by the pandemic and shorter duration of the study.

The objective of the study was to evaluate participants’ perceptions of the online training programs on COVID-19 management conducted by MoH. This involved comparing perceptions of the relative value of online learning versus face-to-face (F2F) learning methodologies, as well as hospital capacity to deliver programs successfully. This was done to determine whether there is a favourable environment for possible future adaptation of online learning to be utilized for continuous professional development of health staff to strengthen health system processes and outcomes.

Methods

This descriptive cross-sectional study evaluated the perceptions and experiences of participants who enrolled in online training programs on COVID-19 management, conducted in May-June 2020. All the participants (18,922 program participant combinations) who enrolled in the nine online training programs in 50 hospitals, where COVID-19 treatment centres were established and training programs were conducted, were the study population (Supplemental File-II). Out of above 50, the following seven hospitals were selected using cluster sampling: District General Hospital (DGH) Ampara, Hospital Group of Provincial Director of Health Services (PDHS) – Eastern Province with Base Hospital – Kattanudy, DGH Kilinochchi, DGH Matara, DGH Monaragala, DGH Negombo, and DGH Nuwara Eliya.

Subsequently, considering the study population, the required sample size was calculated using Raosoft® online sample size calculator (Raosoft Inc, 2004). It was 377 (to achieve a 95% confidence limit and 50% response distribution). With the design effect of two for the clustering, the sample size was 754, and with a 10% non-response rate, this was 829 (Alimohamadi & Sepandi, 2019). Next, stratified random sampling was done according to the staff category to represent the perceptions of all categories. Seven hospitals were asked to select 120 health staff in four categories randomly: Medical Officers including consultants (30), Nursing Officers including Special Grade Nursing Officers (30), Professionals Supplementary to Medicine and Paramedical Staff (Allied Health) (30), and Other Staff (30). Selected staff members needed to have participated in at least five out of the nine training programs.

The effectiveness of the training programs was measured by the initial three levels of Kirkpatrick’s model of training evaluation, that is, reaction, learning, and behaviour (Kirkpatrick & Kirkpatrick, 2006). In addition, the perceptions of health staff on online training experiences were analyzed and compared with the F2F learning. Finally, the capacity of the hospital to conduct online training was assessed. The study instrument was a self-administered online distributed (Google Form®) questionnaire. It had five sections with respective operational variables (Supplemental File-III). The questionnaire was designed based on Haley (2008) and Ventayen et al. (2018) to ensure content validity, checked with Training Focal Points to ensure face validity, and then pilot-tested among 10 staff of MoH. Collected data were automatically uploaded to a Google Sheet®.

Ethical clearance was obtained by the Ethics Review Committee of the Postgraduate Institute of Medicine, University of Colombo (ERC/PGIM/2020/050). The recruitment of study participants was done by identified Training Focal Points in participating hospitals after obtaining verbal consent. The questionnaire was emailed to the respective participants, who were required to express their consent at the beginning of the online survey. If any participant was unable to access or complete the questionnaire, the relevant training focal point was expected to help. Data collected in Google Sheet® (Moises Jr., 2020) was exported to the SPSS (Field, 2024), and statistical analysis was done in relation to the above variables. The relationships between institutional, socio-demographic, and work-related data were descriptively and quantitatively (chi-square test) analyzed (Hinton et al., 2014).

Results

A total of 637 health staff responded, with a response rate of 75.8%. However, except for DGH Matara and Nuwara Eliya, the response rates were lower than the expected number of 120. The mean age of the participants was 36.58 (SD+/−9.283). Mean healthcare experience was 126.48 months (SD+/−98.066), and mean experience in the present post was 82.89 months (SD+/−75.723). The distribution of the characteristics is illustrated in Table 2.

Table 2.

Characteristics of the study participants.

Hospital	Frequency	Percent
DGH Matara	184	28.9
DGH Ampara	149	23.4
DGH Monaragala	81	12.7
PDHS Eastern Province Group	76	11.9
DGH Negombo	57	8.9
DGH Nuwara Eliya	42	6.6
DGH Kilinochchi	37	5.8
Not responded	11	1.7
Total	637	100.0
Gender
Male	228	35.8
Female	409	64.2
Staff category
Medical services	159	25.0
Nursing services	290	45.5
Allied health services	54	8.5
Others	129	20.3
Not responded	5	0.8
Total	637	100.0
Educational level
Passed A/L	77	12.1
Passed O/L	45	7.1
Diploma or higher diploma	272	42.7
Postgraduate diploma	20	3.1
Other vocational qualifications	7	1.1
Bachelor’s degree	194	30.5
Master’s degree	5	0.8
MD or PhD	9	1.4
Not responded	8	1.3
Total	637	100.0

Participants’ experiences in relation to satisfaction, usefulness, and effectiveness of online training programs on COVID-19 management revealed that the most useful, satisfied, and effective training program was ‘Use of Personal Protective Equipment’ (Figure 2).

Figure 2.

Distribution of perceptions on online training programs.

Participants’ perceptions indicated that the highest-ranked advantage of online training was time and cost savings, while more interaction and effectiveness were highest ranked for F2F training. Most staff (>75%) preferred online training during the COVID-19 environment but not during normal (non-pandemic) conditions (approximately only 43%) (Figure 3).

Figure 3.

Distribution of perceptions on online learning and F2F learning methodologies.

There were significant differences in the perceived effectiveness and preferences of online training among participants except when conducted within the institutions or within the district during non-pandemic periods (p < .000). Additionally, there were significant associations between hospitals, age, gender, staff categories, educational categories, and healthcare experience categories in different circumstances. Hospital category had significant association with the perception of online training being effective and preferred in all circumstances, even during normal times (p < .000).

During the pandemic, there was no significant association between gender and perceptions of online lectures as the most effective or preferred method unless they were conducted by professional associations (p = .001) or within the hospital (p = .001). However, gender has a significant association with the perceived effectiveness (p = .001) and preference (p = .002) for online training, even at normal times. Similarly, age categories had significant associations with perceptions of online lectures as the most effective (p = .004), preferred method (p = .048), and for the MoH training (p = .017) even during the non-pandemic period.

Staff category was significantly associated with the perception that online training is preferred in the COVID-19 period when they are conducted by professional associations (p = .000), within the hospital (p = .000), or outside the district (p = .048). Even during the normal periods, the perceived effectiveness and preference for online training were significantly associated with staff category (p < .05) unless they were conducted by professional associations.

Perceived effectiveness and preference for online training were significantly associated with categories of education in selected elements, that is, the training conducted by professional associations during the pandemic (p = .000), training conducted within the district (p = .014) in normal periods, and within the hospital during both the pandemic (p = .000) and normal periods (p = .002). Similarly, there were significant associations of perceived effectiveness (p = .002) and preference (p = .011) for online training between healthcare experience categories even during normal periods and for the training conducted by MoH (p = .047) during the pandemic. However, the association with healthcare experience categories is less prominent than other categories.

Age (p = .020), gender (p = .012), and healthcare experience categories (p = .046) had a significant association with the perception that the online training delivery tool (Google Classroom®) was easy to understand. Furthermore, age (p = .012), gender (p = .014), staff (p = .003), and healthcare experience (p = .000) categories had significant associations with the perception that Google Classroom® was easy to learn. Similarly, age (p = 0.044), gender (p = .015), staff (p = .034), and healthcare experience (p = .011) categories had significant associations with the perception that Google Classroom® was easy to operate.

Detailed statistical tables are depicted in Supplemental File-IV.

Participants’ perceptions of hospital capacity for the conduct of online training programs are illustrated in Supplemental Files V and VI. More than 20% of the participants perceived that their hospitals did not have adequate finances and ICT facilities for online training. Most participants (>90%) perceived that their focal point had adequate physical facilities, except for library and internet facilities. However, approximately 30% of the participants believed that their focal point had inadequate human resources, except for medical officers.

Discussion

This article illustrates the process of implementing online training programs for health staff during COVID-19 pandemic, incorporating all the elements of training program implementation processes, that is, rapid training needs assessment, implementation to maximum possible participants within a short duration, and training evaluation using online tools. The evaluation indicated that key programs in relation to technical components of COVID-19 management had more than 50% of overall satisfaction, effectiveness, and usefulness. Furthermore, study participants perceived online training as effective and preferred during the COVID-19 pandemic but perceived it as comparatively less preferred and effective during normal times. However, there were variations in perceptions related to gender, educational levels, staff category, and the type of institution.

Competency improvement during COVID-19 pandemic

A systematic review by San Juan et al. (2022) reported that health staff learning needs during the pandemic were unique due to its rapid progression, which required practice-based needs identification, collaborative design of training programs, online, simulation-based training, and repeated sessions to reinforce competencies (San Juan et al., 2022). Our training sessions also incorporated these strategies to deliver and improve the competencies of Sri Lankan health staff effectively. The successful outcomes produced can also be attributed to the incorporation of adult and social learning theories (Bandura & Walters, 1977; Conner et al., 2018; Knowles, 1978; Taylor & Hamdy, 2013) in the development and execution of training sessions, including the integration of content with real-life experiences related to participants’ challenges in performing COVID-19 management activities, incorporating strategies to enhance participant’s interaction, and the utilization of self-paced, user-friendly online access to pre-recorded training materials.

Use of online training (Google Classroom®) and linkage to learning theories

These training programs were conducted using Google Classroom®, which is a learning management system and are freely available for educational activities. This makes it particularly useful in settings with limited resources to expend on online training programs, including Sri Lanka. The other advantages were that it has high-security features and can be used to work anywhere, anytime, and on any device to access class assignments, course materials, and feedback, in addition to other benefits such as time-saving, improved communication, cloud-based, and ease of use (Google, 2024). Google Classroom® is considered one of the best learning platforms, as it handled 30 million assignments within six months of initiation (Iftakhar, 2016).

Nevertheless, the training sessions intended to increase the awareness of online training were perceived to be less satisfactory, effective, and useful, than other training sessions. Additionally, some categories of staff perceived Google Classroom® to be difficult to understand, learn, and operate. In contrast, a Philippine study reported that 94.1% of students recommended and 44% highly recommended Google Classroom® for online learning. The same study evaluated this Learning Management System in terms of ISO 9126 standards (Understandability, Learnability, Operability, and Attractiveness), and students perceived that Operability was the leading feature, followed by Understandability (Ventayen et al., 2018). Kaiser et al. (2023) reported that online workplace training requires the facilitation of inter-participant, instructor-to-participant, and participant-to-content interactions, focusing on pragmatic applications, and inclusive teaching approaches that align content to the work environment contexts of participants (Kaiser et al., 2023). Adequate infrastructure has also been identified as an essential requirement of successful online training programs (Boutros et al., 2023).

Holistically, the literature demonstrates that effectiveness in online learning can be achieved through inclusive learning practices, facilitation of ongoing opportunities for multiple types of interactions, and delivery of context-specific content to participants that align with their diverse socio-demographic characteristics and life experiences, and applying these approaches through deployment of appropriate infrastructure (Boutros et al., 2023; Kaiser et al., 2023; Taylor & Hamdy, 2013). When viewed through the lens of these insights from the social learning literature, our study results indicate that there may have been opportunities to further refine the online training programs for closer alignment to best practice and theory (Bandura & Walters, 1977; Taylor & Hamdy, 2013), by considering the unique scenario of COVID-19, participants’ limited prior experience with online training, and infrastructure constraints. When considering the application of these conclusions to comparable contemporary programs in Sri Lanka, some of these barriers are likely to have organically reduced in scope due to ongoing exposure to online training techniques, and increased institutional resourcing, experience, and support.

Similar online training in LMICs during COVID-19 pandemic

There have been several studies evaluating online training programs conducted to improve the competencies of health staff in multiple low- and middle-income countries (LMICs) during the COVID-19 pandemic (Mohamed et al., 2023; Otu et al., 2021; Panda et al., 2022; Sharma et al., 2021; Thomas et al., 2022; Tsiouris et al., 2022). A series of training programs were conducted in Papua New Guinea (‘COVID-19 Healthcare E-Learning Platform – CoHELP’), comprised of self-paced online modules with downloadable resources (Mohamed et al., 2023). A Nigerian training program used a mobile tutorial app (Otu et al., 2021), while another Nigerian program utilized a simple, vignette-based, 10-module design combined with feedback and assessments, which was designed through a comprehensive learner-centred design thinking process (Thomas et al., 2022).

Additionally, a tele-mentoring program was conducted in India (Project Extension for Community Healthcare Outcomes – ECHO) to improve the competencies of health staff on COVID-19. This web-based video conferencing program was composed of training and case discussions (Panda et al., 2022). A comprehensive ten training programs conducted in 11 African countries trained 8797 health staff in 945 health facilities, through mixed methods (online or F2F or by listening to the recording). These programs were designed after developing a competency framework through a review of existing guidelines (Tsiouris et al., 2022).

Effectiveness of online learning during COVID-19 pandemic

Online training programs during COVID-19 pandemic contributed to improved satisfaction among health staff. A USA study reported an overall satisfaction rate of 88% (Joyce et al., 2022). Evaluation of training programs in African countries indicated that the majority (87%) of staff were either satisfied or extremely satisfied, and 90% perceived the training to be relevant or extremely relevant (Tsiouris et al., 2022). The Indian program reported high levels of satisfaction (97%) (Panda et al., 2022). The Papua New Guinean study reported a satisfaction range of 71%–88% in different domains (Mohamed et al., 2023). All these studies reported an overall higher level of satisfaction than our study, which may be due to rapid initiation, with less time for preparation, the relatively longer duration of training conduction, or a one-month gap between implementation and evaluation.

Similarly, online training led to improved outcomes in the management of the COVID-19 pandemic. A Nepalese study reported that participating health staff had significantly better-perceived knowledge, attitudes, and practices (p < .05) than those who did not. The same study reported that participation in online training programs was the only significant determinant factor for having perceived positive attitudes (Tamang et al., 2020). Similarly, the participants reported significantly improved outcomes in relation to stress, resilience, and anxiety subsequent to the program conduction in the USA (Joyce et al., 2022). The perceived application of knowledge and skills of the Papua New Guinean participants was in the range of 54%–83%, and perceived usefulness had the range of 56%–90% in different domains (Mohamed et al., 2023). All these studies reported much higher outcomes than in our study, which may be due to the above same reasons in relation to satisfaction.

There are a notable number of studies analyzing the effectiveness of COVID-19 training programs. The study in 11 African countries reported a significant increase in individual pre- and post-test scores (p-value <.0001) (Tsiouris et al., 2022). Thakre et al. (2020) reported significant improvement between pre- and post-test scores for Indian health workers (p < .005) (Thakre et al., 2020). Another Indian study and two Nigerian studies reported (in all three studies, p-value <.001) better pre- and post-test scores following the training (Otu et al., 2021; Sharma et al., 2021; Thomas et al., 2022). However, our study did not analyze pre- and post-test scores, as the training programs were implemented quickly due to the urgency of the situation.

Similarly to our study, Panda et al. (2022) reported that satisfaction, learning and competence, and performance varied according to participants’ educational qualifications, practice size, and practice locations (Panda et al., 2022). A Nigerian study also reported that males and younger staff had significantly better post-test scores and significant regional differences (Otu et al., 2021). This may be due to already improved knowledge among these categories of health staff, as in the Nepalese study, where it was reported that males, nurses, doctors, and staff with higher educational levels had significantly more perceived knowledge on COVID-19 and nurses had significantly better-perceived practice (Tamang et al., 2020). These socio-demographic and setting-specific variations highlight the importance of individual and environmental contexts and communities of practice in facilitating and guiding training program participants (Bandura & Walters, 1977; Taylor & Hamdy, 2013). Our study used in-service Training Focal Points, Q&A sessions, access to recorded content, and social media groups for guidance, interaction, and facilitation, but COVID-19 restrictions and the need to cater to a large group with rapid and minimal planning posed challenges.

Most of the study participants in our study preferred F2F training programs instead of online training during normal circumstances. This result aligns with another study done among orthopaedic residents in Chile regarding their orthopaedic resident training during COVID-19. It was reported that, despite having positive responses regarding online educational activities, F2F activities were still valued as a complementary activity during normal circumstances (Figueroa et al., 2020).

Importance of appropriate infrastructure and pedagogical approaches to improve effectiveness

The negative perceptions of online workplace training in our study may have been associated with limited institutional capacity to conduct high-quality online training, and also the inherent constraints on interaction posed by online mode of delivery. In particular, the use of online training may have restricted participant–facilitator interaction, reducing instructor capacity to adaptively adjust content to participants’ diverse socio-demographic characteristics and training needs, despite the attempts that were made to address this limitation by utilizing multiple strategies for learner-to-learner interactions such as social media groups, learner-to-content interactions such as access to recorded content, and learner-to-instructor interaction such as Q&A sessions (Kaiser et al., 2023). The lack of interaction was also substantiated by the Indian study as one of the major limitations of online training for healthcare professionals (Panda et al., 2022). The Papua New Guinean study also referenced networking and internet issues as key challenges (67%), followed by issues related to data (54%) (Mohamed et al., 2023). Conversely, the online training program for Chinese community pharmacists had significantly higher (p < .001) pre- and post-test scores and more than 85% satisfaction, which may be due to the utilization of the O-AMAS (Objective, Activation, Multi-learning, Assessment, and Summary) teaching model and integration of flipped classroom technique within the online program (Shen et al., 2022). This Chinese study highlights the importance of using interactive techniques and where possible and appropriate catering to a uniform group of participants.

Similar observations regarding the importance of employing optimal pedagogical design have been noted in relation to graduate online education programs. A study in Pakistan revealed that university students had many challenges in participation for online training, such as weak interaction, lack of resources, and poor connectivity, and therefore employed various methods, including the provision of recorded versions, limiting sessions to 30 minutes, and supplying required ICT resources, which significantly improved student satisfaction (Faize & Nawaz, 2020). Similarly, a Saudi Arabian training program for medical students and residents identified important barriers (software and hardware infrastructure, technical support) that limited participants’ satisfaction, necessitating the innovative restructuring of how the online program was being delivered (Alsaywid et al., 2021).

The study findings align with the broader literature regarding the importance of utilizing innovative and appropriate interventions based on adult and social learning theories (Conner et al., 2018; Knowles, 1978; Taylor & Hamdy, 2013), for example, facilitating interaction, transferring context-specific content, and utilizing inclusive teaching practices to match the diverse socio-demographic characteristics of participants (Kaiser et al., 2023; San Juan et al., 2022). However, limited opportunities for reflections and assessment of competencies amidst COVID-19 restrictions posed challenges in achieving expected learning outcomes through transfer of competencies in our study (Ash & Clayton, 2009; Foley & Kaiser, 2013). Accounting for these principles in online training curricula design and delivery for health professionals gives the greatest likelihood of effectiveness.

Limitations

The main limitation of this study was the limited response rate and inability to gain adequate representation of allied health and other staff categories, with over-representation of nursing staff. This was mainly linked to the inclusion criteria and low level of participation of these professional groups in the online training programs. At the same time, there are many medical officers and nursing officers within a hospital compared to the remaining staff categories. In addition, there was a gap of approximately one month between training conduct and evaluation, leading to a possibility of recall bias. There was also no pre–post evaluation conducted, though the initial needs assessment supplemented the results of the post-intervention evaluation.

Conclusion and recommendations

The COVID-19 professional development online training programs in Sri Lanka were found to be useful, preferred, and effective during the pandemic when compared to F2F methods. However, several hospitals and key socio-demographic groups included in this study questioned whether online programs would be preferred in normal (non-pandemic) environments. Based on these findings, and with the expectation that the MoH will increasingly deliver training programs online rather than F2F in the future, it is vital for policymakers to address the critical barriers to effective online training uncovered through this study. This includes the provision of adequate digital and physical facilities, as well as the utilization of appropriate software and pedagogical approaches to enable interaction, discussion, and networking among participants. These lessons will be useful to the MoH in informing future planning, but the results are also of relevance to health policymakers in other countries as well, aiming to expand the utilization of online training programs for professional development purposes.

Supplemental Material

Supplemental Material - Evaluation of online training programs on COVID-19 management in Sri Lanka

Supplemental Material for Evaluation of online training programs on COVID-19 management in Sri Lanka by Dilantha Dharmagunawardene, Nishanthini Nadarajah, Jayawardana Priyantha, Vitiyala Vidanage Thayal Nathasha, Dharshini Kantharuban, Katugampalage Achala Dilhani Jayathilake, Charani Madara Adikari Mudiyanselage Gunathilake, Jayasingha Arachchilage Sujeewa, Lal Panapitiya, and Reece Hinchcliff in Journal of Adult and Continuing Education.

Supplemental Material

Supplemental Material - Evaluation of online training programs on COVID-19 management in Sri Lanka

Supplemental Material

Supplemental Material - Evaluation of online training programs on COVID-19 management in Sri Lanka

Supplemental Material

Supplemental Material - Evaluation of online training programs on COVID-19 management in Sri Lanka

Supplemental Material

Supplemental Material - Evaluation of online training programs on COVID-19 management in Sri Lanka

Supplemental Material

Supplemental Material - Evaluation of online training programs on COVID-19 management in Sri Lanka

Footnotes

Acknowledgements

First and foremost, resource persons, professional colleges, and institutions who contributed to the training programs are gratefully thanked. Authors would also like to thank the heads of institutions, study participants, and staff of participating hospitals for their contribution to the research, amidst challenging constraints imposed by COVID-19 pandemic. Finally, staff of Finetech Consultancy (Pvt) Ltd, Google® premier partner for Sri Lanka, and members of New Zealand Sri Lanka Buddhist Trust are thanked for the donation of online training platforms, to conduct the health staff training during the COVID-19 pandemic.

Author contributions

DD was involved in initial conceptualization, design of the research, analysis, interpretation of results, and preparation of initial draft of the manuscript. NN, JPR, NVVT, KD, JKAD, GAMCM, and SJA collectively contributed to designing the methodology, reviewing initial conceptualization, design, and analysis, and interpretation of results. PPWC supervised and refined the study design and methodology and co-reviewed the publication. HR reviewed the manuscript to ensure overall accuracy and integrity and did final revision and approval of the manuscript. All authors reviewed the manuscript before final submission.

Declaration of conflicting interests

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The first author was the Director - Medical Services, Ministry of Health, Sri Lanka, who coordinated these online training programs, and LP was the Deputy Director General - Medical Services, Ministry of Health, Sri Lanka, who supervised the conduct of these online training programs. The other authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Dilantha Dharmagunawardene

Charani Madara Adikari Mudiyanselage Gunathilake

Lal Panapitiya

Reece Hinchcliff

Supplemental Material

Supplemental material for this article is available online.

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