Innovative Training to Improve Childhood Cancer Knowledge Among Primary Health Care Providers: Evaluating a Blended Learning Program in Kenya.

Abstract

Purpose: Early detection and timely referral are vital to improving childhood cancer outcomes in low- and middle-income countries. However, training primary health care providers (HCPs) remains challenging because of limited time and resources. This study assesses the knowledge of primary health care workers after a blended learning program on childhood cancer and examines impact on referrals.

Methods: A prospective study in Bungoma, Kenya (January-June 2023), evaluated the first blended pediatric oncology training. Knowledge was assessed via a semistructured questionnaire before (pretest), after (post-test), and 6 months later (evaluation test). Median scores were compared across subgroups (eg, sex, worker type, facility level, training attendance, and short message service learning appreciation). Referral numbers from Bungoma County to the referral hospital were analyzed before and after the program.

Results: Of the 3,040 participants, 496 (16%) completed the blended learning program. Median pretest score was 7 (IQR, 6-8), which significantly increased to eight (IQR, 7-9) in post-test (P < .001) but significantly decreased to six (IQR, 5-7) in evaluation test (P < .001). Community health volunteers consistently scored significantly lower than other HCPs on all three test points (P < .001, P < .001, and P = .028). Live training attendance did not significantly affect test scores. In total, 181 participants (36%) reported suspecting childhood cancer cases since the launch of the program. However, this is not reflected in the annual average of 14 referrals in the 2 years after the program.

Conclusion: The blended learning program improved knowledge initially but declined significantly after 6 months. Digital learning showed promise, yet low referral rates highlight the need to address barriers to effective referrals.