abstract: 'Background: The in-service training of frontline health workers (FHWs) in primary health care facilities plays an important role in improving the standard of health care delivery. However, it is often expensive and requires FHWs to leave their posts in rural areas to attend courses in urban centers. This study reports the implementation of a digital health tool for providing video training (VTR) on maternal, newborn, and child health (MNCH) care to provide in-service training at scale without interrupting health services. The VTR intervention was supported by satellite communications technology and existing 3G mobile networks. Objective: This study aims to determine the feasibility and acceptability of these digital health tools and their potential effectiveness in improving clinical knowledge, attitudes, and practices related to MNCH care. Methods: A mixed methods design, including an uncontrolled pre- and postquantitative evaluation, was adopted. From October 2017 to May 2018, a VTR mobile intervention was delivered to FHWs in 3 states of Nigeria. We examined changes in workers'' knowledge and confidence in delivering MNCH services through a pre- and posttest survey. Stakeholders'' experiences with the intervention were explored through semistructured interviews that drew on the technology acceptance model to frame contextual factors that shaped the intervention''s acceptability and usability in the work environment. Results: In total, 328 FHWs completed both pre- and posttests. FHWs achieved a mean pretest score of 51\% (95\% CI 48\%-54\%) and mean posttest score of 69\% (95\% CI 66\%-72\%), reflecting, after adjusting for key covariates, a mean increase between the pre- and posttest of 17 percentage points (95\% CI 15-19; P<.001). Variation was identified in pre- and posttest scores by the sex and location of participants alongside topic-specific areas where scores were lowest. Stakeholder interviews suggested a wide acceptance of VTR Mobile (delivered via digital technology) as an important tool for enhancing the quality of training, reinforcing knowledge, and improving health outcomes. Conclusions: This study found that VTR supported through a digital technology approach is a feasible and acceptable approach for supporting improvements in clinical knowledge, attitudes, and reported practices in MNCH. The determinants of technology acceptance included ease of use, perceived usefulness, access to technology and training contents, and the cost-effectiveness of VTR, whereas barriers to the adoption of VTR were poor electricity supply, poor internet connection, and FHWs''workload. The evaluation also identified the mechanisms of the impact of delivering VTR Mobile at scale on the micro (individual), meso (organizational), and macro (policy) levels of the health system. Future research is required to explore the translation of this digital health approach for the VTR of FHWs and its impact across low-resource settings to ameliorate the financial and time costs of training and support high-quality MNCH care delivery.' affiliation: 'Allsop, MJ (Corresponding Author), Univ Leeds, Acad Unit Palliat Care, Leeds Inst Hlth Sci, Worsley Bldg,Clarendon Way, Leeds LS2 9LU, W Yorkshire, England. Hicks, Joseph Paul; Ebenso, Bassey, Univ Leeds, Nuffield Ctr Int Hlth \& Dev, Leeds, W Yorkshire, England. Allsop, Matthew John, Univ Leeds, Acad Unit Palliat Care, Leeds Inst Hlth Sci, Worsley Bldg,Clarendon Way, Leeds LS2 9LU, W Yorkshire, England. Akaba, Godwin O., Univ Abuja, Dept Obstet \& Gynaecol, Abuja, Nigeria. Yalma, Ramsey M., Univ Abuja, Dept Community Med, Abuja, Nigeria. Dirisu, Osasuyi, Populat Council, Abuja, Nigeria. Okusanya, Babasola; Okunade, Kehinde; Ajepe, Adegbenga, Univ Lagos, Coll Med, Dept Obstet \& Gynaecol, Lagos, Nigeria. Tukur, Jamilu, Aminu Kano Teaching Hosp, Kano, Nigeria. Akeju, David, Univ Lagos, Coll Med, Dept Sociol, Lagos, Nigeria. Okuzu, Okey, Instrat Global Hlth Solut, Abuja, Nigeria. Mirzoev, Tolib, London Sch Hyg \& Trop Med, Dept Global Hlth \& Dev, London, England.' article-number: e24182 author: Hicks, Joseph Paul and Allsop, Matthew John and Akaba, Godwin O. and Yalma, Ramsey M. and Dirisu, Osasuyi and Okusanya, Babasola and Tukur, Jamilu and Okunade, Kehinde and Akeju, David and Ajepe, Adegbenga and Okuzu, Okey and Mirzoev, Tolib and Ebenso, Bassey author-email: m.j.allsop@leeds.ac.uk author_list: - family: Hicks given: Joseph Paul - family: Allsop given: Matthew John - family: Akaba given: Godwin O. - family: Yalma given: Ramsey M. - family: Dirisu given: Osasuyi - family: Okusanya given: Babasola - family: Tukur given: Jamilu - family: Okunade given: Kehinde - family: Akeju given: David - family: Ajepe given: Adegbenga - family: Okuzu given: Okey - family: Mirzoev given: Tolib - family: Ebenso given: Bassey da: '2023-09-28' doi: 10.2196/24182 files: [] issn: 2291-5222 journal: JMIR MHEALTH AND UHEALTH keywords: 'primary health worker training; digital health technology; eHealth; video-based training; maternal and child health; Nigeria; mobile phone' keywords-plus: MIDDLE-INCOME COUNTRIES; MOBILE HEALTH language: English month: SEP number: '9' number-of-cited-references: '39' orcid-numbers: 'AKABA, GODWIN/0000-0002-8149-5492 AKABA, GODWIN/0000-0002-8149-5492 Ebenso, Dr. Bassey E./0000-0003-4147-0968 Mirzoev, Tolib/0000-0003-2959-9187 Allsop, Matthew/0000-0002-7399-0194 Hicks, Joseph/0000-0002-0303-6207 Tukur, Jamilu/0000-0002-1529-0448 OKUNADE, KEHINDE/0000-0002-0957-7389 Ajepe, Adegbenga/0000-0002-4967-4597' papis_id: 6528c951ff20d54abfc80fd8dec9881e ref: Hicks2021acceptabilitypotenti researcherid-numbers: 'Yalma, Ramsey Msheliza/AGZ-4237-2022 AKABA, GODWIN/GLV-1941-2022 AKABA, GODWIN/S-7756-2019 Ebenso, Dr. Bassey E./H-5536-2017 OKUNADE, KEHINDE/A-8201-2017 ' times-cited: '4' title: 'Acceptability and Potential Effectiveness of eHealth Tools for Training Primary Health Workers From Nigeria at Scale: Mixed Methods, Uncontrolled Before-and-After Study' type: Article unique-id: WOS:000709011500002 usage-count-last-180-days: '1' usage-count-since-2013: '2' volume: '9' web-of-science-categories: Health Care Sciences \& Services; Medical Informatics year: '2021'