Marinucci Francesco DETC 620 Section: 9020 July 28th, 2013 Assignment #3: Project proposal Multimedia learning

for malaria diagnosis improvement in Kenya Francesco Marinucci University of Maryland University College, US

Introduction The purpose of this project is to introduce multimedia learning in the Malaria Diagnosis course offered by a clinical laboratory diagnostic company. The rationale behind this approach is to provide an innovative product for improving the quality of the diagnosis by reaching in-service health workers involved in malaria case management at different level of the health system. This is part of the national strategy in Kenya of decentralizing malaria testing through the introduction of Rapid Diagnostic Tests (RDTs) and strengthening of existing microscopy centers. Due to the lack of training and refresher courses for health workers on duty, this approach aims at positioning the company in the fast-growing niche of distance learning in the African health market. This is particularly exciting because of the wide introduction of numerous rapid diagnostic tests to be used by non-laboratory staff. The use of multimedia can definitely offer quick access to key information to end users, even in remote locations. The choice of using multiple media is due to the different diagnostic products available and

their use across the whole health system. It also takes into account the IT infrastructure and computer skills available at the different levels of the health systems. Design Model The five-step instructional design model ADDIE consisting of Analysis, Design, Development, Implementation, and Evaluation is used for this course. A first, major step is in-depth analysis of the current scenario to make sure that the introduction of multimedia effectively contributes to achieve learning objectives. Analysis At present, health workers in Kenya are taught how to diagnose malaria during undergraduate courses, with very limited in-service training available. With the introduction of the new national guidelines for malaria diagnosis in 2010, local authorities have introduced new diagnostic tests and new testing algorithms with the goal of improving the classification of fever cases. Besides, the massive introduction of RDTs at lower levels of the health system has brought the primary testing point at primary facilities where health workers, often without formal training, perform the RDTs. Lastly, the high turnover of health workers, especially at lower levels, make it urgent to offer new staff access to training that allow them to quickly acquire the basic skills for ensuring quality diagnosis of malaria. In this scenario, the primary need is to ensure that health workers performing the test, regardless the type of test, receive updated, timely training to quickly understand how to correctly execute the testing procedure. Design The overall goal is to ensure quality testing for malaria diagnosis at any level of the health system through the introduction of multimedia product. A first key objective is to ensure that community health workers receive adequate training on how to perform the

new RDTs. Second, to provide microscopy centers refresher training both on RDTs and on microscopy techniques so to strengthen the national laboratory network. To emphasize the role that accurate diagnosis plays in managing malaria from clinical and public health perspectives, a storyboard to highlight the role played by each testing site will be developed and used as course framework. The storyboard approach is frequently used in these settings so as to offer trainees a familiar layout, and it will be integrated by multimedia with the purpose of underlining the most critical steps. Development Based on the design phase, the development of the course will comprise two major activities: the storyboard and the multimedia. The former will represent a real case scenario so as to have trainees identifying themselves in the main character; while the latter will comprise both audio and video. Implementation The plan for rolling out the course comprises an initial pilot in one province only. At this stage, a pre-course meeting is held to inform all trainees about the design, learning objectives, and expectations. Following this meeting, learners receive paper-based storyboard, short videos are made available on the Learning Management System (LMS), while regular communication is ensured either through short-text-messages or emails. Evaluation The ADDIE model includes both formative and summative evaluations, with the former carried out after design and development stages, while the latter is performed to assess customers satisfaction and to evaluate benefits and impact of the model adopted. For the summative evaluation, trainees are given the opportunity for feedback, but also the national authorities will be involved to effectively evaluate the impact of the course. Due to

the location of end users, the additional E as proposed by Gokool-Ramdoo (2008) in the ADDIEE model, which implies addressing a range of issues including creating quality learning resources using technologies suitable for the target audience (p.12). Multimedia learning According to Mayer (2001) there is no single approved definition of multimedia learning. For the purpose of this project, Bates and Pooles (2003) description of media as mean of communication requiring a source of information, a means of transmitting information, and a receiver is followed. Advantages In the theoretical framework of learning with media, Kozma (1991) described the learner actively collaborating with the medium to construct knowledge (p.179). In this framework the learning is viewed as an active process that is sensitive to characteristics of the external environment (p.180) and where the processing capabilities of a medium can complement those of the learner (p.181). In the context of this project, the use of paperbased material will provide learners the solidity of the printed page with the combination of orthographic symbols and pictures. The use of symbol systems contextualized into the storyboard will facilitate learners in mapping the situation described. The videos will be exclusively use to reinforce the key steps by guiding learners through the expected learning process. As highlighted by Kozma (1994) the visual and social nature of the story, as presented with video, is more likely to activate relevant situation-based prior knowledge so that students can use this to solve the problem (p.12). Disadvantages A major challenge in using multimedia is to be sure that the set of attributes of the media selected are the most effective in reaching the learning goal of the course. In this

context, the familiarity of learners with storyboard and oral communication provide good evidence that the media used will be successful. Another disadvantage are the costs associated to the media and their attributes (Clark, 1994). In this regard, the choice of media in this project is cost-effective due to the fact that they can be reused multiple times and able to provide learners those strategies necessary for learning. Rationale for multimedia learning environment The combination of storyboard and videos provide learners with a familiar symbol system that is easily understandable regardless of their background. Videos are very important to reiterate the message and emphasize the key steps, but also to improve satisfaction and persistence. The different stimuli they provide are likely to increase longmemory storage capacity in learners not used to be trained with instructional videos. Lastly, the multimedia learning environment is more flexible by offering different learning options able to accommodate different learning style. Target group This course targets all health workers performing malaria tests at rural, peri-urban, and urban health centers, in particular the following three sub-groups: community health workers, laboratorians at primary and secondary level labs, and laboratorians at tertiary level diagnostic centers. For RDTs training, the target group comprises both laboratory professionals and health community workers, while for the microscopy techniques training the target is only laboratory staff. The two cadres of trainees differ by pre-service education, professional experience, and, very important, they have different computer literacy. These differences will be taken into account in the selection of the delivery technology; however, it is very likely that all trainees have mobile phones. No language barriers are present since English is the national language.

Presentation modes In addition to learners different computer skills, the variable level of IT infrastructures countrywide makes mandatory the use of different presentation modes. The course will be made available through the Canvas LMS so to offer all trainees the opportunity of having all course content, such as training material, quizzes, discussions, links, and documents, all in one place. The storyboard in paper-based format is provided to all learners while the videos will be delivered either through the Internet or smartphone. In case of a very remote location, all instructional videos are provided on Digital Versatile Disc (DVD) so to be watched by using any DVD reader. Media selection criteria The LORI manual is used to evaluate the most appropriate multimedia learning objects that Leacock and Nesbit (2007) defined as any digital learning resource combining text, images, and other media and that are intended for re-use across educational settings (p.44). Items of the LORI manual of particular importance for this project are: Learning Goal Alignment, Motivation, Accessibility, and Reusability. In defining media selection criteria, it is also important to consider the characteristics of the target group. Due to its large size and the broad age range of trainees, different media belonging to all three generations of distance education, such as correspondence, telecommunication, and computer, should be selected (Garrison, 1985). Schedule of the course The course covers two main topics: malaria RDTs and microscopy techniques. Following general introduction to malaria disease and to the national malaria control program common to both areas, each topic will include the following units: test principles, test procedure, pre- and post-analytical steps, quality assurance, clinical-laboratory

interface. All learners will start with the first unit, while they will have access to the following only upon completion of the knowledge assessment of the previous one. The learner decides the pace, but each unit must be completed within one-week period. In this way the overall schedule of the course will not exceed seven weeks. Project team members The team for this project comprises the following five professionals: team manager, instructional designer, multimedia specialist, subject-matter expert, and graphic designer. Besides the supervision role, the team manager is also responsible to support the layout and design of the course, to involve local authorities in the preliminary stages of course development, and to perform both formative and summative evaluations. The instructional designer major responsibility is to perform the needs analysis and, based on the outcomes, to propose the most suitable instructional method and media. The multimedia specialist is mainly responsible for developing and testing the multimedia material, while the subjectmatter experts role is focused on providing course content and making sure to align it with the learning objectives. Lastly, the graphic designer is responsible for the overall layout of the course and, more important, to create the characters of the storyboard by keeping in mind the local culture. Roll-out plan The estimated time for project realization, including also the discussion and development of learning objectives with local authorities, is one year. As soon as the storyboard and videos are ready, a pilot will be performed in one province by using the course content on DVD only. This allows the team to get preliminary feedback from the learners so to eventually refine course content and instructional method before focusing on the different delivery technologies. Following this revision, the course is fully implemented

and continuously evaluated and revised at the end of each delivery cycle. Local authorities are regularly informed on the status of the implementation and pass/fail rate, so to tailor specific interventions to evaluate the impact of the course on the quality of malaria diagnosis. Conclusion Accurate diagnosis of malaria is crucial to effectively implement control strategies and minimize the burden of the disease. The decentralization of testing capacity due to the introduction of malaria RDTs demands for competency-driven distance training of all health workers involved in malaria diagnosis. Despite the numerous challenges, such as different background, IT infrastructure, and technology and computer literacy of trainees, the use of multimedia can significantly improve the quality of testing by satisfying the chronic demand for in-service trainings. Therefore, the distance learning strategy is supported by different media so to overcome the barrier of reliable Internet access, which hampers the delivery of in-service training at distance. The approach proposed above focuses on areas that, in the authors opinion, are crucial for delivering effective in-service training for laboratory professionals in these settings

References Bates, A.W., & Poole, B. (2003). Effective teaching with technology in higher education. San Francisco, CA: Jossey-Bass Clark, R. E. (1994). Media will never influence learning. Educational Technology Research and Development, 42(2), 34-38. Garrison, G. R. (1985). Three generations of technological innovation in distance education. Distance Education, 6(2), 235-241. Gokool-Ramdoo, S. (2008). Beyond the theoretical impasse: Extending the applications of transactional distance theory. International Review of Research in Open and Distance Learning, 9(3), 1-17. Kozma, R. B. (1991). Learning with media. Review of Educational Research, 61(2), 179-211. Kozma, R. B. (1994). Will media influence learning? Reframing the debate. Educational Technology Research and Development, 42 (2), 7-19. Leacock, T. L., & Nesbit, J. C. (2007). A framework for evaluating the quality of multimedia learning resources. Educational Technology & Society, 10 (2), 44- 59. Mayer, R. E. (2001). Multimedia learning. Cambridge: Cambridge University Press.