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Table 5 Barriers and facilitators to implement synchronous and asynchronous E-learning activities

From: Process evaluation of E-learning in continuing medical education: evidence from the China-Gates Foundation Tuberculosis Control Program

Domain Themes Related E-learning format Description Predefined themes
Barriers Matching the supply and demand Asynchronous and synchronous Some TB health workers complained that the training materials in synchronous sessions were too difficult to learn, while some sessions were not related to their daily practices No
Organizational coordination Asynchronous and synchronous Leaders paid relatively little attention to the capacity-building subprojects, so they could not mobilize adequate resources they needed Yes
Synchronous No coordinating mechanism for TB training: the CDCs and TB designated hospitals worked separately No
Internet technology Synchronous 1. Professional remote equipment with a special remote centre was only available in a few provincial hospitals. Most institutions only have limited space for synchronous training. 2. The synchronous learning sessions still required all participants to join the virtual classroom at the same time, which often conflicted with their schedule Yes
  Asynchronous and synchronous 1. Technical issues: slow processing speed of E-learning platform, network jams, system errors, fuzzy sound and blurry videos. 2. Barriers in teacher-student communications Yes
Motivations Asynchronous and synchronous (1) The lack of motivation among TB health workers due to the incentive mechanism, both extrinsic (low income) and intrinsic (lack of work motivation). (2) The incentive mechanism caused a vicious circle: low salary could only attract people with limited learning capacities and digital literacy, which further hinder them learning. (3) Still rely on external incentives such as continuing medical education credits or rules, but neither of them works very well Yes
Sustainability Asynchronous and synchronous The capacity to mobilize resources of the training organizers was very limited, which make it difficult to continue the training after the program. In addition, the platform could not charge to sustain itself due to the existing rules Yes
Facilitators Training format Asynchronous and synchronous E-learning have expanded access to high-quality continuing medical educational resources, timesaving, and reduced its costs Yes
Training content Synchronous Provincial and city-level TB health workers preferred the knowledge about disciplinary frontiers in synchronous E-learning activities Yes
Asynchronous County-level TB health workers favoured sections about routine clinical practice in asynchronous E-learning activities Yes
  1. Note: Data source: Key informant interviews and FGDs
  2. TB tuberculosis, CDC Centres for Disease Control and Prevention
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