In 2014, the Centers for Disease Control and Prevention and the US Office of Population Affairs jointly developed Providing Quality Family Planning Services
(QFP) for use by all reproductive health and primary care providers [
- Gavin L
- Moskosky S
- Carter M
- Curtis K
- Glass E
- Godfrey E
- et al.
Providing quality family planning services: Recommendations of CDC and the U.S. Office of Population Affairs.
]. QFP outlines how to provide services related to contraception, pregnancy testing and counseling, achieving pregnancy, infertility, preconception health, and sexually transmitted infections. When national guidelines such as QFP are released, staff working in clinical practice settings must learn about and understand the implications of those recommendations for their practice. Without being put into practice in a clinic setting, the recommendations themselves cannot produce the health benefits they seek to achieve. New evidence takes an average of 17 years to become routine clinical practice [
- Morris ZS
- Wooding S
- Grant J.
The answer is 17 years, what is the question: Understanding time lags in translational research.
Educating staff working in settings funded by the Title X Family Planning Program—the only federal program dedicated to comprehensive family planning service delivery—presents one opportunity for increasing awareness about and disseminating implementation strategies related to QFP recommendations [
]. Staff in Title X-funded settings includes a broad range of clinical service providers (physicians, advanced practice nurses), nurses, and clinic administration staff (clinic managers, front desk staff, billing, and finance staff).
In 2020, we—a team of trainers and instructional designers who receive funding from the Office of Population Affairs to develop training for staff working in Title X-funded settings—developed a QFP eLearning Series to provide staff with evidence-based recommendations along with practical tips and suggestions for putting QFP recommendations into practice. We explored how participants reacted to the eLearning modules and if they intended to apply what they learned.
2. Material and methods
The QFP eLearning Series consists of 7 modules: Introduction to the QFP; Reproductive Anatomy and Physiology; Determining the Client's Need for Services and Discussing Reproductive Goals; Pregnancy Testing and Counseling; Contraceptive Counseling and Education; Support for Achieving a Healthy Pregnancy; and Sexually Transmitted Infection (STI) Services.
To develop each module, we reviewed QFP recommendations; reviewed and discussed questions received from staff working in Title X-funded settings about the topic; identified learning objectives to guide the module content; and developed and iterated on the content, interactions, and scenarios. Modules were user-tested by staff working in Title X-funded settings, and reviewed for clinical accuracy by a clinician.
The modules are grounded in the principles that adults learn most effectively when they can (1) self-direct their learning (i.e., there is minimal passive instruction and maximal opportunities for experiential learning); (2) connect learning to their own experiences; (3) collaborate and engage with peers; and (4) see how learning will help them address real problems using examples and case-based scenarios [
- Knowles MS
- Holton EF
- Swanson RA.
The adult learner.
]. To that end, each module contains activities (flash cards, quizzes) to support users to apply the content immediately in their own working settings, as well as case scenarios that align with real patient cases.
The modules present content in alignment with the organization of QFP, with the addition of 2 introductory modules. However, the modules are designed to be taken in any order, in line with the principle that adult learners learn best when they can direct their own course of learning. Similarly, staff are encouraged to complete only the modules needed based on the requirements of their job and training needs. Each module landing page directs learners to the other modules in the QFP eLearning series.
Modules were developed using the eLearning course development platform, Articulate Rise. The modules adhere to standards established in Section 508 of the Rehabilitation Act (29 U.S.C. § 794d) so that they are accessible to people with disabilities [
]. Participants can choose whether to listen to narration. Spanish translations of the modules are currently in process.
Drawing on the Kirkpatrick model for training evaluation, we assessed participation reaction and intention to apply what they learned using an evaluation survey immediately presented to participants upon completing each module (Appendix) [
- Kirkpatrick J
- Kirkpatrick W.
The four levels of evaluation: An update.
]. Learners can obtain a certificate of completion and continuing education (CE) credits (when applicable) upon completing the evaluation.
In 2021, 6132 unique individuals completed 12,102 modules, and of those, 5324 unique individuals completed 10,460 evaluations (86% evaluation response rate). On average, each participant completed 1.97 (standard deviation 1.49) out of 7 modules. Between 79% and 97% of individuals who completed the module also completed an evaluation, with the Pregnancy Testing and Counseling eLearning module having the highest evaluation completion rate.
Nearly all respondents agreed or strongly agreed that the module objectives were met (98%), the modules were useful (97%), and that they would recommend the training to others (96%), as shown in Table 1
. When asked how the training could be improved to better meet participant expectations, 97% of respondents said they found the training satisfactory and had no feedback.
Table 1Participation in and reactions to the Quality Family Planning Recommendations eLearning modules for staff working in Title X-funded settings (Jan 1–Dec 31, 2021).
Overall 97% of respondents said they were confident in their ability to apply content, as shown in Table 2
. Six in 10 (60%) respondents intended to share information and tools with colleagues and with clients. One in 10 (10%) respondents intended to make a change in program practices and 4% of respondents intended to make a procedural or policy change.
Table 2How participants intend to apply what they learned from Quality Family Planning Recommendations eLearning modules for staff working in Title X-funded settings (Jan 1–Dec 31, 2021).
Note: Totals > 100% because participants could select multiple response options.
Participant reactions to the QFP eLearning modules were positive. Almost all participants were confident in their ability to apply what they learned, and were able to identify at least one way they intended to apply lesson material, from sharing information to making a practice, procedure, or policy change. That over half of evaluation respondents said they intended to share information with colleagues and/or clients suggests that the modules helped to disseminate the content found in the QFP recommendations as intended. The lower level of intention to change program practices, procedures, and policies may reflect the fact that these types of change require more time and support of other staff, such as leadership. Future research should further explore the perceived barriers to applying what eLearning participants learned, in order to identify opportunities to further support eLearning participants in making these more system-level changes.
The primary limitation of our analysis is that we were unable to connect immediate intention to apply with resulting behavior change. We attempted to conduct a follow-up evaluation with module participants, however, we were unable to achieve a high-enough response rate to report conclusions. Future studies should explore strategies for following up with eLearning participants to ascertain behavior change resulting from their participation.
Particularly in 2021, during the context of the public health COVID-19 pandemic, self-paced eLearning modules became widely used. In this case, they ensured that staff working in Title X-funded settings was still able access training about QFP recommendations. Thousands of staff were able to complete the QFP eLearning modules, found the modules to be useful and had a high level of intention to apply content immediately following their completion. eLearning modules can be an efficient way to share information about national recommendations and disseminate implementation strategies to staff working in clinical practice settings across the country.
Appendix. Immediate evaluation instrument
3. What did you find most useful about this training?
4. How do you intend to apply what you learned in this training? (check all that apply)
Share information/tools with program staff
Share information/tools with clients
Make a change in program practices
Make a procedure or policy change
None of the above
Other - please specify
5. If this training did not meet your needs or expectations, please tell us why: (check all that apply)
I found the training to be satisfactory and have no feedback at this time
The content was too complex or unclear
The content was too basic
Technical challenges made it hard for me to follow the training
Other - please specify
6. What, if anything, could have made this training better?
7. What additional supports or resources from the RHNTC are needed to make use of the content presented in the training?
Disclosures and funding
Conflicts of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.
Funding: This work was supported by the Department of Health and Human Services Office of Population Affairs grant number FPTPA006030 . The views expressed do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
Published online: October 14, 2022
Received in revised form:
Publication stageIn Press Corrected Proof
© 2022 The Author(s). Published by Elsevier Inc.