Design of a Blended Learning Course for Training Community Healthcare Providers on eHealth-enabled Newborn Hearing Screening

Abstract

Objectives. We present in this article the design and evaluation of a blended learning approach for training community healthcare providers in performing newborn hearing screening (NHS).Methods. We developed a blended learning course for training community healthcare providers on eHealth-enabled NHS, following Bloom’s revised taxonomy of educational objectives. The training involved three components: computer-based training (CBT), face-to-face (FTF) training, and on-site coaching. We used surveys and post-training interviews following Level 1 Kirkpatrick’s training evaluation model to get initial feedback on the training program.Results. Thirty-one community healthcare providers from five rural health units and a private hearing screening center, with a mean age of 42.2 ± 12.0 years, participated in the pilot. 93.5% of the participants agreed that the program content met stated objectives and was relevant to their practice. The length of the course was perceived to be adequate. Overall satisfaction with the program was rated at 8.5 ± 0.9 (with ten as the highest). The majority expressed that the CBT and FTF course were satisfactory at 93.5% and 100%, respectively. All participants agreed that the course enhanced their knowledge of newborn hearing screening and telehealth. Positive reviews were received from participants on the use of CBT to improve theoretical knowledge before FTF training. Participants declared that FTF training and on-site coaching helped improved NHS skills and implementation.Conclusion. Competent community healthcare providers are critical to strengthening the performanceof the health system, and advances in the education and technology sectors offer promising potential inupskilling local healthcare providers. The increasing access of Filipino healthcare providers to improvedinformation and communications technology (ICT) is a significant catalyst for pedagogical innovation, like the use of blended learning in the continuous professional development of health practitioners. As ICTs gradually penetrate the health sector, the challenge we now face is not whether but how we can use innovations in education strategies to benefit healthcare providers.

Full text

Design of a Blended Learning Course for
Training Community Healthcare Providers on
eHealth-enabled Newborn Hearing Screening
Abegail Jayne P. Amoranto, MSc,1,2 Romeo Luis A. Macabasag, MSc,1 Talitha Karisse L. Yarza, MclinAud,3
Teresa Luisa G. Cruz, MD, MHPEd,2,3 Abby Dariel F. Santos, RN,1 Philip B. Fullante, MD,3 Rosario R. Ricalde, MD,3,4
Luis G. Sison, PhD,5 Charloe M. Chiong, MD, PhD2,3 and Pora Grace F. Marcelo, MD, MPH1,2
1National Telehealth Center, National Institutes of Health, University of the Philippines Manila
2College of Medicine, University of the Philippines Manila
3Philippine National Ear Institute, National Institutes of Health, University of the Philippines Manila
4Department of Otolaryngology – Head and Neck Surgery, College of Medicine and Philippine General Hospital, University of the Philippines Manila
5Electrical and Electronics Engineering Institute, College of Engineering, University of the Philippines Diliman
ABSTRACT
Objecves. We present in this arcle the design and evaluaon of a blended learning approach for training community
healthcare providers in performing newborn hearing screening (NHS).
Methods. We developed a blended learning course for training community healthcare providers on eHealth-enabled
NHS, following Bloom’s revised taxonomy of educaonal objecves. The training involved three components:
computer-based training (CBT), face-to-face (FTF) training, and on-site coaching. We used surveys and post-training
interviews following Level 1 Kirkpatrick’s training evaluaon model to get inial feedback on the training program.
Results. Thirty-one community healthcare providers from ve rural health units and a private hearing screening
center, with a mean age of 42.2 ± 12.0 years, parcipated in the pilot. 93.5% of the parcipants agreed that the
program content met stated objecves and was relevant to their pracce. The length of the course was perceived
to be adequate. Overall sasfacon with the program was rated at 8.5 ± 0.9 (with ten as the highest). The majority
expressed that the CBT and FTF course were sasfactory at 93.5% and 100%, respecvely. All parcipants agreed that
the course enhanced their knowledge of newborn hearing screening and telehealth. Posive reviews were received
from parcipants on the use of CBT to improve theorecal knowledge before FTF training. Parcipants declared that
FTF training and on-site coaching helped improved NHS skills and implementaon.
Conclusion. Competent community healthcare
providers are crical to strengthening the performance
of the health system, and advances in the educaon
and technology sectors oer promising potenal in
upskilling local healthcare providers. The increasing
access of Filipino healthcare providers to improved
informaon and communicaons technology (ICT) is a
signicant catalyst for pedagogical innovaon, like the
use of blended learning in the connuous professional
development of health praconers. As ICTs gradually
penetrate the health sector, the challenge we now
face is not whether but how we can use innovaons in
educaon strategies to benet healthcare providers.
Keywords: blended learning, course design, newborn hearing
screening, eLearning, computer-based training
eISSN 2094-9278 (Online)
Published: September 28, 2023
hps://doi.org/10.47895/amp.v57i9.5032
Corresponding author: Abegail Jayne P. Amoranto, MSc
Naonal Telehealth Center
3rd Floor IT Center, Joaquin Gonzalez Compound,
University of the Philippines Manila
Padre Faura St., Ermita, Manila 1000, Philippines
Email: apamoranto@up.edu.ph
ORCiD: hps://orcid.org/0000-0002-0613-0231
VOL. 57 NO. 9 2023 95
ORIGINAL ARTICLE

INTRODUCTION
Competent local primary care providers, as frontline
health workers, are critical to strengthening the performance
of the health system. However, training has become complex
and expensive, limiting health workers' access to continuing
professional development. is situation aggravates existing
challenges posed by resource- and support-limited envi-
ronments often present in primary care.1 While there are
development programs for specic health practitioner groups,
advocacy for most health professionals to work together to
achieve more extensive individual and population health
goals falls short.2 e World Health Organization (WHO)
noted an increasing mismatch in the healthcare workers’
competencies against the individual and population health
needs.3 is discrepancy can be associated with the static,
fragmentary, and sometimes outdated curricula that educate
healthcare workers.
Alongside shifts in the health system, the education
sector is also challenged by the increasing volume and access
to information brought by information and communication
technologies (ICTs). In 2005, the Organization for Economic
Cooperation and Development called on universities and
other educational institutions to reconsider their task
to produce competent members of society, considering
continuous technological advancement, which contributes
to the development of educational innovations and
approaches needed by the education sector.4,5 An example
of this innovation is eLearning—the use of the internet
and computers in delivering learning activities.6 Electronic
learning (or eLearning) has gained attention among health
education scholars and practitioners because of its promising
potential to alleviate gaps in educating healthcare workers.7-9
In brief, eLearning is benecial not just because it can
transcend spatial and temporal boundaries but it can also
promote individual and collaborative learning and use up-
to-date information.9-12 Subscribing to eLearning mode,
although benecial, can also be costly because of technological
requirements and maintenance and can sometimes promote
feelings of isolation among its learners.12 ese challenges
are not unknown to Filipinos given the technological and
infrastructural challenges13 that limit the use of interactive
eLearning in educating health workers in remote and isolated
areas. In such a setting, a blended learning approach, a
combination of traditional and technology-based education,
can be maximized.
Blended learning combines traditional face-to-face and
online learning approaches, either through asynchronous or
synchronous eLearning.14 It oers a promising alternative to
health education.15 Although it has shown rapid growth and
utilization in education16,17, it is not as simple as combining
the two latter approaches since it is highly context-dependent,
making generalization across disciplinary domains
challenging18. is notion suggests that implementing
blended learning in one discipline does not guarantee success
in another domain. More than the computers and internet
used for blended learning, we agree with Laurillard19 that
determining the most appropriate way to deliver a specic
topic and how our technology can enhance our teaching
approaches should take precedence.
We present in this article our design of a blended learning
approach to training community healthcare providers in
performing newborn hearing screening. We proceeded in four
steps. First, we reviewed the literature to elaborate and clarify
ideas about what blended learning means and what it entails.
Our review was rather selective since our goal was to provide
a modest picture of the literature about blended learning
relevant to the knowledge and skills needed in newborn
hearing. We then reviewed existing training program designs
about telehealth and newborn hearing screening. ird, we
discussed in greater detail how we applied the concepts of the
blended learning approach—using Anderson and colleagues’
extended version of Bloom’s taxonomy20—highlighting
the selection, sequence, blend of training objectives, and
instructional and evaluation activities. We then presented
participants’ initial feedback on the training program. We
concluded by discussing the considerations and implications
of using the blended learning approach.
Interrogang the blended learning approach
ere are contestations among education scholars
concerning the way blended learning is understood. Blended
learning is an approach that systematically combines online
and face-to-face learning activities to deliver ecient and
meaningful educational interaction among learners, educators,
and available resources.21-23 is learning approach has
gained considerable attention16,17 because it has synthesized
the benets of online and face-to-face approaches into one
learning approach12,21,24. However, this explanation was
criticized by scholars, claiming that understanding blended
learning as a particular form of traditional teaching strategy
with technology as an add-on may be limiting.25
Several scholars explained that blended learning is beyond
the media used to deliver learning activities. On the one hand,
blended learning can be understood as a combination of web-
based technologies, pedagogical approaches, and instructional
technologies, either with face-to-face instructor-led training
or with actual job tasks.26 is conceptualization suggests
that blended learning can be done by chunking learning
programs into modules to determine the best platform for
various learning activities.27 Other scholars, on the other
hand, suggest that blended learning centers on the intended
focus of learning, which can be competency-, attitude-, or
skills-driven.28 is conceptualization of blended learning
posits pedagogy, learning, and resources as if they were the
same type. ese two conceptualizations suggest that blended
learning can consist of almost anything, thus making the
discussion more complicated.
While the conceptual debates on blended learning appear
to be convoluted—which may cause scholars to abandon the
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A Blended Learning Course on eHealth-enabled Newborn Hearing Screening

term entirely—Oliver and Trigwell, in 2005, suggested that
rather than focusing on the “blended” component of blended
learning, we should underscore the “learning” component
instead.25 Emphasizing the learning component brings the
learning theories to the center, serving as a basis for blended
learning. Of relevance is the variation theory of learning,
which posits that variation must be experienced by the learner
for the learning to occur. Experiencing variation is essential
for discernment to occur. Discernment is described, in simple
terms, as experiencing an aspect of the world against previous
experiences, which are more or less dierent.29 Learning
occurs through the discernment of the critical elements of
various backgrounds. Against this backdrop, Oliver and
Trigwell argued that using ICTs, along with other traditional
learning approaches, makes it easier for learners to experience
variations in learning specic topics.25 ey stressed further
that the crucial aspect of blended learning is not the blend of
media but rather “the attempt to help the students experience
the critical patterns of variation in topics” through dierent
media and learning activities.
The Hearing for Life (HeLe) Project: Increasing the
Rates of Newborn Hearing Screening with Novel
Technologies and Telehealth
A blended learning course was designed and developed
as part of the Hearing for Life (HeLe) project, which seeks
to increase newborn hearing screening rates in selected
rural health facilities in the Philippines.30 e HeLe is led
by the University of the Philippines (UP), in collaboration
with the University of California, under the Commission on
Higher Education (CHED)-Philippine California Advanced
Research Institute (PCARI).
HeLe was proposed to support the Republic Act (RA)
9709 or the Universal Newborn Hearing Screening and
Intervention Act of 2009. e National Newborn Hearing
Screening Reference Center (NHSRC), based at the UP
Manila National Institutes of Health, is deputized by and
with the Department of Health (DOH), certies personnel
and their facilities to be ocial service providers for newborn
hearing screening and intervention. While RA 9709 was
enacted years before, reach among Filipino newborns
is limited and implemented mostly in large (private or
government regional) hospitals or smaller private facilities
in the city or provincial centers that can purchase imported
hearing screening devices. Vendors of these devices train
health personnel in the use of their hearing screening devices.
Prior to the HeLe implementation, data from NHSRC
showed that there were 309 facilities certied to oer
newborn hearing screening and intervention—of which none
is a government rural health unit (RHU). To fully universalize
newborn hearing screening in the Philippines, we advance the
need to reach the rural areas, considering the current fertility
rate in the country. While national fertility data from 1993
to 2022 suggests a decreasing trend (4.1 children per woman
in 1993 vis-à-vis 1.9 children per woman in 2022), the
disaggregated data reveals that women in the rural areas have
higher birth rates (2.2 children per woman) than those in the
urban centers (1.7 children per women).31 Among others,
HeLe sought to further capacitate primary care facilities in
rural areas (i.e., RHUs and/or lying-in clinics) to scale up
the coverage of newborn hearing screening services even in
hard-to-reach and isolated areas of the country.
HeLe developed novel technologies: a standards-based
hearing screening device that is seamlessly linked to an
electronic medical record and telehealth technologies. e
project sought to demonstrate that government primary care
health centers can become NHSRC Category A Newborn
Hearing Screening Centers (i.e., centers that can provide
hearing screening and could also provide for the preventive
aspect of hearing impairment).32 Consistent with the spirit
of the law, these community centers are within the locale
where mothers and their newborns reside. Once adequately
equipped with trained sta and the correct equipment, these
readily accessible centers will encourage early screening
of more newborns. e HeLe project aims to address both
requirements of a Category A Newborn Hearing Center.
With the explosion of new knowledge, the health system
is strained anew with twin responsibilities of care delivery and
the need for health sta to be updated with new information
and new processes in care delivery. e health professionals
are often pulled out of these primary care health centers
to attend training programs held in centralized locations;
services are thus sacriced. Hence, a blended learning strategy
was proposed to deliver needed cognates and maximize the
limited face-to-face events to sessions meant specically for
skill-building on innovative solutions for newborn hearing
screening.
METHODS
e training component of the HeLe project centered
on conceptual and practical discussions on using newborn
hearing screening devices and how eHealth can strengthen
the newborn hearing screening service in local health
settings. Hence, in designing the course, we built on the
training programs (Table 1) oered by the NHSRC33 and
the National Telehealth Center (NTHC)34, both of which
are under the National Institutes of Health, the University
of the Philippines Manila (UP Manila). As mentioned, the
NHSRC was established through the Philippine Republic
Act 9709 and is the lead agency in training healthcare
providers on newborn hearing screening34.
We combined the topics listed in Table 1 to develop a
training program that may allow learners to experience varied
learning activities, adopting principles of andragogy. We
designed the blended learning course following the theoretical
perspectives of the variation theory of learning, and Bloom’s
revised taxonomy of educational objectives, to guide the
selection of appropriate delivery methods and sequencing of
learning activities (i.e., the blend of the learning activities).
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A Blended Learning Course on eHealth-enabled Newborn Hearing Screening

Anderson et al. extended Bloom’s original one dimension of
educational objectives taxonomy into two distinct dimensions:
the knowledge and cognitive process dimension.20 e
knowledge dimension classies the subject matter content,
while the cognitive process dimension categorizes what is to
be done with or to the subject matter content. On the one
hand, the revised knowledge dimension consists of four major
categories: factual, conceptual, procedural, and metacognitive.
On the other hand, the cognitive process dimension includes
remembering, understanding, applying, analyzing, evaluating,
and creating. Discussing the background in the revision
of Bloom’s taxonomy is beyond the scope of this article.
Nonetheless, the revision highlighted the distinction between
the nature of the subject matter and the active cognitive
processes involved in facilitating learning.
By subscribing to the revised Bloom’s taxonomy, the
design of the blended learning course was sequenced to
engage learners’ lower- and higher-order thinking skills.
Table 2 details the dierent objectives of each component of
the blended learning course. We then plotted these objectives
against a two-dimensional taxonomy table to demonstrate
where the objectives are placed in the intersection of
knowledge and cognitive process dimension. Education
scholars35-37 utilized this taxonomy table to enable the design
of appropriate assessment, instruction, and evaluation methods
in relation to certain knowledge types and required cognitive
processes of the subject matter content. As seen in Table 3, the
objectives of the three components of the blended learning
course covered lower- to higher-order thinking skills and
factual to metacognitive types of knowledge. Computer-based
training (CBT) focuses on remembering and understanding
factual and conceptual knowledge. e basic concepts about
the project (Obj. 1.1), newborn hearing screening (Obj.
1.2), and eHealth (Obj. 1.3–1.5) are reviewed during the
computer-based training so that the face-to-face (FTF)
training can focus on developing the skills of the learners
in using the HeLe technologies (Obj. 2.3–2.7), in analyzing
ethical and legal issues (Obj. 2.2), in interpreting readings of
HeLe device (Obj. 2.4), and in formulating plans for project
implementation (Obj. 2.8). Also, the learners review the
subject matter content discussed during the computer-based
training (Obj. 2.1) to facilitate the transition to face-to-face
training. To complete the learning activities, the trainers of
the blended learning course conduct on-site visits to health
facilities, among others, to ensure continued use of HeLe
technologies (Obj. 3.1), and to assist in the implementation
and revisions of the project implementation plan (Obj. 3.2).
We designed the instructional methods and evaluation
tools based on the educational objectives per component of
the blended learning course (Table 4). e lectures in the CBT
program are delivered online via Moodle technology, where
the learners are enrolled and engaged remotely. Each module
has a unit examination that the learners must complete before
moving to the next unit or module. A pre-test and a post-
test were administered to assess learners’ improvements in
Table 1. Topics under Newborn Hearing Screening and
Telehealth Training
Newborn Hearing Screening Training
1. Introducon to Republic Act 9709, Universal Newborn Hearing
Screening and Intervenon Act of 2009
2. Hearing Screening and Diagnosc Modalies in Determining
Hearing Loss in Infants
3. Available Intervenons for Hearing Loss in the Philippines
4. Newborn Hearing Screening Using Otoacousc Emissions (OAE)
5. Newborn Hearing Screening Using Automated Auditory
Brainstem Response (AABR)
6. Reporng and Registry
Telehealth Training
1. The Ethical-legal aspects of eHealth in the Philippines
2. Using an Electronic Medical Record: Community Health
Informaon Tracking System (CHITS)
3. Telemedicine and the Naonal Telehealth Service Program
4. Basic Computer Literacy and Troubleshoong
Table 2. Objecves of the Dierent Components of Newborn
Hearing Screening Blended Learning Course
1. Computer-Based Training (CBT)
1.1. Recognize the historical background and importance of
newborn hearing screening in the Philippines
1.2. Recognize and classify methods in newborn hearing
screening
1.3. Recognize and interpret relevant ethical and legal principles
in the pracce of eHealth in the Philippines
1.4. Recall and explain the use of the electronic medical record
Community Health Informaon Tracking System (CHITS)
and telehealth plaorm Naonal Telehealth System (NTS)
as supporng tools for newborn hearing screening services
1.5. Recall and summarize how to use CHITS, NTS, and HeLe
Device.
2. Face-to-Face Training (FTF Training)
2.1. Explain the basic concepts of newborn hearing screening,
the Universal Newborn Hearing Screening and Intervenon
Act, and the Hearing for Life (HeLe) Project
2.2. Analyze and crique case studies regarding the applicaon
of eHealth using relevant ethical and legal guidelines in the
pracce of eHealth and telemedicine
2.3. Use HeLe Device
2.4. Dierenate and evaluate the results of the newborn
hearing screening device (HeLe Device) against pass criteria
2.5. Use the Community Health Informaon Tracking System
(CHITS) to maintain records of newborns for hearing
screening
2.6. Use the tele-audiology module of the Naonal Telehealth
System (NTS)-Telemedicine in referring newborns to a
higher category facility
2.7. Demonstrate ability to troubleshoot potenal technology
problems; dierenate well-funconing HeLe technologies
(HeLe Device, CHITS, NTS) against malfunconing ones; and
evaluate the technical status of HeLe technologies
2.8. Formulate a HeLe Project implementaon plan for each
health facility by organizing available resources and checking
their potenal feasibility
3. On-Site Coaching
3.1. Use HeLe technologies in newborn hearing screening
3.2. Organize the workow to accommodate newborn hearing
screening service; check the appropriateness or feasibility of
the project implementaon plan; and generate dra policies
and procedures based on the project implementaon plan.
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their knowledge and understanding of the basic concepts of
newborn hearing screening and eHealth. For face-to-face
training, we utilized dierent participatory instructional
techniques to emphasize the application of what was learned
during the CBT. In addition to traditional lectures that aim
to reinforce what was learned in the CBT component, we
used small group discussions to encourage analysis of eHealth
ethics cases and the development of a project implementation
plan. Demonstration and return demonstration were also used
to teach and evaluate skills using HeLe technologies. Lastly,
the trainers visited the health facilities in the on-site coaching
sessions. ey encouraged the learners to use the HeLe
technologies in their practice in the community to build their
capacities further. is stage of the blended learning course
focuses on assisting the learners in implementing the project
in the health facility. Hence, several debrieng sessions and
focus group discussions were facilitated.
Following Kirkpatrick's evaluation model, we used
qualitative and quantitative evaluation methods to get
feedback on the training program. In this article, we
presented the Level 1 Kirkpatrick training evaluation
results—Participant’s Reaction.38 For Level 1, we measured
participants’ reactions to the training course and methods,
its relevance to their practice, and their satisfaction with the
program using self-administered questionnaires and post-
training interviews.
Ethical Consideraons
Ethical approval was obtained from the University of
the Philippines Manila Research Ethics Board before its
implementation.
RESULTS
We conducted a pilot of the blended-learning course
on newborn hearing screening (NHS) and telehealth among
31 community healthcare providers from ve rural health
units and a private hearing screening center. Most of the
participants were midwives (13, 41.9%), followed by doctors
(8, 25.8%), nurses (8, 25.8%), and medical technologists (2,
6.5%). Twenty-three (74.2%) were female, and 8 (25.8%) were
male. e mean age of the participants was 42.2 ± 12.0 years.
e results of the rst-level Kirkpatrick evaluation
indicated that 29 of the 31 participants (93.5%) declared that
the program content met the stated objectives and their needs,
and that the course length was adequate. On a scale of 1 to
10, with ten being the highest, overall satisfaction with the
program was rated at 8.5 ± 0.9. Most participants expressed
satisfaction with the CBT and FTF course at 93.5% and
100%, respectively. All participants agreed that the course
enhanced their knowledge of NHS and telehealth. 93.5% (29
of 31) participants declared that the blended training program
provided content relevant to their practice.
Based on the post-training surveys, 54.8% (17 of 31) of
the participants stated that computer-based training was at
least of the same quality as face-to-face training. Participants
said CBT and FTF training increased their condence in
performing NHS. 67.7% (21 of 31) reported feeling condent
they could perform NHS after the CBT. 51.6% (16 of 31)
believed that they could conduct NHS and use the HeLe
systems (i.e., documentation using electronic medical record
and referral via the electronic referral system) after CBT.
Although more than half of the participants reported that
Table 3. Taxonomy Table of the Blended-Learning Course’s Objecves
Remember Understand Apply Analyze Evaluate Create
Factual Knowledge Objecves 1.1,
1.2, 1.3, 1.4, 1.5
Conceptual Knowledge Objecves 1.2,
1.3, 1.4, 1.5, 2.1
Objecve 2.2 Objecve 2.2
Procedural Knowledge Objecves 2.3,
2.5, 2.6, 2.7, 3.1
Objecves 2.4,
2.7
Objecves 2.4,
2.7
Metacognive Knowledge Objecves 2.8,
3.2
Objecves 2.8,
3.2
Objecves 2.8,
3.2
First row: Cognive Process Dimension; First Column: Knowledge Dimension. Refer to Table 2 for the list of objecves
Table 4. Instruconal Methods and Evaluaon Strategies for the Components of the Blended Learning
Objecves* Instruconal Methods Evaluaon Strategies
Computer-Based Training 1.1–1.5 Lecture Wrien examinaon (Pre-test, Post-test, Unit quiz)
Face-to-Face Training 2.1 Lecture Wrien examinaon (Pre-test, Post-test)
2.2 Lecture and small group discussion Case study analysis
2.3–2.7 Lecture and skills demonstraon Skills return demonstraon
2.8 Small group discussion Creaon of project implementaon plan
On-Site Coaching 3.1–3.2 Coaching Debrieng and focus group discussion
Refer to Table 2 for the list of objecves
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CBT increased their condence and ability to do NHS,
the majority (16, 51.6%) noted that there is still a need for
face-to-face training, especially practicum and/or return
demonstration, to gain or improve NHS-related skills. After
the face-to-face training sessions, 30 (96.8%) participants
declared that they could successfully enroll and document the
NHS in CHITS, while 29 (93.5%) believed that they could
successfully refer a patient using the HeLe referral system.
Twenty-eight of the 31 participants (90.3%) believed that
they could demonstrate proper use of the hearing screening
device after FTF training.
Participants of the course reported that completing the
CBT before the FTF training made the lecture and skills
demonstration during the FTF course easier to understand.
CBT was considered a practical preparatory course before the
FTF training sessions. Participants reported that CBT could
reduce the training time, especially on theoretical aspects of
learning. However, F TF training sessions were perceived
as crucial to learning the skills for conducting the hearing
screening. Participants were also appreciative of the on-site
coaching provided. ey reported that on-site coaching
allowed them to see what aspects or skills need to be improved
after handling patients. Participating municipal health ocers
also expressed satisfaction with on-site coaching as it provided
opportunities to ask questions and guidance on implementing
and integrating NHS in their clinic workow successfully.
DISCUSSION
We crafted this three-component, blended learning
course to enable community healthcare workers to experience
variations in learning experiences. ese variations are
considered valuable in building learners’ proper knowledge
and skills in using eHealth-enabled tools in newborn hearing
screening. A critical aspect of the course we developed is the
computer-based training portion, apart from the traditional
face-to-face training and on-site coaching sessions, which
enabled us to alter the traditional educational paradigm.
Scholars observed that using ICTs promotes new forms of
teaching and learning, which may produce new forms of
relations, behaviors, and ways of thinking.39 In some studies,
the use of such tools in teaching and learning seems to occur
rather slowly in educational programs that use face-to-face
teaching exclusively, like nursing.40 Yet, we regard the use
of blended learning courses as an opportune move, utilizing
technological and pedagogical advances in education. ICTs
are being used in lower-middle income countries like the
Philippines for continuing education of healthcare workers,
along with its clinical services provision.41 is is true despite
the costs and logistical barriers imposed by traditional face-
to-face learning, especially for those in far-ung areas.42
Using technologies, we shortened the duration of face-to-face
training since the computer-based training already covered
the fundamental concepts of the course content. In eect,
we were able to allocate much of the learning activities of
the face-to-face training toward skills development. Despite
favorable results in the use of online learning43, the learners
still see it as a complement to traditional face-to-face learning
and not an alternative 44-48.
Given the nature of the topics covered, we view our
blended learning course as suitable to address our educational
objectives. We rst considered using a purely computer-
based learning mode for the training to further increase the
reach of our course, even to those in the remote areas of the
country.49,50 However, given the infrastructural challenges in
the Philippines, which limits the use of ICTs for health51, w e
did not pursue this plan and instead explored the possibility
of combining online and traditional teaching approaches.
Nevertheless, we consider this development as an open case—
whether or not our design is feasible for the HeLe Project
and perhaps can be adapted to other technology-based health
projects. Bringing computer-based training even to remote
areas of the Philippines may be challenging, yet we argue that
it is doable.
Adding technologies to the traditional educational
paradigm holds great potential for advancing improved
teaching and learning experience. In developed countries,
for instance, sophisticated virtual simulations, in both
asynchronous and synchronous modes, oered promising
prospects for continuing education of health professionals.52,53
e challenge of subscribing to high-delity e-learning
materials is that it requires a larger bandwidth to work
eectively46, which in the Philippines remains a concern54.
Regardless of the nature of technological innovation in health
professions education, however, we underscore that coherent
educational planning is vital in applying technological
resources in view of the intended educational goals.
CONCLUSION
Competent community healthcare providers are critical
to strengthening the performance of the health system,
and advances in the education and technology sectors oer
promising potential in upskilling local healthcare providers.
HeLe demonstrated how a blended-learning design can
be used to deliver new knowledge and skills to healthcare
sta and to provide training to a wider audience through its
computer-based learning module. e increasing access of
Filipino healthcare providers to improved ICT is a signicant
catalyst for pedagogical innovation, like the use of blended
learning in the continuous professional development of health
practitioners. As ICTs gradually penetrate the health sector,
the challenge we now face is not whether but how we can
use innovations in education strategies to benet healthcare
providers.
Statement of Authorship
All authors certied fulllment of ICMJE authorship
criteria.
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A Blended Learning Course on eHealth-enabled Newborn Hearing Screening

Author Disclosure
All authors declared no conicts of interest.
e study on which this report was based was undertaken
with the nancial and administrative support of the
Commission on Higher Education, Philippine-California
Advanced Research Institutes, and the National Institutes of
Health, University of the Philippines Manila. ese, however,
did not have any inuence on the content of this report.
Funding Source
is research was funded by the Commission on Higher
Education, Philippine-California Advanced Research
Institutes.
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