Research Article: Comparing the effectiveness of a hybrid and in-person courses of wheelchair service provision knowledge: A controlled quasi-experimental study in India and Mexico

Date Published: May 31, 2019

Publisher: Public Library of Science

Author(s): Yohali Burrola-Mendez, Francisco J. Bonilla-Escobar, Mary Goldberg, Jon Pearlman, Stefano Federici.


Evidence highlights a global shortage of wheelchair service provision education and training that results in inappropriate wheelchair provision with associated health and economic consequences. Two learning methodologies, a hybrid and an in-person course, based on the World Health Organization Wheelchair Service Training Package Basic Level, currently are available to train wheelchair service providers worldwide. The effectiveness of the in-person methodology, used as the standard of practice, has never been tested. Meanwhile, the Hybrid Course, which combines online and in-person training, was developed to reduce training costs and to scale training interventions and has shown potential effectiveness in increasing basic level wheelchair service provision knowledge. The objective of this study was to compare the effectiveness of both learning methodologies based on knowledge and satisfaction among a group of wheelchair service providers in India and Mexico.

We conducted a controlled quasi-experimental study to evaluate changes in basic wheelchair knowledge and levels of satisfaction between Hybrid and In-person course learners in India and Mexico. A convenience sampling method guided by local stakeholders’ input was used to recruit participants. Outcomes were assessed using self-administered online surveys, the International Society of Wheelchair Professionals Wheelchair Service Provision Basic Test (primary outcome) completed pre- and post- the learning intervention and an anonymous Satisfaction Survey (secondary outcome) completed post- intervention. Baseline characteristics were compared among groups using hypothesis tests based on their assumptions. The primary analysis was intention-to-treat. To address missing values and lost to follow-up, multiple chained imputations were conducted. The primary outcome was analyzed using linear mixed models. The secondary outcome was analyzed using a two-tailed two independent samples t-test.

A total of 81 participants, 43 (53.1%) in the In-person group and 38 (46.9%) in the Hybrid group, participated in the study. Mean baseline knowledge scores were below the passing cutoff of the test (53 points) in both groups. Both study groups experienced statistically significant improvements in the primary outcome when comparing pre- and post-test scores (p<0.0001) with total mean scores above the passing cutoff of the test. The in-person group experienced, on average, larger effects on the primary outcome. The difference in mean change from post-test to pre-tests between In-person groups and Hybrid was 3.6 (95% Confidence Interval: 1.7;5.4), Cohen’s d = 0.36, with a small effect size favoring the In-person training. With regards to satisfaction, the difference between the two interventions was 0.23±0.07 in favor of the In-person group (p = 0.0021). Both learning methodologies had a statistically significant effect in increasing wheelchair service knowledge with overall high levels of satisfaction. However, the In-person group reported overall larger effects when compared with the Hybrid methodology. This study provided recommendations on how organizations can improve blended learning interventions to enhance participants’ learning experiences and reduce potential barriers and limitations.

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The World Health Organization (WHO) estimates that only 5–15% of the 100 million people in the world who need a wheelchair for mobility and function have an appropriate wheelchair that meets their needs [1–3]. Inappropriate wheelchair provision impacts the life, safety, health, and other basic human rights of people with disabilities [2, 4–8]. In addition, when a wheelchair does not meet the wheelchair user’s needs, it may result in underutilization or abandonment [9, 10]. This situation may be more problematic in low- and middle-income countries (LMICs) where disability and poverty are interconnected, the incidence of disability is higher, people with disabilities often are marginalized, there is less availability of skilled health personnel, and there is a limited range of quality, affordable wheelchairs [1, 11–15].

This study was a quasi-experimental design with nonequivalent control groups conducted to evaluate changes in basic level wheelchair service knowledge with a group of wheelchair service providers in Bengaluru, India and Puebla, Mexico. In each setting, one of the groups was trained using the Hybrid Course (blended methodology), and the other followed the In-person training methodology. A post-assessment was used to evaluate levels of satisfaction after the educational interventions. The study was approved by the University of Pittsburgh Institutional Review Board.

Evidence highlights the global shortage of wheelchair service provision education and training that is related to inappropriate wheelchair provision. The results from this study suggest that both currently available learning methodologies, a hybrid and in-person course, are effective in increasing knowledge in basic level wheelchair service provision with overall high levels of satisfaction among participants.




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