Date Published: September 08, 2017
Author(s): Sara Munera, Mary Goldberg, Krithika Kandavel, Jonathan Pearlman.
In many countries, availability of basic training and continued professional development programmes in wheelchair services is limited. Therefore, many health professionals lack access to formal training opportunities and new approaches to improve wheelchair service provision. To address this need, the World Health Organization (WHO) developed the WHO Wheelchair Service Training of Trainers Programme (WSTPt), aiming to increase the number of trainers who are well prepared to deliver the WHO Wheelchair Service Training Packages. Despite these efforts, there was no recognised method to prepare trainers to facilitate these training programmes in a standardised manner.
To understand if the WSTPt is an effective mechanism to train aspiring wheelchair service provision trainers.
An action research study was conducted using a mixed-methods approach to data collection and analysis to integrate feedback from questionnaires and focus groups from three WHO WSTPt pilots.
Trainees were satisfied with the WHO WSTPt and the iterative process appears to have helped to improve each subsequent pilot and the final training package.
The WHO WSTPt is an effective mechanism to train wheelchair service provision trainers. This programme has potential to increase the number of trainees and may increase the number of qualified service providers.
As defined by Reason and Bradbury (2001):
As described above, the pilot trainings were held in Nairobi, Kenya, Cape Town, South Africa, and Bangkok, Thailand, and had an average of 5 trainers, 22 trainees and 6 observers to participate in each training. Table 2 shows the number of attendees at each training.
The results of this study were based on an independent evaluation of the WHO WSTPt and the ISWP Trainer Recognition Process. While the evaluators were collaborators of the stakeholder author group, they were not involved in the design of the WHO WSTPt materials or process. The evaluators provided feedback into the ISWP Trainer Recognition Process and TCA, but were not involved in completing any TCAs (the trainers completed these on behalf of the trainees). It is possible that because of the evaluators’ involvement in the ISWP Trainer Recognition Process and TCA, trainees may have felt slightly inhibited in sharing candid feedback through both surveys and focus groups.
In response to our research question, there is ample quantitative and qualitative evidence to suggest that the WHO WSTPt and its materials are an effective mechanism to train aspiring wheelchair service provision trainers in terms of both process and content. This is demonstrated through gains in trainee knowledge, skill and confidence.
This action research study resulted in several practical improvements to the WHO WSTPt but has several limitations including how data were collected, by whom the data were collected and generalisability of data. First, because of the incremental nature of the programme and evaluation approaches, data were not collected in a uniform way in terms of both data collection tools and subject groups, which may bias the interpretation of changes implemented between pilots. The data collection tools, along with the training content itself, were iteratively modified between pilots, making direct comparisons challenging. While trainee satisfaction surveys did not include names, one sheet was collected per trainee to ensure that feedback was obtained from each trainee (one sheet per trainee). Because of this, trainees may have been compelled to respond in a more favourable manner, knowing that while anonymity was encouraged, it may not have been guaranteed.
The iterative action research approach used to evaluate the WHO WSTPt demonstrated an improvement of the training programme content and process from one pilot to the next. The WHO WSTPt appears to be successful in increasing trainees’ knowledge, skills and confidence to deliver trainings prior to the trainees’ co-training experience. This standardised training package, by increasing the number of trainers conducting WHO WSTP worldwide, may assist in training wheelchair service providers uniformly and appropriately to ensure that wheelchair users are provided with high-quality service and products.
Future work will include how to improve the content of the WHO WSTPt, including exploring other training of trainers materials to identify different ways to improve engagement and peer interaction, relevance and value of ‘modelling’ good trainer techniques, as well as knowledge sharing tools and methods. Feedback from participants or trainers of other training of trainers programmes in healthcare may also provide helpful feedback, because they would have a basis of comparison that would not be possible for our population who is unlikely to have completed another training of trainer programme in any healthcare field.