RADIC Educational Handbook - 5. Good pedagogical practices

a person in front of the whiteboard

The aim is to provide teachers with strategies and methods to teach the principles and applications of Digital Rehabilitation to students and healthcare professionals. By offering practical, real-world examples, this chapter aims to provide an idea of Digital Rehabilitation education and ultimately contribute to better healthcare delivery in the region. 

These examples are tailored to the unique educational and healthcare landscapes of East African countries, providing relevant and adaptable solutions that address local challenges and opportunities. This chapter aims not only to inform, but also to inspire and empower teachers to provide training that prepares healthcare professionals to use Digital Rehabilitation technologies in their practice.
The examples are either a learning activity or an entire course design and include information about the teaching approach, the learning plan and ideas for assessments. 

5.1 Good practice example 1

Designing a community based Digital Rehabilitation program to improve access and affordability of rehabilitation services: A learning activity for undergraduate physiotherapy learners - an example from Kenya. 

Context:

  • The activity described below is embedded in the course "Community based Rehabilitation" (CBR) and is conducted in the third year of the bachelor of physiotherapy program at MOI University in Kenya. The course is worth a total of six credits. The course lasts six weeks.
  • The competences that are targeted in the course are the following:
    • Clinical and technical skills in CBR
    • Digital literacy and technology proficiency
    • Community engagement and advocacy
    • Interdisciplinary collaboration

Aim of the learning activity: 

  • Develop a digital community-based rehabilitation program to improve accessibility and affordability of rehabilitation services.

Learning outcome for the learning activity: 

  • The learner will demonstrate the ability to design and develop a Digital Rehabilitation program that effectively enhances the accessibility and affordability of rehabilitation services in the community. This includes the application of relevant technological solutions, understanding user needs, and evaluating the programs impact on diverse populations in Kenya.

Detailed breakdown of the learning outcome

Technical proficiency:

  • The learner will be able to utilize appropriate digital tools and technologies to create a functional rehabilitation program.
  • The learner will demonstrate skills in integration of digital health solutions.

Project management:

  • The learner will plan the implementation of the Digital Rehabilitation program, including project management, resource allocation, and timeline management.
  • The learner will demonstrate the ability to collaborate with stakeholders, such as healthcare professionals and clients.

Evaluation and improvement:

  • The learner will collect and analyze data to evaluate the program impact on accessibility, affordability, and patient outcomes.

Ethical and social considerations:

  • The learner will understand and address ethical issues related to digital health interventions, such as client privacy, data security, and equitable access.
  • The learner will demonstrate awareness of social determinants of health and strive to reduce health disparities through their program.

Learning prerequisites:

  • Knowledge to assess rehabilitation needs. 
  • Knowledge of different rehabilitation concepts, including Digital Rehabilitation and community-based rehabilitation and their benefits and challenges. 
  • Ability to measure the factors for successful rehabilitation services and the impact on all stakeholders. 
  • Knowledge of digital tools and technologies that can be used for different rehabilitation purposes (including supporting accessibility and affordability). 

Teaching method

Community engagement and service learning:

  • Collaborating with local healthcare facilities, NGOs, and community organizations to provide learners with opportunities to interact with real users and stakeholders.
  • Learners can gather insights, validate their solutions, and understand the local context better.
  • See for the community-based and service-learning method section 4.2.5.

Project-based learning (PBL):

  • Learners engage in a real-world project that involve developing a Digital Rehabilitation program.
  • Learners can work in teams to address specific challenges related to accessibility, affordability, and effectiveness in Kenyan healthcare settings.
  • For more information about the project-based learning method see Almulla (2020): https://journals.sagepub.com/doi/full/10.1177/2158244020938702

Learning plan:

Week 1:

  • Online software demos: Arrange demos of Digital Rehabilitation tools and software platforms, allowing learners to explore features and functionalities relevant to improving accessibility, and affordability of rehabilitation services.
  • Below are some examples of digital tools that can be introduced at this stage. The following examples show technologies that can be used in the community. Technologies should be used in the community that facilitate access to rehabilitation and can be used with limited resources. The use of technologies often depends on the availability of the internet or hardware (tablets, smartphones). This is why low-tech solutions such as apps or text-messaging tools are often used in resource restraint areas. More digital technologies, the advantages of those technologies for this context, and the resources required to use the individual solutions can be found in the handbook “Digital Rehabilitation in Health Care for East African countries” in chapter 6: https://www.jamk.fi/en/project/radic/radic-handbook-6-technologies. 
     
  • Mobile Apps:
    • Tools: Physitrack, Kaia Health, etc.
    • Purpose: To provide learners with insights into remote app-based rehabilitation programs for chronic pain, musculoskeletal pain, and mental health. Students can explore app features like exercise programs, progress tracking, and client education. Mobile applications are highly effective for rehabilitation in underserved areas like East Africa due to their widespread accessibility, cost-effectiveness, and ability to provide remote monitoring, personalized care, and educational content. These apps leverage mobile technology to deliver scalable and culturally adaptable healthcare services, improving health outcomes and empowering patients.
       
  • Text messaging:
    • Tools: SMS, WhatsApp, etc.
    • Purpose: To provide the learners the insights that text messaging can be used as a therapy reminder to improve therapy adherence, as a motivator to promote physical activity, as a digital supported intervention, and as client education on the knowledge of diseases. Text- messaging technologies are powerful tools in rural areas, because it does not require always an internet connection. In addition, participants text-messaging is less dependent on literacy and therefore accessible and usable by more people.
       
  • Videoconferencing:
    • Tools: Zoom, Microsoft Teams, etc. 
    • Purpose: To demonstrate remote client monitoring and virtual consultations, showcasing how telehealth can improve access to rehabilitation services, especially in underserved areas.

Week 2: 

  • Virtual field trip: Take a virtual tour of successful community-based rehabilitation programs around the world, allowing learners to interact with program coordinators and beneficiaries.

Week 3:

  • Case-based learning: Present real-life case studies of individuals with disabilities and ask learners to discuss and propose appropriate rehabilitative interventions.

Week 4:

  • Online software demos: Arrange demos of Digital Rehabilitation tools and software platforms, allowing learners to explore features and functionalities relevant to improving accessibility, affordability, and effectiveness of rehabilitation services.
  • Continuation and consolidation of week 1 or introduction of new technologies. In a deepening, the learners should not only try out the technologies, but also try to use them in a community-based rehabilitation situation.

Week 5:

  • Group project: Task learner groups with developing a proposal for a Digital Rehabilitation program, including considerations for accessibility and affordability, and present their proposals to the class.

Week 6:

  • Virtual community engagement: Organize virtual meetings or interviews with stakeholders from communities to discuss their experiences and challenges related to access rehabilitation services.
  • Case study analysis: Present case studies of successful community-based rehabilitation projects and facilitate discussions on the strategies and approaches used to overcome challenges and improve access to services (Comprehensive Community Based Rehabilitation Tanzania (CCBRT)).

Assessment:

For this course, formative assessments are appropriate to evaluate the skills and knowledge for the following reasons:

Continuous Feedback: Formative assessments provide ongoing feedback, allowing students to continually refine their understanding and skills as they develop their Digital Rehabilitation programs.
Real-Time Adaptation: These assessments help instructors identify areas where students are struggling and adjust their teaching methods or provide additional resources promptly, ensuring that learning objectives are met throughout the course.

Skill Development: Formative assessments emphasize the development of practical skills and critical thinking necessary for designing effective rehabilitation programs, rather than solely focusing on theoretical knowledge.

Contextual Learning: In a course with a specific regional focus, such as Kenya, formative assessments can be tailored to the local context, allowing students to address real-world challenges and apply their learning in meaningful ways.

Collaborative Learning: These assessments can facilitate peer collaboration and discussions, fostering a community of practice among students that mirrors the collaborative nature of community-based rehabilitation programs.

Iterative Improvement: Formative assessments encourage an iterative learning process, where students can test, receive feedback, and improve their Digital Rehabilitation designs, leading to more robust and effective final projects.

To assess the skills in this module you can use the following formative assessments: 

  • Case study analysis   
  • Case study application
  • Case study reflection 
  • Project proposal 

5.2 Good practice example 2

An introduction to “Digital Health” in undergraduate studies – a course example from Rwanda. 

Context: 

  • The course “Digital Health” is included in the bachelor of “Medicine”. The course contains of 5 credit points and takes place at the “University of Global Health Equity” in Rwanda. 
  • Digital Health is a comprehensive term that encompasses the utilization of digital technologies for patient communication and the evaluation of physical conditions and diseases. It stems from the broader concept of electronic health (eHealth), which acknowledges the application of information and communications technology to address healthcare needs and support health systems. 
  • The competences that are targeted in the course are: 
    • Proficiency with digital health tools
    • Health informatics skills
    • Ethical and legal competencies
    • Analytical and problem-solving competencies
    • Communication competencies

Learning outcome of the course Digital Health: 

  • Describe the key components of the Digital Health
  • Describe technologies and their application in Digital Rehabilitation
  • Understand how to create/deliver/evaluate digital health technology solution
  • Understand the concepts of data privacy
  • Implement Digital Rehabilitation technologies

Learning prerequisites:

  • Basic knowledge of rehabilitation practices
  • Understanding of traditional rehabilitation practices.
  • Familiarity with current digital technologies used in healthcare, such as electronic health records (EHRs), telemedicine, wearable devices, and mobile health apps.
  • Ability to conduct thorough assessments to identify client needs, capabilities, and limitations, which are critical for tailoring rehabilitation efforts.
  • Effective communication is crucial for working with interprofessional teams and for solving problems that arise during Digital Rehabilitation processes.
  • Ability to analyze situations, identify problems, and devise effective solutions, especially when integrating new technologies into traditional practices.

Learning plan:

Week 0:

  • Pre-Course readings: Canvas LMS orientation

Week 1 -2:

  • Introduction to Digital Health. Here are the main components that could be included: 

    Definition and scope of Digital Health

    • What is Digital Health?: Overview of digital health, including its definition and various subfields such as telemedicine, mobile health (mHealth), health informatics, and wearable technologies.
    • Scope and Importance: Explanation of the scope of digital health, its significance in modern healthcare, and its potential to transform healthcare delivery and outcomes.

    Technological foundations

    • Data management: Introduction to data collection, storage, and management in digital health, including the importance of data security and privacy.

    Applications of Digital Health

    • Telemedicine: Use of telecommunications technology to provide clinical health care at a distance.
    • Mobile Health (mHealth): Health practices supported by mobile devices such as smartphones and tablets.
    • Wearable devices: Technologies that monitor and record data related to personal health and fitness.
    • Health informatics: Integration of healthcare sciences, computer science, information science, and cognitive science to assist in the management of healthcare information.

    Benefits of Digital Health

    • Improving access: How digital health technologies enhance access to healthcare services, especially in remote and underserved areas.
    • Cost-effectiveness: Discussion on how digital health can reduce healthcare costs for both providers and patients.
    • Quality of care: How digital health can improve the quality of care through better diagnostics, personalized treatment plans, and continuous monitoring.

    Challenges and barriers

    • Technological challenges: Issues related to the integration and interoperability of digital health systems.
    • Regulatory and ethical issues: Legal and ethical considerations in the implementation of digital health technologies, including data privacy, security, and regulatory compliance.
    • Adoption barriers: Barriers to the adoption of digital health technologies by healthcare providers and patients, such as resistance to change, lack of digital literacy, and infrastructure limitations.

Week 3 - 4: 

  • Digital determinants of health and data system management. The content focuses on understanding how digital tools and systems influence health outcomes and the effective management of health data. Here are the main components that could be included:

    Introduction to digital determinants of health

    • Definition and scope: Explanation of digital determinants of health, which are factors related to digital technologies and systems that impact health outcomes.
    • Components: Overview of various digital determinants including access to technology, digital literacy, and online health information.

    Role of digital technologies in health determinants

    • Health literacy: The role of digital platforms in improving or hindering health literacy and education.
    • Social determinants: Interaction between digital health technologies and broader social determinants of health such as socioeconomic status, education, and geographic location.

    Data collection and management

    • Data collection methods: Techniques and tools for collecting health data (e.g., surveys, sensors, patient portals).
    • Data quality and accuracy: Ensuring data integrity, accuracy, and reliability in digital health systems.
    • Data storage and security: Best practices for storing health data securely and ensuring patient privacy.

    Data analysis and utilization

    • Decision support systems: Use of data to support clinical and administrative decision-making processes.

    Impact of digital determinants on health equity

    • Equity and access: Exploring how digital health tools can either bridge or widen health disparities.
    • Strategies for equity: Approaches to ensuring equitable access to digital health resources for underserved populations.

Week 5 - 6:

  • Implementation and evaluation of Digital Health technologies solutions. The module should provide a thorough overview of the processes involved in deploying and assessing digital health technologies:

    Implementation strategies for Digital Health technologies

    • Planning and preparation:
      • Needs assessment: Creating a plan how to identify and analyze the needs of the target population.
      • Stakeholder engagement: Plan how to involve stakeholders, including healthcare providers, patients, and policy makers, in the planning process.
    • Technology selection:
      • Criteria for selection: Factors to consider when selecting digital health technologies (e.g., usability, integration with existing systems).
    • Deployment:
      • Pilot testing: Conducting pilot studies to test the technology in a controlled setting before full-scale deployment.
      • Scaling up: Strategies for expanding the technology to broader populations once the pilot phase is successful.

    Evaluation of Digital Health technologies

    • Evaluation frameworks:
      • Models and frameworks: Overview of common models and frameworks for evaluating digital health technologies (e.g., Kirkpatrick Model, RE-AIM framework).
    • Outcome measures:
      • Effectiveness: Assessing the impact of the technology on health outcomes, such as improved patient care or reduced costs.
      • User satisfaction: Measuring user satisfaction and experience with the technology.
      • Cost-effectiveness: Evaluating the cost versus benefits of the technology to determine its economic impact.
    • Data collection methods:
      • Quantitative methods: Use of surveys, tests, and metrics to gather numerical data on technology performance.
      • Qualitative methods: Interviews, focus groups, and observations to gain insights into user experiences and challenges.
    • Performance metrics:
      • Key performance indicators (KPIs): Identifying and tracking KPIs relevant to the technology’s goals (e.g., adoption rates, engagement levels).

    Learning activity after week 6 and assessment: 

    • Mapping of rehabilitation needs in the community:
      • Proposal: Clarity, scope, and feasibility of the project.
      • Literature Review: Depth of research and understanding of existing methodologies.
      • Survey design: Relevance and clarity of survey questions.
      • Data analysis: Accuracy and insightfulness of the preliminary analysis.
      • Final report: Comprehensive coverage of all components, clarity, and coherence.
      • Presentation: Effectiveness in communicating findings, engagement with the audience, and use of visuals.
      • This assignment provides a holistic approach to understanding and mapping rehabilitation needs, incorporating research, data collection, and, analysis. It prepares students for real-world public health planning and interventions.
      • Individual contribution: Each group will need to create a web page presentation mapping data including the Digital Rehabilitation needs of specific people (Sex, Age, MET+UNMET) from any community.


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