The requirements of providing health education for rural people through electronic methods: the experiences and perspectives of community health workers | BMC Medical Education

Our findings with the Behvarzan were categorized into three main categories and ten subcategories, including (1) Technology (technical infrastructure, content production, content delivery methods, and content delivery channels). (2) Facilities and Equipment (communication equipment and electronic content repositories) 3. Stakeholders (training of providers, motivating providers, persuading learners and target groups, and reference groups).

The results reported in the first and second main categories are similar to the findings of the study by Kazemi et al. [26] ,which ranked the influential factors in developing e-learning as hardware and software infrastructure, social communications, and collaborative techniques, teaching content and educational materials, learner evaluation methods, educational fields, and finally, student recruitment methods. The supporting factors, content, and educational tools were reported as influential factors in the success of the e-learning and teaching system in the study by Jafari Yaghoobi et al. [27]. The technology factor was also emphasized for the successful implementation of the virtual education system by Hosein Dargahi et al. [28].

Arasti et al. [29] categorized the factors affecting the success of e-entrepreneurship education into three groups: individual factors (including instructor and student characteristics), systemic factors (including the quality of education and content, internet infrastructure quality, virtual education system quality, and university performance and services), and environmental factors (including interactions and evaluation). The content of the first two categories is similar to the main categories of stakeholders and facilities and equipment, but the environmental characteristics were not mentioned by Behvarzan. The studies highlight the importance of technology and infrastructure, including technical infrastructure, content production, content delivery methods, content delivery channels, hardware and software infrastructure, social communications, and collaborative techniques in e-learning and virtual education systems. Facilities and equipment, such as communication equipment and electronic content repositories, are also crucial, with systemic factors like the quality of education and content, internet infrastructure quality, virtual education system quality, and university performance and services playing a role in e-entrepreneurship education. Additionally, stakeholders, including training providers, motivating providers, persuading learners and target groups, and reference groups, are vital, along with individual factors like instructor and student characteristics. Environmental factors such as interactions and evaluation, are also critical in e-entrepreneurship education.

According to Behvarzan, in the technical infrastructure subcategory, unstable internet connectivity, poor cellular coverage, and the lack of a telephone line for virtual education were the critical barriers to implementing e-learning. From the perspective of the faculty members of Urmia University of Medical Sciences, the technical and support factor was also the most significant obstacle to the development of virtual education in the university. Therefore, by increasing internet speed, replacing outdated systems with new ones, and strengthening technological infrastructure, the inhibiting factors for using virtual education can be reduced [30]. Likewise, Gholamreza Shams et al. [31] referred to issues such as weaknesses in network communications, lack of technical support from the IT unit, and weakness in physical and hardware infrastructure as the infrastructure barriers in e-learning. These studies suggest that institutions and policymakers should prioritize investments in strengthening technical infrastructure to overcome the barriers to implementing e-learning and virtual education. This includes upgrading internet speed, replacing outdated systems, and providing adequate technical support from IT units to ensure seamless network communications and reliable physical and hardware infrastructure. By addressing these technical infrastructure challenges, institutions can reduce the inhibiting factors that hinder the adoption of virtual education, ultimately enhancing the quality and accessibility and improving the overall learning experience for students.

One critical requirement for implementing e-learning programs in HHs is access to reliable multimedia content, necessitating access to content creation programs and equipment. Some active participants in e-learning emphasized the importance of using various audio-visual media for content delivery. Using short messages accompanied by pictures and short videos was also highlighted by the participants as an influential approach. Additionally, there were references to the need for content banks so that all Behvarzan could use the available standardized content.

Taghi Panahi et al. [32]. referred to factors such as quality, awareness-raising, credibility, added value, expertise, motivation, entertainment, uniqueness, relevance, realism, timeliness, creativity, feasibility, shareability, and personalization as essential for the successful acceptance of content in the virtual space by users. Nobakht et al. [33] also mentioned content quality and accessibility as criteria for the quality of e-learning courses.

Regarding the content delivery (teaching) methods, the need for conciseness, gradual and appropriate presentation based on the audience’s level of knowledge, and the instructor’s proficiency were emphasized points. Thani et al. also referred to objectives, content, learning activities, teaching strategies, grouping, materials and resources, time, place, and evaluation as effective in the success of e-learning [34]. These studies suggest that developing and implementing effective e-learning programs in HHs requires considering multimedia content creation, delivery, and accessibility. Specifically, institutions should invest in content creation programs and equipment, utilize diverse audio-visual media, and develop content banks with standardized and high-quality materials. Additionally, content should be designed with user needs, incorporating credibility, motivation, entertainment, and personalization to ensure successful acceptance. Furthermore, instructors should employ concise and gradual teaching methods, tailoring content to the audience’s level of knowledge and utilizing effective teaching strategies, materials, and evaluation methods to ensure the success of e-learning programs. By prioritizing these aspects, HHs can create engaging and effective e-learning experiences that meet the needs of their users.

According to Behvarzan, the main content delivery channels during the COVID-19 pandemic were messaging apps and social media platforms, which seem to be the most suitable and accessible communication channels between healthcare providers and learners. However, using these channels requires the technological infrastructure and necessary software and hardware resources.

The lack of the ability for face-to-face interaction between the learner and the instructor and influential question-and-answer sessions was a weakness, and they emphasized its importance. E-learning can lead to a sense of isolation and separation due to the lack of genuine interactions, as seen in most e-learning platforms, and these feelings can reduce the user’s motivation to learn. The study by Wu et al. [35] showed that a chatbot alongside the e-learning platform can be helpful and reduce the sense of isolation in users.

The availability of necessary facilities and equipment for learners and providers of e-learning is essential. Otherwise, its implementation will not be feasible. The existence of smartphones and, subsequently, home computers connected to the internet are among the required equipment. A study in Uganda showed that tablet-based education is competitive with traditional education in knowledge transfer and leads to learner satisfaction [20].

These studies show that e-learning programs in HHs should leverage popular messaging apps and social media platforms as primary content delivery channels, but ensure that necessary technological infrastructure and resources are in place to support these channels. To mitigate the limitations of e-learning, such as the lack of face-to-face interaction and a sense of isolation, HHs can consider incorporating innovative solutions like chatbots to facilitate user engagement and motivation. Furthermore, the availability of essential facilities and equipment, including smartphones and internet-connected devices, is crucial for the successful implementation of e-learning programs. By acknowledging these factors, HHs can develop effective e-learning strategies that promote learner satisfaction and knowledge transfer, ultimately enhancing the quality of healthcare education.

For implementing any project, the critical factor is human resources. In e-learning, attention to human resources is also of great importance, and one of the most significant barriers is the lack of familiarity of the personnel with content production methods and related programs. The participants emphasized the production of content by specialists. Therefore, to strengthen the knowledge and skills of Behvarzan in e-learning, these individuals should receive continuous e-learning training. Robert Bollinger et al. also recommended providing specialized training for instructors and students to increase their skills in using e-learning platforms [36].

According to the participants, organizational support for active individuals in e-learning is critical in promoting and strengthening e-learning. Karimian and Farrokhi introduced the steps for developing virtual education in medical universities, identified training of human resources, setting regulations, and encouraging and motivating them as the main strategies in developing virtual education [37].

These studies emphasize that the success of e-learning programs in HHs hinges on the development and empowerment of human resources, particularly in content production and e-learning platform proficiency. To overcome the barriers of inadequate familiarity with e-learning methods, HHs should invest in continuous training and capacity-building programs for Behvarzan, enabling them to produce high-quality content and effectively utilize e-learning platforms.

Behvarzan also emphasized the need to persuade learners and target groups. The cooperation and willingness of the program’s target audience were participant’s concerns as one of the main components of the educational process. One requirement for implementing e-learning was the needs assessment from the learners to identify educational topics and design them accordingly. The participants believed that this survey would help them choose more appropriate content and methods, and in the next step, they could use the evaluation results to improve and strengthen the program. In another study, individual characteristics of the learner, cultural considerations, the relationship between learners, the relationship between the learner and the teacher, the learner’s prior knowledge, and the learner’s interaction with the environment were influential components of the quality of e-learning [38].

Behvarzan also emphasized tailoring the content to the target age group. Besides, attention to specific groups as reference and liaison groups was suggested. For example, mothers could be utilized as liaisons for e-learning, which would enhance the effectiveness of the training, and also utilize teenagers as health ambassadors to strengthen family engagement and facilitate the rapid transmission of health information. In this regard, Mahdavi-Nasab et al. emphasized the analysis of the learner as one of the influential components of the effectiveness of e-learning [39]. These studies suggest that the success of e-learning programs in HHs relies on understanding and catering to the needs and characteristics of the target audience, including learners and their families. HHs should conduct needs assessments to identify educational topics and design content accordingly, considering individual characteristics, cultural considerations, prior knowledge, and environmental interactions. Moreover, tailoring content to specific age groups and utilizing reference and liaison groups, such as mothers and teenagers, can enhance the effectiveness of e-learning and facilitate the transmission of health information. By prioritizing learner analysis and engagement, HHs can create e-learning programs that are responsive to the needs of their target audience, ultimately leading to improved health outcomes and more effective health education.

Among the limitations of this study, one can refer to the unwillingness of some Behvarzan to be interviewed due to fear of their names being disclosed, addressed by assuring them of the confidentiality of the participants’ names in the initial contact. Additionally, since this study was conducted in Karaj City, there is a presumption that the people in this region and Behvarzan have access to more resources, and the results may not accurately reflect the deprived provinces. The study’s strength was the participants’ distribution in areas with diverse geographical characteristics.