Training as a means of cultivating communities of practice around health information systems. The potential of a blended learning approach in low and middle income countries

Abstract

This thesis is an illustration of an action research study framed within a pragmatic worldview in a developing country context. It was undertaken with the aim of harnessing the potential of training in cultivating communities of practices (CoPs) around the electronic health information system (eHIS) - the District Health Information System 2 (DHIS2). DHIS2 is an open-source public health software used globally in many low and middle income countries (LMICs). The Health Information Systems Program (HISP) at the University of Oslo manages its core activities including providing training for implementers and super-users. Given the expansion of the DHIS2 community and the demand for training, HISP decided to make use of online learning tools to support its flagship training program; the DHIS2 academy. However, introducing online learning tools in place of face-to-face training became a challenge despite its perceived benefits. Thus, the key motivation for undertaking this research was the challenges perceived in introducing online learning tools for eHIS training in LMIC settings. In pursuing its research aim, this study was informed by the theoretical inputs from literature related to communities of practice (CoP) and boundary objects. The concept of CoP was utilized by this study given the different professional groups involved in providing eHIS training and because it could explain the work-based learning processes existing in a domain such as health. Further, the concept of CoP and its related discourse also informed this study regarding the potential of cultivating CoPs and its applicability in professional domains. When it comes to the notion of boundary objects, it was utilized by this study to understand how online learning tools and blended learning programs behave at the boundary between different professional groups. It was expected that by applying the notion of boundary objects it would be possible for this research to shed light to the tensions that may arise and understand the ways of resolving such tensions in a particular setting. Together, the analytical perspective formed was expected to provide a means of understanding how training can be used in cultivating CoPs in relation to the study context. Informed by these practical and theoretical inputs, the study formed three research questions. First was to identify the different dimensions of a blended learning program that determine its potential towards cultivating CoPs around eHISs. The second question focused on ways and means of facilitating social construction of learning by integrating between the eHIS and the different dimensions of a blended learning program. The third research question focused on unraveling the role of participation when training is being used as a tool for cultivating CoPs. The empirical evidence for this study was drawn from multiple iterations of DHIS2 academies based on a blended learning approach from 2011 to 2014. In addition, the study also drew empirical evidence from a cohort of medical doctors from Sri Lanka who also underwent training at DHIS2 academies. This particular cohort allowed this study to follow them up into their work practices and to observe their participation in a Free and Open Source Software (FOSS) community around DHIS2. The gathered empirical evidence was analyzed using qualitative and quantitative means including using social network analysis. Based on its analysis, the study contributes both theoretically and practically. One of its theoretical contributions is to understand the role of training in relation to CoPs in Information Technology for Development (ICT4D) contexts. Firstly, the study expands the usability of online learning tools in facilitating an environment suitable for generating higher order knowledge among the eHIS users. Secondly, the study contributes to expand the concept of =network of actions‘ by illustrating how it can facilitate micro-level communities, or CoPs, using training as a tool. Thirdly, the study illustrates how training could play a key role in sustaining and scaling ISs. Fourthly, the study contributes to facilitate the call for interdisciplinarity in ICT4D by utilizing pedagogically driven blended learning programs. Another theoretical contribution made by this study is to elaborate on the epistemic potential of blended learning programs. Based on the findings, the study revealed the association between technological frames or technologies-in-practice with epistemic and boundary objects within the ambits of this research. Secondly, the study contributes to the education literature by shifting the current understanding regarding blended learning programs from being a =state of permanency‘ and =control‘ to a =state of fluidity‘ and =freedom‘. Thirdly, the study elaborates on the potential of an epistemic blended learning program to function as an alternative channel of scientific inquiry around an IS artefact. In terms of the evolutionary process of an IS, this means that a blended learning program - as perceived by this study - may have the potential to accelerate the said evolutionary process, particularly in an ICT4D context. As the practical contribution, the study elaborates on ways and means of designing and implementing blended learning programs, which are empowering, informal, participatory and equitable. As perceived by this study, such programs not only have the potential to facilitate cultivating CoPs around ISs, but also to sustain IS implementations in LMIC settings.