Variations,effectiveness and its associated factors of a nati-onwide web-based hypertension management training pro-ject in China:insights from a government-led campaign for 1.2 million lay health workersOA

OBJECTIVES To evaluate the effectiveness of a large-scale,web-based,in-service hypertension management training project among lay health workers(LHWs)at primary care health(PHC)settings in China,and to examine the factors contributing to the variations of effectiveness. METHODS We used data from a web-based national hypertension management training project implemented in 2018,it was designed to facilitate LHWs to learn,understand,and apply the relevant knowledge and skills in hypertension management through providing training courses by use of the web-based platform with unified standards.All LHWs were required to parti-cipate in the exams before and after training to acquire scores for the use of evaluating their performance of hypertension man-agement knowledge.We first used descriptive analysis to present the variations of effectiveness in hypertension management knowledge among LHWs by important subgroups.Afterwards,we used multilevel logistic regression to examine the individual and regional factors contributing to the variations and quantify the magnitude of how these factors affected training effectiveness. RESULTS There were 1,208,610 LHWs who completed training and were certificated.Nationally,the scores of LHWs in-creased significantly from 62.87±21.14 out of 100 in the pre-test to 88.30±11.31 in the post-test by 25.43(95％confidence interval[CI]:25.40-25.47).Training contents involved in antihypertensive medication showed the lowest score(54.36)in the pre-test and soared the most after training,up to 84.22 by 54.94％.Individual factors associated with disparities in the knowledge of hyperten-sion management decreased substantially after training,which included sex,age,education,practice type,professional level,and hierarchy of working institutions.Geographical variations were shown at the provincial level,with the majority of them being ex-plained by factors at the regional level. CONCLUSIONS Accessible web-based training modality,government efforts,accompanied with experiences derived from the training,could be generalized to other low-and middle-income countries in facilitating the hypertension management capacity of LHWs.Localization and evaluation is warranted on the way to its further application.