The “ABCs of AD”: A pilot test of an online educational module to increase use of the autonomic dysreflexia clinical practice guidelines among paramedic and nurse trainees

Abstract

Context/Objective: Despite availability of clinical practice guidelines (CPGs), gaps in autonomic dysreflexia (AD) knowledge and practice persist. A free, online educational module, the "ABCs of AD", was developed to improve knowledge of the AD-CPGs among emergency healthcare personnel. We examine short-term changes in paramedic and nurse trainees' knowledge of, and social cognitions towards using, the AD-CPGs following module completion. Design: Pre-post. Methods: Thirty-four paramedic and nurse trainees from two training programs in Canada completed measures immediately before and after viewing the online "ABCs of AD" module. Outcome measures: AD knowledge test; Theory of Planned Behavior social cognition questionnaire; module feedback survey. Results: Paired samples t-tests revealed significant increases in participants' AD knowledge test scores (M ± SDpre = 9.00 ± 2.46, M ± SDpost = 12.03 ± 4.07, P < 0.001; d = 0.84). Prior to viewing the module, participants reported positive social cognitions for using the AD-CPGs (all Ms ≥ 4.84 out of 7). From pre-to post-module, no significant changes were seen in participants' social cognitions for using the AD-CPGs. Participants' average module viewing time was 36.73 ± 24.17 minutes (range 8-90 minutes). There was a decline in viewing from the first to the last module sections, with only half of participants viewing all six sections. Conclusion: Knowledge alone is insufficient for clinical behavior change; as such, social cognitive determinants of behavior should be explicitly targeted in future iterations of the module to increase the likelihood of increased use of the AD-CPGs. To engage viewers across all module sections, the "ABCs of AD" module should include supplementary learning strategies, such as interactive quizzes and peer-to-peer interaction.

Online training improves paramedics’ knowledge of autonomic dysreflexia management guidelines

“…First, consistent with findings observed in paramedic trainees 16 and emergency health-care professionals, 11 the module proved effective for increasing professional paramedics' knowledge of how to recognise and manage AD, as reflected in significant improvements in AD test scores at all time points relative to baseline. It is encouraging to see that the effects were maintained at 6 months.…”

“…Taken together, these results attest to the importance of incorporating information and strategies to alter beliefs about the targeted behaviour (e.g., using a new CPG) when developing educational interventions for paramedics. 16,39 In addition to patient testimonials, such strategies may include testimonials from other health-care professionals about the importance of using the CPGs (to foster positive attitudes and create social pressure), and videos showing paramedics implementing the CPGs in real-world situations (to enhance self-efficacy and perceived control).…”

“…The pilot study was conducted among student paramedics. 16 Post training, students had significant improvements in their knowledge, but no change in beliefs about, or intentions to use, the AD-CPGs. In hindsight, the null effects likely reflected students having little or no experience with SCI, implementing CPGs, treating patients or working in the field.…”

“…The pilot study yielded an effect size of d = 0.84 for the primary outcome measure of change in AD knowledge. 16 A sample size calculation conducted using G*Power 3.1 21 indicated that 82 participants were needed to have 90% power to detect d = 0.84 with α = 0.05, in a single-group analysis of variance with four measurement points. In the pilot study, attrition was 60% from pre-to post-testing.…”

“The ABCs of AD”: A prospective evaluation of the efficacy of an educational intervention to increase knowledge of autonomic dysreflexia management among emergency health care professionals

“…Work is currently underway to translate the content contained in the educational seminar into an easily accessible online training module to enhance the dissemination of the AD clinical practice guidelines to a broader segment of HCPs. 25 …”