The Health Inequality Monitoring team followed a process outlined in the Analysis-Design-Development-Implement-Evaluate (ADDIE) model for developing instructional courses and training programmes [23]. This model, which is highly adaptable across settings and applications, emphasizes a learner-based approach that relies on the continuous evolution of courses through feedback from diverse stakeholders. It has been previously applied in the development of eLearning courses for the public health and health care workforce, generating a series of best practices [24] that benefited the development of the health inequality monitoring courses.
The analysis phase included the initial conceptualization of the health inequality monitoring eLearning courses and the assessment of learner characteristics and knowledge gaps. Course contents were partly derived from the team’s reports, tools and resources, which included inputs from subject-matter experts. This phase was also informed by the experiences of the Health Inequality Monitoring team in conducting health inequality monitoring capacity building workshops over the past 15 years (see Table 1).Footnote 1 Each workshop gathered feedback from workshop participants through a short post-workshop survey. Interactions with workshop participants across different settings provided rich insights into their knowledge, skills, experiences, and technical abilities, as well as their interests and needs with regards to health inequality monitoring. A particular need emerged for a learning option that was highly accessible, flexible and complementary with existing resources. The team reviewed various eLearning platforms as options to host the courses and compiled a list of their respective functionalities. The team consulted scientific and grey literature about eLearning best practices across different contexts to determine the general features that would enhance the impact of the courses.
As part of the design phase, the Health Inequality Monitoring team brainstormed an initial list of topics to address expressed learner interests and capacity-strengthening opportunities. These topics were grouped by theme (constituting individual courses comprised of modules) and further organized according to their intended purpose (constituting a series). In preparing course applications for the eLearning platform, the team identified preliminary learning objectives for the courses and constituent modules. This process entailed mapping several courses simultaneously and reviewing the scope and content of each to ensure compatibility and complementarity. The team also identified the course presentation style; formative and summative assessment approaches; and learner certificate requirements.
The development phase involved the preparation of course transcripts, visual and audio components, quiz questions, additional reading lists, examples, exercises and other accompanying materials. These materials underwent reviews by the Health Inequality Monitoring team as well as, where appropriate, reviews by WHO staff members and consultants, subject matter experts, and learners. The feedback solicited from the reviewers helped to enhance and refine diverse aspects of the courses. WHO staff members and consultants provided technical reviews and ensured consistency and linkages with existing and planned WHO tools and resources, including those for health inequality monitoring. Senior-level WHO colleagues reviewed select course materials, as warranted, to advise on potential sensitivities. Subject matter experts provided technical reviews, ensuring that the learning material reflects the current state of knowledge in the field. Learner perspectives and feedback enhanced the usability and clarity of the course materials.
During the implement phase, the OpenWHO team uploaded the course materials to the OpenWHO eLearning platform. Testing was carried out by members of the Health Inequality Monitoring team before publication. Concurrent with the publication of the eLearning courses, the Health Inequality Monitoring team held virtual launch events to promote their wide dissemination. Although the evaluate phase was undertaken, in part, within the course development, a process was integrated for obtaining continuous feedback about the eLearning courses directly from learners using linear scale and free text questions. Learner feedback will assist in the ongoing improvement and planned periodic updates of the courses.
Health inequality monitoring channel
Health inequality monitoring eLearning courses address an unmet need for a self-directed learning environment where learners can acquire a conceptual understanding of the monitoring process, navigate its application to different health topics, and learn/refine practical skills. The Health Inequality Monitoring channel therefore contains three distinct series of courses. Health inequality monitoring foundations courses introduce the components of health inequality monitoring, emphasizing key concepts and best practices. Topic-specific health inequality monitoring courses showcase the application of health inequality monitoring within specific health topics. Health inequality monitoring skill building courses provide practical guidance on health inequality analysis methods, including the use of selected software programmes. The target audiences for the courses on the Health Inequality Monitoring channel include monitoring and evaluation officers, data analysts, academics and researchers, public health professionals, medical and public health students, and others with a general interest in health data, inequality monitoring and data analysis. Learners can be from individual countries (including in ministries of health and other health institutes, statistical offices, universities and non-governmental organisations) or working at thein multilateral or inter-governmental organizations (such as agencies of the United Nations, including WHO).
The OpenWHO eLearning platform was selected to host these courses. OpenWHO contains many courses related to a variety of public health topics, therefore accommodating a large and varied audience, including the target audience for health inequality monitoring courses. The functionalities of the platform met the requirements of the team, including: free access to online courses; straightforward user interface; multiple evaluation (quiz question) formats and assessment options; discussion forums and collab spaces; and certificates of achievement. In addition, the platform allowed for: upload of accompanying learning materials; creation of a dedicated thematic channel; tracking of course enrollment, learner engagement and feedback; regular course updates; addition of new courses to the channel; and translation of courses into multiple languages.
An initial set of 12 courses was planned for the Health Inequality Monitoring channel. This included five health inequality monitoring foundations courses, launched in September 2022. Each course is approximately one and a half hours in duration, with the content delivered through 4–6 modules (Appendix 1). The Overview course gives a general introduction to the monitoring process and key terminology and concepts, highlighting how it can be adapted to different contexts. It serves as an entry point for the other courses in this series. The Data sources course examines the strengths, limitations and opportunities to improve common data sources for health inequality monitoring. It covers household surveys, administrative data sources, civil registration and vital statistics systems and censuses, as well as the processes of data source mapping and data linking. The Health data disaggregation course explores how disaggregated health data are integral across the steps of monitoring, helping learners gain skills in assessing and reporting disaggregated data. The Summary measures of health inequality course breaks down the general characteristics of simple and complex summary measures, and guides learners through the selection, calculation, interpretation and reporting of a range of measures. The Reporting course addresses the components of high-quality health inequality reporting, emphasizing purpose-driven, audience-centred, and technically rigorous approaches. It includes a set of best practices for reporting health inequalities.
Two topic-specific health inequality monitoring courses have been launched, each two hours in duration (Appendix 2). The Inequality monitoring in immunization course (launched in December 2021) and Inequality monitoring in HIV, tuberculosis and malaria course (launched in May 2022) examine the five general steps of inequality monitoring in the context of immunization programmes as well as HIV, tuberculosis and malaria programmes, respectively. A third course in this series, Inequality monitoring in sexual, reproductive, maternal, newborn, child and adolescent health, is under development.
The skill building course series consists of four planned courses, addressing the use of HEAT and HEAT Plus, and the use of software programmes for health inequality analyses (featuring Excel, R and Stata). These courses, anticipated for launch in December 2022, are each two hours in duration.