2.5.1. Acceptability and Feasibility Indicators

We collected process indicators to determine participant engagement and use of each of the training programs. This included: daily attendance at the F2F training; metrics collected from the Learning Management System for the digital training programs (for both the DGT and DGT+ programs), including the number of days to complete the training program and the number of modules completed; the number of phone calls made by the participants for seeking technical assistance (for both the

DGT and DGT+ programs) from the research team; and the number of phone calls initiated by the research team to participants for follow up with their queries and types of challenges or questions that commonly were mentioned (for the DGT+ only).

After completing the training (end line), we also collected a satisfaction and acceptability questionnaire adapted from an existing measure of motivation and engagement in face-to-face and online education programs called the MUSIC® model of motivation inventory [55–58]. The 26-item questionnaire asks about the level of satisfaction with the training, acceptability of the content and method of instruction, and feasibility of completing the training. The items are rated on a six-point Likert scale, and relate to feasibility, acceptability, adoption, and appropriateness of the training programs. The questionnaire was translated into Hindi and modified for the F2F and digital (DGT and DGT+) training programs. The items are rated on a six-point Likert scale, with 1 being the lowest and 6 the highest score. The questionnaire covers the domains of acceptability, appropriateness, adoption, and feasibility. The average score of each domain was calculated by adding the score of all the items in the domain divided by the number of questions in the domain.

We also conducted one focus group discussion for all the participants in each arm to obtain feedback about the training and to ask questions pertaining to acceptability and appropriateness of the content, methods of instruction, and engagement in the training, as well as the feasibility of accessing and navigating the digital training platform on the smartphone app, and providing recommendations for what could be improved in the training program. The focus group discussions lasted about 45–60 min, were facilitated by a qualitative researcher and were audio-recorded for analysis. Another researcher from our team observed the focus groups to collect field notes to identify key recommendations from participants for modifying the training programs.
