*2.6. Data Analysis*

Descriptive statistics were computed for socio-demographic characteristics between the three training programs. Process indicators and the satisfaction questionnaires were summarized in tables. Field notes were collected during the focus group discussions to capture key feedback for supporting refinements to the programs. As this was a pilot study with the primary goal of determining feasibility and acceptability of the training programs and to inform improvements to the instructional content and delivery of the training programs, we did not conduct an in-depth thematic analysis of the qualitative data. Rather, we followed guidance from the person-based approach to intervention development [33,62], which enabled the combination of quantitative and qualitative data to inform modifications to the training programs. Specifically, we used a framework analysis approach [63] to guide our identification of common topics within the qualitative data, following a coding framework with the four core domains outlined from the satisfaction and acceptability questionnaire (i.e., appropriateness, acceptability, adoption, and feasibility) [55]. One researcher from our team who was not involved in the development of the training programs coded the transcripts following this *a priori* framework and categorized key observations from participants according to each of the broad domains. Two additional researchers from our team who supported the development of the training programs reviewed the classification of participants' observations and the key recommendations for improving the program. This second round of review provided an opportunity to expand on any observations that were not clear, and to draw from the field notes to supplement the description of the recommendations. A fourth researcher who was external to this process then reviewed the tables summarizing the qualitative feedback to ensure that actionable steps could be identified for improving the usability and acceptability of the training programs in preparation for a subsequent large scale randomized controlled effectiveness study.

As part of an exploratory analysis of change in the competency assessment outcome, we used a paired *t*-test to determine if there was a statistically significant mean difference between the competency scores obtained before and after the training. We also explored pre- and post-training differences in the competency assessment scores within the three training programs using a non-parametric Wilcoxon signed-rank test [64]. This method was selected to account for the small sample size. Due to the heteroscedasticity, since the *p*-value for the Bartletts's test for homogeneity of variance was less than 0.05, we used Welch's one-way ANOVA test to determine if the change in competency assessment scores obtained before and after the training program was different for the three arms, followed with a Games–Howell post-hoc test. All analyses were completed using STATA (StataCorp LLC, College Station, TX, USA), and *p* < 0.05 was considered statistically significant.

#### **3. Results**

Out of 92 potentially eligible non-specialist health workers, we contacted a total of 73 until reaching our recruitment target of 45. These 45 non-specialist health workers were invited to attend the group information session to learn more about the study. As outlined in Figure 1, 42 consented and enrolled in the study and were randomly allocated to the three study arms. This included 23 ASHAs, 10 ASHA Facilitators, and 9 MPWs. Participant characteristics are summarized in Table 1. Of the 42 enrolled participants, 36 started the training programs to which they were randomized (*n* = 10 in F2F; *n* = 12 in DGT; *n* = 14 in DGT+) and 36 (86%) participants completed post-training assessments (*n* = 11 in F2F; *n* = 12 in DGT; *n* = 13 in DGT+). We found that there were no differences in participant baseline characteristics (such as type of health worker, mean age, education, and gender) between those who completed the training compared with those who did not complete the training. No harms were recorded for any participants throughout the duration of this pilot study.

*Int. J. Environ. Res. Public Health* **2020**, *17*, 6368

**Figure 1.** Participant flow diagram. DGT: Digital Training.


**Table 1.** Baseline socio-demographic characteristics of study participants.
