Co-designing a heart failure diagnosis and management training program for non-specialists in Uganda: a blended learning experience
I Ssinabulya, N Haynes, J Kayima, M Ssebuliba Kiwanuka, W Amutuhaire, G Bukka Zziwa, D Iraguha, J Atala, S Christie, M Nabadda, C Muhangi Ngonzi, S Wali, V Wambugu, H Ross, J SchwartzAbstract
Background
Task-sharing models supported by point-of-care technologies, including ultrasound (POCUS), offer a sustainable strategy to decentralize heart failure (HF) care and expand access in resource-constrained settings. However, scalable and contextually appropriate training programs for non-specialist providers remain limited. Implementing a standardized HF curriculum for non-specialists may facilitate earlier diagnosis, strengthen frontline management, and improve clinical outcomes.
Purpose
For the initial implementation strategy of the MEDLY Uganda trial, we aimed to co-design and implement a training curriculum for non-specialists (nurses, clinical officers, medical officers, and physicians) to decentralize HF care by strengthening capacity across six Regional Referral Hospitals (RRHs) in Uganda.
Methods
Our long-term partnership includes the Uganda Heart Institute (UHI), the Uganda Initiative for Integrated Management of NCDs, academic institutions, and referral hospitals to co-create a blended learning program which we call “Core HF”. Core HF includes: 1. Clinical equipment, including ECG machines and Kosmos echo probes; 2. A standardized algorithm to identify, manage and treat HF, aligned with Uganda Clinical Guidelines; 3. Echo training and support; and 4. Self-Care guidelines for patients, with accompanying visual materials. The training model pairs UHI mentors with regional cardiologists and applies Experience-Based Co-Design (EBCD) to inform an implementation strategy integrating: (1) asynchronous education, (2) onsite hands-on training, (3) periodic mentored refreshers, (4) AI-assisted echo image acquisition and interpretation, and (5) supportive supervision by a central team of cardiologists. The 3-day training incorporates multiple evidence-based interventions including locally contextualized training models and cases, expert patients, and practical sessions. All sites were given one ECG machine and one echo probe.
Results
A total of 96 healthcare workers (42 nurses, 5 clinical officers, 37 medical officers, and 12 physicians) from four RRHs and 22 lower-level facilities participated in training. Post-training evaluations indicated improved confidence in managing patients with HF and in communicating self-care messages. Suggestions for improvement included more time for ECG practical training and interpretation.
Conclusion(s)
A co-created curriculum for non-specialists is feasible, acceptable, and shows early promise for improving HF care in resource-constrained settings. Core HF has the potential to strengthen diagnostic capacity, support task sharing, and advance decentralized HF care at regional hospitals and lower-level facilities where most Ugandans access care. The collaborative process ensured that the training met the needs of multiple healthcare worker cadres and sets a foundation for sustainable and continuous improvement in cardiac care in resource-constrained settings.