The Feasibility of Using a Theory-Based, Online Delivery Microlearning System to Educate Nurse Practitioners about Clinical Skin Examination for Melanoma

Abstract

Background: The incidence of malignant melanoma (MM) has doubled in the United States over the past 20 years. Early diagnosis and favorable prognosis rely on patients’ accessibility to healthcare providers for clinical skin examination (CSE). Primary care nurse practitioners (PCNPs) can play a vital role in skin cancer early detection but are underprepared with the knowledge and skills to perform this function. Conceptual Framework: This study is guided by the information, motivation and behavior skills (IMB) model, which highlights the concepts of information, motivation, and behavioral skills that promote behavior change. The study also uses microlearning as a framework to deliver CSE education. Microlearning is the use of short-term, informal learning activities using small, but self-explanatory learning resources. Purpose: The purpose was to explore the feasibility of delivering and developing an evidence-based intervention to educate PCNPs about comprehensive CSE for MM. Aim 1 was to develop three evidence-based, brief skin cancer videos with content on comprehensive CSE skills (risk assessment, head-to-toe skin examination, skin lesion assessment) that are suitable for online, theory-based delivery to PNCPs in various formats. Aim 2 was to determine enrollment and retention rates, intervention adherence, and acceptability and usability of the intervention following completion of the one-week intervention. The exploratory aim was to explore preliminary associations among information, motivation and behavior skills for CSE behavior (practice). Methods: An expert panel of three dermatologists assessed content validity for the videos and the microlearning approach. For Aim 2, 10 PCNPs were recruited from a state NP conference. Feasibility measures included: enrollment and retention rates, and intervention adherence, usability (Brooke’s System Usability Scale) and acceptability (Attitudes Towards Web-based Continuing Learning Survey). For the exploratory aim, the associations among the IMB constructs were assessed using an adapted survey. Findings: Three short videos with content on comprehensive CSE for MM were developed. The enrollment rate was 35%, the retention rate was 83% and the intervention adherence was at least 50%. The mean average for usability was better (M = 85.8, SD = 10.6) with a range of scores from 72.5 (better) and 100 (superior). The mean for each of the acceptability constructs all ranged between “somewhat agree” and “mostly agree.” The mean score for the IMB constructs included: information (M = 91%, SD = 14%), behavior skills (ranking) (M = 60%, SD = 49%), behavior skills (survey) (M = 4.27, SD = .27, α = .72), and motivation (M = 3.18, SD = .62, α = .60). The average number of CSEs performed the week after the intervention was 11 (SD = 9) with a range of 1 to 26. Actual CSE practice had the strongest association with behavior skills (survey) (r = -.33); actual CSE practice shared 11% of the variation in exam scores (R2 = .11). Conclusion: Findings from this feasibility study provide a foundation for the use of the microlearning as a method for delivering brief CSE training to PCNPs. The findings also provide support for using the intervention in a future pilot randomized trial.