Health Informatics Education Effectiveness in Nepal (HI-EDU)

Assessing the Comparative Effectiveness of Health Informatics Education: Knowledge Retention and Technological Awareness in Health Science Students

This study evaluates the effectiveness of a blended Health Informatics (HI) course (HI471) on knowledge retention and technology awareness among health science students in Nepal. Bachelor of Public Health (BPH) students (intervention group, n=17) received a 14-week HI471 course combining online, virtual, and in-person practical sessions. A control group of Bachelor of Pharmacy (B.Pharm) students (n=17) continued their standard curriculum without dedicated HI instruction. Both groups completed a validated 44-item knowledge assessment and an 11-item technology awareness survey at baseline (Week 1) and post-intervention (Week 15). The primary outcome was the between-group difference in knowledge gain scores. Results showed that BPH students significantly improved their total knowledge scores (median +31.5 points, r=0.879), while the B.Pharm control group showed no significant change. BPH students achieved 100% awareness of 9 out of 11 digital health tools at post-test. This study provides strong evidence that the HI471 blended course is highly effective in building informatics competencies in a low- and middle-income country (LMIC) academic setting. The study was retrospectively registered.

Study Overview

• Status: Completed
• Conditions: Health Informatics Education
• Intervention / Treatment: Other: Health Informatics-471 Blended Course

Detailed Description

This controlled pre-test/post-test quasi-experimental study with a non-equivalent control group evaluated the effectiveness of the Health Informatics-471 (HI471) blended course at Madan Bhandari Academy of Health Sciences (MBAHS) in Nepal. The intervention group (G1) consisted of all 17 Bachelor of Public Health (BPH) students enrolled in the 7th semester, who received the HI471 course. The control group (G2) consisted of 17 Bachelor of Pharmacy (B.Pharm) 7th-semester students, randomly sampled from 29 eligible students, who received no dedicated HI instruction. The HI471 course integrated three blended modalities over 14 weeks: (i) online asynchronous LMS instruction (pre-recorded lectures, readings, quizzes), (ii) live synchronous Google Meet sessions, and (iii) in-person practical laboratory sessions covering EHR platforms, DHIS2, SPSS/R, and telemedicine interfaces. A validated 44-item Health Informatics Knowledge Assessment Tool (with weighted partial-credit scoring, maximum 100 points) and an 11-item binary technology awareness instrument were administered at T1 (Week 1, baseline) and T2 (Week 15, post-intervention). The primary outcome was the between-group difference in total knowledge gain scores (Δ = T2 - T1), analyzed using non-parametric statistics (Mann-Whitney U, Wilcoxon signed-rank, Friedman, McNemar) with bootstrap effect sizes. The study demonstrated large, significant knowledge gains in the intervention group (median +31.5 points, r=0.824, p<0.001) compared to the control group, with robust findings across three pre-specified sensitivity analyses. The intervention group achieved near-complete technology awareness (100% on 9 out of 11 tools). This research addresses the evidence gap for controlled educational evaluations in low- and middle-income country (LMIC) academic settings. The study protocol was approved by the MBAHS Institutional Review Committee (IRC-134-082-083), and all participants provided written informed consent. The study was conducted in compliance with the Declaration of Helsinki (revised 2013). The study was registered retrospectively.

• Study Type: Interventional
• Enrollment (Actual): 34
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Nepal
  • Bagmati
    • Hetauda, Bagmati, Nepal, 31206
      • Madan Bhandari Academy of Health Sciences

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Active enrollment in the 7th semester of the Bachelor of Public Health (BPH) program (intervention group) or the Bachelor of Pharmacy (B.Pharm) program (control group) at Madan Bhandari Academy of Health Sciences (MBAHS).
• Voluntary written informed consent obtained prior to any study procedure.
• Completion of both T1 (Week 1, baseline) and T2 (Week 15, post-intervention) assessments.

Exclusion Criteria:

• Withdrawal from the study before completion of all study procedures.
• Incomplete paired data (missing T1 or T2 assessment).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: BPH Intervention Group; Bachelor of Public Health (BPH) 7th-semester students (n=17) who received the 14-week Health Informatics-471 (HI471) blended course, consisting of online asynchronous LMS instruction, live synchronous Google Meet sessions, and in-person practical laboratory work covering seven HI content domains.	Other: Health Informatics-471 Blended Course; A 14-week blended educational course combining: (i) online asynchronous LMS instruction (pre-recorded lectures, readings, quizzes); (ii) live synchronous Google Meet sessions (2 hours, 3 days per week); and (iii) in-person practical laboratory sessions (4 hours per week) covering Electronic Health Records (EHR), DHIS2, SPSS/R, and telemedicine interfaces. No drug, device, biological product, or surgical procedure was involved. This is a purely educational/behavioral intervention delivered in an academic setting.
No Intervention: B.Pharm Control Group; Bachelor of Pharmacy (B.Pharm) 7th-semester students (n=17) who continued their standard curriculum without any dedicated Health Informatics instruction. This group served as the non-equivalent control group.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Total Health Informatics Knowledge Score	Measured using the Health Informatics Knowledge Assessment Tool (HIKAT) - a validated 44-item multiple-select instrument with weighted partial-credit scoring. Scores range from 0 to 100 points, where higher scores indicate better health informatics knowledge. Administered to both groups at T1 (Week 1, pre-test) and T2 (Week 15, post-test). The primary causal contrast is the between-group difference in gain scores (Δ = T2 - T1), analyzed using Mann-Whitney U test with bootstrapped effect sizes.	Baseline (Week 1) to post-intervention (Week 15)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Domain-Specific Knowledge Gains Across Six HI Content Areas	Change in knowledge scores across six domain areas assessed using the Health Informatics Knowledge Assessment Tool (HIKAT): D1 General HI/Introduction to IT, D2 Operating Systems & Software, D3 Public Health & IT, D4 Database Management, D5+6 Data Analysis & Coding, and D7 Telemedicine. Each domain score is expressed as a percentage of the domain maximum (minimum: 0%, maximum: 100%), where higher scores indicate greater domain-specific health informatics knowledge. Domain gains are analyzed using Friedman test with Kendall W and Holm-corrected post-hoc Wilcoxon signed-rank tests within the intervention group.	Baseline (Week 1) to post-intervention (Week 15)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Technological Awareness Across Digital Health Tools	Change in binary (Yes/No) awareness of 11 digital health tools: EHR, Telemedicine, HMIS, Public Health Informatics, GIS, HIMS, DBMS, Python, Programming Language, Telehealth Platforms, and Remote Patient Monitoring.	Baseline (Week 1) to post-intervention (Week 15)

Collaborators and Investigators

• Sponsor: Axon Infotech Research Academy Pvt. Ltd.
• Investigators: Principal Investigator: Dip Bahadur Singh, Axon Infotech Research Academy

Study record dates

Study Major Dates

• Study Start (Actual): April 15, 2026
• Primary Completion (Actual): June 20, 2026
• Study Completion (Actual): June 30, 2026

Study Registration Dates

• First Submitted: July 2, 2026
• First Submitted That Met QC Criteria: July 7, 2026
• First Posted (Actual): July 8, 2026

Study Record Updates

• Last Update Posted (Actual): July 8, 2026
• Last Update Submitted That Met QC Criteria: July 7, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: HI471-MBAHS-2026; IRC-134-082-083 (Registry Identifier: Madan Bhandari Academy of Health Sciences IRC)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be shared because participants did not provide consent for their individual-level data to be shared with external researchers. Additionally, the small sample size (n=34) increases the risk of participant re-identification, even with de-identification. All aggregated, anonymized summary data are presented in the published manuscript and supplementary materials

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No