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| ORIGINAL ARTICLE |
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| Ahead of print publication |
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Introduction of spatial technology for surveillance of vectors of mosquito-borne diseases as an innovative training tool for undergraduate medical students: Qualitative assessment
Kavita N Thakur, Devidas T Khedkar, Deepu Palal, Johnson Subhash, Sudhir L Jadhav, Hetal Rathod, Vallari Jadav, Gracia Sohkhlet, Prerna Verma, Nirankush Borah, Sandeep Nallapu, Shweta Gangurde, Anil Mahajan
Department Of Community Medicine, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
| Date of Submission | 08-Dec-2021 |
| Date of Decision | 13-Feb-2022 |
| Date of Acceptance | 19-Feb-2022 |
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Correspondence Address:
Kavita N Thakur,
Qtr. no. 102, Major Quarters, R and D E Colony, Alandi Road, Dighi, Pune - 15, Maharashtra
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/mjdrdypu.mjdrdypu_975_21
Introduction: Innovative teaching has been the topic of research with variable learning outcomes. This study was done with an objective to assess the undergraduate medical students' perception about the effect of introducing spatial technology training for surveillance of vectors of dengue and other mosquito borne diseases. Methods: Undergraduate medical students were invited to participate in the training program on Mosquito borne diseases. A total of 80 students participated in the program. After the training, they were divided into two groups to conduct mosquito larval survey using conventional method and GIS technology. Qualitative feedback was collected about their experience in writing from participants using open-ended questions. The feedbacks were analyzed using thematic analysis and participants' observation, NVivo 12 software. Results: Non-response rate was 20-30% in conventional group compared to GIS group. About 44% (n=63) of the participants found the training content to be educational, interesting and informative , 53.4% (n=58) of the participants said the field activity experience was interesting, 72.3%(n=58) found the overall training program to be amazing, engaging in addition to being informative and educational hands on learning experience. Field activity was liked by 50.8% (n=57) participants while 36.8% liked presentation and field activity both. NVivo 12 was used to build a word cloud and the concept diagram. Conclusion: The findings suggest that introduction of new technology acted as an engaging factor and increased the interest in the topic. Participants were more willing to get hands-on experience of GIS. Innovative teaching with hands-on experience of the topics could be an effective way of teaching in medical education.
Keywords: Geographic Information Systems, Medical education, Students, Mosquito, Mosquito Borne Diseases, Qualitative study
How to cite this URL:
Thakur KN, Khedkar DT, Palal D, Subhash J, Jadhav SL, Rathod H, Jadav V, Sohkhlet G, Verma P, Borah N, Nallapu S, Gangurde S, Mahajan A. Introduction of spatial technology for surveillance of vectors of mosquito-borne diseases as an innovative training tool for undergraduate medical students: Qualitative assessment. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2023 Mar 20]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=343498 |
| Introduction | |  |
More than 700,000 people die each year from vector-borne diseases, which account for more than 17% of all infectious diseases.[1] Mosquito-borne diseases like dengue, chikungunya, Japanese encephalitis, malaria, West Nile, Yellow fever and Zika are a few of the common and emerging viral diseases that have spread globally.[2]
In 2018, an estimated 228 million cases of malaria occurred worldwide with 405000 deaths and sub-Saharan African countries and India carried almost 85% of the global burden.[3] Other major mosquito-borne diseases like dengue caused an estimated 96 million cases and 40000 deaths per year.[1] Also, chikungunya is endemic in our country, while recently cases of Zika virus disease have been reported from Rajasthan and Gujarat.[4],[5]
Global Vector Control Response (GVCR) 2017-2030 approved by World Health assembly in 2017 emphasizes importance of strong vector control program as the key to control and prevent the Mosquito borne diseases (MBD) outbreaks. GVCR also highlights the importance of strengthening the existing monitoring and surveillance systems and community participation.[1]
Conventional vector surveillance methods involves manual data recording. Newer technologies like Epi-map, Geographic information system (GIS) based tools like ArcGIS and QGIS open source are few computer-based surveillance tools that have been used currently. Data recording using GIS is comparatively easier. GIS based surveillance for mosquito control are found to be very low cost, rapid and accurate.[6] These tools can be used to visualize surveillance data and efficiently share real time information and resources with field and operational staff to make better decision that lead to cost savings and improved community health outcomes.[7] The use of geospatial technology for surveillance is common nowadays as it provides a visual dynamic map to understand the precise location and distribution of the vector breeding sites.[8]
It helps in early recognition and prevention of an impending outbreak by initiating timely and effective control measures.
Vector-borne diseases and vector control methods are taught using conventional teaching methods. Mosquito-borne diseases being a very important public health problem should be taught using innovative teaching methods that include visual presentations, demonstration of the various methods of vector surveillance and hands-on experience of carrying out the larval surveys using newer advances like geospatial technology at actual location of the mosquito larval breeding sites. Innovative teaching has been the topic of research with variable learning outcomes. Teaching with field-based activities has shown to be effective method of teaching.[9],[10] We assumed that hands-on experience of conventional or GIS application will arouse interest and an in depth understanding of the topic among the students. Therefore, with this assumption this study was planned to know the perceptions of undergraduate medical students towards GIS based method versus conventional method on the mosquito larvae surveillance-training program.
| Materials and Methods | | |
This qualitative assessment was part of major interventional study that was conducted in August 2021. The study was approved by Institutional Ethics Committee. Undergraduate medical students from a medical college in Pune were selected by convenience sampling method. The details of participants' recruitment, data collection and data analysis are given in [Figure 1]. | Figure 1: Participants' recruitment, data collection and data analysis flowchart
Click here to view |
Training program
One day training program was conducted for the participants on the topic of Mosquito Borne Diseases and recent advances in surveillance methods for larvae. Experts in the field gave all the sessions and the demonstration to the participants.
After the lecture, demonstration was given by using props and models. The participants were divided into two groups as Conventional (C) group and GIS (G) group. The (C) group was given demonstration and taught how to identify the Aedes mosquito larvae and larval breeding sites and note down the data using pen and paper while the (G) group was given training and demonstration for identifying Aedes mosquito larvae and larval breeding sites and then transmitting the data using GIS app. Training content for both the groups was same except for the methods of recording and reporting data. The duration of training for C group was 10 minutes and for G group was 20 minutes as the GIS group students had to download and install Telegram application and then join the GIS vector server group in the Telegram. After the installation the G group students were taught the accurate way of sending the data for e.g. if they identify a potential vector breeding site then they should sent location by typing 0 and if that container has larvae then they can send the location by typing 1. For the field activity, each group was further divided into three subgroups each. To ensure availability of breeding sites for the field activity, Aedes larvae were implanted in variety of small artificial containers at various sites in the campus. Implanted containers were implanted in such as way that they may or may not contain the Aedes larvae. Each group had a supervisor who ensured that the identification and reporting of breeding spots by the students was done rightly. Participants were free to identify all the potential breeding sites that may or may not contain the larvae. During the 30 minutes of field activity using conventional and GIS application, the students in the conventional group noted the vector breeding sites and container positivity using pen and paper and reported to the research team whereas the GIS group used mobile application to send the vector breeding sites location via Telegram application. The location sent by them was automatically updated on the central server and GIS Map was created for the same.
The whole field activity was supervised by field supervisors for following purposes:
- To cross check whether the larval survey was correctly performed or not
- To confirm the correctness of larvae positive containers and larval identification up to genus level by the participants
- To destroy the implanted and natural occurring breeding spots identified by participants
Data Collection: After the field activity, the participants were given Google forms to answer 5 objective questions and 4 open-ended questions to get the Qualitative data from the participants of both the groups using Google forms.
Objective questions
The questions asked were - No. of containers surveyed by them; Ease of conduction of survey method of mosquito breeding sites; Usefulness of the training given to carryout the field survey; Opinion about the vector survey method? (interesting, interesting and useful, boring) and Whether they would like to work in national program?
Open-ended questions
The four open ended questions were-Views on the workshop content and its usefulness in learning VBD; Views on the field exercise undertaken; Overall experience during field activity in short; What was liked most in the training program? (Tests, speaker's style of presentation, content of presentation, field activity demo sessions and group field activity).
Data Analysis: For the objective data, percentages were calculated while the feedback was transferred to spreadsheets and then all their feedbacks were color coded as per recurrent themes identified in the raw data. Word cloud was created to see most used words in the feedback using NVivo 12 Software for each subjective feedback.
Results
A total of 76 participants responded to the feedback Google forms. There were 53 females and 23 males participants. 40 (53%) participants belonged to Conventional group while 36 (47%) belong to GIS group.
Non-response rate for the Conventional group for the 4 open-ended questions ranged between 8-12 (20%-30%) while in GIS group it was 5-7 participants (13.8% to 19.4%) which was not statistically significant.
The number of sites surveyed by the conventional group ranged between 3 to 29 while in GIS group it was between 3 to 11.
Ease of conduction of survey
In the conventional group, 17(42.5%) participants found conventional method easy, 21 (52.5%) said somewhat easy and 2(5%) said it was tough while in GIS group, 12(33.3%) participants found GIS method easy, 21 (58.3%) found it somewhat easy and 3 (8.3%) said it was tough.
The method of surveillance was found interesting and useful by 31 participants (86.1%) in GIS group while 26 participants (65%) in the conventional group said the conventional methods was interesting and useful.
The training given to conduct the larval survey was found useful by 38 participants (95%) in conventional group and 33 participants (91.67%) in GIS group.
When asked whether they would like to work in national programs in future, 30 (75%) in conventional and 31(86.1%) in GIS group said yes. While 3 (7.5%) participants in the Conventional group said no they would not like work in national program.
At the end of field activity, a GIS map was also developed shown in [Figure 2] below:  | Figure 2: GIS Map developed after the field activity based on the data send by GIS participants through smartphones for breeding site location. Yellow: Implanted containers (These were implanted by the field supervisors which may or may not be positive for the larvae) Blue : Untagged container (These were the containers wherein the participants identified them but failed to code it as 0 and 1 while sending its location through Telegram)Green : Container without larvae ( coded as '0' for absence of larvae) Red: Container with larvae (coded as '1' for presence of larvae). Note: For the field activity, the participants were instructed to identify potential breeding containers. The participants were unaware of the implanted containers so they identified both natural and implanted containers. Therefore, the red and green containers may or may not include the yellow implanted containers
Click here to view |
As per the training program facilitator's and field supervisor's feedback:
Initially all the participants wanted to go to into GIS group but when explained about the research half of them agreed to enter the conventional group. Also the facilitators' created a sense of competition between the two groups that led to more enthusiasm to participate. Also in the field, the supervisors found that all the students irrespective of the group were very excited if they found a container with larvae. One of the field supervisors shared, “It was like a treasure hunt for them.” Even after the field survey both the groups were equally interested in seeing the output GIS map generated. Most of the participants desired that the entire program should be conducted frequently. All the participants enjoyed the activity.
| Themes and reflective quotes generated from verbatim: | | |
Share views on Training Content and its usefulness in learning vector borne diseases (n=63):
About 28 (44.5%) participants found it educational, informative and 29(46%) found the content good and useful, 6(9.5%) found it interesting, liked the style of speaker, interactive.
[Word cloud 1]: Question: Please share your views on the workshop content? Was it useful in learning VBD? Word cloud based on the verbatim of participants is given below:
Verbatim of participants:
Participant 27: “The session was extremely informative and interesting. I realized that VBDs are a public health emergency and necessary action needs to be taken to tackle them. The content, manner of presentation and practical surveillance was instrumental in helping us understand the process.”
Participant 2: “It was very helpful n now I can identify the different species of mosquitoes...”
Participant 9: “Yes, it was very helpful and interesting. It was a new way of learning and we are unlikely to forget this information.”
Participant 18: “Yes, it was informative as well as interesting. Personally, I request the department to conduct such activities in future. It was a new and fantastic experience in the med school.”
Share views on Field Exercise (n=58):
About 31 (53.4%) participants said the field activity was interesting, 16(27.6%) found it educational, 10(17.2%) found it good and 1(1.72%) said it was exhausting.
[Word cloud 2]: Question 2: Please share views on the field exercise? Word cloud based on the verbatim of participants is given below:
Verbatim of participants:
Participant 6:”So important to actually have hands on experience and also would remember all the topics and indices.”
Participant 16: “Super interesting, hands-on experience was better than sitting in a classroom and seeing on a slide, loved the adventure that it carried, even if it was just our campus, the adrenaline rush was exhilarating!”
Participant 26: “The field exercise gave us hands on experience on how vector surveillance was done. It was extremely well planned.”
Participant 27: “It was a brilliant experience with a lot of insight into VBDs and identifying possible infected sites. We were also taught how to tackle infection sites by disposing the accumulated water into soil.”
Describe the overall field activity experience (n=58):
About 24 (41.4%) participants said the overall experience was very informative and educational, hands-on learning experience, 18(31%) participants said it was interesting, amazing, fun, engaging and 16 (27.6%) said it was good.
[Word cloud 3]: Question: Describe your overall experience during field activity in short? Word cloud based on the verbatim of participants for the question is given below:
Verbatim of participants:
Participant 10: “It was very interesting and new.”
Participant 26: “The field was interactive and fun.” We were able to identify larvae and it provided a great learning experience for us.”
Participant 28: “It was an amazing experience. I love practicals and fieldwork. And it was my first time doing anything like this in college, which made it all the more interesting and all the more fun. I really want to thank the department for doing this for us.”
Participant 42: “We were allotted into 6 groups and we had to find sites where we could find mosquito larva or not. We got to know the seriousness of this issue closely.”
Participant 58: “Amazing. I am quite happy to be a part of such activity and I will again try to participate in such event in future.”
What was liked most in the training program? (n=57) :
About 29 (50.9%) participants like field activity most, 21(36.8 %) liked both the presentation and field activity while 7(12.3%) said they liked presentation most.
[Word cloud 4]: Question: Please share what you liked most in the training program? (Tests, speaker's style of presentation, content of presentation, field activity demo sessions and group field activity). Word cloud based on the verbatim of participants is given below:
Verbatim of participants
Participant 18: “Field activity was the best I would say. Also the guest lecture and the practical instruments they showed us. The specimens were amazing. Also, the whole day was administered very nicely. I would expect such workshops in future too.”
Participant 19: “Innovation!”
Participant 26: “Session with guest speaker and the GIS field activity was amazing. It provided an enriching experience to us and we would love to have more such sessions in the near future.”
Participant 28: “The part I liked the most was that there was a competition and quiz involved. Because of this, since the beginning of the workshop, I stayed fully alert and concentrated. I tried my best to absorb all the information that I could. I feel, if there's competition involved, students tend to work harder and take things more seriously. Apart from this, both the teachers presented very well, especially the guest speaker, I loved her presentation. One thing I'm sure about, I'm not going to forget what I learnt today in the workshop. It was an amazing experience. I would love to be part of more such event.”
Participant 51: “The presentation was useful and the way the speakers demonstrated made the activity/workshop interesting. Also the field activity was good with the cooperative group members”
Participant 58: “I liked the way of presentation and the content of presentation was quite informative as well. As it helped me to know about vector and how to prevent such diseases.”
| Discussion | | |
The present study revealed that around 50.87% student found field activity to be most interesting part of the workshop. The hands-on training feature of this study had a great impact in grasping the responsiveness of students. Additionally, the GIS group students found this activity to be more fun and interesting. In the GIS group, 86.1% of the participants the found vector survey method to be more interesting and useful while in conventional group about 65% found the method of vector surveillance to be interesting and useful. This was interesting to know that in spite of spending more time on training and finding this method less easy compared to the conventional method, the GIS method was considered to be significantly more interesting by the participants. A student quoted the content to be “very helpful and unlikely to forget”. It appeared that people in GIS group had high enthusiasm due to participation in field activity. The study also highlights how a topic can be made fun-filled and interesting using a combination of gaming attitude and use of the language the students understand along with demonstration and then adding the field experience of the newer advances in the topic. The practical experience involving use of geo-spatial technology in larval tracking made learning exciting like a treasure hunt.These innovative and interactive teaching methods help arouse interest in students. It also involves more engagement from students along with improving their knowledge and skills. A simple technique of hands-on experience can go a long way. It can bridge the gap between teaching–learning efforts and can also help in covering must-know topics of the subject. The literature review on methods of health education and training.
Hilal et al. found in their study that hands-on training improves technical skills.[11] GIS provides an opportunity for teachers to engage students in new learning methods.
A similar study done by Egiebor et al found that use of GIS promotes students engagement[12] Ruiz et al also found in their study that students highlighted their preference of experiential learning over traditional methods of teaching like lectures.[13] Farah Naz also found that innovative teaching strategies should be implemented and modified as per students need to increase their performance.[14]
The literature review by Mello et al. also emphasizes that for acquisition of skills and competencies not only active learning and innovative teaching strategies but also willingness to learn and an interesting and significant content are necessary.[15] This study findings also confirms this.
The use of innovative teaching techniques helps students to acquire knowledge along with the ability for its practical implementation. The study findings emphasizes that experiential learning using innovative new technology and field activity can lead to meaningful positive changes in student's perception of the subject. Such effective way of teaching is estimated to bring more involvement of undergraduates. Based on the findings of qualitative feedback a concept diagram for effective teaching was developed for better engagement of students [Figure 3]. | Figure 3: Concept diagram for an effective teaching method recommended for teaching
Click here to view |
| Conclusion and Recommendation | | |
The findings suggest that introduction of new technology may act as an engaging factor and increase the interest in the topic. This kind of teaching will definitely act as one of the contributing factor in developing a positive attitude towards in depth learning and exploration of the subject.
It is recommended that to teach a topic of public health importance like mosquito borne diseases, the teaching should incorporate hands-on experience of GIS technology in community settings so as to make the medical students future ready.
Such innovative and experiential teaching method with the recent advances in the field should be explored further to fill in the gaps in medical curricula. More studies in real community settings are needed to confirm the findings of this study.
| Limitations | | |
In the current COVID scenario, the study was conducted in the college campus in controlled conditions wherein the actual application of GIS could not be completely explored. This on-campus field activity likely led to a lesser participation from the students. The findings could also have been different if done in unknown community settings where the GIS based technology could have been more interesting to demonstrate. The fact that the participants were volunteers for the entire program including the field activity might have influenced the success of the training program as they were highly motivated and wanted to learn about the new spatial technology. Despite these limitations, we feel that this training program's qualitative findings might serve as a suitable example that can be replicated by other institutions with comparable educational needs to make learning effective.
Financial support and sponsorship
The training program was funded by Dr. D. Y. Patil Medical College, Pimpri, Pune.
Conflicts of interest
There are no conflicts of interest.
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