Abstract:

Introduction & Purpose
The use of globalized instructional design allows multiple communities to access instruction without duplication of effort. However, the adoption, implementation, and transfer implications of this model require consideration of contextual factors. A series of print-based distance learning materials were developed by the World Health Organization (WHO) using a globalized design model and have been used by medical professionals in multiple countries since the early 1990s. Users of the materials were surveyed to investigate if contextual factors influenced adoption, implementation, and transfer, and if there were differences in development, educational, and healthcare indicators.

Methods
95 Blood Safety Country representatives were surveyed using an electronic questionnaire to establish whether the materials were being used in their country (adoption) and the factors influencing implementation and transfer. The representatives of countries where the materials were used contributed opinions about the match of the materials with their users. Results were condensed into groups and the UNDP healthcare, development, and educational statistical indicators compared.

Results
55 countries returned the questionnaire (58.5%), with 28 countries using the materials (50.9%) There were no significant differences in development, educational, or healthcare characteristics of the countries using the materials vs those not using the materials (p < .05). Surrounding contextual factors influenced adoption more than lack of suitability of the materials across the varied audiences. Primary reasons for not adopting the materials were lack of awareness of the resource (47%), difficulty obtaining materials (32%), no funds (26%), and lack of support from regional organizations (26%) (N = 18).

Respondents were asked if budget, insufficient administrative support, lack of recognition of training, inadequate facilities, availability of trainers or supporters, and insufficient release time for learners influenced the organization of training. Budget influenced the organization of training the most for countries using the materials and not using the materials, and was the only factor significantly different between the two groups (t = -2.612, p < .05).

Representatives were also asked to report the amount of support available for transfer of training in the form of legislative reinforcement, quality assurance, public relations, organized recruitment strategies, and standard operating procedures. The factor with the lowest amount of support was legislative reinforcement and those countries with support had higher educational development indices (EDI) (t = 2.18, p < .05). The presence of incentives was also surveyed (salary, promotion, recognition, job satisfaction, and qualifications). There were minimal or no salary or promotional opportunities as a result of the training; in some cases recognition or qualifications were reported. The countries where qualifications were present as incentives had higher human development indices (HDI) (MW = 22. p < .01).

Conclusion
Developing countries have numerous factors that may limit the effectiveness of the project, or prevent performance changes. The complexities of these contextual factors are just as important to consider as the pure instructional design and warrant additional attention in a globalized model.

Keywords:

globalized instructional design, context of instruction, healthcare continuing.