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Mobile and blended learning solutions, when designed and implemented successfully, have a capacity to respond to educational needs of learners dispersed across vast regions and cultures. Learning at a distance using mobiles, or a combination of modes, has been accepted as beneficial both in developed and developing countries, particularly in settings where potential learners do not have direct access to education. The majority of sub-Saharan African countries, including Ghana, which is the focus of this discussion, have recognized the benefits of distance learning with ICT and seek to develop programs to meet their specific educational goals (Onwe, 2013; Uneke et al., 2014). Lately, there have been more initiatives to build local expertise and involve home-grown professionals in the co-creation of innovative technology-assisted learning solutions in new educational environments. Effective learning artifacts, courses, and programs necessitate a design-development-evaluation-implementation framework that fits the needs and characteristics of the specific educational and socio-cultural context. An appropriate framework, embraced by all participants, is needed for successful transcultural projects, including collaborative research studies. That common frame of reference should underpin the decisions and activities of any transnational team effort as it provides a starting point for the discourse around differences in perspectives, assumptions, concepts, values and practices. It is also crucial that the framework evolves to respond to the changing understanding of the context and needs, as well as emerging requirements and future scenarios. For that reason, the reported Design-Based Research (DBR) project adopted the Integrative Learning Design Framework (ILDF) (Bannan, 2009; Palalas, 2012) to guide the design of a Physician Assistant (PA) program delivered at a distance by the Central University College (CUC) in Ghana. This educational intervention, if successful, will address the need for health care personnel in rural regions, in Ghana, by educating physician assistants in their home communities.
The doctor-patient ratio in Ghana and in many parts of Africa is at an all-time low. The severity of these statistics was corroborated by the Director of Health Service for the Greater Accra region, Dr. Linda Van Otoo (Ansah, 2014), who confirmed that a doctor in Ghana attends to approximately 15,259 patients a year, a Physician Assistant sees about 38,000 patients in a year and midwives and nurses - about 6,000 and 1,400 patients respectively. In response to this urgency, members of the PA Program at the Central University College partnered with the University of New Mexico and Athabasca University to address these healthcare needs by training more PAs using mobile technology and blended learning. The transnational team comprised a Primary Investigator, Financial Officer, Program Manager and IT Officer from CUC, as well as instructional design and m-learning consultants from Canada and the USA. The team received support from a Grand Challenges Canada grant award which enabled the launch of the DBR study in May 2013. This ongoing project has leveraged mobile and e-learning technologies to support knowledge building and skill acquisition amongst PA practitioners in remote areas in Ghana. The educational intervention designed in the study blends innovative distance learning approaches, including e-learning and mobile learning content, resources, strategies and tools, with occasional face-to-face (f2f) clinical sessions to provide a hybrid PA program. The project has been nicknamed Physician Assistant Hybrid E-Learning Program (PA-HELP) to cohere the blend of mobile and f2f with more traditional e-learning approaches. The collaborative process of the design and implementation of the PA-HELP solution has been guided by the previously mentioned ILDF model - a DBR framework that has been progressively modified to reflect the real-life application of the transcultural research project. The effectiveness of the framework has been examined across all stages of its implementation, as part of the Evaluation Phase of the project, as well as retrospectively, resulting in refinements to the original framework and the conclusions presented hereby.