Development and initial testing of e-learning stroke care modules for low- and middle-income settings: a user-centered co-design project

Abstract Background Stroke is a leading cause of death and disability worldwide. The greatest burden of stroke occurs in low- and middle-income countries (LMICs), where access to organised stroke care and trained multidisciplinary stroke teams remains limited. Sustainable workforce development is essential to improving stroke care, yet traditional in-person training approaches are resource-intensive and difficult to scale. This project aimed to develop and undertake initial user-testing of culturally and contextually relevant asynchronous e-learning modules to support core stroke skills training for multiprofessional health workers in Ghana and Zambia. Methods A user-centred co-design approach was undertaken with healthcare professionals in Ghana and Zambia. Eight e-learning modules, covering core stroke care skills, were developed from established face-to-face training materials and adapted for online delivery. The first two module prototypes underwent user feedback in Ghana, and the final six in Zambia. Feedback was sought from health workers, who were recruited using convenience sampling, with efforts to include diverse professional roles and experience levels. Think-aloud “interviews” were conducted as health workers completed modules to capture real-time feedback on usability, content clarity, and contextual relevance. Comprehensive field notes were recorded, and findings were reviewed through regular team discussions to identify recurring themes. Insights were used iteratively refine content and platform design, resulting in a final suite of 8 published (and freely available) online modules. Results: A total of 79 health workers participated (Ghana n = 34; Zambia n = 45), including physicians, nurses, and physiotherapists. Feedback clustered into three key themes: training structure and user experience, training content, and assessment methods. Participants valued the interactive, case-based design and multidisciplinary relevance of content. Identified challenges included navigation, account registration, and quiz functionality, which were addressed through iterative modifications. The co-design process also fostered interdisciplinary collaboration and leadership development within participating teams. Conclusions: This project demonstrates the feasibility of collaboratively developing contextually relevant e-learning modules for stroke workforce development in LMIC settings. Think-aloud methods supported pragmatic refinement of content and usability. Further research is required to evaluate implementation, scalability, and impact on clinical practice and patient outcomes. Trial Registration not applicable