Jamie S. Johnston

All Publications

• Effectiveness of interactive satellite-transmitted instruction: Experimental evidence from Ghanaian primary schools ECONOMICS OF EDUCATION REVIEW Johnston, J., Ksoll, C. 2022; 91

  View details for DOI 10.1016/j.econedurev.2022.102315

  View details for Web of Science ID 000874026400003

• Evaluation of a community-based mobile video breastfeeding intervention in Khayelitsha, South Africa: The Philani MOVIE cluster-randomized controlled trial. PLoS medicine Adam, M., Johnston, J., Job, N., Dronavalli, M., Le Roux, I., Mbewu, N., Mkunqwana, N., Tomlinson, M., McMahon, S. A., LeFevre, A. E., Vandormael, A., Kuhnert, K. L., Suri, P., Gates, J., Mabaso, B., Porwal, A., Prober, C., Bärnighausen, T. 2021; 18 (9): e1003744

  Abstract

  In South Africa, breastfeeding promotion is a national health priority. Regular perinatal home visits by community health workers (CHWs) have helped promote exclusive breastfeeding (EBF) in underresourced settings. Innovative, digital approaches including mobile video content have also shown promise, especially as access to mobile technology increases among CHWs. We measured the effects of an animated, mobile video series, the Philani MObile Video Intervention for Exclusive breastfeeding (MOVIE), delivered by a cadre of CHWs ("mentor mothers").We conducted a stratified, cluster-randomized controlled trial from November 2018 to March 2020 in Khayelitsha, South Africa. The trial was conducted in collaboration with the Philani Maternal Child Health and Nutrition Trust, a nongovernmental community health organization. We quantified the effect of the MOVIE intervention on EBF at 1 and 5 months (primary outcomes), and on other infant feeding practices and maternal knowledge (secondary outcomes). We randomized 1,502 pregnant women in 84 clusters 1:1 to 2 study arms. Participants' median age was 26 years, 36.9% had completed secondary school, and 18.3% were employed. Mentor mothers in the video intervention arm provided standard-of-care counseling plus the MOVIE intervention; mentor mothers in the control arm provided standard of care only. Within the causal impact evaluation, we nested a mixed-methods performance evaluation measuring mentor mothers' time use and eliciting their subjective experiences through in-depth interviews. At both points of follow-up, we observed no statistically significant differences between the video intervention and the control arm with regard to EBF rates and other infant feeding practices [EBF in the last 24 hours at 1 month: RR 0.93 (95% CI 0.86 to 1.01, P = 0.091); EBF in the last 24 hours at 5 months: RR 0.90 (95% CI 0.77 to 1.04, P = 0.152)]. We observed a small, but significant improvement in maternal knowledge at the 1-month follow-up, but not at the 5-month follow-up. The interpretation of the results from this causal impact evaluation changes when we consider the results of the nested mixed-methods performance evaluation. The mean time spent per home visit was similar across study arms, but the intervention group spent approximately 40% of their visit time viewing videos. The absence of difference in effects on primary and secondary endpoints implies that, for the same time investment, the video intervention was as effective as face-to-face counseling with a mentor mother. The videos were also highly valued by mentor mothers and participants. Study limitations include a high loss to follow-up at 5 months after premature termination of the trial due to the COVID-19 pandemic and changes in mentor mother service demarcations.This trial measured the effect of a video-based, mobile health (mHealth) intervention, delivered by CHWs during home visits in an underresourced setting. The videos replaced about two-fifths of CHWs' direct engagement time with participants in the intervention arm. The similar outcomes in the 2 study arms thus suggest that the videos were as effective as face-to-face counselling, when CHWs used them to replace a portion of that counselling. Where CHWs are scarce, mHealth video interventions could be a feasible and practical solution, supporting the delivery and scaling of community health promotion services.The study and its outcomes were registered at clinicaltrials.gov (#NCT03688217) on September 27, 2018.

  View details for DOI 10.1371/journal.pmed.1003744

  View details for PubMedID 34582438

• Exploring the role of community health organizations in promoting public health during a health crisis: a qualitative study of COVID-19 responses in South Africa and Zambia. Global health promotion Johnston, J. S., Zhang Aluri, K., Job, N., Kuhnert, K. L., Prober, C., Ward, V., Skinner, N. A. 2023: 17579759231205854

  Abstract

  While the COVID-19 pandemic amplified the need for accurate and actionable health information, uncertainty and the proliferation of misinformation have contributed to significant mistrust in public health messages, especially among marginalized communities. Community health organizations can play an important role in creating trust and providing targeted health information to vulnerable groups. This qualitative study, which is focused on community health organizations supporting vulnerable populations in South Africa and Zambia, finds that during the pandemic, community health organizations expanded their roles and leveraged their established access and trust to support the communities they serve with health education and services. However, the reliance on external support limits the organizations' ability to respond in an effective and efficient manner during health crises.

  View details for DOI 10.1177/17579759231205854

  View details for PubMedID 37909401

• Use of open-source online course content for training in public health emergencies: Evidence from COVID-19 education for health professionals. JMIR medical education Skinner, N. A., Job, N., Krause, J., Frankel, A., Ward, V., Johnston, J. 2023

  Abstract

  BACKGROUND: The onset of the COVID-19 pandemic generated an urgent need for credible and actionable information to guide public health responses. The massive open-source online course (MOOC) format may be a valuable path for disseminating timely and widely accessible training for health professionals during public health crises; however, the reach and effectiveness of health-worker directed online courses during the pandemic remains largely unexplored.OBJECTIVE: This study investigates the use of an open-source online course series designed to provide critical COVID-19 knowledge to frontline health workers and public health professionals globally. The study investigates how open-source online educational content can be optimized to support knowledge sharing among health professionals in public health emergencies, particularly in resource-limited contexts.METHODS: The study examines global course enrollment patterns (N=2,185) and in-depth interviews with a purposive sub-sample of health professionals enrolled in the course series (N=12) selected to investigate the sharing of online content in pandemic responses. Interviewed learners were from Ethiopia, India, Kenya, Liberia, Malawi, Rwanda, Thailand, Uganda, the United Arab Emirates, and the United States. Inductive analysis and constant comparative methods were used to systematically code data and identify key themes emerging from interview data.RESULTS: Analysis revealed that the online course content helped fill a critical gap in trustworthy COVID-19 information for pandemic responses and was shared through health worker professional and personal networks. Enrollment patterns and qualitative data illustrate how health professionals shared information within their professional networks. While learners shared knowledge they gained from the course, they expressed a need for contextualized information to more effectively educate others in their networks and in their communities. Due to technological and logistical barriers, participants did not attempt to adapt content to share with others.CONCLUSIONS: This study illustrates that health professional networks can facilitate the sharing of online open-source health education content, yet to fully leverage potential benefits, additional support is required to facilitate the adaptation of course content to more effectively reach communities globally.CLINICALTRIAL:

  View details for DOI 10.2196/42412

  View details for PubMedID 36735834

• Barriers to COVID-19 vaccine acceptance to improve messages for vaccine uptake in indigenous populations in the central highlands of Guatemala: a participatory qualitative study. BMJ open Skinner, N. A., Sanders, K., Lopez, E., Sotz Mux, M. S., Abascal Miguel, L., Vosburg, K. B., Johnston, J., Diamond-Smith, N., Kraemer Diaz, A. 2023; 13 (1): e067210

  Abstract

  INTRODUCTION: As of July 2022, a little over one-third of Guatemalans were fully vaccinated. While COVID-19 vaccination rates are not officially reported nationally by racial/ethnic groups, non-governmental organisations and reporters have observed that COVID-19 vaccination rates are especially low among high-risk Indigenous populations. We conducted one of the first studies on COVID-19 vaccine acceptance in Indigenous populations in the Central Highlands of Guatemala, which aimed to better understand the barriers to COVID-19 vaccine uptake and how to improve vaccine promotional campaigns.METHODS: In November 2021, we conducted eight focus group discussions (FGDs) with 42 Indigenous men and women and 16 in-depth interviews (IDIs) with community health workers, nurses and physicians in Chimaltenango and Solola. Using a participatory design approach, our qualitative analysis used constant comparative methods to understand the inductive and deductive themes from the FGD and IDI transcripts.RESULTS: We found three major overarching barriers to vaccination within the sampled population: (1) a lack of available easily understandable, linguistically appropriate and culturally sensitive COVID-19 vaccine information; (2) vaccine access and supply issues that prevented people from being vaccinated efficiently and quickly; and (3) widespread misinformation and disinformation that prey on people's fears of the unknown and mistrust of the medical establishment and government.CONCLUSION: When developing COVID-19 vaccine messages, content should be culturally relevant, appropriate for low-literacy populations and in the languages that people prefer to speak. Promotional materials should be in multiple modalities (print, radio and social media) and also have specific Maya cultural references (dress, food and concepts of disease) to ensure messaging connects with intended targets. This study supports the need for more robust research into best practices for communicating about COVID-19 vaccines to marginalised communities globally and suggests that policy makers should invest in targeted local solutions to increase vaccine uptake.

  View details for DOI 10.1136/bmjopen-2022-067210

  View details for PubMedID 36707110

• Evaluating the impact of a linguistically and culturally tailored social media ad campaign on COVID-19 vaccine uptake among indigenous populations in Guatemala: a pre/post design intervention study. BMJ open Abascal Miguel, L., Lopez, E., Sanders, K., Skinner, N. A., Johnston, J., Vosburg, K. B., Kraemer Diaz, A., Diamond-Smith, N. 2022; 12 (12): e066365

  Abstract

  OBJECTIVES: To evaluate the impact of culturally and linguistically tailored informational videos delivered via social media campaigns on COVID-19 vaccine uptake in Indigenous Maya communities in Guatemala.METHODS: Our team designed a series of videos utilising community input and evaluated the impact using a pre-post intervention design. In-person preintervention surveys were collected from a sample of respondents in four rural municipalities in Guatemala in March 2022. Facebook, Instagram and browser ads were flooded with COVID-19 vaccine informational videos in Spanish, Kaqchikel and Kiche for 3weeks. Postintervention surveys were conducted by telephone among the same participants in April 2022. Logistic regression models were used to estimate the OR of COVID-19 vaccine uptake following exposure to the intervention videos.RESULTS: Preintervention and postintervention surveys were collected from 1572 participants. The median age was 28 years; 63% (N=998) identified as women, and 36% spoke an Indigenous Mayan language. Twenty-one per cent of participants (N=327) reported watching the intervention content on social media. At baseline, 89% (N=1402) of participants reported having at least one COVID-19 vaccine, compared with 97% (N=1507) in the follow-up. Those who reported watching the videos had 1.78 times the odds (95%CI 1.14 to 2.77) of getting vaccinated after watching the videos compared with those who did not see the videos when adjusted by age, community, sex and language.CONCLUSION: Our findings suggest that culturally and linguistically tailored videos addressing COVID-19 vaccine misinformation deployed over social media can increase vaccinations in a rural, indigenous population in Guatemala, implying that social media content can influence vaccination uptake. Providing accurate, culturally sensitive information in local languages from trusted sources may help increase vaccine uptake in historically marginalised populations.

  View details for DOI 10.1136/bmjopen-2022-066365

  View details for PubMedID 36523220

• "The Videos Gave Weight to Our Work": Animated mHealth Videos and Tablet Technology Boost Community Health Workers' Perceived Credibility in Khayelitsha, South Africa. Qualitative health research Adam, M., Job, N., Mabaso, B., Barnighausen, T., Kuhnert, K., Johnston, J., Mqungwana, N., Le Roux, I., Mbewu, N., Gates, J., Scott, K., Vandormael, A., Greuel, M., Prober, C., McMahon, S. A. 2022: 10497323221091504

  Abstract

  Mobile health (mHealth) interventions are increasingly used to support community health workers (CHWs) in low-and middle-income countries. As near-peers within their communities, the credibility of CHWs is sometimes questioned-a recognized barrier to their efficacy. Nested within a large, randomized-controlled trial, this qualitative study captured the experiences of South African CHWs, called "Mentor-Mothers," using tablets and animated videos to promote exclusive breastfeeding. We conducted in-depth telephone interviews with 26 tablet-carrying Mentor-Mothers. We analyzed interview transcripts using a Grounded Theory approach, then developed a theoretical framework, based on an emerging theme, for understanding how tablet technology boosts the perceived credibility of CHWs. Tablet-carrying Mentor-Mothers described an increase in their perceived credibility, which they attributed to overt and signaling effects related to enhanced credibility of (1) their messages, (2) themselves as messengers, and (3) the program employing them. Mobile technology investments in CHWs could enhance their credibility, translating into meaningful investments in the health of under-served communities.

  View details for DOI 10.1177/10497323221091504

  View details for PubMedID 35674176

• Correction: Teaching From Afar: Development of a Telemedicine Curriculum for Healthcare Workers in Global Settings. Cureus Lowe, J. T., Patel, S. R., Hao, W. D., Johnston, J., Butt, A., Strehlow, M., Lindquist, B. 2022; 14 (6): c68

  Abstract

  [This corrects the article DOI: 10.7759/cureus.20123.].

  View details for DOI 10.7759/cureus.c68

  View details for PubMedID 35800193

• Digital Education for Health Professionals: An Evidence Map, Conceptual Framework, and Research Agenda. Journal of medical Internet research Tudor Car, L., Poon, S., Kyaw, B. M., Cook, D. A., Ward, V., Atun, R., Majeed, A., Johnston, J., van der Kleij, R. M., Molokhia, M., V Wangenheim, F., Lupton, M., Chavannes, N., Ajuebor, O., Prober, C. G., Car, J. 2022; 24 (3): e31977

  Abstract

  Health professions education has undergone major changes with the advent and adoption of digital technologies worldwide.This study aims to map the existing evidence and identify gaps and research priorities to enable robust and relevant research in digital health professions education.We searched for systematic reviews on the digital education of practicing and student health care professionals. We searched MEDLINE, Embase, Cochrane Library, Educational Research Information Center, CINAHL, and gray literature sources from January 2014 to July 2020. A total of 2 authors independently screened the studies, extracted the data, and synthesized the findings. We outlined the key characteristics of the included reviews, the quality of the evidence they synthesized, and recommendations for future research. We mapped the empirical findings and research recommendations against the newly developed conceptual framework.We identified 77 eligible systematic reviews. All of them included experimental studies and evaluated the effectiveness of digital education interventions in different health care disciplines or different digital education modalities. Most reviews included studies on various digital education modalities (22/77, 29%), virtual reality (19/77, 25%), and online education (10/77, 13%). Most reviews focused on health professions education in general (36/77, 47%), surgery (13/77, 17%), and nursing (11/77, 14%). The reviews mainly assessed participants' skills (51/77, 66%) and knowledge (49/77, 64%) and included data from high-income countries (53/77, 69%). Our novel conceptual framework of digital health professions education comprises 6 key domains (context, infrastructure, education, learners, research, and quality improvement) and 16 subdomains. Finally, we identified 61 unique questions for future research in these reviews; these mapped to framework domains of education (29/61, 47% recommendations), context (17/61, 28% recommendations), infrastructure (9/61, 15% recommendations), learners (3/61, 5% recommendations), and research (3/61, 5% recommendations).We identified a large number of research questions regarding digital education, which collectively reflect a diverse and comprehensive research agenda. Our conceptual framework will help educators and researchers plan, develop, and study digital education. More evidence from low- and middle-income countries is needed.

  View details for DOI 10.2196/31977

  View details for PubMedID 35297767

• Design preferences for global scale: a mixed-methods study of "glocalization" of an animated, video-based health communication intervention. BMC public health Adam, M., Chase, R. P., McMahon, S. A., Kuhnert, K., Johnston, J., Ward, V., Prober, C., Barnighausen, T. 2021; 21 (1): 1223

  Abstract

  BACKGROUND: Designing health communication interventions for global scaling promotes health literacy and facilitates rapid global health messaging. Limited literature explores preferences for animation prototypes and other content characteristics across participants in different global regions. Prior research underscores an urgent need for health communication interventions that are compelling and accessible across culturally and geographically diverse audiences. This study presents feedback from global learners on animation design preferences and other key considerations for the development of educational video content intended for global adaptation and scaling.METHODS: We used a mixed-methods, sequential explanatory design, with a qualitative descriptive approach to the analysis of the qualitative data. We recruited participants from an international group of learners enrolled in a massive open online course. Through an online quantitative survey (n=330), we sought preferences from participants in 73 countries for animation design prototypes to be used in video-based health communication interventions. To learn more about these preferences, we conducted in-depth interviews (n=20) with participants selected using maximum variation purposive sampling.RESULTS: Generally, respondents were willing to accept animation prototypes that were free of cultural and ethnic identifiers and believed these to be preferable for globally scalable health communication videos. Diverse representations of age, gender roles, and family structure were also preferred and felt to support inclusive messaging across cultures and global regions. Familiar-sounding voiceovers using local languages, dialects, and accents were preferred for enhancing local resonance. Across global regions, narratives were highlighted as a compelling approach to facilitating engagement and participants preferred short videos with no more than two or three health messages.CONCLUSIONS: Our findings suggest that global learners may be willing to accept simplified visuals, designed for broad cross-cultural acceptability, especially if the content is localized in other ways, such as through the use of locally resonating narratives and voiceovers. Diverse, inclusive portrayals of age, gender roles and family structure were preferred.

  View details for DOI 10.1186/s12889-021-11043-w

  View details for PubMedID 34172016

• The Philani MOVIE study: a cluster-randomized controlled trial of a mobile video entertainment-education intervention to promote exclusive breastfeeding in South Africa. BMC health services research Adam, M., Tomlinson, M., Le Roux, I., LeFevre, A. E., McMahon, S. A., Johnston, J., Kirton, A., Mbewu, N., Strydom, S., Prober, C., Barnighausen, T. 2019; 19 (1): 211

  Abstract

  BACKGROUND: In South Africa, rates of exclusive breastfeeding remain low and breastfeeding promotion is a national health priority. Mobile health and narrative entertainment-education are recognized strategies for health promotion. In-home counseling by community health workers (CHWs) is a proven breastfeeding promotion strategy. This protocol outlines a cluster-randomized controlled trial with a nested mixed-methods evaluation of the MObile Video Intervention for Exclusive breastfeeding (MOVIE) program. The evaluation will quantify the causal effect of the MOVIE program and generate a detailed understanding of the context in which the intervention took place and the mechanisms through which it enacted change. Findings from the study will inform the anticipated scale-up of mobile video health interventions in South Africa and the wider sub-Saharan region.METHODS: We will conduct a stratified cluster-randomized controlled trial in urban communities of the Western Cape, to measure the effect of the MOVIE intervention on exclusive breastfeeding and other infant feeding practices. Eighty-four mentor-mothers (CHWs employed by the Philani Maternal Child Health and Nutrition Trust) will be randomized 1:1 into intervention and control arms, stratified by neighborhood type. Mentor-mothers in the control arm will provide standard of care (SoC) perinatal in-home counseling. Mentor-mothers in the intervention arm will provide SoC plus the MOVIE intervention. At least 1008 pregnant participants will be enrolled in the study and mother-child pairs will be followed until 5months post-delivery. The primary outcomes of the study are exclusive breastfeeding at 1 and 5months of age. Secondary outcomes are other infant feeding practices and maternal knowledge. In order to capture human-centered underpinnings of the intervention, we will conduct interviews with stakeholders engaged in the intervention design. To contextualize quantitative findings and understand the mechanisms through which the intervention enacted change, end-line focus groups with mentor-mothers will be conducted.DISCUSSION: This trial will be among the first to explore a video-based, entertainment-education intervention delivered by CHWs and created using a community-based, human-centered design approach. As such, it could inform health policy, with regards to both the routine adoption of this intervention and, more broadly, the development of other entertainment-education interventions for health promotion in under-resourced settings.TRIAL REGISTRATION: The study and its outcomes were registered at clinicaltrials.gov ( #NCT03688217 ) on September 27th, 2018.

  View details for PubMedID 30940132

• The Effects of Blended Online Learning in Higher Education STEM Courses: Experimental Evidence from Mongolia Johnston, J. Stanford Center for Education Policy Analysis. 2018 ; Stanford CEPA Working Papers (18-11):
• Effectiveness of Interactive Satellite-Transmitted Instruction: Experimental Evidence from Ghanaian Primary Schools Johnston, J., Ksoll, C. Stanford Center for Education Policy Analysis. 2017 ; Stanford CEPA Working Papers (17-08):
• The Impact of Vocational Teachers on Student Learning in Developing Countries: Does Enterprise Experience Matter? COMPARATIVE EDUCATION REVIEW Johnston, J., Loyalka, P., Chu, J., Song, Y., Yi, H., Huang, X. 2016; 60 (1): 131-150

  View details for Web of Science ID 000369717700006

• Authoritarian Parenting and Asian Adolescent School Performance: Insights from the US and Taiwan INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT Pong, S., Johnston, J., Chen, V. 2010; 34 (1): 62–72

  Abstract

  Our study re-examines the relationship between parenting and school performance among Asian students. We use two sources of data: wave I of the Adolescent Health Longitudinal Survey (Add Health), and waves I and II of the Taiwan Educational Panel Survey (TEPS). Analysis using Add Health reveals that the Asian-American/European-American difference in the parenting-school performance relationship is due largely to differential sample sizes. When we select a random sample of European-American students comparable to the sample size of Asian-American students, authoritarian parenting also shows no effect for European-American students. Furthermore, analysis of TEPS shows that authoritarian parenting is negatively associated with children's school achievement, while authoritative parenting is positively associated. This result for Taiwanese Chinese students is similar to previous results for European-American students in the US.

  View details for DOI 10.1177/0165025409345073

  View details for Web of Science ID 000272872000007

  View details for PubMedID 24850978

  View details for PubMedCentralID PMC4026298

• Marriage, Money, and African American Mothers' Self-Esteem JOURNAL OF MARRIAGE AND FAMILY Mandara, J., Johnston, J. S., Murray, C. B., Varner, F. 2008; 70 (5): 1188–99

  View details for DOI 10.1111/j.1741-3737.2008.00559.x

  View details for Web of Science ID 000261116200011