Evaluating the role of key learning theories in ECHO: a telehealth educational program for primary care providers.

BACKGROUND ECHO (Extension for Community Healthcare Outcomes) is a telehealth educational program that uses videoconference technology to train community-based primary care providers (PCP's) on the management of complex, chronic diseases. The main components of ECHO are didactics, case presentations, and case-based learning. ECHO was developed using the key principles of Social Cognitive Theory, Situated Learning Theory, and Community of Practice Theory. OBJECTIVES In a prior study, we implemented an ECHO curriculum to improve management of resistant hypertension. The goals of the current study were to determine the extent to which the learning theories served as the foundation of the ECHO curriculum and identify opportunities to more effectively incorporate key principles of these theories into the ECHO program. METHODS We conducted semi-structured interviews with the nine clinicians who participated in the pilot curriculum. A community-based PCP assisted with question development, analysis, and manuscript preparation. We analyzed the interview transcripts using Directed Content Analysis. RESULTS Transcript analysis supported the contention that ECHO is based upon Social Cognitive Theory, Situated Learning Theory, and Community of Practice Theory. Comments from study participants highlighted benefits of each theory's principles. Conversely, they also suggested we could improve our implementation of ECHO by adhering more closely to specific learning theory strategies. CONCLUSIONS Our results indicate that ECHO indeed reflects the key tenants of Social Cognitive Theory, Situated Learning Theory, and Community of Practice Theory. Several aspects of our ECHO curriculum can be improved by more complete application of these learning theories.