Case study:
Measuring Up Online- Aboriginal Health Workers
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This case study was developed by the APY Lands TAFE SA, Nganampa Health and TAFEStart, with funding and support from the national training system’s e-learning strategy, the National VET E-learning Strategy (Strategy). The Strategy provides the VET system with the essential e-learning infrastructure and expertise needed to respond to the challenges of a modern economy and the training needs of Australian businesses and workers.

1.1 The Team
APY TAFE SA developed and delivered the training for this course in partnership with Nganampa Health and TAFE Start.
Janet Skewes managed the project and negotiated with TAFE Start which has previously delivered programs with employees in the health and community sector including one at Ptor Augusta. Kay Freeth has been the Literacy/Numeracy lecturer from regional Whyalla campus and Georgina Nou has been the project facilitator and online support based in Adelaide.
Janet as manager at APY TAFE SA and has initiated and supported the delivery of e-learning as well as facilitating the professional development of community lecturers in the use of various e-tools and strategies. Kay Freeth has over 20 years experience in regional TAFE, especially supporting students in the trades, nursing and women's education sector. Georgina Nou has supported and worked with aboriginal people in Central Australia for the last 10 years, instigating online delivery to remote aboriginal communities in order to give learning opportunities to people disadvantaged by location, literacy skills and lack of employment readiness. Anna Papazoglov manages TAFE Start projects and Workplace Education programs involving literacy and numeracy skill development.
Cyndi Cole is the Training Manager at Nganampa Health and David Busuttil is the Nganampa Health Manager. Their support has been integral to the success of the project both by releasing participants from work commitments and assisting with trips and online access for AHWs (Aboriginal Health Workers). Mary Willis is an Aboriginal Health Worker at Ngamapa Health, who is also a NAATI accredited interpreter and has her TAE qualification. Her role in the project was as a language facilitator and subject matter support.
We had essential and responsive ICT support from both Nganampa Health (Philip Craig), TAFE SA Regional (Simon Pollard) and Moodle host and resource developer Richard Wallace.
Cyndi, Georgina and Kay

Mary, the language facilitator

1.2 Knowledge and experience

APY Lands TAFE SA has been delivering training to remote aboriginal communities, using e-learning and online platforms, for the past six years, so we've learned a lot about e-learning from that work. In that time we've initiated a range of projects involving various e-learning strategies:
  • Point of View glasses for demonstration and assessment,
  • Virtual Worlds for role playing in Business and Interpreting,
  • pre-employment program training and support,
and the development of relevant e-learning resources to make learning more accessible to anangu (aboriginal people) living in remote communities.

TAFE community lecturers and aboriginal learning support have been involved in the development and delivery of these projects. The utilisation of web-conferencing through the internet has enabled staff to address the issues that arise through the tyranny of distance in outback Australia. ADSL connection is available across the communities in the APY Lands making the online experience reliable and robust. Mobile connection is only available in one community.
Both APY TAFE and Nganampa Health have excellent ICT support and we were familiar with the procedures that needed to take place in order to make the programs and platforms accessible on the laptops through both the TAFE building and the clinic. On the second trip across the Lands we had programs installed remotely as we introduced participants to the various online tools.
The main issue which we were unsure about was how familiar participants were with using computers. People who had used computers learned very quickly to use the online environment where those who had rarely or never used a computer needed a lot more support than we could give on our visits. At that point we enlisted the support of TAFE staff in each community who were able to assist people getting into Centra, the web-conferencing program we used. The language facilitator also made it possible to talk and walk people through the navigation of web pages and programs so all could participate in sessions.

2.1 Aim
Nganampa Health Council, like many remote/regional primary health service providers are reliant on their aboriginal workforce to provide effective services to remote communities in Central Australia where health statistics are alarming and staff turnover of non-aboriginal staff is high. They deliver health training at the Cert II, III, and IV level.
Aboriginal Health Workers (AHWs) are identified on the national skills shortage list. Nationally there are critical literacy and numeracy skills gaps preventing AHWs, including those employed at Nganampa Health in the APY Lands from accessing educational opportunities and employment pathways.
Online training success with ADSL broadband in the Lands by APY TAFE SA, raised the possibility of exploring e-learning solutions for Nganampa Aboriginal Health workers, using online delivery - web-conferencing and interactive activities on Moodle.
An early visit to the clinics gave us the opportunity to assess the numeracy, literacy (including digital literacy) levels of AHWs. As we visited clinics we also observed the workplace and identified literacy and numeracy skills essential to the AHWs day to day functioning.
For 12 weeks, participants accessed training and learning support in work-based numeracy and literacy activities, from both the clinics and TAFE using Centra online session rooms.

2.2 Objective

The often inadequate literacy/numeracy skill levels of many AHWs nationwide, affect how they can do their job, for example, tasks like writing patient records and updating them online, measurements, and working with medicines. This can then limit the scope of work for Aboriginal Health Workers.
Access to language/literacy/numeracy (LLN) skill development through online training has developed skills of AHWs with minimal disruption to work schedules and has been met with enthusiasm. We visited the Lands on two occasions, once to establish the LLN (including digital literacy) needs of learners and identify workplace tasks and the other to familiarise participants with the computer and internet platforms. Participants then attended online training in various ways for 12 weeks of training. They could attend the TAFE in their local community, they could access training from the clinic using laptops that we provided and on one occasion participants attended training from Umuwa community Trade Training Centre using an interactive whiteboard during their Primary Health Care training. This allowed us to explore the flexibility that e-learning gives learners and test out how people cope with changing arrangements and logging on with slightly different information.
Training was delivered for 2 groups X 1.5hrs +additional time arranged with tutor where negotiated. We worked together through Centra and Moodle. The tools in Centra made it possible to keep the sessions very dynamic and hands on and when we needed to run some people at a different pace we could make that work by using breakout rooms. Working online immediately gave us access to a host of numeracy and literacy activities. The relevance and interactivity of these resources were key to the motivation of learners. Learners each had an email account set up for them and the more advanced group began using these, bringing them into the network of other health staff and establishing a pattern of using the main clinic computer, which has not been usual.
Over the 12 weeks all AHW attended, if only for some of the sessions. There were several funerals during that time and participants had commitments with family or were travelling for appointments. Rescheduling can easily be done for online sessions, a far more practical proposition than reorganising a face to face trip, which is how trainers have previously delivered training.
The ability to speak in English and in language works well and the anonymity in web conferences actually suits aboriginal learners.
The more advanced Cert 3 and 4 participants progressed confidently and have grown in skills and confidence to attempt further study. The Cert 2 participants generally had less familiarity with the internet so progressed more slowly but were equally as responsive when working online and seeing the possibilities for improving their skills in this innovative way.


3.1 Starting the project

The team had our first online meeting in Centra to begin looking at key issues to be addressed whilst establishing the online training program for literacy/numeracy skill development of Aboriginal health workers at Nganampa Health. We joined online from Adelaide, Whyalla and Umuwa; for some it was their first online meeting. Anna was able to share her insight into workplace programs and the need for a whole approach to the support of new training initiatives. This training was going to be beneficial for the organisation on several fronts, as it has started using computers and the internet for integral aspects of its service. Patient records have shifted online so e-records are available as community members move around and interviews and consultations are done online. With the commencement of online training there were logistical considerations around timetabling, access to computers and support mechanisms in the workplace - the clinic. Management was very supportive of release time for employees which was
carer.jpg important step in the success of workplace training.

As APY TAFE have been involved in the delivery of online training we were aware of what set up needed to happen (programs loaded onto the laptops we'd provided) as well and log ins. We were also aware of limitations - too many people simultaneously online in any one community leads to problems and the need for plugs to enable two participants to share a computer from the clinic if required. The setup was achieved using remote access by the ICT people. It was time consuming as we travelled from community to community but the installations were quite straight forward and we had relatively few issue with logins during the course.
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The IT support from both TAFE and Ngnampa Health worked together online to streamline logins while keeping the integrity of the security, given clinic files are confidential and there is a caution about content which could be downloaded.
We have ADSL connection across the communities in the APY Lands, something which has made online training very viable over the past 7 years.
The technical issues encountered were mainly the unfamiliarity of new users and logging on. Once we had an issue with slow connection cutting the audio out so we used the text chat instead - we were fortunate that the participant had literacy skills to manage. If not we could have used a phone linkup simultaneously.
After the first visit to the clinics it became clear that a significant issue for participants was finding a quiet place to attend sessions. Clinics are busy, often noisy places and the 'office' area is open space. Early in the project we decided then to make computers available at the TAFE in each community and give support to accessing the online platforms.
Without the responsive support from IT people, things could never have run so smoothly. Both the TAFE and Nganampa Health support had been organised for the first trip so that we could test connections and any issues that might arise from firewalls and software. Simon from TAFE had provided laptops for each clinic and had installed relevant software to run Centra. As we moved across the communities, the IT support from Nganampa spoke with use via remote and phone so we could assign logins, passwords and emails for AHWs. Good planning for these issues is essential and needs to begin early to avoid time wasting when delivery begins. Always do test runs.

3.2 Running the project

In delivering training online over the past 7 years to the APY Lands, we've had ADSL connection and have pushed it to the limit. We've run online synchronous sessions using all the features in web-conferencing, used webcam for visual contact, we've uploaded videos in live sessions and delivered projects in Second Life virtual world. The latter took us to the limit and participants in communities without ADSL2 were often left suspended and floundering in the air! Otherwise we have had a fairly problem-free run as long as we didn't have too many users (not often more than 6) using the connection at any one location. Amata has always performed a little worse than other communities and sometimes the audio has dropped out there. That being said, a faster connection would enable a greater capacity to do effective training and health service provision, giving better resolution to visuals and clarity to audio/video. 'Face to face' demonstrations could be given and even comprehensive pre-diagnosis consultations. These are things that Nganampa Health are beginning to do which would be massively improved with faster broadband speeds.

A number of the participants had used computers only a few times and then with someone else, so initially there was a big challenge for them. These learners also weren't familiar with the keyboard or navigation of the computer. Despite this they were enthusiastic and good-humoured about learning. In my work with aboriginal people I have generally found them able to catch on to using computers quickly and not have the usual fear that they might do something wrong. The 'I show then you do' approach ensures people remember where to go and what to do on the computer. Once people were IN the online session rooms we found we could explain and give guidance with most technical issues using the microphone and application share. In the first instance Cyndi, the Nganampa Health trainer gave assistance by phone when AHWs rang her with problems. This was an important role and I'm sure she encouraged and urged people to persevere, which they did.
During the TAFE holidays people came on from the laptops in the clinic. Generally this went well but we had a couple of times where the session had started and we weren't able to adequately guide someone through the steps. This highlights the need for hovering support to get into the web conference when something goes wrong e.g headphone jack in wrong port.
After the first two trips to the Lands, most technical issues were sorted. We had taken headsets and shown everyone how to correctly insert and use, pointing out problems with audio/volume that needed to be checked. Once delivery was underway, we had little reason to contact IT support, just once when someone had changed their name between visits, and their email/logins needed to change. Credit to the set up process really. Most of the issues from then on were forgotten logins and the computer occasionally not spontaneously picking up the audio source from microphones.
The TAFE staff have quite a lot of experience with Centra workings so most problems were quickly solved. Their assistance for supporting people getting onto the internet and into Centra and Moodle was very important at the beginning of the project. After a few times the participants worked by themselves on accessing the sessions. Some of the Cert 2 learners only attended a few sessions for various reasons. The more familiar they become with the programs the less help they will obviously need. None of the participants were reluctant users but coming with no digital literacy means more effort to effectively participate. That being said, the visual, interactive and participatory environment of online sessions worked well for low literacy learners, especially with engagement factors.

3.3 Wrapping up the project

Each team member has different strengths and we all came to this project with a commitment to give it our best shot. There was a significant investment of time, effort and resources by TAFE and Nganampa Health staff. From previous online training there was a vision that this kind of training could be effective and there was no doubt that it was necessary. Recent surveys with AHWs around Australia clearly outlined their desire to be more involved in clinical work and registration requirements will make literacy/numeracy skills essential.
Previously Nganampa Health had employed a tutor to come up a few times in the year and work with AHWs on their literacy. This was a good foundation but face to face delivery is not really a viable option in remote Australia with accommodation and travel either not available or extremely costly for multiple visits. Through the project those who were reserved at first about online delivery could see that there were real possibilities for training but also that this could be a key to greater involvement by AHWs in the organisation's networks, for instance, using emails.
TAFE management has worked at building connections with local community employers and to offer suitable training for their employees. This project has piloted a process that could be used for other employers. We undertook this project with that in mind, so were constantly noting issues that related uniquely to the workplace. Things like confidentiality and suitable training areas. Also access issues in terms of numbers of computer terminals and the traffic on them. We negotiated training around daily commitments of AHWs and also the primary health care training that took place. This led to us using electronic whiteboards for the fist time in delivery as the training was happening at Umuwa and there is a new Trade Training Centre that employs this hardware. Aboriginal people are flexible about these things and adapted to the changing arrangements for access.


The literacy/numeracy lecturer came with lots of experience working with trade/community service students and in workplace literacy. She had not worked in an online environment however Georgina had a great deal of experience in that area, as well as a background in literacy/numeracy and workplace delivery and together they grew the course so that it met the specific needs of the learners and workplace. Time was taken to familiarise Kay with Centra and look at features that would maximise the benefit of training. We began using breakout rooms when learners needed to spend more time on a topic or if we wanted to work on different things with those involved. The interactive activities available on websites were trawled and we could always find excellent resources for developing skills in numeracy. There is a resource that's been written for AHWs literacy/numeracy skill development. 'Community health worker resource kit: literacy, numeracy, workplace communication', which was created with input from Nganampa Health and others and the content is very relevant but somewhat static. We were able to utilise this resource but make it more dynamic with whiteboard activities and demonstrations during online sessions. It was challenging having 8+ learners online with basic numeracy needs as people are working and understanding at different levels but that's when we worked in breakout rooms effectively. I would recommend groups of no more than eight with basic numeracy and literacy needs. The language facilitator Mary, had not worked in online webinars before but quickly became competent and confident. The lecturers needed that backup to make participants feel comfortable with the training and explain concepts and directions in language where required. Mary was a great advocate for the training at the Melbourne Showcase where she jointly presented with the lecturers and one of the other students. She's prepared to do further work in this area and already has her TAE. She was a valued member of the team.
In terms of cost saving, there is always investment necessary when employing new strategies.
Cyndi took two weeks out of her schedule to accompany and drive us across the communities and introduce us to the Health Workers and other clinic staff. This was a critical part of getting engagement by participants and cooperation of staff, not to mention assessing peoples' literacy/numeracy skills, and all at a time when 'Business' was happening in the Lands and usual routes to communities had to be avoided. The reference group met every month to guide the process and delivery and address any issues that were arising.
For future projects this work has established relationships and processes and there would indeed be cost savings by building on this project. Considering literacy and numeracy training has not satisfactorily been delivered out bush due to the expense of having visiting lecturers, this project certainly maps out a suitable strategy for not only health organisations but other employers in the APY Lands.

Online in Centra

It's fair to say that this project has created a model for designing and delivering literacy and numeracy training using online platforms for aboriginal health workers in remote and regional locations. This model could be adapted to other workplaces with aboriginal workers needing literacy training, anywhere in Australia where internet connection is possible.
There has been interest from other organisations including Aged Care facilities and Community Services providers where workers have similar tasks. Literacy and numeracy skill levels are a significant barrier to workplace and training participation for aboriginal people in remote and regional locations Online training lets both trainers and learners be flexible about session times, and place is only determined by available internet connection.
We have explored funding opportunities for ongoing training through WELL (Workplace Education Language and Literacy) and are hopeful of some support. Several media releases throughout the project and our Showcase presentation has attracted attention. Good news stories are welcome from remote communities and we're keen to spread the word that online training IS possible in remote locations and that aboriginal people disadvantaged by distance amongst other things, can take advantage of the possibilities that online training gives.
Nganampa Health Council and TAFE have, at the core of their aims, the improvement of services and increase in opportunities for Aboriginal people living and working in remote Central Australia in order to improve the well-being of individuals and communities. This project has enabled us to establish an innovative and effective way of addressing some of those needs and the enthusiasm is there in both organisations to explore and invest further.


4.1 Main project outcomes

From the beginning this project was about the Aboriginal Health Workers who are integral to the functioning of Nganampa Health across the APY Lands. We've been able to assess the language/literacy/numeracy (LLN) needs of the AHWs and deliver a program that develops their skills for use in their everyday work at the clinic. By visiting the clinics and identifying LLN needs in the workplace we were always able to contextualise the learning. We've collected links to a range of excellent online interactive activities that can be used by learners on the Moodle website as well as providing literacy programs for the laptops at the clinic.
During the 12 weeks of delivery literacy and numeracy skills were developed and units of competency were achieved. There have been good foundations laid here for further work. Many of the AHWs were not confident with numeracy skills but slowly remembered aspects that they had covered when at school, for instance 24 hour clocks and basic operations.
All participants have had an opportunity to gain digital literacy skills, some just beginning and others soaring, using PowerPoint to develop community health promotions.
This e-learning has trialled a new model for delivery of health worker training at Nganampa Health Council. The organisation uses new technology for patient records, transmission of X-rays and now telemedicine. This project has provided a case study for other remote health organisations wanting to extend training opportunities for their employees using e-learning.
Health support staff at the clinic tend to be very busy with the everyday demands of patients so we were not able to have them as involved as we had hoped in the support of AHWs at the clinic. It was clear during the visits that clinic sisters were generally pleased the AHWs were participating in this training but time didn't seem to permit more support. It is hoped that increased skills in, say, taking notes and using the computer will assist with health staff working more closely together.
TAFESTART had not previously used online delivery for courses. This project has not only developed the online delivery skills of the lecturer but also given rise to thinking about how other courses could be done using online for delivery or part of the offering.
The monthly get togethers online with the reference group developed an action research approach to the project. As issues arose we would problem-solve them through discussions and suggested actions. One of these issues was attendance at sessions. Because this was new it took people a while to establish a pattern of attending. We discussed it and decided it would be a good idea to send a fax to the clinics each week with a reminder of session times. That way, clinic staff were also aware that sessions were on. Later we also sent faxes to TAFE as they sometimes gave a call to the clinic to see where people were up to.
Some of the Cert 4 AHWs became confident in using programs such as Publisher and PowerPoint to begin creating community health education promotions.
We set out to trial online platforms as to their suitability for literacy and numeracy training. We were very pleased with the engagement we had from participants, we kept things very hands on and that's a key! They were very motivated and always keen to learn more. Often we worked over the scheduled time through negotiation. Using interactive website activities made the training come alive. Everyone could do it at the same time and at their pace. No-one was sitting watching others do things passively, they always could work on the whiteboard or websites together.

APY TAFE Moodle, with some of activities

We identified specific health-oriented resources, some which needed to be used in more interactive ways. The online sessions enabled that to happen and static resources with great content became very useful when worked on together. There were resources which covered all levels of measuring in weight, length and volume as well as fractions and these used health examples. That program was great for someone working through levels on their own. The series of sessions also clarified good methodologies that could be employed in teaching literacy and numeracy skills whilst making the most of the resources on the web - images, information, activities and exercises.
We had hoped that this project would strengthen the networks between TAFE and employers in the APY Lands and that's indeed what's happened. We are now working closely together to secure funding so we can continue to deliver this training. The success of this program also gives leverage with other employers in Central Australia and conversations are starting with other organisations regarding initiatives using e-learning.
4.2 How the outcomes were measured

There has been a great deal of evaluation of outcomes along the way. The monthly meetings with staff from Nganampa Health have given us an update on the AHWs perspectives. There has been a keenness shown from the first fact to face visits when we introduced the computer and online session room and talked about what we intended to cover. During the course there has been updates from Nganampa Health and also comments and feedback from the participants as we met up each week. We'd often invite feedback in the sessions, asking how they found certain activities. Learners loved the web activities which often involved game features and drills with measuring various lengths or reading gauges, starting with simple tasks and often progressing to more complex examples. They again gave feedback about collaborative exercises, often talking amongst each other at the same location to solve a problem. These comments and conversations assisted in guiding activities that would be effective.
Feedback about e-learning can be evaluated as to its effectiveness in the health sector. TAFESTART has been delivering LLN training in metro/regional areas. This project will trial online learning platforms for their LLN delivery. Ongoing evaluation through online team meetings will establish what type of support is needed. APY TAFE will build on established networks and conversations with employers to meet LLN training needs in the Lands. Pre and post surveys for staff and participants will provide valuable feedback. Repository resources will be adapted for the Health sector.
Word has spread about the course and we had requests from other aboriginal staff at Nganampa Health to join the training. We took these requests as a positive recommendation from others. Interest shown by other organisations and training providers is also a measure of the distance we'd travelled in the program.


5.1 Key successes

One of the key successes from this project is the partnership that worked so well between TAFE and Nganampa Health, at the management and the staff level. A degree of trust has developed that enables forward looking with training.

Taking literacy and numeracy training online is a new thing. This kind of training is often believed to be done better as a face to face delivery. We built up great relationships with participants over the 12 weeks and we as teachers and the AHWs as learners found the richness of resources available on the internet a huge asset to learning. The capacity to application share and guide people through procedures such as creating a poster is not something that can be easily done face to face, without breathing down someone's neck. Having a distance and anonymity with the participants worked well as often 'eye contact' is not comfortable for indigenous people.
We collected a useful array of resources and web links to relevant activities. The Cybercentre Toolbox has fantastic information, often using audio which is excellent when working with people with low literacy. We also purchased some specific numeracy in health resources that covered measuring weights, length, temperature and volume.
Cybercentre Toolbox

The professional development that's happened with lecturers has been significant. The working relationship between the lecturers enables a sharing of skills and resources around using Centra and online platforms, as well as content to be covered and how best to teach it.
The delivery of a course like this has paved the way for other similar programs to be done. There is such a critical need for aboriginal people in remote communities to have an opportunity to improve their literacy and numeracy skills. It is a challenge that faces not only employers but job service providers and aboriginal people in governance and as parents. This initiative gives one strategy that can be used to address these issues in some way.
The program has reignited, in Aboriginal Health Workers, the interest in learning more about numeracy. The 12 weeks has only touched the surface of many of the basic number operations they need to know but they have been eager and excited to learn. They realise they can make progress with those skills. There is a long way to go but the enjoyment and eagerness around learning is an important part of encouraging the next generation to take learning seriously.
Everyone one in the program has played a vital role in the successes and shares the satisfaction of a job well done.

5.2 Suggested improvements

We've reflected on what improvements we can make as we look to plan further training.
To work effectively it's important that the session groups are not too large, especially for the students with lower levels of literacy/numeracy skills. We have considered dividing the group into three groups. We had 20 enrolled, roughly two thirds were Certificate 3 or 4 and one third were Certificate 2. In future training we would have the three groups working separately. For some activities a large group worked well but when individual attention was needed the teaching task became more challenging.
Although numeracy resources were great online we would benefit from still more activities that come directly from the health sector. The resources that are available in this area are often too advanced in nursing calculations so the static ones we used could be modified.
We had planned to have informal tutoring sessions between classes each week. Although this happened on some occasions this is something that could be developed to improve the learning support.


6.1 Knowledge Transfer
TAFE has already demonstrated the practice of knowledge transfer through the development of this program based on their experience through other e-learning projects. We've been fortunate to learn many lessons over the range of projects we've undertaken using a broad range of e-learning strategies. The Point of View Glasses project worked with those in the Aged Care sector and heavy machinery sector using videos made for demonstration and assessment purposes. Then we worked with the Business studies sector in Second Life. Another project which has informed us and the local JSA (Job Service Aust.) agency, delivered training and services for pre-employment programs. In this project participants did work experience at Uluru, and we liaised closely with them throughout. It has taken time to begin work with employers in the APY Lands but this project has given us something tangible to show employers and organisations, who work with aboriginal people in remote communities, what can be achieved with online training - that's it's possible, effective, engaging and embraced by local people.
This case study and the monthly reports on the wiki give a detailed outline of the model we developed and how it could be adapted to other organisations.

6.2 Mentorship
Through the project there is a cumulative knowledge base between those involved. Community TAFE lecturers, clinic staff, and management all now have a better idea of how some of these educational challenges can be met. Through the networks that we all belong to, we can now promote the process we used and report on the progress made for learners and possibilities for organisations.
We have happily shared the story of this project with others through conferences, network meetings and media releases and we hope to have more opportunities to not only show other organisations and employers possibilities but work with them to instigate this model with their employees and Aboriginal colleagues.


For more information on the APY Lands TAFE SA
Janet Skewes
Manager APY
Measuring Up Online - Aboriginal Health Workers
Phone: 84636106
m 0418 504 596

For more information on the National VET E-learning Strategy: