Online Rural Provider Training on Adverse Childhood Experiences: Evaluation of Knowledge Translation and Sustainability

Background In the United States, 63.9% of adults report ≥1 adverse childhood experience (ACE), and 17.3% report ≥4. The presence and number of ACEs increases the odds of opioid misuse, overdose, and suicide. Rural children are more likely to experience ACEs. Despite ACEs’ well-documented sequela, a large proportion of providers are unaware of their detrimental effects, creating a significant need for training. There is limited research on ACEs workforce training. Objective The objective of this study is to evaluate the implementation of an online ACEs training to cross-sector providers in 5 high-needs rural counties, assess knowledge to action, and the sustainability of that action. Methods The online training was launched through the university’s Extension Canvas platform in May 2024. The training content included 5 modules. Recruitment occurred through networking, internet searches, and snowball recruitment. To receive credit for completion, participants were required to complete a pretraining survey, 6 discussion assignments, 5 quizzes, and a posttraining survey. This evaluation used a single group, pretest-posttest design with data collected at 3 time points (pretraining, posttraining, and follow-up approximately 9 months after the course opened). Wilcoxon signed-rank tests compared pre- and posttraining knowledge of ACEs and ACEs-related practice patterns. Conventional content analysis was applied to short answer, open-ended questions to identify patterns and initial codes, with the coding scheme then applied to individual responses. Results A total of 150 providers living and/or working in 5 rural Missouri counties requested training enrollment. Of those, 125/150 (83.3%) were enrolled and 114/150 (76%) accessed the training. Of those who accessed the training, 98/114 (86%) completed the pretraining survey and 55/114 (48.2%) completed the verifiable requirements of: (1) a pretraining survey; (2) 6 discussion assignments; (3) 5 quizzes, earning a score of >80% on each; and (4) a posttraining survey. A total of 40 posttraining survey responses were linked to the pretraining survey. In total, 11 participants completed the follow-up survey. Most participants intended to apply the training content to their personal life (36/40, 90%) and work or practice (35/40, 87.5%), and felt confident to implement the knowledge gained (37/40, 92.5%). ACEs knowledge increased significantly from pre (medians 3.0-4.0, IQRs 2.0-5.0) to post (medians 5.0, IQRs 5.0-5.0) training, P values <.001. Median practice pattern ratings were the same at posttraining and follow-up time points for all items. Conclusions Broad challenges in translating research into practice and policy underscore the continued importance of accessible, cross-sector ACEs workforce training, especially in rural areas. Given attrition, interpretation of findings is limited to participants who completed the training and associated assessments. Findings demonstrate the effectiveness, acceptability, knowledge to action, and sustainability of an ACEs training to a broad cross-sector of rural providers.