Table 3.

Findings on potential mechanisms leading to change in knowledge, attitude and practice with quotes

Potential mechanisms	Quote
1. Emphasis on practicing	“The practical session on screening was the most interesting part, after learning theory, practice helps me understand it clearer.”
2. Applying different learning methods	“The use of different learning methods such as listening, speaking, reading and true of false games helps us to remember the information better.”
3. Enough free and fun time	“Trainers integrated “tickle methods” during the long training days that helped trainees to stay motivated, such as culture performances and funny games. Also, the breaks gave energy to trainees.“
4. Efficient coordination of time located for theory and practice	“For future training I would recommend to spend less time on theory and focus more on practice. One third of the time for theory and two third for practice. Without good coordination 7.5 hours a day is not possible”
5. Handout materials	“The handout materials support self-learning of the trainees, to help themselves, their families, and other people with self-prevention at home.”
6. Group size*	“The training venue was a bit small, especially when playing games. With eight ISHCs it was crowded. Less ISHCs in one course would be more suitable, so that trainers can efficiently train all ISHCs.”
7. Difficulty in learning how to use a digital screening application	“The screening application is quite difficult to learn. It would be useful to have an instruction video on the use of the application.”

*There are +/-100 participants in the training on average