Digital knowledge dissemination: The Global Alliance for Nursing and Midwifery community of practice

ABSTRACT

Objective.

To analyze a community of practice, the Global Alliance for Nursing and Midwifery (GANM), and illustrate the evolution and sustainability of a virtual community of practice aimed at enhancing knowledge acquisition and dissemination.

Methods.

Retrospective content analysis of data gathered from the online tracking of GANM’s community activities, engagement data, and platform logistics was conducted and analyzed.

Results.

The GANM hosts a diverse community of over 4 300 members from 160 countries. Members benefit from opportunities for knowledge sharing, access to evidence-based tools and materials, and the ability to engage in a creative space for asking questions, discussing current issues, networking, and forming collaborative professional relationships. The discussion forum is frequently used for disseminating new information about evidence-based practice and announcing educational opportunities.

Conclusions.

Through a wide variety of activities, the GANM engages a diverse community and provides an opportunity for nurses, midwives, and allied healthcare professionals around the world to network, engage in discussions, and build collective knowledge. The development of future communities of practice can be guided by existing evidence and the GANM’s collective experiences, to maintain and enhance community engagement and prevent dormancy.

Lifelong learning has long been recognized as a necessity for the professional performance of nurses and midwives to keep pace with the rapid development of evidence-based information. Organizations like the World Health Organization (WHO) continuously produce educational materials, research, guidelines, and other resources that define best practices in nursing and midwifery. However, barriers to the incorporation of knowledge into practice include the intricate process of both obtaining and transforming knowledge into action. Equitable access to disseminated information continues to be a challenge, particularly in under-resourced and rural communities. Communities of practice (CoPs) offer one mechanism to foster continuous learning, enhance shared understanding, and contribute to collective knowledge in a specific domain (1, 2).

The idea of CoPs, introduced by Lave and Wenger in 1991, has gained significant attention in knowledge management from practitioners and researchers (3). CoPs are collaborative groups that foster continuous learning, knowledge sharing, and professional development. CoPs enable practitioners to interpret and apply knowledge through discussions, observations, and implementation. They can transcend professional silos, enhance access to quality resources, connect experts, and promote uniform care standards (3). However, maintaining active and meaningful engagement in CoPs can be challenging. Factors such as the relevance of the community’s goals to its members, the platform’s ease of use, and the perceived value of the community interaction influence long-term participation. To ensure a CoP’s sustainability, ongoing interaction, relevance of activities, and continuous delivery of value to its members is necessary for continued interaction and accessibility of content. Over time, CoPs evolve dynamically based on the levels of community engagement. This evolution is crucial in dictating the community’s vitality and its ability to adapt to members’ changing needs and interests (3).

CoPs must continually adapt to survive. While current literature supports the potential of CoPs to strengthen professional practice, there is limited literature on strategies for building and maintaining a CoP over time. The Johns Hopkins School of Nursing (JHSON) WHO Collaborating Centre for Nursing Information, Knowledge Management, and Sharing hosts the Global Alliance for Nursing and Midwifery (GANM). The GANM is an online CoP that was developed to strengthen nursing and midwifery practice by offering a platform for nurses, midwives, and other healthcare professionals around the globe to engage in knowledge exchange through discussion and equitable access to up-to-date, evidence-based information to improve the health of communities across the lifespan. This article describes our experiences developing and supporting a CoP. We detail activities to provide an evaluation highlighting strengths and challenges and apply the GANM’s collective experiences to form recommendations for the development, maintenance, and expansion of other professional CoPs.

METHODS

GANM origins and structure

The GANM was established in 2006 as a collaborative initiative between the JHSON and the WHO Collaborating Centres for Nursing and Midwifery. It was originally hosted on the IBP Network online platform, with support from the United States Agency for International Development (USAID) and the United Nations Population Fund (UNFPA) (1). The GANM is managed by a team within the JHSON Center for Global Initiatives (CGI) comprising a director, manager, and graduate student interns. Expert advisors from Johns Hopkins faculty contribute to planning and preparation of content. The GANM collaborates with global partners including the Pan American Health Organization (PAHO) and WHO Regional Advisors, International Council of Nurses, Sigma Theta Tau Inc., Jhpiego, and AFREhealth to design and implement its activities.

GANM activities

The GANM operates through a comprehensive online platform that supports a variety of activities including:

Discussion board – a space for members to share insights and best practices;

Research library – a repository of evidence-based resources;

Blogs/video blogs (vlogs) – sharing professional insights and updates;

Webinars – interactive sessions featuring expert speakers on critical topics;

Newsletters – regular updates on activities and developments in nursing and midwifery.

The GANM team translates content from English to Spanish using a guide created to standardize the process. The guide includes commonly used nursing and midwifery terms from PAHO/WHO and outlines a step-by-step process to maintain consistency and accuracy.

Data collection and analysis

A retrospective content analysis was conducted to examine GANM’s community activities, member demographics, and engagement metrics. Data sources included:

Platform analytics – membership demographics and engagement data obtained from the IBP Network website analytics for the period January 2022–May 2023;

Social media metrics – data from GANM’s social media platforms including Twitter (X), Instagram, Facebook, and the GANM blog website to assess external engagement and outreach;

Video platform usage – data gathered from Kaltura, the GANM video-hosting platform, to evaluate multimedia content reach and interaction;

Historical comparison – data from the period January 2022–May 2023 were compared with findings from a qualitative content analysis published in 2021, which included data from GANM’s inception in August 2006 through December 2021.

Analytic approach

Quantitative data on member engagement and activity levels were descriptively analyzed to identify trends in participation and content utilization. Qualitative analysis of discussion content and activity themes provided contextual insights into member interactions and overall effectiveness of GANM activities. Comparing recent data with historical findings allowed for an evaluation of changes in engagement and patterns and content delivery over time. This mixed-methods approach offers a comprehensive assessment of GANM’s reach and evolving role in supporting the global nursing and midwifery community.

RESULTS

GANM membership

The GANM membership has expanded since its inception. As of May 2023, the GANM maintains a membership list totaling 4 310 members from 165 countries. Members join by visiting the GANM website: https://nursing.jhu.edu/GANM. Countries with the highest membership include the United States of America (n = 878), Kenya (n = 132), Nigeria (n = 122), India (n = 117), and the United Kingdom (n = 114) (4).

GANM engagement

As a continuously growing digital learning network, understanding CoP utilization and evolution is essential to the advancement of knowledge management and its value in the fields of nursing and midwifery (5). Member engagement and participation in the GANM varies significantly by type of activity. The discussion board has historically been the most active area of the GANM, with an average of 51.5 discussion posts per month from a variety of members throughout 2022, an increase from an average of 20 posts per month in 2020 (5). Since 2006, the GANM discussion forum was most frequently utilized to disseminate information about evidence-based practice (43.8%) through press releases, policy briefs, and newsletters (5). The next most common usage was to announce educational and professional opportunities to the community (24.8%), such as online courses, conferences, and webinars (5).

The most frequent topics of discussion among the GANM members between 2006 and 2020 included nursing (14.3%), maternal health (13.8%), and infectious disease (9%) (5). The topics that generated the most discussion included the “Midwives Voices, Midwives Realities” report (59 responses) and a search for board members for an African nursing review journal (66 responses) (4). Additionally, an average of 35 private messages per month were sent between GANM members via the discussion board messaging platform in 2022 (4).

A priority in GANM’s evolution over time has been engaging users with digital content in ways that meet their changing preferences and needs. With the rise of consumption of short-form videos and attention-grabbing content on social media and other digital content platforms (6), the GANM has sought to engage its community by delivering content in shorter, more digestible formats including videos and posts on Instagram and X social media platforms.

The GANM sees the highest engagement on its X platform. As of June 2023, the GANM X account has 2 043 followers and averages 1 318 monthly profile visits and 4 494 monthly impressions. The GANM also has 595 followers on Facebook and 283 followers on Instagram. It has seen an increase in recent social media engagement using “reels” and other short videos, with the most popular videos being viewed 2 185 times on X and 752 times on Instagram.

The most popular blog topics since 2022 include ultrasound providers in Malawi (294 views), maltreatment of birthing mothers in Liberia (168 views), women’s rights in Iran (159 views), lactation during climate emergencies (152 views), and patient-to-midwife ratios in Malawi (121 views) (7). From August 2021 to August 2022, GANM vlogs had a collective total of 402 views. The English blogs had 564 views, and the Spanish blogs had 334 views. The GANM’s most popular video was titled “Fear and Anxiety of Working in COVID-19 Wards,” which was viewed 1 136 times in 2021 (7).

DISCUSSION

Improving digital tools for nursing and midwifery education addresses the critical need for accessible and innovative solutions that bridge the gap between research and clinical practice and reduce disparities in increasingly complex healthcare environments (2). Persistent barriers include unequal access to technology, lack of dedicated time for participation, and resource constraints in underserved areas (2). An evaluation and discussion of the GANM CoP’s strengths and weaknesses can provide guidance on strategies for improving these tools.

Strengths

The GANM succeeds in offering four core services to members: 1) ongoing dialogue regarding key health issues through its discussion board; 2) education and training through webinars and virtual continuing education; 3) networking to promote excellence in nursing and midwifery education and practice; and 4) support for research.

A significant asset to the GANM CoP is the institutional support from Johns Hopkins University, PAHO/WHO, and the Global Network for WHO Collaborating Centres for Nursing and Midwifery. By engaging these networks and stakeholders, GANM can effectively meet the diverse needs of various populations while providing members with vital resources, including funding and research expertise, which aids in addressing challenges and adapting to dynamic public health scenarios, such as the COVID-19 pandemic. This enhances the CoP’s credibility and facilitates sustainable practices, such as active community engagement and effective knowledge dissemination.

Another strength of the GANM CoP is the size and diversity of its membership. Members vary across age groups, languages spoken, geographical area, and work experience. The membership includes students from various academic fields, new graduates, and professionals with all career experience levels, including subject matter experts in various health fields. The diversity within the GANM’s community promotes knowledge exchange and global health discussions for innovation in addressing complex health issues. It fosters collaboration and highlights various methodologies, which are crucial for advancing healthcare strategies that result in more sustainable and culturally sensitive solutions globally.

Additionally, since the GANM community is designed to promote equitable access to resources, membership and participation on all platforms are free and open to the public regardless of institutional affiliation or resources. All information and knowledge dissemination through the GANM are open access, with a content focus on low- and middle-income countries and vulnerable populations. Through discussion board communication and guest authors from various geographic locations, ethnicities, and backgrounds, the GANM aims to amplify less-heard voices from around the world and highlight different perspectives throughout the field of nursing and midwifery. The variety of health topics addressed in the GANM’s disseminated content is a significant strength. While topics are generally focused on the targets of Sustainable Development Goal (SDG) 3, “Good Health and Well-being,” they cover a wide range of subjects. Non-health-related SDGs are commonly addressed, emphasizing the need for a unified, interconnected approach to health globally. Recent topics have addressed poverty (SDG 1), gender equality (SDG 5), industry, innovation, and infrastructure (SDG 9), reduced inequalities (SDG 10), and climate action (SDG 13). Specific topics have included violence against women, training ultrasound providers, breastfeeding during climate change emergencies, human mobility and migrants’ needs, antimicrobial stewardship, obstetric maltreatment, and nurses as primary providers of health care globally.

During the COVID-19 pandemic, the GANM enhanced its social media presence, sharing weekly resources and information; serving as a reliable and trustworthy knowledge dissemination tool amid the uncertainty related to the pandemic and the growing spread of misinformation. Infodemic and misinformation are a threat to global health that can cost lives; there have been well-documented cases of misinformation that have reduced the effectiveness of public health measures and led to devastating consequences (8). CoPs such as the GANM play an important role in responding to the infodemic and can prevent the spread of misinformation through a science-based digital sphere.

Challenges

The GANM faced significant challenges when switching to the IBP Network platform in 2021 for cost efficiency. The new platform required separate user accounts for the landing page and discussion board, neither of which were mobile-friendly, leading to a drop in re-registrations. Only 203 of the 2 452 discussion board members transitioned to the IBP Network platform, complicating access. To address this, the GANM launched a mobile-friendly landing page in January 2023 (https://nursing.jhu.edu/ganm) on the JHSON Server, which does not require login or registration. Registration on the IBP Network platform is now only needed for the discussion board. Other access barriers, such as Internet connectivity issues and technological literacy, also pose challenges.

Social media engagement on Facebook and Instagram has been low. To boost interaction, a student intern with social media management experience was hired as part of the 2023 strategic plan. The 2022 annual survey indicated that blogs and the IBP Network platform were the least useful resources due to accessibility issues. Increasing awareness and usage of the new website is expected to improve resource usefulness.

Post-pandemic email fatigue is a concern, with 48% of members preferring a digest of the GANM emails and 24% preferring daily summaries. The GANM team limits email posts to three per day to balance information dissemination and email fatigue. The 2023 strategic plan intends to expand and retain membership, especially among rural nurses and midwives, including developing a mobile-friendly content hub, creating promotional videos, increasing short educational videos, and leveraging partnerships.

Recommendations

The experiences of the GANM CoP provide valuable insights for developing capacity-building strategies in creating a learning system. While literature exists on CoPs aiding healthcare professionals in accessing specialized knowledge and translating research into practice, there is limited focus on nursing and midwifery (2). Future research may consider comparing GANM’s challenges with those encountered by similar CoPs and digital learning platforms. Understanding whether these challenges are unique to GANM or shared across digital platforms would provide valuable context and could inform future development strategies.

Using the GANM’s experiences, we have developed recommendations for the development, maintenance, and expansion of CoPs to advance equitable knowledge dissemination in nursing and midwifery. These recommendations, supported by existing literature and guided by the PAHO/WHO publication Building Communities of Practice (9), part of the Methodologies for Information Sharing and Knowledge Management in Health series, are outlined in Table 1. As technology evolves, it is crucial to explore how digital platforms like CoPs enhance the learning experience and professional growth of nurses and midwives through continued research, development of standardized frameworks, and addressing implementation challenges.

TABLE 1. Recommendations for the development, maintenance, and expansion of communities of practice (CoPs), 2024.

Recommendations for the development, maintenance, and expansion of CoPs

1. Establish a clear purpose: Define a clear target audience, describe the problem to be solved by the community, and define expected results (9). Establish an objective oriented toward problem solving, generation of ideas, sharing knowledge between institutions, developing best practices, and sharing lessons learned (9). 2. Provide easy access to a navigable platform: Ensure step-by-step instructions on joining the community are clear and easily visible to potential members. Platform access should be simple and easy. All content should be available and clearly displayed on one central, navigable site, with direct links to each platform or activity. Require collection of basic demographic member information such as age, gender, profession, and location upon joining the community. 3. Promote equity: Provide free, open access to all posted content and resources. Provide mobile-friendly, low Internet bandwidth access to content to promote access for those on mobile devices in low- and middle-income countries (LMICs). Promote accessibility and diversity by ensuring content translations are made in a timely and accessible manner. Content creation should align with CoP objectives and strategic initiatives proposed by global health agendas. Amplify voices from LMICs and diverse backgrounds by featuring guest authors or presenters from under-represented populations or groups. 4. Establish measures for quality control: Ensure that all content and material shared is evidence-based, peer-reviewed, and ideally published within the last five years. Outline two-tier processes for manual approval of disseminated content on all platforms to prevent sharing of spam, false links, inappropriate recruitment, or unsolicited marketing of services and/or products. 5. Leverage social media: Utilize free infographics available in the WHO Social Media Toolkit or create original graphics using Canva, a free design tool, to promote community activities on X, Instagram, and Facebook (10). Utilize short videos such as reels for sharing promotional and educational content. Access account analytics and insights monthly to monitor platform growth and follower engagement trends. 6. Avoid email fatigue: Disseminate short, digestible content. Bundle email notifications and allow members to set their own notification preferences such as daily summaries or grouped notifications. 7. Implement engagement and growth strategies: Set strategies to recruit new membership and reach nurses and midwives working at the bedside, such as promotion through social media, webinars, conferences, and cross-promotion with other health platforms. Collaborate with field experts, universities, global health organizations, and health delivery systems. Maintain member engagement by avoiding email fatigue, implementing feedback, and tailoring content to group interests based on annual surveys. 8. Evaluate impact: Outline specific impact indicators utilizing objective data to ensure a transformative impact of the community and compare results with other similar CoPs. Periodically assess member engagement, accessibility, and usefulness of information disseminated through annual surveys to analyze and reflect on activities and improve them in the future (9). Establish a process to evaluate whether the community is achieving its stated objective and communicate results to community members (9).

Source: Prepared by the authors.

Conclusion

Communities of practice facilitate the rapid dissemination of ideas and best practices, accelerating innovation and professional development. They provide a support network where less experienced members gain insights from seasoned professionals. The value and relevance of a CoP are crucial for maintaining active membership. This value is enhanced by aligning the community’s objectives with members’ professional goals, integrating new technologies, and adapting to shifts in demographics and societal changes such as pandemics, conflicts, or climate challenges. Sustained relevance requires proactive adaptation to internal and external changes; failure to adapt can lead to declining participation and eventual dormancy.

Disclaimer.

Authors hold sole responsibility for the views expressed in the manuscript, which may not necessarily reflect the opinion or policy of the RPSP/PAJPH and/or the Pan American Health Organization (PAHO).