E-learning Intervention Research Articles

Effect of an eLearning Intervention on Undergraduate Health Professional Student's General Histology and Embryology Summative Examination Scores.

Sub-Saharan Africa has the worst global shortage of health professionals. The use of eLearning interventions, that lead to increased interactions according to the Interaction Equivalency theorem, is a potential means of addressing this shortage of health professionals. In this audit we set out to determine the effect of an eLearning general histology and general embryology intervention on student’s summative examination scores. The audit compared the written and practical summative examination scores of three sets of student examinations one of which had a five-week eLearning intervention. Two of the examinations were for the same students in one year but different courses while the other two were for students doing the same subject but in different years. In each of the above pair of examinations there was one group from the course that had the eLearning intervention. A Bayesian multilevel regression modelling approach was used to analyse the student scores. The course with the online eLearning intervention had significantly better scores (p-value < 0.01), than the course on a different subject offered at the same time to the same students without the intervention and the same course with students from the previous academic year. On controlling for other factors, the eLearning intervention led to higher examination scores though this was not significant. Student’s nationality, sponsorship and program significantly affected the examination scores, controlling for other factors. Overall the students in the course with the online eLearning intervention had significantly better examination scores. The student’s nationality, sponsorship and program significantly affect their examination scores. Future, larger and or qualitative studies, are needed to further explore the effect of these factors on student’s examination scores.

The Effects of Gender and Age on Students’ Use of a Learning Management System in Saudi Arabia

The success of an e-learning intervention relies, to a considerable extent, on the student’s acceptance of the system. Still, the challenge for educational institutions is to determine the factors that influence the user’s acceptance of a Learning Management System (LMS) particularly, the demographic variables of age and gender, which would allow for effective approaches to implementation. Therefore, this study aims to analyse the moderating effects of gender and age in the acceptance and use of an LMS. Furthermore, the study is located in a Saudi tertiary learning context where students have unique psychological and social characteristics and where LMS are being rolled out on a national level. To this end, the study utilised a UTAUT (Unified Theory of Acceptance and Use of Technology) model as a base model, with an additional six usability variables, to investigate empirically the variables that influence the students’ use of an LMS in Saudi higher education. By using a quantitative research approach and a sample size of 605 students, data were collected from students in five Saudi universities. Partial Least Squares Structural Equation Modelling (PLS-SEM) in conjunction with multigroup analysis techniques were employed to assess the model. The findings revealed that both gender and age moderated a single association between the facilitating conditions and actual use where female and younger students exhibited higher perceptions of the association than did their counterparts. The research has several implications for decision-makers, administrators and designers of e-learning systems. In light of the study findings, the limitations and future research avenues were discussed.

Evaluation of e-learning for medical education in low- and middle-income countries: A systematic review

In low- and middle-income countries (LMICs), e-learning for medical education may alleviate the burden of severe health worker shortages and deliver affordable access to high quality medical education. However, diverse challenges in infrastructure and adoption are encountered when implementing e-learning within medical education in particular. Understanding what constitutes successful e-learning is an important first step for determining its effectiveness. The objective of this study was to systematically review e-learning interventions for medical education in LMICs, focusing on their evaluation and assessment methods.Nine databases were searched for publications from January 2007 to June 2017. We included 52 studies with a total of 12,294 participants. Most e-learning interventions were pilot studies (73%), which mainly employed summative assessments of study participants (83%) and evaluated the e-learning intervention with questionnaires (45%). Study designs, evaluation and assessment methods showed considerable variation, as did the study quality, evaluation periods, outcome and effectiveness measures. Included studies mainly utilized subjective measures and custom-built evaluation frameworks, which resulted in both low comparability and poor validity. The majority of studies self-concluded that they had had an effective e-learning intervention, thus indicating potential benefits of e-learning for LMICs. However, MERSQI and NOS ratings revealed the low quality of the studies' evidence for comparability, evaluation instrument validity, study outcomes and participant blinding. Many e-learning interventions were small-scale and conducted as short-termed pilots. More rigorous evaluation methods for e-learning implementations in LMICs are needed to understand the strengths and shortcomings of e-learning for medical education in low-resource contexts. Valid and reliable evaluations are the foundation to guide and improve e-learning interventions, increase their sustainability, alleviate shortages in health care workers and improve the quality of medical care in LMICs.

Effects of E-Learning in a Continuing Education Context on Nursing Care: Systematic Review of Systematic Qualitative, Quantitative, and Mixed-Studies Reviews.

BackgroundE-learning is rapidly growing as an alternative way of delivering education in nursing. Two contexts regarding the use of e-learning in nursing are discussed in the literature: (1) education among nursing students and (2) nurses’ continuing education within a life-long learning perspective. A systematic review of systematic reviews on e-learning for nursing and health professional students in an academic context has been published previously; however, no such review exists regarding e-learning for registered nurses in a continuing education context.ObjectiveWe aimed to systematically summarize the qualitative and quantitative evidence regarding the effects of e-learning on nursing care among nurses in a continuing education context.MethodsWe conducted a systematic review of systematic qualitative, quantitative, and mixed-studies reviews, searching within four bibliographic databases. The eligibility criteria were formulated using the population, interventions, comparisons, outcomes, and study design (PICOS) format. The included population was registered nurses. E-learning interventions were included and compared with face-to-face and any other e-learning interventions, as well as blended learning. The outcomes of interest were derived from two models: nursing-sensitive indicators from the Nursing Care Performance Framework (eg, teaching and collaboration) and the levels of evaluation from the Kirkpatrick model (ie, reaction, learning, behavior, and results).ResultsWe identified a total of 12,906 records. We retrieved 222 full-text papers for detailed evaluation, from which 22 systematic reviews published between 2008 and 2018 met the eligibility criteria. The effects of e-learning on nursing care were grouped under Kirkpatrick’s levels of evaluation: (1) nurse reactions to e-learning, (2) nurse learning, (3) behavior, and (4) results. Level 2, nurse learning, was divided into three subthemes: knowledge, skills, attitude and self-efficacy. Level 4, results, was divided into patient outcomes and costs. Most of the outcomes were reported in a positive way. For instance, nurses were satisfied with the use of e-learning and they improved their knowledge. The most common topics covered by the e-learning interventions were medication calculation, preparation, and administration.ConclusionsThe effects of e-learning are mainly reported in terms of nurse reactions, knowledge, and skills (ie, the first two levels of the Kirkpatrick model). The effectiveness of e-learning interventions for nurses in a continuing education context remains unknown regarding how the learning can be transferred to change practice and affect patient outcomes. Further scientific, methodological, theoretical, and practice-based breakthroughs are needed in the fast-growing field of e-learning in nursing education, especially in a life-learning perspective.Trial RegistrationInternational Prospective Register of Systematic Reviews (PROSPERO) CRD42016050714; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=50714

Perspectives for effective integration of e-learning tools in university mathematics instruction for developing countries

This paper analyses student views on an e-learning intervention that incorporated a content development tool and computer algebra systems, aimed at improving performance and applicability of mathematics knowledge. The study deliberately relied on open source tools, with high usability both online and offline, that can be customized to address the peculiarities of mathematics instruction in developing countries. Repeated ANOVA and logistic regression were among the statistical methods used to analyze the data. Key findings showed that usability and detailed feedback were the qualities of computer algebra system that were most desired by students. Content quality, problem solving abilities and internet availability were key factors for mathematical e-learning satisfaction. The research showed that the use of an interactive content development tool and computer algebra systems can help the teachers to be more innovative and adopt project-based examination formats that encourage knowledge applicability. The e-learning tools helped the students to self-regulate and discover their own knowledge, which increased their chances of handling application type problems. Among others, the study recommended set up of mathematical e-laboratories which can be accessed by students for at least 3 days per week.

Developing and testing a theory-driven e-learning intervention to equip healthcare professionals to communicate with parents impacted by parental cancer.

Parents have a desire and need for instructive support from healthcare professionals on how best to communicate a cancer diagnosis with their dependent children. Healthcare professionals lack confidence to initiate and facilitate parent-child communication, reporting the need for training. To address the evident gap, this paper outlines the planning, development and testing phases of an e-learning intervention, using a person-based approach. The planning and development phases combined evidence from reviews of qualitative and quantitative literature, an expert group and data generated from primary research of two focus groups with frontline oncology professionals (n = 23) to develop the e-learning intervention prototype. An iterative approach was adopted with 14 'think aloud' interviews for prototype usability testing, resulting in continuous movement between data collection, analysis and modification of the e-learning intervention. Involving end-users throughout all phases of this process, optimised the intervention development. As a result, a communication framework on how healthcare professionals can initiate these conversations with parents was integrated, alongside role-play videos and original artwork by children expressing their views associated with parental cancer. During the testing phase, think-aloud interviews identified key navigational difficulties which were modified and resolved. Minor modifications were made to the content and 'look and feel' of screen pages. The systematic and iterative, person-based approach, yielded important and complementary insights to enhance acceptability of the e-learning intervention. Providing a detailed description of the foundations that underpinned the development of this e-learning intervention, promotes transparency in the planning and design process, therefore aids methodological rigour.

Impact of a co-produced e-learning intervention on medication review provision to medically under-served groups

Impact of a co-produced e-learning intervention on medication review provision to medically under-served groups

Teaching general practitioners to activate older patients: The intervening role of changes in perceived communication skills

ObjectiveThis report examined whether a change in the perceived communication behaviour (PeCoBe) of general practitioners (GPs) influenced the effect of the Promoting Active Aging (PRACTA) intervention on activation of older patients as perceived by GPs. MethodsPre- and post-intervention questionnaires were filled out by 225 GPs, who were assigned to three groups, e-learning, pdf-article, and control. GPs self-reported their communication behaviour and their perceptions of the attitudes of older patients toward treatment and health. ResultsParticipation in the e-learning intervention showed an increase in the PeCoBe of GPs, while reading the pdf-article resulted in a decrease of such behaviours. An increase in the PeCoBe of GPs was positively related to an increase in their perception of an active attitude among older patients. The indirect effects observed for e-learning and pdf-article interventions had opposite directions. ConclusionBoth types of PRACTA intervention exerted an impact on GPs’ perception of the attitudes of older patients, and change in PeCoBe of GPs could be considered as a mechanism driving this effect. Practical implicationsThe methods based on a combination of knowledge delivery and modelling of communication skills are strongly recommended forms of teaching for GPs on how to communicate with and activate seniors.

A cluster randomised controlled feasibility study of nurse-initiated behavioural strategies to manage interruptions during medication administration.

To examine the feasibility of a behavioural e-learning intervention to support nurses to manage interruptions during medication administration. A cluster randomised feasibility trial. The cluster trial included four intervention and four control wards randomly selected across four metropolitan hospitals in Sydney, Australia. We observed 806 (402 pre-intervention and 404 post-intervention) medication events, where nurses prepared and administered medications to patients within the cluster wards. The primary outcome measured was the observed number of interruptions occurring during administration, with secondary outcomes being the number of clinical errors and procedural failures. Changes in the use of behavioural strategies to manage interruptions, targeted by the e-learning intervention, were also assessed. No significant differences were found in the number of interruptions (P = 0.82), procedural failures (P = 0.19) or clinical errors per 100 medications (P = 0.32), between the intervention and control wards. Differences in the use of specific behavioural strategies (engagement and multitasking) were found in the intervention wards. This behavioural e-learning intervention has not been found to significantly reduce interruptions, however, changes in the use of strategies did occur. Careful selection of clinical settings where there is a high number of predictable interruptions is recommended for further research into the impact of the behavioural e-learning intervention. An increase in the intensity of this intervention is recommended with training undertaken away from the clinical setting. Further research on additional consumer-sensitive interventions is urgently needed.

Long-term effects of an e-learning course on patient safety: A controlled longitudinal study with medical students.

BackgroundTo improve patient safety, educational interventions on all system levels, including medical school are necessary. Sound theoretical knowledge on elements influencing patient safety (such as error management or team work) is the basis for behavioral changes of health care professionals.MethodsA controlled, quasi-experimental study with repeated measures was deployed. The intervention group participated in a mandatory e-learning course on patient safety (ELPAS) between October 2016 and December 2016. The control group did not receive any didactic session on patient safety. In both groups we measured technical knowledge and attitudes towards patient safety before the intervention (T0), directly after the intervention (T1) and one year after the intervention (T2). Participants were 309 third-year medical students in the intervention group and 154 first- and second-year medical students in the control group.ResultsTechnical knowledge in the intervention group (but not the control group) improved significantly after the intervention and remained high after one year (F(2, 84) = 13.506, p < .001, η2 = .243). Students of the intervention group felt better prepared for safe patient practice, even one year after the intervention F(2, 85) = 6.743, p < .002, η2 = .137). There was no sustainable significant effect on attitudes towards patient safety.ConclusionThis study shows, that eLearning interventions can produce significant long-term effects on patient safety knowledge, however, the study did not show long-term effects on attitudes towards patient safety. Our study implies two potential developments for future research: e-learning might be used in combination with face-to-face sessions, or more intensive (in terms of frequency and duration) e-learning sessions may be needed to achieve lasting changes in attitude.

E-Learning for Medical Education in Sub-Saharan Africa and Low-Resource Settings: Viewpoint.

E-learning has been heralded as a revolutionary force for medical education, especially for low-resource countries still suffering from a dire lack of health care workers. However, despite over two decades of e-learning endeavors and interventions across sub-Saharan Africa and other low- and middle-income countries, e-learning for medical education has not gained momentum and continues to fall short of the anticipated revolution. Many e-learning interventions have been cul-de-sac pilots that have not been scaled up but rather terminated after the pilot phase. This is usually a result of not adopting a system-wide approach, which leads to insufficient scope of training, insufficient technological maintenance and user support, unattainably high expectations, and unrealistic financial planning. Thus, a multitude of e-learning evaluations have failed to provide scientifically sound evidence of the effectiveness of e-learning for medical education in low-resource countries. Instead, it appears that technological development has overwhelmed rather than revolutionized medical education. The question of how to push e-learning into a higher gear in low-resource countries persists. Provision of e-learning as a technology is insufficient. E-learning needs to be vigorously and sustainably integrated into the local educational setting and aligned with national strategies and other national endeavors and interventions. Adhering to a standardized framework for the implementation and evaluation of e-learning endeavors is key, especially to bridge the gap in robust evidence that should also guide e-learning implementations. The primary objective of e-learning for medical education is to strengthen the health system in order to serve the population’s health care needs and expectations. Currently, medical e-learning does not measure up to its potential or do justice to medical students in low-resource countries. Technology may help unfold the potential of e-learning, but an all-encompassing change is needed. This can only be achieved through a joint effort that follows a systematic and standardized framework, especially for implementation and evaluation.

How Self-Directed e-Learning Contributes to Training for Medical Licentiate Practitioners in Zambia: Evaluation of the Pilot Phase of a Mixed-Methods Study.

BackgroundZambia faces a severe shortage of health workers, particularly in rural areas. To tackle this shortage, the Medical Licentiate program was initiated at Chainama College of Health Sciences in the capital, Lusaka, in 2002. The objective of the program was to alleviate the shortage of human resources in curative care. On-the-job training is conducted in decentralized teaching hospitals throughout Zambia. However, the program faces significant challenges such as shortages of senior medical instructors and learning materials.ObjectiveOur aim was to address these challenges by introducing a self-directed, e-learning platform with an offline tablet as part of a collaborative blended-learning intervention to supplement local teaching and training.MethodsThe pilot phase of the e-learning platform was evaluated using a mixed-methods approach with a convergent parallel design. Various methods were employed to test the data’s adequacy and potential for generating valid results. Methods included questionnaires according to the technology acceptance model and information system success model by DeLone and McLean, semistructured interviews, learner diaries, pretesting, the collection of usage data, exam results, demographics, and informal feedback. Outcome measures included usage, adoption, efficiency, acceptance, user-friendliness, and gained knowledge and skills.ResultsIn total, 52 students and 17 medical instructors participated in the pilot evaluation. The questionnaire results showed a high acceptance of the technology (>80%) and high agreement (>75%) with the e-learning platform. Semistructured interview results showed an overall appreciation of the e-learning intervention, but the need for more e-learning materials. Respondents identified a need for multimedia materials that transfer skills such as medical procedure visualization and interactive exercises to practice procedural knowledge. The learning diaries identified the lack of specific learning materials and potential shortcomings of existing learning materials. However, students were satisfied with the current e-learning content. The majority of students used the e-learning platform offline on their tablets; online e-learning was underutilized.ConclusionsThe pilot phase of the tablet-based e-learning platform to support the self-directed learning intervention was well received and appreciated by students and medical instructors of Chainama College of Health Sciences. E-learning for knowledge acquisition appears to be adequate and feasible for this low-resource educational environment. Our evaluation results guide the further development of the full implementation of the e-learning platform in this educational setting. E-learning materials should reflect curriculum requirements, and additional multimedia and interactive content is needed, as well as improved integration and active participation from medical instructors in the e-learning processes.

Offline and computer-based eLearning interventions for medical students' education

Offline and computer-based eLearning interventions for medical students' education

Offline and computer-based eLearning interventions for medical doctors' education

Offline and computer-based eLearning interventions for medical doctors' education

Online- and local area network (LAN)-based eLearning interventions for medical doctors' education

Online- and local area network (LAN)-based eLearning interventions for medical doctors' education

CN22 - Developing and testing a theory-based e-learning intervention to enhance healthcare professional’s self-efficacy when supporting parents newly diagnosed with cancer who have dependent children

CN22 - Developing and testing a theory-based e-learning intervention to enhance healthcare professional’s self-efficacy when supporting parents newly diagnosed with cancer who have dependent children

An systematic review of e-learning outcomes in undergraduate dental radiology curricula-levels of learning and implications for researchers and curriculum planners.

To examine the outcomes of e-learning or blended learning interventions in undergraduate dental radiology curricula and analyze the nature of the knowledge levels addressed in learning interventions. A systematic literature review was performed using a search strategy based on MeSH key words specific to the focus question and indexed in the MEDLINE database. The search again was supplemented by hand-searching of selected journals. Data were extracted relating to outcomes of knowledge and student perceptions. Analysis of the e-learning intervention was performed using a new framework to examine the level of knowledge undertaken: (1) remember/understand (2) analysis or evaluation or diagnosis and (3) performance ("knows how" or "shows how"). From the selected 17 papers, 11 were positive about student reported outcomes of the interventions, and 8 reported evidence that e-learning interventions enhanced learning. Out of the included studies, 8 used e-learning at the level of remember/understand, 4 at the level of analysis/evaluate/diagnosis, and 5 at the level of performance ("knows how," "shows how"). The learning objectives, e-learning intervention, outcome measures and reporting methods were diverse and not well reported. This makes comparison between studies and an understanding of how interventions contributed to learning impractical. Future studies need to define "knowledge" levels and performance tasks undertaken in the planning and execution of e-learning interventions and their assessment methods. Such a framework and approach will focus our understanding in what ways e-learning is effective and how it contributes to better evidence-based e-learning experiences.

E-learning and health inequality aversion: A questionnaire experiment.

In principle, questionnaire data on public views about hypothetical trade‐offs between improving total health and reducing health inequality can provide useful normative health inequality aversion parameter benchmarks for policymakers faced with real trade‐offs of this kind. However, trade‐off questions can be hard to understand, and one standard type of question finds that a high proportion of respondents—sometimes a majority—appear to give exclusive priority to reducing health inequality. We developed and tested two e‐learning interventions designed to help respondents understand this question more completely. The interventions were a video animation, exposing respondents to rival points of view, and a spreadsheet‐based questionnaire that provided feedback on implied trade‐offs. We found large effects of both interventions in reducing the proportion of respondents giving exclusive priority to reducing health inequality, though the median responses still implied a high degree of health inequality aversion and—unlike the video—the spreadsheet‐based intervention introduced a substantial new minority of non‐egalitarian responses. E‐learning may introduce as well as avoid biases but merits further research and may be useful in other questionnaire studies involving trade‐offs between conflicting values.

Using a Wireless Electroencephalography Device to Evaluate E-Health and E-Learning Interventions.

Measuring engagement and other reactions of patients and health professionals to e-health and e-learning interventions remains a challenge for researchers. The aim of this pilot study was to assess the feasibility and acceptability of using a wireless electroencephalography (EEG) device to measure affective (anxiety, enjoyment, relaxation) and cognitive (attention, engagement, interest) reactions of patients and healthcare professionals during e-health or e-learning interventions. Using a wireless EEG device, we measured patient (n = 6) and health professional (n = 7) reactions during a 10-minute session of an e-health or e-learning intervention. The following feasibility and acceptability indicators were assessed and compared for patients and healthcare professionals: number of eligible participants who consented to participate, reasons for refusal, time to install and calibrate the wireless EEG device, number of participants who completed the full 10-minute sessions, participant comfort when wearing the device, signal quality, and number of observations obtained for each reaction. The wireless EEG readings were compared to participant self-rating of their reactions. We obtained at least 75% of possible observations for attention, engagement, enjoyment, and interest. EEG scores were similar to self-reported scores, but they varied throughout the sessions, which gave information on participants' real-time reactions to the e-health/e-learning interventions. Results on the other indicators support the feasibility and acceptability of the wireless EEG device for both patients and professionals. Using the wireless EEG device was feasible and acceptable. Future studies must examine its use in other contexts of care and explore which components of the interventions affected participant reactions by combining wireless EEG and eye tracking.

The use of e-learning program in nursing education

Over the past decade, the rapid developments and growth of information and communication technology (ICT) have had a profound influence on nursing education. E-learning has grown tremendously has been integrated into education and training. The aim of this review is to examine the effect of e-learning program in nursing education. Akdeniz University electronic databases center including MEDLINE, CINAHL, Sciencedirect, Cochrane library were searched published studies in English with “e-learning, nursing education, nursing students” key words and 554 articles were reached by the search results. By the analysis, published 2011-2016, the original six manuscripts have been sampled. A cross-over design study examined the effect of lecture and e-learning methods were compared, no significant difference was found between two methods. In another study, the effect of using e-learning versus lecture of nursing students was examined. Students were indicated to be pleased with the e-learning program. Another study evaluated the effectiveness of an e-learning intervention on pain management for nursing students, it was found to be useful. In another study, experiences of e-learning in a midwifery training package and student's views were evaluated, the students generally welcomed to e-learning however they suggested face-to-face learning. Another study tested the effectiveness of an e-learning program to increase pediatric medication management among students who take pediatric nursing courses, e-learning program is an effective learning method than lecture program. In another study, the effects of e-learning, lectures and role playing on learning, retention and satisfaction of nursing students were evaluated, it was found lectures to be a significantly more effective teaching method than role playing and e-learning. Results of this review showed that students’ satisfaction with e-learning was lower than traditional lecture instruction. However different and well planned e-learning programmes can support the development of nursing students' skills, knowledge and attitudes. Keywords: E-learning; nursing students; nursing education.