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Table 2 Study characteristics and summary of the factors associated with e-learning

From: A systematic review of the factors – enablers and barriers – affecting e-learning in health sciences education

Study (First author and year), country

Focus of study

Stated research methods and anlysis

Participants

Categories reflect factors (i.e. policy & context, instructional design and delivery, and learning outcomes) influencing (the implementation or utilisation of) e-learning in HSE framework components

Potential influencing factors

Reported drivers or enablers

Reported barriers or challenges

Delivery mechanisms

Wider impact

Golband 2014 [3]

Iran

Factors influencing e-learning

Analytical cross-sectional; ANOVA and Scheffe tests.

Postgraduate students (n = 60)

Education approach; e-learning global era in education

Consider four components of effective learning – learning content, educator, system and learner. Address learners’ backgrounds, motivations and expectations and needs

Not reported

E-learning of medicaleducation

Improved learning – learning content, educator, system and learner, improved motivations and met expectations, addressed learners’ short-term and long-term education needs in HSE.

Beckman 2008 [42]

Belgium

E-learning and classification of pressure ulcers

Repeated measure design – experimental; chi-square tests

Nursing students (n = 236, 212 experimental and 214- control)

Evidence-based learning and education

Flexibility, quality, flexibility and costs, learning takes place regardless of learners’ geographical location and time

Labour-intensive, poor computer skills, demands high level of educational skills/experience

E-learning

Improved knowledge and performance, improved learning and application in practice

Boye 2012 [43]

Norway

E-learning and medical immunology

Quantitative study; Mann-Whitney U-test

UG medical students (n = 73; 30 expt. And 43- control)

Popular approach in medical education, advancement of information technology in HE

Flexibility, improve learners’ reasoning and understanding skills.

Poor/lack of participation

E-learning

Students well appreciated e-learning, improved examination performance and outcomes, improved users’ satisfaction

Docherty 2006 [44]

UK

E-learning - enablers or facilitators

Qualitative methods (Evaluation methods using a mixed methods)

Students

n = 30 (face-to-face), 5 GPs, 2 nurses

Healthcare education and service provision, learning embeds multifaceted values, national plan – NHS, lifelong learning

Practice influenced learning, learning place and time, minimal involvement, flexible, integration with commitments, value and skills acquisition

Poor support, limited resources, lack of IT skills, isolation, lack of students’ self-discipline, isolated learning, resource-intensive costs and learning resources

E-learning in CDP

Increased knowledge and accessibility; increased flexibility. Improved working practice, improved learners motivation, expectation; improved knowledge and skills, flexible learning and integration

Gagnon 2007 [45]

Canada

E-learning - barriers

Qualitative methods; theoretical framework

Physicians (n = 40)

Principles of evidence-based medicine, influence of the current paradigm of best clinical practice

Motivation, individualised flexible learning, tutors/peers support and feedback, flexible learning

Time constraints, poor technology, poor planning and delivery, lack of sufficient feedback, lack of familiarity with IT/computers, poor integration of learning in practice

E-learning in evidence-based

Medicine

Increased learners’ motivation and self-discipline, received individualised support/feedback, improved learning and flexibility in practice.

Gardner 2016 [46]

Australia

E-learning and students’ perspectives

Qualitative study, grounded theory

Physiotherapy students (n = 23)

Capacity – health workforce development

Flexibility – cost and time, motivation for learning, easy access to materials, encourage learners to learn through doing

Interactive learning, e.g. embedding quizzes or discussions, case-studies, real examples, would make learning effective

E-learning

Enhanced students’ learning; improved students’ attitude towards working in an inter-professional team; suitable for learning for both interdisciplinary and multi-disciplinary health professionals

Gensichen 2009 [47]

Germany

E-learning and primary care

Modified Delphi - Quantitative study; descriptive stats

Primary healthcare experts (n = 60)

Education and learning are mainly financially independent in the healthcare industry

Workplace learning practice, clinical knowledge transfer in practice; embedding different styles or modes of learning (mixed learning) to suit learners’ learning needs/demands.

Resource-intensive – time and cost, problems of integration of learning into the existing academic and professional curriculum; fear of replacing traditional methods of teaching and learning; often failing to consider learners’ needs and interests

E-learning in primary care education

Improved learning; increased clinical knowledge using virtual clinical case studies in practice

Gormley 2009 [48]

UK

E-learning and clinical skills

Survey; t-test and multiple regression analysis

UG medical students (n = 304)

Established method for teaching in medical schools, technological advancement in academic education

Facilitates learning, helpful for revision and exam preparation, motivates to learn, saving costs as learners don’t need to purchase textbooks

Potential isolation of learning, learners need to engage more to learn better, learners need to be familiarized with different modalities of teaching

E-learning

Reported confident, encouraged learners to attend the clinical attachment, standardized teaching, found useful in revising work, better performance in clinical skills

Hadadgar 2016 [49]

Iran

E-learning and GPs - medical education

quantitative study; Kurtosis and skewness tests

GPs (n = 148)

Technology advancement, provisions of CPD in academic and healthcare industry

Satisfactory

accessibility, increase flexibility

Problem of access to computers, time constraints, and unfamiliarity with computers

E-learning

Acceptance of e-learning in CPD

Hammarlund 2015 [50]

Sweden

Factors influencing e-learning

Qualitative; content analysis

Undergraduate physiotherapy students (n = 34)

Both factors - external and internal influence learning including pedagogical design, collaborative learning in HSE.

Contextualised learning, learning aligned with course learning outcomes, appropriate assessments; opportunity to interact with teachers and peers, feedback from tutors, flexibility

Poor instructional design, poor course structure, limited learning space, poor relationship with peers and tutors, limited engagement, motivation, inflexibility, anxiety and stress, and low self-efficacy

Self-directed learning online

Increased healthcare learners’ knowledge, performance and progress; learners ‘freedom’ and motivation; improved current and future professional development in healthcare practice

Hawthrone 2009 [51]

UK

E-learning and delivery modes

Evaluation methods, quantitative; Kruskal-Wallis and chi-square tests

Final year UG medical students (n = 223)

Not reported

Self-directed learning; learning tailored to individual students’ needs and preferences; convenience of learning, i.e. choose learners’ own time and place

Required appropriate knowledge in technologies to make effective learning, need to understand how people learn, poor teaching design/choice of tools

E-learning

Improved students’ learning, improved students’ performance, learning appeared relevant in practice, self-directed learning, and provoked thinking.

Hugenholtz 2008 [52]

Netherlands

E-learning and continue professional development for occupational physicians

Randomised control trials – 4 blocks randomisation, t-test and chi-square tests

Physiotherapy students (n = 23)

E-learning is an effective teaching approach in continuing medical education, integration of internet technologies into CME programmes

Learners can choose any time and any geographical place for learning; useful for professional education and development in practice

None discussed

E-learning

Enhanced or sustained knowledge gains and improved learners’ behaviour change as compared to traditional learning/teaching approaches

Ikram 2015 [53]

Netherlands

Developing effective module

Quantitative method; paired t-test

4th year medical students (n = 281)

Quality of care, equitable healthcare services, teaching patient diversity in medical curricula

Learning in practice; application of knowledge to practice, interactive learning

Language barriers – learners/patients and providers; problems of integrating biomedical contents into e-learning curricula, labour-intensive (time, cost) approach

E-learning

Improved learners’ knowledge and self-efficacy, developed confidence in solving clinical/health related problems related to learning in practice, interactive learning between learners and tutors

Khasawneh 2015 [54]

USA

E-learning and paediatric education

Descriptive – quantitative study; Wilcoxon rank sum tests

UG 3rd year medical students (n = 67)

Use of technology in education

Autonomy, flexibility, reflective thinking, self-confidence and satisfaction

None discussed

E-learning

Improved medical students’ performance, self-confidence in learning, improved satisfaction

Kitching 2015 [55]

Australia

Web-based/e-learning and education (medical)

Qualitative; framework analysis

Senior stakeholders from nursing home sector (N = 25)

Management policy, learning management systems in HSE.

Change in learning and clinical practice through considering learners’ individuality – background, experiencing support in learning, access to and diversity of information

Poorly considered learners’ needs and interest in learning curricula, poor reflection of current and future workforce needs and demographics, time constraints, inappropriate equipment for technologically illiterate learners

Web-based social media

E-learning is associated with enhanced learning and engagement, thereby positively changing in clinical practice; offered currency and practice contributing to contemporary information; considered learners’ individuality – background, experiencing support in learning; delivered using various styles and formats; access to and diversity of information, meeting learners’ current and future needs

Kokol 2006 [56]

Slovenia and USA

E-learning

Mixed methods approach

Full-time and part-time students (n = 125)

National and international policy changes in education and learning including advancement of science and technology, including IT

Credibility and motivation, and accessibility. Lifelong learning, promising alternative mode of delivery

Issues related to self-control, inappropriate learning for full-time learners due to their work and personal commitments, lack of knowledge in IT, limited interaction between learners and tutors, and poor access to resources. E-learning is not for all, as some learners are naturally technology-phobic

E-learning

Improved quality of education and integration/application of theoretical context in practice; offered multidisciplinary users.

Morente 2013 [57]

Spain

E-learning tool and education on pressure ulcer

RCT - t-test and chi-square tests

Nurses (n = 60; 30 received traditional education; 30- Computer-assisted training)

Influence of technological advancement, promising alternative method to traditional teaching

Flexibility, easy access to materials, immediate feedback from the tutors and/or peers, generate interest, satisfaction

None discussed

E-learning

Reported as an effective and valuable educational tool, positive impact on clinical decision-making process, better learning acquisition, improved education efficiency

Morton 2016 [58]

UK

Blended learning

Mixed methods approach

Intercalated BSc 4th year medical students (n = 26), F (n = 12)

Increasingly use of e-learning in UG medical education, interactive,

more student-centred learning in medical education

Appropriate to teach basic knowledge, interactive component of e-learning

Problems related to learners’ engagement

with online self-directed learning

Blended learning

Improved computer literacy, high level of satisfaction, improved medical students’ engagement, improved understanding, efficient approach to learning

Moule 2010 [59]

UK

E-learning and students’ experience

Mixed methods approach

Staff (n = 35) and students (n = 41) from 93 HEIs.

Education policy development and advancement in technological developments in HEIs, constructivist (learner-focused) approach in healthcare education

Flexibility, motivation, and engagement in learning, relevance to practice

Poor access to computers in workplace, limited IT skills as well as poor peer commitments

E-learning

Improved motivation to learning, student-centred learning and engagement.

Naeem 2019 [60]

Pakistan

Challenges in blended course

Qualitative design, framework analysis

Postgraduate healthcare students (n = 22)

Institutional support

Flexible, feasible, self-regulation and self-directed learning

Poor instructional design, limited resource provision, poor admin support, poor financial position, poor feedback, issue of time-management,

Blended learning

Enhanced students’ learning; Identified needs of the stakeholder and students

Ota 2018 [61]

Australia

Nursing students’ perceptions and challenges to blended study

Quantitative design

UG nursing students (n = 109)

Technology in higher education

Autonomy and accountability

Technical difficulties, lack of flexibility, unexpected workload, difficult to link theoretical aspects in practice e.g. real life clinical context

Blended on-line learning

Enhanced students’ motivation and learn

Padalino 2007 [62]

Brazil

E-learning and knowledge apprehension

True experimental design- ANOVA tests

Occupational physicians (n = 74)

Technology

revolution, strategic changes in HE, support CPDs and collaborative learning

Effective and efficient learning, flexibility, cost- and time-saving, provides more individualised learning, adjusted learners’ rhythm

None discussed

E-learning

Obtained higher score, e-learning strategy reported equally effective learning approach, provided opportunities for both tutors and learners by using both technical and pedagogic teaching methods and tools

Parry 2007 [63]

UK

E-learning and bioscience

Quantitative; Kruskal-Wallis one-way ANOVA

UG students (n = 124; 71 – first year, 33- s year, 20- third year)

Quality of student experience, demands of the programme, changing, i.e. use of VLEs in HE environment

Flexible, convenient and efficient in time – off-campus, access to learning materials (anytime, anywhere). Feedback (formative) received from tutors/peers ‘open dialogue’ found useful and motivating

Lack of engagement due to poor internet access and technical difficulties

E-learning

Increased the depth and breadth of learning, utilised a new method of learning, independent or self-learning,

found useful and motivating, developed confidence and promoted engagement

Sinacori 2019 [64]

USA

Experiences of nurse educators to online learning

Qualitative design

Nurse educators (n = 8)

Faculty development, professional development, contents organisations

Learning new pedagogy, facilitating learning, interaction between students and staff

Lack of professional development, lack of knowledge and online pedagogy, poor learning management system

E-learning

Enhanced students’ motivation and self-regulation.