@Article{info:doi/10.2196/63136,
author="Koka, Avinash
and Stuby, Loric
and Carrera, Emmanuel
and Gabr, Ahmed
and O'Connor, Margaret
and Missilier Peruzzo, Nathalie
and Waeterloot, Olivier
and Medlin, Friedrich
and Rigolet, Fabien
and Schmutz, Thomas
and Michel, Patrik
and Desmettre, Thibaut
and Suppan, M{\'e}lanie
and Suppan, Laurent",
title="Asynchronous Distance Learning Performance and Knowledge Retention of the National Institutes of Health Stroke Scale Among Health Care Professionals Using Video or e-Learning: Web-based Randomized Controlled Trial",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="4",
volume="27",
pages="e63136",
keywords="stroke",
keywords="e-learning",
keywords="video",
keywords="medical education",
keywords="randomized controlled trial",
keywords="knowledge retention",
keywords="knowledge acquisition",
keywords="NIHSS",
keywords="National Institutes of Health Stroke Scale",
keywords="learner satisfaction",
abstract="Background: Stroke treatment has significantly improved over the last decades, but the complexity of stroke cases requires specialized care through dedicated teams with specific knowledge and training. The National Institutes of Health Stroke Scale (NIHSS), widely used to assess neurological deficits and make treatment decisions, is reliable but requires specific training and certification. The traditional didactic training method, based on a video, may not adequately address certain NIHSS intricacies nor engage health care professionals (HCPs) in continuous learning, leading to suboptimal proficiency. In the context of time-constrained clinical settings, highly interactive e-learning could be a promising alternative for NIHSS knowledge acquisition and retention. Objective: This study aimed to assess the efficacy of a highly interactive e-learning module compared with a traditional didactic video in improving NIHSS knowledge among previously trained HCPs. Furthermore, its impact on knowledge retention was also assessed. Methods: A prospective, multicentric, triple-blind, and web-based randomized controlled trial was conducted in 3 Swiss university hospitals, involving HCPs previously trained in NIHSS. Invitations were sent through email, and participants were randomized to either the e-learning or traditional didactic video group through a fully automated process upon self-registration on the website. A 50-question quiz was administered before and after exposure to the training method, and scores were compared to assess knowledge acquisition. The quiz was repeated after 1 month to evaluate retention. Subjective assessments of learning methods that is, user satisfaction, probability of recommendation, perceived difficulty, and perception of duration, were also collected through a Likert-scale questionnaire. A sample size of 72 participants were deemed necessary to have an 80\% chance of detecting a difference of 2 points in the postcourse quiz between groups at the 5\% significance level. Results: Invitations to participate were sent through email to an estimated 325 HCPs. 174 HCPs enrolled in the study, of which 97 completed the study course. Both learning methods significantly improved NIHSS knowledge, with an improvement of 3.2 (range 2.0-4.3) points in the e-learning group and of 2.1 (1.2-3.1) points in the video group. However, the e-learning group performed better, with higher scores in knowledge acquisition (median score 39.0, IQR 36.0-41.0 vs 37, IQR 34.0-39.0; P=.03) and in knowledge retention (mean score 38.2, 95\% CI 36.7-39.7 vs 35.8, 95\% CI 34.8-36.8; P=.007). Participants in the e-learning group were more likely to recommend the learning method (77\% vs 49\%, P=.02), while no significant difference was found for satisfaction (P=.17), perceived duration (P=.17), and difficulty (P=.32). Conclusions: A highly interactive e-learning module was found to be an effective asynchronous method for NIHSS knowledge acquisition and retention in previously NIHSS-trained HCPs, and may now be considered for inclusion in NIHSS training programs for HCPs. International Registered Report Identifier (IRRID): RR2-10.3390/healthcare9111460 ",
doi="10.2196/63136",
url="https://www.jmir.org/2025/1/e63136",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053772"
}


@Article{info:doi/10.2196/52591,
author="Johnston, Sewan Jamie
and Skinner, Ann Nadine
and Tokar, Anna
and Arabi, Elham
and Ndiaye, Yabsa Ngouille
and Strehlow, Charles Matthew
and Utunen, Heini",
title="Global Use, Adaptation, and Sharing of Massive Open Online Courses for Emergency Health on the OpenWHO Platform: Survey Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="10",
volume="27",
pages="e52591",
keywords="MOOCs",
keywords="online learning",
keywords="global health education",
keywords="digital health",
keywords="health worker training",
keywords="health emergencies",
keywords="outbreak",
keywords="COVID-19",
abstract="Background: The COVID-19 pandemic demonstrated the global need for accessible content to rapidly train health care workers during health emergencies. The massive open access online course (MOOC) format is a broadly embraced strategy for widespread dissemination of trainings. Yet, barriers associated with technology access, language, and cultural context limit the use of MOOCs, particularly in lower-resource communities. There is tremendous potential for MOOC developers to increase the global scale and contextualization of learning; however, at present, few studies examine the adaptation and sharing of health MOOCs to address these challenges. Objective: The World Health Organization's Health Emergencies Programme Learning and Capacity Development Unit and the Stanford Center for Health Education collaborated to survey learners from 4 emergency health MOOCs on the OpenWHO platform to examine differences in course use by World Bank country income classification across three dimensions: (1) how health education MOOCs are used and shared, (2) how health workers adapt MOOC content to meet local training and information needs, and (3) how content adaptations help frontline health workers overcome barriers to using MOOCs. Methods: This study draws upon two sources of data: (1) course enrollment data collected from the 4 emergency health MOOCs (N=96,395) and (2) survey data collected from learners who participated in at least 1 of the 4 MOOCs (N=926). Descriptive statistics are used to summarize learner characteristics. Differences in enrollment, sharing, and adaptation by country income classification are examined using Pearson chi-square test. Results: Of the enrollees who indicated their country of residence, half were from lower-middle-income countries (LMICs; 43,168/85,882, 50\%) and another 9\% (7146/85,882) from low-income countries. The majority of all respondents shared content (819/926, 88\%) and used content in official trainings (563/926, 61\%). Respondents were more likely to share and use content for trainings in LMICs than in high-income countries (91\% vs 81\%; P=.001). Learners in LMICs also shared content with more people on average compared with high-income country learners although the difference is not statistically significant (9.48 vs 6.73 people; P=.084). Compared with learners in high-income countries, learners in LMICs were more likely to adapt materials to distribute via offline formats or technologies, such as WhatsApp or text message (31\% vs 8\%; P<.001); to address cultural, linguistic, or other contextual needs (20\% vs 12\%; P=.076); and to meet local guidelines (20\% vs 9\%; P=.010). Learners in LMICs indicated greater accessibility challenges due to technological and linguistic barriers. Conclusions: Learners commonly share content from MOOCs about public health emergencies; this is especially true in low-income countries and LMICs. However, content is often adapted and shared via alternative formats. Our findings identify a critical opportunity to improve MOOC design and dramatically scale the impact of MOOCs to better meet diverse global needs. ",
doi="10.2196/52591",
url="https://www.jmir.org/2025/1/e52591",
url="http://www.ncbi.nlm.nih.gov/pubmed/39792445"
}


@Article{info:doi/10.2196/60312,
author="Ogundiya, Oluwadamilola
and Rahman, Jasmine Thahmina
and Valnarov-Boulter, Ioan
and Young, Michael Tim",
title="Looking Back on Digital Medical Education Over the Last 25 Years and Looking to the Future: Narrative Review",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="19",
volume="26",
pages="e60312",
keywords="digital health",
keywords="digital medical education",
keywords="health education",
keywords="medical education",
keywords="mobile phone",
keywords="artificial intelligence",
keywords="AI",
abstract="Background: The last 25 years have seen enormous progression in digital technologies across the whole of the health service, including health education. The rapid evolution and use of web-based and digital techniques have been significantly transforming this field since the beginning of the new millennium. These advancements continue to progress swiftly, even more so after the COVID-19 pandemic. Objective: This narrative review aims to outline and discuss the developments that have taken place in digital medical education across the defined time frame. In addition, evidence for potential opportunities and challenges facing digital medical education in the near future was collated for analysis. Methods: Literature reviews were conducted using PubMed, Web of Science Core Collection, Scopus, Google Scholar, and Embase. The participants and learners in this study included medical students, physicians in training or continuing professional development, nurses, paramedics, and patients. Results: Evidence of the significant steps in the development of digital medical education in the past 25 years was presented and analyzed in terms of application, impact, and implications for the future. The results were grouped into the following themes for discussion: learning management systems; telemedicine (in digital medical education); mobile health; big data analytics; the metaverse, augmented reality, and virtual reality; the COVID-19 pandemic; artificial intelligence; and ethics and cybersecurity. Conclusions: Major changes and developments in digital medical education have occurred from around the start of the new millennium. Key steps in this journey include technical developments in teleconferencing and learning management systems, along with a marked increase in mobile device use for accessing learning over this time. While the pace of evolution in digital medical education accelerated during the COVID-19 pandemic, further rapid progress has continued since the resolution of the pandemic. Many of these changes are currently being widely used in health education and other fields, such as augmented reality, virtual reality, and artificial intelligence, providing significant future potential. The opportunities these technologies offer must be balanced against the associated challenges in areas such as cybersecurity, the integrity of web-based assessments, ethics, and issues of digital privacy to ensure that digital medical education continues to thrive in the future. ",
doi="10.2196/60312",
url="https://www.jmir.org/2024/1/e60312"
}


@Article{info:doi/10.2196/45468,
author="Rahadiani, Pratiwi
and Kekalih, Aria
and Soemantri, Diantha
and Krisnamurti, Budi Desak Gede",
title="Exploring HTML5 Package Interactive Content in Supporting Learning Through Self-Paced Massive Open Online Courses on Healthy Aging: Mixed Methods Study",
journal="JMIR Med Educ",
year="2024",
month="Aug",
day="22",
volume="10",
pages="e45468",
keywords="HTML5 package",
keywords="H5P",
keywords="students' perspectives",
keywords="students' acceptance",
keywords="massive open online courses",
keywords="MOOCs",
keywords="healthy aging",
keywords="self-paced MOOC",
keywords="student",
keywords="perception",
keywords="acceptance",
keywords="opinion",
keywords="attitude",
keywords="MOOC",
keywords="self-paced",
keywords="self-guided",
keywords="online course",
keywords="online learning",
keywords="geriatric",
keywords="gerontology",
keywords="gerontological",
keywords="learning",
abstract="Background: The rapidly aging population and the growth of geriatric medicine in the field of internal medicine are not supported by sufficient gerontological training in many health care disciplines. There is rising awareness about the education and training needed to adequately prepare health care professionals to address the needs of the older adult population. Massive open online courses (MOOCs) might be the best alternative method of learning delivery in this context. However, the diversity of MOOC participants poses a challenge for MOOC providers to innovate in developing learning content that suits the needs and characters of participants. Objective: The primary outcome of this study was to explore students' perceptions and acceptance of HTML5 package (H5P) interactive content in self-paced MOOCs and its association with students' characteristics and experience in using MOOCs. Methods: This study used a cross-sectional design, combining qualitative and quantitative approaches. Participants, predominantly general practitioners from various regions of Indonesia with diverse educational backgrounds and age groups, completed pretests, engaged with H5P interactive content, and participated in forum discussions and posttests. Data were retrieved from the online questionnaire attached to a selected MOOC course. Students' perceptions and acceptance of H5P interactive content were rated on a 6-point Likert scale from 1 (strongly disagree) to 6 (strongly agree). Data were analyzed using SPSS (IBM Corp) to examine demographics, computer literacy, acceptance, and perceptions of H5P interactive content. Quantitative analysis explored correlations, while qualitative analysis identified recurring themes from open-ended survey responses to determine students' perceptions. Results: In total, 184 MOOC participants agreed to participate in the study. Students demonstrated positive perceptions and a high level of acceptance of integrating H5P interactive content within the self-paced MOOC. Analysis of mean (SD) value across all responses consistently revealed favorable scores (greater than 5), ranging from 5.18 (SD 0.861) to 5.45 (SD 0.659) and 5.28 (SD 0.728) to 5.52 (SD 0.627), respectively. This finding underscores widespread satisfaction and robust acceptance of H5P interactive content. Students found the H5P interactive content more satisfying and fun, easier to understand, more effective, and more helpful in improving learning outcomes than material in the form of common documents and learning videos. There is a significant correlation between computer literacy, students' acceptance, and students' perceptions. Conclusions: Students from various backgrounds showed a high level of acceptance and positive perceptions of leveraging H5P interactive content in the self-paced MOOC. The findings suggest potential new uses of H5P interactive content in MOOCs, such as interactive videos with pop-up questions, to substitute for synchronous learning. The study underscores the significance of tailored educational strategies in supporting the professional development of health care professionals. ",
doi="10.2196/45468",
url="https://mededu.jmir.org/2024/1/e45468",
url="http://www.ncbi.nlm.nih.gov/pubmed/39049507"
}


@Article{info:doi/10.2196/51915,
author="Jones, Jennifer
and Johnston, Sewan Jamie
and Ndiaye, Yabsa Ngouille
and Tokar, Anna
and Singla, Saumya
and Skinner, Ann Nadine
and Strehlow, Matthew
and Utunen, Heini",
title="Health Care Workers' Motivations for Enrolling in Massive Open Online Courses During a Public Health Emergency: Descriptive Analysis",
journal="JMIR Med Educ",
year="2024",
month="Jun",
day="19",
volume="10",
pages="e51915",
keywords="massive open online course",
keywords="MOOC",
keywords="online learning",
keywords="online courses",
keywords="online course",
keywords="health care education",
keywords="medical education",
keywords="education",
keywords="training",
keywords="professional development",
keywords="continuing education",
keywords="COVID-19 training",
keywords="infectious disease outbreak response",
keywords="emergency",
keywords="public health",
keywords="crisis",
keywords="crises",
keywords="outbreak",
keywords="pandemic",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="coronavirus",
keywords="humanitarian emergency response",
keywords="health care workers",
keywords="nurse",
keywords="nurses",
keywords="practitioner",
keywords="practitioners",
keywords="clinician",
keywords="clinicians",
keywords="health care worker",
keywords="medic",
keywords="low-income",
keywords="lower-middle income",
keywords="LIC",
keywords="LMIC",
keywords="developing country",
keywords="developing countries",
keywords="developing nation",
keywords="developing nations",
keywords="case study",
keywords="survey",
keywords="surveys",
keywords="descriptive analysis",
keywords="descriptive analyses",
keywords="motivation",
keywords="motivations",
keywords="lower-middle--income country",
keywords="low-income country",
abstract="Background: Massive open online courses (MOOCs) are increasingly used to educate health care workers during public health emergencies. In early 2020, the World Health Organization (WHO) developed a series of MOOCs for COVID-19, introducing the disease and strategies to control its outbreak, with 6 courses specifically targeting health care workers as learners. In 2020, Stanford University also launched a MOOC designed to deliver accurate and timely education on COVID-19, equipping health care workers across the globe to provide health care safely and effectively to patients with the novel infectious disease. Although the use of MOOCs for just-in-time training has expanded during the pandemic, evidence is limited regarding the factors motivating health care workers to enroll in and complete courses, particularly in low-income countries (LICs) and lower-middle--income countries (LMICs). Objective: This study seeks to gain insights on the characteristics and motivations of learners turning to MOOCs for just-in-time training, to provide evidence that can better inform MOOC design to meet the needs of health care workers. We examine data from learners in 1 Stanford University and 6 WHO COVID-19 courses to identify (1) the characteristics of health care workers completing the courses and (2) the factors motivating them to enroll. Methods: We analyze (1) course registration data of the 49,098 health care workers who completed the 7 focal courses and (2) survey responses from 6272 course completers. The survey asked respondents to rank their motivations for enrollment and share feedback about their learning experience. We use descriptive statistics to compare responses by health care profession and by World Bank country income classification. Results: Health care workers completed the focal courses from all regions of the world, with nearly one-third (14,159/49,098, 28.84\%) practicing in LICs and LMICs. Survey data revealed a diverse range of professional roles among the learners, including physicians (2171/6272, 34.61\%); nurses (1599/6272, 25.49\%); and other health care professionals such as allied health professionals, community health workers, paramedics, and pharmacists (2502/6272, 39.89\%). Across all health care professions, the primary motivation to enroll was for personal learning to improve clinical practice. Continuing education credit was also an important motivator, particularly for nonphysicians and learners in LICs and LMICs. Course cost (3423/6272, 54.58\%) and certification (4238/6272, 67.57\%) were also important to a majority of learners. Conclusions: Our results demonstrate that a diverse range of health care professionals accessed MOOCs for just-in-time training during a public health emergency. Although all health care workers were motivated to improve their clinical practice, different factors were influential across professions and locations. These factors should be considered in MOOC design to meet the needs of health care workers, particularly those in lower-resource settings where alternative avenues for training may be limited. ",
doi="10.2196/51915",
url="https://mededu.jmir.org/2024/1/e51915"
}


@Article{info:doi/10.2196/43977,
author="B{\"a}lter, Olle
and Jemstedt, Andreas
and Javan Abraham, Feben
and Persson Osowski, Christine
and Mugisha, Reuben
and B{\"a}lter, Katarina",
title="Effect of Personalized Email-Based Reminders on Participants' Timeliness in an Online Education Program: Randomized Controlled Trial",
journal="JMIR Form Res",
year="2023",
month="Oct",
day="13",
volume="7",
pages="e43977",
keywords="online learning",
keywords="personal reminders",
keywords="timeliness",
keywords="self-regulated learning",
keywords="adult education",
keywords="education",
keywords="students",
keywords="learning",
keywords="email",
keywords="online",
keywords="tool",
keywords="intervention",
keywords="program",
abstract="Background: Postsecondary students need to be able to handle self-regulated learning and manage schedules set by instructors. This is particularly the case with online courses, as they often come with a limited number of social reminders and less information directly from the teacher compared to courses with physical presence. This may increase procrastination and reduce timeliness of the students. Reminders may be a tool to improve the timeliness of students' study behavior, but previous research shows that the effect of reminders differs between types of reminders, whether the reminder is personalized or general, and depending on the background of the students. In the worst cases, reminders can even increase procrastination. Objective: The aim of this study was to test if personalized email reminders, as compared to general email reminders, affect the time to completion of scheduled online coursework. The personalized reminders included information on which page in the online material the participants ought to be on at the present point in time and the last page they were on during their last session. The general reminders only contained the first part of this information: where they ought to be at the present point in time. Methods: Weekly email reminders were sent to all participants enrolled in an online program, which included 39 professional learners from three East African countries. All participants in the Online Education for Leaders in Nutrition and Sustainability program, which uses a question-based learning methodology, were randomly assigned to either personalized or general reminders. The structure of the study was AB-BA, so that group A received personalized reminders for the first unit, then general reminders for the rest of the course, while group B started with general reminders and received personalized reminders only in the third (and last) unit in the course. Results: In total, 585 email reminders were distributed, of which 390 were general reminders and 195 were personalized. A Bayesian mixed-effects logistic regression was used to estimate the difference in the probability of being on time with one's studies. The probability of being on time was 14 percentage points (95\% credible interval 3\%-25\%) higher following personalized reminders compared to that following general reminders. For a course with 100 participants, this means 14 more students would be on time. Conclusions: Personalized reminders had a greater positive effect than general reminders for a group of adults working full-time while enrolled in our online educational program. Considering how small the intervention was---adding a few words with the page number the student ought to be on to a reminder---we consider this effect fairly substantial. This intervention could be repeated manually by anyone and in large courses with some basic programming. ",
doi="10.2196/43977",
url="https://formative.jmir.org/2023/1/e43977",
url="http://www.ncbi.nlm.nih.gov/pubmed/37831487"
}


@Article{info:doi/10.2196/48398,
author="Lumini, Jos{\'e} Maria
and Sousa, Rui Maria
and Salazar, Berta
and Martins, Teresa",
title="Assessing the Effectiveness of a Massive Open Online Course for Caregivers Amid the COVID-19 Pandemic: Methodological Study",
journal="JMIR Form Res",
year="2023",
month="Sep",
day="25",
volume="7",
pages="e48398",
keywords="caregivers",
keywords="education",
keywords="COVID-19",
keywords="distance",
keywords="effectiveness",
keywords="skill",
keywords="safe care",
keywords="health system",
keywords="older people",
keywords="family",
keywords="social isolation",
keywords="massive open online courses",
keywords="care challenges",
abstract="Background: The COVID-19 pandemic has presented significant challenges to health care systems, particularly impacting the older population due to their vulnerability and increased susceptibility to severe complications. Many of the most vulnerable individuals rely on informal caregivers, who play a vital role in enabling them to continue living in their homes. However, social isolation and limited access to health services during the pandemic have made caregiving more difficult. In response, massive open online courses (MOOCs) have emerged as a training and support solution for caregivers. This study focuses on a MOOC developed to assist caregivers during the pandemic, aiming to enhance their knowledge of COVID-19 and prevention measures and promote effective self-care practices. Objective: The study's aim is to develop and validate a MOOC integrating personal and housing hygiene measures to be adopted in self-care--related activities, surveillance, and monitoring by caregivers of the most vulnerable home-dwelling--dependent people, to provide safe care and prevent SARS-CoV-2 infection. Methods: A methodological study was developed. The content of the MOOC was developed based on scientific evidence and a Delphi study. The course was organized into 9 modules, addressing aspects related to safe self-care assistance and minimizing the risk of contagion. A convenience sample of 33 informal caregivers was recruited through a caregivers' association to verify the adequacy of the course. Knowledge questionnaires were administered before and after the course to assess the impact on caregivers` knowledge. The Family Caregiving Factors Inventory was used to evaluate caregiver resources, knowledge, expectations, and difficulties. Additionally, the technology acceptance model was applied to assess participants' satisfaction with the MOOC. Results: Prior to attending the MOOC, participants demonstrated an average knowledge level score of mean 14.94 (SD 2.72). After completing the course, this score significantly increased to mean 16.52 (SD 2.28), indicating an improvement in knowledge. Caregivers found the course accessible, valuable, and applicable to their caregiving roles. Feedback regarding the MOOC's structure, illustrative videos, and language was overwhelmingly positive. Participants perceived the course as a valuable resource for decision-making in care delivery, leading to enhanced self-esteem and confidence. Conclusions: The MOOC has proven to be an effective tool for increasing caregivers' knowledge and empowering them in their roles. Remarkably, even low-literacy caregivers found the course valuable for its clear and understandable information. The MOOC demonstrated its adaptability to challenges faced during the pandemic, ensuring access to relevant information. This empowering strategy for caregivers has yielded positive outcomes. The MOOC represents a tool to support and empower informal caregivers, enabling them to provide optimal care during difficult times. ",
doi="10.2196/48398",
url="https://formative.jmir.org/2023/1/e48398",
url="http://www.ncbi.nlm.nih.gov/pubmed/37747772"
}


@Article{info:doi/10.2196/47777,
author="Gisondi, Albert Michael
and Keyes, Timothy
and Zucker, Shana
and Bumgardner, Deila",
title="Teaching LGBTQ+ Health, a Web-Based Faculty Development Course: Program Evaluation Study Using the RE-AIM Framework",
journal="JMIR Med Educ",
year="2023",
month="Jul",
day="21",
volume="9",
pages="e47777",
keywords="lesbian, gay, bisexual, transgender, queer",
keywords="LGBTQ+",
keywords="queer",
keywords="faculty development",
keywords="medical education",
keywords="continuing education",
keywords="sexual and gender minority",
keywords="web-based learning",
keywords="asynchronous learning",
keywords="education technology",
keywords="diversity, equity, inclusion",
keywords="DEI",
abstract="Background: Many health professions faculty members lack training on fundamental lesbian, gay, bisexual, transgender, and queer (LGBTQ+) health topics. Faculty development is needed to address knowledge gaps, improve teaching, and prepare students to competently care for the growing LGBTQ+ population. Objective: We conducted a program evaluation of the massive open online course Teaching LGBTQ+ Health: A Faculty Development Course for Health Professions Educators from the Stanford School of Medicine. Our goal was to understand participant demographics, impact, and ongoing maintenance needs to inform decisions about updating the course. Methods: We evaluated the course for the period from March 27, 2021, to February 24, 2023, guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. We assessed impact using participation numbers, evidence of learning, and likelihood of practice change. Data included participant demographics, performance on a pre- and postcourse quiz, open-text entries throughout the course, continuing medical education (CME) credits awarded, and CME course evaluations. We analyzed demographics using descriptive statistics and pre- and postcourse quiz scores using a paired 2-tailed t test. We conducted a qualitative thematic analysis of open-text responses to prompts within the course and CME evaluation questions. Results: Results were reported using the 5 framework domains. Regarding Reach, 1782 learners participated in the course, and 1516 (85.07\%) accessed it through a main course website. Of the different types of participants, most were physicians (423/1516, 27.9\%) and from outside the sponsoring institution and target audience (1452/1516, 95.78\%). Regarding Effectiveness, the median change in test scores for the 38.1\% (679/1782) of participants who completed both the pre- and postcourse tests was 3 out of 10 points, or a 30\% improvement (P<.001). Themes identified from CME evaluations included LGBTQ+ health as a distinct domain, inclusivity in practices, and teaching LGBTQ+ health strategies. A minority of participants (237/1782, 13.3\%) earned CME credits. Regarding Adoption, themes identified among responses to prompts in the course included LGBTQ+ health concepts and instructional strategies. Most participants strongly agreed with numerous positive statements about the course content, presentation, and likelihood of practice change. Regarding Implementation, the course cost US \$57,000 to build and was intramurally funded through grants and subsidies. The course faculty spent an estimated 600 hours on the project, and educational technologists spent another 712 hours. Regarding Maintenance, much of the course is evergreen, and ongoing oversight and quality assurance require minimal faculty time. New content will likely include modules on transgender health and gender-affirming care. Conclusions: Teaching LGBTQ+ Health improved participants' knowledge of fundamental queer health topics. Overall participation has been modest to date. Most participants indicated an intention to change clinical or teaching practices. Maintenance costs are minimal. The web-based course will continue to be offered, and new content will likely be added. ",
doi="10.2196/47777",
url="https://mededu.jmir.org/2023/1/e47777",
url="http://www.ncbi.nlm.nih.gov/pubmed/37477962"
}


@Article{info:doi/10.2196/42412,
author="Skinner, Ann Nadine
and Job, Nophiwe
and Krause, Julie
and Frankel, Ariel
and Ward, Victoria
and Johnston, Sewan Jamie",
title="The Use of Open-Source Online Course Content for Training in Public Health Emergencies: Mixed Methods Case Study of a COVID-19 Course Series for Health Professionals",
journal="JMIR Med Educ",
year="2023",
month="Feb",
day="23",
volume="9",
pages="e42412",
keywords="global health education",
keywords="digital education",
keywords="digital health",
keywords="COVID-19 pandemic",
keywords="health care access",
keywords="partnerships for health",
keywords="community health workers",
keywords="remote learning",
abstract="Background: The onset of the COVID-19 pandemic generated an urgent need for credible and actionable information to guide public health responses. The massive open-source online course (MOOC) format may be a valuable path for disseminating timely and widely accessible training for health professionals during public health crises; however, the reach and effectiveness of health worker--directed online courses during the pandemic remain largely unexplored. Objective: This study investigated the use of an open-source online course series designed to provide critical COVID-19 knowledge to frontline health workers and public health professionals globally. The study investigated how open-source online educational content can be optimized to support knowledge sharing among health professionals in public health emergencies, particularly in resource-limited contexts. Methods: The study examined global course enrollment patterns (N=2185) and performed in-depth interviews with a purposive subsample of health professionals enrolled in the course series (N=12) to investigate the sharing of online content in pandemic responses. Interviewed learners were from Ethiopia, India, Kenya, Liberia, Malawi, Rwanda, Thailand, Uganda, the United Arab Emirates, and the United States. Inductive analysis and constant comparative methods were used to systematically code data and identify key themes emerging from interview data. Results: The analysis revealed that the online course content helped fill a critical gap in trustworthy COVID-19 information for pandemic responses and was shared through health worker professional and personal networks. Enrollment patterns and qualitative data illustrate how health professionals shared information within their professional networks. While learners shared the knowledge they gained from the course, they expressed a need for contextualized information to more effectively educate others in their networks and in their communities. Due to technological and logistical barriers, participants did not attempt to adapt the content to share with others. Conclusions: This study illustrates that health professional networks can facilitate the sharing of online open-source health education content; however, to fully leverage potential benefits, additional support is required to facilitate the adaptation of course content to more effectively reach communities globally. ",
doi="10.2196/42412",
url="https://mededu.jmir.org/2023/1/e42412",
url="http://www.ncbi.nlm.nih.gov/pubmed/36735834"
}


@Article{info:doi/10.2196/35878,
author="R{\o}ynesdal, {\O}ystein
and Magnus, H. Jeanette
and Moen, Anne",
title="Pedagogical Approaches and Learning Activities, Content, and Resources Used in the Design of Massive Open Online Courses (MOOCs) in the Health Sciences: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="30",
volume="11",
number="5",
pages="e35878",
keywords="MOOC",
keywords="scoping review",
keywords="collaborative learning",
keywords="PhD",
keywords="postgraduate",
keywords="education",
keywords="health sciences",
keywords="massive open online course",
abstract="Background: Developing online, widely accessible educational courses, such as Massive Open Online Courses (MOOCs), offer novel opportunities to advancing academic research and the educational system in resource-constrained countries. Despite much literature on the use of design-related features and principles of different pedagogical approaches when developing MOOCs, there are reports of inconsistency between the pedagogical approach and the learning activities, content, or resources in MOOCs. Objective: We present a protocol for a scoping review aiming to systematically identify and synthesize literature on the pedagogical approaches used, and the learning activities, content, and resources used to facilitate social interaction and collaboration among postgraduate learners in MOOCs across the health sciences. Methods: We will follow a 6-step procedure for scoping reviews to conduct a search of published and gray literature in the following databases: Medline via Ovid, ERIC, SCOPUS, Web of Science, and PsychINFO. Two reviewers will screen titles, abstracts, and relevant full texts independently to determine eligibility for inclusion. The team will extract data using a predefined charting form and synthesize results in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. Results: The scoping review is currently ongoing. As of March 2022, we have performed initial data searches and screened titles and abstracts of the studies we found but revised the search string owing to inaccurate results. We aim to start analyzing the data in June 2022 and expect to complete the scoping review by February 2023. Conclusions: With the results of this review, we hope to report on the use of pedagogical approaches and what learning activities, content, and resources foster social and collaborative learning processes, and to further elucidate how practitioners and academics can harvest our findings to bridge the gap between pedagogics and learning activities in the instructional design of MOOCs for postgraduate students in the health sciences. International Registered Report Identifier (IRRID): DERR1-10.2196/35878 ",
doi="10.2196/35878",
url="https://www.researchprotocols.org/2022/5/e35878",
url="http://www.ncbi.nlm.nih.gov/pubmed/35635750"
}


@Article{info:doi/10.2196/30603,
author="Alvarez-Perez, Yolanda
and Perestelo-Perez, Lilisbeth
and Rivero-Santana, Amado
and Wagner, M. Ana
and Torres-Casta{\~n}o, Alezandra
and Toledo-Ch{\'a}varri, Ana
and Duarte-D{\'i}az, Andrea
and Alvarado-Martel, D{\'a}cil
and Piccini, Barbara
and Van den Broucke, Stephan
and Vandenbosch, Jessica
and Gonz{\'a}lez-Gonz{\'a}lez, Carina
and Perello, Michelle
and Serrano-Aguilar, Pedro
and ",
title="Cocreation of Massive Open Online Courses to Improve Digital Health Literacy in Diabetes: Pilot Mixed Methods Study",
journal="JMIR Diabetes",
year="2021",
month="Dec",
day="13",
volume="6",
number="4",
pages="e30603",
keywords="diabetes",
keywords="digital health literacy",
keywords="health education",
keywords="MOOC",
abstract="Background: Self-management education is a fundamental aspect in the health care of people with diabetes to develop the necessary skills for the improvement of health outcomes. Patients are required to have the competencies to manage electronic information resources---that is, an appropriate level of digital health literacy. The European project IC-Health aimed to improve digital health literacy among people with diabetes through the cocreation of massive open online courses (MOOCs). Objective: We report the preliminary results obtained in 3 participating countries in the IC-Health project (Italy, Spain, and Sweden) regarding (1) experience of the participants during the cocreation process of MOOCs, (2) perceived changes in their digital health literacy level after using MOOCs, and (3) a preliminary assessment of the acceptability of MOOCs. Methods: The cocreation of the MOOCs included focus groups with adults and adolescents with diabetes and the creation of independent communities of practice for type 1 diabetes and type 2 diabetes participants aimed to co-design the MOOCs. Quantitative measures of the acceptability of MOOCs, experience in the cocreation process, and increase in digital health literacy (dimensions of finding, understanding, and appraisal) were assessed. Results: A total of 28 participants with diabetes participated in focus groups. Adults and adolescents agreed that the internet is a secondary source of health-related information. A total of 149 participants comprised the diabetes communities of practice. A total of 9 MOOCs were developed. Acceptability of the MOOCs and the cocreation experience were positively valued. There was a significant improvement in digital health literacy in both adults and adolescents after using MOOCs (P<.001). Conclusions: Although the results presented on self-perceived digital health literacy are preliminary and exploratory, this pilot study suggests that IC-Health MOOCs represent a promising tool for the medical care of diabetes, being able to help reduce the limitations associated with low digital health literacy and other communication barriers in the diabetes population. ",
doi="10.2196/30603",
url="https://diabetes.jmir.org/2021/4/e30603",
url="http://www.ncbi.nlm.nih.gov/pubmed/34898453"
}


@Article{info:doi/10.2196/21681,
author="Claflin, B. Suzi
and Campbell, A. Julie
and Doherty, Kathleen
and Farrow, Maree
and Bessing, Barnabas
and Taylor, V. Bruce",
title="Evaluating Course Completion, Appropriateness, and Burden in the Understanding Multiple Sclerosis Massive Open Online Course: Cohort Study",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="7",
volume="23",
number="12",
pages="e21681",
keywords="multiple sclerosis",
keywords="massive open online course",
keywords="health promotion",
keywords="eHealth education",
keywords="mobile phone",
abstract="Background: Massive open online course (MOOC) research is an emerging field; to date, most research in this area has focused on participant engagement. Objective: The aim of this study is to evaluate both participant engagement and measures of satisfaction, appropriateness, and burden for a MOOC entitled Understanding Multiple Sclerosis (MS) among a cohort of 3518 international course participants. Methods: We assessed the association of key outcomes with participant education level, MS status, caregiver status, sex, and age using summary statistics, and 2-tailed t tests, and chi-square tests. Results: Of the 3518 study participants, 928 (26.37\%) were people living with MS. Among the 2590 participants not living with MS, 862 (33.28\%) identified as formal or informal caregivers. Our key findings were as follows: the course completion rate among study participants was 67.17\% (2363/3518); the course was well received, with 96.97\% (1502/1549) of participants satisfied, with an appropriate pitch and low burden (a mean of 2.2 hours engagement per week); people living with MS were less likely than those not living with MS to complete the course; and people with a recent diagnosis of MS, caregivers, and participants without a university education were more likely to apply the material by course completion. Conclusions: The Understanding MS MOOC is fit for purpose; it presents information in a way that is readily understood by course participants and is applicable in their lives. ",
doi="10.2196/21681",
url="https://www.jmir.org/2021/12/e21681",
url="http://www.ncbi.nlm.nih.gov/pubmed/34878985"
}


@Article{info:doi/10.2196/28945,
author="Utunen, Heini
and Van Kerkhove, D. Maria
and Tokar, Anna
and O'Connell, Gillian
and Gamhewage, M. Gaya
and Fall, Soc{\'e} Ibrahima",
title="One Year of Pandemic Learning Response: Benefits of Massive Online Delivery of the World Health Organization's Technical Guidance",
journal="JMIR Public Health Surveill",
year="2021",
month="Apr",
day="21",
volume="7",
number="4",
pages="e28945",
keywords="COVID-19",
keywords="e-learning",
keywords="massive open web-based courses",
keywords="OpenWHO",
keywords="pandemic",
keywords="public health",
keywords="web-based learning",
keywords="World Health Organization",
doi="10.2196/28945",
url="https://publichealth.jmir.org/2021/4/e28945",
url="http://www.ncbi.nlm.nih.gov/pubmed/33881404"
}


@Article{info:doi/10.2196/16687,
author="Claflin, B. Suzi
and Gates, Rachael
and Maher, Maree
and Taylor, V. Bruce",
title="Building a Successful Massive Open Online Course About Multiple Sclerosis: A Process Description",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="29",
volume="22",
number="7",
pages="e16687",
keywords="multiple sclerosis",
keywords="health education",
abstract="Background: Over the course of a year, we developed and tested a 6-week massive open online course (MOOC) on multiple sclerosis (MS) in consultation with the MS community. The course targeted the MS community and interested laypeople and was titled Understanding MS. The primary purpose of the course was to improve MS knowledge, health literacy, and resilience among participants. The final version of the MOOC made available for open enrollment was ranked first among all MOOCs released in 2019 (n>2400) based on participant reviews. Objective: The aim of this study was to present a detailed description and assessment of the development process of the Understanding MS MOOC. Methods: The development process included a course development focus group; the creation of more than 50 content videos and related text, quizzes, activities, and discussion prompts; the creation of original images and animations; a pilot study; and collaborations with people living with MS, MS nurses, allied health care practitioners, and neurologists and researchers from 4 universities. Results: Overall, the process was efficient and effective. With a few small changes, we recommend this approach to those seeking to develop a similar course. This process led to the development of a highly reviewed MOOC with excellent user satisfaction. Conclusions: We identified 5 key lessons from this process: (1) community support is essential, (2) stakeholder involvement improves content quality, (3) plan for research from the beginning, (4) coordination between the academic lead and project manager team ensures a consistent voice, and (5) a network of collaborators is a key resource. ",
doi="10.2196/16687",
url="https://www.jmir.org/2020/7/e16687",
url="http://www.ncbi.nlm.nih.gov/pubmed/32723726"
}


@Article{info:doi/10.2196/17318,
author="Blum, R. Elizabeth
and Stenfors, Terese
and Palmgren, J. Per",
title="Benefits of Massive Open Online Course Participation: Deductive Thematic Analysis",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="8",
volume="22",
number="7",
pages="e17318",
keywords="MOOC",
keywords="MOOC evaluation",
keywords="qualitative",
keywords="thematic analysis",
keywords="learner",
keywords="online education",
keywords="Kirkpatrick framework",
keywords="outcomes",
keywords="MOOC outcomes",
abstract="Background: Massive open online courses (MOOCs), as originally conceived, promised to provide educational access to anyone with an internet connection. However, the expansiveness of MOOC education has been found to be somewhat limited. Nonetheless, leading universities continue to offer MOOCs, including many in the health sciences, on a number of private platforms. Therefore, research on online education must include thorough understanding of the role of MOOCs. To date, studies on MOOC participants have focused mainly on learners' assessment of the course. It is known that MOOCs are not reaching the universal audiences that were predicted, and much knowledge has been gained about learners' perceptions of MOOCs. However, there is little scholarship on what learners themselves gain from participating in MOOCs. Objective: As MOOC development persists and expands, scholars and developers should be made aware of the role of MOOCs in education by examining what these courses do offer their participants. The objective of this qualitative synthesis of a set of MOOC evaluation studies was to explore outcomes for MOOC learners, that is, how the learners themselves benefit from participating in MOOCs. Methods: To explore MOOC learners' outcomes, we conducted a qualitative synthesis in the form of a deductive thematic analysis, aggregating findings from 17 individual studies selected from an existing systematic review of MOOC evaluation methods. We structured our inquiry using the Kirkpatrick model, considering Kirkpatrick levels 2, 3, and 4 as potential themes in our analysis. Results: Our analysis identified six types of Kirkpatrick outcomes in 17 studies. Five of these outcomes (learning/general knowledge, skills, attitudes, confidence, and commitment) fit into Kirkpatrick Level 2, while Kirkpatrick Level 3 outcomes concerning behavior/application were seen in four studies. Two additional themes were identified outside of the Kirkpatrick framework: culture and identity outcomes and affective/emotional outcomes. Kirkpatrick Level 4 was not represented among the outcomes we examined. Conclusions: Our findings point to some gains from MOOCs. While we can expect MOOCs to persist, how learners benefit from the experience of participating in MOOCs remains unclear. ",
doi="10.2196/17318",
url="https://www.jmir.org/2020/7/e17318",
url="http://www.ncbi.nlm.nih.gov/pubmed/32672680"
}


@Article{info:doi/10.2196/13851,
author="Alturkistani, Abrar
and Lam, Ching
and Foley, Kimberley
and Stenfors, Terese
and Blum, R. Elizabeth
and Van Velthoven, Helena Michelle
and Meinert, Edward",
title="Massive Open Online Course Evaluation Methods: Systematic Review",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="27",
volume="22",
number="4",
pages="e13851",
keywords="online learning",
keywords="learning",
keywords="computer-assisted instruction",
abstract="Background: Massive open online courses (MOOCs) have the potential to make a broader educational impact because many learners undertake these courses. Despite their reach, there is a lack of knowledge about which methods are used for evaluating these courses. Objective: The aim of this review was to identify current MOOC evaluation methods to inform future study designs. Methods: We systematically searched the following databases for studies published from January 2008 to October 2018: (1) Scopus, (2) Education Resources Information Center, (3) IEEE (Institute of Electrical and Electronic Engineers) Xplore, (4) PubMed, (5) Web of Science, (6) British Education Index, and (7) Google Scholar search engine. Two reviewers independently screened the abstracts and titles of the studies. Published studies in the English language that evaluated MOOCs were included. The study design of the evaluations, the underlying motivation for the evaluation studies, data collection, and data analysis methods were quantitatively and qualitatively analyzed. The quality of the included studies was appraised using the Cochrane Collaboration Risk of Bias Tool for randomized controlled trials (RCTs) and the National Institutes of Health---National Heart, Lung, and Blood Institute quality assessment tool for cohort observational studies and for before-after (pre-post) studies with no control group. Results: The initial search resulted in 3275 studies, and 33 eligible studies were included in this review. In total, 16 studies used a quantitative study design, 11 used a qualitative design, and 6 used a mixed methods study design. In all, 16 studies evaluated learner characteristics and behavior, and 20 studies evaluated learning outcomes and experiences. A total of 12 studies used 1 data source, 11 used 2 data sources, 7 used 3 data sources, 4 used 2 data sources, and 1 used 5 data sources. Overall, 3 studies used more than 3 data sources in their evaluation. In terms of the data analysis methods, quantitative methods were most prominent with descriptive and inferential statistics, which were the top 2 preferred methods. In all, 26 studies with a cross-sectional design had a low-quality assessment, whereas RCTs and quasi-experimental studies received a high-quality assessment. Conclusions: The MOOC evaluation data collection and data analysis methods should be determined carefully on the basis of the aim of the evaluation. The MOOC evaluations are subject to bias, which could be reduced using pre-MOOC measures for comparison or by controlling for confounding variables. Future MOOC evaluations should consider using more diverse data sources and data analysis methods. International Registered Report Identifier (IRRID): RR2-10.2196/12087 ",
doi="10.2196/13851",
url="https://www.jmir.org/2020/4/e13851",
url="http://www.ncbi.nlm.nih.gov/pubmed/32338618"
}


@Article{info:doi/10.2196/19076,
author="Utunen, Heini
and Ndiaye, Ngouille
and Piroux, Corentin
and George, Richelle
and Attias, Melissa
and Gamhewage, Gaya",
title="Global Reach of an Online COVID-19 Course in Multiple Languages on OpenWHO in the First Quarter of 2020: Analysis of Platform Use Data",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="27",
volume="22",
number="4",
pages="e19076",
keywords="online learning",
keywords="OpenWHO",
keywords="novel coronavirus",
keywords="COVID-19",
keywords="coronavirus",
keywords="pandemic",
keywords="WHO",
keywords="e-learning",
keywords="MOOC",
keywords="public health",
abstract="Background: At the onset of the coronavirus outbreak, the World Health Organization's (WHO) Health Emergencies Learning and Capacity Development Unit, together with the WHO's health technical lead on coronaviruses, developed a massive open online course within 3 weeks as part of the global response to the emergency. The introductory coronavirus disease (COVID?19) course was launched on January 26, 2020, on the health emergencies learning platform OpenWHO.org. Objective: The aim of this paper is to investigate the geographic reach of different language courses accessed by a worldwide audience seeking information on COVID-19. Users' professional identities and backgrounds were explored to inform course owners on the use case. The course was developed and delivered via the open-access learning platform OpenWHO.org. The self-paced resources are available in a total of 13 languages and were produced between January 26 and March 25, 2020. Methods: Data were collected from the online courses' statistical data and metrics reporting system on the OpenWHO platform. User patterns and locations were analyzed based on Google Analytics and the platform's own statistics capabilities, and data sets were overlaid. This analysis was conducted based on user location, with the data disaggregated according to the six WHO regions, the top 10 countries, and the proportion of use for each language version. Data included affiliation, gender, age, and other parameters for 32.43\% (52,214/161,007) of the users who indicated their background. Results: As of March 25, 2020, the introductory COVID-19 course totaled 232,890 enrollments across all languages. The Spanish language course was comprised of more than half (n=118,754, 50.99\%) of all course enrollments, and the English language course was comprised of 38.21\% (n=88,988) of enrollments. The WHO's Region of the Americas accounted for most of the course enrollments, with more than 72.47\% (138,503/191,130) enrollment across all languages. Other regions were more evenly distributed with less than 10\% enrollment for each. A total of 32.43\% (52,214/161,007) of users specified a professional affiliation by choosing from the 12 most common backgrounds in the OpenWHO user profiles. Before the COVID-19 pandemic, users were spread over the 11 distinct affiliations, with a small fraction of users identifying themselves as ``Other.'' With the COVID-19 introductory course, the largest number of users selected ``Other'' (16,527/52,214, 31.65\%), suggesting a large number of users who were not health professionals or academics. The top 10 countries with the most users across all languages were Argentina, Chile, Colombia, Ecuador, India, Mexico, Peru, Spain, the United Kingdom, and the United States. Conclusions: The online course has addressed a worldwide learning need by providing WHO's technical guidance packaged in simple formats for access and use. The learning material development was expedited to meet the onset of the epidemic. Initial data suggest that the various language versions of the course, in particular Spanish, have reached new user groups, fulfilling the platform's aim of providing learning everywhere to anyone that is interested. User surveys will be carried out to measure the real impact. ",
doi="10.2196/19076",
url="https://www.jmir.org/2020/4/e19076",
url="http://www.ncbi.nlm.nih.gov/pubmed/32293580"
}


@Article{info:doi/10.2196/15177,
author="Blakemore, M. Louise
and Meek, M. Sarah E.
and Marks, K. Leah",
title="Equipping Learners to Evaluate Online Health Care Resources: Longitudinal Study of Learning Design Strategies in a Health Care Massive Open Online Course",
journal="J Med Internet Res",
year="2020",
month="Feb",
day="26",
volume="22",
number="2",
pages="e15177",
keywords="health care education",
keywords="learning analytics",
keywords="MOOC",
keywords="plagiarism",
keywords="ehealth",
keywords="eHealth literacy",
keywords="digital health literacy",
keywords="misinformation",
keywords="assessment",
keywords="digital literacy",
abstract="Background: The digital revolution has led to a boom in the number of available online health care resources. To navigate these resources successfully, digital literacy education is required. Learners who can evaluate the reliability and validity of online health care information are likely to be more effective at avoiding potentially dangerous misinformation. In addition to providing health care education, massive open online courses (MOOCs) are well positioned to play a role in providing digital literacy education in this context. Objective: This study focused on learners enrolled in a MOOC on cancer genomics. The aim of this study was to evaluate the efficacy of a series of digital literacy--related activities within this course. This was an iterative study, with changes made to digital literacy--related activities in 4 of the 8 runs of the course. Methods: This mixed methods study focused on learner engagement with the digital literacy--related activities, including the final course written assignment. Quantitative data including the number of references listed in each written assignment were compared between successive runs. Qualitative data in the form of learner comments on discussion forums for digital literacy--related tasks were evaluated to determine the impact of these educational activities. Results: Using the number of references included for each final course assignment as an indicator of digital literacy skills, the digital literacy--related activities in the final 2 runs were judged to be the most successful. We found a statistically significant increase in the number of references cited by learners in their final written assignments. The average number of references cited in Run 8 was significantly higher (3.5) than in Run 1 (1.8) of the MOOC (P=.001). Learner comments in Runs 7 and 8 showed that a poll in which learners were asked to select which of 4 online resources was reliable was effective in stimulating learner discussion about how to evaluate resource reliability. Conclusions: Similar to many health care MOOCs, the course studied here had a heterogeneous group of learners, including patients (and their families), the public, health care students, and practitioners. Carefully designing a range of digital literacy--related activities that would be beneficial to this heterogenous group of learners enabled learners to become more effective at evaluating and citing appropriate online resources within their written assignments. ",
doi="10.2196/15177",
url="http://www.jmir.org/2020/2/e15177/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130120"
}


@Article{info:doi/10.2196/10982,
author="Alturkistani, Abrar
and Majeed, Azeem
and Car, Josip
and Brindley, David
and Wells, Glenn
and Meinert, Edward",
title="Data Collection Approaches to Enable Evaluation of a Massive Open Online Course About Data Science for Continuing Education in Health Care: Case Study",
journal="JMIR Med Educ",
year="2019",
month="Apr",
day="02",
volume="5",
number="1",
pages="e10982",
keywords="education, distance",
keywords="education",
keywords="teaching",
keywords="online learning",
keywords="online education",
keywords="MOOC",
keywords="massive open online course",
abstract="Background: This study presents learner perceptions of a pilot massive open online course (MOOC). Objective: The objective of this study was to explore data collection approaches to help inform future MOOC evaluations on the use of semistructured interviews and the Kirkpatrick evaluation model. Methods: A total of 191 learners joined 2 course runs of a limited trial of the MOOC. Moreover, 7 learners volunteered to be interviewed for the study. The study design drew on semistructured interviews of 2 learners transcribed and analyzed using Braun and Clark's method for thematic coding. This limited participant set was used to identify how the Kirkpatrick evaluation model could be used to evaluate further implementations of the course at scale. Results: The study identified several themes that could be used for further analysis. The themes and subthemes include learner background (educational, professional, and topic significance), MOOC learning (learning achievement and MOOC application), and MOOC features (MOOC positives, MOOC negatives, and networking). There were insufficient data points to perform a Kirkpatrick evaluation. Conclusions: Semistructured interviews for MOOC evaluation can provide a valuable in-depth analysis of learners' experience of the course. However, there must be sufficient data sources to complete a Kirkpatrick evaluation to provide for data triangulation. For example, data from precourse and postcourse surveys, quizzes, and test results could be used to improve the evaluation methodology. ",
doi="10.2196/10982",
url="http://mededu.jmir.org/2019/1/e10982/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30938683"
}


@Article{info:doi/10.2196/12152,
author="De Gagne, C. Jennie
and Manturuk, Kim
and Park, K. Hyeyoung
and Conklin, L. Jamie
and Wyman Roth, Noelle
and Hook, E. Benjamin
and Kulka, M. Joanne",
title="Cyberincivility in the Massive Open Online Course Learning Environment: Data-Mining Study",
journal="JMIR Med Educ",
year="2018",
month="Dec",
day="21",
volume="4",
number="2",
pages="e12152",
keywords="aggression",
keywords="cyber incivility",
keywords="discussion forums",
keywords="education",
keywords="massive open online courses",
abstract="Background: Cyberincivility is a pervasive issue that demands upfront thinking and can negatively impact one's personal, professional, social, and educational well-being. Although massive open online courses (MOOCs) environments could be vulnerable to undesirable acts of incivility among students, no study has explored the phenomena of cyberincivility in this learning environment, particularly in a health-related course in which mostly current or eventual health professions students enroll. Objective: This study aimed to analyze the characteristics of text entries posted by students enrolled in a medicine and health care MOOC. The objectives were to (1) examine the prevalence of posts deemed disrespectful, insensitive or disruptive, and inconducive to learning; (2) describe the patterns and types of uncivil posts; and (3) highlight aspects that could be useful for MOOC designers and educators to build a culture of cybercivility in the MOOC environment. Methods: We obtained data from postings in the discussion forums from the MOOC Medical Neuroscience created by a large private university in the southeast region of the United States. After cleaning the dataset, 8705 posts were analyzed, which contained (1) 667 questions that received no responses; (2) 756 questions that received at least one answer; (3) 6921 responses that applied to 756 posts; and (4) 361 responses where the initiating post was unknown. An iterative process of coding, discussion, and revision was conducted to develop a series of a priori codes. Data management and analysis were performed with NVivo 12. Results: Overall, 19 a priori codes were retained from 25 initially developed, and 3 themes emerged from the data---Annoyance, Disruption, and Aggression. Of 8705 posts included in the analysis, 7333 (84.24\%) were considered as the absence of uncivil posts and 1043 (11.98\%) as the presence of uncivil posts, while 329 (3.78\%) were uncodable. Of 1043 uncivil posts analyzed, 466 were coded to >1 a priori codes, which resulted in 1509 instances. Of those 1509 instances, 826 (54.74\%) fell into ``annoyance'', 648 (42.94\%) into ``disruption'', and 35 (2.32\%) into ``aggression''. Of 466 posts that related to >1 a priori codes, 380 were attributed to 2 or 3 themes. Of those 380 posts, 352 (92.6\%) overlapped both ``annoyance'' and ``disruption,'' 13 (3.4\%) overlapped both ``disruption'' and ``aggression,'' and 9 (2.4\%) overlapped ``annoyance'' and ``aggression,'' while 6 (1.6\%) intersected all 3 themes. Conclusions: This study reports on the phenomena of cyberincivility in health-related MOOCs toward the education of future health care professionals. Despite the general view that discussion forums are a staple of the MOOC delivery system, students cite discussion forums as a source of frustration for their potential to contain uncivil posts. Therefore, MOOC developers and instructors should consider ways to maintain a civil discourse within discussion forums. ",
doi="10.2196/12152",
url="http://mededu.jmir.org/2018/2/e12152/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30578221"
}


@Article{info:doi/10.2196/ijmr.4937,
author="Liyanagunawardena, Rekha Tharindu
and Williams, Ann Shirley",
title="Elderly Learners and Massive Open Online Courses: A Review",
journal="Interact J Med Res",
year="2016",
month="Jan",
day="07",
volume="5",
number="1",
pages="e1",
keywords="massive open online courses",
keywords="loneliness",
keywords="older adults",
keywords="elderly",
keywords="eLearning",
keywords="education",
keywords="continuing education",
keywords="computer-assisted instruction",
abstract="Background: Massive open online courses (MOOCs) have become commonplace in the e-learning landscape. Thousands of elderly learners are participating in courses offered by various institutions on a multitude of platforms in many different languages. However, there is very little research into understanding elderly learners in MOOCs. Objective: We aim to show that a considerable proportion of elderly learners are participating in MOOCs and that there is a lack of research in this area. We hope this assertion of the wide gap in research on elderly learners in MOOCs will pave the way for more research in this area. Methods: Pre-course survey data for 10 University of Reading courses on the FutureLearn platform were analyzed to show the level of participation of elderly learners in MOOCs. Two MOOC aggregator sites (Class Central and MOOC List) were consulted to gather data on MOOC offerings that include topics relating to aging. In parallel, a selected set of MOOC platform catalogues, along with a recently published review on health and medicine-related MOOCs, were searched to find courses relating to aging. A systematic literature search was then employed to identify research articles on elderly learners in MOOCs. Results: The 10 courses reviewed had a considerable proportion of elderly learners participating in them. For the over-66 age group, this varied from 0.5\% (on the course ``Managing people'') to 16.3\% (on the course ``Our changing climate''), while for the over-56 age group it ranged from 3.0\% (on ``A beginners guide to writing in English'') to 39.5\% (on ``Heart health''). Only six MOOCs were found to include topics related to aging: three were on the Coursera platform, two on the FutureLearn platform, and one on the Open2Study platform. Just three scholarly articles relating to MOOCs and elderly learners were retrieved from the literature search. Conclusions: This review presents evidence to suggest that elderly learners are already participating in MOOCs. Despite this, there has been very little research into their engagement with MOOCs. Similarly, there has been little research into exploiting the scope of MOOCs for delivering topics that would be of interest to elderly learners. We believe there is potential to use MOOCs as a way of tackling the issue of loneliness among older adults by engaging them as either resource personnel or learners. ",
doi="10.2196/ijmr.4937",
url="http://www.i-jmr.org/2016/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26742809"
}


@Article{info:doi/10.2196/mededu.4394,
author="Kononowicz, A. Andrzej
and Berman, H. Anne
and Stathakarou, Natalia
and McGrath, Cormac
and Barty?ski, Tomasz
and Nowakowski, Piotr
and Malawski, Maciej
and Zary, Nabil",
title="Virtual Patients in a Behavioral Medicine Massive Open Online Course (MOOC): A Case-Based Analysis of Technical Capacity and User Navigation Pathways",
journal="JMIR Medical Education",
year="2015",
month="Sep",
day="10",
volume="1",
number="2",
pages="e8",
keywords="computer-assisted instruction",
keywords="education, medical",
keywords="medical informatics applications",
abstract="Background: Massive open online courses (MOOCs) have been criticized for focusing on presentation of short video clip lectures and asking theoretical multiple-choice questions. A potential way of vitalizing these educational activities in the health sciences is to introduce virtual patients. Experiences from such extensions in MOOCs have not previously been reported in the literature. Objective: This study analyzes technical challenges and solutions for offering virtual patients in health-related MOOCs and describes patterns of virtual patient use in one such course. Our aims are to reduce the technical uncertainty related to these extensions, point to aspects that could be optimized for a better learner experience, and raise prospective research questions by describing indicators of virtual patient use on a massive scale. Methods: The Behavioral Medicine MOOC was offered by Karolinska Institutet, a medical university, on the EdX platform in the autumn of 2014. Course content was enhanced by two virtual patient scenarios presented in the OpenLabyrinth system and hosted on the VPH-Share cloud infrastructure. We analyzed web server and session logs and a participant satisfaction survey. Navigation pathways were summarized using a visual analytics tool developed for the purpose of this study. Results: The number of course enrollments reached 19,236. At the official closing date, 2317 participants (12.1\% of total enrollment) had declared completing the first virtual patient assignment and 1640 (8.5\%) participants confirmed completion of the second virtual patient assignment. Peak activity involved 359 user sessions per day. The OpenLabyrinth system, deployed on four virtual servers, coped well with the workload. Participant survey respondents (n=479) regarded the activity as a helpful exercise in the course (83.1\%). Technical challenges reported involved poor or restricted access to videos in certain areas of the world and occasional problems with lost sessions. The visual analyses of user pathways display the parts of virtual patient scenarios that elicited less interest and may have been perceived as nonchallenging options. Analyzing the user navigation pathways allowed us to detect indications of both surface and deep approaches to the content material among the MOOC participants. Conclusions: This study reported on first inclusion of virtual patients in a MOOC. It adds to the body of knowledge by demonstrating how a biomedical cloud provider service can ensure technical capacity and flexible design of a virtual patient platform on a massive scale. The study also presents a new way of analyzing the use of branched virtual patients by visualization of user navigation pathways. Suggestions are offered on improvements to the design of virtual patients in MOOCs. ",
doi="10.2196/mededu.4394",
url="http://mededu.jmir.org/2015/2/e8/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27731844"
}