@Article{info:doi/10.2196/62741,
author="Mbeya-Munkhondya, E. Tiwonge
and Meek, J. Caroline
and Mphande, Mtisunge
and Tembo, A. Tapiwa
and Chitani, J. Mike
and Jean-Baptiste, Milenka
and Kumbuyo, Caroline
and Vansia, Dhrutika
and Simon, R. Katherine
and Rutstein, E. Sarah
and Mwapasa, Victor
and Go, Vivian
and Kim, H. Maria
and Rosenberg, E. Nora",
title="Anticipated Acceptability of Blended Learning Among Lay Health Care Workers in Malawi: Qualitative Analysis Guided by the Technology Acceptance Model",
journal="JMIR Form Res",
year="2025",
month="Apr",
day="7",
volume="9",
pages="e62741",
keywords="blended learning",
keywords="technology acceptance model",
keywords="index case testing",
keywords="acceptability",
keywords="partner notification",
keywords="contact tracing",
abstract="Background: HIV index case testing (ICT) aims to identify people living with HIV and their contacts, engage them in HIV testing services, and link them to care. ICT implementation has faced challenges in Malawi due to limited counseling capacity among lay health care workers (HCWs). Enhancing capacity through centralized face-to-face training is logistically complex and expensive. A decentralized blended learning approach to HCW capacity-building, combining synchronous face-to-face and asynchronous digital modalities, may be an acceptable way to address this challenge. Objective: The objective of this analysis is to describe factors influencing HCW anticipated acceptability of blended learning using the Technology Acceptance Model (TAM). Methods: This formative qualitative study involved conducting 26 in-depth interviews with HCWs involved in the ICT program across 14 facilities in Machinga and Balaka, Malawi (November-December 2021). Results were analyzed thematically using TAM. Themes were grouped into factors affecting the 2 sets of TAM constructs: perceived usefulness and perceived ease of use. Results: A total of 2 factors influenced perceived usefulness. First, HCWs found the idea of self-guided digital learning appealing, as they believed it would allow for reinforcement, which would facilitate competence. They also articulated the need for opportunities to practice and receive feedback through face-to-face interactions in order to apply the digital components. In total, 5 factors influenced perceived ease of use. First, HCWs expressed a need for orientation to the digital technology given limited digital literacy. Second, they requested accessibility of devices provided by their employer, as many lacked personal devices. Third, they wished for adequate communication surrounding their training schedules, especially if they were going to be asynchronous. Fourth, they wished for support for logistical arrangements to avoid work interruptions. Finally, they wanted monetary compensation to motivate learning, a practice comparable with offsite trainings. Conclusions: A decentralized blended learning approach may be an acceptable method of enhancing ICT knowledge and skills among lay HCWs in Malawi, although a broad range of external factors need to be considered. Our next step is to integrate these findings into a blended learning package and examine perceived acceptability of the package in the context of a cluster randomized controlled trial. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2023-077706 ",
doi="10.2196/62741",
url="https://formative.jmir.org/2025/1/e62741"
}


@Article{info:doi/10.2196/52230,
author="Chien, Cheng-Yu
and Tsai, Shang-Li
and Huang, Chien-Hsiung
and Wang, Ming-Fang
and Lin, Chi-Chun
and Chen, Chen-Bin
and Tsai, Li-Heng
and Tseng, Hsiao-Jung
and Huang, Yan-Bo
and Ng, Chip-Jin",
title="Effectiveness of Blended Versus Traditional Refresher Training for Cardiopulmonary Resuscitation: Prospective Observational Study",
journal="JMIR Med Educ",
year="2024",
month="Apr",
day="29",
volume="10",
pages="e52230",
keywords="cardiopulmonary resuscitation",
keywords="blended method",
keywords="blended",
keywords="hybrid",
keywords="refresher",
keywords="refreshers",
keywords="teaching",
keywords="instruction",
keywords="observational",
keywords="training",
keywords="professional development",
keywords="continuing education",
keywords="retraining",
keywords="traditional method",
keywords="self-directed learning",
keywords="resuscitation",
keywords="CPR",
keywords="emergency",
keywords="rescue",
keywords="life support",
keywords="cardiac",
keywords="cardiopulmonary",
abstract="Background: Generally, cardiopulmonary resuscitation (CPR) skills decline substantially over time. By combining web-based self-regulated learning with hands-on practice, blended training can be a time- and resource-efficient approach enabling individuals to acquire or refresh CPR skills at their convenience. However, few studies have evaluated the effectiveness of blended CPR refresher training compared with that of the traditional method. Objective: This study investigated and compared the effectiveness of traditional and blended CPR training through 6-month and 12-month refresher sessions with CPR ability indicators. Methods: This study recruited participants aged ?18 years from the Automated External Defibrillator Donation Project. The participants were divided into 4 groups based on the format of the CPR training and refresher training received: (1) initial traditional training (a 30-minute instructor-led, hands-on session) and 6-month traditional refresher training (Traditional6 group), (2) initial traditional training and 6-month blended refresher training (an 18-minute e-learning module; Mixed6 group), (3) initial traditional training and 12-month blended refresher training (Mixed12 group), and (4) initial blended training and 6-month blended refresher training (Blended6 group). CPR knowledge and performance were evaluated immediately after initial training. For each group, following initial training but before refresher training, a learning effectiveness assessment was conducted at 12 and 24 months. CPR knowledge was assessed using a written test with 15 multiple-choice questions, and CPR performance was assessed through an examiner-rated skill test and objectively through manikin feedback. A generalized estimating equation model was used to analyze changes in CPR ability indicators. Results: This study recruited 1163 participants (mean age 41.82, SD 11.6 years; n=725, 62.3\% female), with 332 (28.5\%), 270 (23.2\%), 258 (22.2\%), and 303 (26.1\%) participants in the Mixed6, Traditional6, Mixed12, and Blended6 groups, respectively. No significant between-group difference was observed in knowledge acquisition after initial training (P=.23). All groups met the criteria for high-quality CPR skills (ie, average compression depth: 5-6 cm; average compression rate: 100-120 beats/min; chest recoil rate: >80\%); however, a higher proportion (98/303, 32.3\%) of participants receiving blended training initially demonstrated high-quality CPR skills. At 12 and 24 months, CPR skills had declined in all the groups, but the decline was significantly higher in the Mixed12 group, whereas the differences were not significant between the other groups. This finding indicates that frequent retraining can maintain high-quality CPR skills and that blended refresher training is as effective as traditional refresher training. Conclusions: Our findings indicate that 6-month refresher training sessions for CPR are more effective for maintaining high-quality CPR skills, and that as refreshers, self-learning e-modules are as effective as instructor-led sessions. Although the blended learning approach is cost and resource effective, factors such as participant demographics, training environment, and level of engagement must be considered to maximize the potential of this approach. Trial Registration: IGOGO NCT05659108; https://www.cgmh-igogo.tw ",
doi="10.2196/52230",
url="https://mededu.jmir.org/2024/1/e52230",
url="http://www.ncbi.nlm.nih.gov/pubmed/38683663"
}


@Article{info:doi/10.2196/43916,
author="Preiksaitis, Carl
and Dayton, R. John
and Kabeer, Rana
and Bunney, Gabrielle
and Boukhman, Milana",
title="Teaching Principles of Medical Innovation and Entrepreneurship Through Hackathons: Case Study and Qualitative Analysis",
journal="JMIR Med Educ",
year="2023",
month="Feb",
day="24",
volume="9",
pages="e43916",
keywords="hackathon",
keywords="innovation",
keywords="entrepreneurship",
keywords="medical education",
keywords="gamification",
keywords="curriculum",
keywords="biodesign",
keywords="emergency medicine",
keywords="health care innovation",
keywords="medical innovation",
keywords="training",
keywords="design",
keywords="implementation",
keywords="development",
keywords="physician",
keywords="educational",
abstract="Background: Innovation and entrepreneurship training are increasingly recognized as being important in medical education. However, the lack of faculty comfort with the instruction of these concepts as well as limited scholarly recognition for this work has limited the implementation of curricula focused on these skills. Furthermore, this lack of familiarity limits the inclusion of practicing physicians in health care innovation, where their experience is valuable. Hackathons are intense innovation competitions that use gamification principles to increase comfort with creative thinking, problem-solving, and interpersonal collaboration, but they require further exploration in medical innovation. Objective: To address this, we aimed to design, implement, and evaluate a health care hackathon with 2 main goals: to improve emergency physician familiarity with the principles of health care innovation and entrepreneurship and to develop innovative solutions to 3 discrete problems facing emergency medicine physicians and patients. Methods: We used previously described practices for conducting hackathons to develop and implement our hackathon (HackED!). We partnered with the American College of Emergency Physicians, the Stanford School of Biodesign, and the Institute of Design at Stanford (d.school) to lend institutional support and expertise in health care innovation to our event. We determined a location, time frame, and logistics for the competition and settled on 3 use cases for teams to work on. We planned to explore the learning experience of participants within a pragmatic paradigm and complete an abductive thematic analysis using data from a variety of sources. Results: HackED! took place from October 1-3, 2022. In all, 3 teams developed novel solutions to each of the use cases. Our investigation into the educational experience of participants suggested that the event was valuable and uncovered themes suggesting that the learning experience could be understood within a framework from entrepreneurship education not previously described in relation to hackathons. Conclusions: Health care hackathons appear to be a viable method of increasing physician experience with innovation and entrepreneurship principles and addressing complex problems in health care. Hackathons should be considered as part of educational programs that focus on these concepts. ",
doi="10.2196/43916",
url="https://mededu.jmir.org/2023/1/e43916",
url="http://www.ncbi.nlm.nih.gov/pubmed/36826988"
}


@Article{info:doi/10.2196/40082,
author="Zeng, Minrui
and Cai, Yiyuan
and Cao, Jin
and He, Qianyu
and Wang, Xiaohui
and Lu, Yun
and Liang, Huijuan
and Xu, Dong
and Liao, Jing",
title="The Agreement Between Virtual Patient and Unannounced Standardized Patient Assessments in Evaluating Primary Health Care Quality: Multicenter, Cross-sectional Pilot Study in 7 Provinces of China",
journal="J Med Internet Res",
year="2022",
month="Dec",
day="2",
volume="24",
number="12",
pages="e40082",
keywords="virtual patient",
keywords="unannounced standardized patient",
keywords="primary health care",
keywords="primary care",
keywords="quality assessment",
keywords="quality improvement",
keywords="scenario",
keywords="simulation",
keywords="simulate",
keywords="medical education",
keywords="cross-sectional",
keywords="digital health",
keywords="eHealth",
abstract="Background: The unannounced standardized patient (USP) is the gold standard for primary health care (PHC) quality assessment but has many restrictions associated with high human and resource costs. Virtual patient (VP) is a valid, low-cost software option for simulating clinical scenarios and is widely used in medical education. It is unclear whether VP can be used to assess the quality of PHC. Objective: This study aimed to examine the agreement between VP and USP assessments of PHC quality and to identify factors influencing the VP-USP agreement. Methods: Eleven matched VP and USP case designs were developed based on clinical guidelines and were implemented in a convenience sample of urban PHC facilities in the capital cities of the 7 study provinces. A total of 720 USP visits were conducted, during which on-duty PHC providers who met the inclusion criteria were randomly selected by the USPs. The same providers underwent a VP assessment using the same case condition at least a week later. The VP-USP agreement was measured by the concordance correlation coefficient (CCC) for continuity scores and the weighted $\kappa$ for diagnoses. Multiple linear regression was used to identify factors influencing the VP-USP agreement. Results: Only 146 VP scores were matched with the corresponding USP scores. The CCC for medical history was 0.37 (95\% CI 0.24-0.49); for physical examination, 0.27 (95\% CI 0.12-0.42); for laboratory and imaging tests, --0.03 (95\% CI --0.20 to 0.14); and for treatment, 0.22 (95\% CI 0.07-0.37). The weighted $\kappa$ for diagnosis was 0.32 (95\% CI 0.13-0.52). The multiple linear regression model indicated that the VP tests were significantly influenced by the different case conditions and the city where the test took place. Conclusions: There was low agreement between VPs and USPs in PHC quality assessment. This may reflect the ``know-do'' gap. VP test results were also influenced by different case conditions, interactive design, and usability. Modifications to VPs and the reasons for the low VP-USP agreement require further study. ",
doi="10.2196/40082",
url="https://www.jmir.org/2022/12/e40082",
url="http://www.ncbi.nlm.nih.gov/pubmed/36459416"
}


@Article{info:doi/10.2196/34171,
author="Jung, Dukyoo
and De Gagne, C. Jennie
and Choi, Eunju
and Lee, Kyuri",
title="An Online International Collaborative Learning Program During the COVID-19 Pandemic for Nursing Students: Mixed Methods Study",
journal="JMIR Med Educ",
year="2022",
month="Jan",
day="24",
volume="8",
number="1",
pages="e34171",
keywords="COVID-19",
keywords="distance education",
keywords="global competencies",
keywords="nursing students",
keywords="program evaluation",
keywords="synchronous virtual classroom",
keywords="video conferencing",
abstract="Background: Given the limitations imposed by the COVID-19 pandemic, a better understanding of how nursing programs around the globe have implemented distance education methods and related initiatives to provide international collaborative learning opportunities as well as complementary aspects of practical education would be constructive for nursing students. It is expected that international collaboratives through web-based communication will continue to be increasingly utilized after the pandemic; therefore, it is time to discuss the effects and direction of these developments. Objective: We aimed to examine the impact of an online international collaborative learning program on prelicensure nursing students' international and global competencies in South Korea. Methods: We conducted a mixed methods study (web-based surveys and focus group interviews). A total of 15 students participated in the study. The surveys were used to examine changes in participants' global leadership competencies, and the focus group interviews were used to evaluate the program's effectiveness and to identify opportunities for improvement. The online international collaborative program consisted of 7 synchronous web-based classroom sessions. Each session ran for 60 to 90 minutes. Faculty experts and nurses working in the United States discussed various topics with students, such as nursing education in the United States and evidence-based teaching and learning. The students gave presentations on the South Korean nursing education system. Data were analyzed with descriptive statistics, the Mann-Whitney U test, and content analysis methods. Results: Participants reported improvement in their global leadership competencies. Four main categories emerged from analysis of the focus interviews: (1) realistic applicability, (2) clarification, (3) expansion of perspectives, and (4) initiative. Conclusions: The online international collaborative learning program had a positive impact on the development of students' international competencies. The findings support the further development of international exchange programs through web-based meetings in the postpandemic era. ",
doi="10.2196/34171",
url="https://mededu.jmir.org/2022/1/e34171",
url="http://www.ncbi.nlm.nih.gov/pubmed/34982035"
}


@Article{info:doi/10.2196/32356,
author="Peng, R. Cynthia
and Schertzer, A. Kimberly
and Caretta-Weyer, A. Holly
and Sebok-Syer, S. Stefanie
and Lu, William
and Tansomboon, Charissa
and Gisondi, A. Michael",
title="Assessment of Entrustable Professional Activities Using a Web-Based Simulation Platform During Transition to Emergency Medicine Residency: Mixed Methods Pilot Study",
journal="JMIR Med Educ",
year="2021",
month="Nov",
day="17",
volume="7",
number="4",
pages="e32356",
keywords="simulation",
keywords="graduate medical education",
keywords="assessment",
keywords="gamification",
keywords="entrustable professional activities",
keywords="emergency medicine",
keywords="undergraduate medical education",
abstract="Background: The 13 core entrustable professional activities (EPAs) are key competency-based learning outcomes in the transition from undergraduate to graduate medical education in the United States. Five of these EPAs (EPA2: prioritizing differentials, EPA3: recommending and interpreting tests, EPA4: entering orders and prescriptions, EPA5: documenting clinical encounters, and EPA10: recognizing urgent and emergent conditions) are uniquely suited for web-based assessment. Objective: In this pilot study, we created cases on a web-based simulation platform for the diagnostic assessment of these EPAs and examined the feasibility and acceptability of the platform. Methods: Four simulation cases underwent 3 rounds of consensus panels and pilot testing. Incoming emergency medicine interns (N=15) completed all cases. A maximum of 4 ``look for'' statements, which encompassed specific EPAs, were generated for each participant: (1) performing harmful or missing actions, (2) narrowing differential or wrong final diagnosis, (3) errors in documentation, and (4) lack of recognition and stabilization of urgent diagnoses. Finally, we interviewed a sample of interns (n=5) and residency leadership (n=5) and analyzed the responses using thematic analysis. Results: All participants had at least one missing critical action, and 40\% (6/15) of the participants performed at least one harmful action across all 4 cases. The final diagnosis was not included in the differential diagnosis in more than half of the assessments (8/15, 54\%). Other errors included selecting incorrect documentation passages (6/15, 40\%) and indiscriminately applying oxygen (9/15, 60\%). The interview themes included psychological safety of the interface, ability to assess learning, and fidelity of cases. The most valuable feature cited was the ability to place orders in a realistic electronic medical record interface. Conclusions: This study demonstrates the feasibility and acceptability of a web-based platform for diagnostic assessment of specific EPAs. The approach rapidly identifies potential areas of concern for incoming interns using an asynchronous format, provides feedback in a manner appreciated by residency leadership, and informs individualized learning plans. ",
doi="10.2196/32356",
url="https://mededu.jmir.org/2021/4/e32356",
url="http://www.ncbi.nlm.nih.gov/pubmed/34787582"
}


@Article{info:doi/10.2196/27441,
author="Tackett, Sean
and Green, David
and Dyal, Michael
and O'Keefe, Erin
and Thomas, Emmanuelle Tanya
and Nguyen, Tiffany
and Vo, Duyen
and Patel, Mausam
and Murdock, J. Christopher
and Wolfe, M. Erin
and Shehadeh, A. Lina",
title="Use of Commercially Produced Medical Education Videos in a Cardiovascular Curriculum: Multiple Cohort Study",
journal="JMIR Med Educ",
year="2021",
month="Oct",
day="7",
volume="7",
number="4",
pages="e27441",
keywords="commercial videos",
keywords="flipped classroom",
keywords="organ-systems courses",
keywords="medical education",
keywords="medical students",
keywords="teaching",
keywords="education",
keywords="health science education",
keywords="e-Learning",
abstract="Background: Short instructional videos can make learning more efficient through the application of multimedia principles, and video animations can illustrate the complex concepts and dynamic processes that are common in health sciences education. Commercially produced videos are commonly used by medical students but are rarely integrated into curricula. Objective: Our goal was to examine student engagement with medical education videos incorporated into a preclinical Cardiovascular Systems course. Methods: Students who took the first-year 8-week Cardiovascular Systems course in 2019 and 2020 were included in the study. Videos from Osmosis were recommended to be watched before live sessions throughout the course. Video use was monitored through dashboards, and course credit was given for watching videos. All students were emailed electronic surveys after the final exam asking about the course's blended learning experience and use of videos. Osmosis usage data for number of video views, multiple choice questions, and flashcards were extracted from Osmosis dashboards. Results: Overall, 232/359 (64.6\%) students completed surveys, with rates by class of 81/154 (52.6\%) for MD Class of 2022, 39/50 (78\%) for MD/MPH Class of 2022, and 112/155 (72.3\%) for MD Class of 2023. Osmosis dashboard data were available for all 359 students. All students received the full credit offered for Osmosis engagement, and learning analytics demonstrated regular usage of videos and other digital platform features. Survey responses indicated that most students found Osmosis videos to be helpful for learning (204/232, 87.9\%; P=.001) and preferred Osmosis videos to the traditional lecture format (134/232, 57.8\%; P<.001). Conclusions: Commercial medical education videos may enhance curriculum with low faculty effort and improve students' learning experiences. Findings from our experience at one medical school can guide the effective use of supplemental digital resources for learning, and related evaluation and research. ",
doi="10.2196/27441",
url="https://mededu.jmir.org/2021/4/e27441",
url="http://www.ncbi.nlm.nih.gov/pubmed/34617911"
}


@Article{info:doi/10.2196/26927,
author="Stuby, Loric
and Currat, Ludivine
and Gartner, Birgit
and Mayoraz, Mathieu
and Harbarth, Stephan
and Suppan, Laurent
and Suppan, M{\'e}lanie",
title="Impact of Face-to-Face Teaching in Addition to Electronic Learning on Personal Protective Equipment Doffing Proficiency in Student Paramedics: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Apr",
day="30",
volume="10",
number="4",
pages="e26927",
keywords="personal protective equipment",
keywords="electronic learning",
keywords="prehospital",
keywords="student paramedics",
keywords="infection prevention",
keywords="face-to-face learning",
keywords="protection",
keywords="student",
keywords="online learning",
keywords="online education",
keywords="protocol",
keywords="randomized controlled trial",
keywords="gamification",
abstract="Background: The COVID-19 pandemic has brought attention to the importance of correctly using personal protective equipment (PPE). Doffing is a critical phase that increases the risk of contamination of health care workers. Although a gamified electronic learning (e-learning) module has been shown to increase the adequate choice of PPE among prehospital personnel, it failed to enhance knowledge regarding donning and doffing sequences. Adding other training modalities such as face-to-face training to these e-learning tools is therefore necessary to increase prehospital staff proficiency and thus help reduce the risk of contamination. Objective: The aim of this study is to assess the impact of the Peyton 4-step approach in addition to a gamified e-learning module for teaching the PPE doffing sequence to first-year paramedic students. Methods: Participants will first follow a gamified e-learning module before being randomized into one of two groups. In the control group, participants will be asked to perform a PPE doffing sequence, which will be video-recorded to allow for subsequent assessment. In the experimental group, participants will first undergo face-to-face training performed by third-year students using the Peyton 4-step approach before performing the doffing sequence themselves, which will also be video-recorded. All participants will then be asked to reconstruct the doffing sequence on an online platform. The recorded sequences will be assessed independently by two investigators: a prehospital emergency medicine expert and an infection prevention and control specialist. The assessors will be blinded to group allocation. Four to eight weeks after this first intervention, all participants will be asked to record the doffing sequence once again for a subsequent skill retention assessment and to reconstruct the sequence on the same online platform to assess knowledge retention. Finally, participants belonging to the control group will follow face-to-face training. Results: The study protocol has been presented to the regional ethics committee (Req-2020-01340), which issued a declaration of no objection as such projects do not fall within the scope of the Swiss federal law on human research. Study sessions were performed in January and February 2021 in Geneva, and will be performed in April and June 2021 in Bern. Conclusions: This study should help to determine whether face-to-face training using the Peyton 4-step approach improves the application and knowledge retention of a complex procedure when combined with an e-learning module. International Registered Report Identifier (IRRID): PRR1-10.2196/26927 ",
doi="10.2196/26927",
url="https://www.researchprotocols.org/2021/4/e26927",
url="http://www.ncbi.nlm.nih.gov/pubmed/33929334"
}


@Article{info:doi/10.2196/16504,
author="Vall{\'e}e, Alexandre
and Blacher, Jacques
and Cariou, Alain
and Sorbets, Emmanuel",
title="Blended Learning Compared to Traditional Learning in Medical Education: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="10",
volume="22",
number="8",
pages="e16504",
keywords="blended learning",
keywords="virtual patients",
keywords="online learning",
keywords="computer-aided instruction",
keywords="traditional learning",
keywords="meta-analysis",
abstract="Background: Blended learning, which combines face-to-face learning and e-learning, has grown rapidly to be commonly used in education. Nevertheless, the effectiveness of this learning approach has not been completely quantitatively synthesized and evaluated using knowledge outcomes in health education. Objective: The aim of this study was to assess the effectiveness of blended learning compared to that of traditional learning in health education. Methods: We performed a systematic review of blended learning in health education in MEDLINE from January 1990 to July 2019. We independently selected studies, extracted data, assessed risk of bias, and compared overall blended learning versus traditional learning, offline blended learning versus traditional learning, online blended learning versus traditional learning, digital blended learning versus traditional learning, computer-aided instruction blended learning versus traditional learning, and virtual patient blended learning versus traditional learning. All pooled analyses were based on random-effect models, and the I2 statistic was used to quantify heterogeneity across studies. Results: A total of 56 studies (N=9943 participants) assessing several types of learning support in blended learning met our inclusion criteria; 3 studies investigated offline support, 7 studies investigated digital support, 34 studies investigated online support, 8 studies investigated computer-assisted instruction support, and 5 studies used virtual patient support for blended learning. The pooled analysis comparing all blended learning to traditional learning showed significantly better knowledge outcomes for blended learning (standardized mean difference 1.07, 95\% CI 0.85 to 1.28, I2=94.3\%). Similar results were observed for online (standardized mean difference 0.73, 95\% CI 0.60 to 0.86, I2=94.9\%), computer-assisted instruction (standardized mean difference 1.13, 95\% CI 0.47 to 1.79, I2=78.0\%), and virtual patient (standardized mean difference 0.62, 95\% CI 0.18 to 1.06, I2=78.4\%) learning support, but results for offline learning support (standardized mean difference 0.08, 95\% CI --0.63 to 0.79, I2=87.9\%) and digital learning support (standardized mean difference 0.04, 95\% CI --0.45 to 0.52, I2=93.4\%) were not significant. Conclusions: From this review, blended learning demonstrated consistently better effects on knowledge outcomes when compared with traditional learning in health education. Further studies are needed to confirm these results and to explore the utility of different design variants of blended learning. ",
doi="10.2196/16504",
url="https://www.jmir.org/2020/8/e16504",
url="http://www.ncbi.nlm.nih.gov/pubmed/32773378"
}


@Article{info:doi/10.2196/14550,
author="Siemer, Lutz
and Ben Allouch, Somaya
and Pieterse, E. Marcel
and Brusse-Keizer, Marjolein
and Sanderman, Robbert
and Postel, G. Marloes",
title="Patients' User Experience of a Blended Face-to-Face and Web-Based Smoking Cessation Treatment: Qualitative Study",
journal="JMIR Form Res",
year="2020",
month="Jun",
day="3",
volume="4",
number="6",
pages="e14550",
keywords="smoking cessation",
keywords="cognitive therapy",
keywords="blended treatment",
keywords="smoking",
keywords="user experience",
keywords="tobacco",
keywords="patient perspective",
abstract="Background: Blended web-based and face-to-face (F2F) treatment is a promising electronic health service because the strengths of one mode of delivery should compensate for the weaknesses of the other. Objective: The aim of this study was to explore this compensation by examining patients' user experience (UX) in a blended smoking cessation treatment (BSCT) in routine care. Methods: Data on patients' UX were collected through in-depth interviews (n=10) at an outpatient smoking cessation clinic in the Netherlands. A content analysis of the semantic domains was used to analyze patients' UX. To describe the UX, the Hassenzahl UX model was applied, examining 4 of the 5 key elements of UX from a user's perspective: (1) patients' standards and expectations, (2) apparent character (pragmatic and hedonic attributes), (3) usage situation, and (4) consequences (appeal, emotions, and behavior). Results: BSCT appeared to be a mostly positively experienced service. Patients had a positive-pragmatic standard and neutral-open expectation toward BSCT at the treatment start. The pragmatic attributes of the F2F sessions were mostly perceived as positive, whereas the pragmatic attributes of the web sessions were perceived as both positive and negative. For the hedonic attributes, there seemed to be a difference between the F2F and web sessions. Specifically, the hedonic attributes of the web sessions were experienced as mostly negative, whereas those of the F2F sessions were experienced as mostly positive. For the usage situation, the physical and social contexts were experienced positively, whereas the task and technical contexts were experienced negatively. Nevertheless, the consequential appeal of BSCT was positive. However, the consequential emotions and behavior varied, ultimately resulting in diverse combinations of consequential appeal, emotions, and behavior (positive, negative, and mixed). Conclusions: This study provided insights into the UX of a blended treatment, and the results support the expectation that in a blended treatment, the strengths of one mode of delivery may compensate for the weaknesses of the other. However, in this certain setting, this is mainly achieved in only one way: F2F sessions compensated for the weaknesses of the web sessions. As a practical conclusion, this may mean that the web sessions, supported by the strengths of the F2F sessions, offer an interesting approach for further improving the blended treatment. Our theoretical findings reflect the relevance of the aspects of hedonism, such as fun, joy, or happiness in the UX, which were not mentioned in relation to the web sessions and were only scarcely mentioned in relation to the F2F sessions. Future research should further investigate the role of hedonistic aspects in a blended treatment and whether increased enjoyment of a blended treatment could increase treatment adherence and, ultimately, effectiveness. ",
doi="10.2196/14550",
url="https://formative.jmir.org/2020/6/e14550",
url="http://www.ncbi.nlm.nih.gov/pubmed/32343245"
}


@Article{info:doi/10.2196/17101,
author="Lozano-Lozano, Mario
and Fern{\'a}ndez-Lao, Carolina
and Cantarero-Villanueva, Irene
and Noguerol, Ignacio
and {\'A}lvarez-Salvago, Francisco
and Cruz-Fern{\'a}ndez, Mayra
and Arroyo-Morales, Manuel
and Galiano-Castillo, Noelia",
title="A Blended Learning System to Improve Motivation, Mood State, and Satisfaction in Undergraduate Students: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2020",
month="May",
day="22",
volume="22",
number="5",
pages="e17101",
keywords="learning",
keywords="teaching",
keywords="students, health occupations",
keywords="mobile apps",
keywords="education",
abstract="Background: Smartphone-based learning, or mobile learning (m-learning), has become a popular learning-and-teaching strategy in educational environments. Blended learning combines strategies such as m-learning with conventional learning to offer continuous training, anytime and anywhere, via innovative learning activities. Objective: The main aim of this work was to examine the short-term (ie, 2-week) effects of a blended learning method using traditional materials plus a mobile app---the iPOT mobile learning app---on knowledge, motivation, mood state, and satisfaction among undergraduate students enrolled in a health science first-degree program. Methods: The study was designed as a two-armed, prospective, single-blind, randomized controlled trial. Subjects who met the inclusion criteria were randomly assigned to either the intervention group (ie, blended learning involving traditional lectures plus m-learning via the use of the iPOT app) or the control group (ie, traditional on-site learning). For both groups, the educational program involved 13 lessons on basic health science. The iPOT app is a hybrid, multiplatform (ie, iOS and Android) smartphone app with an interactive teacher-student interface. Outcomes were measured via multiple-choice questions (ie, knowledge), the Instructional Materials Motivation Survey (ie, motivation), the Profile of Mood States scale (ie, mood state), and Likert-type questionnaires (ie, satisfaction and linguistic competence). Results: A total of 99 students were enrolled, with 49 (49\%) in the intervention group and 50 (51\%) in the control group. No difference was seen between the two groups in terms of theoretical knowledge gain (P=.92). However, the intervention group subjects returned significantly higher scores than the control group subjects for all postintervention assessed items via the motivation questionnaire (all P<.001). Analysis of covariance (ANCOVA) revealed a significant difference in the confusion and bewilderment component in favor of the intervention group (P=.01), but only a trend toward significance in anger and hostility as well as total score. The intervention group subjects were more satisfied than the members of the control group with respect to five out of the six items evaluated: general satisfaction (P<.001), clarity of the instructions (P<.01), clarity with the use of the learning method (P<.001), enough time to complete the proposed exercises (P<.01), and improvement in the capacity to learn content (P<.001). Finally, the intervention group subjects who were frequent users of the app showed stronger motivation, as well as increased perception of greater gains in their English-language competence, than did infrequent users. Conclusions: The blended learning method led to significant improvements in motivation, mood state, and satisfaction compared to traditional teaching, and elicited statements of subjective improvement in terms of competence in English. Trial Registration: ClinicalTrials.gov NCT03335397; https://clinicaltrials.gov/ct2/show/NCT03335397 ",
doi="10.2196/17101",
url="http://www.jmir.org/2020/5/e17101/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32441655"
}