JMIR Publications

ABSTRACT

Background:

E-learning for health professionals in many low-and middle-income countries (LMICs) is still in its infancy, but with the advent of COVID-19, a significant expansion of digital learning has occurred. Asynchronous e-learning can be grouped into interactive, meaning user influenceable content, and non-interactive, static material. Studies conducted in high-income countries suggest that interactive e-learning is more effective than non-interactive e-learning at increasing learner-satisfaction and knowledge, however, there is a gap in our understanding on whether this also holds true in LMICs.

Objective:

The aim of this study was to validate this hypothesis in a resource-constrained and real-life setting to understand e-learning quality and delivery. This was done by comparing interactive and non-interactive e-learning in user satisfaction, usability, and knowledge gain in a new medical university in Zambia.

Methods:

We conducted a web-based, mixed methods randomized controlled trial at Levy Mwanawasa Medical University (LMMU) in Lusaka, Zambia, between April and July 2021. We recruited Medical Licentiate students (second, third and fourth study year) via email and randomized them to undergo asynchronous e-learning with an interactive or non-interactive module on chronic obstructive pulmonary disease. Participants were informally blinded towards their group allocation, as it was unknown which interventions were being compared. The interactive module included interactive interfaces, quizzes, and a virtual patient, whereas the non-interactive module consisted of PowerPoint slides. Both modules comprised the same scope of content. Primary outcome was learner-satisfaction. Secondary outcomes were usability, short- and long-term knowledge gain, and barriers to e-learning. The mixed methods study followed an explanatory sequential design in which rating conferences delivered further insights to quantitative findings, which were evaluated via online questionnaires.

Results:

Initially, n=94 study participants were enrolled in the study, of which n=41 (44%) (18 intervention/23 control) remained in the study and thus were analyzed. There were no significant differences in satisfaction ((median (Q1, Q3)), intervention: 33.5 (31.3, 35), control: 33 (30, 37.5); p=0.66), usability or knowledge gain between intervention and control group. Challenges in accessing both e-learning modules led to many dropouts. Qualitative data suggested the content of the interactive module was more challenging to access, due to technical difficulties, but also due to individual factors, e.g. limited experience with interactive e-learning.

Conclusions:

An increase in user satisfaction with interactive e-learning could not be shown under our study conditions. However, this result may not be generalizable for other low-resource settings as the post-hoc power was low, and the e-learning system at LMMU has not yet reached its full potential. Consequently, access barriers to e-learning, of technical and individual nature, may have affected the results, particularly as the interactive module was deemed harder to access and use. Nevertheless, qualitative data showed there was a high motivation and interest for e-learning. Future studies should minimize technical e-learning barriers to further evaluate interactive e-learning in LMICs.