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Table 2 Details of the studies

From: An integrative review of e-learning in the delivery of self-management support training for health professionals

Author/s location Sample participants Delivery methods & E-learning processes Conceptual framework Outcome measures Major findings Strengths (S) & limitations (L)
Yank et al. (2013) [33] (USA) (6 groups of 8–14 each) Groups 1–4: 19 internal & 10 family medicine. Groups 5–6: 13 physicians, 7 nurses, 8 allied HPs. Serving patients in community and veteran health centres Weekly webinars to deliver core intervention using sequential, real-time, interactive, multimedia. Homework assignments between webinars. Groups 1–3 - at least one in-person session. Groups 4–6 - all content delivered by webinar. Access to archived on-line class designed to teach SMS skills. Brief review of prior week’s topic. Introduction to new skills and role modeling of skills by facilitator, participant activities to practice skills (role playing), introduction to the homework assignment (real-world applications of SMS skills between sessions in clinical and online patient class), and wrap up. Week 1: Formation of an achievable action plan Week 2: Problem solving Week 3: Reinterpretation of symptoms and modelling of all prior skills with patients Week 4: Learned for the application in the clinic Bandura’s theory of self-efficacy Primary: Changes over time in both beliefs and confidence regarding SMS, measured by retrospective pre/post intervention survey questions (10 point Likert scale) Secondary: Session attendance rates and exploratory focus group qualitative data by semi-structured interview 74% attended 3 or more of the 4 learning sessions; enhancement in the performance of action planning/ positive attitude to SMS/ desire patient involvement and partnership/ desire for other providers to have the training/ reduced burnout (S): Addressed an unmet need (L): Convenience sample, survey not externally validated, pre/post survey design/response drift, baseline exposure to SMS training not assessed, focus group data analyzed by single researcher
Heartfield et al. (2013) [60] (Australia) 500 practice nurses Serving veterans in primary care Used evaluation data from a national education and training program; interactive modules offered online provided at no cost to HPs and organization; training session delivered as a sequence of screens presenting visual and auditory information: graphics, content-related additional web links, supporting resources, quiz assessment, free text, true/false responses. Formative learning approach with content, practice and assessment linked by aim and objectives; learners type their responses to learning activities, with automated feedback provided by onscreen text. Cognitive Behavioural Therapy Motivational Interviewing Formal and informal qualitative evaluation data: learning needs, relevance of training to practice, clarity of instructions, design and access to resources; open-text comment on what worked well and what needed to be changed to improve the learning experience. Identified benefits: A new and more patient-centred approach identified and recommended; flexibility in finding time, time saving. Identified challenges: access, navigation, and time. Not identified (L): Evaluation methods
Welch (2014) [51] (UK) All registered nurses in any capacity on 3 medical-surgical units and 1 telemetry unit Serving hospital inpatients Online learning module regarding use of brief motivational Interviewing as a communication style to influence health behaviour change. Estimated 1 h or less for the entire activity. Topics included understanding chronic disease, patient engagement and nurses’ responsibility for promoting health; health behaviour change model, principles of MI, examples of OARS communication skills, scenario about discharge education with and without MI. Rogers 5 stage decisional process- innovations theory Extended theory of planned behaviour (Côté et al. [80]) Pre/post assessment tool: 6-item questionnaire for MI (Spollen et al. [81]); an attitude survey including 3 items with a 5-point Likert Scale. 2-week data evaluation period. Positive attitudes toward and statistically significant increase in mean score about effectiveness of online learning modules for MI (S): Facilitators and role models that might include experienced existing staff in various areas; use of train-the-trainer approach with designated unit staff (educators and first-line managers); (S): Staff completed the module during paid work time: (L): Need more short and long-term outcome measures (L): Project conducted in a single facility
Newton et al. (2011) [42] (Australia) 13 GP supervisors; 13 medical educators; 40 GP Registrars Serving osteoarthritis (OA) patients in primary care Module: web-interface using the concept of ‘rooms’ (learning material to be streamed into 3 distinct areas) (1) The library room: reading, references, websites, and guidelines to explore knowledge; (2) The consultation room: interactive case studies where GP can engage with patients both online and in an interactive workshop- short interactions about 20 min based on the GP’s preferred learning style (blend learning); and (3) The project room: 3 investigative approaches - patient education, practice quality improvement and learning from patients to increase chronic condition self-management (CCSM) and lifestyle risk modification (LRM) understanding. Detailed manual for GP supervisor; MI: online learning and workshop on motivational interviewing (MI) built around two case studies of 10 min consultations using brief MI techniques. Online quiz for self-knowledge of OA, CCSM and LRM, and immediate feedback. 4 themes identified through the literature review and scoping exercise and encapsulated by the nationally defined Capabilities (Lawn & Battersby, 2009 [34]) (Qualitative and quantitative) Pre/post survey with open and closed questions. MI workshop feedback using 5-point Likert scale questions. 3 qualitative questions: ‘What I learned’, ‘What was a challenge’, and ‘The best part was’. 82.5% of GP registrars considered themselves already well prepared for CCSM and LRM. Supervisors confirmed need to improve CCSM and LRM and lack of skills in this area. Increased confidence in SMS. Immediate feedback; digestible and reasonable size of information; positive learning experiences on MI and highlighted the effects of patient simulation for consultation skills. Technical difficulties. (S): (L): Low enrolments. Short timeframe of the study (4 weeks). Need for supervision and development of SMS competencies at all stages of health professional development. Low engagement with some aspects of the website.
Bosnic-Anticevich et al. (2014) [53] (Australia) Pharmacists, GPs and practice nurses and 234 people with asthma Serving patients with asthma in community clinics Parallel group, repeated measure design. 3 continuing education models (2.5 h workshops or Model 2 online) for HPs to educate patients in correct use of their inhalers and equip the HPs with skills to engage in collaborative relationships with each other. 3 intervention groups and 1 control group; after completing the education module, HPs recruited 10 people with asthma into the study and followed them up for 6 months. The online module modelled the best practice in skill teaching, using a process of instruct-demonstrate-practice, which focuses on the teaching factors that influence learning of motor skills. Scenario-based vignettes showed a HP and patient interaction where all the skills about the inhaler use were explained; HPs observe patients making errors and suggest appropriate action for correction. Focusing on individual transformation in the clinical context of inhaler technique mastery and maintenance. Patient asthma outcome and inhaler technique control: patients asked to complete a 6-question asthma control questionnaire. HPs completed: The attitudes toward health care teams scale questionnaire; semi-structured interviews; Inhaler technique checklist developed for this study within 1 week after the module completion. Protocol paper. Potential challenges identified in the online module: participants could miss out on the interaction and demonstration of correct inhaler technique with fellow participants. Challenge of mirroring the educational content of the models in 3 different learning styles. (L): Significant financial resources for development of study materials and longitudinal involvement of HPs. Large scale of study could pose challenges for recruitment.
Bowler (2010) [61] (UK) 31 community Matrons Serving patients in community primary care One hour e-learning CD using cartoon character (STAN) to represent a patient with chronic conditions and how the HP can help patients promote self-care. (STAN case study = Skills, Tools, Advice, Networks offered to the patient) The STAN tool features promotional self-care aids such as tape measures, drinking bottles and pedometers to raise self-awareness of self-care activities. It provides examples of how HPs can support patients in the areas of care planning, goal setting, self-monitoring devices, patient education, home adaptions and peer support networks. 7 core self-care principles (Skills for Care and Skills for Health, 2008) 2 questionnaires used to gather feedback: focusing on the tool’s accessibility and its content. Participants had little difficulty accessing and going through the online learning module; 45% learnt some new information; mainly a reminder of what was learned in the past. (S): Involvement of staff in development, piloting and roll out of the tool. (L): Small pilot in one context.
LeRoy et al. (2014) [55] (USA) Clinicians (professionals unspecified) Serving populations with chronic disease across healthcare Development of a multimedia library of action-oriented SMS resources and 3 companion videos illuminating SMS skills and concepts, illustrating what SMS is, why it is important and how to provide it in a clinical setting; and illustrating the patient role, building relationships, sharing information, collaborating on agenda setting, goals and action plans, problem-solving and follow-up. An initial environmental scan was conducted to develop the resource library: involved a technical expert panel of 10 clinicians reviewing findings from searched literature; 3 clinicians and 1 clinician-patient pair interviewed; 12 clinicians: short self-administered feedback An environmental scan. Expert panel of 10 clinicians and patients participated in a 1-day meeting to review all scan materials. Videos tested by being shown at the Annual AHRQ Conference, USA. 3 clinicians and 1 clinician-patient pair interviewed; 12 clinicians voluntarily viewed videos and completed short self-administered feedback form. Outcomes of scan: 17% of SMS resources were interactive; 13% were videos (eg. MI, group visits, behavior change); most resources were print materials. Clinicians suggested adding more images about patient interactions and improving interactivity. (L): Need for translating tools into languages other than English and Spanish; and customizing tools for specific ethnic groups, developing tools beyond action plans, creating materials for non-physician providers and staff.
Wheeler et al. (2013) [79] (Australia) Pharmacists and pharmacy staff: Serving mental health patients and carers Multi-step planning and delivery process. Online mental health and education training program for community pharmacy staff using intervention mapping to improve the outcomes for mental health consumers and carers. Techniques include lectures, PowerPoint presentations; question and answer interaction with live audience; resource list, web links, reading material, Previously recorded role plays of staff-patient interactions, discussion, case vignettes, problem-solving tasks. 8 online modules (4 of these for pharmacy staff/8 for pharmacists), each of them taking 30 min to complete followed by a multi-choice assessment taking 5 min to complete; participants must answer all of the questions correctly to pass the test and proceed to the text module, but the test can be repeated as many times as necessary, a certificate is awarded on completion. 6 steps: Needs assessment, program objectives, theory-based methods and practical applications, program planning and development (face-to-face), adoption and implementation plan (online), plan evaluation. Intervention mapping based on 3 primary activities: Needs assessment (NE), program planning and development (PPD), program evaluation (PE). Baseline pre-training measures administered to assess knowledge, skills, attitudes and behaviours of pharmacy staff, with a questionnaire to explore reflective learning 6 months post-training. (NE) Interviews with 74 mental health consumers and carers, 15 key stakeholders, and survey with 504 pharmacy staff. (PPD) Face-to-face pilot with 24 pharmacy staff and focus group feedback. (PE) Interviews with 211 consumers and carers, online questionnaire with 282 pharmacists and 222 pharmacy staff. It allowed the health educators and researchers to approach the education program in a systematic stepwise manner and bring their wide range of theoretical, practical and experiential contributions together to make decisions. Actual outcomes of training not reported in this paper (pending). Some view intervention mapping as a protocol rather than a guide that is flexible and assists with the decision-making process to meet developers’ needs and circumstances. The process can be cumbersome and time consuming.
Sassen et al. (2014) [52] (Netherlands) 69 HPs (nursing & physiotherapy) Serving cardiovascular patients Web-based intervention to increase patient intention and risk reduction behaviour toward cardiovascular risk. Several online modules to increase health professionals’ awareness of their thoughts, and learn skills and strategies to support patients’ self-management, such as listing the pros and cons of encouraging patients in the short and long term; supporting behaviour change, feedback system on the progression of the behaviour change. The Theory of Planned Behaviour RCT Self-assessed questionnaires. Social-cognitive determinants, intention and behaviour were measured pre-intervention and at 1 year follow-up. No significant effect detected from the intervention group where the online learning package delivered, no significant differences detected between the two groups. (L): Low rate of enrollments, didn’t use website intensively due to time and organizational constraints.
Ruiz et al. (2006) [54] (USA) 38 licenced practice nursing students Serving patients with dementia Dementia computer-based training: aimed to improve knowledge, self-efficacy and attitudes by providing a combination of theory, laboratory, and clinical course work. 7 CD-ROM training modules (20–30 min each): topics included understanding dementia, communication, distress behaviour, loved ones’ activities to daily living, environment, and ethics. Incorporates a variety of content presentation formats to target different learning styles, including text, animations, video, audio, and interactive exercises. Not identified Questionnaire to test knowledge and attitudes administered immediately before and after the CD-ROM training. Knowledge measured with 24-item quiz that contained true-false questions; self-efficacy assessed with a 7-item questionnaire (5-point Likert scale). Post-training feedback questionnaire. Significant improvements in all 3 areas: knowledge, self-efficacy, attitudes. Positive ratings on utility, usability and satisfaction with training modules. Quality of software teaching materials could contribute to development of reusable learning objects that can also be used in blended –learning approaches to improve effectiveness and efficiency of training. (S): Easy to use; rich multimedia (L): No control or comparison group; generalizability limited by homogeneous sample.