B. BASE TEÓRICA 1 FACTORES
6. CUIDADO DE ENFERMERÍA
Implementation and Maintenance steps 9-10;Cook and Dupras, (83): 9. Pilot the website before full implementation.
10. Plan to monitor online communication and maintain the site by resolving technical problems.
Step 9 of the guide identifies testing in a usability lab as the gold standard for piloting an online course. Failing this, the authors recommend assembling a group of learners similar to the target audience to test each component of the course informally. A usability lab was not accessible and therefore the latter option was perused. i-BeST version 1 was piloted with the content experts (Professor Sallie Lamb and Dr Zara Hansen), an e-learning expert (Dr David Davies) and five health care professionals naïve to the BeST intervention (two health care professionals working in an NHS Trust and three senior research
physiotherapists from the Warwick Clinical Trials Unit). Individuals were set up on Moodle and enrolled in i-BeST. They were provided with log-in details and a feedback form
(appendix 8) to ensure all features of the course were covered including: the course content, the session modules, the mini tests, the use of media, the length of time to complete the course, and operational factors, such as, the structure of the course, navigation, likes/dislikes, and its ease of use. Any technical errors or difficulties were also recorded. The feedback generated from the pilot of version 1 was extremely beneficial and changed the shape of the online course considerably. The key issues generated from the feedback are summarised below.
Publishing
The Adobe Captivate modules in i-BeST version 1 were published in Adobe Flash (Adobe) since several learning objects (activities) were only supported by Flash. However, Flash is a propriety piece of publishing software that is not supported by Apple for use on iOS devices (95). This meant the content could not be displayed on the iPad and iPhone, restricting user
access. Therefore, other technical publishing formats were considered, namely HTML 5, which is the worldwide standard for publishing web-based materials (96). This format has widespread support across all modern web browsers and mobile platforms including iOS devices (96). Thus, HTML5 was the optimal choice for publishing the Adobe Captivate modules in i-BeST, offering greater reliability and support for the future. Therefore, any learning objects in the Adobe Captivate modules that required Flash were modified and version 2 was published in HTML5.
Hosting
Aspects of the online course were slow to load and respond when simultaneous users were using i-BeST. Therefore, a decision was made to move from the virtual server provided by EasySpace (93) to one provided by Amazon (97), since it offer greater capacity and flexibility.
Navigation
In version 1, a user could access a module from the homepage. Once they had finished the module, they had to exit the activity to return to the homepage before then selecting the next module from the homepage screen. This was found to be a cumbersome process that wasted time. Therefore, the navigation was altered to include links to the relevant next sections at the end of each module (Figure 4).
Online tutorials
Version 1 did not include any tutorials to guide users on how to use the course. Feedback suggested that these would be useful to speed up the process of learning how to use the training programme. Therefore, two online video screencasts were produced using Adobe Captivate; the first showed users how to navigate around the homepage and access the course content, and the second demonstrated how to actually work through the course materials.
Meet the team
Prior to logging into the course, version 1 included an ‘About Us’ section where users could read about the Clinical Trials Unit. However, there was no information regarding the people behind the creation of either the BeST intervention or the online training programme. The inclusion of this information was thought to provide the course with greater credibility and hence a ‘Meet the Team’ section was added to version 2. This included a picture and brief profile of the people responsible for BeST and i-BeST (Figure 5).
Structure
The structure of the course underwent extensive change following user feedback; creating new modules and moving content around (see Figures 9 and 10 for course structure maps). One significant change was moving the downloadable session narratives from the end of the corresponding module to be beginning. A key theme reported from pilot users was the lack of context to the module content without seeing the narratives until the end of the module. It was thought that moving them to the beginning would show users what they need to deliver to patients, with the module content then providing them with the knowledge and skills required to deliver the session to patients. This change reflected a move away from the associative learning perspective to one that leant more towards a constructivist learning perspective. Another important change was moving the content from the ‘Introduction’ to a ‘Background’ section and using the introduction module as an overview of the course and of the BeST intervention rather than providing the background to CBT. A new module, labelled ‘Clinical Skills’ was created allowing ‘Delivering the
Intervention’ to be dissolved as the title was thought to be misleading. The patient assessment was changed to an independent module sitting before the beginning of
sessions 1-6. Another crucial change was the addition of a ‘Contents’ page that hosted all of the course materials, leaving the ‘Homepage’ less cluttered and hosting only a few links (Figure 6). Following these structural changes, i-BeST consisted of 10 core modules, as illustrated in figures 9 and 10.
Hints and tips
There were many points along the course where users could start practising specific skills as they progressed through the material. To highlight these skills, an illustrated character was used (UFO – the User Friendly Olga) and appeared every time a key skill was covered, providing a means of consistently identifying important key stills. UFO highlighted the skill and offered tips on how to start practising it (Figure 7).
Aesthetics
The aesthetics of the Homepage and Contents pages, as well as the table of contents within each module, were improved. This included modifying the text colour and size, and
personalising the theme that was being used in Moodle. Whilst the majority of changes could be made within the Moodle Home and Content pages, the layout of text was still restricted by Moodle’s features and no images could be added to these pages. The instructions on progressing through the course were made clearer.
Content
A large proportion of the content was expanded or modified based on the user feedback. For example, the ‘explain pain’ section in Session One was expanded to include a section on basic neurophysiology before the information about chronic pain was presented. As
another example, the Clinical Skills section was expanded to provide more examples and information about questioning styles (examples in Figure 8).
Resources
A resources section was added to provide extended reading and additional web resources should users wish to explore aspects further.
Learner analytics
From studying the user statistics and logs provided by Moodle during this usability testing, it was apparent that Moodle did not provide detailed learner analytics for the individual Adobe Captivate modules. Therefore, the technical expert (Andrew Williamson) authored bespoke learner analytic software capable of recording every mouse click that a learner made within the Adobe Captivate projects. Combining these analytics with the Moodle logs
yielded a comprehensive and detailed record of learners’ online behaviour. The analytics could be downloaded anytime into Microsoft Excel from an independent, secured website.
Whilst not an exhaustive list, the points above summarise many of the key modifications to the online course based on user feedback and personal observations. Figures 9 and 10 show the resulting new course structure. The modification and production of i-BeST version 2 was time consuming; however, the iterative process of developing the online course was essential and resulted in the fully operational training programme, ready for evaluation in the next phase of this thesis.
*Expanded in diagram 3.9
Meet the team Online tutorial i-BeST User Forum Back Skills Training
Homepage
M y Co ur se s * Five profiles: Professor Sallie Lamb Zara Hansen
Helen Richmond Dr David Davies Andy Williamson
Two online tutorials: Navigating the
Homepage Getting Started
Final test for course completion Session1 Mini test Session2 Mini test Session3 Mini test Session4 Mini test Session5 Mini test Session6 Mini test Background
Introduction Clinical
Skills
AssessmentDownloads Resources Hints/tips
Post training questionnaires
Contents page
All tabs accessible from contents page
101 Session 2 MT Session 2 narrative downloads Training content for therapist Finish Session 2
Contents Page*
BackgroundIntroduction Clinical Skills Assessment
Denotes suggested progression through the
*Allboldtabs could be directly accessed from the contents
Denotes forced progression through the course
KEY
Session 1 MT Session 1 narrative downloads Training content for therapist Finish Session 1Video demonstration of Session 1
Session 3 MT Session 3 narrative downloads Training content for therapist Finish Session 3
Video demonstration of Session 3
Session 4 MT Session 4 narrative downloads Training content for therapist Finish Session 4 Session 5 MT Session 5 narrative downloads Training content for therapist Finish Session 5 Session 6 MT Session 6 narrative downloads Training content for therapist Finish Session 6