Usability and value of a digital learning resource in nursing education across European countries: a cross-sectional exploration

This is one of a few studies that has explored usability and value for learning of a shared repurposed e-learning resource in nurse education across three European universities. Despite being originally developed for students in Norway, the e-compendiums were in most aspects of learning rated more positively by students in Spain. Further, the UK students did not value the e-compendiums any less than students at the Norwegian study site; in fact, they found them to be more important for learning engagement. One explanation for this positive response from all three intuitions might be linked to the interdisciplinary approach in the development of the adapted e-compendiums. Academic teaching staff and technical staff from all three institutions were included in workshops, transnational meetings and feedback loops. The use of a transparent collaborative digital working platform laid the foundation for open and visible communication in the project group [16]. As lack of support from technical experts is often described as a barrier for e-learning development [21, 22], our close interdisciplinary collaboration might have played an important role in the quality of the solution.

Another explanation for the positive results might be the emphasis on user involvement in the current project. Due to policy initiatives, students should become involved as co-creators of their own learning, and student involvement has increasingly been seen as important for health education improvement [23, 24]. In the current project, student representatives from all three universities participated in all phases of the adaptation and translation process. The goal for this involvement was to place students’ needs at the centre of the design process, based on the view of students as a knowledgeable and critical partner in learning [25]. Their critical feedback guided the further development of the e-compendiums. For instance, based on students’ feedback, more images and interactive elements as well as the use of audio were included in the e-compendiums.

Interestingly, students at the VCU were more enthusiastic about the e-compendiums than students from the UoS. In fact, students at VCU valued the learning tool up to 9 times more highly for some aspects of learning compared to students at the UoS. With regard to the validity of our results, it is important to emphasize that the three universities did not differ regarding attitudes towards e-learning in general in terms of confidence in the use of digital devices. The reasons for the higher scores among students at the VCU are not clear. It has been claimed that study participants from different cultures might respond differently on Likert scales, such as in their willingness to select extreme responses [26]. However, this has mostly been an issue when reporting strong emotional matters and therefore might not be the case in our study, which focused on learning-oriented issues [27]. Another explanation for the difference might be that the UoS and the UoN have longer traditions of using e-learning approaches in nurse education compared to the VCU, which has adopted a more traditional learning approach. Thus, one could assume that the e-compendiums represented an exciting, novel approach for the students at the Spanish study site.

For the total group, the e-compendiums were especially valued for reinforcing and retaining knowledge. Furthermore, our findings indicate that visual and interactive elements in the e-compendiums were more appreciated by younger students than older ones. This might be explained by the fact that younger students have grown up with new technology and are described as “digital scholars” [28]. They use technology of all forms for research, communication, and data processing and, consequently, accept modernized pedagogical approaches when entering higher education. Our study also indicated some differences between male and female students in terms of usability of the e-compendiums. For example, female students more often reported that the audio element—being able to listen to the content as a podcast—was important than male students. The advantages of audio learning material have been previously reported due to the efficiency of listening while doing other time-consuming activities, such driving, walking, or doing housework [29]. Whether or not the aspects of multitasking are linked to gender is not clear. However, our results support the conclusion that e-learners seem to differ in their preferences in relation to aspects beyond age [29].

The present study has some limitations. Despite including a large number of participants, the participants were not equally distributed across the three institutions. Due to practical issues, UoN included a smaller number of participants than VCU and UoS. Therefore, the interpretation of the results comparing UoN and UoS should be done with caution. Furthermore, due to the lack of an existing suitable questionnaire being specific and sensitive enough to capture the value and usability of the specific e-learning tool in our study, we adapted a questionnaire used for evaluating RLOs. Although this adapted version of the questionnaire was not validated or pre-tested, it was adapted within the context of our study. This included perspectives from researchers, teachers, technicians, and students. The adapted version was perceived to be relevant for capturing the relevant aspects of the value and usability of the e-learning tool. Hence, the acceptability, feasibility, and relevance of the questionnaire were ensured.

Based on the experiences from the current project, sharing of learning material across institutions from different countries required more work than assumed. It was never assumed to be a simple language translation exercise but there was considerable adaptation needed in terms of culture, practical guidelines and pedagogical traditions. For instance, the nutrition topic required rigorous adaption as this strongly linked to culture [17]. To our knowledge, there are no guidelines for translation of learning material across cultures. However, for future work we would suggest a need for building rigorous guidelines similar to those required for translation of cross-culture questionnaire instruments. Systematic use of activities such as “back translation” and “face validity” are key steps in instrument translation and similar standardised protocols could be of help also in the translation of pedagogical material [30].