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Research Article
Revised

Massive Open Online Course (MOOC) Opportunities in Health Education (HE) in a mandatory social isolation context

[version 2; peer review: 2 approved, 1 not approved]
PUBLISHED 26 May 2022
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Abstract

Background: Routine care for prevention and health promotion has reduced significantly due to the Covid-19 pandemic and mandatory social isolation measures. In this context, it is necessary to identify and describe Massive Open Online Courses (MOOCs) that provide opportunities for health education, promotion, and prevention aimed at the general population. The study is a systematic review of MOOCs on health education, health promotion, and prevention for the general population in a pandemic context.
Methods: We developed a search for MOOC courses aimed at the general population on health education, health promotion, and prevention in different available MOOC platforms. We executed a descriptive analysis of the main characteristics of the selected MOOCs. Terms such as healthy living, physical activity, healthy eating, mental health, and variants aimed at the general population were explored. We did not include advanced or specialized studies aimed only at professionals that required prior knowledge. A descriptive analysis of the main characteristics of the selected MOOCs was performed.
Results: There were 117 MOOCs chosen on health education, promotion, and prevention for the general population. Coursera (40.3%) was the platform that offered the highest quantity of MOOCs; more than half of the MOOCs were in English (52.9%). The median (interquartile range) duration of the selected MOOCs was 11 (6–15) hours. The predominant themes were "Health promotion" (43%) and "Food and nutrition" (31%), and the origin was mainly from Europe (37.8%).
Conclusions: Potentially MOOCs could improve access to massive open online public health courses. Adaptation to different languages and topics needed for each context could increase access to important health promotion messages, even outside of "times of pandemic and enforced social isolation".

Keywords

health education, MOOC, eHealth, digital health literacy, eLearning, Social isolation

Revised Amendments from Version 1

The main changes in the new version were made at the conclusion of the summary. It was added that online courses even without pandemics are an important resource that would improve accessibility to information about health promotion. In addition, paragraphs and references justifying the growing demand for online courses were added to the introduction. Finally, changes were made to a more direct wording, using active verbs.

See the authors' detailed response to the review by Maya Adam
See the authors' detailed response to the review by Waleed Al-Rahmi

Introduction

In December 2019, the severe acute respiratory syndrome coronavirus 2 (SARSCov-2) triggered the COVID-19 pandemic In December 2019, the severe acute respiratory syndrome coronavirus 2 (SARSCov-2) triggered the COVID-19 pandemic; as of February 1, 2021, the cases amounted were 134,228,450, with 2,229,565 deaths worldwide1 and the countries with the highest fatality due to COVID-19 are mostly low-middle-income countries (LMICs) with precarious health systems or those that have already collapsed.2,3

The efforts of primary care services have been focused on containing the COVID-19 pandemic, so there is great concern about the neglect of routine care and preventive health visits (OPS/OMS Perú - OPS/OMS Perú), reduction in access to medical doctors, drugs and growth monitoring during the lockdown period.4 Also, disruptions in drug supply chains are likely associated with defaulters on immunization schedules, which may lead to future outbreaks of preventable diseases such as diphtheria.5 Researchers suggest that maternal and child health neglect in LMICs could be devastating in a context where maternal deaths could increase up to 60% and infant mortality up to 41%.6 The control of endemic infectious diseases, such as malaria,7 as well as chronic non-communicable diseases (NCDs), such as hypertension and diabetes, have been neglected or suspended,8 and there has been an increase in mental illnesses such as anxiety, depression, and suicide.9 Furthermore, there is a concern of the population to visit health systems for their routine care for fear of contagion.10 Against this, some countries implemented remote healthcare systems (teleconsultation)11 and health communication campaigns. However, these strategies have been insufficient to cover the demand for healthcare effected by the pandemic and mandatory social isolation measures.

The pandemic context calls for innovation of strategies to help counteract the neglect of non-COVID-19 diseases in health systems. Class Central, a website that offers online courses, described in its December 2019 report that MOOCs had 110 million students worldwide, excluding China. In addition, according to Shravan Goli, chief product officer at MOOCs provider Coursera, between March 17 and April 16, 2020, international enrollments in the United States were up 607% over the same period in 2019, with the largest increases in enrollments in public health; social sciences, arts, and humanities; and personal development courses.12,13

MOOCs, in the past, have been an opportunity for health education for developing countries. Among their advantages are global accessibility, flexible hours, multiple teaching tools, and that they are generally free. MOOCs have been an educational response to emerging and re-emerging disease epidemics.14 However, to access these resources, inequities exist for developing countries, such as language barriers and technological access.15 Therefore, the study aimed to identify and describe MOOCs that provide health education, promotion, and prevention opportunities for the general population during a COVID-19 pandemic.

Methods

For this study, we conducted a digital search on MOOC platforms like Coursera, edX, FutureLearn, XuentangX, Udacity, Miríadax, Alison, Canvas Network, and OpenWHO, among others to identify MOOCs with content related to health education (education, promotion, and prevention of health) aimed at the general public. Also, the search involved explored topics related to health, well-being, and medicine. We included terms as nutrition, healthy life, physical activity, medical care, healthy nutrition, mental health, and variants.

Three authors conducted the MOOC search manually and independently on the mentioned virtual platforms. The search development was between the months of June and December 2020. Likewise, we had to consult websites on larger platforms available in the world like Class Central and MOOC List. We started the search of each virtual platform and examined MOOC contents with the terms described above. The eligibility criteria for selecting the MOOCs were that they had content related to health education, and were aimed at the general population; further, we considered availability of registration/access at the time of the search.

Subsequently, through a peer review, the researchers excluded MOOCs that showed highly specialized content or requested a prerequisite. MOOCs aimed at professionals or indicated that they were MOOCs for professional certification were also not considered, neither were those only available as paid content. If a conflict or inconsistency existed about our exclusion criteria, it was solved through deliberation peer review. We organized MOOCs by groups according to similar topics for a better description.

The data analysis was about the place of origin, principal language, and duration of the course. We used frequency measures to describe the categorical characteristics and dispersion measures to describe the hours. The analysis was using STATA version 16 (RRID:SCR_012763), Statistical analysis may also be performed using RStudio open source software for Windows, version 4.0.0.

Results

With the established search criteria, a total of 217 MOOC courses were found on the different platforms. After excluding MOOC courses because they were specialized, unavailable, aimed at other target audiences, or without relation to health education, we selected 117 of the total MOOCs to be analyzed (Figure 1).

8270dda5-c36e-4d99-ad68-7124b6901668_figure1.gif

Figure 1. Flow diagram.

The 117 MOOCs analyzed were classified into six groups according to their content, with themes such as “health promotion” and “food and nutrition”. These latter two accounted for more than 60% of the total MOOCs included. Regarding the duration of time, the MOOCs had a median (interquartile range) of 11716 hours and the topics of health promotion and community health and social rights presented higher medians, as well as a minimum of 8.5 hours and a maximum of 16.5 hours (Table 1).

Table 1.

Frequency, median and interquartile range of MOOC duration time.

TopicsN (%)Median (IR)
1Health promotion42 (35.9)12 (8.5-16.5)
2Food and nutrition31 (26.5)9 (6-12)
3Psychology and mental health23 (19.7)11 (5-16)
4Health care13 (11.1)10 (6-12)
5Climate change and health4 (3.4)2 (2-5)
6Community health/social rights Total4 (3.4)15 (13.5-16)
Total117 (100)11 (6-15)

Of the total number of courses on the topics “Health promotion” and “Psychology and mental health”, 21 (50%) and 12 (52.17%) were offered on the Coursera platform. (Table 2). Likewise, all the courses around COVID19 (5 MOOCs) were classified (4 MOOCS) in “Psychology and mental health” and 1 (4 MOOC) in “Health promotion”.

Table 2.

Distribution of MOOC topics by platform.

Platform
TopicsCourseraFuture LearnClass CentralEdxOtherTotal
n (%)n (%)n (%)n (%)n (%)n (%)
Health promotion21 (50)6 (14.3)8 (19.1)6 (14.3)1 (2.3)42 (100)
Food and nutrition9 (29.0)10 (32.3)8 (25.8)1 (3.2)3 (9.7)31 (100)
Psychology and mental health12 (52.2)8 (34.8)1 (4.3)0 (0.00)2 (8.7)23 (100)
Health care2 (15.4)3 (23.0)2 (15.4)5 (38.5)1 (7.7)13 (100)
Climate change and health0 (0)0 (0)0 (0)0 (0)4 (100)4 (100)
Community health/social rights Total3 (75)1 (25)0 (0)0 (0)0 (0)4 (100)

* The rows represent 100%.

Regarding the principal language, English was identified in 62 (53%) of the MOOCS the language of preference, followed by Spanish in 18 (15.4%) MOOC courses (data not shown). Likewise, the principal language for all topics was English, with the exception of the climate change and health topics (See Table 3).

Table 3.

Distribution of MOOC topics by language and origin.

TopicLanguageOrigin
EnglishSpanishFrenchRussianOtherAmericaAsiaEuropeOceaniaOther
n (%)n (%)n (%)n (%)n (%)n (%)n (%)n (%)n (%)
Health promotion20 (47.6)6 (14.3)6 (14.3)5 (11.9)5 (11.9)11 (26.2)10 (23.8)16 (38.1)1 (2.4)4 (9.5)
Food and nutrition16 (51.6)5 (16.1)3 (9.7)1 (3.2)6 (19.4)7 (22.6)10 (32.3)9 (29)2 (6.4)3 (9.7)
Psychology and mental health15 (65.2)1 (4.4)1 (4.4)4 (17.4)2 (8.6)5 (21.7)4 (17.4)10 (43.5)2 (8.7)2 (8.7)
Health care8 (61.5)1 (7.7)2 (15.4)0 (0.0)2 (15.4)1 (7.7)2 (15.4)8 (61.5)1 (7.7)1 (7.7)
Climate change and health0 (0.0)4 (100)0 (0)0 (0)0 (0)0 (0)0 (0)0 (0)4 (100)0 (0)
Community health/social rights Total3 (75)1 (25)0 (0)0 (0)0 (0)3 (75)0 (0)1(25)0 (0)0 (0)

* The rows represent 100%.

Regarding the origin of the MOOC courses, we found that 44 (37.6%) of the MOOCs were from institutions in Europe, followed by America 27 (23.1%) and Asia 26 (22.2%) (Data not shown). In the case of America, 25 (21.4%) were from North America and 2 (1.7%) from South America (data not shown). The topics of health promotion, psychology, and mental health and health care came mainly from universities in Europe; and the food and nutrition topic mainly from Asia (See Table 3).

Discussion

We identified 117 MOOC courses on health promotion. The majority are offered in English and are carried out mainly by institutions in Europe. Most of the courses were on the topics of health promotion and food and nutrition.

From the preliminary search, it was evident that a large number of MOOCs were highly specialized, were aimed at professionals,12,13 or offered professional certification,14,1618 and some are not available without payment. Although we have not included these MOOCs in the study, it is essential to notice that it can be an indicator of the limited supply of MOOCs with a profile aimed at the general public or users of primary level care centers, with the content of free health education and aimed at prevention and healthcare. We consider that this is an extremely important point regarding access to health education in a context of compulsory social isolation.

Regarding the predominant themes of health promotion and food and nutrition, certain similarity was found with another study whose main topics were food, nutrition, your health, and introduction to health nursing, courses were aimed at professionals.19 MOOCs on health and medicine allow patients to acquire health education on specialized topics. Patients can gain understanding in disease implications, conditions, techniques, and available interventions around their disease, especially in the early stages. Besides, there are some useful topics which are still taboo, such as contraception, drug addiction, and acquired immunodeficiency syndrome (AIDS); courses focused on these topics help people educate themselves without having to visit an office.

The MOOCs found around psychology and mental health turn out to be a learning opportunity for stress management in times of compulsory social isolation. The results end up being part of recommendations to review said web-based interventions in mental health literacy promotion.20 Because adolescents and young people present more difficulties21 for decision-making in health often searching for information on the web,22 it is evident that they do not differentiate between reliable and less reliable information and that they do not know how to translate what they read into healthy behaviors.23

Among other issues, community health and social rights take a position in the context of compulsory social isolation since many decisions about health can be taken collectively in the community environment;24 additionally, many of them can be taken at the family level or by the influence of peers, without considering the repercussions of community leadership in some scenarios.25 Therefore, individual decisions can be even more relevant; for example, vaccination can affect a significant group of the population and have an impact on a higher incidence of some pathologies at the community level,26 especially when there is an increase in those who will not be vaccinated even during the COVID-19 pandemic.27

Therefore, access to information through a MOOC could empower people who would not otherwise know about the options offered.19 This study shows that various institutions and organizations worldwide have seen MOOCs as an educational opportunity due to their relatively low cost28 and whose success depends on the quality of their contents,29 the teacher's strategies, and the focused courses.

Similar to previous studies was evidence that the Coursera platform was the one that hosted the largest number of MOOCs.19,30 Regarding the origin of the MOOCs, the largest number were from developed countries,31 from institutions in Europe and North America, similar results were described in other studies,14,19,32 being, by default smaller quantity offered by Latin American countries.33 This predominant origin could be because more than half of the MOOCs were offered and developed in English14,19,34 and only 22% in Spanish. Proof of this is that of the 23, 13, and four MOOCs on psychology and mental health, health care, community health and social rights, respectively, only one MOOC for each topic was in Spanish.

Because the majority of MOOCs are in English, it may be a limitation for access and learning opportunities in times of pandemic for the Latin American population. As well as language, aspects such as the absence of a computer and internet, or educational level35 may also limit access to MOOCs in times of compulsory social isolation.

Considering the fact that these courses were offered by developed countries, this could limit the topics addressed to being oriented with a different health reality from that of developing countries, where diseases such as anemia, malnutrition, or infectious diseases are the most frequent. This scenario could explain the high level of MOOCs from North America and Europe36,37 compared with South America, Africa, and Oceania.38 It is known that courses are built based on a context and socioeconomic condition for a target population, and participation levels were higher when considered these variables.29 MOOCs with an approach based on the reality of LMICs39 could be an opportunity, addressing issues such as chronic malnutrition, anemia, among frequent health problems that this population suffers, even more so in times of pandemic due to the restricted care of primary health centers to provide services on these issues.

Among the limitations were that the chosen courses are based exclusively on the authors' criteria. The possibility of including studies that did not meet the inclusion criteria was lowered by performing the peer review. Courses classified into topics related to health education considered when compiling MOOCs for the review. However, if a MOOC has an incorrect classification, it would not have been identified for review. In cases for which MOOCs were offered in languages different than English, we used Google Translate for content translation. Finally, the study aimed not to evaluate the quality of the contents in the MOOCs; however, almost all the MOOCs declared their institutional origin, which was predominantly universities.

Finally, the study showed most of the MOOC courses in health education aimed at the general population or users of health systems were framed mainly in the themes of health promotion and food and nutrition, originating from European institutions and North America and with a higher predominance of the English language.

MOOCs are shown as key tools to empower people, so in a pandemic context, the need to invest in alternative methods of dissemination of knowledge for knowledge-based empowerment would arise, covering the capacities of the general public that at present it is affected by not having access to care in health services of the first level of care. In addition to this, a critical shortage of human resources in health and healthcare, comprising a limited number of medical professors and limitations in physical infrastructures are reasons that increase the need to access online courses in health education of the level primary. Although the MOOCs’ origin was mainly from university institutions a future analysis of the quality of the contents must be addressed for greater comprehensiveness.

Data availability

Underlying data

Open Science Framework: Underlying data for ‘Massive Open Online Course (MOOC) Opportunities on in Health Education (HE) during of mandatory social isolation context, https://doi.org/10.17605/OSF.IO/UFQYC.40

This project contains the following underlying data:

A database with information from the MOOCS, institutions, platform and language.

Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication).

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Dolores-Maldonado G, Cañari-Casaño JL, Montero-Romainville R and Malaga G. Massive Open Online Course (MOOC) Opportunities in Health Education (HE) in a mandatory social isolation context [version 2; peer review: 2 approved, 1 not approved]. F1000Research 2022, 10:322 (https://doi.org/10.12688/f1000research.52049.2)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
Version 2
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PUBLISHED 26 May 2022
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Reviewer Report 05 Mar 2024
Khin Thandar Aung, Kulliyyah of Nursing, International Islamic University, Kuala Lumpur, Malaysia 
Approved
VIEWS 3
Regarding the specific systematic review paper, I would like to suggest the following to the authors:
  1. The research topic and specific research question should be addressed in the review.
     
  2. Methodology should
... Continue reading
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Aung KT. Reviewer Report For: Massive Open Online Course (MOOC) Opportunities in Health Education (HE) in a mandatory social isolation context [version 2; peer review: 2 approved, 1 not approved]. F1000Research 2022, 10:322 (https://doi.org/10.5256/f1000research.134018.r226861)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Reviewer Report 05 Sep 2022
Maya Adam, Stanford University, Stanford, CA, 94305, USA 
Approved
VIEWS 6
These changes look good to me. Best of luck to the authors ... Continue reading
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Adam M. Reviewer Report For: Massive Open Online Course (MOOC) Opportunities in Health Education (HE) in a mandatory social isolation context [version 2; peer review: 2 approved, 1 not approved]. F1000Research 2022, 10:322 (https://doi.org/10.5256/f1000research.134018.r139136)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Reviewer Report 16 Feb 2022
Maya Adam, Stanford University, Stanford, CA, 94305, USA 
Approved with Reservations
VIEWS 23
In general, I think this is a very interesting manuscript and it makes a potentially valuable contribution to the literature on open online public health education.

Some suggestions for improvement follow:

In the background/rationale ... Continue reading
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Adam M. Reviewer Report For: Massive Open Online Course (MOOC) Opportunities in Health Education (HE) in a mandatory social isolation context [version 2; peer review: 2 approved, 1 not approved]. F1000Research 2022, 10:322 (https://doi.org/10.5256/f1000research.55275.r121485)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
  • Author Response 26 May 2022
    GANDY KERLIN GANDY KERLIN, Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru
    26 May 2022
    Author Response
    Dear Maya Adam

    We are very grateful for your comments and suggestions. Below are the responses to each of the comments:

    In general, I think this is a ... Continue reading
COMMENTS ON THIS REPORT
  • Author Response 26 May 2022
    GANDY KERLIN GANDY KERLIN, Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru
    26 May 2022
    Author Response
    Dear Maya Adam

    We are very grateful for your comments and suggestions. Below are the responses to each of the comments:

    In general, I think this is a ... Continue reading
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Reviewer Report 21 Jun 2021
Waleed Al-Rahmi, School of Education, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Johor Bahru, Malaysia 
Not Approved
VIEWS 33
1. The aim of this research not clear. The authors should clarify the aims.

2. The research problems are not clear. Therefore, the authors should address the research gap first, and I suggest adding new section to ... Continue reading
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Al-Rahmi W. Reviewer Report For: Massive Open Online Course (MOOC) Opportunities in Health Education (HE) in a mandatory social isolation context [version 2; peer review: 2 approved, 1 not approved]. F1000Research 2022, 10:322 (https://doi.org/10.5256/f1000research.55275.r85974)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
  • Author Response 26 May 2022
    GANDY KERLIN GANDY KERLIN, Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru
    26 May 2022
    Author Response
    Dear Waleed Mugahed Al-Rahmi
    We are grateful for your comments. Our responses are described below.

    1. The aim of this research not clear. The authors should clarify the aims.
    ... Continue reading
COMMENTS ON THIS REPORT
  • Author Response 26 May 2022
    GANDY KERLIN GANDY KERLIN, Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru
    26 May 2022
    Author Response
    Dear Waleed Mugahed Al-Rahmi
    We are grateful for your comments. Our responses are described below.

    1. The aim of this research not clear. The authors should clarify the aims.
    ... Continue reading

Comments on this article Comments (0)

Version 2
VERSION 2 PUBLISHED 26 Apr 2021
Comment
Alongside their report, reviewers assign a status to the article:
Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
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