Knowledge into Action
Feasibility of integrating evidence-based behaviour change techniques within a massive open online course (MOOC) to influence practice change
What we know
There is some evidence to support the use of educational interventions (including e-learning) to raise awareness of, or promote confidence in, delivering care. Many such interventions can lead to good intentions to e.g. a more person-centred approach. However, it has been shown that intentions do not always lead to desired actions and that providing education-based content alone does not always result in behaviour change, which is fundamental to the implementation of evidence-based practice.
The Scottish Improvement Science Collaborating Centre - Knowledge Into Action At Scale (KIAAS) programme of work, was established in July 2015, to examine effective and cost-effective large-scale approaches to education about quality improvement, and to creating change through knowledge translation and exchange.
A Compassionate Care: Getting it Right massive open online course (MOOC), was designed and delivered with over 9600 people enrolled worldwide and 2453 active learners. The original runs of this MOOC and another, were evaluated in terms of content and delivery and impact on knowledge and attitudes. This was done through the analysis of questionnaire data, discussion boards and information from the MOOC platform provider. In addition, a stakeholder engagement process was undertaken, across multiple sectors.
Findings suggested that participants found the learning useful and reported intentions to incorporate what they had learnt in their practice. However, it was unclear to what extent the MOOC impacted upon practice change.
This research builds on the outcomes from earlier work within the KIAAS programme. The purpose of this study was to enhance the existing evidence-base around how to influence practice change, through the co-design of a MOOC for behaviour change, with health and social care practitioners. The aim was to understand whether and how behaviour change can be supported by providing learners with evidence-based behaviour change techniques (BCTs), actions and tools delivered through a MOOC.
What this research explored
Based on the evaluation, the original five-week Compassionate Care: Getting it Right MOOC was re-developed to be delivered over a 3-week period with a view to improving attrition rates.
The evidence around changing behaviour (changing practice) through e-learning was reviewed and a protocol for testing the feasibility of using evidence-based behaviour change techniques within a MOOC was also developed. The scoping review revealed evidence to support the use of educational interventions (including e-learning) to raise awareness of, improve communication, change attitudes and promote confidence in, delivering care. Many such interventions can lead to good intentions to, for example, be more person-centred, but it is well known that intentions do not always lead to desired actions (known as the intention-behaviour gap). Solely providing education-based content therefore does not always result in behaviour change, which is fundamental to the implementation of evidence-based practice. Available studies indicate that the BCTs goal setting, self-monitoring, feedback and action planning, in particular, can change professional behaviour in clinical settings.
A co-design approach was undertaken to identify appropriate BCTs and co-produce relevant content for inclusion within the MOOC. These subject matter experts participated in a range of collaborative activities – interviews, a co-design workshop, feedback via email correspondence, the online course, and a pre and post behaviour change survey. Appropriate BCTs were identified and incorporated into the MOOC to tip the balance from good intentions to enactment of desired actions.
In order to evaluate the MOOC in terms of both content and delivery and impact upon knowledge and attitudes, online questionnaires were developed to be completed by MOOC participants before and after completion of the training.
What this study adds
The 3-week Compassionate Care MOOC ran with 921 active learners. The reduction to 3 weeks made no difference to completion rates which were broadly similar.
Pre-MOOC questionnaire data was collected from 686 learners and 73 learners submitted post-MOOC questionnaires. In addition, around a third of learners participated in the discussion forums. From this data, it was identified that the vast majority of learners were able to give examples of how their behaviour at work had changed as a result of participating in the course.
Questionnaire data identified a self-reported increase in person-centredness, improved communication skills and active listening. Increased confidence and motivation were also reported. Comparing pre and post-questionnaire data identified that following participation in the course, learners were more likely to agree that they had regular discussions with their colleagues about compassionate score, more likely to agree that they felt competent in applying a compassionate approach in their workplace and more likely to agree that they felt competent in applying a compassionate approach in their personal life. In addition, they were less likely to agree that some people are more deserving of compassion than others and less likely to agree that health and social care practitioners do not always have time to be compassionate.
Interviews were conducted with MOOC participants to explore uptake of the BCT tools and evaluate how they were used in practice. Participants reported that the behaviour change resources provided were clear and easy to understand, however the vast majority reported having not yet used them. Participants reported intentions to use the resources in the future and gave examples of how all the tools could have a positive impact on both their professional and personal lives.
Benefits and impact
Findings identified that it is feasible to engage a target audience of (frontline) health and social care practitioners with a MOOC exploring the delivery of compassionate care.
Post-MOOC interview data identified that it was however challenging to sustain their engagement over the course of the three-week course.
Data suggests that a compassionate care MOOC can result in change at the level of the individual and the organisation. At the level of the individual, there is evidence of increased person-centeredness, improved communication skills, increased reflection and increased confidence and motivation to provide compassionate care. At the level of the organisation, there is evidence of sharing of MOOC resources with colleagues and intention to change practice. It is unclear to what extent BCTs facilitate these changes.
As part of this project we worked with health and social care experts to identify a combination of behaviour change techniques, along with actions and tools that can be used to support and optimise behaviour and practice change. As well as including these within the MOOC, a stand-alone behaviour change toolkit was developed to provide access to resources around five mechanisms for successful behaviour change: Goal Setting – Action Planning – Problem Solving – Self-monitoring – Feedback.
This project has been led by Dr Jason Tang, Research Fellow, University of Dundee, in conjunction with colleagues from the School of Health Sciences at Dundee, University of the West of Scotland, Edinburgh Napier University and NHS Education for Scotland (NES).
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