Table 2.

Study characteristics and summary of the factors associated with e-learning

Study (First author and year), country	Focus of study	Stated research methods and anlysis	Participants	Categories reflect factors (i.e. policy & context, instructional design and delivery, and learning outcomes) influencing (the implementation or utilisation of) e-learning in HSE framework components
				Potential influencing factors	Reported drivers or enablers	Reported barriers or challenges	Delivery mechanisms	Wider impact
Golband 2014 [3] Iran	Factors influencing e-learning	Analytical cross-sectional; ANOVA and Scheffe tests.	Postgraduate students (n = 60)	Education approach; e-learning global era in education	Consider four components of effective learning – learning content, educator, system and learner. Address learners’ backgrounds, motivations and expectations and needs	Not reported	E-learning of medicaleducation	Improved learning – learning content, educator, system and learner, improved motivations and met expectations, addressed learners’ short-term and long-term education needs in HSE.
Beckman 2008 [42] Belgium	E-learning and classification of pressure ulcers	Repeated measure design – experimental; chi-square tests	Nursing students (n = 236, 212 experimental and 214- control)	Evidence-based learning and education	Flexibility, quality, flexibility and costs, learning takes place regardless of learners’ geographical location and time	Labour-intensive, poor computer skills, demands high level of educational skills/experience	E-learning	Improved knowledge and performance, improved learning and application in practice
Boye 2012 [43] Norway	E-learning and medical immunology	Quantitative study; Mann-Whitney U-test	UG medical students (n = 73; 30 expt. And 43- control)	Popular approach in medical education, advancement of information technology in HE	Flexibility, improve learners’ reasoning and understanding skills.	Poor/lack of participation	E-learning	Students well appreciated e-learning, improved examination performance and outcomes, improved users’ satisfaction
Docherty 2006 [44] UK	E-learning - enablers or facilitators	Qualitative methods (Evaluation methods using a mixed methods)	Students n = 30 (face-to-face), 5 GPs, 2 nurses	Healthcare education and service provision, learning embeds multifaceted values, national plan – NHS, lifelong learning	Practice influenced learning, learning place and time, minimal involvement, flexible, integration with commitments, value and skills acquisition	Poor support, limited resources, lack of IT skills, isolation, lack of students’ self-discipline, isolated learning, resource-intensive costs and learning resources	E-learning in CDP	Increased knowledge and accessibility; increased flexibility. Improved working practice, improved learners motivation, expectation; improved knowledge and skills, flexible learning and integration
Gagnon 2007 [45] Canada	E-learning - barriers	Qualitative methods; theoretical framework	Physicians (n = 40)	Principles of evidence-based medicine, influence of the current paradigm of best clinical practice	Motivation, individualised flexible learning, tutors/peers support and feedback, flexible learning	Time constraints, poor technology, poor planning and delivery, lack of sufficient feedback, lack of familiarity with IT/computers, poor integration of learning in practice	E-learning in evidence-based Medicine	Increased learners’ motivation and self-discipline, received individualised support/feedback, improved learning and flexibility in practice.
Gardner 2016 [46] Australia	E-learning and students’ perspectives	Qualitative study, grounded theory	Physiotherapy students (n = 23)	Capacity – health workforce development	Flexibility – cost and time, motivation for learning, easy access to materials, encourage learners to learn through doing	Interactive learning, e.g. embedding quizzes or discussions, case-studies, real examples, would make learning effective	E-learning	Enhanced students’ learning; improved students’ attitude towards working in an inter-professional team; suitable for learning for both interdisciplinary and multi-disciplinary health professionals
Gensichen 2009 [47] Germany	E-learning and primary care	Modified Delphi - Quantitative study; descriptive stats	Primary healthcare experts (n = 60)	Education and learning are mainly financially independent in the healthcare industry	Workplace learning practice, clinical knowledge transfer in practice; embedding different styles or modes of learning (mixed learning) to suit learners’ learning needs/demands.	Resource-intensive – time and cost, problems of integration of learning into the existing academic and professional curriculum; fear of replacing traditional methods of teaching and learning; often failing to consider learners’ needs and interests	E-learning in primary care education	Improved learning; increased clinical knowledge using virtual clinical case studies in practice
Gormley 2009 [48] UK	E-learning and clinical skills	Survey; t-test and multiple regression analysis	UG medical students (n = 304)	Established method for teaching in medical schools, technological advancement in academic education	Facilitates learning, helpful for revision and exam preparation, motivates to learn, saving costs as learners don’t need to purchase textbooks	Potential isolation of learning, learners need to engage more to learn better, learners need to be familiarized with different modalities of teaching	E-learning	Reported confident, encouraged learners to attend the clinical attachment, standardized teaching, found useful in revising work, better performance in clinical skills
Hadadgar 2016 [49] Iran	E-learning and GPs - medical education	quantitative study; Kurtosis and skewness tests	GPs (n = 148)	Technology advancement, provisions of CPD in academic and healthcare industry	Satisfactory accessibility, increase flexibility	Problem of access to computers, time constraints, and unfamiliarity with computers	E-learning	Acceptance of e-learning in CPD
Hammarlund 2015 [50] Sweden	Factors influencing e-learning	Qualitative; content analysis	Undergraduate physiotherapy students (n = 34)	Both factors - external and internal influence learning including pedagogical design, collaborative learning in HSE.	Contextualised learning, learning aligned with course learning outcomes, appropriate assessments; opportunity to interact with teachers and peers, feedback from tutors, flexibility	Poor instructional design, poor course structure, limited learning space, poor relationship with peers and tutors, limited engagement, motivation, inflexibility, anxiety and stress, and low self-efficacy	Self-directed learning online	Increased healthcare learners’ knowledge, performance and progress; learners ‘freedom’ and motivation; improved current and future professional development in healthcare practice
Hawthrone 2009 [51] UK	E-learning and delivery modes	Evaluation methods, quantitative; Kruskal-Wallis and chi-square tests	Final year UG medical students (n = 223)	Not reported	Self-directed learning; learning tailored to individual students’ needs and preferences; convenience of learning, i.e. choose learners’ own time and place	Required appropriate knowledge in technologies to make effective learning, need to understand how people learn, poor teaching design/choice of tools	E-learning	Improved students’ learning, improved students’ performance, learning appeared relevant in practice, self-directed learning, and provoked thinking.
Hugenholtz 2008 [52] Netherlands	E-learning and continue professional development for occupational physicians	Randomised control trials – 4 blocks randomisation, t-test and chi-square tests	Physiotherapy students (n = 23)	E-learning is an effective teaching approach in continuing medical education, integration of internet technologies into CME programmes	Learners can choose any time and any geographical place for learning; useful for professional education and development in practice	None discussed	E-learning	Enhanced or sustained knowledge gains and improved learners’ behaviour change as compared to traditional learning/teaching approaches
Ikram 2015 [53] Netherlands	Developing effective module	Quantitative method; paired t-test	4th year medical students (n = 281)	Quality of care, equitable healthcare services, teaching patient diversity in medical curricula	Learning in practice; application of knowledge to practice, interactive learning	Language barriers – learners/patients and providers; problems of integrating biomedical contents into e-learning curricula, labour-intensive (time, cost) approach	E-learning	Improved learners’ knowledge and self-efficacy, developed confidence in solving clinical/health related problems related to learning in practice, interactive learning between learners and tutors
Khasawneh 2015 [54] USA	E-learning and paediatric education	Descriptive – quantitative study; Wilcoxon rank sum tests	UG 3rd year medical students (n = 67)	Use of technology in education	Autonomy, flexibility, reflective thinking, self-confidence and satisfaction	None discussed	E-learning	Improved medical students’ performance, self-confidence in learning, improved satisfaction
Kitching 2015 [55] Australia	Web-based/e-learning and education (medical)	Qualitative; framework analysis	Senior stakeholders from nursing home sector (N = 25)	Management policy, learning management systems in HSE.	Change in learning and clinical practice through considering learners’ individuality – background, experiencing support in learning, access to and diversity of information	Poorly considered learners’ needs and interest in learning curricula, poor reflection of current and future workforce needs and demographics, time constraints, inappropriate equipment for technologically illiterate learners	Web-based social media	E-learning is associated with enhanced learning and engagement, thereby positively changing in clinical practice; offered currency and practice contributing to contemporary information; considered learners’ individuality – background, experiencing support in learning; delivered using various styles and formats; access to and diversity of information, meeting learners’ current and future needs
Kokol 2006 [56] Slovenia and USA	E-learning	Mixed methods approach	Full-time and part-time students (n = 125)	National and international policy changes in education and learning including advancement of science and technology, including IT	Credibility and motivation, and accessibility. Lifelong learning, promising alternative mode of delivery	Issues related to self-control, inappropriate learning for full-time learners due to their work and personal commitments, lack of knowledge in IT, limited interaction between learners and tutors, and poor access to resources. E-learning is not for all, as some learners are naturally technology-phobic	E-learning	Improved quality of education and integration/application of theoretical context in practice; offered multidisciplinary users.
Morente 2013 [57] Spain	E-learning tool and education on pressure ulcer	RCT - t-test and chi-square tests	Nurses (n = 60; 30 received traditional education; 30- Computer-assisted training)	Influence of technological advancement, promising alternative method to traditional teaching	Flexibility, easy access to materials, immediate feedback from the tutors and/or peers, generate interest, satisfaction	None discussed	E-learning	Reported as an effective and valuable educational tool, positive impact on clinical decision-making process, better learning acquisition, improved education efficiency
Morton 2016 [58] UK	Blended learning	Mixed methods approach	Intercalated BSc 4th year medical students (n = 26), F (n = 12)	Increasingly use of e-learning in UG medical education, interactive, more student-centred learning in medical education	Appropriate to teach basic knowledge, interactive component of e-learning	Problems related to learners’ engagement with online self-directed learning	Blended learning	Improved computer literacy, high level of satisfaction, improved medical students’ engagement, improved understanding, efficient approach to learning
Moule 2010 [59] UK	E-learning and students’ experience	Mixed methods approach	Staff (n = 35) and students (n = 41) from 93 HEIs.	Education policy development and advancement in technological developments in HEIs, constructivist (learner-focused) approach in healthcare education	Flexibility, motivation, and engagement in learning, relevance to practice	Poor access to computers in workplace, limited IT skills as well as poor peer commitments	E-learning	Improved motivation to learning, student-centred learning and engagement.
Naeem 2019 [60] Pakistan	Challenges in blended course	Qualitative design, framework analysis	Postgraduate healthcare students (n = 22)	Institutional support	Flexible, feasible, self-regulation and self-directed learning	Poor instructional design, limited resource provision, poor admin support, poor financial position, poor feedback, issue of time-management,	Blended learning	Enhanced students’ learning; Identified needs of the stakeholder and students
Ota 2018 [61] Australia	Nursing students’ perceptions and challenges to blended study	Quantitative design	UG nursing students (n = 109)	Technology in higher education	Autonomy and accountability	Technical difficulties, lack of flexibility, unexpected workload, difficult to link theoretical aspects in practice e.g. real life clinical context	Blended on-line learning	Enhanced students’ motivation and learn
Padalino 2007 [62] Brazil	E-learning and knowledge apprehension	True experimental design- ANOVA tests	Occupational physicians (n = 74)	Technology revolution, strategic changes in HE, support CPDs and collaborative learning	Effective and efficient learning, flexibility, cost- and time-saving, provides more individualised learning, adjusted learners’ rhythm	None discussed	E-learning	Obtained higher score, e-learning strategy reported equally effective learning approach, provided opportunities for both tutors and learners by using both technical and pedagogic teaching methods and tools
Parry 2007 [63] UK	E-learning and bioscience	Quantitative; Kruskal-Wallis one-way ANOVA	UG students (n = 124; 71 – first year, 33- s year, 20- third year)	Quality of student experience, demands of the programme, changing, i.e. use of VLEs in HE environment	Flexible, convenient and efficient in time – off-campus, access to learning materials (anytime, anywhere). Feedback (formative) received from tutors/peers ‘open dialogue’ found useful and motivating	Lack of engagement due to poor internet access and technical difficulties	E-learning	Increased the depth and breadth of learning, utilised a new method of learning, independent or self-learning, found useful and motivating, developed confidence and promoted engagement
Sinacori 2019 [64] USA	Experiences of nurse educators to online learning	Qualitative design	Nurse educators (n = 8)	Faculty development, professional development, contents organisations	Learning new pedagogy, facilitating learning, interaction between students and staff	Lack of professional development, lack of knowledge and online pedagogy, poor learning management system	E-learning	Enhanced students’ motivation and self-regulation.