Review of Effective Internet Interventions for Health Education

We know that internet-based education can be effective for health education, a recent review of internet-based health care instruction (2010, Academic Medicine 85:909-922), suggests which kinds of materials may be the most effective. 

The authors searched several databases for papers looking at the effect of internet-based learning for a number of different audiences including students and professional doctors, nurses, pharmacists, dentists, and others.  They classified the different approaches to get an idea of what kinds of different designs lead to the most effective learning outcomes.

They found that the methods that lead to better learning outcomes include interactivity, practice exercises, repetition, and feedback.  Interactivity included activities such as self-assessment questions, interactive models, or thought-stimulating activities.  Repetitive designs used repeated exposures to materials, for instance, emails with multiple repetitions of the same material. 

This paper is freely available and is a very good read for people interested in a survey of the different online methods used for health education, and for a review of the methods that have proven the most effective.

Is Classroom Learning Better?

Distance learning is often cheaper and more convenient than classroom-learning.  Sometimes people have a feeling though, that it just can't be quite as good as classroom learning -  We must be giving up something if we try to teach people at a distance. 

Distance and internet learning tends to hold up in studies comparing it to classroom based learning.  A recent paper in JAMA looked at increases in knowledge and practice change for education on the NIH Cholesterol Education Program, comparing distance learning and live-CME, and found little difference between the 2 methods (with the only difference favoring learning at a distance).  (JAMA, Sept. 7, 294:1043-1051). 

This is a nice study, because it compared distance methods to live-CME methods that had been shown to be successful in the past.  The two instructional methods were designed to be as similar as possible.  Both had a one-hour didactic session, followed by interactive cases with feedback, supporting resources (like a risk calculator), step-by-step clinical practice guidelines, a guidelines summary, and access to expert advice.  Students in the live-sessions attended a 1.5-2 hour class.  Student using the online instruction had 10 days to complete their materials. 

The researchers took a thorough look at instructional outcomes by measuring knowledge before the interventions, immediately after, and most important, 12 months later.  Practice change was assessed by chart audits. 

There was only one significant difference between the two groups, the internet group had a significantly higher number of high-risk patients treated with pharmacotherapuetics according to the guidelines.  Internet-based CME was effective. 

This study isn't out there by itself, there have been many studies comparing distance methods to live instruction.  It's very common to find that well-designed distance methods are usually as good, and sometime slightly better, than classroom instruction, a finding that is reinforced by a recent report by the US Dept. of Education goes into great depth comparing outcomes in distance education and comes to a similar conclusion. 

This is an area that needs more study because it's likely that classroom-based learning will be more efficient for certain learning objectives and learners, but for many skills, distance learning has proven just as effective as classroom training.