Blended learning is a formal educational method in which a person learns in part:
- through self-guided or independent learning where they have some control over time, place, path and pace; and
- by attending a supervised learning environment led by a facilitator.
The modules within a blended learning course are connected to provide a unified learning experience. The recommendations and considerations below apply to both adults and children unless specified otherwise.
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We adapted the definition above from one provided by the Christensen Institute via Khan Academy.
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Guidelines
Good practice points
- Blended learning may increase learners’ knowledge, as well as build their confidence and willingness to act.
- Self-directed components should be paired with a facilitated session that focuses on learning and practising first aid skills with the support of a trained facilitator (this could be face-to-face in a classroom or facilitated virtually in real-time through video communication).
- Including facilitator-led segments and encouraging peer interactions may provide an opportunity to influence learners’ attitudes, such as confidence and willingness to act.
- The optimal “blend” of learning methods and the order most effective for different audiences is unknown. Regardless of the combination, blended learning may provide an opportunity to reinforce learning through repetition.
- The self-led learning segment may come before or after the facilitator-led segment but must be a separate session. (I.e., playing a video during the facilitator-led segment is not blended learning. Learners must watch the video before or after their time with the facilitator.)
- Safeguarding measures are crucial for online learning; adherence to national and organisational protocols for protecting children online should always be followed.
Chain of survival behaviours
Blended learning can be used to develop knowledge within each domain so long as a practical component, guided by a supportive facilitator, is included to facilitate first aid skills and build confidence within learners.
Education considerations
Context considerations
- Technological advances provide the opportunity to enhance and apply learning in virtual environments. Refer to Online learning for adults for an example of a successful application in a military context and Gamification for one within a water safety context.
- In areas where technology or internet access may be a barrier to learning, explore low or technology-free options to avoid exclusion. For example, you could provide written content for learners to study beforehand or to use as a reference tool after the facilitator-led session.
Learner considerations
- This approach can be used with a variety of audiences (e.g., youth or older adults, in the workplace, those travelling or living in remote areas or those training to be professional responders). The self- and facilitator-led methods must have a meaningful, integrated connection and form an enhanced learning experience. We advise programme designers to consider which elements need reinforcement based on the learners’ needs.
Facilitation tips and tools
- Prepare facilitators on how to bridge the self-guided and supervised learning components together. Time with a facilitator should enhance learning, not repeat it.
- If the facilitator-led session occurs after the self-led learning, focus on applying knowledge in a way that will build learners’ confidence. Facilitators can support learners by:
> providing clarification on self-guided topics
> completing an assessment of learning (what the person has learned so far) and for learning (any gaps in understanding that require additional support)
> encouraging people to link the learning to their real-life context, transitioning from knowledge to application - If the self-guided learning component takes place first, facilitators may need to distribute learning materials in advance. Consider the type of tool and how much time learners need to explore it thoroughly to determine when distribution should occur.
- Encourage learners to revisit the self-guided learning components as this may increase their retention of the content.
- It is important to determine how you will protect children and other vulnerable learners as they engage in online learning. Consider how they will interact with the tool – and who can interact with them while using it. Research the data and child protection laws for your country, context and organisation (e.g., school) and follow the regulations and guidelines carefully.
Benefits and limitations
- Completing the self-guided component first may reduce costs by shortening the time needed with a facilitator in the physical learning environment.
- Alternatively, keeping the face-to-face session the same length provides facilitators with more time to develop learners’ knowledge, skills and attitudes.
- There is a significant variation in cost to produce and implement different blended methods. In all combinations, facilitators will need to be prepared to support the learning approach.
Scientific foundation
We reviewed studies that looked into whether blended learning impacts the learner or person in need of care, compared to face-to-face learning only. We excluded studies that did not include a comparison between a blended and control method.
Very few studies compared blended learning (as the intervention) with a classroom-only session (as the control) with regards to learning first aid. The reason is likely because blended learning is a relatively new approach – especially if the self-led component is completed online as using this technology to learn first aid is also relatively new. We found ten studies from the literature searches, but after a full review, only one of these met the inclusion criteria. We included an additional study found during a hand search.
Video and face-to-face
Brannon et al. (2009) completed a study assessing the impact of watching a video before attending a face-to-face session. Parents of premature babies watched a video on baby CPR before attending a session with a facilitator. The study compared the intervention group to a control group of parents who did not receive any information before attending the classroom component. The intervention group watched the video within 48 hours of completing the CPR class. All parents completed a CPR test based on a set of standardised skills, usually within seven days after the course and before the baby’s hospital discharge. The test rated the parents’ skills in assessment, ventilation and chest compressions as either “good”, “fair” or “fail”. Participants had to receive a good or fair on all three segments to pass.
The study took place over six months and enrolled 28 participants. In the end, 23 completed the final test; ten in the blended learning group and 13 in the control group. The study did not find any significant variation in the data. All ten subjects in the video group passed the CPR skills test, whereas only nine from the control group passed. However, this difference was not significant (p=0.08). Eight of ten subjects in the video group received a good on all three sections (assessment, ventilation and compressions), versus three out of 13 from the control group. The authors noted this as a significant difference (p=0.012). In conclusion, the results from the standardised skills test suggest that watching a video before attending a face-to-face session is linked to improved skill performance.
Blended versus facilitated-only
Another study compared the difference in knowledge, confidence and willingness to act between learners who completed a facilitated session versus a blended one using the British Red Cross Everyday learning approach (e-learning followed by a face-to-face segment). The control group (facilitator-led only) contained 58 learners, while the intervention group had 70. The study measured the effectiveness of learning through evaluation forms completed before and after the learning experience for both cohorts. The blended cohort also completed a post-digital evaluation using the zero to ten Likert scales with questions about what action to take.
They found comparable results between the facilitator-only and blended learning groups with regards to improved first aid knowledge. However, statistical analysis showed that blended learning was superior to improve learners’ willingness and confidence. The authors concluded that this specific blended approach (e-learning followed by a face-to-face segment) is a reasonable alternative to face-to-face only learning and that it offers greater flexibility to facilitators and learners (Oliver et al., 2020).
Blended learning for children
Studies on blended learning for children were found through our search for Online learning for children. Three relevant studies from that topic are also reflected here.
1. Reder et al. (2005) compared the following three methods:
> interactive computer training
> interactive computer training with a facilitator-led practice session
> traditional classroom instruction to teach CPR and how to use a defibrillator to high school students.
They found evidence that interactive computer-based learning, completed independently, was sufficient to teach CPR and defibrillator knowledge, as well as defibrillator skills, to the students. All forms of instruction were highly effective when teaching how to use a defibrillator. Conversely, the physical skills required to perform CPR were challenging to teach across all three methods.
2. Another study used a clustered randomised trial to look at the effect of a national online course that provided participants with knowledge before learning how to physically perform CPR. The study showed that completing an online course before CPR training did not influence practical CPR skills or a willingness to act. However, it did improve the participants’ recognition of heart attack and stroke symptoms, as well as their knowledge of lifestyle factors (Nord et al., 2017).
3. Lifesaver is an immersive, interactive game developed for basic life support training. The Lifesaver study ran in three United Kingdom schools and compared the impact of three learning methods for CPR skills and attitudes (Lifesaver-only, face-to-face facilitation and a combination of both). The first outcome examined was mean chest compression rate and depth; the second was flow fraction. The study also looked at CPR performance (using an identified course assessment tool to determine whether CPR was successful) and the results from an attitude survey. The study’s overall results showed that the use of Lifesaver-only, compared to face-to-face facilitation only, led to comparable success for several of the key components of CPR. However, Lifesaver was most effective when paired with face-to-face facilitated learning (Yeung et al., 2017).
References
Brannon, T. S., White, L. A., Kilcrease, J. N., Richard, L. D., Spillers, J. G., & Phelps, C. L. (2009). Use of instructional video to prepare parents for learning infant cardiopulmonary resuscitation. Baylor University Medical Center Proceedings, 22(2), 133–137.
DOI: 10.1080/08998280.2009.11928493
https://www.tandfonline.com/doi/pdf/10.1080/08998280.2009.11928493
Oliver, E., Forsyth, M., Colebourn, D., Gordon, E., Taylor, H., & Mulligan, J. (2020). A randomized trial of blended first aid education for the public. International Journal of First Aid Education, 3(1) 38–48.
https://oaks.kent.edu/ijfae/vol3/iss1/randomized-trial-blended-first-aid-education-public
Nord, A., Svensson, L., Claesson, A., Herlitz, J., Hult, H., Kreitz-Sandberg, S., & Nilsson, L. (2017). The effect of a national web course “Help-Brain-Heart” as a supplemental learning tool before CPR training: a cluster randomised trial. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, (25)93.
https://link.springer.com/article/10.1186/s13049-017-0439-0
Reder, S., Cummings, P., & Quan, L. (2006). Comparison of three instructional methods for teaching cardiopulmonary resuscitation and use of an automatic external defibrillator to high school students. Resuscitation, 69(3), 443–453.
https://www.sciencedirect.com/science/article/abs/pii/S0300957205004442
Yeung, J., Kovic, I., Vidacic, M., Skilton, E., Higgins, D., Melody, T., & Lockey, A. (2017). The school Lifesavers study-A randomised controlled trial comparing the impact of Lifesaver only, face-to-face training only, and Lifesaver with face-to-face training on CPR knowledge, skills and attitudes in UK school children. Resuscitation, 120, 138–145.
doi:10.1016/j.resuscitation.2017.08.010
http://wrap.warwick.ac.uk/93282/21/WRAP-school-lifesavers-study-randomised-controlled-trial-comparingYeung-2017.pdf
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