Online learning refers to self-directed or facilitator-led interactive learning tools accessed on digital devices such as tablets, phones or computers. Approaches include digital education programmes, mobile apps, online games and multimedia. Online learning is suitable for a variety of audiences because of its accessibility and flexibility.
Guidelines
- Online learning may be most beneficial when paired with face-to-face learning. *
- Online learning could be as effective as face-to-face learning to develop first aid knowledge for conditions such as heart attack, stroke, lifestyle factors and using a defibrillator. *
Good practice points
- Online learning may be useful when the child has a preferred location in which they like to learn, or when there is limited time and resources.
- Safeguarding measures are crucial for online learning and adherence to national and organisational protocols for protecting children online should always be followed.
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NOTE
While the evidence available is specific to the topics of heart attack, stroke, lifestyle factors and using a defibrillator, it is likely the above guideline applies to other first aid topics, but evidence is not yet available.
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Chain of survival behaviours
Online learning can be used in the domains of prevent and prepare, early recognition, and access help. However, there is no conclusive evidence whether this method improves the performance or retention of first aid skills (Mancini et al., 2009). Regardless, knowledge is critical in building confidence and a willingness to act. Online learning may contribute to improving learners’ skills when combined with other facilitation methods, such as physical practise.
Education considerations
Context considerations
- Online learning is most effective when the necessary technology is available. This factor may present a barrier in areas without these resources or when regulation exists for limiting access as learners may be unable to access the information. Consider how learners will access online learning, including the availability for offline access (e.g., through an app).
- The cost of online learning and the equipment to develop it may create issues of discrimination and exclusion.
- Learners in high-resource settings may have access to technology at home and school and will be familiar with navigating a website or app.
- The evidence of the effectiveness of online learning could be used to support advocacy campaigns for first aid learning for children.
Learner considerations
- Learners’ cultural and socioeconomic backgrounds may influence their confidence and ability to complete online learning. Many learner groups, particularly younger generations, are more familiar and comfortable with online learning.
- Learners’ attention spans will vary with age. Consider the level of engagement and length of online activities to ensure they meet learners’ needs.
- If online learning is blended with face-to-face learning, it may be possible (and appropriate) to shorten the length of the in-person session and focus on practising skills. This will make lessons more affordable and appealing to learners. (See Blended learning.)
- Children that might not otherwise be able to attend a first aid course (because they are remote or have a disability, for example) might be able to engage with online learning.
Facilitation tips
- Use online learning to supplement other approaches (such as face-to-face facilitation and Peer learning) to improve learners’ knowledge and skills. For example, show short learning videos shared on social media.
- Encourage learners to return to the online content and use it as a reference tool and share with peers. This may help them to retain more knowledge.
Facilitation tools
- It is important to determine how you will protect children 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.
- You can deliver online learning in a variety of ways such as mobile apps, online games, and multimedia (e.g., 3D videos or virtual reality). Children learn through play, so gamification is an important method to consider.
Scientific foundation
A review of six papers looked into whether online learning impacts the learner or person in need of care. The studies took place in schools and universities, and the online learning methods were generally interactive.
Two topics emerged from the evidence:
The use of online learning methods to teach first aid, specifically CPR knowledge and skills
App-based learning was evaluated as an alternative to facilitators teaching basic life support to school children. The randomised controlled trial consisted of 165 participants (ages 16–18). The control group completed a facilitator-led course, while the intervention group used an application on a tablet. The two groups worked in separate classrooms for 40 minutes, and there was no significant difference in the level of knowledge or skills between them after the learning experience. However, a sub-analysis determined that the facilitator-led group had significantly better results for checking the airway, asking for a defibrillator and shocking the ill or injured person (Doucet et al., 2018).
Another study used a clustered randomised trial to look at the effect of a national online course that provides participants with knowledge before learning how to perform the actual skill of 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 symptoms, stroke and their knowledge of lifestyle factors (Nord et al., 2017).
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 identify 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).
The use of online learning without a facilitator and fewer resources
Online learning can be useful when resources or time do not permit formal face-to-face education (Yeung et al., 2017).
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 the students across all three methods.
Hawkes et al. (2015) tested the use of a Mobile Phone Resuscitation Guide (MPRG) on school children ages 15–16 using a randomised controlled trial. All subjects were taught baby CPR skills using the American Heart Association’s Infant CPR Anytime kit. Two weeks later, the students were randomised into one of two cohorts, either using the guide or not, and their CPR skills were re‐assessed. The group using the guide was better at accessing the emergency services, completing sufficient CPR cycles, and following the correct sequence for CPR. There was no difference between the cohorts regarding resuscitation skills.
References
Doucet, L., Lammens, R., Hendrickx, S., & Dewolf, P. (2018). App-based learning as an alternative for instructors in teaching basic life support to school children: a randomized control trial. International Journal of Clinical and Laboratory Medicine, 74(5), 317–325.
https://www.tandfonline.com/doi/10.1080/17843286.2018.1500766
Hawkes, G., Murphy, G., Dempsey, E. M., & Ryan, A. C. (2015). Randomised controlled trial of a mobile phone infant resuscitation guide. Journal of Pediatrics and Child Health, 51(11), 1084–1088.
https://www.researchgate.net/profile/Geraldine_Murphy8/publication/281140918_Randomised_controlled_trial_of_a_mobile_phone_infant_resuscitation_guide/links/5ce30795a6fdccc9ddc13ebc/
Randomised-controlled-trial-of-a-mobile-phone-infant-resuscitation-guide.pdf
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
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Published: 15 February 2021
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About the guidelines
Here you can find out about the process for developing these Guidelines, and access some tools to help you implement them locally.