TITLE: Android for Good User Survey
Mwogi TS; Umoren RA; Thirikwa D; Litzelman, DK; Were, MC
Authors:
Dr. Thomas Sang Mwogi1
Dr. Dennis Thirikwa1
1. Moi Teaching & Referral Hospital, Eldoret, Kenya
Abstract
There has been an increase in access to personal computers, mobile devices and internet in subSaharan Africa. Given this, mobile learning can be used to improve the quality of learning by
facilitating the access to resource, services, and remote collaboration through the internet.
Despite this, there is still a relatively low utilization of new multimedia technologies and the
internet for medical education.
Simply providing mobile learning devices may not yield the desired effect if learner input is not
obtained early enough in the implementation phase. It is important to obtain learner input at early
stages using usability questionnaires such as the system usability scale and to align the goals of
educators and learners in order to achieve maximum benefit.
Institutions in high-resource settings have adopted “Web 2.0” practices which involve the use of
mobile technology for collaborating, exploring new knowledge, pursuing inquiry, and publishing
to audiences. Learning Management Systems (LMS) such as Canvas, Blackboard and Moodle
are examples of these “Web 2.0”. Moodle is among the most widely used because of its features
and characteristics that support e-learning and has been shown to increase Self Directed Learning
(SDL). We propose to use Moodle in this study to evaluate e-Learning.
We will combine longitudinal surveys with objective measures of ICT use, such as, anonymous
topic search tracking, internet usage, and device location to evaluate familiarity, usage-learning
materials, and educational outcomes using the Moodle learning management system on Google
Android tablets in a medical school located in a low-resource setting.
Table of Contents
Abstract ....................................................................................................................................... 2
Table of Contents ........................................................................................................................ 3
Background & Literature Review ............................................................................................... 4
Justification/Rationale................................................................................................................. 5
Materials & Methods .................................................................................................................. 6
Study Participants: .................................................................................................................. 6
Inclusion Criteria: ................................................................................................................... 6
Exclusion Criteria: .................................................................................................................. 6
Study Methods: ....................................................................................................................... 6
Evaluations:............................................................................................................................. 6
Data Analysis .......................................................................................................................... 7
Ethical Considerations ................................................................................................................ 7
Expected Outcomes .................................................................................................................... 7
Timeline ...................................................................................................................................... 8
References ................................................................................................................................... 8
Signatures of Investigators ........................................................................................................ 10
Appendix 1
Androids for GOOD User Survey ...................................................................... 11
Background & Literature Review
Mobile technologies enable knowledge building by learners in different contexts, enable learners
to construct understandings and often change the pattern of learning or work activity.1 Over the
past 10 years, there has been a dramatic increase in access to information and communication
technology (ICT) in sub-Saharan Africa with some reports showing that nearly all medical
school faculty and a majority of medical students own computers and have some internet
access.2-4 This contrasts with a 2004 report that showed only a quarter of students and faculty
owning a computer.5 While there is growing access to personal computers and the internet, there
is still relatively low utilization of new multimedia technologies and the internet for medical
education. ICT is mostly accessed and utilized on an individual basis and most students surveyed
were relatively unfamiliar with the concepts of e-learning.2,6,7
Mobile learning can be used to improve the quality of learning by facilitating the access to
resource, services, and remote collaboration.8 Learners are motivated by certain aspects of
mobile learning including: ownership of the learning process, opportunities for communication,
and the ability to learn-in-context.9 Some types of learning activities that are supported through
the use of mobile devices include: use of images and animations for learning basic sciences10,
procedures11 and patient history taking12; creating, sharing and reflecting with peers through
audio or text13; and access to electronic medical records at the point of care with use of clinical
and drug reference guides to reduce prescribing errors.14,15 Nearly half of U.S. medical students
report using tablets in the clinical setting.15,16 However, simply providing mobile learning
devices may not yield the desired effect without creating an enabling environment for
collaborative learning.17 It is important to obtain learner input at early stages using usability
questionnaires such as the system usability scale and to align the goals of educators and learners
in order to achieve maximum benefit.18-20
Sociocultural Ecological Framework for Mobile Learning
Many theories of mobile learning place importance on both location and context.21 Using the
sociocultural perspective on mobile learning educators must consider the concepts of
sociocultural structures, agency and cultural practices.22 Sociocultural structures refer to the
user-generated content and individualized communication facilitated by mobile devices.
Learning can be viewed as the process of making meaning through acts of communication
mediated by mobile devices. They also give users access to knowledge distributed across people,
communities, locations, time, social context and sites of practice. An example of this is the
introduction of specific sources of evidence such as UpToDate which has allowed healthcare
workers in low resource settings to access internet based medical information resources for
teaching and practice.23 Another important element of mobile phone use is the concept of
“Agency”. This involves the formation of an identity by which users communicate and form
technology mediated relationships with others. The goal is to not to replace direct experience and
communication, but to facilitate learning experience in the clinical or fieldwork setting.17,24 The
last element, Culture refers to the way individuals use mobile devices in everyday life and for
education. It involves the adoption of personalized media and application preferences,
development of computer skills, and creation and dissemination of content. Culture also refers to
how individuals use devices for socializing and networking which create the contexts for
learning.24
Institutions in high-resource settings have adopted “Web 2.0” practices which involve the use of
mobile technology for collaborating, exploring new knowledge, pursuing inquiry, and
publishing to audiences.25 Examples of Web 2.0 software include Learning Management
Systems (LMS) such as Canvas, Blackboard and Moodle that can be used for posting teaching
materials, course objectives, syllabi, or events. Among these, Moodle is mostly used because of
its features and characteristics that support e-learning. Moodle is an acronym for Modular
Object-Oriented Dynamic Learning Environment. Moodle is based on the social constructivist
pedagogy, which relates to contemporary achievements for increasing interaction among
students (https://docs.moodle.org/27/en/Philosophy). Moodle has been shown to increase Self
Directed Learning (SDL).26 There are over 6,000 sites from over 130 countries which use
Moodle. Moodle also supports over 60 languages.27 It is designed in a modular approach and the
basic version includes at least 15 modules. The themes, activities, interface languages, database
schemas and course formats are also modular enabling anyone to add features to the main code
base or to even distribute it freely.
Moodle shows course listings with descriptions for every course on the server, including
accessibility to guests. Courses can be categorized and searched. It also has robust grading
capabilities for forums, journals, quizzes and assignments. Full user logging and tracking activity reports for each student are available with graphs and details about each module (last
access, number of times read) as well as a detailed "story" of each student involvement including
postings etc. A successful Moodle implementation can be easily transferred to other setting.28
Moodle supports some of the widely accepted standards and specifications in e-learning
(http://www.adlnet.gov/scorm). SCORM (Sharable Content Object Reference Model) is a
standard specification for Web-based Training contents, developed by ADL (Advanced
Distributed Learning) in the United States. There is a certification process run by ADL to ensure
compliance with SCORM. Compliance with SCORM enables materials to run on different LMS,
and to use SCOs (Sharable Content Objects) in different course structures. The increased
accessibility of the internet in these settings makes the use of a LMS with e-learning material
feasible for information dissemination and active learner participation in resource limited
settings.
Justification/Rationale
While the use of ICT in medical schools in Sub-Saharan Africa is expanding, most of the
evaluations of ICT use are made through questionnaires.2,4,7-11 There are few reports on mobile
device use to inform a strategy for implementation in institutional settings in low and middle
income countries. In addition, little is known of the sociocultural and educational impact of the
use of mobile devices in conjunction with learning management systems. In this study we will
combine longitudinal surveys with objective measures of ICT use, such as, anonymous topic
search tracking, internet usage, and device location to evaluate familiarity, usage-learning
materials, and educational outcomes using the Moodle learning management system on Google
Android tablets in a medical school located in a low-resource setting.
Materials & Methods
Study Participants:
Study participants will be Moi University School of Medicine students and teachers, HI-TRAIN
students (Masters and PhD in Health Informatics), and Clinicians working within the AMPATH
Care Program.
Inclusion Criteria:
Faculty and students at Moi University who collect the tablets for use
Exclusion Criteria:
Students who have completed their studies at the University
Study Methods:
A: Intervention
Participants will be given tablet devices for use primarily for educational purposes. In addition to
routine software contained within the tablet devices, a Moodle eLearning application, and several
other educational applications will be installed. The educational content within the tablet will be
loaded manually or automatically as part of the eLearning platform. The content will be in
various formats including PDFs, PowerPoint presentations, and various kinds of Media (video,
images or audio). Content will be updated as needed for the particular user.
The devices will also contain applications with ability to limit access to particular features on the
device. As such, features can be turned off or on by the study team as needed. Participants will
have access to particular educational materials as determined by the investigators. Oftentimes,
this same material will be available online with the right authentication.
Applications will have the ability to identify use patterns through in-built functionality to log
device use, and there will also be ability to offer pre- and post-testing for specific educational
content. Surveys will include questions on familiarity with ICT and internet use, usability of the
device, rating of mobile applications, rating of the Moodle learning management system (LMS)
and elearning content.
Evaluations:
We will perform the following evaluations during the implementation period:








Baseline comfort and literacy with technology and mLearning/eLearning approaches (by
both teachers and learners) will be evaluated through surveys and/or focus group
discussions.
Perceptions of the mLearning options (as compared with other learning modalities) will
be evaluated through surveys and/or focus group discussions.
Use patterns of the mobile technology and devices will be determined through logs and
survey responses. This will include which topics are most accessed, what are the usage
patterns, what else do they use the devices for? How often do they use the other medical
apps?
Improvement in knowledge through the eLearning platform will be evaluated through
surveys, and evaluation of performance by pre- vs. post- testing.
Cost implications of using mobile technology / scalability implications / mobility
implications will be determined.
Impact of mobile technology on student perspectives, motivation, synchronous and
asynchronous interactions and clinical practice will be evaluated through surveys and/or
focus group discussions.
Use of mobile technology to facilitate user-generated content, communication, and
reflection will be evaluated through surveys and/or focus group discussions
We will also evaluate impact of targeted learning experiences based on decision supportgenerated educational suggestions
Data Analysis
Longitudinal survey data will be reported using mean and standard deviation. Pre-/post-user data
will be compared using the paired t-test for the baseline and last survey collected. Mean data at
interval points will be compared within and between groups using ANOVA. Pair-wise
comparisons will be made between the study group performance and historical controls using the
two-tailed independent t-test. A p-value of < 0.05 will be considered significant.
Ethical Considerations
Surveys will be administered through the LMS. All reports will be made in aggregate and survey
data will be stored securely. Device-related data will be collected and stored anonymously. All
study data will be stored securely in a locked file cabinet in the PI’s office and every effort will
be made to protect the confidentiality of study participants. Study data in paper or electronic
format will be destroyed seven years after completion of the study.
Expected Outcomes
We expect to define the acceptability and patterns of use of the learning management system and
mobile devices for medical education in a low-resource setting. This study will add to the
growing body of evidence on elearning in Sub-Saharan Africa.
Timeline
1.
2.
3.
4.
Event
Distribution of tablets and registration of user accounts
Administration of user surveys
Data Analysis
Publication
Data
January – March 2015
March 2015 then Quarterly
January 2016
June 2016
References
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Winters N. What is mobile learning. Big issues in mobile learning. 2007:7-11.
Bediang G, Stoll B, Geissbuhler A, et al. Computer literacy and E-learning perception in
Cameroon: the case of Yaounde Faculty of Medicine and Biomedical Sciences. BMC
medical education. 2013;13(1):57.
Ahmed A, Yousif E, Abdalla M. Use of the Internet by Sudanese doctors and medical
students. East Mediterr Health J. 2008;14(1):134-141.
Asangansi IE, Adejoro OO, Farri O, Makinde O. Computer use among doctors in Africa:
Survey of trainees in a Nigerian teaching hospital. Journal of Health Informatics in
Developing Countries. 2008;2(1).
Bello IS, Arogundade FA, Sanusi AA, Ezeoma IT, Abioye-Kuteyi EA, Akinsola A.
Knowledge and utilization of Information Technology among health care professionals
and students in Ile-Ife, Nigeria: a case study of a university teaching hospital. Journal of
medical Internet research. 2004;6(4).
Chowdhury NS, Chowdhury NN, Rabbi F, Tabassum R, Ishrat S. Computer Literacy and
Attitudes Towards e-learning among Bangladeshi Medical Students. Update Dental
College Journal. 2014;3(1):3-6.
Woreta SA, Kebede Y, Zegeye DT. Knowledge and utilization of information
communication technology (ICT) among health science students at the University of
Gondar, North Western Ethiopia. BMC medical informatics and decision making.
2013;13(1):31.
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the Council and the European Parliament;2001.
Jones A, Issroff K. Motivation and mobile devices: exploring the role of appropriation and
coping strategies. Research in Learning Technology. 2007;15(3).
George P, Dumenco L, Doyle R, Dollase R. Incorporating iPads into a preclinical
curriculum: A pilot study. Medical teacher. 2013;35(3):226-230.
Davis JS, Garcia GD, Wyckoff MM, et al. Use of mobile learning module improves skills
in chest tube insertion. Journal of Surgical Research. 2012;177(1):21-26.
Tews M, Brennan K, Begaz T, Treat R. Medical student case presentation performance
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Medical education online. 2011;16.
Laurillard D. Pedagogical forms of mobile learning: framing research questions. 2007.
Russ AL, Zillich AJ, McManus MS, Doebbeling BN, Saleem JJ. Prescribers’ interactions
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investigation of the human–computer interaction. International journal of medical
informatics. 2012;81(4):232-243.
Sclafani J, Tirrell TF, Franko OI. Mobile tablet use among academic physicians and
trainees. Journal of medical systems. 2013;37(1):1-6.
Robinson RL, Burk MS. Tablet Computer Use by Medical Students in the United States.
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Colbert JA, Chokshi DA. Technology in Medical Education—Osler Meets Watson.
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Russ AL, Baker DA, Fahner WJ, et al. A rapid usability evaluation (RUE) method for
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Brooke J. SUS-A quick and dirty usability scale. Usability evaluation in industry.
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Finstad K. The system usability scale and non-native english speakers. Journal of
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Signatures of Investigators
Investigator
1
Dr. Thomas Sang Mwogi
2
Dr. Dennis Thirikwa
Signature
Appendix 1
Androids for GOOD User Survey
Please answer the following questions. Your participation will help us understand the needs of the
program and improve the selection of software offered. We will be administering this survey quarterly,
so please provide responses that reflect the use of the device in the last three months [RU1].
1. For trainees, please select your level of training:
Medical Student: Year 1 2 3 4 5 6
□ House Officer
□ Registrar: Year 1 2 3 >3
□ Other (please specify): __________________________
2. For faculty, please select your current appointment:
□ Lecturer II;
□ Lecturer I;
□ Senior Lecturer;
□ Reader;
□ Assistant Professor,
□ Associate Professor,
□ Professor
□ Other (please specify): __________________________
3. Gender:
□ Male
□ Female
4. Age (Years)
□ <24
□ 24-35
□ 34-45
□ 44-55
□ 54-65
□ >65
5. Years since medical school graduation:
□ 0-3 years;
□ 3-5 years;
□ 5-10 years;
□ 10-20 years;
□ > 20 years
6. Please select the sources of medical information to which you regularly have access (check all that
apply):
□ Library text books
□ Library journals
□ Personal text books
□ Personal journal subscription
□ AMPATH/Departmental resource materials (hard copy)
□ Android GOOD tablet educational resources
□ Internet via Android GOOD tablet
□ Internet via source other than Android GOOD tablet (please specify): ……………………………………..
□ News media
□ Other (please specify):
7. Currently, I use a personal computer device (include smartphone, but not basic cell phone)…
□ Daily
□ Weekly
□ Monthly
8. Currently, I access the internet on a personal computer device
□ Daily
□ Weekly
□ Monthly
9. What are your sources of internet wifi access when using the Android GOOD tablet? (Check all that
apply)
□ hostel
□ internet cafe
□ university library
□ hot spots
□ other...
10. On a scale of 1 to 5 with 1 being very accessible and 5 being very inaccessible, how would you rate
your access to medical information resources using the Android GOOD tablet?
□1
□2
□3
□ 4
□5
11. Considering only the last 3 months, how often you have used the device for:
The device is used for literature search on patient care related questions
□ Never
□ Rarely
□ Sometimes
□ Often
□ Frequently
□ Often
□ Frequently
The device is used for medical education
□ Never
□ Rarely
□ Sometimes
The device is used for literature search for research purposes
□ Never
□ Rarely
□ Sometimes
□ Often
□ Frequently
Other (please specify): …………………………………………..
□ Never
□ Rarely
□ Sometimes
□ Often
□ Frequently
12. If you use the device for literature search on patient care related questions please select the
location(s) in which the device is frequently used (check all that apply):
□ Hospital Inpatient Care
□ Hospital Outpatient Care
□ Community based/Outreach Care
□ Other (please specify):
13. If you use the device for medical education please select the location(s) in which the device is
frequently used (check all that apply):
□ The clinical area
□ The classroom
□ The library
□ The office
□ At home
□ Other (please specify):
14. If the device is used for medical education, please select how it is frequently used (check all that
apply):
□ Power Point presentation
□ Class Schedule
□ Teaching Videos
□ Video Conferencing
□ Tests
□ Class Assignments
□ Reading course work
□ Email
□ Other (please specify):
15. Please answer the following questions regarding your use of the Moodle platform
System Usability Scale
Strongly
Disagree
1. I think that I would like to use this
Strongly
Agree
system frequently.
2. I found
complex.
the
system
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
unnecessarily
3. I thought the system was easy to use.
4. I think that I would need the support of a
technical person to be able to use this
system.
5. I found the various functions in this
system were well integrated.
6. I thought there was too
inconsistency in this system.
much
7. I would imagine that most people would
learn to use this system very quickly.
8. I
found
the
system
cumbersome/awkward to use.
very
9. I felt very confident using the system.
10. I needed to learn a lot of things before I
could get going with this system.
Taken from The System Usability Scale (© Digital Equipment Corporation, 1986).
16. Please rate the following aspects of the Moodle platform on a scale of 1 to 5 with 1 being least
useful and 5 being most useful
□ calendar
□ messaging
□ courses
17. Please provide an overall rating of the educational content on Moodle using the following
categories
□ applicable to my healthcare setting
□ current/up-to-date
17. Rate the following preloaded mobile applications from 1 to 5 with 1 being most useful and 5 being
least useful
Insert application list
1 2 3 4 5
16. Select the top two search engines that are used most frequently for literature searches:
□ Google Scholar
□ Hinari
□ PubMed
□ Other (please specify below):
17. Please select the Specialty Area(s) most commonly searched (select all that apply)
□ Internal Medicine
□ Paediatrics
□ Obstetrics & Gynaecology
□ Surgery
□ Psychiatry
□ Radiology
□ Laboratory Medicine
□ Other (please specify):
17a. Please select the Subject Area(s) most commonly searched (select all that apply)
□ Adolescent Medicine
□ Allergy/Immunology
□ Critical Care Medicine
□ Gastroenterology
□ Haematology
□ Hepatology
□ Nephrology
□ Cardiology
□ Infectious Disease
□ General Internal Medicine
□ Genetics
□ Geriatrics
□
□
□
□
□
□
□
□
HIV Medicine
Dermatology
Neurology
Pulmonology
Endocrinology
Rheumatology
Oncology
Other (please specify):
17b. Please select the Subject Area(s) most commonly searched (all that apply)
□ Adolescent Medicine
□ Paediatric Allergy/Immunology
□ Developmental-Behavioural Paediatrics
□ Paediatric Critical Care
□ Paediatric Gastroenterology
□ Paediatric Nephrology
□ Paediatric Cardiology
□ Paediatric Infectious Disease
□ Paediatric Dermatology
□ Paediatric Neurology
□ Neonatology
□ Paediatric Pulmonology
□ Paediatric Endocrinology
□ Paediatric Rheumatology
□ Paediatric Haematology/Oncology
□ Other (please specify):
17c. Please select the Subject Area(s) most commonly searched (select all that apply)
□ Obstetric Critical Care
□ Obstetrics
□ Maternal & Fetal Medicine
□ Gynaecology
□ Reproductive Endocrinology
□ Gynaecological Oncology
□ Other (please specify):
17d. Please select the Subject Area(s) most commonly searched (select all that apply)
□ General Surgery
□ Trauma Surgery
□ Cardiothoracic Surgery
□ Head & Neck Surgery
□ Oral & Maxillofacial Surgery
□
□
□
□
□
□
□
□
□
Paediatric Surgery
Cosmetic Surgery
Neurosurgery
ENT
Orthopedics
Ophthalmology
Surgical Oncology
Urology
Other (please specify):
17e. Please select the Subject Area(s) most commonly searched (select all that apply)
□ Clinical Pathology
□ Chemical Pathology
□ Medical Microbiology
□ Molecular Genetics
□ Haematology
□ Histology
□ Other (please specify):
18. Please select the primary purpose of the use of the educational material on the device (select all
that apply):
□ Clarifying concepts
□ Anatomy
□ Physiology
□ Biochemistry
□ Physical examination skills
□ Clinical presentation
□ Differential Diagnosis
□ Definitive Diagnosis
□ Investigations and labs
□ Treatment/Management
□ Prognosis
□ Preventive care
□ Aetiology/Pathophysiology
□ Staging and Grading of disease
□ Complications of disease
□ Drug Interactions
□ Drug side effects
□ Drug dosages
□ Drug choices
□ Other (please specify below):
(use logic from questions 1 and 2) 19. Please indicate the aspect of students’ (doctors’) clinical practice
that is impacted by access to the educational material on the Android GOOD device (check all that
apply):
□ History-taking
□ Examination skills
□ Investigation(s) ordering decision
□ Diagnosis
□ Therapy choice
□ Prognosis
□ Preventive care
□ Procedure decision
□ Referral decision
□ Other (please specify below):
Please enter any other comments including difficulties with the use of the educational material on the
device in the field below.
………………………………………………………………………………………………………………………………..………………………………
……………………………………………………………………………………………………………………………………..……
Thank you for your responses. Please contact mwogin@gmail.com for additional questions or concerns
regarding the educational applications on this device. Any technical difficulties or device malfunction
should be brought to the attention of the IT team immediately by contacting Mr. Macharia at 0724
333780