Objective: To investigate reasons, advantages, disadvantages and obstacles in the use of digital technology media for health learning during the coronavirus disease-2019 pandemic.
Methods: The systematic review was conducted from January to February 2022 and comprised search on Google Scholar, ProQuest, PubMed, ScienceDirect and Scopus databases for articles published from 2020 to March 2022 related to the use of digital technology by medical students, teachers and academics. Key words used for the search included digital technology, health learning, health education, COVID-19, COVID-19 pandemic, and coronavirus disease 2019. Main themes were identified which were then grouped into components using Joanna Briggs Institute guidelines and tools.
Results: Of the 128 articles initially found, 10(7.8%) were subjected to detailed analysis. Reasons identified were lockdown and accessibility of flexible learning materials. Advantages were effective time, better effort, saving money, improving technical skills, health security, feasibility, e-learning standardising, dedicated teaching, interdisciplinary collaboration network, creativity, inclusivity and professional development. Disadvantages were inadequate tools, poor internet connection, lack of technical skills, practical in classes, unclear policies, examinations, distribution of grades and limited online exam time. Obstacles included virtual class etiquette disobedience, inadequate interactions, time limitations, infrastructure, distractions, lack of engagement, stress, technical and limited data plans.
Conclusion: Many universities used digital technology in health learning during the pandemic-led lockdowns as it provided greater advantages.
Keywords: COVID-19, Digital Technology, Pandemics, Communicable disease control. (JPMA 73: S-135 [Suppl. 2]; 2023)
On December 31, 2019, coronavirus disease-2019 (COVID-19) was identified and reported by China in its Wuhan city. Only two months later, on March 11, 2020, the World Health Organisation (WHO) declared it a global pandemic, indicating that the virus had spread rapidly throughout the world.1 Subsequently, almost all countries implemented lockdowns which had an impact on various aspects of life, including the process of teaching and learning in schools, which needed innovation with digital technology systems to facilitate distance learning. Digital technology media, such as computers, smartphone and laptops, enriched with Zoom applications, Google Meet, WhatsApp, Skype, and learning management system (LMS) were very useful for facilitating digital-based learning. Such technology gave high motivation to students to keep learning anywhere and anytime during the pandemic.2 Until May 22, 2022, WHO notified 522 million cases and 6 million deaths globally, 58 million deaths and 788,157 deaths in Southeast Asia, 6.05 million cases and 156,586 deaths in Indonesia, and 22,913 cases and 131 deaths in Timor-Leste.3
Digital learning applications can facilitate the performance of students to share knowledge with colleagues. Computer information technology (CIT) contributes to improving research skills and technical competence of students.2 Using digital technology, such as computers, has a significant positive correlation with students’ attitudes and self-efficacy (r=0.60, p<0.001).4
The current systematic review was planned to investigate reasons, advantages, disadvantages and obstacles in the use of digital technology media for health learning during the COVID-19 pandemic.
The systematic review was conducted from January to February 2022 and comprised search on Google Scholar, ProQuest, PubMed, ScienceDirect and Scopus databases for articles published from 2020 to March 2022 related to the use of digital technology by medical students, teachers and academics.
The studies included were the ones that focussed on medical students and academics who had used digital technology for learning or teaching purposes during the pandemic. The outcome of the study explained the reasons for the choice of digital technology as well as the advantages, disadvantages and obstacles of using digital platforms. Cross-sectional, quantitative and qualitative studies published in the English language were included.
Those excluded were studies that did not discuss the use of digital technology in medical education during the pandemic, had no comparative factor, the outcome did not discuss factors related to the choice of digital technology, those that were published before 2020 or published in a language other than English.
Quality appraisal of the included studies was done using the Joanna Briggs Institute (JBI) guidelines and tools (Joanna Briggs Institute & JBI, 2017)5 the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist6 and the Population, Intervention, Comparison, Outcomes and Study (PICOS) format (Cumpston et al., 2021).7
Details of all the selected articles, like authors, date, methods (design, subject, variable, instrument and analysis) and results, were noted. Main themes were identified and then grouped into four components.
Of the 128 articles initially found, 10 (7.8%) (Figure).
These were done in Pakistan, Brunei, Malaysia, Saudi Arabia, Jamaica, India, Jordan, Nepal, Lebanon and California in the United States.2,8-15 There were 5(50%) studies using a cross-sectional design, 3(30%) were quantitative, and 2(20%) were qualitative. JBI critical appraisal value ranged between 80-100% (Table 1), indicating eligibility for inclusion.
The assessment of all the 10(100%) studies suggested there may be bias, but on a small scale, because they were all clearly designed. However, since most of the data-collection instruments were questionnaires, it was necessary to test their validity and reliability which was mentioned by 1(10%) study. In addition, the readiness or ability of the digital users’ learning capacity may have also caused bias during data-collection. Among the studies, 1(10%) study reported having collected data online which could have been shared by a friend or other person while answering the questionnaire received online.
Reasons identified included lockdown and accessibility of flexible learning materials. Advantages included effective time, better effort, saving money, improving technical skills, health security, feasibility, e-learning standardising, dedicated teaching, interdisciplinary collaboration network, creativity, inclusivity and professional development.16 Disadvantages included inadequate tools, poor internet connection, lack of technical skills, practical in classes, unclear policies, examinations, distribution of grades and limited online exam time. Finally, obstacles included virtual class etiquette disobedience, inadequate interactions, time limitations, infrastructure, distractions, lack of engagement, stress, technical and limited data plans (Table 2).16
Digital applications used in the learning process generally had three main reasons; obligation to follow government decision, flexibility offered by digital technology, and protection against COVID-19. This reflected in the studies analysed.8,9
The current review identified 5 major advantages of using a digital learning system; flexibility in terms of time and place, effective time utilisation, saving money, decreased risk of accident, and health security.10 A study8 stated that digital learning decreased the risk of accident, because people did not have to travel from home to college to access learning activities.
However, it is not as smooth as one may expect, and while digital learning has flexibility, it also has weaknesses, like lack of participants’ engagement during the learning process and the consequent mental stress.11
The current review identified 10 distractions in the use of digital technology for distance learning.8,12
Many universities used digital technology in health learning during the pandemic-led lockdowns as it provided greater advantages. However, there were disadvantages and obstacle as well that need to be addressed for optimising the experience.
Limitation: The current literature review was not registered with the Prospective Register of Systematic Reviews (PROSPERO), which is a limitation.
Acknowledgment: We are grateful to the online database providers, the committee of the International Nursing Conference of Universitas Airlangga (UNAIR), Marni, of Duta Bangsa University, Indonesia, Sebastiao Pereira and Agostinho dos S. Goncalves, of Instituto Superior Cristal, and Nelson Martins, of Dalso Research and Development, Timor-Leste, for their support.
Disclaimer: The study was presented at the 13th International Nursing Conference, 2022, at Universitas Airlangga, Indonesia.
Conflict of Interest: None.
Source of Funding: None.
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