Care, Compassion and Self-compassion: A Mixed Methods, Realistic Evaluation of a Massive Open Online Course (MOOC)

Abstract

Abstract Background Compassion is intrinsic within modern healthcare and is heavily debated and discussed within current news and literature (Dewar and Nolan, 2013; Mills et al, 2015). Massive Open Online Courses (MOOCs) are a relatively new phenomenon not just in healthcare but also in education, as a whole (Sarabia-Cobo et al, 2015; Parkinson, 2015). Their main purpose is to capture the attention of a diverse and global audience in order to increase knowledge and understanding through the provision of university level education (Sneddon et al, 2018; Hebdon et al, 2016). The Scottish Improvement Science Collaborating Centre, University of Dundee, developed a care and compassion MOOC hosted by FutureLearn, a digital education platform. This five-week MOOC provided learning resources, activities and information to healthcare professionals and the public in order to raise awareness and understanding of compassion and help improve the provision of compassionate care. Aim The aim of this research was to (1) evaluate a new educational intervention, delivered by a MOOC, focused on compassion, and (2) consider how and why it could help facilitate change in the attitudes, behaviours, and practices of healthcare professionals. Design A Realistic Evaluation approach was taken which allowed for an understanding of how an educational intervention could facilitate change in healthcare professionals by asking how and what, worked for whom, in what circumstances. The realistic evaluation design was underpinned by the philosophical principle of pragmatism which allowed for the who, what and why questions to be answered through a combination of both qualitative and quantitative methods. Sample/Data Collection Quantitative research was undertaken and created two sets of data. Data set 1 (3888 registered learners): fundamental demographics and attrition/retention rates (which were collected automatically via the FutureLearn platform). Data set 2 (957 completed the pre-course, 84 completed the post-course and 42 completed both): relating to those who had completed the pre and post MOOC survey for this project (initiated, designed, and managed by the researcher for the purpose of this research). Qualitative data were collected via two methods: MOOC discussion board (112 participants) and MOOC participant interviews (14 participants). Results Findings from quantitative data set 1 (MOOC demographics) – these data provided a contextual background to the online learning and demonstrated participation and engagement. 3888 learners originally registered at the beginning of the course with only 8% of this number making the conscious choice to no longer be part of the course at some point during the learning. Of those that remained registered 49% were described as active learners, 18% as social learners and the rest falling out with either of these descriptors. Additionally, findings relating to the pre, and post course survey data also demonstrated that the MOOC learning was met positively overall by the learners with the majority of those indicating that it was interactive, well balanced, and useful to their work and lives going forward. Data set 2 (pre and post course surveys relating to compassion and self-compassion) - these data demonstrated little significant change amongst all tested categories. In keeping with the theoretical underpinning of realistic evaluation and its need to be more considered than simply if something works or not, this research considers what changes have been made within what conditions. These data could imply that, although not statistically significant, there is a trend in changes to survey responses that could suggest that learning could be providing an opportunity for deeper thought. Findings from the qualitative analysis exposed 4 overarching themes: Changes to attitudes and behaviours around compassion; Compassionate care changes reflected in practice; The emotional burden of compassion; and Experiences of the MOOC. Conclusion In conclusion, it is important to acknowledge that realistic evaluation does not aim to merely prove or disprove theories but rather unearth observable patterns which can explain what works and why. Each area of analysis; learning analytics, quantitative and qualitative, demonstrated a degree of change from pre to post course. Overall, this MOOC was acknowledged as being a potentially valuable educational tool due to its flexibility, content and most importantly the availability of discussion forums in which learners could share differing narratives and stories in order to enhance their learning. In summarising, the author identified two valuable conclusions: Self-compassion – results demonstrated that through the MOOC learning, participants were able to link the way in which they care for themselves with the way they can care for others including colleagues and patients. Discussion boards - provided a valuable opportunity for healthcare professionals, lay people and the general public to share thoughts, experiences, opinions and anecdotes. This rich learning environment was particularly poignant in a world in which healthcare education is restricted to learning “within healthcare”. Recommendations Further in depth research needs to be undertaken in order to better understand the connection between online learning in complex subject areas such as compassion and possible improvement in healthcare practices. An observational study undertaken over a prolonged period of time would provide research to strengthen the argument for the use of MOOCs in healthcare education. Additionally, data which measures the patient perspective and the impact on the quality of compassionate care that they receive would provide further value in the evaluation of MOOCs in this area. Implications for Practice The overall findings from the research project will be used to inform educators, healthcare leaders and practitioners of the usefulness of a MOOC to learn about compassionate care. However, the researcher identified a significant area for development in practice which would allow the vital messages of self-compassion and compassion to be shared. This could be done through the utilisation of the MOOC learning and the creation of a new champion role within healthcare, the “Compassion Champion”.