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Editor’s Note
: This study reinforces the significance of eLearning for professional development and its ability to support unserved and underserved populations. It also explores parameters that influence learner comfort and success influenced by language, culture, geography, learning style preferences, technology literacy and technology support.

Promoting Comfort in E-Learning for Professional Women:
Examining Access, Language and Culture,
Learning Preferences and Role Integration

Mary-Anne Andrusyszyn and C. E. (Betty) Cragg


E-learning, from the context of distance education for professional women, is discussed in this paper. Studies conducted with women, principally nurses, in graduate and undergraduate distance programs, that reflect the issues of gaining comfort when studying by distance education are highlighted. An overview of some of the technological and design conditions that contribute to e-learning environments which enhance students’ success in and satisfaction with distance programs and promote knowledge development are presented. Specifically, comfort is addressed as it relates to technological access, learner preferences for distance delivery methods, language and culture, and integration of the e-learning role into one’s life.

Keywords: e-learning, professional women, learning preferences, role integration, distance education


E-learning encompasses any technologically-mediated interaction between teacher and students and among students. It includes online communication, print-based materials, and audio-and video teleconferencing. For e-learning to be successful, learners must achieve comfort in technologically-mediated environments so that they can concentrate on learning outcomes rather than technology. Discomfort may arise from the technology, the language and culture of the teacher, fellow participants, and/or course, as well as the role integration required to learn from home using technology.

E-learning, from the context of distance education for professional women, is discussed in this paper. Studies conducted with women, principally nurses, in graduate and undergraduate distance programs, that reflect the issues of gaining comfort when studying by distance education are highlighted. These include students in the Primary Health Care Nurse Practitioner (NP) post-baccalaureate certificate program offered in Ontario, Canada through a 10-university consortium since 1995 (Andrusyszyn, et al., 1999; Andrusyszyn, Cragg, & Humbert, 2001; Cragg, Andrusyszyn, Humbert & Wilson, 1998; Cragg, Humbert, & Doucette, 2000; Cragg, McLean, Andrusyszyn, Doucette & Mes, 1998; Cragg, Humbert, & Doucette, 2004; Doucette, Cragg & Humbert, 2002). Additionally, they include a study that linked Canadian and Norwegian nursing graduate students through computer-and videoconferencing (Andrusyszyn et. al., 2001; Iwasiw et. al., 1999; Moen et. al., 2000), as well as recent work with women in Canadian distance education programs (Cragg, Andrusyszyn, & Fraser, 2005).

An overview of some of the technological and design conditions that contribute to e-learning environments which enhance students’ success in and satisfaction with distance programs and promote knowledge development are presented. Specifically, comfort will be addressed as it relates to technological access, learner preferences for distance delivery methods, language and culture, and integration of the e-learning role into one’s life.

Women in Distance Education

Women are important participants in distance education in Canada. Many professional women are taking distance courses to advance academically, gain credentials, and maintain or enhance professional competence (Bray, 1988; Coulter, 1989; Gwyther, 1999). Before the advent of readily accessible professional education by distance, participating in continuing education placed a considerable burden on professional women. Many had to travel long distances to access educational opportunities despite family, work, and community obligations. The role of student was added to their already complex lives as employees, employers, spouses, mothers, community volunteers, and caregivers for elderly and ill relatives (Crosby, 1991; Repetti, 1987; Repetti, Matthews & Waldron, 1989). Making a commitment to continuing education, although professionally and personally desirable, required more sacrifice than many women could accept or manage. Distance education eased the integration of the student role into busy lives, facilitated access to programs, and enhanced learner control over timing and location of educational efforts.

One of the challenges professional women as distance learners face, however, is adapting to and gaining comfort with the technological learning environment (Fraser & Haughey, 1999). Nurses and other mature women who have not been previously exposed to computers in their education may be daunted by the prospect of relying on computers and the Internet for their education. Using unfamiliar technology, engaging in learning activities not congruent with learning preferences, or studying in places or at times that interfere with life circumstances, may lead to discouragement or frustration. Learners may be unable to readily achieve cognitive and affective learning outcomes intended by program developers (Hara & Kling, 2000).

Comfort in the learning environment is fundamental for student achievement. Adapting quickly to an e-learning environment and shifting concentration from the context to the content of the learning experience are essential for success. Ideally, learners can achieve this comfort when educational programs ensure an infrastructure that supports learners’ adaptation to delivery methods, and develop course designs that are congruent with the content and complement individual learners’ preferences and experiences.

Promoting E-Learning Comfort by Easing Technological Access

The Nurse Practitioner Experience

One of the prerequisites for comfort in e-learning is developing the ability to access the online environment and navigate within the program (Bates & Poole, 2003). From annual data collected from participants enrolled in the Primary Health Care Nurse Practitioner (NP) Program offered by distance through a consortium of 10 Ontario universities since 1995, program administrators were concerned that it took a majority of NP students and professors at least 6 weeks to log on and feel comfortable communicating in their courses (Cragg, et al., 2004). While a number of distance delivery methods were used, computer-based learning materials, conferencing, and chat rooms were increasingly important. Spending 50% of a 13-week term adapting to the learning environment was a major source of discomfort and anxiety to students. They were frustrated by their inability to navigate and participate easily in their courses. As a result, they were not focused on achieving intended learning outcomes such as expanding their knowledge about diagnostic reasoning, evaluating changes in their roles and responsibilities, or applying critical reasoning to the evidence supporting their expanded practice.

To help these learners adapt more rapidly to the e-learning environment, a “toolbox” of strategies developed with funding from the Office of Learning Technologies (OLT) of Human Resources Development Canada (HRDC) was tested (Cragg, et al., 2000). The project allowed refinement of existing materials and approaches, creation of new strategies, and systematic evaluation of the toolbox. Since implementation, support strategies continued to evolve with annual revisions (Doucette, et al., 2002). These included written materials sent to learners on admission to help them purchase or upgrade computers, select an Internet Service Provider (ISP), and log on to the program. Frequently Asked Questions (FAQs), and online guidelines assisted students with particular tasks. A CDROM providing learners with standardized versions of software required for the program and supported by the program’s technical support staff, tutorials for software, and video-clips of professors introducing their courses, were also developed. Standardized software minimized downloading problems; prevented being timed-out by ISPs during downloads; and provided common software.

Strategies were implemented to help students learn the necessary technical skills before they began courses. They attended a mandatory, standardized, face-to-face orientation with extensive hands-on practice. Chats were scheduled to let students log in and practice synchronous participation from home. Online self-tests helped students demonstrate their ability to log on to discussions, and send and receive both e-mails and attachments. Online pre-course tests assisted students to identify gaps in prerequisite knowledge necessary to succeed in the program, and provided practice with the program’s online exam format. Human support was also available by telephone and e-mail, and the majority of students contacted their assigned support person for help and advice at least once, usually at the beginning of the program.

Pre- and post-surveys to assess NP students’ attitudes to computers and computer efficacy with a number of tasks were conducted on admission and completion of their first term in the program (Cragg, et al., 2004). Students also reported on their experience with the toolbox elements and how rapidly they were able to log on and feel comfortable in their courses. Interestingly, the group admitted the first year after the toolbox was implemented showed few differences on questionnaire results from the group admitted the year before the toolbox was developed. This lack of difference may be partly attributed to supports already in place before the project began (e.g., written materials, FAQs, orientation), and which were only revised. Another factor noted was that students coming into the program the year after the toolbox was implemented demonstrated different initial attitudes for and efficacy with computer skills. That is, although they demonstrated a significant increase in scores from pre-test to post-test, their post-test scores on attitudes to computers and efficacy with required skills did not reach the pre-test levels of the students admitted the year before toolbox implementation. These results demonstrate that different groups of students and different individuals within groups, even in the same program, come to their e-learning with varying levels of technological proficiency. Thus, they may require different amounts and types of help. For example, in 2002, 95% of students entering the NP program were online and comfortable communicating in their courses in four weeks or less (Cragg et al., 2004). Thus, a range of flexible supports to address multiple learner needs is helpful and program planners need to keep pace with changing program requirements and student experiences.

The Canada-Norway Experience

Learners’ access to e-learning tools can have a profound effect on the quality and experience of e-learning (Andrusyszyn et. al., 2001; Iwasiw et. al., 1999; Moen et. al., 2000). In 1996, 24 nursing graduate students from Canada and Norway participated in an international study, funded by the Network of Ontario Distance Education (NODE), which examined the effectiveness of using computer-conferencing (CC) to link learners in Master’s level courses focused on nursing leadership Following an orientation to the technology, participants dialogued online for three weeks using case studies as the stimulus to frame knowledge development. Desired study outcomes were for students to develop common understandings about leadership and health care issues that crossed borders and cultures, and to develop comfort with asynchronous CC.

The ease of access to technology was undeniably different for both groups. Only two of the 16 Norwegian students had personal computers and all came to the university computer lab to access postings, while all eight of the Canadian students had personal computers at home or had access through their employers. The rich dialogue that one might expect in a CC course was still present, although it was different in nature as Norwegian students did not normally submit individual contributions. They met face-to-face in groups, discussed the cases, and then composed collective responses. Thus, Norwegian students had the opportunity to share individual reflections in person, examine and integrate their ideas, and then contribute shared impressions to the evolving dialogue. This approach was very similar to what normally happens in a face-to-face classroom, yet it was different from the strategy used by Canadian colleagues, who put forward individual responses to the online discussion. Norwegian students were confronted with numerous contributions from their Canadian counterparts each time they entered the system. They had to make sense of what they read, synthesize it, consider responses from their perspective, and then compose a collective response. Lack of easy access to computers meant they had little time to prepare by reading the evolving dialogue and therefore had little opportunity to reflect on individual understandings before contributing. Norwegian nurses had to accelerate their critical thinking and reflection skills to keep the discussion moving. Although a reasonable approach, it was not one educators anticipated. It added a very interesting, but complex, and perhaps unbalanced dimension to the development of the learning activity. Although nothing precluded Canadian students from meeting in groups to discuss the cases, this was not an expectation nor did it occur spontaneously.

Promoting E-Learning Comfort by Recognizing
Preferred Delivery Methods

The Nurse Practitioner Experience

Comfort with e-learning is also enhanced when the chosen technology and the design of learning materials are congruent with learner preferences (Andrusyszyn, et al., 1999; Cragg, et al., 1998; Cragg, McLean, et al., 1998). In 1997, NODE funded research studies that examined the consequences of using different forms of technology for NP students in Ontario. An evaluation study of the NP program, funded by the Ontario Ministry of Health, was also conducted at this time (Andrusyszyn et. al., 1999). Nurse practitioners were an ideal group for comparative study of technologies because these students were expected to adapt to a variety of distance delivery methods and rapidly become proficient using them. Anglophone and francophone students responded to qualitative interviews and quantitative surveys (N=86; 71% response rate) in which they identified their preferences for technologically-mediated delivery method (Cragg, 1998; 1999). Their choices were based on individual approaches to learning, type of content to be learned, and experiences with various forms of technology.

Students’ preferences for approaches to learning included considering the big picture, setting their own learning plans, and focusing on concrete examples. They preferred learning on their own or in small groups. There were significant associations among several learning approaches and delivery methods. For example, those who preferred learning on their own favored reading. As anticipated, CC was negatively related to preference for learning new things by observation (Cragg, et. al., 1999). At the time the study was conducted, CC was a new technology for both learners and professors. Student reports indicated this delivery method showed the greatest perceived increase in comfort from the beginning to end of the program (Andrusyszyn, et al., 1999; Andrusyszyn, et al., 2001). After having adapted to this e-learning environment, learners were grateful for having developed computer and Internet proficiency, and valued these as transferable and life-long learning skills.

When the NPs were asked to identify delivery methods they would prefer for specific program content, a variety were chosen. Video-teleconferencing was preferred for counseling, political action, and transcultural content. Videotapes were preferred for physical assessment. Using a CDROM scored high for learning pathophysiological principles and pharmacotherapeutics. For all content areas, print-based materials were rated among the most preferred delivery methods. Reading was perceived as a foundation to learning, a reliable, portable, and familiar approach. Audiotapes, despite their familiarity, were always among the least preferred methods (Cragg, et al., 1999).

Reliability and familiarity were important factors in students’ choice of preferred delivery methods (Cragg et al., 1999). Technological breakdown, poor technical quality of materials like videotapes, and lack of familiarity with computers were among the factors that led students to give low ratings to some of the more highly technological delivery methods. Provided they could access materials, students reported they often modified them to suit their preferred means of learning. They printed CCs, taped audio-teleconferences or tutorials, and formed face-to-face study groups. Sixty-five individuals (75.6% of valid responses) acknowledged making such a conversion.

Reflecting upon students’ preferences, it is evident that experience with technology and access are important factors in designing e-learning. If students do not have ready access to the requisites for learning, or if they cannot readily adapt to make the e-learning conditions familiar and comfortable, educators run the risk of having students reject or take exception to this mode of learning.

Language, Culture and E-Learning Comfort

Language and culture are factors that should be considered in relation to e-learning comfort (Andrusyszyn et. al., 2001). Canadian anglophone and Norwegian Master’s students and Canadian anglophone and francophone NP students, provided interesting perspectives related to linguistic and cultural e-comfort. Even though the Norwegian group’s command of the English language was excellent, they required more time to synthesize ideas and present them coherently online. They needed more time to discuss case studies (Andrusyszyn et. al., 2001). They put effort into understanding the nuances of Canadian expressions and viewed this uncomfortable process as one in which they experienced “cultural pain”. Analyzing one case per week made sound conceptual and andragogical sense, however, one extensive case, unfolding over time and approached from multiple perspectives over three weeks, might have helped Norwegian learners achieve intended learning outcomes with greater comfort. They would have had time to study the same case from different perspectives and possibly feel less pressured to shift conceptual gears.

In the NP program, anglophone and francophone students studied in their own linguistic groups, although their professors collaborated in the development of parallel course materials and approaches. Quantitative comparisons were difficult because of the small numbers of francophone students. However, it was clear that differences identified were due more to experiences with technology than linguistic or cultural issues. Francophones were more satisfied with audio-teleconferences than anglophones (Cragg, et. al., 1998; Cragg, McLean, et al., 1998). However, this difference was attributed to the fact that francophone courses had smaller enrolments, and therefore, each student could participate more actively in discussions. Anglophone students selected video-teleconferencing as a preferred delivery medium for specific content more frequently than francophones. Anglophones had not been exposed to the medium and believed that visual images would enhance their learning, while the francophones, who had experience with video-teleconferences, had been frustrated by frequent technological breakdowns. In these studies, both groups of NPs had been learning in their own language and culture, and differences in perspectives could be attributed to these factors. Nevertheless, creating a comfortable learning environment is integral to course design. Not only must attention be given to making sure access is unencumbered and smooth, language and culture of participants are important considerations. Access to technology should be parallel among participants to promote balance in discussion.

E-Learning Comfort and Role Integration

In addition to engaging positively with technology, experiencing meaningful through course designs that are congruent with their learning preferences, language, and culture, students need to be able to integrate their role as e-learners into their lives. For example, women assume many roles in society and adding the role of e-learner can upset the balance of their lives (Coulter, 1989; Pym, 1992). To concentrate on learning, they must reconcile competing demands for attention. The issue of student role integration was the focus of studies funded by the OLT (HRDC) with professional women. These two studies examined the advantages and stressors for women of being a distance education student in a professional program (Fraser, Cragg & Andrusyszyn, 2003). A qualitative study (phase one) was based on interviews with 25 Canadian women in nursing and accounting programs. A subsequent quantitative study (phase two) was conducted using a survey based on data from phase one and the literature. Five hundred and eighty one women in accounting, nursing, health studies, business administration, and education completed the questionnaire. While respondents identified some concerns about technology, these were secondary to those about how adding the role of student influenced family and work life. The results provided insight into the factors that influence success in maintaining a comfortable, balanced life while studying at a distance.

Women identified advantages to taking professional education electronically. These included goal achievement, job enhancement, lifestyle changes, and role modeling life-long learning for children and colleagues. Saving travel time and controlling study time to accommodate other demands were important positive factors, especially for those in asynchronous delivery programs. Women responding to the survey items on self-esteem indicated high levels of personal and professional well-being. They also reported they had gained respect from spouses. In items that could be perceived as either positive or negative, depending on the circumstances, flexibility, self-transformation, independence, and accessibility (to education) were rated as positive attributes of distance education by a majority of these women.

Stressors these professional women identified reflected difficulties in adding the e-learner role to many others. Phase one respondents reported that family relationships and friendships suffered as life was put on hold for the duration of the program. Only two of the 25 reported placing their priorities on personal life instead of academic demands. Less time for family and children was frequently mentioned. Guilt or frustration at not being able to “do it all” was evident. In the survey (phase 2), women reported that similar patterns of disruption to relationships occurred. A majority rated interruptibility, a potentially positive or negative characteristic of distance education, negatively. Although a large majority stated they were in good health, a number of somatic complaints were reported in both the qualitative and quantitative study groups. The problems included a decline in fitness, weight gain, increased use of caffeine, sleep disturbances, and eye and ergonomic strains. A number of students commented negatively about group work requirements, viewing them as incongruent with the flexibility they expected in e-learning. Time zones and reduced control over the learning environment made group work problematic, and many believed group assignments had little value for mature students. Correlations conducted on the survey responses revealed that when student control was low, anxiety/stress scores were higher and there were more negative personal outcomes. Anxiety/stress scores were also higher when support was low.

Strategies for success in e-learning identified by these multiple role women included effective time management and reliance on supports from a variety of sources. Support from the tutor, spouse, children, immediate work supervisor, and upper management at work were rated as very important. Actual support received showed similar patterns. However, though tutor support was perceived to be very important, ratings for actual support received were lower.

Recommendations by participants for changes to improve the situation of professional women as e-learners included giving students more control over course requirements, better orientation to the program and technology, and notifying them regularly of program/course changes and up-dates. These strategies recognize students’ complex lives and can improve retention and satisfaction.

This study dealt with women who were succeeding in adding professional programs by distance education to their busy lives. Perceptions of women who withdrew or failed in distance education programs were not examined. It would be worthwhile to discover the problems these learners encountered that led to leaving programs. Given the problems the successful women reported having overcome, consideration must be given to enhancing supports and implementing a variety of teaching and communication strategies so that as many students as possible are able to complete programs.

Conclusions and Implications

A recurring theme evident in the reported studies has been that women who succeed in professional e-learning desire easy, flexible, and meaningful access to technology, have learning preferences but are able to adapt them to their learning contexts, and integrate e-learning into their existing multiple roles to make learning possible. They tolerate technological problems or poor instructional design because, for them, the advantages of distance education outweigh the problems. The women in our studies wove e-learning into their lives, mastered the technological requirements, and demonstrated successful achievement of course outcomes.

Professional women tend to be educated and affluent and thus may have more resources available to them for overcoming problems encountered in e-learning than less advantaged learners. However, their experiences provide useful insights into the needs of all learners engaged in e-learning. These professional women provided many lessons to educators using e-learning that can benefit learners who may not be as determined or well supported. With increasing competition for students and globalization of learning opportunities, distance educators cannot afford to be complacent. If they do not learn from the experiences and difficulties of their students and modify their approaches, they may lose the opportunity to provide educational opportunities.

Among the factors educators must bear in mind is the need for suitable support for learners as they adapt to technology. New delivery methods and software are often tempting as they promise to solve existing logistical and educational problems. The following questions must be carefully considered and answered when developing e-learning courses for all distance students, but for women in particular. How much time and energy will be needed for new students to integrate e-learning into their lives and master the technological environment? What design strategies will support individual learning preferences, as well as language and cultural differences?

Learners, especially those who are not computer literate, or who do not have access to high-speed connections, may be excluded, or at best, marginalized if the technological requirements for courses are too sophisticated. Even for those with computer and e-learning experience, new applications or upgrades may create difficulties. At such times, a real person responding in real time may be the only way to solve the problems promptly, relieve stress and frustration, and allow students to comfortably concentrate on the business of learning. When supports are in place and students can overcome their technological frustrations quickly, they have shown that they can adapt new delivery methods to suit their personal learning needs, and thus focus on achieving learning outcomes.

Assessing technology for its efficiency and effectiveness for creating positive learning environments is essential. In the research presented, participants expressed preferences for a blending of delivery methods to suit the content and their approaches to learning. They adapted technologies to match their learning preferences. To appreciate these adaptations is to acknowledge the value of different delivery methods to suit different content, contexts, and learning preferences. Educators should contemplate what they can do to enhance this process, so that students can focus quickly on achieving learning outcomes.

Educational environments and processes are constantly evolving. In traditional educational institutions, students are demanding course websites and e-mail communication with faculty. Technologies first used by distance educators are moving into the mainstream. Web-based platforms and other technologies that are commonplace today were not dreamt of 10 years ago. There will continue to be rapid advances. Students can help educators to exploit the opportunities new communications technologies make possible. We can hope that the ‘educational evolution’ will become increasingly learner-friendly and learner-sensitive.

Should modifications or alternative activities leading to the same learning outcomes be available for learners who are uncomfortable with a particular delivery method? Placing the learner at the center of the learning circle is integral to arriving at sound and satisfying solutions to many of the problems posed by e-learning. Discussing how learning can be best promoted by a particular delivery method and evaluating the impact of the selected method on the quality of the learning experience should be fundamental to e-learning decisions.

It is clear from the studies discussed in this chapter that a number of technological, educational, and personal factors contribute to comfort with e-learning. E-learning occurs in a challenging and constantly evolving technological environment. Educators and potential learners have to be open to change, while maintaining a healthy skepticism when assessing the value of new technologies or educational approaches. If educators make sure that the learners’ needs are always the chief consideration, they will make selections that will promote positive learning experiences. It will be necessary to continue to conduct research on the experiences and perceptions of learners in technologically mediated learning environments to ensure that educators’ decisions are truly based on the needs and desires of those who enroll in e-learning programs.


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About the Authors

Mary-Anne Andrusyszyn, RN, EdD is Associate Professor at the University of Western Ontario, Faculty of Health Sciences, School of Nursing AT THE University of Western Ontario, Canada and co-Founding Editor: International Journal of Nursing Education Scholarship (IJNES) at http://www.bepress.com/ijnes and co-Author of Curriculum Development in Nursing Education http://www.jbpub.com/catalog/0763727199/

Mary-Anne Andrusyszyn, RN, EdD
Associate Professor, University of Western Ontario
Faculty of Health Sciences, School of Nursing
HSA #31, London, Canada, N6A 5C1
tel: 1-519-661-2111 x86577; fax: 1-519-661-3928

email: maandrus@uwo.ca Web: http://publish.uwo.ca/~maandrus/

C. E. (Betty) Cragg, RN, EdD. is Professor at the University of Ottawa, Faculty of Health Sciences, School of Nursing.

Email: bcragg@uottawa.ca

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