Delivering Health Education Curriculum Online in the Wake of COVID-19

Abstract

The core skills taught in the subject “Health Education Development” at La Trobe University are essential for students studying health promotion. As part of this subject, students are supported to adopt the role of a health education and development facilitator in delivering tailored sessions to their peers. In these simulated sessions, students engage in the practice (and teaching) of cooperative learning addressing the needs of vulnerable population groups across different settings. COVID-19 forced the delivery of this subject to an online-only model with little time for preparation. Changes that were introduced as a response to this transition included online workshops replacing face-to-face (F2F), modification of the F2F component of assessments to online, F2F workshop content adapted to online version, implementation of a “coteaching” model for the initial 3 weeks post-COVID-19 lockdown, and weekly online sessions held with the teaching team. The use of innovative activities provided ongoing feedback, which informed timely actions to improve and continue with the successfully delivery of the subject.

Keywords

teaching strategy undergraduate public health education online active learning

Health Education Development (HED) is a second-year core subject within the health promotion major of the bachelor of health sciences degree offered at La Trobe University, Australia. Since 2017, HED has been a 12-week blended subject delivered in Semester 1 (March to June). In 2020, this coincided with the COVID-19 pandemic (from March 16, 2020 academics were locked off campus) and after the first 3 weeks of delivery all teaching was paused for 1 week in preparation for teaching the rest of the semester online.

On any given year, the cohort for this subject is approximately 165 students across different professional disciplines, including public health, health promotion, rehabilitation counselling, sports counseling and athlete welfare, and occupational therapy.

Principles of cooperative learning theories (Macpherson, 2015) are at the core of the subject. Students are required to learn and apply cooperative learning in their peer interactions to acquire and practice the elements of health education ethically and responsibly. Students must identify the learning needs of particular populations with a focus on more marginalized groups including people from culturally and linguistically diverse communities, sexually and gender diverse populations, refugees, those living with a disability, and people living with mental health issues/conditions. This is paramount to their understanding of the principles of public health and social justice (United Nations General Assembly, 1948; Whitehead, 1991). On completion of the subject, it is expected that students will have basic health education knowledge and facilitation skills for one-to-one or small group formats across institutional or community health settings.

What the Subject HED Looked Like Prior to COVID-19

Purpose of the Subject

Students develop knowledge, skills, and attitudes that allow them to access and use resources that facilitate the planning, implementation, and evaluation of health education in diverse settings. Students engage in salient teaching and learning theories and practices with the view of empowering people as individuals and small groups to have better health outcomes. The learning outcomes we expect students to have achieved on completing this subject include (1) to facilitate and evaluate a health education literacy program that employs cooperative learning theory in diverse institutional and community settings, (2) to identify the learning needs of particular groups and develop cooperative learning resources and activities that are appropriate to cultural context and settings, and (3) to create effective, clear, and evidence-based funding proposal to support a “strengths-based” health literacy project for an identified “vulnerable group.”

Subject Structure Pre-COVID-19

Prior to COVID-19, HED was a blended subject, comprising both face-to-face (F2F) workshops blended with online delivery. Two-hour weekly F2F workshops were designed around cooperative learning strategies, such as active learning, class-based discussion, problem-based learning, and peer instruction (Macpherson, 2015). The online component was displayed weekly on the University’s virtual subject learning management system (LMS). It included weekly learning objectives, preworkshop activities completed in the student’s own time (readings, watching videos, and reflections), and a description of the workshop activities planned for each week.

Assessment

HED included a series of authentic assessment tasks, emphasizing the practical application of learned skills in real-world settings (Fook & Sidhu, 2010). In addition, students were expected to develop more sophisticated levels of thinking aligning with the peak of Bloom’s taxonomy within this assessment (Bloom, 1956). The realistic contexts developed made the specific assessments more engaging for students who also gained skills that could be applied in paid work settings. Examples of authentic assessments introduced included a mock modified grant application from a philanthropic trust in which the key competencies of health educators, as outlined by the World Health Organization, was required (Hou, 2014). Similarly, students designed and ran two health education sessions, which we refer to as icebreakers, targeted to specific vulnerable groups utilizing cooperative learning strategies (Macpherson, 2015). Students were expected to submit a one-page narrative addressing the needs and assets of their chosen vulnerable group, and design and implement a tailored health education activity for the session.

Briefly, the icebreakers included a template for cooperative learning activities as outlined by Macpherson (2015), which we have taken and implemented in modified format. For example, in one early session students provided a “visual expression” of what health encompasses on their campus. A subsequent group discussion considered how this may apply to a vulnerable group. Through this process students experienced the elements of cooperative learning identified in Tuckman’s model (forming, storming, morning, and performing; Tuckman, 1965). To see an example of the narrative and one accompanying visual expression refer to the appendix.

In addition, each presenting team received formal F2F feedback from their facilitators on their icebreaker session. Second, each member of the team engaged in a series of self-reflective activities in which they were given a safe space to evaluate their performance, individually and as a team, in the planning and delivery of the sessions. It was within these individual and team self-reflective activities that teaching staff were able to identify, understand and address student needs.

Student reflections on their icebreakers have been embraced by students as an integral component of the activity. The exercise allowed them to integrate learning and develop strategies that help them to improve their subsequent icebreaker assessment and in their future role as health professionals. To illustrate, students were required to plan and deliver two icebreakers, that is, the running of health education sessions targeted to specific vulnerable groups. Students worked with their team members using cooperative learning principles to develop the two icebreaker assessments. All students were required to complete a formal team agreement document stipulating how they would communicate on an accessible and familiar platform with each other and to outline steps for the resolution of any potential conflict. Conflict resolution scenarios were also included as part of the initial workshops.

Last, students were expected to complete a written essay showing an understanding of the application of cooperative learning theories (Macpherson, 2015), feedback for which was provided in written format against a marking rubric criterion. HED provided students with clear messaging and guidance around assessments. This included well-developed rubrics and standard instructions. This approach allowed for consistent assessment explanations to be delivered across the workshops by the facilitators. Qualitative data from formal, university driven, end-of semester subject feedback surveys (SFS); as well as the subject-level engagement statistics derived from the LMS, suggested that these resources were well utilized by students. Ethics approval to use the anonymous student data was received from the La Trobe University Human Research Ethics Committee (No. HEC20358).

The content was engaging and presented in a fun, interactive way. There was a lot of assessment help when needed . . . I found there was a lot of information on each assessment and it was very clear what needed to be done . . . (SFS, 2019)

Innovative Activities

Strategic activities to engage, advise, support, and promote class participation included the following: Legacy Letters, a Hopes and Fears activity, and reflections from the icebreaker assessment task. “Legacy Letters” (addressed to a future student of HED) were completed at the end of the semester by students anonymously outlining what would have been helpful to know about the subject when they started the semester. These letters were then provided to the new cohort of students in their first workshop and were used as another form of qualitative feedback for the subject. In the “Hopes and Fears” activity students wrote an anonymous list to their facilitator outlining their expectations for the subject. This information was used by facilitators in subsequent workshops to set class expectations. Also, students completed a reflection after delivering icebreakers (health education sessions), allowing them to assimilate learning and set strategies helping them to perform better in following assignments.

COVID-19 Modifications for HED

Five main changes were introduced in HED for the first semester (March 2020) as a result of the pandemic COVID-19: (1) F2F workshops were replaced by online Zoom sessions, (2) modification of the icebreaker assessment task, (3) video recordings of weekly presentations, (4) implementation of a “coteaching” model during the COVID-19 lock down, and (5) F2F weekly teaching team meetings were replaced by online Zoom sessions.

Replacement of F2F Sessions by Zoom Sessions

A new component to teaching this semester was the use of Breakout rooms, a feature of Zoom that allows the host to allocate students to smaller groups enabling private conversations within their teams. This component allows students to continue with their teamwork activities (based on cooperative learning), and to reflect on their initial icebreaker evaluations. Student reflections, as mentioned above, were maintained with the use of breakout rooms. Similar to the F2F classroom setting, breakout rooms enabled facilitators to move between rooms and engage with students in their learning reflections, group work activities, and identifying future goals for their subsequent icebreaker assessment task.

Three themes were identified from student reflections of their icebreakers: applied learning, team skills, and development of empathy and understanding of working with vulnerable groups. Students described the development of “real,” and “applicable” skills that benefited the community or the specific vulnerable group. Students felt that these applied learning skills had relevance for their future professional lives.

Students perceived team skills, including group dynamics and processes, and understanding the complexities of working in team-work environments as the key features of the subjects’ learnings.

We used Facebook messenger to communicate regularly and everyone contributed. I delegated tasks and made sure everyone was doing okay and offered to help if anyone was in need. Google docs, was utilised as our platform to add and compile information so everyone could see and collaborate effectively. (Student, 2020, reflection from icebreakers)

The most important factor for teamwork is respecting each other and building rapport for successful outcome. I will implement what I have learnt from doing icebreakers in the next team project. (Student, 2020, reflection from icebreakers)

Third, it was perceived that students articulated empathy and understanding for working with vulnerable populations as suggested in the narrative from a student this year:

I enjoyed learning more about mental health for people with intellectual disabilities and therefore relaying this information in our icebreaker activity. This allowed me to think more about the challenges people with disabilities face with mental health issues and the effect this can have on their tertiary education. (Student, 2020, reflection from icebreakers)

Modification of the Icebreaker Assessment Task

As previously noted, prior to COVID-19, the icebreaker assessment task consisted of designing and implementing two F2F health education sessions targeted to a vulnerable group. Due to the lock down of COVID-19, students were unable to run these sessions as planned. Instead, students submitted a narrative addressing the needs and assets of their chosen vulnerable group but were also required to provide a more comprehensive and detailed description of the planned (but not implemented) icebreaker activities. The marking workload of this reworked assessment was more time consuming and intensive for facilitators.

While students reported finding the icebreaker activity engaging and valuable, they also felt an opportunity was lost by not being able to deliver it to their class peers.

I enjoyed creating the “fear in hat” activity with my teammates. We had similar goals, contributes equally, and worked well together. However, due to COVID-19 we were not able to present this activity with our class however I expected it would have run smoothly. (Student, 2020, reflection from icebreakers)

I really enjoyed researching the considerations for students with refugee backgrounds. I really liked our activity section and thought it would have been a fun one to deliver to the class, had we not been online. (Student, 2020, reflection from icebreakers)

The challenges identified by students to work with the technology and deliver online icebreaker sessions is worthy of exploration in future delivery of this subject.

Our experience in teaching the subject both online and F2F presented its own challenges. We note that students in the current COVID-19 situation reported in their icebreaker reflections more difficulty engaging with their team virtually compared with their prior university experiences in F2F classes.

In the previous ice breaker activity, we had a chance to meet twice before the social distancing restriction was in place. For this activity, it would be great if we have a chance to sit down together and discuss or brainstorming instead of through zoom sessions. As we cannot discuss the activity face to face, the communication process and the preparation for the narrative became harder. (Student, 2020, reflection from icebreakers)

I just struggled with planning everything over technology. Everyone in the group was good at communicating I just find it easier to communicate face to face. (Student, 2020, reflection from icebreakers)

Video Recordings

Facilitators used a congruent set of presentation slides for their weekly workshops both pre– and during COVID-19. This year a shared workload roster was developed for all teaching staff. Each Week 1 of the facilitators prerecorded a video using the presentation slides, which was uploaded to the subject LMS page allowing for asynchronous engagement with the material by all students individually. This also enabled a consistent approach to teaching. In this way, if students either missed the workshop or wanted to revisit material they had the opportunity to do so. Feedback from facilitators indicated that students valued accessibility to this resource “. . . Students from all workshops reported that video recordings were working really well” (Notes from staff meeting 20 May 2020).

Implementation of a “Coteaching” Model for the Initial 3 Weeks Post-COVID-19

Importantly, although somewhat time intensive, we also implemented a “coteaching” model for the first 3 weeks post-COVID-19 whereby the subject coordinator (FNB) actively supported the less experienced facilitators in their Zoom sessions. Initial apprehension was allayed by this strategy and it was also reported to be helpful by facilitators in keeping students engaged.

In weekly staff meetings, facilitators reported feeling supported through the implementation of the “coteaching” model. This was specifically in relation to technology, student engagement and alleviating apprehension. The coteaching model was useful for novice facilitators. Feedback from students suggested that having two academics was useful as more robust discussions were generated with more examples given from the academics’ personal perspectives. Feedback from facilitators suggested that it was easier and allowed for more time to be allocated when working in breakout rooms. This model may not be the most feasible and sustainable depending on budget considerations. An alternate suggestion may be to have sporadic coteaching sessions so that students still gain the benefit of another academic perspective at key points during the semester.

Replacement of F2F Weekly Teaching Meetings by Zoom Weekly Sessions

Weekly teaching team sessions are a usual part of this subject in which support, feedback, and class preparation are discussed. Subsequent to COVID-19 lockdown these were moved to an online weekly Zoom format, which also allowed for a “well-being check in” for staff as well as providing space for any potential problems to be resolved quickly through peer discussion.

Results From Legacy Letters

Thematic and content analysis of the 2018, 2019, and 2020 letters indicated that time management and preparation were the most essential aspects of successfully completing the subject (81% of students commenting on this in 2018; 89% in 2019; 75% in 2020). Other aspects discussed included group work; incorporation of creativity and fun within the icebreaker assignments to encourage engagement and cooperative learning; and applicability of subject content to future work as health professionals. The 2020 cohort faced the COVID-19 lockdown and 61% of them mentioned the value of support received from the teaching team in contrast to 32% in 2018 and 40% in 2019. In addition, 63% of the 2020 students discussed online learning and engagement via this medium. Selective quotations from 2020 legacy letters are presented in Table 1.

Table 1.

Quotes From Legacy Letter to a Future Student in HED.

Are you wondering, as I did, what lies ahead in the next 12 weeks of HED? Please don’t worry. Even in our brave new COVID-19 world, this was a friendly subject. The icebreakers give you the chance to meet and work with a small group and I enjoyed the ongoing communication.

This subject was enlightening and challenging at the same time. We started doing this subject in the classroom to and that was great! You will build friendships and build rapports. We did most of the subject online and this can have it challenges!! That is for sure we still build friendships but possibly not as many! It was tricky to get people to be accountable with it being online but we got there in the end!

It was very different experience online, but I encourage you to engage with the Zoom workshops as they are an excellent opportunity to connect with your classmates, participate in the online activities and ask questions relevant to your assignments.

I did this subject online, and hopefully you don’t have to as I imagine it would be a lot more fun F2F! If you do have to do the class online, try your best to stay motivated and make sure you continue to attend all classes, it can be easy to skip classes when they are just at home but make sure you attend!

It was an interesting and challenging transition moving the class online during the unprecedented circumstances, however I think the teachers have done an amazing job and put in a lot of effort. The zoom classes online were an interesting experience, but I think they worked really well.

The zoom sessions were different and sometimes hard to get my head around but by the end we got the hang of it.

During the breakout rooms don’t sit silently waiting to go back to the main session, attempt to start the conversation and encourage other students to share ideas and opinions, but at the same time don’t lose focus because the right conversations are there to benefit your learning. Try to make some friends in the class and perhaps even create a group chat, that way you can answer each other’s questions and provide more insight to one another on what you learnt or on upcoming assignments.

Don’t let online learning scare you, you will be provided with all the information you need to know and if you ever need any help don’t be afraid to reach out to your tutors.

Personally, I had fears of how group work would be completed especially since the subject had to be converted to online learning, however, I really enjoyed the icebreaker tasks. A tip is to use ZOOM video call and a Google Document in which all members have access to. This is efficient in the creation of an interesting icebreaker tasks!

However, whether you are doing the subject online or F2F, there will be a lot of support available from the university and especially from the tutors.

I hope for you to have the opportunity to do this class F2F because it is much more enjoyable and interactive that way. If you have this subject online, enjoy it, it is content heavy however, it is enjoyable because peers and the facilitator make it fun.

We had if not most, all of our classes online except for the first 2 weeks. I personally don’t like online classes but given the circumstance I had to deal with it. Overall, the online zoom classes were not that bad, but they were just tiring as listening to your online class for 2 hours on a laptop screen does cause headaches and all. I hope you enjoy this class and gain new insight and knowledge which may be beneficial to you in your future profession.

Note. HED = health education development; F2F = face to face.

Discussion and Conclusion

The impact of COVID-19 on the delivery of this subject has been a diverse and surreal experience for both the student cohort and the teaching team. The move to the online only mode presented challenges however, we believe that the subject has been successful in achieving its teaching goals.

Challenges

There were three main challenges—time, technology, and uncertainty. The initial phase of transition to an online only space meant having two staff coteaching was an over allocation of resources, but the rapid transition required creating confidence for facilitators to use the technology. However, coteaching also allowed the workshops to be run efficiently and effectively.

The time required to transform subjects from blended to online is substantial (Bennett & Lockyer, 2004; Wigginton et al., 2020). Given that we only had a week to prepare our move onto the online platform, the use of some previously developed resources (e.g., Microsoft PowerPoint weekly presentation slides, guidelines for facilitators, prerecorded assessment instruction videos) allowed for a smoother transition. Students also had to adapt to communicating in an online space, however, many were already familiar with these technologies. Lack of time availability was one COVID-19 related challenge that may have been linked to multiple family members using a single computer device at home; carer responsibilities including online schooling; and paid work commitments. We acknowledge that some students faced difficulty in interacting and communicating online. This is similar to the barriers identified by others (see Butler & Sellbom, 2002; Hannache-Heurteloup & Moustaghfir, 2020). To address such difficulties, the University offered online advise and support particularly in relation to using the Zoom collaboration tool. In addition, during the workshops the teaching team provided opportunities for students to share their experiences and discuss strategies that may have been effective. In addition, applying Macpherson’s (2015) principles of cooperative learning through continuous weekly engagement with the teaching team was crucial in the context of COVID-19 as a way of supporting staff through these unforeseen times.

While acknowledging that there are challenges in the use of teaching-related technology (Butler & Sellbom, 2002), it is important to bear in mind that there was a level of preexisting skill among the teaching team, which implied the move to an online-only space did not require additional training. However, ongoing engagement with students in the online space remains suboptimal for staff. While the team made use of the generic resources provided to academics across the university, there is a need to keep abreast of the technologies that can help deliver a better overall experience.

The Zoom sessions, which replaced the F2F component of the subject, were well supported by both staff and students, but challenges remained. Students found it difficult to engage with their teams in an online only space. This is similar to the barriers identified by Butler and Sellbom (2002) on gaining familiarity on how to use technology for online learning. Interestingly, students expressed some disappointment in not having the opportunity to deliver icebreaker presentations suggesting that future online iterations of this subject should incorporate an aspect that allows for this.

Another aspect to consider in the transformation of F2F to online presentations, is the marking of assessments, which may be more onerous and intensive for staff. Further development of this process is required to make it more efficient. With the continued use of such technologies, students and staff will inevitably gain more expertise and familiarity with such approaches though the extent of this is yet to be ascertained.

The SFS during COVID-19 was 4.07 (out of 5); This University formal feedback shows an improvement when compared with previous years (3.96 and 3.93, respectively in 2018 and 2019). Innovative activities such as “hopes and fears,” “legacy letters,” and reflections from “icebreakers” meant we received ongoing feedback on the subject and were able to amend accordingly. The provision of more informal ways of receiving feedback rather than relying on the SFS end of semester evaluations, enabled our timely responses. More important, the use of multiple forms of receiving feedback, permitted triangulation of the results and informed actions to improve the subject.

It is noteworthy that given the pandemic situation, we feel that students were more receptive to online learning than they may have been in different circumstances. Possible explanations include that students were in a forced lockdown situation in their home environments with limited distractions. However, assumptions about students’ experiences should be made carefully as these may not be uniform. For instance, we were acutely aware of the difficulties some students faced due to shared housing, carer responsibilities, accessibility to the internet, adequate study spaces, particularly in situations where other family members were working from home. The digital divide should be considered as this could lead to further marginalization of certain student populations (Park, 2017). Important, the University did establish schemes to provide financial assistance, which included technology or crisis support bursaries for those who required it (La Trobe University, 2020).

Lessons Learned

As these are health education sessions targeted to vulnerable groups, they can serve as a catalyst to develop a more effective, efficient, and innovative approaches in their future practice as health professionals. In hindsight, we may have been able to deliver icebreakers in an online space but the uncertainty of how COVID-19 would evolve and the impact that this may have in overwhelming staff and students, meant that we did not. In anticipation of changed living, working and recreation circumstances we were perhaps more conservative than we needed to be. However, the Zoom sessions with the use of breakout rooms worked well and can be seen as an effective tool for the delivery of health education sessions. We believe students are able to achieve the subject learning outcomes in both teaching formats (online and F2F). The continued impact of and adjustments made in response to COVID-19 means that the subsequent iterations of the subject has incorporated further development of the material including online icebreaker planning and delivery by students.

One final comment worth noting is that students were generous in their acknowledgement of the teaching teams’ efforts to deliver the subject in these unusual circumstances. Our experience has been that they were more forgiving than previously for any problems that may have arisen in the subject delivery or for their peers who may have been facing adversities.

Our experiences of delivering HED during COVID-19 show that there are benefits to health education sessions being taught in both F2F and online formats. By embracing the opportunities afforded by online engagement, we have shown that flexible teaching and learning options work for both students and potentially for community groups for whom traditional approaches may not be ideal. Our learnings from this year augur well not only for the development of HED but also for the development of health promotion practitioners into the future.

Footnotes

Appendix

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Peter Higgs

Notes

References

Bennett

Lockyer

(2004). Becoming an online teacher: Adapting to a changed environment for teaching and learning in higher education. Educational Media International, 41(3), 231–248. https://doi.org/10.1080/09523980410001680842

Bloom

B. S.

(1956). Taxonomy of educational objectives: The classification of educational goals: Handbook 1: Cognitive domain. David McKay.

Butler

D. L.

Sellbom

(2002). Barriers to adopting technology. Educause Quarterly, 2(1), 22–28.

Department of Education and Training. (2018). International student data monthly summary: November 2018. https://internationaleducation.gov.au/research/International-Student-Data/Documents/MONTHLY%20SUMMARIES/2018/Nov%202018%20MonthlyInfographic.pdf

Fook

C. Y.

Sidhu

G. K.

(2010). Authentic assessment and pedagogical strategies in higher education. Journal of Social Sciences, 6(2), 153–161. https://doi.org/10.3844/jssp.2010.153.161

Hannache-Heurteloup

Moustaghfir

(2020). Exploring the barriers to e-learning adoption in higher education: A roadmap for successful implementation. International Journal of Management in Education, 14(2), 159–182. https://doi.org/10.1504/IJMIE.2020.105407

Hou

S. I.

(2014). Health education: Theoretical concepts, effective strategies and core competencies. Health Promotion Practice, 15(5), 619–621. https://doi.org/10.1177/1524839914538045

La Trobe University. (2020). COVID-19 Financial Assistance Program. https://www.latrobe.edu.au/scholarships/la-trobe-university-covid-19-financial-assistance-program

Macpherson

(2015). Cooperative learning group activities for college courses. Kwantlen Polytechnic University.

10.

Okanagan Charter. (2013). An International Charter for Health Promoting Universities & Colleges. https://www.healthpromotingcampuses.org/okanagan-charter

11.

Park

(2017). Digital inequalities in rural Australia: A double jeopardy of remoteness and social exclusion. Journal of Rural Studies, 54, 399–407. https://doi.org/10.1016/j.jrurstud.2015.12.018

12.

Poyrazli

Grahame

K. M.

(2007). Barriers to adjustment: Needs of international students within a semi-urban campus community. Journal of Instructional Psychology, 34(1), 28–45.

13.

Stuckey

H. L.

Nobel

(2010). The connection between art, healing, and public health: A review of current literature. American Journal of Public Health, 100(2), 254–263. https://doi.org/10.2105/AJPH.2008.156497

14.

Tuckman

B. W.

(1965). Developmental sequence in small groups. Psychological Bulletin, 63(6), 384–399. https://doi.org/10.1037/h0022100

15.

United Nations General Assembly. (1948). Universal Declaration of Human Rights. https://www.un.org/en/universal-declaration-human-rights/

16.

Whitehead

(1991). The concepts and principles of equity and health. Health Promotion International, 6(3), 217–228. https://doi.org/10.1093/heapro/6.3.217

17.

Wigginton

N. S.

Cunningham

R. M.

Katz

R. H.

Lidstrom

M. E.

Moler

K. A.

Wirtz

Zuber

M. T.

(2020). Moving academic research forward during COVID-19. Science, 368(6496), 1190–1192. https://doi.org/10.1126/science.abc5599

18.

World Health Organization. (2012). Health education: Theoretical concepts, effective strategies and core competencies: A foundation document to guide capacity development of health educators. http://apps.who.int/iris/bitstream/10665/119953/1/EMRPUB_2012_EN_1362.pdf

19.

Wong

J. K. K.

(2004). Are the learning styles of Asian international students culturally or contextually based? International Education Journal, 4(4), 154–166.