Developing and Evaluation of an Electronic
     Educational Program about Palliative Care for
     Healthcare Workers in Syria
     nahawand alhalabieh  (  nahawnd1990@gmail.com )
      Syrian Virtual University
     Mayssoon Dashash 
      Damascus University
     Eyad Chatty 
      Damascus University
     Research Article
     Keywords: E-learning, educational program, palliative care, medical education, Syria, healthcare workers.
     Posted Date: June 16th, 2022
     DOI: https://doi.org/10.21203/rs.3.rs-1729158/v1
     License:   This work is licensed under a Creative Commons Attribution 4.0 International License.  
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    Abstract
    Purpose: The e-learning systems act as a powerful aid to traditional teaching to provide high-quality
    education. E-learning can improve the effectiveness of medical education by transferring knowledge
    easily. There is neither a virtual nor traditional educational program on palliative care in Syria. E-learning
    can improve medical education in Syria by transferring primary knowledge of palliative care to healthcare
    workers. This study aimed to develop an electronic educational program about palliative care basics.
    Methods: A nonprobability convenience sample of (19) Syrian healthcare workers was included. The
    General Model for Instructional Design (ADDIE) was used in developing the electronic educational
    program. The program's effectiveness was measured by using the valid Palliative Care Knowledge Test.
    The test was translated into Arabic. One-Group Pretest-Posttest design was adopted. A comparison
    between pre-test and post-test after the sample attended an electronic educational program on palliative
    care was conducted and its effect was measured.
    Results: The mean score of the sample in the pre-test about knowledge of the basics of palliative care
    was (59.74%), while mean score of the sample in the post-test was (98.94%), meaning that the level of
    knowledge increased by (39.21) after the intervention, where the effect was (0.97).
    Conclusion: There is a lack of primary knowledge of palliative care basics among the studied sample.
    The described program provides an innovative learning strategy on the basics of palliative care delivered
    in an asynchronous online format. E-programs are effective in transferring knowledge of palliative care.
    Introduction
    Palliative Care (PC) is an approach that improves the quality of life of patients and their families who are
    facing life-threatening illnesses [1]. There is an urgent need for PC in the Middle East. However, there are
    still countries with very limited PC activity such as Syria [2]. Acknowledging the fact that topics related to
    PC are not covered in the Syrian medical curricula as a separate subject, an electronic educational
    program about PC would be of particular importance in which health care workers can be more qualied
    in providing health care services for life-limiting illness patients under the supervision of medical
    education program at the Syrian Virtual University (SVU). This study was undertaken to evaluate the
    effectiveness of online programs about PC in improving the knowledge of health workers.
    Material And Methods
    A nonprobability sampling technique was used [3]. The study population included a convenience sample
    of (19) healthcare workers in Syria who had information technology means including a laptop, a good
    speed internet, and a personal email. An assessment of the PC educational program's effectiveness was
    performed using the Palliative Care Knowledge Test (PCKT), a validated instrument with a (True/false)
    response to test the PC knowledge of general physicians and nurses [4]. The test was translated to
    Arabic, then 2 independent bilingual non-experts Syrian doctors checked it to ensure the accuracy of the
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    translation of medical terms, one of them is a resident doctor in pathology and the other one is a resident
    doctor in obstetrics and gynecology. Then, an Arabic translator carried out a backward translation of the
    Arabic version into English, and a comparison between the backward translation and the original test was
    made to ensure that the meaning of the items was preserved. The General Model for Instructional Design
    (ADDIE) was chosen [5]. The educational program was designed in four stages:
    1)Analysis Stage
    included three steps,
    The rst step was to determine the general education outcomes of the program. They were dened based
    on the World Health Organization book. The second step was setting the main areas of the program. The
    Association for Palliative Medicine dened the nine main areas to be covered in any PC program [6].
    These areas were modied to suit the technical and time limits. Then it was organized as separated eight
    modules and each module was divided into educational units.
    2) Design stage
    the content material was designed according to textbooks, peer-reviewed, and journal articles. The
    content was scientically reviewed by a professor in medicine. Then, its validity as a teaching material
    was reviewed by a professor of medical education. The proposed changes were adopted to achieve
    scientic accuracy and educational goals.
    3) Development stage
    ‘PowerPoint’ was used to coordinate presentations before uploading them to the learning management
    system related to the SVU. Supportive illustrations and helpful references were uploaded on the site for
    further reading.
    4) Implementation stage: The program was delivered on the learning management system related to the
    SVU through the link https://lms.svuonline.org/login/index.php
    5) Evaluation stage
    Pre and post-tests were undertaken to assess the improvement of knowledge before and after the
    educational program.
    The primary knowledge about PC was determined by the participants’ average scores in the pre-test.
    (70%) score as a criterion for the presence of knowledge in the eld of PC was adopted. A score of (5)
    was calculated for each correct answer to each question, therefore the individual who answered the
    twenty questions correctly would get a score of 100. The mean scores of the sample in the pre-test were
    compared with their mean scores in the post-test.
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     Results
     The studied sample consisted of 19 participants, 4 males and 15 females, 15 pharmacists and 4 doctors.
     In pretest, the overall score was 59.74% (SD = 0.52, maximum score of 100). As for the post-test, overall
     score was 98.94% (SD = ± 2.0, maximum score of 100). The Difference between mean scores was
     39.21053 Table 1 and Table 2 compared the results of the pretest and post-test of the 19 participants.
     Across 20 items in the pretest, the overall score was 2.98 whereas in the posttest overall score was 4.94
     (maximum score 5), deemed to be a good level of knowledge (Table 3). All items were rated as good.
     Student opinion about the program from emails after the participation included (quote) 'the topic was
     foggy but the presented program was able to make it clear'. The value of the effect size using the ETA
     square on knowledge in PC is (0.97). The cut-off value of the large effect is 0.5. Therefore the effect was
     large.
                                                   Table 1
                                   comparison of pre- and post-test results-1
                       pretest      Posttest      Difference between mean scores   p Value    T Value
        
       Scores range    40% − 80%    95% − 100%                                                 
       Scores SD       ± 8.5        ± 2.0                                                      
       Scores mean     59.74%       98.94%        39.21053                         < 0.001    18.957
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