Aung Kalya Win, Kibia Angela, Onwumere Juliana
Department of Psychology, Institute of Psychology, Psychiatry and Neuroscience, King's College London, Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, United Kingdom, 44 7386692555.
J Med Internet Res. 2025 Aug 28;27:e72808. doi: 10.2196/72808.
Informal carers, people providing unpaid support to relatives or close others with an illness, disability, or advanced age-related care needs, are key stakeholders in health care systems. Carers have their own health and well-being challenges; however, their needs and care pathways are often overlooked by health care providers. Open online courses offer opportunities to address the information and support needs of large numbers of carers. However, our collective understanding of the design and outcomes of courses and learner experiences is limited.
This systematic integrative review aimed to map the characteristics of open online courses for informal carers, explore learner experiences, and identify barriers and enablers to participation to inform the design of future courses.
Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we systematically searched 4 electronic databases (APA PsycINFO, CINAHL, EMBASE, and MEDLINE) for papers published from inception to January 30, 2025. Included papers were peer-reviewed, in the English language, and reported on the development, delivery, or outcomes of open online courses for informal carers aged more than 16 years. Excluded papers had no carer focus or were conference abstracts. Two reviewers independently screened titles and abstracts for eligibility. Backward and forward citation searches were conducted. Due to study heterogeneity, data on paper methodology, course characteristics, and course evaluations were extracted and synthesized narratively. Quality assessments of quantitative papers and the quantitative components of mixed methods papers used the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. Qualitative components within mixed methods papers were appraised using the Critical Appraisal Skills Program (CASP) toolkit.
Searches identified 201 papers, of which 10 (6 quantitative and 4 mixed methods) met the inclusion criteria. No qualitative papers were identified. All included courses were massive open online courses. Sample sizes ranged from 3 to 17,591 participants, primarily targeting carers of older individuals (n=4). Completion rates ranged from 42% to 67% (n=5). Five papers reported improved carer knowledge and application of skills. Key enablers to learning included course accessibility and flexibility. Key barriers to learning included limited peer interaction, technical difficulties, time constraints, language challenges, and online privacy challenges. Most papers were of weak quality, except for 1 strong quantitative RCT.
The evidence was limited by moderate-to-weak study quality, inconsistent measures, and exclusion of gray literature. Despite these limitations, findings suggest that open online courses may improve carers' knowledge and skills and enable accessible, flexible learning. However, barriers to learning, including limited learner-to-learner interaction within and external to the course, time constraints, and digital or language barriers, highlight the need for more inclusive and interactive course designs. Further high-quality research is needed to standardize outcomes.
非正式护理人员，即那些为患病、残疾或有高龄护理需求的亲属或亲密他人提供无偿支持的人，是医疗保健系统中的关键利益相关者。护理人员自身面临着健康和幸福方面的挑战；然而，他们的需求和护理途径往往被医疗保健提供者忽视。开放在线课程为满足大量护理人员的信息和支持需求提供了机会。然而，我们对课程设计、成果以及学习者体验的总体理解是有限的。
本系统综合评价旨在梳理面向非正式护理人员的开放在线课程的特点，探索学习者体验，并确定参与的障碍和促进因素，以为未来课程的设计提供参考。
按照PRISMA（系统评价和Meta分析的首选报告项目）指南，我们系统检索了4个电子数据库（美国心理学会心理学文摘数据库、护理学与健康领域数据库、荷兰医学文摘数据库和医学期刊数据库），以查找从数据库建立至2025年1月30日发表的论文。纳入的论文需经过同行评审、为英文，且报道了针对16岁以上非正式护理人员的开放在线课程的开发、授课或成果。排除的论文未聚焦于护理人员或为会议摘要。两名评审员独立筛选标题和摘要以确定是否符合纳入标准。进行了前后向引文检索。由于研究的异质性，提取了关于论文方法、课程特点和课程评价的数据，并进行叙述性综合。定量论文和混合方法论文的定量部分的质量评估使用了有效公共卫生实践项目（EPHPP）质量评估工具。混合方法论文中的定性部分使用批判性评估技能计划（CASP）工具包进行评估。
检索到201篇论文，其中10篇（6篇定量研究和4篇混合方法研究）符合纳入标准。未检索到定性研究论文。所有纳入的课程均为大规模开放在线课程。样本量从3名至17591名参与者不等，主要针对老年护理人员（n = 4）。完成率在42%至67%之间（n = 5）。五篇论文报告了护理人员知识的提高和技能的应用。学习的关键促进因素包括课程的可及性和灵活性。学习的关键障碍包括同伴互动有限、技术困难、时间限制、语言挑战和在线隐私挑战。除了1项高质量的定量随机对照试验外，大多数论文质量较弱。
证据受到研究质量中等到较弱、测量不一致以及排除灰色文献的限制。尽管存在这些局限性，但研究结果表明，开放在线课程可能会提高护理人员的知识和技能，并实现可及、灵活的学习。然而，学习障碍，包括课程内外学习者之间互动有限、时间限制以及数字或语言障碍，凸显了需要更具包容性和互动性的课程设计。需要进一步开展高质量研究以规范成果。
