Journal XML Archive (2014~)

A one-group, pretest-posttest design was used to examine the effects of implementing the developed flipped learning course.

Eligible students were third-year undergraduate nursing students enrolled in the "Public Health Nursing" course. Before the class began, the students were provided with information concerning the change to flipped learning. Further, any questions or concerns expressed by the students were addressed. Participants who gave free and voluntary informed written consent to participate in the study were included. If they did not want to participate in this study but wanted to experience the flipped class activities, they could join the class. However, those who did not complete the questionnaires were excluded. Among the 92 third-year undergraduate students, a baseline survey was obtained from 89 students. Six students did not complete both pre-post surveys, and two students were on leave of absence, and one declined the survey. Finally, 80 students were included in the analysis.

This study was conducted at D University in Korea between April 14 and June 5, 2016. According to the University's practices with which the author is affiliated, this course is in the form of a block lecture, and each session lasted two hours. The classes were divided into two, each comprising 40 students. The survey was conducted using questionnaires administered to 80 students.

The author's University encourages its faculty to redesign courses to implement flipped learning. It provides technical support and guidelines based on those set forth by the Center for Teaching and Learning (CTL) at D University. The Learning Management System (LMS) was reconstructed to allow access to pre-class content at any time via computer and mobile devices. Before the course began, the faculty was provided with a CTL training program that included information on "How to make a pre-class video" and "Strategies for designing and managing participation activities for students."

A need assessment was conducted to identify students' needs and explore learning experiences in a public health nursing course. Students who had previously taken this course (lecture-based course) were eligible to participate. In recruiting students, the author provided the study's aim through emails, the social network service, and selected those willing to participate in the interview. Six students were selected from the upper, middle, and lower academic achievement groups. The author developed open-ended interview questions (What is your general learning experience in the current public health nursing class? What difficulty did you face in the public health nursing class? What are your expectations or needs from the professor teaching public health nursing? What do you think about a new teaching method, including flipped learning? What kinds of support are needed to study public health nursing?). The author conducted the interview only once in a seminar room at the University, and it lasted for two hours. During the interviews, the interview took field notes.

The course redesign process was conducted in accordance with the ADDIE model (Figure 1). ADDIE is a model of instructional system design (Branch, 2009). It comprises the following instructional design phases: analysis, design, development, implementation, and evaluation.

Figure 1. 
Change in the average attendance rates for the pre-recorded lectures according to the academic achievement.

In the analysis phase, literature reviews with flipped learning based on nursing were conducted to examine studies using flipped classes and implementing relevant strategies in higher education. In the design phase, class plans were developed for weekly classes over 15 weeks. Weekly learning goals were established based on the learning objectives of the middle and small classifications by subject area, as proposed by the Korean Academy of Community Health Nursing Society. During the development stage, the course was redesigned to encourage students to participate in class while using problem-solving and teamwork abilities actively. Based on the weekly lesson plans, detailed teaching plans for each class were developed, including pre-class, in-class, and post-class plans, following the flipped learning class design guidelines presented by the CTL. According to the week's learning objectives for the pre-class plans, the author developed new materials and related reading assignments each week. In the implementation phase, each class was carried out by the lesson plan. The students attended the 2-hours class and completed small group activities led by the professor.

Regarding pre-class online attendance, attendance was counted if the students attended the lecture within the professor's timeframe within the LMS program. Planned activities were suggested for developing in-depth learning through the sharing of knowledge with other students. These were in the form of problem-solving activities that were to be completed in small groups of 5~6 persons. When the students seemed to be disengaged, the faculty encouraged them to engage in classroom activities through pre-planned questions actively. Students' achievements were evaluated using a small quiz in the evaluation stage, and a guide for the last post-class was provided.

The pre-class modules helped students actively participate in class activities because they could study the pre-recorded lectures and content beforehand. These modules included learning objectives, guidelines for required textbook reading, a pre-recorded introductory video about 20-minutes-long, and supplementary reading material. The module was developed by the author using the Office Mix program. For in-class learning, the students were instructed to watch a relevant lecture online before attending the class, and they took an exam on the pre-class content each time.

During class, the students were asked to watch the relevant lectures online before arriving at the class. These lectures averaged 25 minutes in length and consisted of narration (by the author) over a video file developed using the Office Mix program. The in-class module was designed based on two types of strategies (individual and group activities). For the individual activity, 3~4 quizzes were provided to each class via the smart communication tool to verify students' understanding of the pre-recorded lectures and increase interest and feedback. Moreover, the think-pair-share strategy with rapid and post response methods was used for group activities. The rapid response method requires faculty to present discussion questions to the students and facilitate student discussion regarding the question; then, they show the results to the other students during class. The students have 24~36 hours to answer the discussion question in the post response method, and then they submit their results online. After class, they were provided with a summary note and feedback regarding the post-response activity. In facilitating student participation in class, a small quiz was given in each session, and the results reflected each student's academic achievement.

A questionnaire survey was administered to measure the effectiveness of flipped learning. It comprised questions on academic self-efficacy (28 items), self-leadership (18 items), learning satisfaction (7 items), and the general characteristics of the participants. The length of the pre-class, attendance, and the number of plays were reported to assess the flipped learning course results.

Self-efficacy was measured using an academic self-efficacy scale (Kim & Park, 2001). Context-specific self-efficacy can effectively predict the academic performance of a student in an overall academic situation. This scale consists of three subscales, each rated on a 5-point Likert scale: assignment difficulty preference (10 items), self-regulated efficacy (10 items), and self-confidence (8 items). Higher scores indicate higher self-efficacy. This scale has strong internal reliability (Kim & Park, 2001): Cronbach's ⍺=.84, .76, and .74 for the difficulty of assignment, self-regulated efficacy, and confidence, respectively. In this study, assignment difficulty preference was .84, self-regulated efficacy was .75, and self-confidence was .82. The overall reliability of the scale was .83.

Self-leadership was measured using a questionnaire developed by Kim (2002) based on Manz's conceptual framework and initial questions (1983). It consisted of 18 items, including self-observation (3 items), rehearsal cueing strategies (3 items), self-goal setting (3 items), self-reward (3 items), self-punishment (3 items), and constructive thought (3 items). Higher scores, measured on a 5-point Likert scale, are associated with higher levels of self-leadership. Reliability at the time of development was .87, and the reliability in this study was .80.

Learning satisfaction was measured at the end of the class without a baseline check. The measure consisted of seven questions using a seven-point scale and one open-ended question provided by the CTL at D University. Questions about satisfaction, class operation, degree of understanding, improvement in interest, learning time, class participation, intention to retake, and willingness to recommend the class to others were asked. These are commonly used measures relating to the subjects for which the University carries out flipped learning. One open-ended question is, "What are the most important difficult things you have learned so far in this class?"

Academic achievement was measured using the final course score and grade point average (GPA). After implementing flipped learning, the students were divided into four groups according to their academic score: below 25%, 25~50%, 50~75%, and above 75%.

The Institutional Review Board of D University approved this study (IRB -***15-03-007), the data were collected at the end of the class by a trained teaching assistant who was not otherwise involved in this study to ensure voluntary participation so that the students felt free to respond to the survey.

Descriptive analysis was performed for participants' demographics and flipped learning-related variables, such as length of the pre-class, attendance rate, and several plays using SPSS 23.0 (SPSS Inc. Chicago, IL). A paired t-test was conducted on self-efficacy and self-leadership to compare the changes between the pre-course and postcourse surveys, according to the academic performance quartile (upper 25%, upper 25~50%, lower 25~50%, lower 25%). Finally, student satisfaction was measured at the end of the class using the LMS.

In terms of survey participants, 80 students completed the 15-week course. The general characteristics of the participants are shown in Table 1. They were in their third year of college, and 76 (95.0 %) were female. Since a single school year was targeted, 67 (83.8%) of the students had a mean age of 22.5 years (SD 1.2); however, there were also transfers and returning students. Regarding the students' interest in public health nursing, 35 (43.8%) had a moderate interest, and 52 (65.0%) said they were satisfied with their nursing major. All students surveyed had never previously been involved in flipped learning classes.

The needs collated through the focus group interview were as follows:

The students said, "The class was not bad because it did not need my efforts to join the course. However, sometimes the course culminated regardless of students' understanding, with a weekly plan prepared. In particular, those who had a low GPA had difficulty zeroing in their weaknesses, and those who knew theirs did not know how to make up for them. Moreover, it was found that a conventional lecture made the students passive and bored. The students needed to receive appropriate feedback from the professor at the end of the class and catch up.

It was assessed using the length of the pre-class, attendance, and number of plays.

The pre-class length: The length of the pre-recorded lectures was between 20.5 and 35.0 minutes, and the average time was 23.42 minutes (SD 5.21). The students' average attendance rate for the ten online pre-classes was 7.3 (77.3%). Figure 1 shows the change in the average attendance rates for the pre-recorded lectures according to academic achievement. It was the lowest at the beginning of the first lecture and the highest for the fifth lecture. After that, it dropped, and all groups had their lowest rates right after the midterm exam, after which it tended to rise again. The first session had the lowest (54, 67.5%), while the fifth session had the highest (71, 88.8%).

Attendance: The students were divided into quartiles based on their final academic scores to identify a difference in pre-recorded lectures' attendance rates according to the students' academic scores. As a result, the attendance rates for the upper 25.0 %, upper 25.0~50.0%, lower 25.0~50.0%, and lower 20.0% were 87.5%, 82.0%, 74.6%, and 65.0%, respectively. The upper 25.0% showed the highest attendance rate. Overall, the pre-recorded lectures' attendance rates were significantly correlated with self-efficacy (r=.33, p<.05).

The number of plays: The average number of times the pre-recorded lecture was played was 2.3. There were differences in the academic scores. The average number of plays for the upper 25%, upper 25~50%, lower 25~50%, and lower 25% were 1.6, 1.3, 3.0, and 3.0 times, respectively. Regarding the reasons for repeated watching, insufficient understanding of the lecture (41; 50.3%) and pre-test review (28; 35.0%) were the most common.

Regarding the device enrollment of the pre-recorded lectures, 26 (32.5%) of the students attended the lessons using the computer only, 36 (45.0%) took the course via mobile devices only, and 17 (21.3%) took the course using both. The most common pre-class lecture time preference was "20 minutes or less" (66; 82.5%), while 7 (8.8%) answered "over 30 minutes."

Table 2 shows the effects of flipped learning on self-efficacy and self-leadership. Self-efficacy was 101.91±13.47 before and 105.04±10.74 after taking the class. Thus, it increased by 3.3, showing a statistically significant difference (t=-3.46. p<.001). The self-leadership scores did not show any difference. When comparing the differences in self-efficacy according to academic performance quantities, it was observed that the lower 25% group showed a significant increase.

Overall, 49 out of 80 (64.5%) responded positively to class operation (Item 1, Agree: 43; Strongly agree: 6). Additionally, 45 (59.2%) of 80 responded that the flipped learning content was understandable (Item 2, Agree: 41; Strongly agree: 4). In particular, in-class activities were the most exciting and helpful (54.4%) (Item 3, Agree: 31; Strongly agree: 5). However, 73 (96.1%) students answered that they spent more time on this subject than any other (Item 4). The number of those who responded that they wanted to take flipped learning again was not very high (Item 6, 35.6%).