Who can benefit more from massive open online courses? A prospective cohort study

Background: Massive open online courses (MOOCs) are innovative courses that have aroused great interest in the field of nursing education. However, most studies have focused only on the benefits of MOOCs rather than the issues and how to ameliorate them. Objectives: To compare the differences between the blended learners (who studied at a university and via a MOOC) and social learners (MOOC-only learners) in course completion, participation, performance, and online interactions. Design: A prospective cohort study. Settings and participants: The participants were social and blended learners registered on a 16-week Health Assessment MOOC on a Chinese MOOC platform. Methods: The data were collected from the MOOC learning records. The participants were categorized based on their participation: Committed learners (participated in all topic tests and the final exam), Early dropout learners (initially participated but did not finish the course), and Other learners (the remainder). The differences in course completion, participation, performance, and online interactions (in three case discussions and free discussions) between the blended and social learners, and among the three participation types, were assessed. Results: At total of 4106 participants registered, comprising 57 blended and 4049 social learners. The completion rates for blended and social learners were 100% and 7.14%, respectively. The blended learners showed stable participation rates over the course (chi(2) = 0.190, P = 0.663) while the social learners showed a trend of high to low participation (chi(2) = 179.602, P < 0.001). The blended learners had better performance than the social learners (all P < 0.05) except among the committed learners. The blended learners also had more online interactions than the social learners (chi(2) = 25.107, P < 0.001). The Early dropout and Other learners among the social learners participated more in the free discussions than the case discussions (P < 0.001). Conclusion: Blended learners benefit more from MOOCs than social learners, and online-to-offline blended approaches are recommended for future nursing education.