Quality of radiotherapy care by development of e-feedback knowledge

The aim of this three phase study was to develop quality of radiotherapy care by the e-Feedback knowledge of radiotherapy -intervention (e-Re-Know). In Phase I, the purpose was to describe the quality of radiotherapy care and its deficits experienced by cancer patients. Based on the deficits in patient education in Phase II, the purpose was to describe cancer patients’ e-knowledge expectations in radiotherapy. In Phase III, the purpose was to develop and evaluate the outcomes of the e-Re-Know among breast cancer patients. The ultimate aim was to develop radiotherapy care to support patients’ empowerment with patient e-education. In Phase I (2004-2005), the descriptive design was used, and 134 radiotherapy patients evaluated their experiences by Good Nursing Care Scale for Patients (GNCS-P) in the middle of RT period. In Phase II (2006-2008), the descriptive longitudinal design was used and 100 radiotherapy patients’ e-knowledge expectations of RT were evaluated using open-ended questionnaire developed for this study before commencing first RT, in the middle of the treatment, and concluding RT period. In Phase III, firstly (2009-2010), the e-Re-Know intervention, i.e. knowledge test and feedback, was developed in terms of empowering knowledge and implemented with e-feedback approach based on literature and expert reviews. Secondly (2011-2014), the randomized controlled study was used to evaluate the e-Re-Know. Breast cancer patients randomized to either the intervention group (n=65) receiving the e-Re-Know by e-mail before commencing first RT and standard education or the control group (n=63) receiving standard education. The data were collected before commencing first RT, concluding last RT and 3 months after last RT using RT Knowledge Test, Spielberger’s State Trait Inventory (STAI) and Functional Assessment of Cancer Therapy - Breast (FACT-B) –instruments. Data were analyzed using statistical methods and content analysis. The study showed radiotherapy patients experienced quality of care high. However, there were deficits in patient education. Furthermore, radiotherapy patients’ multidimensional e-knowledge expectations through Internet covered mainly bio-physiological and functional knowledge. Thus, the e-Re-Know was developed and evaluated. The study showed when breast cancer patients’ carried out the e-Re-Know their knowledge of side effects self-care was significantly increased and quality of life (QOL) significantly improved in line with decrease in anxiety from time before radiotherapy period to three months after. In addition, the e-Re-Know has potential to have positive effects on anxiety and QOL, regardless of patient characteristics or knowledge level. The results support the theory of empowering patient education suggesting that empowerment can be supported by confirming patients’ understanding of own knowledge level. In summary, the e-Feedback knowledge of radiotherapy (e-Re-Know) intervention can be recommended in development of quality of radiotherapy care experienced by breast cancer patients. Further research is needed to assess and develop patient-centred quality of care by patient education among cancer patients.

Designing new learning experiences? : exploring corporate E-learners’ self-regulated learning

The context of this study is corporate e-learning, with an explicit focus on how digital learning design can facilitate self-regulated learning (SRL). The field of e-learning is growing rapidly. An increasing number of corporations use digital technology and elearning for training their work force and customers. E-learning may offer economic benefits, as well as opportunities for interaction and communication that traditional teaching cannot provide. However, the evolving variety of digital learning contexts makes new demands on learners, requiring them to develop strategies to adapt and cope with novel learning tools. This study derives from the need to learn more about learning experiences in digital contexts in order to be able to design these properly for learning. The research question targets how the design of an e-learning course influences participants’ self-regulated learning actions and intentions. SRL involves learners’ ability to exercise agency in their learning. Micro-level SRL processes were targeted by exploring behaviour, cognition, and affect/motivation in relation to the design of the digital context. Two iterations of an e-learning course were tested on two groups of participants (N=17). However, the exploration of SRL extends beyond the educational design research perspective of comparing the effects of the changes to the course designs. The study was conducted in a laboratory with each participant individually. Multiple types of data were collected. However, the results presented in this thesis are based on screen observations (including eye tracking) and video-stimulated recall interviews. These data were integrated in order to achieve a broad perspective on SRL. The most essential change evident in the second course iteration was the addition of feedback during practice and the final test. Without feedback on actions there was an observable difference between those who were instruction-directed and those who were self-directed in manipulating the context and, thus, persisted whenever faced with problems. In the second course iteration, including the feedback, this kind of difference was not found. Feedback provided the tipping point for participants to regulate their learning by identifying their knowledge gaps and to explore the learning context in a targeted manner. Furthermore, the course content was consistently seen from a pragmatic perspective, which influenced the participants’ choice of actions, showing that real life relevance is an important need of corporate learners. This also relates to assessment and the consideration of its purpose in relation to participants’ work situation. The rigidity of the multiple choice questions, focusing on the memorisation of details, influenced the participants to adapt to an approach for surface learning. It also caused frustration in cases where the participants’ epistemic beliefs were incompatible with this kind of assessment style. Triggers of positive and negative emotions could be categorized into four levels: personal factors, instructional design of content, interface design of context, and technical solution. In summary, the key design choices for creating a positive learning experience involve feedback, flexibility, functionality, fun, and freedom. The design of the context impacts regulation of behaviour, cognition, as well as affect and motivation. The learners’ awareness of these areas of regulation in relation to learning in a specific context is their ability for design-based epistemic metareflection. I describe this metareflection as knowing how to manipulate the context behaviourally for maximum learning, being metacognitively aware of one’s learning process, and being aware of how emotions can be regulated to maintain volitional control of the learning situation. Attention needs to be paid to how the design of a digital learning context supports learners’ metareflective development as digital learners. Every digital context has its own affordances and constraints, which influence the possibilities for micro-level SRL processes. Empowering learners in developing their ability for design-based epistemic metareflection is, therefore, essential for building their digital literacy in relation to these affordances and constraints. It was evident that the implementation of e-learning in the workplace is not unproblematic and needs new ways of thinking about learning and how we create learning spaces. Digital contexts bring a new culture of learning that demands attitude change in how we value knowledge, measure it, define who owns it, and who creates it. Based on the results, I argue that digital solutions for corporate learning ought to be built as an integrated system that facilitates socio-cultural connectivism within the corporation. The focus needs to shift from designing static e-learning material to managing networks of social meaning negotiation as part of a holistic corporate learning ecology.

Social media in the purchasing of knowledge-intensive business services

The purpose of this thesis was to understand how industrial buyers utilize social media in the purchasing of knowledge-intensive business services. By combining theories from past research a theoretical framework was formed to visualize the role of the social media at the different stages of the purchasing process. The subject was approached from the industrial buyers’ perspective instead of the knowledge-intensive business firm. The research was conducted using two qualitative research methods: interviews and netnography. The selected interviewees have been involved in the decision-making unit for purchasing knowledge-intensive business services. Additionally all of them are using various social media. Based on the interviews social media is used merely to support decision-making. Some of the interviewees had also shared their own experiences about the service and collaboration with the service provider with other social media users. Based on the interviews two social media were chosen for closer examination. The findings from netnography support the results from the interviews. The outcome of knowledgeintensive business services is dependable of the professionals. Therefore the information is used during decision-making process to confirm the formed image of the service, and the professionals of the service provider. Information obtained from social media complements information provided by the supplier. Even though the interviewees had not themselves used social media to find information about the service during search process, finding from netnography suggest it to exist. Industrial buyers ask other users’ opinions and experience about the services, and receive recommendations to them. Some recommendations are given publicly, but more discreet information is shared in private conversations. Observations in social media show that industrial buyers might be exposed to triggers to promote problem recognition as well. Companies share news and successful customer cases through their social media profiles, which might affect the industrial buyers, but to confirm this requires further research. The industrial buyers’ use of social media during different purchasing processes of knowledgeintensive business services can be conceptualize based on the findings. This helps companies to create right content to their social media pages, and encourage professionals to develop their networks in social media.

Opportunities and challenges of content marketing as a way of digital marketing communications

Tämän tutkimuksen tavoitteena on tunnistaa sisältömarkkinoinnin mahdollisuuksia ja haasteita digitaalisessa markkinointiviestinnässä. Lisäksi tavoitteena on antaa yksiselitteinen määritelmä sisältömarkkinoinnille sekä selvittää, miten se eroaa muista markkinointiviestinnän keinoista. Sisältömarkkinointi on strateginen markkinointiviestinnän keino, johon kuuluu asiakkaan kannalta mielenkiintoisen ja hyödyllisen sisällön tuottaminen ja jakaminen. Sisältömarkkinointi tarjoaa keinon muodostaa brändimielikuvia luonnollisin keinoin ilman mainoksen leimaa, jota osa kuluttajista välttelee tietoisesti jopa mainosten esto-ohjelmien avulla. Perinteiset markkinointiviestinnän keinot pyrkivät usein lyhyen aikavälin myyntituloksiin, kun taas sisältömarkkinointi pyrkii maksimoimaan asiakkaan koko elinkaaren arvon. Onnistunut sisältömarkkinointi vaatii yrityksiltä kärsivällisyyttä sekä asiakkaiden kokonaisvaltaista tuntemista.

To Integrate Or Not: A Comparison of the English Skills of Finnish Students in Mainstream Education and Content and Language Integrated Learning

The objective of the thesis was to study the possible linguistic differences of English of Finnish mainstream students and Finnish students following content and language integrated learning (CLIL), in terms of the given language test. The difference of test results between the test groups was further analyzed in more detail. The research was carried out by comparing the 9th grade students of the Finnish comprehensive school (the mainstream group) and CLIL students of the 9th grade of the Finnish comprehensive school (the CLIL group). The comparison was based on the national language test for the 9th grade students of the Finnish comprehensive school 2006 (A-English), produced by Sukol-Palvelu, owned by the Federation of Foreign Language Teachers in Finland SUKOL. The mainstream group of the present study consisted of 30 students, whereas the CLIL group included 27 students. Testing was carried out in spring 2007. The test results of the mainstream group (average of 64.1% out of the maximum score) were consistent with the results of the national average (63.9%). The average score of the CLIL students for the present study was 83.3% out of the maximum score. The results of the two groups in question were rather similar in the tasks measuring the skill of listening comprehension, in addition to one of the reading comprehension tasks. Moreover, a particular task with requirements of cultural and reactional skills produced results rather similar between the test groups. The differences between the results of the mainstream group and the CLIL group were most evident in three particular tasks. In general, the CLIL group performed clearly better than the mainstream group in the task measuring the knowledge of the polite conversational manners of the English-speaking world and in the tasks with requirements of lexical and structural knowledge of English. However, the writing task resulted in the most evident difference of results between the groups. In other words, the CLIL students of the present study were clearly more capable of producing English language with more varied vocabulary and more complex structures than the mainstream students. Thus, it might be argued whether the CLIL programme is to enhance the students´ performance in the productive skill of writing in particular. As a result, it might be useful to consider the possibilities of the CLIL programme in developing certain linguistic skills of the mainstream students of English as well.