Exploring Relationship between Pakistani Teachers’ Pedagogical Beliefs and ICT Use for Teaching and Learning

Background: The aim of present study is to investigate relationship between Pakistani teachers’ pedagogical beliefs and ICT use for teaching and learning. Previous studies found close relationship between pedagogical beliefs and teaching practices including use of ICT. However, variation in results is also reported and attributed to cultural and contextual differences. Methodology: Quantitative approach was used to study a sample of 231 Pakistani basic education teachers from middle and upper-middle range private schools, mostly from large urban centres. Results: This study confirmed previously study results that constructivist-compatible pedagogical beliefs are significantly related to both traditional and constructivist use of ICT. However, it is also found that traditional-transmission pedagogical beliefs are significantly related to traditional use of ICT – a finding not reported in previous studies. Some amounts of ICT training for pedagogical purpose exhibit significant impact on ICT use, in particular constructivist use of ICT. Similarly age also play a role as younger teachers are more likely to use ICT, however, no significant difference of pedagogical beliefs and ICT use was found between male and female teachers. Recommendation for practice and further investigation are made in chapter 5.

Using Moodle to provide added value in the teaching of a software development course

The rate of adoption and use of learning management systems to support teaching and learning processes in academic institutions is growing rapidly. Universities are acquiring systems with functionalities that can match with their specific needs and requirements. Moodle is one of the most popular and widely deployed learning management systems in academic institutions today. However, apart from the system, universities tend to maintain other applications for the purpose of supplementing their teaching and learning processes. This situation is similar to Lappeenranta University of Technology (LUT), which is our case study in this project. Apart from Moodle, the university also maintains other systems such as Oodi, Noppa and Uni portal for the purpose of supporting its educational activities. This thesis has two main goals. The first goal is to understand the specific role of Moodle at LUT. This information is fundamental in assessing whether Moodle is needed in the university’s current teaching and learning environment. The second aim is to provide insights to teachers and other departmental stakeholders on how Moodle can provide added value in the teaching of a software development course. In response to this, a Moodle module for a software development course is created and the underlying features are tested. Results of the constructive work proposed some improvements through (i) the use of Moodle for in-class surveys, (ii) transfer of grades from Moodle to Oodi, (iii) use of Moodle in self-study courses and MOOCs, (iv) online examinations, and (v) Moodle integrations with third party applications. The proposed items were then evaluated for their utility through interviews of five expert interviews. The final results of this work are considered useful to LUT administration and management specifically on ways that Moodle can bring changes to the university at managerial, economical and technical level. It also poses some challenges on platform innovations and research.

A case study of the English language teachers’ attitudes toward use of information and communication technology (ICT) in Finland

This qualitative study was aimed at investigating foreign language teachers’ attitudes toward use of information and communication technology (ICT) in their instruction. The insight was gained through the reported experience of ICT implementation by teachers, in what way and for which purpose they refer to use of technology, what kind of support and training they are provided with, and what beliefs they express about the influence of ICT implementation. This case study took place in one of the training schools in Finland. Five teachers participated in semi-structured interviews through a face-to-face approach. The findings demonstrated positive attitudes of teachers toward integration of ICT. The teachers shared their opinions about positive influence that ICT implementation has on both teaching and learning processes. However, they also pointed out the negative sides of ICT use: distraction of the students from usage of technology and technical problems causing frustration to the teachers. In addition, the responses revealed that the teachers are provided with adequate training aimed at enhancing their qualification which is provided with well-timed technology support and colleagues’ collaboration facilitating an efficient and smooth pace of the teaching process. According to the teachers’ opinions ICT integration in education appeared to have changed the role of the teacher. Due to different alterations in the field of ICT development teachers are required to upgrade their skills. The paper concludes with the limitations of the study and the recommendations for conducting further research.

A case study of the English language teachers’ attitudes toward use of information and communication technology (ICT) in Finland

This qualitative study was aimed at investigating foreign language teachers’ attitudes toward use of information and communication technology (ICT) in their instruction. The insight was gained through the reported experience of ICT implementation by teachers, in what way and for which purpose they refer to use of technology, what kind of support and training they are provided with, and what beliefs they express about the influence of ICT implementation. This case study took place in one of the training schools in Finland. Five teachers participated in semi-structured interviews through a face-to-face approach. The findings demonstrated positive attitudes of teachers toward integration of ICT. The teachers shared their opinions about positive influence that ICT implementation has on both teaching and learning processes. However, they also pointed out the negative sides of ICT use: distraction of the students from usage of technology and technical problems causing frustration to the teachers. In addition, the responses revealed that the teachers are provided with adequate training aimed at enhancing their qualification which is provided with well-timed technology support and colleagues’ collaboration facilitating an efficient and smooth pace of the teaching process. According to the teachers’ opinions ICT integration in education appeared to have changed the role of the teacher. Due to different alterations in the field of ICT development teachers are required to upgrade their skills. The paper concludes with the limitations of the study and the recommendations for conducting further research.

Developing Processes and Learning in a Project-based Firm

Tämän diplomityön tavoitteena on kuvata tiedonkulkua projektiliiketoimintaa harjoittavassa yrityksessä sekä analysoida kuvausta määrittäen mahdolliset kehityskohdat. Työssätuotetut kuvaukset ja kehityskohtien määrittäminen toimivat pohjana yrityksen kehittäessä projektien hallintaansa tulevaisuudessa. Työssä valitaan tietojohtamisen näkökulma sopivaksi lähestymistavaksi yrityksen toiminnananalysointiin. Haastatteluin kerätyn tutkimusmateriaalin perusteella luodaan prosessikuvaukset jotka mallintavat tietovirtoja yrityksen projektien aikana tapahtuvien prosessien välillä. Kuvausta peilataan tietämyksen luomisen sekä projektien tietojohtamisen teoriaan ja määritetään kehityskohteita. Kehityskohteiden määrittämisen lisäksi ehdotetaan mahdollisia toimenpiteitä tiedon ja tietämyksen hallinnan kehittämiseksi. Kokemusten ja opittujen asioiden sekäpalautteen kerääminen projektien aikana sekä niiden jälkeen havaittiin tärkeimmäksi kehityskohdaksi. Näiden keräämisen voidaan todeta vaativan järjestelmällisyyttä jotta projektien onnistumiset sekä niissä saavutetut parannukset voidaan toistaa jatkossa ja virheet sekä epäonnistumiset sitä vastoin välttää.

Building the ‘Digital’ Library: Routes to Managing our Institutional Digital Learning, Teaching and Research Assets Together

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Socially shared metacognitive regulation during collaborative learning processes in student dyads and small groups

Traditionally metacognition has been theorised, methodologically studied and empirically tested from the standpoint mainly of individuals and their learning contexts. In this dissertation the emergence of metacognition is analysed more broadly. The aim of the dissertation was to explore socially shared metacognitive regulation (SSMR) as part of collaborative learning processes taking place in student dyads and small learning groups. The specific aims were to extend the concept of individual metacognition to SSMR, to develop methods to capture and analyse SSMR and to validate the usefulness of the concept of SSMR in two different learning contexts; in face-to-face student dyads solving mathematical word problems and also in small groups taking part in inquiry-based science learning in an asynchronous computer-supported collaborative learning (CSCL) environment. This dissertation is comprised of four studies. In Study I, the main aim was to explore if and how metacognition emerges during problem solving in student dyads and then to develop a method for analysing the social level of awareness, monitoring, and regulatory processes emerging during the problem solving. Two dyads comprised of 10-year-old students who were high-achieving especially in mathematical word problem solving and reading comprehension were involved in the study. An in-depth case analysis was conducted. Data consisted of over 16 (30–45 minutes) videotaped and transcribed face-to-face sessions. The dyads solved altogether 151 mathematical word problems of different difficulty levels in a game-format learning environment. The interaction flowchart was used in the analysis to uncover socially shared metacognition. Interviews (also stimulated recall interviews) were conducted in order to obtain further information about socially shared metacognition. The findings showed the emergence of metacognition in a collaborative learning context in a way that cannot solely be explained by individual conception. The concept of socially-shared metacognition (SSMR) was proposed. The results highlighted the emergence of socially shared metacognition specifically in problems where dyads encountered challenges. Small verbal and nonverbal signals between students also triggered the emergence of socially shared metacognition. Additionally, one dyad implemented a system whereby they shared metacognitive regulation based on their strengths in learning. Overall, the findings suggested that in order to discover patterns of socially shared metacognition, it is important to investigate metacognition over time. However, it was concluded that more research on socially shared metacognition, from larger data sets, is needed. These findings formed the basis of the second study. In Study II, the specific aim was to investigate whether socially shared metacognition can be reliably identified from a large dataset of collaborative face-to-face mathematical word problem solving sessions by student dyads. We specifically examined different difficulty levels of tasks as well as the function and focus of socially shared metacognition. Furthermore, the presence of observable metacognitive experiences at the beginning of socially shared metacognition was explored. Four dyads participated in the study. Each dyad was comprised of high-achieving 10-year-old students, ranked in the top 11% of their fourth grade peers (n=393). Dyads were from the same data set as in Study I. The dyads worked face-to-face in a computer-supported, game-format learning environment. Problem-solving processes for 251 tasks at three difficulty levels taking place during 56 (30–45 minutes) lessons were video-taped and analysed. Baseline data for this study were 14 675 turns of transcribed verbal and nonverbal behaviours observed in four study dyads. The micro-level analysis illustrated how participants moved between different channels of communication (individual and interpersonal). The unit of analysis was a set of turns, referred to as an ‘episode’. The results indicated that socially shared metacognition and its function and focus, as well as the appearance of metacognitive experiences can be defined in a reliable way from a larger data set by independent coders. A comparison of the different difficulty levels of the problems suggested that in order to trigger socially shared metacognition in small groups, the problems should be more difficult, as opposed to moderately difficult or easy. Although socially shared metacognition was found in collaborative face-to-face problem solving among high-achieving student dyads, more research is needed in different contexts. This consideration created the basis of the research on socially shared metacognition in Studies III and IV. In Study III, the aim was to expand the research on SSMR from face-to-face mathematical problem solving in student dyads to inquiry-based science learning among small groups in an asynchronous computer-supported collaborative learning (CSCL) environment. The specific aims were to investigate SSMR’s evolvement and functions in a CSCL environment and to explore how SSMR emerges at different phases of the inquiry process. Finally, individual student participation in SSMR during the process was studied. An in-depth explanatory case study of one small group of four girls aged 12 years was carried out. The girls attended a class that has an entrance examination and conducts a language-enriched curriculum. The small group solved complex science problems in an asynchronous CSCL environment, participating in research-like processes of inquiry during 22 lessons (á 45–minute). Students’ network discussion were recorded in written notes (N=640) which were used as study data. A set of notes, referred to here as a ‘thread’, was used as the unit of analysis. The inter-coder agreement was regarded as substantial. The results indicated that SSMR emerges in a small group’s asynchronous CSCL inquiry process in the science domain. Hence, the results of Study III were in line with the previous Study I and Study II and revealed that metacognition cannot be reduced to the individual level alone. The findings also confirm that SSMR should be examined as a process, since SSMR can evolve during different phases and that different SSMR threads overlapped and intertwined. Although the classification of SSMR’s functions was applicable in the context of CSCL in a small group, the dominant function was different in the asynchronous CSCL inquiry in the small group in a science activity than in mathematical word problem solving among student dyads (Study II). Further, the use of different analytical methods provided complementary findings about students’ participation in SSMR. The findings suggest that it is not enough to code just a single written note or simply to examine who has the largest number of notes in the SSMR thread but also to examine the connections between the notes. As the findings of the present study are based on an in-depth analysis of a single small group, further cases were examined in Study IV, as well as looking at the SSMR’s focus, which was also studied in a face-to-face context. In Study IV, the general aim was to investigate the emergence of SSMR with a larger data set from an asynchronous CSCL inquiry process in small student groups carrying out science activities. The specific aims were to study the emergence of SSMR in the different phases of the process, students’ participation in SSMR, and the relation of SSMR’s focus to the quality of outcomes, which was not explored in previous studies. The participants were 12-year-old students from the same class as in Study III. Five small groups consisting of four students and one of five students (N=25) were involved in the study. The small groups solved ill-defined science problems in an asynchronous CSCL environment, participating in research-like processes of inquiry over a total period of 22 hours. Written notes (N=4088) detailed the network discussions of the small groups and these constituted the study data. With these notes, SSMR threads were explored. As in Study III, the thread was used as the unit of analysis. In total, 332 notes were classified as forming 41 SSMR threads. Inter-coder agreement was assessed by three coders in the different phases of the analysis and found to be reliable. Multiple methods of analysis were used. Results showed that SSMR emerged in all the asynchronous CSCL inquiry processes in the small groups. However, the findings did not reveal any significantly changing trend in the emergence of SSMR during the process. As a main trend, the number of notes included in SSMR threads differed significantly in different phases of the process and small groups differed from each other. Although student participation was seen as highly dispersed between the students, there were differences between students and small groups. Furthermore, the findings indicated that the amount of SSMR during the process or participation structure did not explain the differences in the quality of outcomes for the groups. Rather, when SSMRs were focused on understanding and procedural matters, it was associated with achieving high quality learning outcomes. In turn, when SSMRs were focused on incidental and procedural matters, it was associated with low level learning outcomes. Hence, the findings imply that the focus of any emerging SSMR is crucial to the quality of the learning outcomes. Moreover, the findings encourage the use of multiple research methods for studying SSMR. In total, the four studies convincingly indicate that a phenomenon of socially shared metacognitive regulation also exists. This means that it was possible to define the concept of SSMR theoretically, to investigate it methodologically and to validate it empirically in two different learning contexts across dyads and small groups. In-depth micro-level case analysis in Studies I and III showed the possibility to capture and analyse in detail SSMR during the collaborative process, while in Studies II and IV, the analysis validated the emergence of SSMR in larger data sets. Hence, validation was tested both between two environments and within the same environments with further cases. As a part of this dissertation, SSMR’s detailed functions and foci were revealed. Moreover, the findings showed the important role of observable metacognitive experiences as the starting point of SSMRs. It was apparent that problems dealt with by the groups should be rather difficult if SSMR is to be made clearly visible. Further, individual students’ participation was found to differ between students and groups. The multiple research methods employed revealed supplementary findings regarding SSMR. Finally, when SSMR was focused on understanding and procedural matters, this was seen to lead to higher quality learning outcomes. Socially shared metacognition regulation should therefore be taken into consideration in students’ collaborative learning at school similarly to how an individual’s metacognition is taken into account in individual learning.

Integrating environmental education in primary school education in Tanzania : teachers’ perceptions and teaching practices

The study focuses on primary school teachers’ perceptions of environmental education, its integration into primary school education and teachers’ teaching practices in Tanzania. The thesis is based on empirical research. The theoretical underpinnings of the study are based on Palmer’s (1998) model of environmental education. According to the model, meaningful environmental education should include education about, in or through and for the environment. The study is supported by national and international literature from research done on environmental education and education for sustainable development and policy statements. The study is qualitative in nature, adopting phenomenography and phenomenology as points of departure. The empirical data was collected from four primary schools in Morogoro region in Tanzania. The study sample consisted of 31 primary school teachers. Data was collected through interviews and lesson observations. According to the results of the study, primary school teachers expressed variations in their perceptions of environmental education and education for sustainable development. Most of the teachers focused on the aspect of knowledge acquisition. According to Tanzanian education and training policy, environmental education has to be integrated into all subjects. Although there is environmental education in the primary school curriculum, it is not integrated on an equal footing in all subjects. Some subjects like science, social studies and geography have more environmental content than other subjects. Teachers claim that the approach used to integrate environmental education into the school curriculum was not favoured because many claimed that what is to be taught as environmental education in the various subjects is not shown clearly. As a result, many teachers suggested that to ensure that it is taught properly it should be included in the curriculum as an independent subject or as specific topics. The study revealed that teachers’ teaching practices in integrating environmental education varied from one subject to another. Although most of the teachers said that they used participatory methods, lesson observations showed that they limited themselves to question and answer and group discussion. However, the teachers faced a number of barriers in the teaching of environmental education, some of which include lack of teaching and learning resources, time and large class size. The role of teachers in the implementation of environmental education in developing an environmentally literate citizenry is of great significance. The responsibility of the government in developing a curriculum with clear goals and content, developing teachers’ capacity in the teaching of environmental education and provision of teaching and learning materials needs to be taken seriously by the government in educational plans and programs.

Focusing on the quality of learning processes

S. 327-333

Integration of learning supportive applications into the development of the e-portfolio construction process

The portfolio as a means of demonstrating personal skills has lately been gaining prominence among technology students. This is partially due to the introduction of electronic portfolios, or e-portfolios. As platforms for e-portfolio management with different approaches have been introduced, the learning cycle, traditional portfolio pedagogy, and learner centricity have sometimes been forgotten, and as a result, the tools have been used for the most part as data depositories. The purpose of this thesis is to show how the construction of e-portfolios of IT students can be supported by institutions through the usage of different tools that relate to study advising, teaching, and learning. The construction process is presented as a cycle based on learning theories. Actions related to the various phases of the e-portfolio construction process are supported by the implementation of software applications. To maximize learner-centricity and minimize the intervention of the institution, the evaluated and controlled actions for these practices can be separated from the e-portfolios, leaving the construction of the e-portfolio to students. The main contributions of this thesis are the implemented applications, which can be considered to support the e-portfolio construction by assisting in planning, organizing, and reflecting activities. Eventually, this supports the students in their construction of better and more extensive e-portfolios. The implemented tools include 1) JobSkillSearcher to help students’ recognition of the demands of the ICT industry regarding skills, 2) WebTUTOR to support students’ personal study planning, 3) Learning Styles to determine students' learning styles, and 4) MyPeerReview to provide a platform on which to carry out anonymous peer review processes in courses. The most visible outcome concerning the e-portfolio is its representation, meaning that one can use it to demonstrate personal achievements at the time of seeking a job and gaining employment. Testing the tools and the selected open-source e-portfolio application indicates that the degree of richness of e-portfolio content can be increased by using the implemented applications.

In search of good relationships to music : understanding aspiration and challenge in developing music school teacher practices

This study focuses on teacher practices in publicly funded music schools in Finland. As views on the aims of music education change and broaden, music schools across Europe share the challenge of developing their activities in response. In public and scholarly debate, there have been calls for increased diversity of contents and concepts of teaching. In Finland, the official national curriculum for state-funded music schools builds on the ideal that teaching and learning should create conditions which promote ‘a good relationship to music’. The meaning of this concept has been deliberately left open in order to leave room for dialogue, flexibility, and teacher autonomy. Since what is meant by ‘good’ is not defined in advance, the notion of ‘improving’ practices is also open to discussion. The purpose of the study is to examine these issues from teachers’ point of view by asking what music school teachers aim to accomplish as they develop their practices. Methodologically, the study introduces a suggestion for building empirical research on Alperson’s ‘robust’ praxial approach to music education, a philosophical theory which is strongly committed to practitioner perspectives and musical diversity. A systematic method for analysing music education practices, interpretive practice analysis, is elaborated with support from interpretive research methods originally used in policy analysis. In addition, the research design shows how reflecting conversations (a collaborative approach well-known in Nordic social work) can be fruitfully applied in interpretive research and combined with teacher inquiry. Data have been generated in a collaborative project involving five experienced music school teachers and the researcher. The empirical material includes transcripts from group conversations, data from teacher inquiry conducted within the project, and transcripts from follow-up interviews. The teachers’ aspirations can be understood as strivings to reinforce the connection between musical practices and various forms of human flourishing such that music and flourishing can sustain each other. Examples from their practices show how the word ‘good’ receives its meaning in context. Central among the teachers’ concerns is their hope that students develop a free and sustainable interest in music, often described as inspiration. I propose that ‘good relationships to music’ and ‘inspiration’ can be understood as philosophical mediators which support the transition from an indeterminate ‘interest in music’ towards specific ways in which music can become a (co-)constitutive part of living well in each person’s particular circumstances. Different musical practices emphasise different aspects of what is considered important in music and in human life. Music school teachers consciously balance between a variety of such values. They also make efforts to resist pressure which might threaten the goods they think are most important. Such goods include joy, participation, perseverance, solid musical skills related to specific practices, and a strong sense of vitality. The insights from this study suggest that when teachers are able to create inspiration, they seem to do so by performing complex work which combines musical and educational aims and makes general positive contributions to their students’ lives. Ensuring that teaching and learning in music schools remain as constructive and meaningful as possible for both students and teachers is a demanding task. The study indicates that collaborative, reflective and interdisciplinary work may be helpful as support for development processes on both individual and collective levels of music school teacher practices.

The Roles of Cultural, Functional and Value Diversity in Innovativeness and Learning

Tutkielman tavoite on tutkia kulttuurista, funktionaalista ja arvojen diversiteettiä, niiden suhdetta innovatiivisuuteen ja oppimiseen sekä tarjota keinoja diversiteetin johtamiseen. Tämän lisäksi selvitetään linjaesimiesten haastattelujen kautta miten diversiteetti case -organisaatiossa tällä hetkellä koetaan. Organisaation diversiteetin tämänhetkisen tilan tunnistamisen kautta voidaan esittää parannusehdotuksia diversiteetin hallintaan. Tutkimus- ja tiedonkeruumenetelmänä käytetään kvalitatiivista focus group haastattelumenetelmää. Tutkimuksessa saatiin selkeä kuva kulttuurisen, funktionaalisen ja arvojen diversiteetin merkityksistä organisaation innovatiivisuudelle ja oppimiselle sekä löydettiin keinoja näiden diversiteetin tyyppien johtamiseen. Tutkimuksen tärkeä löydös on se, että diversiteetti vaikuttaa positiivisesti organisaation innovatiivisuuteen kun sitä johdetaan tehokkaasti ja kun organisaatioympäristö tukee avointa keskustelua ja mielipiteiden jakamista. Case organisaation tämänhetkistä diversiteetin tilaa selvitettäessä havaittiin että ongelma organisaatiossa ei ole diversiteetin puute, vaan paremminkin se, ettei diversiteettia osata hyödyntää. Organisaatio ei tue erilaisten näkemysten ja mielipiteiden vapaata esittämistä jahyväksikäyttöä ja siksi diversiteetin hyödyntäminen on epätäydellistä. Haastatteluissa tärkeinä seikkoina diversiteetin hyödyntämisen parantamisessa nähtiin kulttuurin muuttaminen avoimempaan suuntaan ja johtajien esimiestaitojen parantaminen.

Delivery of European Cross-Border Health Care and the Relevance and Effects of EU Regulations and Judicial Processes with Reference to Delivery of Drugs and Blood Donor Information Material.

Valtion rajat ylittävät terveyspalvelut Euroopan unionissa sekä Euroopan unionin säädösten merkitys ja vaikutus erityisesti lääkejakeluun ja verenluovuttajille jaettavaan tiedotusaineistoon Valtion rajat ylittävä terveydenhuolto on suuren kiinnostuksen kohteena Euroopan unionissa. Resurssien hyödyntäminen parhaalla mahdollisella tavalla ja tiedon keskittäminen ovat tarpeen terveydenhuollon kustannusten alati noustessa. Terveydenhuoltopalvelut kuuluvat Euroopan sisämarkkinoiden vapaan liikkuvuuden piiriin. Euroopan unionilla ei ole kuitenkaan toimivaltaa säädellä terveydenhuoltojärjestelmiä, vaan sen mahdollisuudet ovat enimmäkseen kansanterveyden edistämisessä ja suojelussa, myös muilla toimialueilla kuin terveydenhuollossa. Tutkimuksen tavoitteena oli tutkia Euroopan unionin säädösten vaikutusta terveydenhuoltosektoriin, erityisesti valtion rajat ylittäviin terveydenhuoltopalveluihin. Erityiskohteena olivat lääkemääräyksen toimittaminen toisen Euroopan unionin jäsenmaan apteekista, resepti-lääkkeiden maahantuonti omaan henkilökohtaiseen käyttöön, sähköisen lääkemääräyksen käyttö kansallisesti ja mahdollisuudet sen käyttöön eri jäsenmaiden välillä, online-apteekkien soveltuvuus Euroopan unionin sisämarkkinoille sekä verenluovuttajille jaettavan tiedotusaineiston yhtenäistämistarve Euroopan unionin alueella. Tutkimuksen osa-alueiden aineisto koottiin vuosina 1999–2003, jolloin Euroopan unioniin kuului 15 jäsenmaata. Apteekit toimittivat useimmiten myös ei-kansalliset, toisessa Euroopan unionin jäsenmaassa annetut lääkemääräykset. Kaikki jäsenmaat rajoittivat lääkemääräyksen vaativien lääkkeiden maahantuontia. Rajoituksia oli maahantuontimäärissä ja -tavoissa. Lisäksi sairasvakuutuskorvausten saaminen ulkomailla lunastetuista reseptilääkkeistä oli hankalaa. Sähköiset lääkemääräykset olivat käytössä vain kahdessa maassa, mutta useissa maissa suunniteltiin niiden kokeilua. Standardit ja käyttöjärjestelmät olivat erilaisia eri maissa. Euroopan unionin alueelle on perustettu online-apteekkeja, joiden toiminta on kuitenkin vaatimatonta. Verenluovuttajille annettava tiedotusaineisto ei missään maassa täyttänyt veridirektiivin vaatimuksia. Tutkimuksen tulokset osoittivat kansallisten käytäntöjen eroavaisuuksien rajoittavan valtion rajat ylittäviä terveydenhuoltopalveluita. Vaikka Euroopan unionin tavoitteena ei ole yhtenäistää terveydenhuoltojärjestelmiä, on tarpeen arvioida uudelleen unionin ja jäsenmaiden välistä työnjakoa. Kansalliset terveydenhuoltojärjestelmät eivät ole erillään Euroopan sisämarkkinoista, jotka merkittävästi vaikuttavat terveydenhuoltoon.