In health sciences education today, courses offered online have become common. The advantage with an online setting may be the possibility for students to work independently, as the course material and information are accessible at all hours [1]. Also communication with teachers and peers may occur in an individualized and flexible fashion. An online course design that promotes collaboration, based on the theory of connectivism [2], supporting processes of collaboration and communication, may facilitate the transition from being a dependent learner to an active and autonomous learner, taking charge of one’s learning [2-4]. The online courses may thus scaffold the development of problem-solving skills and promote an explorative and interactive collaborative learning opportunity [3-5]. Lund University in Sweden is a diverse university with many faculties. The education is on campus and also offering distance learning education. The physiotherapy program is mainly on campus and in clinical practice. One of these courses is developed and designed for online learning targeting undergraduate second year physiotherapy students. To develop an online environment further it is important to broaden the understanding of how students perceive working and learning online [6]. The aim of this study is to identify aspects influencing students’ learning processes and their adaptation to self-directed learning online.

The ‘basic research methodology’ course is a five-week full-time online course. It is based on learning theories of connectivism and social constructivism, which postulate that social and cultural interactions stimulate and enhance learning [2]. Accordingly, the students had to collaborate, mainly in pairs, making decisions on learning strategies and what they needed to elaborate on to reach the goals. The learning management system contained assignment guidelines with clearly stated goals, a bulletin board, course library, discussion forum and folders for student created content, to scaffold their learning processes. The course assignments were aligned to the examination task, and included additional structured questions to elaborate on. This self-directed and problem-oriented learning environment was designed to create a notion of a shared learning space where the students created the content and could exchange experiences and ideas, which also included writing peer-reviews.

The structure of the assignments represented different aspects of basic research methodology scaffolding the development of a project plan (final examination task). Each assignment should be elaborated on in relation to a topic of their own choice and their learning needs. It was also mandatory to publish individually written self-reflections at the end of each week during the five weeks. The students were encouraged to reflect on how the assignments during the past week were accomplished.

Two main categories emerged from the elaborated sub-categories: ‘the influence of the structured framework’ and ‘communication and interaction with teachers and peers.’ Representative quotes were selected to illustrate the categories and subcategories.

When designing the course, we expected that the course structure would facilitate the students’ learning and adaptation to the new online environment. However, it was valuable to discover the extent of which internal factors were influencing the students’ approaches and adaptation. In the latent analysis it became evident that external and internal factors/aspects were influencing both the adaptation to the online course and the learning processes. External factors were defined as environmental influences, e.g. course structure, learning space, and relationships. Internal factors included internal psychological and emotional manifestations and dimensions of active student engagement influencing their perceptions, attitudes and motivation. Based on these findings, feed-back that actively encourages communicating with peers should be promoted, also suggested in previous studies [2-4]. The experiences of overcoming difficulties were described as supporting the process of becoming more flexible. Overcoming barriers may in fact potentially strengthen the students’ self-efficacy. Bandura defined perceived self-efficacy as the ability to sense one’s capacity to accomplish a certain level of performance. Some students did express having performance anxiety and low self-efficacy [8]. To promote self-regulated learning, it may be important that these students receive encouraging feedback, stressing the progression of their learning [9], since self-efficacy may have a substantial impact on motivation [10].

‘The influence of the structural framework’ comprised mostly external factors influencing the learning processes, e.g., the importance of clear guidelines and clarity on purpose and goal. The structural framework of the course was perceived as important, but both facilitating and challenging. In a constructivist perspective the perceived challenges may indicate a need for clear and articulate guidelines, in agreement with previous studies [6]. The main concern is then if the challenge was balanced and reasonable or too much. Students who took advantage of the early access of course guidelines and study aids expressed that it helped them to take responsibility for their learning. A previous study emphasized that the instructional design was important in online learning [6]. There were also evidence in our study confirming that clear alignment and instructions supported active and autonomous learning strategies. The online structure may thus have promoted independent learning processes, based on the student-reported sense of ownership of the course material. Another interesting finding was that the students’ described perceived benefits of their newly gained knowledge and skills with respect to their future work and profession. This may suggest a deep approach to learning and motivation found beyond the task.

In addition, the triangulated data showed many signs of increased motivation created by the values of making own choices, being challenged to explore and summarize a topic not previously familiar. The students also expressed the advantage as well as challenge of taking control of time management and study aid selection, various forms of collaboration, and taking the consequences of their own planning. These findings were corroborated with previous findings suggesting that structural design also may influence intrinsic and extrinsic motivation [11]. ‘Communication and interaction with teachers and peers’ included several reported internal factors influencing learning and development. An interesting finding was that some students expressed a desire to have face-to-face contact. This may be an expression of previous experiences and limited use of self-directed learning.

What was the impact on collaboration? Students recognized peer communication and interaction as meaningful for their learning. These activities are complex and maybe it is the calibration and assurance by reading others work, or the cognitive processes of giving and receiving feedback, or all these activities put together that creates the meaningful environment. Peer feedback that involved constructive suggestions was perceived as useful. This finding was in line with a previous study, which found that critique and negative comments did not have the same impact as when students explained and justified their views and ideas [12].

How feedback from both teachers and peers is perceived may stem from multiple factors including emotional reactions, self-perceptions and personal goals. Feedback may thus either lower or augment motivation and improvement depending on prior experiences of success or failure [13]. Feelings of pride or shame, positive attitude or hopelessness may also have an impact on the student’s motivation and sense of self-worth. Motivation by these processes seems therefore to be influenced by both external and internal stimuli [14]. This may explain the different reactions to the self-directed learning in our study, which were expressed both as personally relevant and motivating by some, and also challenging to others. This finding corroborates with previous studies [4,14].

The results indicated that this self-directed research-based education model, as designed here, may well be a useful approach for higher education. With regard to transferability, we feel that our findings may apply to other university undergraduate students. From the perspective of teaching, the students’ self-reflections provided valuable information about how the students perceived their learning processes, the context and the content of the course. Many of the students expressed a sense of personal growth with increased understanding. However, the presence of low self-efficacy and performance anxiety pointed towards a need for more support and encouragement as suggested earlier [12]. To early on encourage and support collaboration among peers may reduce feelings of worry and anxiety among those who may not yet have adapted to the requirements of higher education. This representation of internal factors influencing learning needs to be investigated further.

A potential study limitation may be that the students’ self-reflections were published as part of the collaborative environment and thereby available for others to read. This may have influenced the present findings, as the students might potentially have chosen to restrict or in other ways shaped their writing. We acknowledge that the results may be affected by our experiences as teachers in online courses. However, all authors worked separately with the data during the phases of condensing the data to meaning units and the coding. There were continuous discussions when sorting the data to categories and sub-categories to remind us of possible influences of previous experiences [7]. We strategically selected a whole cohort of students in order to have a representative variety of students.

In conclusion, the analyses reflected important perspectives targeting areas which enable further course development. The influences of external and internal factors on learning strategies and self-efficacy are important aspects to consider when designing online courses. Factors such as pedagogical design, clarity of purpose and goals and guidelines were important as well as continuous opportunities for communication and collaboration. Further studies are needed to understand and scaffold the motivational factors among students with low self-efficacy.