No abstract

Background: Offering widespread access to training, massive open online courses (MOOCs) are regarded in the literature as a tool for democratizing knowledge. However, to be universal they must be culturally contextualized and have access to broadband Internet with adequate connectivity. Aiming to strengthen capacities in low- and middle-income countries, the SDH-Net multicenter consortium created a 10-hour MOOC specifically designed to enhance understanding of the social determinants of health (SDH). Methods: This is crucial for tackling health inequalities through public policy. Using a mixed methods approach, we evaluated the implementation of the SDH-Net MOOC from the perspective of e-literacy, Internet connectivity, course contents and instructional design: we administered a questionnaire to a pilot group of 29 course participants from Brazil, Colombia, Kenya, Mexico, South Africa and Tanzania, and conducted semi-structured interviews with a subset of 15 individuals who had completed the course. Results: While participants in general considered the content of the course adequate, those who were not English speakers found certain instructions somewhat unclear and 55% of respondents experienced difficulties with Internet connectivity and speed. Therefore, a key finding of this study was that binomial e-literacy-technological access play a major role in enrollment in, and completion of MOOCs. Conclusions: Course design is reflected in all course elements, such as the definition of competencies, instructional objectives, learning activities using multimedia resources and evaluations for each thematic unit, and these are central to the acceptability and effectiveness of MOOCs. These results shed light on the discussion regarding the function of MOOCs as a tool for democratizing knowledge and cast doubts on their usefulness in mainstreaming global health knowledge.