Study design
This quasi experimental study with pretest/posttest design was conducted in Shiraz University of Medical Sciences in 2018.
Sampling
The research population based on the research by Chang et al.(24). Considering α=0.05, 10% loss, and using NCSS software and the following formula, a 40-subject sample size was determined for the study (20 subjects in each group).
The inclusion criteria of the study were being involved in education at the time of study, having passed the theoretical courses of pharmacology and mental health prior to the study, being involved in mental health apprenticeship at the time of study, being willing to cooperate in the study, and signing written informed consents. The exclusion criteria were not taking part in group discussion sessions and lack of possibility to install the prepared application on mobile phones.
From 40 students who had taken mental health apprenticeship 32 students had inclusion criteria and were randomly assigned to two groups of 16 students in the intervention and control groups using the table of random numbers It should be noted that 4 students in the group trained via group discussion technique were excluded from the study (Figure 1).
Instruments
The study data were collected using a demographic information form, students learning scale, a questionnaire assessing the students’ attitude towards mobile learning, and a questionnaire evaluating nursing students’ satisfaction with the instruction methods. The demographic information form included age, sex, marital status, living place, educational semester, previous semesters’ average point, type of mobile phone, membership in social groups, membership in scientific websites, and methods of access to course questions. Students learning scale was designed with 20 Items, according to the main goals of learning questionnaire assessing the rate of learning of psychotropic drugs, including antipsychotics, anti-anxiety drugs, antidepressants, and mood stabilizers. Each question had one score and a total was twenty.
The questionnaire assessing the students’ attitude towards mobile learning was designed by Naderi et al. in form of a test containing 13 items. The items were responded via a 5-point Likert scale with the following options: completely agree (5), agree (4), no idea (3), disagree (2), and completely disagree (1). The reliability of the questionnaire was approved by Cronbach’s alpha = 0.90. Additionally, its validity was confirmed by factor analysis(25).
The students’ satisfaction with the instruction methods was evaluated using a researcher-made questionnaire designed by Breimnejad et al.(26).
This questionnaire consisted of 16 items responded through a 3-option Likert scale (completely, to some extent, never), ranging from 1 to 3. Thus, the minimum and maximum scores of the questionnaire were 16 and 48, respectively. Accordingly, scores 0-16, 16-32, and above 32.
The face and content validity of the questionnaire were assessed by 15 experts using Waltz and Bausell’s index and the required modifications were applied. Accordingly, the content validity index was 0.85. Moreover, the reliability of the questionnaire was found to be 0.9 using the test-retest method(26).
Procedure
After approval of the research proposal and gaining the approval of the University’s Research Vice-chancellor and Ethics Committee, the researcher began searching in library resources as well as the related articles in order to collect the required content. The next stage involved preparation of the educational content, which included information about different categories of psychotropic drugs, pharmacology, pharmacokinetics, pharmacodynamics, clinical pharmacology, drug toxicity complications, names of different drug categories, nursing care, and advisable points. After preparing and designing the educational content and gaining the approval of the research team, the researcher referred to the virtual college (Comprehensive Center of Excellence for Electronic Learning in Medical Sciences) to set up a standard format for the software scenario. Then, sound recording from the educational content was done in two stages at the virtual college. After that, the researcher was introduced to a company to prepare the software that could be installed on mobile phones. The software was designed by engineers through meetings held with the researchers. Meanwhile, the researcher prepared the required images, animations, and videos regarding psychotropic drugs and gave them to the company. The videos were uploaded on the software in coordination with the virtual college. It should be noted that all stages were evaluated by the research team and deficiencies were resolved.
The prepared software included sounds, images, movies, animations, text files, searchability, chat room, and a final exam at the end of each drug category. The students observed eight icons on the software’s homepage and could have access to the materials by clicking on each icon. It should be noted that the final exam icon could not be run until the end of the course.
After all, the educational software was organized in five main sections, namely antidepressants, mood stabilizers, antipsychotics, anti-anxiety drugs, and summary. Each section consisted of subsidiary divisions, including the drug category’s basic and clinical pharmacology, pharmacokinetics and pharmacodynamics, side-effects, drug interactions, drug toxicity, and nursing care and advice while receiving medications. The advantages of this software included the possibility to use the audio or written file based on the students’ desire at the time of learning, existence of images related to drugs shapes and doses in order to make the students visually familiar with different types of psychotropic drugs, and existence of animations and videos regarding drugs side-effects in order to facilitate the students’ learning of theoretical concepts.
In order to avoid information exchange, the educational interventions were conducted in the two groups with a specific time interval. In so doing, first group discussion sessions were held. A week after the end of the intervention and the related assessments, the educational intervention using mobile phones was started. In this group, the software including the educational content was installed on the students’ Android mobile phones and the students received the content for two weeks. If they had any questions, would communicate with the researcher on the social network and the forum. The students in the group discussion group got familiar with group discussion in a training session. Then, based on a specific plan, they discussed various drug categories in the psychiatry department in the hospital where their apprenticeship course was held through six 45-minute sessions.
The two groups’ learning and satisfaction with the instruction methods were assessed before and two weeks after the educational intervention. The second group was also required to fill out the questionnaire evaluating attitude towards mobile learning before and after the intervention.
Statistical methods
After all, the data were entered into the SPSS statistical software, version 16 and were analyzed using descriptive (quantitative and qualitative tables, mean, and Standard Deviation and inferential (paired and independent t-test) statistics. P<0.05 was considered to be statistically significant. It should be noted that four students in the group discussion group were excluded from the study due to omitting the mental health apprenticeship.
Ethical considerations
After gaining the approval of the Ethics Committee of Shiraz University of Medical Sciences (code: 95-01-08-13957), the research objectives were explained to the students and their written informed consents were obtained. The students were reassured that their demographic information would remain confidential. Moreover, the control group students were provided with the educational software content after the end of the study.