Web-based learning design in paediatric perioperative care : the importance of including an educational framework and children’s own perspectives

The perioperative period is a significant and unforgettable life event for children with both short-term and long-term effects. Despite evidence highlighting the importance of including children’s perspectives, their right to and need for preparation, children’s views of the perioperative period are rarely sought and many are still arriving in the operating room unprepared and with preoperative anxiety. Today, there is an increasing availability of web-based preparation programs for children in paediatric care. The overall aim of the thesis is to provide understanding of how web-based technology can support children to learn about and be prepared for perioperative care.

The thesis adopted a pragmatic stance and employed different research approaches. All studies were grounded in children’s perspectives and based on the Anaesthesia-Web (www.anaesthesiaweb.org), a widely used, comprehensive web-based preparation program. In Study 1 children’s level of knowledge about perioperative care after receiving either interactive web-based information or conventional brochure material preoperatively was investigated in a prospective randomised controlled trial. In Study 2 key educational principles in the development and design of websites for children in paediatric care were identified with directed content analysis based on a defined theoretical educational framework. In Study 3 children’s perspectives, experiences and perceptions facing anaesthesia and surgery were explored using inductive interpretative manifest and latent content analysis. In Study 4 children’s use and experiences of a web-based perioperative preparation program were investigated with a directed content analysis based on the theoretical themes identified in study 2 that described children’s learning on a website. The results revealed that web-based technology can function as a significant resource for preparation and learning in paediatric perioperative care. Such programs have to change from simply providing information to incorporate the child’s need to process the information in order to learn and understand. An interactive web-based design was shown to support children to obtain higher levels of knowledge about perioperative care compared with conventional brochure material. Analysis of children’s use of and experiences with a web-based preparation program displayed how the inclusion of children’s perspectives and an educational framework of children’s learning can improve the development and design of websites in paediatric care. Important characteristics supporting children’s learning on a website were found to let the child be; In charge of own learning, to Discover and play, to Recognise events and situations and to identify with others, to Get feedback in the learning process and to facilitate Interaction with other children.

Children’s perceptions and interpretations of the perioperative period were found to differ from those of adults and health care providers. Understanding children’s perspectives, and awareness of their need to process the information provided to understand and be prepared, are significant factors in establishing trust and confidence in the highly technological perioperative environment. Web-based technology constitutes an important part of children’s preparation but helping children to become confident also require awareness of communication strategies and preparation as a continuous process, signified by perceptiveness and individualised adjustments during all perioperative phases. It is time to improve existing perioperative structures by taking account of children’s perspectives.

List of scientific papers

I. Lööf G, Liljeberg C, Eksborg S, Lönnqvist P-A. Interactive web-based format vs conventional brochure material for information transfer to children and parents: a randomized controlled trial regarding preoperative information. Pediatric Anesthesia. 2017;(27)6:657-664.
https://doi.org/10.1111/pan.13142

II. Lööf G, Andersson-Papadogiannakis N, Karlgren K, Silén C. Web-based learning for children in pediatric care: Qualitative study assessing educational challenges. JMIR Perioperative Medicine. 2018;1(2).
https://doi.org/10.2196/10203

III. Lööf G, Andersson-Papadogiannakis N, Silén C. Children’s own perspectives demonstrate the need to improve paediatric perioperative care. [Submitted]

IV. Lööf G, Andersson-Papadogiannakis N, Silén C. Children’s use of and experiences with a web-based perioperative preparation program: Directed content analysis. JMIR Perioperative Medicine. 2019;2(1).
https://doi.org/10.2196/13565