title: External and internal factors influencing self-directed online learning of physiotherapy undergraduate students in Sweden: a qualitative study.
abstract: OBJECTIVE
  Online courses have become common in health sciences education. This learning environment can be designed using different approaches to support student learning. To further develop online environment, it is important to understand how students perceive working and learning online. The aim of this study is to identify aspects influencing students' learning processes and their adaptation to self-directed learning online.
  
  
  METHODS
  Thirty-four physiotherapy students with a mean age of 25 years (range, 21 to 34 years) participated. Qualitative content analysis and triangulation was used when investigating the students' self-reflections, written during a five week self-directed, problem-oriented online course.
  
  
  RESULTS
  Two categories emerged: 'the influence of the structured framework' and 'communication and interaction with teachers and peers.' The learning processes were influenced by external factors, e.g., a clear structure including a transparent alignment of assignments and assessment. Important challenges to over-come were primarily internal factors, e.g., low self-efficacy, difficulties to plan the work effectively and adapting to a new environment.
  
  
  CONCLUSIONS
  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, 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.
authors.affiliation: Department of Health Sciences, Lund University, Lund, Sweden.|The PRO-CARE Group, School of Health and Society, Kristianstad University, Kristianstad, Sweden.
authors.forename: Catharina Sjödahl
authors.identifier: 0000-0001-6071-6922
authors.initials: CS
authors.lastname: Hammarlund
authors.affiliation: Department of Health Sciences, Lund University, Lund, Sweden.
authors.forename: Maria H
authors.identifier: 0000-0002-6580-6721
authors.initials: MH
authors.lastname: Nilsson
authors.affiliation: Department of Health Sciences, Lund University, Lund, Sweden.|Faculty of Medicine, Centre for Teaching and Learning, Lund University, Lund, Sweden.
authors.forename: Christina
authors.identifier: 0000-0002-5791-356X
authors.initials: C
authors.lastname: Gummesson
keywords: Communication; Cooperative behavior; Learning; Perception; Physiotherapy