Conceptions of learning and online learning environments among higher education social and health care students

Authors Terhi Myller and Mervi Vänskä |

Hand in hand with societal and technological changes, education in the social and health care fields – comprising higher level education in social services, social work and psychology – is required to change and find new ways to organize. In line with these demands and their potential reflections in students, our article aimed at analyzing the learning conceptions of social and health care students, particularly targeting on principles of connectivism. We were also interested in the ways that the learning conceptions would guide students’ activities in practice, in online learning environments. Our analysis was based on both a literature review and our own experiences as teachers in higher education. We found that the learning conceptions of social and health care students mostly reflected the principles of constructivism and social constructivism, as students were eager to learn collaboratively and producing joint knowledge. On the other hand, many students seemed to prefer social interaction face-to-face rather than online, which would have implied connectivistic conceptions. However, particularly adult students and the students with difficulties to join in face-to-face classes were happy with distance learning. To conclude, our study points out the need to combine both face-to-face and distance learning to make both ways of collaborating available for the students. However, more empirical and theoretical research about social and health care students’ learning conceptions and studying environments is warranted to request postmodern changes, challenges and possibilities in education, for example, in combining face-to-face and distance learning.


Facilitating learning in social and health care fields, especially with students who already have previous education and working-life experience, needs development and fresh ways to organize and actualize. Traditional learning contexts and styles are rupturing as online and collaborative learning is turning in.  At the same time, study orientations are changing, and individual learner agency is becoming more and more emphasized. Student groups are becoming more heterogeneous and unbound, as studying is no longer limited into a classroom or some other physical context.  Despite of the growing distance between students, collaborative groups and tasks are typically required. Virtual learning environments are defined as systems of social and technical aspects, where learners and teachers are involved (Khan 2000; Dillenbourg, Scheider & Synteta 2002). These structural and functional changes and new learning requirements (Khan 2000) make the field of social and health care education an important focus of research. Yet, we do not know much about social and health care students’ learning conceptions and their role in the new learning environments.  

Therefore, this paper focuses on learning conceptions of students in social services, social work and psychology at the higher-level education, together defined as social and health care fields. By utilizing previous research, we aim to analyze 1) what kinds of learning conceptions students have and whether principles of connectivism can be identified within them, and 2) how do the learning conceptions guide students’ activities in practice, in online learning environments? These topics are not widely studied, and therefore our review focuses mostly on international articles and papers. We also utilize own experience and observations from online teaching practice periods in our analysis. We cover social and health care education generally, not emphasizing the specific features or unique academic knowledge formulation between disciplines.

Our first pre-assumption is that particularly students with working-life experience have a lot of practical and tacit knowledge of client work and working methods.  However, we also assume that despite the experience, professional social and health care workers’ ideas about learning still emphasize classic learning conceptions. Maintaining these traditional conceptions in new learning contexts may cause dilemmas for individual students and the entire learning groups. Students are required to search for information, construct their own learning processes and be active members of collaborative groups, for example, virtual learning circles. Yet, interaction between students as well as the shapes of networks are no longer traditional, and these new requirements are likely to collide with traditional conceptions about learning.

The construction of this paper is following: in the beginning, we define the concept of learning conception and build up a theoretical framework for the analysis, stressing the connectivistic orientation. We also describe the social and health care online learning contexts. Then we analyze social and health care students’ learning conceptions, and whether we can identify ideas/principles of connectivism in them. We further analyze, how do the learning conceptions guide students’ actions in practice, in online environments. In the end, we consider some ideas how to develop social and health care online education and how to support social and health care professionals to form new ways to use online environment in their own learning but also in client work.

Connectivism as an attempt to conceptualize postmodern learning

Despite wide and long traditions of studying learning in the fields of psychology and education, no general agreement exists on what learning is or what is demanded of a definition of learning (Barron et al., 2015; Qvortrup, Wiberg, Christensen, & Hansbøl, 2016). There have been some attempts to unify the field into one comprehensive learning theory (e.g. Illeris, 2006; Jarvis, 2006), but most theories have chosen to emphasize particular aspects, contexts or perspectives on learning (Qvortrup, Wiberg, Christensen, & Hansbøl, 2016). Such learning conceptions can differentiate between deep vs. superficial understanding of learning (e.g. Purdie & Hattie, 2002), or they can be understood as unique approaches and theories to the process and conceptualization of learning (Burns, 2018; Pritchard, 2009).

Most profound learning conceptions include behaviorism, cognitive-constructivism, and socio-constructivism (Krull, Koni, & Oras, 2013; Pritchard, 2009).  Behavioristic perspective considers learning as automatic or mechanic conditioning of responses to stimuli, leaving the learner’s information processing disregarded (O’Donohue & Ferguson, 2001); cognitive-constructivist view focuses on the mental processing of information, leading to knowledge acquiring and constructing of meaning within the learned material (Pritchard, 2009); and socio-constructivist perspective focuses on aspects of learning that result from participation in meaningful social practices (Wildman, 2008).

Lately, hand-in-hand with the emergence of new technologies into the field of education, connectivistic conceptualizations of learning have been introduced (Siemens, 2005). Connectivism as a learning conception aims to explain, how new internet-based technologies create opportunities for people to learn and share information (Siemens, 2005; Downes, 2010). It derives from the basic need to broaden the idea of learning occurring inside a person into socially enacted learning processes.  According to Goldie (2016) and Siemens (2005), learning in connectivism is conceptualized through the following principles: a) diversity of opinion facilitates learning; b)learning is a process of connecting specialized nodes or information sources; c) non-human appliances are important devices to facilitate learning; d) capacity to know is more critical than what is currently known; e) connections are needed to facilitate learning; f) ability to see connections is vital; and g) decision making is a learning process in itself. According to connectivistic approaches, learning can take place in peer networks through internet technologies that offer new possibilities to share information (Downes, 2010).  The role of a teacher is to guide students to the sources of information and to answer their key questions if needed to support learning and sharing of information on their own (Downes, 2010). Students are encouraged to seek out information online and to express and share what they have found (Siemens 2005; Downes 2010.)

Although connectivist ideas have been widely and rapidly disseminated during the past decade, educational scientists have raised several problems in regarding connectivism as a learning theory (e.g. Kop & Hill, 2008; Lange, 2012). Namely, the development of connectivism has taken place in contexts that lack proper academic control procedures such as double-blind peer review processes (Bell, 2011), which has led to a lack of rigour and systemacity in the postulates (Clarà & Barberà, 2014). According to Clarà and Barberà (2014), the most important psychological and epistemological problems in the connectivist paradigm include a) the lack of addressing and solving the ‘learning paradox’, an important epistemological problem that all learning theories have had to deal since the time of Socrates; b) the under-conceptualization of interaction, including under-conceptualizing the role of the other, oversimplifying what interaction means, and considering interaction as a state rather than a process; and c) the inability to explain the development of concepts. Therefore, connectivism has substantial theoretical problems that need revision before it can really be regarded as a learning theory (Clarà & Barberà, 2014). At the same time, however, connectivism is regarded as one of the most prominent attempts to understand learning in modern e-learning environments (Goldie, 2016), and provides thus an interesting avenue to understand the changing learning conceptions of today’s university students. 

Changing social and health care education learning environment – toward online environment?

Social and health care fields and organizations have been traditionally seen as hierarchical and professional-based constructions. Lately, these structures have been rupturing, and a new trend is to aim at knowledge-based development, including experimental as well as research- and value-based knowledge (Rissanen & Lammintakanen 2011). The changing conceptions of work and organizations imply new needs to social and health care students’ and professionals’ education. For example, evidence-based thinking has become a part of the social and health care fields’ teaching, research and practice (Rissanen & Lammintakanen 2011), but also dialogical and reciprocal theories have been highlighted during the recent years (Mönkkönen 2018; Jokinen 2008; 2016). Client’s role as an active member, equal to professionals in health and social care processes is emphasized (e.g. Juhila 2006), and complexity in healthcare delivery, communication between team members, patient outcomes and prepared healthcare providers are important challenges to respond (Crouch, Phillmore, Phelps, Ukot 2015).

On the practical level, social and healthcare workers meet clients more and more in online contexts. At the same time, studies show, for example, that clients are becoming more responsible of their own health and welfare (Toikko 2014; Karjalainen 2011). During a time when the cost of health care is an issue, online consulting has cost-saving benefits as clients can access information and support through the internet.  (O’Neil 2009).

Hand in hand with these changes in the social and health care practices, also the education of new professionals into the field goes through significant changes, namely due to increased online learning environments. Online learning environments can be defined as systems surrounding the learner and teacher in terms of technical and social aspects (Khan 2000) or as designed information, social and virtual spaces that are explicitly represented; the representation can vary from text to 3D immersive worlds. In these definitions, students are seen as active co-constructers of the virtual space. Importantly, virtual learning environments are not restricted to distance education: they can also enrich classroom activities. Virtual learning environments integrate heterogeneous technologies and multiple pedagogical approaches and overlap with physical environments. (Dillenbourg et. al. 2002.)

Generally, online learning environments are noted to reduce time and space barriers to learning and are thus called “anytime, anywhere learning.” Such learning can take place totally online or it can happen partially online and partially face-to-face, in so called hybrid or blended learning environments. Online learning can be instructor moderated, instructor taught or instructor mentored, yet student self-directed. An online learning environment can comprise large discussion groups, small group discussions, individual activities, group activities, and various levels of interaction between and among students, faculty, and mentors. Material can be presented in a variety of ways, including videotaping, audio taping, films, links to Web sites that host online learning environments, charts, graphs, statistical data, formulas, and case studies. Interaction can be synchronous (real time) or asynchronous (delayed). (O’Neil 2009.)

Reeves and Reeves (2008) argue that a fundamental misunderstanding has been made among social and health care educators; that is, the failure to fully appreciate what is possible when teaching and learning online. In many cases, the traditional modules of onsite-teaching, including e.g. lectures and home-assignments, have been merely transferred into the online environments per se, without really utilizing the new possibilities of online teaching. Despite of such challenges, social and health care education has seen increasing use of technology and online learning in the delivery of courses and programs in recent years (Harris &Parrish, 2006; O’Neil, Fisher & Newbold 2009; Quellette, Westhius, Marshall, & Chang, 2006).

According to Morgan, Rawlinson and Weaver (2006), social and health care education values the process of reflective learning on the basis of understanding and developing professional practice. They state that it is essential to build a structured e-learning environment that allows reflections to be posted in an integrated way with clearly defined digital tools. However, Moyle, Ward and Lockyer (2010) show, that social and health care students have experiences that limited computer access, computing skills, technical issues and poor peer commitment negatively affect the reflective processes of e-learning. Instead, motivation and relevance of the course and practice, in addition to an appreciation of the potential for student-centred and flexible learning, are likely to facilitate the e-learning processes. The authors state that there is still a scope to broaden the use of e‐learning to engage students in the social construction of knowledge. In addition, experiences of e-learning could be improved if factors adversely affecting engagement were addressed. (Moyle 2010.)

Reeves and Reeves (2010) have described a ten phase pedagogical dimensions of online learning environments, where each of the 10 dimensions in the model is presented as a two-ended continuum with contrasting values at both ends. The model includes, for example, pedagogical philosophy (instructivism-constructivism), learning theory (behavioural-cognitive), task orientation (academic-authentic), goal orientation (sharply focused-general) and teacher’s role (didactive-facilitative). According to Reeves and Reeves, this model can be useful for planning, implementing, and assessing online learning and teaching. In addition, Goldie (2016) highlights that the role of a teacher would become more of a facilitator, being available for face-to-face, on-line small group, or on-line one-on-one discussions. Teacher participation would be more intensive in the beginning, reducing as the learners become more engaged in the learning process. According to Goldie (2016), the “social presence” of facilitators in networks promotes student participation and autonomy. 

Madoc-Jones and Parrott (2005) concluded that e-learning is at least as effective as face-to-face learning, and even more effective in specific areas of learning such as learning critical thinking, inquiry, and encouraging engagement. Blended learning may be the tool that allows to provide students the increased flexibility, accessibility, and depth of learning (Ayala 2009, 281). However, skeptics cite various concerns about the use of technology in social and health care practice and education. As examples, technology is believed to minimize the importance of meaningful human interaction and to increase student isolation (Ayala 2009 ref. Collins, Gabor, Coleman, & Ing 2002). It has also been stated that the human connection, embedded in social and health care professions, should not be ineffectively compromised through the use of technology. It is hard to substitute the nuances of direct human connections that may give way to technology (Stotzer, Fujikawa, Sur, & Arnsberger, 2013).

Reeves and Reeves (2008) state, that today, students need robust mental models of complex processes as well as powerful problem-solving skills, as the practices in all social and health care fields are inherently complex. Teaching, learning and assessment must reflect appropriate levels of complexity in online, blended and traditional learning environments. As other aspects, Reeves and Reeves (2008) find out that teaching online can release social and health care instructors from the burden of having to be the primary source of content in a course and allow them to serve as guides in the learning process. Co-learners and the development of online learning environments can provide the opportunity for academic staff to reform the curriculum and online teaching can provide individual instructors with an opportunity for professional renewal.

Still, some studies have shown that teaching online takes more time than teaching face to-face, while others have noted minor differences in time demands. Online environments of social and health care fields and authentic innovation will require health and social work academic staff to engage in long-term research and development initiatives focused on designing, testing and refining the blend of pedagogical dimensions most suited to the needs of their students. (Reeves & Reeves 2008.)

Despite of the huge changes in social and healthcare system during the past decade, reflected in the requirements of change in social and health care learning environments, the learning processes and conceptions have rarely been studied. In Finland, Holmström (2011), who has researched social and health care students’ learning, points out that learning takes place in social interaction within the learning community and is guided by the learning culture of the organization. In her research, learning culture is understood as a communal perception of learning occurrences, where the student can participate in community’s action. Therefore, it is interesting to study, how social and health care students’ learning conceptions and understanding of learning can be defined in online learning environments, where the community may differ from a traditional one. We are also curious about the ways that students apply their knowledge into working life, where the connection between professional and client is at the center of the interaction.

Social and health care students learning conceptions and activities in online environment

Despite individual conceptions, learning usually takes place in social environments. In the field of social and health care, social environments are particularly important contexts of learning, as the practical work occurs in interaction with the clients.  To support such learning, social and health care students have practical training periods throughout their studies. In addition, among social work students, mentoring is an important mode of learning. According to Pehkonen (2010), learning through mentoring is approached from the perspective of ideas of learning, the centre of contemplation are the creation of meanings and refining them through reflection of experiences and conceptions. Pehkonen states that constructivism, socio-constructivism and experimental learning are approaches behind learning. Reflective learning is involved to learning process, as well. (Pehkonen 2010.)

In international studies, Tsang (1997) indicates learning among students in five different dimensions that are learning as perception, learning as a dynamic process that transcends time and space, the significant others in learning, the instrumental functions of learning, and learning as a rational and emotional process. These perspectives have also ideas of learning as a constructive process, where other people are involved. In addition, studying common learning styles of social workers, researches have noticed that the diverging learning style, having an interest in people, awareness of emotion, and tending to be imaginative, are essential (Franz & Roman 2017). Similarly, research has found constructivist conceptions of learning to be more typical to psychology students when compared e.g. to medical students, who tend to see learning more as behavioristic intake of knowledge (Lonka & Lindblom-Ylänne, 1996). Yet, other studies have failed to find any typical patterns of learning conceptions among psychology students as compared to technical-scientific students (Vezzani, Vettori, & Pinto, 2018). However, these studies show that reflective orientation and emotional level of learning are important in social and health care fields.

According to our teaching experiences during practical trainings with social and health care students at higher education, learning conceptions among students have features from constructivism and socio-constructivism. For example, many students want to study together, and aim at dialogical relationship with each other. Especially, adult students favor online studies and value freedom of studying that is not connected to any certain place or time. Learning can occur anywhere, anytime and technical software is utilized. Students have also pointed out that experimental learning is an efficient way to learn, meaning that own experiments can form the basis of learning, and this perspective has features from constructivism, as well. However, not all students feel alike, and studying by many is favored as traditionally, involving rather behavioristic classroom lectures and teacher-managed sessions. In online environments, these conceptions of learning get somewhat different aspects. In our experience, online environments are mostly seen as supported technical tools for learning. For many students, it appears to be rather difficult to search, choose and construct relevant information as well as to share and deepen it with others in online environments. If a person is not committed to his/her online study community, high responsibility and internal motivation to learn is needed to maintain the individual study path.  

According to the study by Kemp and Grieve (2014), psychology students prefer to complete activities face-to-face rather than online, although no significant difference was found in test performance between the two modalities. Students preferred class discussions to be conducted face-to-face, reporting that they felt more engaged and received more immediate feedback, compared to online discussions (Kemp & Grieve, 2014). Our teaching experiences are partly in line with these results, although we have witnessed rather conflictual behavior from our students. On one hand, they keep asking for face-to-face teaching and exercises, and criticize for teaching that is only organized online. Yet, on the other hand, they are often reluctant to take part in non-compulsory face-to-face teaching, but rather watch lectures as online videos from home.

It is not easy to recognize ideas of connectivism in social and health care students’ learning conceptions. Yet, the idea of learning as a social rather than individual process is characteristic in connectivismn (Siemens, 2005), and this we can clearly see in our students who prefer group work, discussions and other social ways of learning. According to Goldie (2016, ref. Siemen 2005), learning is a process of connecting specialized nodes or information sources. This aspect is visible in many students’ learning, as they actively aim at assimilating new information into their prior knowledge and experiences. Still, choosing relevant information sources and connecting them to individual learning processes seems challenging  in practice. The structures of online environments should be organized so that too technical and traditional solutions do not obstruct learning and the construction of individual learning processes.

Many students in higher education also see the value of sharing a variety of ideas and discussing with co-students who have very different opinions and impressions of the learned material, which is in line with the principles of connectivism (Siemens, 2005). However, regarding other principles of connectivism, it appears difficult for many to guide their learning processes via the connectivistic idea that capacity to know is more critical than what is currently known. For example, arguments for the information that is important to each student is not meant for the teacher, but the students themselves. In addition, the teacher and students should have a connection, where students can feel free to construct their own learning processes and teacher can support their developing capacity to find and choose individually significant information. This means that also teachers as facilitators need to refresh their conceptions of learning and teaching, for instance by understanding assessment in a new way. It is also important to nurture and maintain connections to facilitate continual learning and ability to see connections between fields, ideas, and concepts is a core skill (Goldie 2016). For example, learning circles and other online groups should be seen as social and cultural units, where these aspects can be practiced.

Concerning the teacher and student roles, we feel that many students would still prefer the teacher to be the one who ‘knows it all’, rather than a mentor who merely guides students to the sources of information, as depicted in connectivistic ideas (Downes, 2010). Yet, most students in higher education are very familiar with seeking out information online as well as expressing and sharing their findings with other students, which is considered essential for the role of students in connectivistic approach to learning (Siemens 2005; Downes 2010.)


Social and health care fields have lately gone through notable changes in terms of conceptions of work, organizations, client work – and learning (Rissanen & Lammintakanen 2011). For example, evidence-based thinking, more open communication, activating of clients, and producing more efficient care with less expenses have provided important challenges for both the conductors of social and health care, as well as the providers of higher education. New technical solutions are helping the education providers to bring teaching more accessible to larger groups of people, both near and far. In this article, we reviewed and analyzed research on learning conceptions of social and health care students, particularly aiming to identify principles of connectivism in them.

We found it more difficult than we expected to identify connectivistic ideas of learning among the studies or our own students in higher education. What was mostly evident in student learning conceptions, was the idea of learning as a social phenomenon. Many students want to study together, and aim at dialogical relationship with each other. Many of them prefer to collaborate and discuss face-to-face rather than online (Kemp & Grieve, 2014), although particularly adult learners favor online studies that give students more freedom in terms of both time and place. Some of our students tend to act in a conflictual way, both asking for more contact hours and – at the same time – not showing up in them. Perhaps our experiences are thus in line with Kemp and Grieve (2014) in that teachers should aim at structuring classes so that students can benefit from both the flexibility of online learning and the greater engagement experienced in face-to-face discussion.

In our analysis, reflection behind the learning process did not show up in a special way. According to previous studies, reflection still has an important role in social and health care education and individual professional growth (Morgan et. al. 2006; Pehkonen 2010). The future of learning in social and health care education should consider including reflective practices in all the studies whether studying takes place in face-to-face environment or online. Professional reflective practices are crucial in client work, and connectivistic learning approaches do not necessarily support reflection instantly, if pedagogical solutions do not guide and even obligate students to practice them. To use and utilize a connectivistic approach among social and health care students, education needs more empirical and theoretical research to focus especially on such fields where humanity and professional relationships are mostly constructed face-to-face. This may help to find new ways to combine face-to-face and distance learning.


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Terhi Myller (corresponding author & Mervi Vänskä,