Norwegian Public Health Nursing Students’ Experiences with the Transition from Classroom to Online Lectures: Benefits and Challenges

Abstract

The integration of technology in higher education increased online courses available to students, although traditional face-to-face interaction remains dominant. The COVID-19 pandemic forced a rapid transition to emergency remote teaching (ERT), impacting public health nursing (PHN) education in Norway, which primarily consists of adult learners. The impact of the transition to online-only lectures on these students remains largely unexplored. The aim of this study is to examine how Norwegian PHN students experienced the transition from traditional classroom lectures to online-only lectures during the global pandemic. It also identifies the self-reported advantages and challenges associated with online-only lectures and whether this transition affected their perceived learning outcome. A cross-sectional sample of public health nursing (PHN) students (n = 275) participated in a survey in from May to November 2020. The questionnaire was specifically developed for this study and covers student motivation, perceived benefits and challenges of transitioning to online lectures, peer collaboration, and self-assessed learning outcomes. It was distributed to the PHN students via their respective education’s LMS system. Most PHN students managed the technical aspects of the abrupt transition to online-only lectures effectively. They reported high digital competence, found the transition relatively easy, and remained motivated to continue their studies. Despite these positives, students reported a reduction in learning outcomes compared to classroom lectures. Challenges included the missing face-to-face interaction with peers, difficulties in managing childcare, and issues with structuring their studies.

1. Introduction

The integration of technology into higher education transformed both learning and teaching. Advances such as the internet and computer technology contributed to a global paradigm shift, leading universities and colleges to embrace online learning. This shift resulted in a substantial increase in the number of online courses available to students [1,2]. Since the 1980–1990s, online learning as a mode of delivery has been employed both exclusively and as a complement to traditional classroom teaching [2,3]. Despite this development and increased access to online solutions, the tradition of in-person interaction between students and lecturers remained a strong standing in higher education. Face-to-face lectures and in-person interaction in other pedagogical activities remained one of the most commonly used approaches in higher education [4].

This changed when the COVID-19 pandemic emerged in the spring of 2020. To control the spread of the virus, governments worldwide implemented social distancing measures and temporarily shut down societies, which led universities and colleges to suspend all in-person activities including face-to-face lectures [5,6,7,8]. The urgent need to continue educational activities while maintaining social distancing measures required a swift transition, and most universities and colleges quickly shifted all their activity to emergency remote teaching (ERT) [9,10]. In contrast to online learning as planned activities, ERT constitutes a temporary shift of instructional delivery to an alternate delivery mode due to crisis circumstances [10]. With the rapid transition to ERT, staff had to create and prepare teaching material for both real-time (synchronous) and on-demand learning (asynchronous) for students almost overnight [8,10]. When Norway experienced a national shutdown of society caused by the COVID-19 pandemic, universities and colleges rapidly transitioned to ERT, forcing students to rely entirely on online solutions to continue their education [7]. However, this abrupt shift to fully digital learning occurred against a backdrop where, prior to the pandemic, the Norwegian government already decided to focus on digitalisation in education [11,12]. Despite this, the actual implementation of digital tools was limited in scope. Various learning management systems (LMS) were primarily used for administrative tasks, such as submission of exams, mandatory assignments, and distributing syllabi, rather than for interactive learning. Communication between students and teachers typically occurred through email or other online platforms, but face-to-face lectures and in-person interaction still dominated the educational experience [12]. When the shift to ERT became necessary, many students and educators faced significant challenges in adapting to the new, fully online environment, revealing a critical tension between pre-existing digitalization efforts and the reality of its integration into teaching and learning practices, including public health nursing (PHN) education. PHN education is a specialised post-graduate programme designed to prepare nurses to become specialists in public health promotion and illness prevention work for children and adolescents 0–20 years, as well as their guardians and caregivers [13]. In Norway, the majority of PHN students are adult learners or adult students (≥25 years), who often balance multiple responsibilities, such as managing families and children [14]. These adult learners in higher education face several challenges compared with their younger counterparts, as they frequently have to manage multiple roles and complex identities, including those of spouses, parents, students, and colleagues [15,16]. Even though PHN students were accustomed to some online tools, lectures and other pedagogical activities were mainly conducted in face-to-face settings. With the abrupt shift to ERT, where all activities moved online, little is known about how adult learners experienced this transition, and the potential advantages and disadvantages they encountered.

This study aims to explore how Norwegian PHN students experienced the transition from traditional classroom lectures to online-only lectures during a global pandemic.

Additionally, this study aims to assess whether the transition to online-only lectures impacted the student’s perceived learning outcome; and finally, to describe the student’s self-reported advantages and challenges associated with online-only lectures.

Thus, we hypothesised that the PHN nurses considered their learning outcome as poorer after online learning only was introduced compared to the pre-pandemic situation. Further, we hypothesised that the level of perceived learning outcome was associated with age of the respondents, e.g., we anticipated younger PHN students to be more positive to the e-learning only experience.

1.1. Background and Previous Research

1.1.1. Online Learning

The evolution of the World Wide Web (WWW) and its associated technologies in the 1990s marked a significant turning point in education, creating new opportunities for the development of web-based courses and lectures [17]. As the accessibilities to required facilities and learning platforms became more available, the interest and opportunity for developing web-based courses and lectures online coalesced [18], all of which paved the way for the development of LMS [19].

While this technological shift was transformative, it also led to an ongoing struggle in defining what online learning truly encompasses. Terms such as “online learning”, “e-learning”, “distance learning”, and “digital learning” emerged in academic literature after 1995 [19,20,21,22], but the lack of consistency in their use points to deeper conceptual ambiguities.

Although online learning or e-learning can be broadly defined as the use of technology to access educational experiences [16,17], or as a range of electronic applications and tools to support education and training [23], these definitions are often incomplete and the focus on technology in many definitions tends to overshadow the core aspect of learning itself. Singh and Thurman’s systematic review highlighted this issue, identifying 46 different definitions of online learning, each interspersed with overlapping terms and concepts. While technology, interactivity, and temporal aspects—such as synchronous (real-time) or asynchronous (delayed) learning—are frequently cited as essential components, many definitions fail to adequately incorporate the pedagogical elements of the learning experience itself.

Singh and Thurman make an argument for a more comprehensive definition that includes elements of interactivity and learning, urging a shift from viewing learning as merely a technological substitute for the classroom to recognising it as a dynamic, evolving pedagogical space. Other themes found in most definitions, but not in all, were, among others, physical distance and comparison to the traditional classroom [19].

Three modes are described that differentiate online education: adjunct mode, mixed mode, and fully online mode, which offer a framework for understanding varying levels of integration between technology and academic activities. In the adjunct mode, the Internet supplements traditional education by allowing students and faculty to access research resources and communicate with peers. While this mode is present across all academic levels, its role is often supportive rather than central.

Mixed mode, on the other hand, integrates technology into teaching, but it often remains inconsistent in its application. While it enhances learning through online discussions or group projects, these activities frequently function as isolated components rather than as integral parts of the overall course design, but still a more seamless blending of traditional and digital learning. Finally, the fully online mode relies exclusively on the Internet for both content delivery and interaction, with all academic activities conducted online. This mode represents a complete departure from the physical classroom, offering a wholly digital learning environment. While it enables place- and time-independent learning, it also risks isolating students and creating a more transactional learning environment. The absence of face-to-face interaction can diminish the sense of community, which is crucial for student engagement and motivation. Moreover, the effectiveness of this mode relies heavily on the quality of course design, instructor presence, and digital literacy among both educators and students. In summary, while these modes and attributes highlight the flexibility and potential of online education, they also reveal gaps in implementation. The success of any online educational model depends on thoughtful, intentional course design and a recognition of the distinct pedagogical needs of digital environments. Without this, the technology’s full capacity to enrich and transform learning remains underutilised [2,21,24,25,26].

1.1.2. Emergency Remote Teaching (ERT)

When COVID-19 emerged, universities and colleges suspended all face-to-face lectures and other in-person learning experiences, forcing a rapid shift to ERT to maintain study progression. As described by Hodges et al. (2020), ERT differs from online teaching as it is a response to a crisis, characterised by a temporary shift in instructional delivery to an alternative mode. This approach differs from online learning, which is planned from the beginning with intentional instructional design. In contrast, ERT employs fully remote teaching solutions, such as lectures online (online-only lectures), as a temporary measure for courses typically delivered in a face-to-face format, with the expectation that instruction will return to its original format once the crisis or emergency is resolved [10]. The use of ERT became a solution in the early days of the COVID-19 pandemic, but also for other emergencies such as armed conflicts or in cases with natural disasters. Unlike planned online education, ERT leaves little time for preparation or establish infrastructures, and the existing resources and systems must be put to use. Further on, both students and lectures are removed from their regular learning environments, making them fully dependent on technological solutions [27,28].

In the early phase of the closedown caused by the pandemic, it was expected that the closedown would be short-lived, and societies could return to normal. However, as the pandemic persisted, the ERT, which was hastily put in place, began to take on a more permanent character as universities and colleges kept on delivering education in a fully remote environment [29].

1.1.3. Benefits and Challenges with Online Learning

Several studies examined the advantages and disadvantages of online learning within the educational sector, considering both students’ and teachers’ perspectives [30,31,32,33,34,35,36]. Among the well-known advantages are the cost-efficiency with online learning, as online learning can reduce institutional and student expenses [30]. Flexibility is another benefit, allowing both students and teachers to engage with learning at any time and place [37]. However, these advantages depend on the teaching being carefully designed and well-organised to ensure students can effectively engage with the material asynchronously. To achieve this, course material must go beyond merely presenting lecture slides and should include a variety of comprehensive educational materials that facilitate independent learning [38]. A well-designed and pedagogically sound prepared online learning environment should also allow for self-paced study, enabling students to progress through the material at a speed that suits their individual learning needs, whether slower or faster [31,32]. Additionally, the elimination of geographical barriers removes the necessity for travel, making education more accessible [39].

For effective online learning to succeed, even when students are at home, access to technological devices such as personal computers, smartphones, and broadband is essential, especially for students studying from home [40]. Successful online teaching also depends on the student’s attitude, more precisely, positive or negative attitude to digital mediums. Students’ skills and familiarity with specific technologies and web applications are significant predictors of their attitude towards online learning. Those with more experience and confidence in using digital tools are generally more receptive to online learning. In contrast, students who lack such skills may find the transition to online learning challenging. Furthermore, factors such as prior computer training, years of computer use, ownership of devices, and the frequency of use all contribute to students’ comfort and effectiveness in an online learning environment [41,42,43]. This suggests that while access to technology is fundamental, it is equally important to provide support systems that help students develop the necessary digital competencies [44,45]. Online learning, while offering significant benefits, is not without its challenges. One of the most notable drawbacks is the absence of face-to-face interaction, which can diminish the sense of community among students and between students and teachers, [32,33,36]. The lack of personal connection may lead to feelings of isolation, which can negatively impact motivation and engagement. Moreover, the lack of a structured framework in online learning requires a high level of self-discipline among students. Students must manage both their time and learning activities independently, which can be difficult for those who are not accustomed to self-directed learning. These challenges underline the need for robust instructional design and support systems to guide students in the process and maintaining their academic focus [32].

Other challenges include inadequate institutional support, unstable network structure, and a lack of information and communications technology (ICT) knowledge among students and teachers [32,34,46]. Benefits and challenges of EMT do not differ significantly from those of online teaching. Ferri et al. (2020) found that the transition to ERT became a pragmatic solution when the COVID-19 pandemic hit. Furthermore, several challenges were also identified, including technological, pedagogical, and social issues. Technological challenges involved students’ lack of access to computers or smartphones and the strain on broadband network when a large number of users were online simultaneously. Pedagogical challenges included the lack of digital skills among students and limited time for teachers to design and develop quality online courses. Finally, social challenges included the lack of interaction between students and teachers as well as the students themselves [47]. These obstacles emphasise that while online education and ERT offer pragmatic solutions, they require careful planning and substantial support to overcome technological, pedagogical, and social barriers. Without addressing these issues, the potential of online learning will remain underutilised, leaving many learners at a disadvantage [44].

1.1.4. Adult Learners

In the evolving society with demographic shifts, new forms of labor division, technological advancements, ongoing reskilling and upskilling, and increased digitization are becoming increasingly prevalent. These factors are shaping future skill requirements and creating a demand for new knowledge and competencies within the population, highlighting the necessity of lifelong learning [48,49,50,51]. Additionally, the incorporation of technology into educational practice democratised access to learning, providing a wide range of opportunities for diverse groups, including adult learners, to pursue further education, enhance professional competencies, and engage in personal enrichment activities [18,52]. This resulted in a rapid increase in the number of adult students over the past decades [16]. By 2022, approximately 47% of working-age adults (ages 25–64) in the European Union were participating in education and training programs [53]. In Norway, the guarantee of free education for adult learners reflects the commitment to lifelong learning as an important principle in the education policy [54]. However, policy alone does not mitigate the substantial barriers many adult learners encounter. Unlike younger students, adult learners in higher education often face several unique challenges that can impact their learning experiences and academic success. They often have to balance their studies with other significant responsibilities, such as family obligations, work alongside studying, technical issues with software or internet access, a lack of suitable study environments at home, limited interaction with fellow students and teachers, and other personal commitments. These competing demands can lead to stress and may affect their academic performance and engagement [46,55,56,57]. As technology and online platforms become more central to education, some adult learners face difficulties adapting to these new tools, which can hinder their learning process [46,58,59]. While it is not uncommon for students to work while studying, adult students are required to contribute to their household’s financial stability by working alongside their studies [46]. A report from Statistics Norway on students’ living conditions in 2021 found that 81.4% of Norwegian students between 30 and 44 years old had paid work alongside their studies [60]. This dual responsibility can place significant demands on their time and energy, as they must juggle academic commitments with the need to earn an income [46].

Adult learners often have different learning needs and styles compared to traditional students [61]. Knowles’ framework of andragogy outlines six key principles of adult learning, which explain these differences [62]. The first principle is the learner’s need to understand the relevance and purpose of their learning, including what they will learn, how it will be taught, and why it is important. The second principle is self-directed learning, which emphasises the learner’s ability to take control over their learning processes and objectives. The third principle recognises the importance of prior experience, acknowledging that adult learners bring diverse backgrounds, accumulated knowledge, and personal biases into the learning environments. These experiences shape how they engage with new material and contribute to their self-identity as learner.

The fourth principle, the readiness to learn, suggests that adults are most motivated to learn when their current life circumstances require a need for new knowledge or skills. The fifth principle is orientation to learning, which posits that adults prefer problem-centered learning that is relevant to real-life situations. They are more engaged when the learning directly applies to solving practical problems they encounter in their personal or professional lives. Finally, the sixth principle is motivation to learn, which asserts that adults are highly motivated when the learning outcome is directly applicable to solving significant life problems [63,64]. In sum, while Knowles’ principles of andragogy provide a useful framework, they should be applied with caution. Adult learners are diverse, and their motivations, experiences, and learning environments vary significantly. A more flexible and nuanced understanding of adult learning is required to address the complexities they face in today’s dynamic educational landscape [65].

Motivation among students is a critical factor influencing their academic success and overall engagement in the learning process. It encompasses two main types, intrinsic motivation where students are driven by a personal interest for the subject and extrinsic motivation, which is based on external rewards or pressure such as grades, career prospects, or societal expectations [66,67]. For many adult learners in higher education, motivation is often closely tied to practical outcome, particularly career advancement. When they perceive a clear connection between their studies and professional aspirations, their motivation to perform well tends to increase [61].

Sogunro (2015) identified eight motivating factors important for adult learners’ motivation factors, the quality of curriculum, its relevance to adult learners need, interactive classroom environment, effective management practices, progressive assessment, timely feedback, self-directedness, conducive learning environment, and academic advising practices [68].

2. Materials and Methods

2.1. Design and Sampling

This study uses a cross-sectional design and aims to recruit a sample representative for the target population, more precisely Norwegian PHN students.

The research team contacted teachers in the respective PHN study programmes by e-mail, providing detailed information about the study along with a link to the questionnaire. Additionally, we followed up with a telephone call to offer further details about the study and provide assistance if needed. Due to confidentiality constraints, the respective PHN education institution could not provide us with contact information for their students. Consequently, information about the study and the link to the questionnaire was disseminated to PHN students through the learning management systems (LMS) utilised by the respective universities/colleges. This allowed students to maintain anonymity while accessing and responding to the questionnaire. Information regarding the study was incorporated into the introduction section of the questionnaire, and students were required to provide active consent before proceeding to the questionnaire items. Students who did not provide consent were automatically excluded from participation.

We employed an anonymous self-administered web survey utilising Net survey (Nettskjema) [69], a Norwegian tool designed for creating and administration online surveys tailored for research purposes. The platform is user-friendly, allowing students to access questionaries and provide responses conveniently using a computer, tablet, or cell phone. Three reminders were disseminated and posted on the LMS system of the respective universities/colleges.

Participants were recruited from eight PHN study programmes, ensuring representation from all regions of Norway. The included universities or colleges vary in size and geographical location, covering both urban and rural areas. Additionally, the PHN students have diverse socio-cultural backgrounds [14].

Data collection occurred during the COVID-19 pandemic, specifically between mid-May 2020 and November 2020, which was 2–8 months into the Norwegian lockdown. Given that PHN study programmes offer both full-time and part-time options, the students’ progression in their studies at the time of data collection varied. However, due to the lockdown restrictions, all the participants were exposed to online-only lectures only during the time frame of this study. We did not have access to contact information, making it impossible for all PHN students to participate in this study. As a result, we were unable to obtain data on students enrolled in participating institutions who did not consent to participate (non-responders). Consequently, we lack complete and accurate information about the entire PHS student population, as we only have data from those who responded. This limitation prevented us from comparing responders and non-responders, making it impossible to assess possible selection bias.

2.2. The Questionnaire

To the best of our knowledge, no suitable national or international questionnaire was developed and/or validated by spring 2020 that fully addresses our study aims.

Consequently, we developed a new questionnaire in Norwegian, tailored to meet our specific research objective. Additionally, this study was conducted during the first phase of the COVID-19 lockdown, aiming to capture the students’ experiences under emergency circumstances in the overnight transitions from classroom lectures to online-only lectures.

The items in the questionnaire were developed based on a comprehensive review of the literature on online education, with relevant questions incorporated into the instrument. Prior to its distribution to the PHN study programs, the questionaries underwent a review by university colleagues. Their feedback was integrated, and the questionnaire was subsequently revised accordingly.

The questionnaire includes demographic variables such as age, sex, civil status, number of children, and the age of the children. Additionally, it features questions addressing the student’s motivation, their self-perceived benefits and challenges associated with the abrupt transition from classroom lectures to online-only lectures, collaboration with fellow students, and the students’ self-assessed learning outcomes from the previous week when subjected to online-only lectures.

The questions were designed to be answered using yes/no responses, a fixed set of predefined alternatives, or on a Likert ordinal scale ranging from 1 to 6 (1 as not motivated at all to 6 as very motivated; 1 as very dissatisfied to 6 as very satisfied; 1 as very bad to 6 as very good; and 1 as totally agree to 6 as totally disagree). For the question in which students were asked to self-report their perceived learning outcome over the past week, a follow-up question was included, prompting the students to elaborate on their responses.

To facilitate the analysis, several responses were dichotomised and presented as numbers and percentages. The questions utilising a Likert scale were dichotomised into the following categories: motivated (category 4–6) versus not motivated (category 1–3), satisfied (category 4–6) versus not satisfied (category 1–3), and agree (category 4–6) versus not agree (category 1–3). Additionally: the civil status variable was merged into the categories of married/cohabiting, divorced, and single.

2.3. Ethical Considerations

All participants provided written informed consent upon recruitment and did not receive any financial compensation. The questionnaire did not include questions about personal health information or other sensitive data; therefore, the Norwegian Regional Committee for Medical and Health Research Ethics concluded that additional ethical approval was not required (2020/143629/REK-Sør-Øst). Consent from the Norwegian Centre for Research Data (SIKT) was not required because no identified information of the participant, electronic or otherwise, was collected. There are no conflicts of interest involved in this project, and it did not receive any external funding.

2.4. Statistical Analyses

Categorical variables were presented as frequencies and percentages. Crude associations between pairs of categorical variables were assessed with Pearson’s chi-square test. p-values < 0.05 were considered statistically significant, and all tests were two-sided.

Data were handled in the Statistical Package for Social Sciences (SPSS), version 27 (SPSS Inc., Chicago, IL, USA).

3. Results

A total of 275 PHN students returned the questionnaire; almost all responders were females (97.8%). The majority of PHN students were between 30 and 40 years old (53.8%), married or cohabiting (85.8%), and had children (77.8%). Among those with children, the majority had children under the age of 11 years old (75.8%) (

Table 1. Study sample.

Variables. n = 275	n (%)
Age
<30 years	57 (20.7)
30–40 years	148 (53.8)
>40 years	70 (25.5)
Gender
Female	269 (97.8)
Male	6 (2.2)
Civil status
Married/cohabiting	236 (85.8)
Divorsed/singel	39 (14.2)
Children
Yes	214 (77.8)
No	61 (22.2)
Variable. n = 214	n (%)
Age children
<6 years	113 (52.8)
6–11 years	55 (25.7)
>11 years	46 (21.5)

).

3.1. The PHN Students Experience with the Transition to Online Lectures

At the time this study was conducted, the vast majority of students (89.1%) attended online-only lectures, with 83.7% expressing satisfaction with this format (

Table 2. PHN student’s experience with online-only lectures.

Item:	n (%)
Have you attended online-only lectures?
Yes	245 (89.1)
No	30 (10.9)
Total	275 (100)
If yes, how satisfied are you with online-only lectures?
Satisfied (4–6)	205 (83.7)
Not satisfied (1–3)	40 (16.3)
Total	245 (100)
How was the transition from face-to face lectures to online-only lectures?
Easy (4–5)	148 (53.8)
Neutral (3)	81 (29.5)
Hard (1–2)	46 (16.7)
Total	275 (100)
How do you assess your digital competence?
Good (4–6)	228 (82.9)
Not good (1–3)	47 (17.1)
Total	275 (100)
Did you received help managing the online-only lectures?
Yes	51 (18.5)
No	224 (81.5)
Total	245 (100)
I received help from: (n = 51 (100%))
Family and friends	35 (68.6)
Staff at University/college	16 (31.4)
Total	51 (100)
How motivated are you to continue your education?
Motivated (4–6)	254 (92.4)
Not motivated (1–3)	21 (7.6)
Total	275 (100)

). Overall, 53.8% of students reported finding the transition from traditional classroom lectures to online-only lectures relatively easy (score 4–5), while only 16.7% found this transition difficult (score 1–2).

Furthermore, a substantial majority (82.9%) of the participants perceived their digital competence to be good (scale 4–6).

Fewer than one-fifth of responders received assistance in managing online lectures, with support primarily provided by family and friends. Among students who collaborated with fellow students, approximately two-thirds (57.5%) did so within the context of mandatory assignments (Supplementary Table S1). Additionally, more than one-half of the responders, approximately six in ten, reported missing being able to collaborate with fellow students in a face-to-face setting (Supplementary Table S1).

There were no statistically significant associations between the students’ reported digital competence, their motivation to continue their studies, their satisfaction with online-only lectures or their learning outcome, and age and how the students experienced the transition to online-only lectures was (Supplementary Tables S2–S5).

The vast majority of students (92%) reported being motivated to continue their studies. However, our data still reveal a statistically significant age-related pattern: the older the participants were, the higher the proportion of students who reported being motivated to continue their studies. Among those who were not motivated to continue, only 14.3% were 40 years and older, whereas nearly 43% belonged to the youngest age group (<30 years) (

Table 3. Association between age and motivation to continue their studies.

Age Group	Motivated 1 n (%)	Not Motivated 2 n (%)	Total n (%)	p-Value
<30 y	48 (18.9)	9 (42.9)	57 (20.7)	0.049 3
30–40 y	139 (54.7)	9 (42.9)	148 (53.8)
>40 y	67 (26.4)	3 (14.3)	70 (25.5)
	254 (100)	21 (100)	275 (100)

¹ Scale 4–6, ² scale 1–3, ³ Fisher’s test by Monte Carlo.

).

3.2. Comparing Learning Outcomes in Online-Only Lectures with Classroom Lectures

When the students self-reported their perception of the previous week’s learning outcome from online-only lectures compared to classroom lectures, nearly half (44%) felt they learned less, while only one in ten responders (9.5%) thought the learning outcome was better in online-only lectures (

Table 4. PHN students’ self-reported learning outcomes in online-only lectures compared with classroom lectures. n = 275.

Online-Only Lectures Are:	n (%)
Better than face-to-face lectures	26 (9.5)
The same as the face-to-face lectures	78 (28.4)
Less than face-to-face lectures	121 (44.0)
I do not know, wait, and see	50 (18.2)
Total	275 (100)

).

The students were asked to rate (on a scale from 1, totally disagree, to 6, totally agree) whether they believed online-only lectures were as instructive as classroom lectures, and a statistically significant association was found between age and agreement with this statement (p = 0.034). A smaller proportion of younger students perceived online-only lectures to be as instructive as classroom lectures compared to the oldest (>40 years) students. Among those over 40 years of age, only one in four (n = 18) did not agree, whereas this proportion was 40.4% and 43.9% among those under 30 and between 30 and 40 years of age, respectively (

Table 5. The relationship between age category and students’ thoughts of whether online-only lectures were as instructive as classroom lecture.

Age Group	Not Agree 1 n (%)	Agree 2 n (%)	Total n (%)	p-Value
<30 y	23 (40.4)	34 (59.6)	57 (100)	0.034
30–40 y	65 (43.9)	83 (56.1)	148 (100)
>40 y	18 (25.7)	52 (74.3)	70 (100)
Total	106 (38.5)	169 (65.1)	275 (100)

¹ scale 4–6, ² scale 1–3.

).

Students were given the opportunity to elaborate on their responses. Those who reported a lower learning outcome (89 out of 121) and those who reported a better learning outcome (25 out of 26) provided additional comments. PHN students who reported lower learning outcomes from online-only lectures compared to classroom lectures primarily reported missing interaction with fellow students and teachers as the main reason. They also reported difficulty concentrating and a perceived lack of structure. On the other hand, students who reported better learning outcomes from online-only lectures indicated that this format was more practical and flexible. They also found it easier to concentrate and felt more motivated in online-only lectures (

Table 6. The PHN students’ elaboration on their answer to learning outcome in online-only lectures.

Student’s Elaborations:
Students who reported less learning outcomes	n (%)
They missed interaction, discussions, and the opportunity to ask questions of their fellow students and teachers.	49 (55.0)
They had difficulty concentrating and felt online-only lectures lacked structure.	16 (18.0)
There were no lectures, cancelled lectures, poor-quality lectures, and technical problems.	15 (16.9)
Caring for children.	4 (4.5)
Other (such as could not choose one alternative, did not understand the question).	5 (5.6)
Total	89 (100)
Students who reported better learning outcomes	n (%)
They found online-only lectures to be flexible, easier to concentrate on, and more motivating.	17 (68.0)
Online-only lectures saved time travelling.	4 (16.0)
Other (better lectures, did not understand the question).	4 (16.0)
Total	25 (100)

).

3.3. Challenges in the Transition to Online Lectures

When asked about challenges experienced during the transition to online-only lectures, 75.6% of students reported difficulties. The most frequent answers included caring for children (29.8%); a lack of contact and feedback from fellow students and teaching staff (13.6%); and difficulties structuring their studies (12.0%). Only one in four (24.4%) students reported they encountered no challenges (

Table 7. Challenges PHN students experienced during the transition from classroom lectures to online-only lectures.

Items	n (%)
Caring for children	82 (29.8)
No challenges	67 (24.4)
Difficulty structuring my studies	33 (12.0)
Lack of contact with and feedback from my fellow students	21 (7.6)
Bad internet connection	18 (6.5)
Limited physical space in my house	16 (5.8)
Other challenges besides those listed	13 (4.7)
Lack of contact with and feedback from professors and administration	11 (4.0)
Uncertainty what the best pedagogical solution is	7 (2.5)
Lack of IT equipment	5 (1.8)
Been sick with COVID-19	2 (0.7)
Total	275 (100)

).

4. Discussion

This study aimed to examine the experience of Norwegian PHN students during the sudden shift from traditional face-to-face classroom lectures to online-only lectures. The study focused on identifying the self-reported advantages and challenges the students encountered, as well as their perceived learning outcomes. The main findings indicate that, while the majority of students found the transition to be relatively easy and were satisfied with the online lectures, they also reported reduced learning outcomes and several challenges related to online-only lectures.

As anticipated, younger students were more satisfied with e-learning-only outcomes compared to older students.

4.1. Transition to Online-Only Lectures

The majority of students rated their digital competence as good and found the transition from classroom lectures to online-only lectures to be easy. Less than 20% of the students received help in managing their online-only lectures, and those who did primarily relied on support from families and friends (Table 2).

The high digital competence reported by PHN students can partly be attributed to the generally high digital literacy within the Norwegian population [70,71].

In Norway, digital skills are essential for participation in the labor market, education, and various aspects of daily life, including social interaction [72]. A 2021 report on digital competence in Norway, based on interviews with 3004 respondents age 16 years and older, found that both students and working professionals in Norway demonstrate a high level of digital competence [73]. Admission to PHN programs at Norwegian universities or colleges requires a bachelor’s degree in nursing [13] typically accompanied by at least one year of work experience. Therefore, it is reasonable to assume that most PHN students were already were familiar with digital tools and computers prior to commencing their PHN education, given their prior academic and professional background. Moreover, access to technological devices, such as personal computers and smartphones is widespread in Norway, with broadband available to 98% of the Norwegian population [72,74], a context that applies to PHN students as well. Most PHN students also expressed satisfaction with the online-only lectures. These factors likely contribute to the smooth transition to online learnings, at least from a technical perspective. Our findings align with those of Peytcheva-Forsyth (2018), who found that students with a positive attitude toward online learning were generally experienced computer users in their daily lives, professional, and educational activities [41].

We anticipate an association between students’ age and their perception of the the transition to online-only lectures, however our data did not reveal any such association. This might be explained with the fact that a great majority of the participants reported high levels of digital competence. To the best of our knowledge, no prior studies reported similar findings. However, factors such as feelings of loneliness, isolation, and a lack of interaction with fellow students may have influenced their responses. Several studies highlighted that loneliness and social isolation were prevalent across the population, including students during the COVID-19 pandemic [75,76,77,78].

4.2. Learning Outcome in Online-Only Lectures and Students’ Motivation

Although the majority of PHN students was motivated to continue their studies and rated their digital competence as high, they reported a decreasing learning outcome in online-only lectures compared to classroom lectures (Table 4). Notably, the oldest students (>40 years) found online-only lectures to be less instructive than face-to-face lectures compared to the younger age groups (<30 and 30–40 years). Additionally, 44% of PHN students perceived their learning outcomes from online-only lectures as inferior, while only 9.5% believed that online lectures offered better learning outcomes than traditional classroom-based lectures (Table 5).

These findings are in line with research, which also found that students were generally satisfied with online teaching despite reporting reduced learning outcomes. For example, a study from Indonesia among 238 students aged 17–40 years during the COVID-19 pandemic found that 91.5% of the students felt they did not gain as much knowledge through online learning as compared to traditional in-person mode [79]. Likewise, a Norwegian study among nutrition education students reported comparable results [7].

However, it is important to note that studies comparing learning outcomes between online-only lectures and face-to-face lectures show inconsistent results. A scoping review from 2021 on this topic revealed that out of 91 studies, 37 (41%) reported better learning outcomes with online learning, 17 (18%) concluded that face-to-face teaching led to a better learning outcomes, while 37 (41%) reported no significant difference between face-to-face and online learning [80].

Factors that contribute to students’ learning outcomes are complex with several internal and external factors at play [81]. One of the most important elements for achieving successful learning outcomes is the student’s motivation to study [82,83].

We found that most PHN students expressed satisfaction with the online-only lectures, and further reported they were motivated (category 4–6) to continue their studies even if the circumstances changed. Interestingly, we found that a larger proportion of older (≥30 years) students reported higher levels of motivation compared to their younger (<30 years) fellow students (Table 3).

Adult students are described to have a higher motivation towards their studies than traditional students [62,84]. According to Knowles’ theory of andragogy, key principles include adults’ readiness and motivation to learn, assuming that adults are self-directed learners, purposeful, and driven by internal rather than external factors [62]. Research indicates that adult students’ level of motivation and achievement in learning are also influenced by factors such as age and prior work experience, using this as a valuable resource in their learning [15,85]. Kimmel (2016) found that students aged 25–34 were primarily motivated by the desire for a new career, while those over 35 had a range of motivations, including career advancement, salary increases, and the desire for greater respect from peers [86].

This suggests that adult learners often have strong intrinsic motivation for self-improvement, particularly in expanding their knowledge and developing critical thinking skills. Although we lack specific data on whether these factors apply to PHN students, the findings align with the broader characteristics of adult learners. Additionally, the social relations students have with peers and faculty members play a significant role in their academic success [87,88,89]. Among the students who reported reduced learning outcomes (Table 4) and elaborated their answers, the majority cited missing in-person interaction, collaboration, and face-to-face discussions with fellow students and teaching staff as key reasons (Table 6). Although most students engaged in online collaboration, primarily for mandatory tasks, the majority expressed that they missed the opportunity for face-to-face collaboration (Supplementary Table S1). Students construct knowledge within a social context through interaction and feedback from others [88,90].

Moreover, those students who interact with peers and faculty members generally report higher motivation and satisfaction compare to students with less social interaction [87,91].

A study by Paechter and Maier found that university students preferred face-to-face interaction with fellow students when establishing personal relationships, particularly in situations requiring collaboration on tasks or the development of conceptual knowledge. Additionally, students favoured face-to-face communication with teaching staff when deepening their understanding and establishing relationships with the teaching staff [92]. Previous studies suggest that when designing online courses and lectures, it is crucial to facilitate meaningful interaction between students and teaching staff. Recommendations include implementing live chats, online discussion forums, regular webinars with teaching staff, virtual office hours, and other interactive measures to enhance student engagement [93,94].

Other reasons for reduced learning outcome mentioned by the PHN students include difficulty concentrating and a lack of structure. These issues, along with other disadvantages associated with online lectures, such as the feeling of isolation, loss of motivation and self-discipline, boredom, and difficulties with self-organising capabilities, are documented in previous studies [6,32,95].

The students also reported cancellations of lectures, poor-quality lectures, and teachers’ technical problems as reasons for their reduced learning outcomes in online lectures (Table 6). Considering that the facilitation and knowledge of teaching staff are important determinants of students’ learning outcomes [96], inadequate instructional design of online courses can influence the students’ satisfaction and learning outcomes [97]. According to Castro, the learning experience is shaped primarily by students, educators, and course content [94]. Therefore, educators need to pay special attention to the planning and design of online courses or lectures, focusing on key elements such as flexibility, personalization, the use of small group learning, and intentionally designed interactions [94,98,99]. A small proportion of students reported better learning outcomes in online-only lectures, stating that they found it easier to concentrate, felt more motivated, and saved time travelling (Table 6). These benefits with online learning are described in previous studies [82]. Students have different learning styles and some students prefer to study at their own pace or from home, and they find that online learning offers better self-regulating learning than plenary learning [92].

A study by Biwer et al. [96] examined how university students adapted to the shift from face-to-face to online education and adapted four profiles: the adapters, the maintainers, the surrendered, and the overwhelmed. The adapters were those who reported being more motivated and better able to regulate their attention, time, and effort in the new situation. They appreciated the ability to study at their own pace and to pause online-only lectures to control and monitor their understanding. However, even these students reported missing social contact and interaction with their peers and teaching staff.

4.3. Challenges

Despite that most students found the transition to online-only lectures to be relatively easy, 75.5% of PHN students reported several challenges. Many of these students were adults with families, and one of the challenges was caring for children (Table 7). This study was conducted during the COVID-19 lockdown, a time when children who typically attended daycare centres and older children (≥6 years, 47.2%) who usually attended schools were forced to stay at home. As a result, PHN students had to manage their own studies while also caring for younger children or arranging home-schooling for the older ones. A study by Manze et al. (2021) found that female college students with children during the COVID-19 lockdown often shifted their focus from their studies to support their children’s learning [100]. The increased burden for families, particularly on women with children during the epidemic, are documented in other studies as well [101,102].

In general, adult learners often have to manage other roles and more complex identities than younger students, such as that of a spouse, parent, student, and colleague [15]. Markle (2015) found that female adult learners (>25 y) with children experienced a significant increase in responsibilities and obligations associated with the student role [103]. Additional challenges reported by the PHN students include limited space in their homes and a bad internet connection. Our findings are in line with previous studies which also found the same challenges among students attending online teaching, including online-only lectures [5,7,32].

This study offers valuable insights into the experiences of adult learners, more precisely, PHN students during the abrupt shift from face-to-face lectures to online-only lectures. The research highlights the benefits and challenges of online learning, which are crucial for informing the development of targeted learning activities and have significant implications for educational practice. Findings could guide the planning and design of online education to meet the needs of adult learners who face different challenges compared to younger students. The study emphasises the need for educational institutions, where learning environments are typically designed for younger, more traditional students, to adapt and provide supportive measures tailored to the needs of adult learners.

4.4. Limitations

Our sample is sizable, including respondents from rural and urban areas. At the time this study was conducted, the students were all at the same stage in their study programme. However, there are several limitations to this study. First, the study had a response rate of 63%, which many introduce bias. Additionally, the study was conducted during the COVID-19 lockdown in Norway, and stress related to the unprecedented situation could have influenced the low response rate. Furthermore, we have no information about the students who did not participate, making it impossible to determine whether there is any difference between participants and non-participants. Another limitation is the questionnaire. To the best of our knowledge, no existing questionnaire addressed the specific aim of our study, necessitating the development of a custom instrument. Given that this study was conducted shortly after the lockdown, pre-testing of the questionnaire was not feasible. The response rate on surveys is often low, and as a measure to maximise the response rates, the questionnaire was intentionally kept short.

Regarding the question about students’ perceived learning outcome from the previous week, we have no information on the students’ actual achieved learning outcomes since we had no opportunities to monitor and assess the quality of their work. Additionally, it is important to consider that the sudden change brought about by the COVID-19 pandemic may have influenced the students’ experiences and perceptions. This includes uncertainties related to the pandemic, societal shutdowns, and concerns about the future, which could have affected the learning outcomes reported by PHN students and others.

5. Conclusions

The study examined Norwegian PHN students’ experience with the abrupt shift from face-to-face lectures to online-only lectures during the COVID-19 pandemic. Although most students found the transition easy and were satisfied with online-only lectures, they reported reduced learning outcomes and several challenges. High digital competence, largely due to Norway’s digital literacy, facilitated the transition. Despite challenges such as the lack of interaction with peers and teachers, balancing family responsibilities, and technical issues, the majority of students remained motivated to continue their studies. The use of online learning is here to stay, and the shift to online-only lectures during the COVID-19 pandemic provided valuable insights into the potential and challenges of digital learning. Overall, the study highlights the need for improved online course design to enhance interaction between students and teachers, as well as stronger student support to improve learning outcomes.