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 Adaption of E-Learning during the
COVID-19 Pandemic: An International
Analysis of Health Students’ Perspective

Saima TASNEEM1a
Zalihe YARKINER1b
Muhammad WAQAS2
Muhammad Asif RABBANI1c

Abstract
Despite the advancements in the health-related fields, the 21st century could not stop the advent
of a new infectious disease that started in Wuhan, Hubei province China in December 2019 and
soon spread to the rest of the world like a wildfire. On March 11, 2020, the World Health
Organization declared COVID 19 outbreak as a pandemic. As a measure to prevent the spread of
disease, the lockdown was implemented in various forms around the globe. The educational
institutions were also closed and this opened a new era of digitalization in education, a change
that was sudden for the teachers as well as the students. This particular study was carried out in
the prevailing pandemic situation to learn the perspective of health students towards this abrupt
change. The study was conducted in The Turkish Republic of Northern Cyprus, Qatar, and
Pakistan. The results showed that the students in Qatar had easy access to the internet in contrast
to the students in Pakistan and TRNC. The students in Pakistan faced difficulties during online
learning sessions due to poor infrastructure. The students in all three countries believed that face
to face contact with the course instructor is necessary and hold the opinion that online learning is
not the replacement of face to face learning.
Keywords: COVID 19, Online Education, E-learning, North Cyprus, Qatar, Pakistan

1a
Cyprus Science University, TRNC, Email: saimatasneem@csu.edu.tr
1b
Cyprus Science University, TRNC, Email: zaliheyarkiner@csu.edu.tr
1c
Cyprus Science University, TRNC, Email: asifrabbani@csu.edu.tr
2
Nafees Medical College, Islamabad, PAKISTAN. Email: muhammadwaqas2005@yahoo.com

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INTRODUCTION
Despite the advancements in science and technology and health-related fields, the 21st century could not
stop the advent of a new infectious disease that started in Wuhan, Hubei province China in December
2019 that soon spread to the rest of the world. On February 12, 2020, the disease was officially named
as Coronavirus Disease 2019 (COVID 19) by the World Health Organization (Zu, et al., 2020). On
March 12, 2020, the World Health Organization declared COVID 19 outbreak as a pandemic (WHO,
2020). It was suggested that the best way to prevent the spread of the disease is to avoid close contact
(CDC, 2020). Keeping this strategy in view nationwide lockdowns were implemented in many parts of
the world that affected almost all walks of life and educational institutions were not an exception. In the
Turkish Republic of Northern Cyprus, educational institutions were shut down on 10 March 2020, by
the authorities for a week, but then it lingered on for months (Cyprus, 2020). In Qatar, the ministry of
education closed schools and universities on March 10, 2020 to prevent the wild increase in the number
of COVID 19 cases (World, 2020). In Pakistan also the educational institutions were closed by the
concerned authorities (WHO, 2020) (BBC, 2020), and likewise in the rest of the world, either complete
or localized lockdowns were implemented to reduce the social contact among people and thereby
minimize the spread of the disease. Globally 1.6 billion children and young adults have suffered because
of the lockdown of educational institutions (Unicef, 2020).

Figure: School closures caused by Coronavirus (COVID 19)

Source: en.unesco.org accessed on 3rd August 2020

The students who are to leave the college and the university graduates of 2020 suffer the worst blow of
the pandemic as they are facing an interruption in their routine education practices and are bearing the
stress of being launched in the job market during the times of worst recession (Kaur, 2020).

90
In an attempt to minimize the adverse impacts of disruption of education, the educational authorities,
world over decided to take advantage of flourishing innovative technologies and learning management
systems both for teaching the course works and assessment of students. The policymakers in the
education sector availed this opportunity to implement the use of information technology during the
quarantine days to minimize the student losses. Various distance learning tools were utilized in various
parts of the world. The developing and underdeveloped countries with limited resources and insufficient
infrastructure relied more on using radio and television for delivering course content to the students as
part of their distance learning programs. In developed countries, online education was preferred for
delivering subject material (Nations, 2020). Many major software companies like Microsoft, Google,
Zoom, and Slack offered free features of their products during these crisis learning times (Basilaia &
Kvavadze, 2020).
The transition from the traditional in-class education to current distance crisis learning took various
forms such as
 Knowledgebase: a set of lessons are published on the assigned website with the instructions for
the students to follow but with a lack of support.
 Online support: in addition to the published material on the website, the support on some topics
is also available for the students.
 Asynchronous: with no real-time lessons; rather the content is uploaded regularly for students
by the assigned instructors, who are available to provide support via email or other
communication platforms.
 Synchronous: conducted in real-time by the assigned instructor in a live session at a pre-
allocated time to log-in to the online education environment. This provides the participants with
an opportunity to communicate directly and more effectively with the teacher and other group
members.
 Hybrid: a balanced combination of online and face to face interaction (Basilaia & Kvavadze,
2020).
Distance learning has its pros and cons. The greatest advantage is staying safe at home, by bringing
education to the doorsteps of students who are unable to go out in search of knowledge, because of the
current pandemic situation. The other advantages of distance learning are better convenience, easy
access to resources, and reduced cost, and better environment due to lesser carbon dioxide emissions
from vehicles. At the same time this distance learning comes with its costs because of the exhaustive
needs of resources (Mukhtar, Javed, Arooj, & Sethi, Advantages, Limitations and Recommendations
for online learning during COVID-19 pandemic era., 2020), like lack of good quality internet
connection, unavailability of laptops and computers in each household, inadequate digital skills of
students, uneducated or under-qualified parents, long-scheduled electricity cutdowns, etc. are a few to
name (Ahmed, Khan, Faisal, & Khan, 2017). The COVID 19 pandemic widened the gaps for availing
the existing learning opportunities due to the nonuniform and inequitable distribution of resources.
Another challenge faced by the new digitalized education system is the untrained or undertrained staff
who are not adapted to this new teaching methodology (UNESCO, International Task Force on Teachers
for Education 2030, 2020). Despite the available infrastructure, many academic staff members lack
adequate information and computer technology (ICT) skills (UNESCO, Supporting teachers and
education personnel during times of crisis, 2020), which adversely affects the quality of education that
is delivered.

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Keeping the current crisis e-learning carried out during the COVID 19 pandemic, this study aimed at:
1. Learning the students’ perspective on online education.
2. See the efficacy of online learning programs.
3. Bring to light the shortcomings faced by students which reduced the effectiveness of online
education.

Statistical Analysis and Results

A survey was carried out focusing on students studying in the Health Department of three universities
in the Turkish Republic of Northern Cyprus (TRNC), Qatar, and Pakistan. These students continued
their online education during the spring semester of 2019-2020 academic year due to a lockdown caused
by the Covid-19 pandemic.
The survey comprised of a total of 19 questions. The first 7 study questions measured the descriptive
characteristics of participants such as their demographics and the information regarding the online
program they were currently studying while the rest 11 questions measured the perception of students
towards online education. The 11 questions which aimed at measuring the perception of students
towards online education used a 5-point Likert scale (1=Strongly Agree, 2=Agree, 3=Neither Agree nor
Disagree, 4=Disagree, 5=Strongly Disagree).
The study population comprised all students registered full-time in the Faculty of Health Sciences in
TRNC, Qatar, and Pakistan. An online survey was distributed to the students studying in the mentioned
countries. A volunteer sampling technique was used to get responses from the study participants and a
total of 261 responses were obtained.
Firstly, the descriptive statistical analysis of the first 7 survey questions was carried out on a sample of
261 students and the results are as in Table 1.
Table 1: Descriptive Statistics of the sample of 261 students
Variable N (%)
Gender
No. of students (Female) 169
No. of Students (Male) 91
First Language spoken by students
Arabic language 99/261
English language 65/261
Urdu language 97/261
Age Group
18-22 years of age 189
23-27 years of age 45

92
 28-32 years of age 11
33 and above 16
Country
TRNC 21.8%
Qatar 39.5%
Pakistan 38.7%
Program Studied
2 years Program 3.8%
Undergraduate 82.8%
Postgraduate 9.6%
Doctoral 3.8%
Variable Median (Q1-Q3)
Number of online courses studied 3 (2-5)

Total number of hours spent each week 10 (6-15)

Kolmogorov-Smirnov and Shapiro-Wilk normality tests were performed on each continuous variable in
the study and it was noticed that all of the continuous variables under investigation were not normally
distributed. Therefore, in Table 1 as well as in all the other tables in the study, median (quartile 1 and
quartile 3) values were reported for continuous variables, categorical variables frequencies, and the
corresponding percentage values were stated.
From the results of Table 1, it was observed that 169 were females, 189 of the total sample was in the
age group 18-22 and 82.8% of the study sample was studying in an undergraduate degree program. The
median number of online courses studied was 3 and the median of the total number of hours spent per
week for online learning was 10.
In terms of inferential statistical analysis, firstly, each of the 11 questions measuring the student
perception towards online education was analyzed separately to identify whether there is a statistically
significant difference between the gender groups (Table 2), between the first language spoken by the
student (Table 3), between the age groups (Table 4) and between the currently residing country (Table
5). After that, collinearity analysis was performed to observe if any collinearity exists between the
student perception scores. Collinearity analysis showed that there is no collinearity between the 11
student perception questions. An independent median test was used to measure the significance. Any p-
value less than 0.05 was considered a statistically significant difference.
The gender difference and its effect on education were studied, keeping in view the fact that to date most
of the studies carried out to study the impact of the COVID 19 pandemic on education have not
considered gender (UNESCO, COVID-19 Webinar #3, 2020) The results showed that there is no
statistically significant difference in student perceptions towards online education between female and
male students with an overall median score of 2.5 for females and 2 for males.

93
Arabic and English language speakers can communicate more efficiently electronically using online
programs advised by their universities compared to Urdu language speakers (p<0.001). This particular
finding coincides with a study carried out in a private university in Pakistan where it was observed that
competency in the English language is a hurdle in delivering online education. One reason can be that
software programs used for e-learning are in English and this makes it difficult for them to comprehend
the program and use it effectively (Qureshi, Ilyas, Yasmin, & Whitty, 2012). All students in different
language groups agreed that face to face contact with the course instructor is necessary, Arabic and
English language speakers agreed more than the Urdu language speakers (p=0.013). Arabic and English
language speakers said that they could manage their study time effectively and were able to complete
their assignments in time in contrast to the Urdu language speakers (p<0.001), which is in contrast to
the results of a study carried out for the higher education students in Pakistan. The study revealed that
students were able to manage their assignments and course timings in an effective manner (WHO, 2020).
It also found that it is easier for English language speakers to work with class fellows as a group than
Arabic or Urdu language speakers (p=0.045).
When student perception towards online education was compared between the residing countries, it was
found that there is a statistically significant difference in the overall median score on the perception of
students towards online education.
It was found that students in Qatar strongly agreed to have easy access to the internet for their lectures
in contrast to the students in TRNC and Pakistan (p<0.001). Similarly, students in Qatar agreed to
communicate easily electronically using online programs advised by their universities (p=0.001), were
able to effectively manage their study time and able to complete their assignments on time (p<0.001) as
compared to students in TRNC and Pakistan. Students in TRNC have agreed more on easily accessing
their teachers other than the class timings and receiving timely responses from them (p=0.033) compared
to students in Qatar and Pakistan. All the students in the study believed that there is a difference between
in-class learning and online learning, students in Qatar and Pakistan agreed more than students in TRNC
(p=0.010).

CONCLUSION
The abrupt transition in the education sector from traditional face to face learning to online learning is
a change for which neither the teachers nor the students were well prepared. Keeping the resource
restrictions and other barriers in mind the best solutions were offered by various educational institutions.
These solutions have sufficed the basic needs but failed to fulfill all the course requirements. This
particular study highlighted issues faced by students like poor internet access in TRNC and Pakistan,
inability to work efficiently with the course mates for group assignments particularly in Pakistan,
delayed responses from the course instructors in Pakistan and Qatar. In the 21st century, digitalized
education is not for the moment but to stay in the years to come. This can be achieved if we can overcome
the challenges faced by the E-learning system.

94
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