The research questions were:
• How much did the nurses know about AIDS before and after participating in the courses?
• Is there any difference in the effectiveness of web-based instruction and face-to-face instruction in terms of the nurses' learning outcomes?
Of 2391 nurses affiliated to the Tehran Medical University who were working in different hospitals, 140 eligible nurses were selected by the systematic random sampling method. To ensure equal numbers of patients in each group, the blocking random allocation method was used. The inclusion criteria were access to the Internet and having the necessary skills to use it, as reported by the subjects. The study was conducted in winter 2007.
Data were collected via two questionnaires drawn up by the researchers concerning demographic information and knowledge about AIDS. The demographic questionnaire included questions about age, gender, years of working, the current working ward, and marital status. The knowledge questionnaire consisted of 24 multiple choice questions. Correct answers scored 1 and incorrect or no-response answers scored 0. The total score of knowledge ranged from 0 to 24, which was categorized into good, moderate and poor categories on the following basis: nurses who answered fewer than 11 items correctly were classified into the "poor knowledge" class, those who answered 12 to 18 items correctly into the "moderate knowledge" class, and those who answered more than 19 items correctly into the "good knowledge" class.
The content and face validity of the knowledge questionnaire were established by a panel of experts in the field of medical-surgical nursing education. The reliability of the questionnaire was determined by the test-retest method with a 2-week interval. Twenty nurses were recruited for this purpose, who were excluded from the final analysis. Finally, a Pearson product-moment correlation coefficient of 0.90 was obtained.
A quasi-experimental method was used with a pre-test and post-test design. In both groups the key learning outcomes included the following.
On completion, the learner will be able to:
1. Describe the transmission routes of HIV infection
2. Explain the clinical manifestations of HIV infection and AIDS
3. Describe the diagnostic tests for detecting HIV infection
4. Describe the management of patients with HIV infection and AIDS
5. Describe the precautionary measures against the transmission of HIV infection
6. explain the nursing care of patients with HIV infection and AIDS
The contents of the learning materials were the same for both groups and were reviewed prior to use by a panel of medical-surgical nursing instructors who were not involved in the study. The course material was the same for both groups, and consisted of information about AIDS pathology, clinical manifestations, diagnostic tests, transmission routes, preventive measures, medical management, and nursing care. The online course consisted of a self-study text and some interactive multiple choice questions about an HIV-positive case. The participants were asked to study the online educational materials and use the interactive questions for better understanding. If they gave wrong answers to the interactive questions, a warning message led them to another one. However, if the participants selected the right answer, they received detailed information about that question. Before starting the online course, a 1-day workshop about using on-line programs and how to enter and work with the online system and chat rooms was held for the web-based group. At the beginning of the workshop, participants completed the demographic and knowledge questionnaires and each one was given a username and password. Participants were allowed to access the educational material for one week and study it at their own pace any time during day or night. In order to have interaction between the tutor and learners, and between the learners themselves, a chat room was used for synchronous and asynchronous discussion. E-mailing, telephone, and chat rooms were also used for answering questions. After one week, the passwords were expired and the online course material was not accessible anymore. Then, the knowledge questionnaire was emailed to the participants, who were asked to complete and deliver it via e-mail or in printed format. We also included these two questions in the post-test questionnaire: "how many hours did it take you to complete the online course?" and "which educational method do you prefer for future continuing education programs, a traditional face-to-face method or a web-based one?" The role of the tutor in the web-based program was managing the aforementioned workshop, preparing the course material and making it available online, receiving and answering the participants' questions via email, telephone or chat rooms, and finally sending and receiving the knowledge questionnaire.
The face-to-face group attended an interactive 3-hour lecture about AIDS given by a tutor who was also responsible for the web-based group. The participants were able to actively participate in the emerging discussions and ask their questions about the course materials and also make their class notes during the lecture. The course resources were also not available for this group after the lecture session. Then, the participants were asked to complete the post-test knowledge questionnaire. Again, we included the aforementioned question: "which educational method do you prefer for future continuing education programs a traditional face-to-face method or a web-based one?" The post-test was not open-book. Here, the tutor was responsible for preparing and presenting the course material to the participants, answering their questions, managing the lecture session, and also giving the pre- and post-tests.
Data were analyzed using SPSS software version 11. Descriptive statistics involving tables of frequencies, percentages and appropriate summary statistics were used to asses the nurses' knowledge in both groups about AIDS. The independent t test was used to compare the means of knowledge in the pre- and post tests between groups. The paired t test was used to compare the means of knowledge in the pre- and post test within groups. The independent t tests and Chi-square analysis were used to compare the two groups regarding demographic characteristics. For establishing the test-retest reliability of the knowledge questionnaire, the Pearson product moment correlation test was used. The level of significance was set at p < 0.05.
Approval was obtained from the Ethical Review Committee of Tehran Medical Sciences University in spring 2007. Detailed information on the purpose of the study and guarantees of anonymity and confidentiality were explicitly explained to each enrollee. Written informed consent was obtained from all participants.