INTERNATIONAL JOURNAL OF CHANGES IN EDUCATION
Research Article
Aug 08, 2026 139 49

Lessons Learned Co-creating a Massive Open Online Course (MOOC) on Refugees’ Health Integration

Ioanna Dratsiou 1 * ,
Annita Varella 1,
Anastasia Gkrimoura 2,
Iraklis Tsoupouroglou 1,
Stathis Konstantinidis 3,
Natalia Stathakarou 4,
Klas Karlgren 4,
Maxine G. Harjani 4,
Maria Segura Segura 5,
Vicente Traver Salcedo 5,
Panagiotis D. Bamidis 1
1 Medical Physics and Digital Innovation Laboratory, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece2 EU Project Implementation Department, IEK EUROTraining, Greece3 School of Health Sciences, University of Nottingham, UK4 Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden5 Institute of Information and Communication Technologies, Polytechnic University of Valencia, Spain* Corresponding Author
International Journal of Changes in Education, 3(3), 2026, 255-267, https://doi.org/10.47852/bonviewIJCE52024606
Online publication date: Mar 27, 2025
Publication date: Aug 08, 2026
Full Text (PDF)

ABSTRACT

Refugee integration into healthcare is a global challenge, with millions facing barriers in accessing healthcare services due to language, cultural differences, and limited health literacy. In response to these challenges, this study explores the experiences and recommendations contributed by individuals directly involved in the co-design and co-creation of a massive open online course (MOOC) and its effectiveness in addressing refugees’ integration into the European healthcare system. A bimodal research approach was employed, combining qualitative insights from individuals involved in the design and development of the MOOC and quantitative data from refugees and professionals engaged in the MOOC’s evaluation. Stakeholder discussions were conducted to explore experiences, challenges, and recommendations related to MOOC development. Additionally, a Computer System Usability Questionnaire (CSUQ) was administered to evaluate the MOOC’s usability, quality, and interface. Stakeholder discussions emphasized the importance of collaboration, cultural sensitivity, and participatory design in MOOC development. Involving stakeholders and refugees in this participatory process ensured that the MOOC addressed real-world needs and experiences. Additionally, CSUQ results indicated high participant satisfaction with the MOOC, with digital users’ literacy level and educational background influencing their perceptions. In summary, this study contributes to the ongoing discussion on refugee healthcare integration and the role of digital education in this context.

KEYWORDS

massive open online courses (MOOCs) refugees’ health education healthcare integration best practices digital health awareness e-learning participatory approach co-creation ASPIRE framework focus group

CITATION (APA)

Dratsiou, I., Varella, A., Gkrimoura, A., Tsoupouroglou, I., Konstantinidis, S., Stathakarou, N., Karlgren, K., Harjani, M. G., Segura, M. S., Salcedo, V. T., & Bamidis, P. D. (2026). Lessons Learned Co-creating a Massive Open Online Course (MOOC) on Refugees’ Health Integration. International Journal of Changes in Education, 3(3), 255-267. https://doi.org/10.47852/bonviewIJCE52024606
Harvard
Dratsiou, I., Varella, A., Gkrimoura, A., Tsoupouroglou, I., Konstantinidis, S., Stathakarou, N., . . . Bamidis, P. D. (2026). Lessons Learned Co-creating a Massive Open Online Course (MOOC) on Refugees’ Health Integration. International Journal of Changes in Education, 3(3), pp. 255-267. https://doi.org/10.47852/bonviewIJCE52024606
Vancouver
Dratsiou I, Varella A, Gkrimoura A, Tsoupouroglou I, Konstantinidis S, Stathakarou N, et al. Lessons Learned Co-creating a Massive Open Online Course (MOOC) on Refugees’ Health Integration. International Journal of Changes in Education. 2026;3(3):255-67. https://doi.org/10.47852/bonviewIJCE52024606
AMA
Dratsiou I, Varella A, Gkrimoura A, et al. Lessons Learned Co-creating a Massive Open Online Course (MOOC) on Refugees’ Health Integration. International Journal of Changes in Education. 2026;3(3), 255-267. https://doi.org/10.47852/bonviewIJCE52024606
Chicago
Dratsiou, Ioanna, Annita Varella, Anastasia Gkrimoura, Iraklis Tsoupouroglou, Stathis Konstantinidis, Natalia Stathakarou, Klas Karlgren, Maxine G. Harjani, Maria Segura Segura, Vicente Traver Salcedo, and Panagiotis D. Bamidis. "Lessons Learned Co-creating a Massive Open Online Course (MOOC) on Refugees’ Health Integration". International Journal of Changes in Education 2026 3 no. 3 (2026): 255-267. https://doi.org/10.47852/bonviewIJCE52024606
MLA
Dratsiou, Ioanna et al. "Lessons Learned Co-creating a Massive Open Online Course (MOOC) on Refugees’ Health Integration". International Journal of Changes in Education, vol. 3, no. 3, 2026, pp. 255-267. https://doi.org/10.47852/bonviewIJCE52024606

REFERENCES

  1. Brell, C., Dustmann, C., & Preston, I. (2020). The labor market integration of refugee migrants in high-income countries. Journal of Economic Perspectives, 34(1), 94–121. https://doi.org/10.1257/jep.34.1.94
  2. Ryom, K., Simonsen, C. B., Rau, S. R., Maindal, H. T., & Agergaard, S. (2022). Newly arrived refugees’ perception of health and physical activity in Denmark. Journal of Migration and Health, 6, 100111. https://doi.org/10.1016/j.jmh.2022.100111
  3. Filmer, T., Ray, R., & Glass, B. D. (2023). Barriers and facilitators experienced by migrants and refugees when accessing pharmaceutical care: A scoping review. Research in Social and Administrative Pharmacy, 19(7), 977–988. https://doi.org/10.1016/j.sapharm.2023.02.016
  4. Stevenson, M., Guillén, J. R., Bevilacqua, K. G., Arciniegas, S., Ortíz, J., & López, J. J., ... & Wirtz, A. L. (2023). Qualitative assessment of the impacts of the COVID-19 pandemic on migration, access to healthcare, and social well-being among Venezuelan migrants and refugees in Colombia. Journal of Migration and Health, 7, 100187. https://doi.org/10.1016/j.jmh.2023.100187
  5. Lebano, A., Hamed, S., Bradby, H., Gil-Salmerón, A., Durá-Ferrandis, E., & Garcés-Ferrer, J., ... & Linos, A. (2020). Migrants’ and refugees’ health status and healthcare in Europe: A scoping literature review. BMC Public Health, 20, 1–22. https://doi.org/10.1186/s12889-020-08749-8
  6. United Nations High Commissioner for Refugees (UNHCR). (2024). UNHCR refugee education report 2023: Unlocking potential: The right to education and opportunity. Retrieved from: https://www.unhcr.org/media/unhcr-education-report-2023-unlocking-potential-right-education-and-opportunity#:~:text=Its%20findings%20reveal%20that%20despite,chance%20to%20fulfil%20their%20potential
  7. United Nations High Commissioner for Refugees (UNHCR). (2024). Global trends: Forced displacement in 2023. Retrieved from: https://www.unhcr.org/global-trends-report-2023
  8. Walther, L., Rayes, D., Amann, J., Flick, U., Ta, T. M. T., Hahn, E., & Bajbouj, M. (2021). Mental health and integration: A qualitative study on the struggles of recently arrived refugees in Germany. Frontiers in Public Health, 9, 576481. https://doi.org/10.3389/fpubh.2021.576481
  9. Liamputtong, P., & Kurban, H. (2018). Health, social integration and social support: The lived experiences of young Middle-Eastern refugees living in Melbourne, Australia. Children and Youth Services Review, 85, 99–106. https://doi.org/10.1016/j.childyouth.2017.12.020
  10. Akik, C., Asfahani, F., Elghossain, T., Mesmar, S., Rabkin, M., El Sadr, W., …, & Ghattas, H. (2022). Healthcare system responses to non-communicable diseases’ needs of Syrian refugees: The cases of Jordan and Lebanon. Journal of Migration and Health, 6, 100136. https://doi.org/10.1016/j.jmh.2022.100136
  11. Gunst, M., Jarman, K., Yarwood, V., Rokadiya, S., Capsaskis, L., Orcutt, M., & Abbara, A. (2019). Healthcare access for refugees in Greece: Challenges and opportunities. Health Policy, 123(9), 818–824. https://doi.org/10.1016/j.healthpol.2019.06.003
  12. Álvarez-Pérez, Y., Perestelo-Pérez, L., Rivero-Santanta, A., Torres-Castaño, A., Toledo-Chávarri, A., Duarte-Díaz, A., ... & Ic-Health Project Consortium. (2022). Co-creation of massive open online courses to improve digital health literacy in pregnant and lactating women. International Journal of Environmental Research and Public Health, 19(2), 913. https://doi.org/10.3390/ijerph19020913
  13. Castillo, N. M., Lee, J., Wagner, D. A., & Zahra, F. T. (2015). MOOCS for development: Trends, challenges, and opportunities. International Technologies & International Development, 11(6), 35–42.
  14. Lambert, S. R. (2020). Do MOOCs contribute to student equity and social inclusion? A systematic review 2014–18. Computers & Education, 145, 103693. https://doi.org/10.1016/j.compedu.2019.103693
  15. Longhini, J., De Colle, B., Rossettini, G., & Palese, A. (2021). What knowledge is available on massive open online courses in nursing and academic healthcare sciences education? A rapid review. Nurse Education Today, 99, 104812. https://doi.org/10.1016/j.nedt.2021.104812
  16. Bolon, I., Mason, J., O’Keeffe, P., Haeberli, P., Adan, H. A., & Karenzi, J. M., ... & de Castañeda, R. R. (2020). One health education in Kakuma refugee camp (Kenya): From a MOOC to projects on real world challenges. One Health, 10, 100158. https://doi.org/10.1016/j.onehlt.2020.100158
  17. Lovey, T., O’Keeffe, P., & Petignat, I. (2021). Basic medical training for refugees via collaborative blended learning: Quasi-experimental design. Journal of Medical Internet Research, 23(3), e22345. https://doi.org/10.2196/22345
  18. Lewtak, K., Kanecki, K., Tyszko, P., Goryński, P., Kosińska, I., Poznańska, A., ... & Nitsch-Osuch, A. (2022). Hospitalizations of Ukrainian migrants and refugees in Poland in the time of the Russia-Ukraine conflict. International Journal of Environmental Research and Public Health, 19(20), 13350. https://doi.org/10.3390/ijerph192013350
  19. Kaufman, K. R., Bhui, K., & Katona, C. (2022). Mental health responses in countries hosting refugees from Ukraine. BJPsych Open, 8(3), 1–10. https://doi.org/10.1192/bjo.2022.55
  20. Murphy, A., Fuhr, D., Roberts, B., Jarvis, C. I., Tarasenko, A., & McKee, M. (2022). The health needs of refugees from Ukraine. BMJ, 377, o864. https://doi.org/10.1136/bmj.o864
  21. World Health Organization. (2016). Universal health coverage: Moving towards better health action framework for the Western Pacific Region. Switzerland: WHO Press.
  22. Coumans, J. V. F., & Wark, S. (2024). A scoping review on the barriers to and facilitators of health services utilisation related to refugee settlement in regional or rural areas of the host country. BMC Public Health, 24(1), 199. https://doi.org/10.1186/s12889-024-17694-9
  23. Saleh, S., Ibrahim, S., Diab, J. L., & Osman, M. (2022). Integrating refugees into national health systems amid political and economic constraints in the EMR: Approaches from Lebanon and Jordan. Journal of Global Health, 12, 03008. https://doi.org/10.7189/jogh.12.03008
  24. Kalocsányiová, E., Bîlici, N., Jenkins, R., Obojska, M., & Samuk Carignani, Ş. (2024). What works to facilitate displaced and refugee-background students’ access and participation in European higher education: Results from a multilingual systematic review. Educational Review, 76(6), 1722–1743. https://doi.org/10.1080/00131911.2022.2085670
  25. Laverack, G. (2018). The challenge of promoting the health of refugees and migrants in Europe: A review of the literature and urgent policy options. Challenges, 9(2), 32. https://doi.org/10.3390/challe9020032
  26. Hanemann, U. (2018). Language and literacy programmes for migrants and refugees: Challenges and ways forward (Background paper prepared for the 2019 Global education monitoring report: Migration, displacement and education: Building bridges, not walls). Retrieved from: https://unesdoc.unesco.org/notice?id=p::usmarcdef_0000266077
  27. Asif, Z., & Kienzler, H. (2022). Structural barriers to refugee, asylum seeker and undocumented migrant healthcare access. Perceptions of Doctors of the World caseworkers in the UK. SSM: Mental Health, 2, 100088. https://doi.org/10.1016/j.ssmmh.2022.100088
  28. Cerna, L. (2019). Refugee education Integration models and practices in OECD countries. France: OECD Publishing. https://doi.org/10.1787/a3251a00-en
  29. Colucci, E., Smidt, H., Devaux, A., Vrasidas, C., Safarjalani, M., & Castaño Muñoz, J. (2017). Free digital learning opportunities for migrants and refugees. An Analysis of current initiatives and recommendations for their further use. Luxemburg: Publications Office of the European Union. https://doi.org/10.2760/684414
  30. Huang, H., Jew, L., & Qi, D. (2023). Take a MOOC and then drop: A systematic review of MOOC engagement pattern and dropout factor. Heliyon, 9(4), e15220. https://doi.org/10.1016/j.heliyon.2023.e15220
  31. Goldberg, L. R., & Crocombe, L. A. (2017). Advances in medical education and practice: Role of massive open online courses. Advances in Medical Education and Practice, 8, 603–609. https://doi.org/10.2147/AMEP.S115321
  32. Halkic, B., & Arnold, P. (2019). Refugees and online education: Student perspectives on need and support in the context of (online) higher education. Learning, Media and Technology, 44(3), 345–364. https://doi.org/10.1080/17439884.2019.1640739
  33. Thiele, T., & Homer, D. (2023). ‘Trying to open the doors’: The co-creation of digital resources for disadvantaged primary school pupils. International Journal for Students as Partners, 7(2), 65–83. https://doi.org/10.15173/ijsap.v7i2.5166
  34. Wharrad, H., Windle, R., & Taylor, M. (2021). Designing digital education and training for health. In S. T. Konstantinidis, P. D. Bamidis & N. Zary (Eds.), Digital innovations in healthcare education and training (pp. 31–45). Academic Press. https://doi.org/10.1016/B978-0-12-813144-2.00003-9
  35. Carver, R. (1996). Theory for practice: A framework for thinking about experiential education. Journal of Experiential Education, 19(1), 8–13. https://doi.org/10.1177/105382599601900102
  36. Wenger, E. (1998). Communities of practice: Learning as a social system. Systems Thinker, 9(5), 2–3.
  37. Clark, R. C., & Mayer, R. E. (2016). E-learning and the science of instruction: Proven guidelines for consumers and designers of multimedia learning (4th ed.). USA: John Wiley & Sons.
  38. Mayer, R. E. (2014). The Cambridge handbook of multimedia learning. UK: Cambridge University Press. https://doi.org/10.1017/CBO9781139547369
  39. Qi, D., Zhang, M., & Zhang, Y. (2022). Influence of participation and value co-creation on learner satisfaction of MOOCs learning: Learner experience perspective. The Asia-Pacific Education Researcher, 31(1), 61–70. https://doi.org/10.1007/s40299-020-00538-6
  40. Stathakarou, N., Konstantinidis, S., Wharrad, H., Spachos, D., Bamidis, P. D., Aparici Tortajada, L., & Karlgren, K. (2020). Co-Creating digital learning resources to enhance refugees’ health integration. In Europe 14th International Technology, Education and Development Conference Proceedings, 3799–3803.
  41. Dratsiou, I., Varella, A., Stathakarou, N., Konstantinidis, S., & Bamidis, P. (2021). Supporting healthcare integration of refugees exploiting reusable learning objects: The ASPIRE framework. In J. Mantas, L. Stoicu-Tivadar, C. Chronaki, A. Hasman, P. Weber, P. Gallos, … , & O. S. Chirila (Eds.), Public health and informatics (pp. 565–569). IOS Press. https://doi.org/10.3233/shti210234
  42. Lewis, J. R. (1995). IBM computer usability satisfaction questionnaires: Psychometric evaluation and instructions for use. International Journal of Human Computer Interactions, 7, 57–78. http://doi.org/10.1080/10447319509526110
  43. Antoniou, P. E., Pears, M., Schiza, E. C., Frangoudes, F., Pattichis, C. S., Wharrad, H., … & Konstantinidis, S. T. (2023). Eliciting co-creation best practices of virtual reality reusable e-Resources. Virtual Worlds, 2(1), 75–89. https://doi.org/10.3390/virtualworlds2010005
  44. Harjani, M. G., Stathakarou, N., Konstantinidis, S. T., Dratsiou, I., Varella, A., & Salcedo, V. T., ... & Karlgren, K. (2024). Identifying the health educational needs of refugees: Empirical evidence from a Delphi study. Journal of Immigrant and Minority Health, 26(6), 984–997. https://doi.org/10.1007/s10903-024-01626-1
  45. Biasutti, M., Concina, E., & Frate, S. (2020). Working in the classroom with migrant and refugee students: The practices and needs of Italian primary and middle school teachers. Pedagogy, Culture & Society, 28(1), 113–129. https://doi.org/10.1080/14681366.2019.1611626
  46. Haynes, D., Hughes, K. D., & Okafor, A. (2023). PEARL: A guide for developing community-engaging and culturally-sensitive education materials. Journal of Immigrant and Minority Health, 25(3), 666–673. https://doi.org/10.1007/s10903-022-01418-5
  47. Herati, H., & Meyer, S. B. (2023). Mental health interventions for immigrant-refugee children and youth living in Canada: A scoping review and way forward. Journal of Mental Health, 32(1), 276–289. https://doi.org/10.1080/09638237.2020.1818710
  48. Hassan, N., Sellappans, R., Chen, P. Y. V., Yap, W. H., Ayub, E., Konstantinidis, S. T., … & Taylor, M. G. (2021). Participatory approach in reusable learning object (RLO) development using ASPIRE framework: Taylor’s University’s experience. In P. Nair, M. J. Keppell, C. L. Lim, T. Mari, & N. Hassan (Eds.), Transforming curriculum through teacher-learner partnerships (pp. 90–104). IGI Global. https://doi.org/10.4018/978-1-7998-6445-5.ch006
  49. Manning, J. C., Carter, T., Latif, A., Horsley, A., Cooper, J., & Armstrong, M. (2017). ‘Our Care through Our Eyes’. Impact of a co-produced digital educational programme on nurses’ knowledge, confidence and attitudes in providing care for children and young people who have self-harmed: A mixed-methods study in the UK. BMJ open, 7(4), e014750. https://doi.org/10.1136/bmjopen-2016-014750
  50. Wenger, E. (2010). Communities of practice and social learning systems: The career of a concept. In C. Blackmore (Ed.), Social learning systems and communities of practice (pp. 179–198). Springer. https://doi.org/10.1007/978-1-84996-133-2_11
  51. Benson, J., Brand, T., Christianson, L., & Lakeberg, M. (2023). Localisation of digital health tools used by displaced populations in low and middle-income settings: A scoping review and critical analysis of the participation revolution. Conflict and Health, 17(1), 20. https://doi.org/10.1186/s13031-023-00518-9
  52. Narla, N. P., Surmeli, A., & Kivlehan, S. M. (2020). Agile application of digital health interventions during the COVID-19 refugee response. Annals of Global Health, 86(1), 135. https://doi.org/10.5334/aogh.2995
  53. Castrillo, M. D., & Sedano, B. (2021). Joining forces toward social inclusion: Language MOOC design for refugees and migrants through the lens of maker culture. CALICO Journal, 38(1), 79–102. https://doi.org/10.1558/cj.40900
  54. Husna Hafiza, R. A., & Roslina, I. (2019). Development and evaluation of massive open online course (MOOC) as a supplementary learning tool: An initial study. International Journal of Advanced Computer Science and Applications, 10(7), 532–537. https://doi.org/10.14569/IJACSA.2019.0100773
  55. AlQaidoom, H., & Shah, A. (2020). Digital literacy of educators and their attitude towards MOOC platform in Arab world. In 2020 IEEE 7th International Conference on Engineering Technologies and Applied Sciences, 1–6. https://doi.org/10.1109/ICETAS51660.2020.9484170
  56. Castaño-Muñoz, J., Kreijns, K., Kalz, M., & Punie, Y. (2017). Does digital competence and occupational setting influence MOOC participation? Evidence from a cross-course survey. Journal of Computing in Higher Education, 29(1), 28–46. https://doi.org/10.1007/s12528-016-9123-z
  57. Bayeck, R. (2016). Exploratory study of MOOC learners’ demographics and motivation: The case of students involved in groups. Open Praxis, 8(3), 223–233.
  58. Despujol, I. M., Turró, C., Busquéis, J., & Cañero, A. (2014). Analysis of demographics and results of student’s opinion survey of a large scale MOOC deployment for the Spanish speaking community. In 2014 IEEE Frontiers in Education Conference (FIE) Proceedings, 1–8. https://doi.org/10.1109/FIE.2014.7044102
  59. Ding, Y., Wang, M., He, Y., Ye, A. Y., Yang, X., & Liu, F. (2014). “Bioinformatics: Introduction and methods,” a bilingual massive open online course (MOOC) as a new example for global bioinformatics education. PLoS Computational Biology, 10(12), e1003955. https://doi.org/10.1371/journal. pcbi.1003955

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