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CHAPTER I
INTRODUCTION
Background of the Study
While the field of massage therapy has grown over the past 30 years from a
vocation to a profession, it is not fully operating at a professional level equivalent to other
healthcare fields. According to Rosen (2009), one of the essential components of a
mature profession is an active research focus. Research provides results and conclusions
which are evidence-based and “[e]vidence-based practice is the watchword these days”
(Rosen, 2009, p. 4). It is important for the profession as a whole to pursue a research
agenda. However, it is just recently that the importance of rigorous research in this field
has been taken seriously by its practicing professionals.
As early as 1982, the Touch Research Institute was established, and it is the first
center in the world devoted solely to the study of touch and its application in science and
medicine. Members of the Touch Research Institute complete research geared toward
defining touch and its promotion in health and benefits to the treatment of disease as well
as data on the benefits of touch-related therapies. Outside of the limited work being
accomplished at the Touch Research Institute, there is very little scholarly research
conducted in the area of massage therapy (Committee on the Use of Complementary and
Alternative Medicine by the American Public, 2005), and there is a concern that](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-12-320.jpg)
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“practitioners, teachers and researchers also understand the advantages of more
systematic audit and rigorous research within their practice” (Mills & Budd, 2000, p. 88).
Even when there is research available, it is not used to the same degree by massage
therapists as by their peer healthcare workers (Suter, Vanderheyden, Trojan, Verhoef, &
Armitage, 2007). A number of articles and studies published regarding massage therapy
indicate the lack of a research base in the field. For instance, in a study conducted by
Sherman et al. (2005) that surveyed the training and practice patterns of massage
therapists in the United States, there were a number of references in their publication
regarding the lack of research in massage therapy to substantiate their findings. One of
the key points listed in a publication of the National Center for Complementary and
Alternative Medicine (NCCAM; 2006) is “[s]cientific evidence on massage therapy is
limited” (p. 1). In addition to the need for more evidence-based research regarding the
benefits of massage therapy for health is that there is little to no scholarly research
conducted in the area of effective teaching strategies in massage programs (Sherman et
al., 2005). In sum, despite the use of the term massage therapy profession, the industry
“is plagued by incongruities in the domains of education, practice and regulation”
(Rosen, 2009, p. 5).
Another component that is important for the field of massage therapy is the
existence of accrediting agencies and state governing boards (Eisenberg, et al., 2002).
They often mandate the base curriculum provided in massage therapy programs.
According to Rosen (2009), approximately 40% of massage therapy schools are](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-13-320.jpg)
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accredited. There are five agencies that are broad-spectrum vocational accreditors
overseeing particular massage programs, including the following:
● Accrediting Bureau of Health Education Schools (ABHES)
● Accrediting Council for Continuing Education and Training (ACCET)
● Accrediting Commission of Career Schools and Colleges of Technology
(ACCSCT)
● Commission on Massage Therapy Accreditation (COMTA)
● National Accrediting Commission of Cosmetology Arts and Sciences (NACCAS;
American Massage Therapy Association [AMTA], 2011, ¶ 2)
The NACCAS deals primarily with the field of cosmetology and expanded its
scope into massage therapy a few years ago, yet there is only one agency established
solely for the massage therapy field, the COMTA (COMTA, 2008; Rosen, 2009). With
an estimated 1,200 to 1,400 massage therapy schools in the United States (Hodgson,
Dryden, Finch, & White, 2008), the implication is that over 500 schools are lacking the
rigors of accreditation or an established body of research to guide their practice.
With massage therapy growing as an integral part of the Western healthcare
system, there are certificate or career program options, associate degree courses of study,
and full bachelor’s programs at universities (Medical and Nursing Training, 2011). These
programs are based on different time requirements, but most are governed by a minimum
curriculum and practical requirement set by accreditors or the state. Vocational programs
generally offer smaller class sizes and more specialized massage modalities, such as](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-14-320.jpg)
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button level) should be aligned with direction of stroke; there should be geometric
leverage in terms of proper body and arm angles; the therapist should lean in as opposed
to pushing with the arms; the therapist’s legs should be placed properly for weight
distribution (about shoulder length apart); the therapist should use lunges so that pressure
originates from the center of body; and the therapist’s wrist and hand should be relaxed
while conducting the massage technique.
Definition of Terms
The following definitions were used in this study:
Anchored Instruction. Teaching design that includes the use of an anchor, usually
in the form of video, that can be explored by the learner, for subsequent instruction and
learning based on a real-world situation (Cognition and Technology Group at Vanderbilt
University [CTGV], 1990).
Blended Learning. Instruction that combines face-to-face instruction with
computer mediated instruction (Bonk & Graham, 2006).
Cognitive Apprenticeship. A method of instruction that stems from the idea of
traditional apprenticeship of learning within a social context experiencing real practice
through activity and social interaction: an idea of knowing how, instead of knowing what
(Love, 2005).
Community College. A community college is part of the “[p]ublic 2-year
postsecondary institutions, regardless of the actual name of the institution” and offers](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-21-320.jpg)
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programs that include associate’s degrees, vocational programs and certificates (National
Center for Education Statistics [NCES], 2008, p. 3).
Contraindication. A medical condition that indicates that a massage therapist
should exercise caution concerning giving or receiving a massage.
Endangerment Sites. An area of the body to which extreme caution needs to be
considered when giving a massage.
Friction. A massage technique in which the therapist uses a back and forth
alternating motion with the tips of the fingers or edges of the hands over the area being
massaged.
Inert Knowledge. A term coined by Whitehead (1929) as knowledge that is
readily available when one is asked explicitly for it, yet is not used spontaneously in
problem solving, although it is relevant (CTGV, 1990).
Meaning making. Process of learning “in which individuals construct mental
models that ground their understanding in a deeply personal and unique fashion” for
integrating new knowledge (Osberg, 1997, p.8).
Nontraditional Student. A student with one or more of the following
characteristics:
(a) they have delayed enrollment after finishing high school, (b) they attend
college part time (c) they work full time (d) they have dependents other than a
spouse [usually children] (e) they are single parents, or (f) they have not earned a](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-22-320.jpg)
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high school diploma, having completed a general equivalency diploma or other
type of high school certificate. (NCES, 2002a, p. 2)
Petrissage. A massage technique in which the therapist uses the palms of the
hands to lift and squeeze the tissue.
Postsecondary Institution. Any institution in higher education with the following
description: “[l]ess-than-2-year institutions providing short-term vocational training, 2-
year institutions offering associate’s degrees and vocational certificates, and 4-year
colleges and universities which offer bachelor degrees and higher” both private and
public (NCES, 2002a, p. 98).
Situated Cognition. A theory of learning that suggests that learning takes place
within a social context or real life application or situation (CTGV, 1990).
Swedish Massage. A term used for referring to a variety of techniques including
kneading, friction, tapping, stroking, and vibration in which pressure is applied to tissue
centripetally, resulting in improved circulation of blood and lymph in the body.
Tapotement. A massage technique that is applied by rhythmic short rapid
movements of the fingers or sides of the hands to loosen tissue or over the chest area to
loosen mucus.
Web Enhanced. A term used to describe instruction that is supplemented with the
use of the World Wide Web.
Significance of the Study](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-23-320.jpg)
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this type of learner are the convenience of working from home or office, flexibility of
time, and culturally-diverse group interactions (Gibson et al., 2001). Offering an online
video-based portion of the course has allowed these students the flexibility needed to
hold down a full-time job and/or raise a family as they continue their education. The
availability of an online video-based segment fulfills the need of the program’s current
and future student population in terms of availability, accessibility, and improved
instruction.
In addition to filling a need for its nontraditional students, this study has created a
building block for more scholarly research regarding educational strategies in the area of
massage therapy. Hodgson et al. (2008) stated that there was “insufficient [massage
therapy] research data being generated” and “too few trained [massage therapy]
researchers to sustain a high quality, regularly appearing [massage therapy] journal” (p.
3). Indication of the lack of research in the area of massage therapy in general is evident
by new journals in the discipline, specifically those studies related to effective
educational strategies. Data generated from this study regarding the effectiveness of
instruction has provided a foundation for further research in this area. This study has also
assisted in the preparation of proposals and grants necessary for supplemental funding of
the program’s sustenance and growth.
Summary
This study was conducted to observe any difference in skill development of
students in a blended Swedish massage therapy course. Both quantitative and qualitative](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-26-320.jpg)
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instruction to teach pre-service teachers integration of technology in the curriculum.
Themes that emerge from this study relate directly to the study’s problem statement.
Research questions were related directly to the treatment.
The content of the review was drawn from research publications and peer-
reviewed academic journals. There was very little experimental research in the area of
massage that relates specifically to educational practices. Hodgson et al. (2008) state that
“[r]esearch literacy and research capacity are underdeveloped within the massage therapy
community” (p. 1). Therefore, some of the literature contains statements from
conferences or data collected by accredited massage associations.
This chapter addresses what has been found in terms of massage therapy research
and its infancy. The effectiveness of anchored instruction was also examined in terms of
its use in a number of disciplines. The use of blended learning instruction with an
integrated online video-based component was explored in terms of accommodating the
growing nontraditional students’ population entering higher education.
Massage Therapy Research
According to Grant (2008), “[t]he massage profession has grown rapidly since the
late 1980s,” and “[t]he increasing use of massage as an element of health and wellness
care has attracted more attention from established health professions, health care case
managers, legislators, and liability attorneys” (p. 1). According to AMTA (2010a), it is
estimated “that in 2009, massage therapy was a $16-20 billion industry” (p. 1) and that
“[i]n July 2009, 32 percent of adult Americans said they had at least one massage in the](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-32-320.jpg)
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last five years to reduce stress or relax—up from 22 percent reported in 2007” (p. 2).
Grant reports that “[m]ore practitioners are using massage as a means of intervention for
specific conditions. More [massage therapists] are also practicing in a greater variety of
health care contexts” (p. 6). With the assimilation of massage therapy techniques as a
valid health care option, massage therapy’s increased use and visibility will be in direct
correlation to increased research regarding its effectiveness, means of use, and education.
Massage therapy research has not kept up with the growing interest and demand
in this profession. According to Kahn (2001), “[t]he field of research in therapeutic
massage and bodywork is just beginning to develop” (¶ 23). As early as 1999, The
American Massage Therapy Foundation funded a conference to address the need for a
research agenda within the field of massage. Kahn indicates that the reasons for investing
in this type of endeavor are that “research is a key to the professionalization [sic] of any
health-care field” (¶ 13), research is one of the ways to improve what massage therapists
offer as a continued generation of a relevant body of knowledge, and “research is also a
prerequisite for access to some of the contexts in which we would like to practice” (¶ 15).
For instance, some massage therapists may want to practice in conjunction with medical
environments, and/or have the ability to be reimbursed by insurance companies. It is
important for the profession to have inroads to these contexts.
Kahn (2001) believes that having a research agenda is a way to open the doorway
to those who cannot afford massage therapy for medical reasons. Kahn compares the
infancy of massage in research to that of chiropractic care for low back pain. A decade](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-33-320.jpg)
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ago, chiropractic was included for the first time at a consensus conference held for
reviewing treatments for low back pain. They contributed this inclusion to chiropractors
spending “the past 10 years systematically funding and conducting research on the
potential of chiropractic to treat back pain” (¶ 16). According to Kahn, “[t]here was a
body of literature published in reputable journals reporting the results of studies on
chiropractic and back pain. They had the necessary research data” (¶ 16). Massage
therapists did not have this type of data.
At the conference in 1999, a Massage Research Agenda Workgroup that included
scientists, clinical research scientists, social scientists, and massage therapists developed
several recommendations regarding research in massage therapy. They found that “[t]he
literature on therapeutic massage and bodywork is so scant and problematic that the
groups proceeded under the assumption that the entire field needed to be investigated”
(Kahn, 2001, ¶ 25). Members of the Massage Research Agenda Workgroup also
recommended the need for a research infrastructure to drive a research agenda, a step that
they think is crucial to the profession of massage therapy. Their research infrastructure
includes funding for research, establishing a bridge between researchers and academics
active in the field, and working with other associations to build research as a core
competency within the field.
Hymel (2002) suggests basic guidelines for a systems-based model of integrating
research competencies within massage therapy education. Hymel’s model includes a unit
on experimental research process as a way to “begin the quest to make our profession](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-34-320.jpg)
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more research competent” (p. 5). Becoming more research competent is a concept
supported by the Massage Therapy Foundation which provides grants and outreach
programs and “also supports the education of massage students and therapists in gaining
greater research literacy” (Rosen, 2009, p. 4). Although there has been an accumulation
of massage therapy research over the time frame from 1988 to 2008, massage therapy
research is still in its infancy compared to other medical fields with definite research
infrastructures.
Moyer et al. (2009) state that “[t]he practice of [massage therapy] is very old, but
only in the last twenty years or so has scientific research on [massage therapy] begun to
accumulate” (¶ 1). Their report is based on an interactive workshop with 37 participants
to examine the “current state of [massage therapy] research and to explore approaches,
directions, and strategies with the potential to make the next two decades of [massage
therapy] research optimally productive” (Purpose section, ¶ 2). A number of items were
discussed in depth and analyzed including the amount of massage therapy research in
existence and the strengths and weaknesses of the studies. The results of the participants’
concerns regarding massage therapy research were documented and expanded upon in the
report. In reference to education and training research, it was found that “[t]raining and
education are critical to the success of a profession” (Results section, ¶ 22) to include the
content being taught, methods for teaching and training that are ideal for massage therapy
students, and whether the amount and type of training indicate the professional success of
the student. These aspects related to “education and training are all worthy of study”](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-35-320.jpg)
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The purpose of the anchor, which in this study included a video-based online
component as part of the treatment, was to provide a “common core of knowledge for all
class members” (Cena & Mitchell, 1998, p. 539). The general principles of anchored
instruction are that learning and teaching activities should be designed around an anchor
and that curriculum materials should allow exploration by the learner (Bransford et al.,
1990). According to CTGV (1990), “[t]he major goal of anchored instruction is to
overcome the inert knowledge problem” (p. 3). The way to overcome the inert knowledge
problem is to alter how students store it cognitively. Many times knowledge is stored in a
way that is not easily retrieved or effectively used. It is important that students acquire
knowledge that can be used and applied within a context, instead of being memorized and
repeated.
Inert knowledge. Inert knowledge was coined by Alfred Whitehead (1929) as the
information a student is able to express but is unable to use. Therefore, by providing
instruction which incorporates an authentic situation or context through the use of an
anchor, the student is able to capture the knowledge used by the expert in that situation
better than a student in a strictly lecture-based instruction in which the teacher provides a
set of rules and facts for students to memorize and document as evidence of learning
(Glaser, Reith, Kinzer, Colburn, & Peter, 1999). Therefore, using an anchor for
instruction allowed a student to visualize the areas of the body with endangerment sites
versus memorizing a list of endangerment sites. Anchored instruction is a model that](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-37-320.jpg)
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context, culture, and activity in which it is situated” (p. 301). Therefore, the student is
exposed to knowledge which is an integral part of the context. Knowledge is acquired
and can be applied, instead of remaining a separate entity from the environment in which
it is used.
In this study, the video-based anchor was set up in modules according to massage
techniques conducted by a veteran and teacher in massage therapy with twenty plus years
of experience in massage therapy. Students were able to view the instructor providing
face-to-face demonstrations during class. The treatment was fashioned according to these
demonstrations with the veteran instructor providing information while conducting a full
body massage. The use of video for the treatment allowed the student to control the areas
of instruction that needed to be revisited for reinforcement of information and retention.
Video-based anchors. In a study conducted by Choi and Johnson (2005) the
participants indicated that the use of video for the basis of instruction “was more
memorable than traditional text-based instruction” (p. 215). The concept that a video-
based anchor allows for recalling material easily from memory “implies that context-
based videos in online courses have the potential to enhance learners’ retention and
motivation” (p. 215). According to the CTGV (1990), individuals prefer visual context
rather than textual formats because “visual formats allow [us] to develop pattern
recognition skills” (p. 3). Connecting mental models to video which simultaneously
presents video and computer-generated information is a basis for anchored instruction
(Kozma, 1991).](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-39-320.jpg)
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According to Crews, Biswas, Goldman, and Bransford (1997), “[t]he use of video,
animation, graphics, and simulation allow [sic] the presentation of material in realistic
contexts, thus addressing the problems of inert knowledge while promoting constructive
and generative learning” (p. 142). Specifically, using video clips as a form of anchored
instruction offers an additional learning tool for processing the lesson visually.
Availability of the video clips online allows learners to view the lessons at their
convenience; it also offers repetitiveness of material in areas in which the learner has
evaluated the need for reinforcement. The repetition of viewing the video clips offered a
more memorable learning experience for the student in the study.
According to Langone, Malone, and Clinton (1999), “technologies such as
videodisc and CD-ROM can provide immediate access to rich video models and allow
the instructor to link short video examples to specific concepts being taught” (p. 85).
Effective anchors such as the use of video segments may help students discern features
that make particular actions relevant. The conversion of a fully face-to-face course into
blended instruction providing an online component allowed the learner “to interact with
the media (i.e., stopping to read overlaid text, replaying segments)” (Dieker et al., 2009,
p. 182). Interactive video allows learners to control the video and monitor their own
learning, rather than passively viewing an instructional video as an instructor plays the
clips or on television (Wetzel, Radtke, & Stern, 1994). Students are able to retain
information longer and learn more when they are actively involved in a self-driven
learning project versus passively sitting and listening (Newman & Scurry, 2001).](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-40-320.jpg)
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The use of commercially-produced videotape programs for instruction cannot
provide the advantages of using anchored instructional methods including the instructor’s
ability to expand on conventional modes of instruction, such as overheads, print, and
images, to focus on specific content and subject areas being taught, and to tailor the
material to fit the instructor’s and students’ needs (Langone et al., 1999). Although there
are many commercial digital versatile discs (DVDs) on various massage techniques and
modalities, there are no commercial DVDs that are based on the specific course being
studied. The uniqueness of the anchor in the study is that it is instructor-based and
fashioned to fit the structure, content, and design of the face-to-face component.
Instructor-based video anchors. Instructor-based video anchors allow the
instructor to bridge content matter from lectures with video, thus producing “an
experiential context through which meaningful and active learning can occur. Video
content can be tailored to the specific lecture being provided and [students can] have
immediate and repeated access to video examples” (Langone, Malone, Stecker, &
Greene, 1998, p. 100). In this study, the video anchor was based on the face-to-face
demonstrations conducted by the instructor.
The video segments were sequenced according to the particular area being
concentrated on during a full body massage. When students examine an anchor in the
form of video, they are able to integrate new information with their own perspective and
background knowledge. The anchor serves as the bond between on-site instruction and
the link that assists students with melding new knowledge with their existing knowledge](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-41-320.jpg)
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that of an expert providing information to that of a coach (Baumbach, Brewer, & Bird,
1995). Anchored instruction sets up the context in which the teacher and students are
participating in a learning environment that offers a situation conducive to even more
learning opportunities. According to Sanny and Teale (2008), “[b]y looking repeatedly at
a video segment from different perspectives and for different purposes, one is left with a
deeper understanding of the interaction of factors that are involved in the respective
instructional situation” (p. 6). Therefore, using video as the anchor is a unique way to
overcome the problem of inert knowledge.
The purpose of an anchor is to “encourage active knowledge construction by
students” and to offer a setting that is larger in scope and is easily explored by the
students and teacher through the use of anchor videos (Love, 2005). McLarty et al.
(1989) provide the following seven guiding design principles for developing and
implementing anchored instruction:
1 choosing an appropriate anchor;
2 developing shared expertise around the anchor;
3 expanding the anchor;
4 using knowledge as tools for problem solving;
5 teaching with the anchor;
6 merging the anchor with literacy experiences; and
7 allowing student exploration. (p. 1)](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-44-320.jpg)
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Swedish massage is the assimilation of proper body mechanics and draping while
maintaining smoothness of strokes in addition to focus and tracking of the client. Most
amateur massage therapists do not have a repertoire of various techniques or the
knowledge base to conduct a massage with this type of efficiency and effectiveness that
provides comfort, security, and the appropriate therapy for the client.
Massage therapy students must be able to integrate all of these elements easily
while conducting a full body massage that can last from 45 minutes to an hour.
Fundamentals for meaning making include “[v]isual, audio, gestural, spatial, and
multimodal designs” (Love, 2005, p. 307). Images, screen formats, and layouts are types
of visual design. Sound effects and music are forms of audio design. Gestural design
includes body language and behavior. Environmental or architectural spaces are
considered spatial design. According to Love (2005), multimodal design is considered the
most significant because it connects visual, audio, gestural, and spatial forms of design
dynamically, providing patterns of connections between what is being learned. Access to
viewing a video demonstration allowed the students to observe and study the way in
which an expert conducts the necessary techniques, skills, and knowledge effortlessly
within the context and atmosphere of providing a full body massage.
Teaching with the anchor. It is necessary for the instructor to refer to the anchor
video and connect with the instructional objectives (Love, 2005). The anchor in this study
was used in conjunction with the lecture and demonstration format of each module. The
students were assigned to view the video after each session with the expectation of being](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-47-320.jpg)
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blended course, the anchor provided the students the ability to share their experiences,
knowledge, and perspectives within the on-site classes regarding observation of the
anchor.
Blended instruction. Surveyed respondents in a study by Kim and Bonk (2006)
indicated that a greater emphasis will be placed on blended learning than on fully online
courses in the future. Their predictions included a distinct shift from one fourth of
blended classes currently to a substantial amount of courses having some Web
component by the end of 2013. However, even with this positive prediction toward
blended learning, “[b]lended courses are not more prevalent than fully online courses”
(Allen, Seaman, & Garrett, 2007, p. 1). When surveying consumers identified as those
who were seeking to pursue a postsecondary education within the next three years, 76%
preferred a delivery mode with at least some online element, and 81% preferred a
delivery mode with at least some face-to-face element (Allen et al., 2007). According to
Allen et al. (2007), “it is unlikely that the proportion of postsecondary students in the
United States in blended programs is much higher than 7 percent” (p. 18). These statistics
are an indication that consumer preference or demand for blended delivery is far in
excess of what is being offered.
In particular, consumer preference for a web-facilitated program that is primarily
on campus was 24% versus preference for a course or program that is equally balanced
between online and on campus (blended), 14%. Web-facilitated courses are those that use
“web-based technology to facilitate what is essentially a face-to-face course” (Allen et](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-49-320.jpg)
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al., 2007, p. 5). According to Allen et al. (2007), a course or program that offers between
30 and 79% of the content delivered online, using a combination of online and face-to-
face delivery and online discussions with some face-to-face meetings is considered
blended education.
Whether a course is web enhanced or blended, the idea of offering more than one
delivery system is “perceived by some as a ‘best of both worlds’ approach compared to
fully online courses” (Allen et al., 2007, p. 2). According to Albrecht (2006), “[b]lended
learning amounts to a step in that direction, moving away from the single delivery system
that inevitably favors one segment of any student population” (p. 5). With the diversity of
the community college population, traditional instructional methods are inadequate for
meetings its students’ individual needs (Albrecht, 2006).
The concept of blended instruction implies a basic combination of face-to-face
and distance education. However, this is not a sufficient definition and may imply that to
design a blended course is simply to interject technology into a traditional course as an
“add on” or supplemental information component of the instruction. According to Bleed
(2001), blended learning should be considered an opportunity to restructure instruction in
terms of development, scheduling, and delivery with a combination of virtual and
physical instruction or “bricks and clicks.” Another concept of blended learning is
viewed as blending a variety of learning technologies and traditional approaches, a
technique which results in a reduction of “seat time” (Garrison, Kanuka, & Hawes,
2002). These two concepts are considered to be hybrid models of instruction (Vaughan,](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-50-320.jpg)
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Between the 1994-95 and 1997-98 school years, enrollment and the number of
courses taught at a distance nearly doubled in postsecondary institutions, and in the time
frame between 1997 and 1998, higher education experienced an increase in distance
learning programs of over 70% (NCES, 2000). Research supports that there will be a
persistent increase in distance education and “[f]uture projections suggest that this
incredible increase will continue because of the demand for online or [w]eb-based
instruction” (Johnson, Benson, Shinkareva, Taylor, & Treat, 2003, p. 10). For community
colleges, enrollment has grown from 55,000 in 1981 to over 500,000 in 2001 (Synergy
Plus, 2002), a growth attributed to distance education “through the development and
delivery of telecourses” (Johnson et al., 2003, p. 3). As institutions become more adept at
developing and offering courses at a distance, instruction from these courses will become
even more meaningful and noteworthy. Salyers (2005) suggests that “[w]eb-enhanced
courses are increasingly popular for providing rich learning experiences and greater
flexibility in achieving course outcomes” (p. i). Providing distance education is an
important consideration for higher educational institutions, but it is also important to
offer instruction that will enhance learning for its students.
Therefore, the growing number of distance education courses has sparked interest
in its research related to its effectiveness. The question arises, “Can a quality education
be provided at a distance?” (Johnson et al., 2003, p. 4). Technological advances
attributing to the growth in distance education have been met with the same skepticism as
other technological advances in the past. Johnson et al. (2003) state that technologies](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-52-320.jpg)
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such as “the printing press, the typewriter, the telephone, the television, and the
computer” involve substantial capital investments with, some say, little return for use in
enhancing knowledge (p. 3). It is evident that the educational community has come to
embrace these technologies.
Distance education supported by technology has become increasingly popular
since the 1970s (Synergy Plus, 2002). Since the mid 1990s, this type of learning has
expanded with the introduction of the World Wide Web. According to Johnson et al.
(2003),
[a] variety of labels are used to describe this new form of distance learning, the
most common of which are online learning, [w]eb-based instruction, and e-
learning. Whatever labels are used for educational programs delivered using the
Internet, they share a common characteristic: courses are accessible 24 hours a
day, 7 days a week (24/7) from most any location in the world. (p. 9)
Therefore, “learning can occur any time, any place, and any pace” (Johnson et al., 2003,
p. 9). The convenience of online learning has been a major component in its popularity
and demand by many students and faculty.
In addition to the convenience online learning provides, there are additional
benefits that are a byproduct of implementing blended instruction. Vaughan (2007)
concluded in his study that blended learning offers several positive aspects for students,
faculty, and administrators in higher education. Students stated that blended learning
allows for improved learning and flexibility in terms of time management. Faculty](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-53-320.jpg)
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One of the major components to address in the design and development of
instruction are the learners and how they learn (Richey & Klein, 2007). According to
Jinkens (2009), “[p]ast research has indicated that different students learn differently,”
therefore, an examination of the community of learners in the context of integrating
technology within a community college setting is crucial for the design, impact, and
implications of this study (p. 979). By identifying the student population and aligning
instruction to the way in which they learn, “we could help students learn more
effectively” (p. 979). A diverse group of learners is a community college’s primary
student base and “report various reasons for going to a community college” (NCES,
2008, p. 12). Serving this diverse group of learners presents a number of challenges for
designing and developing effective instruction.
A community college is part of the postsecondary education system. The
postsecondary education system consists of various types of institutions, both private and
public. Postsecondary institutions include institutions with programs that are less-than-2-
years long, institutions that provide vocational programs, institutions offering 2-year
vocational certificates and associate’s degrees, and 4-year universities and colleges that
offer bachelor’s degrees and higher. All of these institutions serve those who are high
school graduates plus all ages of adults who enroll for personal or career-related reasons
and goals. Postsecondary institution students vary “in terms of age, sex, race/ethnicity,
socioeconomic background, academic goals, and work and enrollment patterns” (NCES,](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-55-320.jpg)
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2002a, p. 98). Examining and recognizing the characteristics of these learners will help
the postsecondary education system serve them more effectively.
The student body’s characteristics are related to the type of institution that serves
it, for instance the “[s]tudents at public 2-year institutions are more likely to have
dependents, work full time, and delay enrollment than those at 4-year institutions”
(NCES, 2002a, p. 99). This tendency indicated an older population for a public 2-year
institution than those attending a 4-year institution. The community college in this study
falls within the classification of a public 2-year institution, therefore, indicating a diverse
and older student population enrolled in its classes. According to Horn and Nevill (2006),
“[c]ompared to students attending 4-year colleges and universities in 2003-04, higher
proportions of community college students were older, female, and from low-income
families, and lower proportions were White [sic]” (p. 9). It was important to explore the
classification, diversity, and other data regarding student characteristics in postsecondary
institutions in this study for consideration in the design of the course and the implications
for using an online component.
Higher education students are classified as traditional or nontraditional students,
“where traditional students were frequently considered to be those less than 24 years of
age, and nontraditional students were frequently considered to be those 24 years of age or
older” (Jinkens, 2009, p. 979). Those students attending a doctorate-granting, private,
not-for-profit institution are more apt to have the characteristics of a traditional student, a
recent high school graduate who attends full time and does not have regular employment](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-56-320.jpg)
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varying means of instructional delivery, and there is an increase in nontraditional
students’ looking for feasible opportunities of education. The nontraditional student, one
who is older than the traditional student, attempts to find distance courses that offer
videoconferencing or online delivery, since this format allows them the flexibility needed
for a lifestyle that balances other responsibilities such as a family and a career (Skopek &
Schuhmann, 2008). Student demand and expectations toward course delivery are
accompanied by a change in student demographics.
In general, the reality is that “[w]hat the average student looks like has changed
and continues to change” (Kelton, 2007, p. 4). According to New Media Consortium and
EDUCAUSE Learning Initiative (2007), there are many more students currently, who
work and commute than there were in the past. In their report, NCES (2002b) posits that
“[t]oday’s undergraduate population is different than it was a generation ago” (p. 102).
Based on their report, NCES indicate that this population is “72 percent larger in 1999
than in 1970” (p. 102). Also, there are more students entering 2-year colleges and
enrolling on a part-time basis. The same report indicates that among higher education
students, there are more women than there are men and an increase in older students
enrolled (NCES, 2002b, p. 102). In 1999, “39 percent of all postsecondary students were
25 years or older in 1999, compared with 28 percent in 1970” (NCES, 2002b, p. 102).
These statistics indicate that the traditional student is becoming “the exception rather than
the rule” (NCES, 2002b, p. 102).](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-58-320.jpg)
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Not only are more nontraditional students entering the arena of higher education,
but these students are also becoming more comfortable with using online methods of
communication and need the flexibility of being able to complete their work at night and
on the weekends (Sreebny, 2007). Technology for these learners is “assumed to be a
natural part of the environment” (Oblinger, 2003, p. 38). Oblinger (2003) lists 10
attributes of the information-age mindset:
Computers are not technology, the Internet is better than TV, reality is no longer
real, doing is more important than knowing, learning more closely resembles
Nintendo than logic, multitasking is a way of life, typing is preferred to
handwriting, staying connected is essential, there is zero tolerance for delays,
consumer and creator are blurring. (p. 40)
Inevitably the generation that has been accustomed to the use of distance learning will be
replaced by a generation which uses Internet technologies at the K-12 level. A
consideration for the education and instruction of the information-age mindset of future
students is that the “evolving Internet-literate generation will be much more receptive to
distance learning” (Johnson et al., 2003, p. 4). The future learners will see technology as
an implicit part of their environment.
In addition to becoming more comfortable with technology, students and faculty
members also find using online instruction as a valuable component in education. Heffner
and Cohen (2005) found in their study that “[s]elf-reports from students evaluated the
course Website as highly valuable. These results suggest important advantages in](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-59-320.jpg)
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Based on the research, there is a shift in higher education toward online courses
and most of the program’s courses are fully face-to-face, limiting the program’s
competitiveness and accessibility to students. Most states require continuing education
and refresher courses to maintain licensure in the massage therapy profession. Practicing
massage therapists may not have the convenience in terms of time, money, and schedule
to participate in many existing continuing education courses, since many continuing
education courses are in the form of on-site workshops. According to Skopek and
Schuhmann (2008), “[p]ractitioners pursuing continuing education are not usually well
accommodated by traditional delivery methods such as residential programs because they
are typically ‘site bound’ often the result of career and family obligations” (¶ 2).
Therefore, a blended course design with the use of a video-based online component is a
positive move toward offering massage therapy continuing education for the community
this program serves.
Structure of the Course
The fully face-to-face course included lecture sessions and demonstration
sessions. The lecture sessions included information regarding contraindications,
pathologies, endangerment sites, etiquette, and professional considerations. The
demonstration sessions had a basic format or sequence in which the instructor conducts a
massage for a particular area of the body on one of the students while the other students
observed the demonstration. During the demonstration, the instructor explained the type
of technique used, and why one would use it, while explaining any contraindications or](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-70-320.jpg)
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Skill-level survey (Appendix A). The lead instructor, in collaboration with other
instructors, determined the criterion validity of the individual skills and sub skills to
ensure that the instrument adequately differentiates between skill levels. All of the
instructors have taught in the massage therapy program for the last 10 years, are licensed
massage therapists, and have practical experience in the area of massage therapy to
include other modalities such as Swedish, sports, neuromuscular techniques, pregnancy
and infant massage. The instructors examined the survey to determine the content validity
of the survey or “the systematic examination of the test content to determine whether it
covers a representative sample of the behaviour [sic] domain to be measured” (Anastasi
& Urbina, 1997, p. 114). All of the instructors are licensed massage therapists and used
the knowledge of skills, laws, and content for instrument design. This instrument is
regularly used when assessing the students in their clinical evaluation.
The skill-level survey (Appendix A) included the date the massage was given, the
student’s (therapist’s) name, and the observer’s (instructor’s) name. Each basic skill was
evaluated using a 5-point Likert-type scale. A rating of 1 indicates major improvement
needed; a rating of 2 indicates minor improvement needed; a rating of 3 indicates average
skill level; a rating of 4 is very good; and a rating of 5 is excellent. The main skills that
were rated in the clinical experience were the student’s draping techniques, massage
techniques and skills, continuity, focus and tracking, and body mechanics. These skills
are comprised by a set of sub skills that allowed the evaluator to rate the student](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-75-320.jpg)
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thoroughly regarding that particular basic skill. Each main skill can be addressed with
four to six sub skills.
A list of the requirements regarding many of the knowledge, skills, and abilities
for massage therapists is outlined by the AMTA (2010b). In regard to draping, a massage
therapist must be able to “[d]emonstrate appropriate and professional client/patient
draping techniques” (p. 32). Draping techniques are important for setting boundaries and
are referred to in most state laws regarding massage therapists’ conduct. The Florida
Administrative Code (2010) for “Misconduct and Negligence in the Practice of Massage
Therapy” refers specifically to the issue of draping and what constitutes misconduct and
negligence in the practice of massage therapy. According to AMTA (2010b), “failure to
ensure privacy in disrobing/dressing or though [sic] use of proper draping is one part of a
series of behaviors that may constitute sexual misconduct” (p. 44). The issues and facts
surrounding these laws were reiterated through most of the program’s content regarding
therapist-client relationships.
Assessment of draping included whether the therapist provided security for the
client by taking such measures as tucking in the sheet, securing the sheet for the client’s
comfort, and using appropriate draping for the temperature of the room, for example, a
blanket if it is cold. Assessment for draping also included whether the therapist was able
to treat the area of the body being worked on while ensuring ethical and professional
boundaries and used accessories such as supporting bolsters and pillows for providing a
comfortable massage. According to AMTA (2010b), “[d]raping variations which](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-76-320.jpg)
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Therapist continuity was comprised of the therapist’s smoothness of strokes and
the ability to transition from one technique or one body part to another. Contact with the
hand and palm should be firm and even. It is extremely important that a polarity hold is
completed at the beginning of the massage session, at recenter, and, ideally after the
massage. Centering with the client consists of the therapist placing the hands on the
client’s back, over the face, or on the shoulders and communicating to the client to take
three deep breaths. At this time, the therapist adjusts his or her breathing in sync with the
client before beginning the massage. The therapist must “[d]emonstrate varying
rhythms/pace, depth, stroke sequence and flow/continuity for specific applications and
intended outcomes” (AMTA, 2010b, p. 35). It is important for the therapists to have
awareness of how they are conducting the massage in addition to awareness of the client,
a skill which involves focus and tracking.
Focus and tracking of the client comprised the therapist’s intent during the
massage and whether the massage was nurturing or mechanical. Focus and tracking of the
client indicated the therapist’s sensitivity to the client’s body language, such as guarding
for pain, in which case the therapist would use less pressure. The application of massage
must be “client focused” (AMTA, 2010b, p. 34). The speed of strokes indicated whether
the therapist is rushing the massage or allowing for thorough, smooth strokes and
working from the center of the body. The ability of the therapist to stay focused while
conducting a massage is defined by AMTA (2010b) as “the capacity to observe and be
aware of how and where the hands and body of the therapist are located while giving a](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-78-320.jpg)
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massage” (p. 38). In reference to tracking the client, the AMTA posits that the attention
to the client is “[t]he direction of awareness to any object, sense or thought for the sake of
gaining clarity. Such awareness may precede or occur simultaneously with the motor
activity of a massage” (p. 38). In addition to being able to successfully conduct the
massage therapy session, a therapist’s health and longevity in the field involves using
proper body mechanics.
Alignment of the therapist’s navel with the direction of the stroke suggested that
the therapist was using proper body mechanics. In addition to this positioning, proper arm
and body angles give leverage in using the body weight for applying pressure. Leaning in
and lunging allow the therapist to distribute weight properly to administer pressure.
Therapists avoid suffering from carpal tunnel when the wrists and hands are relaxed
during the session. Body mechanics is defined by the AMTA (2010b) as the “[a]wareness
of posture, use of body weight and movement and their effect on determining massage
therapy techniques and application” (p. 14). It is also “[b]alance, equilibrium and stability
as they relate to movement and function” (AMTA, 2010b, p. 14). According to AMTA,
the therapist can “optimize application while minimizing adverse effects and supporting
longevity in the field” with the use of following techniques:
[p]osture, balance and positioning; [s]tructural alignment of bones and joints;
[u]se of body weight and leverage; [a]pplication of various forms of force; [f]oot
positions and stances; [u]nderstanding of the relationship among effective body](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-79-320.jpg)
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mechanics, massage therapy applications and injury prevention; [i]njury
prevention strategies. (p. 31)
Also, it is important that a massage therapist “[d]emonstrate efficient and effective body
mechanics during massage therapy application” and “[u]se efficient and effective body
mechanics for injury prevention of the massage therapist and the client/patient” (AMTA,
2010b, p. 32). Learning proper body mechanics early in the profession allows therapists
to integrate this skill easily into their massage therapy repertoire of routines.
Demographic survey (Appendix B). The demographic survey (Appendix B)
included basic information such as age, education, gender, ethnicity, and marital status.
The extent of the student’s massage experience was taken into account, specifically
whether they had none, informal, or formal experience since this factor may have had an
effect on the student’s skill-level evaluation. With the study being geared toward an
online video-based anchor, the researcher thought it important to ask about each student’s
accessibility and experience with a computer. Therefore, the researcher asked if they had
computers at home and the extent of their experience with computers: none, informal
(self taught), or formal. Other technology-related questions asked whether they had ever
taken online courses before, whether they ever worked in Google, and what their
experience was in taking courses online. In addition to ascertaining basic information, the
demographic survey (Appendix B) also covered how many children were in the
household, whether the student worked while attending school, and family income to](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-80-320.jpg)
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Table 1
Summary of Quantitative Reliability and Validity
Quantitative Reliability and
Validity
Steps taken in Study
Reliability: consistency or
stability of a measure of
behavior, a set of
measurements, or a
measuring instrument.
The lead instructor, in collaboration with other
instructors, determined the criterion validity of the
individual skills and sub skills to ensure that the
instrument adequately differentiates between skill
levels. A lead instructor evaluated students on how
well they demonstrated skills during their clinical
experience.
Internal validity: the basic
minimum without which an
experiment is
uninterruptible.
The instructors examined the survey to determine the
content validity of the survey or “the systematic
examination of the test content to determine whether it
covers a representative sample of the behaviour [sic]
domain to be measured” (Anastasi & Urbina, 1997, p.
114).
External validity: asks the
question of
generalizability.
Detailed procedures, appendixes, and clear
descriptions were provided in the study.
Objectivity: the ability to
communicate the results to
advance understanding and
ensure reproducibility.
Conclusions made based on the study will be
examined within the dissertation defense process by
external, objective parties on the dissertation
committee.](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-87-320.jpg)
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confirmed the null hypothesis. With alpha set at 0.05, the results were in the expected
direction but were not significant (z = -1.24, p = 0.1075).
There was no significant statistical difference between the control group’s and
treatment group’s scores for body mechanics on the skill-level survey (Appendix A), yet
the treatment group scored higher on average than the control group. A significant
difference may have been found with a greater N. However, the difference between M2
and M1 of 3.9 may be an indication that the treatment group’s learner achievement in
terms of demonstrating proper body mechanics during the massage was improved
because of the redesigned course with an integrated online video-based anchor.
Descriptive Characteristics of Participants
The researcher analyzed the data collected from the demographic survey
(Appendix B) for the results pertaining to the participants’ characteristics. The following
characteristics are discussed in this section: age, gender, ethnicity, participants’ education
and enrollment pattern, marital status and number of dependents employment status, and
income level. These characteristics were examined in detail to determine the prevalent
nontraditional characteristics and nontraditional classification of the participants.
Age of participants. Measures of central tendency regarding the students’ ages
in the study indicate how well the sample parallels with the median age of community
college students. According to NCES (2008), “[i]n 2003-04, the median age of
community college students (24 years old) was higher than the median age for both](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-95-320.jpg)
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Marital status and dependents of participants. In Horn’s (1996) study on
trends in enrollment of nontraditional undergraduates, one of the three sets of criteria
used for identifying the nontraditional student was financial and family status.
Specifically, in regard to having dependents and being a single parent, Horn describes
that students were designated as nontraditional if they were married and had dependents
other than a spouse or were single parents. Horn further specifies, “[i]n addition to
children, dependents may include elder parents, siblings, or other members of the family
for whom the student is financially responsible” (p. 7). Many nontraditional students
assist with taking care of family members, such as elderly parents and younger or
disabled siblings. The assistance provided to their family members may include taking on
additional financial and health care responsibilities.
There were no missing data for identifying the marital status and having
dependents other than a spouse of the participants. Most of the students in the control
group (62%, 8 out of 13) had dependents other than a spouse (five) or were single parents
(three), only five students in the treatment group (33%) had dependents other than a
spouse (three) or were single parents (two). Less than half of all of the participants or
46% (13 out of 28) had dependents other than a spouse or were single parents in regard to
fitting this nontraditional student characteristic.
Employment status of participants. In Horn’s (1996) study on trends in
nontraditional undergraduate enrollment, one of the three sets of criteria used for](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2F1560a924-dd57-46fa-8cef-545903b656d3-161015190624%2F85%2FPeters_Pearl_Darlene_201105_EdD-doc-99-320.jpg)
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This study examined the use of blended instruction with an online video-based component in a Swedish massage course at a postsecondary massage therapy program. The goal was to provide effective instruction for nontraditional learners and lay the groundwork for further research on teaching strategies in massage therapy. Students' skill levels were measured after half received traditional instruction and half received blended instruction including an online video component. A mixed-methods approach was used to collect and analyze quantitative skill scores and qualitative data on students' perceptions of online and blended learning. The results provide insights into the impact of blended learning on skills and how to design effective online components for nontraditional vocational students.
![138 1176-1-sp[1]](/proxy?url=https%3A%2F%2Fcdn.slidesharecdn.com%2Fss_thumbnails%2F138-1176-1-sp1-110621111024-phpapp01-thumbnail.jpg%3Fwidth%3D640%26height%3D640%26fit%3Dbounds)
