Is the Understanding Dementia Massive Open Online Course Accessible and Effective for Everyone? Native Versus Non-Native English Speakers


  • Sarang Kim University of Tasmania
  • Aidan Bindoff University of Tasmania
  • Maree Farrow University of Tasmania
  • Fran McInerney University of Tasmania
  • Jay Borchard University of Tasmania
  • Kathleen Doherty University of Tasmania



massive open online course, dementia, effectiveness, accessible, non-English speakers, MOOC


Most massive open online courses (MOOCs) are offered in English, including those offered by non-English speaking universities. The study investigated an identified English language dementia MOOC’s accessibility and effectiveness in improving the dementia knowledge of non-native English speaker participants. A total of 6,389 enrolees (age range 18–82 years; 88.4% female) from 67 countries was included in analyses. Dementia knowledge was measured by the Dementia Knowledge Assessment Scale (DKAS) before and after the MOOC completion. Rates of completion were also compared. Native English speakers (n = 5,320) were older, more likely to be female, less likely to be employed, and had lower educational attainment than non-native English speakers (n = 1025). Native English speakers were also more likely to care for or have cared for a family member or friend living with dementia than were non-native English speakers. Native English speakers had a significantly higher DKAS score both pre- (M = 33.0, SD = 9.3) and post-MOOC (M = 44.2, SD = 5.5) than did non-native English speakers (M = 31.7, SD = 9.1; and M = 40.7, SD = 7.7 for pre- and post-MOOC, respectively). Non-native English speakers with low pre-MOOC dementia knowledge scores gained significantly less dementia knowledge following course completion than did native English speakers (p <.001, adjusted for age and education). There was no significant difference between the two groups in their likelihood of completing the MOOC. Our findings suggest that non-native English speakers are motivated and able to complete the MOOC at similar rates to native English speakers, but the MOOC is a more effective educational intervention for native English speakers with low dementia knowledge.


Altbach, P., G. (2014). MOOCs as neocolonialism: Who controls knowledge? International Higher Education, 75, 5–7.

Alzheimer’s Disease International. (2019). World Alzheimer report 2019: Attitudes to dementia.

Annear, M. J., Toye, C., Elliott, K.-E. J., McInerney, F., Eccleston, C., & Robinson, A. (2017). Dementia knowledge assessment scale (DKAS): Confirmatory factor analysis and comparative subscale scores among an international cohort. BMC Geriatrics, 17(1), 168.

Australian Institute of Health and Welfare. (2016). Exploring the aged care use of older people from culturally and linguistically diverse backgrounds: A feasibility study.

Ayalon, L. (2013). Re-examining ethnic differences in concerns, knowledge, and beliefs about Alzheimer’s disease: Results from a national sample. International Journal of Geriatric Psychiatry, 28(12), 1288–1295.

Ayalon, L., & Arean, P. A. (2004). Knowledge of Alzheimer’s disease in four ethnic groups of older adults. International Journal of Geriatric Psychiatry, 19(1), 51–57.

Batsch, N. L., & Mittelman, M. S. (2012). World Alzheimer report 2012: Overcoming the stigma of dementia.

Breining, A., Lavallart, B., Pin, S., Leon, C., Moulias, S., Arwidson, P., Beck, F., Berr, C., & Verny, M. (2014). Perception of Alzheimer’s disease in the French population. Journal of Nutrition, Health and Aging, 18(4), 393–399.

Cahill, S., Pierce, M., Werner, P., Darley, A., & Bobersky, A. (2015). A systematic review of the public’s knowledge and understanding of Alzheimer’s disease and dementia. Alzheimer Disease and Associated Disorders, 29(3), 255–275.

Class Central. (2019). Top 100 free online courses.

Class Central. (2020).

Connell, C. M., Scott Roberts, J., & McLaughlin, S. J. (2007). Public opinion about Alzheimer disease among Blacks, Hispanics, and Whites: Results from a national survey. Alzheimer Disease and Associated Disorders, 21(3), 232–240.

Doherty, K., Bindoff, A., Robinson, A., Vickers, J., & McInerney, F. (2018). Sustainability of the understanding dementia MOOC: Participant motivation and engagement [Poster presentation]. 33rd International Conference of Alzheimer’s Disease International, Chicago, USA.

Eccleston, C., Doherty, K., Bindoff, A., Robinson, A., Vickers, J., & McInerney, F. (2019). Building dementia knowledge globally through the Understanding Dementia massive open online course (MOOC). Science of Learning, 4(1), 3.

Emanuel, E. J. (2013). MOOCs taken by educated few. Nature, 503, 342.

Faure-Delage, A., Mouanga, A. M., M’Belesso, P., Tabo, A., Bandzouzi, B., Dubreuil, C.-M., Preux, P.-M., Clément, J.-P., & Nubukpo, P. (2012). Socio-Cultural perceptions and representations of dementia in Brazzaville, Republic of Congo: The EDAC survey. Dementia and Geriatric Cognitive Disorders Extra, 2(1), 84–96.

Goldberg, L. R., Bell, E., King, C., O’Mara, C., McInerney, F., Robinson, A., & Vickers, J. (2015). Relationship between participants’ level of education and engagement in their completion of the Understanding Dementia massive open online course. BMC Medical Educucation, 15, 60.

Hadi, S. M., & Rawson, R. (2016, February 22–24). Driving learner engagement and completion within MOOCs: A case for structured learning support. In M. Khalil, M. Ebner, M. Kopp, A. Lorenz & M. Kalz (Eds.), Proceedings of the European stakeholder summit on experiences and best practices in and around MOOCs (EMOOCS 2016, pp. 81–92), Graz, Austria.

Hart, P. L., & Mareno, N. (2014). Cultural challenges and barriers through the voices of nurses. Journal of Clinical Nursing, 23(15–16), 2223–2232.

Hone, K. S., & El Said, G. R. (2016). Exploring the factors affecting MOOC retention: A survey study. Computers & Education, 98, 157–168.

Jordan, K. (2014). Initial trends in enrolment and completion of massive open online courses. International Review of Research in Open and Distributed Learning, 15(1), 27.

King, C., Kelder, J.-A., Doherty, K., Phillips, R., McInerney, F., Walls, J., Robinson, A., & Vickers, J. (2014). Designing for quality: The Understanding Dementia MOOC. The Electronic Journal of e-Learning 12(2), 161–171.

Kizilcec, R. F., Saltarelli, A. J., Reich, J., & Cohen, G. L. (2017). Closing global achievement gaps in MOOCs. Science, 355(6322), 251–252.

Lee, S. E., Lee, H. Y., & Diwan, S. (2010). What do Korean American immigrants know about Alzheimer’s disease (AD)? The impact of acculturation and exposure to the disease on AD knowledge. International Journal of Geriatric Psychiatry, 25(1), 66–73.

Liyanagunawardena, T., & Williams, S. (2014). Massive open online courses on health and medicine: Review. Journal of Medical Internet Research, 16(8), e191.

Liyanagunawardena, T., Williams, S., & Adams, A. (2013). The impact and reach of MOOCs: A developing countries’ perspecitve. eLearning Papers, 33, 1–8.

Loi, S. M., & Lautenschlager, N. T. (2015). Dementia literacy in older adults. Asia-Pacific Psychiatry, 7(3), 292–297.

Low, L. F., Anstey, K., Lackersteen, S. M., Camit, M., Harrison, F., Draper, B., & Brodaty, H. (2010). Recognition attitudes and causal beliefs regarding dementia in Italian, Greek and Chinese Australians. Dementia and Geriatric Cognitive Disorders, 30(6), 499–508. 10.1159/000321667

Ludecke, D., von dem Knesebeck, O., & Kofahl, C. (2016). Public knowledge about dementia in Germany—Results of a population survey. International Journal of Public Health, 61(1), 9–16.

Mavromaras, K., Knight, G., Isherwood, L., Crettenden, A., Flavel, J., Karmel, T., Moskos, M., Smith, L., Walton, H., & Wei, Z. (2017). The aged care workforce, 2016.

McParland, P., Devine, P., Innes, A., & Gayle, V. (2012). Dementia knowledge and attitudes of the general public in Northern Ireland: An analysis of national survey data. International Psychogeriatrics, 24(10), 1600–1613. doi:10.1017/S1041610212000658

Prince, M., Wimo, A., Guerchet, M., Ali, G.-C., Wu, Y.-T., & Prina, M. (2015). World Alzheimer report 2015: The global impact of dementia (An analysis of prevalence, incidence, cost and trends). Alzheimer’s Disease International.

Rambe, P., & Moeti, M. (2017). Disrupting and democratising higher education provision or entrenching academic elitism: Towards a model of MOOCs adoption at African universities. Educational Technology Research and Development, 65(3), 631–650.

Roberts, J. S., McLaughlin, S. J., & Connell, C. M. (2014). Public beliefs and knowledge about risk and protective factors for Alzheimer’s disease. Alzheimer’s & Dementia, 10, S381-S389.

Robinson, A., Eccleston, C., Annear, M., Elliott, K.-E., Andrews, S., Stirling, C., Ashby, M., Donohue, C., Banks, S., Toye, C., & McInerney, F. (2014). Who knows, who cares? Dementia knowledge among nurses, care workers, and family members of people living with dementia. Journal of Palliative Care, 30(3), 158–165.

Small, J., Chan, S. M., Drance, E., Globerman, J., Hulko, W., O’Connor, D., Perry, J., Stern, L., & Ho, L. (2015). Verbal and nonverbal indicators of quality of communication between care staff and residents in ethnoculturally and linguistically diverse long-term care settings. Journal of Cross-Cultural Gerontology, 30(3), 285–304.

Smith, B. J., Ali, S., & Quach, H. (2014). Public knowledge and beliefs about dementia risk reduction: A national survey of Australians. BMC Public Health, 14(1), 661.

United National Educational, Science and Cultural Organization. (2008). Mother tongue matters: Local language as a key to effective learning.

Web Accessibility Initiative. (2019). Introduction to Web accessibility.

Walsh, K., & Shutes, I. (2013). Care relationships, quality of care and migrant workers caring for older people. Ageing and Society, 33(3), 393–420.

World Health Organization. (2015). Dementia: A public health priority. World Health Organizaton.



How to Cite

Kim, S., Bindoff, A., Farrow, M., McInerney, F., Borchard, J., & Doherty, K. (2021). Is the Understanding Dementia Massive Open Online Course Accessible and Effective for Everyone? Native Versus Non-Native English Speakers. The International Review of Research in Open and Distributed Learning, 22(3), 19–33.



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