An Open Access e-Learning Strategy for Infectious Disease Epidemiology in Latin America: The Epi Training Kit Pilot Study

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Velasco-España, Adriana Buitrago-López, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7745292/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The COVID-19 pandemic has revealed significant gaps in outbreak response and data analysis training, particularly in low- and middle-income regions. In Latin America and the Caribbean (LAC), challenges such as limited resources, language barriers, and gender disparities hinder the adoption of data science tools in public health, highlighting the need for accessible, culturally relevant public health training. Methods: To address these gaps, we developed the Epi Training Kit (EpiTKit), an open-access, Spanish-language online training strategy delivered as a Massive Open Online Course (MOOC) with context-specific resources and a gender perspective. This descriptive study presents the findings from the 2023 pilot, which involved 223 participants from 13 LAC countries. Mixed methods were used, alongside descriptive statistics and thematic content analysis, to assess course content, learning objectives, educational resources, platform experience, and the integration of regional and gender perspectives. Results: The MOOC earned a mean rating of 4.6/5 (n=90). Over 95% of participants acknowledged that the course met expectations with clear, relevant content (n=630), while most emphasized its value for Latin America, quality education, and gender equity. Additionally, 89% found it relevant for professional development, 92% valued its regional focus, and nearly 90% recognized its promotion of gender equity (n=105). Thematic analysis highlighted key themes related to content quality, learning methodology, peer collaboration, and the integration of regional and gender perspectives. Conclusions: The Epi Training Kit highlights the potential of regionally tailored online learning to address public health challenges, reduce educational gaps, promote gender equity, and strengthen data science capacities. The pilot implementation showed that flexible and inclusive e-learning strategies can engage diverse professionals across Latin America and the Caribbean, fostering skill development and expanding access for underrepresented groups. These findings underscore the value of digital education initiatives in advancing equity, scalability, and preparedness in public health training. Outbreak response training Massive Open Online Course (MOOC) capacity building data science in public health public health infectious disease modelling context-specific learning gender perspective Figures Figure 1 1. Background The increasing frequency of health emergencies has underscored the global importance of infectious disease epidemiology and revealed persistent gaps in outbreak response training, particularly in low- and middle-income countries (1–4). Traditional in-person training presents significant accessibility challenges for remote and underserved populations (5). These limitations are further compounded by barriers such as limited access to education, language exclusion, and gender disparities, all of which hinder the adoption of data science tools in public health (6–8). Among these barriers, linguistic exclusion remains a persistent and frequently underestimated challenge (9–14). The dominance of English in global health research and education exacerbates disparities in access to training, professional development, and international collaboration (9–12,14,15). Rather than representing isolated challenges, language barriers reflect structural inequities that marginalize entire regions from scientific dialogue and limit the integration of evidence into decision-making. In Latin America and the Caribbean (LAC), where Spanish and Portuguese are the predominant languages, this linguistic divide further constrains local capacity-building efforts. The consequences of these gaps become especially evident during public health emergencies such as pandemics, where linguistic exclusion undermines the potential of scientific contributions to inform effective responses to current and future crises (16). Although the burden of overcoming language barriers is often placed on nonnative English-speaking researchers, trainees, and practitioners, addressing linguistic exclusion requires systemic action (9). Promoting multilingual strategies and inclusive training environments is essential for expanding access and reducing inequities. During the COVID-19 pandemic, the World Health Organization (WHO) addressed this gap by translating key courses into several languages through OpenWHO.org, prioritizing access for low- and middle-income countries (17,18). These efforts have proven effective; evidence indicates that training delivered in multiple languages yields comparable outcomes, reinforcing the importance of multilingual approaches (13,14,19). The pandemic has accelerated the global shift toward online education, reinforcing the importance of Massive Open Online Courses (MOOCs) as scalable and flexible training tools in public health (20–24). This underscores the urgent need for health professionals proficient in data analysis and statistical software, increasing the demand for adaptable training solutions such as MOOCs (25–27). MOOCs offer low-cost, accessible, and flexible learning through videos, exercises, and forums, helping reduce commuting barriers and expanding educational access (28–34). However, their potential remains limited in low- and middle-income countries because of persistent challenges, including language barriers, gaps in digital literacy, unreliable internet connectivity, and a lack of local contextualization (24,35–42). In Latin America and the Caribbean, the adoption of MOOCs expanded after 2015 through platforms such as Coursera, edX, and MiríadaX (43). However, participation in the region remains lower than that in the U.S. and Europe, largely due to persistent inequalities in infrastructure and access (44–47). Moreover, most MOOCs are delivered in English, restricting access for Spanish- and Portuguese-speaking learners, despite Spanish being among the most spoken languages worldwide (48,49). Gender disparities further influence access to education, particularly in STEM fields (50,51). Although MOOCs have the potential to democratize education, women remain underrepresented, and participation rates are less than 25%, despite having completion rates comparable to those of men (50,52,53). Nonetheless, online courses have been shown to increase women's participation in STEM by offering flexible and accessible alternatives (54). Programs that integrate computational skills with real-world applications may help overcome these barriers (54,55). Open-source tools play a key role in expanding access to data science training for public health, particularly in resource-constrained settings, by offering scalable and cost-effective solutions that support both individual and institutional capacity building. Tools such as R, a free statistical programming language, along with RStudio and RMarkdown, facilitate hands-on learning and promote collaborative, reproducible research (56,57). Repositories such as Rpubs and GitHub further support knowledge sharing and global learning communities (57). To address the intersecting challenges of language, technological access, and gender inequality in the Latin American and Caribbean (LAC) region, it became necessary to design and develop an e-learning strategy specifically adapted to the regional context. This study presents findings from the pilot phase of the Epi Training Kit (EpiTKit), an open-access, Spanish-language initiative aimed at strengthening outbreak response capacities among public health professionals, STEM students, and public health decision-makers in the region. As a MOOC, EpiTKit integrates contextualized content, open-source tools, and a gender equity perspective to provide inclusive and regionally relevant training in infectious disease epidemiology. 2. Methods The Epi Training Kit adopts a learner-centered approach, focusing on active engagement and positioning learners at the heart of the educational process (58). This approach fosters active participation, adaptability to individual needs, autonomy, and skill development to create meaningful learning experiences. To guide the development of this e-learning strategy, the ADDIE model was applied (59). This structured framework, consisting of five phases—Analyse, Design, Develop, Implement, and Evaluate—ensured that the course content and structure aligned with both the learning objectives and the participants' needs. Aligned with the ADDIE model, the Epi Training Kit followed four phases. (1) Exploratory phase (August 2022– July 2023): Defined audiences, tested content, and identified educational and technological needs, incorporating a community engagement approach by connecting with key actors (students, participants, and users) in the identification process (e.g., internet access and time flexibility), refine materials on the basis of feedback from 317 participants across five Colombian cities. (2) Design and development (March – November 2023): Incorporate insights from the exploratory phase to develop the first MOOC units, including content creation, instructional design, the gender approach and the production of educational resources for deployment on the edX Edge. (3) Pilot phase (November 10–December 21, 2023): Five MOOC units were delivered asynchronously in Spanish on the edX Edge platform, with 223 participants from 16 countries. (4) Implementation and evaluation (November – December 2024): Launched the MOOC with 10 learning units and 2,208 enrollments from 13 LAC countries, incorporating pilot-phase adjustments and integrating the use of Epiverse packages (60). 2.1. Piloting methods According to Crouch, S., & Broadbent, P. (61), pilot planning should focus on content, learning materials, delivery, and assessment to ensure a positive learner experience and gather actionable feedback for future improvements. Below, we present the course content structure, the chosen e-learning platform, the types of educational resources used, and a detailed description of the gender-sensitive approach and its implementation. Academic Content of the Pilot : The pilot tested five learning units, along with a welcome module. Each unit was designed with specific objectives, as outlined in Appendix 1. The units were as follows: History of Epidemics and Pandemics Introduction to Epidemic Theory Introduction to R and RStudio Data Visualization in R with ggplot2 Reporting and Technical Writing in R Markdown To enhance engagement, a narrative strategy was introduced, positioning participants as health detectives who revealed clues and tools to address public health challenges. Activities, characters, and missions followed this investigative theme to promote active participation. The participants earned badges upon completing each unit, contributing to a Detective Clue Board that culminated in a final knowledge summary map, consolidating key concepts acquired throughout the course. Online Platform and Educational Resources of the Pilot: The MOOC was delivered on the edX Edge platform from [University], an e-learning platform widely recognized in Latin America for its accessibility and open-source framework, aligning with our commitment to knowledge sharing (62). A total of 57 educational resources were produced and assembled, including 17 explanatory videos and tutorials, expert interviews, 1 podcast, 2 infographics, 10 animated diagrams, and 15 interactive presentations (all with subtitles and transcripts), along with 3 discussion forums, 4 challenges, and 3 R programming practices. Gender Approach of the Pilot: We adopted a gender-sensitive approach by 1) developing an inclusive graphic line, 2) highlighting female role models, 3) ensuring balanced representation in multimedia content and avoiding gender-based stereotypes, 4) selecting authors and interviewees from diverse backgrounds, 5) creating spaces for gender-awareness discussions, 6) addressing the underrepresentation of women in the field, and 7) adopting gender-neutral language, avoiding masculine forms or pronouns as generic references. This pilot aimed to evaluate key aspects of the EpiTKit MOOC: 1) alignment of the course content with the target audience’s needs, 2) achievement of learning objectives, 3) effectiveness of educational resources, 4) the web platform experience, and 5) the course’s suitability for the Latin American and Caribbean context, including gender considerations. A descriptive study was performed to evaluate these key aspects (63). 2.2. Participants In total, 223 individuals from 16 countries were included in the pilot study. Participants were selected from the 592 applicants to the 2023 Epimodelac course on Outbreak analysis and modelling in public health in Colombia, whose applicants were from 13 LAC countries (www.epimodelac.com). Two forms of inclusion criteria were used for the pilot: i) The highest-scoring individuals were selected for in-person training (n = 78) and were required to complete the MOOC prior to attending. ii) The next highest score was 200 unselected applicants (n = 128). iii) An additional group included in-person trainers (n = 8) and [Project] team members (n = 9). 2.3. Data collection We used a series of methods for data collection, including satisfaction surveys, end-of-course experience surveys and focus groups. Satisfaction survey: Both closed- and open-ended questions were conducted at the end of each unit (Appendix 2). Closed-ended questions used a Likert scale to gauge participants' agreement with specific statements, whereas open-ended questions allowed them to share their likes and dislikes about the unit. End-of-course experience survey: Surveys were sent to both participants who completed the survey and those who did not complete the survey to explore their experiences with and perceptions of the MOOC. The survey was created in Microsoft Forms and distributed via email to participants (Appendix 3). Focus Groups: Focus group discussions were conducted to gather participant observations and perspectives (64). A total of 19 participants, with balanced gender representations, were assigned to either a national or an international focus group. All discussions were audio-recorded, transcribed, and moderated by a research team member. The sessions followed a structured set of guiding questions (Appendix 4) and included visual aids such as posters and Post-it notes. The following demographic variables were gathered through the surveys: age group, gender, country, education level and institutional membership. 2.4. Data analysis Quantitative analysis: The distribution of responses for each item was analysed, and the mean values, standard deviations, and percentages for all assessed components were calculated. The data analysis included overall experience ratings and Likert scale survey results, capturing participant feedback on content, learning objectives, educational resources, study time, and experience with R. Qualitative analysis: To analyse the open-ended survey responses and focus group transcriptions, we applied content analysis, a method for identifying patterns and themes (64,65). A mixed-method approach combining deductive coding (based on literature-derived categories) and inductive coding (emerging themes) was used to classify the data (64). The process involved (1) transcription of audio and open-ended survey responses; (2) identification of key issues; (3) coding relevant topics; (4) grouping related information; (5) critical analysis; (6) incorporating moderator observations; and (7) synthesizing findings (66). The initial coding scheme was based on the pilot's objectives and theoretical framework categories, with additional emergent themes analysed inductively (67). NVivo 15 was used for coding. 3. Results 3.1. Demographic characteristics The pilot of the MOOC "Course in Data Science in Public Health and Infectious Disease Modelling" had 228 participants from Colombia (including regions such as Amazonas, Antioquía, and Bogotá) and 13 countries across Latin America and the Caribbean (Argentina, Brazil, Chile, Cuba, Mexico, Panama, and others). The cohort had a balanced gender distribution, with 66.4% identifying as female, and most participants (54.3%) held a master's degree. The majority were aged between 25 and 45 years, with a concentration between 32 and 38 years. Most participants were from Colombia (76.2%) and came from various sectors, such as the government, academia, and NGOs. Experience with R programming varied, with many beginners and some with no prior experience. The MOOC had a 57.4% completion rate, and 73.1% completed at least half of the course. However, the completion rate was not deeply analysed, as 36% were required to complete the course before attending the in-person event (see Appendix 5). The results from our instrument designed to evaluate the objectives are as follows: Satisfaction unit surveys: The survey received 630 responses, with participants able to submit up to five responses, one for each unit. End-of-course experience survey: This survey received 105 responses. Of these, 90 were from completers, representing a 71% response rate among those who completed the course, whereas 15 responses came from noncompleters. Focus group: Two focus groups with 19 participants from Colombia, Latin America, and the Caribbean were conducted in person. The first group (10 participants, 80% female) was from various Colombian regions (Amazonas, Bogotá, Sucre, Meta, Putumayo, Quibdó, and Tolima), whereas the second group (9 participants, 40% female) included individuals from Brazil, Chile, the Dominican Republic, Ecuador, Mexico, and Peru. The participants, aged 25-53 years (mainly 32-45 years), had diverse backgrounds, and all completed the course, with scores between 56% and 100%. Most held undergraduate or master’s degrees (36.8% each), followed by PhDs (21.1%) and undergraduates (5.3%). R proficiency was mostly basic (31.6%) or intermediate (42.1%), with some advanced (15.8%) and no prior experience (10.5%). 3.2. Quantitative analysis According to the satisfaction unit surveys (n = 630). Over 75% of the participants found the content clear, sufficient, and aligned with their expectations, with 89% rating it relevant for professional development across the units. Learning objectives and activities were effective for more than 81% of the participants, and 77% felt that educational resources supported their learning. The study time was deemed appropriate by 85% of the respondents. For the last three units that use R software, more than 74% found R instructions clear, and 79% agreed that the final R exercise reinforced their knowledge (Appendix 6). In terms of overall experience, more than 90% of the participants rated the course units between 4 and 5 on a 5-point scale. The highest ratings were for the first two units related to the history of epidemics and epidemic theory. Technical units received lower scores, with the R programming unit rating 5 by 48% of participants and 91% rating it between 4 and 5. However, the data visualization and data reporting units received 5 ratings from more than 64% of the participants, and 96% rated the ratings between 4 and 5 (Table 1). Table 1 . How would you rate your overall experience in the MOOC? How would you rate your overall experience in the MOOC? (with 5 being the highest rating and 1 the lowest) Unit 5 4 3 2 1 History of epidemics and pandemics 77% 22% 1% 0% 0% Introduction to epidemic theory 79% 19% 2% 0% 0% Introduction to R and RStudio 48% 43% 8% 0% 0% Data Visualization in R with ggplot2 64% 32% 4% 1% 0% Reporting and Technical Writing in R Markdown 67% 30% 2% 0% 0% Caption: Distribution of participant ratings (1–5 scale) for each MOOC unit, showing the percentage selecting each score. In the end-of-course experience survey by participants who completed the MOOC, the course received a 4.6/5 rating (n = 90, SD 0.55) and a 9.3/10 recommendation score (SD 1.2). More than 97% agreed that the topics were well covered, addressed the need for Spanish-language materials, met objectives, were relevant to their professional training, and promoted quality education. Over 95% felt that the course met expectations with clear, sufficient content. Approximately 92% recognized its relevance to Latin America and the Caribbean, and close to 90% noted its promotion of gender equity ( Figure 1 ). On the other hand, more than 53% of the participants who did not complete the MOOC (n = 15) indicated that they did not have time to complete it because of personal matters or a lack of time. Twenty-six percent faced technical issues (internet, devices, electricity, or platform), and 21% struggled with the methodology. 3.3. Qualitative analysis The qualitative results reveal participants' overall positive experience, highlighting the value of the content, methodology, educational resources and platform experience. They particularly appreciated the practical exercises that improved their R skills and the content's relevance to their professional practice. However, participants faced challenges such as language barriers in the bibliography and code language, limited access to academic papers, and time constraints. The analysis also emphasized the need to expand educational resources for R learning, as well as expand regional representation to enhance relevance. The following sections explore the following key themes: (1) meaningful content, (2) engaging resources, (3) peer engagement, (4) flexible methodology, (5) relevant objectives, (6) learning barriers, (7) R learning experience, (8) platform experience, (9) interdisciplinary approach, (10) emotional response, (11) gender perspective, (12) regional representation, and (13) capacity development in public health data science (Appendix 7). Meaningful content The content of the MOOC pilot was highly praised for its clarity, organization, and relevance. The participants appreciated the well-structured material, which presented key concepts and examples in an accessible way and was supported by diverse educational resources. They emphasized the practical applicability of the content, noting its direct relevance to their professional work. Additionally, the structured progression of the content within the platform enhanced usability, guiding participants through the learning process step by step. “What I liked most about the unit was the theoretical-conceptual approach—it was clear and precise. The most important concepts were covered in a simple way but supported by the literature, which is beneficial for both expert and nonexpert audiences. Additionally, two elements I particularly enjoyed were the podcast and the expert videos, which I believe added extra value.” Survey participant "I truly liked the didactic way in which the topics were explained, progressing from the simplest to the most complex. They covered concepts that may seem basic, but I believe this is what sets this course apart from others I have taken. Nothing felt like filler, and I finally understood many things I had previously asked about but never got clear answers to. I truly enjoyed the course.” Survey participant Engaging educational resources The educational resources in the MOOC pilot were highly valued for their diversity, quality, and ability to maintain engagement. The participants appreciated the mix of formats, such as readings, infographics, videos, interactive presentations, and practical exercises, which facilitated learning and reinforced key concepts. The inclusion of short, engaging videos with complementary written content was especially noted as an effective approach. Additionally, the availability of downloadable materials, diagrams, and multiple access options contributed to a flexible and user-friendly learning experience. “The materials are of high quality, innovative, and engaging. The information is clear and to the point, ensuring a concise yet effective message.” Survey participant “The variety of access options for the materials makes the learning process more manageable and helps maintain attention for longer.” Focus group participant "I come from Mocoa de Putumayo (a rural area with limited access to the internet and electricity). Interactives don’t work very well for me, but I felt comfortable downloading the material and reading it in a traditional way." Focus group participant Peer Engagement Despite the asynchronous nature of the course, the participants highlighted that the forums played a key role in fostering collaboration, answering questions, and building a sense of community. The opportunity to engage with peers through discussions facilitated knowledge exchange and mutual support, enhancing the overall learning experience. “Peer participation in the forum was valuable for successfully conducting the exercises” Survey participant Flexible learning methodology The course methodology was widely appreciated for its flexibility, allowing participants to balance their learning with professional and personal responsibilities. The autonomous learning approach, combined with a structured sequence of content, enabled participants to engage with the material at their own pace. "I appreciated being able to manage my time. Alternating between readings, videos, and infographics was very helpful in keeping track of the content.” Focus group participant "It’s an interactive course, not tiring, and encourages you to finish it." Survey participant Relevant learning objectives The participants praised the course's rigorous academic standards, clear objectives, and relevance to regional public health challenges. They valued the opportunity to engage with professionals from various disciplines, which enriched their learning and fostered interdisciplinary collaboration. The MOOC effectively reinforced their knowledge and provided practical tools for their professional practice. The alignment between content and objectives was considered crucial for its educational impact, with some participants suggesting the inclusion of additional units focused on mathematical modelling and advanced analytics. “I found the course to have a high technical and academic level, with a well-defined objective that is highly relevant to the region. I appreciate having been selected, and the opportunity to engage with people from diverse disciplines was an added benefit. It provided me with new tools that I hope to apply and share in my work.” Survey participant Learning Barriers The participants faced challenges related to access to bibliographic resources, language barriers, and course scheduling. Some struggled with English-only academic articles or paid-walled content, limiting their exploration of topics beyond the MOOC. Additionally, balancing the course with professional and personal commitments was difficult for some. In technical units, especially those involving R programming, language barriers with English R commands and functions were noted. The participants suggested adding resources such as more video tutorials, access to written code, a Q&A section, and an error bank to improve comprehension and enhance the fully asynchronous learning experience. “To run the data, there is a lot of terminology in English, even in the videos, and for people like me who are just learning the language, it becomes a barrier.” Focus group participant Learning Experience in R Software The participants emphasized the value of self-learning and practical exercises in mastering R, with hands-on tasks helping them grasp key concepts and apply them directly. The step-by-step video tutorials were appreciated for their clarity, allowing participants to build skills progressively. Those with prior knowledge found the course helpful for reinforcing their understanding, especially in practical applications. Additionally, the course's focus on open-source tools such as R was highlighted for its accessibility and effectiveness, enhancing the overall learning experience. “The development of the practical exercise allows for a better internalization of the concepts related to R and directly observe their applicability. Attempting to solve these types of exercises enables finding different solutions to a given situation using R. From the outset, the ability to clean and organize databases is extremely useful in the daily work of those involved in data analysis, and optimizing these processes allows for reinvesting time in more analytical rather than operational tasks.” Focus group participant "Personally, I already had a basic understanding of the R language, and this course helped me better understand certain elements, particularly creating graphics with ggplot. I truly liked the methodology, and I found the pace to be just right." Survey participant "I liked that the use of R as a statistical tool is promoted, as it is an open access and free source." Survey participant “It’s the first time I’ve been able to do things with R that, although they may seem simple, like a filter, required a lot of effort on my part... I’m truly excited.” Survey participant Platform experience The participants valued the platform's usability, especially in regions with connectivity challenges. Key features such as downloadable materials, engaging interactive content, and a visually appealing design were appreciated. Despite some internet issues, the platform's lightweight design allows for smoother access than other platforms do. Navigation was described as intuitive and user friendly. “I’m from Leticia, Amazonas. Regarding the internet: it’s not great because we use satellite internet. When it rains, we lose connection, and when there’s thunder, we lose power. If it is sunny, the satellite burns out. (...) However, I truly liked the platform that was used because we’ve tried other platforms before, and they tend to be very heavy. I was worried I would have issues, but I did not.” Focus group participant “I found it visually appealing, with well-chosen colors, interactive materials, and the option to download content. It offered plenty of support and included diverse resources to accommodate different types of learners.” Survey participant Interdisciplinary approach The participants valued the interdisciplinary approach of the MOOC, which effectively integrated history, public health, mathematics, programming, data science, and epidemiology. This interdisciplinary framework allows participants to recognize the relevance of diverse fields in addressing complex public health challenges. "Exploring the connection between history, public health, and epidemiology is enlightening, revealing hidden links between different fields of knowledge. It shows how history can offer valuable insights and help decentralize aspects of the past that inform current public health management." Focus group participant Participants’ emotional response The participants expressed a range of emotions throughout the course, from gratitude and enjoyment of the historical sections to frustration with the technical challenges, particularly in the R-related units and time constraints. Despite these challenges, the course was motivating, reinforcing key concepts while introducing new ones. Many participants were satisfied with the knowledge gained, considering the experience valuable for professional growth and expressing enthusiasm to continue applying the concepts in their practice. “I was truly excited. I think it was in the first unit when they gave me an example to 'calculate the basic reproduction number,' which I had heard about during the pandemic but wasn’t very familiar with those types of terms. However, when I did the exercise, everything turned out great, and I thought, "Oh, wow, this is so cool!" That gave me the motivation to keep going and get to this point.” Focus group participant "It has been a motivational process because it allows you to recall and clarify concepts while taking on new challenges. It has also been quite challenging due to time constraints, as we are at the end of the year and the month, but I enjoy it because I believe it is necessary for the territories to stay updated." Focus group participant Gender perspective The participants had varied perceptions of gender representation in the MOOC. Many praised the visibility of women, especially female leaders, and appreciated the inclusion of their contributions. However, some suggested enhancing gender representation and making it more visible throughout the course for better inclusivity and contextual relevance. Others felt that the current focus was sufficient and appropriate. "It’s very interesting and wonderful that women have been leading this initiative, and it’s great to see how clearly visible their leadership is. (...) I do believe that, in this regard, for instance, the first units highlighted women and significant figures throughout history." Focus group participant Enhancing regional representation The participants suggested expanding the course's focus to include more diverse regional examples from Latin America and the Caribbean. While the course was rich in Colombian content, they felt that incorporating perspectives from other countries would enhance its relevance and inclusivity. Additionally, standardizing data for the region was recommended to improve the course's global applicability. "I believe that adding information and history from our own region would make the course more Latin American." Focus group participant Capacity development in data science in public health The participants had a highly positive experience, highlighting the valuable knowledge gained in epidemiology and data analysis, particularly through tools such as R. The MOOC was seen as an enriching opportunity that enhanced participants' ability to apply their knowledge directly to their work and public health decision-making. The development of technical skills, such as the use of R for data analysis and visualization, was especially appreciated for its potential to drive data-driven decisions in public health and epidemiology. "It was an enriching experience, as I was able to strengthen my skills in data analysis and visualization through R and ggplot. In my area of work, I am assigned to high-incidence events such as VBD and ARI, and since completing this course, I have started to apply what I learned in my basic and intermediate analytical routines. I hope to continue improving these skills so they can be useful for decision-making. Now, my challenge is to advance in the output of information using ggplot for dissemination spaces such as the COVE (from the Spanish acronym for Epidemiological Surveillance Committee), the VBD committee, and epidemiological bulletins." Survey participant 4. Discussion This study addresses a gap in the literature by describing the design, development, and pilot implementation of a fully Spanish-language e-learning strategy for infectious disease epidemiology and data science for public health in the LAC region. Using learner-centered, community engagement, and gender-sensitive approaches, we collaborated with potential users to identify their educational and technological needs and tailor the strategy to their context. The analysis focuses on overcoming barriers, providing diverse resources, and fostering community building, highlighting the potential of MOOCs and online education to address public health training gaps in the region. From barriers to bridges: Expanding access to outbreak response training The Epi Training Kit was developed to address longstanding barriers to training in outbreak response, particularly the lack of high-quality, open-access resources in Spanish concerning infectious disease epidemiology, mathematical modelling, and data science tools. Fieldwork across various regions highlighted additional challenges, including geographic isolation, limited infrastructure, financial and time constraints, limited funding and human resources for in-person training, and heterogeneous baseline knowledge and learning paces. The pilot MOOC received positive feedback for its capacity to overcome many of these barriers, offering flexible, and scalable training (31,32,52,68,69), while also helping to bridge the digital divide (38) and promote participant diversity (70). Feedback confirmed the course’s accessibility, practical relevance, and adaptability to learners’ contexts. The wide geographic representation of participants, including those from remote areas, further confirmed the effectiveness of this approach. As established in earlier sections, language remains a persistent and often underestimated barrier (9–14). This challenge continues to limit access to outbreak response training in Latin America and the Caribbean, particularly in regions where English dominates the majority of high-quality scientific resources (11,31,32,52). The participants consistently emphasized the value of a rigorous, well-structured course delivered entirely in Spanish. For many, this marked their first encounter with specialized epidemiological content in their native language, emphasizing the value of the Epi Training Kit MOOC in removing a significant barrier to comprehension and engagement. The availability of technical content, practical exercises, and expert interviews enhanced both learning and motivation to apply tools such as R to real-world public health challenges (27,69), reinforcing the importance of linguistic accessibility in multilingual and low-resource contexts (9,13). In addition to language and access, the Epi Training Kit also addressed concerns about equity in online learning environments. Although MOOCs have been criticized for potentially perpetuating existing inequalities (52,71–73), this initiative adopted a learner-centered approach that prioritized accessibility and inclusion. The key design elements included downloadable materials, transcriptions of audiovisual content, and the integration of a gender perspective (58). The participants highlighted the value of encountering diverse voices and female role models throughout the course, which helped them connect theoretical content to real-world public health scenarios. Overall, the MOOC’s design effectively addressed many learning barriers, enhancing participants' engagement and sense of belonging within the learning community. With respect to technical skills, a key pedagogical objective was to shift how participants approached data analysis using R for epidemiological thinking in public health. By moving beyond menu-based platforms (e.g., Excel, EpiInfo, SAS, SPSS, Stata) and toward open-source programming, the course emphasized the benefits of reproducibility, transparency, analytical flexibility, and accessibility (27,74). Despite initial challenges, such as interface complexity and language barriers, which are often linked to resistance to new technologies (34), participants recognized R as a valuable tool for evidence-based decision-making in public health. Diverse resources for a diverse learning community MOOCs offer a distinct advantage in reaching a broad and diverse audience, particularly when designed with an interdisciplinary approach. In this context, the course brought together participants from both the STEM and health sectors, fostering a rich exchange of knowledge and perspectives. This diversity extends beyond educational backgrounds and professional experiences to include variations in age, gender, geographic location, time availability, schedules, and access to technological resources. To address these differences and overcome potential barriers, providing inclusive resources that meet the needs of such a varied audience is crucial. In response, the course used asynchronous instructions, allowing participants to access materials at their convenience. Although this provided flexibility, it also posed challenges for engagement and motivation. To address these issues, the Epi Training Kit was developed with a learner-centered design, considering the audience’s needs, skills, and challenges. Research from MOOC pilots and the literature (30,75–77) highlights that engagement is enhanced through diverse resources such as short videos, readings, interactive activities, and forums for communication. This multimodal approach accommodates different learning preferences, including participants in low-resource settings where video access may be limited (38). The Epi Training Kit integrated efforts to promote gender diversity in STEM, using the flexibility and accessibility of online learning to foster collaboration. Moreover, the use of interdisciplinary online courses can help increase the participation of women and underrepresented groups in STEM fields (52,78,79). Consequently, the integration of online learning with interdisciplinary approaches through the Epi Training Kit offers valuable paths for advancing gender equity and promoting diversity within STEM fields. Community building through peer engagement Learner engagement is influenced by internal assessments shaped by interactions with peers and the learning platform (80). Interactivity, particularly on MOOC platforms, plays a crucial role in shaping learners’ cognitive responses and behaviors (81–84). In alignment with Salmon’s (2013) e-tivity framework, the Epi Training Kit MOOC fostered active learning through various interactive strategies. Discussion forums provide participants with opportunities to exchange ideas, seek feedback, and resolve course-related queries, whereas dedicated support forums offer technical assistance. These interactions reinforce engagement by ensuring the platform’s reliability and enhancing the learning experience (34,75). The participants in the pilot considered the forums to be vital resources, in line with research emphasizing the role of forum dynamics in fostering learning communities (44,47,62,85) 5. Conclusion In conclusion, the development and piloting of the Epi Training Kit (EpiTKit) have provided valuable insights into the design of effective online training strategies aimed at strengthening public health capacities in Latin America and the Caribbean (LAC) region. The fieldwork approach was crucial in understanding learners' specific needs, testing and refining course content, and identifying potential cultural and gender biases. Additionally, fieldwork enabled a deeper understanding of the technological resources available to participants, an essential factor for an online learning strategy that must adapt to varying contexts. Integrating fieldwork insights during the design phase significantly enhanced both content and accessibility. The incorporation of region-specific imagery and voices reflective of Latin American and Caribbean communities, along with the use of inclusive language, strengthened learners' sense of recognition and connection to the training. This approach not only increased the content’s relevance but also fostered deeper engagement, highlighting the importance of contextually grounded and culturally sensitive educational strategies. Engaging adult learners in asynchronous online environments presents well-documented challenges, and the EpiTKit was no exception, particularly given its audience of health professionals with demanding schedules. To overcome this, the course incorporated diverse resources such as video lectures, infographics, and discussion forums while encouraging peer interaction to build a sense of community. These elements were essential in achieving the course’s educational goals and fostering ongoing knowledge sharing. As a result, the course successfully promoted the use of data science tools in public health and contributed to bridging regional educational gaps. This experience underscores the value of integrating research, fieldwork, and contextual adaptation when designing effective online learning strategies for public health. Finally, on the basis of Epi Training Kit experience, training approaches should aim to create more inclusive and accessible learning environments by addressing the diverse needs of the global student population. These approaches should prioritize (1) broader coverage through remote access, consideration of limited computing infrastructure, and affordability; (2) recognition of students’ diverse social and educational backgrounds by adapting content, educational resources, and delivery methods; and (3) the promotion of community participation through open-access materials, forums, multilingual options, and a gender-focused approach to foster inclusivity and diversity. Declarations Ethical approval and consent to participate This study complies with the ethical guidelines established in the Colombian Resolution 8430 of 1993. According to this regulation, the research is classified as risk-free, as defined in Article 11, since it relies on retrospective documentary research methods and does not involve any intentional intervention or modification of biological, physiological, psychological, or social variables of the participants. Confidentiality was ensured by anonymizing personal data, including demographic variables such as age, gender, country, education level, and institutional membership. No sensitive topics were addressed, as data collection focused solely on participants' experiences regarding the course and the educational barriers it helps to overcome. To guarantee ethical integrity in data analysis, a mixed-method approach was applied, combining deductive and inductive coding to identify relevant themes while minimizing bias. Additionally, all focus group discussions were audio-recorded and securely stored, with access restricted to authorized personnel only. This study adheres to the ethical principles established for human research, including those outlined in the Declaration of Helsinki, as well as other relevant international ethical guidelines such as the Belmont Report, the CIOMS (Council for International Organizations of Medical Sciences) Guidelines, and the Universal Declaration on Bioethics and Human Rights by UNESCO. These principles ensure respect for autonomy, beneficence, non-maleficence, and justice throughout the research process. Additionally, the Spanish version of the informed consent for semi-structured interviews is attached for reference. Consent for publication The data was collected with the authorization and knowledge of the participants, who signed the data protection policy in accordance with Colombian Statutory Law 1581 of 2012, authorizing the use of their personal data under the responsibility of Pontificia Universidad Javeriana, with restricted access and compliance with ethical regulations. Additionally, those who participated in semi-structured interviews signed informed consent, which was reviewed and approved by the Ethics Committee of Universidad de los Andes. For further information, you may contact [email protected] . Availability of data and materials The data analyzed in this study include information derived from semi-structured interviews as well as survey responses and usage statistics downloaded from the edX platform. These datasets contain personal and potentially identifiable information about participants and platform users and therefore cannot be publicly shared. Anonymized excerpts relevant to the study may be requested from the corresponding author, subject to ethical and data protection considerations. Competing interests The authors of this work explicitly declare that there are no financial, personal, or professional conflicts of interest that could have influenced the objectivity, design, execution, or interpretation of the research presented. We maintain a firm commitment to transparency and assure that this work has been carried out with complete impartiality and without undue influence. Funding This work is part of the TRACE-LAC project (Enhancing Tools for Response, Analytics and Control of Epidemics in Latin America and the Caribbean), funded by the International Development Research Center (IDRC), grant number: 109848-002. The funder had no role in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript. Authors’ contribution (CRediT Classification): LGB: Conceptualization (equal); methodology (lead); Writing – original draft (equal); Writing – review and editing (equal); Formal analysis (equal); Investigation (lead); Visualization (equal); Project administration (equal). JMVE: Writing – original draft (equal); Writing – review and editing (equal); Conceptualization (supporting); Formal analysis (equal); Investigation (supporting); methodology (supporting); Visualization (equal) ABL: Writing – review and editing (supporting). GGM: Writing – review and editing (supporting). ZMC: Conceptualization (equal); methodology (supporting); Writing – original draft (supporting); Writing – review and editing (lead); Investigation (supporting); Funding Acquisition (lead); Supervision (lead); Project administration (equal); Validation (lead). Acknowledgement Not applicable Authors’ information LBG: Training coordinator - Epiverse TRACE-LAC Javeriana; BMath, MSc Education, Management and Leadership JMVE: Research assistant - Epiverse TRACE-LAC Javeriana; RDN, MSc Clinical Epidemiology ABL: Assistant professor - Department of Clinical Epidemiology and Biostatistics; RN, MSc Clinical Epidemiology, DSc Clinical Epidemiology, PhD Health sciences GGM: Software Development Leader - Epiverse TRACE-LAC; ECE, MSc(c) Software Engineer ZMC: Principal Investigator - Epiverse TRACE-LAC Javeriana and Director of the Institute of Public Health, Pontificia Universidad Javeriana, Bogotá, Colombia; MD, MSc Public Health, PhD Epidemiology of infectious diseases References Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3(11):e442. Baker RE, Mahmud AS, Miller IF, Rajeev M, Rasambainarivo F, Rice BL, et al. Infectious disease in an era of global change. 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Social Media and Well-Being: Pitfalls, Progress, and Next Steps. Trends Cogn Sci. 2021;25(1):55–66. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7745292","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":522488459,"identity":"76db9178-8f21-4033-8098-eafaf9e39464","order_by":0,"name":"Laura Gómez-Bermeo","email":"","orcid":"","institution":"Pontificia Universidad Javeriana","correspondingAuthor":false,"prefix":"","firstName":"Laura","middleName":"","lastName":"Gómez-Bermeo","suffix":""},{"id":522488460,"identity":"337dfe57-85a0-4792-81a0-86f6847add4b","order_by":1,"name":"José M. 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Cucunubá","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABLUlEQVRIie2QMUvDQBSAXzhIlhPXg6j5Cw0BEazxr+Q4yFSlIIhDhgPxupRmPf9FXZwLB9cl2DUhDorglKEglA5SjAotaTLoJphveDzeex+P9wBaWv4kiG9SgC76yoLvQqdZMSpK+HtFVXqNiiPpzXgJPo3lmbb70czalUzPn6JHB6zrewJRt7ZDUpENgVGZnoe21DkiachkoF9djvUlAR1uK4hQkWKY0DHpHdrYzBEkiQeBqQxeVojB1bZilkr2vlZWD8hJZm8QrNQpd4pGBZdKvt6yIyaoMx0ioEJRTnCjQvCzyPc6zJNJ4R3fjhhyp8IDOlJM4PDiKKjf4gyYzoorfz8e9Ny8v/DZgUIvxnKhTmJL3aXz+sdq/2ebMz9D0CxU8H8w09LS0vLP+ADZSmumDqlP/wAAAABJRU5ErkJggg==","orcid":"","institution":"Pontificia Universidad Javeriana","correspondingAuthor":true,"prefix":"","firstName":"Zulma","middleName":"M.","lastName":"Cucunubá","suffix":""}],"badges":[],"createdAt":"2025-09-29 21:08:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7745292/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7745292/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93024356,"identity":"b972f0ef-4446-4710-86df-90acf88117e8","added_by":"auto","created_at":"2025-10-08 09:16:09","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":557750,"visible":true,"origin":"","legend":"","description":"","filename":"PaperPilotEpiTrainingKitreviewedcuri.docx","url":"https://assets-eu.researchsquare.com/files/rs-7745292/v1/473281cdf9f323c15124d224.docx"},{"id":93025733,"identity":"e453d757-afb5-485b-9b11-c18a2c31db05","added_by":"auto","created_at":"2025-10-08 09:24:09","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8295,"visible":true,"origin":"","legend":"","description":"","filename":"509b80ddc2c04c1f96d1dc58502bc5d4.json","url":"https://assets-eu.researchsquare.com/files/rs-7745292/v1/46188c45b1059b9310d06b9a.json"},{"id":93024358,"identity":"3e010185-99df-4842-a8a8-1296fbd36c2d","added_by":"auto","created_at":"2025-10-08 09:16:09","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":193621,"visible":true,"origin":"","legend":"","description":"","filename":"509b80ddc2c04c1f96d1dc58502bc5d41enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7745292/v1/e5ade3a037ada4481d98a49f.xml"},{"id":93024355,"identity":"c8318a22-45a2-438d-b530-1b9ebdd12abf","added_by":"auto","created_at":"2025-10-08 09:16:09","extension":"png","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":18343,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7745292/v1/9cdd832d8cdf08da3b6f0089.png"},{"id":93024359,"identity":"b47dedb7-9bd9-4c6e-8d36-d94b5f280e94","added_by":"auto","created_at":"2025-10-08 09:16:09","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":186857,"visible":true,"origin":"","legend":"","description":"","filename":"509b80ddc2c04c1f96d1dc58502bc5d41structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7745292/v1/cf853e7cface66d9ae9ce2b9.xml"},{"id":93024360,"identity":"17e19a3a-c9db-4fbb-9e9b-4a295b56abe2","added_by":"auto","created_at":"2025-10-08 09:16:09","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":214360,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7745292/v1/85e766c0d083912e4315e076.html"},{"id":93024354,"identity":"1fe10c37-ac8d-4cd3-96fe-96379880bd38","added_by":"auto","created_at":"2025-10-08 09:16:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":46249,"visible":true,"origin":"","legend":"\u003cp\u003eSatisfaction unit survey\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCaption: Bar chart summarizing participant feedback from the EpiTKit MOOC satisfaction survey via a five-point scale (strongly agree to strongly disagree). It presents responses on course effectiveness, clarity, relevance to professional development, and the integration of regional and gender equity perspectives. The results highlight the MOOC’s contribution to reducing educational disparities and promoting inclusion across Latin America and the Caribbean.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7745292/v1/aa774aa9108556f71feb886e.png"},{"id":93867918,"identity":"f2e17cfe-c3c1-42e7-aecc-f8d90fdb0d22","added_by":"auto","created_at":"2025-10-19 09:46:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1353530,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7745292/v1/cfaaf516-d772-4f6f-acaf-4de188e2a1ad.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"An Open Access e-Learning Strategy for Infectious Disease Epidemiology in Latin America: The Epi Training Kit Pilot Study","fulltext":[{"header":"1. Background","content":"\u003cp\u003eThe increasing frequency of health emergencies has underscored the global importance of infectious disease epidemiology and revealed persistent gaps in outbreak response training, particularly in low- and middle-income countries (1–4). Traditional in-person training presents significant accessibility challenges for remote and underserved populations (5). These limitations are further compounded by barriers such as limited access to education, language exclusion, and gender disparities, all of which hinder the adoption of data science tools in public health (6–8).\u003c/p\u003e\n\u003cp\u003eAmong these barriers, linguistic exclusion remains a persistent and frequently underestimated challenge (9–14). The dominance of English in global health research and education exacerbates disparities in access to training, professional development, and international collaboration (9–12,14,15). Rather than representing isolated challenges, language barriers reflect structural inequities that marginalize entire regions from scientific dialogue and limit the integration of evidence into decision-making. In Latin America and the Caribbean (LAC), where Spanish and Portuguese are the predominant languages, this linguistic divide further constrains local capacity-building efforts. The consequences of these gaps become especially evident during public health emergencies such as pandemics, where linguistic exclusion undermines the potential of scientific contributions to inform effective responses to current and future crises (16).\u003c/p\u003e\n\u003cp\u003eAlthough the burden of overcoming language barriers is often placed on nonnative English-speaking researchers, trainees, and practitioners, addressing linguistic exclusion requires systemic action (9). Promoting multilingual strategies and inclusive training environments is essential for expanding access and reducing inequities. During the COVID-19 pandemic, the World Health Organization (WHO) addressed this gap by translating key courses into several languages through OpenWHO.org, prioritizing access for low- and middle-income countries (17,18). These efforts have proven effective; evidence indicates that training delivered in multiple languages yields comparable outcomes, reinforcing the importance of multilingual approaches (13,14,19).\u003c/p\u003e\n\u003cp\u003eThe pandemic has accelerated the global shift toward online education, reinforcing the importance of Massive Open Online Courses (MOOCs) as scalable and flexible training tools in public health (20–24). This underscores the urgent need for health professionals proficient in data analysis and statistical software, increasing the demand for adaptable training solutions such as MOOCs (25–27). MOOCs offer low-cost, accessible, and flexible learning through videos, exercises, and forums, helping reduce commuting barriers and expanding educational access (28–34). However, their potential remains limited in low- and middle-income countries because of persistent challenges, including language barriers, gaps in digital literacy, unreliable internet connectivity, and a lack of local contextualization (24,35–42).\u003c/p\u003e\n\u003cp\u003eIn Latin America and the Caribbean, the adoption of MOOCs expanded after 2015 through platforms such as Coursera, edX, and MiríadaX (43). However, participation in the region remains lower than that in the U.S. and Europe, largely due to persistent inequalities in infrastructure and access (44–47). Moreover, most MOOCs are delivered in English, restricting access for Spanish- and Portuguese-speaking learners, despite Spanish being among the most spoken languages worldwide (48,49).\u003c/p\u003e\n\u003cp\u003eGender disparities further influence access to education, particularly in STEM fields (50,51). Although MOOCs have the potential to democratize education, women remain underrepresented, and participation rates are less than 25%, despite having completion rates comparable to those of men (50,52,53). Nonetheless, online courses have been shown to increase women's participation in STEM by offering flexible and accessible alternatives (54). Programs that integrate computational skills with real-world applications may help overcome these barriers (54,55).\u003c/p\u003e\n\u003cp\u003eOpen-source tools play a key role in expanding access to data science training for public health, particularly in resource-constrained settings, by offering scalable and cost-effective solutions that support both individual and institutional capacity building. Tools such as R, a free statistical programming language, along with RStudio and RMarkdown, facilitate hands-on learning and promote collaborative, reproducible research (56,57). Repositories such as Rpubs and GitHub further support knowledge sharing and global learning communities (57).\u003c/p\u003e\n\u003cp\u003eTo address the intersecting challenges of language, technological access, and gender inequality in the Latin American and Caribbean (LAC) region, it became necessary to design and develop an e-learning strategy specifically adapted to the regional context. This study presents findings from the pilot phase of the Epi Training Kit (EpiTKit), an open-access, Spanish-language initiative aimed at strengthening outbreak response capacities among public health professionals, STEM students, and public health decision-makers in the region. As a MOOC, EpiTKit integrates contextualized content, open-source tools, and a gender equity perspective to provide inclusive and regionally relevant training in infectious disease epidemiology.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eThe Epi Training Kit adopts a learner-centered approach, focusing on active engagement and positioning learners at the heart of the educational process (58). This approach fosters active participation, adaptability to individual needs, autonomy, and skill development to create meaningful learning experiences. To guide the development of this e-learning strategy, the ADDIE model was applied (59). This structured framework, consisting of five phases—Analyse, Design, Develop, Implement, and Evaluate—ensured that the course content and structure aligned with both the learning objectives and the participants' needs.\u003c/p\u003e\n\u003cp\u003eAligned with the ADDIE model, the Epi Training Kit followed four phases. \u003cstrong\u003e(1) Exploratory phase\u003c/strong\u003e (August 2022– July 2023): Defined audiences, tested content, and identified educational and technological needs, incorporating a community engagement approach by connecting with key actors (students, participants, and users) in the identification process (e.g., internet access and time flexibility), refine materials on the basis of feedback from 317 participants across five Colombian cities. \u003cstrong\u003e(2) Design and development\u003c/strong\u003e (March – November 2023): Incorporate insights from the exploratory phase to develop the first MOOC units, including content creation, instructional design, the gender approach and the production of educational resources for deployment on the edX Edge.\u003cstrong\u003e\u0026nbsp;(3) Pilot\u0026nbsp;\u003c/strong\u003ephase (November 10–December 21, 2023): Five MOOC units were delivered asynchronously in Spanish on the edX Edge platform, with 223 participants from 16 countries. \u003cstrong\u003e(4) Implementation and evaluation\u003c/strong\u003e (November – December 2024): Launched the MOOC with 10 learning units and 2,208 enrollments from 13 LAC countries, incorporating pilot-phase adjustments and integrating the use of Epiverse packages (60).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.1. Piloting methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to Crouch, S., \u0026amp; Broadbent, P. (61), pilot planning should focus on content, learning materials, delivery, and assessment to ensure a positive learner experience and gather actionable feedback for future improvements. Below, we present the course content structure, the chosen e-learning platform, the types of educational resources used, and a detailed description of the gender-sensitive approach and its implementation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcademic Content of the Pilot\u003c/strong\u003e: The pilot tested five learning units, along with a welcome module. Each unit was designed with specific objectives, as outlined in Appendix 1. The units were as follows:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eHistory of Epidemics and Pandemics\u003c/li\u003e\n \u003cli\u003eIntroduction to Epidemic Theory\u003c/li\u003e\n \u003cli\u003eIntroduction to R and RStudio\u003c/li\u003e\n \u003cli\u003eData Visualization in R with ggplot2\u003c/li\u003e\n \u003cli\u003eReporting and Technical Writing in R Markdown\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eTo enhance engagement, a narrative strategy was introduced, positioning participants as health detectives who revealed clues and tools to address public health challenges. Activities, characters, and missions followed this investigative theme to promote active participation. The participants earned badges upon completing each unit, contributing to a Detective Clue Board that culminated in a final knowledge summary map, consolidating key concepts acquired throughout the course.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOnline Platform and Educational Resources of the Pilot:\u0026nbsp;\u003c/strong\u003eThe MOOC was delivered on the edX Edge platform from [University], an e-learning platform widely recognized in Latin America for its accessibility and open-source framework, aligning with our commitment to knowledge sharing (62). A total of 57 educational resources were produced and assembled, including 17 explanatory videos and tutorials, expert interviews, 1 podcast, 2 infographics, 10 animated diagrams, and 15 interactive presentations (all with subtitles and transcripts), along with 3 discussion forums, 4 challenges, and 3 R programming practices.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGender Approach of the Pilot:\u003c/strong\u003e We adopted a gender-sensitive approach by 1) developing an inclusive graphic line, 2) highlighting female role models, 3) ensuring balanced representation in multimedia content and avoiding gender-based stereotypes, 4) selecting authors and interviewees from diverse backgrounds, 5) creating spaces for gender-awareness discussions, 6) addressing the underrepresentation of women in the field, and 7) adopting gender-neutral language, avoiding masculine forms or pronouns as generic references.\u003c/p\u003e\n\u003cp\u003eThis pilot aimed to evaluate key aspects of the EpiTKit MOOC: 1) alignment of the course content with the target audience’s needs, 2) achievement of learning objectives, 3) effectiveness of educational resources, 4) the web platform experience, and 5) the course’s suitability for the Latin American and Caribbean context, including gender considerations. A descriptive study was performed to evaluate these key aspects (63).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2. Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn total, 223 individuals from 16 countries were included in the pilot study. Participants were selected from the 592 applicants to the 2023 Epimodelac course on Outbreak analysis and modelling in public health in Colombia, whose applicants were from 13 LAC countries (www.epimodelac.com). Two forms of inclusion criteria were used for the pilot: i) The highest-scoring individuals were selected for in-person training (n = 78) and were required to complete the MOOC prior to attending. ii) The next highest score was 200 unselected applicants (n = 128). iii) An additional group included in-person trainers (n = 8) and [Project] team members (n = 9).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3. Data collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe used a series of methods for data collection, including satisfaction surveys, end-of-course experience surveys and focus groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSatisfaction survey:\u0026nbsp;\u003c/strong\u003eBoth closed- and open-ended questions were conducted at the end of each unit (Appendix 2). Closed-ended questions used a Likert scale to gauge participants' agreement with specific statements, whereas open-ended questions allowed them to share their likes and dislikes about the unit.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEnd-of-course experience survey:\u0026nbsp;\u003c/strong\u003eSurveys were sent to both participants who completed the survey and those who did not complete the survey to explore their experiences with and perceptions of the MOOC. The survey was created in Microsoft Forms and distributed via email to participants (Appendix 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFocus Groups:\u003c/strong\u003e Focus group discussions were conducted to gather participant observations and perspectives (64). A total of 19 participants, with balanced gender representations, were assigned to either a national or an international focus group. All discussions were audio-recorded, transcribed, and moderated by a research team member. The sessions followed a structured set of guiding questions (Appendix 4) and included visual aids such as posters and Post-it notes.\u003c/p\u003e\n\u003cp\u003eThe following demographic variables were gathered through the surveys: age group, gender, country, education level and institutional membership.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4. Data analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuantitative analysis:\u0026nbsp;\u003c/strong\u003eThe distribution of responses for each item was analysed, and the mean values, standard deviations, and percentages for all assessed components were calculated. The data analysis included overall experience ratings and Likert scale survey results, capturing participant feedback on content, learning objectives, educational resources, study time, and experience with R.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative analysis:\u0026nbsp;\u003c/strong\u003eTo analyse the open-ended survey responses and focus group transcriptions, we applied content analysis, a method for identifying patterns and themes (64,65). A mixed-method approach combining deductive coding (based on literature-derived categories) and inductive coding (emerging themes) was used to classify the data (64). The process involved (1) transcription of audio and open-ended survey responses; (2) identification of key issues; (3) coding relevant topics; (4) grouping related information; (5) critical analysis; (6) incorporating moderator observations; and (7) synthesizing findings (66). The initial coding scheme was based on the pilot's objectives and theoretical framework categories, with additional emergent themes analysed inductively (67). NVivo 15 was used for coding.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1. Demographic characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe pilot of the MOOC \u0026quot;Course in Data Science in Public Health and Infectious Disease Modelling\u0026quot; had 228 participants from Colombia (including regions such as Amazonas, Antioqu\u0026iacute;a, and Bogot\u0026aacute;) and 13 countries across Latin America and the Caribbean (Argentina, Brazil, Chile, Cuba, Mexico, Panama, and others). The cohort had a balanced gender distribution, with 66.4% identifying as female, and most participants (54.3%) held a master\u0026apos;s degree. The majority were aged between 25 and 45 years, with a concentration between 32 and 38 years. Most participants were from Colombia (76.2%) and came from various sectors, such as the government, academia, and NGOs. Experience with R programming varied, with many beginners and some with no prior experience. The MOOC had a 57.4% completion rate, and 73.1% completed at least half of the course. However, the completion rate was not deeply analysed, as 36% were required to complete the course before attending the in-person event (see Appendix 5).\u003c/p\u003e\n\u003cp\u003eThe results from our instrument designed to evaluate the objectives are as follows:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSatisfaction unit surveys:\u0026nbsp;\u003c/strong\u003eThe survey received 630 responses, with participants able to submit up to five responses, one for each unit.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEnd-of-course experience survey:\u0026nbsp;\u003c/strong\u003eThis survey received 105 responses. Of these, 90 were from completers, representing a 71% response rate among those who completed the course, whereas 15 responses came from noncompleters.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFocus group:\u003c/strong\u003e Two focus groups with 19 participants from Colombia, Latin America, and the Caribbean were conducted in person. The first group (10 participants, 80% female) was from various Colombian regions (Amazonas, Bogot\u0026aacute;, Sucre, Meta, Putumayo, Quibd\u0026oacute;, and Tolima), whereas the second group (9 participants, 40% female) included individuals from Brazil, Chile, the Dominican Republic, Ecuador, Mexico, and Peru. The participants, aged 25-53 years (mainly 32-45 years), had diverse backgrounds, and all completed the course, with scores between 56% and 100%. Most held undergraduate or master\u0026rsquo;s degrees (36.8% each), followed by PhDs (21.1%) and undergraduates (5.3%). R proficiency was mostly basic (31.6%) or intermediate (42.1%), with some advanced (15.8%) and no prior experience (10.5%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2. Quantitative analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the satisfaction unit surveys (n = 630). Over 75% of the participants found the content clear, sufficient, and aligned with their expectations, with 89% rating it relevant for professional development across the units. Learning objectives and activities were effective for more than 81% of the participants, and 77% felt that educational resources supported their learning. The study time was deemed appropriate by 85% of the respondents. For the last three units that use R software, more than 74% found R instructions clear, and 79% agreed that the final R exercise reinforced their knowledge (Appendix 6).\u003c/p\u003e\n\u003cp\u003eIn terms of overall experience, more than 90% of the participants rated the course units between 4 and 5 on a 5-point scale. The highest ratings were for the first two units related to the history of epidemics and epidemic theory. Technical units received lower scores, with the R programming unit rating 5 by 48% of participants and 91% rating it between 4 and 5. However, the data visualization and data reporting units received 5 ratings from more than 64% of the participants, and 96% rated the ratings between 4 and 5 (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 1\u003c/em\u003e. How would you rate your overall experience in the MOOC?\u003c/p\u003e\n\u003ctable\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 389.25pt;border: 1pt solid black;padding: 2pt;height: 24pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cstrong\u003e\u003cspan style=\"color:black;\"\u003eHow would you rate your overall experience in the MOOC? \u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"color:black;\"\u003e(with 5 being the highest rating and 1 the lowest)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 246.75pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;background: rgb(243, 243, 243);padding: 2pt;height: 19.5pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cstrong\u003e\u003cspan style=\"color:black;\"\u003eUnit\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: rgb(243, 243, 243);padding: 2pt;height: 19.5pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cstrong\u003e\u003cspan style=\"color:black;\"\u003e5\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: rgb(243, 243, 243);padding: 2pt;height: 19.5pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cstrong\u003e\u003cspan style=\"color:black;\"\u003e4\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.75pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: rgb(243, 243, 243);padding: 2pt;height: 19.5pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cstrong\u003e\u003cspan style=\"color:black;\"\u003e3\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.75pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: rgb(243, 243, 243);padding: 2pt;height: 19.5pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cstrong\u003e\u003cspan style=\"color:black;\"\u003e2\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: rgb(243, 243, 243);padding: 2pt;height: 19.5pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cstrong\u003e\u003cspan style=\"color:black;\"\u003e1\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 246.75pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 2pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cstrong\u003e\u003cspan style=\"color:black;\"\u003eHistory of epidemics and pandemics\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: rgb(192, 212, 55);padding: 2pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e77%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: rgb(237, 243, 198);padding: 2pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e22%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.75pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: rgb(255, 255, 253);padding: 2pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e1%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.75pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: white;padding: 2pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e0%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: white;padding: 2pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e0%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 246.75pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 2pt;height: 16.5pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cstrong\u003e\u003cspan style=\"color:black;\"\u003eIntroduction to epidemic theory\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: rgb(190, 211, 50);padding: 2pt;height: 16.5pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e79%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: rgb(240, 245, 206);padding: 2pt;height: 16.5pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e19%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.75pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: rgb(254, 254, 250);padding: 2pt;height: 16.5pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e2%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.75pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: white;padding: 2pt;height: 16.5pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e0%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: white;padding: 2pt;height: 16.5pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e0%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 246.75pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 2pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cstrong\u003e\u003cspan style=\"color:black;\"\u003eIntroduction to R and RStudio\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: rgb(216, 229, 131);padding: 2pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e48%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: rgb(220, 231, 144);padding: 2pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e43%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.75pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: rgb(249, 251, 235);padding: 2pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e8%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.75pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: white;padding: 2pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e0%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: white;padding: 2pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e0%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 246.75pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 2pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cstrong\u003e\u003cspan style=\"color:black;\"\u003eData Visualization in R with ggplot2\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: rgb(203, 220, 89);padding: 2pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e64%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: rgb(229, 238, 172);padding: 2pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e32%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.75pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: rgb(252, 253, 245);padding: 2pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e4%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.75pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: rgb(255, 255, 253);padding: 2pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e1%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: white;padding: 2pt;height: 15pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e0%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 246.75pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 2pt;height: 19.5pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cstrong\u003e\u003cspan style=\"color:black;\"\u003eReporting and Technical Writing in R Markdown\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.5in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: rgb(200, 218, 81);padding: 2pt;height: 19.5pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e67%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: rgb(231, 239, 177);padding: 2pt;height: 19.5pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e30%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.75pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: rgb(254, 254, 250);padding: 2pt;height: 19.5pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e2%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.75pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: white;padding: 2pt;height: 19.5pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e0%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;background: white;padding: 2pt;height: 19.5pt;vertical-align: bottom;\"\u003e\n \u003cp style='margin:0in;font-size:13px;font-family:\"Times New Roman\",serif;text-align:justify;line-height:200%;border:none;'\u003e\u003cspan style=\"color:black;\"\u003e0%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eCaption: Distribution of participant ratings (1\u0026ndash;5 scale) for each MOOC unit, showing the percentage selecting each score.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn the end-of-course experience survey by participants who completed the MOOC, the course received a 4.6/5 rating (n = 90, SD 0.55) and a 9.3/10 recommendation score (SD 1.2). More than 97% agreed that the topics were well covered, addressed the need for Spanish-language materials, met objectives, were relevant to their professional training, and promoted quality education. Over 95% felt that the course met expectations with clear, sufficient content. Approximately 92% recognized its relevance to Latin America and the Caribbean, and close to 90% noted its promotion of gender equity (\u003cem\u003eFigure 1\u003c/em\u003e).\u003c/p\u003e\n\u003cp\u003eOn the other hand, more than 53% of the participants who did not complete the MOOC (n = 15) indicated that they did not have time to complete it because of personal matters or a lack of time. Twenty-six percent faced technical issues (internet, devices, electricity, or platform), and 21% struggled with the methodology.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e3.3. Qualitative analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe qualitative results reveal participants\u0026apos; overall positive experience, highlighting the value of the content, methodology, educational resources and platform experience. They particularly appreciated the practical exercises that improved their R skills and the content\u0026apos;s relevance to their professional practice. However, participants faced challenges such as language barriers in the bibliography and code language, limited access to academic papers, and time constraints. The analysis also emphasized the need to expand educational resources for R learning, as well as expand regional representation to enhance relevance. The following sections explore the following key themes: (1) meaningful content, (2) engaging resources, (3) peer engagement, (4) flexible methodology, (5) relevant objectives, (6) learning barriers, (7) R learning experience, (8) platform experience, (9) interdisciplinary approach, (10) emotional response, (11) gender perspective, (12) regional representation, and (13) capacity development in public health data science (Appendix 7).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeaningful content\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe content of the MOOC pilot was highly praised for its clarity, organization, and relevance. The participants appreciated the well-structured material, which presented key concepts and examples in an accessible way and was supported by diverse educational resources. They emphasized the practical applicability of the content, noting its direct relevance to their professional work. Additionally, the structured progression of the content within the platform enhanced usability, guiding participants through the learning process step by step.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;What I liked most about the unit was the theoretical-conceptual approach\u0026mdash;it was clear and precise. The most important concepts were covered in a simple way but supported by the literature, which is beneficial for both expert and nonexpert audiences. Additionally, two elements I particularly enjoyed were the podcast and the expert videos, which I believe added extra value.\u0026rdquo; \u003cstrong\u003eSurvey participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;I truly liked the didactic way in which the topics were explained, progressing from the simplest to the most complex. They covered concepts that may seem basic, but I believe this is what sets this course apart from others I have taken. Nothing felt like filler, and I finally understood many things I had previously asked about but never got clear answers to. I truly enjoyed the course.\u0026rdquo; \u003cstrong\u003eSurvey participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEngaging educational resources\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe educational resources in the MOOC pilot were highly valued for their diversity, quality, and ability to maintain engagement. The participants appreciated the mix of formats, such as readings, infographics, videos, interactive presentations, and practical exercises, which facilitated learning and reinforced key concepts. The inclusion of short, engaging videos with complementary written content was especially noted as an effective approach. Additionally, the availability of downloadable materials, diagrams, and multiple access options contributed to a flexible and user-friendly learning experience.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The materials are of high quality, innovative, and engaging. The information is clear and to the point, ensuring a concise yet effective message.\u0026rdquo; \u003cstrong\u003eSurvey participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The variety of access options for the materials makes the learning process more manageable and helps maintain attention for longer.\u0026rdquo; \u003cstrong\u003eFocus group participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;I come from Mocoa de Putumayo (a rural area with limited access to the internet and electricity). Interactives don\u0026rsquo;t work very well for me, but I felt comfortable downloading the material and reading it in a traditional way.\u0026quot; \u003cstrong\u003eFocus group participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePeer Engagement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite the asynchronous nature of the course, the participants highlighted that the forums played a key role in fostering collaboration, answering questions, and building a sense of community. The opportunity to engage with peers through discussions facilitated knowledge exchange and mutual support, enhancing the overall learning experience.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Peer participation in the forum was valuable for successfully conducting the exercises\u0026rdquo; \u003cstrong\u003eSurvey participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFlexible learning methodology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe course methodology was widely appreciated for its flexibility, allowing participants to balance their learning with professional and personal responsibilities. The autonomous learning approach, combined with a structured sequence of content, enabled participants to engage with the material at their own pace.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;I appreciated being able to manage my time. Alternating between readings, videos, and infographics was very helpful in keeping track of the content.\u0026rdquo; \u003cstrong\u003eFocus group participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;It\u0026rsquo;s an interactive course, not tiring, and encourages you to finish it.\u0026quot; \u003cstrong\u003eSurvey participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelevant learning objectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants praised the course\u0026apos;s rigorous academic standards, clear objectives, and relevance to regional public health challenges. They valued the opportunity to engage with professionals from various disciplines, which enriched their learning and fostered interdisciplinary collaboration. The MOOC effectively reinforced their knowledge and provided practical tools for their professional practice. The alignment between content and objectives was considered crucial for its educational impact, with some participants suggesting the inclusion of additional units focused on mathematical modelling and advanced analytics.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I found the course to have a high technical and academic level, with a well-defined objective that is highly relevant to the region. I appreciate having been selected, and the opportunity to engage with people from diverse disciplines was an added benefit. It provided me with new tools that I hope to apply and share in my work.\u0026rdquo; \u003cstrong\u003eSurvey participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLearning Barriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants faced challenges related to access to bibliographic resources, language barriers, and course scheduling. Some struggled with English-only academic articles or paid-walled content, limiting their exploration of topics beyond the MOOC. Additionally, balancing the course with professional and personal commitments was difficult for some. In technical units, especially those involving R programming, language barriers with English R commands and functions were noted. The participants suggested adding resources such as more video tutorials, access to written code, a Q\u0026amp;A section, and an error bank to improve comprehension and enhance the fully asynchronous learning experience.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;To run the data, there is a lot of terminology in English, even in the videos, and for people like me who are just learning the language, it becomes a barrier.\u0026rdquo; \u003cstrong\u003eFocus group participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLearning Experience in R Software\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants emphasized the value of self-learning and practical exercises in mastering R, with hands-on tasks helping them grasp key concepts and apply them directly. The step-by-step video tutorials were appreciated for their clarity, allowing participants to build skills progressively. Those with prior knowledge found the course helpful for reinforcing their understanding, especially in practical applications. Additionally, the course\u0026apos;s focus on open-source tools such as R was highlighted for its accessibility and effectiveness, enhancing the overall learning experience.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The development of the practical exercise allows for a better internalization of the concepts related to R and directly observe their applicability. Attempting to solve these types of exercises enables finding different solutions to a given situation using R. From the outset, the ability to clean and organize databases is extremely useful in the daily work of those involved in data analysis, and optimizing these processes allows for reinvesting time in more analytical rather than operational tasks.\u0026rdquo; \u003cstrong\u003eFocus group participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Personally, I already had a basic understanding of the R language, and this course helped me better understand certain elements, particularly creating graphics with ggplot. I truly liked the methodology, and I found the pace to be just right.\u0026quot; \u003cstrong\u003eSurvey participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;I liked that the use of R as a statistical tool is promoted, as it is an open access and free source.\u0026quot; \u003cstrong\u003eSurvey participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It\u0026rsquo;s the first time I\u0026rsquo;ve been able to do things with R that, although they may seem simple, like a filter, required a lot of effort on my part... I\u0026rsquo;m truly excited.\u0026rdquo; \u003cstrong\u003eSurvey participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePlatform experience\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants valued the platform\u0026apos;s usability, especially in regions with connectivity challenges. Key features such as downloadable materials, engaging interactive content, and a visually appealing design were appreciated. Despite some internet issues, the platform\u0026apos;s lightweight design allows for smoother access than other platforms do. Navigation was described as intuitive and user friendly.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I\u0026rsquo;m from Leticia, Amazonas. Regarding the internet: it\u0026rsquo;s not great because we use satellite internet. When it rains, we lose connection, and when there\u0026rsquo;s thunder, we lose power. If it is sunny, the satellite burns out. (...) However, I truly liked the platform that was used because we\u0026rsquo;ve tried other platforms before, and they tend to be very heavy. I was worried I would have issues, but I did not.\u0026rdquo; \u003cstrong\u003eFocus group participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I found it visually appealing, with well-chosen colors, interactive materials, and the option to download content. It offered plenty of support and included diverse resources to accommodate different types of learners.\u0026rdquo; \u003cstrong\u003eSurvey participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterdisciplinary approach\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants valued the interdisciplinary approach of the MOOC, which effectively integrated history, public health, mathematics, programming, data science, and epidemiology. This interdisciplinary framework allows participants to recognize the relevance of diverse fields in addressing complex public health challenges.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Exploring the connection between history, public health, and epidemiology is enlightening, revealing hidden links between different fields of knowledge. It shows how history can offer valuable insights and help decentralize aspects of the past that inform current public health management.\u0026quot; \u003cstrong\u003eFocus group participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u0026rsquo; emotional response\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants expressed a range of emotions throughout the course, from gratitude and enjoyment of the historical sections to frustration with the technical challenges, particularly in the R-related units and time constraints. Despite these challenges, the course was motivating, reinforcing key concepts while introducing new ones. Many participants were satisfied with the knowledge gained, considering the experience valuable for professional growth and expressing enthusiasm to continue applying the concepts in their practice.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I was truly excited. I think it was in the first unit when they gave me an example to \u0026apos;calculate the basic reproduction number,\u0026apos; which I had heard about during the pandemic but wasn\u0026rsquo;t very familiar with those types of terms. However, when I did the exercise, everything turned out great, and I thought, \u0026quot;Oh, wow, this is so cool!\u0026quot; That gave me the motivation to keep going and get to this point.\u0026rdquo; \u003cstrong\u003eFocus group participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;It has been a motivational process because it allows you to recall and clarify concepts while taking on new challenges. It has also been quite challenging due to time constraints, as we are at the end of the year and the month, but I enjoy it because I believe it is necessary for the territories to stay updated.\u0026quot; \u003cstrong\u003eFocus group participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGender perspective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants had varied perceptions of gender representation in the MOOC. Many praised the visibility of women, especially female leaders, and appreciated the inclusion of their contributions. However, some suggested enhancing gender representation and making it more visible throughout the course for better inclusivity and contextual relevance. Others felt that the current focus was sufficient and appropriate.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;It\u0026rsquo;s very interesting and wonderful that women have been leading this initiative, and it\u0026rsquo;s great to see how clearly visible their leadership is. (...) I do believe that, in this regard, for instance, the first units highlighted women and significant figures throughout history.\u0026quot; \u003cstrong\u003eFocus group participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEnhancing regional representation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants suggested expanding the course\u0026apos;s focus to include more diverse regional examples from Latin America and the Caribbean. While the course was rich in Colombian content, they felt that incorporating perspectives from other countries would enhance its relevance and inclusivity. Additionally, standardizing data for the region was recommended to improve the course\u0026apos;s global applicability.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;I believe that adding information and history from our own region would make the course more Latin American.\u0026quot; \u003cstrong\u003eFocus group participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCapacity development in data science in public health\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants had a highly positive experience, highlighting the valuable knowledge gained in epidemiology and data analysis, particularly through tools such as R. The MOOC was seen as an enriching opportunity that enhanced participants\u0026apos; ability to apply their knowledge directly to their work and public health decision-making. The development of technical skills, such as the use of R for data analysis and visualization, was especially appreciated for its potential to drive data-driven decisions in public health and epidemiology.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;It was an enriching experience, as I was able to strengthen my skills in data analysis and visualization through R and ggplot. In my area of work, I am assigned to high-incidence events such as VBD and ARI, and since completing this course, I have started to apply what I learned in my basic and intermediate analytical routines. I hope to continue improving these skills so they can be useful for decision-making. Now, my challenge is to advance in the output of information using ggplot for dissemination spaces such as the COVE (from the Spanish acronym for Epidemiological Surveillance Committee), the VBD committee, and epidemiological bulletins.\u0026quot; \u003cstrong\u003eSurvey participant\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study addresses a gap in the literature by describing the design, development, and pilot implementation of a fully Spanish-language e-learning strategy for infectious disease epidemiology and data science for public health in the LAC region. Using learner-centered, community engagement, and gender-sensitive approaches, we collaborated with potential users to identify their educational and technological needs and tailor the strategy to their context. The analysis focuses on overcoming barriers, providing diverse resources, and fostering community building, highlighting the potential of MOOCs and online education to address public health training gaps in the region.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFrom barriers to bridges: Expanding access to outbreak response training\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Epi Training Kit was developed to address longstanding barriers to training in outbreak response, particularly the lack of high-quality, open-access resources in Spanish concerning infectious disease epidemiology, mathematical modelling, and data science tools. Fieldwork across various regions highlighted additional challenges, including geographic isolation, limited infrastructure, financial and time constraints, limited funding and human resources for in-person training, and heterogeneous baseline knowledge and learning paces.\u003c/p\u003e\n\u003cp\u003eThe pilot MOOC received positive feedback for its capacity to overcome many of these barriers, offering flexible,\u0026nbsp;and scalable training (31,32,52,68,69), while also helping to bridge the digital divide (38) and promote participant diversity (70). Feedback confirmed the course’s accessibility, practical relevance, and adaptability to learners’ contexts. The wide geographic representation of participants, including those from remote areas, further confirmed the effectiveness of this approach.\u003c/p\u003e\n\u003cp\u003eAs established in earlier sections, language remains a persistent and often underestimated barrier (9–14). This challenge continues to limit access to outbreak response training in Latin America and the Caribbean, particularly in regions where English dominates the majority of high-quality scientific resources (11,31,32,52). The participants consistently emphasized the value of a rigorous, well-structured course delivered entirely in Spanish. For many, this marked their first encounter with specialized epidemiological content in their native language, emphasizing the value of the Epi Training Kit MOOC in removing a significant barrier to comprehension and engagement. The availability of technical content, practical exercises, and expert interviews enhanced both learning and motivation to apply tools such as R to real-world public health challenges (27,69), reinforcing the importance of linguistic accessibility in multilingual and low-resource contexts (9,13).\u003c/p\u003e\n\u003cp\u003eIn addition to language and access, the Epi Training Kit also addressed concerns about equity in online learning environments. Although MOOCs have been criticized for potentially perpetuating existing inequalities (52,71–73), this initiative adopted a learner-centered approach that prioritized accessibility and inclusion. The key design elements included downloadable materials, transcriptions of audiovisual content, and the integration of a gender perspective (58). The participants highlighted the value of encountering diverse voices and female role models throughout the course, which helped them connect theoretical content to real-world public health scenarios.\u003c/p\u003e\n\u003cp\u003eOverall, the MOOC’s design effectively addressed many learning barriers, enhancing participants' engagement and sense of belonging within the learning community. With respect to technical skills, a key pedagogical objective was to shift how participants approached data analysis using R for epidemiological thinking in public health. By moving beyond menu-based platforms (e.g., Excel, EpiInfo, SAS, SPSS, Stata) and toward open-source programming, the course emphasized the benefits of reproducibility, transparency, analytical flexibility, and accessibility (27,74). Despite initial challenges, such as interface complexity and language barriers, which are often linked to resistance to new technologies (34), participants recognized R as a valuable tool for evidence-based decision-making in public health.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiverse resources for a diverse learning community\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMOOCs offer a distinct advantage in reaching a broad and diverse audience, particularly when designed with an interdisciplinary approach. In this context, the course brought together participants from both the STEM and health sectors, fostering a rich exchange of knowledge and perspectives. This diversity extends beyond educational backgrounds and professional experiences to include variations in age, gender, geographic location, time availability, schedules, and access to technological resources. To address these differences and overcome potential barriers, providing inclusive resources that meet the needs of such a varied audience is crucial.\u003c/p\u003e\n\u003cp\u003eIn response, the course used asynchronous instructions, allowing participants to access materials at their convenience. Although this provided flexibility, it also posed challenges for engagement and motivation. To address these issues, the Epi Training Kit was developed with a learner-centered design, considering the audience’s needs, skills, and challenges.\u003c/p\u003e\n\u003cp\u003eResearch from MOOC pilots and the literature (30,75–77) highlights that engagement is enhanced through diverse resources such as short videos, readings, interactive activities, and forums for communication. This multimodal approach accommodates different learning preferences, including participants in low-resource settings where video access may be limited (38).\u003c/p\u003e\n\u003cp\u003eThe Epi Training Kit integrated efforts to promote gender diversity in STEM, using the flexibility and accessibility of online learning to foster collaboration. Moreover, the use of interdisciplinary online courses can help increase the participation of women and underrepresented groups in STEM fields (52,78,79). Consequently, the integration of online learning with interdisciplinary approaches through the Epi Training Kit offers valuable paths for advancing gender equity and promoting diversity within STEM fields.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCommunity building through peer engagement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLearner engagement is influenced by internal assessments shaped by interactions with peers and the learning platform (80). Interactivity, particularly on MOOC platforms, plays a crucial role in shaping learners’ cognitive responses and behaviors (81–84). In alignment with Salmon’s (2013) e-tivity framework, the Epi Training Kit MOOC fostered active learning through various interactive strategies. Discussion forums provide participants with opportunities to exchange ideas, seek feedback, and resolve course-related queries, whereas dedicated support forums offer technical assistance. These interactions reinforce engagement by ensuring the platform’s reliability and enhancing the learning experience (34,75). The participants in the pilot considered the forums to be vital resources, in line with research emphasizing the role of forum dynamics in fostering learning communities (44,47,62,85)\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eIn conclusion, the development and piloting of the Epi Training Kit (EpiTKit) have provided valuable insights into the design of effective online training strategies aimed at strengthening public health capacities in Latin America and the Caribbean (LAC) region. The fieldwork approach was crucial in understanding learners' specific needs, testing and refining course content, and identifying potential cultural and gender biases. Additionally, fieldwork enabled a deeper understanding of the technological resources available to participants, an essential factor for an online learning strategy that must adapt to varying contexts.\u003c/p\u003e\n\u003cp\u003eIntegrating fieldwork insights during the design phase significantly enhanced both content and accessibility. The incorporation of region-specific imagery and voices reflective of Latin American and Caribbean communities, along with the use of inclusive language, strengthened learners' sense of recognition and connection to the training. This approach not only increased the content’s relevance but also fostered deeper engagement, highlighting the importance of contextually grounded and culturally sensitive educational strategies.\u003c/p\u003e\n\u003cp\u003eEngaging adult learners in asynchronous online environments presents well-documented challenges, and the EpiTKit was no exception, particularly given its audience of health professionals with demanding schedules. To overcome this, the course incorporated diverse resources such as video lectures, infographics, and discussion forums while encouraging peer interaction to build a sense of community. These elements were essential in achieving the course’s educational goals and fostering ongoing knowledge sharing. As a result, the course successfully promoted the use of data science tools in public health and contributed to bridging regional educational gaps. This experience underscores the value of integrating research, fieldwork, and contextual adaptation when designing effective online learning strategies for public health.\u003c/p\u003e\n\u003cp\u003eFinally, on the basis of Epi Training Kit experience, training approaches should aim to create more inclusive and accessible learning environments by addressing the diverse needs of the global student population. These approaches should prioritize (1) broader coverage through remote access, consideration of limited computing infrastructure, and affordability; (2) recognition of students’ diverse social and educational backgrounds by adapting content, educational resources, and delivery methods; and (3) the promotion of community participation through open-access materials, forums, multilingual options, and a gender-focused approach to foster inclusivity and diversity.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study complies with the ethical guidelines established in the Colombian Resolution 8430 of 1993. According to this regulation, the research is classified as risk-free, as defined in Article 11, since it relies on retrospective documentary research methods and does not involve any intentional intervention or modification of biological, physiological, psychological, or social variables of the participants.\u003c/p\u003e\n\u003cp\u003eConfidentiality was ensured by anonymizing personal data, including demographic variables such as age, gender, country, education level, and institutional membership. No sensitive topics were addressed, as data collection focused solely on participants' experiences regarding the course and the educational barriers it helps to overcome.\u003c/p\u003e\n\u003cp\u003eTo guarantee ethical integrity in data analysis, a mixed-method approach was applied, combining deductive and inductive coding to identify relevant themes while minimizing bias. Additionally, all focus group discussions were audio-recorded and securely stored, with access restricted to authorized personnel only.\u003c/p\u003e\n\u003cp\u003eThis study adheres to the ethical principles established for human research, including those outlined in the Declaration of Helsinki, as well as other relevant international ethical guidelines such as the Belmont Report, the CIOMS (Council for International Organizations of Medical Sciences) Guidelines, and the Universal Declaration on Bioethics and Human Rights by UNESCO. These principles ensure respect for autonomy, beneficence, non-maleficence, and justice throughout the research process.\u003c/p\u003e\n\u003cp\u003eAdditionally, the Spanish version of the informed consent for semi-structured interviews is attached for reference.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eThe data was collected with the authorization and knowledge of the participants, who signed the data protection policy in accordance with Colombian Statutory Law 1581 of 2012, authorizing the use of their personal data under the responsibility of Pontificia Universidad Javeriana, with restricted access and compliance with ethical regulations. Additionally, those who participated in semi-structured interviews signed informed consent, which was reviewed and approved by the Ethics Committee of Universidad de los Andes. For further information, you may contact \u003cu\[email protected]\u003c/u\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data analyzed in this study include information derived from semi-structured interviews as well as survey responses and usage statistics downloaded from the edX platform. These datasets contain personal and potentially identifiable information about participants and platform users and therefore cannot be publicly shared. Anonymized excerpts relevant to the study may be requested from the corresponding author, subject to ethical and data protection considerations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors of this work explicitly declare that there are no financial, personal, or professional conflicts of interest that could have influenced the objectivity, design, execution, or interpretation of the research presented. We maintain a firm commitment to transparency and assure that this work has been carried out with complete impartiality and without undue influence.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work is part of the TRACE-LAC project (Enhancing Tools for Response, Analytics and Control of Epidemics in Latin America and the Caribbean), funded by the International Development Research Center (IDRC), grant number: 109848-002.\u003c/p\u003e\n\u003cp\u003eThe funder had no role in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contribution (CRediT Classification):\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eLGB: Conceptualization (equal); methodology (lead); Writing – original draft (equal); Writing – review and editing (equal); Formal analysis (equal); Investigation (lead); Visualization (equal); Project administration (equal).\u003c/li\u003e\n \u003cli\u003eJMVE: \u0026nbsp;Writing – original draft (equal); Writing – review and editing (equal); Conceptualization (supporting); Formal analysis (equal); Investigation (supporting); methodology (supporting); Visualization (equal)\u003c/li\u003e\n \u003cli\u003eABL: Writing – review and editing (supporting).\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGGM: Writing – review and editing (supporting).\u003c/li\u003e\n \u003cli\u003eZMC: Conceptualization (equal); \u0026nbsp;methodology (supporting); Writing – original draft (supporting); Writing – review and editing (lead); Investigation (supporting); Funding Acquisition (lead); Supervision (lead); Project administration (equal); Validation (lead).\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ information\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eLBG: Training coordinator - Epiverse TRACE-LAC Javeriana; BMath, MSc Education, Management and Leadership\u003c/li\u003e\n \u003cli\u003eJMVE: Research assistant - Epiverse TRACE-LAC Javeriana; RDN, MSc Clinical Epidemiology\u003c/li\u003e\n \u003cli\u003eABL: Assistant professor - \u0026nbsp;Department of Clinical Epidemiology and Biostatistics; RN, MSc Clinical Epidemiology, DSc Clinical Epidemiology, PhD Health sciences\u003c/li\u003e\n \u003cli\u003eGGM: Software Development Leader - Epiverse TRACE-LAC; ECE, MSc(c) Software Engineer\u003c/li\u003e\n \u003cli\u003eZMC: Principal Investigator - Epiverse TRACE-LAC Javeriana and Director of the Institute of Public Health, Pontificia Universidad Javeriana, Bogotá, Colombia; MD, MSc Public Health, PhD Epidemiology of infectious diseases\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMathers CD, Loncar D. 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USA: Oxford University Press; 2015. p. 817.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoser A, Korstjens I, Series. Practical guidance to qualitative research. Part 3: Sampling, data collection and analysis. Eur J Gen Pract. 2018;24(1):9\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u0026Aacute;lvarez-P\u0026eacute;rez Y, Perestelo-P\u0026eacute;rez L, Rivero-Santanta A, Torres-Casta\u0026ntilde;o A, Toledo-Ch\u0026aacute;varri A, Duarte-D\u0026iacute;az A et al. Co-Creation of Massive Open Online Courses to Improve Digital Health Literacy in Pregnant and Lactating Women. Int J Environ Res Public Health [Internet]. 2022;19(2). 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Trends Cogn Sci. 2021;25(1):55\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Outbreak response training, Massive Open Online Course (MOOC), capacity building, data science in public health, public health, infectious disease modelling, context-specific learning, gender perspective","lastPublishedDoi":"10.21203/rs.3.rs-7745292/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7745292/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground: \u003c/strong\u003e\u003c/em\u003e\u003cem\u003eThe COVID-19 pandemic has revealed significant gaps in outbreak response and data analysis training, particularly in low- and middle-income regions. In Latin America and the Caribbean (LAC), challenges such as limited resources, language barriers, and gender disparities hinder the adoption of data science tools in public health, highlighting the need for accessible, culturally relevant public health training.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods: \u003c/strong\u003e\u003c/em\u003e\u003cem\u003eTo address these gaps, we developed the Epi Training Kit (EpiTKit), an open-access, Spanish-language online training strategy delivered as a Massive Open Online Course (MOOC) with context-specific resources and a gender perspective. This descriptive study presents the findings from the 2023 pilot, which involved 223 participants from 13 LAC countries. Mixed methods were used, alongside descriptive statistics and thematic content analysis, to assess course content, learning objectives, educational resources, platform experience, and the integration of regional and gender perspectives.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults: \u003c/strong\u003e\u003c/em\u003e\u003cem\u003eThe MOOC earned a mean rating of 4.6/5 (n=90). Over 95% of participants acknowledged that the course met expectations with clear, relevant content (n=630), while most emphasized its value for Latin America, quality education, and gender equity. Additionally, 89% found it relevant for professional development, 92% valued its regional focus, and nearly 90% recognized its promotion of gender equity (n=105). Thematic analysis highlighted key themes related to content quality, learning methodology, peer collaboration, and the integration of regional and gender perspectives.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003e\u003c/em\u003e\u003cem\u003eThe Epi Training Kit highlights the potential of regionally tailored online learning to address public health challenges, reduce educational gaps, promote gender equity, and strengthen data science capacities. The pilot implementation showed that flexible and inclusive e-learning strategies can engage diverse professionals across Latin America and the Caribbean, fostering skill development and expanding access for underrepresented groups. These findings underscore the value of digital education initiatives in advancing equity, scalability, and preparedness in public health training.\u003c/em\u003e\u003c/p\u003e","manuscriptTitle":"An Open Access e-Learning Strategy for Infectious Disease Epidemiology in Latin America: The Epi Training Kit Pilot Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 09:16:04","doi":"10.21203/rs.3.rs-7745292/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a78926b2-2208-40c0-82a1-56d67fc9529a","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-19T09:38:22+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 09:16:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7745292","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7745292","identity":"rs-7745292","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}