The Satisfaction of Health Students to Online Learning Methods During the Covid-19 Pandemic

Received 13 February 2021 Accepted 31 May 2021 Published 25 June 2021 The Covid 19 pandemic has changed the method of learning in the world of health. The United Nations Educational, Scientific, and Cultural Organization (UNESCO) announced that 1.2 billion students worldwide have been affected by school closures at universities due to the Covid-19 outbreak. The online learning (DARING) is increasingly being used during the Covid-19 pandemic. The process of using DARING requires adaptation for students, this is a new experience. The purpose of this study was to evaluate the satisfaction of health students in using e-Learning methods during Covid-19. This research method is a descriptive survey using a questionnaire about student satisfaction with online learning methods. A total of 130 students participated in this study. The results of this study indicated that 39.3% of the students expressed dissatisfaction, 27.7% of the students stated that they were very dissatisfied, 23.1% of the students stated that they were satisfied and 10.0% of the students stated that they were very satisfied. The conclusion in this study is that the majority of health students expressed dissatisfaction in implementing e-Learning methods during pandemic Covid-19 in Medan. Keyword:

This open access articleisunder the CC-BY-SA license.

INTRODUCTION
Pandemic Covid 19 is very influential on the process of teaching and learning in the world wild of education, and nearly 120 countries stop learning with face-to-face of method (Shahzad et al., 2020). United Nations Educational, Scientific, and Cultural Organization (UNESCO) mention that more than 90 % of students in the world currently did not attend school and 1.2 billion of students do not come to school (Abbasi et al., 2020). Indonesia is a country that is affected by cases of Covid 19 continues to increase, the data obtained from the Indonesian Ministry of health, on December 22, 2020 the number of cases of Covid 19 was reach 671.778, teaching and learning process is still using Elearning methods in accordance with the policy of the Ministry of education and culture issued in the month of March 2020 that said that all students perform the process of learning from home, work from home and worship from home until now in Indonesia (Kemendikbud, 2020).
The online learning is a learning method that utilizes Information and Communication Technology (ICT), (Amir et al., 2020). Information and Communication Technology (ICT) has changed the teaching and learning process in the traditional becomes modern called with E-Learning which is used through the web, learning portal, video conferencing, youtube, mobile apps and the use of other technologies (Shahzad et al., 2020). During the pandemic Covid-19 that distance learning to be the solution, but in health education distance education to be disrupted, because health education is required to implement the learning in theory and practice in the clinic or hospital, but in this time the clinics and hospitals limited the students practice to break the chain of exposure to Covid-19, but if we ignore this then the education of the health professions will harm the development of professional nursing and patient care in the future (Puljak et al., 2020). So e-Learning is still being done despite the many challenges faced.
Challenges and problems encountered in the use of e-Learning methods, will affect the student's satisfaction, because e-Learning methods include a new method of learning and heavily in use during the pandemic of covid -19. Student satisfaction is the result of the comparison between the levels of reality with the expectations of the receive and get service in a college (Alexandro, 2020). Student satisfaction will be high if the level of reality with the level of expectation is the same, or higher, on the contrary, if the level of reality and hope lower than the student satisfaction is considered to be low, (Alexandro, 2020). Student satisfaction in the use of e-learning in Indonesia is still relatively low, as seen from the results of research conducted to 170 students, the results showed that 77 % were at the level of satisfaction is low, (Fajar Darmawan, 2015). The research done in Yogyakarta to 34 students shows the results of the level of student satisfaction have a significant effect with the results of the study during the pandemic covid 19, (Prasetya & Harjanto, 2020). The results of Research conducted at the University of Indonesia to 301 students show that of 44.2% students choose to e-learning, of 52.6 % stated that e-learning is more efficient, 87,9 more time to learn, 87,9 % and can review the lesson better, the results of this study also show that the challenges faced by students is the external factor such as the internet connection is unstable, the additional financial burden of buying internet quota, and internal factors is the difficulty of focus in online learning in the long term (Amir et al., 2020).
A qualitative study to 32 nursing students in Spain who carry out the transition of learning from face-to-face to e-learning during the pandemic covid 19 states that students who are older, who comes from the countryside and students who have limited economic as well as students who have a great responsibility in the family who feels difficulty in the use of e-learning (Artha et al., 2021;Rofah et al., 2020). Other studies also show that the use of E-learning is more effective compared to learning traditional such as face-toface to students health, this is because the students stated that using e-learning can facilitate the accessibility, ease of use, freedom-seeking literature, medical images with quality high and can see the repeated practice through youtube (Moazami et al., 2014). So also a study done in saudi Arabia through qualitative studies to 60 medical students, the results of the research shows that online learning can be well received and the students of e-learning are very useful such as time savings and can utilize the time well, but there is also a feeling of e-learning has many challenges such as difficulty understanding the case with the good, the technical problem of learning and exams online, but the majority of students in the study showed prefer e-learning to the next year (Khalil et al., 2020).
The implementation of online learning requires adaptation for students and lecturers as well as has its own challenges in the process of its use in particular agencies of health, because health agencies must still carry out the clinic practice and the hospital even though in times of pandemic covid 19 (Puljak et al., 2020). The challenges facing the lecturer is to be able to demonstrate expertise in the form of case examples in the classroom online, the lecturer should be able to play well with the students, able to build good interaction and should be able to facilitate the discussion of case-based via web video conference, (Fatani, 2020), and the challenges faced by students is the internet connection is unstable, the additional financial burden to buy quota and difficulty focus with online learning in a long time, (Amir et al., 2020). For the researchers interested in doing research, the level of satisfaction of medical students towards learning in the network (E-learning) in Medan.

RESEARCH METHOD
This research design used aquantitative research with a descriptive approach was conducted from June -July 2020. The population of this study was 433 peoples of health student in North Sumatra. The number of samples in this study used the Nursalam formula 20% -30% x the number of pupulation, so there were 130 respondents from some of health institution in North Sumatra. The research was conducted at Politeknik Analisis Kesehatan Kemenkes RI Medan, In Kes Helvetia Medan, Akademi Gizi Lubuk Pakam Kabupaten Deliserdang, Akper Pemkab Tarutung Kabupaten Tapanuli Utara and STIKes Nauli Husada Sibolga Kabupaten Tapanuli Tengah. The research procedure started from obtained a research approval letter from LPPM STIKes Murni Teguh Medan, then submitted a research permit application to the some of health institution as already mentioned up and distributed inform consent to respondents via online in google form. The research instrument used a questionnaire in the form of google form wich refer to (Chernyayeva et al., 2009) questionair of students satisfaction on online learning. This instrument have done of validity and realibility test in Indonesia with Content Validity Indexresults 0.86 and Alpha Cronbach test results 0.850. Analysis of the data on this research used the Likert Scale as much as 14 items of statements with the categories of strongly disagree (SD) score of 1, Disagree (D) score of 2, Agree (A) Score of 3 and Strongly Agree (SA) score of 4. The instrument was distributed online to respondents. The data was processed and analyzed using SPSS 24. Table 1 showed that the majority of respondents had age <20 years as many as 61 people (46.9%), based on the gender of the majority of the respondents were women, as many as 114 people (87.7%) and by the program of study is the majority of the Bachelor of Nursing as many as 46 people (35.4%). Table 2 is showed of the statement that students in carrying out online learning is the majority of the respondents stated "SD" and "D" as many as 34, 6%. The statement online learning can eliminate the tedium of the majority of the respondents stated "SD" and "D" that is as much of 28.5 %, Online increase the motivation to learn the majority of respondents expressed a "D" as much as 31,1 %, the statement online makes students more active the majority of the respondents a stated "D" 33.8 %, the statement online enhance cooperative learning the majority of respondents stated "SD" of 38.5%. Statement of the Online can be used as a learning model onwards the majority of respondents stated "SD" by 44.6 %, statements Online can increase the curiosity of the majority of the respondents expressed the "S" of 38.5 %. Statement of interest in online learning the majority of respondents stated "SD" of 36.9 %, statements Online can boost creativity and motivation, the majority of respondents expressed "A" by 33.1 %, the Statement online effectively used the majority of respondents stated "SD" by 40,8 %, the Statement online increase the concentration of the majority of the respondents stated "SD" by 45,5 %, the statement online learning can make it easier to understand the subjects "SD" by 40.8 %, the statement online learning can create a discussion group more active the majority of the respondents stated "SD" of 36.9 %, the statement of the students often ask questions in class the majority of respondents expressed the "A" of 40 % and a statement of the student often gets pre and posttest with a value satisfying the majority of respondents expressed a "D" by 46,2 %.

RESULTS AND DISCUSSION
Based on the analysis of the answers to the satisfaction of the students about the methods of online learning in the face of the pandemic Covid-19 in Medan 2020, the results show that the majority of the students gave answers on the statement "Strongly Disagree" and "Disagree" to the satisfaction questionnaire that has been distributed.  Table 3 isshowed that the satisfaction of health students about the methods of online learning in the pandemic Covid-19 in Medan the results showed that 39.2 % of students said not satisfied, 27.7 % of the students expressed very not satisfied, 23.1 % of the students expressed satisfaction and 10.0 %.

Fun in the Conduct of Online Learning
The results of this study isshowed that the majority of respondents stated "Strongly Disagree" and "Disagree" fun in performing the learning online that is as much as 34, 6%. Referring to the results of previous research that students feel not satisfied with the Online learning due to the instability of the network which makes the implementation of teaching and learning is disrupted, and clinical skills and practices of the most well-studied face-to-face in the clinic or in the laboratory, (Abbasi et al., 2020). The results of another study conducted in Indonesia is that thing that makes students do not feel happy with the use of the Online is because communication is more difficult and the satisfaction of learning is less, the internet connection is unstable, the financial burden for the purchase of quotas internet a lot, have trouble focusing on learning while studying a long-term and difficulty in time management (Amir et al., 2020).

Online Learning can Eliminate Boredom
Online learning can eliminate the boredom, the results of this study found the majority of respondents stated "Strongly Disagree" and "Disagree" as many as of 28.5 %. This research is conducted to 189 students of medicine that showed that during the pandemic Covid-19 students use online learning turns out to give a bad impact to mental health and increasing fatigue emotional, causing boredom in learning especially for students, the impact is the lack of clinical experience so as to produce a medical student who is not qualified, (Zis et al., 2021). So also with the results of research conducted to 619 health students, the results show that in the use of online during the pandemic covid 19 students experience boredom, anxiety and a decline in the satisfaction of learning even experience symptoms of depression due to the process of the transition to teaching online face to face lectures into Online, this is due to delays in communication and interpersonal relationships of students, especially students who are experiencing quarantine,even the impact of learning online, in some health students in Medan to severe stress during the pandemic Covid-19 (Wahyu & Simanullang, 2020).

Online Learning Increases Creativity and Motivation to Learn
Online learning increases the motivation to learn, the results of this study the majority of respondents expressed a "Not Agree" as much as 31,1 %. The results of this study are in line with research (Bozkurt et al., 2020)said the motivation of students decreased during learning online in the pandemic Covid-19 is caused by a lack of facilities to the system onlinelearning so need to chose the other methode or combination to learning. The motivation and interest of students decreased in the pandemic Covid-19 due to several factors such as: such as changes in the learning system that so far has been changed from a system of learning face-toface be learned online (E-learning), the internet network is weak, the unlimited internet data package and the network access the internet on some site students are not support (Damanhuri, 2020). The online learning can increase the learning motivation for students, although for some it can delay to submission of their duties. In online learning environments, students can participate in interactive learning and have broader insights (Ropitasari, Soetrisno, Sri Mulyani, 2014). Motivation is the cornerstone in online distance learning. Together with the interaction of flexible and effect between the teachers and learners to improve learning outcomes better (Yunitasari & Hanifah, 2020). However, the results of this study contrast with (Harandi, 2015) which states that in learning to E-learning students tend to be motivated, this is because there is the involvement of students and lecturers when implementing e-learning, and there are a few things that must be considered so the motivation is increased when using learning e-learning is to look at the suitability of the content of learning and the interaction with the students when implementing learning through E-learning, pay attention to the facilities used and should assess the economic aspects of the student. The results of the research mentioned that the learning system by the method of e-learning is also very significant effect on the motivation of students. According to (El-Seoud et al., 2016) e-learning gives students different opportunities to learn wherever they are and when time is available. There was a significant relationship between Elearning and the motivation of students (Harandi, 2015).

Online Learning Make Students More Active
Online learning make students more active, the results of this study majority of the respondents do not agree "NA" to 33.8 %. The results of this study in line with that presented by (Damayanthi, 2020) that online learning is not yet effective way to make students more active with several reasons, because of the unpreparedness of students and faculty in using technology and inability to adapt to current conditions. Sostill prefer to face-to-face is more effective in increasing the activeness of the students because the directly askifitis still less unders tood so that it can interact directly between students and teachers or between students and other students. But in contrast to that presented by the (Pratama & Mulyati, 2020) that learning online make students more active because students are increasingly curious so that they are more interested to learn online using the supplied applications such as whatsapp, google meet, edmodo and zoom. However, there are constraints on the method this online as students are not doing the task with the excuse of not having smartpohone because parents are not able to buy it, poor signal and the quota of the internet that are not affordable on a particular area. To over come this kind of problem, then the method of learning a mixture of (blanded learning) is the method of studying combined between offline and online (Aditya et al., 2019).

Online Learning Enhance Cooperative Learning
Online learning enhance cooperative learning, based on this study the majority of respondents stated "Strongly Disagree" of 38.5%. This research is in line with Girey, 2021 that students in Turkey are not satisfied learning in e-learning because it is difficult to interact and collaborate between students and lecturers. This research is contrary to research conducted the previews research that online learning can improve the cooperative among students because they directly discuss with one another for the good cooperation in discussing the learning material. Besides, the lecturer can direct them to control them during the online learning process (Sianturi & Lisum, 2018).

Online Learning can Digunkaanas A Learning Model Onwards
Online learning can be used as a learning model further, the results of this study indicate the majority of respondents stated "Strongly Disagree" by 44.6 %. This research is in line with the research of (Pratama & Mulyati, 2020)where the results of the study concluded that teachers and students prefer learning offline because it can interact directly between students and teachers so that it cannot continue as a learning model for the future. (Anna et al., 2017) find some of the obstacles related to the implementation of learning online at the time of the pandemic, namely the barriers in terms of infrastructure and support to access the information available. So it is advised on the method of learning blanded learning more possible to do in an increased interest, motivation and awareness of learners (Hidayat, 2020). The online learning e-learning shows the downside if done in Indonesia because of several factors. The obstacles faced by students in the learning process online, including the internet network is not stable, the limitations of the features of the application online learning, as well as the constraints in terms of service learning (Rahmawaty, 2014). The constraints of this should be paid attention in preparing and implementing online learning (Hutauruk & Sidabutar, 2020).

Online can Increase the Curiosity of Student
Online can increase the curiosity of students, the results of this study stated that the majority of respondents "Agree" of 38.5 %. This research is in line with research conducted by Pratama and Mulyati, 2020 that online learning make students more active because students are increasing lycurious and they are more interested to learn online using the availability applications such as whatsapp, google meet, edmodo and zoom. So the curiosity of students increased by learning online.

Interest in Online Learning
Interest in online learning, the majority of respondents" Strongly Disagree" of 36.9 %. This research is in line with research conducted by other research that onlinelearning on the pandemic covid-19 effects on the learning interest of students, where students feel bored caused by the student does not meet with their friends and teachers directly in the school, (Yunitasari & Hanifah, 2020).The online learning affects the interest of the student learning because students get bored easily so that onlinelearning is not like learning in the classroom (Asrul & Afil, 2020). However, contrary to research Pratama and Mulyati, 2020 said that online learning make students more active because students are increasingly curious so that they are more interested to learn online using the supplied applications such as whatsapp, google meet, edmodo and zoom . Hidayat, (2020) said that interest in the online learning during the Covid-19 is in the category of medium. Damanhuri, (2020) said that the interest in online learning is influenced by various factors.

Online Learning Effectively Used
Online learning effectively used; the majority of respondents "Strongly Disagree" by 40,8 %. This research is in line with (Dewantara & Nurgiansah, 2020) who said that online learning is continuous as long as the pandemic is not very effective because as much as 79% of the students want learning face-to-face, whereas only 1% students who want learning online. Muslimin & Harintama (2020) said that online learning needs preparation mentally, physically, and financially to support the shortage of student learning. However, this study contradicts with the study (Luaran et al., 2014) said the majority of respondents said effective learning E-learning with the reason they prefer to learn through e-learning it because it gives greater flexibility to learn on their own. The research conducted is to the 45 respondents from 3 universities in Shah Alam, Selangor Malaysia. (Hoerunnisa et al., 2019) said, that the use of Elearning media can significantly enhance the achievement and learning motivation of students in the subjects of computer and basic network on the topic of sharing devices. In addition, the use of E-learning can also increase the participation of students towards learning (Ali et al., 2018). e-learning is effective for University students in Bangladesh. This study will contribute to foster among students and faculty to utilize electronic tools, techniques and platforms for the purpose of acquiring and sharing knowledge (Barkatullah et al., 2011). Learning E-learning is effective for students and faculty to enhance the learning process and improve student achievement. Some of the factors barriers in online learning in the school of health is Difficult and bored, less effective, the quota of the internet which is easily depleted, the internet network is not stable. But different with the opinion of (Rosali, 2020) that online Learning is considered effective if applied during the pandemic covid-19 however we need a model that is varied in order to remain interesting if used in the long term.

Online Learning Increases the Concentration ofstudent
Concentration is the ability to focus and give it your full attention on one task to ignore all the other disorders (Monsma et al., 2017). Online learning improves concentration, based on the results of this study majority of the respondents "Strongly Disagree" by 45,5 %. This research is in line with (Anna et al., 2017) that at a concentration of students distracted because there are some barriers related to the implementation of online learning in the current pandemic, both barriers in terms of facilities and infrastructure supporting up to access the information available. However, another opinion says that E-learning can increase the concentration of students for those who have already used to watch videos, read novels and play games (Pearl & Arunfred, 2020).

Online Learning Can Make It Easier to Understand the Subjects
Online learning can make it easier to understand the subjects, the majority of respondents "Strongly Disagree" by 40.8 %. This study is not in line with the (Yanuschik et al., 2015) said that e-learning can improve the quality of education and improvement of the understanding of students on a topic of learning. This is because that the students who are already familiar with the learning, elearning, will make e-learning as obstacles in the learning process. Of course different in Indonesia, because with the pandemic of Covid-19 so that e-Learning is one of the right ways to use in the process of teaching and learning to prevent the spread of Covid-19 (Panyajamorn et al., 2018).

The Students Often Ask Questions in Class
The students often ask questions in class, based on the results of this study majority of the respondents "Agreed" to 40 %. This research is in line with the (Puljak et al., 2020) that online learning make students more active in learning where students already are easier to find sources of information related to learning materials through google. The Platform can help students to be more active learning because they can learn anywhere and anytime has been more easily connect with one another. (Khan et al., 2017) stated that e-Learning to give space to the students to more actively ask questions in class and discuss during online. (Anggraeni, 2008) that e-Learning can be continued as a method of learning because it can provide support to students in learning, Virtual Learning Environment (VLE) which gives it the ability that is active to the students to speak.

The Level of Student Satisfaction
The results of this study stated that the majority of respondents were not satisfied with the online learning as much as 39.2 %. This research is in line with Girey, (2021) that the student is not satisfied learning in e-learning because it is difficult to interact and collaborate between students and lecturers (Giray, 2021;Ismiyati & Nurhaeni, 2016). However, in some research is not in line with this research, as stated by (Almusharraf & Khahro, 2020) that the students were very satisfied with the learning platform online especially with the use of the app Google Hangout during lectures, followed by Google Classroom and IM (Moodle) during the pandemic Covid-19. The satisfaction of learning in some students are at a high level, means that students are very satisfied with the online learning that has been implemented. So that there is a significant relationship at any indicators of satisfaction with the online learning with academic achievement, means that student achievement will increase (Basith et al., 2020). Chernyayeva et al., (2009) said that the students in Florida are satisfied in learning by method of e-Learning is viewed from three factors, namely the involvement of students, institutions, and evaluation

CONCLUSION AND SUGGESTION
The results of this study indicate that the student is not satisfied with the online learning and of some of the many factors the possible causes of such unavailability of facilities and infrastructure, and besides that online learning is still a new exposed since the pandemic hit the world so that one of the learning methods used through online learning to break the chain of spread of covid-19 in Indonesia. However, unlike in some countries outside of Indonesia, that this method of online learning is not a method of learning which is still new for them because it's been a few years earlier used such methods in western countries.
To research further suggested the need to expand the scope of the respondents to see if just in the health education course e-Learning methods is not satisfactory because of the difficulty in conducting field and laboratory online or are on all of the department of education the same result as it is and examines the application of e-Learning which is effective for health Education.