|Food, Nutrition and Agriculture - 16 - Nutrition Education for the Public (FAO - FPND - FAO, 1996)|
|Using computers in nutrition education|
K.M. Kolasa and M. Miller
Kathryn M. Kolasa is Professor and Section Head, Nutrition Education and Services, East Carolina University School of Medicine, Greenville, North Carolina, USA. Mary Miller is President, Interactive Design and Development, Blacksburg, Virginia, USA.
New technologies provide opportunities for nutrition educators to enhance communication efforts which can improve the health and well-being of people everywhere. Computer technologies are providing viable means of exchanging nutrition information among professionals and informing and influencing the public.
Computer programs that run without telephone, television, satellite or other electronic transmissions are known as stand-alone applications, These programs have received the greatest use in nutrition education to date. Programs are available on floppy disks, CD-ROM (compact disk - read only memory) and laser disks with accompanying floppy disks and can be used at computer workstations or stand-alone kiosks.
The major types of nutrition computer programs pertain to nutrient analysis, food service and recipe management, menu planning, clinical nutrition, drug-nutrient interactions, health risk assessment and lifestyle prescription, food and nutrition education and games. In addition to programs specific to their field, nutrition educators are also assisted by general production tools such as graphics packages, computer photo and clip art collections and presentation software.
Publishing and presentation software
Using word processing and desktop publishing software, nutrition educators with limited computer skills can create professional-looking newsletters, booklets and materials to meet diverse needs. Generic pamphlets and newsletters can be altered to eliminate extraneous material and give a more personalized image.
When preparing printed materials, nutrition educators often encounter difficulties with artwork. Computer graphics software has been used to make better nutrition education posters and counselling cards, even in the developing world (Tisa, 1991). Inexpensive photo collections and clip art software packages are widely available and can reduce costs.
Software for public presentations allows nutrition educators with multimedia computers to enhance their talks by incorporating pictures, sound, animation, texts and video. These permit nutrition instructors to present abstract or complex material in various ways to increase comprehension and interest, Students report that animation is more helpful than static slides.
Nutrient analysis software
During the 1980s and 1990s, software to analyse food intake has proliferated. When a list of foods and beverages along with their serving sizes is keyed in, the program calculates the nutrient intake of individuals or groups of individuals for one or more days and compares this to a nutrient standard. Researchers and dietitians have welcomed these programs because they significantly reduce the time and effort of calculating intakes.
Nutrient analysis programs have been used extensively for classroom assignments at primary to medical school level and have been offered as a nutrition education service at shopping centres, health fairs and science exhibits, Professionals in public health, agricultural extension and medicine, fitness trainers, food scientists and food service workers have incorporated these programs into their work.
The effectiveness of programs for computing nutrient intake for research and education, identifying nutrient excesses and deficiencies and teaching food composition to varied audiences is well documented, The computers speed of calculation has allowed nutrient analysis to be used more frequently in education and counselling settings.
The use of computerized food frequency questionnaires reduces the time needed to collect information about dietary intake. Early questionnaires were difficult to self-administer because keyboard entry was required. Although software to ease data collection and entry was available in the mid-1980s, the expense of the hardware prohibited the wide-scale adoption of this method until recently.
To personalize the questionnaires and reduce the tedium and reading ability needed to complete data input, programs now use storytelling, sound, video and other aids. One example is Nutrition DISCovery, delivered on CD-ROM, which uses both an audio prompt and a short video clip to remind the user of a variety of foods and eating occasions and to allow non-readers to use the program successfully, The user identifies the foods eaten, quantities and frequencies from 100 full-colour photos of food items and can immediately look at the results on screen or receive a printout.
The developer can also include a nutrition education section with games, movies and quizzes. With this type of product it is feasible to make several languages available to the user, Thus dietary data collection is possible even when an interviewer is unavailable.
CREATING EDUCATIONAL MATERIALS IN SWAZILAND Nutrition educators have found that women participating in: breast-feeding and infant feeding programmes respond well to photographs and artists renderings that are locally relevant. in an Infant feeding project In Swaziland, photographs of families were obtained and scanned into computer flies. An artist, using graphics software, produced an image bank to be used for posters and counselling cards. Pre-testing research identified several needed changes which would previously have necessitated reshooting of photographs or redrawing of pictures. With the computer the changes were easily made, and the final flip chart and cards were printed locally.
The effectiveness of this type of program for both collecting nutrition information and changing the behaviour of users is under study. The researchers expect multimedia applications to engage the user effectively and to result in a high percentage of completed and reliable questionnaires from people of all reading levels.
In assessing the nutritional status of patients computers allow more accurate calculations, reducing errors in decisions about care, Computerized medical records can include body composition data, dietary risk factor analysis and preventive care reminders.
Programs to educate patients provide dietary information and teach about causes of disease, symptoms, complications, dietary management and menu planning.
The Nutrition DISCovery CD-ROM uses storytelling, sound, video and other aids to prompt the clients memory of foods eaten Avec le CD-ROM, la lecture aute voix, le son, la videt dautres auxiliaires incitent le client e souvenir de la vari des aliments consomm/I> El CD-ROM Nutrition DISCovery, por medio de la narraciel sonido, las imnes y otros medios, ayuda al usuario a recordar los alimentos que se consumen
The levels of personalization and interactivity vary greatly, Programs of this type have the advantage of providing standard answers to predictable questions independently of whether the staff is rested or fatigued, well or ill. The responses are non-judgemental, and learning is private.
Computer-assisted instruction (CAI) takes advantage of learning theories involving reinforcement of learning experiences, self-paced learning and repetition of difficult material. Multimedia programs for health professionals and students are promoted as means for increasing learning and retention in a shortened learning time, captivating students and providing realism, role modelling and simulations.
Multimedia programs can effectively model nutrition assessment and counselling behaviours, ensure that all students have the opportunity to observe the same events regardless of when they take the course and expose learners to master teachers and experts in the subject matter (Kolasa and Jobe, 1994).
Strategies for evaluating the effectiveness of multimedia computer instruction, beyond comparison to traditional classroom instruction, are emerging, and more are needed. Whether computer-based instruction will maximize learning for the money spent is still being debated (Reeves, Harmon and Jones, 1993; Reeves, 1992).
CAI has been proved effective as a distance learning approach. Computer-based case-studies teach nutrition assessment practices, perform assessment tasks, interpret results and simulate experiences, allowing users to practise. Although CAI cannot replace many clinical or nutrition education experiences, it can build and maintain cognitive and analytical skills with an interactive format, CAI makes it possible to stage cases to challenge both the novice and the expert. The content can be indexed for easy access to any term, image or sound.
Educators have remarked that CAI requires a new way of looking at higher and continuing education, Instructors must adopt a new role, transforming themselves from lecturer to guide, Some professionals fear loss of control of information, while others welcome the opportunities to enhance the educational process.
Instructional programs and games
Most food and nutrition instructional programs have been designed for school-age children. For instance. Ship to Shore allows students to make decisions about their food supply while sailing from Europe to the New World with Christopher Columbus. This program uses nutrition as a vehicle to integrate mathematics, science, language arts and social studies. Sounds and animations, stories and character identification arouse students feelings and imagination and engage them in lessons.
A CD-ROM called 5-A-Day Adventures was designed to increase childrens consumption of fruit and vegetables. Music, video and interactive exercises focus on nutrients, serving sizes, label reading and simple recipes. One feature, quick-time movies, shows foods growing and being processed.
StampSmart is a multimedia program that teaches women who receive food assistance (food stamps) in the United States about diets that are low in fat, low in cholesterol and high in vegetables. The program includes a soap opera video to attract the women; during the story breaks nutrition lessons and questions are given. This program requires a video disk player and keypad. It has been used in a social services office.
Many small programs are being used in public health clinics and physicians offices to teach adults about healthy food selection. Topics include nutrition label reading, healthy fast food choices, the United States Food Guide Pyramid, food safety and foods to eat during pregnancy.
ON-LINE APPLICATIONS AND THE GLOBAL INFORMATION HIGHWAY
The use of on-line applications by nutrition educators is just emerging. With a computer that can communicate with other computers through telephone lines, satellite transmissions or network wires, the nutrition educator can enter cyberspace or the global information highway. Food and nutrition information can be exchanged by using electronic mail (e-mail). Internet and other computer networks, the World Wide Web, electronic databases, electronic bulletin board systems, faxes and interactive noncommercial television, The decentralization of access to information has great implications for nutrition educators as well as governments and international agencies that support nutrition education programmes.
People around the world can be brought together through e-mail. Individually, nutrition educators use e-mail to exchange ideas, projects, documents and data easily, quickly and relatively inexpensively.
Many food and nutrition fora and discussion groups are open to users everywhere through commercial on-line services and Internet. Two-way fora allow members to discuss a topic. One-way services send newspapers, reports and other publications to subscribers.
Some believe that quality control systems are needed to ensure the accuracy of the information being freely exchanged. Others think that misinformation about nutrition cannot be controlled and that it cannot be controlled and that is more appropriate to teach professionals and consumers how to assess the validity and applicability of information.
NUTRITION EDUCATION FOR THE PUBLIC AT KIOSKS
People with limited or no computer skills can obtain information from interactive kiosks which are increasing in popularity in the United States. Several state cooperative extension services (CES)have used kiosks to reach people not usually served by the CES Stand-alone applications can be used in kiosks located in public places such as grocery stores and health centres Kiosks have been used successfully to respond to predictable Information requests. They provide accurate information politely, punctually, 24 hours a day. They can be adapted to the users culture and language
Although many countries do not yet have direct access to the Internet and/or have inadequate telephone lines, systems for networking are being developed. Many experts believe that within ten years communication linkages will not be a real problem.
Networking tools, also known as utilities, allow users to explore and locate valuable resources. One of the better-known tools, the World Wide Web (WWW), provides access to text, graphics, pictures, sound and video, WWW now has millions of users, and the number of documents is increasing rapidly.
On-line applications are fairly inexpensive ways for organizations to offer and receive information around the clock, The user usually pays the cost of a telephone call or Internet connection. The data are available immediately and are usually more up to date than print materials.
Food and nutrition on-line services
Electronic databases are collections of information, usually covering a specific subject, that are arranged to facilitate efficient retrieval and use of information. The Food and Nutrition Information Center (FNIC) of the United States Department of Agriculture (USDA) has been a leader in cataloguing food and nutrition sources available electronically. FNIC maintains a listing of about 200 programs that are accessible to the public.
Computer on-line services offer fast, low-cost access to much of the worlds accumulated nutrition and medical wisdom, An on-line service is much like a personal librarian who can instantly retrieve abstracts, Material can be read on screen or printed. Users can subscribe to on-line databases and clipping services for current and general information.
Electronic bulletin board systems
Bulletin board systems provide access to publications, bibliographies, software, calendars, bulletins and other resources on specific subjects for target audiences, For instance, USDA provides a bulletin board called Agricultural Library Forum (ALF), the Nutrient Data Bank Bulletin Board and a database featuring nutrition education materials with the United States Food Guide Pyramid, The United States Food and Drug Administration maintains a bulletin board with food labelling, food safety and food regulation information. The Technology Transfer Automated Retrieval System (TEKTRAN), sponsored by the Agricultural Research Service of USDA, contains information about the latest studies in agriculture, food and nutrition, giving research results and interpretive summaries.
Computer conferencing, which simulates person-to-person conferences, offers different levels of interaction and different kinds of scheduling. It allows individuals to identify new resources and contacts, interact with colleagues, improve knowledge, develop professionally and take courses at their convenience, Although small cameras are available that allow each participant to see others, most computer conferencing is currently limited to text exchanges, With computer conferencing, several people can communicate with each other at a designated time by logging on to their computers and typing to each other.
Video conferencing, which can link two or more persons, requires an on-line satellite or telephone wire transmission, This technology is used for distance learning, meetings, sharing visual images with distant colleagues, working at multiple worldwide sites and consultation with experts.
The use of interactive television (ITV) for educational and health services is growing, ITV requires either satellite transmission or sophisticated telephone lines to provide several levels of interaction, Telemedicine uses telecommunication technologies to deliver medical information and clinical consultation. It typically involves two-way video and two-way audio, enabling diagnosis, treatment and counselling.
Telemedicine can extend the expertise of health care professionals to rural clinics, nursing homes and ultimately individual homes in addition to being used for meetings and training, Clinical telemedicine programmes are under way in 40 of the 50 states in the United States.
ITV offers great potential for distance learning in public health and nutrition, Several public health and cooperative extension nutrition programmes have used satellite television to extend the reach of courses or workshops, These programmes allow field workers to obtain important training without being away from their jobs for long periods. Students are able to interact with instructors by telephone, and local workshops often supplement the broadcasts.
The uses of computer technologies for distance learning are being evaluated. As technologies for two-way communication increase, the learner has more instantaneous interaction with the instructor, but both instructor and learner have less control over the time and place for learning since both must be active at the same time, With one-way communication, the learner has the convenience of being able to turn on the computer at any time; however, the learner cannot interact immediately with the instructor.
Some of the issues under study include ease of using and learning the system, aesthetic appeal, clarity of feedback, error handling, controls for parallel and serial group communications, and costs.
ACCESS AND TRAINING
Nutrition educators need to be informed and to participate in discussions of access to information technology, Questions are often raised about the availability of equipment and required skills. In developed and developing countries it is common for projects and programmes of all sizes to have a computer, yet the capabilities of most computers are not fully utilized. Nutrition educators need training and time to practise desktop publishing and other stand-alone applications.
For cyberspace access, the concerns at first appear to be more serious, especially where telephone lines are unreliable. Some professionals in developing countries are finding ways to obtain access to e-mail, and alternatives to traditional telephone systems are being developed, In places where fax transmissions are possible, the simple addition of a modem and computer with communications software may make communications faster and less expensive than faxing.
Consultation over Telemedicine network Consultation sur le rau Telemedicine Consulta mediante la red de telemedicina
Where e-mail is available but underutilized, nutrition educators may need orientation programmes to become more comfortable with communicating by computers. Additionally, they should obtain training and develop plans, computer programs and databases to be ready for implementation when access barriers are eliminated.
The computer provides many opportunities for nutrition education. To date, only a limited number of stand-alone programs have been developed and evaluated, and participation of nutrition educators in on-line applications has been minor, Nutrition educators should participate in health-related discussion groups to create a presence for nutrition.
While computer technology is a powerful tool which can enhance the efforts of nutrition educators, all forms of communication can be effective, and in some situations other means may be more appropriate. It is important to determine how the intended audience learns and then to design programmes and campaigns that use a combination of media.
Finally, it is important to remember, that new technology will not guarantee greater success for nutrition education communication programmes. Programmes will be successful only if they are designed to reach out to people and entice them to make healthy food choices.
Further information about some of the resources mentioned in this article is available from the following addresses.1
Ship to Shore
Food and Nutrition Information Center (FNIC
1Mention of specific products does not imply any endorsement on the part of FAO.
Kolasa, K.M. &Jobe, A.C. 1994. Cardiovascular health: focus on nutrition, fitness and smoking cessation. Chapel Hill, North Carolina, USA, Health Sciences Consortium.
Reeves, T.C. 1992. Evaluating interactive multimedia. Educ. Technol., 32: 47-52.
Reeves, T.C., Harmon, S.W. & Jones, M.G. 1993. Computer based instruction in developing countries: a feasibility assessment model, Educ, Technol., 33(9): 58-64.
Tisa, B. 1991. Picture perfect: generating graphics electronically, Dev. Commun. Rep.,73: 10-11.