|Nutrition education for the public. Discussion papers of the FAO Expert Consultation (Rome, Italy, 18-22 September 1995) - FAO Food and Nutrition Paper 62 - (1997)|
|New developments in nutrition education utilising computer technology|
If you give a nutrition educator or a consumer a computer that can communicate with other computers through phone lines, satellite transmissions or network wires, you have given that individual an entrance ticket to Cyberspace or the Global Information Highway. In this section of the paper I will focus on the dissemination and retrieval of food and nutrition information by electronic means such as e-mail, Internet, world wide web (WWW) and other computer networks, electronic databases, electronic bulletin board systems, faxes, and interactive non commercial television. While much of the information presented is of interest to the professional community, access to these technologies is available to consumers. This decentralisation of access to information has great implications for nutrition educators as well as governments and international agencies who support nutrition education programmes. Therefore, discussion of these technologies is appropriate in a paper describing nutrition education for the public.
While some people discount these technologies as a passing fad, the importance of these technologies in the information age, in both developed and developing countries, is acknowledged by nutrition educators interested in learning how best to use these systems.
E-mail or electronic mail
The E-mail is a basic communication tool. Nutrition educators from different parts of the world are using e-mail to exchange ideas, projects, and data easily, quickly and relatively inexpensively. The power of e-mail is that it brings people together regardless of distance. It allows the attachment of files. The recipient can put a file into a word processor, edit and revise the document and use it or return it to the sender.
There are a variety of ways to communicate with individuals and with large numbers of users through e-mail. These include electronic fora and discussion groups. These groups exist on the Internet as well as on commercial on-line services. Some fora or lists are fully automated, others are maintained and administered by individuals. Some have limited access and others are open to everyone in the world. Some are two-way fora that allow members to discuss a topic. Others are one-way services that send newspapers, reports, and other publications to subscribers.
There are fora and discussion groups interested in international health issues. Only a few examples are cited here. See the reference section of this paper for additional health-related listings.
Food and nutrition examples
While there is a number of fora that may include food and nutrition education issues, there are a limited number of exclusive food and nutrition lists or fora. Food and nutrition education professionals are currently seeking and providing information using both the commercial on-line services and the Internet. More nutrition educators need to participate. There are also lists that allow anyone to ask for and receive information. Some of the topics include discussion and support of weight loss, recipe, and foodlore exchange, vegetarianism, food composition, food safety, and nutritional epidemiology. Some, but not all professionals, believe that an important drawback to this freedom to give and receive information is that there is no agency or unit responsible for the accuracy of the information. These fora and discussion groups are open to users from around the world. Some believe that quality control systems need to be put in place. Others stress that we need to teach professionals and consumers alike how to assess the validity and applicability of the information, since we have never been able to control nutrition misinformation.
Examples for meeting international community need
There is a growing number of resources of interest to the international community. Examples related to nutrition education are noted here.
· World Bank PHNLink:
World Bank PHNLink is an electronic network system that links population, health, and nutrition specialists around the world through communication, interaction, and information sharing. In mid-1995 it had an estimated 1,000 subscribers. It operates two services through Internet. PHNFlash is a weekly electronic newsletter and archiving service containing information about population, health, and nutrition programmes and projects.
Information can be posted. Electronic newsletters like Mothers and Children, a bulletin published three times a year in English, French and Spanish by the Clearinghouse on Infant and Maternal Nutrition and the American Public Health Association, are delivered more quickly and inexpensively to a greater number of readers. Additionally, the Mothers and Children newsletter has articles on technology such as using video presentations for community development and using electronic mail.
The Opportunities for Micronutrient Intervention (OMNI) was developed and funded by the Office of Nutrition of the United States Agency for International Development (USAID). Its mission is to control and prevent micronutrient deficiencies in developing countries. As part of its information dissemination effort, it uses electronic networking. For example, OMNI post reports on the micronutrient interventions. OMNI has supported work to improve the availability and access to micronutrient databases. A background paper including recommendations was prepared in 1995.
VITA supports a free, public, on-line discussion forum, Devel-L. It provides opportunity to exchange ideas related to technology transfer in international development.
· Clearinghouse on Infant Feeding and Maternal Nutrition:
The Clearinghouse has actively supported the assessment of information needs as well as the dissemination of resources. The Clearinghouse has collaborated with field-based organisations to strengthen their capacity to produce and disseminate information (Gibbons, 1984).
Regional networking tools
Many countries do not yet have direct access to the Internet and/or have inadequate telephone lines. Systems for networking are being developed to prevent the developing world from becoming more isolated from information sources. The emergence of cellular telephones may change the landscape of telephone communications where telephone systems have not worked. Many communications experts believe that within ten years communication linkages will not be a real problem.
Kenya has not had direct access to the Internet. However, the African Regional Centre for computing is able to communicate and network internationally through the Internet directly, using a low-cost dial-up technology based on Fidonet. Fidonet offers three main services: electronic mail, conference mail, and file transfers. Communication can occur several times a day (Ochuaodho, 1994).
SatelLife/HealthNet is a telecommunications system that links health-care workers around the world and provides them with access to appropriate sources of information. In 1995 it operated in 16 African and five Asian countries. The system, initiated by SatelLife, is a combination of low-earth-orbit satellites, ground stations and telephone-based electronic mail networks. It has been designed to function reliably and inexpensively even in areas where there are poor or non-existent telecommunications infrastructures. This and other computer networks offer exciting possibilities for ending the isolation of people in remote areas with poor access to information. While there are no projects in the area of nutrition as yet, there are plans to distribute material from various health studies conducted by the Academy of Educational Development. HealthNet offers e-mail, electronic conferencing, and long-distance education.
Worldwide networking tools
Other networking tools, also known as utilities, allow users to explore and locate valuable resources anywhere in the world. Some of the better known tools include Almanac, Gopher, and the WWW. Almanac and Gopher allow only text. Almanac is an information server, where requests are submitted and processed through the e-mail. Gopher is a tool that provides a menu structure for navigating and locating resources world-wide. WWW is used by millions of people. Users with direct access to Internet, as well as those who use a commercial vendor to access it, can receive graphics, pictures, sound, and video. The statistics keep changing but one prediction is that there will be more than 11 million users of WWW by 1998. In February 1995 an estimated 27,000 sites existed with more than five million documents. The number of sites is doubling every 53 days and the number of documents is doubling every six months. At present it is recognised as a fairly inexpensive way for organisations to offer information about themselves to anyone who seeks it, or stumbles on it while surfing the Web. The Web displays information in the form of pages which can contain colour photographs, recorded voices or musical selections as well as text. The text can include highlighted words that are called Hyperlinks and refer the user to other pages. Two popular web browsers, Netscape and Mosaic can take you to a WWW Home Page at the click of a mouse. That Home Page may simply provide a directory of the information stored at that site. It may also allow the user to interact and complete activities like subscribing to a newsletter. Universities and governments were the first to operate Web Sites, as the computers in which Web information resides are known. But businesses and individuals are now doing so. For example, a student put the USDA Food Guide Pyramid on a Home Page. A Nutrition Home Page from Mexico can be reached at the address: http://www.spin.com.mx/nutrimex/nutrimex.html. There are many Home Pages for health organisations and food industries.
The benefits of electronic information found on WWW are: around the clock accessibility, low cost, and immediate availability. Often the data available are more up-to-date than printed materials. The cost to the user is usually the telephone call or Internet connection. A browser allows users to easily go to WWW sites without using complicated computer commands.
Another example of a WWW site of value to nutrition educators is the site maintained by The International Food Information Council (IFIC, 1995). The site provides colourful graphics and text, educational materials, scientific research, recent survey data, and tips for health professionals and educators. There is a special section for journalists reporting on food, nutrition and health topics, as well as sound bits from noted experts. It can be reached by using its WWW address http://ificinfo.health.org or Gopher address of gopher://ificinfo.health.org.
Food and nutrition on-line services
The Food and Nutrition Information Centre (FNIC) of the USDA, National Agricultural Library, Beltsville MD (firstname.lastname@example.org) has been a leader in cataloguing sources of food and nutrition information available electronically. Electronic databases are computerised collections of information, usually covering a specific subject, that are arranged to facilitate efficient retrieval and use.
Computer on-line services offer fast, low-cost access to much of the worlds accumulated nutrition and medical wisdom. On-line can deliver up-to-the-minute information. It is much like having access to a library without leaving the office, complete with a personal librarian to conduct a search. It is possible to instantly retrieve information like abstracts, read material on screen, and download material as hard copy. Subscriptions to on-line databases are good for people who want current and general information. Some on-line services have Personal Clipping Services, that alert the user automatically to new items of interest.
The services available are constantly changing. Some of the better known include the International Food and Nutrition Database (IFAN), a full text database containing a wide range of food and nutrition documents for health professionals and consumers (ceasing operation autumn, 1995). The Agricola database from the National Agricultural Library and Medline produced by the National Library of Medicine are on-line and useful in locating journal citations on specific topics such as food and nutrition and medical topics. Some other databases include WHO Micronutrient Deficiency Information System (MDIS), and PAHO/WHO Nutrition database system. Others exist, that are limited to data on a specific nutrient or condition.
There are also electronic journals and newsletters available through commercial on-line services. Some are electronic versions of publications also distributed in print such as the magazine Cooking Light. Others are designed and transmitted only electronically to permit greater reach and frequency of updates.
Electronic bulletin board systems
These computerised systems usually focus on a specific subject area and a target audience. The users can access publications, bibliographies, software, calendars, bulletins, and other resources. Some of the better known ones include the Agricultural Library Forum (ALF) of the USDA, and the Nutrient Data Bank Bulletin Board from the Agricultural Research Service, which offers computer files on the nutrient composition of food. The U.S. Food and Drug Administration maintains a board with food labelling, food safety and food regulation information. The Technology Transfer Automated Retrieval System (TEKTRAN) contains information about the latest studies in agriculture, food, and nutrition. Research results and interpretative summaries are provided. For example, The Food Guide Pyramid database is a collection of nutrition education materials that feature the Food Guide Pyramid. Listings include the source, ordering information, language, audience and keywords and it is found on ALF and the FNIC Gopher. There are several other bulletin boards with information of interest to the international health community.
Other electronic services
Fax on demand
This is also referred to as information in an instant. Many groups are allowing access to information such as news releases and journal advertisers, by fax on demand. An individual using a touch-tone phone can call a known fax service, listen to the menu and request information that will then be faxed. A subscription service like AG Daily News, lists daily information available by fax. This system allows fast and low-cost distribution of information to those who seek it.
Computer conferencing is available at different levels of interaction from one-way video with various types of communication support, to the most sophisticated systems of two-way audio and with two-way video.
· University courses:
Several universities like Kansas State University (KSU), USA, are offering their traditional classes through computer conferencing. At KSU several food science courses are transmitted to the students home or office. The student needs a personal computer with a modem. A communication software is provided, and access comes through a toll-free long distance connection. Training in computer communications is included at the beginning of the course. Benefits include university credits or Continuing Education Units (CEUs), ability to identify new resources and contacts, interaction with others in the same field, improvement of knowledge, and professional development.
Montana State University offered a food safety telecomputing course to teachers nationwide. Teachers dialed into the university via modem and hooked into a computer conferencing system. Participants could take the course on their own time schedule. The students communicated with each other through e-mail and bulletin boards about their experiences implementing food safety activities in their classroom (Stein, 1994).
· Personal conferencing:
Video conferencing is also available, that allows a person to use the computer at his/her desk, and on demand meet with one or several colleagues for real time interactions including video. This technology is being used for participation in remote teaching or distance learning by widely dispersed faculties or experts. This system also allows attendance at regional meetings, sharing visual images with distant colleagues, work group meetings with participants at multiple world-wide sites, consultation with experts and attendance at committee meetings.
Interactive television (ITV)
The commercial communication industry focuses its attention on the ability of consumers to use ITV for home shopping. But there is growing use of ITV for educational (often called distance learning) and health services (Telemedicine). ITV, which requires either satellite transmission or sophisticated phone lines, provides several levels of interaction. Some systems allow one-way video. Some one-way video systems are enhanced by the use of telephone lines, faxes or the e-mail. Other systems allow one-way video but two-way audio.
Telemedicine is broadly defined as the use of telecommunication technologies to deliver medical information and services. It generally means, however, the use of remote electronic clinical consultation. It is typically two-way video and two-way audio, which enables diagnosis, treatment and other health-care activities. Some of the opportunities that Telemedicine provides include extending the expertise of health-care professionals to rural clinics, nursing homes and ultimately individual homes; allowing specialty consultations to a patient in his/her home community; creating an environment for collegial relationships to develop among people in different locations; and transmitting and receiving continued education. Clinical telemedicine programmes are underway in 40 of the 50 states in the USA.
· Opportunities for distance learning:
The potential for ITV in distance learning is great. There are several examples of the use of interactive TV for distance learning in public health and nutrition. Several public health nutrition programmes have used satellite television to extend the reach of high demand courses or workshops. Toll-free numbers are available to allow students live interaction with the instructor. These programmes allow field-workers to obtain important education without being away from their jobs for long periods of time. Local workshops often supplement the broadcasts (Haughton, 1995).
Several food and nutrition agencies have used interactive TV for training conferences. For example, the North Carolina and Georgia Co-operative Extension Services developed a food safety conference for child-care workers. The programme was transmitted to audiences across the two states. The audience had the opportunity to complete learning activities with others at their site as well as the chance to call in questions to a panel of experts. Learners were able to communicate with the instructors via telephone. Videotapes of the presentation which included the instructors presentation as well as pre-recorded videos that demonstrated the issues, activity kits, and slides of bacteria, were made and distributed for later reuse. Evaluation is in progress (Lackey, 1995). Instructors at several universities teach nutrition workshops or courses using two-way audio and two-way video systems (similar to the Telemedicine described earlier) that allow students to interact as if they were sitting in a classroom (Balch, 1995).
Several types of systems have been described above. The use of computer conferencing and ITV can expand the reach of education. Learners can access information regardless of place and time. There are always trade-offs. As the level of interactivity among instructors and learners increases, the learner loses control over time and place for learning. The use of these technologies for distance learning are being evaluated. Some of the issues under study include ease of use and learning the system, aesthetic appeal, clarity of feedback, error handling and controls for parallel and serial group communications, and costs.
In addition to televised conferencing, instant two-way audio communication via satellite has been successful in nutrition education in the South Pacific (Renda & Riordan, 1983).