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 a 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, WORLDWIDE Web and other computer networks, electronic databases, electronic bulletin board systems, faxes, and interactive noncommercial television. While much of the information presented is of interest to the professional community, access to these technologies is available to consumers. This decentralization of access to information has great implications for nutrition educators as well as governments and international agencies who support nutrition education programs. 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 to best use these systems. A. E-MAIL or ELECTRONIC MAIL. 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, revise document and use it or return 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 forums and discussion groups. These groups exist on Internet as well as on commercial on-line services. Some forums or lists are fully automated; others are maintained and administered by an individual(s). Some have limited access and others are open to everyone in the world. Some are two-way forums that allow members to discuss a topic. Others are one-way services that send newspapers, reports and other publications to subscribers.
There are forums 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.
1. FOOD AND NUTRITION EXAMPLES. While there are a number of fourms that may include food and nutrition education issues, there are a limited number of exclusive food and nutrition lists or forums. Food and nutrition education professionals are currently seeking and providing information using both the commercial on-line services and Internet. 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 forums and discussion groups are open to users from around the world. Some believe that quality control systems need to be put in place. Others agree that we need to teach professionals and consumers alike how to assess the validity and applicability of information.
2. EXAMPLES FOR MEETING THE INTERNATIONAL COMMUNITY NEED. There are a growing number of resources of interest to the international community. Examples related to nutrition education are noted here.
a. 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 programs and projects.
Information can be posted. Electronic newsletters like "Mothers and Children" a bulletin published three times per year in English, French and Spanish by the Clearinghouse on Infant and Maternal Nutrition, 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".
b. OMNI. The Opportunities for Micronutrient Intervention (OMNI) was developed and funded by the Office of Nutrition of the USAID. It's mission is to control and prevent micronutrient deficiencies in developing countries. As part of its information dissemination effort, it uses electronic networking. For example, 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.
c. VITA. VITA supports a free, public, on-line discussion forum, Devel-L. It provides opportunity to exchange ideas related to technology transfer in international development.
d. 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 organizations to strengthen their capacity to produce and disseminate information (Gibbons, 1984).
B. OTHER 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 phones may change the landscape of phone communications where telephone systems have not worked. Many experts believe that within 10 years communication linkages will not be a real problem.
1. FIDONET. Kenya has not had direct access to INTERNET. However, the African Regional Center for computing is able to communicate and network internationally through 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 per day. (Ochuaodho, 1994).
2. "HealthNET". 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 operates in 16 African and 5 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 nonexistent telecommunications infrastructures. This and other computer networks offer exciting possibilities for ending 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 email, electronic Conferencing and long distance education.
3. WORLD WIDE WEB. 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, WORLD WIDE WEB (WWW). ALMANAC AND GOPHER allow only text. ALMANAC is an information server where requests are submitted and processed through email. GOPHER is a tool which provides a menu structure for navigating and locating resources worldwide. 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 see to graphics, pictures, sound and video. That 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 5 million documents. The number of sites is doubling every 53 days and the number of documents is doubling every 6 months. At this time it is recognized as a fairly inexpensive way for organizations to offer information about themselves to anyone who seek it, or stumble on it while "surfing" the web. The Web displays information in the form of pages which can contain color 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 browsers that allow the point an click of a mouse are Mosaic and Netscape. Universities and government were the first to operate Web Sites, as the computers in which WEB information resides are known. But business 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 organizations.
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 print materials. The cost to the user is usually the telephone call or Internet connection. A WEB software, known as a browser, allows users to easily go to WWW sites without using complicated computer commands. Two popular web browsers are Netscape and Mosaic can take you to a WWW HOMEPAGE. That HOMEPAGE 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.
One 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 colorful 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.
C. FOOD AND NUTRITION ON-LINE SERVICES. The Food and Nutrition Information Center (FNIC) of the USDA, National Agricultural Library, Beltsville MD (INTERNET fnic@nalusda.gov) has been a leader in cataloguing sources of food and nutrition information available electronically. Electronic databases are computerized collections of information, usually covering a specific subject, that are arranged to facilitate the efficient retrieval and use.
Computer on-line services offer fast, low cost access to much of the world's 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 literature a search. It is possible to instantly retrieve information like abstracts, read material on screen, 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 fall, 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 data bases include WHO Micronutrient Deficiency Information System(MDIS), 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.
D. ELECTRONIC BULLETIN BOARD SYSTEMS. These computerized 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 include the Agricultural Library Forum (ALF) of the USDA, 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 labeling, 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 interpretive 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 bulletin boards with information of interest to the international health community.
E. OTHER ELECTRONIC SERVICES
1. 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 daily lists information available by fax. This system allows fast and low cost distribution of information to those who seek it.
2. COMPUTER CONFERENCING. 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.
a. COLLEGE 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
student's home or office. The student needs a personal computer with a modem. 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 college 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 communicate with each other through e-mail and bulletin boards about their experiences implementing food safety activities into their classroom. (Stein, 1994).
b. PERSONAL CONFERENCING. Videoconferencing is also available that allows a person to use the computer at their 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 faculty or experts. This system also allows attendance at regional meetings, sharing visual images with distant colleagues, work group meetings with attendees at multiple world wide sites, consultation with experts and attendance at committee meetings.
3. INTERACTIVE TELEVISION (ITV). The commercial communication industry focuses their attention on the ability of consumers to use ITV for home shopping. But, it is important to note 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 phone lines, faxes or email. Other systems allow one way video but two way audio.
a. 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 typically is two way video and two way audio which enables diagnosis, treatment and other health care activities. Some of the opportunities that TELEMEDICINE provide include extending the expertise of health care professionals to rural clinics, nursing homes and ultimately individual homes; allowing speciality consultations to a patient in his/her home community; creating an environment for collegial relationships to develop among people in different locations; transmitting and receiving continued education. Clinical telemedicine programs are underway in 40 of the 50 states in the United States.
b. 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 programs have used satellite television to extend the reach of its high demand courses or workshops. Toll free numbers are available to allow students live interaction with instructor. These programs 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 Cooperative Extension Services developed a food safety conference for child care workers. The program was transmitted to audiences throughout 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 instructor's presentation as well as prerecorded 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 the they were sitting in 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 tradeoffs. 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 and Riordan, 1983).