Professional groups are beginning to identify what the term "computer literacy" means for its profession. For example, the Society for Teachers of Family Medicine's Working Group on Computer Applications in Medicine recently proposed computer skills that should be acquired by all medical students before they complete their training. The tentative list includes working knowledge of e-mail, word processing, spread sheets, computerized medical records, data management programs such as SPSS or SAS. A similar set of skills needs to be developed for nutrition educators.
Most individuals develop computer skills by reading how-to-manuals; viewing videotapes; trial and error at the computer; conferring with a colleague or a computer tutor; learning from their children; or attending workshops and classes sponsored by employers, community colleges and commercial companies. There has been little specific computer skills training for nutrition educators.
Some organizations, such as the Association for Progressive Communications, the Clearinghouse on Infants and Maternal Nutrition, SatelLife, The Board on Science and Technology for International Development (BOSTID) and Society for Teachers of Family Medicine have developed fact sheets and articles as introductions to understanding terminology and these tools. These materials are appropriate for nutrition educators to use in their personal computer skill development. The Clearinghouse on Infant Feeding and Maternal Nutrition has held workshops for capacity building and strategic development of communications.
The Society for Nutrition Education (SNE) has included programming to increase awareness about technology in nutrition education for several years. SNE has sponsored a session at its annual meeting where software authors interacted one-on-one with meeting participants to discuss the software they authored, the resources needed to develop the programs, the acceptability to the intended audiences, evaluation data, and the trials and tribulations of developing computer based applications. Several linkage-applications have also been demonstrated at the SNE meeting. In 1995 SNE offered its first hands-on all day hands-on multimedia development workshop. All of these activities have been well received by participants. More hands-on training activities need to be supported at meetings nutrition educators attend. Organizations have been reluctant to schedule these type of sessions because of logistics and expense.
Nutrition educators planning to create computer programs have either needed to identify an instructional designer and computer programmer to work with them or personally develop those skills. There are how-to-books on creating all types of software programs and HOMEPAGES. Most programs described in this paper were developed by teams with the nutrition educator as the content specialist. Kolasa (1994) has described the roles and responsibilities of the multimedia team developing nutrition education materials. She assumes that nutrition educators do not have the time, interest nor skills to develop these programs. The talents and roles of other professionals, including the instructional designer and computer programmer, in the development of software programs must be respected. The nutrition educator's time is best spent in determining the food and nutrition message and then ensuring its accuracy when delivered.
A. Access. The issues of access by the professional for stand-alone applications is often overstated. In developed and developing countries it is common for projects and programs of all sizes to have a computer. The capabilities of most computers, even if purchased for other activities, often are not fully utilized. Computers can be used for more than word processing and data storage. However, nutrition educators need training and time to practice. For the public, access is becoming less of an issue. Interactive television, kiosks in medical centers, physicians offices, libraries, grocery stores, and work sites have been used successfully in nutrition education efforts. Most stand-alone applications can be loaded on computers housed in kiosks and placed in public places.
For CYBERSPACE access the concerns at first appear to be more serious, especially where phone lines are unreliable. Some professionals in developing countries are finding ways to access email. Many agencies are concerned about preventing the creation of a greater information gap between developing and developed countries. Alternatives to traditional phone systems are being developed. In places where FAX transmissions are possible, the simple addition of a modem and computer with communication software may make communications faster and less expensive than faxing. Nutrition educators need to be informed and participate, as appropriate, in those information technology access issues. Nutrition educators should not wait until they are given access but work toward obtaining access to Internet or other networks. Nutrition educators need to participate in the health related discussion groups and other networks to create a presence for nutrition. Where e-mail is available but under utilized, nutrition educators may need orientation programs to become more comfortable with communicating by computers. Then they should use e-mail to exchange program ideas and successes. Nutrition educators need to incorporate the new technologies to process and exchange information. Additionally they should not wait until access is achieved but rather be developing plans, programs and databases to be ready for implementation when access barriers are eliminated.
B. EFFECTIVENESS. The use of technology will not guarantee a more successful nutrition education or communication program. The design and selection of appropriate technology for the purpose of the program are critical. In some cases, programs can reduce the human time needed to collect and analyze data thereby increasing the time for counseling or teaching, or reaching more people. Technology can be used to enhance the efforts of nutrition educators but all forms of communication can be effective. While computers provide a powerful medium other means of communication may be more appropriate to a given situation. It is important to determine the way the intended audience learns and then to design programs and campaigns that use a combination of media. Some elements of computer-mediated programs important to evaluate with the intended audience in mind include: instructional design; branching capability (too much or too little); screen design; learner control and user interface; navigational issues; realism related to the program's goals; level of decision making; feedback; record keeping; and balance of video, audio, animation, text and graphics.
1. FOR THE PUBLIC. Technology can be used to enhance the efforts of nutrition educators. Computer technology, especially multimedia for nutrition education, requires that program planners have a vision for educating in a different manner. These applications hold great promise but are new and only limited evidence has been accumulated to demonstrate that computer-mediated programs may be more effective than current communication techniques in nutrition education. Computer-mediated program have been effective: providing the public with access to information when health professionals are unavailable; in engaging a user visually, sometimes for longer periods of time, to enhance learning; for creating tailored messages that enhance behavior change and compliance; for giving straight information without bias; allowing conversations between health care professional and patient without regard to distance or time; providing medical decision support and expert advice; tailoring information to age, sex, language, literacy level, ethnic background,
socioeconomic status, geographic location, lifestyle, and/or medical history; and helping consumers ask better questions and be more involved in their nutrition treatment plans.
These programs will only be successful, however, if they are designed to reach out to people and entice them to participate in their health care. It is important to determine the way the intended audience learns and then to design programs and campaigns that use a combination of media. Careful design, pilot testing are critical to these efforts. There is a growing literature describing the elements of software design important to successful computer-mediated nutrition education efforts. Elements such as story telling and interactivity are critical to engaging the user. Strategies for evaluating the effectiveness are needed.
1 2. FOR PRODUCTION OF QUALITY NUTRITION EDUCATION MATERIALS. Resources for the development and production of quality nutrition education materials are always scarce. Computer-mediated programs can provide real economies in materials production and printing and distribution. 3. FOR THE NUTRITION PROFESSIONAL. For the nutrition professional computer-mediated technologies hold promise for maximizing education. The participants of the 1994 Bellagio Conference noted that responsive training and research efforts were needed to improve the efforts to reduce global malnutrition. The conference report included a guiding principle that suggested training programs should use a variety of methods including technologies appropriate to the training context. Computer-mediated technologies can meet some of the training principles outlined. They can be field based, reiterative, and designed to build and maintain confidence. Computer-mediated technologies can be used in distance learning and require little absence from the job site. E-MAIL and electronic networks can be used for continuing education and discussion among trainees. C. Consultation. There are many computer consultants available. Selecting the consultant that knows what hardware and software that best suits the nutrition education program needs is critical. Johnson (1992) described seven important keys to sustainable development of microcomputer based information systems in developing countries. These can be helpful in selecting a consultant. It is best to select a consultant that has experience not only in the computer field but also in either nutrition, health, or medicine. The consultant needs to be able to train the staff in the use of the hardware and software. The trainer needs to do more than demonstrate the program. The trainer needs to supervise the trainee "driving the program".
Purchasing software from an established company who produces easy to use software may negate the need for a trainer. However, dedicated time for the nutrition educator to set up and practice the use of the software is imperative.
For nutrition educators developing software, selecting a programmer who knows the appropriate code (i.e., C Language or Authorware) and Platform (i.e., IBM or MAC) is critical. An instructional designer is needed to ensure the program is educationally sound and programmable. A project manager is needed to ensure all the components are identified, acquired and compiled according to the time and budget schedules.
V. RECOMMENDATIONS.
All nutrition educators must become familiar with
the computer-mediated technologies in order to determine those which might
enhance their efforts in nutrition education for the public. All nutrition
educators should receive computer skill training and be given opportunities
to practice those skills. They should obtain access to the Internet or other
electronic networks to enable them to exchange food and nutrition information.
Nutrition educators who use computer-mediated software should provide feedback
and evaluation data to the program developers regarding its effectiveness in
their setting. Some nutrition educators must be actively testing nutrition
education delivered via new technologies.
For nutrition educators to be able to determine which computer- mediated technologies might enhance their efforts, governments and international agencies supporting nutrition education efforts must create opportunities:
a) For capacity building. Nutrition educators need funded opportunities to obtain the computer skills needed to use stand-alone and linkage-applications. They need time and access to equipment to practice those skills.
A number of institutions and agencies are committed to supporting professionals in adopting and using communication technologies. New programs may not be needed. However, it appears that nutrition educators are not involved in these organizations nor do they have access to the materials. The FAO nutrition
program could collect and distribute handouts on building computer skills. The program also could sponsor participation of nutrition educators in courses and workshops offered by commercial as well as educational institutions or organizations. They could provide opportunities at the regional level, similar to the SNE sessions where nutrition educators become more familiar with both stand-alone and linkage applications.
These educational opportunities and increased awareness would elevate the level of computing knowledge of nutrition educators.
b) For nutrition educators to practice skills by having local governments supply computer hardware and software. Agencies could sponsor competitions for acquisition of hardware and software. Awards could be for demonstration, implementation and expansion projects.
c) For nutrition educators to develop and evaluate new or adapt interactive approaches to nutrition education for new audiences. Little is known about the types of media and messages that appeal to different audiences.
Governments and international agencies must provide financial support for demonstration and evaluation of technology and innovative practices that allow recipients of nutrition education and promotion to receive messages tailored to their specific interests and needs. Projects for both consumers and professionals are needed.
d) For nutrition educators to use successful programs. Government and international agencies must provide the financial support for widespread implementation of programs that change user's behaviors.
e) For directors, managers, and nutrition educators to discuss the impact of decentralization of information.
Professionals at all levels and consumers will have access to both credible and inaccurate nutrition and self help information. Governments should ensure that field workers are not prevented from obtaining access to computer-mediated technology (stand-alone and, especially, linkage applications) because of a fear of loss of control of information or loss of power by their supervisors.
International and government agencies should provide the leadership for redefining the role of the nutrition educator during this time characterized by the decentralization of information. Agencies should provide workshops and other training opportunities for nutrition educators to develop skills to help consumers appropriately access and use available nutrition information.