Development and evaluation of a multimedia CD-ROM for exercise during pregnancy and postpartum.

OBJECTIVE: To meet the need for an interactive product on exercise during pregnancy and postpartum, we developed and evaluated a personally tailored multimedia CD-ROM. METHODS: Pregnant and postpartum women, who were randomly assigned to either the experimental group (PregXercise CD-ROM) or the control group (CD-ROM with neutral content), navigated through the CD-ROM for 1 h. Main outcomes were exercise self-efficacy and knowledge. RESULTS: In analyses of covariance, compared with the control group, the experimental group had significant increases in self-efficacy and knowledge. CONCLUSION: The multimedia CD-ROM delivering information about exercise motivation, guidelines, and prescription was effective in improving exercise self-efficacy and knowledge. PRACTICE IMPLICATIONS: Our preliminary results illustrate that healthcare professionals and researchers may use interactive multimedia for improving exercise behavior and related outcomes with pregnant and postpartum women.

Caring for children with intellectual and developmental disabilities: virtual patient instruction improves students' knowledge and comfort level.

Nurses play a vital role in providing health care to children with developmental disability (DD) throughout the United States. Unfortunately, most nurses continue to report that they receive little or no clinical education in the area of DDs. In response to this need, a core development team consisting of nurse practitioners and nursing faculty from three universities, one physician assistant faculty, parents of children with DD, and educational specialists developed two multimedia (virtual patient) pediatric instructional modules in CD-ROM format--one involving a child with Down syndrome, and the other involving an infant born at 26 weeks' gestation. Participants were required to make clinical decisions throughout the cases. The modules on CD were piloted with nursing students from three universities. Results of the effectiveness study demonstrated significant gains in knowledge and comfort level regarding the care of children with DD.

Enhancing self-management in children with sickle cell disease through playing a CD-ROM educational game: a pilot study.

PURPOSE: To determine whether playing a simple CD-ROM educational game (developed specifically for children with sickle cell disease), improved children's knowledge and confidence in selected symptom management and practice. METHOD: Twenty-two eligible children completed a pretest to determine knowledge and confidence levels, played the Sickle Cell Slime-O-Rama Game, then completed an identical posttest. FINDINGS: Significant increases in knowledge (t = 2.828, p =.010) and confidence (t = 3.759, p =.001) levels between pre- and posttests were identified. CONCLUSIONS: It is promising that a simple, interacting CD-ROM game allowed children with sickle cell disease to quickly acquire knowledge about the disease and symptom management, and increased their confidence to apply this new knowledge. Results suggest the high utility of this tailored game to foster active self-management behaviors in this population.

Exploring the black box of a decision aid: what information do patients select from an interactive Cd-Rom on treatment options in breast cancer?

OBJECTIVE: It is thought that patients fare better when they participate in treatment decision-making, and when they have more control over the amount and type of information they receive. To facilitate informed decision-making, interactive decision aids have been introduced in health care. This article describes how much, and which information patients select from an interactive decision aid on breast cancer. To explore whether the interactive system facilitates that different patients receive different information, associations between patients' characteristics and information selection are inspected. METHODS: The interactive decision aid was provided to 106 patients after an initial discussion with their surgeon about their diagnosis and treatment options. Information regarding patients' age, completed education, treatment preference, psychological functioning, decision uncertainty and decision style was collected with a written, structured questionnaire. The questionnaire was completed before patients used the interactive decision aid. To create categories, a median-split procedure was employed on the scores of the continuous background variables. The information patients selected from the interactive decision aid were registered into logfiles. Associations between patients' background variables and information selection were investigated by means of univariate statistics. RESULTS: Patients (n=97; 92%) used the interactive decision aid intensively. On average, patients spent almost 70min searching for information and selected 21 information topics. Overall, treatment related information was clearly more selected than other types of information. Age, education, and decision style factors were associated with information selection. CONCLUSION: The interactive breast cancer decision aid was utilized intensively. The interactive system was found to facilitate that different patients received different amounts and types of information. PRACTICE IMPLICATIONS: Interactive decision aids may improve information giving to patients, and as a result, the quality of care. To safeguard informed-choice, decision aids should be used in conjunction with other communication strategies. Decision aids should be available continuously and throughout the patients' disease journey. The Internet may help to achieve broad dissemination and enduring access.

Betterland: an interactive cd-rom guide for children with cystic fibrosis.

Effective management of cystic fibrosis (CF) depends on adherence to a daily multi-component regimen. Segregation policies have been reported to lead to a dramatic fall in the incidence of cross infection rates in specialist CF centres. Previously, peers provided a valuable source of information and support; segregation means that there is virtually no contact with other people with CF. In this context the Betterland CD-ROM was developed with the aim of improving knowledge and understanding and helping children and young people cope with time-consuming CF treatments (inhalation therapies and physiotherapy) and painful procedures by using filmed-model approaches. Betterland is an interactive computer game, designed in the style of a theme park. Patient and carer feedback has been positive and the CD-ROM has been incorporated into a nurse-led Moving to High School (MotHS) programme, as well as the patient education work of the CF multidisciplinary team, particularly clinical nurse specialists.

Welcome to the techno highway: development of a health assessment CD-ROM and website.

Traditionally teaching nursing students psychomotor skills took place in a laboratory setting; however, recent developments in computer technology have revolutionised how educators can transfer knowledge. To meet the need for an efficient and interactive learning experience a software product was required to educate nursing students about health assessment techniques. This paper presents how existing 'old technology' of a video was given new life by embracing new technology, resulting in development of an interactive CD-ROM with supporting WebCT. This innovation reflects a more flexible approach to learning as it is dynamic, portable, self-paced and more convenient for adult learners especially those in remote areas.

Development and testing of a CD-ROM based tutorial for nursing students: getting ready for HIPAA.

The purpose of this study was to develop and test a CD-ROM tutorial for nursing students to educate them on how the rules and regulations of the Health Insurance Portability and Accountability Act (HIPAA) affect them as they engage in patient care activities in hospitals. The project was completed in two parts, the first of which was production of a stand-alone, audio lecture, image and text self-instruction on CD-ROM to distribute to students as they began their clinical experience. The second part compared the effectiveness of learning the HIPAA content via CD-ROM to a text-directed, self study method. Students were pretested and randomly assigned to one of the types of instruction based on their seminar group assignment. One group received the CD-ROM, Getting Started with HIPAA, along with a journal article on HIPAA, while the other (control) group received only the journal article. All students were instructed to prepare for a test on their understanding about HIPAA by the end of the clinical rotation. The test was analyzed, and items clarified to yield a reliable Web-based examination with 20 questions, 18 of which were used in the analysis. The students' scores were analyzed before and after the instruction, and the methods of instruction were compared. The study findings demonstrated significant differences between experimental-group and control-group students' performance on a knowledge test of HIPAA, as well as overall satisfaction with learning the material by CD-ROM among students who used it. The tutorial is now available for all students, and the Web-based examination provides automatic scoring to a preestablished competence level.

Use of interdisciplinary simulation to understand perceptions of team members' roles.

The aim of this study was to examine the effectiveness of an interdisciplinary approach to learning in helping care providers understand their overlapping roles in the clinical management of asthma. In addition, the perceived usefulness of an interdisciplinary approach for students in the health-care disciplines of nursing, medicine, pharmacy, and respiratory therapy to learn about the clinical management of asthma was explored. The diffusion of innovation framework was used to guide the process of development of CD-ROMs. An interpretative approach was selected for this research because of the emphasis on how a phenomenon is perceived and how meaning is constructed in situations. This approach assumes that multiple ways of interpreting experiences are available through interaction. A convenience sample of health-care practitioners from two rural campuses was selected to participate in this study. The cohort of participants represented students from the population of a large midwestern moderate-sized university that has four geographically distinct campuses. Preliminary results indicate that the use of interdisciplinary learning helps clarify the roles of each discipline and that learning from one another is enhanced.

Effects of multimedia with printed nursing guide in education on self-efficacy and functional activity and hospitalization in patients with hip replacement.

This study aimed to examine the effects of multimedia with printed nursing guides in patient education on the improvement of self-efficacy, functional activity and length of hospitalization in patients with hip replacement. A quasi-experimental design was used. Control group received a routine care, whereas experimental group was given the multimedia with printed nursing guides. In the multimedia, CD is a collection of nursing instructions in the format of multimedia such as video and audio recorded into a CD. The result showed there are statistically different between experimental and control groups on self-efficacy (t = -7.93, P < 0.001), functional activities (t = 4.33, P < 0.001), and length of hospitalization (t = 2.54, P < 0.05). The findings indicated experimental group achieved higher self-efficacy with the help of multimedia with printed nursing guides. Control group needed more assistance in performing functional activities. Length of hospitalization was significantly shorter in experimental group than in control group. To better adapt to continual human resource reduction and to improve nursing service quality, wider applications of multimedia with printed nursing guides in patient education may be worthwhile.

A randomized trial comparing digital and live lecture formats [ISRCTN40455708.

BACKGROUND: Medical education is increasingly being conducted in community-based teaching sites at diverse locations, making it difficult to provide a consistent curriculum. We conducted a randomized trial to assess whether students who viewed digital lectures would perform as well on a measure of cognitive knowledge as students who viewed live lectures. Students' perceptions of the digital lecture format and their opinion as whether a digital lecture format could serve as an adequate replacement for live lectures was also assessed. METHODS: Students were randomized to either attend a lecture series at our main campus or view digital versions of the same lectures at community-based teaching sites. Both groups completed the same examination based on the lectures, and the group viewing the digital lectures completed a feedback form on the digital format. RESULTS: There were no differences in performance as measured by means or average rank. Despite technical problems, the students who viewed the digital lectures overwhelmingly felt the digital lectures could replace live lectures. CONCLUSIONS: This study provides preliminary evidence digital lectures can be a viable alternative to live lectures as a means of delivering didactic presentations in a community-based setting.

Computerized training in breast self-examination: a test in a community health center.

Fifty-eight women recruited from a community health center completed either a brief interactive multimedia training program on breast self-examination using a breast model and computer guided feedback on accuracy of lump detection or read a National Cancer Institute pamphlet on breast self-examination and breast lumps. Women using the computer program as compared to the pamphlet group reported a higher sense of self-efficacy for being able to perform a breast self-examination immediately after their educational session and 1 month later. However, the increase in self-efficacy for the computer group diminished over 4 weeks, underscoring the importance of an environment that reminds and reinforces learning for women about the performance of regular breast self-examination. The increase in sense of self-efficacy to perform breast self-examination with roughly 20 minutes of computer-based training and the partial maintenance of that self-efficacy 30 days later suggests the utility of incorporating short, focused interventions in busy primary healthcare settings.

Patient education materials about the treatment of early-stage prostate cancer: a critical review.

BACKGROUND: To ensure that patients make informed medical decisions, patient education materials must communicate treatment risks and benefits. OBJECTIVE: To survey publicly available patient education materials and assess their suitability to support informed decision making in early-stage prostate cancer. DESIGN: Cross-sectional review of Internet, print, and multimedia sources. SETTING: University data analysis laboratory. MEASUREMENTS: The content of 44 materials that described all standard treatment options was reviewed. Top-rated documents underwent plain-language review. Total score on 54 content items and accuracy, balance, and plain-language evaluation was measured. RESULTS: 502 of 546 patient education materials did not describe all standard treatments (watchful waiting, surgery, radiation, and hormone therapy). Eighty percent of the 44 materials that addressed standard treatments and underwent content review described anatomy, physiology, stage, and grade of cancer. Half of the materials fully described radical prostatectomy and radiation therapy. One third of the materials included risks and benefits of each treatment; none explicitly compared outcomes of all treatments in a single summary. Information was accurate and balanced but did not include key content for informed consent. LIMITATIONS: The search was restricted to publicly available materials and did not include books or materials written in languages other than English. The accuracy, balance, and plain-language reviews were evaluated by 1 reviewer. The criteria reflect the authors' focus on informed decision making. Other aspects of health education may require a different evaluation template. CONCLUSIONS: Currently available patient education materials on early-stage prostate cancer treatment do not contain comprehensive information about the risks and benefits of each treatment. To assist patients and physicians in choosing among prostate cancer treatment options, a new generation of materials is needed.

The evaluation of multimedia learning packages in the education of health professionals: experience of a musculoskeletal examination package.

The last 20 years have seen rapid technological developments within the field of information technology. The internet, sophisticated software packages and increased accessibility to computers have all opened opportunities for educators. Against this background, increasing numbers of multimedia learning packages are available to the health professional. In this paper, Pirashanthie Vivekananda-Schmidt, Andrew Hassell and Monica McLean discuss the methodological issues relating to the evaluation of such multimedia based learning tools, using the example of a specific package, Virtual Rheumatology. They discuss the reasons for the increasing interest in the area of computer-based learning, the available evidence supporting the use of such tools in education, and issues about the design and production of this CD. They then discuss the evaluation of the package to illustrate the considerable methodological difficulties in the research and evaluation of Computer Assisted Learning (CAL) packages generally.

Evaluation of two CD-ROMs from a series on cell biology.

Two CD-ROMs from a series dealing with various major aspects of cell biology are evaluated in this paper using quantitative and qualitative approaches. The findings delimit similarities and differences of the two CD-ROMs and shed light on how the programs could be used in the learning process and how they should not be. The overall impression, as well as the graphical and technical features, received a predominantly good rating. The defined target groups were reached (e.g., students in secondary schools), different learning approaches were supported (e.g., discovery and autonomous learning), the CD-ROMs' usability was assessed as being easy and intuitive, and the majority of the evaluators were satisfied with the level of interactivity. Navigational problems encountered in CD-ROM 1 were overcome by a successful implementation of new navigational functions in CD-ROM 2. Most students found the CD-ROM to be a suitable complement to, or an extension of, their lessons. We conclude that many, but not all of the requirements for the various stages of the learning process could be satisfied with the existing CD-ROMs. The requirements not met are discussed to obtain insights that could help to improve the production of multimedia learning material. The use of quantitative and qualitative approaches in the evaluation of learning modules is discussed, as the study began by collecting and analyzing anecdotal reviews and was then extended to include a qualitative evaluation.

Reading statistics in nursing research: a self-study CD-ROM module.

A statistics CD-ROM tutorial program was developed to replace a classroom course with several self-study modules. For the CD-ROM delivery method, students were asked to complete a Likert-type questionnaire with response options similar to those used for end-of-course evaluations at the nursing school. Ratings ranged from 1 to 5, with 1 equaling outstanding and 5 equaling completely unsatisfactory. Ratings for the CD-ROM were compared with those of a Web-based course taught the prior year. Mean satisfaction ratings of Web-based delivery of content was low due to technical problems with the Internet courseware used. Overall satisfaction with the CD-ROM for students who used all the components was improved substantially, compared to the Web-based delivery method.

Information technologies, health, and "globalization": anyone excluded?

Modern information technologies and worldwide communication through the Internet promise both universal access to information and the globalization of the medico-social network s modes of communication between doctors, laboratories, patients, and other players. The authors, specialists in public health and members of an association that aims to create opportunities for access to training in public health in developing countries, warn that the use of the term "globalization" ignores the reality of the "digital divide," that is, the fact that social inequalities may preclude the realization of this promise on a truly global scale.

Hypermedia-assisted instruction: authoring with learning guidelines.

The use of computers in nursing education has evolved from elementary drill and practice tutorials to challenging presentations. Hypermedia technology has emerged as a powerful method of instruction that allows the user to experience new concepts, gain cognitive skill, and encounter realistic clinical situations in a no-harm environment. Hypermedia incorporates sound, video, graphics, text, and interaction. This article describes the process used to develop a CD-ROM for adult cardiovascular nursing that can be used as an interactive instructional program. A description of the use of Gagne's instructional design theory is incorporated as a framework to guide the project. Educators possess knowledge expertise and must become involved in the design of new teaching methodologies. If instructional design principles are followed when using authoring software, learners are motivated with real, challenging, life-like, nonthreatening scenarios to expand their critical-thinking and decision-making skills.

A CD-ROM tutorial for physical examination.

In 1998 the Committee for University Teaching and Staff Development (CUTSD) awarded a grant of $47,975 to develop an interactive CD-ROM tutorial program to facilitate teaching the process of physical examination of the abdomen, lungs and thorax, to students of nursing. This program was developed to complement current teaching methods and make it possible for tutors to use the available class time to further address students' individual learning needs. It was developed to enable flexible delivery of content, to provide a front seat view of the demonstration of the procedures, and simulated practice opportunities in the safety and privacy of computer simulation. The program was not intended to replace hands-on practice as this learning medium does not address the kinaesthetic component of performing physical examination but it is expected to hasten the development of confidence in practice by strengthening the user's knowledge of the techniques and the sequence of physical examination. Through providing the opportunity to elicit inspection, palpation, percussion and auscultation examination findings in the context of 10 case studies of patients with health problems, it is also expected to facilitate recognition of abnormalities and their significance for health care students who have little clinical experience. The program has been evaluated by senior nursing students for technical problems, effectiveness as a learning aid and user friendliness. Over all, 92% (n=38) of the students considered that the program assisted them to learn physical examination of the abdomen, thorax and lungs and 95% were satisfied with the quality of the product and found that the sounds and images helped their understanding. The content of the program was considered to be logically sequenced, to have assisted understanding, and the case studies were a valuable learning aid. The evaluation data from this trial also indicates that students would like to learn about physical examination of other body systems using this medium.