Web-based instruction in learning nutrition.

Web-based instruction is a new way of teaching popularly adopted at all levels of schooling and it has drawn a great deal of attention in higher education. Web-based instruction has the potential for improving the quality of education by supporting the dissemination of skills and knowledge in a holistic approach. This paper illustrates how web-based instruction can be used to complement formal instruction of a basic nutrition course. Students' responses toward the learning experience were gathered. Instructional implications related to the use of this mode of learning were addressed.

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With the advent of Internet technology in recent years, various computer-based learning courses employing modern techniques have been developed to assist learning. The appropriate application of the Internet supports the dissemination of skills, and knowledge in a holistic approach, not limited to any particular course, technologies, or infrastructures (Henry, 2001). As the ubiquitous World Wide Web (WWW) becomes widely applied to educational setting, attempts have been made to translate the technological advances into solutions to various school problems. The WWW, with its increasing capacity for multimedia, multimode communication and information presentation, easy access to an ever-growing body of information and new way of data representation, has provided educators with exciting opportunities to enhance teaching and learning (Zhao, 1998). In teaching nutrition and health issues, web-based instruction also provides various options for experiential learning.

The WWW is multimedia and hypertext by its very nature (Stover & Zink, 1996). In learning nutrition and health knowledge, it allows users to search learning resources or databases to fulfill their learning curiosity and accomplish their learning tasks. WWW is also a visual learning tool for providing food and nutrition content. When viewing a home page, the user can click icons or buttons to view graphics, pictures, text, and video. With various learning supports available on the web-based environment, WWW offers a popular learning tool for nutrition education, and an increasing number of efforts have been directed to promoting more widespread effective uses of technology.

In this study, the web-based learning approach was integrated into a traditional nutrition course. Web-based instruction was provided, aiming to encourage students to use the Internet as a tool for learning nutrition content. With the already developed resources on food, and a task-oriented approach employed in class, students interacted actively with related resources available on the web. This paper reports how web-based instruction was developed and applied, and how students reacted to web-based learning.

Instructional Application The success of computer-based learning has been demonstrated in the training of dieticians for many years (Shah, George, & Himburg, 1999). Complementing formal instruction, computer-based instruction has been applied to meet general didactic curriculum requirements and the American Dietetic Association Standards of Education for Foundation Knowledge and Skills for entry-level dieticians. Other than dietetics, computer-based instruction has been implemented successfully in the training of professionals in some health fields. For example, it has been employed as self-study tools to improve learning and retention of fundamental concepts and clinical thinking skills (Shah, George, & Himburg, 1999).

During recent years, the Internet technology has changed ways of learning. Traditional computer-assisted nutritional instruction has shifted from providing a standalone individual learning to the web-based learning environment. In a web-based nutrition course, the student's use of computer and Internet technology to facilitate learning is emphasized. Also, information is received and assimilated at a pace set by the user. The use of web-based learning activities, such as email or online discussion, synchronous or asynchronous communication encourages students to learn actively (Dewald, Scholz-Grane, Booth & Levine, 2000).

A web format is particularly suited to the learning of medical and applied life science area. Web-based learning has been widely applied to the life science or medical field to reinforce what students have acquired in classroom, laboratory, or small group activities (Dev, 1997; Klatt, 1997; Grange, Bunker, & Cooper, 1997; Lehmann, Lehmann & Freedman, 1997). A visually oriented discipline that evaluates the gross and microscopic condition of tissues or organisms is essential to provide a successful learning experience among students. With emphasis on learning nutrition concepts, the use of visual representation is also critical in creating real-life experience that allows students to relate the materials with their daily food intake. In addition to learning content, the access to digital resources also permits exploration of different information resources.

Development of Web-Based Nutrition Lesson

To promote right nutrition concepts and appropriate food intake, a web-based learning lesson, entitled "Vitamins and Health", was developed for a basic nutrition course. The learning materials cover the introduction of various vitamins, and how these vitamins influence human health. The daily requirement of each vitamin, its deficiency symptoms, food sources and nutrition compositions of foods are also provided with fruitful visual information. By viewing the pictures showing the quantity per serve of each food and its vitamins content, students would be able to relate the visual materials with their food intake. In addition to basic learning content, the website provides students with on-line discussion opportunity for communicating and sharing ideas. Students were encouraged to post their questions or responses related to nutrition topics.

The learning lesson was created using Dreamweaver and Flash, the commercially available application software for producing HyperText Markup Language (HTML) document. The lesson provides a menu-based learning interface, allowing students to enter the information stream at a variety of points, rather than being forced to follow a predetermined path.

The website also allows students to submit their daily food record and assess their own nutrition status according to their daily food intake. With links to digital resources, students could access information related nutrition provided by government agencies, schools, institutions, and hospitals. In fact, the web-based learning opportunity enables a much more open and less restricted form of instruction in terms of the specific learning outcomes to be achieved within the course. As noted, a web-based learning course should provide students with the broad goals that are to be attained, while leaving them with substantial latitude and initiative to pursue their own goals (Carr-Chellman, 2000). The flexibility of this mode of learning is expected to lead to a diversity of learning outcomes among students who are pursuing their individual interests, all within the context of the common course.

Web-based learning allows more active learning, since the use of web-communication often encourages a high quality person-to-person communication. Three instructional attributes that construct the need of using web-based learning are emphasized in the instruction: (1) a visually learning tool, (2) a task-oriented approach, and (3) learning with resources.

A visual learning tool

WWW offers learners the opportunities to accommodate their preferences for processing sensory information (Ross & Schulz, 1999). In recent years, the increased availability of design tools has also permitted the design of instructional materials that incorporate unlimited variations and forms of verbal and visual information to fulfill learners' visual need (Parkash & Mathur, 2001).

With the help of various design tools, the visual representation of Vitamins and Health aims to foster potential learning interest and stimulates viewer's attention. Online course animation, hypertext, or clickable diagrams and pictures are used to clarify concepts that a static textbook image simply cannot. The use of images, motions, and dynamic features of the learning tool, also makes a scientific phenomenon easily comprehended by learners. The design of graphical user interface in the web learning environment also plays an important role in determining the nature of the knowledge structures users develop.

It is suggested that the use of students' mental models is enhanced if the appropriate visual interface provided, and there is potential effect on long-term retention (McDougall, Curry, & de Bruijn, 2001). Research has shown that the knowledge structure of individuals would change as a result of learning and experience (McDougall, Curry, & de Bruijn, 2001). With visual scenario provided, web-based learning creates an interactive laboratory environment that allows students to manipulate lab objects to simulate a laboratory class in microbiological learning (Andrew, 2001). Several medical schools, such as the University of Iowa and Johns Hopkins University, have explored the use of videos through WWW in learning various human systems. Students might interact with the visual images presented on the screen in a dynamic way, and learn more efficiently (McLean, 1996).

Learning Vitamins and Health also encourages a sense of real-life experiencing. With well arrangement of web-based activities, web-based learning materials can simulate the real-world environment, allowing students to be actively involved in their learning (Lehmann, Lehmann & Freedman, 1997). For learners who prefer learning by doing, the lesson also provides the opportunity to "put theory into practice". It is considered that through the process of practicing problems, doing lab experiments, creating solutions, doing physical activities, engaging in manipulative exercises, and brainstorming ideas, the dynamic web-activities can create potential learning involvement (Ross & Schulz, 1999).

Task-oriented approach

According to constructivist pedagogy, learning occurs when individuals using their experiences as a basis to construct knowledge personally from internal representations. Lacy & Wood (1993) address that in learning activities, knowledge is built on individual constructions that are not tied naturally to the learners' interaction with an external world. Students need to explore the "just-in-time" instruction to create their own knowledge. A task-oriented approach provides potential merit in helping students develop necessary skill experience and encourage learning motivation (Huang, 2000). Since learning through WWW requires students to devote their time and effort to completing their learning task, the learning environment should also provide sufficient resources to facilitate active learning and exploration.

To foster active interaction with instructional materials, Vitamins and Health employs a task-oriented approach to create a need of knowledge among students. Students are requested to record their food intake and self-analyze their nutrient status based on their own nutrition requirement. This level of authenticity is necessary to sustain students' interest and activity in the hypertext environment. Students can search for relevant information pertinent to their learning goals through the wealth of information and learning resources available on the Internet (Jonassen et al., 1995; Wilson, 1996).

As suggested, web-based instruction can be centered on the set of student tasks (projects or assignments) that constitute the learning experiences that the students will engage in, either independently or collaboratively (Carr-Chellman & Duchastel, 2000). Through the assignment of a given task, students would be able to learn by doing and experiencing. They were "also encouraged to assess their own progress, and invoke a multitude of strategies to a given task. The use of task-oriented approach provides a chance for students to master the objectives of the course. This emphasis on tasks to be accomplished as the primary structuring element within the course is in line with the trend in instructional design toward a problem-based learning environment and toward the general goals pursued within that instructional design framework (Savery and Duffy, 1996; Carr-Chellman & Duchastel, 2000).

Learning with resources

Web-based instruction must encourage learners not only to memorize information, but also to use the information. Students should interact with the instruction in some way in order to integrate the new information into their existing knowledge structure (Liaw & Huang, 2000). Giber & Moore (1998) also address the issue that educators must know the features of web learning. With the purposes of either task/instructional competition or social relationship building, interactivity can be achieved in a more meaningful way.

Within the website, Vitamins and Health provides links to information about how to access various medical and nutrition related websites, including government agencies, medical institutes, and non-commercial resources. Students have access to resources and expertise outside their classroom. Resources can be evaluated not just for their accuracy or authority, but also for how they add different perspectives to an issue, or how they approach to a topic.

Siering (1998) addresses that the web resources can be used in a more interactive way. From this perspective, students are encouraged to engage the web activity in a more synthetic way. By promoting the process of interactive and expressive nature of web learning, new knowledge is socially constructed, more meaningful learning is fostered. Through Vitamins and Health, students can gain various cognitive experiences, including thinking, learning, and communicating. The instruction delivered through WWW involves the content of the subject matter as well as the processes employed by students to explore the knowledge world.

As emphasized by Tetiwat & Igbaria (2000), with this mode of learning, students have more opportunities to acquire knowledge of the world because this mode of learning creates greater academic accessibility and flexibility in schedule, which meets many students' varied demands. Lifelong learning also can be fostered (Porter, 1997). Convenient access for students from remote locations provides greater availability of higher education to a larger cross-section of society.

Process of Assessment

Evaluation of the web-based learning on Vitamins and Health was conducted among college students who enrolled "Nutrition and Health" course. The objective of the course is to help college students (non-nutrition major students) to acquire nutritional concepts and eat healthily. In addition to vitamins, several nutrition topics, such as carbohydrates, proteins, fats and minerals were covered in the course. The web-based learning lesson, "Vitamins and Health" were used as an individual learning resource and a supplement to the course. Students were required to study the materials and complete the assignment on the web. They were also encouraged to learn collaboratively through online discussion. The web-based learning lesson offered students with an after-class activity, a different learning experience, and an option of interaction with knowledge.

To fulfill the course requirement, students had to submit two assignments in electronic form. In the first assignment, students were asked to record their food intake of one day before learning the instructional materials. After learning the instructional content, the second assignment was given, and students were asked to evaluate carefully the amount of vitamins contained in their diets and make adjustment according to their own daily requirements. They were also required to provide the reasons why they made the changes. Through the critical analysis, students would be engaged in evaluating their food intake on a nutrition basis. The assignment counted 10 points.

In this course, the mode of learning is less dependent on the acquisition of information from lectures, but more dependent on the application and use of such information in real-world settings. Students were given the tasks to be accomplished in order to fulfill the class requirement. The task-oriented approach provided students with authentic learning opportunity and optimized students' involvement and engagement with the subject matter. Through the wealth of information and learning resources available on the Internet, students can search for relevant information pertinent to their learning goals. For example, in addition to the resources provided at the website, students could also access to the food bank of Department of Health, Taiwan for obtaining more information on food to accomplish the learning task.

At the end of the course, a take-home test was given. Students were provided with two problem cases. In the first case, students were asked to analyze according to the situation given whether there was vitamin deficiency in a particular case. To tackle the problem, students had to use the nutrition components of each food provided in the website, calculate the nutrition intake of each food, and then check the daily food intake against the suggested requirements. In the second case, students were asked to design a dietary plan for a pregnant woman. They had to choose various food sources and evaluate whether their food plan met the suggested nutrition requirements. If not, they needed to make adjustment. The take-home test also counted 10 points.

In addition to the take-home test, the affective responses regarding their reactions toward the instructional materials were also gathered. A questionnaire containing both closed-ended and open-ended questions was given at the end of the course. Fourteen of the closed-ended questions contained in the questionnaire aimed to assess students' responses toward the design and application of the instructional materials. Students chose one of the following responses, "agree", "no comment", and "disagree" to represent their reactions toward each statement. In the open-ended questions, students were asked to describe in words their reaction toward the instruction.

In summary, students' learning was assessed through the following:

* Two electronic assignments recording their individual food intake: one was gathered before learning the instructional materials, and the other after.

* A take-home test containing two problem tasks. Students needed to engage in analyzing and evaluating in order to accomplish the given tasks. The test was given at the end of the course.

* Reactions toward the instructional materials. Students needed to fill out the questionnaires after learning from the instructional materials.

Results

Assignment and Take-home Test From the first assignment, the data showed that most students could not make good choices abouth their food intake. On the 1-10 scale, the mean assignment score among students was 4.95 (SD = 0.22, n = 61). However, in the second assignment, not only were students capable of evaluating their food intake, they were also able to make better food choice and nutrition assessment. Most students improved in making judgment on their food choice. The mean assignment score for the second assignment was 8.03 (SD = 1.673, n = 61). The pair-comparison indicated a significant difference between these two assignments (t = 14.713, df = 60, p = 0.000) (Table 1). Most students improved their learning in the second assignment.

The take-home test conducted after learning also indicates that most students successfully achieved their leaning goal. The mean test score for the second assignment was 8.623 (SD = 1.439, n = 61) on a 1-10 scale. Most students were able to evaluate vitamin deficiency in a given case, and design dietary plan on a nutritional basis.

Evaluation of the Web-Based Instruction

Part I of the questionnaire contains 14 statements, which aim mainly to obtain students' views towards the web-based instruction (WBI) provided. Most students showed a positive attitude towards the WBI and found that it helped them learn. A summary of the students' responses is listed in Table 1. As can be seen, more than 70% of the respondents (n = 61) agree to items 1, 2, 3, 5, 7, 10, and 13 (positive statements), and over 60% of the respondents disagree to items 4 and 14 (negative statements). However, the responses from items 6, 8, 9, 11, and 12 indicate a need for improving the instructional materials from various aspects, including web assignment, discussion, pictures, and time for loading pictures.

Qualitative Data

Qualitative data gathered from the open-ended questions and the in-depth interview with students were summarized. One of the strengths of WBI that appealed most to students was the use of food pictures. Most of them commented that the use of pictures in the instruction fostered their learning in nutritional assessment.

"The pictures showing the amount of specific food sources per serve could be easily related to my daily food intake. They were very helpful. Learning with pictures was much easier than just showing the number of grams per serve."

Students also reacted that more food sources should be included. The lesson only provides 72 kinds of food. Compared with all the food variety available in the market, 72 kinds of food were not enough. "I did not use other food sources, because they were not there (within the learning materials)."

The pictures and visual information provided in the instruction might not satisfy the learning needs of all students because more pictures were needed.

The speed of presenting pictorial information was also a main concern among students. Some felt impatient toward the waiting time of loading up food images. However, most students anticipated more pictures and did not agree to read textual information as the only visual information.

Students also commented that the assignment encouraged them to apply what they learned in the instruction to practical life. However, they anticipated more immediate feedback for the web assignment. The assignments and take-home test encourage them to go through the instruction in greater detail, because they had to gather sufficient information to solve the problem tasks given. Although the discussion and feedback was often given during the class, students preferred having personal feedback from the web.

A few students had participated in online discussion, "Discussion Forum". From the online data, students drew questions from a wide variety of nutrition related issues. Some students actively provided nutritional suggestions. However, not many students agreed that the "Discussion Forum" helped them learn. Some students even had negative attitude toward the online discussion. They complained that the content of discussion was "boring". "Things (information) they (other students) put there might not be correct. I don't know whether I should believe it or not." Some students were too timid to voice their opinions on the web. "I felt more comfortable talking with people face to face. I had a feeling that if I voiced my opinions on the web, I would be talking to the whole world. That made me nervous." Many students would prefer reading the information in the discussion to expressing themselves even though they could choose to remain anonymous.

Instructional Implication

In an ideal learning world, a wide range of viable options would be available to learners, and they would have a deep understanding of their relative strengths, weakness, and attributes (Lewis & Orton, 2000). The use of Internet technology cannot guarantee effective learning unless learners' preferences and the attributes of the technology are considered. Through the assessment of students' responses toward the web-based learning materials designed, the following instructional implications are drawn.

Visual Experience

Offering students with sufficient visual learning experience is important in learning the basic nutrition content. After being given the opportunity to experience online learning, respondents indicated that they preferred the use of food pictures that suited best the content. The use of pictures helped them relate to their daily food intake easily. However, the current bandwidth problem might still limit the potential of web technology for providing sufficient visual experience. More effort should be made to fulfill students' learning needs in the content area.

Task Oriented Assignment:

The use of task-oriented approach offers students the experience to devote their time and effort to completing their learning task. The task-oriented approach also provides authentic learning opportunity to optimize students' involvement and engagement with the nutrition assessment. This level of involvement is necessary to sustain students' interest and activity in the hypertext environment. However, students' anticipation of immediate feedback from the web assignment might be a challenging task for the learning system to provide.

Online Discussion

With respect to learning, the provision of discussion opportunity did not necessarily encourage students' interest in sharing ideas and discussion of the content related issues. For future implementation, a full discussion agenda should be integrated in the course in order to offer students with more positive learning experience with online discussion. Providing opportunities for communicating with experts should also be incorporated in the web-learning environment in order to offer students with accurate dietetics concepts and nutrition suggestion.

Conclusion

With the web approach of learning, the nutrition course incorporated the use of WWW technology within learning tasks. The tools enhanced and facilitated the process of applying knowledge. During the course, the learners understood how the application worked and how they could utilize the knowledge. However, for future learning, students' knowledge needs to extend to more resources available in the Internet. More effort should be made to encourage the use of resources and online interaction.

Table 1
Comparison of the 1st and 2nd Assignments

                 Mean Score   SD         Comparison

1st Assignment     4.95      0.22    T = 14.713, df = 60,
2nd Assignment     8.03      1.673   p = 0.000 ***

*** P <0.001

Table 1
Evaluation Results of Closed-Ended Questions

                                          Agree       No      Disagree
                                           No.     Comments     No.
                Statements                 (%)      No. (%)     (%)

 1. The "Nutrition and Health" lesson       44        17         0
    contains fruitful information         72.1%     27.9%        0%
 2. The structure of the instruction        53        8          0
    is clear and easy to learn.           86.9%     13.1%        0%
 3. The textural information is easy        54        6          1
    to comprehend                         88.5%      9.8%       1.6%
 4. The content of the instruction is       7         16         38
    complex and difficult to learn.       11.4%     26.2%      62.3%
 5. The nutrition contents of various       44        14         3
    food sources provided in the          72.%      23.0%       4.9%
    instruction are useful
 6. The web assignment is helpful and       32        25         4
    meets my learning needs               52.5%     41.0%       6.6%
 7. The instruction provides links to       50        11         0
    related web sites, which is helpful   71.9%     18.0%        0%
    for future exploration.
 8. The "Discussion Forum" is helpful       22        34         5
    in encouraging group interaction.     36.2%     55.7%       8.2%
 9. The pictures and visual information     30        26         5
    provided in the instruction satisfy   49.2%     42.6%       8.2%
    my learning needs.
10. The pictures provided in the            46        13         2
    instruction are necessary for         75.4%     21.3%       3.3%
    learning the lesson.
11. The speed for presenting visual         27        29         5
    information is appropriate.           44.2%     47.5%       8.2%
12. I lost my interest in learning due      22        17         22
    to the long waiting time for          36.1%     27.9%      36.1%
    loading images.
13. The lessons should include more         51        9          1
    pictures if the speed would not be    83.6%     14.8%       1.6%
    slowed down.
14. I would rather read textual             5         14         42
    information instead of spending        8.2%      23%       68.9%
    time waiting for pictures in the
    instruction to be loaded.

N = 61

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Lih-Juan ChanLin, Professor, Department of Library & Information Science, Fu-Jen Catholic University. Rwei-Fen S. Huang, Professor, Department of Nutrition and Food Sciences, Fu-Jen Catholic University. Kung-Chi Chan, Associate Professor, Department of Food and Nutrition, Providence University.

Correspondence concerning this article should be addressed to Lih-Juan ChanLin, Professor, Department of Library & Information Science, Fu-Jen Catholic University. Email: lins [e-mail]