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Using Web-based Distance Education Tools to Promote Health Care Research in Developing Countries

by Sloan-C

ABSTRACT
This paper discusses how asynchronous learning tools can be applied to distance learning as well as to the research agenda of faculty. It begins with a description of the type of training and skills that are required to transform a traditional class into an interactive distance education course. The author describes the types of training and strategies that are required to promote interactive learning among distance education students. Next, the paper describes how these same tools and skills can be used to promote collaborative research in a multi-country healthcare evaluative research project. It discusses how the MEASURE Evaluation Project, which is sponsored by the United States Agency for International Development, is using asynchronous learning tools to engage scholars in 14 countries in collaborative research. It describes the type of training that is required as well as the type of support services that are needed to assist scholars in developing countries to take full advantage of web-based tools in their research and teaching.

I. INTRODUCTION

Faculty who use the Internet and e-mail and other information tools in their teaching are beginning to incorporate these tools in their research. For some, federal agencies and private foundations will influence the use of Internet tools in research activities. Recently organizations such as the National Science Foundation, the National Institute for Health, the United States Agency for International Development and private foundations such as the Mellon and Ford foundations are requesting that research proposals incorporate strategies to use information technology in dissemination and collaboration efforts. This task will be easy for faculty who are currently using information technology tools in teaching. It will be more difficult for those that have yet to employ computer-based telecommunication tools in the classroom.

The push to use the Internet and other information tools in research efforts will also come from faculty--the early adapters who have experimented with ways to promote interactive learning through the use of the Internet in their classrooms. Many enjoy the intense and rapid interactive learning that takes place as a result of instant dialogue and the availability of information from a variety of different sources on the World Wide Web. They realize that these same tools can promote the creation of knowledge. Draft research papers can quickly be reviewed and discussed using e-mail, and asynchronous discussion forums. Dialogue on research findings can take place among a large group of scholars without worrying about the physical location of individuals since access is instant and the costs of sharing papers and data sets are low.

This case study presents my experience of employing instructional technology in my teaching, and consequently my research. The first part discusses the transition from traditional classroom teaching to the delivery of courses at a distance using web-based asynchronous learning tools and e-mail. Next, I discuss how these skills and tools are being used to help implement a large research project at the Carolina Population Center, University of North Carolina at Chapel Hill.

II. THE TRANSITION TO ASYNCHRONOUS DISTANCE LEARNING

Students learn through a variety of different channels including lectures, readings, assignments, and from each other. The primary reason why I integrated web-based information tools into my teaching was to increase student-to-student learning. Another objective was to help students develop the types of communicative and research skills that will be required in the next century.

To transform my teaching, I selected a course that is highly interactive. Plan 46, Introduction to Urbanism and Planning, is an introductory undergraduate course that exposes students to the planning profession. In the course students are required to participate in class discussions and group problem solving exercises. We discuss current events and community problems such as traffic congestion, declining industries in cities, high levels of pollution and crime. This course is usually taught in the fall semester to about 30 students, mostly juniors and seniors who are interested in exploring their options for graduate school. Prior to 1996, it was taught as a conventional classroom course.

A great deal of training and preparation was devoted to adding information technology tools to the course. In our university, the Center for Teaching and Learning and the Center for Instructional Technology work hand-in-hand to help faculty employ web-based communication tools in their teaching. I attended a series of training workshops sponsored by both centers. In the Center for Teaching and Learning, workshop topics included the following: a) theories of learning; b) skill needs of students---analytical, evaluative and problem solving skills; c) strategies to facilitate interactive learning, and d) ways to link learning objectives with information tools. The key objective of the Center was to change our approach to teaching. I moved from being "a lecturer of knowledge" to "a facilitator of knowledge." Through their sessions, I learned strategies to promote collaborative learning among students.

The Center for Instructional Technology played a valuable and supportive role throughout the process. Their staff taught me to design home pages and to use a range of communication tools to meet my teaching objectives. The Center also provided consultants to help me with problems that emerged during course design and implementation. Their staff continues to play a vital role in keeping me abreast of new tools that can be applied in both teaching and research.

Another useful activity that helped in course design and implementation was my involvement in a support group of faculty. All of us were exploring ways to incorporate web-based tools into our teaching. We discussed our needs and problems in monthly meetings. Some of the topics included: a) strategies to effectively use and monitor discussion forums; b) alternative time management skills (given the flood of e-mail messages from students and the numerous conversations on the discussion forums); c) legal issues including copyright protection issues as well as concerns about privacy; and d) alternative ways to help students develop Internet skills. Through these meetings, solutions emerged. The Center for Instructional Technology organized the support group and published our solutions and issues in a newsletter called "New Chalk." The Center also developed a web site where faculty could share their home pages for their courses.

To learn outside the campus, I attended local and national conferences and workshops that focused on the use of information technology in the classroom and distance education. Through the Asynchronous Learning Network course, "Getting Started with Online Courses," sponsored by the Alfred P. Sloan Foundation, I had an opportunity to be a distance education student for several weeks. I learned first hand the problems of juggling a full time job while trying to take a course at a distance. The experience was extremely useful in helping me design my distance education course. I learned that it is necessary to give short simple assignments that can be completed quickly, given the busy schedule of non-traditional students. I also gained insights on the number of assignments that students can perform in a given semester.

Instructional technology tools were used in PLAN 46 for the first time in the spring of 1996. I developed a home page for the course, incorporated web sites into my reading list, introduced select multi-media tools and integrated asynchronous discussion forums into student assignments. A key activity in the course was the use of web-based discussion forums where students discussed political and economic issues facing the state. One of the topics selected was the expansion of large corporate hog farms. At that time, there were more hogs in the state of North Carolina than there were people. Hog manure was leaking into our rivers, streams and ground water. Most of the students came from communities that were affected by the expansion of hog farming.

The discussion on hog farming was centered on a collection of web site readings that were written by one of the local newspapers. While it took seconds to add the web-based readings and the discussion forum to the home page, the identification and selection of web sites, and the crafting of discussion questions for the forum took a great deal of time. Based on student evaluations, the course was highly successful. Through learning about an environmental problem, students developed skills in using the Internet. They learned how to use discussion forums to exchange ideas, employ search engines to identify resources and use e-mail to communicate with their classmates and teacher.

In the fall of 1996, and spring of 1997, Plan 46 was taught to promote dialogue and interaction among two types of students, in-class UNC-CH students and online or distance education students. The spring 1997 course was my largest class, with 36 in-class students and 13 distance education students. I used discussion forums to engage both types of students in discussions on urban and rural problems facing communities including affordable housing, economic development, neighborhood and community development, and environmental issues.

The primary objective of including distance education students in the course was to promote classroom diversity. Most of the on-campus students are from the state of North Carolina and are usually between the ages of 20 and 22. Distance education students were older and lived and worked within the state as well as in other states, including California and Florida. Most of my distance education students were involved in community volunteer efforts and wished to develop insights on how cities are managed by local government. A few were collecting course credit to continue their education. One of the distance education students is now a graduate student in our master’s degree program.

While the student body expanded to include distance education students, the course objectives remained the same. The objectives of the course were: a) to provide students with basic planning skills that will allow them to investigate and design solutions for a broad range of problems facing their community and city; b) to help students improve their written communication skills; and c) to help students develop basic Internet skills to communicate and access information through the World Wide Web.

To offer the combined course, I had to develop a clearly written Lesson Guide for the distance education students. Staff of the Friday Center for Continuing Education assisted me in preparing the guide. The challenge was to develop a guide that would excite distance education students about the planning profession. It took about 3 months to write and finalize the Lesson Guide. The Distance education students enrolled via the Friday Center for Continuing Education which is our university’s extension program. Their staff worked closely with me in developing the Lesson Guide and the home page for the combined course.

To promote dialogue among the two groups of students, a new component was added to the course. Both groups of students played SimCity 2000, which is an interactive urban planning game that can be played individually or by groups of four on the Internet. Students become the Mayor of a city and build it from the ground up. The game forces students to deal with problems of urban decay, unemployment, pollution, and traffic congestion. I also introduced the use of video in the course. Students reviewed a brief video of Washington, D.C.’s, comprehensive plan for the 21st century and read the accompanying urban design plans. Both groups of students shared their ideas on how they wanted their capital city planned via discussion forums.

For class readings, I integrated articles and textbook readings with web sites on city planning. Web sites included comprehensive plans, growth management policies, zoning ordinances and economic development plans. To help students access library resources, I included links to virtual planning libraries on the home page. I found that all students enjoyed the convenience of web site readings and many followed hot links to articles on similar subjects.

One of the greatest tasks that I faced in the joint class was to build a sense of community among students who would not have face-to-face contact. Developing community among both groups of students took a great deal of effort. I used discussion forums to build a sense of belonging to the class. I utilized an incremental process to build community. The first assignment was student introductions. The next assignment had them share something about themselves---their views on the ideal city. Many shared their inner thoughts on their favorite cities and the types of communities where they wished to live, work and play. Next, I had them discuss something they all shared in common, their views on the expansion and design of our national capital, Washington, D.C. The Web offered a wealth of information on the city. Part of their task was to share web sites to help each other complete the assignment.

During the spring of 1998, Plan 46 was offered solely as a distance education course. By that time, I had discovered how to effectively use discussion forums to promote dialogue and engage students in group problem solving case studies. I had also learned how to become a facilitator of knowledge. Most of the time was spent encouraging the students via their assignments to engage in student-to-student learning. A great deal of time was spent sending e-mails to students concerning their assignments as well as commenting on their work. It should be mentioned that the spring 1998 course was small, about 8 students. Given that I had about 30 e-mail exchanges per student, and about 150 postings on the discussion forums, I intend to keep the course under 20 students.

Lessons Learned
First, teaching objectives must be redesigned to focus on interactive learning. Second, it takes a great deal of effort to identify strategies to promote community among all students—in-class and distance learning students, and among distance education students. Building community was a continuous process of designing assignments that would incrementally get them to come together as a class to undertake group problem solving case studies.

I also learned that one needs a strong instructional team to offer assistance along the way. This includes: a) computer staff---training in the use of emerging tools and advising on hardware and software needs; b) legal experts to explain copyright issues and privacy issues; c) library scientists—to discuss ways to evaluate documents found on the Web, and to assist in building resource libraries for the course; and d) monthly support group sessions to discuss ways to use discussion forums, chat rooms, and new teaching software for course management.

I also discovered that students, in-class and distance learning students, become more engaged in their own learning experience through web-based technologies. They used the Web to explore topics and issues, which in many instances brought them back to books and journals to examine issues in more detail. They also used the discussion forums and e-mail to learn from one another.

Since students were able to see their classmates’ work posted on the Web, the quality of their assignments improved greatly. The Web allowed them to compare their individual and group work with others. Please note that I built this into the course. I had them post draft assignments on the discussion forums and critique each other’s work.

Overall, I observed that through the use of telecommunication tools, I could engage all students in dialogue and in interactive learning. I also found that when students can interact at times they choose, the quality of their work improves tremendously.

III. APPLYING ASYNCHRONOUS TOOLS IN RESEARCH

The mission of institutions of higher learning is to educate students and promote the creation of knowledge through research. A great deal of attention in recent years has focused on the use of Internet based telecommunication tools in teaching. Information tools including the Internet and e-mail can also be used to promote the research mission of institutions. As mentioned previously, faculty who are using these tools in the classroom and/or in their distance education courses have begun to use information tools in collaborative research.

In this section I show how information tools are being employed in a large international research project. A number of universities are engaged in implementing multi-country research projects that are sponsored by foundations and/or the federal government. The objective of this section is to generate ideas on ways to use telecommunications effectively in research activities.

The Carolina Population Center of the University of Carolina along with several sub-contractors was recently awarded a five year contract by the United States Agency for International Development (USAID), The MEASURE Evaluation Project, 1997-2003. The Project focuses on developing and testing new tools to monitor and evaluate population and health programs. Over the life of the Project, staff will collaborate on research and provide technical assistance to over 14 developing countries. (See http://www.cpc.unc.edu/measure/.)

The Request for Proposal from USAID requires the Project to employ e-mail and web-based tools to disseminate project documents and data sets, and to promote collaborative research. I helped develop this part of the proposal by relying on my experience in using telecommunication tools in traditional and distance learning courses. Tools such as discussion forums, chat rooms, e-mail, virtual libraries and other telecommunication tools can easily be adopted to engage others in collaborative research. It should be mentioned that the Center employs a highly trained computer staff to assist in these efforts.

The objectives for using information tool in the MEASURE Evaluation project are to promote the exchange of knowledge among scholars who are at different stages of development, engage in collaborative research, and disseminate research findings to policy makers and scholars.

We intend and/or are currently using information tools to:

• Collaborate on research projects within and among countries
• Discuss the use of alternative evaluation methodologies
• Disseminate results on evaluation research
• Share data sets
• Obtain feedback on scholarly work from others, and
• Engage in distance learning

Strategies underway are discussed below. I hope the activities presented will encourage others to explore ways to integrate information tools into the research mission of the university.

A. Training Needs of Scholars in Developing Countries
As mentioned previously, the Internet and e-mail can be invaluable tools to promote collaborative research. However, to use these tools effectively, scholars must develop a set of new skills. These include strategies to search for relevant materials, skills in evaluating the quality of documents found, knowledge of web design, skills in using discussion forums and chat rooms, and a basic understanding of how to send e-mail attachments. An understanding of copyright protection issues and issues of privacy is also useful, especially for those who intend to develop web pages. Knowledge of File Transfer Protocol (FTP) is also needed to publish and update web sites, and to transfer data sets.

Few researchers in developing countries have developed all of the skills mentioned above. To develop and/or expand research partnerships, it is necessary to offer Internet training. We are using two approaches to help scholars develop Internet skills. First, we provide links to Internet tutorials at our web site for those who wish to use our web site to collect materials. In my courses, I discovered that many students, especially non-traditional students were new users of the World Wide Web and needed assistance in learning how to navigate the Web. The same is true for scholars and government officials from developing countries.

For those countries where we will be working, we bring individuals to our campus to participate in our Summer Institute on Monitoring and Evaluation for Population, Health and Nutrition Programs. As part of their training, they receive instructions on using the Internet and e-mail.

Over the life of our project, the MEASURE Evaluation Project will sponsor a four-week summer training program on monitoring and evaluating health programs. During the summer of 1998, we brought 35 participants to our campus from 16 developing countries. Regions of the world included Asia, Latin America, the Caribbean, and Africa. All of the participants were engaged in health care evaluation research. Participants were university faculty, physicians, and/or senior health officials. The training modules primarily focus on program evaluation methods. However, about 12 hours are devoted to the use of telecommunications tools. Participants learn how to: a)exchange information through asynchronous discussion forums; b) develop home pages; c) use e-mail (listserve) to disseminate research findings; d) use search engines and directories, and virtual libraries to identify evaluation research; e) evaluate the quality of materials from the Internet, and f) understand copyright protection and fair use policies.

To identify key topics of interest for training and gain insights into access issues, we conducted a survey among the participants. All of the participants were using e-mail at work. Many had access to the Internet including the World Wide Web at work, particularly in Latin American, Caribbean countries and Asian countries. Those without access to the Web, which included many of our participants from sub-Saharan African countries, were in the process of acquiring the Internet in their offices. Many participants from Latin American countries had computers and servers at home. All of the participants wished to develop skills in using search engines and designing home pages.

Our training goal was to help participants develop information technology skills so they could obtain web-based information to help them improve their efforts in monitoring and evaluating health care programs. We also wanted them to exchange ideas among their classmates using discussion forums and e-mail including listserve. The intent is for them to use these skills to:

• Engage in dialogue on the use of evaluation tools via web-based discussion forums
• Share experiences including problems in monitoring and evaluation activities with others through the use of discussion forums
• Disseminate their reports to others via e-mail and the World Wide Web
• Identify and receive the latest information on reproductive and health research through the Internet
• Engage in distance learning, and
• Receive monitoring and evaluation project documents via the World Wide Web

We will work closely with many of the participants in the coming years on collaborative teaching and research. However, to fully understand the impact of our training on their research activities outside of our project, we will conduct follow-up surveys.

B. Building a Virtual Library: MERLIN
I used virtual planning libraries with my in-class and distance learning students. The libraries allowed students to access resources on topics of interest to them. For distance education students, many of whom worked full time, the libraries allowed them way to engage in research at their convenience.

For our research project, we would also be working with a very busy audience. I also discovered that there are few virtual libraries that focus specifically on monitoring and evaluating population and health programs in developing countries. In addition, many physical libraries in Asia, sub-Saharan Africa and Latin American countries do not have up-to-date books and journals. To assist scholars and program evaluators in gaining access to journals and papers, we decided to develop a virtual library. The name of the library is MERLIN, an acronym for Monitoring and Evaluation Resources for Learning on the Internet. The library provides hot links on evaluation resources, data sources, and electronic journals of interest to those engaged in population and health evaluation. It also has an extensive bibliography on population and health articles, manuals and books. The library will also aid in disseminating the publications of the EVALUATION and MEASURE Evaluation Projects, which provide innovative approaches to monitoring and evaluating health and population programs.

We want the library to be interactive. It will grow in part by user suggestions of web sites. Our library includes a search component to help users define their specific needs and provide web-based links to those resources and documents. We also have Internet tutorial links for those just learning how to navigate the Web. The web site for MERLIN is http://www.cpc.unc.edu/measure/merlin/merlin.html.

C. Distance Learning Activities
Our research project includes efforts to promote distance learning. Of the summer participants who were faculty, many would like to use the Internet for research and teaching. Through funding from the Mellon Foundation, we will train faculty from select institutions to offer web-based distance education courses. We will use our university’s model of integrating theories of collaborative learning into instruction on the use of web-based information tools.

Other participants were interested in taking distance education courses to update their skills. The Project will offer distance learning modules to help meet their needs. The modules are also available to anyone who has access to the Web who is interested or engaged in monitoring and evaluating health and population programs. The primary objective of offering distance education is to improve the quality of health care evaluations. By the end of the project, anyone who has access to the Web can take a short course on monitoring and evaluation methods in the following areas: a) Family Planning, b) Maternal Health, c) Child Survival, and d) STD/HIV. Each Module will have a class home page that includes the learning objectives, readings, exams and additional resources. Faculty in the School of Public Health are developing the modules.

The distance learning modules represent an alternative approach to distance education. The modules are not for university credit. It is for those who wish to engage in skill development. The modules are similar to Internet tutorials. Individuals complete the modules at their own pace. Over the life of the project, we expect thousands of people to take the courses. The modules will be open to the public and free of charge.

D. Sharing Data Sets
We are making data sets produced by the Project available for analysis by others via our web site. Currently, the Tanzanian Family Planning Service Availability Survey of 1994 and 1996 is available for downloading. Information is provided under the link called data on our home page. At this web-based page site, we also provide variable lists, and code books. The data set can be downloaded by those with access to FTP software. Efforts are also underway to make this an interactive analysis web site where users can do simple descriptive statistics.

The availability of data sets will foster collaborative analysis and writing among scholars and students within our project. However, it can also foster joint scholarly work among others on a global basis.

In time, we expect the Internet to play a vital role in collecting primary data. As access to telecommunication tools increases, we can expect faculty to use e-mail surveys and web-based questionnaires to conduct research. One of our participants is exploring ways that the World Wide Web can be used to collect health care service statistics from public and private health care clinics to monitor service delivery.

IV. SUMMARY COMMENTS

Most institutions of higher learning are using information tools in traditional and distance learning courses. Increasingly, faculty are using the Internet and e-mail in their research activities. Tools such as home pages, asynchronous discussion forums, chat rooms, e-mail and FTP can be used to share data sets; organize conferences; jointly write proposals and research papers, and engage scholars on a global basis in dialogue on research issues of interest to them. Researchers can also conduct library research given the growth of electronic journals. This paper offers a glimpse of how information tools can be used in both teaching and research.

Please visit the web site for the Carolina Population Center to explore other ways that faculty and staff are using telecommunication technologies to promote the research agenda of the university: http://www.cpc.unc.edu/

V. ABOUT THE AUTHOR

Linda Lacey is a Professor of City and Regional Planning at the University of North Carolina at Chapel Hill. She received her undergraduate degree from the University of California at Berkeley and her Master’s and Ph.D. in Regional Planning from Cornell University. Through a technology grant from Chancellor Michael Hooker, she developed a distance education course in her department. She is also a research fellow at the Carolina Population Center, where for the past 17 years, she has been engaged in collaborative international research projects sponsored by the United States Agency for International Development. She is also the Associate Dean of the Graduate School with responsibility for developing distance education policies for graduate programs at the University of North Carolina at Chapel Hill.