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Interactive multimedia for promoting physical activity (IMPACT) in children.

OBJECTIVE: To develop and examine the efficacy of a computer-based interactive multimedia curriculum for promoting physical activity in fourth grade children. RESEARCH METHODS AND PROCEDURES: The participants were 209 fourth grade children (mean age of 9.5 +/- 0.4 years) from four schools. Two schools received an 8-week multimedia intervention delivered by interactive CD-ROM, supplemented by four classroom and four homework assignments. Two control schools received educational CD-ROMS not related to health outcomes. Measures conducted before and after intervention included height, weight, percentage body fat (bioimpedance analysis), physical activity (5-day accelerometry), and psychosocial aspects of physical activity by questionnaire. All outcomes were examined using general linear models. RESULTS: There was a significant treatment effect for obesity reduction in girls but not in boys. There were no significant treatment effects on total physical activity by accelerometry (total counts per minute), but there was an overall treatment effect on reducing percent of time in moderate-intensity activity (16.5% to 15% of the time) and significant sex-by- treatment interactions for light-intensity activities (reduction in boys from 78% to 75% of the time and an increase in girls from 78% to 81% of the time). There were marginal/significant treatment effects for improvements in behavioral outcomes, including self-efficacy (p = 0.06), social norms (p = 0.07), and outcome expectancies (p = 0.049). DISCUSSION: The interactive multimedia curriculum favored an improvement in obesity indices in girls and was associated with subtle changes in physical activity in girls and general improvement in psychosocial outcomes related to physical activity.

Body Composition↗

Multimedia versus written information for nocturnal enuresis education: a cluster randomized controlled trial.

OBJECTIVE: This study evaluated the impact of child-focused information provision using a multimedia software package 'All About Nocturnal Enuresis' and written leaflets containing the same information for bedwetting children. DESIGN: A stratified cluster randomized controlled trial with data on 270 children collected longitudinally. SETTING: Fifteen school nurse-led community enuresis clinics in Leicestershire, UK. MAIN OUTCOME MEASURES: The outcome measures were becoming and remaining dry and time to dry, non-attendance and dropout rates. The psychological measures completed by children were the impact of bedwetting and Coopersmith self-esteem scales. Parents completed the maternal tolerance scale. RESULTS: No significant intervention effect was found for any of the outcome measures recorded during treatment, at discharge or six-months post discharge. CONCLUSIONS: Multimedia educational programs and written leaflets are widely used to enable children to learn more about their health-related conditions. However, our result suggests that multimedia is no more effective than traditional materials at effecting health-related behavioural change.

Adolescent↗

The value of intelligent multimedia simulation for teaching clinical decision-making skills.

This paper examines the value of using intelligent multimedia simulation for the teaching of nursing clinical decision-making skills. The possibilities of multimedia-based educational resources are examined and the rapid growth and questionable effectiveness of current multimedia computer-based learning applications for nursing students are discussed. The advantages and disadvantages of this technology and the problems developing intelligent agent-based systems are examined. A case study is presented which uses a modular design with an integrated intelligent agent and knowledge base. It is argued that by using this type of approach, the real value of intelligent CBL to provide individual formative advice to students in a simulated experience can be realized.

Computer-Assisted Instruction↗

[Improving medical education in psychosocial disciplines by multimedia tools].

The use of multimedia tools is gaining increasing importance in medical education. These tools provide adequate techniques and possibilities for education within all medical including the psychosocial disciplines. Until now, a lack of multimedia learning programs and websites providing material related to psychosocial issues has to be considered in Germany. On the other hand, a new Medical Licensure Act (Approbationsordnung fuer Aerzte) will have a dramatic impact on medical education and teaching. On this basis there is a broad need for multimedialearning-environments, covering parts of the changes demanded by the new educational standards. Considering the lack of available multimedia learning programs and the need for those tools due to the medical education reform in Germany, the rapid development, validation and curricular implementation of those programs is required. This should be a goal of high priority, especially for the teaching of issues related to medical psychology, medical sociology, and psychosomatic medicine and psychotherapy.

Audiovisual Aids↗

Impact of a cancer education multimedia device on public knowledge, attitudes, and behaviors: a controlled intervention study in Southern Sweden.

BACKGROUND: The objective was to determine the impact of a multimedia device offering information about malignant melanoma on public knowledge, attitudes, and behaviors. METHODS: Two municipalities in Sweden, Dalby and S Sandby, were chosen. The population of Dalby was exposed to the multimedia program during 1994-97, whereas the S Sandby population was not. A questionnaire was sent to random samples of the populations (10% of those aged 20-59 years) before (1994, n = 373 and n = 409, respectively) and after the intervention (1996, n = 375 and n = 418, respectively). Response rates were 74-89%. RESULTS: The groups were well balanced at baseline. In both areas women scored higher both at baseline and in 1996. Dalby women showed less fear of skin cancer in 1996 than in 1994 (2.13 vs 2.27, p < 0.01). This was not so in the controls. There was no major change in "sun behavior" in Dalby, whereas there was a negative change in S Sandby. After the intervention Dalby men had more "knowledge" (from 2.64 to 2.70, p < 0.05) and a tendency to better "sun behavior" (from 1.77 to 1.85, p = 0.076). There was no significant change over time in the S Sandby men. CONCLUSIONS: The multimedia program had a modest effect. The population in Dalby had more knowledge and changed its attitudes in a sun-protective direction. In the control area, the two-year follow-up sun behavior score was lower than at baseline. There was also significantly less fear of skin cancer after the intervention.

Adult↗

Acceptance by Swedish users of a multimedia program for primary and secondary prevention of malignant melanoma.

BACKGROUND: In Sweden, the incidence of malignant melanoma of the skin is rapidly increasing, and the disease is now one of the ten most common tumor types. The objectives were to apply multimedia techniques to increase public knowledge about malignant melanoma and its risk factors, to increase awareness of preventive measures, and to make people more disposed to change their sunbathing habits. METHODS: A trilingual (Swedish, English, and German) multimedia program was developed for two target groups, health care personnel and the general public, with a total of >500 "pages" in each language. User reactions were studied on-site at a municipal pharmacy and library, where the program was available in a kiosk with touch-screen. RESULTS: Practically all 274 users interviewed found the program easy to use and understand. 92% identified one or more of the recommendations given. 66% found the program information "worrying," and 29%--mainly young women-instantly declared that they were going to change their sun-exposure behaviors. No correlation to skin type was found. CONCLUSIONS: A multimedia program of the present design seems to be a useful tool for health promotion.

Adult↗

Implementation of depth-dependent soil concentrations in multimedia mass balance models.

In standard multimedia mass balance models, the soil compartment is modeled as a box with uniform concentrations, which often does not correspond with actual field situations. Therefore, the theoretically expected decrease of soil concentrations with depth was implemented in the multimedia model SimpleBox 3.0. The effects of this implementation on the model outcomes were explored for nine compounds in four environmental compartments. For compounds with a low penetration depth, the new model predicts substantially higher or lower concentrations in the vegetation compartment than the old model. For those compounds, predicted concentrations in surface water and air were higher in the new model, but the deviations from the old model were smaller than in the vegetation compartment. For compounds with a large penetration depth, the model adaptations show little effect. No field study was carried out to validate the results of the model calculations, but we did collect measured data on concentrations in vertical soil profiles from literature. According to those data, we concluded that the implementation of depth dependent soil concentrations might be a useful extension for steady state multimedia mass balance models. More field study has to be carried out to validate the model outcomes.

Databases, Factual↗

Providing information on metered dose inhaler technique: is multimedia as effective as print?

BACKGROUND: Metered dose inhalers (MDIs) are not easy to use well. Every MDI user receives a manufacturer's patient information leaflet (PIL). However, not everyone is able or willing to read written information. Multimedia offers an alternative method for teaching or reinforcing correct inhaler technique. OBJECTIVE: The aim of this study was to compare the effects of brief exposure to the same key information, given by PIL and multimedia touchscreen computer (MTS). METHODS: A single-blind randomized trial was conducted in 105 fluent English speakers (53% female; 93% White) aged 12-87 years in London general practices. All patients had had at least one repeat prescription for a bronchodilator MDI in the last 6 months. Inhaler technique was videotaped before and after viewing information from a PIL (n = 48) or MTS (n = 57). Key steps were rated blind using a checklist and videotape timings. The main outcome measures were a change in (i) global technique; (ii) co-ordination of inspiration and inhaler actuation; (iii) breathing-in time; and (iv) information acceptability. RESULTS: Initially, over a third of both groups had poor technique. After information, 44% (MTS) and 19% (PIL) were rated as improved. Co-ordination improved significantly after viewing information via MTS, but not after PIL. Breathing-in time increased significantly in both groups. Half the subjects said they had learned 'something new'. The MTS group were more likely to mention co-ordination and breathing. CONCLUSIONS: Short-term, multimedia is as least as effective as a good leaflet, and may have advantages for steps involving movement. MTS was acceptable to all age groups. The method could be used more widely in primary care.

Adolescent↗

A multimedia intervention to support family caregivers.

The lack of choice and predominance of crisis-oriented care in relation to respite and long-term care for family carers and frail older people provided the authors with the rationale for the development, within the European-funded Assisting Carers using Telematic Interventions to meet Older person's Needs (ACTION) project, of two innovative multimedia programs. The key aim of the programs is to provide education, information, and support about respite care and planning for the future for family carers and frail older people in their homes. In this way, it is intended that family carers and frail older people will be able to make informed choices concerning their health and social care needs. The authors describe the conceptual basis of the multimedia programs, the research and development process, the content of the multimedia programs, and the evaluation of the developed product.

Aged↗

Guidelines for cognitively efficient multimedia learning tools: educational strategies, cognitive load, and interface design.

The field of medical education has consistently embraced new technologies in an attempt to improve the training process of our nation's doctors. There are thousands of available multimedia learning tools (MMLTs), but no quantitative scale exists to assess their efficiency and overall educational value. The authors review existing literature and suggest guidelines for creating cognitively efficient medical MMLTs. In 2004, the authors searched PubMed to identify articles regarding mutimedia learning, including educational strategies and existing MMLTs. The primary search terms included "multimedia learning," "cognitive load," and "surgical education." The resulting articles were evaluated and reviewed for educational and interface design techniques, and a list of common features was generated. The authors cross-referenced these features with extensive theories of cognitive load to create a list of methods that demonstrated improved learning. Techniques common to existing MMLTs often neglect to account for theories of cognitive load and may be detrimental to the learning process. The authors outlined important educational considerations and guidelines for the design of effective MMLTs. With large resources being spent to produce MMLTs, more research is necessary to establish successful design techniques. The authors summarized existing research, outlined educational issues in multimedia design, and proposed future directions for study.

Cognition↗

Effectiveness of a multimedia programme and therapist-instructed training for children with autism.

The present study aimed to evaluate the effectiveness of an interactive multimedia training programme and a conventional therapist-instructed training in improving the learning behaviours of children with autism. A multiple-subject, single case-study time-series research design was adopted in the study. Six children with autism, aged 2 years 4 months to 2 years 10 months, were recruited by convenience sampling. They attended a 12-session training programme on basic concepts (e.g. colours, shapes) that was presented as an interactive multimedia training programme and also as a conventional, therapist-led training programme. The attending behaviours and appropriate responses of the subjects were videotaped for further analysis. Participants who attended the conventional therapist-instructed training programme generally showed improvement in attending behaviours and response rates; participants attending the multimedia programme also showed improvement in their attending behaviours and response rates. The results support the hypothesis that both training programmes are effective in improving the attending behaviours and appropriate responses of children with autism. The authors suggest that, because children with autism respond differently to different training approaches, customized training programmes should be considered for individual children. The implications of the methodology and the potential impact of the present study on the training of children with autism are discussed.

Autistic Disorder↗

Fostering interaction through multimedia.

Multimedia is a vehicle for fostering interaction and reinforcing the connection between curriculum and learning. The author discusses ways to energize, reshape, and enrich educational experiences by integrating multimedia into instruction. Examples of teaching-learning strategies and processes that promote learner-content, learner-learner, and learner-instructor interactions are offered to demonstrate how multimedia use can enhance student self-reflection, problem solving, critical analysis, cultural sensitivity, and acquisition and development of new knowledge.

Computer-Assisted Instruction↗

Multimedia messages in genetics: design, development, and evaluation of a computer-based instructional resource for secondary school students in a Tay Sachs disease carrier screening program.

PURPOSE: Tay Sachs disease is a recessively inherited neurodegenerative disorder, for which carrier screening programs exist worldwide. Education for those offered a screening test is essential in facilitating informed decision-making. In Melbourne, Australia, we have designed, developed, and evaluated a computer-based instructional resource for use in the Tay Sachs disease carrier screening program for secondary school students attending Jewish schools. The resource entitled "Genetics in the Community: Tay Sachs disease" was designed on a platform of educational learning theory. METHODS: The development of the resource included formative evaluation using qualitative data analysis supported by descriptive quantitative data. The final resource was evaluated within the screening program and compared with the standard oral presentation using a questionnaire. Knowledge outcomes were measured both before and after either of the educational formats. RESULTS: Data from the formative evaluation were used to refine the content and functionality of the final resource. The questionnaire evaluation of 302 students over two years showed the multimedia resource to be equally effective as an oral educational presentation in facilitating participants' knowledge construction. CONCLUSION: The resource offers a large number of potential benefits, which are not limited to the Tay Sachs disease carrier screening program setting, such as delivery of a consistent educational message, short delivery time, and minimum financial and resource commitment. This article outlines the value of considering educational theory and describes the process of multimedia development providing a framework that may be of value when designing genetics multimedia resources in general.

Adolescent↗

Multimedia benchmarking analysis for three risk assessment models: RESRAD, MMSOILS, and MEPAS.

This paper is one in a series that describes results of a benchmarking analysis initiated by the Department of Energy (DOE) and the United States Environmental Protection Agency (EPA). An overview of the study is provided in a companion paper by Laniak et al. presented in this journal issue. The three models used in the study--RESRAD (DOE), MMSOILS (EPA), and MEPAS (DOE)--represent analytically-based tools that are used by the respective agencies for performing human exposure and health risk assessments. Both single media and multimedia benchmarking scenarios were developed and executed. In this paper, the multimedia scenario is examined. That scenario consists of a hypothetical landfill that initially contained uranium-238 and methylene chloride. The multimedia models predict the fate of these contaminants, plus the progeny of uranium-238, through the unsaturated zone, saturated zone, surface water, and atmosphere. Carcinogenic risks are calculated from exposure to the contaminants via multiple pathways. Results of the tests show that differences in model endpoint estimates arise from both differences in the models' mathematical formulations and assumptions related to the implementation of the scenarios.

Air Pollutants, Radioactive↗

Creating and utilizing a multimedia dermatology medical record for a PocketPC personal digital assistant.

Personal digital assistants are lightweight computers that capture and display data via tapping on their screens with a stylus and are easily linked to desktop and network computers. They have been used in medicine for a variety of purposes, and many believe personal digital assistant use can improve the provision of medical care. The author created a multimedia dermatology electronic medical record for a PocketPC (Microsoft Corp., Redmond, WA) personal digital assistant that contains patient images, tables of phototherapy, laboratory and systemic medication data, and typed chart notes. Such a record can be created and utilized but requires more time to assemble than a handwritten note, mostly due to capturing and organizing images. Future challenges involve streamlining record assembly, integrating multimedia records with hospital and office medical records, and assessing how having multimedia data available might affect care.

Computers, Handheld↗

Learner-control vs. program-control instructional multimedia: a comparison of two interactions when teaching principles of orthodontic appliances.

BACKGROUND: Many studies have compared computer assisted learning (CAL) to more traditional learning formats and have shown CAL to be as effective as or superior to the alternative resources. However, there are only scarce attempts to show which style of CAL leads to the best learning outcomes in orthodontics. AIM: To compare the effectiveness of a learner-control (group A) vs. program-control (group B) multimedia learning environment courseware packages regarding knowledge, understanding and transfer of content when applied to teaching principles of orthodontic appliances to undergraduate students. METHODS: Pre- and post-test assessments of undergraduate dental students (n = 30) who either studied a learner-control multimedia learning environment courseware package (n = 15) or a program-control version (n = 15) on equivalent material of the orthodontic appliances curriculum. Both groups were evaluated by means of multiple-choice questions covering knowledge, understanding and application. A one-way ANOVA was carried out in order to check for statistical difference between the two groups. The P-value was set at 0.05. RESULTS: There was no difference in prior knowledge between both groups at baseline. Although, both groups significantly improved their scores after having studied the course, no significant difference was found between both groups in relation to answers to questions about knowledge, understanding and application. CONCLUSIONS: In this study, the learner-control instructional multimedia program was found to be as effective as the program-control version when teaching principles of the orthodontic appliances to undergraduate students. The focus needs to be on improving the value of CAL. Comparative evaluations of how different CAL approaches compare with or complement one another are certainly needed.

Comprehension↗

Developing protein documentaries and other multimedia presentations for molecular biology.

Computer-based multimedia technology for distance learning and research has come of age--the price point is acceptable, domain experts using off-the-shelf software can prepare compelling materials, and the material can be efficiently delivered via the Internet to a large audience. While not presenting any new scientific results, this paper outlines experiences with a variety of commercial and free software tools and the associated protocols we have used to prepare protein documentaries and other multimedia presentations relevant to molecular biology. A protein documentary is defined here as a description of the relationship between structure and function in a single protein or in a related family of proteins. A description using text and images which is further enhanced by the use of sound and interactive graphics. Examples of documentaries prepared to describe cAMP dependent protein kinase, the founding structural member of the protein kinase family for which there is now over 40 structures can be found at http://franklin.burnham-inst.org/rcsb. A variety of other prototype multimedia presentations for molecular biology described in this paper can be found at http://fraklin.burnham-inst.org.

Computer-Assisted Instruction↗

Content preauthoring: preparing medical imaging information for multimedia authoring and quizzing.

Recent advances in multimedia development software and related hardware have given professionals and nonprofessionals tremendous power and flexibility to create multimedia education and training programs. Nevertheless, content organization remains a key and often neglected component of program development. Content preauthoring puts findings, diagnoses, differential diagnoses, and other standard radiologic concepts into a format that fosters logical program layout, centralized remediation, record keeping, decreased data entry, a variety of user levels, easy addition of cases, and linkage to a question-generating program. The goal of content preauthoring is to organize radiologic material into a hierarchical or spreadsheet-based structure that provides a logical basis for software design. By separating content design from software authoring, both processes become more manageable. This approach is applicable to visually oriented topics that focus on identification. The highly structured, goal-oriented nature of the method makes it particularly suitable for newcomers to multimedia authoring.

Authorship↗