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Formative evaluation of a multimedia program for patients about the side effects of cancer treatment.

Formative evaluation of multimedia programs can prevent costly and time-consuming revisions and result in more effective programs. Yet systematic formative evaluation is seldom conducted. This paper reviews the basic principles of formative evaluation and describes how we applied those principles to the formative evaluation of a multimedia program for patients about the side effects of cancer treatment. It discusses the challenges of developing multimedia programs for patients and provides guidance to other health professionals interested in developing programs on other topics.

Humans↗

Multimedia system based on programmed instruction in medical genetics: construction and evaluation.

A multimedia system used as an auxiliary didactic tool for teaching medical genetics, HGEN, is based on non-linear programmed instruction and multimedia. HGEN was implemented in layers for PC compatible using MULTIMEDIA TOOLBOOK and DELPHI. It includes basic medical genetics concepts (inheritance patterns and cytogenetics) and it is based on multiple choice questions with images, diagrams and animations. The student-program interaction occurs by choosing an alternative in a question and receiving a specific answer as feedback and additional information. Links send the students to a glossary, to short descriptions of diseases used as examples, or to references for further studies. In order to evaluate the performance of the HGEN the authors used two questionnaires: (a) about the students' background in using computers; and (b) the system efficiency as a didactic tool, the software quality and user satisfaction. HGEN was used by 63 students from three medical schools and it was considered efficient as a learning tool (100%). Furthermore the implementation of a navigation map for frequencies analysis of followed path enable the study to detect structure and content inadequacies that could be correct for version 1.1 and proved to be an efficient tool to optimize a didactic software.

Computer-Assisted Instruction↗

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↗

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↗

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↗

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↗

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↗

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↗

A knowledge-based multimedia telecare system to improve the provision of formal and informal care for the elderly and disabled.

We have developed a knowledge-based multimedia telecare system, based on a multimedia PC connected by ISDN at 128 kbit/s. The user display is a television. Multimedia material is accessed through a browser-based interface. A remote-control handset is used as the main means of interaction, to ensure ease of use and overcome any initial reservations resulting from 'technophobia' on the part of the informal carer. The system was used in 13 family homes and four professional sites in Northern Ireland. The evaluations produced positive comments from the informal carers. There are plans to expand the use of the system.

Aged↗

Assisting maxillofacial surgery by using multimedia VR techniques.

Multimedia and VR technologies are examined as regards their potentiality for medicine, specifically for maxillofacial surgery. The goal is to achieve a surgical procedure of better quality as well as a more interesting way of imparting medical knowledge. Close cooperation with the Maxillofacial and Plastic Surgery Department of the University Hospital Benjamin Franklin (UKBF) ensures the suitability of the material for the user. Doctors give regular feedback on the 3D human-computer interface, graphics and interaction devices because they are crucial for the implementation of multimedia and VR systems in medicine. Before implementing a VR or multimedia application, the technical possibilities should be explored in depth. Therefore, a VR tested for 3D input and output devices has been established at the Technical University of Berlin to assess the advantages and technical restrictions of commercially available and self-made devices. Parts of the VR tested are currently being transferred to the Medical Informatics Department of the UKBF, where the usefulness of various 3D input and output devices for different medical applications in a real clinical environment will be evaluated.

Computer Simulation↗

Understanding surgery: multimedia comes to theatre.

Educational technology is well established within Schools of Nursing, however there are few computer based learning packages within the clinical environment. It was felt within the Operating Services Directorate, Royal Hallamshire Hospital, that the development of a multimedia package would enhance and complement existing teaching methods. This paper describes the theory behind the choice of a multimedia presentation and its development within the operating theatres. The package, concentrating on general surgery, has been developed by two experienced theatre nurses and a graphic designer. This has resulted in a structured but flexible, fun package which is relevant to all learners within the operating theatre environment and allied healthcare fields. The feedback obtained from users within the clinical area has reinforced the project team's original feeling that multimedia is a highly appropriate resource for clinical education.

Computer Graphics↗

A multimedia database for dermatology.

The World Health Organisation (WHO) Radiation Emergency Medical Preparedness (REMPAN) centres have built up the International Computer Database for Radiation Accident Case Histories (ICDREC) to document the treatment of acute radiation syndrome (ARS) patients. Radiation induced skin lesions may cause severe late effects in radiation accident patients. Dermatological multimedia documentation is included into the ICDREC. In particular, retrieval and display of digitised skin photographs and medical reports serves to improve patient care, medical education, and scientific analysis concerning the cutaneous radiation syndrome (CRS). The database has been built up as a client/server system. A particular focus has been set on using commercial off-the-shelf software components. The medical data including the multimedia data are stored in a relational database system. The database can be accessed by inexpensive personal computers in the dermatologist's workplace. Authorised institutions can access the database via the Internet. Retrieval of one skin photograph via local area network (LAN) requires approximately 3 seconds. The current state of the application is illustrated with the skin lesion treatment of a Chernobyl patient. An example is given on how to access the ICDREC from a dermatologist's desktop personal computer. The discussion focuses on the advantages of storing the textual and pictorial data in one central database to be accessed from different care centres and how the results can be generalised for medical multimedia information systems.

Dermatology↗

Educational benefits and cost savings from an interactive multimedia "best practice".

BACKGROUND: Developing and deploying "clinical practice guidelines" and "best practices" is a major strategic goal of our organization. We developed and evaluated a novel way of educating our colleagues on the office management of shoulder pain, using an interactive multimedia computer program to allow rapid access to user-selected audiovisual educational materials through a simple point and click interface. METHODS: Pre- and post-testing of 30 practicing primary care providers was conducted to assess ability to evaluate and manage patients who present with shoulder pain, and a post-use survey was administered to assess clinician acceptance and confidence, ability to use as a just-in-time tool, and changes in utilization of medical resources. RESULTS: Pre- and post-testing demonstrated that clinicians used this tool to improve their scores in a wide variety of clinical areas including history, physical examination, diagnosis, and management of conditions causing painful shoulder above their scores using textbooks and other traditional educational materials alone. The post-use survey showed outstanding acceptance by clinicians and their reported increased confidence as well as the potential for their increased abilities to translate into significant cost savings through more focused use of radiographic studies, orthopedic consultations, and physical therapy treatments. CONCLUSIONS: It was concluded that "The Multimedia Reference for Office Management of Shoulder Pain" is an effective and valuable learning resource for practicing clinicians, and demonstrates the potential to use an interactive multimedia tool to augment clinical skills and promote cost effective management of patients with this common clinical problem.

Attitude to Computers↗

Creating an interactive multimedia computer-assisted instruction program.

An interactive multimedia computer-assisted instruction on congenital heart disease was developed to increase nursing students' understanding of congenital heart disease. Computer-assisted instruction, with its ability to incorporate sound, visuals, and interactivity, provides a multimedia and interactive learning environment that enhances the teaching and learning process. Computer-assisted instruction is a cost- and time-effective teaching and learning strategy that can be tailored to the subject and student population. This article presents information regarding the process of developing an interactive multimedia computer-assisted instruction program on congenital heart disease.

Computer-Assisted Instruction↗

Children in Japan and multimedia.

Many parents in Japan today are very concerned and have daily problems with their children over the following kind of issues concerning video games, multimedia, and similar devices. 1) Is children's enthusiasm for video games actually harming their growth (physically or mentally)? 2) Is there any way that video games can help children in the future? For example, will playing these games help children learn to use computers or develop their power of thought? 3) Will excessive enthusiasm for TV games undermine our basic lifestyle? Is the time they spend studying at home or playing outside actually decreasing? 4) Will the methods of communication brought about by computers, pagers, and cellular phones weaken human relations among children? 5) Will being immersed in a virtual world created by computers result in a diminished sense of reality? The causes of this uneasiness may be traced to parents' own anxieties and concerns about the exceedingly rapid growth of the "information society" of today, together with the fact that their children are directly caught up in the deluge of this information and multimedia society. The development of media has coincided with the growth of today's adults, but children are immersed in a media-filled environment from the day they are born. In Japan, there are now children who can play video games before even learning to write. No one can predict what kind of adults these children will grow to be in the future, and it is fair to say that the most parents and children in Japan are being tossed about on the waves of this information explosion. At this international symposium, we hope to hear the many views that are held around the world concerning children and multimedia.

Adult↗

Multimedia unplugged: a workshop on learning designs at the neoMuseum, Japan.

In Japan, we have a growing field called 'Information Education,' but people are paying too much attention to computers and the internet. That's why I am proposing unplugging the computer and thinking about the more essential aspects of learning and information design. 'Unplugged' means that technology and multimedia need not be limited to digital forms. Pencil-and-paper and traditional 'by hand' media also have important roles to play. In the Multimedia Unplugged workshop, participants use different forms of expression and media, including paper and styrofoam cubes, freeform construction kits and a wide variety of everyday objects, like bamboo leaves and post-it papers. Through this workshop, participants can understand that each medium has its own constraints and opportunities, and have a change to rethink the roles of multimedia from new perspectives. They can then replug and thus be able to choose appropriate media--digital or physical or both--to express their ideas.

Art↗