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Journal of Computer Assisted Learning (2001) 17, 186-199

2001 Blackwell Science Ltd 186

Evolving open learning environments using hypermedia technology

A. Trikic Edge Hill College of Higher Education, Lancashire, UK

Abstract A number of features of web-based hypermedia are identified as providing a suitable medium for the design of open learning environments. The underlying object-oriented architecture of hypermedia systems accords with the need for representational diversity of pedagogic mechanisms and the ongoing re-construction that an evolutionary approach to the design of learning activity demands. A web-based prototype has been constructed to represent aspects of the National English Board curriculum in diabetes mellitus. The design and development process tries to take account of features of the environment likely to influence or be influenced by the intervention. Quantitative and qualitative methods have been employed to enable an evaluation of the hypermedia design and its environment of use.

Keywords: Activity theory; Diabetes; Hypermedia; Interview; Post-graduate; Pre/post test; World-wide web

Introduction

Exploiting technology continues to be a focus of interest in many fields of research including education, computer science, cognitive science and artificial intelligence. Ambitious claims have often been thwarted by both a limited understanding of the constituent complexities of the relationship between learning and teaching and how technological tools can best serve and enhance this symbiotic relationship. It is suggested that computational tools embedded in hypermedia combined with computer mediated communication systems act as a synergistic agent for learning under certain conditions. There are two main conditions are: first, a common communication system and access to information and knowledge resources exists; second, that all individuals have easy access to these computing and communication resources for engaging in learning activities. The latter condition means that the structure and content of the learning environment generally have a positive impact on the success or otherwise of technology supported learning tasks. The existence, reliability and support of a technological infrastructure therefore constitute a critical factor for the success of learning environments built through technical innovation.

This paper’s primary purpose is to identify particular attributes of hypermedia technology that may support learning. Some of the attributes have been designed and constructed as web-based learning resources for nurses undertaking specialist

Accepted 1 October 2000

Correspondence: Angela. Trikic, Assistant Director - Open Learning, Centre for Pharmacy Postgraduate Education, School of Pharmacy, University of Manchester, M13 9PL Email: [email protected]

Open learning environments using hypermedia technology 187

2001 Blackwell Science Ltd, Journal of Computer Assisted Learning, 17, 186-199

training for the care and management of diabetes mellitus. A precondition for design and development must be the wide set of socio-psychological influences that impact upon cognitive processes and the need to take account of these in the design of human-computer systems. The definition of ‘open learning’ adopted here is that proposed by Goodyear & Steeples (1992) in the context of the European JITOL project (Lewis, 1995). In this sense the hypermedia environment is conceived as an integral layer and vehicle through which learning activities may be conducted. Its appropriateness as a form of learning support relies on the degree to which the learner is not simply engaged in knowledge application, but also understands the underlying reasoning that forms the basis for practice and/or further thought and investigation. The link-node structure of hypermedia provides the underlying architecture by which the semantic relationship of static and dynamic knowledge may be represented. Nothing is assured without good design and a sound methodology and, for example, the extensive and critical review of hypermedia as an educational technology by Dillon & Gabbard (1998) was only able to single out the rapid search and retrieval tasks as yielding positive support for learning. A contrary view is argued for in this paper suggesting that salient features of web-based hypermedia afford support and stimulus to the learning process.

Rationale and context

The capacity for hypermedia to provide a multilayered environment capable of incorporating visual representations of units of knowledge in static and dynamic form appeared to present an avenue for learning worth pursuing. Initial ideas were based upon the possible effectiveness of integrating the use of visual and other forms of multimedia into a curriculum domain with a significant visual presence. The interest and co-operation of the Health Studies Department at Edge Hill College of HE led to fruitful contact with the Diabetes team at Fazakerley Hospital. Discussion with the course leader established the initial parameters defining the type of web-based materials that were to be developed.

The nature of the curriculum for nurses specialising in diabetes care and management requires a high level of understanding of social and psychological factors affecting the behaviour of diabetic patients as well as the procedural and management aspects that control of the disease entails. An initial judgement was taken to prioritise the anatomical and physiological knowledge for computer-based design. This was motivated by two main factors: first, by a belief that this may provide an improved vehicle for knowledge accumulation; secondly, it would have the additional benefit of affording more contact time for discursive components of the curriculum. The consequence of developing a web-mediated delivery resource would, it was hoped, facilitate 3 × 2 hour timetabled slots currently designated to the anatomy and physiological course component.

Extending boundaries

The first stage of the development process took place during the Autumn of 1998. This was the implementation of a hypermedia design to represent two aspects of the National English Board curriculum in diabetes mellitus. Normal and abnormal physiological states along with the application of physiological knowledge to support diagnostic and analytic skill required for care and management was constructed as a

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research prototype. The physiological knowledge base lends itself to diverse representations utilising

text and image-processing techniques providing students with visual images and cues of static knowledge with dynamic access to supplementary textual information. To limit the web-site to cover only the anatomical and physiological knowledge base seemed to be a deficient strategy to support student learning and unlikely to promote anything other than a shallow engagement with the materials. Providing students with a variety of activities, which call for applied knowledge became an extended aim, which would nevertheless help to secure earlier objectives. Mechanisms for promoting diagnostic and inferential tasks involved in gaining expertise in diabetes mellitus and related complications were incorporated as an integral part of the web environment including the representation of case studies and scenarios, multiple choice assessment and predefined web searches.

Adopting an essentially iterative method of ongoing construction and re-construction gives the advantage of both facilitating feedback from stakeholders and enabling exploration of burgeoning techniques offered in a hypermedia environment.

Multiple representations: learning facilitation?

Recent advances in hypermedia technology have been based upon a document object model, which contains many static and dynamic objects. These objects, for example, text objects, image objects and interface widgets, may be designed to offer multiple layered representations of domain knowledge to assist learner understanding. The multimedia formats offer the potential of simulating the relationship between the conceptual knowledge structure and the processes that are described by it. For example, human physiology requires an understanding of internal organs, their location, function and relationship with other organs. The many interrelationships that exist between the hormonal and nervous systems form an integral part of knowledge understanding of human physiology. Contained within the knowledge description there exists a number of hormonal processes triggered by particular events or conditions that may be represented dynamically. The pedagogic potential for promoting an understanding of dynamic processing defined by conceptual

Fig. 1. Capability of hypermedia to trigger additional visual and textual information.



descriptors is an intuitive assertion but the cognitive complexity needed to capture causality of that which moves compared to that which is still for us to ponder has been accepted for some time. A simple computational representation of process knowledge illustrated in Fig. 1 may be more effective in promoting learning compared with paper based texts that must rely on linguistic expression and diagrammatic modelling. There is some evidence to suggest that location and representational format of difficult concepts impact on the degree of comprehension in paper-based medium (Sweller, 1994). The same may be true of hypermedia.

Pedagogic theories and tools

Activity theory has been used to illuminate understanding of the development of forms of human–computer interaction (Kuuti, 1997). Viewing different forms of human practices as development processes at the individual and social level provides a context that can be finely grained to apply to psychological activities stimulated by interface objects that themselves become subject of complex forms of human mediated interaction. These objects constitute pedagogic mechanisms. Both application-domain objects and computer-domain objects use object-oriented concepts and notation (Booch, 1991; Rumbaugh et al., 1991). All objects have identity, properties and methods, which distinguish them from other objects. It is the capacity of hypermedia to support an expanding repertoire of object-based mechanisms that makes it a useful vehicle for constructing learning environments.

Whilst pedagogy may be an art that requires great versatility much can be learnt from the vast body of educational and psychological literature on this subject. Multiple strategies are required because students learn by adopting diverse strategies which may conform to a Pask (1976) type ‘serialist’ in one context or domain and lead them to behave more like a ‘holist’ in another context. A student is unlikely to possess a single-strategy — a range of strategies are likely to be employed on a trial-by-trial basis. Accepting that human cognition may be stimulated in various ways means that a range of strategies must be embedded in the hypermedia. There are a number of properties, events and methods described by the document-object model resident in web browser software that enables dynamic interaction. Knowledge representation and forms of interaction may trigger further visualisation or didactic discourse designed to encourage diagnostic reasoning. A learner event may cause object-object communication or trigger a dialogue to invite a further learner response. Since the dialogue structure is embedded within the primary object, the behaviour can be modified and developed during the process of evolving the environment. This is a direct consequence of encapsulation. Analogy, cues, the presentation of selective case-study data constitute examples of familiar forms of pedagogy designed to promote a variety of learning activities, which were embedded in the research prototype to provide a safe practice environment for learning.

Extensibility and reuse The object-oriented architecture and design of hypermedia means that knowledge objects can be changed without affecting the structure and content of other knowledge objects external to it. Large systems can be constructed using modules which are structured so that interfaces are simple and well defined. The capacity for hypermedia systems to be extended and/or updated is a critical attribute for the design of learning environments.

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The implication of accepting the provisional status of much of our knowledge (Popper, 1975) is to acknowledge the possibility of its modification at some point in time. Consideration of the question of how provisional is provisional is an important one, but will not be discussed here. Suffice to assert that knowledge based upon physical and physiological properties or constructed from symbolic and logical abstractions to form mathematical and scientific principles and structures is largely stable knowledge. Stable knowledge can be characterised by the degree of agreement that exists on the fundamental structures and principles upon which this form of knowledge is based. Nevertheless an extension of knowledge resulting from a single research finding will affect the application of the knowledge. Changed practices and medicines may arise from a better understanding of the aetiology of a disease, but this does not challenge a view of disease as having aetiology, symptoms, a possible set of treatments and so on. It is the extensibility of hypermedia technology that may make it a suitable medium for representing changed practices and improved understanding of prior knowledge.

Monitoring and evaluation The monitoring and evaluation function of educational practice conducted in part through an innovative delivery mechanism can be an important vehicle for improvement. The capacity for changing a learning environment leads on to a consideration of the stakeholders in the teaching and learning process. Client-based surveys and evaluation forms may be designed to interface and interact with the server’s CGI programs. These may then become refinable instruments with which to measure performance and provide process indicators. Monitoring form-based data directed at the learners and teachers can be collated and analysed periodically to help inform future enhancements.

The development process The computer-supported learning environment described here requires two distinct forms of technologies. Hypermedia technology offers an environment in which learning activities may be crafted such that the representational aspects of the learner experience are attended to as well as supporting mechanisms for the process of development. This process of development is increasingly fuelled by the generation of an expanding technology toolset with both properties that enable representation of established pedagogic models as well as the creation of new ones. Information visualisation research (Card et al., 1991) in particular offers techniques derived from the field of scientific visualisation that will be fruitful to our less tightly structured multimedia information and knowledge formats. These emerging pedagogic possibilities, in the parlance of developers, can be summed up by the shift from passive to active web pages. These achievements have been signalled by the facilitation of client-based programming and greater acceptance of de jure standardisation from the World Wide Web Consortium (W3C). This means that Internet applications offer a distributive network through which web-based applications can be accessed and used. In practice web-based applications can access heterogeneous data sources concurrently via a common interface approach. The design of the human–computer interaction that triggers the event driven dialogue mediating the technology of the application with the technology of the communication layer can be described and informed by Activity theory (Nardi,



1997). It is Activity theory (Nardi, 1997) that forms the intervening theoretical link between artefacts designed to mediate human thought and behaviour and how they are (or not) integrated into social practice. The next section reports on the initial steps taken to integrate a hypermedia application into an existing undergraduate module using the college’s web server and networked infrastructure in a hospital location.

Student Population The School of Health Studies at Edge Hill College of HE is responsible for the structure of the learning environment that the diabetes team operates within. The population has been determined by the number of students enrolled to the module adopting a concrete, educational environment along with the human practices as they occur in it as the direct object of study. A group of 15 qualified nurses aiming to specialise in the care and management of diabetes studied the Level III module (HEA 327). The nurses are currently in practice at Fazakerley Hospital or other health institutions in the North-west region of England. The module is part of a programme offered by Edge Hill’s School of Health Studies. The curriculum content of the module conforms to the standards set down by the English National Board (ENB) which is the professional body governing nursing education. Successful completion of the programme will lead to the award of a Diploma or B.Sc (Hons) Health and Social Care with Management.

Preparing the ground for intervention

A briefing evening was designed to provide students with an overview of the course including information on timetabling and assessment events. The web-based material as a new form of educational intervention to the module was integrated into the schedule for the evening. Opportunity was given to describe the materials and the anticipated role they were envisaged to play.

The first session was designed to introduce the web-based materials and initiate students into associated navigation skills required to access the site. This form of preparation was of partial success only. Two factors intervened to confound the key objectives. First the students had not yet received their userIDs and passwords. Although guest logins had been arranged, the initial stage of the session was transformed into a network introduction as none of the students had used a computer network before. Initiation into its ways was a precondition of entry to the web-site. Having accomplished network entry for all, the steps to accessing the web-site were followed. A demonstration was given to display the scope of the activities included. The students then had an opportunity to explore the materials further. At this stage the ISP line went down. This meant a freezing of the application and an effective curtailment to the session. The main concern resulting from this experience was apprehension that many students would be deterred (understandably) from using the web-based courseware during and prior to subsequent sessions.

Methodology

The design and development methodology employed to create the web site accords with the star life-cycle (Hartson & Hix, 1989) primarily oriented to the demands of developing interactive systems usable by people. The emphasis is on prototype

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production using alternating waves of analytic (top-down) and synthetic (bottom-up) perspectives to evaluation, fundamental to a user-centred approach. The methodology utilises a set of methods that generate both quantitative and qualitative data to monitor test and evaluate those aspects of the learning experience that relate to the quality of the hypermedia design and the web, as the delivery vehicle. Both methods then have been designed to provide a means of assessing the effectiveness of the learning resource and relevant features of the learning environment. The distinction between methods and tools designed to implement them is an important one emanating from the inherent complexity of social and material structures. The design rationale of our tools, whether they be utilised for quantitative or qualitative methods must be viewed as providing complementary intelligence necessary to make sense of the fragile and complex relationship of learners, educational environments and technical infrastructures. This conforms to all socio-technical approaches to system design that is based on an understanding of both social systems and technical systems and the levels at which they integrate or rupture.

The time frame for Phase I of this research extends across two academic years therefore a further set of quantitative and qualitative data will be collected during 1999/00. A more comprehensive analysis of the data will be possible on completion of the second cycle of the fieldwork trials but interim findings from quantitative and qualitative data help to shed light on what may appear, at first, to be modest evidence upon which to proceed with this endeavour.

Methods

A pre-test was issued during the briefing evening designed to assess the level of declarative and inferential knowledge of diabetes mellitus that students possessed prior to starting the course. This took the form of a multiple-choice test the results of which could be analysed as evidence of fact-based and inferential type knowledge.

Interviews with students and staff were arranged to assist in the monitoring and design enhancement process. The purpose of interviews with students is to obtain their view of the design of the web-site including suggested ideas for improvements and to ascertain how they appear to be using it in practice. Students are invited to give some information about their work and their perceptions of how they manage to accommodate study with work. Specific questions have been included both about computer experience and access to facilities at college, work and home. Interviews then have been designed to provide the qualitative data indicating both the suitability of the hypermedia learning environment for the nurses and the effectiveness of the web as a delivery platform.

Interviews with staff invite comment on the web-site design and suggestions for further developments. A staff/student perspective on the effectiveness of the intervention and consideration of methods of improvement will be critical to assimilating the web-based resources into the overall learning environment.

A post-test was issued at the evaluation session described above and was administered at the end of the module in July 1999. The content of the test structured to determine the level of declarative, conceptual and skill-based knowledge that has been assimilated and understood, respectively, is identical to the pre-test. Memory recall was unlikely to influence test performance given the six-month period that had elapsed since the pre-test was taken. The advantage of using the same test derives from the consistency of cognitive demands and the degree of knowledge



understanding it entails. The aim of issuing pre- and post-tests is to obtain a comparison of the results to help determine the effectiveness of the web-based resources to reinforce and promote physiological knowledge and its application.

The test and monitoring tools adopted will be reviewed along with the results they have generated. It is envisaged that some monitoring activity may in due course be best embedded in the web-site itself. The overall results are expected to inform the evolution of computer-mediated learning activities and the educational structures in which such activities are situated drawing directly on the evidence generated. This is a direct consequence of adopting a methodological perspective, which calls for an iterative approach to design.

Initial results

The first set of fieldwork results were collected and findings from the pre- and post-test are reported below and drawn from Table 1. An analysis of the results has been conducted in three parts focussed on pre- and post-test percentage for fact-based results, diagnostic-based results and overall totals, respectively. The results were analysed for tests of significance at 10% level. The assumption taken is that the mean of this population is normal, giving a null hypothesis of Ho: µ = 0 and its rejection using a one-sided alternative hypothesis as H1: µ > 0.

11 5.0 7.0 2.0 8.0 6.0 -2.0 13.0 13.0 0.0 sum(diff.)2 51.0 89.3 199.3 Mean 8.6 9.6 1.0 5.6 6.5 0.9 14.3 16.1 1.9 SD 2.9 2.5 2.0 3.5 3.6 5.5 Var. 8.7 6.1 3.9 12.0 13.2 30.4 Dates: pre-test February 1999; post-test July 1999

For the fact-based data the t score of 1.7 is significant, supporting the hypothesis that there is some evidence to suggest that the hypermedia intervention has been effective.

For the diagnostic-based data the t score of 1.0 is not significant, which means acceptance of the null hypothesis that there is insufficient evidence to suggest that the hypermedia intervention has been effective in promoting increased diagnostic skills.

For the overall effectiveness of the intervention for increasing the marks gained the t-score for the mean difference is 4.88. Consulting the decision rules it appears that there is some evidence for rejecting the null hypothesis and accepting the

Table 1. Pre-test and post-test results

Fact-based questions Diagnostic-based questions Overall total n pre-test post-test (post-pre) pre-test post-test (post-pre) pre-test post-test(post-pre) (16) (16) (diff.) (13) (13) (diff.) (29) (29) (diff.)

1 13.0 14.0 1.0 7.0 11.5 4.5 20.0 25.5 5.5 2 10.0 9.0 -1.0 5.0 6.0 1.0 15.0 15.0 0.0 3 7.0 10.0 3.0 3.0 6.0 3.0 10.0 16.0 6.0 4 8.0 11.0 3.0 5.0 11.0 6.0 13.0 22.0 9.0 5 10.0 11.0 1.0 5.0 4.0 -1.0 15.0 15.0 0.0

6 5.0 9.0 4.0 9.0 9.0 0.0 14.0 18.0 4.0 7 7.0 8.0 1.0 3.0 1.0 -2.0 10.0 9.0 -1.0 8 11.0 8.0 -3.0 6.0 4.0 -2.0 17.0 12.0 -5.0 9 13.0 13.0 0.0 7.0 10.0 3.0 20.0 23.0 3.0 10 6.0 6.0 0.0 4.0 3.0 -1.0 10.0 9.0 -1.0

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alternative hypothesis that student learning of anatomy and physiology has been demonstrated to be significant at the 10% level.

Interview and observation results Selected fragments from the interview data focussed more on the technical conditions of the learning environment than design. These are reported in the Appendix drawing on students who performed particularly well (student 9, 1) compared to those who did not (student 7, 11). • Access to the web-site was identified as a key problem. Access difficulties were

expressed in various ways. Students appeared to have persistent problems logging onto the college network, a precondition for using web facilities. Most students do not have Internet access at home or work making this particular attribute of the technology redundant for the moment.

• Time to learn was restricted by vocational pressures on nurses facing a requirement to accumulate qualifications to enhance their professional prospects alongside the continued demands of work. All the students are mature, part-time, qualified nurses, juggling with work, study and domestic commitments. Many nurses found it difficult to ‘drop-in’ outside contact hours, although many managed to visit the lab prior to their regular 5:30pm. session during the course of module delivery.

• Prior computer experience varied in direct proportion to student confidence levels with the technology. Most students were pleased however, to have some form of introduction to the technology, even if they found some parts of it difficult. Even the most reluctant participants reported that they would have to adjust their approach. Most nurses recognise that the use of computer technologies would play a more prominent role as a future learning tool supporting professional practice.

• All students reported partial web-site use. Their own backgrounds gave them specialised interest in the disease, which guided their navigation and use.

• Some aspects of the endocrinology need further refinement to reduce textual descriptions. Some simplification and editing was requested.

• The case studies were considered a good feature of the site, but better developed case scenarios were called for as a positive means of improving the quality of this section.

• Navigation of the web-site was generally found easy by students, although interview data suggests that all features of the site had not been explored. All students interviewed were asked about ease of use and no one reported difficulty working with the web-site.

Discussion

The quantitative and qualitative methods that are described and reported here focus on two dimensions of the research. The first concerns the suitability of innovative hypermedia design representations to support learning tasks in the domain of diabetes mellitus. The statistical results from the pre- and post-test data are unsurprising. The confidence level and statistical significance of the results is likely to become a more reliable indicator of efficacy of assessment goals as greater integration of technology tools in the learning environment is achieved. The impact of access difficulties, affective lapse and competing assessment pressures at the end



of the module are likely to have depressed post-test scores. The interview data generated further ideas for design enhancements. The case-study section of the site has been significantly developed from material supplied by the Manchester Diabetes Centre giving rise to richer descriptions for students to work from. The effectiveness of design enhancements of the interface and content will depend, not simply on technical skills, but upon the professional practitioners interested in using computer-supported courseware as a medium for training delivery. Collaborative work is underway with staff from a variety of HEIs and health care bodies including Edge Hill College of HE, Fazakerley Hospital, Walton Diabetes Centre, Salford Royal Hospitals National Health Trust and the University of Liverpool.

The second dimension to this research addresses the reliability and appropriateness of a distributive web environment to support learning goals. It is the qualitative data that exposes both weaknesses in the technical infrastructure as well as the perceived and actual limitations in student experience with both forms of technologies. The problems of accessing the site via the network reported by some students may have indeed resulted in an unintended diminished focus on this aspect of the curriculum rather than leading to an enhanced understanding of the underlying anatomy and physiology. The problems related to the computer mediated learning conditions have served as a barrier and inhibited adequate feedback on the suitability of scope and depth of the web site design.

One method of improving access to the web-site was the production of a CD-ROM containing the web-site and Netscape. The number of students with PCs is far greater than those who are connected to the Internet so a CD ROM solution to the access problem can be thought of as a reasonable method of solving the problem. 75% of the first group of students have requested a CD suggesting that the materials may be used post-module and thus become a longer term learning resource. This is, however, a limited short-term solution that cannot incorporate existing and planned pedagogic tools that require client-server communication.

To supplement the initial introduction to Diabetes Web, scheduled for the first session of the course, a further one hour slot has been allocated later into the course to provide students with additional supported contact time.

At the beginning of this paper the assertion was made that technological infrastructure constitutes a critical factor for the success of learning initiatives crafted through technical innovation. The first set of results suggest that the quality and effectiveness of the online hypermedia application developed for nurses training in the care and management of diabetes mellitus do need further design enhancements. It is not possible, however, to make a judgement about their adequacy as a useful pedagogic tool as the experimental conditions of the learning environment has made sufficient evaluation problematic.

The epistemological foundations of the development methodology used in this study are grounded in the socio-psychological theory referred to earlier in this paper. The results of the research accord with those that one would generally expect at the initial stage of systems development. Design decisions, project planning and management go beyond the ad hoc but have largely avoided chaos. Repetition of parts of the design and the process are suggested in part by the research results, but guided too by intuition and heuristics. This constitutes the interface with a more definable product and manageable process.

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Interim conclusions

One of the most striking conclusions that flow from constructing web-based hypermedia materials designed for integration into an undergraduate module are the important levels of conceptual and practical distinction between design and development. At the level of the product, the object-oriented structures of hypermedia permit ongoing design enhancements to the application and reflect different planes of development of the artefact. Design and development of the learning environment implicated by the need for expansive transition is essentially a social and practical process that entails a degree of turbulence as a prelude and complementary feature to changed material practices. These environmental factors often provide most of the challenges. These may present in the form of restrictive or inconsistent institutional practices, variable learning conditions, problematic technical infrastructure and a fragmented support structure. The quality of the product then becomes but part of the storyline in evolving a computer-mediated learning environment.

Earlier computer-based instructional systems were criticised for being driven by the technology with little attention paid to theories of learning (Harel & Papert, 1991). The corollary of this has led to the surge of computer-supported systems and technology interventions often explicitly framed in a constructivist learning paradigm. Attention to pedagogic issues is of course important and must always represent an ongoing concern as different forms of representation emerge with advances in computer tools. Variability of environmental features does have implications for the time frame within which innovative educational tools are received. Learners must be given long enough and sufficient scope for gaining familiarity and ownership of new technologies. The adaptive and developmental roots of constructivist theory grounded in Vygotsyian socio-psychological theory (Vygotsky, 1978; Bruner, 1985; Lee, 1985; Wertsch, 1985) and represented in the recent literature on Activity theory emphasises the importance of a methodological commitment both to evolving computer-mediated learning activities and the educational structures in which such activities are situated. It is here that more work is needed in fine-tuning the correspondence between our systems of development and theories of learning.

Acknowledgements

The author would like to thank Edge Hill’s Diabetes team and participating nurses for their co-operation in this study. I would also like to thank Professor Peter Goodyear for helpful feedback and suggestions on an earlier draft of this paper.

References

Booch, G. (1991) Object-Oriented Design. Benjamin/Cummings, Redwood City, CA. Bruner, J. (1985) Vygotsky: A historical and Conceptual Perspective. In Culture,

Communication and Cognition: Vygotskian Perspectives (ed. J.V. Wertsch) pp. 21-34. Cambridge University Press, New York.

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Dillon, A. & Gabbard, R. (1998) Hypermedia as an Educational Technology. A Review of the Quantitative Research Literature on Learner Comprehension, Control and Style. Review of Educational Research, 68, 322–349.

Goodyear, P. & Steeples, C. (1992) IT-based open learning. Tasks and Tools. Journal of Computer Assisted Learning, 8, 163–176.

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HCI development. International Journal of Man-Machine Studies, 31, 477–, 494. Kuuti, K. (1997) Activity Theory as a Potential Framework for Human Computer Interaction

Research. In Context and Consciousness: Activity Theory and Human Computer Interaction (ed. B.A. Nardi) pp. 17-44. MIT Press, Cambridge, MA.

Lee, B. (1985) Intellectual Origins of Vygotsky’s semiotic analysis. In Culture, Communication and Cognition: Vygotskian Perspectives (ed. J.V. Wertsch) pp. 66-93. Cambridge University Press, New York.

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Appendix

Selections from transcripts of interviews of training nurses conducted in fieldwork trials during June/July 1999.

Student 9 is a staff nurse who has spent two years on a medical ward and aims to become a Diabetes Specialist Nurse. Comments on the website include:

'When I've read through books they use more technical words without giving an explanation in simple terms of what is actually meant so when you're reading it doesn't make sense whereas when you're looking at that (A & P screen) you understand exactly what is going on.'

'The diagrams and the way that you can put the arrows on different parts so that it will give you more information breaks it down more easily. Sometimes just text in itself can get a bit tedious and boring and you tend to just skip through whereas if you've got something else like a picture it helps you break it down rather than just getting something from a text book.'

'The case studies at the end and the quiz as well gave a quick way at looking at things.'

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'Most of the work is on my own as my friends on the course work different hours. By working on my own I probably get more done though.'

On language use: 'Is at the right level and the diagrams reinforce what the text is actually saying. In a package you do need the diagrams and not just the text.'

On problems: 'A lot of problems were at the beginning where we had the problem of getting into the package and then we didn't have passwords and it was about 3 weeks down the line by which time we were all thinking we need to get some information for assignments as well so I think one of the problems was because we couldn't use the package straight away.'

On computers and networks: 'I'm not really experienced at computer use. I have a computer at home but I do find them quite complicated…The college network is OK to login in but if you want to find out where things are it's difficult. The computer was definitely a useful tool in the course and I'm glad that it was a part of it.'

On Internet access: 'We do have Internet access at work. I thought that would be more practical (i.e. accessing Internet via work) but the fact is that where I'm employed actually charge you to go onto the Internet. This put me off because I thought I'd be forced to rush through the work and not take it in so therefore this has confined me to travelling up to Aintree, which I can't do as often.'

Student 1 works in a research unit. Comments on the website include:

'The actual design of the package I found quite easy to use. My first impressions were that the writing was quite small. It talks about the normal physiology and then you've got the pictures that are scrolling down the side, that was quite good. What you have got written as a step you can look at the picture and sort of visualise that and try and learn the picture rather than the written word, but I did find it a bit difficult to read at the beginning.'

'I think one of the main problems with teaching A & P in a classroom is that it is very structured and it is just lots of the same thing coming at you and what I did like (about Diabetes Web) was whilst some of the information you are giving is quite technical, and is quite hard to grasp, I think the fact that you varied the way it is presented helps. You are sort of quite curious to go onto the next bit and find out what the next bit does. It is not as if the same format is coming at you, it sort of kept my interest, it made me want to keep going and find out what all the boxes were for.'

On access: 'There were tremendous problems with getting passwords. Once I'd got my password, it still wouldn't let me in. It turned out that I had a library card with the wrong number on so I had to go back through the process again myself, coming back to getting another library card which is why I now have still got confusion in my passwords and it took about 4 weeks into the course before I could actually access the thing. I've actually not needed to use it at the library because I found I could get into it at home and that is what I've actually done, I've sort of abandoned trying to get in here.'

On study style: 'I am doing the sort of job where I have to work on my own. I have responsibility for my own projects and I have to be quite self motivated. I like tutors to be there to tell me I am on the right track because I don't like to think that I am wasting time going down a blind alley, but I am somebody who can motivate themselves to do my own thing.'

On computers: 'I am certainly not a stranger to them. I have to use computers at work mainly for



word processing, but certainly for some spreadsheet work as well plus my husband is a programmer so he can set things up to make it easier for me to do things, so if I do have problems I can ask him. I try not to let it defeat me.'

'I couldn't imagine doing the job without it (computer) now. I think access is the big issue you know. I find the fact that all these passwords to Netscape to actually get to use the package, you are talking about six different things that you have to remember.'

Student 7 works in a stroke and rehabilitation unit. Background:

'I find the work and the course very helpful because I'm able to relate it to practice. Although it is hard to do the assignments otherwise I'm thoroughly enjoying the course.'

Comments on the website include: 'Not actually used the web-site much yet. Only been on it once. Not really gone into any depth yet. Can't comment on effectiveness of the site because I haven't used it that much.'

'This is the first course I've been on that has introduced me to the Internet.'

Student 11 works on the community as a district nurse. Background:

'I work full time and I have two little ones as well so it's quite hard work. I'm only really managing a bit of library access time of an afternoon and on a Monday if I can get in a bit earlier.'

Comments on the website include: 'I think the information on there is very good, but I do feel that if you're not really up to date with computers and you haven't got computer skills it's a bit of a disadvantage.'

'I haven't had any problems getting going. I've mainly used the complications especially the aetiology, therapy and care management. It seems to be at the right level of detail and makes me think of the complications more.'

On access: 'I have found the Website easy to access in college but outside, no.'

'I've used it about three times. Mainly due to the time factor and not being able to access the computer at home so it means having to make time to actually use it which working full-time is very difficult.'

On study style: 'I work on my own although I would consider other options and work with the other girls on the course.'

On computer background: 'Even if I had basic computer skills it might have been better. I didn't even know how to use a mouse before I came here so I've learnt a few things.'

'I personally would have preferred to have had a lecture basically because I'm not really very good with computers and don't know very much.'

'It has a good potential to be helpful (Diabetes Web). It depends on your computer skills and whether you've got one at home.'