In his articles A History of Instructional Design and Technology Part 1 and 2, Robert Reiser covers some lessons learned from the history of instructional media (part 1) and instructional design (part 2). The most outspoken takeaway from this was the juxtaposition between the expectations of what the instructional media can achieve in education and learning, and the lackluster outcomes that have preceded them. Reiser mentioned Thomas Edison’s enthusiasm for film education and the National Education Association excitement over the radio (Reiser, 2001). Then both technologies found themselves becoming less popular and eventually unused.
This reflects my current workplace as some of my executive leads team (ELT), have a zeal for new technology, and sometimes older technology, that they wish to implement with the hopes of uptake and buy-in from our users. Unfortunately, as Audrey Watters stated in her book, The Monster of Education Technology, what ends up happening is we use the new technology with the perspective of the old methods (Watters, 2014).
For example, we found less people were becoming engaged with a monthly educational series that brought guest speakers to talk about health policies and standards via Skype for Business. After the meeting, there would be time for questions and an email would be sent to the participants with a survey. The ELT replaced the old lecture style of the lesson and implemented a more “interactive” style that would have a guest speaker talk about policy and standards, followed by an interactive whiteboard where participants could post questions and comments. Then we would provide a poll that would gauge in real-time how people felt about the lesson. Initially, yes, there was a bit of an uptick in interest, but it soon faltered as the innovations became less novel. This left us to redesign the method of education into more video formats, experimenting with podcasts, and trying to add in more interactive aspects.
The greatest lesson from Martin Weller came from his statement that the information age with social media has given everyone a voice that at times can be used negatively and causes issues between learners and institutions (Weller, 2018). In his conclusion Weller also touches on sociocultural differences between sectors (Weller, 2018). This lesson causes a lot of trouble for myself and my colleagues. One of our main question is, “how do you get people who are disinterested in self-health, to learn and become aware of their own health and to take steps to become healthier?”
Our goal is to get patients to take more responsibility for their own health, to eat well, exercise, see their family doctor and not to use the hospital unless it is a true emergency to name a few desired outcomes. However, the cultures around instant gratification, convenience, media saturation, etcetera, cause patients to questions what is healthy, to visit walk-in clinics or hospitals rather than their family doctors, and to give-up on healthy life choices due to a lack of instant results.
References
Reiser, R. A. (2001). A History of Instructional Design and Technology: Part I: A History of Instructional Media. Technology Research and Development, 49(1), 53–64. Retrieved from https://docdrop.org/static/drop-pdf/A-history-of-instructional-design-and-technology-1-8nOHG.pdf
Watters, A. (2014). The Monsters of Education Technology, 207. Retrieved from https://s3.amazonaws.com/audreywatters/the-monsters-of-education-technology.pdf%0Afiles/434/MonstersWatters.pdf
Weller, M. (2018). Twenty Years of Edtech. Retrieved from https://er.educause.edu/articles/2018/7/twenty-years-of-edtech
Hello Alastair,
I really enjoyed reading your post! Your example of the monthly educational series got me thinking about society’s level of engagement as a whole. As you mentioned, the advent of technology has bred a culture of instant gratification and convenience. This statement caused me to reflect on my own expectations in this regard. If I want to read something, I no longer go to the library or purchase a book, I open my Kobo app, download and begin reading within minutes. If I want to purchase something, I can open my Wayfair app and have it in my hands the next day, rather than driving to the mall and exploring several stores before I make my purchase. If I want to know how far I have walked or what my heart rate is I can look at my Fitbit etc. All of these apps utilize artificial intelligence (AI) and are highly customized to my preferences without any action on my part. Could AI be a solution to reach your goal of getting your patients to take more responsibility for their own health or is it as Watters (2017) posits ideological? Do you think AI’s popularity will wane just as other new technologies have in the past?
Watters, A. (2014). The monsters of education technology. Licensed under the Creative Commons CC BY-SA 4.0.
Alastair, please note an error in my reference. The correct Watter’s reference is below
Watters, A. (2017, November 1). AI is ideological. [Blog post]. Retrieved from https://newint.org/features/2017/11/01/audrey-watters-ai
Thank you so much for you comment Sue! I love your observations on how technology, specifically AI, has made many of the learnings we get day-to-day more accessible. It’s the wave of the go-go culture that we do everything on the fly. I hardly read books anymore thanks to apps like Audible where I can listen to books on the bus or train, while answering emails, or setting up appointments. Everything we do is on the move and must fit into our lifestyle. When it comes to educating people on health, I can see podcasts fitting into this model, but other than a great amount of marketing and advertising, I wonder how to get people interested? Where do people normally go to get health information?
Thanks for the conversation above Alistair and Sue. There are good ideas and great questions there! I think the whole conversation supports Watters (2014) writings that state “…while building new technology is easy (easy-ish), changing behaviors and culture is much much harder.” (n.p.).
Speaking from experience, change behavior for our patients and clients goes much deeper than your best intentions as a care provider, administrator, or policymaker. In fact, on the whole, I believe that many individuals in the healthcare sector in positions of power and influence have completely lost sight of what the patient wants in the midst of their own agendas for “best care” or “safest care”. If we truly meant to affect peoples lives, we would ask them about their own values, goals, and needs more often than we consider our own.
Sue supported that instant gratification and AI devices were driving her throughout her day. Tricks and tools look great on paper but we now know from Reiser (2001) and Weller (2018) that the tech should not overshadow the teachings. There are certain applications of technology that are helping patients to improve their self-care (two of my clients have medication administration machines in their homes to remind them to take their pills); however, so far, I am unimpressed by the use of technology in preventative healthcare for older populations with chronic illnesses.
Many of my older clients have no idea of how to use a smartphone or a tablet and I occasionally use part of my assessment time teaching them basic skills if they have the devices. Otherwise, they ask questions of family and friends. Some may be able to ask “Dr. Google” if they know how to use a computer. Physicians are retiring fast and the young ones don’t have any more than 15 minutes per client. The sources for help are few and far between. Our program is one of the few I have been proud of over the years. We connect healthcare professionals to those with chronic respiratory illness for home education, self-management, support and therapy. Face to face using patient-directed care strategies.
Your ideas about podcasts are probably helpful. Do you need to ask the question: What kind of technology are the patients comfortable with? CDs? DVD’s? Television shows? Consider their perspective…
References
Reiser, R. A. (2001). A history of instructional design and technology: Part I: A history of instructional media. Educational Technology Research and Development, 49(1), 53-64
Watters, A. (2014). The monsters of education technology. Licensed under the Creative Commons CC BY-SA 4.0
Weller, M. (2018). Twenty years of EdTech. EDUCAUSE Review, 53(4).
I’m getting the feeling that healthcare might be a hot-button issue for most people and perhaps getting a little away from patient education. However, it is true, for the longest time healthcare has been administered from a top down approach, research is conducted through doctors and hospital administration in order to determine what focuses, policies or programs are needed. Clinics, family care practices, and specialty care had mostly been forgotten. For this reason we have a healthcare system that it fixated on more hospitals and more beds, when we really should be looking at preventative care within primary care and the social determinants of health. Access is a huge problem, especially in areas that rate in lower transportation options or walk-ability. Social determinants of health comes into play as you put it, in peoples “values, goals, and needs”, in Alberta we have established programs that involve patient advisory committees completely made of patients who want to establish change for the better (and not just a place to air personal grievances). Patient voice is determined as one of the primary means of healthcare improvement in primary care.
Now back to education. From what I’m hearing it’s a matter of what information is being learned as opposed to what technology is being utilized. There certainly is a lot of misinformation out there that has detrimental effects on health outcomes, but how are patients to know which resources and tools are the proper ones to use? This I think when technology does come into play as we really need to allow accessibility to the resources that are developed by healthcare professionals and backed by a governing entity.
Chronic disease management requires much more than just technology, it’s behavioural change that is required to help manage and prevent hospitalization. Sure an app or device to help inform when to take pills is nice, however when it comes to chronic conditions there is much more than is needed to be done. Most of what can be done involves regular check-ups and maintaining healthy habits that are either learned from healthcare professionals or in class style programs.
I have to agree, the patient-centred care model is an effective care strategy as well as face-to-face patient-physician counseling on personal health goals. Your program sounds great! Establishing the connections between patient and healthcare education programs are invaluable to the overall care in the community. I’m wondering how else are patients supposed to gain awareness of such programs? How is your program marketed and where do you find your clients? Why isn’t the healthcare system doing more in health promotion to reach out?
Alastair, you make some great points in your blog. I am always interested in how our worlds of health care and high schools connect when we speak of technology. I can relate to your frustration with your ELT dilemma, trying to find the next best way to engage with our people. I am not sure if we have the same frustration, as mine is becoming about time. The amount of time invested in creating new platforms to deliver or to use new technology takes a tremendous amount of time and I can relate to not feeling invested in something that just might be out of date in the next year.
I also want to comment on your instant gratification in terms of health care. I did not connect this way of thinking to the health care system. I am curious about your thoughts on the economic sector and the connection to technology. We could argue that education and equal access would play a significant role in terms of privilege and arguably a greater understanding of healthcare, therefore less impact on our hospitals for example. Where does technology play in terms of education and the health care system for a lower socioeconomic sector? How or does technology play a role in having less of an impact on this system?
Danielle
Fantastic points Danielle! You’re right that socioeconomic status plays an incredible role in equal access. A person who works a 9-5 job with access to a car and who can afford to survive on one income will have much better access to healthcare resources, such as family doctors and specialty clinics, than someone who is a single parent, working two jobs, trying to pick up children and do chores by taking public transit. These problems are outlined in the social determinants of health and unfortunately, patient education even with technology cannot solve this. It would require education and empathy of all people, especially those in levels of government to make policy changes to help vulnerable populations. We would need systems in place that would help them find the time and accessibility to healthcare. Once that has been established concentration on patient education would be more effective for that demographic.
Well, this opens a can of worms doesn’t it?!
One of the important insights in the readings as far as I am concerned is that of culture and context. To connect this point back to your post Alastair, in Victoria there’s no family doctors taking patients. The situation is not improving, nor is it expected to. The norm is walk-in clinics. Put differently, the majority of people in this area don’t have the privilege of a family doctor. Because there’s a lack of family doctors, and walk-in clinics don’t take appointments (they are walk-in clinics after all!), there’s wait times at walk-in clinics. All this to say that there are lots of pressures on the system. Is there a better system? People will continue to have access to health information online – some of it relevant and useful and some of it filled with conspiracy theories and promoting the latest gizmo/remedy. What can health educators do to tackle all this?
Thank you for the food for thought…
Indeed, I would say the can of worms has been opened and subsequently exploded! Thank you very much for the food for thought. Context and culture do play the invaluable roles in communication, especially on a blog when such things aren’t generally communicated, more taken for granted. That being said, I do have to admit, my lends is coming from an Albertan, specifically Calgarian perspective. With luck I work for a provincial healthcare team, so I have a fair idea of the conditions in rural areas and other larger cities in Alberta. However, I’m missing a huge piece of information considering the culture my fellow RRU colleagues and the perspectives they would be using when regarding my post.
Not having enough family practices to sustain the population is a problem, at this moment I don’t have any information to create a valid hypothesis, but I’m now very interested in why would Victoria have a lack of family practices. I do know there are access improvement programs designed to help create efficiencies in clinics. It may not be education for patients, but for the management and staff of the clinic. These efficiencies could open capacity to allow for more patients (AIMAlberta.ca, 2007).
To get an idea of better systems I would have to know more about how the healthcare system operates in BC, specifically Victoria. There are a number of health system frameworks that are showing a lot of promise in Canada and around the world, I wonder if the Government of BC have plans on implementing these frameworks or elements of them.
Indeed, part of the problem of people accessing information online is that most people do not know how to check for reliable sources. I’m unaware of a specific patient health resource library like https://myhealth.alberta.ca, but I do know that BC has a health link. By dialling 8-1-1 on your phone you should be put in touch with a registered health professional who will provide on the spot advice and perhaps provide additional resources. How does the health system promote such a tool? How do we make sure that fads like Gwyneth Paltrow’s goop, which has poisoned women (Senapathy, 2016), from being the primary resource for health information? This is supposed to be where health promotion steps in, unfortunately, that is not my expertise so I cannot add very much to this.
“What can health educators do to tackle all this?” That is an amazingly good question. I think if I were able to answer that, I might have a chance at becoming the next deputy minister of health. I will give it some thought though.
Thank you again for the food for thought!
AIM Alberta. (2007). Retrieved September 16, 2018, from http://aimalberta.ca/
Senapathy, K. (2016, July 21). Gwyneth Paltrow Sells ‘Toxic’ Goop With Ingredients She Says Are Dangerous. Retrieved September 16, 2018, from https://www.forbes.com/sites/kavinsenapathy/2016/07/21/gwyneth-paltrow-sells-toxic-goop/#3771515e7ec3