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Online Learning in Nutrition and
Dietetics: Student Performance and Attitudes
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Dominic Upton, PhD
University of Wales Institute
Cardiff, School Of Health and Social Sciences
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Correspondence:
Dominic Upton
University of Wales Institute
Cardiff, School Of Health and Social Sciences
Llandaff, Cardiff, CF5 6YB
DUpton@UWIC.ac.uk
Citation:
Upton, D. Online learning in nutrition and dietetics: Student performance
and attitudes. The Internet Journal of Allied Health Sciences and
Practice. January 2005. Volume 3 Number 1.
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Abstract
Context:
Behavioural studies can form an
essential component of the Nutrition and Dietetics undergraduate
degree.
Aims: This study aimed to firstly produce on-line teaching
material in
Behavioural studies suitable for
undergraduate Nutrition and Dietetic students. Secondly, to explore
students’ views on the online material, and record their performance
when taught through this innovative method.
Methods: Nutrition and Dietetics students completed an online
health psychology/sociology module and their performance compared to
students who completed a traditional lecture based course. Student
evaluations of the online course were also recorded.
Findings: Results suggested that students taught through
on-line medium performed no differently to those taught through
“traditional lectures”. Students appeared to enjoy the material
although there was some reluctance to develop an independent learning
style.
Conclusion: It was apparent that material has to be developed
that can both engage and motivate learners, thereby further developing
independent learning, and that this may have to be tailored dependent
on a number of student factors.
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Acknowledgement: The author wishes
to thank UWIC’s Learning and Teaching Support Unit, LTSN-psychology,
and LTSN-Health Science and Practice for financial assistance in
developing the on-line learning material. |
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Key words and
terms: e-learning, online learning, digital education,
interactivity, nutrition and dietetic education, independent learning |
Introduction
Degree level education is
provided for nutritionists and dietitians at many specialized higher
education institutions worldwide. Within Higher Education (HE) there is a
move towards flexible, online learning for it has a number of benefits. For
example, by increasing the access to flexible learning, access to these
courses is extended to those geographically isolated, those whose disability
prevents them accessing HE and those whose particular social and personal
circumstances are not conducive to on campus learning.1
Furthermore, it has been
reported that traditional lectures are not a good way to learn.2
Today’s students have grown up in a technological age of television,
computers and videogames.3, 4 Some researchers argue that
neither students nor teachers regard lectures as effective and students now
expect technology to be use effectively as part of their learning
experience.3, 5-7 The challenge for teachers is hold the
attention of students from this high-tech generation. Many authors have
suggested designing the learning and teaching environment to promote greater
student participation and engagement thereby increasing deep learning in the
students.2,8 Some have suggested that web-based learning appeals
to students both on and off campus.9 Students find such learning
appealing and engaging and may therefore be more involved and motivated as a
consequence.
The benefits of on-line
learning within the health and social care professional curriculum have been
reported on- for example in nursing, medicine introductory biology and
anatomy/physiology related to the subjects allied to medicine amongst
others.10-14
The benefits of on-line
learning within the nutrition and dietetic curriculum have yet to be
explored extensively- although Shah et al (1999) do state that “…it will pay
an essential role education in the 21st century”. 15
Litchfield et al (2000) do present a picture of the future and how dietetic
education can be improved through on-line distant education.16
However, the small numbers (n=8) and limited outcome variables employed in
the pilot study reduce the conclusions that can be drawn although the
benefits of the approach taken were apparent. We report here on the
development of an on-line health psychology and health sociology module and
the performance of students on the module compared to previous cohorts
taught through a traditional lecture based method, along with the recorded
evaluation by the students.
Methods
A pseudo-experimental design
was undertaken; such that a cohort taught through a traditional lecture
based medium was compared to those completing the course on-line. The
dependent variables were performance on the end of module assessment,
engagement with the online material and evaluation of the online course.
In terms of the evaluation,
a survey of all students completing the on-line course was undertaken at the
end of the final teaching session, but before the assessment had been
completed and graded (as it was assumed that graded assessment could have
affected the views of the students).
Materials
The on-line material
included a range of behavioural science resources co-ordinated through the
Blackboard Virtual Learning Environment (VLE). Blackboard (http://www.blackboard.com)
is an online learning system which provides the functionality required to
successfully manage distance, web-enhanced, or hybrid education programmes.
It features a robust environment for content management and sharing, online
assessments, student tracking, assignment and portfolio management, and
virtual collaboration.17 In essence, it provides a ready made
online shell for tutors to populate with content, together with a set of
commonly used online tools.
Students were presented with
the online behavioural sciences module material (on topics such as
definition and measurement of health, social class and health, gender,
stigma, stress, pain and pain management) throughout the academic year along
with three traditional lectures throughout a twelve-week semester. One of
the lectures was placed at the start of the semester to introduce the
module, one in the middle to re-visit the students’ learning and iron out
any difficulties, and one at the end to review progress and provide a
revision session.
Student outcome was assessed
according to three variables: performance, engagement and evaluation. These
were assessed through:
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a written assignment as per the validated course descriptor. All
assessments were subject to both internal and external moderation, both
internal and external examiners had no formal contact with the design or
delivery of the module;
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the amount of
contact the student had with the on-line module;
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the
evaluation form that was completed at the end of the module.
At the final session,
students were asked to complete an evaluation form which has been previously
published.18 It consisted of a series of statements asking the
respondent’s views on their learning experience and the materials with which
they had engaged. There were sections on technical features (e.g. speed of
response, accessing material), Blackboard features (e.g. announcements,
information), academic support (e.g. e-mail response, marking of material),
module design (e.g. organisation, usefulness), comparison of Blackboard to
face-to-face teaching (e.g. convenience, learning) and overall comments
(e.g. amount of material, views on learning by computer). Each of the
statements was rated on a five point “strongly agree” to “strongly disagree”
continuum. The questionnaire has been used in previous study and provides an
indication of the students’ views on the online learning environment.
Limited comments on the reliability and validity are provided, but in the
context of a small-scale evaluative pilot study this is not of key
importance.
Sample
This report details the
experiences of a cohort of students completing the online module. A total of
31 students progressed through the module during this time of which the
majority (n=30) were female and under twenty-one (n=21). The module was
compulsory for all students on the nutrition and dietetic undergraduate
degree programme. The comparison was made with the previous cohort of
students who had completed the module through the traditional lecture
method. There were no discernable differences in sex, age or course entry
requirements (see table 1) between the cohorts. In contrast to the first
group (the online lecture group who just had three lecture sessions), the
traditional lecture group had a series of ten two-hour lectures throughout
one term. The latter group was used for comparison in order to determine if
the presentation pf material had an impact on performance. The sample
consisted of all students recruited onto the Behavioural Sciences course of
the Nutrition and Dietetics degree over two successive years.
Table 1:
Profile of student cohorts.
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On-line group |
Traditional lecture group |
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Male |
8 |
4 |
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Female |
30 |
32 |
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Under 21
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21 |
21 |
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Aged 21-25 |
7 |
8 |
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Aged 25 years and
above |
10 |
7 |
Results
Students completed the module after one semester and were
assessed via the usual procedure. In addition at this time, the students
completed an evaluation questionnaire. On the basis of this information and
data collated through the Blackboard VLE, analyses explored: student
performance, student achievement and engagement and student evaluation of
the online module.
1. Student Performanc
The performance of the traditional lecture method cohort
compared with the performance of the cohort experiencing the on-line module
is outlined in Table 2. As is apparent, there is no difference in
performance between the teaching methods adopted- performance did not
improve (nor deteriorate) with the introduction of the on-line learning
module.
Table
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Student performance: On-line compared to traditional lectures.
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Year |
Mean score on assessment (SD) |
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On-line |
57.84 (8.54) |
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Traditional |
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2. Relationship between student performance and
engagement with the module.
Blackboard allows for the recording and tracking of
student use of the presented material. Using this data, a correlation was
computed between the amount of times students used the on-line learning
material and their final exam marks. No relationship between performance on
the module assessment and usage for the students was revealed (rs=‑0.10,
ns).
3. Student Evaluation
A comprehensive evaluation was undertaken at the module
end, and both qualitative and quantitative data collected. All 31 feedback
forms (100% response rate) were received and each responded to a series of
questions on: technical features, Blackboard features, academic support,
module design and content and comparison of Blackboard to traditional
teaching.
In terms of technical features, 96% agreed that the speed of response
was acceptable, and a similar percentage found it easy to access the
material from the University, although a slightly smaller number
(approximately 78%) felt it was easy to access from home or work. The
response to each of the statements on the questionnaire related to the
technical features of Blackboard is presented in figure 1. This has been
collapsed into either “Agree” (which includes both Strongly Agree and
Agree), the mid-point, or “Disagree” (which includes both Strongly Disagree
and Disagree)- a convention adopted throughout this report.
Figure 1:
Views on technical features of module.

In terms of the module design and content evaluation, the
students’ viewed the material positively- with no student reporting it to be
badly organised or lacking in interactivity (see figure 2). It was
noticeable that this group rated the content as interesting and engaging
(88% reporting), along with being well organised (96% reporting positive)
and found the material interactive in nature. On the basis of the results
presented here it is evident that the group was satisfied with the design
and content of the module.
Figure 2:
Student perspective on module design and content.

When students’ overall
views were recorded it was notable that they found Blackboard an interesting
way to learn (88%- see figure 3). They also found it an interesting way to
learn and felt that Blackboard was an effective supplement and replacement
for missed lectures. However, 36% did not enjoy learning at their own rate.
Figure 3:
Student overall views.

When comparisons
between the use of on-line teaching and face-to-face teaching there was more
of a mixed picture (see figure 4). On the one hand, the majority (80%)
considered Blackboard to be more convenient than attending regular lectures
and tutorials but given the choice between studying through Blackboard and
through the traditional method, students would select the traditional method
(64%). Similarly, they appeared to enjoy the traditional method slightly
more than the Blackboard method.
Figure 4:
Student views on Comparison between Face-to-Face and online learning.

Finally, students were
asked their views on the development of independent learning through the
online material. It was evident (see figure 5) that students felt less
motivated to learn through online learning, but felt that the module had
made them more of an independent learner.
Figure 5:
Student views on development of independent learning.

Discussion
The results of this investigation reveal some interesting
findings at a number of different levels that may be of interest in
nutrition and dietetic education. Firstly, students performed no worse with
on-line learning material compared to the previous cohort who did not access
this material and had a traditional lecture based course. This finding is
in line with other studies that generally suggest either improvement or
limited difference between on-line and traditional courses. 9, 19
However, the analyses completed here was at a rather superficial level- it
may be that different elements of performance are affected by mode of
learning. For example, it has been found that there is no difference in
factual knowledge between those taught through the traditional method and
those taught through a Problem Based Learning (PBL) method. However, the PBL
students performed significantly better in terms of deeper understanding.20
The same may be true of online learning, and needs to be assessed in any
future studies.
Second, students reported that they had a positive
experience in terms of the technical capabilities, the features inherent in
Blackboard, the academic support provided by the tutor and the module design
and content. Additionally, students felt that Blackboard was more
convenient than attending regular lectures, enjoyed learning at their own
rate, found e-learning an interesting way to study and using a VLE made them
more independent in their learning.
Despite this, few reported that they would choose this
method over traditional lectures and most felt they learned more in a
traditional lecture setting. Hence, there appears to be a contradiction:
students valued e-learning, yet still retain an urge for traditional
lectures. Why should there be this paradox? Some explanations can be
uncovered from the qualitative comments also recorded. A recurring theme
was that the students felt that Blackboard required commitment and active
learning that lectures did not. For example, students found it “hard to
motivate themselves” or “difficult to prioritise” and that it was “tempting
to leave until the last minute” (a perspective supported by the
questionnaire results). In the current climate, with a number of competing
demands on students they may be happier to have a structured time around
which other activities can be accommodated. Students may obviously need
assistance so they can motivate themselves to complete such online
activities. This has previously been highlighted as a potential drawback
for on-line learning but one that is key to learning and together with
intelligence, influences the success of a programme. 9, 21, 22
Therefore, the challenge is to provide students with an environment that
enhances motivation, engages them but which also directs and rewards.
The use of on-line learning is certainly increasing, but
there is a need for a greater examination of the material, and how this is
presented to best engage with the learner.21 Students are
becoming more conversant with the experience of on-line learning and with
this experience come expectations. Tutors and on-line developers are going
to have to increase their skills in the development of interactive material
in order to encourage students to use it, interact with it, and engage with
it.
Obviously the individual methods described in this report
have been employed within other settings and for other groups, although not
extensively for dietetic and nutrition students. Clearly there is still some
way to go in terms of enhancing motivation of students- although we believe
that we have reported on a method that helps. However, there may be
individual differences, which may be influential in online performance. For
example, it may be related to student’s learning style, or their
expectations of teaching. Both of these variables may be linked to the way
students, or groups of students, approach learning through an on-line
medium.23 There is no doubt that on-line teaching is going to
become ever more prevalent throughout higher education in the UK and it is
therefore important that the material is appropriately written and
delivered. It may also be possible to identify student factors (e.g.
attitudes and expectations) at the outset that could be modified, or
accommodated through the on-line resource. Indeed, this could lead to a
more tailored and appropriate pedagogy.
A final comment has to be made on the tutor’s experience.
Despite the enthusiasm and encouragement for the use of on-line learning,
often mediated through a virtual learning environment, the potentially
overwhelming preparation time should not be underestimated.24 The
development time associated with this material ran into several hundred
hours and certainly in excess of the time required for the development of a
traditional lecture based course. The time involved in learning new skills
was also considerable and this has to be taken into account with the
development time.
In conclusion, online education can offer a great deal to
nutrition and dietetic education. However, there needs to be an appreciation
of the amount of time taken to prepare the learning material that has to be
tailored to student characteristics. Although we have reported here a first
step, there still remains a quest for online material that can engage the
student and move them towards successful independent learning.
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