health

Project Members
Ivan Watkins

Introduction
This project focuses on teaching older adults (over the age of 60) how to evaluate the reliability of health information they encounter online. Although the Internet provides an invaluable resource for accessing reliable health information, determining the quality of health information requires practice and experience. Older adults, especially those unfamiliar with Internet, may be especially vulnerable to unreliable information. This project is divided into three lessons: (1) Understanding the reliability issue (2) How can I tell if a website is reliable? and (3) Examining and evaluating live health websites. Class discussion, web-based video tutorials, and practice exercises will be the primary methods of instruction. After completing these lessons, students should understand how to evaluate the reliability of any health website they encounter online. This project will not focus on a specific health topic, and does not teach students how to search for health information. However, this project could serve as a unit in a more comprehensive curriculum covering those topics.

The Topic & Standards
This project uses the American Association of School Librarians “[|Standard for the 21][|st][| Century Learne]r” as guidelines for developing the technology based curriculum. Although these standards were developed for school libraries, the concepts are readily transferable into the public library or senior center setting. Further, the fundamental pedagogic principles reflected in these standards are equally applicable to life-long learners. This project will also use section 3 of the “[|Guidelines for Library and Information Services to Older Adults]” developed by the American Library Association. Section 3 focuses on making libraries “safe, comfortable, and inviting for all older adults.” Adopting and implementing these standards will ensure that the lessons do not impose any physical hardship on students. The primary goal of the project is consistent with section 2.4.1, which states that students should “determine how to act on information (accept, reject, modify).” In this context, students will develop skills for how to act on information presented by health websites. By the end of the project, students should be capable of making informed decisions on whether to “accept, reject, [or] modify” the information they encounter on various health websites. The project is also consistent with the following rules through the focus on developing students’ ability to think critically about health information websites:


 * 2.1.1**: //Continue an inquiry-based research process by applying critical-thinking skills (analysis, synthesis, evaluation, organization) to information and knowledge in order to construct new understandings, draw conclusions, and create new knowledge.//
 * 2.1.3**: //Use strategies to draw conclusions from information and apply knowledge to curricular areas, real-world situations, and further investigations.//

Next, each lesson is structured to maximize collaboration. This is demonstrated in the class discussion time incorporated into each lesson, along with activities that encourage collaboration with students seated at neighboring computers. The following rules support this type of collaborative effort:


 * 2.1.5:** //Collaborate with others to exchange ideas, develop new understandings, make decisions, and solve problems//
 * 3.2.3:** //Demonstrate teamwork by working productively with others//
 * 3.3.5:** //Contribute to the exchange of ideas within and beyond the learning community//

In the context of older adults, working collaboratively in a social environment may be a valuable experience for students that become socially isolated as a result of aging. Therefore, I would include an additional standard that reads “create a collaborative environment that maximizes the social nature of the class. This includes accommodating class discussions that may diverge from pedagogical goals, but create a more socially connected experience for students.” Implementation of the section 3 of the "[|Guidelines for Library and Information Services to Older Adults]" standards should occur prior to the beginning of the project, when instructors evaluate a public library, senior center, or other educational setting to determine whether it can accommodate the class. Specifically, instructors should ensure the following standards are met when evaluating a potential class site:


 * 3.7**: //Ensure that signage is clear, Brailled (where appropriate), and readily visible to all, including users in wheelchairs//
 * 3.8**: //Provide at least one computer station prominently labeled and installed with large type software for older adults with low-vision. If needs warrant and resources are available, acquire other assistive technology such as a stand-alone Reading Machine which speaks the book’s text to a blind reader; speech synthesizer and related software; low-tech magnification and other device//

In addition to these standards, section 3.3 seeks to accommodate older adults for whom extended standing may be an issue. For this project, this standard will be reformulated to accommodate older adults that may experience difficulty sitting for extended periods of time. This standard will now read: “accommodate users for whom prolonged [sitting] is difficult, by [taking frequent breaks of sufficient time for each student to remain physically comfortable throughout the lesson].” The lesson plans implement this standard by including extra time in each lesson plan to accommodate any breaks that may be necessary. Last, the project uses the National Library of Medicine’s guidelines found in the “[|Evaluating Internet Health Information: A Tutorial from the National Library of Medicine]” web-based video tutorial. These guidelines provide general criteria for evaluating the quality of information presented on health websites. For the final two lessons, these criteria will be presented in a handout that students can review between lessons. The tutorial presents these criteria as questions that Internet users can asks themselves whenever they encounter a new website. Sample questions include: //"Who is in charge of the website?"// //"Why are they providing the site"// //"Can you contact them?"// //"Does the site ask for your personal information"// //"Does the site avoid unbelievable or emotional claims?"// These questions appear towards the end of the tutorial. During the course of the tutorial, students are instructed on how the answers to these questions should influence their evaluation of the reliability of information on a health website.

The Setting and Context
Older adult education typically occurs outside of the classroom in non-traditional educational settings. These settings may include public libraries, senior centers, or any other communal space easily accessible to older adults. While each setting presents unique challenges, this curriculum is designed with adaptability in mind. As a result, the curriculum only requires a computer with an Internet connection for each pair of students. In the ideal situation, each student will have their own computer, along with a set of headphones. Public libraries present the greatest challenge for executing the curriculum because resources must be shared with the general public. Ambient noise, distracting patrons, and time limits on computer access interfere with students’ ability to focus on their lesson. Using headphones during the tutorial can mitigate auditory distractions, but effective planning and collaboration with staff is essential. Library staff can help seat students in adjacent seats, ask patrons to be quiet, and give students ample computer time to complete their lesson. Similarly, instructors should work with senior center staff to limit distractions and ensure students can work at adjacent computers. If it is impossible for students to sit in adjacent seats, instructors should implement the individualistic learning version of the curriculum. Scheduling class times also requires close collaboration with staff. Three challenges present themselves when scheduling classes for older adults (1) transportation and (2) other appointments/engagement and (3) available computer time. Instructors should schedule classes consistent with public transportation schedules to ensure access for students lacking their own transportation. To accommodate students’ appointment schedules, instructors should offer the same lesson over multiple days. For example, students could offer the first lesson on a Monday and Tuesday, the second lesson on a Wednesday and Thursday, and schedule that final lesson on the following Monday and Tuesday. This method will ensure that students unable to attend a class on one day have the opportunity to attend a class the following day. Last, instructors should work with library or senior center staffs to ensure students have ample time on the computer to complete lessons. While each lesson is scheduled to take two hours to complete, the instructor should schedule plan for the lesson to take an additional half hour to complete. By scheduling an additional half hour, the instructor can accommodate students that may need more frequent breaks. Should the instructor complete the lessons within two hours, the final half hour can be used to answer student questions. When implementing the lesson plan, instructors should be conscious of each student’s experience, ability, and limitations with the computer. Students’ experience will vary significantly depending on their background, and affects their ability to operate the tutorial. Although the curriculum is designed for students of all abilities, students without computer experience will require hands-on assistance from the instructor. Similarly, experienced students may also have a low ability to operate the computer. This may occur as a result of physical impairments (such as poor vision or tactile ability) or because their experience with computers is not easily transferrable to the tutorial. For example, a student may have significant experience using accounting software but little experience using windows or the Internet. Before the project begins, instructors should contact students by phone to remind them of class times and to inquire about any limitations or concerns students may have. When the instructor contacts a student, they should ask about the students’ experience with the computer, along with an inquiry about any physical disabilities that may affect the students’ ability to use a computer. This method maximizes privacy for students and allows instructors to plan ahead for any accommodations that may be necessary. In the case of students with physical impairments, reasonable affordances should be made to accommodate each student. For example, students with poor vision may benefit from using a keyboard where the letters are clearly visible through sharp contrast (e.g. a black keyboard with white lettering). For students with a poor ability to use the mouse, instructors should ensure that the area surrounding the mouse is clear and that the cord does not become tangled. Last, instructors should work with and assist any caregivers present for the lesson. In addition to physical limitations, instructors should be cognizant of cultural and socioeconomic differences between students that may influence their approach to the curriculum. These differences could manifest themselves in a variety of subtle ways that could affect the ability of students to carry out the lessons, or even be disruptive to the classroom atmosphere. For example, some students may have little experience with participating in a formal educational setting and be unfamiliar with conventions like raising a hand to speak. In this situation, the instructor should confer privately with a student to work through the situation should this be an issue. Similarly, instructors should be cognizant of student sensitivities throughout the discussion portion of each class. While each student should be encouraged to participate in discussions, it should not be required for participation in the class. Cultural, political or social differences may also influence how students evaluate the quality of health information. For example, the criteria presented to evaluate health websites was developed by the National Library of Medicine, which is part of the National Institutes of Health. Some students may take issue with criteria developed by the federal government. Similarly, students may disagree with the validity of information on a website that otherwise fits the criteria of a reliable website. An example would be a website for a non-profit organization that promotes flu shots. If a student believes flu shots contain poison, they will likely dispute the validity of the website’s information. In either situation, students should be encouraged to present their views to the class during discussion sessions. This method gives students the ability to voice their opinion and understand that their perspective is valued. In any event, instructors should always prepare for students to challenge the content presented in each lesson. Issues with implementing technology should be expected, and instructors should prepare accordingly. Although each lesson relies heavily on using a computer with a working Internet connection, instructors should bring handouts with screenshots of different health websites to each session. In the event of a technology failure, these handouts will be used as the basis for a discussion. The discussion should focus on what aspects of the screenshots indicate reliability, and the instructor should encourage students to develop ideas for what aspects of the website they would change to make them more trustworthy and reliable.

The Materials and Technology Tools You will Need
The emphasis of this curriculum is on developing a critical approach to health information online, not computer literacy. Older adults with little or no experience using a computer may be quickly overwhelmed with unfamiliar technology. Therefore, the curriculum uses technology primarily as a way to limit potential distractions. [|Voicethread] will be used as an easy way to present students with screenshots of different websites. Voicethread’s interface is intuitive and permits to students to view screenshots at their own pace. Further, brief narration can be prerecorded for each screenshot that can help guide the student. Using screenshots instead of live websites limits potential distractions that arise when students click on links that can take them away from relevant content. Similarly, using Weebly to provide a list of links to health websites obviates the need for students to navigate between websites using the address bar. With Weebly, students can click on a link to a website, then use the back arrow to return to the Weebly site. While effectively using the address bar to navigate to different websites is a valuable skill, it falls outside the focus of the curriculum. Older adults frequently experience difficulty correctly entering web addresses into the address box, so providing a list of links will be especially important to ensuring that the session runs smoothly.

The Implementation & Assignments
Instructors should aim to teach these sessions fairly close together in time, preferably over the course of several weeks. Each lesson builds on knowledge and skills developed during prior sessions, so extended time between sessions makes it more difficult for older adults to recall each lesson. That said, instructors should take several minutes at the beginning of each session to describe material covered in previous sessions, and answer any questions. [|Lesson 1 "Understanding the Reliability Issue"] focuses on developing an understanding of importance of distinguishing between reliable and unreliable information online. Many older adults, especially non-Internet users, are not aware that information on the Internet may be unreliable. Further, many older adults are not aware that the Internet can be a source of free, high-quality health information. As a result, the first lesson focuses on developing an appreciation of these two important points. [|Lesson 2 "How can I tell if a website is reliable?"] teaches older adults how to determine the reliability of health websites. Students will then have the opportunity to view screenshots of different health websites and practice using the criteria presented in the tutorial. Screenshots are used to limit distractions, forcing students to evaluate distinct aspects of each website and limit difficulties associated with navigating live websites. [|Lesson 3 "Examining and evaluating live health websites"] is similar in nature to Lesson 2, but students will use live websites. Building on the knowledge gained in Lesson 2, students should be better equipped to deal with the complexity inherent in operating live websites. Students will be assessed based on their participation and performance during class activities. Because these classes are not for credit or a grade, instructors should focus on providing helpful feedback to students. Feedback should be provided throughout the course of the three lessons, in the form of positive comments or suggestions. At the completion of the lessons, the instructor should provide a handout with feedback for students to take home with them. Again, this handout should provide positive feedback and suggestions for students to try in the future (because the instructor will have to prepare this handout prior to the third lesson, it will not include comments specific to the students' performance during that lesson). == ==