Effectiveness of Web-Based Computer-Assisted Instruction(CAI)

in Child Safety Education

Bae, Jeong-Yee

Department of Nursing, Inje University, 633-165, Kaegum-dong, Busanjin-gu, Busan, 614-735, Korea.. E-mail: jibai@inje.ac.kr

Abstract: The purpose of the study was to find out the effects of Computer-Assisted Instruction through the Multimedia CD-ROM for prevent of child accidents. A total of 154 Korean school-aged-children who were attending 3rd grade elementary school in Busan, were participated in this study. The design of this study was non equivalent control group pretest-posttest design. Experimental Group1 studied safety education through lecture and CAI, Experimental Group2 studied through lecture only, Group3 studied through CAI only and control group didn't study at all. A statistically significant difference was identified in the scores between before education and after in all experimental group. For subjects who participated in experimental group1, there was marked improvement on their knowledge and behavior. After lecture and CAI education, the score of children's knowledge was higher than before. After education, the score of children's behavior for prevention of accidents was higher than before. Therefore, this CAI was revealed the positive effect for children's knowledge and attitude for prevention of child accident.

Keyword:  Safety, Child Accident, Computer Assisted Instruction, Health Education

I. Introduction

Child accidents are an important cause of death and disability. The reported rate of childhood death due to accidents has reached 40%, and it ranks as the highest cause of death in age group. Such accidents also have enormous financial implications[1].

Young children easily become accident victims due to their fragility and their inability to cope with the circumstances that arise during an accident. Once they have been in an accident, children who are not fully developed can suffer from devastating long-term effects. Some injuries result in extended periods of absence from school and lead to long-term health problems[2]. In addition to the physical signs and symptoms of injury, accidents can leave lifetime emotional scars that lead to disability.

The risk of accident in childhood is strongly related to social disadvantage[3]. The death rate from childhood accidents aged 0-14 by health districts is strongly correlated with social deprivation[4]. This data suggest that children are exposed to unsafe environments, and indicate how vulnerable children are in such environments.

Lee, Lee, Kang and Han reported that 90% of accidents could be prevented[5]. Neverthless, there is no national system to manage, evaluate, and analyze the information related to childhood accidents, although this is necessary for developing accident-prevention policies and promoting general public health[5]. Furthermore, a shortage of healthcare facilities and providers is another problem.

Currently, the public seems to recognize that it is imperative to prevent childhood accidents rather than to treat the victims of accidents after the fact. Teachers and parents must also acquire the knowledge needed to actively participate in preventing children from becoming accident victims and protecting them from the harmful effects of childhood accidents. The best solution of this problem could be safety  education for prevention of child accidents.

Written information, movies, and computer programs have all been used to inform and educate clients. CAI can now be used for the same purpose. A CAI has several advantages over computer programs, including high capacity and low production, duplication, and distribution costs. Currently, CAI are leading in sales of educational multimedia software. Previous research [6][7][8] indicates that computer-assisted instruction (CAI) is effective in reinforcing certain behaviors. Information available via computer is expected to become an important factor affecting health behavior[9].

Therefore, investigator had developed a web-based safety education and information system and multimedia CD-ROM title for prevention of child accident in 2002. Korea Science and Engineering Foundation funded this project.

The second phase of this project was evaluated this program for further development. The investigator was planed to examine the changes in knowledge, attitude, and behavior of the children who had an opportunity to participate in the program. The purpose of the study was to find out the effects of web-based computer-assisted instruction in safety education for child.

II. Methods

1. Development of Web-Based Safety              Education

There have been few systematically implemented interventions and research studies on accidents involving children. The steps involved in developing this system consisted of 1)reviewing the literature, 2)analyzing existing programs, 3)identifying needs and requirements, 4)defining the problem and identifying preventive strategies relating to childhood accidents, 5)developing an educational program for preventing such accidents, 6)designing the relevant software, 7)implementation of the web-based safety education and information system, 8)evaluating the application to ensure that it meets customer requirements, 9)revising the product, and 10)using the CAI for educational purposes.

To develop an effective accident prevention program for Korean children, the investigator conducted a descriptive study that involved conducting surveys, interviews, and workshops for 2,726 young children, 9 teachers, and 1,494 parents in urban and rural districts in Korea. The purpose of the survey was to assess needs and to determine how to deliver an educational program to promote childhood accident prevention. Data collection for the study began in September 2000 and was completed in 20 March 2001.

Collaborative work involving health educators and engineers was used to produce a meticulous program that met the unique educational goals, content, and methods of this project. The program focuses on accommodating children's educational needs and interests by giving them an opportunity to interact with the program using modeling and problem-solving methods.

The program presents different scenarios that might occur in the children's homes, schools, playgrounds, and social environments, so that the participants can relate the material to their activities of daily living. The designers selected material, characters, and instructions appropriate for children in primary school and their parents.

The software used to develop the system includes MS NT Serve4.0, MS IIS3.0, MS SQL7.0, MS Front Page, Flash 4.0, Adobe Photoshop 5.0, Adobe illustrator, Sound edit, and Namo web editor 3.0, .

2. Effectiveness of Computer-Assisted            Instruction

A total of 154 Korean school-aged-children who were attending 3rd grade elementary school in Busan, were participated in this study. The design of this study was non equivalent control group pretest-posttest design. Experimental Group1 studied safety education through lecture and CAI, Experimental Group2 studied through lecture only, Group3 studied through CAI only and control group didn't study at all.

Subjects took this test as the pretest and posttest to determine whether there was a difference in overall test scores. The objectives of the program were both to decrease the incidence of childhood accidents by educating the public, including children, on the importance of safety awareness and to empower children by improving their capability to protect themselves against accidents. It is hoped that the program will change children's behavior and provide them with safety skills and coping abilities that help to prevent accidents. An additional purpose of this program was to provide resource materials for parents and professionals affected by this problem, including schoolteachers, administrators, police, government agencies, health care providers, and social worker.

Data was collected before and after the education was given to the subjects, to assess their knowledge, attitudes and behavior in child accidents.

Table1. Research Design

Experimental Group1	Ye1	X1(lecture+ CAI)	Ye2
Experimental Group2	Ye1	X2(lecture only)	Yc2
Experimental Group3	Ye1	X3(CAI only)	Ye2
Control Group	Yc1		Yc2

Knowledge, attitude and behavioral instruments were used in this study. Cronbach's ALPHA validity and reliability measures were used to test these instruments. The analysis of the data was done with SPSS PC+ for descriptive statistics, paired t-test and ANOVA.

III. Results

The program contains an introduction, and children's, parents', and resource pages. Based on the results of the study, different scenarios that might occur at home, at school, in the playground, and in social environments were constructed, so that the participants could relate the material to their activities of daily living. The designers also selected material, characters, and instructions appropriate for children in primary school and their parents.

After introduction, the homepage appears, which contains buttons to access the children's, parents', and resource pages. Animated cartoon characters appear continually and are intended to become symbols associated with the prevention of childhood accidents.

The children's page trains children to acquire preventive strategies for coping with childhood accidents through seven different learning games and simulations based on problem solving. The parents' page presents parent and teacher guidelines for the assessment, early detection, and coping methods for childhood accidents. There are hyperlinks to Internet sites of counseling agencies, and groups that provide financial help and support related to childhood accidents. It is possible to interact with clients through the question and answer function on the screen.  Children can learn specific methods to avoid being injured both at home and outside the home through games and simulations based on problem solving. This system should provide an intervention strategy for preventing childhood accidents. This program can  be viewed on the Internet at http://kidsafety

.baejy.com

Figure 1. Introduction

To find out the effects of computer-assisted instruction through this system, investigator was conducted the experimental study.

Table2.  The Characteristics of subjects

Characteristics	class	frequency
		C	E1	E2	E3
Sex	male female	21 19	20 17	19 18	22 18
Experience of accident	yes no	17 23	19 18	15 22	17 23

C; Control              E1; Experimental 1

E2; Experimental 2     E3; Experimental 3

A statistically significant difference was identified in the scores between before education and after in all experimental group. For subjects who participated in experimental group1, there was marked improvement on their knowledge and behavior. After lecture and CAI education, the score of children's knowledge was higher than before (t=-5.57, p=0.003). After education, the score of children's behavior for prevention of accidents was higher than before (t=-6.095, p=0.004). Therefore, this CAI was revealed the positive effect for children's knowledge and attitude for prevention of child accident.

Table3. Comparison of Knowledge, Attitude and Behavior before & after CAI

Group	before (M±SD)	after (M±SD)	t	p
Control knowledge attitude behavior	36.20±3.35 22.36±4.47 33.45±2.12	36.66±1.79 21.86±5.37 32.19±2.22	-.647 0.343 0/587	0.553 0.749 0.589
Experimental 1 knowledge attitude behavior Experimental 2 knowledge attitude behavior Experimental 3 knowledge attitude behavior	38.26±4.38 22.66±6.22 34.60±3.86 35.60±6.88 24.80±6.98 32.66±5.43 37.80±3.42 21.66±4.77 33.40±2.07	49.26±4.97 13.65±6.02 49.24±4.97 46.40±6.78 21.06±6.22 36.80±6.94 42.40±4.69 25.20±6.38 36.40±3.07	-5.570 -0.162 -6.095 -4.332 -2.794 -1.208 -4.146 -1.425 -3.891	0.003* 0.123 0.004* 0.012* 0.049* 0.274 0.014* 0.227 0.018*
*p<0.05 **p<0.001

The findings from this study will provide an intervention strategy. Children especially, can learn specific methods to avoid being injured both at home and outside the home through a learning game and simulation based on problem solving.

Research indicates that CAI is effective in reinforcing certain behaviors CAI intervention did increase knowledge and preventive attitude related accidents.

IV. Discussion & Conclusion

Until recently, books and videotapes have been the main media for children's education outside the classroom in Korea. However, it was believed that an interactive multi-media computer directed at individuals and groups would be a more effective way to meet different needs based on level of education and interest. According to the Korean National Statistical Office, Korea currently has the highest rate of home computers in the world (78.7%)[10]. Nearly all of the parents of children in the target age group have a high school education. The current primary school curriculum in Korea addresses traffic rules, health, guided field trips, observation of public morals, and human relationships. However, it does not include any material related to childhood accidents. Safety education should be actively promoted throughout life, with special emphasis on safety education for children.

This program promoting accident-prevention behavior should be an initial step in establishing a mechanism for future integration. The goal of this project was to raise awareness of childhood accidents as a public health issue and to increase the awareness of children, parents, and teachers of such accidents.

Research indicates that CAI is effective in reinforcing certain behaviors[7-9]. This findings support previous research. Computer science is being used for education at an accelerating pace, forcing educators and clients to become familiar with this technology. Multimedia material for CAI, which combines audio and visual data in an interactive form, has proved an effective tool in child education. CAI may supplement and reinforce more traditional teaching methods and create opportunities to illustrate clinical situations in an interactive way. CAI has the potential to help children develop knowledge. Children easily adapt to CAI, although their current computer literacy is still low.

Typical computer programs for client educationare didactic and fail to tailor information to an individual's specific needs. New technology greatly enhances the potential of computers in client education. Computer-assisted instruction programs can now elicit information from users before leading them through problem-solving exercises. New authoring systems enable health professionals to develop their own programs. The capacity to elicit and report back information about factors that influence client health behaviors gives the newest computer programs the ability to tailor an educational message for an individual patient; this is one of the strengths of face-to-face patient counseling. This report stresses the importance of developing teaching strategies using computational means to teach nursing, which should empower the nurses of the next millennium.

References

1. Kim S.S., Lee E. S. A study on the occurrences and cause of accidents in lower grade elementary school children. Journal of Korean Academy of Nursing, 1999; 29(1), 117-125.

2. White L., O’Donnell. Working children and accidents: understanding the risks. Child Care Health Dev., 2001; 27(1), 23-34.

3. Laing G.J., Logan S. Patterns of unintentional injury in childhood and their relation to socio-economic factors. Public Health. 1999; 113(6), 291-294.

4. Avery J.G., Vaudin J.N., Fletcher J.L., Watson J.M. Geographical and social variations in mortality due to childhood accidents in England and Wales 1975-1984. Public Health, 1990; 104(3), 171-82.

5. Lee K.J., Lee C. Y., Kang K.S., Han J.S. A study on the occurrences and policy development for accident prevention. Journal of Korean Academy of Nursing, 1995; 25(2), 363-371.

6. Cohen PA, Dacanay LS. A meta analysis of computer based instruction in nursing education. Comput Nurs, 1994 2, 89-97.

7. Fisher LA, Johnson TS, Porter D, Bleich HL, Slack WV. Collection of a clean voided urine specimen: a comparison among spoken, written, and computer-based instruction. Am J Public Health1977; 67:640-644.

8. Kann LK. Effects of computer-assisted instruction on selected interaction skills related to responsible sexuality. J Sch Health 1987;57:282-287.

9. Kim HS, Kim E, Kim JW. (2001). Development of a breast self-examination program for the Internet: health information for Korean women. Cancer Nurs. 24(2), 156-61.6.

10. Korea National Statistical Office. Korea National Statistical Office, http://www.nso.go.kr: Seoul. 2002.

* This work was supported by the 2003 Inje University research grant.