Tools for online collaboration are becoming increasingly prevalent in recent years. Certain characteristics of these tools encourage this proliferation: they are easy to use, always available, allow knowledge to be built collaboratively and disseminated quickly through social networks, and are usually free of charge. In this context, blogs are becoming increasingly important in the field of health as digital newspapers and magazines that support a large number of multimedia formats. The possibility to subscribe to blogs and their availability in formats adaptable to mobile devices mean their content can be taken anywhere.
Although the use of blogs is well-established among Health Science professionals, their use among university professors as a component of the teaching strategies in these disciplines is much less common, and thus the benefits, risks and limitations of using blogging as a pedagogical tool are poorly understood.
In this preliminary evaluation of a pedagogy, a public WordPress-based blog was developed for the Nutrition and Dietetics module of the undergraduate course in Nursing at the University of Castilla-La Mancha (Spain). This was primarily intended as way to use ICT to increase the level of student engagement and interest in learning the subject, but also as a way to introduce future health professionals to the world of blogging.
This paper describes our experiences with this pedagogical project and discusses the advantages and disadvantages of the use of blogs in university Health Sciences teaching. Incorporating this tool into teaching methodologies takes advantages of the theoretical possibilities it offers, which include crucial aspects such as developing critical thinking, acquiring knowledge, answering questions from students, and enabling new mechanisms to develop the skills that must be acquired. However, the challenges and inconveniences are also highlighted; these are principally the lack of motivation and the low participation of the students. By analysing the outcomes of this preliminary evaluation of a pedagogy, it is concluded that blogs are a very useful tool, although it is suggested that the literature shows a certain bias toward the publication of successful trials.
The European Higher Education AreaFootnote1 has radically transformed university studies by placing the student at the centre of the educational process (Esteve, 2016). The new paradigm and the implicit assessment of acquired skills has forced teachers to rethink classical learning objectives (Correa & de Pablos, 2009). Therefore, recent years have seen a revolution in the classroom, with a large number of teachers striving to develop forms of active learning that seek to promote critical thinking and a high degree of autonomous learning (Initiative, 2004).
In this context of shifting pedagogical trends, one aspect referred to by some authors as the “digital revolution” stands out (Kaplan & Haenlein, 2016). This is the process adopted by those teachers who have been attracted by the possibilities of Information and Communication Technologies (ICT), which have great potential when it comes to transferring knowledge and allowing students to develop the necessary broad-spectrum skills (Zayer, Beran, & Alcaide-Pulido, 2017). In principle, wikis, blogs and social networks, to name just a few of the best-known examples, allow students to work on the proposed content in a participatory and collaborative way, thereby acquiring the necessary skills in an asynchronous and delocalised manner (Aguilar Martínez, Medina, Pons Albalat, & Saigí Rubió, 2013; Camacho, Carrión, Chayah, & Campos, 2016; Hamm, Klassen, Scott, Moher, & Hartling, 2013), as well as giving the subject matter a certain attractive aesthetic aspect. In the words of Bruns and Humphreys, these tools are capable of generating suitable communication spaces for the development of the desired skills, allowing a new model of critical, collaborative and creative technological literacy that opens a new pedagogical horizon unknown until recently (Bruns & Humphreys, 2005).
For the more specific case of the use of blogs (an abbreviation of the term web logFootnote2 first coined in 1997 by Jon Barger (Blood, 2000)) -that was boosted in higher education by activities at Harvard University in the early years of the twentieth century (Lara, 2005)-, the literature has underlined the advantages of the incorporation of blogs into the university education toolkit: versatility when creating, updating and using different types of resources (videos, press releases, tweets, audio content, links to other blogs and websites, etc.) with no requirement for prior technical knowledge (Bonus, Wright, Scheidt, & Herring, 2005); the possibility of collaboration and involvement on the part of the student body as a consequence of the fact that all posts invite conversation and thus combine receptive skills (reading) with productive skills (writing); the ability to arrange posts by chronological order; and the possibilities this type of tool enables to disseminate teaching and research activity not only among students, but also among those professionals with an interest in continuing education (Soto, Senra, & Neira, 2009). All of these elements mean blogs should be considered as a means to support curricular content, especially since the available literature emphasises the positive results that have previously been obtained in a good number of similar initiatives in higher education (Alventosa, Peris, & Guerrero, 2016; Chun, Skinner, & Rosewall, 2019; Du & Wagner, 2007; Ferdig & Trammell, 2005; Molina, Valencia-Peris, & Gómez-Gonzalvo, 2016; Pérez-Nevado et al., 2012; Williams & Jacobs, 2004). Other voices have been more pessimistic, highlighting the fact that the use of this type of tool has been more a myth than a reality, since students ultimately prefer more conventional, passive and linear forms of learning (Margaryan, Littlejohn, & Vojt, 2011).
In the specific realm of Health Sciences education, the available evidence points to a noticeable increase in the use of this type of media (Kala, Isaramalai, & Pohthong, 2010; Myrick, Caplan, Smitten, & Rusk, 2011; Vogt, Schaffner, Ribar, & Chavez, 2010; Zinger & Sinclair, 2013). These works have suggested that the use of blogs can have a significant impact on the formative development of students, since the reflections and discussions that the blogs enable are very helpful (Churchill, 2009). Furthermore, looking at professional practice, teaching biomedical students to use blogs also has its merits, especially given the importance such publication routes may have in the future for disseminating medical scientific research and supporting the health education of patients (Boulos, Maramba, & Wheeler, 2006). In this sense, this medium represents a unique opportunity to improve the transmission of knowledge in the field of health, due to the interactive communication it facilitates between health professionals and citizens (Bissonnette-Maheux et al., 2015). This is reflected in the current growth of what some authors have referred to as the “medical blogosphere” (Kovic, Lulic, & Brumini, 2008): a large collection of blogs dealing with all kinds of health-related issues, from general aspects to such specific issues as Palliative Care (Ngwenya & Mills, 2014) or Diabetes (Kaufman, 2010). Blogs are even used in training biomedical students, frequently to engage learners and enhance education, because students may still achieve benefits by engaging in emotional disclosure and personal reflection (Becker & Freberg, 2014; Garrity, Jones, VanderZwan, de la Rocha, & Epstein, 2014; Sterling, Leung, Wright, & Bishop, 2017). For all these reasons, the boom in the use of blogs in university training programmes in Health Sciences seems to be just starting, especially as more and more teachers recognise that if this is to be a commonly-used tool in the future, its management must be standardised during the years of university learning.
The use of blogs has also become popular in aspects of Health Science as important as food, nutrition and dietFootnote3. Many of the advantages of blogs are indispensable here in making content development more dynamic and the dissemination process more versatile in these times of so-called fake news. Evidence on the use of blogs in teaching subjects in these areas reveals the wide variety of possibilities, including their use as tools for a better understanding of food systems, work on cultural aspects, narratives of students’ own experiences in implementing sustainable practices, and regular training in nutritional assessment instruments (Leveritt, Ball, & Desbrow, 2013; Maher & Burkhart, 2017; Paulus & Spence, 2010; Romero, Espinoza, & Hernández, 2019). Other articles have analysed the use of blogs in the teaching of nutrition in the field of Nursing, where a good number of previous approaches focussed on factors such as the good reception by students (Lin & Shen, 2013; Reed & Edmunds, 2015) provided the factors influencing low participation are addressed (Moule, Ward, & Lockyer, 2010), the possibilities they offer to improve the standard of training (Garrity et al., 2014; Maag, 2005), and the advantages of being able to reach a greater number of people interested in health care and food given the potential of blogs to share knowledge and inform (Almeida, Christovam, & Correia, 2018).
It is in precisely this context that the experience we shall examine here is framed. In the following, we will present results obtained from research into the advantages and disadvantages of, and attitudes of students to, the use of blogs as a pedagogical tool in the Nutrition and Dietetics module of the undergraduate course in Nursing at the University of Castilla-La Mancha (Spain).
Our general objective was to do a preliminary implementation and evaluation of the potential of a virtual learning environment, specifically a blog, developed for the Nutrition and Dietetics module of the undergraduate course in Nursing. This initiative was designed to increase student engagement and improve the quality of education through the use of ICT. Through the use of this virtual learning environment, we focus on facilitating the acquisition of critical thinking skills through reflection on how the ways in which evidence is produced necessitate both continuous training and a critical attitude toward this evidence (Lee, Abdullah, Subramanian, Bachmann, & Ong, 2017; Reed & Edmunds, 2015; Schuelke & Barnason, 2017; Shirazi & Heidari, 2019).
A secondary objective was to develop general skills that would facilitate our future professionals’ health promotion work, which nowadays includes the management of virtual learning environments as an essential part of the concept of digital care (Mitchell & Kan, 2019). In addition, the structure of the contents of the blog provides a more open insight into the professional networks that exist, using references and quotations from other blogs or experts on the topic that can be found and contacted on social networks such as Twitter. The exchange of information in the field of Nutrition and Dietetics is very fast, due to the high rate of scientific output and the challenges posed by nutritional epidemiology (Ioannidis, 2018). The use of blogs allows us to work collaboratively and directly in this frenetic context of constantly-evolving evidence, as well as providing a point of reference where students and professionals can share experiences and find answers to questions.
Implementation and evaluation of a pedagogy
The study described in this paper comes from the second stage of a larger two-stage project. The former stage took place during the academic year 2016/2017, when a blog on the subject of Nutrition and DieteticsFootnote4 was created and hosted on WordPress.com using a free plan, and served to prototype the project in its initial phases and to develop a more detailed and systematic plan for the remainder of the project. This stage was necessary to gather information from the students so that they cope with (an accept) a tool such as blogs for teaching purposes and which aspects of this tool they found most attractive. A key finding was that the teaching staff needed resources to introduce students to the new tools. In addition, during this stage the research team adopted the decision that the blog should be distributed in a publically-available way (accessible to anyone through search engines and published under a Creative Commons (CC BY-NC-ND 4.0) license). Therefore, this project also meant that the doors of the classroom were opened not just to students from other courses, but also to society in general.
The second stage of this work took place during the academic year 2017/2018, when the experience described here was carried out. During this stage, the project contemplated two main milestones: the development of a common public blog, which would fulfil with the characteristics of the use of blogs in education described in the literature, and to promote the development of blogs of similar characteristics by the students of the course, to evaluate the potential for developing the activity themselves as future health educators.
The Nutrition and Dietetics module is a one-semester course taken in the second semester of the first year of the undergraduate course in Nursing. The University of Castilla-La Mancha itself is situated in the centre of Spain and has a multi-campus structure. The evaluation of a pedagogy reported here took place on the Toledo campus, and was therefore conducted in Spanish. During the academic year 2017/2018, 99 students were attending the Nutrition and Dietetics module.
In a first session at the beginning of the academic year 2017/2018, the students were introduced to the concept of blogs, as well as to their potential uses in Health Sciences. In this same training session, the students were introduced to the WordPress platform and practised some basic blog management skills (editing posts and pages, publishing posts and basic concepts of personalisation). The video tutorials used to train the students are published on YouTube and described in Table 1.
Throughout the Nutrition and Dietetics module (which ran from February 1 to May 18), the instructor published a weekly blog post summarising the basic concepts covered in that week’s theoretical and practical classes. These posts included both the elements studied in class and practical examples drawn from current news to facilitate understanding of the concepts which had been developed through face-to-face teaching. These posts were published in the course’s general category, and labels were used to facilitate their later retrieval by subject. Additionally, a specific questions category was used to publish answers to questions asked by the students, which were generally related to myths in nutrition, based on the available scientific evidence. Finally, students were asked to subscribe to the blog in order to stay up-to-date with new publications.
At the beginning of the course, the students were divided into working groups to develop a class group project accounting for 30% of their final grade. This group project involved the students, in groups of five or six, publishing their own blog focussing on, at least, one of the major themes of the module (eating habits, nutritional anthropometry, consumption of harmful substances, or the impacts of physical activity or sedentary lifestyles on health).
Finally, the students’ degree of satisfaction with the exercise, as well as any feedback, were evaluated using an anonymous online questionnaire (hosted on Google Forms) consisting of 5 general (yes or no) questions on their previous experience with virtual learning environments, along with a series of questions about the use of the blog (4 questions), the impact of the blog on their work during the course (8 questions) and the teacher’s work in the developing the blog (4 questions), which were answered using a scale of estimated ratings (from strongly disagree to strongly agree, including an unsure option), that were adapted from previously published questionnaire (Churchill, 2009).
Answering these questions was not obligatory, nor was any kind of reward offered to those students who responded; the students were asked to participate in this online survey via an email sent only at the end of the course once the grades had already been published. The students signed a virtual consent form to participate in the survey and were duly informed of the confidentiality of the survey. Students were also invited to provide more information by participating in informal interviews lasting about 10 min. These interviews were intended to provide data complementary to those collected by the questionnaire, with questions designed to motivate students to communicate their comprehension of the activity, their experiences in this regard and their opinions on the effectiveness of the activity. This also took place after the publication of the grades in order to avoid possible bias in the responses.
During the academic year 2017/2018, a total of 14 posts were published in the module’s general category, and 8 posts in the questions category. The traffic generated during this period (February to May) amounted to 2415 views by 442 visitors, for an average of 5.5 views per visitor. The data quoted here were obtained directly from the traffic analysis tool available in WordPress and are broken down by month in Fig. 1. While each visitor on average made 5.5 visits to the blog, if we assume that the vast majority of those visitors would be students taking the module, it is reasonable to assume that each of the module’s 99 students visited the blog an average of 24.4 times. This would imply that each post published during the course was visited approximately once by each student. No post received any comments from any student.
The main menu of the Nutrition and Dietetics blog (see Fig. 2) offers four pages that visitors can access: all published posts (Home), a page explaining the blog’s main objectives (Objetivo del blog), links to other blogs and professional dietitians to follow on social networks (Para aprender más …), and a contact form to directly contact the project director (Contacto). The blog posts were organised into two categories: the first comprised weekly posts (with information pertaining to the week they were published), organised according to the academic year in which they were published (in this case 17–18); the second category (Dudas, meaning questions or doubts in Spanish) consisted of posts taking students’ questions as a starting point to discuss a specific topic from the course in more detail. In addition, specific labels were used to tag each post according to its content, making it possible to search for posts on a given subject.
Writing and posting blog content
During each week of the course (with the exception of the first week, in which the training for students took place), a post was published compiling the information covered during that week, with a total of 14 posts during the course. In this section, the general characteristics of these publications will be discussed using a specific post as a concrete example.
As a general rule, each weekly post focussed on a topic previously addressed throughout the week in the theoretical and practical classes, taking advantage of the general characteristics of blogs to provide additional information that would encourage students’ interest in the subject. Figure 3 shows an example of this type of post, where a discussion on the vitamin C content of blueberries, which was taken from a radio programme popular among university students, is used to explain in detail how the nutrient content of foods can be calculated using databases (in this case the Spanish Food Composition Database (BEDCA)). In addition to showing how to make these calculations and which sources of information to refer to, links to additional content related to the subject matter are provided.
Answering questions via blog posts
Students sometimes ask questions to the whole class through Moodle, the Learning Content Management tool used at the University of Castilla-La Mancha. The most interesting questions raised are answered in a blog post on that topic. Generally, each of these posts starts with the student’s question framed in a box. From that starting point, the question is addressed using the most up-to-date evidence available, enhanced by the features of the blog (i.e. using images and video where possible). An example of this type of post is shown in Fig. 4. The student’s question here is related to a previous post which asked whether our culture has any influence on the food we eat. In this case, new evidence had become available to clarify the debate on this issue: firstly, the work of Stringhini and collaborators, which postulates that there is an relationship between socioeconomic status and health with a relevance comparable to other well-known health determinants such as the consumption of tobacco or alcohol; and secondly, the ALADINO study involving 10,000 Spanish children in 2015 also observed greater incidences of obesity with lower socioeconomic status (Estudio ALADINO 2015, 2016; Stringhini et al., 2017).
As part of the grading of the module, the students had to carry out a group task which involved creating a blog on a specific topic of their choice from those covered in the module. The idea was to apply the scientific method to resolve a specific question: problem statement, hypothesis statement, study of literature and, finally, evidence-based conclusions. To do this, all the information obtained had to be organised into a blog. Figure 5 shows a representative example of a blog created by one of the 15 groups of studentsFootnote5; this example addresses the issue of nutritional supplements for sportsmen and women, and provides evidence-based recommendations for their consumption.
Students were asked to evaluate this project by voluntarily answering an anonymous self-administered questionnaire. Out of a total of 99 students who took the Nutrition and Dietetics module, only 14 filled in the questionnaire (14.1% response rate), so the analysis of these responses may not represent the actual opinions of the class about this project. However, disregarding the possible bias in the analysis, the students who did respond generally expressed good levels of satisfaction with the use of the online blogging environment in the course, as well as its ease of use and the work of the instructor. The students also stated they were willing to use this tool again in the future.
From a qualitative point of view, the students’ comments underline the positive way in which the initiative was received, recognising and valuing the work and dedication of the teacher. However, the students also commented that these approaches involve more work for students in an environment that they perceive as already saturated, admitting that their main motivation is to pass, while the learning process itself remains a secondary priority.[“source=educationaltechnologyjournal”]