Abstract

Traditional approaches to parent education for pregnancy are restrictive and limited in terms of the level of communication between partners and the direct involvement of the man. They are also in particular limited for parents whose first language is not English and for second time parents who essentially require just specific information.

Hypermedia systems can in contrast increase learning and communication by offering the information in a flexible interactive manner with a multitude of different pathways. Additionally through the incorporation of various media, the whole subject of childbirth can be bought to life. The parents can gather the same information that is found in the traditional sources but in a more interesting and exciting way.

Birth is a prototype interactive hypermedia guide for pregnancy which incorporates sound and graphics, for use by both the pregnant woman and her partner.

Hypermedia and traditional information sources in ante-natal education

Hypermedia is in essence the non-linear arrangement of chunks of multimedia information which are inter-related by a variety of links. A user has the ability to navigate through an information space composed of all the multimedia chunks via these links. Since there is no defined structure the users are able to follow a variety of paths depending on their own interests.

The ability to present information in an engaging manner combined with the user control makes hypermedia applications powerful information facilitators. For example the benefits of such systems for education are well documented ([2], [3], [5]). One aspect of hypermedia that is not often given the same attention is that of its ability to enhance and facilitate communication between users.

It was this particular aspect of the medium that was of primary importance in the development of the Birth system. Birth is a hypermedia guide for pregnancy which would be available in clinics and surgeries for use by both the pregnant woman and her partner.

It is our belief that such a system would serve not just as an educational or informational system, but rather it would increase and enhance the communication between the partners, and also with the medical staff.

Often for example, the man avoids going to an ante-natal clinic with his partner because he may feel that is boring, embarrassing or of no concern to him. This attitude can be detrimental in that it can isolate and place pressure on the pregnant woman; she has to try to explain to her partner the physical and mental changes affecting her and the baby.

Second time parents may not bother to regularly attend a clinic as they may think that they are already familiar with the issues. They may not consider any new areas of importance that they need to be aware of. It is important that these individuals are not presented with the same basic material and, in fact, they should have the flexibility in independently determining and selecting their own appropriate information.

Parents from ethnic backgrounds, often have to deal with cultural and language barriers which can restrict their ability to discuss issues both between themselves and with others. This can make them feel intimidated because they cannot communicate properly with other parents, midwives and doctors, and reduce their attendance or involvement. This constrains their knowledge, since the only other sources of information are books and videos, both of which are limited in terms of content and language.

There are three main traditional means of obtaining educational information about pregnancy. The most obvious is that of direct communication with the clinic's midwives, nurses and doctors. This method however is not as efficient as one would at first assume, since there are often time constraints and other factors involved, including parents not being able to understand what they are being told or forgetting the information that is presented to them [1].

The solution to direct communication would be to present the information through some persistent media, which the parents could refer to repeatedly until they are familiar with the material. These mediums are either printed in the form of books and pamphlets or alternatively as video programmes.

Printed material can be comprehensive and detailed with a multitude of pictures and diagrams. Yet there are issues of relevance; for example the readers may be interested in dietary aspects, and would have to scan through the entire material following any cross references that exist, to find the relevant information. Whilst there are pictures and illustrations these do not offer the user any dynamic information. To elaborate, a series of pictures can be used to show the development of the child, but the information would be better presented via video or animation sequences.

In addition printed materials tend to be more suited for unitary and isolated reading as opposed to both partners sitting and reading the material together. This does not really afford enhanced communication and understanding and again places the onus on the woman to ensure that her partner understands the issues.

Videos on the other hand do offer dynamic information as well as being suitable for an audience. However there is limited scope for the parents to control and interact with the video and they become passive viewers. This can have a negative effect on the educational value of the videos as there would be better flow of information in cases where there is first person involvement through interaction [4].

A survey undertaken for this work found that out of a sample group of 40 couples, 33% of the women and 60% of the men were not happy with the information they received. Many of the men added that traditional sources of information did not actively involve them. This could partially account for the lack of interest in the issues by the man.

Hypermedia systems can overcome these problems by offering the information in a flexible manner with a high degree of interactivity. The parents can sit together and navigate through, and interact with the information space. Additionally by incorporating various media, the whole subject of childbirth can be brought to life. The parents can gather the same information that is found in traditional sources of media in a more interesting and exciting way.

The user control and interactivity increases the involvement and participation of both partners, and consequently can increase both information assimilation and communication.

The Birth system

The Birth prototype system has been designed with reference to the provision of detailed information about pregnancy and related health issues. It offers users photographs, illustrations and sound, with a high degree of interactivity.

Whilst hypermedia applications offer the obvious advantages of user control and preference they can cause fragmentation of the information and this can reduce the overall value of the information [8]. To reduce this problem the information space was deliberately restricted in certain sections in order to guide the users through a particular order. This was achieved through the use of a tree structure for the representation of the information. To ensure that the user was not to restricted the tree structure had an embedded network of hypertext links .

To aid user interaction, interface metaphors are useful as they utilise familiarity of another domain in learning to use the system. A number of different possible metaphors were considered, and finally a book metaphor was chosen as this is a familiar object that is reasonably universal across cultures and also can be closely related by the parents to the printed material found in clinics. Each category of information such as development; health; and birth was represented as chapters, with hypertext links being available across chapter sections. In order to allow parents to look directly at any stage of development, in any order, the development chapter utilised nine buttons for each month, which were available on each page of that section.

Additionally, in order to maximise usability for parents from other cultures it is critical to ensure that both the system and the information is presented in an appropriate manner for them.

This at the most obvious level would mean provision for different languages but language is not the only issue, so are the users and their requirements. Even the issue of language is complex since it requires more than simple translation. The semantecs of the words must be fully understood as certain words convey different messages in different cultures, whilst slang words may lose all meaning or become offensive.

For any interface design the end users of the interface must be understood. But when looking at a range of users the underlying cultures must also be critically understood. There will be variations in the use, meaning and acceptability of words, colours, symbols and images, and it is critical that these are considered [6].

To use an example, the images within the Birth system for obvious reasons present nude photographic images of women in labour. Although this is perfectly acceptable in some societies, it might be offensive and humiliating in other cultures, or sections of society. One solution to overcome this problem would be to use more illustrations rather than photographs. Another approach to incorporate multiple cultures is through the provision of instructional analogies which can explain the subject in an indirect manner making it possibly more acceptable [7].

Currently the prototype has considered the language issues with reference to Hindi, but the work is in too early a stage of development to make sound conclusions about the accuracy of the design.

Conclusions and further work

Traditional approaches to parent education for pregnancy are restrictive and limited in terms of the level of communication between partners and the direct involvement of the man. Hypermedia based systems can facilitate all of the issues pertaining to information assimilation amongst these groups and has the ability to engage and maintain an interest in the topics.

The Birth system is currently in the prototype stage and we are looking for suitable clinics to evaluate and refine the basic design. Future work would be the inclusion of dynamic media and further investigation of the cultural issues of development.

References

[1] Cochrane D et al The Use of Hypermedia For Parent Education in Pediatric Neurosurgery. Pediatric Neurosurgery 1992 Vol. 18 5-6

[2] Hammond N., Allinson L., Extending Hypertext for learning: an investigation of access and guidance tools in A. Sutcliffe & L. Macaulay (eds.) People and Computers V, Cambridge: Cambridge University Press, 1989.

[3] Jonassen D. H., Hypertext as instructional design, Educational Technology: Research and Development, 1990.

[4] Laurel B., Computers as Theatres: A dramatic theory of interactive experience. Reading MA: Addison-Wesley 1991.

[5] Mayes T et al., Learning about learning from hypertext. In D. Jonassen and H. Mandl (eds.) Designing Hypermedia for Learning. Berlin: Springer-Verlag, 1990.

[6] Russo.P, Boor S. How Fluent is Your Interface. Proceedings of Human Factors

in Computing Systems InterCHI 93. Amsterdam 1993

[7] Tejani A.S., Sykes J.T., Hypermedia, Instructional Analogies and Learning. Proceedings of AoM 13th International Conference Vancouver 1995.

[8] Whalley P., An alternative rhetoric for hypertext. In C. McKnight, A. Dillion, J. Richardson (eds.) Hypertext a psychological perspective. Chichester : Ellis Horwood 1993.

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