Technology, Pedagogy and Education Pupils' views ...

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Pupils’ views on an ICT-based learning environment in health learning a

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Teija Räihä , Kerttu Tossavainen , Jorma Enkenberg & Hannele Turunen

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Department of Nursing Science , University of Eastern Finland , Kuopio , Finland b

Department of Teacher Education , University of Eastern Finland , Savonlinna , Finland Published online: 30 May 2013.

To cite this article: Teija Räihä , Kerttu Tossavainen , Jorma Enkenberg & Hannele Turunen , Technology, Pedagogy and Education (2013): Pupils’ views on an ICT-based learning environment in health learning, Technology, Pedagogy and Education, DOI: 10.1080/1475939X.2013.795076 To link to this article: http://dx.doi.org/10.1080/1475939X.2013.795076

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Technology, Pedagogy and Education, 2013 http://dx.doi.org/10.1080/1475939X.2013.795076

Pupils’ views on an ICT-based learning environment in health learning Teija Räihäa*, Kerttu Tossavainena, Jorma Enkenbergb and Hannele Turunena a

Downloaded by [University of Eastern Finland] at 03:44 27 November 2013

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Department of Nursing Science, University of Eastern Finland, Kuopio, Finland; Department of Teacher Education, University of Eastern Finland, Savonlinna, Finland

(Received 15 June 2011; final version received 21 December 2012) This paper presents a study that examined pupils’ views on an ICT-based learning environment in health learning. The study was a part of the wider European Network of Health Promoting Schools programme (ENHPS; since 2008, Schools for Health in Europe, SHE) in Finland, and particularly its subproject, From Puijo to the World with Health Lunch, which sought to renew secondary schools’ health education by developing and utilising an ICT-based learning environment. The research data were collected through a structured questionnaire presented to pupils (N = 92) in two secondary schools, one rural and one urban, in Eastern Finland. The results showed that pupils’ opinions about the ICT-based learning environment were fairly positive. Pupils felt that the ICT-based learning environment was easy to use and supported cooperative learning. Computing and Internet skills positively supported pupils’ favourable attitudes towards the ICT-based learning environment. An interesting result from the point of view of e-learning was that the pupils increased their awareness of how to critically evaluate health information found on the Internet. Keywords: pupils; health learning; ICT; secondary school

Introduction Previous studies have indicated that information and communication technology (ICT) is attractive in health learning because of its convenience, availability and interactivity (Crutzen et al., 2011; Hastie, Casey, & Tarter, 2010; Skinner, Maley, & Norman, 2006; Stretcher, 2007). ICT use is exceptionally high among youths, as social networks have become one of adolescents’ primary means of communication (Kamel Boulos & Wheeler, 2007; Livingstone, 2008, O’Hara, 2008). Communication is a central aspect of health learning and makes ICT a popular option among young people. When discussing ICT, the attention has often been on the increasing time that young people spend on computers, playing games or surfing the Web, activities that may cause problems from the point of view of health, as the daily time youths are involved in physical activities decreases (Vandelanotte, Sugiyama, Gardiner, & Owen, 2009). Therefore, it is a challenge to develop health education to harness the potential of ICT for the positive advancement of education (Tang et al., 2009). Health education via ICT has been applied to reduce the consumption *Corresponding author. Email: teija.raiha@uef.fi Ó 2013 Association for Information Technology in Teacher Education


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of fat and to promote weight loss as well as to stimulate consumption of fruit and vegetables (De Nooijer, Veling, Ton, De Vries, & De Vries, 2008; Tate, Wing, & Winett, 2005). The findings of these earlier studies indicate that ICT can positively stimulate individuals to become motivated in health learning (DiSogra & Glanz, 2000). Furthermore, the studies suggest that ICT presently offers enormous potential for developing and delivering health education (Brug, Oenema, & Campbell, 2003). An earlier study by Crutzen’s (2008) research group indicated that a good start for health learning in an ICT-based learning environment would be to identify health-related topics that are of interest to pupils and include information that pupils might try to find, for example fruit consumption. Furthermore, a literature review by Papastergiou (2009) suggested that ICT tools, such as electronic games, present many potential benefits as educational tools for health education and physical education, and that these games may improve young people’s knowledge, skills, attitudes and behaviour in relation to health and physical exercise. It should also not be forgotten that it is easier for health promotion experts, such as those working in school health care, to use an ICT-based learning environment to participate in health learning situations or to do their planning in cooperation with teachers, family members, and pupils (Selwyn, 2007). Today, health information is more and more frequently available on the Internet. While many of the websites are intended for health experts, an increasing number of websites directly address young people with a view of providing information on health problems and their prevention. Thus, ICT can bring individuals together into a collective that helps to inspire, support, and sustain their activity. Overall, in Europe, the importance of the Internet as a source of health information has increased. In 2007, about 47% of the European population perceived the Internet as an important source of health information (Kummervold et al., 2008). Girls in particular like to use the Internet to seek health information, for instance, on diet and nutrition (Griffiths, Lindenmeyer, Powell, Lowe, & Thorogood, 2006; Stretcher, 2007). However, visiting websites could be associated with an increased drive for thinness, a poorer perception of one’s appearance, and more perfectionism among girls (Custers & Van den Bulck, 2009). The use of ICT in health education has high expectations. However, the results of the PISA survey (Organisation for Economic Co-operation and Development [OECD], 2004) of 15-year-old European students showed that the frequency of computer use in schools varies widely and that this is, naturally, related to the amount of computers in the school (Korte & Hüsing, 2007). In the Nordic countries, use of the Internet is particularly frequent. Pupils use computers for email and browsing the Internet, while the use of educational software appears to be declining (OECD, 2004). According to Korte and Hüsing (2007), teachers often use computers in the classroom, but again, the differences between countries are remarkable. The highest percentages of teachers who use ICT in the classroom are in the United Kingdom (96%) and Denmark (95%), and the lowest in Latvia (35%) and Greece (36%). Korte and Hüsing (2007) said that in Europe, among the frontrunners in ICT use in schools, the use of ICT has become the norm for most of the teachers and pupils in all aspects of life. According to the Second Information Technology in Education Study (SITES) (Law, Pelgrum, & Plomp, 2008), many educational systems around the world have the will to integrate ICT into education in order to achieve pedagogical changes. Many countries have compiled strategic policies for ICT and learning environments to promote development of the national education


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system (Law et al., 2008). This has particularly meant equipping schools with computers and network connections, and has required curricular changes and teaching materials for teachers in e-learning support. Finland, like the other Nordic countries, differs from most countries participating in PISA in the pace at which pupils enter academic life. PISA has introduced generalisations of the superiority of comprehensive schools, partially based on the excellent performance of Finnish pupils (OECD, 2010). The high quality of Finnish teacher education has been presented as one reason. Finnish teacher education has a long academic tradition of taking place in universities. Teacher education is also an attractive field: there are many applicants and the admission rate is low (Kupiainen, Hautamäki, & Karjalainen, 2009). Furthermore, the Finnish education system is a mixture of state-controlled or state-steered, relatively autonomous elements. In particular, the Finnish Ministry of Education and Culture (1999, 2004, 2010) as an organisation holds a key position. Finland’s third National Information Society Strategy (NISS) for 2007–15, launched by the Finnish Prime Minister’s Office (2006), declares that teachers have high-quality education and information society skills which have already been utilised increasingly in renewing teaching and learning methods in schools in Finland. However, it seems that in spite of the two previous National Information Society Strategies in the 1990s, preparedness for the information society has still remained the responsibility of individual teachers or school communities (Finnish Ministry of Education and Culture, 2010). There is a threat of inequality among pupils, and thus information society know-how, and experiences should be shared and utilised more broadly. According to the NISS, the target for 2015 is to further encourage schools to harness innovative methods of learning. In addition, the Finnish Ministry of Education and Culture (1999, 2004, 2010) outlined information for education and research strategies to eliminate the boundaries between the learning environments at school and at home. This means paying increasing attention to the relationship between ICT-based education and classroom instruction, and also more varied methods in the planning, implementation, and evaluation of school instruction. Therefore, the improvement and research of health education are a topic of current interest and significance from the viewpoint of the Finnish information society, the new health knowledge policy, and the recommendations for the improvement of school health care. This paper presents the results of a survey of pupils’ views on an ICT-based learning environment in health learning. The study was a part of the wider European Network of Health Promoting Schools (ENHPS; since 2008, Schools for Health in Europe, SHE) programme in Finland, and especially its sub-project, From Puijo to the World with Health Lunch. Puijo is a tall local landmark in the city of Kuopio and a well-known attraction in Finland. It was also chosen as the symbol for this health promotion project. The project was carried out as action research and its main goal was to develop and implement health issues in two secondary school communities, one rural and one urban, by utilising an ICT-based learning environment (WebCT) to support pupils’ health learning during their secondary school years, from grade seven to grade nine (pupils aged 13 to 16 years). The schools had a strong desire to integrate ICT into health education. The major limitations were lack of confidence, lack of competence and lack of access to resources. Since confidence, competence and accessibility have been found to be the critical components of ICT integration in schools, ICT resources, including software and hardware, effective professional development, sufficient time, and technical support,

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need to be provided to school staff (Bingimlas, 2009). No component alone is sufficient to provide good teaching. However, the presence of all components increases the possibility of excellent integration of ICT into health education opportunities. Therefore, the project was initiated with training for school staff (teachers, school health nurses, and school catering workers) and pupils in cooperation with the researcher. The purpose of the training was to get acquainted with health education and ICT. The training included planning health education curricula from grade seven to grade nine and practising skills related to ICT. After the training, the classrooms in the schools were equipped with computers with Internet connections. Context of the study Two secondary schools in Eastern Finland, one in a rural area and one in an urban one, participated in this study. The secondary schools were selected by purposive sampling on the basis of discussions between local policymakers and researchers. The schools participated in the study voluntarily. As previously mentioned, the living environment influences pupils’ ability to acquire, maintain and sustain good health behaviour (World Health Organization, 2004). Furthermore, academic performance seems to be related to where a pupil lives (Wang & Holcombe, 2010). Issues influencing variations in academic performance include geographic location, resources, availability of ICT, and quality of teachers (Eraikhuemen, 2003). Therefore, it is important to examine the influence of school location and pupils’ gender on academic performance in health learning and the effects of an ICT-based learning environment on pupils’ health learning from grade seven to grade nine in rural and urban schools. Table 1 presents the objectives of health learning in computer science, home economics, student counselling, health education, chemistry, and biology, as well as in school catering, school health counselling, and school–home cooperation. All these subjects are studied in grades seven to nine. In the seventh grade, the ICTbased learning environment was first introduced in computer science classes so that the pupils could practise achieving the skills needed in using the ICT-based learning environment independently and together with their classmates. Secondly, in student counselling lessons, the pupils familiarised themselves with learning skills and issues connected to learning through the ICT-based learning environment. Thirdly, the ICT-based learning environment was utilised in home economics studies to promote and support interaction between the pupils and teachers, and to promote the pupils’ positive attitude towards healthy eating habits and food preparation. Fourthly, the pupils searched for information on nutrition and health, and produced either an oral or a written report. Fifthly, in chemistry studies, the pupils learned to combine nutrition health and environmental issues which were handled in both home economics and chemistry. Sixthly, the ICT-based learning environment was utilised in biology and in a separate learning environment for feeling fresh – feeling good, health topics, a lifestyle free of drugs and alcohol (and also non-smoking), self-image, family, friends, physical exercise and hobbies, nutrition, dating, and sleep. Furthermore, the ICT-based learning environment was developed during secondary school in school catering, school health counselling, and school–home cooperation to provide health information to the pupils as well as to their family members.

Learn to improve one’s own holistic development and health condition. Learn to adopt healthy lifestyles. Learn to advance one’s own healthy growth and development.

Learn to eat healthy food.

Learn to make healthy food choices. Learn to appreciate the Finnish free, statutory, and well-rounded school lunch.

Home economics (7th–9th): Learn to take control of everyday life. Learn to appreciate a healthy diet. Learn to understand what is a healthy and versatile diet. Learn to choose healthy food. Learn to prepare healthy food independently and together with classmates.

Learn to contribute to a healthy and safe school as a partner. Learn to promote health and prevent health problems.

Learn to have a square school meal every school day, which is put together according to nutrition recommendations. Learn good table manners and new tastes during the school meal.

Learn to understand the importance of Learn to create a basis for a school lunch for one’s own health and healthy adulthood. well-being.

Learn to understand the longterm follow-up of pupils’ health condition in school health care.

Learn to understand school lunch as a practical model of health education.

Computer science (7th): Learn to use the computer, ICT and the Internet as a part of health learning.

Student counselling (7th): Learn to evaluate one’s own learning and learning strategies. Learn to understand what comprehensive learning means, and which factors (e.g. sleeping, healthy eating and exercise) are related to it.

School health counselling

School catering

Instruction by subject (grade)

Table 1. Pupils’ objectives in health learning from grade seven to grade nine (ages 13 to 16 years).


(Continued)

Learn to use ICT with family members.

Learn to offer information through the ICT-based learning environment to family members.

Learn to familiarise family members with health education and ICT.

Learn to emphasise the importance of cooperation for one’s own learning and healthy growth.

School–home cooperation

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Feeling fresh – feeling good (9th) Learn to discuss health and nutrition topics with teachers and classmates. Learn to search for health information and produce presentations on health topics.

Biology (9th) Learn information about drugs and alcohol, microbiology and cell biology.

Chemistry (8th): Learn to combine home economics and chemistry issues that focus on nutritional health (e.g. environment and nutritional health).

Health education (8th): Learn to make conscious choices of health and well-being. Learn to search for information on the Internet and to evaluate the validity of that information.

Instruction by subject (grade)

Table 1. (Continued). School catering

School health counselling


School–home cooperation

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Purpose of the study and study questions The purpose of this study was to examine Finnish secondary school pupils’ views of an ICT-based learning environment in health learning. The research questions were: (1) What kinds of opinions did the secondary school pupils have on the ICT-based learning environment as an integral learning tool, on health learning in the ICT-based learning environment, and on the usability of the ICT-based learning environment? Were there any differences between urban and rural schools and between boys and girls? (2) How did the pupils’ experiences of the ICT-based learning environment change in the two-year period from the seventh grade to the ninth grade in secondary school? Were there any differences between urban and rural schools and between boys and girls? Data collection and analysis The data of this study were collected from the pupils (N = 92) of the two participating schools, one urban (n = 53) and one rural (n = 39), with a structured questionnaire, which was composed for this study. The questionnaire included six background variables (the pupil’s gender, computer and Internet connections at home, computing and Internet skills, and use of computers and the Internet during free time) and 77 Likert-type items related to ICT-based learning, assessed on a scale of 1 to 5 (1 = totally agree, 2 = somewhat agree, 3 = I don’t know, 4 = somewhat disagree, 5 = totally disagree). The views of the pupils relating to nutrition behaviour are reported in other research articles by the authors. The questionnaire was piloted on a separate group of pupils (n = 39) to ensure that it was comprehensive and understandable, and it can, therefore, be considered to have sufficient and valid content. Table 2 presents the timetable and the contents of the questionnaire. The experiences of the ICT-based learning environment and the Internet (11 items) were measured from the same pupils in two secondary schools, first in grade seven (spring 2002), and then the follow-up data were collected in grade nine (spring 2004). Furthermore, the pupils’ opinions on the ICT-based learning environment as an integral learning tool (29 items), health learning in the ICT-based learning Table 2. Timetable and contents of the study from grade seven to grade nine, in the two participating schools. Timetable

Contents of the study

Spring 2002 / 7th grade

Experiences of the ICT-based learning environment and the Internet (11 items)ª

Spring 2004 / 9th grade

Experiences of the ICT-based learning environment and the Internet (11 items)ª The ICT-based learning environment as an integral learning tool (29 items) Health learning in the ICT-based learning environment (30 items) The usability of the ICT-based learning environment (7 items)

ªFollow-up study.


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environment (30 items) and the usability of the ICT-based learning environment (7 items) were investigated at the end of secondary school, in grade nine (spring 2004). The pupils’ participation in the survey was voluntary, and their parents and guardians were informed of the survey and its schedule. Furthermore, the head teachers of the schools had given their permission for conducting the research. The pupils participated in the survey during a lesson supervised by a researcher or a teacher, where they had a chance to ask questions connected to the research, and also to receive guidance in the completion of the questionnaire. Frequencies and percentages were calculated from the background data on the respondents, and the urban and rural schools, and girls and boys, were compared using cross-tabulation and Fisher’s exact test. The pupils’ experiences of the ICTbased learning environment from grade seven to grade nine were compared with the Wilcoxon test. A p-value of less than 0.05 was considered statistically significant (Burns & Grove, 2010). Factor analyses were applied in order to compress the data by forming combined ordinal scale variables for the purposes of further analyses. Factor analyses were conducted separately with the Varimax rotation method for the parts that measured the ICT-based learning environment. Before the factor analysis, the relationships between variables were evaluated using Spearman’s rank correlation coefficient. The variables correlated with at least one other variable (r > .30). The factor analyses were produced separately for items that dealt with the ICT-based learning environment as an integral learning tool, health learning in the ICT-based learning environment, and the usability of the ICT-based learning environment. The number of factors was restricted to factors with an eigenvalue of over 1, and to factors whose contents were meaningful. The non-standard factor scores were calculated for the factors using weighting coefficients. Two-way analysis of variance was used to examine the influence of categorical background information variables (independent variables) on combined ordinal scale variables calculated from the factors identified (dependent variables). Two-way analysis of variance was an appropriate analysis method for this study with a quantitative outcome and two or more categorical explanatory variables. Furthermore, two-way analysis of variance can not only determine the main effect of contribution of each independent variable but also identifies if there is a significant interaction effect between the independent variables (Gelman, 2005; Seltman, 2012). Results Pupils’ background information Fifty-eight per cent of the pupils who participated in the study attended the urban school and 42% attended the rural school. Girls (51%) and boys (49%) presented nearly the same number of respondents. A majority of the pupils (91%) reported having a computer at home. More than half (57%) of the pupils evaluated their computing skills as good. Less than half (46%) of the respondents reported using a computer daily. Approximately three-quarters (76%) of the respondents thought they had a computer with an Internet connection at home, and the same number of pupils (76%) evaluated their Internet skills as good. More than a third (38%) of the pupils reported using the Internet daily. The pupils in the urban school were more likely to have a computer with an Internet connection at home (85% vs. 64%,


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p = 0.020) compared with the pupils in the rural school. The pupils in the urban school used a computer (58% vs. 26%, p = 0.002) and the Internet (56% vs. 13%, p < 0.0005) more often than the pupils in the rural school. Correspondingly, more boys than girls evaluated their computer skills as good (71% vs. 43%, p = 0.008).

Pupils’ opinions about the ICT-based learning environment as an integral learning tool The pupils’ opinions on the ICT-based learning environment as an integral learning tool were measured with 29 items. Factor analysis yielded eight factors which explained 73.5% of the total variance. The most explaining factor, easy-to-use and cooperative learning environment, was loaded strongly by variables that described cooperative learning and the suitability of the ICT-based learning environment for health learning. The items which loaded the second factor described the usefulness of the links and source materials of the ICT-based learning environment in the pupils’ health learning. This factor was interpreted to represent the everyday tool in information seeking. The third factor was formed by arguments that described the participation of the siblings and parents of the pupils in the use of the ICT-based learning environment. The factor was interpreted to describe the learning environment of the family. Four variables most strongly loaded the fourth factor: I participated actively in the discussions in the ICT-based learning environment; my computing skills developed while I studied in the ICT-based learning environment; I communicated with others in the discussion area of the ICT-based learning environment; and my information-seeking skills developed while I studied in the ICT-based learning environment. The factor was named Internet as an activating learning environment. The fifth factor was loaded by arguments that described pupils’ need of assistance. The sixth factor was loaded by arguments that described the transferability of experiences outside the school context. The seventh factor was loaded most strongly by variables that described the use of the ICT-based learning environment outside school. This factor was interpreted to describe studying independent of time and place. The eighth factor was loaded only by the variable describing the teacher’s feedback and support.

Pupils’ opinions about health learning in the ICT-based learning environment The pupils’ opinions about health learning in the ICT-based learning environment were measured with 30 items, which yielded five factors in the factor analysis. The factors explained 66.1% of the total variance. The first factor, networked health learning on demand, included variables that described health learning contents and the sense of health learning. The second factor, the transfer effect of health learning, described how ideas that had been learned could be transferred to everyday situations and to making health choices. The third factor, socialisation of health learning, described the participation of siblings and parents in health learning. The fourth factor, deepening and integration of health learning, included exploitation of earlier knowledge, links, and practical examples in everyday situations. The fifth factor, the meaning of peers for health learning, appeared as an active small-group operation in the ICT-based learning environment.

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Pupils’ opinions on the usability of the ICT-based learning environment The pupils’ opinions on the usability of the ICT-based learning environment were measured with seven items, which made up two factors in the factor analysis. The factors explained 73.2% of the total variance. Technological functionality referred to the clarity of the ICT-based learning environment, how easy it was to perceive, smoothness of navigation and whether there were technical problems during lessons. The reliability of network connections was correspondingly related to how trouble-free the technology of the ICT-based learning environment was outside of the school.

Background information related to the ICT-based learning environment in health learning The rural school pupils (df = 1.88, MS = 11.13, F = 8.51, p = 0.004) had more positive experiences of an easy-to-use and cooperative learning environment compared with the urban school pupils. Furthermore, the girls (df = 1.88, MS = 6.83, F = 5.22, p = 0.025) had better experiences of an easy-to-use and cooperative learning environment than the boys. The pupils who had an Internet connection at home (df = 1.90, MS = 4.94, F = 4.04, p = 0.047) had a more positive attitude towards the ICT-based learning environment as an everyday tool in information seeking compared with those who did not have an Internet connection at home. The pupils in the rural school (df = 1.90, MS = 7.12, F = 5.94, p = 0.017) had a more favourable impression of the Internet as an activating learning environment than the pupils in the urban school. It was easier for the pupils who could use the Internet (df = 1.89, MS = 11.33, F = 8.59, p = 0.004) to ask for assistance compared with the pupils who could not use the Internet. Furthermore, the pupils who used the Internet in their free time (df = 1.89, MS = 5.51, F = 4.18, p = 0.044) asked for assistance more readily than the pupils who did not use the Internet in their free time. The interaction between school and gender was significant; boys in the rural school had more transferability of experiences than boys in the urban school (df = 1.86, MS = 4.18, F = 4.20, p = 0.044). Furthermore, the rural school pupils (df = 1.86, MS = 8.54, F = 8.57, p = 0.004) were sympathetic to the transferability of experiences in the ICT-based learning environment. An Internet connection at home (df = 1.86, MS = 7.14, F = 7.17, p = 0.009) had a positive connection to the transferability of experiences in the ICT-based learning environment. The pupils’ use of the Internet in their free time (df = 1.86, MS = 6.35, F = 6.37, p = 0.013) also had a positive effect on the transferability of experiences in the ICT-based learning environment. The pupils in the rural school (df = 1.84, MS = 14.43, F = 14.89, p < 0.0005) had a positive attitude towards deepening and integrating of health learning in the ICT-based learning environment. The girls (df = 1.84, MS = 6.99, F = 7.21, p = 0.009) had better experiences of deepening and integrating health learning than the boys. Having skills in computer use (df = 1.84, MS = 11.85, F = 12.22, p = 0.001) was associated with pupils’ positive opinions on deepening and integrating health learning. Skills in using the Internet (df = 1.84, MS = 4.41, F = 4.54, p = 0.036) also had a positive connection to pupils’ opinions about deepening and integrating health learning.


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The rural school pupils (df = 1.88, MS = 6.33, F = 5.27, p = 0.024) had a more favourable impression of their peers in their health learning compared with the urban school pupils. The pupils in the rural school (df = 1.90, MS = 5.33, F = 4.03, p = 0.048) were more confident with the technological functionality in the ICT-based learning environment than the pupils in the urban school. Pupils’ experiences of the ICT-based learning environment and the Internet from grade seven to grade nine The pupils’ experiences of the ICT-based learning environment were quite positive as a whole. The pupils experienced studying in the ICT-based learning environment as significantly less pleasant in grade nine than in grade seven (2.80 ± 1.23 vs. 2.46 ± 1.05, p = 0.022). This was especially the case among the urban school pupils, where a 24% decrease was found (3.28 ± 1.28 vs. 2.64 ± 1.00, p = 0.003). However, the urban school pupils’ skills in finding information about health nutrition on the Internet increased during secondary school (3.02 ± 0.99 vs. 2.49 ± 0.87, p = 0.005). Furthermore, the pupils’ critical attitude towards information found on the Internet improved significantly from grade seven to grade nine (2.89 ± 0.96 vs. 2.53 ± 1.04, p = 0.001). An increase was found especially among rural school pupils, 20% (2.56 ± 1.00 vs. 2.13 ± 1.01, p = 0.034), and girls, 15% (2.90 ± 0.79 vs. 2.53 ± 0.93, p = 0.004). The pupils’ awareness of the precision of information found on the Internet also improved significantly during secondary school (2.84 ± 1.04 vs. 2.29 ± 1.01, p = 0.001). An increase was found among the rural school pupils, 46% (2.87 ± 1.26 vs. 1.97 ± 1.01, p = 0.002), and girls, 17% (2.80 ± 0.84 vs. 2.39 ± 0.92, p = 0.004). Discussion This study examined pupils’ views on an ICT-based learning environment for their health learning. The research data were collected with a questionnaire from the pupils (N = 92) of two secondary schools, one rural and one urban, in Eastern Finland. The reliability of the questionnaire was evaluated by the means of Cronbach’s alpha. The internal consistency of the variables varied from 0.76 to 0.92. The internal consistency of an indicator can be said to be good if the alpha factor is higher than 0.60 (Polit & Hungler, 1995), and the values of this indicator were thus generally sufficient. Despite the small number of participants in the study, the views obtained from the study of the ICT-based learning environment corresponded well with the results of international studies (cf. Crutzen et al., 2007; Stretcher, 2007). A larger number of participants would probably have produced more exact descriptions of factors influencing the user experiences, but would not have provided actual new health learning views. The sample of pupils came from two secondary schools in Eastern Finland, and the results cannot be extensively generalised due to the small, geographically defined sample. However, the results are suggestive for other schools around Finland. The results illustrated that most pupils had a computer at home that in many cases had an Internet connection. The urban school pupils were more likely to have a computer with the Internet at home than rural school pupils. However, less than half of the pupils used a computer or the Internet daily. The pupils in the urban


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school used a computer and the Internet more often than the pupils in the rural school. More than half of the pupils evaluated their computing and Internet skills as good. More boys than girls evaluated their computing skills as good. Some earlier studies (Kamel Boulos & Wheeler, 2007; Livingstone, 2008) obtained similar results. The results regarding the views of pupils on the ICT-based learning environment as an integral learning tool revealed eight factors: an easy-to-use and cooperative learning environment, everyday tool in information seeking, learning environment for the family, the Internet as an activating learning environment, need of assistance, transferability of experiences, studying independently of time and place, and the teacher’s feedback and support. The school’s status and gender comparisons showed that girls and the pupils in the rural school had positive experiences of an easy-touse and cooperative learning environment. Furthermore, the rural school pupils had a favourable impression of the Internet as an activating learning environment, and on the transferability of experiences. The boys in rural school were particularly sympathetic to the transferability of experiences. The results indicated that it was easier for the pupils who used the Internet to ask for assistance. Additionally, the pupils who used the Internet in their free time had a positive effect on the transferability of experiences, and they asked for assistance more readily. Correspondingly, an Internet connection at home had a positive connection to everyday tools in information seeking and the transferability of experiences. This is in line with previous findings (Crutzen et al., 2008; Kamel Boulos & Wheeler, 2007; Livingstone, 2008; O’Hara, 2008; Stretcher, 2007) that suggested that the networks of social media and the Internet have become a popular tool among young people for seeking health information. Based on the results of this study, one might assume that the pupils’ positive experiences may result in an outcome of improved health learning methods in the ICT-based learning environment. For example, cooperative assignments in the ICT-based learning environment caused pupils to discuss and solve practical, health-related problems together with their fellow pupils and teachers. It is also possible that the same pupils who used the Internet in their free time also used the ICT-based learning environment outside school hours, or that the pupils’ computing skills that they had acquired at home affected their positive experiences of the ICTbased learning environment. We suggest that when utilising ICT at school, attention should be paid to issues such as committing pupils’ parents to health education and promoting health learning within the entire school community. Furthermore, special attention should be paid to planning health tasks so that they are reasonable and motivating to pupils and support the pupils’ broad health learning. For example, we should plan learning exercises that involve both schoolmates and parents, as this would support and develop health learning situations independent of time or place, and also improve the use of technology by pupils’ families (cf. Geiger et al., 2002). Thus, health learning is also possible and flexible outside the classroom and schools will promote both pupils’ and their family members’ know-how of ICT. However, this requires more time and equipment resources in health education and more diversified and continuing education on ICT for teachers. The results on health learning in the ICT-based learning environment as viewed by the pupils yielded five factors: networked health learning on demand, the transfer effect of health learning, socialisation of health learning, deepening and integration of health learning, and the meaning of peers in health learning. Girls and the pupils



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in the rural school had a positive attitude towards deepening and integrating their health learning. Furthermore, the rural school pupils had a favourable impression of their peers in health learning. Correspondingly, having skills in computer and Internet use was associated with pupils’ positive opinions on deepening and integrating health learning. Results supported assertions by other researchers (Crutzen et al., 2008; DiSogra & Glanz, 2000) that indicated the ICT-based learning environment to be an interesting learning method for pupils through which to learn about health. Based on the results of this study, it may be suggested that the ICT-based learning environment is well suited to deepening and integrating health learning, and that it also fits learning-on-demand. In particular, the pupils in the rural school had positive attitudes, as learning and understanding this topic also required combining and structuring previously learnt knowledge with the ICT-based learning environment. The results on the usability of the ICT-based learning environment yielded two factors: technological functionality, and the reliability of the networks’ connections. The results also indicated that the rural school pupils felt technological functionality to be more significant for their health learning than the urban school pupils did. Based on the results of this study, one may assume that the positive outcomes in technological functionality may have resulted from the pupils’ active participation in health education, which helped pupils to acquire experience in learning about health in the ICT-based learning environment. Furthermore, we argue that the ICT-based learning environment was new for the pupils in the rural school, and they had not previously used a computer at school every day. In secondary school, the rural school pupils were motivated by using the ICT-based learning environment, and also learned to use computers in their health learning. Therefore, they did not have technological problems with the ICT-based learning environment. Additionally, the rural school pupils did not consider themselves lonely or separated from other pupils. With the help of their ICT skills, they utilised what they had learned in after-school classes or at weekends in their free time, whereas urban school pupils had other complementary means of gathering health information, for example, by visiting a library. In this study, the ICT-based learning environment introduced new challenges to health learning. The ICT-based learning environment in this context referred to the software that enables offering learning material on health, and provides tools for cooperative interaction independent of time and place for the pupils. This helped the pupils to have an opportunity to use the ICT-based learning environment in different places, e.g. home, libraries, and classrooms. The ICT-based learning environment did not only include material for independent studying, but it was also possible to create learning situations and opportunities for individual information construction and cooperative learning with the help of pupils’ active thinking and learning material connected to practical problem situations. Therefore, combining different learning forms and tools is clearly justified in health learning. However, producing learning material for the ICT-based learning environment is a challenge, and its implementation requires great investments. In order to manage these factors, both technical knowledge as well as knowledge regarding contents is required from both pupils and teachers, and the pupils must be jointly committed to ICT-based health learning. In that way, pupils can strengthen their partnership and cooperation in learning about health. High-quality health learning is based on both individual and communal development.


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Overall, the pupils’ opinions on the ICT-based learning environment reflected fairly positive and user-friendly experiences, although pupils considered studying in the ICT-based learning environment less pleasant in grade nine than in grade seven. Previous studies have produced similar results. Kreisel (2004) evaluated a computer-based nutrition education tool for younger children aged 8 to 11 years, and her results show that most of the sampled 271 pupils had positive experiences of learning about health with a computer, and wanted to work with computers and the Internet in class. Younger and younger pupils are accustomed to using computers, but it is possible that they do this without using enough criticism, and do not necessarily consider if the information available online is accurate. Indeed, an interesting result of this study was that the pupils increased their awareness of the fact that information on the Internet is not always reliable and must therefore be considered with certain reservations. An increase in awareness was found especially among rural school pupils and girls. A reason for this could be that the parents of girls in rural areas are more active in warning their children of the dangers of the Internet than before. In fact, earlier research by Borzekowski and Rickert (2001) found that most adolescents in their study thought that the information on the Internet is reliable. Only a quarter of the sampled 319 adolescents in their study suggested that the available information may not be reliable. Benigeri and Pluye (2003) noticed that the rapid increase in health information available on the Internet raises the issues of the quality of websites. This requires pupils to have sufficient skills in media literacy. Therefore, it is important for teachers to teach pupils how they can estimate the validity of websites. Conclusion The ICT-based learning environment can increase the possibilities of health learning in secondary schools. It is possible to make learning about health more versatile and cooperative. However, it is going to be important to develop modern ICT tools, such as wireless tablet computers, to enable various learning environments outside of schools, such as forests and markets, and to acquire health knowledge in connection with searching, exploring, and analysing health information in real-life situations. Moreover, in further research, it will be important to study pedagogical views related to the implementation of ICT-based learning environments from the point of view of teachers, and to find out how the ICT-based learning environment can be utilised in learning contexts by emphasising information on teachers’ attitudes towards community-based health education. Notes on contributors Teija Räihä is a PhD from the University of Eastern Finland, Kuopio Campus, and Project and Development Manager at the Kyyhkylä Rehabilitation Center, Mikkeli, Finland. Her main research interests include health education, health promotion and use of ICT for health and wellbeing. Kerttu Tossavainen is Professor of Nursing Science in the University of Eastern Finland, Kuopio Campus. Her special fields and research interests are nurse education and health promotion. She has been involved in the Health Promoting Schools programme, and she has been the leader of the Finnish European Network of Health Promoting Schools (ENHPS; since 2008, Schools for Health in Europe, SHE) in close cooperation with the Finnish Centre for Health Promotion.


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Jorma Enkenberg is Emeritus Professor of Pedagogics at Savonlinna Campus of Teacher Education, University of Eastern Finland. He is involved in research on teaching of mathematics and natural sciences, problem solving, technology-based learning environments, individual and organisational learning, distance learning as well as more theoretical topics.


Hannele Turunen is Professor of Nursing Science in the University of Eastern Finland, Kuopio Campus and Docent in Health Pedagogies at the Department of Nursing Science, University of Turku, Finland. Her research interests are nurse education and health promotion. She has been a member of the Finnish European Network of Health Promoting Schools (ENHPS; since 2008, Schools for Health in Europe, SHE) research group in cooperation with Kerttu Tossavainen and the Finnish Centre for Health Promotion.

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