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Web Paper

Assessment of the quality of interaction in distance learning programmes utilizing the Internet or interactive television: perceptions of students and lecturers

, , , , &
Pages e1-e9 | Published online: 03 Jul 2009

Abstract

WebCT, a web-based virtual learning environment (VLE) and Interactive TV (ITV) are relatively new technologies that are used to deliver distance education at the Faculty of Health Sciences, Stellenbosch University. This study explores how effective current approaches to instructional design and interaction have been in utilizing these two technologies to support interaction and what lessons can be learnt. Five focus-group interviews were held with students and lecturers to assess the perceived quality of student–lecturer/student–student interactions. All students were invited to complete a questionnaire at the end of every module to assess their perceptions of interaction. Interaction was highly valued by students and lecturers participating in distance-learning programmes utilizing either VLE or ITV. Students rated courses using both technologies as moderately interactive. Significant differences between VLE and ITV were detected in student–lecturer and student–student interactions, use of additional modes of communication, instructional design, technological interactivity and social rapport activities. The groups did not differ across a number of likely barriers to interaction and both also reported the need for more flexible and better paced instructional designs.

Introduction

The Faculty of Health Sciences at Stellenbosch University (SU) is increasingly exploring distance education in its postgraduate programmes as a means of reducing additional costs and increasing accessibility for students. At present WebCT, a web-based virtual learning environment (VLE) and interactive television (ITV) are the main technological methods used to deliver distance education.

As an increasing number of distance education programmes were developed at SU there was a need to assess the effectiveness of the current approaches to instructional design. In particular, the quality of interaction in distance education was recognized as a key factor (Ragan, Citation1999; Wulff et al., Citation2000; Pittinsky & Chase, Citation2000).

Interaction includes the way students interact with fellow students, lecturers, and the educational contents of the programme (Wulff et al., Citation2000). In distance education, the transactional distance is not determined by geography but by the quality of the interactive relationship and the balance between dialogue and other instructional events (Moore, Citation1990). To be successful a distance-education lecturer should understand that the transactional distance is the extent to which he or she manages to engage the students in interactive learning (Frith & Kee, Citation2003; Halpin et al., Citation2003; Christopher et al., Citation2004). Likewise it is not the location that determines the effect of instruction but the frequency and quality of interaction between student and lecturer (Pittinsky & Chase, Citation2000). Interaction in distance education is not something that happens automatically but is something that needs to be incorporated consciously into the instructional design (Ragan, Citation1999). Constructivist educational theory focuses on the student constructing knowledge and participating actively, rather than passively, in the learning process (Boettcher, Citation1997). Dialogue that supports active learning should be discursive, interactive, adaptive and reflective (Laurillard, Citation2002). Effective instructional designs should include student–lecturer interaction, cooperation amongst students, prompt feedback and active learning (Chickering & Gamson, Citation2003).

Roblyer & Ekhami (Citation2000) have presented a four-dimensional rubric that can be used to score the interactivity of distance education using the following criteria:

  1. Social goals of interaction: Interaction should build rapport between the students and lecturer by enabling the exchange of personal information.

  2. Instructional goals of interaction: Interaction should enable reflection, dialogue and participation in the learning process with other students and the lecturer.

  3. Types and uses of technologies: Technological resources should be used appropriately to enable a high level of interactivity.

  4. Impact of interactivity changes student behaviours: Effectively designed programmes should impact the students in such a way that there is an increased and spontaneous use of the opportunities for interaction within the programmes.

The aim of this study, therefore, was to explore the perceptions of students and lecturers within the current instructional designs employed in distance learning programmes using both VLE and ITV. The Departments of Family Medicine and Primary Care, Human Nutrition and Nursing Sciences participated in the research study.

Description of distance-learning programmes

Virtual learning environment (VLE)

The VLE (specifically WebCT in this instance) is a self-contained software package for organizing and presenting a programme on the Internet. The software is licensed to the institution and resides on its server. Lecturers can then construct web-based learning using the tools provided. In terms of interaction for example the VLE supports chat rooms, bulletin boards, private mail and interactive whiteboards. Students dial up to the Internet from home and access the VLE using a password.

Use of VLE by Family Medicine Programme

The Department of Family Medicine and Primary Care runs a four-year VLE-based programme for general practitioners to obtain a Master's degree. The instructional design process has been fully described elsewhere (Mash, Citation2001). Students follow a web-based study guide and are provided with resource materials on the web, as well as on CD-ROM and in printed format. Students interact with the material through self-assessment quizzes, reading and watching video. Students perform experiential tasks in their own practice settings, reflect on these individually as well as in group discussions on the web and report on these in the form of written assignments. In addition a variety of tasks involve dialogue around problem-solving, brainstorming, sharing viewpoints, consensus building and clarification of learning by experts. Students have one face-to-face contact session for five days at the beginning of each year.

Interactive Television (ITV)

Interactive TV involves the connection of a parent TV studio via satellite to approximately 20 other TV studios around the country. The sessions are in real time and students must physically be at the studio nearest to them in order to participate. The tutor can be seen and heard in all the studios on a TV monitor and can interact with the students via a telephone link on the student's desk. The students can hear but not see each other when they speak on the telephone link. The tutor can likewise hear but not see the students. Videotapes of the sessions can be sent to students who do not attend.

Use of ITV by Human Nutrition Programme

The Department of Human Nutrition runs a two-year programme for a Master's degree in which students are mostly dietitians but include a variety of professionals. Students follow a printed study guide that defines both summative written assignments and formative self-study tasks, and are provided with a printed reader. ITV sessions were used for correcting and discussing the self-study tasks, transmitting model answers, giving administrative information and enabling some social presence as there was no face-to-face element in the programme.

Use of ITV by Nursing Programme

Lastly the Department of Nursing Sciences runs a one-year programme for registered nurses to obtain a Diploma in Primary Health Care. Students are provided with a printed study guide, which defines the module framework, written assignments as well as a reader and video or CD-ROM. ITV sessions were used to answer questions regarding the assignments, share administrative information and provide additional content in the form of lectures. Nurses living close to the university also attended clinical skills training one day per week and had face-to-face contact with the lecturer, whereas distance students needed to organize their own clinical skills training with a registered nurse in their area.

Methods

Five focus-group interviews (FGIs) were conducted to explore the students’ and lecturers’ perceptions of the quality of interaction. One FGI was held with six lecturers from Family Medicine and Human Nutrition; however the Nursing Sciences programme only joined the research study after this FGI. Two FGIs, with eight students in each, were held during the Family Medicine contact session, one FGI was held with six Human Nutrition students living close to the university and one FGI with four Nursing Sciences students attending a practical session at a nearby clinic (). The FGIs were facilitated by two trained investigators from the Centre for Teaching and Learning of SU who were not known to or involved in the training of the students.

Table 1.  Summary of number of student questionnaires received and participation in focus-group interviews

In addition all students enrolled during one year were invited to complete a questionnaire (see ). The questionnaire was designed to explore students’ perceptions of interaction and was based on key issues identified from the literature (Moore, Citation1990; Cronje, Citation1996; Boettcher, Citation1997; Ragan, Citation1999; Pittinsky & Chase, Citation2000; Roblyer & Ekhami, Citation2000; Wulff et al., Citation2000; Bender, Citation2003; Frith & Kee, Citation2003; Garrison & Anderson, Citation2003; Halpin et al., Citation2003; Meyer, Citation2003; Simonson et al., Citation2003; Christopher et al., Citation2004) as well as those that arose from the FGIs. In particular, the questionnaire incorporated a previously published rubric for assessing the quality of interaction in distance learning (Roblyer & Ekhami, Citation2000), and explored the following main domains:

  • demographics of the students;

  • extent of social interaction;

  • influence of instructional design on interaction;

  • influence of technology on interaction;

  • perceived quality of interaction.

The questionnaire was administered using the survey tool in VLE for both the Family Medicine and Human Nutrition students and by email for students in Nursing Sciences. The questionnaire was offered to students at times that made most sense within the individual course structures, at the end of either modules or semesters. The response rate to the questionnaire for VLE was 76% (117/154) and for ITV 67% (43/64). As an inducement to participation in the study, the completion of the questionnaire was rewarded with a 1–2% ‘bonus’ mark.

The quantitative data were entered into Excel and analysed in Statistica 6.1.409 using categorical data analysis of two-way contingency tables by a consultant statistician. The ‘Framework’ approach to qualitative data analysis was adopted (Ritchie & Spencer, Citation1994).

Results

Student profile

The student profiles are given in . VLE students were general practitioners, mostly males, in their thirties, living with a partner, in almost all provinces of South Africa as well as abroad, including Namibia, Europe and Asia. ITV students were mostly female, in their twenties, living with extended families and mostly located in the two most urbanized South African provinces. VLE students (general practitioners) worked within the district healthcare system (primary care and district hospitals) whereas the ITV students (dietitians and nurses) were in primary care or secondary–tertiary hospital-based care.

Table 2.  Student profile

Importance of interaction

Students and lecturers in both VLE and ITV believed that interaction was essential for success and should be reinforced. Interaction was seen to remove feelings of being alone, motivate students, provide moral support, encourage exchange of ideas, provide an opportunity to learn from each other, and act as a benchmark for students to determine whether they were on a par with their peers.

I think it is very important in the sense that it encourages us to exchange ideas, rather than sitting alone in our respective places reading notes. [B16]

It gives you a wider perspective, over and above that, you can gauge where you are. [B48]

Interaction was very, very important, especially on the practical side that we systematically had to go through and it would be impossible to do it on our own. [D62]

Student-to-lecturer and student-to-student interaction

Quantitative data on the quality of student–lecturer and student–student interaction are given in . Qualitatively, VLE students and lecturers who had face-to-face contact perceived it as important for building a sense of community and for providing training opportunities in the use of VLE. However, ITV students who had no formal face-to-face session did not believe that this would be beneficial.

Table 3.   Student–lecturer and student–student interaction

Lecturers in VLE were of the opinion that the university should timetable specific times on a regular basis, as if they were giving a lecture, to teach and interact online as part of their academic activities.

ITV students and lecturers were of the opinion that, although lecturers were well prepared, their presentation skills needed attention. Lecturers portrayed a lack of self-confidence and expressed the need for more training before using ITV. Generally, students preferred discussions to lectures, or question-and-answer sessions. Lecturers mostly preferred discussion of case studies as opposed to lecturing and would like longer or more ITV sessions to cover all the topics. Although students were expected to prepare specific topics for discussion during ITV sessions the lecturers had to force students to interact and students felt uncomfortable when they were singled out for a reply:

So you had to contribute an intellectual answer and then you sometimes feel kind of stupid. [D374]

Interactivity score

Overall interactivity scores were 12.3 for VLE and 10.0 for ITV, which implies a moderate degree of interaction for both according to Robyler's rubric ().

Figure 1. Rubric for assessing interactivity score. Source: Roblyer & Ekhami (Citation2000). Note: Total score for VLE = 12.3 and for ITV = 10.0. Low interactivity score = 1–7, moderate interactivity score = 8–14, high interactivity score = 15–20. # = p < 0.05.

Figure 1. Rubric for assessing interactivity score. Source: Roblyer & Ekhami (Citation2000). Note: Total score for VLE = 12.3 and for ITV = 10.0. Low interactivity score = 1–7, moderate interactivity score = 8–14, high interactivity score = 15–20. # = p < 0.05.

Social interaction was rated low in both modes, but neither group of students expressed a need for substantial social interaction:

[We] manage to work on a task together and it did not matter so much that we did not interact socially. [B129]

Lecturers expressed a desire for contextual information, such as photographs or biographical introductions, to know their students on a more personal level:

All lecturers would have liked to have more communication with the students on a more personal level because we do not even know what they look like. [A414]

Modes of communication

Technologies used for interaction around coursework, administrative and social topics are shown in . VLE students used the software tools (bulletin boards and private mail) to support social and academic interaction but also relied on the telephone for administrative purposes. For ITV students, email and telephonic modes outside the ITV sessions were also needed to support academic, administrative and social interactions. An important theme was the rejection by the ITV students of using ITV sessions for conveying administrative information.

Table 4.  Mode of interaction for coursework, administration and social

Barriers to interaction

Quantitative data on barriers to interaction are set out in . Qualitatively VLE students appeared to be more concerned about the cost of and their ability to use the computer-based technology. Technophobia was especially rife amongst the ITV students with Nursing Science students reporting that their experience with ITV was ‘terrifying and stressful’ and even indicated that they attended the TV studios but did not ‘log on’ so that the lecturer could not ask them any questions. Similarly, most of the web-based students initially found it a daunting experience to go on the Internet to use chat rooms, bulletin boards and other VLE facilities. Technical and logistical problems—both personal and institutional—added a fair amount of frustration. Some of the web-based students travelled extensively and struggled with finding telephone connections for laptops, using Internet cafés or relying on friends’ Internet connections.

Table 5.  Barriers to interaction

Although just more than half of the students were not English (first-language) speaking, the majority did not find language a barrier to adequate communication and interaction. In contrast, though, the Nursing Sciences students complained about the sole use of English as the mode of instruction since all but one of the students were Afrikaans (first-language) speakers. Lecturers were of the opinion that poorly spoken and written English complicated the task of marking assignments:

A lot of them were not fluent in English—they were from Eastern countries and some have Afrikaans as first language. [A204]

For ITV students the physical distance from the ITV studios and loss of concentration in long sessions were perceived as barriers to interaction, and they requested that their working hours and conditions should be considered when scheduling ITV sessions after hours. Their personal circumstances, differing working environments and time management impacted on their ability to participate. Demanding work schedules also made it difficult for VLE students to log on regularly and they found it:

… challenging in the sense that you had to work around your personal environment and fit it into that timetable. Sometimes I stay up to 4 a.m. to submit an assignment.

Nursing Sciences students, however, stated that a distance education module is easier due to the advantage of determining their own time schedule. The students’ learning styles also differed, for example a number of students preferred to study from textbooks, write individual assignments and avoid interaction via the technology altogether, even though the majority appreciated interaction.

Instructional design and interaction

Quantitative data on the aspects of the instructional design that may impact on interaction are given in . Qualitatively lecturers agreed that they would have to pay more attention to the ‘deliberate planning of interaction’ in their programmes. There was general agreement from the web-based students that the modules were intentionally designed to encourage interaction, whereas interaction in the ITV sessions was less and seen by students and lecturers as an aspect that could be improved in the instructional design:

[lecturer]—we must definitely work and focus more on interaction between lecturers, students and programme material. [A328]

Table 6.  Instructional design and interaction

Between 24% and 35% of both groups perceived the pace of the modules as being too fast to complete all the tasks comfortably or not flexible enough to allow for changing personal circumstances.

I had to go to India and could not complete my assignments. I had to leave the whole module. [C287]

However, the structured design of tasks in VLE also served to pace students:

It forces students to study—to keep up, it is necessary to log on every day. [B29]

VLE lecturers were concerned about ‘virtual absenteeism’ of some students and indicated that they were reflecting on ways of encouraging these students to participate. Even so, the bulletin board was found to be difficult to read by students in the sense that it could become cluttered and replies were easily overlooked:

I did find it very frantic. Messages are sort of hidden—I later stopped using it. [B37]

Lecturers commented that the system of allocating marks for interaction on the bulletin board resulted in quantity and not necessarily quality. Lecturers often refrained from participation, giving students the opportunity to analyse and give each other feedback.

Differences between VLE and ITV

The VLE and ITV groups differed significantly in a number of areas. The student profiles differed significantly in terms of location, family structure, work setting, age and sex (p < 0.05). Although the strength of the relationship with their lecturer was closer in VLE (p < 0.05) the ITV students found that interaction with their lecturer was more likely to solve their problems and enhance their learning (p < 0.05). In VLE student–student interaction happened more often and for longer and led to a stronger relationship that was more likely to support a dialogue, take place without the lecturer, motivate completion of the module and support the achievement of learning outcomes (p < 0.05). The two groups also differed significantly in the modes of communication needed to support academic, administrative and social interaction. In general terms the tools in VLE were more comprehensive than ITV, which required students also to use the telephone and personal email to a large extent. The two groups did not differ significantly in any of the measured barriers to interaction. In terms of instructional design the VLE group felt the balance between studying alone and interacting with others was significantly better. In terms of the interactivity score the VLE and ITV groups did not differ significantly overall but showed significant differences in individual parameters dealing with social rapport, instructional design and technological interactivity ().

Discussion

When comparing VLE with ITV the quantitative results must be interpreted with caution as this descriptive study does not attempt to control for the potential variables that may influence the findings. For example differences may be explained not only by the characteristics of the technology itself but also by the characteristics of the lecturers, instructional design and students. Nevertheless the quantitative data may be triangulated with the qualitative focus-group data and with the participant observations of the research team who were all involved as lecturers and designers on the various courses. In addition the results of exchange structure analysis (ESA), which was also performed in a separate part of this study and reported on elsewhere (Mash et al., 2004), can also be triangulated. ESA was used to evaluate the structure of conversations in VLE bulletin boards, VLE chat rooms and in ITV sessions. This part of the study, not reported in detail here, found that the roles of lecturers and students differed significantly between these three settings. VLE bulletin boards supported a reflective primarily student–student dialogue, which was characterized by reasoning and mutual feedback, whereas VLE chat rooms supported a reflective symmetrical dialogue, which was characterized by the seeking and sharing of information as well as reasoning, as opposed to ITV, which supported a more traditional lecturer-dominated format characterized by lecturing in conjunction with question-and-answer sessions. If cognitive presence is described as the extent of critical and reflective thinking (Garrison et al., Citation2000) then it appears that VLE supported more cognitive presence than ITV. Taking these methodological constraints and triangulated findings into account, what lessons can be learnt for future designers and lecturers from the results of this study?

The finding that student–lecturer interactions in ITV were perceived as more likely to solve problems and enhance learning can be explained by the ESA findings, as in ITV these interactions were more instructional with the lecturer delivering a large amount of content and answering questions directly. In VLE the lecturer was more facilitative in guiding the dialogue within the bulletin boards where learning evolved as much from student–student interaction as from the lecturer's input. The ability to dialogue with lecturers in a more guiding style may explain why the relationship was felt to be closer and warmer in VLE. In addition VLE emerged as an environment that enabled student–student as much as student–lecturer dialogue. This raises the question as to whether these differences are a function of the technology or the instructional design.

The nature of the technology clearly does impose certain opportunities and constraints on the type of interactions (Bates, Citation1997). Simonson argues that ideally technology should support synchronous communication and symmetrical access to the dialogue (Simonson et al., Citation2003). VLE is limited in the extent to which it supports synchronous communication as this is only possible in the chat rooms, while ITV is limited in the extent to which it supports symmetrical access, as only the lecturer is portrayed visually and interaction is channelled primarily between lecturers and students. Students can only dialogue with other students at distant sites through the lecturer in the parent studio and the locus of control remains with the lecturer. The finding therefore that student–student interaction was of a much lower quality in ITV can be explained in part as a function of the medium itself. On the other hand, if teaching presence is defined as non-verbal behaviours that reduce physical and/or psychological distance between teachers and students (Garrison et al., Citation2000) then the visibility of the lecturer in ITV provides a potentially greater teaching presence. According to the media equivalence hypothesis, however, the effectiveness of the learning experience may be more a function of the way in which the media are used or the type of instructional design rather than the attributes of the media themselves (Commonwealth of Learning, Citation2005). Is it possible therefore for these media to be used differently, in ways that overcome these limitations in more innovative instructional designs?

White (Citation2002) reports that certain attributes of the lecturer in ITV increase interaction and these include enthusiasm, a sense of humour, non-verbal warmth, approachability, frequent positive encouragement and timely feedback. It can be anticipated that these qualities would to some extent diminish the technophobia that ITV students expressed. In addition Cronje (Citation1996) has suggested various ways of enhancing student–student interaction by designing activities that require interaction between the students gathered in individual studios. The value of this, however, may be limited by the small numbers of students present in some studios on the courses studied here. Simonson has also argued that ITV lecturers should focus on increasing overall group interaction rather than individual participation as this was more strongly linked to student satisfaction. He also notes that student attitudes towards interaction may be more important than the actual time spent interacting, in determining the perceived level of interaction.

In VLE and ITV up to a third of the class reported that the pace and flexibility of the course was a problem. In VLE for example this led to a recognition that initial modular designs were over-ambitious in terms of content to be covered and too rigid in the number of tight deadlines within the modules. This led to a revision of the modules, which allowed more responsiveness to changing personal circumstances and where possible to a reduction in the workload. In conclusion therefore although there are constraints imposed by the technology it may be possible for the lecturers and designers to further maximize the potential for interaction.

Another interesting outcome at the end of this study was that the course designers utilizing ITV decided to introduce VLE as another element in their programmes. One reason for this may be that VLE offers a more continuous and comprehensive package of communication tools and may decrease the variety of modes of communication required for different purposes in ITV-based courses (ITV, personal email and telephone). Dialogue and communication can also be more easily sustained for the whole class outside the broadcast schedule.

Students in this study did not perceive a need for sharing much information on a personal level, which is in contradiction to the argument that social presence is a strong predictor of satisfaction with computer-mediated interactions (Halpin et al., Citation2003) and a determinant of the quality of interaction (Roblyer & Ekhami, Citation2000). Neither group rated social rapport activities very highly, but VLE was significantly better in this regard and this may be explained by its ability to support student–student interaction as well as by the annual five-day contact time that was part of the course design. ESA showed that chat-room conversations had the highest percentage of social exchanges. ITV did not support a high degree of social presence beyond the face-to-face contact of those students sharing the same studio and neither course had any class contact sessions.

Students in both VLE and ITV rated the amount of voluntary and spontaneous interaction equally and gave it a moderate score. Interaction was mostly in response to required sessions, tasks and assignments. The qualitative data, however, revealed a worrying fear of participation amongst some of the ITV students although it was not clear if this was primarily due to anxieties about using the technology, being ‘put on the spot’ by the lecturer or less self-confidence as a student group.

One further aspect that was debated by the researchers was the high cost to the faculty of licensing software, purchasing satellite time and maintaining equipment. In ITV, particularly, studios were often opened for a very small number of students. Up to 20% of both groups of students also reported that the cost of using the technology was a barrier to interaction. In VLE this was presumably the cost of computer hardware and Internet connections whereas in ITV it was presumably the cost of travelling to the studios. Further research may be warranted to explore the cost–benefit of these media to both faculty and students.

Conclusion

Interaction was highly valued by student and lecturers participating in distance-learning programmes utilizing either VLE or ITV. Students rated courses using both technologies as moderately interactive. Significant differences were detected in student–lecturer and student–student interactions, use of additional modes of communication, instructional design, technological interactivity and social rapport activities. The groups did not differ across a number of likely barriers to interaction and both also reported the need for more flexible and better paced instructional designs.

Practice points

Acknowledgements

The authors would like to thank Professor Daan Nel from the Centre for Statistical Consultation, Department of Statistics and Actuarial Science, Stellenbosch University for analysing the data in Statistica Version 6, Ms Rattie Louw for typing the transcripts and Ms Ineke Buskens from Research for the Future for training the researchers in qualitative data analysis. The Faculties of Health Sciences and Education at Stellenbosch University provided funding for this project.

Additional information

Notes on contributors

Bob Mash

BOB MASH currently works as a family physician and is the programme manager for postgraduate distance education courses in Family Medicine and Primary Care at Stellenbosch University. He is the editor of the Handbook of Family Medicine and has special interests in the fields of mental health, chronic care, communication skills and distance education.

Debbie Marais

DEBBIE MARAIS is a registered dietitian, lecturing in community nutrition, and is coordinator of the postgraduate programme within the Department of Human Nutrition (including Master's and PhD and Continued Professional Development opportunities). Her areas of interest lie in education, health promotion and the effective utilization of IT in education.

Stephanie Van Der Walt

STEPHANIE VAN DER WALT is a lecturer in Community Health Nursing Science and Primary Health Care. She obtained her Master's degree with a distinction in 2002, exploring the experience of TB through the eyes of the patient. She is currently busy with her PhD through the Department of Education.

Idilette Van Deventer

IDILETTE VAN DEVENTER currently holds a post of Advisor: Higher Education at the Centre for Teaching and Learning, University of Stellenbosch. Her teaching career has spanned three decades and includes primary, secondary and higher education institutions. Her fields of expertise include teaching and learning in higher education, education management and gender equity.

Margot Steyn

MARGOT STEYN currently holds the post of Advisor: Higher Education at the Centre for Teaching and Learning at Stellenbosch University. Previously she was a Senior Lecturer in the Department of Chemistry at the University of South Africa, a distance-teaching institution. Her fields of expertise include teaching and learning in higher education, design of computer-aided learning materials and research aspects of organometallic chemistry.

Demetre Labadarios

DEMETRE LABADARIOS is a Professor and Head of the Department of Human Nutrition at Stellenbosch University and the Tygerberg Academic Hospital, an elected Fellow of the American College of Nutrition and holds the J. Kinney International Award Committee in Nutrition Research, and the Albert Strating prize for Preventive Medicine of the South African Academy of Science and Arts.

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