What we learned from Covid-19 about discourse-based learning.

Now is an auspicious time to make student-centered discourse a centerpiece of social and civic education, as well as across the curriculum more broadly. We describe here the features of the middle-school program we have developed and implemented for this purpose, emphasizing its concentration on direct student-to-student communication, in contrast to the more common whole-class teacher-led discussion. The Covid-19 epidemic forced us to modify the way in which we implemented the program, eliminating face-to-face contact. What had been an in-person interactive discourse-based workshop we transformed into a remotely-experienced, technology-supported interaction between rotating student pairs. Each participant debated individually with a sequence of individual peers who held an opposing view on a series of social issues. This modified distance-learning approach revealed some unanticipated benefits that we share here. Most notable among them were the enhanced comfort in sharing their views that participants reported they experienced, due to the remote, text-only connection that concealed their personal identities.

Information processing by community health nurses using mobile health (mHealth) tools for early identification of suicide and depression risks in Fiji Islands.

OBJECTIVES: High rates of depression and suicide and a lack of trained psychiatrists have emerged as significant concerns in the low-income and middle-income countries (LMICs) such as the Pacific Island Countries (PICs). Readily available smartphones were leveraged with community health nurses (CHNs) in task-sharing for early identification of suicide and depression risks in Fiji Islands, the largest of PICs. This investigation examines how CHNs can efficiently and effectively process patient information about depression and suicide risk for making diagnostic and management decisions without compromising safety. The research is driven by the theoretical framework of text comprehension (knowledge representation and interpretation) and decision-making. METHODS: Mobile health (mHealth) Application for Suicide Risk and Depression Assessment (ASRaDA) was designed to include culturally useful clinical guidelines for these disorders. A representative sample of 48 CHNs was recruited and presented with two clinical cases (depression and suicide) in a simulated setting under three conditions: No support, paper-based and mobile-based culturally valid guideline support. Data were collected as the nurses read through the scenarios, 'thinking aloud', before summarising, diagnoses and follow-up recommendations. Transcribed audiotapes were analysed using formal qualitative discourse analysis methods for diagnostic accuracy, comprehension of clinical problems and reasoning patterns. RESULTS: Using guidelines on ASRaDA, the CHNs took less time to process patient information with more accurate diagnostic and therapeutic decisions for depression and suicide risk than with paper-based or no guideline conditions. A change in reasoning pattern for nurses' information processing was observed with decision support.DiscussionAlthough these results are shown in a mental health setting in Fiji, there are reasons to believe they are generalisable beyond mental health and other lower-to-middle income countries. CONCLUSIONS: Culturally appropriate clinical guidelines on mHealth supports efficient information processing for quick and accurate decisions and a positive shift in reasoning behaviour by the nurses. However, translating complex qualitative patient information into quantitative scores could generate conceptual errors. These results are valid in simulated conditions.