Sten Ludvigsen
email: sten.ludvigsen@intermedia.uio.no

Anders Mørch
email: anders.morch@intermedia.uio.no

CATEGORISATION IN KNOWLEDGE BUILDING Task specific argumentation in a co-located CSCL environment

In this paper we explore how students talk and reason when they were exposed to a set of categories taken from scientific discourse. The scientific categories are built into a web-based discussion forum (Fle) as part of a pedagogical and technological design. The scientific categories are based on the concepts of the progressive inquiry model for knowledge building. Socio-cultural theory with a focus on concepts like categories and prompting is our theoretical framework. In the DoCTA NSS project we have used the progressive inquiry model to explore how the students use categories to collaboratively build new understanding of a specific knowledge domain. Based on the theoretical framework and an empirical example, we argue that the progressive inquiry model -in its conceptual form -is too rationalistic for student knowledge building. We found that student knowledge building is task-specific and local oriented, rather than aimed at conceptual artifacts.

INTRODUCTION

Design experiments in different knowledge domains have been directed at how the learning environment could be designed to promote conceptual development beyond procedures and rules [START_REF] Brown | Design Experiments: Theoretical and Methodological Challenges in Creating Complex Interventions in Classroom Settings[END_REF][START_REF] Anderson | Canonical and Sociocultural Approaches to Research and Reform in Science Education: The Story of Juan and His Group[END_REF][START_REF] Greeno | Thinking Practices in Mathematics and Science Learning[END_REF][START_REF] Abbas | Scaffolding features to support inquiry based learning: Study of the ARTEMIS digital libary interface[END_REF]. In many of these studies the authors have been able to show positive results, but they have also identified some shortcomings, such as fact-finding patterns (Hakkarainen & Palonen, 2002). An important finding is that students need to be prompted to articulate their conceptual understanding. The need for teacher intervention for creating conditions for the conceptual talk is also well documented [START_REF] Hakkarainen | Epistemology of Inquiry and Computer-Supported Collaborative Learning[END_REF].

One important aspect of prompting that we explore in this paper is to use categories as "guiding principles" for the understanding-making process. Computer systems provide means for implementing such guiding principles, for example as different kinds of "sentence openers" built-into the ICT.

Design experiments can be seen as an intervention in the educational practice; since the researchers in collaboration with teachers, try to change the way the students work. These shifts often presuppose a change in participation structures and how agency and division of labour are distributed between the teacher and the students. One aspect of this change is epistemological. By epistemological change we mean how the teachers and students think about the knowledge construction process. Their perception of this process has impact on what kind of participation structures will develop in the educational setting (Stenning, et al. in press;Hakkarainen, Lipponen and Järvelä, 2001).

From a socio-cultural perspective on learning the notion of activity is seen as the T.H.E. Editor(s) (ed.), Book title, 1-6. © yyyy Kluwer Academic Publishers. Printed in the Netherlands.

1 basic concept for design and analysis. The participants in an activity are connected to each other by their involvement in talk and action with the teacher and their fellow students. The activity is mediated by the use of scaffolds inscribed in the computational environment. One scaffold we explore in this paper is prompting categories. The goal of the paper is to understand the relationship between students' activities when solving specific tasks and their use of categories during the problem solving.

We address the following research questions in this paper:

• What impact did the categories have on collaboration and problem solving? • What meanings did the students attribute to the categories?

The research context where we explore these questions is design experiment with 9 graders in Oslo and Bergen, in Norway. The knowledge domain is biotechnology, with emphasise on ethical issues.

This paper is organized as follows. In the first section we will give a brief overview of the theoretical position we take regarding the relationship between learning activities, how we can understand the use of categories, and we discuss the progressive inquiry model proposed by Hakkarainen, Lipponen and Järvelä (2001).

In the second section we describe the learning environment and the design experiment. In the empirical part we give a few examples on how the students perceived and used the categories. Finally, in the discussion we elaborate our findings and theoretical position.

SOCIOCULTURAL PERSPECTIVE ON PROMPTING, CATEGORISATION AND KNOWLEDGE BUILDING

Categories are important assets in all human activity, and learning how to classify events, things and activities is part of the process of creating social order [START_REF] Sacks | Lectures on conversation[END_REF][START_REF] Garfinkel | Studies in ethnomethodology[END_REF] for recent review see [START_REF] Mäkitalo | Categorizing Work: Knowing, Arguing, and Social Dilemmas in Vocation Guidence[END_REF][START_REF] Mäkitalo | Talk in institional context and institutional context in talk: categories as situated practices[END_REF]. By sorting things out we are able to cope with complexity and maintain a measure of social order in our private and professional lives [START_REF] Bowker | Sorting Things Out[END_REF]. This is a historical process initiated by individuals in specific activities (e.g. personal concerns), but when generalized categories may serve as governing parts of institutional activities (e.g. laws).

In this paper we address a specific aspect of categorization, namely prompting categories. In computational learning environments it is possible to build-in these as "sentence openers" or scaffolds in the computational environment, which the students then can use in their interaction with the learning environment.

There are different approaches to understanding categorization. One of the approaches is to see the categories as external representations, a topic which has also been studied in the cognitive sciences [START_REF] Zhang | The nature of external representations in problem solving[END_REF]. However, the main focus of cognitive science is related to how individuals use and develop mental representations. On the other hand, working with external representations is prominent among CSCL researchers. For example, [START_REF] Suthers | The Effects of Representations on Students' Elaborations in Collaborative Inquiry[END_REF] have extended the cognitive perspective by looking at the use of external representations in collaborative activities. However, often the cognitive processes remain as the unit of analysis, leaving social and institutional aspects unaccounted. Our interest is how students understand and use categories in problem solving and collaboration, as an activity situated in a social practice. Categories in educational settings don't come as empty vessels (as the name may imply), but are loaded with history and politics [START_REF] Suchman | Do Categories Have Politics? Computer Supported Cooperative Work[END_REF][START_REF] Mäkitalo | Talk in institional context and institutional context in talk: categories as situated practices[END_REF]. Categories have evolved over time and can seen as part of what [START_REF] Bowker | Sorting Things Out[END_REF] labels categorical work. Categorization is therefore not neutral. Categories become real to the extent they get used by people in specific activities.

Progressive inquiry and knowledge building

Our understanding of progressive inquiry and knowledge building has taken as staring point the Future Learning Environment 2 (FLE2) [START_REF] Muukkonen | Collaborative Technology for Facilitating Progressive Inquiry: Future Learning Environment Tools[END_REF], an online discussion forum with built-in posting categories implemented according to the progressive inquiry (PI) model. The progressive inquiry model includes the following aspects of inquiry: Identifying (initially fuzzy) questions, producing personal working theories, collaboratively evaluating and redirecting the inquiry, searching for deepening knowledge by consulting more capable peers and teachers, finding reference information in online resources, generating subordinate and refined questions and producing elaborated explanations and shared theories for the whole learning community. Hakkarainen, Lipponen and Järvelä (2001) argue there are two primary sources for the PI model: philosophy of science and cognitive science, or in their own words "the knowledge seeking inquiry starts from an agent's cognitive or epistemic goal that arise out of his or her dissatisfaction with the present state of knowledge." (p. 131). There are clear differences between the notion of knowledge in the philosophy of science and in the cognitive sciences, especially in that the former tend to objectify knowledge whereas the latter tend to personalize it (i.e. as internal mental states). However, they do have in common a focus on problem solving, i.e. that a problem and its associated set of questions drive a knowledge building process aiming at answering the problem. This includes finding new and innovating questions to reframe a problem and to restart the knowledge building process when it reaches temporary impasses.

From a cognitive science perspective the relevance of questioning is to establish a goal for a problem solving process. This implies that the learner's cognitive goals are the driving force in the knowledge seeking process. When knowledge seeking is driven by questions, different ways to answer becomes important and crucial for the quality of the learning process and its outcome. This includes how to problematize (Stenning et al., in press), how to deal with multiple and conflicting information, and how to construct explanations and hypotheses.

By objectification is meant that the basic elements of scientific inquiry (problems, tentative theories, critical evaluations) are publicly available (as external representations) and shared by the members of a research community (Popper, 1972). Sharing is realized by the simple fact that information is publicly available, but also (indirectly) in that information is not associated with any individual owner. It is the latter aspect that has been the focus of Popper's approach to scientific knowledge building [START_REF] Popper | Epistemology Without a Knowing Subject[END_REF], and he refers to the "ownerless objects" as World 3 objects (Popper, 1972). Examples of World 3 objects are theories published in books and stored in libraries, conference papers in proceedings, and words in a dictionary. These objects have no owners although they may have originated by the efforts of individuals. [START_REF] Bereiter | Education and Mind in the Knowledge Age[END_REF] calls these objects conceptual artefacts.

Although the categories of the PI model have its heritage in the scientific schema proposed by Popper, we cannot expect students to manipulate knowledge objects as professional scientist do. Instead, we propose a new concept for student scientific knowledge building, Micro Third World object (MTW1 for short). An MTW object is a "localized" Popperian World 3 object. Its World 3 characteristic stems from the fact that it is shared (e.g. an external representation) and may originate as a proper World 3 object (i.e. a published resource stored in a public repository). By localized we mean the object is adopted by a community of learners and attributed a meaning not a priori given but locally constructed by small groups. Examples of MTW objects are the problems, theories, and explanations produced by pupils in the science classes we have studied. In the empirical section we give concrete examples.

MTW knowledge is the combination of objectified knowledge stored in public places and the students' use of that knowledge in their social activity of knowledge building. As such they bear resemblance to categorical work (Bower & Star, 1999). Categorical work entwines objective knowledge (shared categories in specific knowledge domains) with social activities and politics [START_REF] Suchman | Do Categories Have Politics? Computer Supported Cooperative Work[END_REF]. In our "miniature" society we have found tentative evidence of entwining, namely between categories of scientific inquiry and student knowledge building and between objective knowledge (published resources) and negotiated meaning in small groups.

The goal for introducing the progressive inquiry model in our classrooms is to the increase the awareness and focus on the students' abilities to practice 'scientific reasoning', which is necessary in order to develop abstract or theoretical knowledge [START_REF] Donald | Orgins of the Modern Mind. Three Stages in the Evolution of Culture and Cognition[END_REF]. As we have emphasized previously how to achieve these learning processes is very demanding and hardly part of everyday practice in most educational activity. This is therefore an urgent problem to focus on, both at the practical and the theoretical level.

The knowledge building metaphor could be interpreted as a normative model for how we should organize students' work. However, the normative view is taken from a very different institutional setting as distinct type of activity (scientific reasoning), to a school setting. This transformation is not trivial.

DESIGN OF THE LEARNING ENVIRONMENT

In the DoCTA NSS project (Design and Use of Collaborative Telelearning Artefacts, Natural Science Studios) we have adopted the progressive inquiry model as our main design principle. However, our research goal was not to replicate any of the studies referred to in this tradition (Scardemalia & Bereiter, 1994;Hakkarainen, Lipponen and Järvelä, 2001). Our goal was to explore the design space of this model and to assess its impact on the students' actions and use of categories.

The progressive inquiry model is implemented in FLE2 [START_REF] Muukkonen | Collaborative Technology for Facilitating Progressive Inquiry: Future Learning Environment Tools[END_REF]. FLE2 is a groupware system, with tools oriented towards distributed collaboration and knowledge building. The tool most relevant for this study is the knowledge-building forum, which is a discussion board with categories to prefix the postings (Figure 1).

Figure 1. Knowledge building categories in FLE2

The students had to select a category before a message could be posted. The categories are listed on the top of the screen and presented in different colours. In the original system they were written in English (as in Figure 1). In the version of the system we adopted the categories was first translated into Norwegian. The Norwegian equivalent is slightly different for the English version shown in Figure 1 since we split the Deepening Knowledge category into two: Reliable knowledge, and Uncertain knowledge. In the original system there was no distinction between reliable and uncertain knowledge.

In addition to asynchronous discussion with FLE2 the students had access to technology for sharing resources, synchronous discussion, small-scale simulation, and domain-specific Internet resources. The Internet resources were browsed through a search engine called ATEKST. ATEKST is a front end to Norwegian newspaper articles. It was used when the students needed references to back up (support or refute) claims and arguments.

The content of the learning environment was biotechnology, in particular the ethical dimensions of this knowledge domain. The students mainly focused on the ethical dimensions in our design experiment. The students were from grade 9. One group of students was located in Oslo and the other group in Bergen. In this study we analyse the use of categories based on data from one of the co-located settings.

The students were expected to produce a web page about biotechnology as the final outcome. The web page should include information from multiple resources and include the local group's discussions (positions and arguments) as well as the counter positions produced by the collaborating group at the other school.

Methodological issues in design experiments

The socio-cultural theory on learning gives analytic tools for understanding how students learning activities is 'played' out in interactions with artifacts, here more specifically the use of a set of categories [START_REF] Jordan | Interaction Analysis: Foundations and Practice[END_REF]. We see the design and the concrete use of specific learning environment as historical unfolding activities. Design experiment is one type of formative intervention in a social practice, with the intension is to create new types of activities for students to take part in. The design is based on a set of abstract principles. We argue that it's important to make a clear distinction between the abstract principles behind the design of a learning environment and how the students actually interact with the environment [START_REF] Rasmussen | Openness and structure in technology rich learning environments -how is agency and knowledge construction distributed between tools, students and teachers? Paper ISCRAT[END_REF].

In the whole DoCTA NSS study we have collected data by video recordings of classrooms where the students work during the design experiment (two weeks). The activities of two of the group in Oslo and Bergen where recorded more in detail. These groups where followed with two cameras during the design trial. In addition the students where interviewed and we have collected log files of some of the activities in FLE 2. In this paper we base our illustration on the part of the data where the students use the categories as part of their activities. We have transcribed these episodes. We analyse in some detail how the students used the categories.

The analysis could in principal take two pathways, one following the templatebased approach that inherits the rationale build into the progressive inquiry model (scientific inquiry), and the approach used in this paper, where we try to find the meaning making in the actual use of the templates. We argue that a drawback of the template-based approach is that we could miss important dimensions of the situated character of the students' learning processes and how the students activities become social accountable [START_REF] Garfinkel | Studies in ethnomethodology[END_REF].

EMPRIRICAL ANALYSES -TASKS, UNDERSTANDING AND CATEGORIZATION

In these analyses we will try to understand how the students actually used the categories during knowledge building, based on moment-by-moment interaction data.2 In this excerpt three students have written an argument, which they are going to post in FLE 2. They discuss what category to use for the posting.

The first student X suggests one of the categories (reliable knowledge), but the other student Y disagrees and the remaining is a discussion of a relation between a certain segment of text, which they have written and how it should be categorized. In segment 5 and 7 student Y tries to elaborate her argument about why she thinks it's not reliable knowledge. The student's argument is twofold: it is a special kind of statement and it is a study rather than published research. By the use of the categories the student at least to certain extent is able to problematize what kind of status a segment of text have in relation to a problem.

In this next excerpt the students are trying to find relevant information in one of the resources of the newspaper search engine ATEKST.

8. Teacher: How are things going? 9. Student Y: Yes, we are working …., we have already send one reliable knowledge! 10. Teacher: Have you -where did you find the reliable knowledge? 11. Students (all): In the "Atext" 12. Teacher: In "Atext", in which newspaper? 13. Student Y: In Aftenposten 14. Teacher: Are you sure that it's reliable knowledge, when it's written in Aftenposten? 15. Student W: It's was a statement from a physician 16. Student X: I don't know 17. Student Y: What can we take as reliable knowledge then? 18. Teacher: No, I'm only ask, how sure you can be on a newspaper…., is it true when it stands in a newspaper? 19. Student Y: No. " The talk between the teacher and students is a continuation of the discussion about the status of resources. When the teacher asks about where they have found the information they categorize as reliable knowledge they refer to a search engine, which is connected to a large number of Norwegian newspapers. The teacher asks a question that prompts the students to elaborate about what kind of resources they can rely on. The students answer concretely, but also in a more general way. When the teacher asks whether or not newspaper articles per definition can be said to be reliable resources, the students assume this is not the case. The discussion between the teacher and the students goes on, and they try to sort out how to make sure that the resources they find are trustworthy.

When we take the excerpts into consideration the students generate meaning with respect to the categories in different ways. The categories trigger a discussion about how to understand the relation between text and a certain category. When the students don't agree they are stimulated to elaborate their argumentation. This argumentation makes the relation between their written text and the category more transparent, which creates an important condition for knowledge building. This process makes the students aware of the content for their argumentation.

The teacher's intervention and the talk that follows stimulate the process of problematization. What level of trustworthiness can be attributed to the resources the students find in ATEKST or other resources? The students know that they should be critical to facts or arguments presented in newspapers. The teacher's question serves as an important part of the knowledge building process. His question raises the awareness of the status of resources, so that the students need to articulate their opinions of ways of working with the content. When student-student and studentteacher interaction make use of the categories in the way we have described, the activities can be seen as examples of knowledge building processes.

If we see this analysis in relation to previous work [START_REF] Ludvigsen | Categories at work: Collaboration in co-loacted and distributed setting[END_REF] we would argue that students have pragmatic orientation to the categories. They don't take the categories for given by the computer system, or the categories used by other students for granted. Nevertheless, they consider them useful, since the categories in use give them prompts, which is part of their scaffolding structure. This pragmatic interpretation could also indicate that the students are more concerned with the overall goal of solving the task, rather than the actual knowledge building process by itself. These finding of mixed patterns is interesting, because they point towards that we have knowledge seeking and fact-finding patterns embedded in students talk, in a complex way.

DISCUSSION AND CONCLUSIONS

The categories used in the FLE2 learning environment could be considered part of a broader scientific discourse. Furthermore, the categories of the progressive inquiry model could be seen as part of categorical work that applies to different disciplines [START_REF] Bowker | Sorting Things Out[END_REF]. One the other hand, the use of the categories is connected to the local meaning production in the different scientific disciplines. The categories chosen, such as problem, reliable knowledge and uncertain knowledge, give clear indication that the students are able to establish a participation pattern that belong to knowledge building.

The students' use of the categories could be interpreted as a kind of categorical work [START_REF] Bowker | Sorting Things Out[END_REF]. The reasoning of some of the students and the student-teacher interaction show that the students are able to make their reasoning transparent, i.e. to elaborate, problematize and make critical judgments. This is partly connected to the categories themselves and partly to the teachers' intervention in the process. We can say, to a certain extent, the students when collaborating, make use of aspects of the progressive inquiry model (se also [START_REF] Arnseth | From Categories of Knowledge Building to Trajectories of Participation. Analyzing the Social and Rhetorical Organization of Collaborative Knowledge Construction[END_REF]. When it comes to scientific discourse (which lies at the heart of the PI model), our findings indicate that the students discourse is not "objective", but local and task-oriented. Exposing the students to categories of a scientific discourse and the advanced vocabulary of this discourse don't make a scientific practice visible to the students. The work that becomes transparent to the students is their own work with the categories.

On the other hand, when the students get socialized to a more demanding work environment, they have opportunities to take part in and get experienced with how scientific knowledge building could take place. The learning environment could under specific conditions create a new type of agency for the students, which imply different division of labour between teacher and students [START_REF] Boaler | Identity, Agency, and Knowing in Mathematics Worlds[END_REF]Hakkarainen, Lipponen and Järvelä, 2001). The examples we have shown in this paper give suggestions of types of interactions in which the students have possibilities to develop conceptual knowledge, since they are engaged in a conceptual type of talk. Conceptual talk goes beyond the regular classroom talk where the focus often is on task. The conceptual level of discourse is not automatically part task related talk. As argued the teacher intervention is of significant importance for creating a type of talk where the conceptual resources is used at part of the knowledge building activities.

We will argue that the analysis of the moment-by-moment interaction gives indications about how the categories are used, and how the categories helps to support how the students' deal with specific content [START_REF] Stahl | Contributions to a Theoretical Framework for CSCL[END_REF]. However the students' use of the categories is part of their local processes of solving their tasks. It's a great challenge not only to support the working process, but also the how students work with the content. In other studies done by Ludvigsen et al (2002) we have fund that it is very difficult to find ways to supported the content of the students work. As other have shown the teacher is the most critical resource for creating conceptual oriented talk.

Its' important to emphasize even if the students use same of the categories in their work as scientist do, we would argue than we should be careful to make interpretations, which imply that the scientific categories in the progressive inquiry model 'travels' in en unidirectional way. The students work is fare from a research laboratory, so the categorization process, which the students are part of, is generated by the local meaning production in this specific setting. The categories are useful, even if the meaning making process is fare from a more rationalistic model of doing science. The categories make the students aware of the systematic part of the knowledge building process. This is important for developing skills that are sensitive to the differences between types of knowledge involved in problem solving.

The theoretical part has been an argumentation that students learning should be understood as a different type of activity than scientific processes, or internal cognitive processes. The PI inquiry model seems to rationalistic and don't provide us with analytic lenses sensitive to the local meaning production. We understand learning as a highly institutionalised activity, where the social accountability is negotiated in the intersection between long cycles of activities and moment-bymoment interaction [START_REF] Rasmussen | Openness and structure in technology rich learning environments -how is agency and knowledge construction distributed between tools, students and teachers? Paper ISCRAT[END_REF].

T.H.E. Editor(s) (ed.), Book title, 1-6. © yyyy Kluwer Academic Publishers. Printed in the Netherlands.

MTW is not only an acronym but also an integration of two words: MTV and WWW (World Wide Web). MTV has set a new standard for TV (fast paced, abrupt juxtaposition) and Internet has created a fertile ground for the proliferation of MTW objects, since it is so easy to locate, copy and reuse information published on the WWW.T.H.E. Editor(s) (ed.), Book title, 1-6. © yyyy Kluwer Academic Publishers. Printed in the Netherlands.

The enumeration is for organization of this paper. The excerpts are not sequential in the whole data set.T.H.E. Editor(s) (ed.), Book title, 1-6. © yyyy Kluwer Academic Publishers. Printed in the Netherlands.

Acknowledgements

We want to thank the Network for IT-Research and Competence in Education for funding of the DoCTA NSS project. We are grateful to all the participants in the project for creating inspiring work condition. We also want to thank teachers and students at the schools, which take part in project. Especially we would thank the master students', which have worked with the data we have used in this paper: Anne Brandshøi and Karianne Omdahl.

We would also like to thank InterMedia, University of Oslo for financial support and colleagues in our research group on Net-based learning and the socio-cultural research group in education for valuable discussions.


RN, PhD Anne Moen

PhD Ole Smørdal

Informatics-based Learning Resources for Patients and their Relatives in recovery

Keywords: Patient learning, trajectory, consumer health informatics, tailoring, 'just-in-time', 'just-in-case', Open Source, universal access

In this paper we describe experiences from design of an informatics-based learning resource for patients and relatives. The prototype, REPARERE (learning REsource for PAtients and RElatives during REcovery), aims to support patients and their family recovering from heart surgery in meeting challenges in to daily living post discharge. 'just-in-case' and 'just-in-time' strategies to information retrieval and knowledge construction in health and learning trajectories. Findings from the literature, discussions with patients as well as health care providers indicate that unfulfilled information needs in the recovery period are common. Resources like REPARERE would be valuable supplement to facilitate patient learning about symptom management, self-care and coping while recovering.

Using recovery experiences and patient teaching material, REPARERE includes examples of textual information, videoclips, images and illustrations relevant to the recovery trajectory and a user's digitally represented profile. The development of the prototype focuses on flexibility and usability, tailoring and sequencing resources, and inclusion of recommendations for universal access. Development of web-based learning resources allows for exploration of

Introduction

In new or unfamiliar situations access to "common" or "normal" experiences or suggested strategies can promote self-care, enhance coping and independence [START_REF] Johnson | Self-regulation theory and coping with physical illness[END_REF][START_REF] Brennan | HeartCare: an Internet-based information and support system for patient home recovery after coronary artery bypass graft (CABG) surgery[END_REF][START_REF] Safran | The collaborative edge: patient empowerment for vulnerable populations[END_REF]. Appropriate information resources to handle personal health and illness situations are in increasing demand. The general public as well as recovering patient and their families request valid information and useful strategies appropriate to handle specific health issues [START_REF]S@mspill 2007[END_REF]. Dealing with health and illness can be understood as trajectories [START_REF] Corbin | A nursing model for chronic illness management based upon the trajectory framework[END_REF][START_REF] Corbin | The Corbin and Strauss Chronic Illness Trajectory Model: an update[END_REF]. Although an individual's trajectory is most often seen in retrospect, insight from common paths in a specific condition's trajectory are important to understand developing and changing nature of information and communication needs in a period of recovery. Carefully developed and deployed technology mediated information-and communication interventions carry potential to effectively support trajectories of recovery following acute illness, or in learning to live with chronic conditions. Previously reported experiences of information and communication resources like HeartCare [START_REF] Brennan | HeartCare: an Internet-based information and support system for patient home recovery after coronary artery bypass graft (CABG) surgery[END_REF], Baby-Care Link [START_REF] Safran | The collaborative edge: patient empowerment for vulnerable populations[END_REF] and CHESS [START_REF] Gustafson | CHESS: 10 years of research and development in consumer health informatics for broad populations, including the underserved[END_REF] have pointed to increased consumer proficiency and coping, improved symptom management, enhanced self care, and increasingly empowered users. However, web-based learning resources seem few in number, and may therefore be regarded as an underused resource for self-care, symptom management and coping. This paper shares some experiences from design of the prototype REPARERE (learning REsource for PAtients and RElatives during REcovery), a learning resource supporting patients and relatives in recovery from Coronary Artery Bypass Graft (CABG) surgery. These experiences are used to illustrate potential uses for web-based learning resources that strengthen current approaches to patient education.

Materials and Methods

Information content for the prototype REPARERE came from analyses of collected information from four different sources. These included 1) semi-structured interviews with convalescents and one of their family member, 2) participatory observation of information meetings for patients and relatives when they were still in the collaborating heart clinic, 3) focus group interviews with health care providers about their patient information program, and 4) recovery experiences and information needs published in the literature. Using a purposeful sampling technique, a group of convalescents in different periods of their recovery (10 male, 7 female) consented to semi-structured interview. They were asked about their recovery experiences and information and communication needs post hospital discharge. Only the male participants pointed out a family member, therefore 10 female family members also provided information about their role as family member, and their information and communication needs during the family member's CABG recovery. The health care providers (physicians, nurses, physical therapists and social worker in the heart clinic's surgical or rehabilitation unit) provided information about their patient teaching program to prepare for the recovery period. The literature was identified by combining keywords; 'recovery', 'CABG', 'rehabilitation', 'trajectory', 'quality of life', 'spouse'. This collected material was subject to content analysis [START_REF] Cavanagh | Content analysis: concepts, methods and applications[END_REF][START_REF] Lorensen | Spørsmålet bestemmer metoden. Forskningsmetoder i sykepleie og helsefag[END_REF]. The themes identified in the analysis gave a picture of information and communication needs according to the perspective of the convalescent, family member and health care provider. This informed selection of content, sequencing of material according to the recovery trajectory, and choice of presentation modality, i.e. text, picture, video, illustration, in the REPARERE-prototype. We used a horizontal prototype approach to development [START_REF] Pressman | Software engineering: a practitioner's approach[END_REF]. REPARERE is developed in an Open Source Environment, using the Apache Lenya Content Management System1 . The health information is represented in XML style sheets (XSL) and Cascade Style Sheets (CSS) 2 for flexible presentation of the content. To match the content to the trajectory of recovery, a digital user profile allows for customized retrieval or system tailoring based on pieces of information retrieved from defined elements in XML-document and XSL style sheets for presentation [START_REF] Moen | Considerations leading to of learning resources for patients and relatives during recovery (REPARERE)[END_REF]. In addition, inclusion of Web Accessibility Initiative (WAI) requirements for universal access [START_REF] Caldwell | Web Content Accessibility Guidelines 2.0. W3C Working Draft: Web Accessibility Initiative (WAI)[END_REF], e.g. making the resource useable for the vision or cognitively impaired too, and support user who may request special accessibility features or alternative use. The prototype has been tried in a small design experiment to learn from and with two volunteer patients about the potential uses of REPARERE. The volunteers participated in the heart clinic's rehabilitation program, and approximately 12 weeks into their recovery period. They used REPARERE for 3 weeks, and took notes about their experiences. At the end of the period, a walk trough of a typical use situation and a group interview was carried out.

Results

Creating web-based learning resources, like REPARERE, involve an interdependent mix of health, learning and technologically related challenges. Our example incorporates examples of 1) relevant, sequenced information according to common experiences in the trajectory of CABG recovery; 2) communication arena for peer and/or professional interaction and support; and 3) universal access and alternative presentation and interaction. Findings from our interviews with CABG-convalescents and their family member as well as health care providers, reiterated published literature about CABG recovery experiences, content of patient information and suggested secondary prevention of cardiovascular disease. This information informed selection of content in our design. In a web-based resource, using information about changing focus of attention in a recovery opens for sequencing and tailoring to match information to anticipated user needs. In the immediate period post CABG surgery, monitoring physical recovery, e.g. pain and wound management, rest, exercise and nutrition, is most important and receives most attention. In addition to such physically oriented recovery activities, unexpected experiences of memory problems, mood changes, problems to focus attention, and fatigue created some insecurity and uneasiness to the convalescent and/or family member. Later in the recovery trajectory, the object of activities shifted to regaining functional levels, secure psychosocial wellbeing and initiate life style changes. Likewise, examples of gender differences shaped recovery trajectories, e.g. men's expressions pointing to emotional suffering when realizing the "drama" of CABG, and women's expressions pointing to felt lack of social support and less exercise or physical activity. Therefore, in REPARERE, information and communication resources for symptom management and self care during the recovery trajectory relates especially to

• physical healing and immediate recovery from surgery,

• increase physical activity and social functioning,

• psycho-social well-being and return to work and/or usual activities

• long-term changes for secondary prevention and healthy life style

Information relevant to such challenges in the recovery trajectory is presented in text, pictures, video and illustrations, to capitalize on the web's strength to communicate information in suitable form to the user. The prototype REPARERE currently supports system tailored 'just-in-time' interactions; i.e. filtering information according to "this is most likely relevant for you now", and 'just-in-case' presentation, i.e. information that "is important about CABGrecovery". Generally, such an information and interaction design is reflected in the following diagram:

Just-in-time

Just-in-case

Traditional, hard copy

Information design

Interaction design

Figure 1 -Model for informatics-based learning resources

For tailoring information in a learning resource, information about health outcomes at different points during the recovery, may provide relevant information to the user, individualized and aligned to a particular situation. An individual's recovery trajectory; embedded information and communication needs seems more important than time elapsed since surgery.

Therefore, in addition to time since surgery, age, gender, comorbidities, and/or special interest, we suggest that information about role as convalescent or family member, and perceived health related quality of life (HRQoL) can enable more dynamic customization and tailoring in the trajectory. We suggest to use an instrument like SF-36, that is in use as a quality of life measure in our country [START_REF] Lindsay | Assessment of changes in general health status using the short-form 36 questionnaire 1 year following coronary artery bypass grafting[END_REF][START_REF] Loge | Translation and Performance of the Norwegian SF-36 Health Survey in Patients with Rheumatoid Arthritis. 1. Data Quality, Scaling Assumptions, Reliability, and Construct Validity[END_REF] and in groups of CABG convalescents [START_REF] Barnason | Functional status of patients with a coronary artery bypass graft over time[END_REF][START_REF] Sjöland | Improvement in quality of life differs between women and men after coronary artery bypass surgery[END_REF] to individualize information to the user. The health and learning related considerations point to technical challenges in design of REPARERE. To facilitate interaction, and to design simple and consistent user-interface, knowledge about the user's capacities is important. Separation of the actual content, the 'just-in-time' functionality, and presentation of content allows for more flexible presentation. The chosen Open Source platform, Apache-Lenya Content Management System (CMS) provides such flexibilities. This platform is used and extended to meet specific challenges in the design. XSL stylesheets manage and arrange presentation of information according to information about the user. This way REPARERE accommodate a 'just-in-time' composition, with tailored or customized retrieval and presentation of relevant information according to anticipation of needs in the trajectory of recovery.

In addition, incorporation of principles for Universal Design improved accessibility regardless of transient impairment or disabilities [START_REF] Chrisholm | Web Content Accessibility Guidelines 1.0 W3C Recommendation: Web Accessibility Initiative (WAI)[END_REF].

The volunteers participating in the design experiment showed much interest in the content available in the prototype. They browsed REPARERE web-site like a booklet, i.e. according to a 'just-in-case' presentation, and did not use REPARERE as a tailored resource, i.e. the 'just-in-time' interaction. They perceived the available information as relevant for their own or family member's trajectory of recovery. However, to them all the information was important. They asked for more in-depth information about challenges or problems they had experienced as especially stressful, and emphasized peer to peer communication and exchange that REPARERE could facilitate in the future.

Discussion

Patient education and consumer health issues pose many challenges to design, such as affordability, adaptability and localizations, as well as personalization, customization and appropriation [START_REF] Kaplan | Consumer Informatics Supporting Patients as Co-Producers of Quality[END_REF]. Therefore, the REPARERE prototype includes 1) examples derived from the analyzed material, presented as relevant, sequenced information according to common experiences in a trajectory of recovery. This information can be presented as such or customized mindful of age, gender, co-morbidities, role as convalescent or family member, and perceived health related quality of life; 2) communication arena for peer and/or professional support; and 3) universal design requirements to support alternative interaction and presentation. As knowledge, expertise and experiences are re-combined or redistributed by web-based learning resources; the division of labor expressed in traditional roles, existing norms and power balance are challenged. Herein dilemmas, gaps and tensions may be illuminated. Multiple perspectives and different forms of knowledge (experiential knowledge, expert knowledge, and everyday practical knowledge) are integrated in the emergence of new social practices [START_REF] Engeström | Imagine the World you Want to Live in: A study on Developmental Change in Doctor-Patient Interaction[END_REF][START_REF] Strauss | Social organization of medical work[END_REF]. Taking the convalescent's and/or family members' experiences actively into account shifts attention from "episodes of care", and point to complexities and challenges of living with a health condition, either recovering from acute illness, facing permanent change in health or a chronic illness. Conceptualizing recovery as a social practice opens for exploration of the interplay of trajectories of convalescent and/or family members, where they may utilize, contribute and continuously develop their expertise.

The future users of services like REPARERE share in common challenge to handle a set of new issues and challenges. At the same time they constitute a heterogeneous group regarding age, gender, socio-economic status, co-morbidities and role as patient or family member. Conceptualizing and modeling the recovery as intertwining trajectories [START_REF] Corbin | The Corbin and Strauss Chronic Illness Trajectory Model: an update[END_REF][START_REF] Strauss | Social organization of medical work[END_REF][START_REF] Hawthorne | Using the trajectory framework: Reconceptualizing Cardiac Illness[END_REF], and eliciting information about "common" experiences in a specific condition's trajectory helps understand developing and changing nature of information and communication needs over time. The recovering patient and their families' trajectories seems shaped by efforts to understand expected, "normal" progress, return to usual life, work and leisure activities as well as initiate risk modification to delay recurrence of cardiovascular symptoms [START_REF] Knoll | Uncertainty and expectations: taking care of a cardiac surgery patient at home[END_REF]. Concurrently, focusing on normality may detract from necessary and beneficial life style changes to address chronic aspects of cardio-vascular disease [START_REF] Lindsay | Experience of cardiac rehabilitation after coronary artery surgery: effects on health and risk factors[END_REF].

REPARERE is an example of a web-based learning resource bringing together patients' recovery experiences, clinical expertise and practices, and requirements for universal access. Unfamiliar or un-chosen situations coupled with limited access to information about common experiences or suggested strategies can lead to disappointment and ill-use of valuable energy during recovery. In the case for REPARERE, the focus of attention shifts or develops during the recovery trajectory.

Examples of relevant content are presented according to common experiences and changing focus of attention over time.

Including and attending to multiple perspectives, e.g. convalescent, family members, health care providers, provide a broader basis to facilitate symptom management, self-care and coping. This opens for inclusion of collective experiences and collaborative coping and learning in peer groups related to health-illness recovery patterns. Selection of objects and use of ICT to convey content, and tailoring presentation should be mindful of variation in users' qualifications, knowledge and previous experiences. Knowing more specifics about health-illness experiences, interest, capacity, as well as experience with technology mediated learning objects are important to select appropriate information and facilitate interaction [START_REF] Schuler | Participatory Design, Principles and Practices[END_REF]. REPARERE is designed with respect to diversity amongst lay people; patients and their families. Information and communication interventions with the specific goal of supporting and empowering patients and/or their families during periods of recovery or in managing chronic conditions offer complementary services to this on-going work.

Web-based learning resources may support complex healthillness experiences and recovery trajectories expressed by multifacetted experiences and changes for the individual and his or her family. Equally important, these resources can be a useful communication arena for peer and professional support, sharing everyday experiences of living with a condition. Applying 'Just-in-Time' strategies to individualize, tailor and contextualize information to patients and their families recovery can offer information and communication in a more timely fashion, and support symptom management and self-care to enhance well-being. The REPARERE prototype exemplifies a shift from a "one-size-fits-all" approach to patient learning.

Tailored, individualized and contextualized information can support users who share a common challenge to handle a specific set of new issues and challenges. 'Just-in-time' (JIT) access to knowledge and clinical information may be a strategy to provide the most relevant, updated information matching the particularities of an individual's trajectory. At the same time, the multiple social networks of people using such a tool constitute a heterogeneous collective. [START_REF] Johnson | Self-regulation theory and coping with physical illness[END_REF][START_REF] Orem | Nursing, Concepts of Practice[END_REF]. REPARERE constitute a complex, shared resource that may point towards new possibilities when coping with a new life condition. It also points to how informatics-based resources may augment current approaches to patient education. The design experiment showed a large interest and need for internet based resources. In particular the volunteers emphasized peer to peer communication and exchange that REPARERE could facilitate. The use of internet communication services, such as chats was brought into the discussion, and encouraged integrations between chats and information resources. Also, the way the 'just-in-time' mechanism was discussed pointed to information highlighting rather than current information filtering. Interactive, web-based learning resources allow for new patterns in learning and knowledge construction through new modes of interaction between multiple stakeholders [START_REF] Dickerson | The Internet as a Catalyst for Shifting Power in Provider-Patient Relationships[END_REF]. Developed into a full-scale information and communication resources, informatics-based learning resources can provide dynamically tailored information according to intertwined trajectories of recovery and learning for the convalescent and their families. Information and communication interventions with the specific goal of supporting and empowering patients and/or their families are complementary services. Equally important, these resources can be a useful communication arena for peer and professional support, sharing everyday experiences of living with a condition and managing a trajectory. REPARERE takes into account diversity amongst future users, and acknowledges that health-illness experiences and recovery trajectories are complex, multi-facetted experiences manifested by many changes. Providing comprehensive and relevant content tailored to individual health information needs or care responsibilities, raise security concerns needing more careful attention before REPARERE is tried out in field experiments. At the same time, using the current prototype as a tool in discussions about development of infrastructures and applications may accommodate processes to explore potential for support to handle situations encountered by the convalescent and/or family during recovery.

Concluding remarks

Informatics-based learning resources can be valuable supplements for purposes of primary prevention or management of health-illness trajectories in periods of recovery or "living with" any chronic health condition. Patient education and consumer health issues pose many challenges to design, such as affordances adaptability and localizations -for personalization, customization and appropriation [START_REF] Kaplan | Consumer Informatics Supporting Patients as Co-Producers of Quality[END_REF]. As discussed in this paper, REPARERE is an example of a web-based resource bringing together patients' recovery experiences, clinical expertise and practices, and requirements for universal access in the design process. Further, REPARERE can become a communication arena for peer support or interaction with health care providers. These experiences are valuable to design resources for primary illness prevention, as well as resources for symptom management, coping, self-care and independence following acute illness episodes or chronic condition. Resources like REPARERE providing support to a convalescent and their families is an example of a shift from a 'Just-in-Case' approach aimed to fit all, to tailored and contextualized information enabled by a 'Just-in-time' approach to information retrieval and knowledge construction. In REPARERE, the 'Just-in-time' approach in the information and interaction design is demonstrated by the path of a CABG recovery trajectory, and combining the Open Source Content Management System and XSL stylesheets. In future research, it is also important to explore changing patterns of interactions, and how these may challenge and change traditional division of labor in the health care activities for illness prevention, as well as during period of recovery or in living well with a chronic condition.

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  flyers, brochures, books -Individualized, tailored -F2F, Phone call, sessions -C u s to m iz e & s e q u e n c e a c c o rd in g to s p e c if ic tr a je c to ry Phone call, sessions -C u s to m iz e & s e q u e n c e a c c o rd in g to s p e c if ic tr a je c to ry

http://lenya.apache.org/

http://www.w3.org/Style/CSS/

Acknowledgments

This study was supported by the Norwegian Research Council (grant no. 147993/V50), and IT-FUNK (Dr. Anne Moen, RN. PhD, Principal Investigator). We acknowledge collaboration with Feiringklinikken A/S, and InterMediaLab, Jan-Eirik Bakke Naevdal, Jan A. Dolonen and Yngve Refseth's contributions to develop REPARERE.