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57 Seiten, Note: 3.0
CHAPTER ONE: INTRODUCTION
1.1 Background information
1.2 Case description
1.3 Statement of the problem
1.4 Aim of the study
1.5 Specific Objectives
1.6 Research Questions
1.7 Significance of the study
1.8 Conceptual Framework
1.8.1 Wilson’s Model of Information seeking
1.9 Scope and limitations of the study
CHAPTER TWO: LITERATURE REVIEW
2.2. Information Needs
2.3 Awareness and health information sources
2.4 Benefits of consulting health information sources
2.5 Challenges to Seeking Health Information
2.6 Healthcare delivery System in Malawi
CHAPTER 3: METHODOLOGY
3.2 Research design
3.3 Study area
3.4 Sampling technique
3.5 Instrumentation and procedures of data collection
3.6 Data Collection
3.7 Data Analysis
3.8 Ethical Consideration
3.10 Dissemination of Results
CHAPTER FOUR: DATA ANALYSIS, PRESENTATION AND INTERPRETATION OF FINDINGS AND RESULTS
4.2 Response rate
4.3 Demographic profiling
4.4 Health information needs
4.5 Awareness of health information sources
4.5.1 General awareness of health information sources
4.5.2 Types of health information sources that they were aware of
4.5.3 Source of awareness of health information sources
4.5.4 Level of proficiency
4.6. Health information sources consulted by rural health workers
4.6.1 Format preferences in accessing health information sources
4.6.2 Electronic health information sources
4.6.3 Print health information sources
4.6.4 Purpose of consulting health information sources
4.7 Benefits for consulting health information sources
4.7.1 Preferred place of accessing health information sources
4.8. Challenges faced in accessing and using health information sources
CHAPTER 5: DISCUSSIONS OF THE FINDINGS, SUMMARY AND RECOMMENDATIONS
5.2 Health information needs
5.3 Awareness of health information sources
5.4 Health information sources consulted by rural health workers
5.5 Benefits of consulting health information sources
5.6 Challenges faced by rural health workers in accessing and using health information sources
5.7 Summary of the key findings
5.7 Study implications
5.8 Recommendations for Further Study
Annex 1 References
Annex2 : Questionnaire
This research is dedicated to my beloved father Mr Wycliffe XY. He has raised me into the man I am today and I am forever grateful. The sacrifices made and tireless work invested to provide financially during this journey I am forever grateful. I also dedicate this paper to my brothers Williams, Wellington and sister Bester for your encouragement and financial support during this journey, I am forever grateful.
I thank God Almighty father Emmanuel for his unfailing love, grace and mercy, protection, guidance and the gift of life. He should get all the credit for giving me this opportunity to study at University of Livingstonia (Laws Campus).
I would like to extend my warmest gratitude to my supervisor, Dr Malanga for his immense amount of support, endeavour, advice, and tireless guidance throughout the process. I couldn’t have done any of this without his support.
I would also like to thank all members of staff at University of Livingstonia especially from Public health Department for their support, encouragement and cooperation during the period of my study.
Special thanks to Chawanangwa Beza and Hudson Nyasulu, for all the support that you have provided throughout this process. I am grateful for being such a great friends and advisors.
Warmest gratitude to my closest friend Abraham Kamboni for the encouragement during these years you are a blessing brother.
Finally, I thank Alinafe Kachanje for her support during the time of data collection.
Table 1.Distribution of questionnaires to respondents
Table 2.Demographic profile of respondents
Table 3.Respondent’s awareness of health information sources
Table 4. Electronic health information sources consulted by rural health workers
Table 5.Frequency of print health information sources consulted by rural health workers
Table 6.Respondent’s purpose of consulting health information sources
Table 7.Respondent’s benefits for consulting health information
Table 8. Respondent’s challenges faced in accessing and using health information sources
Figure 1.Showing Wilson’s information seeking model
Figure 2.Respondent’s health information needs
Figure 3.General awareness of health information sources
Figure 4. Respondent’s sources of awareness of health information sources
Figure 5.Respondent’s proficiency level
Figure 6.Respondent’s format preferences in accessing health information
Figure 7.Respondent’s preferred place for consulting health information
Abbildung in dieser Leseprobe nicht enthalten
Information is inevitable in the health profession. The need to become informed and knowledgeable which leads to “information seeking behaviour processes” is important among qualified health workers who have vital roles in achieving health goals of a given country. However, in Malawi, little effort have been made in understanding the information seeking behaviour of health workers. Therefore, the general objective of this study was to investigate information seeking behaviour among health workers in rural public health facilities in Karonga. The specific objectives included: to establish the health information needs of rural health workers; to determine awareness of health information sources by rural health workers; to ascertain the health information sources consulted by rural health workers; to determine the benefits of consulting health information sources and to establish the challenges faced by rural health workers in accessing and using health information sources. The study used a cross-sectional study design employing quantitative method of data collection. Purposive sampling was used to select a study sample of 50 health workers to participate in the study. Descriptive methods was used to analyse quantitative data using SPSS version 20. Results showed that almost all study participants (96%) had an information need. In conclusion, there is insufficient effort made to understand information seeking behaviour and address information needs of rural health workers in Malawi. There is need for governments and other key stakeholders to develop supportive policies and programs which encourage a culture for improved information seeking behaviour among rural health workers by promoting initiatives which address the key issues as far as information seeking behaviour is concerned.
Information-seeking behaviour has been defined by Wilson as ‘the totality of human behaviour in relation to sources and channels of information, including both active and passive information-seeking and information use’ (Wilson and Walsh, 2000). Information-seeking behaviour by health professionals embraces a pattern of information resource use, time spent searching, barriers to information searching and information searching skills (Flynn & McGuinness, 2011).The development of knowledge among health care providers is dependent on continuing access to relevant, reliable information through effective cooperation and flow of information among all stakeholders involved in the provision and use of information. Health information is important to improve knowledge based on which evidence-based decision is made to serve the clients of health facilities.
Access to health information facilitates to use new medical technologies, handle properly the necessary medical procedures and treatment of patients. The proper health information management brings health workers to act melodiously in a similar manner on medical and health practice (Dubow & Chetley, 2011).The relevance of health information is measured using two indicators. Information need: is a recognition that the knowledge is inadequate to satisfy a purpose that someone needs to achieve (Mohamed, 2009). Information Seeking Behaviour: is the purposive searching for information because of a need to satisfy some goals. Health professionals usually come across with two basic HIRs: formal (hard and soft copies) and informal (human resources) (Dubow & Chetley, 2011). Information needs and seeking behaviours varied among HWs working in rural and urban areas due limited access to information outlets (Ghebre, 2005). Internet use, access to library, provision of training use of audios and videos displays are the means that provide health information to the users (Garcia, 2010).
The use of health information may vary depending on circumstances. The need reaches pick during emergencies. Information needs of public health workforce had become more urgent and mandatory due to the emergency of new infectious diseases like severe acute respiratory syndrome (SARS), HIV/AIDS, malaria and tuberculosis (Gatero, 2011). Currently, resource limited countries face several health challenges that threaten the lives of millions of people (Ojo, 2006). Lack of health information communication creates such situations that produces medical errors, which are common in health facilities. This situation has the potential to cause miss-diagnosis, wrong treatment, increase multi drug resistance, severe injury and unexpected patients death (Dubow & Chetley, 2011).
Karonga District is in the northern region of Malawi. The district covers 3355km square and has a population of 10950 who access services. It is a border district between Malawi and Tanzania, mainly occupied by Nkhonde tribe. The district has 1 district hospital, 2 rural hospitals (in chilumba and Kaporo) and fifteen rural health centers throughout the district. (Government of Malawi, 2008). According to MoH (2014), rural hospitals and health centres in Malawi face many challenges in delivering healthcare due to a shortage of labour, a lack of basic health-facility infrastructure, poor management practices, and insufficient financing. These are poorly equipped with regard to electricity, communications equipment, computers with Internet, and emergency transport.
In addition, rural health facilities also have irregular and weak practices for facilitating communication and coordination among staff, and between facility staff and the communities that they serve (MoH, 2014).Therefore, this study was conducted in karonga targeting the following health facilities; Chilumba rural hospital, Furiwa health center, Chilumba barracks health center, Sangilo health center and St Anne’s health center in order to investigate health information needs of rural health workers and identify the areas in need of improvement. Furthermore, the information needs of health workers working in rural areas have been given little attention which underpins the need for this study. Nevertheless, no known study is currently documented on information seeking behavior in the study area. In developing countries, of which Malawi is included, healthcare workers at all levels of service delivery have substantial needs for information which is very important in delivering of quality and sustainable health care services to their clients. Therefore, understanding the information seeking behavior of health professionals is a prerequisite to meeting their information needs (Mohamed, 2011).
In the aspect of health information being requisite in delivery of quality healthcare services, many health workers have inadequate access to new information updates such as emerging diseases and medical technologies to enable them deliver quality care (pakenham-walsh & Bukachi, 2009).Many of the health workers rely on observations, advice from colleagues and building experience empirically through their own treatment success and failures. Mohamed (2011) reported that many deaths (Over 800 children and 40 women per hour) could have been avoided if health workers had access to appropriate and reliable health information updates in health care. According to Gatero (2011), understanding information seeking behavior of health professionals is the only realistic strategy for addressing their health information needs.
Rural hospitals and health centres in Malawi face many challenges in delivering healthcare due to a shortage of labour, a lack of basic health-facility infrastructure, poor management practices, and insufficient financing. These are poorly equipped with regard to electricity, communications equipment, computers with Internet, and emergency transport (MoH, 2014). This in one way or the other, affects the health information seeking behaviour of rural health workers. Therefore, this study was aimed to investigate health information seeking behavior among rural health workers in Karonga District.
The aim of the study was to investigate health information behavior of rural health workers in karonga, Malawi
The specific objectives were:
1. To establish the health information needs of rural health workers.
2. To determine awareness of health information sources by rural health workers.
3. To ascertain the health information sources consulted by rural health workers.
4. To determine the benefits of consulting health information sources
5. To examine the challenges faced by rural health workers in accessing and using health information sources.
The above stated specific objectives were achieved and the study was focused on the following research questions:
1. What are the health information needs of rural health workers?
2. Are rural health workers aware of health information sources?
3. What are the health information sources consulted by rural health workers?
4. What are the benefits of consulting health information sources
5. What are the challenges faced by rural health workers in accessing and using health information sources?
The study will provide key insight on information seeking behavior of rural health workers and their information needs in health care delivery. The results and accompanied recommendations will provide useful lead to study implications and program stakeholders in developing initiatives for addressing identified gaps, challenges and opportunities for improving information seeking behavior among the rural health workers. The study will also contribute to the available research and knowledge on health care services for documentation, further research and reference.
This research was aimed at examining the health information seeking behaviour of rural health workers in Karonga District using Wilson’s model of information seeking behaviour.The model suggests that information-seeking behavior arises as a consequence of a need perceived by an information user, who, in order to satisfy that need, makes demands upon formal or informal information sources or services, which result in success or failure to find relevant information. If successful, the individual then makes use of the information found and may either fully or partially satisfy the perceived need or, indeed, fail to satisfy the need and have to repeat the search process. Furthermore, the model also shows that part of the information seeking behavior may involve other people through information exchange and that information perceived as useful may be passed to other people, as well as being used (or instead of being used) by the person himself or herself.
However, as argued by some authors, the limitation of this model is that:
- It provides no suggestion of causative factors in information behavior
- It does not directly suggest hypotheses to be tested.
- The model also did not take account of the factors responsible for people not using information.
On the other hand, the strengths of this model is that it is described as macro-model or a model of the gross information-seeking behaviour and it suggests how information needs arise and what may prevent (and, by implication, aid) the actual search for information. It also embodies, implicitly, a set of hypotheses about information behaviour that are testable: for example, the proposition that information needs in different work roles will be different, or that personal traits may inhibit or assist information seeking.Despite of the weaknesses mentioned above, Wilson’s model of information seeking has been proved working as several studies have used this model to explain the information seeking behaviour of health workers. The following are some of the studies that used Wilson’s model of information seeking:
- Constance. B and Ina.F (2012).An investigation of information seeking behaviour of geography teachers for an information service intervention: the case of Lesotho
- Jacob k, and Deborah F, (2015). Information Seeking Behaviour of Health Information Management Students, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State, Nigeria
- Madely D.P. (2008). Information needs and information seeking behaviour of consulting engineers in South Africa. Qualitative investigation
- Shakeel A.K (2011). Information needs and seeking behaviour: A survey of college Faculty at Bahawalpur in Pakistan.
- Sonika R. (2015).Health information seeking behaviour and needs of community health workers in Chandigarh in Northern India.
Therefore, as proven by these studies, this research adopted the Wilson’s model of information seeking behaviour because rural health workers in Karonga District might be also going through the same process of information seeking behaviour as suggested by the Wilson’s model.
Abbildung in dieser Leseprobe nicht enthalten
Figure 1. Showing Wilson’s information seeking model
This study was conducted in Karonga specifically in Chilumba targeting 5 health facilities namely; Chilumba rural hospital, Chilumba barracks health center, Sangilo health center, St Anne’s health center and Furiwa health center. The study covered rural health workers and the sample included clinicians, HSAs, nurses, medical assistants, and others. The limitation of this study was that due to time and financial constraint, the study only targeted health workers in rural health facilities and therefore its finding cannot be generalized to health workers working in District hospitals. Another limitation of the study was the small size sample due to lack of financial resources and short period of time. A bigger sample would have been preferred, as this would have given a more certain estimation of the health information seeking behavior of rural health workers in karonga.
The above chapter has discussed the concept of health information seeking behavior of rural health workers within the developed, developing countries and Malawian context. It has also defined the statement of the problem, the objectives, and the research questions of the study.
Gray, et al (2007) defined literature review as an objective, critical summary of the published research literature relevant to a topic under consideration for research. Creswell (2009), also defined literature review as the systematic identification, location and analysis of documents containing information related to the research problem. This literature review is extracted from the previous documents such as articles, abstracts, reviews, monographs, dissertations, other research reports and electronic media. The literature review of this study is organized based on health information needs, awareness of health information sources, challenges to seeking health information, and the health information sources.
Understanding of information needs and seeking behaviour of various professional groups is essential as it helps in the planning, implementation and operation of information system and services in the given work settings (Younger, 2010).Reviews have indicated that health workers need timely, easy to digest, and up-to-date information that is filtered and summarized from authoritative content sources (Debra & Anne, 2007). Therefore, the working environment and type of task performed by individuals shape their information needs and the ways they acquire, select and use this information.
A study by Lundeen and Wermager (2000) on health information needs and seeking behavior of rural medical practitioners in Kenya, indicated that rural health practitioners appear to have the same basic needs for patient-care information as their urban counterparts. The study reported that Health care providers need information about diseases, diagnostic procedures, treatment side effects and daily living activities. The demand for health information needs by health practitioners depends mainly on work roles and tasks they perform regularly (Lundeen and Wermager, 2000).
Another study conducted by Tannery et al,(2007)on nursing students and clinical nurses’ information-seeking behavior mentioned that health care providers need health information depending on the nature and type of services they are providing. For instance, majority of the population in developing countries live in rural areas, while the majority of the medical community exists in the cities. In India, for example, 80% of the population is served by 20% of the doctors (Tannery et al, 2007).
Andrews and Pearce, (2005) study on information-seeking behavior of practitioners in a primary care practice based research network, whereby clinicians were asked how often they sought information from colleagues, print resources or online resources (excluding drug dosing or drug information interaction) to care for their patient, 58% stated they did this several times per week, 18% daily, 22% rarely and 2% never.Information needs are thus a requirement that may drive health professionals into an information seeking process to meet their information gaps. Knowledge about the information needs, information behaviour and information seeking patterns of health professionals is crucial to effectively satisfy the felt information needs and improve the delivery of health care services in a country. A recent review of the literature on doctors’ information needs in high income countries revealed that doctors mainly needed information in the following areas: clinical care, Continuing Professional Development (CPD) and patient information (Younger 2010). Information on diagnosis and treatment were also major information needs for primary care health professionals in Spain (Tumwikirize, et al, 2009).Studies from low-income countries also showed that colleagues remained the major source of medical information for health professionals in Uganda (Tumwikirize, et al, 2009).
According to Chardrasekhar and Ghosh (2008), ICT resources such as textbooks, internet, PDAs, telephones, Facsimile, television and newspapers are the most common known and sources of health information. They also reported colleagues as a source of health information used by health professionals. Godlee and Pakenham 2004 conducted a survey on the role of information in a lifetime process concluded that among general and social topics, the public including health professionals are mostly interested in receiving health information from different media channels. The results of the survey showed that the types of media that were contributing most to the public's health literacy are health magazines and health supplements of newspapers, closely followed by television and the Internet. The traditional technology such as the radio and modern technology such as the mobile telephone in many African countries are the most preferred in facilitating the dissemination of public health messages and disease prevention techniques in developing countries. (Godlee and Pakenham, 2004).
A study of public health professionals in the Massachusetts Department of Public Health by Lapelle et al, 2006 reported that consulting health information sources aided public health professions in handling issues related emergence of new infectious diseases such as severe acute respiratory syndrome (SARS) and Asian bird flu, as well as the increasing concern about acts of bioterrorism. Another survey by Prendiville on 156 hospital-based paediatricians in Ireland reported increasing significance in the day-to-day clinical practice of evidence-based medicine, memory refresh and knowledge update as benefits of consulting health information sources.
A study by the Clyvedon press (2006) on health information needs and seeking behavior pediatric nurses in Pakistan indicated challenges that hinder health care providers from seeking health information were pride, anxiety, resistance, and lack of skills or knowledge. Others include lack of time, long distances, bad weather, restrictive policies, and isolation. However, lack of computers and inadequate Internet infrastructure, inadequate library access and databases, equipment, costs and space are among the reported challenges.
The Clyvendon press (2006) study further identified that poor quality of health information from the source makes health professionals frequently fail to access information they need. However, their unfamiliarity with several important health information resources also contributes to such failures. This causes clinicians to choose the information sources that are most readily available, or those that are easily accessible and easy to use, so as to avoid complicated ways of searching health information from more dependable resources.However a study among rural health care workers on the Islands of Hawaii reported these challenges; inadequate technological infrastructure, increasing demands without static support resources, high cost of online delivery, and lack of ability to consult with colleagues (Godlee and Pakenham, 2004).
The provision of health services in Malawi falls under the responsibility of the Ministry of Health, which regulates both the public and the private sectors and works in cooperation with district councils, as well as management and advisory committees down to the village level. The public sector covers 60 percent of all healthcare demand, including more than 374 health facilities; it accounts for 43.5 percent of all generalist medical practitioners and 64.5 percent of all nursing professionals in the country, according to the 2008 census.
Approximately 40 percent of the available health services in Malawi are delivered by private for-profit and non-profit organizations, with the Christian Hospital Association of Malawi (CHAM) dominating the private sector (MoF, 2014).Malawi’s health system is organized at four levels namely: community, primary, secondary and tertiary. These different levels are linked to each other through an established referral system. Community, Primary and Secondary level care falls under district councils. The District Health Officer (DHO) is the head of the district health care system and reports to the District Commissioner (DC) who is the Controlling Officer of public institutions at district level.
This study was mainly concerned with the community level and primary level because this where rural health workers are. Health information seeking behavior of health workers in urban areas is much better as compared to rural areas where there are limited resources .Rural health facilities face challenges raging from a lack of basic health-facility infrastructure, poor management practices, and insufficient financing.
The chapter has reviewed literature based on previous studies on the health information seeking behaviours of rural health workers in both low- income and high-income counties. Reviews shows that health care providers need information about diseases, diagnostic procedures, treatment side effects and daily living activities. Most research shows that health professionals rely on human sources of information (colleagues) most often, particularly for issues related to diagnosis. Health professionals are cited to be aware of health information sources but they rarely use electronic sources and new information technologies. Among the challenges, literature shows that poor quality of health information from the source makes health professionals frequently fail to access information they need. The chapter has also reviewed the literature on healthcare delivery system in Malawi.
This chapter provides the method that were used during the research study. Research methodology is a way to systematically solve the research problem that involves the steps that are generally adopted by a researcher in studying the research problem along with the logic behind them (Kothari, 2004). This chapter also gives a description of the methods used. Methods are the tools used to collect data (Dawson, 2002). It therefore develops on the research design, study area description, sampling technique, data collection and data analysis.
Kothari (2004), states that research design is the arrangement of conditions for collection and analysis of data in a manner that aims to combine relevance to the research purpose with economy in procedure. This study used a cross sectional design. A cross sectional study, takes a snapshot of a population at a certain time, allowing conclusions about phenomena across a wide population to be drawn. This helps to identify specific issues in an identified population.This is the case since cross sectional studies involve only one contact with the study population thereby being comparatively cheap to undertake and easy to analyze (Kumar, 2014).
Karonga is the northernmost district of Malawi, bordered by Lake Malawi on the East, by the Songwe River (border with Tanzania) on the North and Nyika plateau and highlands on the West and South. It also borders with Chitipa and Rumphi districts and it has an altitude of 96m above sea level. Its geographical coordinates are 14.49 degrees South and 34.38 degrees East (Taboo, 2014). The study was conducted in karonga District particularly in Chilumba which is located at 10.4364 degrees south and 34.2449 degrees east(Taboo,2014). There are two rural hospitals (in chilumba and Kaporo) and fifteen rural health centers throughout the district. This study concentrated on three public health facilities namely; Chilumba rural hospital, Chilumba health center and Furiwa health center and two CHAM health facilities which are St Anne’s mission hospital and sangilo health center.
Sampling techniques are methods or procedures used for obtaining a sample from a given population (Kothari, 2004). This study utilized purposive sampling. Purposive sampling relies on the judgment of the researcher when it comes to selecting the units that are to be studied. This sampling technique was selected in order for the researcher to focus on particular characteristics of a population that are of interest, which enabled the researcher to answer research questions. Total population purposive sampling was therefore used to arrive at the sample size of 50 rural health workers from 5 health facilities.
The study used questionnaires. The questionnaire included closed ended questions for the purpose of getting short answers from the respondents.
A questionnaire consists of a set of questions presented to a respondent for answers (Kothari, 2004). The questionnaire consist of questions that are based on the objectives of the study to obtain information that is relevant to the study. Questionnaires were administered to 54 respondents to collect quantitative data.
Primary data was collected from rural health workers personally in the study area using a questionnaire having closed questions.
The statistical package for social science (SPSS) computer software version 20.0 was used to analyze the data. A variety of statistical tools was employed in order to describe the study population. SPSS was preferred because it is easy to use and accepts a wide range of data manipulation to give desired values and is also readily available as compared to other statistical packages. Questions will be coded and entered into the SPSS spread sheet for easy analysis.
Ethical issues considered in this study included the rights of respondents, honesty of the researcher and confidentiality of the respondents. The participants were asked for their consent to participate in the study and assured that the information will be confidential and used for education purposes only.
At the end of the study, a report is written in which one copy shall be sent to the library, another one submitted to research committee of University of Livingstonia for approval, the Department of public health and a personal copy.
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