Informed and Healthy

Theoretical and Applied Perspectives on the Value of Information to Health Care

Maria G. N. Musoke

• Publisher: Academic Press
• Year: 2016
• Print ISBN:
  9780128042908
• eBook ISBN:
  9780128043660
• Topic: Scienze biologiche
• Subtopic: Farmacologia

Informed and Healthy: Theoretical and Applied Perspectives on the Value of Information to Health Care focuses on two major issues: the value attributed to information by users and its effect on health care; and, a new model of information behavior in which the value of information drives various information activities (unlike many information models which tend to give prominence to information needs). The inductive development of the model is explained, with associated implications for theory and transferability or applicability elsewhere. The book uses a case study of the health information system in Uganda and expands the analysis by comparing it to other systems utilized by different countries in diverse levels of development. Topics such as access and use of information; value attribution and effect on health outcomes; and modelling information behavior and its implications on health informatics are discussed in detail. This book is a valuable resource for health professionals, planners, and policy makers, as well as researchers interested in health information systems and their applicability in different environments. - Provides a new model of information behaviour that emerges inductively from qualitative data - Focuses on value of information rather than information needs - Explains in detail the methodological approach used to value attribution - Serves as a valuable resource for health professionals, planners, and policy makers, as well as researchers interested in health information systems and their applicability in different environments

Chapter 1

Health Information in Uganda

Abstract

The chapter introduces the subject of the book and sets the scene by presenting information that describes the setting, therefore putting the content in context. It has six sections: Introduction; Information concept; Primary Health Care; Information technology in the health sector and related policies; Health information challenges; Organization of the book; and References cited in the chapter.

Keywords

Health information; Primary Health Care; Information technology; Information concepts; Uganda; Sub-Saharan Africa; Developing countries

1.1 Introduction

the provision of health information to rural women is an asset to rural health care … it helps us to improve personal, family and community health, and to reduce the incidences of disease

A woman from Lira district, Northern Uganda

we accessed information about the management of HIV/AIDS patients that recommended a combination of medication by adding Septrin that was not the case fifteen years ago, and now patients live longer and the quality of their life is much better than it was then

A clinical officer from a health centre in Masaka district, Central Uganda

The quotes above, from a rural woman and a clinical officer working in rural Uganda, introduce the subject of the book by highlighting the value attributed to information by its users and the effect of information on health care.

Access to information is an essential component of development; it is a human right, and it does bring about sustained development and socioeconomic progress. However, over the years, Sub-Saharan Africa and other developing countries experienced some harsh economic policies that affected the social sector immensely. At the country level, the economic policies led to a reduction in public health spending. This had negative consequences on public health as a whole, but mainly its information sector. Consumers of health information faced various information accessibility challenges.

Setting up and implementing effective information services for rural people and the policies governing their use depend on ample knowledge of rural people’s information environment and behavior. Hardly any empirical data exist on this topic in Uganda. Focusing research on rural health workers, who serve 80% of Uganda’s population, is an important step in improving their information services and health care delivery in general. This would indirectly enhance the provision of information to the communities they serve and improve health outcomes in the end. At a local level, such research is important because the majority of Ugandans¹ do not see high-level health workers when they seek health care; it is provided within the family, community, or health units run by nurses and clinical officers.

Although studies in the developed world tend to focus on information systems and retrieval (Lemberger and Morel, 2012; Dwivedi et al., 2012; Spink, 1999; Spink and Dee, 2007; Vakkari, 1999; Vakkari and Järvelin, 2005; Vakkari and Huuskonen, 2012), the interest of an information researcher in a rural African setting is inevitably information in everyday life. In a post civil war situation and after health epidemics in an African rural area, can the use of available information make a difference in the lives of rural people? Knowing that many diseases can be prevented by information/awareness of what to do or avoid or where to go, are people aware that information is important? Has the gradually increasing availability of information driven by technology been felt by the people? Is the provision of information by health workers to rural people or by information providers to health workers and rural people important? Is it important to health planners and policy makers, or does it become an issue only in times of epidemics? Does the notion “prevention is better than cure” still hold true in these situations? These thoughts or questions inspired the author to conduct a doctoral study titled “Health information access and use in rural Uganda” (Musoke, 2001). Having compiled several bibliographies, the author had identified a gap in existing studies on health and rural Uganda in particular and Sub-Saharan Africa in general. Furthermore, in 2014–15, the author conducted a follow-up study to update the previous findings where necessary.

This book draws extensively from the findings of the aforementioned studies, whose main aim was to investigate the accessibility and use of health information by women and health workers, who are at the lowest level of Primary Health Care (PHC) service delivery in Uganda.

1.2 Information Concept

Information researchers have generally expressed the difficulties of defining or conceptualizing information (Roberts, 1976; Dervin, 1977; Belkin, 1978; Wilson, 1981; Browne, 1997). Information may be taken as the raw material from which knowledge is derived. To be utilized, information, like other resources, has to be tapped. In practice, however, this has been difficult to achieve in many African countries because of various factors, such as financial, sociocultural and lack of a supportive policy (Musoke, 2007a; Gadau & Lwoga, 2013). Even in the developed world, cognitive barriers have been reported to affect information access and use (Savolainen, 2015).

In Uganda where the research was conducted, however, the word “information” does not exist in various local languages. Consequently, the words “knowledge,” “happenings” and/or “news” are used to refer to information. To put information in the right context, one has to phrase a sentence that would make the word information different from the ordinary usage of the words knowledge, news, or happenings. This was reflected in the way some questions were worded or phrased in the interviews conducted in the vernacular with women. Other authors have shared similar experiences; for example, Namyalo (2002) highlighted the challenge of translating health messages in a multilingual and multicultural Uganda where some words are difficult to correctly translate from English because they do not exist in the vernacular, and yet Uganda has no national language.

For a long time, many authors have recognized the fact that the term “information” is used in many different contexts; therefore, there is a need for an agreed-on concept of information. Furthermore, a suitable concept of information is necessary for both theoretical and practical development in information science. Authors such as Roberts (1976, 1982) and Belkin (1978) developed concepts that they considered suitable or proposed that existing information concepts from other fields could be applied to the context of information science. A list of eight requirements that are definitional, behavioral and methodological was elaborated by Belkin (1978: 59–62). The variety of frameworks used led to information for information science being variously considered, for example: a fundamental category such as matter; a property of matter; the probability of the occurrence of an event; a raw material from which knowledge is derived; reduction in the degree of uncertainty in a state of knowledge or similar construct; an event that takes place when a recipient encounters a text; data of value in decision-making; publicly communicated scientific information and simply information as message.

Dervin (1977) conceptualized information in three ways: objective information that describes external reality; subjective information that describes internal reality and information as the behaviors enacted by the individual in the process of understanding reality. Dervin therefore brought on board the objective and subjective aspects of information as well as the behavior.

Information has also been regarded as a commodity because it can be bought and sold (Browne, 1997). Although it is true that various types of information, such as printed, audio-visual and/or electronic sources, are bought and sold, the commoditization of information, in that sense, is something this book may not emphasize because there are several other intervening factors (Apalayine and Ehikhamenor, 1996; Musoke, 2001).

Generally agreeing with Dervin’s (1977) conceptualization and Browne’s (1997) definition, Braman (1989) provided a hierarchical set of definitions comprising four groups: information as a resource, information as a commodity, information as a perception and information as a constitutive force in society. The first two definitions are generally objective. The third definition, perception, refers to information as intangible and subjective. The last one combines the first three and has some behavioral perspectives.

Since then, some of the aforementioned concepts have become commonly used in information work. For example, Wilson (1999) reported that the purpose of his study was to explore information behavior based on the “problem-solving process and upon the concept of uncertainty reduction.” Ross’s (1999) definition of information was also close to that: “We adopt a definition of information as something that fills in a gap in understanding or makes a difference to an individual’s cognitive structure or helps people with their lives” (Ross, 1999: 343).

Other concepts, however, have been dropped. Several authors (Belkin, 1978; Wilson, 1981) reported that the most commonly proposed information concept for information science, at that time, was Shannon’s “mathematical theory of communication”: source, transmitter, receiver and destination, with message and noise. This was originally proposed for telecommunication. However, the concepts were found not to fulfill the requirements for information science concepts: “Shannon’s information measure refers not to the message itself in terms of its contents, but rather to the probabilities assigned by the potential recipient to the set of all possible messages … it is an extremely limited view of information, and one which might be difficult to apply to the context of information science, where information is traditionally associated with the meaning of a message, rather than the probability (or improbability) of its receipt. In particular, this concept of information fails to meet any but the last two of the requirements of an information concept for information science, for it explicitly aims not to consider meaningful, social communication, or the problems raised by the requirements which refer to the effect of information and the relationships between information and state of knowledge” Belkin (1978: 66).

Shannon’s model or concepts could not apply to a study of information access and use. The situations in which information is accessed and used are generally social; hence, the study had to focus particular attention on the social context in which information processes take place. Furthermore, information use usually leads to changes in the user’s state of knowledge, which involves interpretation and putting meaning to information, and yet these are issues Shannon’s model tended to ignore.

Hence, the author conceptualized information in the context of user studies research following Wilson (1981), who pointed out that the problem with the information concept may not lie so much in the lack of a single definition as it does with a failure to use a definition appropriate to the level and purpose of the study. The term “health information” is used to refer to information on or about health and is not limited to epidemiological or statistical information.

In this book, the concept information is, therefore, used in a broad sense to include the objective and subjective aspects of information, for example, information as a physical entity (eg, books and posters), as facts, advice and opinions (printed, electronic, oral, audio or visual). Dervin’s (1977) conceptualization of information is used in the book, namely, objective and subjective information as well as information behavior of the individuals.

1.3 Primary Health Care

Since the 1978 international conference in Alma-Ata (USSR), many developing countries, including all Sub-Saharan African countries, adopted a PHC strategy after endorsing the Alma-Ata Declaration. The declaration defined PHC as follows: “Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self reliance and self determ...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Foreword
• Foreword
• Dedication
• Acknowledgments
• Abbreviations
• Chapter 1. Health Information in Uganda
• Chapter 2. Access and Use of Information by Women and Health Workers
• Chapter 3. The Value of Information and Effect on Health Outcomes
• Chapter 4. Modeling Information Behavior
• Chapter 5. Implications for Theory, Practice and the Future
• Index