1、INFORMATION BEHAVIOUR IN HEALTHCARE OF HOME-BASED ELDERLY PEOPLE IN NAKURU DISTRICT,KENYAMARIE KHANYANJI KHAYESIDEPARTMENT OF INFORMATION SCIENCE,UNIVERSITY OF SOUTH AFRICA(UNISA)Doctoral ForumUNISA5th 6th March,2009INTRODUCTIONLiving longer is a success story of improved healthcare services.The res
2、ult is an increase in the number of elderly people that need continued services for their healthcare.But it appears that the care of elderly people in most developing countries like Kenya is the responsibility of individuals and families.The situation brings into sharp focus the role of information
3、in healthcare of elderly people.The specific issues of concern in the role of information include information needs,access and use in healthcare of the group.The current study investigated the above issues in relation to the healthcare of elderly people in Nakuru District,Kenya.STATEMENT OF THE PROB
4、LEM The core research problem that the study identified was the general neglect to include elderly people in outreach services for healthcare.The study advances the view that information may partly help to address the challenges that elderly people in Nakuru District,Kenya experience in their health
5、care.AIM OF THE STUDY The objective of the study was to explore in order to understand the use and contributions of information in healthcare of elderly people in Kenya,using Nakuru District as a study site.Research questions What are the information needs in healthcare of elderly people in Nakuru D
6、istrict?Where do elderly people and care providers get information for healthcare from?How do they use the information in healthcare of elderly people?What challenges do elderly people and care providers(formal and informal)encounter in access and use of information for healthcare?Health information
7、 need(s):What kind of information is needed?Medical Nutritional etcDeterminants of access Economic Cultural beliefs Political e.g.Legislation&Policy Environmental e.g.geographical distances.Individual characteristicsInformation sources and services:Formal Government,Media,Libraries,ICTs ii)Informal
8、networks e.g.NGOs,public meetings,family members,friends.Use of information.Create awareness.Make decision Maintain personal health.Share experiences with others Figure 1:A conceptual model for access and use of information in the healthcare of the elderly.Source:Modified from Wilson(1991,1997&2000)
9、Explanation about the modelThe model shows that respondents first experience and identify different needs for information in healthcare of elderly people.They start to look for information to help them address healthcare needs.They encounter challenges as they search for and use information for heal
10、thcare.Respondents use the information they get in to respond to a variety of healthcare issue.They go back to their information needs drawing board and repeat the process for as long as they have needs.METHODOLOGYStudy design:Qualitative study Phenomenological design with two elements:exploratory a
11、nd descriptiveReasons for choice of design:A fairly under-researched area that needed a research approach that would explore research issues identified for the study.Some of the respondents were unable to respond to a written interview because of illiteracy in English and Kiswahili.The method gave r
12、espondents a voice to be able to express their experience.Research site:Two divisions in Nakuru DistrictNakuru Municipality/TownRongai Reasons for choice of siteThe District has a history of economic activities that attracted job seekers from different ethnic communities as workers in farms owned by
13、 white settlers.Generations of the workers have since settled in the District and provide a good representation of the national population both in the rural and urban setting of the District.Sampling of respondentsSnowball technique at two levels1st LevelThe researcher explained to the local adminis
14、tration the purpose of the study.The administration helped to identify two elderly people,a lady and a gentleman that could respond to the interview.The first two elderly respondents identified other elderly people that could respond to the interview.Elderly people identified their actual informal c
15、are providers and the healthcare facilities that they went to.2nd LevelAdministrators at the Provincial General Hospital(PGH)and Rongai Health Centre helped to identify a medical staff that treated elderly people in the filter sections.Staff identified colleagues that provided healthcare services to
16、 elderly people.The procedure was repeated at both levels until a total of 40 respondents(18 elderly;16 medical staff and 6 informal care providers)was reached.The researcher explained to the respondents what the study was about and obtained their consent before making appointments for interviews.A
17、summary of respondents is shown in the table 1.Table 1:Summary of respondents interviewed for the studySub-groupNumberBrief descriptionElderly18Gender:Male(11),female(7)Age:between 55 and 89 yearsSetting:rural 8 respondents(4 males,4 females);urban 10 respondents(7 males,3 females).Living arrangemen
18、ts:alone(12);with spouse(2);with family members(2);family members living within a walking distance(2).Informal care providers6Relationship to elderly:Gender-male(2):sons to elderly parents.-female(4):2 spouses,1 daughter,and 1 daughter-in-lawFormal care providers16Gender:male(9),female(7)positions:d
19、octors(5-all males),nurses(5-all females),clinical officers(4-all males),nutritionists(2 both females)Data collectionA pilot study was conducted using 20 respondents.The results and experiences of the study were used to improve the instruments.Face-to face interviews were conducted among elderly peo
20、ple,formal healthcare and informal care providers.Semi-structured interview schedules were used to collect data from all the respondents.Data was recorded manually.Researcher also kept a field notebook or diary.Reasons for the choice of face-to-face interviews:Results and experiences of pilot study
21、revealed that some of the respondents were illiterate and had never participated as subjects in a study.There was need for a method that would promote dialogue and narration in order to collect data from respondents that faced this challenge.The method also gave respondents a“voice”to provide detail
22、s and experiences about issues that the study raised.The method enabled the interviewer to get insightful data about the research issues for the study.It would have been difficult to gather detailed information about the experiences of respondents if alternative methods were used.The method had the
23、advantage of producing high response rates since the researcher worked directly with the respondents.Data analysis Simultaneous data collection,analysis and write up of the research report following the procedure of data processing and analysis in qualitative research.Each interview session was tran
24、scribed and summarized.Each script stored in Ms Word.Data analyzed using content analysis:words and sentence by sentence reading of summary for each interview.Continuous rechecking,comparison and reflection on the data carried throughout the research period.Open coding was used to categorize and cla
25、ssify data.Data was further analyzed and categorized under themes and sub-themes that emerged from the analysis.Descriptive statistics were used to present the data.Tables and diagrams were used to provide summaries of the findings.Validity of the study Pilot study was conducted help edit and update
26、 the instruments.Participatory approach was used.Member checking done.Detailed description was provided to convey the findings.Shared the draft at every stage with supervisors.Incorporated suggestions from supervisors.Reliability of the study Pilot study provided the first basis for reliability.Inco
27、rporated experiences gained from the pilot study in the final version of the instruments used for the study.R E S U L T SINFORMATION NEEDS IN HEALTHCARE OF ELDERLY PEOPLE Introduction The study identified ten different types of needs for information for healthcare of elderly people in Nakuru Distric
28、t.Table 2 summarizes the identified needs.XTable 2:A Summary of needs for information in healthcare of elderly peopleInformation needed onElderlyInformal healthcareproviders Formal healthcareprovidersMedicationComplementary and alternativemedication(CAM).NutritionBasic counselling approachesEmotiona
29、l/spiritual support.Financial support Self protection Physical fitnessClothingGerontological servicesKey:An identified information need Did not show in the dataInform Medical staffTo help them prescribe medicine for elderly peopleBe able to advise elderly people and informal care providers about the
30、 healthcare of the formerBe able to help elderly people to accept changes in their health and to their lifestyles.Elderly peopleTo help them to understand the contributions of medicine to their health.Understand long term effects of the medicines that they used.About places(pharmacies)from which the
31、y could buy medicines cheaply.To help them to choose the right complementary and alternative medicine(CAM)and healthcare services.To choose traditional foods that had medicinal value.About organizations that could provide financial help,for example,pay for their medication;provide funds to individua
32、ls.Suitable clothing for elderly people(warm,light,affordable shoes,jackets).(Some had resorted to second hand clothing)Geriatric services in Kenya:if the government plans to provide doctors for aged people as it is done for children and expectant mothers or ladies.Informal care providersOrganizatio
33、ns that could provide financial help for their parents,especially meeting the cost of medication.To be able to understand the contributions and effects of conventional medicine on health of elderly people.To be able to accept changes in the lives of elderly people under their care.To help them to co
34、unsel and encourage their elderly parents to accept changes in their health and adhere to medication schedules.To be able to protect elderly people from contagious ailments.To help them to maintain of physical fitness as they continued to provide healthcare services to elderly parents and attended t
35、o other chores in their lives.SOURCES OF INFORMATION Introduction Results showed that respondents used both formal and informal sources to get information for healthcare of elderly people However,there were variations in the use of sources due to factors like levels of education;economic abilities,g
36、eographical location of respondents(urban/rural);availability of sources,and literacy skills(language,use of the new technology).Tables 3 and 4 are summaries of the sources that respondents used and the reasons for preference for each type of source.Table 3:Formal sources of information for healthca
37、re of elderly people SourceType of informationReasons for preferring sourceChallenges in use of sourceUser groupProfessional services Medical Nutritional Trustworthy staff Reliable information High costs Long distances Brief discussions Too fast in giving instructions Elderly people Informal care pr
38、ovidersCAM Alternative medicine for specific diseases.Nutrition.Counselling.Perceived poor results of conventional medication.Easily accessible up to village level.Affordable at negotiable costs.Payable in instalments.Trusted No side effects Friendly staff Provided Leaflets with summarized informati
39、on.Took long to realise results.Difficult to choose from a wide range of CAM services available Elderly people.Informal care providers.Television Nutritional Health advice on specific diseases.Use of medicines Prevention Audio and aural Available in homes and social places Presenters were too fast I
40、nformation was brief.Most healthcare programs were non-interactive.most healthcare programs were presented in English.Medical staff Elderly people Informal care providersRadioAs above Aural Portable Available in small size Community stations used local languages to present health information.Used Ki
41、swahili language in presenting information about healthcare.As above Medical staff Elderly people Informal care providersNewspapers and magazines Nutritional Use of medicines.Information for general management of health.Detailed information Possible to share newspapers among several people.Expensive
42、.Lack of elderly-specific healthcare information Urban population(elderly,formal and informal respondents)SourceType of informationReasons for preferring sourceChallenges in use of sourceUser groupInternet Disease specific Research reports Provides more current information.Takes a short time to acce
43、ss information Poor connectivity (occasionally)Lack of skills.High costs.Unavailable in rural areas.Impossible to access some sites due to lack of subscription Medical staff.Informal care providers (urban).Cell phone Prescriptions Advice.Accessible from anywhere.Useful in emergency healthcare situat
44、ions.Possible to send short text messages in any language.Cost in maintaining are still high.Lack of skills to operate.Unaffordable for some respondents.Low/poor network (occasionally)Elderly people Medical staff.Informal care providers.Books Medication.Nutritional General Management of health.Authe
45、ntic information.Possible to use one among many people.Expensive to replace with new editions.Detailed information.Use of medical language.Lack of literacy skills Takes time to read.Elderly people(CAM texts).Medical staff.Informal care providers (CAM texts).Journals Medical research.Advances in trea
46、tment of specific diseases.Current information.Scholarly and reviewed works.Expensive to subscribe to.Medical staff.SourceType of informationReasons for preference of sourceChallenges User groupFamily members,neighbours and friendsAdvice about illnessPersonal experiences in Management of healthNutri
47、tionalAvailability of new healthcare facilitiesEmotional supportAvailability and use of CAM Closest and easily accessible Trusted.Face-to-face interactions Can be consulted any time No financial costsNon-professionalNeeded confirmationI n f o r m a t i o n overloadElderly peopleInformal carersAgricu
48、ltural showsNutritionalInformation was presented orally Use national language(Kiswahili).Familiar background.Involved financial costs Held once a year.Long distance for rural people.Pamphlets were written in English and were few.Elderly people(from urban site).Personal experience in care provisionMe
49、dicationNutritional Internalised and easy to recall Familiar/proved useful in previous cases.Trusted No financial costs.Misleading if health challenge is newElderly peopleFormal care providersInformal care providersTable 4:Informal Sources of information for healthcare of elderly people Women groups
50、 Nutritional Availability of herbal/CAM treatment Emotional support Common social interests.Same gender.Easily accessible.Availability of confidants.Interact with med.and other professionals informally.No financial costs Met After a reasonably long time.Records of healthcare information shared were
