INFORMATION BEHAVIOUR IN HEALTHCARE OF
HOME-BASED ELDERLY PEOPLE IN NAKURU
DISTRICT, KENYA
MARIE KHANYANJI KHAYESI
DEPARTMENT OF INFORMATION SCIENCE,
UNIVERSITY OF SOUTH AFRICA (UNISA)
Doctoral Forum
UNISA
5th – 6th March, 2009
INTRODUCTION
• Living longer is a success story of improved healthcare services .
• The result 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 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 PROBLEM
• 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 healthcare.
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 District?
• 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?
Figure 1: A conceptual model for access and use of information in the healthcare of the elderly.
Health information need (s):
What kind of information is
needed?
• Medical
• Nutritional etc
Use of information
. Create awareness
. Make decision
Maintain personal health
. Share experiences with
others
Source: Modified from Wilson (1991, 1997 & 2000)
Determinants of access
• Economic
• Cultural beliefs
• Political e.g.
Legislation & Policy
• Environmental e.g.
geographical distances.
• Individual characteristics
Information sources and services:
• Formal
• Government, Media, Libraries,
ICTs
ii) Informal networks e.g.
. NGOs, public meetings, family
members, friends.
Explanation about the model
The 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 healthcare .
• 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.
METHODOLOGY
Study design:
• Qualitative study
• Phenomenological design with two elements:
exploratory and descriptive
Reasons 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 respondents a ‘voice’ to be able to express their
experience.
Research site:
Two divisions in Nakuru District
Nakuru Municipality/Town
Rongai
Reasons for choice of site
• The District has a history of economic activities that attracted job seekers
from different ethnic communities as workers in farms owned by 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 respondents
•
Snowball technique at two levels
1st Level
•
The researcher explained to the local administration 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 care providers and the healthcare facilities that they went to.
2nd Level
•
Administrators 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 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 summary of respondents is shown in the table 1.
Table 1: Summary of respondents interviewed for the study
Sub-group
Number
Brief description




Elderly
Informal care providers
18
6
Relationship to elderly:
 Gender
- male (2): sons to elderly parents.
- female (4): 2 spouses, 1 daughter,
and 1 daughter-in-law


Formal care providers
16
Gender: Male (11), female (7)
Age: between 55 and 89 years
Setting: rural 8 respondents (4 males, 4
females); urban 10 respondents (7 males,
3 females).
Living arrangements: alone(12 ); with
spouse (2 ); with family members (2);
family members living within a walking
distance (2).
Gender: male (9), female (7)
positions: doctors (5 - all males ), nurses
(5 - all females), clinical officers (4 - all
males), nutritionists (2 – both females )
Data collection
•
•
•
•
•
•
A 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 people, 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 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 details 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 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 transcribed 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 classify 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 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.
• Incorporated experiences gained from the pilot study in
the final version of the instruments used for the study.
RESULTS
INFORMATION NEEDS IN HEALTHCARE OF
ELDERLY PEOPLE
Introduction
• The study identified ten different types of
needs for information for healthcare of
elderly people in Nakuru District.
• Table 2 summarizes the identified needs.
Table 2: A Summary of needs for information in healthcare of elderly people
Information needed on
Elderly Informal healthcare
providers
Formal healthcare
providers
Medication



Complementary and alternative
medication (CAM).



Nutrition



Basic counselling approaches



Emotional/spiritual support.



Financial support



Self protection



Physical fitness



Clothing



Gerontological services



Key:

An identified information need
X
Did not show in the data
Inform Medical staff
•
To help them prescribe medicine for elderly people
•
Be able to advise elderly people and informal care providers about the healthcare of the former
•
Be able to help elderly people to accept changes in their health and to their lifestyles.
Elderly people
•
To 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 they 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
individuals.
•
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 providers
•
Organizations 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 counsel 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 to 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, geographical
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 healthcare of elderly people
Source
Type
information
Professional
services
of
Reasons for preferring source
Challenges in use of source
User group
• Medical
• Nutritional
• Trustworthy staff
• Reliable information
• High costs
• Long distances
• Brief discussions
• Too fast in giving
instructions
• Elderly people
• Informal care providers
CAM
• 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 information.
• 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
• Information was brief.
• Most healthcare
programs were noninteractive.
• most healthcare programs
were presented in English.
• Medical staff
• Elderly people
• Informal care providers
Radio
As above
•
•
•
•
Aural
Portable
Available in small size
Community stations used local
languages to present health
information.
• Used Kiswahili language in
presenting information about
healthcare.
As above
• Medical staff
• Elderly people
• Informal care providers
Newspapers
and
• Nutritional
• Use of
• Detailed information
• Possible to share newspapers
• Expensive.
• Lack of elderly- specific
• Urban population (elderly,
formal and informal
Source
Type
information
of
Reasons for preferring source
Challenges in use of
source
User group
Internet
• Disease specific
• Research reports
• Provides more current information.
• Takes a short time to access
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
situations.
• 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.
• Authentic 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
treatment of specific
diseases.
• Current information.
• Scholarly and reviewed works.
• Expensive to subscribe to.
• Medical staff.
Table 4: Informal Sources of information for healthcare of elderly people
Type of information
Reasons for preference
of source
Challenges
User group
•
•
• Closest and easily accessible
• Trusted.
• Face-to-face interactions
• Can be consulted any time
• No financial costs
•
•
Non-professional
Needed
confirmation
Information
overload
•
•
•Information 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).
Misleading if
health challenge is
new
•
•
Elderly people
Formal
care
providers
Informal care
providers
Source
Family members,
neighbours and friends
•
•
•
•
Agricultural shows
Advice about illness
Personal experiences in
Management of health
Nutritional
Availability of new
healthcare facilities
Emotional support
Availability and use of
CAM
Nutritional
•
•
•
•
Personal experience in
care provision
•
•
Medication
Nutritional
• Internalised and easy to recall
• Familiar/proved useful in
previous cases.
• Trusted
• No financial costs.
•
•
Elderly people
Informal carers
Women groups
• 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 not
kept
• Information
overload.
• Membership was
almost exclusive
(mature married
women).
• Older ladies
(elderly,
formal and
informal
carers).
Religious
organizations
• Spiritual support.
• Hope &
encouragement.
• Easily accessible
• No financial costs
• General
information for
spiritual
encouragement
• Elderly people
• Informal
carer providers
• Formal carer
providers
Personal experience
from previously held
responsibilities.
• Nutritional
• Physical fitness.
• Internalized / kept in personal
memory.
• Accessible any time
• No written records kept.
• Individualized and
rarely
shared.
• Possible to forget part
of or
all the information.
• Elderly people.
Colleagues
• Advice about
prescribing medicine
for elderly people
Nutrition
• Easily accessible
• Professional
information
• No financial costs
• incurred.
• Lack of current
information
• Lack of elderlyspecific
information
• Formal care
providers
(medical staff)
USE OF INFORMATION
INTRODUCTION
• Respondents discussed the actual
situations in which they used or applied
information in healthcare of elderly people.
• Figure 2 is a summary of the different
ways in which respondents used
information.
FIGURE 2: USE OF INFORMATION
Share with colleagues,
family and friends
• consultation
 update
 encourage
 create awareness
Decision making
• health care facilities
 treatment
INFORMATION FOR
HEALTHCARE OF
ELDERLY PEOPLE
Seek herbal treatment
• chronic conditions
 protection against illness
 encourage other elderly
people to use CAM
Give advice about
• use of medicine
 use of right diet
 general healthcare
Home healthcare
 administer medication
 use right diet
 monitor progress in
health condition
USES
1.DECISION MAKING
3. ADVISE/COUNSEL
Information was used at
THREE levels for
decision making:
• Medical staff: provided healthcare professional
advice to elderly people and informal care
providers
• Elderly: advised friends to seek professional
healthcare services.
• Informal care providers: advised elderly people
about the importance of observing medication
schedules.
1st level:
•
Elderly and family care providers: type of
healthcare facility to go to (government/
public, private or CAM).
2nd level:
•
Medical staff: type of treatment to give
elderly people.
4. HOME HEALTHCARE MANAGEMENT
3rd
Elderly people and informal
care providers: able to handle day-to-day
healthcare issues.
•
level:
Elderly and informal care providers/family:
continue with healthcare services or change
to a different facility.
2. SHARE WITH OTHER PEOPLE
•
Medical staff: with colleagues through
consultations, and with elderly people and
informal care providers.
•
Elderly people and informal care providers:
family, friends, neighbours, other informal
care providers.
5. SEEK COMPLEMENTARY ALTERNATIVE
MEDICINE (CAM)
Elderly people and informal care providers: used
information contained in diagnostic reports from
formal healthcare services to seek CAM
treatment.
CONTRIBUTIONS OF INFORMATION IN
HEALTHCARE
INTRODUCTION
• Researcher sought to learn from respondents if they
experienced, observed and noted changes after using
information in various healthcare situations.
• Responses from participants were categorized into six areas of
use and impact: made the right decisions; improvement of
health conditions; reduced costs of medication; acquired
confidence, learn new knowledge and created awareness
among respondents (Figure 3).
FIGURE 3: IMPACT OF INFORMATION IN HEALTHCARE
Created awareness
• Precaution measures
among family care
providers.
• Some informal care providers took
measures of prevention.
Made right decisions
• Saved/prolonged lives
• Were to affordable
healthcare facilities
Confidence
• Provide services at
home
 Carry out self-care
INFORMATION APPLIED
IN HEALTH CARE
Improved health
• Reduced/stabilized blood pressure.
 Attend to house chores
 Supervise workers.
Reduced costs
• Transport to hospital
Medical bills/buying
medicines
New knowledge
• Increased
understanding about
ageing
 Management of health
conditions for elderly people
CONTRIBUTIONS
1. Made right decisions
a) Medical staff
•
appropriate prescriptions for elderly people
•
advising elderly people and informal care providers
•
about the mode of treatment to give elderly people: in or out-patients
b) Elderly people and informal care providers
•
choice of healthcare facilities (government, private, CAM).
•
changing from one type of healthcare service to another.
2. Acquired confidence
Informal care providers
•
confident in dealing with minor healthcare issues for elderly people at home.
•
able to inject parent (where necessary)
3. Learnt new knowledge
(All respondents)
•
learnt new ideas about ageing and healthcare challenges,
•
able to tell when health condition of an elderly person was improving or declining.
4. Created awareness
Informal care providers:
•
aware of some of the healthcare challenges of ageing,
•
begun to use some of the information for their own health.
5. Improvement in health
Elderly people:
able to undertake personal care ( e.g. bathing, simple laundry)
able to attend to other simple chores at home ( e.g. trim fences, work in their vegetable
gardens) experienced less emergencies that require calling medical staff or being
rushed to hospital.
Medical staff: noted improvement in the health of elderly people that used well
information given them.
6. Reduced costs
Elderly people/informal care providers:
• made few trips to hospital.
• less frequencies in purchase of drugs
STORAGE OF INFORMATION
•
Respondents reported that they stored information before and after use in various
ways.
•
Storage included the use of: medical records, files, personal memory, people, and in
electronic format.
CHALLENGES AND COPING STRATEGIES IN THE SEARCH AND
USE OF INFORMATION
INTRODUCTION
The study categorized the challenges that respondents
experienced into the following inter-related groups:
•
•
•
•
•
•
economic ability;
a challenging healthcare environment;
personal or individual characteristics such as
illiteracy, poor eyesight and loss of memory;
cultural influence;
lack of political good will.
Table 5 is a summary of the challenges that respondents
experienced, and the coping strategies that they used.
TABLE 5: CHALLENGES AND COPING STRATEGIES
Factors
Effects
Coping strategies
1. Economic ability
• low income
• unemployment
• insufficient funds to meet
all needs
• unable to purchase current
information
• unable to keep appointments
• sought financial help
from family and
friends
• waited until funds were
available
• continued to use old
information
2. Healthcare
environment
• lack of geriatric services
• lack of specifically
designated places for
elderly people
• long queues
• less limited time of
interaction between
medical staff and elderly
people
• sometimes encountered
impatient staff
• poor communication between staff
and elderly people
• strained relationship between staff
and the elderly,
• discouragement to continue
accessing information from public
healthcare facilities.
• accompanied to hospital by a
relative to take instructions
from staff
• sought CAM treatment
• continued to use public
healthcare facilities because
they were affordable.
3. Individual
characteristics
• illiteracy and other
language difficulties
• lack of time to devote to
searching for information
• physical challenges e.g.
limited mobility, poor
eyesight and hearing etc.
• unable to access information using
• limited interaction with information
• environment
• sought help from family,
friends and colleagues;
• relied on oral communication;
• relied on shapes, sizes and
colour of drugs;
• accessed information by
coincidence;
• relied on health information
from the media.
4. Cultural influences
• age gap
• gender
• belief in use of
• herbal medicine
• use of metaphoric
language
• obstructed flow of information
between staff and elderly people
• used older members
of staff to share with elderly
people information for
healthcare
• used staff of same gender or
ethnic background to talk to
elderly people;
• staff learnt some of the metaphors
used in healthcare to be able to
communicate with elderly people.
5. Lack of political good
will
• lack of general and health specific
research output about elderly
people in the country
• lack a specific healthcare
information systems for the group
• contended with available
information;
• installed Internet privately
(doctors);
• continued to consult family
members, friends or colleagues for
information.
• delayed implementation of
a policy for the care of
elderly people.
CONCLUSION AND RECCOMENDATIONS
•
This research was undertaken to establish how information was accessed and used in healthcare of home-base elderly people
in Nakuru District.
The results revealed:
•
that information needs of the respondents arose out of their varying responsibilities for providing healthcare services for
elderly people.
•
that information needs in healthcare of elderly people were not restricted to core health activities like medicine and nutrition.
Instead, related human needs like economic, spiritual, emotional, clothing and self protection contributed to the needs for
information in healthcare of the group.
•
that information needed to address healthcare issues for the group was either scattered or unavailable.
•
therefore respondents turned to their immediate environment: family, friends, and colleagues as their primary sources of
information for healthcare of elderly people.
•
that use of formal sources like books, journals, and the Internet seemed to be low among elderly people and informal care
providers for a number of factors already discussed in this presentation.
•
results also showed that respondents were actively involved in using information to attend to different needs in healthcare of
elderly people.
•
there were indications that information was used repeatedly due to challenges that respondents experienced.
•
elderly people used information from medical staff to seek CAM treatment
•
results are a wake-up call to LIS professionals that work in health libraries and systems to identify elderly people as a
marginalized user group,
•
LIS professionals should take initiatives to develop a one-stop-data base, at least at the local level, to be used to respond to
health information needs and other issues that affect elderly people
•
LIS professionals should collaborate with other stakeholders to identify health information needs of the group in every
healthcare system and help to put in place mechanisms of addressing the needs.
•
the study recommends more research about information needs of elderly people from areas such as financial, spiritual,
political, health policy, and clothing.
•
study also recommends a research about development of a one-stop-database that can help respond to information for
healthcare of the elderly people.
E N D