INTRODUCTION

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, 2009

2. 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.

3. 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.

4. 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.

5. 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?

6. Health information need (s): • What kind of information is needed? • Medical • Nutritional etc • Determinants of access • Economic • Cultural beliefs • Political e.g. • Legislation & Policy • Environmental e.g. • geographical distances. • Individual characteristics Use of information . Create awareness . Make decision Maintain personal health . Share experiences with others • Information sources and services: • Formal • Government, Media, Libraries, • ICTs • ii) Informal networks e.g. • . NGOs, public meetings, family • members, friends. Figure 1: A conceptual model for access and use of information in the healthcare of the elderly. Source: Modified from Wilson (1991, 1997 & 2000)

7. 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.

8. 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.

9. 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.

10. 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.

11. Table 1: Summary of respondents interviewed for the study

12. 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..

13. 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.

14. 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.

15. R E S U L T S

16. 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.

17. Table 2: A Summary of needs for information in healthcare of elderly people Key: An identified information need Did not show in the data X 

18. 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.

19. 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.

20. Table 3: Formal sources of information for healthcare of elderly people

22. Table 4: Informal sources used for information in healthcare of elderly people Table 4: Informal Sources of information for healthcare of elderly people

24. 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.

25. Share with colleagues, family and friends • consultation • update • encourage • create awareness • Decision making • health care facilities • treatment INFORMATION FOR HEALTHCARE OF ELDERLY PEOPLE • Home healthcare • administer medication • use right diet • monitor progress in health condition • 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 FIGURE 2: USE OF INFORMATION

26. 1.DECISION MAKING Information was used at THREE levels for decision making: 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. 3rd 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. 3. ADVISE/COUNSEL 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. 4. HOME HEALTHCARE MANAGEMENT Elderly people and informal care providers: able to handle day-to-day healthcare issues. 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. USES

27. 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).

28. Made right decisions • Saved/prolonged lives • Were to affordable • healthcare facilities • Created awareness • Precaution measures • among family care • providers. • Some informal care providers took • measures of prevention. • Confidence • Provide services at • home • Carry out self-care INFORMATION APPLIED IN HEALTH CARE • New knowledge • Increased • understanding about • ageing • Management of health conditions for elderly people • Improved health • Reduced/stabilized blood pressure. • Attend to house chores • Supervise workers. • Reduced costs • Transport to hospital • Medical bills/buying medicines FIGURE 3: IMPACT OF INFORMATION IN HEALTHCARE

29. 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. • 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.

30. 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

31. 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.

32. 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.

33. TABLE 5: CHALLENGES AND COPING STRATEGIES

35. 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.

36. E N D