ABSTRACT
Physicians,
as health care providers, require information to effectively carry out their
duties. They need relevant, accurate and up-to-date information when making
clinical decisions as the cost of wrong diagnosis could be fatal. It has,
however, been observed that the information behaviour of physicians in
government hospitals and the quality of their work delivery fall below
acceptable standards. Also, there
is uncertainty as to what extent physicians’ information behaviour affect their
work effectiveness. This study was therefore carried out to investigate the
relationship between information behaviour and work effectiveness of physicians
in selected government hospitals in Edo State, Nigeria.
The
study adopted a survey research design. The population for the study comprised
all the physicians in general and tertiary hospitals in Edo State. Purposive
sampling was used to select 6 out of the 12 government hospitals because they
are well known. Since the population was not very large, census was used to
include all the 623 physicians in the study. A structured questionnaire titled
“Information behaviour and work effectiveness of physicians in government
hospitals in Edo State” (IBWEPQ) was used to gather data. The questionnaire was
validated and the Cronbach’s Alpha reliability test for the constructs yielded
0.728 for information needs, 0.986 for information retrieval and 0.756 for work
effectiveness. Out of the 623 copies of questionnaire administered, 516 (82.8%)
were retrieved for analysis. Six hypotheses were tested at 0.05 level of
significance. Descriptive and regressive/correlation inferential statistics
were used to analyze the data collected.
The findings
revealed a positive relationship between information needs of physicians and
their work effectiveness (r = 0.422: p< 0.05); a positive relationship
between information seeking behaviour of physiciansand their work effectiveness
(r = 0.090:p<0.05);a positive relationship
between information consulted and their work effectiveness (r = -0.159: p<0.05). However, there was a negative
relationship between information retrieval by physicians and their work
effectiveness (r = 0.004:p<0.05); a
negative relationship between information they usedand their work effectiveness
(r = 0.605: p<0.05). The
findings also revealed that the major health information need of
physicians in government hospitals in Edo State was on treatment and test of
patients (87.2%); the major sources of information consultedincluded medical
texts, colleagues and the Internet (97.9%, 97.1%, 90.3%, respectively); the
major challenges facing physicians in government hospitals were ignorance of
existing relevant materials, lack of time and financial constraints (100%;
97.1%; 96.9%, respectively); respondents’
commitment to organizational goals wasnot satisfactory (34.4%).
The study concluded that financial constraints and
lack of time adversely affected physicians’ ability to access relevant
materials necessary for work effectiveness. The study recommended that the
management of government hospitals should boost their e-libraries and provide
better working conditions for physicians to enhance their service delivery and
commitment to organizational goals. Physicians in government hospitals should
be pro-active in updating themselves in general medical knowledge in order to
keep abreast emerging diseases.
Keywords: Information use, Information
behaviour, Information retrieval
skills, Work,effectiveness, Government hospitals, Physicians.
Word Count: 479
TABLE OF CONTENTS
Content Page
Title page i
Certification ii
Dedication iii
Acknowledgements iv
Abstract v
Table of Contents vi
List of Tables x
List of Figures xi
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study 1
1.2 Statement of the Problem 11
1.3 Objective of the Study 12
1.4 Research Questions 13
1.5 Hypotheses 13
1.6 Scope of the Study 14
1.7 Significance of the Study 14
1.8 Operational Definition of Terms 15
CHAPTER
TWO: REVIEW OF LITERATURE
2.0 Introduction 17
2.1 Medical Health Care Sectors in Nigeria 17
2.2 The Concept of Information Behaviour of Physicians 18
2.2.1 Information Needs of Physicians 19
2.2.2 Information Seeking of Physicians 20
2.2.3 Information Sources of Physicians 21
2.2.4 Information Retrieval of Physicians 23
2.2.5 Information Use of Physicians 25
Content Page
2.3 The Concept of Work Effectiveness 27
2.4 Information Behavior of Physicians and Work Effectiveness 28
2.5 Information needs of physicians and work effectiveness 29
2.6 Information Seeking Behavior and Work Effectiveness of Physicians 30
2.7 Information sources consulted by physicians and work effectiveness 32
2.8 Information Retrieval and Work Effectiveness of Physicians 33
2.9 Information Use and Work Effectiveness of Physicians 34
2.10 Work Effectiveness of Physicians in Government Hospitals 35
2.11 Theoretical Frame work 37
2.11.1 Leckie’s Model of Information Seeking 38
2.11.2 Kanter’s theory of Structural Empowerment 40
2.12 Relevance of the Theories 41
2.13 Conceptual Model 42
2.14 Appraisal of Literature 44
CHAPTER THREE: METHODOLOGY
3.0 Introduction ` 46
3.1 Research Design 46
3.2 Population 46
3.3 Sample size and sampling Technique 47
3.4 Instrumentation 48
3.5 Validity and Reliability of Instrument 50
3.6 Data Collection Procedure 50
3.7 Method of Data Analysis 50
CHAPTER FOUR: DATA ANALYSIS, RESULTS AND DISCUSSION OF FINDINGS
4.0 Introduction 51
4.1 Data Presentation, Analysis and Interpretation 51
Content Page
4.1.1 Demographic Information of Respondents 51
4.2 Research Questions 56
4.3 Test of Hypotheses 65
4.3.1 Hypothesis One 65
4.3.2 Hypothesis Two 66
4.3.3 Hypothesis Three 66
4.3.4 Hypothesis Four 67
4.3.5 Hypothesis Five 67
4.3.6 Hypothesis Six 68
4.4 Discussion of Findings 69
4.4.1 Health Information Needs of Physicians 69
4.4.2 Information Seeking Behaviour of Physicians 70
4.4.3 Physicians’ Sources of Information 71
4.4. 4 Physicians’ Information Retrieval Skills 72
4.4..5 Physicians’ Use of Information 73
4.4.6
Challenges and Physicians’ Quality of Work Delivery 73
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.0 Introduction 77
5.1 Summary 77
5.2 Conclusion 79
5.3 Recommendations 79
5.4 Contribution to Knowledge 80
5.5 Suggestions for Further Study 80
5.6 Limitations of the Study 80
REFERENCES 82
APPENDICES 97
LIST
OF TABLES
Table
Page
3.1 Population and Sample Size of Physicians and Hospitals in Edo
State, Nigeria 47
4.1.1 Distribution of Respondents by Sex 51
4.1.2 Distribution of Respondents by Age 52
4.1.3 Distribution of Respondents by Marital Status 52
4.1.4 Distribution Respondents Number of Years in Practice 53
4.1.5 Distribution Respondents by Level of Education Attained 53
4.1.6 Distribution Respondents by Area of Specialization 54
4.1.7 Distribution Respondents by Hospital 55
4.1.8 Distribution of Respondents by Rank/Designation 55
4. 2.1 Health Information Needs of Physicians 56
4. 2.2 Information Seeking Behaviour of Physicians 57
4.2. 3 Sources of Information Consulted by Physicians 58
4. 2.4 Physicians’ Information Retrieval 59
4.2. 5 Physicians’ Use of Information 60
4.2. 6 Work Effectiveness of Physicians 61
4.2.7. Challenges Encountered with Information Seeking for Work Effectiveness by Physicians 64
LIST
OF FIGURES
Figure Page
2.1 The Information-seeking of Professionals model 38
2.2 Conceptual Framework of Information
Behaviour and Work
Effectiveness of Physicians in Government Hospitals 41
CHAPTER ONE
INTRODUCTION
- Background
to the Study
Physicians play
a critical role in the search for an acceptable quality of life. They make
decisions that positively or adversely affect the wellbeing of individuals and
populations. Since such decisions are based on information it is imperative to
know that the way physicians perceive, gather, and use information have serious
health and wellness implications. It is expected by stakeholders in a society
that is increasingly becoming health conscious and phenomenally advancing in
science that care providers, particularly physicians, cannot just do their work
in a perfunctory manner; but that the important task of bringing relief to the
sick should be done effectively and with a high sense of professionalism. Of
all professions, the medical profession may perhaps be singled out as a career
that should be least tolerant to mediocrity and a laissez faire attitude to
work. This is because there is much at stake in dealing with health issues. The
aphorism that “health is wealth” underscores the important role health plays in
the overall wellbeing of a nation. The productive capacity of a society is
inextricably tied to the health of the citizenry.
The Constitution of the World Health Organization,
which came into force on April 7, 1948, defined health “as a state of complete
physical, mental and social well-being” (Sartorius, 2006: 662). Specifically, in Nigeria, the evolution of the health
care sector has come a long way and may be traceable to various
European expeditions in the early-to mid-nineteenth century (Chuke, 1988). The
early church missionaries played a major role in the establishment of health
care centres for the people. Indeed, the
first hospital in Nigeria was the Sacred Heart Hospital in Abeokuta, built by
the Roman Catholic Mission in 1885 (Scott-Emakpor, 2010). Nigeria has had
several National Development Plans in which health care delivery was a major
component. It has however been observed that she has not come close to
achieving the lofty objectives in the Development Plans. As a matter of fact,
services have hopelessly deteriorated to the extent that industrial actions by
all classes of doctors became the order of the day in the 1980s (Scott-Emakpor,
2010). It was at the same time in the 1980s that a Military Government in
Nigeria gave as a reason for the Military intervention in the deplorable state
of health services, declaring “our teaching hospitals have been reduced to
mere consulting clinics” (Cited in Scott-Emakpor, 2010:58). The situation
seems not to have changed much today.
The unsavoury situation in the Nigerian health sector
may have given rise to medical tourism for a range of care needs. According to the Nigerian Sovereign
Investment Authority (NSIA), Nigerians spend $1billion annually for medical
tourism (PwC, 2017). Instructively, the published Ministry of Health budget
proposal for 2016 totalled $1.3billion while total government expenditure was
$5.85billion for 2015 (PwC, 2017). The implication of this is that the cost of
medical tourism is almost 20% of the total expenditures on public sector care,
including capital and operating costs of all the health facilities nationwide.
Medical tourism constitutes a huge drain to the scarce resources and the
external reserves of the nation. It has a negative impact on the Nigerian
health sector and on the overall economy. In some of the surveys that have been
conducted to identify some of the factors that motivate patients to seek health
care abroad it has been found that a key theme running through the responses is
lack of trust in the local healthcare delivery system (PwC, 2017). There is
lack of confidence in medical treatment in Nigeria. The medical tourists feel that they will not
be given the correct treatment for their conditions; that the care will not be
delivered by healthcare professionals with the required competence; and that
there is no clear protocols to ensure proper diagnosis and treatment. In the
healthcare delivery system, like any other profession, relevant information is
crucial to the healthcare providers. Adequate, timely and accurate information
is, no doubt, a necessity in enhancing the health profile of any given society.
Reflecting on the vital role information plays in the
workplace and the society, Olatunji (2009) draws a relationship between
judicious use of relevant information and nation-building process. It is an
important tool for societal development and advancement. Alakpodia (2010) opined that one of the bases
of accessing whether a country is developed or not is the extent to which its
information availability and accessibility is enhanced to improve its
socio-economic growth. Basically,
information is the major key to every individual and organizational success. Information plays a significant role in our
individual lives and our professions; it is a crucial feature of production of
good, service, consumption and exchange in the information society. The global
community has entered an era where the source of wealth and power is increasing
from information and human mental creativity as compared to physical resources
(Martin, 1995).
Information plays a crucial role in the workplace
setting of the physicians. For one to be informed, it is necessary to be armed
with the requisite information; thus information is vital in the life of any individual or
organization. Tiamiyu (2003) conceptualizes information as the meaning that a
person infers from some communicated data. This definition recognizes that
information is only formed in the minds of human beings as they interpret data.
It is also the outcome of conscious observations, thoughts and actions. Another
way of understanding the concept of information is to see it as statements of
facts, figures, ideas and creative works of the human intellect, which are by
way of reasoning interrelated and being communicated, recorded and distributed
formally in any format (Reitz, 2004). Information is not independent of social
practices. It serves as a reliable basis for adequate successful behaviour.
Without information, no individual or business can anticipate
circumstances.
Information feeds anticipation because the more information one
receives, the better an individual or business can anticipate and therefore
make informed decisions. Persons that can better anticipate situations become
masters of circumstances while people or organizations that cannot properly
anticipate their circumstances become victims of the situation. This also
applies to physicians because of the nature of their work. Physicians need to seek timely and accurate
information to better anticipate their job effectively and efficiently at the
end of the day.
Information behaviour is a concept that refers to how
an individual needs, seeks and uses information in different situations. Wilson (2000:49) defined information behaviour
as the “totality of behaviour in respect to sources and channels of
information, including both active and passive information seeking and
information use. Information behaviour
involves face-to-face interactions, as well as the passive receiving of
information.” Examples of passive
information behaviour may include information received from television or radio
without having any intention of acting on the information provided. On the
other hand, Wilson (2007: 8) further explained that information seeking
behaviour is “purposive seeking for information as a result of the need to
satisfy set goals.”
As
posited by Gorman (1995) the information need of physicians can be viewed in
four dimensions: (i) Unrecognized
needs. This type of need exists when
physicians are not aware of the information they need or their knowledge is
insufficient to fulfil the needs. Unrecognized needs should be known from
physicians’ knowledge of clinical practices.
This need cannot depend on information system because the user cannot
recognize their need. The potentials for
the use of automated reminder systems and diagnostic decision support systems
may be ignored because the physician would not know how to search for these
needs. (ii) Recognized needs are articulated by physicians as something needing
further examination although not always followed up. (iii) Pursued needs are recognized needs that are
followed up. (vi) Satisfied needs are recognized and pursued needs where
answers are found.
Olatunji, Ibegwan and Odugbemi (2002) affirmed that information need of
physicians is connected to issues on medical decisions that will involve the
area of specialization, educational level, and years of experience. For example, the paediatric physicians will
be in quest of information on how to handle children’s health conditions while
the obstetrics and gynaecologists will be interested in women information
related health issues in the emergency room. Other physicians seek for
information to handle cases that are before them in order to carry out their
work, effectively. In fact, physicians more often need information related to
patient-specific decisions, such as questions about treatment, diagnosis,
drugs and other medical opinions and patient management, information to
update their professional knowledge in general
and also for their understanding of a particular disease. Physician’s information need will lead to
information seeking.
Akpan-Atata (2012:15) “reveals that information needs often reflect the
age and changing socio-economic, health, family and personal circumstances of
people and are therefore not permanent but ever changing.’’ As rightly observed
by Ucak and Kurbanoglu (2008), information need and information seeking
behaviour are two of the most important research areas of the user’s studies
and they are two complementary concepts which are affected by many
factors. They further stated that
research carried out in these areas of user’s studies indicate that information
need and information seeking behaviour of physicians vary from one career to
another. So, such different needs and
behaviours necessitate information seeking behaviours. For information seeking to take place the
individual must be actively and consciously searching for information. Information seeking is a conscious effort to
gain information; and information behaviour is the ‘totality’ of all
information interactions from unintentional and passive encountering to active
seeking (Case, 2012).
Information seeking is a process and action undertaken
by an individual to locate current information from the various media available
in the libraries; that is, books encyclopaedias, journals and more currently
electronic sources, in order to make informed decisions. Information seeking is a behaviour when there
is a task to accomplish in an individual’s mind; for example, preparing to
write an examination, the individual actively seeks information by reading
books and having discussions with people until the need is satisfied (Kaur,
2010). Information seeking is a
conscious effort to acquire information to solve problems in daily
activities. Information seeking reveals
that there is a gap in the knowledge of the seeker and there is a desire to
bridge the gap; in order to fill up the gap the seeker interacts with the
information sources in the library or archival centres.
Nnadozie (2014) described sources of information as
carriers of information and this can be in the form of physical objects on
which information is recorded for preservation, utilization and dissemination,
such as books, periodicals, documents, newspapers and also in electronic media
( e.g. Internet and CD), but to mention a few.
They are transmitted orally, audio-visually and electronically. These are materials or sources from which
seekers find information, wisdom to be informed, and become knowledgeable that
will enable them to carry out their work effectively, in order to make
decisions and guide actions. These sources are considered to be reliable,
relevant, accurate, up-to-date, timely, comprehensive, credible and adequate
information for making useful, effective and efficient decision at workplace.
Again, Tiamiyu (2003) stated that information sources are documents generally
stored in different media print and non-print formats (such as books, journals,
newspapers, maps, paintings, computers, sound and video recordings, database on
various media). In addition, people themselves serve as important storehouse
and conveyors of information that is transmitted by printing, audio-visually
and electronically. Aina (2004) emphasized that users of information sources
must have the ability to use large and significant amount of stored
information. Therefore, there is need for accessibility and relevancy of
information since the use of information sources can effectively impact
physician’s clinical decisions and work effectiveness. In submission, information sources refer to
where to locate and retrieve the information for problem-solving in order to be
effectively and efficiency at work place.
Information retrieval is concerned with searching for
materials that are relevant to users’ information needs (Dunlop and Reid,
1998). This view is corroborated by Mutshewa (2008) who noted that information
retrieval involves the retrieval of information from a collection which could
be a manual library catalogue, a database or Internet in response to
information for problem solving. It is essential for the physician to search for
specific information to make a clinical decision. Information retrieval may sometimes pose
little or no difficulty and at other times a huge challenge. For example, if
there are few information sources like 15-20 books available and information is
contained in two or more of them, it will be easy for one to browse through the
books to get the one that has the needed information. But if the number of
information sources from which to search for needed information is huge (say
about 15,000 volumes of book), then it becomes really difficult to go through
all the sources to get the needed information, so the physician is faced with
an information retrieval challenge. The physician may then need to depend on
information retrieval device to get the needed information. Harter (1986) defines information retrieval
as a device interposed between a potential user of information and the
collection of information itself.
Information retrieval system could be a library catalogue, an online
public access catalogue (OPAC), a CD-ROM or online database such as Ebscohost,
Jastor, Science direct, PubMed. These
retrievals help the users to access the needed information by acquiring
information and putting it to use.
Information use by physicians is based on diagnosis,
treatment, drugs and other medical opinions and work effectiveness. This has to do with the Physician’s use of
the right information which is accurate and relevant to make a clinical
decisions in day to day activities. There are different stages of use which can
be recognized. The first stage of use
simply involves examining whether information is worth using, the usefulness of
the information or whether it fails to satisfy need. The second stage is
whether the use of the information is relevant for meeting the need of good
clinical decisions that would help the physician’s practice. Information use is considered in respect to
the types of work to handle by the physician in the hospitals.
One of the most important aspects of physicians’ work
effectiveness is the availability and accessibility to right health information
which will enable them to manage patients’ case effectively. This involves
clinical decision-making and clinical judgment made by physicians to decide
specific aspects of cares such as diagnosis, choice of tests, and prescription
of drugs, surgery and therapy. Some of
these health information needed by the physicians include information about the
spread of particular diseases, to get information on patient-related treatment
and tests. Therefore, physicians needed to have access to relevant information;
this is especially the case for epidemiologists who examine the patterns of
illness in the population and try to know with accurate information why certain
groups or individuals develop a particular disease, whereas others do not. Such information is particularly relevant in
matters relating to a disease condition that is of public health issue. The
question as to why physicians need certain information to enhance their
productivity may further be explained by the critical nature of their work
which requires that before they can make clinical decisions they must seek adequate and right information at the right
time and at the right place. Accurate, relevant and adequate use of health
information is thus a very important aspect in the daily clinical practice of
the physician.
It must be reiterated that for physicians to be more
effective, succeed, and achieve their goals, timely and relevant health
information is highly necessary. Ibenne (2010) draws an analogy by saying that
information is like what the central nervous system is to the body. It
controls, directs and monitors the functioning of different organs of the
system. Therefore, having access to credible,
trustworthy and valid information at the right time, helps the physicians to
save the lives of patients.
It has, however, not been quite easy for a number of
physicians to attain optimum effectiveness in the manner they carry out their
routine tasks. The factors responsible for this are numerous; namely, the
individual, the organization, and the environment, to mention a few. Whereas
the individual physicians may have a large share of the blame as a result of
personal characteristics, the organization where they carry out their duties cannot
be absolved completely. Work has a way of impinging on workers’ effectiveness
and productivity.
It can no longer be taken for granted the huge impact
technology makes on the effectiveness and efficiency of workers. Physicians
would therefore need to be abreast of recent trends in technological
advancement to hone their skills otherwise their methods would soon be outdated
thus affecting negatively their effectiveness. This is where the information
behaviour of physicians becomes very important since they would need to take
advantage of easy access to accurate, up-to-date and relevant information
offered by modern technology.
Non-availability of relevant information sources also hamper work
effectiveness of the physicians. Another factor is financial constraint; that
is, when the management of the hospitals are not willing to support financially
by providing necessary equipment for use.
Work effectiveness is one of the
important goals and values of any organization or institution in which an
individual works; it continues to exist as a crucial element in organizational
behaviour. It has been noted that
improving work effectiveness is one of the primary reasons for organizational
or institutional growth and success.
Work effectiveness is all about individual potential, asp
