HEALTH-CARE ISSUES WITHIN A DEVELOPMENT CONTEXT

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CHAPTER THREE HEALTH-CARE ISSUES WITHIN A DEVELOPMENT CONTEXT

INTRODUCTION

In the previous chapter, basic concepts relevant to this study and theoretical models that offer explanations of information-seeking and use behaviour were discussed. Several factors were found to have had a critical influence on these components of information behaviour. This chapter presents a synthesis of the literature on the EPs and their ICPs and FHCPs with regard to a health-care information environment set within a development context. Given that this study focuses specifically on information behaviour related to the health-care of home-based EPs in the Nakuru District of Kenya, this chapter focuses on health-care practices as they manifest in a development context, with special reference to the situation in Kenya. Special attention is given to the existing structure and organisation of the health-care system in the country. Most importantly, the discussion focuses on the information behaviour of the most prominent users of health-care, namely EPs and their ICPs and FHCPs. The discussion of these three groups of users serves to ground this study within a clearly defined context.

DEFINITION OF A DEVELOPMENT CONTEXT

When conducting an investigation into how and why a group of people use information, a key problem is related to the influence of the context on the IB of people operating within a particular context. Within any context there are a variety of factors that can influence the information-seeking and use behaviour of a group of people. In the case of the current study, the fact that the setting is within a development context seems to play a cardinal role in determining the IB of EPs, ICPs and FHCPs that support the elderly.
The concept of “development” is difficult and elusive to define (Lund 2010:19). A simple way of defining the term is “to make the world a better place”, especially for the poor (Chambers 2004:1). The concept of development has also been defined as “the reproduction and transformation processes which somehow impinge on inequality, impoverishment and human insecurity” (Lund 2010:20). These various definitions are consistent in referring to a change or an improvement in people‟s lives by providing education, a better income, tools for communication, improved skill levels, employment, better and more secure housing, and reliable and accessible health-care services. A development context is by nature, dynamic rather than static and as Meyer (2009:4; 2000) observes, information users in a development context are not a homogeneous group. Some may be illiterate and dependent on indigenous systems of knowledge and oral communication to access and use information, while others may be literate and have more ready access to health-care information. Discussions about the particularities of a development context are bound to be broad-based because the concept covers a wide range of issues affecting virtually every aspect of human life: industry, agriculture, transport, health, education, social services and nutrition, to mention only a few (Sturges & Neill 1990:42). This study highlights the health-care of EPs as one focused dimension within a development context in order to illustrate how conditions specific to such a context are pivotal to determining the information behaviour of the EPs and their ICPs and FHCPs.

Variations in health-care contexts for elderly people (EPs)

There seems to be variations in health-care services in developed and developing countries in terms of policy and provision of services. Health policy is one of the factors impacting on the lives of the elderly within the development context. Formulation and implementation of health-care policies in developing countries seems to focus on providing services to segments of the population deemed to be socially and economically productive for the growth of the country (Republic of Kenya 2007; Waithaka, Anyona & Koori 2003; Kalasa 2001). Policy makers seem to assume that populations like those of EPs are naturally catered for through health-care services provided to the public. This assumption may be correct to some degree but also wrong since EPs form a unique group of users of health-care services. This section provides a review of literature about health-care services for EPs in developed and developing contexts. There are aged populations in both contexts.

Developing countries

Developing countries are sometimes collectively called the “South” or countries and tend to be associated with low and middle income countries with a gross national income per capita of under US$ 905 or with a gross national income per capita of US$ 906-US$ 3595 (World Bank, 2008, Definitions of Groups section, Para. 3). Countries that fit in this category are 44 considered to be in a state of economic development and thereby fall into the category of “developing countries”. Developing countries are less industrialized and characterized than developed countries by having high levels of premature mortality, illiteracy and poor health-care for a large part of their populations (Anand 2000:2029-2049). Kenya falls in the category of a developing country.
On the other hand are the “North” or developed countries. Developed or upper-middle or high income countries have a gross national income per capita of US$ 3596-US$ 11,115 and above (World Bank, 2008, Definitions of Groups section, Para. 3). Countries in this category are industrialized more than the developing countries. They also experience low levels of premature mortality; they have high levels of literacy rates and good health-care for their populations.
Most developing countries look towards developed countries for economic support and for models of development. As observed for developed countries, health is one of the indicators used to determine levels of development among nations. In many developing countries, healthcare is provided by the government and the private sector. In most cases, public health facilities are affordable for low income earners in developing countries. Services in public health facilities may not be within the reach of most people, particularly the ones from the rural areas. With the exception of charitable health institutions, the private sector often provides health services at a profit making level, making it too expensive for poor people to benefit from them. Health is one of the key yardsticks for human development. This section provides an overview of health-care of EPs in a development context, with a specific focus on Kenya.
Health-care systems in developing countries are set against a backdrop of complex social, economic and political factors that contribute to the challenges that marginalized groups experience as they endeavour to access health-care services (HelpAge International 2001b; Apt 1997). Poverty and poor health among most populations in developing countries are linked to low or declining economic growth. The introduction of cost sharing or user-fee payments in the health-care sector has made it more difficult for people living in developing countries to access health-care services (Mbatia 2003). Such a situation is still less tenable for the EPs and their ICPs and FHCPs as they access information relevant to geriatric health-care. It seems that the health-care situation of EPs in developing countries is aggravated by the lack of political support to implement policies for the care of the elderly (Kalasa 2005; 2001; Waithaka, Anyona & Koori 2003:1-13; Apt 1997; 1991), and this failure relates to the constraints of internal conditions of national socio-economic growth and governance.
Cultural beliefs and practices also contribute to the type of health-care services provided for marginalized groups in a more traditional context in developing countries, such as EPs. For example, in some communities, adult children are expected to take care of older members of their families (Kalasa 2005:7-22; Waithaka, Anyona & Koori 2003:1-13; Apt 1997:1-14). Governments in developing countries seem to take advantage of this cultural practice and make little or no plans for provision of elderly specific health-care programmes. Currently, no African government has fully implemented a policy for the care of ageing populations (Waithaka, Anyona & Koori 2003). Also, research in the field of gerontology in developing countries, in particular, in relation to how people seek for and use information in geriatric health-care was found to be almost non-existent. Thus, EPs and their ICPs and FHCPs in developing countries have very limited access to geriatric health-care services and information and very little is also known about their IB.

Africa

Reports about aged populations in Africa show that there is a relationship between poor health and socio-economic levels of most EPs (Kalasa 2005:7-22; Mathangani 2005:3; Mba 2004:14-18; Waithaka, Anyona & Koori 2003:1-13; Gilbert & Soskolne 2003:11-13; Kalasa 2001:1-10; Apt 1997:1-14). Limited financial resources may make it difficult for individuals, families and communities to meet the cost of health-care services.
Most EPs depend on their own income or receive financial support from their families. Although HelpAge International and Help-Age Kenya (non-governmental organizations) make efforts to assist the elderly in Kenya the impact of their efforts may be limited by factors such as an increasing elderly population, limited funding and other conflicting institutional commitments (Muigana 2006; Mathangani 2005). Most EPs have difficulty in accessing health-care services because they cannot pay for these services without financial and other forms of support.
Health-care service delivery in Africa is also challenging because of the frequent migration of health-care workers, popularly known as “brain drain” from the continent to wealthier countries which offer better remuneration, (Couper & Worley 2006:1). It has also been found that a high level of absenteeism of FHCPs (Muthama et al. 2008:2) and low levels of governmental funding (Mclntyre & Gilson 2005:2-6) have a detrimental effect on the quality of health-care services provided. These factors, among many others, may make it difficult for health-care systems in Africa to accommodate the needs of special groups such as the aged. Due to limited human and financial resources, most African countries are currently focusing their health-care policies and services on mothers, children and HIV/AIDS, while geriatric health-care issues remain low-priority concerns (Mclntyre & Gilson 2005:2-6).
Research demonstrates nonetheless that there is an emerging awareness among some researchers in Africa about the need to provide specific health-care programmes and services for EPs on the continent (Ahadzie & Doh 2008:5; Gureje et al. 2006:1784-1789; Asagba 2005:39-41; Akanji, Ogunniyi & Baiyewu 2002:1289-1292; Apt 1997:11-14; 1991:5-10) They argue that their increasing numbers points to a need for programmes that can provide them with information about employment, family care, individual rights, housing, social welfare, and food and nutrition. For example, EPs in Africa may need services that provide information to help them with household chores, claim pensions and to care for themselves and their dependants. A geriatric health-care policy focused on the care of the elderly is needed to help EPs, ICPs and FHCPs in a development context to access services for geriatric care.
The call for research to inform policy makers to plan for the elderly in Africa is gradually emerging (Ahadzie & Don 2008:35-38; Kalasa 2005:1-10; Mathangani 2005:3; Mba 2004:4-18; Waithaka, Anyona & Koori 2003:1-13; Apt 1997:1-14; Apt 1991:5-10). At the same time, the lack of meaningful evidence-based research has been a major impediment to policy formulation (Asagba 2005:39-41; Kalasa 2001:1-10; Apt 1997:1-14). Research has shown that governmental policy implementation is crucial in the provision of effective health-care services for EPs in the developing countries of Africa. Correspondingly, research is necessary to sensitize policy makers to the many related challenges and issues and to ensure that they realise what the consequences would be if these issues were ignored in the face of the current rapid increase in the size of the elderly population (Asagba 2005:40). Unfortunately, access to information about health-care especially that which is related to geriatric care, in Africa is very limited, unlike in developed countries (Couper & Worley 2006:1). Lack of support from governmental authorities in Africa contributes to situations where EPs look after themselves or depend on their families for support.
The general picture emerging from the literature referred to in this section reveals that governments in developing countries apparently assume that EPs are catered for by their families and through health-care programmes and other services that are already available to the public (Kalasa 2005:7-22; Mathangani 2005:3; Mba 2004:14-18; Waithaka, Anyona & Koori 2003:1-13; Gilbert & Soskolne 2003:11-13; Kalasa 2001:1-10; Apt 1997:1-14). Existing initiatives for providing care for EPs and disseminating health-care information include HelpAge Kenya, HelpAge International, and Health InterNetwork Access to Research Initiatives (HINARI). These initiatives focus their efforts towards a few groups in the urban areas, researchers, health workers and academics. However, such initiatives have not yet addressed issues of how to provide information for groups such as the EPs and their ICPs and FHCPs who are not catered for in health-care and other governmental policy documents in developing countries.

Kenya

Studies show that the number of EPs in the country is increasing against a backdrop of lack of social and geriatric services (KNCHR 2009; WHO 2006a:1-22; Waithaka, Anyona & Koori 2003:1-11). The growing numbers of EPs in Kenya should be a wake-up call to the government to plan for social services appropriate to the population group.
A World Health Organization (WHO) study that investigated the health seeking behaviour of the EPs in Kenya found that they were sometimes unable to pay for the high consultation fees charged in private health facilities, that there was a lack of professionals specialized in geriatric services in hospitals and that FHCPs sometimes used bad language when speaking to the elderly (WHO 2006a:1-22). The WHO study also found that some FHCPs were reluctant to examine EPs thoroughly at primary health-care facilities and that the EPs were deprived of access to information because the environment in the facilities was unfriendly towards them. The EPs interviewed in the WHO study (WHO 2006a) expressed concern about drugs being prescribed without making laboratory tests, long queues that discouraged them from waiting to receive services, being considered as having merely “old age” complaints by some of the FHCPs and a lack of continuity in health-care services for EPs by way of home-based care or visits from FHCPs to the aged in their homes. The results of the WHO study suggested that the flow of information to EPs seeking services from formal health-care systems was low. The results also showed that FHCPs in Kenya are inadequately prepared to handle the health-care issues of EPs and that their conduct towards the EPs showed that they lacked the appropriate information for providing geriatric health-care services. Although the core business of FHCPs is to provide a health-care service, their approach to the elderly had a negative impact that helped in creating a reciprocal negative attitudes towards the public health-care system. This consequently leads to some of the EPs having an adverse attitude towards receiving health-care services in public health facilities. As a result, they had less exposure to professional health-care information with which to care for their health.
The literature also showed that EPs in Kenya found it difficult to meet the cost of medical services for diseases such as poor eyesight, arthritis, cardiovascular and others (Amuyunzu, Muniu & Katsivo 1997:614-618; McLigeyo 1997:607-610). The struggle to maintain good health among these EPs was complicated for some of them as they had additional domestic responsibilities like caring for HIV/AIDS orphaned grandchildren (Juma, Okeyo & Kidenda 2004:1-8). In such a socio-economic environment, the elderly nonetheless still need information to help them to care for themselves and others. However, due to the lack of formal studies about the problem of information access on geriatric health-care in Kenya, little is known about the information behaviour of EPs, ICPs and FHCPs.
Some studies found that EPs in Kenya sometimes experience abuse and neglect in local health-care facilities (KNCHR 2009:25; WHO 2006a:1-22; Mathangani 2005:3; HelpAge International 2001b). The experiences include negative attitudes from some FHCPs, rushing EPs through consultations, and having their consultations brushed aside as “old age” complaints. Subjecting EPs to abuse was intimidating and the experience became a barrier to them to access information for health-care from some FHCPs. It seems that efforts to implement a policy for care of the elderly in Kenya have not been fully realised (KNCHR 2009; Muigana 2006; Waithaka, Anyona & Koori 2003). Apparently, this lack of political good will to implement a policy for the care of the elderly is also a barrier and marginalises EPs from accessing information for geriatric care. In addition, some of the EPs in Kenya carry out self-care out of necessity when their children migrate to other regions, including urban centres as they search for greener pastures (Muigana 2006; Gachui 2001). These events make it necessary for most EPs to be assisted in accessing and using health-care information.
Recent reports in the news media show that the government is planning to support EPs aged 65 years and above by providing each of them with a monthly allowance of Ksh 1,500 (US $ 19.48) for food and health-care services (KNCHR 2009; Jamah 2009). Such a gesture represents a good beginning for care of the elderly people. However, it seems that the amount of money allocated by the government is still far from taking a significant part of the responsibility for caring for EPs (Okoth 2010; KNCHR 2009). Personal discussion with some members of the public after the press reports and launching of the KNCHR report about ageing in Kenya showed that they were unaware of the government plan to give EPs a monthly allowance and of the initial pilot project that would benefit only 33,000 of them. From both the literature and from personal observations, it became apparent that the general public knows little about gerontology and this ignorance seemingly affects the ability of the public to effectively advocate for better health-care services for EPs.
Gachui and Kiemo (2005:36-38) indicated that research about ageing is given low priority in African countries and universities. It seems that there is little concern about the issue of population ageing in African countries than in Western countries. It is thus not surprising that no studies could be found dealing with EPs and health information behaviour in Kenya. This study therefore, has attempted to address this gap in research. In addition, other studies about the environmental contexts show that, even within the same country, city or community, there are variations due to different socio-economic and educational levels that were determinants in accessing information and other services related to geriatric health-care.

THE HEALTH-CARE SYSTEM IN KENYA

For purposes of this study, it is necessary to take a closer look at some features of the health-care system that could influence the provision of health-care information to EPs in Kenya, including legislation, administrative structures, official services, user groups and stakeholders. These are discussed below.

Legislation

The purpose of legislation is to provide laws or a framework for daily operations in the provision of services. The resulting laws should govern the delivery of health-care services to individuals, and groups within communities. Legislation can be applied under local, regional or international agreements. For example, Kenya is a signatory to regional and international policies and legislation, including the ones applying to health-care services. The government also has its own policies that govern the provision of health-care services to citizens. Therefore, health-care legislation and policies in the country are shaped by decisions of national governments, regional and international organizations policies for the health sector.
Health-care legislation should provide information about types of services and how they are delivered. The legislation should also provide information about the rights of individuals and groups and how they may be protected from exposure to risky health-care services and conditions. Legislation normally stipulates how specific user groups such as EPs are to be treated when receiving health-care and therefore places the responsibility for the delivery of information on the health-care providers.
Current governmental health-care policy in Kenya is focused on meeting the goals of the Alma-Ata declaration that stated that countries should provide health-care for all by the year 2000 (WHO 1978). Towards the end of the period Alma-Ata, the UN led countries to adopt the Millennium Development Goals (MDGs) (UN 2000). The goals for health-care services under the MDGs include reducing child mortality; improving maternal health, and combating HIV/AIDS, malaria and other diseases (UN 2000). The current health-care policy in Kenya is also based on the same goals (Republic of Kenya 2007), but it says little about how to best provide geriatric information to benefit the EPs and their ICPs and FHCPs.
With regard to EPs, the current health-care policy briefly states that “EPs will practise healthy lifestyles; be protected against exploitation and abuse, and ensure that they are able to survive common health conditions affecting them” (Republic of Kenya 2007: 8). The policy now needs to move from theory to become part of a day-to-day structured health-care service delivery for EPs.
The current health-care policy in Kenya includes an annual operation plan specifying expected results for each identified group of health-care service users but as already indicated, it does not specify geriatric health-care activities. The priorities expressed in the current plan indicate a need to include elderly specific programmes of health-care in government policies which could, in turn, be channels for sharing information about health-care.
The most recent Government Health Policy is Vision 2030 (Republic of Kenya 2008:4-5), which gives guidance on the planning and delivery of health-care services in the country. The objectives, in line with Vision 2030, are to reduce children under-5 and maternal mortality; increase the population of birth deliveries by using trained personnel; increase the proportion of immunized children below one year and reduce the number of cases of tuberculosis. The government also plans to reduce the proportion of in-patient malaria fatality and national HIV/AIDS prevalence rate. Like other government policies, Vision 2030 lacks a plan for programmes of health-care and information for EPs in the country. This leaves Kenya still without immediate plans for specific geriatric health-care.
Considering the situation discussed above, Kenya as a developing country urgently needs programmes to encourage and support the care of EPs who are often impoverished along with their families (KNCHR 2009:20-23; Muigana 2006: 30-32; Mathangani 2005:3; Odongo 2002:3-5). Some of the programmes could be the actual implementation of policies for improved social and physical environments, the promotion of healthy lifestyles and the provision of related information.

Administrative structures

Kenya has two main complementary health-care systems: the conventional and the traditional. Conventional health-care refers to what is often called Western medicine, first introduced in the country by missionaries and the colonial government. Traditional health-care refers to indigenous African and other complementary and alternative medicine (CAM) or herbal medical systems that are found in the country. This study focuses more on the former system because it has a formal administrative structure but it is important to note that both systems are important and may complement each other.
There are two main providers of conventional health-care services in Kenya: the government and private agencies (churches, missions, industrial health units, private institutions, individuals and NGOs). The government is the major provider of health-care services in the country and is responsible for the conventional health-care system which provides information about its preventive, promotive and curative health-care services. It helps individuals to understand how they can stay free from contracting diseases, be able to maintain good health and seek treatment from specialists.
In contrast, the CAM health-care system provides information for natural health-care. It would appear that the conventional and the CAM systems are complementary but in actual fact, they operate independently. According to Nyongesa and Makenzi (personal communication 27 August 2008) practitioners in CAM register their business with the Natural Traditional Healers and Practitioners Association (NTHPA) and the Ministry of Culture and Social Services. It appears that the CAM system lacks the administrative structures like the ones found in conventional health-care systems, and most of the practitioners operate independently of one another although there is a CAM association that welcomes the membership of CAM practitioners.
The administrative structure in the governmental health-care system, often referred to as the public health-care system, is headed at the ministerial level and branches out into provincial, district and divisional administrative levels. Currently, Kenya has two ministries providing health-care services: the Ministry of Medical Services and the Ministry of Public Health and Sanitation. Each is headed by a minister who is assisted by two assistant ministers, a permanent secretary, provincial, district and divisional medical officers. The Ministry of Medical Services focuses on the management of community health needs within the social context of diseases and health (Republic of Kenya 2008:92). The Ministry of Public Health and Sanitation deals with implementation of disease prevention and health promotion interventions (Republic of Kenya 2008:77). There is also a top-level director of medical services within the governmental health-care sector. The national hospitals (Kenyatta National Hospital, Moi Teaching and Referral Hospital, and Mathare Mental Hospital), provincial and district hospitals, and health centres provide subsidized health-care services to the public.
Each ministry is responsible for formulation of policies and strategic planning that respect principles of equity, gender balance and human rights (Republic of Kenya 2007:4-5). The Ministry also monitors and evaluates the performance and impact of policy changes, conducts research, ensures security for public health commodities, strengthens capacity, plans for resource mobilization and coordination and operationalization of health-care plans (Republic of Kenya 2007:4). Provincial directors coordinate health-care services at the provincial level, while the district medical officer of health coordinates services at the district level. Each district has a health management team made up of officers-in-charge from provincial and district hospitals, health centres and dispensaries that provide what could become an infrastructure permitting the flow of information about geriatric health-care, given the nature of the services they provide, that would reach the EPs at the grass-root level.
The public health-care sector in Kenya is thought to have some of the most highly qualified FHCPs in the country and is characterized by having a large number of users; high staff turnover; and occasional complaints from users – particularly the EPs – (Muigana 2006:30-32; Mathangani 2005:3), which may make it difficult for users of the service of the FHCPs to access health-care information.

TABLE OF CONTENTS
SUMMARY
DECLARATION
ACKNOWLEDGMENT
DEDICATION
TABLE OF CONTENTS
LIST OF TABLES
LIST OF FIGURES
LIST OF MAPS
LIST OF ACRONYMS
CHAPTER ONE INTRODUCTION TO THE STUDY
1.1 INTRODUCTION
1.2 BACGROUND OF THE STUDY
1.3 ELEDERLY PEOPLE (EPs) AND HEALTH-CARE
1.4 STATUS OF ELDERLY PEOPLE (EPs) IN KENYA
1.5 STATEMENT OF THE RESEARCH PROBLEM
1.6 RESEARCH METHODOLOGY AND DESIGN
1.7 RELEVANCE OF THE STUDY
1.8 MOTIVATION AND JUSTIFICATION
1.9 SCOPE OF THE STUDY
1.10 KEY CONCEPTS
1.11 OUTLINE OF CHAPTERS
1.12 SUMMARY AND CONCLUSION
CHAPTER TWO THEORIES AND MODELS OF INFORMATION BEHAVIOUR RELEVANT TO HEALTH-CARE
2.1 INTRODUCTION
2.2 USER GROUPS
2.3 INFORMATION BEHAVIOUR
2.4 MODELS OF INFORMATION BEHAVIOUR
2.5 FACTORS THAT INFLUENCE INFORMATION BEHAVIOUR
2.6 SUMMARY AND CONCLUSION
CHAPTER THREE HEALTH-CARE ISSUES WITHIN A DEVELOPMENT CONTEXT
3.1 INTRODUCTION
3.2 DEFINITION OF DEVELOPMENT CONTEXT
3.3 THE HEALTH-CARE SYSTEM IN KENYA
3.4 STAKEHOLDERS IN HEALTH-CARE FOR ELDERLY PEOPLE (EPs)
3.5 INFORMATION PREFERENCES
3.6 SUMMARY AND CONCLUSION
CHAPTER FOUR RESEARCH METHODOLOGY
4.1 INTRODUCTION
4.2 RESEARCH DESIGN
4.3 GEOGRAPHICAL SETTING FOR THE STUDY
4.4. POPULATION AND SELECTION OF RESPONDENTS
4.5 PILOT STUDY
4.6 DATA COLLECTION METHODS
4.7 DATA ANALYSIS
4.8 ETHICAL CONSIDERATIONS
4.9 VALIDITY OF THE STUDY
4.10 RELIABILITY OF THE STUDY
4.11 PREVENTING BIAS IN THE STUDY
4.12 RESEARCH CHALLENGES
4.13 SUMMARY AND CONCLUSION
CHAPTER FIVE INFORMATION NEEDS IN HEALTH-CARE OF THE HOME-BASED ELDERLY
5.1 INTRODUCTION
5.2 INFORMATION NEEDS IN HEALTH-CARE OF ELDERLY PEOPLE (EPs)
5.3 OVERVIEW OF THE FINDINGS
5.4 SUMMARY AND CONCLUSION
CHAPTER SIX SOURCES AND CHANNELS OF COMMUNICATION USED FOR INFORMATION ABOUT HEALTH-CARE
6.1 INTRODUCTION
6.2 FORMAL SOURCES OF INFORMATION
6.3 INFORMAL SOURCES OF INFORMATION
6.4 CHANNELS OF COMMUNICATION
6.5 OVERVIEW OF THE FINDINGS
6.6 SUMMARY AND CONCLUSION
CHAPTER SEVEN THE USE OF INFORMATION IN GERIATRIC HEALTH-CARE
7.1 INTRODUCTION
7.2 SPECIFIC USES OF INFORMATION
7.3 OVERVIEW OF THE FINDINGS
7.4 SUMMARY AND CONCLUSION
CHAPTER EIGHT FACTORS THAT INFLUENCE ACCESS OF INFORMATION FOR GERIATRIC HEALTH-CARE
8.1 INTRODUCTION
8.2 ENVIRONMENTAL FACTORS THAT INFLUENCE ACCESS TO HEALTH-CARE INFORMATION
8.3 PERSONAL FACTORS THAT INFLUENCE ACCESS TO HEALTH-CARE INFORMATION
8.4 OVERVIEW OF THE FINDINGS
8.5 SUMMARY AND CONCLUSION
CHAPTER NINE CONCLUSION AND RECOMMENDATIONS
9.1 INTRODUCTION
9.2 RESEARCH PROBLEM
9.3 THEORETICAL APPROACHES TO THE STUDY OF INFORMATION BEHAVIOUR
9.4 METHODOLOGY
9.5 FINDINGS
9.6 CONTRIBUTION OF THE STUDY TO THEORY
9.7 CONCLUSION
9.8 SUGGESTIONS FOR FURTHER RESEARCH
BIBLIOGRAPHY
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