- 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, aspirations and contribution to organization or institution gains, effectiveness, and survival. Work effectiveness is one of the most essential factors within work, involving maintaining and increasing productivity for organization or institution. Conway (2015) noted that physicians cannot afford to ignore their work effectiveness simply because it is only when their work effectiveness is improved upon that they can render quality services and provide patients with prompt attention. Yahya and Johari (2009) viewed work effectiveness as one of the important indicators in managing organizational performance. They further explained that a growing emphasis has been on employee work effectiveness as a source of competitive edge to promote responsiveness in enhancing overall organizational effectiveness. Work effectiveness can be defined as doing the right thing at the time; that is, when the employee is doing the job rightly and making continuous contributions in improving the organization or institution (Abayomi, 2015). Further, it refers to how workers deal with their works and how they accomplish different tasks in the organization or institution.
Shadare and Hammed (2009) proposed the following guidelines to measure work effectiveness: quality of work services delivery, information/knowledge of patients records, physicians work commitment and clinical decision making. Whereas clinical judgment is useful in day-to-day management of patients, access to relevant information sources needed by the physicians, adequate information skill, sufficient computer-based services are equally necessary for a better job performance. The working place is vital to work effectiveness; this implies adequate facilities that aid work effectiveness. These include access to needed information, information seeking, information sources, information retrieval and information use and of course a conducive work place.
Work effectiveness of physicians could be measured in an organization or hospital through the following indicators: Quality of work service delivery, physicians information/knowledge management of the patients, physicians work commitment to organization or hospital values, clinical decision making. For physicians to be effective at work place the ability to discharge quality high service to the community it serves is very important. Therefore, availability, accessibility and up-to-date information is highly needed because effectiveness has to do with doing the right thing at the right time (Nwachukwu, 2007; Mosadeghrad, 2013). In addition, work effectiveness has been found to be a very effective way of improving and delivery service in the medical field (Novack, Suchman, Clark, Epsein, Najberg and Kaplan, 1999). Impliedly, if there will be work effectiveness in government hospitals in Edo State they will need to put in place quality assurance standards for the organizations. This will ensure that service delivery and effectiveness will not fall below standard. To measure standards for work effectiveness will entail the following:
Patient’s Information/knowledge management: This has to do with managing patient’s information effectively and efficiently and being able to take accurate and prompt decision. It also means to seek knowledge, knowledge base search and retrieval tools to create new knowledge collaborative decision-making process and support tools (Wyatt, 1991; Korthari, et al, 2011) . Physicians’ effectiveness in patients’ information management consists of tacit knowledge of patients. This type of information is considered “health status” of patient own complex knowledge in current and past medical conditions that the physicians may not know about (Abidi, 2001). However, such knowledge is vital for physicians to know, especially when it comes to the diagnosis and prescription treatments of illness.
Physicians Work commitment: A great premium is to be placed on organizational or hospitals’ values and this includes maintaining confidentiality to patients, ensuring good relationship between colleagues and patients, accountability for any course of actions in the organization (Freund, 2005). Work commitment is an internal decision which cannot be forced. It happens when one’s thoughts and emotions are pointing to the same direction.
Clinical decision making: Sound and practical decisions that are needed to deal effectively with critical situations and are based on careful analysis and diagnosis. In other words, it means clinical judgment made by physicians to decide specific aspects of care such as diagnosis, choice of tests, prescription of drugs, surgery and therapy (Mandin, Jones, Woloschuk and Harasym, 1997).
For effective work in the hospitals every physician should be armed with the right information. The relevance of information to effectiveness is that it is necessary for physicians to have access to information which must be provided at the right time, in the right quality and quantity (Menachemi, Langley and Brooks, 2007; Ndukwe, 2005). It should be located at the right place and properly disseminated. Physicians need information to keep them abreast and to inform others about the current discoveries in the field of medicine; information is also crucial for better work effectiveness to make specific clinical decision. Information is a vital resource, a key currency for work effectiveness (Komolafe-Opadeji, 1999 and Zakari, 2015).
This study provides a general picture of information behaviours and work effectiveness of physicians in government hospitals in Edo State. The question may be asked, who are physicians? Physicians may be described as persons who have been educated, trained and licensed to practice the art and science of medicine (Stedman’s Medical Dictionary, 2006; Dawes & Sampson, 2003). A practitioner of medicine as contrasted with a surgeon is a person who formally and legally accepts patients for admission to a health care facility. In other words, a physician is a registered medical practitioner who specializes in the treatment of diseases and disorders. They are also responsible for the patients care throughout their stay in the hospital. Physicians work in three healthcare levels: primary (e.g. family health centres, clinics, General Practitioners), secondary (e.g. general hospitals) and tertiary (or specialist hospitals). This study focuses on physicians working in secondary and tertiary hospitals who are identified as clinicians working in hospitals. Almost all hospital physicians specialize in a particular area of medicine or surgery, such as anaesthetics, cardiology, ophthalmology, paediatrics or pathology.
Cheibi and Abba (2003) and Ajuwon (2015) affirmed that physicians have vital roles in achieving health care goals of a given state or country; updating knowledge with relevant information is very important for health professionals to deliver quality and sustainable health care services to their patients. However, this is possible only when there is sustainable access to health information sources. Graham, Fional and Colin, (2011) identified the duties of the physician as follows: Physicians carry out duties such as conducting medical histories and physical examination to assess the patients, to investigate, and carry out diagnosis on chronic conditions. Diagnosis is a vital element of physician’s expertise in medical practice and it is based on knowledge and strong assessment skills. Also physicians work collaboratively with the healthcare team to provide optimal care. This includes providing referrals to other practitioners or services that the patient may need. They provide reports and updates of patient’s condition and needs to other services such as physical therapists.
Another important role of physicians is that they provide continuous care for the patient while in the hospital. They manage and treat variety of medical conditions from minor cuts to mental health to palliative care to surgery. Therefore, physicians need information required to manage complexity and risk in situations that often times are uncertain and changing. Physicians play a vital role as an advocate for patients and families. They help the patients go through a complex medical system to be able to obtain most patient-centred care in a cost effective manner. The physicians work to identify and meet the need of the individual patient, the practice population and the community by working with a variety of partners in the community, public health sector and hospital system. In addition, physicians offer information that patients can use to make informed decisions about their treatment plan. The work of the physicians are to keep their professional knowledge and skills up-to-date; they also give patients the information they need in a way they can understand. In addition, they are personally accountable for their professional practice and always be prepared to justify their decisions and actions.
Physicians seek for right information in order to manage the patient and work effectively. Quite pertinent is the type of health information needs of the physician and their use for clinical practices. Availability and accessibility of information sources are very important, simply because they require accurate, comprehensive information in order to treat patients effectively and more also the lives of people are in their hands. In other words, access to a wide variety of information is vital to physicians. But few studies have been carried out to find out the information behaviours of physicians working in government hospitals. Specifically, it is pertinent to know the information behaviour and work effectiveness of physicians in Edo state. But since so much has not been done in this area there is the need to fill the gap in knowledge.
The present Edo State was carved out from the then Mid-West region, and then later known as Bendel State. Edo State was created in 1991 out of the former Bendel state which lies roughly between longitudes 060 04’E and 060 43’E and latitudes 05044’ N and 07034’ N. It is bounded in the South by Delta State; in the North by Kogi State and in the East by Anambra State. It occupies a land area of about 17,802 square kilometres (Fafunwa, 1974). From the 1991 census, the state has a population of about 2,159,848. The 2014 population estimate is about 5 million. The main ethnic groups in Edo state are Edos, Afemais, Esans, Owans and Akoko Edos.
Edo State people are agrarian, and they produce rubber, yam, cocoyam, cassava, maize, melon, pineapple, plantain, banana, groundnut and cashew, amongst other crops. The major occupations of these people are farming, trading and fishing. The state is endowed with natural resources such as limestone, clay, crude oil, wood products and aquatic products. Onoriode, Samson and Ankomah (2012) affirmed that the vegetation are made up of mangrove and tropical rain forest in the south and central zones and savannah woodlands in the north. The income levels of the people are low and about 70% of them live below the poverty line. Edo State is divided into 18 Local Government Areas (LGAs) and 192 wards, grouped under three senatorial districts; namely Edo North, Edo South and Edo Central. Among the tertiary institutions in Edo State are the following: University of Benin, Benin City; Ambrose Ali University, Ekpoma; Auchi Polytechnic, Auchi; Ekiadolor College of Education, Benin City; School of Nursing, Benin City; University of Benin Teaching Hospital, Benin City; School of Health, Benin City (Agbonlahor, 2002).
1.2 Statement of the Problem
Physicians need accurate and relevant information at the right time in order to deal with current and emerging diseases as well as other health related conditions. There is the perception which has been established over the years by personal experience, and those of others, media reports and the visible state of disrepair of healthcare infrastructure that the healthcare delivered in Nigeria is of low quality. Since physicians are major stakeholders in the healthcare delivery system of any nation, they can play a crucial role in reversing the perception that many of the government hospitals in Nigeria are mere consulting centres, a belief that has been reinforced by escalating medical tourism. Specifically, the information behaviour of physicians in government hospitals in Edo State may have contributed to the negative evaluation of government hospitals. The way they gather and use information in their day-to-day duties is a source of concern. Other areas of concern include the physicians’ quality of work delivery and the level of professionalism in their clinical decision-making. It would also be interesting to know if there are significant relationships between information needs, information seeking pattern, sources of information, information access/retrieval, information use and work effectiveness of physicians in government hospitals in Edo State.
1.3 Objective of the Study
The main objective of this study is to investigate the relationship between information behaviour of physicians and their work effectiveness in government hospitals in Edo State, Nigeria. The specific objectives are to:
- identify information needs of physicians in government hospitals in Edo State, Nigeria;
- find out the information seeking pattern of physicians in government hospitals in Edo State;
- find out the sources of information consulted by the physicians in government hospitals under study;
- find out physicians method of information retrieval in government hospitals in Edo State;
- find out the physicians’ information use in government hospitals;
- examine the work effectiveness of physicians in government hospitals in Edo State;
- ascertain the relationship between information needs of physicians and their work effectiveness in government hospitals in Edo State;
- find out the relationship between information seeking behaviour and work effectiveness of physicians in government hospitals in Edo State;
- examine the relationship between sources of information consulted and work effectiveness of physicians in government hospitals in Edo State;
- find out the relationship between physicians’ information retrieval and work effectiveness;
- determine the relationship between information use and work effectiveness of physicians;
- investigate the composite relationship of information needs, seeking behaviour, sources, retrieval, and use and work effectiveness of physicians in government hospitals in Edo State, Nigeria and
- find out the challenges encountered with information seeking behaviour of physicians in government hospitals in Edo State.
1.4 Research Questions
In order to achieve the objectives of this study, the following research questions are posed:
- What are the information needs of physicians in government hospitals in Edo State?
- What are the information seeking patterns of the physicians in government hospitals in Edo State?
- What are the sources of information consulted by the physicians in government hospitals under study?
- How do physicians retrieve information in government hospitals in Edo State?
- What do the physicians use information for in government hospitals in Edo State?
How effective are physicians in their work in select