The analysis done under this theme contributes to answering the second research question of this study:
• In what ways do paediatric physicians in Nigeria engage in information practices towards patient care?
During the interviews, the physicians were asked to explain what their information needs were within the context of their roles as paediatric physicians. Interpretations of the
physicians’ awareness of their information needs, the reasons for the information needs, the frequency of the information needs and their reasons for information source preferences are presented in this section.
Figure 29 represents the theme information needs and its sub themes; awareness of need for information, reasons for information need, frequency of need for information and reasons for information source preference, among the paediatricians.
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Figure 29: The paediatric physicians' information needs
4.5.1.1 The paediatricians’ awareness of their information need
Data analysed under this category contributes to meeting the first specific objective of this study which was to provide understanding about the physicians’ awareness, perception and experience of information literacy towards patient care.
Determining the paediatricians’ awareness of their need for information was necessary for gaining understanding how they engaged and made sense of their other information practices within their patient care role. The views of the paediatricians suggest that people possessed a good degree of awareness of the necessity for information use in patient care. The various views are presented as follows (emphasis in quotes is the researcher’s):
Discussing how information contributes to the physician’s self-improvement, interviewee 2 (male, Resident) said: “One cannot work without being better than he was yesterday. As I am now, I believe that before I leave here today I would have become a better person than I was through the information I will receive […]”. This physician recognised the need to be open to the receiving new information on a daily basis in order to continuously improve perhaps his personality and his ability for better patient care. He equally understood that engaging in self-information-seeking could cover areas of his deficiency in practice: “[…] in paediatrics there are many fields and sub specialties, you must invest more time in any field you have a deficiency […]”.
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Similarly, another interviewee said: “It is true that the process of our preparation in medical school was rigorous and we can say we have some level of expertise, but certainly what is in
your brain is not enough, so you need constant updates to remain the doctor that you are
called” (Interview 13, Resident, male).
It appears also that some clinicians were aware of the importance of engaging in evidence- based practice, which could be possible only when they obtained the right information to support it. However, there were some factors that that were noted by clinicians which
appeared to limit the extent to which people engaged in the use of evidence in patient care. As one consultant said:
“You know that we are in a world of evidence-based medicine, so most of the things we do now has to be evidence-based and you need a lot of information which is the evidence that such a thing has worked somewhere before you can bring it into your own practice. So if you don’t have that information maybe because of lack of sources of information, or your sensibility to such information or even ignorance that such information exists, it’s going to really put you back because every day new things keep coming […]”(Interview 15,
Consultant, female).
Discussing in similar vein, some physicians highlighted the importance of having the knowledge of sources for obtaining the evidence, as well as knowing what the correct information was:
“[…] knowledge has a key role to play in paediatric practice, a very key role. You must be aware of the source where the particular information you need for something is.” (Interview
1, Male, Resident).
“[…] because there’s so much information out there. You need to know the one that’s correct. If you are able to get the correct information you’ll be able to treat your patients well”. (Interview 6, female, Resident).
The physicians’ extent of awareness of their need for information for carrying out their patient care duties tend to be summed up by these clinicians who said that: “Nobody wants to be archaic” (Interview 4, Registrar, female), and that “Information access and use gives the patient the best and it reduces making mistakes or assumptions about what you are doing” (Interview 3, male, Resident). The later comment shows that the clinician believed that information use has implications for outcomes in patient care because, in his view, its non-use could lead to mistakes being made by the clinician on the patients. This view partly addresses the fourth specific objective of this study which is to provide perceptions about the potential
125 4.5.1.2 Reasons for information need
The analysis done in this category contributes towards achieving the first and the fourth objectives of this study which aimed to provide understanding of:
• the physicians’ awareness, perception and experience of information literacy for patient care; and
• the potential implications of the physicians’ information practices for providing care to patients.
The paediatricians gave various reasons why they had need for information. Eight classifications of these needs were identified and presented as follows:
i. Managing challenging and confusing cases
“The basic challenge for me is to be sure about whatever I want to do for any patient because I need to convince myself that I have not left out any option that could have worked better for that patient” (Interview 1, Male, Resident).
“[…]if you are dealing with a confusing scenario when the patient’s presentation is not straightforward you’ll want to access information at that point…about 2 weeks ago in the clinic, I had a patient that presented and I wasn’t sure what it was. The patient came up with some symptoms, but I wasn’t sure what I was dealing with […]”. (Interview 6, female, Resident).
ii. Supporting diagnostic decisions
“…maybe I have a diagnostic dilemma and I’ve looked at the case and cannot really say what exactly it is, I can access the internet to verify the presentation and the symptoms […]” (Interview 16. Male, Resident).
“[…] it is very important to be sure, particularly when there is decision that is hazy and one is not so clear on the most appropriate step” (Interview 17. Male, Resident).
iii. How to manage evolving diseases
“Diseases evolve, and as the days pass by more symptoms of that disease evolve also […]” (Interview 2, male, Resident).
“[…] Things keep changing especially when it comes to tropical illnesses […]”. (Interview 1, Resident, male).
“[…] every day new things keep coming. There are changes both in causes of disease and the interventions. What you may be practicing maybe like last year by this year another thing has come up […]”. (Interview 15, Consultant, female).
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“[…] many times things change concerning the management of childhood diseases, for example, it’s not the way asthma was treated ten years ago that it is being treated now […]” (Interview 16, male, Resident).
iv. Understanding the contextual peculiarities of managing some illnesses “I am usually interested in understanding how the diseases present here in the tropics because geography affects disease conditions a lot”. (Interview 18, Female, Resident). “You see that most of the things you work with in terms of studies being done are based on studies done in the west. For example if they say that a drug has been working or a drug has been used, most of the studies on that drug and the clinical trials were done in the west not considering that there could be differences in terms of the genetic
components of the people to make the drug work” (Interview 8, Resident, male). v. Drugs and dosage information
“In paediatrics, the drug dosages differ according to the ages of the children and there is always this need to be sure of the amount of drug a patient should take” (Interview 9, Resident, male).
“The main issue that led up to that is, well the main information that we actually look out for is dosing. That is just the main thing. Most times the information I look for is about the dosage. The treatment for this disease is for so and so drug. Because we have many cases that occur commonly you know how to treat them, so dosage is the main information we look for with particular interest on the side effects”. (Interview 3, Resident, male).
vi. Refreshing the memory
“Your memory may fail at that moment to remember what you learnt back in the medical school days […]” (Interview 10, Registrar, female).
“[…] there are some cases with challenging presentations or something you know but are not sure of or no longer vivid in your mind […]”.(Interview 5, Resident, male).
vii. Keeping updated
“[…]most patients can check up what you tell them online, so if you tell them what was done in the ‘80s and they already have information on what was done in 2015, they won’t trust you” (Interview 19, Consultant, male).
“[…]I need to know what the current trends are, what other people in other places are doing, where the world is going to now as you cannot just stay with the old practice, you might need to verify some things and also share some of the things you are doing with others” (Interview 11, Senior Registrar, female).
viii. Examination purposes
“[…] as residents your primary goal is to pass your exams and go to the next level because it’s time-bound” (Interview 8, Resident, male).
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“Most of us are into active reading because we are resident doctors” (Interview 5, Resident, male).
“[…] because we are resident doctors. There’s hunger for information from all quarters because exams are around the corner […]”. (Interview 7, Male, Resident).
Most interviewees believed that meeting these outlined information needs, played a major role not only in how well they managed their patients, but also how well the patients could trust them as knowledgeable and competent physicians.
One information need; the need for information to pass examinations, appeared to be peculiar to a limited set of physicians - the physicians below the rank of consultant, and specifically; the residents. This information need was necessitated by career progression requirements of the physicians in the lower ranks.
4.5.1.3 Frequency of need for information
Most of the physicians noted that their need for information was vital towards making decisions on their patients; also, that the need for information occurred as a daily factor of their work:
“In the daily work you do, when you come to work you encounter challenges and you need to broaden your knowledge base in order to surmount those problems […]”. (Interview 2, Male,
Resident).
“I need information basically to support what I do on a daily basis in seeing my patients.”
(Interview 1, Male, Resident).
Besides ensuring certainty in the physician’s decision-making process on the cases presented by their patients, the physician’s daily need for information was necessitated by the need for pro-activeness and not reactiveness in the management of diseases. In this regard a clinician in the epidemiology team said:
“I need to be constantly aware of what is happening, so I will say that it is every day that I require one form of information or the other. I do not have to wait until a child arrives at the hospital with a disease condition that’s likely from an epidemic. I need to keep
monitoring the situation together with my team because that’s what my work entails. I need information on a consistent basis to do this properly”. (Interview 18, female, Resident). It appeared that the main reasons for the daily occurrence of information needs were for overcoming challenges during patient care, such as when complications were encountered and during confusing presentations, and the need for the physician to be convinced about decisions taken. Other reasons adduced as necessitating the physicians’ frequent need for
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information were concerned with obtaining information about drugs and people refreshing their minds on forgotten aspects of previous knowledge.
Regardless of this daily need for information, not every physician engaged in information search on a daily basis to meet the needs. The search for information depended on various factors, for example, the level of challenge the case posed to the physician’s tacit or residual knowledge at that moment:
“It is not in every case that I specifically search for information. There are cases that are common and you already know what to do off the cuff, but some cases present with difficult scenario and you have to search for additional information to support whatever decision you might take eventually. What I will say is that this happens on a consistent basis, though I can also say that in some way one requires information every day” (Interview 20, Female,
Resident).
Confirming this perspective, another interviewee said that:
“It depends on what you are managing. If it’s the normal malaria fever there will be no need for extra information. But if you get some interesting or rare cases, that’s when you search for additional information, maybe what is new or what you are not doing that could help in managing the patient better”(Interview 11, Senior Registrar, Female).
In general, the main factors suggested by majority of the paediatricians as necessitating their need for information on a daily basis were: a) the occurrence of difficult, challenging or rare cases; b) being sure of decisions taken on their patients; c) following current treatment procedure for their patients, and, d) the fact that every case is unique and oftentimes cases present different peculiarities in management.
4.5.1.4 Reasons for information source preference among individual physicians
The paediatricians’ awareness of their need for information in the discharge of their patient care duties appeared to have a relationship with their disposition to engage in conscious information seeking to meet those information needs. It, however, appeared that in meeting those needs, the physicians’ had individual preferences and inclinations for using different information resources due to reasons adduced in the statements below.
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Table 5: Reasons for physician's preference of information sources
Reason Quotes
1 Reliability/authenticity “The internet is fast and has a lot of useful information, though not everything is reliable. Books are much more reliable and serve as reference for me at all times” (Interview 17, Resident, Male).
“Textbooks are more reliable sometimes […] (Interview 5, male, Resident). “For us in paediatrics we’ve termed the Nelson book of paediatrics the bible of paediatrics, so most times whatever you want to do in terms of information, you start from there. Whatever we can’t find or can’t understand from there, we then digress to other sources” (Interview 6, female, Resident).
2 Type of needed information
“The source I use may depend on if I need information for treating a patient or I want to know what is going on in the communities I cover” (Interview
18, female, Resident). 3 Availability,
accessibility, speed of access
“[…] textbooks are usually accessible and available” (Interview 5, male,
Resident).
“When I need medical information I first start with what is readily available” (Interview 6, female, Resident).
What I do depends on the circumstance because I may face some challenging situation and I call a colleague. You know here internet access may not be as fast as you want it, sometimes you log in and there is network problem. What you want to access will be delayed at that moment, so many time calling a colleague on phone and describing the nature of the illness … is better. Your colleague will quickly let you know what he or she thinks and that will assist. Most doctors do it and that is the most instant way to access information”
(Interview 9, male, Resident). 4 Usefulness to
information need
“Anything that gives me what I want is what I use” (Interview 2, male,
Resident).
“[…] I can call my consultant as my first source of information because of the wealth of knowledge […].”(Interview 8, Male, Resident).
5 Format of the resource “For textbooks, personally I prefer hard copies so I can actually make jottings […]” (Interview 1, Male, Resident).
6 Ability to make comparison
“I also searched the internet because it helps you understand how such cases have been treated elsewhere” (Interview 4, female, Registrar).
“[…] when we needed to compare what we saw with what was in the literature; we had to go to the internet” (Interview 1, Male, Resident).
7 Scope covered by resource
“[…] for American Academy of Paediatrics, the reason is that most topics are discussed in details with some clarity. I use the Nigerian Academy of
Paediatrics Journal, because it’s tropicalized and contains basically things that concern us here. That covers up the part where the American Academy of Science wouldn’t, then Medscape is for general knowledge in paediatrics”
(Interview 8, Male, Resident).