Working Together to Meet the Information Needs of Health Care Providers, Program Managers, and Policy Makers in Low- and Middle-Income Countries

Within the health system, policymakers, program managers, and health care providers require needs-driven and evidence-based information to inform decision making and improve the quality of services delivered. However, many international health and development organizations continue to rely on a push model of information dissemination, routinely sending information out the door to health care professionals in low- and middle-income countries but failing to fully take into consideration the needs of information consumers in these settings. It is surprising that few have researched the specific information needs of different types of health care professionals to determine whether their needs are being met and, if not, how to improve access to and use of relevant, reliable information. Yet, timely access to such information is essential for good health and the most “cost-effective and achievable strategy for sustainable improvement in health care” (Pakenham-Walsh, Priestley, & Smith, 1997).

Over the past decade, the world has experienced an information revolution with the exponential growth of information and communication technologies, whose expansion has opened up access to health information through the Internet and, more recently, through mobile phones. Today, there are more than 2 billion Internet users worldwide and 6 billion mobile phone subscriptions (International Telecommunication Union, 2011; Internet World Stats, 2011). These advances have dramatically increased access to health information for many health care professionals. However, those who live in remote areas, work at the grassroots level, and are most in need of information at the point of care continue to have the least access to these new technologies.

Support for this special issue of the Journal of Health Communication was provided by the U.S. Agency for International Development, Bureau for Global Health, Office of Population and Reproductive Health through the K4Health Project, Cooperative Agreement No. GPO-A-00-08-00006-00. The views expressed herein do not necessarily reflect those of the U.S. Agency for International Development or of the U.S. government.

At the same time, opening the floodgates to information has its challenges. Exposure to a wide variety of health information resources demands more time and critical appraisal skills. A typical Google search, for example, can yield hundreds of thousands of resources. Sifting through the morass of information requires time and information search skills, and while access to information has rapidly expanded across the world, we must continue to ask ourselves: Are we meeting the needs of health care providers, program managers, and policymakers? Is the information we are disseminating useful and relevant? Are we simply pushing information out, or are we exchanging information and allowing for user response and feedback?

This special issue of the Journal of Health Communication aims to answer these questions by exploring the perspectives of health care providers, library services, and donors on providing access to and promoting use of evidence-based information, highlighting the impact that health information can have on health outcomes. We also present results of health information needs assessment conducted in three countries—India, Malawi, and Senegal—by the Knowledge for Health (K4Health) project based at the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs. These qualitative research studies examine information needs and information exchange at different levels of the health system, identify gaps in the system, and explore opportunities for meeting these needs.

In “Towards a Collective Understanding of the Information Needs of Health Care Providers in Low-Income Countries, and How to Meet Them,” Pakenham-Walsh explores how and why existing research-to-practice paradigms are not working. He discusses health care providers' inadequate access to relevant and reliable health information and stresses the importance of a needs-led approach, one that extends beyond perceptions to identify actual needs based on health care providers' current knowledge and practice. He argues that the current knowledge system is falling short in low- and middle-income countries and that through the HIFA2015 initiative (Healthcare Information For All by 2015), along with increased donor and government commitment, we can provide urgent life-saving knowledge to those who need it most.

Gathoni describes the advances made in Africa toward providing health information in “Enhancing Access to Health Information in Africa: A Librarian's Perspective.” However, she notes that, despite increased access to information in Africa through information and communication technologies, health care workers still face language barriers (the majority of materials are in English), lack computer skills, and have poor information literacy. Thus, ensuring access to knowledge, and promoting its use, remains difficult. Gathoni discusses the important role of librarians and associations, such as the Association for Health Information and Libraries in Africa, in promoting and enhancing access to health information. The Association for Health Information and Libraries in Africa and similar groups can improve information literacy through a number of activities, such as training of health care providers and disseminating and repackaging information into appropriate formats.

In the piece “Meeting the Health Information Needs of Health Workers: What Have We Learned?” D'Adamo et al. offer the perspective of a donor organization working to address gaps in health information access and use. The authors present common themes, challenges, and barriers to information flow among the three studies in this supplement, and they outline what we can learn from the information challenges faced by health care workers in these diverse settings. They also discuss the importance of investing in comprehensive knowledge management systems to ensure that evidence-based information and knowledge is used by health care professionals to improve health outcomes and meet Millennium Development Goals.

Kapadia-Kundu et al. present findings from the needs assessment in India, in “Understanding Health Information Needs and Gaps in the Health Care System in Uttar Pradesh, India.” The needs assessment found that perceptions or definitions of health information varied across different levels of the health system in Uttar Pradesh. Information mainly flows vertically from the national level down to district levels and then encounters an “information divide” between district and grassroots levels. This study also identified five parameters for actionable information: language, timeliness, simplification, quantity, and accessibility. The authors conclude that providing actionable information across all health system levels is key to getting information into practice and to strengthening the health system and improving the quality of services.

Next, we switch continents, from Asia to Francophone Africa. In Sylla et al.'s “Qualitative Study of Health Information Needs, Flow, and Use in Senegal,” health care professionals identified mobile phones as a promising platform for improving access to health information, but there remains a strong need for print and interpersonal communication across the health system. Political support, along with more attention to the knowledge management role of health care coordinators and supervisors, is necessary to create a more robust and comprehensive knowledge management strategy for the health sector in Senegal.

The final needs-assessment study in this special issue, “Building a National Model for Knowledge Exchange in Malawi: Findings From a Health Information Needs Assessment,” by LeMay and Bocock, reveals a weak information-sharing culture and a need for easy-to-use and up-to-date health information. Information movement up and down the health system is sluggish and a central source of standardized health information does not exist. Internet access is also limited outside the central level, but growing mobile technology coverage presents an opportunity to expand access to critical health information. LeMay and Bocock conclude that to overcome these barriers, projects aimed at increasing access to the latest research among health care professionals should use multiple communication channels and work through existing structures, such as technical working groups and district health centers.

The findings presented in this supplement reveal that tailoring materials to the varying needs and preferences of health care professionals across health systems is vital for improving information access and knowledge sharing. Study findings also confirm a need among health care workers for timely access to the most current information, in simple formats, to develop policy, manage health care programs, and deliver high-quality services. Further, although information and communication technologies are important for expanding reach and for exchanging information, face-to-face meetings remain the way that most health care workers communicate with each other. Technical working groups, professional associations, and networks also play significant roles in information and knowledge sharing, and they seem to rely more on traditional communication channels than on new media.

It is important to note that findings demonstrate a persistent need for a variety of information types—from research syntheses to job aids and case studies. They also suggest the need to establish multi-faceted knowledge management systems and approaches that take advantage of expanding information and communication technologies, especially mobile phones; support existing professional and social networks; and adapt to the varying needs of health care professionals. These common lessons can be applied universally to expand health care workers' access to reliable, practical, evidence-based information. Strengthening knowledge management systems can facilitate the flow, exchange, and use of information, which, in turn, can improve the health system in general.

An adequate assessment of health information needs, including opportunities, barriers, and gaps, is necessary for designing effective communication strategies and producing actionable information. The articles in this special issue contribute to the evidence base of the information needs of health care professionals working at different levels of the health system. Through an examination of information flow throughout an entire health system, the research studies provide concrete findings on the information needs and wants of individual health care professionals and document the role of professional networks. The commentary pieces further explore these issues to help design sound programs that improve knowledge management and sharing. Taken together, the pieces in this special issue form a picture of how actors at different levels of the health system can work together to meet the information needs of all health care professionals.