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Health Information Forum: Working together to improve access to reliable information for healthcare workers in developing and transitional countriesWorkshop 1: Meeting the information needs of the isolated healthcare worker The Health Information Forum was launched on Tuesday 14 July 1998 at the Royal College of Physicians, 11 St Andrews Place, Regent's Park, London. This meeting was the first of an initial series of six meetings, whose overall objectives are:
These activities are to be conducted among and across the various sectors of the health information provider community, with the common purpose of improving access to reliable information for healthcare workers in developing and transitional countries. Chaired by Dr Richard Smith (Editor, British Medical Journal). Guest speakers: Andrew Chetley (Healthlink, formerly AHRTAG) Participants included: Professor KGMM Alberti (President, Royal College of
Physicians) Apologies: Professor David Morley (TALC) The objective of the meeting was to exchange ideas and experience relating to three questions with regard to the isolated healthcare worker:
Each question was addressed by a combination of presentation, small-group discussion, and rapporteur. 1. What can we do to improve access to and distribution of health information? Andrew Chetley described the various types of isolation, including not only the geographically isolated, but also professional, numerical and contextual isolation. For example, he described the scenario of the paediatric nurse who has recently returned from training and who finds her enthusiasm and proposals stone-walled by the healthcare hierarchy and by the hustle and bustle of hospital work. Health information is needed for health education, research, policy-making, service delivery and training. Looking at the needs of healthcare workers, `the underlying, consistent need has been for easy to understand, simple, practical material that helps health workers do their daily tasks more easily'. And it is vital to look at quality of information rather than simply quantity, particularly with regard to the Internet. Andrew Chetley also pointed out the need for both information and interaction: exchange of information, dialogue with healthcare workers. He underlined that provision of health information is potentially the most cost-effective strategy to improve the quality of health care. `Health workers use the information they get to share, to train, to learn, to develop – and to save lives.' Discussion Group 1 To whom should the materials be distributed? The group noted that one difficulty was in identifying the contact details of frontline health workers who might best benefit. Healthlink had done this partly by linking production of materials with training courses. Getting health information to institutions and policy-makers was also seen to be important. There was a suggestion that subscriber databases might be linked in some way to avoid duplication. The `cascade system' was also discussed whereby materials were provided to information centres, and then distributed locally, but the problem was in identifying the right central places. The group also noted the importance of information exchange and South-South transfer of information, although one participant from the South noted that many southern health workers have a perception that information from the South is less reliable. What form should the information take? The group briefly discussed the roles of journals, books, radio, and electronic information. Internet connectivity remains almost entirely urban-based, though solar-powered IT equipment and satellite might make widespread rural use more feasible in the future. 2. What can we do to improve the quality and appropriateness of health information? Georgina Stock spoke about the development of the newsletter Practical Pharmacy, whose subscription base has increased to more than 2500 within 2-3 years, and will soon be available in French also. The newsletter is targeted to health workers with little or no special training in drug management. Regarding appropriateness, only the user can say it's appropriate – though people don't know what they haven't seen or experienced. Georgina worked in Tanzania with health workers for 2 years through VSO, which gave her a feel for what was needed. Characteristics of appropriateness of Practical Pharmacy include: relevant practical contents, easy to read, clearly illustrated, easily filed and photocopied. She has maintained a focus on the principles of drug management and on ways for health workers to implement change locally. Discussion Group 2 Health information should be easy to understand - simple, practical material that helps healthcare workers do their daily jobs more easily and more effectively. The text should be in a language appropriate to the target audience. Authors and editors need guidelines on writing styles to ensure ease of understanding . Information needs to be relevant to local circumstances – or at least adaptable to local circumstances. The target audience needs to be clearly defined to ensure that information is appropriate. As with printed information, Internet users need to be able to find reliable appropriate information easily and quickly. Internet information therefore needs to be searchable/filterable as appropriate to different target audiences. Appropriateness and quality are dependent on our understanding of healthcare workers' information wants and needs. At present, these needs are poorly understood. An increased demand for information, and feedback from users, would assist the process. More appropriate materials might be produced by planning and writing together with representatives of the target audience. We need to be ready to change our approach if necessary to respond to new understandings in healthcare workers information needs. 3. What can we do to improve demand for and use of health information? Pauline Monro described her work with healthcare workers in the Former Soviet Union and in the Neurology International Partnership Programme. She emphasized that the provision of information in itself is not enough. It is essential to understand the local situation to ensure both the relevance and appropriate recipients. In the FSU major problems arising from years of political pressures and isolation are lack of demand for reliable up-to-date information and a resistance to change away from outdated and potentially harmful medical practices, and poor ability to evaluate new information, including that provided by pharmaceutical companies. She felt one of the priorities is to identify potentially receptive people on the ground, people on the front line in health care, educators and those with influence, and to build supportive relationships with them so as to encourage openness to new ideas, and to motivate learning and implementation of evidence-based improvements in clinical practice, which can then serve as models. In this process observation of good medical practice can be the most effective means of information transfer, of motivating, and ensuring effectiveness of written information. Dr Monro emphasized that the aim of all health information provision is to improve health and medical care. in this process patients and relatives as well as health workers can be effective recipients of information. Discussion Group 3The group emphasized the need to identify and face the core problems before they could be in a position to promote demand for and use of health information. These problems include:
As health information providers, we require a greater understanding of the needs of the target audience. This is associated with a lack of understanding of the culture of the target audience, its politics, and its educational and healthcare systems. These vary both between countries and within countries. Sri Lanka was described as a national model of successful change from a didactic educational system to a participatory one. Much information is not being used or asked for because it has been/is of poor quality, is difficult to understand, or is in some other way inappropriate to the needs of the user. Often, information is not used because it is in a form that cannot be easily adapted to local needs. There is a need not only to exchange information with health workers, but also among and across the health information provider community. One participant suggested the Forum might hold a workshop to brainstorm ways of improving exchange of information among and about ourselves. It was noted that both the World Health Organization and the World Bank were now looking more seriously at ways of improving access to health information in developing and transitional countries. It was suggested that we might invite representatives to the Forum. One participant found the talks section particularly useful as a way of describing our activities to one another. Another felt the talks might have been shorter, or two instead of three, to allow more time for discussion. Participants were invited to make comments and suggestions for future meetings of the Forum. These included:
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