DOI: 10.1111/hir.12086
Learning and Teaching in Action
Abstract In this feature, guest writer Kondwani Wella presents an overview of his PhD – a study which investigated the information experience of serodiscordant couples with HIV and AIDS in Malawi. In particular, for this article, he considers the information behaviour of people who need HIV- and AIDS-specific information and the role of the librarian in helping to deliver what is needed to support engagement in relevant learning. H.S.
Keywords: access to information; Africa, South; communicable diseases; consumer health information; health information needs; information literacy; information seeking behaviour; learning; patient education
The information experience and learning needs of couples living with HIV in Malawi Kondwani Wella Guest Writer Information School, University of Sheffield, Regent Court, Sheffield, S1 4DP, UK [email protected]
Introduction For many years, HIV and AIDS have been a public health concern in Malawi and Africa affecting social–economic development. According to the Malawi Government,1 the first HIV case was diagnosed in Malawi at Kamuzu Central Hospital in Lilongwe in 1985. The 2010 Malawi Demographic and Health Survey (MDHS) reported that 11% of adults aged 15–49 in Malawi were infected with HIV. The survey further indicated that from women and men of the same age group,
13% of women and 8% of men2 were infected. In the absence of a cure for HIV, information plays a pivotal and fundamental role in influencing behaviour change in people and helping them to learn about their condition. Although the 2010 Malawi Demographic and Health Survey showed that there was universal awareness of HIV and AIDS in Malawi, several studies have indicated that this did not translate into behaviour change.1–3 In a report to the United Nations Joint Programme on HIV/AIDS, the Malawi Government1 reported that 80% of new HIV infections occurred among partners in stable heterosexual relationships, and it identified discordance as the second most important driver of the HIV pandemic in Malawi. The Malawi Government1 further stated that persons with higher educational qualifications in Malawi were the ones who were at greater risk of contracting HIV and yet they were the ones who were more knowledgeable about HIV including how it is transmitted and prevented. Working as a librarian in the University of Malawi, Kamuzu College of Nursing offered me an opportunity to experience first-hand the challenges of consumer access to health information for the purposes of learning about HIV and AIDS. Most health information is available in English and only in some cases translated into local languages. In addition, the cost of publication makes it impossible for the Malawi Government to make the most of the information widely available to consumers. In this study, a different approach to disseminating HIV and AIDS information is considered. Based on the results of the PhD study, it is argued that HIV and AIDS information services need to go beyond delivering information to target audiences by beginning to engage them and use their feedback in the design and dissemination.
© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Journal Health Information & Libraries Journal, 31, pp. 325–329
325
326
Learning and Teaching in Action
The missing piece in the jigsaw In the absence of a HIV vaccine, HIV and AIDS information is the most effective tool that can be used to fight the HIV pandemic. It plays a fundamental and powerful role in helping people to achieve information health to learn about and manage their condition. In Uganda, Albright, Kawooya and Hoff4 found that effective HIV and AIDS information interventions have the potential to change people’s behaviour and reduce the spread of HIV. However, the ability to design successful HIV and AIDS information campaigns is highly dependent on knowledge of the people’s information behaviour. Accordingly, there is a need for good understanding of information behaviour of specific groups of people affected and infected by HIV including serodiscordant couples. I know, based on my knowledge from working in the library and information profession in Malawi, that HIV and AIDS information materials are designed with expert knowledge from all other relevant professions except librarians. I believe that this is the missing piece in the HIV and AIDS information campaign jigsaw puzzle. HIV and AIDS information is designed by ‘experts’ and delivered to passive recipients. Unless we understand the information dynamics on the receiving end and feed those back into the design process, HIV and AIDS information will not achieve the intended behaviour changes through the facilitation of key learning. It was therefore imperative to investigate how serodiscordant couples experience HIV and AIDS information. Serodiscordant couples were chosen as a study group because the World Health Organization identified this group as the most neglected in HIV intervention programmes.5 In addition, the Malawi Government in 2012 and the World Health Organization in 2009 stated that 80 per cent of new HIV infections were occurring in heterosexual serodiscordant couples.1,5 But what shape is this missing jigsaw piece? Most HIV and AIDS information campaigns use mass media models to design and deliver information to target populations. However, as stated by Albright,6 these fail because of the wide
range of information needs and processes through which individuals go to learn and make sense of their worlds. To answer this question, I set out to investigate how serodiscordant couples experience HIV and AIDS information. Serodiscordant couples are couples where only one partner is HIV positive. Phenomenological in-depth interviews were used to invite serodiscordant couples to describe how they experience HIV and AIDS information. The interview data were analysed using Van Manen’s approach to analysis of phenomenological data to come up with descriptions and interpretations of the experiences. The sample Data for the study were collected between September and October 2013 in Lilongwe and Dedza districts in Malawi. Twenty-one serodiscordant couples (42 participants) and three participants who had separated from their partners were interviewed. 10 couples had the female partner HIV positive, and 11 had the male partner HIV positive. Two of the couples that had separated had the male partner HIV positive. The challenges of accessing HIV and AIDS information for serodiscordant couples A reflection on the emerging results of the study indicates that serodiscordant couples in Malawi face many challenges when accessing HIV and AIDS information. Serodiscordant couples need HIV and AIDS information to learn and make critical decisions about their health and relationships. In this study, serodiscordant couples often reported that information about serodiscordance was rare and superficial. In addition, serodiscordance itself is a challenge: the two partners have different learning and information requirements. On one hand, the HIVpositive partner needs information to learn how to manage the HIV and AIDS and prevent transmission to their spouse. On the other hand, the HIV-negative partner needs information to learn how to remain negative. In addition, as a carer, the HIV-negative partner needs information
© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Journal Health Information & Libraries Journal, 31, pp. 325–329
Learning and Teaching in Action
to learn how to assist in caring safely for their HIV-positive spouse. As people in a marriage union, some couples wanted to seek HIV and AIDS information so they were able to learn together. This was not always possible as the HIV-negative partner was considered ‘a spy’ at HIV and AIDS support group meetings. By default, one had to be HIV positive to be eligible for membership to HIV and AIDS support groups. Therefore, it was out of the ordinary for someone who was HIV negative to be accepted. This was a source of frustration for most serodiscordant couples. In Malawi, libraries are not used by consumers for information. A study by Kaunda7 found that public libraries are only used by students and unemployed people searching for jobs. Consistent with this finding, serodiscordant couples interviewed in this study did not mention libraries as sources of HIV and AIDS information. Although serodiscordant couples were aware that reliable HIV and AIDS information could be obtained from the hospital, they chose to seek information from other sources. Gombachika, Chirwa, Malata and Maluwa8 reported that couples living with HIV in Malawi avoided hospitals as sources of HIV and AIDS information because of the unwelcoming attitude of health workers. Another barrier to accessing HIV and AIDS information and learning for serodiscordant couples was illiteracy. DeWalt, Berkman, Sheridan, Lohr and Pignone9 state that people with low reading ability generally have low levels of health knowledge and consequently poor health outcomes. In Malawi, with the literacy rate at 65%,10 some couples are not able to read printed HIV and AIDS information. Gombachika, Chirwa, Malata and Maluwa8 noted that lack of literacy skills to read written media communicating HIV and AIDS, and reproductive health issues, was a barrier to accessing information in Malawi and hinders important learning processes. A further barrier is the language used as a medium of communication. Kamwendo11 noted that although Malawi is linguistically categorised as English-speaking, the majority of people cannot competently read or write that language. Therefore, English is not the best medium for communicating HIV and AIDS information or as
an aid to learning. This means that HIV and AIDS information, which is largely available in English, is translated into local languages. The problems of translating HIV and AIDS information have been widely addressed in literature. In her study, Namyalo,12 referring to Luganda, noted that there is unstable development of HIV and AIDS terminology in African languages. While appreciating that this is characteristic of the development of terminology in any language, Namyalo argues that this is undesirable for HIV and AIDS terminology where there is an urgency for HIV and AIDS information to combat the pandemic. On the other hand, Kamwendo11 observed that there was lack of culturally appropriate HIV and AIDS terminologies in Malawian languages. Some of the couples interviewed in the study said that some HIV and AIDS messages are obscene. These couples, who were mostly of the older generation, referred to their past when explicit information like that concerning HIV and AIDS was shared in private. Where do serodiscordant couples find information? Because of their different HIV statuses, serodiscordant couples face complicated health issues that require access to correct and update HIV and AIDS information. Particularly as HIV and AIDS information is a hot topic in public conversation, there is a big interaction between correct and authentic information from formal sources and incorrect opinionated information from informal sources. Within their communities, serodiscordant couples obtain HIV and AIDS information and learn from their peers. This information is either encountered or actively sought. Gombachika, Chirwa, Malata and Maluwa8 reported that couples living with HIV in Malawi obtained HIV and AIDS information from media, kin, peers and health workers. As part of marriage rites, couples were given information in traditional fora. Among other things, the information provided addressed HIV and reproductive issues. Gombachika, Chirwa, Malata and Maluwa8 also reported that all couples were
© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Journal Health Information & Libraries Journal, 31, pp. 325–329
327
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Learning and Teaching in Action
aware that information from the hospital was a reliable source for HIV and reproductive healthrelated information. However, when seeking HIV and AIDS information, couples went to peers and not to the hospital. In such cases, an information literate person would not be able to identify more reliable sources and choose which to use depending on their need. The process of accessing information has physical, intellectual and social aspects.13 Furthermore, it is an individual and interpersonal process, and most of the time affected by socioeconomic status, knowledge, skills and perceptions of the information seeker.13,14 Sligo and Jameson15 contend that people favour and learn from information that is validated and accepted by their communities. With respect to serodiscordant couples in this particular study, without information literacy skills, they believed incorrect HIV and AIDS information. Consistent with Gombachika, Chirwa and Maluwa’s findings,8 serodiscordant couples believed myths perpetuated by peers in their communities. Most HIV and AIDS information services in Malawi are designed without knowledge about the information behaviour and learning habits of the target populations. As a result, information needs of the recipients of HIV and AIDS information are not taken into consideration. Implications for practice Although policy makers and practitioners in Malawi are aware that health education and essential learning from HIV information is an indispensable component of the fight against the HIV pandemic, their focus seems to be more on getting information to the people and not the information-related dynamics or learning habits that drive behaviour change. As already noted, the World Health Organization identified that serodiscordant couples were neglected in HIV and AIDS interventions.5 This study has shown that the neglect includes lack of attention to their information and learning needs. As a result, serodiscordant couples use
general HIV and AIDS information which does not adequately address serodiscordance. Provision of HIV and AIDS information to people living with HIV in general, and specifically serodiscordant couples should follow specific information standards. For instance in UK, information standards ensure that health information, including HIV and AIDS information, is balanced, evidence-based, user-tested and regularly reviewed. Every organisation that produces and disseminates health information is certified using these set standards.16 If similar standards were adopted in Malawi, this would ensure that there is a user feedback loop in HIV and AIDS information design and delivery models. The feedback from the target audience would make sure that information designed is relevant to their learning needs. This could effectively be implemented if the expertise of librarians was utilised. Libraries in Malawi are viewed as services that support academic and research programmes. Therefore, librarians only work within the parent institutions. In institutions that have community outreach programmes, librarians only attend to the information needs of staff going to work in the community. Librarians, however, have the fundamental skills to facilitate the learning that is necessary to achieve information health (and therefore good physical health) in people affected by HIV and AIDS. Based on the results of this study, it is proposed that librarians should be part of front line staff working in communities and taking leadership of information components of health outreach programmes. The absence of information services for serodiscordant couples is highlighted in the following interview excerpt: ‘For me to travel to where that book is found it is expensive because it is not available at our clinic here, it is only available at The Lighthouse Clinic. I wish I had that book in my home. If those books were made available to all people they know have this problem we would not have all these problems’ (HIV+ Female partner, Couple #3) Therefore, librarians need to reach out to people for whom access to information and learning is, quite literally, a matter of life and death.
© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Journal Health Information & Libraries Journal, 31, pp. 325–329
Learning and Teaching in Action
Acknowledgements Kondwani Wella is a Commonwealth Scholar, funded by the UK government. The PhD is supervised by Ms Sheila Webber and Prof. Philippa Levy. References 1 Malawi Government. 2012 Global AIDS Response Progress Report: Malawi Country Report for 2010 and 2011. Malawi Government: Lilongwe, Malawi, 2012. 2 National Statistical Office (NSO) and ICF Macro. Malawi Demographic and Health Survey 2010. Zomba, Malawi, and Calverton, Maryland: NSO and ICF Macro, 2011. 3 Malawi National Aids Commission. Malawi Biological and Behavioral Surveillance survey 2006 and Comparative Analysis of 2004 BSS and 2006 BBSS2007. Lilongwe, Malawi: National AIDS Commission, 2006. 4 Albright, K., Kawooya, D. & Hoff, J. Information vaccine: Information and Uganda’s reduction of HIV/AIDS. In: Mcharazo, A. & Koopman, S. (eds). Librarianship as a Bridge to an Information and Knowledge Society in Africa. K.G. Saur: Munchen, Germany, 2007. 5 World Health Organisation and Joint United Nations Programme on HIV/AIDS. AIDS Epidemic Update 2009. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2009. 6 Albright, K. HIV/AIDS Information Seeking and Healthcare Communications in Sub-Saharan Africa, In World Library and Information Congress: 73rd IFLA General Conference and Council. South Africa, Durban, 2007: 1–13. 7 Kaunda, S. G. Assessing service expectation and perception of public library users: towards development of user needs and user satisfaction measurement instruments for the national library service of Malawi. Information and Knowledge Management 2013, 3, 30–41. 8 Gombachika, B. C., Chirwa, E., Malata, A. & Maluwa, A. Sources of information on HIV and sexual and reproductive health for couples living with HIV in rural southern Malawi. AIDS Research and Treatment, 2013, 2013, 1–11. 9 DeWalt, D. A., Berkman, N. D., Sheridon, S.Lohr, K. N. & Pignone, M. P. Literacy and health outcomes. Journal of General Internal Medicine 2004, 19, 1228–1239.
10 Malawi Government. Integrated Household Survey 2010– 2011: Household Socio-economic Characteristics Report. National Statistical Office of Malawi: Zomba, Malawi, 2012. 11 Kamwendo, G. H. ‘But having small houses spreads HIV’: problems of language and communication in health services in sub-Saharan Africa. In: International Conference on Globalisation and Languages: Building on Our Rich Heritage. Tokyo, Japan, 2008. 12 Namyalo, S. Challenges of translating and disseminating HIV/AIDS messages in a multilingual and multicultural nation: the case of Uganda. In: HIV/AIDS Communication Facing African Multilingualism: Exploratory Workshop. 16– 20 November 2010. Switzerland: University of Lausanne, 2010. 13 Burnett, G., Jaeger, P. T. & Thompson, K. M. Normative behavior and information: the social aspects of information access. Library & Information Science Research 2008, 30, 56–66. 14 Huber, J. T. & Cruz, J. M. Information needs and information-seeking behaviors of HIV positive men and women. Medical Reference Services Quarterly 2000, 19, 39–48. 15 Sligo, F. X. & Jameson, A. M. The knowledge - behavior gap in use of health information. Journal of the American Society for Information Science 2000, 51, 858–869. 16 The Information Standard. What is the Information Standard? 2014. Accessible at: www.theinformationstandard.org (Accessed 12 August 2014).
For details on how to contribute to this feature please contact: Hannah Spring Senior Lecturer: Research and Evidence Based Practice Faculty of Health and Life Sciences York St John University Lord Mayor’s Walk York YO31 7EX, UK Tel: +01904 876813 E-mail: [email protected]
© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Journal Health Information & Libraries Journal, 31, pp. 325–329
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Learning and Teaching in Action
Abstract In this feature, guest writer Kondwani Wella presents an overview of his PhD – a study which investigated the information experience of serodiscordant couples with HIV and AIDS in Malawi. In particular, for this article, he considers the information behaviour of people who need HIV- and AIDS-specific information and the role of the librarian in helping to deliver what is needed to support engagement in relevant learning. H.S.
Keywords: access to information; Africa, South; communicable diseases; consumer health information; health information needs; information literacy; information seeking behaviour; learning; patient education
The information experience and learning needs of couples living with HIV in Malawi Kondwani Wella Guest Writer Information School, University of Sheffield, Regent Court, Sheffield, S1 4DP, UK [email protected]
Introduction For many years, HIV and AIDS have been a public health concern in Malawi and Africa affecting social–economic development. According to the Malawi Government,1 the first HIV case was diagnosed in Malawi at Kamuzu Central Hospital in Lilongwe in 1985. The 2010 Malawi Demographic and Health Survey (MDHS) reported that 11% of adults aged 15–49 in Malawi were infected with HIV. The survey further indicated that from women and men of the same age group,
13% of women and 8% of men2 were infected. In the absence of a cure for HIV, information plays a pivotal and fundamental role in influencing behaviour change in people and helping them to learn about their condition. Although the 2010 Malawi Demographic and Health Survey showed that there was universal awareness of HIV and AIDS in Malawi, several studies have indicated that this did not translate into behaviour change.1–3 In a report to the United Nations Joint Programme on HIV/AIDS, the Malawi Government1 reported that 80% of new HIV infections occurred among partners in stable heterosexual relationships, and it identified discordance as the second most important driver of the HIV pandemic in Malawi. The Malawi Government1 further stated that persons with higher educational qualifications in Malawi were the ones who were at greater risk of contracting HIV and yet they were the ones who were more knowledgeable about HIV including how it is transmitted and prevented. Working as a librarian in the University of Malawi, Kamuzu College of Nursing offered me an opportunity to experience first-hand the challenges of consumer access to health information for the purposes of learning about HIV and AIDS. Most health information is available in English and only in some cases translated into local languages. In addition, the cost of publication makes it impossible for the Malawi Government to make the most of the information widely available to consumers. In this study, a different approach to disseminating HIV and AIDS information is considered. Based on the results of the PhD study, it is argued that HIV and AIDS information services need to go beyond delivering information to target audiences by beginning to engage them and use their feedback in the design and dissemination.
© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Journal Health Information & Libraries Journal, 31, pp. 325–329
325
326
Learning and Teaching in Action
The missing piece in the jigsaw In the absence of a HIV vaccine, HIV and AIDS information is the most effective tool that can be used to fight the HIV pandemic. It plays a fundamental and powerful role in helping people to achieve information health to learn about and manage their condition. In Uganda, Albright, Kawooya and Hoff4 found that effective HIV and AIDS information interventions have the potential to change people’s behaviour and reduce the spread of HIV. However, the ability to design successful HIV and AIDS information campaigns is highly dependent on knowledge of the people’s information behaviour. Accordingly, there is a need for good understanding of information behaviour of specific groups of people affected and infected by HIV including serodiscordant couples. I know, based on my knowledge from working in the library and information profession in Malawi, that HIV and AIDS information materials are designed with expert knowledge from all other relevant professions except librarians. I believe that this is the missing piece in the HIV and AIDS information campaign jigsaw puzzle. HIV and AIDS information is designed by ‘experts’ and delivered to passive recipients. Unless we understand the information dynamics on the receiving end and feed those back into the design process, HIV and AIDS information will not achieve the intended behaviour changes through the facilitation of key learning. It was therefore imperative to investigate how serodiscordant couples experience HIV and AIDS information. Serodiscordant couples were chosen as a study group because the World Health Organization identified this group as the most neglected in HIV intervention programmes.5 In addition, the Malawi Government in 2012 and the World Health Organization in 2009 stated that 80 per cent of new HIV infections were occurring in heterosexual serodiscordant couples.1,5 But what shape is this missing jigsaw piece? Most HIV and AIDS information campaigns use mass media models to design and deliver information to target populations. However, as stated by Albright,6 these fail because of the wide
range of information needs and processes through which individuals go to learn and make sense of their worlds. To answer this question, I set out to investigate how serodiscordant couples experience HIV and AIDS information. Serodiscordant couples are couples where only one partner is HIV positive. Phenomenological in-depth interviews were used to invite serodiscordant couples to describe how they experience HIV and AIDS information. The interview data were analysed using Van Manen’s approach to analysis of phenomenological data to come up with descriptions and interpretations of the experiences. The sample Data for the study were collected between September and October 2013 in Lilongwe and Dedza districts in Malawi. Twenty-one serodiscordant couples (42 participants) and three participants who had separated from their partners were interviewed. 10 couples had the female partner HIV positive, and 11 had the male partner HIV positive. Two of the couples that had separated had the male partner HIV positive. The challenges of accessing HIV and AIDS information for serodiscordant couples A reflection on the emerging results of the study indicates that serodiscordant couples in Malawi face many challenges when accessing HIV and AIDS information. Serodiscordant couples need HIV and AIDS information to learn and make critical decisions about their health and relationships. In this study, serodiscordant couples often reported that information about serodiscordance was rare and superficial. In addition, serodiscordance itself is a challenge: the two partners have different learning and information requirements. On one hand, the HIVpositive partner needs information to learn how to manage the HIV and AIDS and prevent transmission to their spouse. On the other hand, the HIV-negative partner needs information to learn how to remain negative. In addition, as a carer, the HIV-negative partner needs information
© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Journal Health Information & Libraries Journal, 31, pp. 325–329
Learning and Teaching in Action
to learn how to assist in caring safely for their HIV-positive spouse. As people in a marriage union, some couples wanted to seek HIV and AIDS information so they were able to learn together. This was not always possible as the HIV-negative partner was considered ‘a spy’ at HIV and AIDS support group meetings. By default, one had to be HIV positive to be eligible for membership to HIV and AIDS support groups. Therefore, it was out of the ordinary for someone who was HIV negative to be accepted. This was a source of frustration for most serodiscordant couples. In Malawi, libraries are not used by consumers for information. A study by Kaunda7 found that public libraries are only used by students and unemployed people searching for jobs. Consistent with this finding, serodiscordant couples interviewed in this study did not mention libraries as sources of HIV and AIDS information. Although serodiscordant couples were aware that reliable HIV and AIDS information could be obtained from the hospital, they chose to seek information from other sources. Gombachika, Chirwa, Malata and Maluwa8 reported that couples living with HIV in Malawi avoided hospitals as sources of HIV and AIDS information because of the unwelcoming attitude of health workers. Another barrier to accessing HIV and AIDS information and learning for serodiscordant couples was illiteracy. DeWalt, Berkman, Sheridan, Lohr and Pignone9 state that people with low reading ability generally have low levels of health knowledge and consequently poor health outcomes. In Malawi, with the literacy rate at 65%,10 some couples are not able to read printed HIV and AIDS information. Gombachika, Chirwa, Malata and Maluwa8 noted that lack of literacy skills to read written media communicating HIV and AIDS, and reproductive health issues, was a barrier to accessing information in Malawi and hinders important learning processes. A further barrier is the language used as a medium of communication. Kamwendo11 noted that although Malawi is linguistically categorised as English-speaking, the majority of people cannot competently read or write that language. Therefore, English is not the best medium for communicating HIV and AIDS information or as
an aid to learning. This means that HIV and AIDS information, which is largely available in English, is translated into local languages. The problems of translating HIV and AIDS information have been widely addressed in literature. In her study, Namyalo,12 referring to Luganda, noted that there is unstable development of HIV and AIDS terminology in African languages. While appreciating that this is characteristic of the development of terminology in any language, Namyalo argues that this is undesirable for HIV and AIDS terminology where there is an urgency for HIV and AIDS information to combat the pandemic. On the other hand, Kamwendo11 observed that there was lack of culturally appropriate HIV and AIDS terminologies in Malawian languages. Some of the couples interviewed in the study said that some HIV and AIDS messages are obscene. These couples, who were mostly of the older generation, referred to their past when explicit information like that concerning HIV and AIDS was shared in private. Where do serodiscordant couples find information? Because of their different HIV statuses, serodiscordant couples face complicated health issues that require access to correct and update HIV and AIDS information. Particularly as HIV and AIDS information is a hot topic in public conversation, there is a big interaction between correct and authentic information from formal sources and incorrect opinionated information from informal sources. Within their communities, serodiscordant couples obtain HIV and AIDS information and learn from their peers. This information is either encountered or actively sought. Gombachika, Chirwa, Malata and Maluwa8 reported that couples living with HIV in Malawi obtained HIV and AIDS information from media, kin, peers and health workers. As part of marriage rites, couples were given information in traditional fora. Among other things, the information provided addressed HIV and reproductive issues. Gombachika, Chirwa, Malata and Maluwa8 also reported that all couples were
© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Journal Health Information & Libraries Journal, 31, pp. 325–329
327
328
Learning and Teaching in Action
aware that information from the hospital was a reliable source for HIV and reproductive healthrelated information. However, when seeking HIV and AIDS information, couples went to peers and not to the hospital. In such cases, an information literate person would not be able to identify more reliable sources and choose which to use depending on their need. The process of accessing information has physical, intellectual and social aspects.13 Furthermore, it is an individual and interpersonal process, and most of the time affected by socioeconomic status, knowledge, skills and perceptions of the information seeker.13,14 Sligo and Jameson15 contend that people favour and learn from information that is validated and accepted by their communities. With respect to serodiscordant couples in this particular study, without information literacy skills, they believed incorrect HIV and AIDS information. Consistent with Gombachika, Chirwa and Maluwa’s findings,8 serodiscordant couples believed myths perpetuated by peers in their communities. Most HIV and AIDS information services in Malawi are designed without knowledge about the information behaviour and learning habits of the target populations. As a result, information needs of the recipients of HIV and AIDS information are not taken into consideration. Implications for practice Although policy makers and practitioners in Malawi are aware that health education and essential learning from HIV information is an indispensable component of the fight against the HIV pandemic, their focus seems to be more on getting information to the people and not the information-related dynamics or learning habits that drive behaviour change. As already noted, the World Health Organization identified that serodiscordant couples were neglected in HIV and AIDS interventions.5 This study has shown that the neglect includes lack of attention to their information and learning needs. As a result, serodiscordant couples use
general HIV and AIDS information which does not adequately address serodiscordance. Provision of HIV and AIDS information to people living with HIV in general, and specifically serodiscordant couples should follow specific information standards. For instance in UK, information standards ensure that health information, including HIV and AIDS information, is balanced, evidence-based, user-tested and regularly reviewed. Every organisation that produces and disseminates health information is certified using these set standards.16 If similar standards were adopted in Malawi, this would ensure that there is a user feedback loop in HIV and AIDS information design and delivery models. The feedback from the target audience would make sure that information designed is relevant to their learning needs. This could effectively be implemented if the expertise of librarians was utilised. Libraries in Malawi are viewed as services that support academic and research programmes. Therefore, librarians only work within the parent institutions. In institutions that have community outreach programmes, librarians only attend to the information needs of staff going to work in the community. Librarians, however, have the fundamental skills to facilitate the learning that is necessary to achieve information health (and therefore good physical health) in people affected by HIV and AIDS. Based on the results of this study, it is proposed that librarians should be part of front line staff working in communities and taking leadership of information components of health outreach programmes. The absence of information services for serodiscordant couples is highlighted in the following interview excerpt: ‘For me to travel to where that book is found it is expensive because it is not available at our clinic here, it is only available at The Lighthouse Clinic. I wish I had that book in my home. If those books were made available to all people they know have this problem we would not have all these problems’ (HIV+ Female partner, Couple #3) Therefore, librarians need to reach out to people for whom access to information and learning is, quite literally, a matter of life and death.
© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Journal Health Information & Libraries Journal, 31, pp. 325–329
Learning and Teaching in Action
Acknowledgements Kondwani Wella is a Commonwealth Scholar, funded by the UK government. The PhD is supervised by Ms Sheila Webber and Prof. Philippa Levy. References 1 Malawi Government. 2012 Global AIDS Response Progress Report: Malawi Country Report for 2010 and 2011. Malawi Government: Lilongwe, Malawi, 2012. 2 National Statistical Office (NSO) and ICF Macro. Malawi Demographic and Health Survey 2010. Zomba, Malawi, and Calverton, Maryland: NSO and ICF Macro, 2011. 3 Malawi National Aids Commission. Malawi Biological and Behavioral Surveillance survey 2006 and Comparative Analysis of 2004 BSS and 2006 BBSS2007. Lilongwe, Malawi: National AIDS Commission, 2006. 4 Albright, K., Kawooya, D. & Hoff, J. Information vaccine: Information and Uganda’s reduction of HIV/AIDS. In: Mcharazo, A. & Koopman, S. (eds). Librarianship as a Bridge to an Information and Knowledge Society in Africa. K.G. Saur: Munchen, Germany, 2007. 5 World Health Organisation and Joint United Nations Programme on HIV/AIDS. AIDS Epidemic Update 2009. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2009. 6 Albright, K. HIV/AIDS Information Seeking and Healthcare Communications in Sub-Saharan Africa, In World Library and Information Congress: 73rd IFLA General Conference and Council. South Africa, Durban, 2007: 1–13. 7 Kaunda, S. G. Assessing service expectation and perception of public library users: towards development of user needs and user satisfaction measurement instruments for the national library service of Malawi. Information and Knowledge Management 2013, 3, 30–41. 8 Gombachika, B. C., Chirwa, E., Malata, A. & Maluwa, A. Sources of information on HIV and sexual and reproductive health for couples living with HIV in rural southern Malawi. AIDS Research and Treatment, 2013, 2013, 1–11. 9 DeWalt, D. A., Berkman, N. D., Sheridon, S.Lohr, K. N. & Pignone, M. P. Literacy and health outcomes. Journal of General Internal Medicine 2004, 19, 1228–1239.
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