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Libri

International Journal of Libraries and Information Studies

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Volume 67, Issue 1

Issues

An Integrated Framework for Disseminating Health Information to Students in Zimbabwe

Thomas Matingwina
  • Corresponding author
  • Library and Information Science, National University of Science and Technology, Box AC 939 Ascot, Bulawayo, Zimbabwe
  • Library and Information Studies Centre, University of Cape Town, Level 6, Chancellor Oppenheimer Library Private Bag X3 Rondebosch, Cape Town, Western Cape 7701, South Africa
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/ Jaya Raju
  • Library and Information Studies Centre, University of Cape Town, Level 6, Chancellor Oppenheimer Library Private Bag X3 Rondebosch, Cape Town, Western Cape 7701, South Africa
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Published Online: 2017-02-24 | DOI: https://doi.org/10.1515/libri-2016-0054

Abstract

University students in Zimbabwe lack immediate access to accurate health information. There is lack of explicit and integrated structures for disseminating health information to students in Zimbabwe. Informed by the salutogenic theory of health, the study assessed the health information needs of students and evaluated existing health information dissemination methods at National University of Science and Technology (NUST), Zimbabwe, in developing a framework for disseminating health information. A case study strategy was used to gather data within the pragmatic paradigm of grounded constructivism. The findings reveal that students need health information on a wide range of health topics and prefer mobile electronic media, workshops, qualified health professionals and peers for their health needs. There are significant gaps between the strategies that are being used by NUST to disseminate health information and the health information needs of the students. Therefore, this paper proposes a needs-based, integrated information dissemination framework for promoting health amongst students. The proposed framework emphasizes utilization of synchronous information and communication technologies, the need for integration of activities, a viable policy, health information literacy training and the use of a mix of persuasion techniques as an effective health promotion strategy.

Keywords: health information dissemination; health information literacy; salutogenesis; Zimbabwe; university students

Introduction and Background

Young people in Zimbabwe used to receive information pertaining to their emotional and physical health from their extended families. Aunts, grandmothers and grandfathers used to play a pivotal role on matters such as relationships, sex, marriage and general well-being of young people (Mufanechiya and Mufanechiya 2011, 102). However, globalization coupled with the European educational system changed this social fabric. Most youths now spend most of their time in boarding schools, universities and colleges; this has widened the gap between young people and their parents and, therefore, youths in Zimbabwe no longer have immediate access to critical information on matters that define their wellbeing (Kim et al. 2001; Chibaya 2012).

The World Health Organisation (WHO) (2005), through the Bangkok Charter for Health Promotion, advocates settings-based approaches to health promotion. This has prompted the need for health promotion in universities and has given birth to the concept of health-promoting universities, which has been received well in the developed world (Leger 2006; Meier, Stock, and Krämer 2007; Shalin 2009). Of late, there has been a steady increase in health intervention programmes within African universities, with some universities establishing wellness centres and developing health information systems for students.

Although the concept of health-promoting universities has been widely adopted in the developed world, and has begun to take shape recently in Africa (Dooris 2001; Buor 2008), there has been little attention to university-based health intervention programmes in Zimbabwe. Moreover, documentation on the effectiveness of health promotion strategies in Zimbabwean universities is still poor (Lionis et al. 2006). Therefore, more research on different aspects of university-based programmes is necessary in order to explore possible unused potentials (Helleve et al. 2011, 847).

Studies that have been carried out in Zimbabwean universities reveal that students are confronted with a wide array of health problems that mainly include sexually transmitted illnesses, HIV and AIDS, as well as accommodation and financial problems, among others (Terry, Masvaure, and Gavin 2005; Chiparaushe, Mapako, and Makarau 2010; Savadye 2011; Zimbabwe National Statistics Agency 2011; Chibaya 2012). Therefore, the university should serve as a key life transition stage for young people exploring and experimenting away from parental influence (Dooris and Doherty 2010). However, universities in Zimbabwe have not done enough to address the health problems that affect students (Savadye 2011; Chibaya 2012).

Information dissemination is a key element in health promotion efforts. Disseminating health information can improve knowledge transfer from health professionals to the student population, and helps them to maintain and improve their health (Benigeri and Pluye 2003; World Health Organisation 2016). A significant number of studies have reported on the effectiveness of information dissemination in promoting health and preventing diseases (Appleby, Walshe, and Ham 1995; King, Hawe, and Wise 1998; Brener and Gowda 2001; Duggan and Banwell 2004; Robertson 2008; Jones and Cunningham-Williams 2016). However, studies reveal that isolated information dissemination efforts are not effective in addressing health problems (Hoffman and Jackson 2003; Garrard et al. 2004; Jackson et al. 2006; American College Health Association 2010). There is a need for coordinated effort in addressing students’ health needs in universities.

However, little attention has been given to holistic, integrated information-based health promotion strategies in Zimbabwe and studies that have been carried out tended to focus on disease-specific health promotion strategies (Terry, Masvaure, and Gavin 2005; Zimbabwe National Statistics Agency 2011). This paper therefore proposes a needs-based, integrated information dissemination framework for promoting health amongst students.

Problem Statement

University students lack immediate access to accurate health information (Kim et al. 2001; Dooris and Doherty 2010; Moumtzoglou 2016). Universities can play an important role in promoting healthy behaviours amongst students by providing them with reliable health information (Brener and Gowda 2001; Xiangyang et al. 2003). Therefore, universities need to offer comprehensive health information services to promote students’ physical and emotional health (WHO 2005; Savadye 2011). However, there is a lack of explicit and coordinated structures for disseminating health information in Zimbabwean universities. This scenario leads to a lack of accessibility to health information by students (El Kahi et al. 2012).

Study Aim and Objectives

The aim of the study was to develop an integrated framework for disseminating health information to undergraduate students, using the National University of Science and Technology (NUST) as a case study. The specific objectives were:

  • to establish the health information needs of undergraduate students at NUST;

  • to evaluate the health information practices at NUST; and

  • to develop a needs-based framework for disseminating health information to undergraduate students.

Literature Review

This section reviews literature related to the objectives of the study. The literature pertains to health information needs of students and health information dissemination practices within universities.

Health Information Needs

Fourie (2008) alluded to the fact that the concept of information needs is seldom clarified in most research reports. It seems there is still no consensus on the dimensions that make up an information need (Nicholas and Herman 2010). Case and Given (2016, 94) interposes that the concept of information need is rather awkward in that it is not easily observable. This article will not debate the concept in detail but will make some propositions on the concept, based on some inherent limitations and gaps around the concept.

The paradox in understanding the concepts also stems from the dichotomy between health sciences research and library and information science (LIS) research. Most studies carried out in the health sciences tend to view information needs from a content dimension; that is, health topics demanded by individuals (Davies et al. 2000; Kitzrow 2003; Timmins 2006; and Braun et al. 2007). Studies in the LIS field incorporate other dimensions of information-seeking behaviour and information sources (Ramasodi 2009; Baro, Onyenania, and Osaheni 2010; Fourie 2008, 2012; Westwood 2012; Greenberg and Bar-Ilana 2014; Otoide 2015).

This study views the concept of health information needs from a broader perspective. The study views health sources as an important dimension of information needs. In the context of health information, sources of health information play a significant role in the use and believability of the content (Kwan et al. 2010; Zullig, Reger-Nash, and Valois 2012). In other words, even if the content is relevant, it should be disseminated from the right source, in the right format, using the right channel to fully meet a health information need. It is therefore difficult to separate the concept of information needs from information sources. Clayton, Butow, and Tattersall (2005) cited the importance of sources in the provision of information regarding prognosis and end-of-life care. The study by Clayton, Butow and Tattersall (2005) noted the value of multimedia methods such as videos, drawings and booklets in caring for terminally ill cancer patients. Fourie (2008) also highlighted the importance of information sources by stating the importance of family members, social networks, gaming and multimedia approaches and important health information sources for cancer patients.

This paper argues that the concept of information behaviour and information needs are inseparable because information needs influence information behaviour. Miranda and Tarapanoff (2008) also argue that information needs and information competencies are inseparable concepts because individual skills such as searching for and evaluating information enable an individual to fully meet their needs. This entails that focusing on the content alone will not fully meet an individual’s information needs. In arguing for comprehensiveness in understanding information needs, Wilson (2006) asserts that “the ‘user’s life world’ can be defined as the totality of experiences centred upon the individual as an information user.”

Nicholas and Herman (2010) divided the concept of information need into two categories: information wants and information demands. They argue that information wants are a subjective expression of an information gap perceived by an individual, while information demands occur when an individual takes the necessary steps to seek information. All these arguments point to the inseparability of information needs and information behaviour. Case and Given (2016, 91) also support that the concept of information seeking is “closely tied to that of [information] need.”

This study builds upon the definition of information need that was proposed by Ormandy (2010), that is, an “information need is a recognition that your knowledge is inadequate to satisfy a goal that you have, within the context or situation that you find yourself at a specific point in time.” This definition puts into perspective the importance of goals, context, situation and time in understanding health information needs. The definition proposed by Ormandy is however built on the assumption that health information seekers always make a conscious decision to seek health information. This poses two problems; the first problem is that sometimes individuals may not realize that they have a health information need due to ignorance or that that need is already being met without the individual’s knowledge (Alzougool, Chang, and Gray 2008, 4). The second problem is that although individuals may recognize an information need, they may choose not to search for information due to fear (Lambert and Loiselle 2007, 682), anxiety and worry, lack of search skills and unavailability of information sources (Godbold 2006, 1014), or lack of time (Nicholas 2000).

This study therefore amalgamates the view of Ormandy (2010) that puts into perspective the importance of goals, context, situation and time, and the proposition of “unrecognized” health information needs (Wilson 1999; Alzougool, Chang, and Gray 2008; Fourie 2008; Nicholas and Herman 2010). Therefore, the proposed definition of a health information need is “an individual’s recognized or unrecognized knowledge and skill gap in health information seeking which can be actively or passively met, within a particular context, situation and time, using appropriate resources and skills.” This definition addresses the fact that health information needs may not be realized by individuals and that information seekers can passively receive health information to meet their information gaps (Dervin 1999). It also puts into perspective the importance of health information literacy and relevant information formats as important dimensions of a health information need (Miranda and Tarapanoff 2008).

Therefore, the concept of health information need in this study includes (i) specific recognized needs to solve existing health problems, including preferred information sources and (ii) unrecognized needs (needs related to information-seeking skills and those which are being unconsciously met). The researcher developed a conceptual model (Figure 1) to illustrate the dimensions of a health information need.

Dimensions of health information needs.
Figure 1:

Dimensions of health information needs.

The content dimension looks at the health topics (both recognized and unrecognized) of interest to individuals. The competencies dimension looks at the ability of individuals to search for and evaluate health information (knowledge, attitudes and abilities). The format dimension looks at individual preferences in terms of the media and channels used to convey health information.

A review of literature (Eisenberg, Golberstein, and Gollust 2007; Hunt and Eisenberg 2010; Austin et al. 2012; Rowe et al. 2012) revealed that health information needs (recognized and unrecognized) of undergraduate students can be broadly categorized into the following areas:

  • Information needs that relate to treatment of specific health problems

  • Information needs that relate to disease prevention and health promotion

  • Information needs related to health care providers and facilities

  • Information needs related to insurance coverage

  • Information needs that individuals already satisfy (e. g. from radio and television programmes)

  • Information needs related to health information sources

  • Information needs that relate to information competencies

Health Information Dissemination Practices within Universities

Yesus and Fantahun (2010, 89) found that universities are the most common source of health information amongst students and stressed the importance of campus-based health promotion programmes. Therefore, most universities have come up with methods of transferring health information to students. Student counselling services have been pivotal in providing counselling to students on a variety of health topics that include alcohol and drug treatment, eating disorders treatment, psychiatric services, psychological assessment and career counselling (Davenport 2009; Yesus and Fantahun 2010). The American College Health Association (2010) cites that university counselling services and student mental health issues have garnered considerable attention over the past several years.

Faculty members have traditionally played a key role in assisting students with stress. Staff members work closely with students and, as a result, they often get the first glimpse of students in distress (University of Maryland Counseling Center 2013). The Ohio State University Counseling and Consultation Service (2013) reports that students perceive faculty staff as individuals who can lend a helping hand or who can listen to their problems. Faculty members have been tasked with identifying problems that include behaviour posing a threat to the student, suicidal tendencies and inability to care for oneself. The staff members should provide adequate help through empathic listening, facilitating open discussion of problems, instilling hope, conveying acceptance and offering basic advice. However, faculty services are inadequate because, in some cases, students need professional help to overcome complex health problems and students need to be referred to professionals (Kwan et al. 2010; Zullig, Reger-Nash, and Valois 2012; University of Maryland Counseling Center 2013).

The Jed Foundation and Education Development Center (2011, 19) states that many campuses are using brochures and posters to address specific health problems. These traditional means of communicating health information are cost effective (Wakefield, Loken, and Hornik 2010). Posters have been successfully used by the University of Wisconsin-Oshkosh to increase student help-seeking (Jed Foundation and Education Development Center 2011, 19). Marshall and Stylianou (2010, 51) also argue that notice boards are an excellent way to promote health around the campus. They cite an example of using notice boards in promoting tobacco cessation: posters may be hung in campus buildings, designating them as tobacco-free or putting up posters showing the aging effects of smoking. This is an effective strategy because students may not make a conscious move to seek out health information.

The University of California Berkeley (2013) uses workshops as a way of promoting health amongst students. Peer educators and professional staff facilitate discussions and lead presentations. Presentation styles include personal testimonials, lectures, group discussion and interactive exercises. The workshops and presentations are available on a wide variety of health topics, including safer sex and sexual health, stress management, preventing sexual assault, intimate partner violence, and sexual harassment, among other health topics. The Duke Student Wellness Center (2013) also runs regular workshops on a variety of health topics. The staff and the students work together to run the workshops, with common topics requested by students being on alcohol abuse prevention, sexual health, and stress management.

Fitness and wellness courses have been seen as agents of change for modifying unhealthy lifestyles among college students (Kulinna et al. 2009, 128). This idea is also supported by Cardinal, Jacques and Levy (2002, 118), who declare that there is evidence that well-taught fitness and wellness classes have the potential to positively affect the attitudes and behaviours of the students that enrol in them. Kicklighter et al. (2010, 100–101) confirm that educational modules are an important tool for health information dissemination and behaviour change.

Peer education has proved to be a cost-effective method of promoting health in universities. White et al. (2009, 497) posit that peer health education is effective because peer health educators are in places that are inaccessible to university administrators and health professionals. The strength of peer education programmes was also highlighted by a study that was carried out by Boyle et al. (2011, 520), which revealed that peer educators also boosted the self-efficacy of students by enabling performance attainments, providing vicarious experience and delivering verbal persuasion.

Social marketing is a health promotion technique that involves the use of community members in collecting, analysing and disseminating health information. According to Maibach, Rothschild and Novelli (2002, 439), “the goal of social marketing is to change certain behaviours by influencing a target population’s voluntary health behaviours.” Social marketers attempt to change negative health behaviours and to reinforce positive health behaviours. Researchers have shown social marketing to be effective in the promotion of awareness and knowledge, especially among youths. Shive and Neyman (2006) evaluated a social marketing campaign and found out that the campaign significantly increased fruit intake by college students.

Web-based applications promising to radically change health information dissemination within universities include social media applications, blogs, wikis, Relatively Simple Syndication (RSS) feeds, podcasts, and Voice over Internet Protocol (VoIP) (Thackeray et al. 2008). A success story in the use of Web 2.0 technologies is the so-called “Life Café” at Kansas State University, which uses Web 2.0 information technologies as an awareness tool for the creation of protective factors against suicide, including a virtual student community (Shalin 2009).

Mobile phones are an effective tool for disseminating health information because they are cost effective (Riley, Obermayer, and Jean-Mary 2008; Sturges 2011). Text messaging is a cheap, fast and efficient method of transferring health information to the student population. Obermayer et al. (2004, 76) states that while websites require participants to seek out a computer with Internet access, text can be “pushed out” to users. A study that was carried out by Riley, Obermayer and Jean-Mary (2008, 24) indicates that mobile phone text messaging is a promising modality for delivering smoking cessation interventions to young adult smokers.

Applicable Information Dissemination Principles and Strategies

The Jed Foundation and Education Development Center (2011, 3) recommended that health information dissemination programmes should be prevention-focused in addition to being response-focused. This entails that the programme should include both proactive and reactive information dissemination channels; that is, they should cater for both recognized and unrecognized health information needs (Wilson 1999; Nicholas and Herman 2010; Case and Given 2016).

Dooris (2001, 6) is of the view that there should be clear integrated information dissemination systems in universities that allow for coordinated effort. On the same note, Leurs et al. (2005) proposed an integrated approach in developing an information dissemination model to improve school health promotion in the Netherlands. Tarhule (2005) used the integration approach to develop an information dissemination model for disseminating climate information. The Jed Foundation and Education Development Center (2011, 16) also believes that health promotion programmes should include a continuum of programmes. They believe that a combination of activities, policies and interventions synergistically working together is more likely to produce results than any single intervention. A key finding of Hoffman and Jackson’s (2003) review was that effective and cost-effective interventions for primary prevention of non-communicable disease used a combination of health promotion strategies at various levels in multiple settings.

Jackson et al. (2006) stressed that health promotion interventions are only effective when they are relevant to the context in which they are being used. This entails that they should be tailored to the unique needs of the users. Harmsworth, Turpin and the TQEF National Co-ordination Team (2000) support this view and argue that the most successful dissemination strategies will be those that actively engage users and deliver what the users both want and need. A dissemination policy is also a very effective and low-cost method of addressing issues of dissemination and utilization (NCDDR 2001, 3–4).

Research Philosophy, Strategy and Design

The study is based on the constructivist grounded theory (Charmaz 2003, 2006). This pragmatic ontological approach recognizes both absolute reality and multiple realities and multiple perspectives on these realities (Thornberg 2012). Baxter and Jack (2008, 545) highlight an advantage of this paradigm by asserting that it “recognizes the importance of the subjective human creation of meaning, but does not reject outright some notion of objectivity.” This approach allowed co-construction of the framework with the participants. The researcher used available literature and information dissemination principles (discussed later under the section on applicable principles in designing health information dissemination framework), together with the views of the participants to come up with a user-driven information dissemination framework. User participation has been viewed as an integral prerequisite for the development of effective information dissemination systems (Debbie 2003; Muhammad et al. 2011).

A case study strategy was used to gather data. The population comprised undergraduate students, the Dean of Students, the Student Counsellor and the Nursing Sister. A sample of 426 students and three members of staff participated in the study. Within-method triangulation with complementary data gathering instruments was used to improve reliability of data. Questionnaires and five focus group discussions were used to gather data from the students and staff members who participated in the interviews. A systematic review of the literature was also done to gather data on applicable principles and procedures for developing an information dissemination framework. Therefore, literature was used as “data.” Stratified random sampling was used to select the students from the Faculty of Applied Sciences, Faculty of the Built Environment, Faculty of Commerce, Faculty of Communication and Information Science, Faculty of Industrial Technology. The Dean of Students, the Student Counsellor and the Nursing Sister were purposively sampled. Attention was also given to ensure that the research sample size was large and representative enough to allow a generalization of the findings to the rest of Zimbabwean universities. The target was to ensure the generalization of research findings to the study population using a confidence level of 96 % and sampling error of 0.4.

Qualitative and quantitative content analysis was used to determine the confounding factors that informed the design of the framework. The data were supplemented with health information dissemination principles and procedures drawn from the literature. Data analysis was done using Statistical Package for Social Sciences (SPSS). Univariate analysis was used to calculate percentages for single variables for descriptive statistics. Bivariate analysis was used for the analysis of two variables for the purpose of determining the empirical relationship between them; for example, gender and health information needs. A non-parametric cross tabulation was done using Pearson’s Chi-Square to test statistical significance between certain research variables.

Data Presentation and Discussion

This section presents and discusses the findings on health information needs of undergraduate students, and health information dissemination practices at NUST.

Health Information Needs of Students

The results, presented in Table 1, indicate that although students require information on almost every health topic, the predominant topics are physical activity (89.9 %); access to health facilities (85.7 %); how to help others in distress (84.7 %); nutrition (82.9 %); HIV, AIDS and STI (80.5 %); and stress reduction (78.4 %). The least sought after topics are suicide prevention (47.7 %), and tobacco use (41 %). Table 1 shows the health topic needs of students, according to their level of demand. Studies that have been conducted in the developed world have stressed the need to provide information on emotional health and stress reduction (Sieben 2011; Repak 2013; Conley, Travers, and Bryant 2013). However, studies that have been carried out in Zimbabwe highlight that more information is needed on specific health problems, especially on HIV and AIDS, STIs and other sexual and reproductive health matters (Terry, Masvaure and Gavin 2005; Chiparaushe, Mapako, and Makarau 2010; Savadye 2011). Similarly, a study by Nwezeh (2008) at the Obafemi Awolowo University in Nigeria indicated that most of the respondents (90 %) required information on reproductive health issues such as unwanted pregnancies, sexually transmitted infections, use of contraceptives, and relationships.

Table 1:

Preferred health topics.

A cross tabulation of data on gender and preferred health topics using Pearson’s Chi-Square revealed that more females than males prefer information on nutrition. This means that females encounter more challenges on nutritional aspects than males. Similarly, a study that was carried out by Stock, Wille, and Krämer (2001) revealed that requests for information on healthy nutrition as well as on eating disorders were higher with female than with male students. Another similarity related to male students. The analysis revealed that more male students need information on alcohol and drug abuse than their female counterparts. A similar result was obtained in a study by Davies et al. (2000), which showed that alcohol and drug abuse is a favourite topic among male students. This result provides evidence that females need more information on nutrition and related issues, while male students need more information on alcohol and other drug-related health problems.

The findings indicate that overall, as depicted in Table 2, most students regard themselves as having average health information literacy skills, especially in searching for, understanding and evaluating health information. A few respondents considered themselves “excellent” in understanding, using, searching for and evaluating information. It was also interesting to note that a significant number, 130 (31 %) of the respondents consider themselves “good” in using health information and 125 (29 %) thought that they are “good” in searching for information. However, a significant number of respondents indicated that they are “poor” in searching for health information, 109 (25 %), evaluating health information, 101 (24 %), and using health information, 98 (23 %). However, a study that was carried out by Ickes and Cottrell (2010, 491) in the United States showed that university students had a high health literacy score of 93.83, which was considered satisfactory functional health literacy. The differences in the health literacy level could be attributable to the fact that the students that participated in the study by Ickes and Cottrell (2010) on health information literacy of students had been exposed to health information literacy training programmes.

Table 2:

Health information literacy skills.

In terms of health information sources, the results indicate that, generally, more students (46 %) (mean 1.54) prefer to consult a Nursing Sister for their health information needs, followed by peer educators 183 (43 %) and community health educators 183 (43 %). The least preferred source is the teaching staff, 65 (15 %) (mean 1.85). Students also highlighted during focus group discussions that they also prefer consulting their personal doctors and the Internet for health information. This supports the fact that students prefer health information from qualified health personnel. These results reveal a striking resemblance to the results of a study that was carried out by Kwan et al. (2010) at St. George campus at the University of Toronto, Canada. The study found that the most believable sources of health-related information were health centre medical staff (92 %) and health educators (90 %). A later study by Zullig, Reger-Nash, and Valois (2012) also found that the qualifications of the information providers influenced the choice of health information sources.

Students indicated that they prefer to receive health information electronically and through videos and text messaging. The results presented in Table 3 show that the mobile phone is the most preferred method for receiving health information, followed by workshops. The students cited that the Short Message Service (SMS) is a convenient means for receiving health information and for sending queries. The results support an observation that was made in a study carried out by Obermayer et al. (2004, 76), where it was found that most students preferred mobile phone text messaging and more interactive media to the university website in receiving and accessing health information.

Table 3:

Preferred media and channels.

Evaluation of Health Information Dissemination Practices

The findings from the interviews with the Student Counsellor and the Dean of Students indicated that NUST mainly uses the Student Counselling Department, departmental counselling services, the Nursing Sister, printouts (mainly posters and flyers), workshops, peer educators and sometimes mobile phones to disseminate health information. NUST is also actively engaging other key stakeholders from the health sector in the dissemination of health information on campus. The organizations that were mentioned include the National AIDS Council of Zimbabwe (NAC), Students and Youths Working on Reproductive Health Action Team (SAYWHAT), Population Services International (PSI), Medical Aid Societies, and qualified personnel from the Ministry of Health and Child welfare. The Dean of Students indicated that her department has established a resource centre where students can interact with key health practitioners from the government and the private sector.

Students preferred to receive health information from qualified health personnel. Several studies have highlighted the importance of professional counselling services in addressing students’ health needs (Davenport 2009; Misch 2009). The American College Health Association (2010, 583) states that “student counselling services have been pivotal in providing counselling to students on a variety of health topics.” It was interesting to note that students at NUST perceived peer educators as an important source of health information. Similarly, a study by White et al. (2009, 497) cites that peer health education is effective because peer health educators are more accessible than university administrators and health professionals. Boyle et al. (2011, 520) also revealed that peer educators boosted the self-efficacy of students by enabling performance attainments, providing vicarious experience and delivering verbal persuasion.

Evaluation of Information Sources

The study evaluated the information sources, the content, and the channels and media. The objective was to determine the overall information dissemination practices at NUST. These concepts of information sources, the content, and the channels and media were recommended by the National Center for the Dissemination of Disability Research (1996, 2001) as important constructs in viewing health information dissemination.

When the students were asked whether they have received health information from the university, a majority of them (53.1 %) indicated that they had not received any health information from NUST. The same sentiments were raised in the focus group discussions, whereby most students highlighted that they have not received any health-related information on campus.

The students were asked to evaluate the sources of information in terms of their accessibility, trustworthiness, competence, experience and sensitivity to user concerns. The results, depicted in Table 4, indicate that the majority of respondents regard the health information sources as “poor” in terms of accessibility and sensitivity to user concerns, and “average” in terms of trustworthiness, competence and experience. This means that the availability of information sources is not enough to address health needs of students if they are not visible. The results support findings of a study that was carried out by El Kahi et al. (2012), which revealed that most university students in Lebanon fail to utilize health facilities because of lack of awareness.

Table 4:

Evaluation of information sources.

Evaluation of Health Information Content

An evaluation of health information topics revealed significant gaps in content delivery. Students complained that NUST is disseminating information on a limited number of health topics. This means that NUST is not disseminating enough health information to students. This supports findings by Brener and Gowda (2001, 223) that only 6 % of American college students reported that they received health information on the topics that they needed. Similarly, a later American study by Kwan et al. (2010, 555) revealed that “nearly half (46 %) of the sample reported not receiving any information, whereas only 0.5 % received information on all health topics.”

NUST students were asked to evaluate the health information content in terms of its accuracy, comprehensiveness, relevance, simplicity and cost-effectiveness. It was interesting to note that a significant number of respondents 179 (42 %) regarded the content as “poor” in terms of its accuracy. The results in Table 5 show that the majority of the respondents perceive the content as “average” in comprehensiveness, relevance, simplicity and cost-effectiveness.

Table 5:

Evaluation of content.

Evaluation of Channels and Media

The findings of this study show that students prefer to receive health information electronically and through videos. Printouts and audio were the least preferred methods for receiving health information. However, NUST mainly uses posters and notice boards to disseminate health information. This scenario is clear evidence that NUST is not consulting users in the design and implementation of its health promotion programmes. This is in contrast to the information dissemination principle of user-centred design and involvement (Harmsworth and Turpin 2000; Jackson et al. 2006).

The study evaluated the existing channels and media to identify their strengths and weaknesses in disseminating health information. Evaluation of the media was done in line with their capacity to reach the intended audience, accessibility and ease of use, timeliness, reliability, flexibility, user-friendliness, cost-effectiveness, and clarity and attractiveness of the information “package.” The findings presented in Table 6 reveal that the majority of respondents view the media and channels as “poor” in almost all the areas, except in the areas of flexibility and cost-effectiveness, where the majority thought they are “average”. This supports an observation made by El Kahi et al. (2012) that lack of explicit and accessible information dissemination strategies makes health information dissemination within universities less cost-effective.

Table 6:

Evaluation of channels and media.

Applicable Principles in Designing a Health Information Dissemination Framework

The results showed that the most popular health information dissemination principle is the need to use synchronous Information and Communication Technologies (ICTs) in disseminating health information. This is in support of the advice by the Jed Foundation (2009), which supports the use of ICTs that work synergistically in disseminating health information to students. This also supports another key information principle of integrating health promotion activities and programmes. The Jed Foundation and Education Development Center (2011, 16) believes that health promotion programmes should include a continuum of programmes. This means that a combination of health information dissemination programmes synergistically working together is more likely to produce better results than a single intervention. The use of ICTs is therefore pivotal in achieving this end.

A majority of the respondents (89 %) agreed with the notion that campus-based health information dissemination programmes should focus on disease prevention. This means that NUST should focus on developing students’ life skills; moreover, there is a need for disseminating information on physical activity, weight control and nutritional control. The results are in line with a study that was carried out by Kicklighter et al. (2010, 98), which demonstrated the importance of a health education module that focused on disease prevention among college students.

The study identified a number of information dissemination principles that were supported by the respondents. A list of the principles in the order of their level of acceptance by the respondents in this study is as follows:

  • 1.

    The information dissemination system should use and synchronize different Information and Communication Technologies (ICTs) such mobile phones and social media applications for easier access to health information.

  • 2.

    Health information dissemination should be prevention-focused so that students can prevent diseases.

  • 3.

    Universities should formulate a policy for effective dissemination of health information to students.

  • 4.

    Disseminate a variety of health topics to students, instead of isolated topics such as HIV and AIDS.

  • 5.

    The health information dissemination system should be integrated into one wellness centre, instead of isolated programmes targeting specific diseases.

  • 6.

    Students should be consulted and involved during the development and implementation of health information dissemination systems.

  • 7.

    Universities should focus their health information dissemination efforts towards the development of students’ life skills so that students can be in control of their health.

Successful dissemination does not entail effective dissemination. This means health information dissemination efforts should not only be concerned with information reaching its destination; it should focus on the effect of that information in catalyzing behaviour change. The Elaboration Likelihood Model (ELM) (Petty and Cacioppo 1986) hypothesizes that persuasion depends on the level of scrutiny given to a message. The Elaboration Likelihood Model places importance on the nature of the message and its origin. It argued that individuals are motivated to change their behaviour if the message triggers their “peripheral processing” (Petty and Cacioppo 1986). Robertson (2008, 7) states that “[a] campaign fronted by a celebrity may provoke interest and, through peripheral processing, lead the viewer to understand the message […] to change habitual behaviours and bring about long-lasting change.” Conversely, if an argument is not convincing enough, individuals use peripheral cues that lead to “less stable” attitude changes, which are less likely to lead to behaviour change (Crano and Prislin 2006).

Proposed Framework for Disseminating Health Information to University Students (FDHIS)

This section presents the proposed framework for disseminating health information to university students (FDHIS). Although the framework was developed in a developing world context, the dissemination framework can be adapted for the developed world since it is grounded on universal information dissemination theory. The proposed framework was influenced by the needs of the respondents and applicable health information dissemination principles gleaned from literature. The proposed framework for disseminating accurate health information to students is made up of six components that include content, sources, media and channels, skills, dissemination principles and persuasion techniques.

Content

The findings of the study managed to reveal that the topics that are in very high demand are physical activity, access to health facilities, how to help others in distress, nutrition, HIV and AIDS, and STI prevention. Those in high demand are stress reduction, access to medical insurance coverage, depression and anxiety, injury prevention, and relationship difficulties. The ones in slightly high demand are problem use of Internet/computer games, cold/flu/sore throat, accommodation, alcohol and other drug use, sleeping difficulty, and violence prevention. The topics in moderate demand are pregnancy prevention, suicide prevention, tobacco use and management of chronic diseases. NUST should ensure that health information on all these topics is disseminated, according to their level of demand. Dissemination of the health topics should use the salutogenic approach. This means that health promoters should proactively disseminate health information to prevent the outbreak of diseases and other ailments.

Sources

The study revealed that preferred information sources include community health educators, Nursing Sister, peer educators, Student Counsellor and teaching staff. External sources include personal doctors, the Internet and family members. The use of multiple sources is in line with a key health information dissemination principle that says that dissemination systems should utilize multiple sources. This improves the availability and variety of health information. Professional health information sources are recommended for disseminating health information. Teaching staff should disseminate information on general health matters. There should be a clear policy for handling health matters, for example, students with emotional health problems should be referred to the Student Counsellor, while those with physical health problems should be referred to the Nursing Sister. However, the NUST resource should facilitate cooperation between the two departments.

Media and Channels

Media and channels are important components of the FDHIS. They allow information to be transferred from the sources to the students and vice versa. The media and channels ensure the success of information dissemination efforts by ensuring that the information reaches its destination at the right time, in the desired format. As depicted in Figure 2, there are various media and channels that are proposed by the study, including mobile phones, websites, social media applications, printouts, flyers, posters, and face-to-face encounters through peer education programmes, workshops and educational programmes. The current health information dissemination system has no feedback mechanisms. The proposed framework improves the accuracy of the information being disseminated because feedback mechanisms allow NUST to evaluate the system and to make necessary improvements.

Proposed framework for disseminating health information to students.
Figure 2:

Proposed framework for disseminating health information to students.

The choice of media and channels should depend on the health promotion programme at hand. Information that is urgent should be transmitted electronically for timely access. Short messages and alerts can be transmitted via SMS. Posters would be effective for programmes that take more time to address, such as tobacco cessation programmes. Social media applications are appropriate for the peer education programme and information sharing among the students. This approach is in line with the health information dissemination principle of using multiple strategies in disseminating health information.

Skills

The study proposes the development of students’ life skills. The theory of salutogenesis argues that individuals need to develop life skills in order to deal or cope with the different situations in life. The findings reveal that NUST students have average skills in most areas of life, which is not encouraging. The information dissemination strategy should incorporate training of life skills to empower students to be in total control over their health. The skills that were given priority in this study are understanding health information, and searching for and evaluating health information. Although these skills are top priority, it is important to note that there is a need for ongoing training of all the skills.

Persuasion Strategies

Successful dissemination does not entail effective dissemination. This means health information dissemination efforts should not only be concerned with information reaching its destination; it should focus on the effect of that information in catalyzing behaviour change. Therefore, the information should be accompanied by persuasion techniques.

The findings reveal that the use of role models is an effective persuasion technique. The technique can therefore be used on dissemination platforms such as conferences and workshops. NUST should identify role models from the community to deliver certain health messages. The findings also reveal that comedies, shows and interactive learning sessions are effective health information dissemination techniques. Persuasion techniques help individuals to accept health information and ultimately change their behaviour. These techniques are effective in areas such as tobacco cessation, fruit intake, and sexual and reproductive issues. The persuasion techniques should be informed by specific behaviour change theories. The Social Marketing Theory, for example, would apply for role models. The Health Belief Model would be appropriate for tobacco cessation because it arouses fear; in this case posters depicting the dangers of smoking would assist in quitting smoking. The framework uses a pragmatic approach whereby a theory, informed by the integrated theoretical framework, would be appropriate for a specific situation.

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About the article

Received: 2016-05-20

Accepted: 2016-12-04

Published Online: 2017-02-24

Published in Print: 2017-03-01


Citation Information: Libri, Volume 67, Issue 1, Pages 35–50, ISSN (Online) 1865-8423, ISSN (Print) 0024-2667, DOI: https://doi.org/10.1515/libri-2016-0054.

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