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Abstract

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. THEORETICAL FRAMEWORK
  5. METHOD
  6. FINDINGS
  7. SIGNIFICANCE
  8. Acknowledgements
  9. REFERENCES

This qualitative study explores the experiences of women as they respond to, make sense of, and use uncertain health information mediated by informal and formal sources encountered with the context of everyday life. A medical case in which health information is explicitly evolving provides context for the investigation. Using a social constructionist approach and social positioning theory, and based on semi-structured interviews with both information seekers and health professionals, this study demonstrates that women participate in complex information worlds and that, in the face of uncertainty, are critically informed by a wide range of sources. Findings suggest that social positioning plays an important role in information behavior and in decision making, and that it is a dynamic construct which is influenced by personal context, the quality of relationships, and the experience of physical symptoms.


INTRODUCTION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. THEORETICAL FRAMEWORK
  5. METHOD
  6. FINDINGS
  7. SIGNIFICANCE
  8. Acknowledgements
  9. REFERENCES

Much attention has focused on evidence-based practice in health fields and on the accompanying challenge, translating knowledge into practice. Scholars have noted, however, that even established medical ‘fact’ represents only a moment within an on-going, indeterminate process of knowledge development (Wood, Ferlie and Fitzgerald 1998), and that evidence itself is provisional and emergent (Upshur 2001). The dilemma presented by uncertain health information is magnified for individuals making health decisions within the context of everyday life, a context in which people are interacting with, integrating, and using health information mediated by a wide range of formal and informal sources (including health professionals (HPs), media, internet, and inter- and intra-personal sources).

This qualitative study focuses on information behavior (IB) within the context of an medical case in which evidence is explicitly uncertain: it explores women's experiences as they respond to, make sense of, and use (or do not use) evolving health information related to the menopause transition. This poster presentation focuses on social positioning and adds depth to the investigation by moving beyond women's accounts as transparent representations of experience, and also by providing a metaphor for exploring how women position themselves and others in the personal stories they relate, and how that positioning shapes IB, relationships with HPs, and decision making.

THEORETICAL FRAMEWORK

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. THEORETICAL FRAMEWORK
  5. METHOD
  6. FINDINGS
  7. SIGNIFICANCE
  8. Acknowledgements
  9. REFERENCES

Based on a social constructionist approach, this research seeks to identify “general sense-making practices on the basis of which people orientate themselves in their everyday and working lives” (Talja, Keso, & Pietilainen, 1999, 761) and notions of meaning-making that incorporate an active, process-oriented view of IB (Dervin 1992). Social positioning theory (Davies & Harré, 1990; Van Largenhove & Harré, 1994) facilitates exploration of the interactive aspects of information IB. In particular, the concept of ‘positioning’ draws attention to the dynamic aspects of encounters with HPs and the multiple ‘storylines’ that are used both unintentionally and intentionally to construct identity within social interactions (Julien and Given 2002).

METHOD

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. THEORETICAL FRAMEWORK
  5. METHOD
  6. FINDINGS
  7. SIGNIFICANCE
  8. Acknowledgements
  9. REFERENCES

This study reports analysis of data gathered through qualitative semi-structured interviews with theoretical, purposive samples of (1) 28 women who were engaged in IB related to menopausal/postmenopausal health concerns, and (2) 12 HPs (including physicians, nurses, pharmecists, and alternative health practitioners) acting as information providers to women navigating the menopause transition. Participants were recruited from both the community and from a multidisciplinary, publicly funded ‘menopause clinic.’ In order to yield rich descriptive data, two interview strategies were used with the first sample. A semi-structured, narrative approach allowed women “scope to articulate their experiences in their own terms” (Petersen, 2006, 34). In addition, Johnson and Weller's (2002) ‘in-the-moment’ elicitation technique was used – women were presented with contrasting media articles in order to elicit reflection on conflicting media-mediated health information and its integration with information from other sources. Semi-structured interviews with HPs provided insight into themes emerging from interviews with women in the first sample, the interpersonal interactions between HPs and patients, and the roles HPs play in facilitating the translation of knowledge within the lives of women.

FINDINGS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. THEORETICAL FRAMEWORK
  5. METHOD
  6. FINDINGS
  7. SIGNIFICANCE
  8. Acknowledgements
  9. REFERENCES

Analysis of data draws attention to the complex information worlds women participate in; to the many sources of health ‘evidence’ (including the media, internet, other people, and intra-personal information sources) which play central informing roles for women; to the pervasive influence of the internet, and the varying approaches which women and HPs take to this medium; to the deep ambivalence towards media-mediated health information; and to the many reasons women gather health information (including as preparation for encounters with HPs, as a ‘second opinion’ or confirming evidence, and out of general interest). Study results highlight the central role of symptoms during the menopause transition and their impact on information need, seeking and use. Data analysis also draws attention to the impact of social positioning on information behavior, and particularly on shared decision making (SDM) between women and HPs. While discussions of SDM in the medical literature focus on eliciting informed patient participation, data from this study demonstrate that women in the menopause transition presume personal responsibility for decision making; express desire for an information-sharing stance from HPs; and value referral to additional, independent information sources. Data also reveal that women's social positioning is dynamic; it is influenced by personal context and beliefs, the quality of relationships with HPs, and the experience of menopausal symptoms.

SIGNIFICANCE

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. THEORETICAL FRAMEWORK
  5. METHOD
  6. FINDINGS
  7. SIGNIFICANCE
  8. Acknowledgements
  9. REFERENCES

With increasing interest in the IB of “ordinary people in everyday life situations and health contexts” (Fisher & Julien, 2009, 317) and with SDM being the “ultimate goal of patient-centered care” (Légaré and Brouillette 2009, 170), this study contributes both theoretically and practically to Library and Information Science and health care fields. Improved understanding of women's IB in situations where health information is evolving is critical for health and information professionals who seek to improve access to high quality health information and facilitate women's decision making. Furthermore, social positioning theory makes a significant contribution to understanding of IB by illuminating the relational aspects of information seeking and use, and by highlighting the critical interplay between personal context and information sources, both formal and informal.

Acknowledgements

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. THEORETICAL FRAMEWORK
  5. METHOD
  6. FINDINGS
  7. SIGNIFICANCE
  8. Acknowledgements
  9. REFERENCES

I am grateful to Dr. Heidi Julien and Dr. Brenda Cameron for ongoing guidance and encouragement; and for the support of the Social Sciences and Humanities Research Council of Canada through a Canada Graduate Scholarship (Doctoral), the University of Alberta QEII Scholarship, and the Medical Library Association 2010 Thomson Reuters/MLA Doctoral Fellowship.

REFERENCES

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. THEORETICAL FRAMEWORK
  5. METHOD
  6. FINDINGS
  7. SIGNIFICANCE
  8. Acknowledgements
  9. REFERENCES
  • Davies, B., & Harre, R. (1990). Positioning: The discursive production of selves. Journal for the Theory of Social Behaviour, 20 (1), 4363.
  • Dervin, B. (1992). From the mind's eye of the user: The sense-making qualitative-quantitative methodology. In J.Glazier & R.Powell (Eds.), Qualitative research in information management (pp. 6184). Englewood, CO: Libraries Unlimited
  • Fisher, K. E., & Julien, H. (2009). Information behavior. In B.Cronin (Ed.), Annual review of information science and technology (Vol. 43, pp. 317358). Medford, New Jersey: Information Today, Inc.
  • Johnson, J. C., & Weller, S. C. (2002). Elicitation techniques for interviewing. In J. F.Gubrium & J. A.Holstein (Eds.), Handbook of Interview Research: Context and Method (pp. 491514). Thousand Oaks: Sage Publications.
  • Julien, H., & Given, L. M. (2002). Faculty-librarian relationships in the information literacy context: A content analysis of librarians' expressed attitudes and experiences. Canadian Journal of Information & Library Sciences, 27 (3), 6587.
  • Légaré, F., & Brouillette, M.-H. (2009). Shared decision-making in the context of menopausal health: Where do we stand? Maturitas, 63 (3), 169175.
  • Petersen, A. (2006). The best experts: The narratives of those who have a genetic condition. Social Science & Medicine, 63 (1), 3242.
  • Talja, S., Keso, H., & Pietilainen, T. (1999). The production of “context” in information seeking research: A metatheoretical view. Information Processing & Management, 35, 751763.
  • Upshur, R. E. (2001). The status of qualitative research as evidence. In J. M.Morse, J. M.Swanson & A. J.Kuzel (Eds.), The Nature of Qualitative Evidence (pp. 526). Thousand Oaks: Sage.
  • Van Largenhove, L., & Harré, R. (1994). Cultural stereotypes and positioning theory. Journal for the Theory of Social Behaviour, 24 (4), 359372.
  • Wood, M., Ferlie, E., & Fitzgerald, L. (1998). Achieving clinical behaviour change: A case of becoming indeterminate. Social Science & Medicine, 47 (11), 17291738.