INFORMATIONBEHAVIOURINHEALTHCAREOFHOME-BASEDELDERLYPEOPLEINNAKURUDISTRICT,KENYA

MARIEKHANYANJIKHAYESI

DEPARTMENTOFINFORMATIONSCIENCE,

UNIVERSITYOFSOUTHAFRICA(UNISA)

DoctoralForum

UNISA

5th–6thMarch,2009INFORMATIONBEHAVIOURINHEALINTRODUCTIONLivinglongerisasuccessstoryofimprovedhealthcareservices.Theresultisanincreaseinthenumberofelderlypeoplethatneedcontinuedservicesfortheirhealthcare.ButitappearsthatthecareofelderlypeopleinmostdevelopingcountrieslikeKenyaistheresponsibilityofindividualsandfamilies.Thesituationbringsintosharpfocustheroleofinformationinhealthcareofelderlypeople.Thespecificissuesofconcernintheroleofinformationincludeinformationneeds,accessanduseinhealthcareofthegroup.ThecurrentstudyinvestigatedtheaboveissuesinrelationtothehealthcareofelderlypeopleinNakuruDistrict,Kenya.INTRODUCTIONLivinglongerisaSTATEMENTOFTHEPROBLEMThecoreresearchproblemthatthestudyidentifiedwasthegeneralneglecttoincludeelderlypeopleinoutreachservicesforhealthcare.ThestudyadvancestheviewthatinformationmaypartlyhelptoaddressthechallengesthatelderlypeopleinNakuruDistrict,Kenyaexperienceintheirhealthcare.STATEMENTOFTHEPROBLEMThecoAIMOFTHESTUDYTheobjectiveofthestudywastoexploreinordertounderstandtheuseandcontributionsofinformationinhealthcareofelderlypeopleinKenya,usingNakuruDistrictasastudysite.AIMOFTHESTUDYTheobjectiveResearchquestionsWhataretheinformationneedsinhealthcareofelderlypeopleinNakuruDistrict?Wheredoelderlypeopleandcareprovidersgetinformationforhealthcarefrom?Howdotheyusetheinformationinhealthcareofelderlypeople?Whatchallengesdoelderlypeopleandcareproviders(formalandinformal)encounterinaccessanduseofinformationforhealthcare?ResearchquestionsWhataretheHealthinformationneed(s):Whatkindofinformationisneeded?MedicalNutritionaletcDeterminantsofaccessEconomicCulturalbeliefsPoliticale.g.Legislation&PolicyEnvironmentale.g.

geographicaldistances.IndividualcharacteristicsInformationsourcesandservices:FormalGovernment,Media,Libraries,ICTsii)

Informalnetworkse.g.

.NGOs,publicmeetings,familymembers,friends.Useofinformation.Createawareness.MakedecisionMaintainpersonalhealth.ShareexperienceswithothersFigure1:Aconceptualmodelforaccessanduseofinformationinthehealthcareoftheelderly.

Source:ModifiedfromWilson(1991,1997&2000)DeterminantsofaccessFigure1ExplanationaboutthemodelThemodelshowsthatrespondentsfirstexperienceandidentifydifferentneedsforinformationinhealthcareofelderlypeople.Theystarttolookforinformationtohelpthemaddresshealthcareneeds.Theyencounterchallengesastheysearchforanduseinformationforhealthcare.Respondentsusetheinformationtheygetintorespondtoavarietyofhealthcareissue.Theygobacktotheirinformationneedsdrawingboardandrepeattheprocessforaslongastheyhaveneeds.ExplanationaboutthemodelMETHODOLOGYStudydesign:QualitativestudyPhenomenologicaldesignwithtwoelements:exploratoryanddescriptiveReasonsforchoiceofdesign:Afairlyunder-researchedareathatneededaresearchapproachthatwouldexploreresearchissuesidentifiedforthestudy.SomeoftherespondentswereunabletorespondtoawritteninterviewbecauseofilliteracyinEnglishandKiswahili.Themethodgaverespondentsa‘voice’tobeabletoexpresstheirexperience.METHODOLOGYStudydesign:Researchsite:TwodivisionsinNakuruDistrictNakuruMunicipality/TownRongaiReasonsforchoiceofsiteTheDistricthasahistoryofeconomicactivitiesthatattractedjobseekersfromdifferentethniccommunitiesasworkersinfarmsownedbywhitesettlers.GenerationsoftheworkershavesincesettledintheDistrictandprovideagoodrepresentationofthenationalpopulationbothintheruralandurbansettingoftheDistrict.Researchsite:SamplingofrespondentsSnowballtechniqueattwolevels1stLevelTheresearcherexplainedtothelocaladministrationthepurposeofthestudy.Theadministrationhelpedtoidentifytwoelderlypeople,aladyandagentlemanthatcouldrespondtotheinterview.Thefirsttwoelderlyrespondentsidentifiedotherelderlypeoplethatcouldrespondtotheinterview.Elderlypeopleidentifiedtheiractualinformalcareprovidersandthehealthcarefacilitiesthattheywentto.2ndLevelAdministratorsattheProvincialGeneralHospital(PGH)andRongaiHealthCentrehelpedtoidentifyamedicalstaffthattreatedelderlypeopleinthefiltersections.Staffidentifiedcolleaguesthatprovidedhealthcareservicestoelderlypeople.Theprocedurewasrepeatedatbothlevelsuntilatotalof40respondents(18elderly;16medicalstaffand6informalcareproviders)wasreached.Theresearcherexplainedtotherespondentswhatthestudywasaboutandobtainedtheirconsentbeforemakingappointmentsforinterviews.Asummaryofrespondentsisshowninthetable1.INFORMATIONBEHAVIOURINHEALTHCAREOFHOME-BASEDELDERLYPEOPLEINNAKURUDISTRICT,KENYA[信息行為在以家庭為基礎(chǔ)的老年人保健納庫魯區(qū)，肯尼亞](-36)課件Table1:SummaryofrespondentsinterviewedforthestudySub-groupNumberBriefdescriptionElderly18Gender:Male(11),female(7)Age:between55and89yearsSetting:rural8respondents(4males,4females);urban10respondents(7males,3females).Livingarrangements:alone(12);withspouse(2);withfamilymembers(2);familymemberslivingwithinawalkingdistance(2).Informalcareproviders6Relationshiptoelderly:Gender-male(2):sonstoelderlyparents.-female(4):2spouses,1daughter,and1daughter-in-lawFormalcareproviders16Gender:male(9),female(7)positions:doctors(5-allmales),nurses(5-allfemales),clinicalofficers(4-allmales),nutritionists(2–bothfemales)Table1:SummaryofrespondentDatacollectionApilotstudywasconductedusing20respondents.Theresultsandexperiencesofthestudywereusedtoimprovetheinstruments.Face-to–faceinterviewswereconductedamongelderlypeople,formalhealthcareandinformalcareproviders.Semi-structuredinterviewscheduleswereusedtocollectdatafromalltherespondents.Datawasrecordedmanually.Researcheralsokeptafieldnotebookordiary.Reasonsforthechoiceofface-to-faceinterviews:Resultsandexperiencesofpilotstudyrevealedthatsomeoftherespondentswereilliterateandhadneverparticipatedassubjectsinastudy.Therewasneedforamethodthatwouldpromotedialogueandnarrationinordertocollectdatafromrespondentsthatfacedthischallenge.Themethodalsogaverespondentsa“voice”toprovidedetailsandexperiencesaboutissuesthatthestudyraised.Themethodenabledtheinterviewertogetinsightfuldataabouttheresearchissuesforthestudy.Itwouldhavebeendifficulttogatherdetailedinformationabouttheexperiencesofrespondentsifalternativemethodswereused.Themethodhadtheadvantageofproducinghighresponseratessincetheresearcherworkeddirectlywiththerespondents..DatacollectionApilotstudywDataanalysis

Simultaneousdatacollection,analysisandwriteupoftheresearchreportfollowingtheprocedureofdataprocessingandanalysisinqualitativeresearch.Eachinterviewsessionwastranscribedandsummarized.EachscriptstoredinMsWord.Dataanalyzedusingcontentanalysis:wordsandsentencebysentencereadingofsummaryforeachinterview.Continuousrechecking,comparisonandreflectiononthedatacarriedthroughouttheresearchperiod.Opencodingwasusedtocategorizeandclassifydata.Datawasfurtheranalyzedandcategorizedunderthemesandsub-themesthatemergedfromtheanalysis.Descriptivestatisticswereusedtopresentthedata.Tablesanddiagramswereusedtoprovidesummariesofthefindings.Dataanalysis

ValidityofthestudyPilotstudywasconductedhelpeditandupdatetheinstruments.Participatoryapproachwasused.Membercheckingdone.Detaileddescriptionwasprovidedtoconveythefindings.Sharedthedraftateverystagewithsupervisors.Incorporatedsuggestionsfromsupervisors.

ReliabilityofthestudyPilotstudyprovidedthefirstbasisforreliability.Incorporatedexperiencesgainedfromthepilotstudyinthefinalversionoftheinstrumentsusedforthestudy. ValidityofthestudyRESULTSRESULTSINFORMATIONNEEDSINHEALTHCAREOFELDERLYPEOPLE

IntroductionThestudyidentifiedtendifferenttypesofneedsforinformationforhealthcareofelderlypeopleinNakuruDistrict.Table2summarizestheidentifiedneeds.INFORMATIONNEEDSINHEALTHCARXTable2:ASummaryofneedsforinformationinhealthcareofelderlypeopleInformationneededonElderlyInformalhealthcareprovidersFormalhealthcareprovidersMedication

Complementaryandalternativemedication(CAM).

Nutrition

Basiccounsellingapproaches

Emotional/spiritualsupport.

Financialsupport

Selfprotection

Physicalfitness

Clothing

Gerontologicalservices

Key: Anidentifiedinformationneed Didnotshowinthedata

XTable2:ASummaryofneedsInformMedicalstaffTohelpthemprescribemedicineforelderlypeopleBeabletoadviseelderlypeopleandinformalcareprovidersaboutthehealthcareoftheformerBeabletohelpelderlypeopletoacceptchangesintheirhealthandtotheirlifestyles.ElderlypeopleTohelpthemtounderstandthecontributionsofmedicinetotheirhealth.Understandlong–termeffectsofthemedicinesthattheyused.Aboutplaces(pharmacies)fromwhichtheycouldbuymedicinescheaply.Tohelpthemtochoosetherightcomplementaryandalternativemedicine(CAM)andhealthcareservices.Tochoosetraditionalfoodsthathadmedicinalvalue.Aboutorganizationsthatcouldprovidefinancialhelp,forexample,payfortheirmedication;providefundstoindividuals.Suitableclothingforelderlypeople(warm,light,affordable–shoes,jackets).(Somehadresortedtosecondhandclothing)GeriatricservicesinKenya:ifthegovernmentplanstoprovidedoctorsforagedpeopleasitisdoneforchildrenandexpectantmothersorladies.InformalcareprovidersOrganizationsthatcouldprovidefinancialhelpfortheirparents,especiallymeetingthecostofmedication.Tobeabletounderstandthecontributionsandeffectsofconventionalmedicineonhealthofelderlypeople.Tobeabletoacceptchangesinthelivesofelderlypeopleundertheircare.Tohelpthemtocounselandencouragetheirelderlyparentstoacceptchangesintheirhealthandadheretomedicationschedules.Tobeabletoprotectelderlypeoplefromcontagiousailments.Tohelpthemtomaintainofphysicalfitnessastheycontinuedtoprovidehealthcareservicestoelderlyparentsandattendedtootherchoresintheirlives.INFORMATIONBEHAVIOURINHEALTHCAREOFHOME-BASEDELDERLYPEOPLEINNAKURUDISTRICT,KENYA[信息行為在以家庭為基礎(chǔ)的老年人保健納庫魯區(qū)，肯尼亞](-36)課件SOURCESOFINFORMATION

IntroductionResultsshowedthatrespondentsusedbothformalandinformal sourcestogetinformationforhealthcareofelderlypeopleHowever,therewerevariationsintheuseofsourcesduetofactorslikelevelsofeducation;economicabilities,geographicallocationofrespondents(urban/rural);availabilityofsources,andliteracyskills(language,useofthenewtechnology).Tables3and4aresummariesofthesourcesthatrespondentsusedandthereasonsforpreferenceforeachtypeofsource.SOURCESOFINFORMATIONIntrTable3:FormalsourcesofinformationforhealthcareofelderlypeopleSourceTypeofinformationReasonsforpreferringsourceChallengesinuseofsourceUsergroupProfessionalservicesMedicalNutritionalTrustworthystaffReliableinformationHighcostsLongdistancesBriefdiscussionsToofastingivinginstructionsElderlypeopleInformalcareprovidersCAMAlternativemedicineforspecificdiseases.Nutrition.Counselling.Perceivedpoorresultsofconventionalmedication.Easilyaccessibleuptovillagelevel.Affordableatnegotiablecosts.Payableininstalments.TrustedNosideeffectsFriendlystaffProvidedLeafletswithsummarizedinformation.Tooklongtorealiseresults.DifficulttochoosefromawiderangeofCAMservicesavailableElderlypeople.Informalcareproviders.TelevisionNutritionalHealthadviceonspecificdiseases.UseofmedicinesPreventionAudioandauralAvailableinhomesandsocialplacesPresentersweretoofastInformationwasbrief.Mosthealthcareprogramswerenon-interactive.mosthealthcareprogramswerepresentedinEnglish.MedicalstaffElderlypeopleInformalcareprovidersRadioAsaboveAuralPortableAvailableinsmallsizeCommunitystationsusedlocallanguagestopresenthealthinformation.UsedKiswahililanguageinpresentinginformationabouthealthcare.AsaboveMedicalstaffElderlypeopleInformalcareprovidersNewspapersandmagazinesNutritionalUseofmedicines.Informationforgeneralmanagementofhealth.DetailedinformationPossibletosharenewspapersamongseveralpeople.Expensive.Lackofelderly-specifichealthcareinformationUrbanpopulation(elderly,formalandinformalrespondents)Table3:FormalsourcesofinfSourceTypeofinformationReasonsforpreferringsourceChallengesinuseofsourceUsergroupInternetDiseasespecificResearchreportsProvidesmorecurrentinformation.TakesashorttimetoaccessinformationPoorconnectivity(occasionally)Lackofskills.Highcosts.Unavailableinruralareas.ImpossibletoaccesssomesitesduetolackofsubscriptionMedicalstaff.Informalcareproviders(urban).CellphonePrescriptionsAdvice.Accessiblefromanywhere.Usefulinemergencyhealthcaresituations.Possibletosendshorttextmessagesinanylanguage.Costinmaintainingarestillhigh.Lackofskillstooperate.Unaffordableforsomerespondents.Low/poornetwork(occasionally)ElderlypeopleMedicalstaff.Informalcareproviders.BooksMedication.NutritionalGeneralManagementofhealth.Authenticinformation.Possibletouseoneamongmanypeople.Expensivetoreplacewithneweditions.Detailedinformation.Useofmedicallanguage.LackofliteracyskillsTakestimetoread.Elderlypeople(CAMtexts).Medicalstaff.Informalcareproviders(CAMtexts).JournalsMedicalresearch.Advancesintreatmentofspecificdiseases.Currentinformation.Scholarlyandreviewedworks.Expensivetosubscribeto.Medicalstaff.TypeofinformationReasonsforTable4:InformalsourcesusedforinformationinhealthcareofelderlypeopleSourceTypeofinformationReasonsforpreferenceofsourceChallengesUsergroupFamilymembers,neighboursandfriendsAdviceaboutillnessPersonalexperiencesinManagementofhealthNutritionalAvailabilityofnewhealthcarefacilitiesEmotionalsupportAvailabilityanduseofCAMClosestandeasilyaccessibleTrusted.Face-to-faceinteractionsCanbeconsultedanytimeNofinancialcostsNon-professionalNeededconfirmationInformationoverloadElderlypeopleInformalcarersAgriculturalshowsNutritionalInformationwaspresentedorallyUsenationallanguage(Kiswahili).Familiarbackground.InvolvedfinancialcostsHeldonceayear.Longdistanceforruralpeople.PamphletswerewritteninEnglishandwerefew.Elderlypeople(fromurbansite).PersonalexperienceincareprovisionMedicationNutritionalInternalisedandeasytorecallFamiliar/provedusefulinpreviouscases.TrustedNofinancialcosts.MisleadingifhealthchallengeisnewElderlypeopleFormalcareprovidersInformalcareprovidersTable4:InformalSourcesofinformationforhealthcareofelderlypeople

Table4:InformalsourcesuseWomengroupsNutritionalAvailabilityofherbal/CAMtreatmentEmotionalsupportCommonsocialinterests.Samegender.Easilyaccessible.Availabilityofconfidants.Interactwithmed.andotherprofessionalsinformally.NofinancialcostsMetAfterareasonablylongtime.RecordsofhealthcareinformationsharedwerenotkeptInformationoverload.Membershipwasalmostexclusive(maturemarriedwomen).Olderladies(elderly,formalandinformalcarers).ReligiousorganizationsSpiritualsupport.Hope&encouragement.EasilyaccessibleNofinancialcostsGeneralinformationforspiritualencouragementElderlypeopleInformalcarerprovidersFormalcarerprovidersPersonalexperiencefrompreviouslyheldresponsibilities.NutritionalPhysicalfitness.Internalized/keptinpersonalmemory.AccessibleanytimeNowrittenrecordskept.Individualizedandrarelyshared.Possibletoforgetpartoforalltheinformation.Elderlypeople.ColleaguesAdviceaboutprescribingmedicineforelderlypeopleNutritionEasilyaccessibleProfessionalinformationNofinancialcostsincurred.LackofcurrentinformationLackofelderly-specificinformationFormalcareproviders(medicalstaff)WomengroupsNutritionalCommoUSEOFINFORMATIONINTRODUCTIONRespondentsdiscussedtheactualsituationsinwhichtheyusedorappliedinformationinhealthcareofelderlypeople.Figure2isasummaryofthedifferentwaysinwhichrespondentsusedinformation.USEOFINFORMATIONINTRODUCTIONFIGURE2:USEOFINFORMATIONINFORMATIONFORHEALTHCAREOFELDERLYPEOPLESharewithcolleagues,familyandfriendsconsultationupdateencouragecreateawarenessSeekherbaltreatmentchronicconditionsprotectionagainstillnessencourageotherelderlypeopletouseCAMDecisionmakinghealthcarefacilitiestreatmentHomehealthcareadministermedicationuserightdietmonitorprogressinhealthconditionGiveadviceaboutuseofmedicineuseofrightdietgeneralhealthcareFIGURE2:USEOFINFORMATIONINUSES1.DECISIONMAKINGInformationwasusedatTHREElevelsfordecisionmaking:1stlevel:Elderlyandfamilycareproviders:typeofhealthcarefacilitytogoto(government/public,privateorCAM).2ndlevel:Medicalstaff:typeoftreatmenttogiveelderlypeople.3rdlevel:Elderlyandinformalcareproviders/family:continuewithhealthcareservicesorchangetoadifferentfacility.2.SHAREWITHOTHERPEOPLEMedicalstaff:withcolleaguesthroughconsultations,andwithelderlypeopleandinformalcareproviders.Elderlypeopleandinformalcareproviders:family,friends,neighbours,otherinformalcareproviders.3.ADVISE/COUNSELMedicalstaff:providedhealthcareprofessionaladvicetoelderlypeopleandinformalcareprovidersElderly:advisedfriendstoseekprofessionalhealthcareservices.Informalcareproviders:advisedelderlypeopleabouttheimportanceofobservingmedicationschedules.4.HOMEHEALTHCAREMANAGEMENT

Elderlypeopleandinformalcareproviders:abletohandleday-to-dayhealthcareissues.5.SEEKCOMPLEMENTARYALTERNATIVEMEDICINE(CAM)Elderlypeopleandinformalcareproviders:usedinformationcontainedindiagnosticreportsfromformalhealthcareservicestoseekCAMtreatment.USES1.DECISIONMAKING3.ADVISECONTRIBUTIONSOFINFORMATIONINHEALTHCAREINTRODUCTION

Researchersoughttolearnfromrespondentsiftheyexperienced,observedandnotedchangesafterusinginformationinvarioushealthcaresituations.Responsesfromparticipantswerecategorizedintosixareasofuseandimpact:madetherightdecisions;improvementofhealthconditions;reducedcostsofmedication;acquiredconfidence,learnnewknowledgeandcreatedawarenessamongrespondents(Figure3).CONTRIBUTIONSOFINFORMATIONIFIGURE3:IMPACTOFINFORMATIONINHEALTHCAREINFORMATIONAPPLIEDINHEALTHCARECreatedawarenessPrecautionmeasuresamongfamilycareproviders.Someinformalcareproviderstookmeasuresofprevention.ImprovedhealthReduced/stabilizedbloodpressure.AttendtohousechoresSuperviseworkers.ConfidenceProvideservicesathomeCarryoutself-careNewknowledgeIncreasedunderstandingaboutageingManagementofhealthconditionsforelderlypeopleReducedcostsTransporttohospitalMedicalbills/buyingmedicinesMaderightdecisionsSaved/prolongedlivesWeretoaffordablehealthcarefacilitiesFIGURE3:IMPACTOFINFORMATIOCONTRIBUTIONS1.Maderightdecisionsa)Medicalstaffappropriateprescriptionsforelderlypeopleadvisingelderlypeopleandinformalcareprovidersaboutthemodeoftreatmenttogiveelderlypeople:inorout-patientsb)Elderlypeopleandinformalcareproviderschoiceofhealthcarefacilities(government,private,CAM).changingfromonetypeofhealthcareservicetoanother.2.AcquiredconfidenceInformalcareprovidersconfidentindealingwithminorhealthcareissuesforelderlypeopleathome.abletoinjectparent(wherenecessary)3.Learntnewknowledge (Allrespondents)learntnewideasaboutageingandhealthcarechallenges,abletotellwhenhealthconditionofanelderlypersonwasimprovingordeclining.CreatedawarenessInformalcareproviders:awareofsomeofthehealthcarechallengesofageing,beguntousesomeoftheinformationfortheirownhealth.CONTRIBUTIONS1.Maderightdec5.ImprovementinhealthElderlypeople:abletoundertakepersonalcare(e.g.bathing,simplelaundry)abletoattendtoothersimplechoresathome(e.g.trimfences,workintheirvegetablegardens)experiencedlessemergenciesthatrequirecallingmedicalstafforbeingrushedtohospital.Medicalstaff:notedimprovementinthehealthofelderlypeoplethatusedwellinformationgiventhem.6.ReducedcostsElderlypeople/informalcareproviders:madefewtripstohospital.lessfrequenciesinpurchaseofdrugs5.ImprovementinhealthSTORAGEOFINFORMATIONRespondentsreportedthattheystoredinformationbeforeandafteruseinvariousways.Storageincludedtheuseof:medicalrecords,files,personalmemory,people,andinelectronicformat.STORAGEOFINFORMATIONRespondCHALLENGESANDCOPINGSTRATEGIESINTHESEARCHAND

USEOFINFORMATIONINTRODUCTIONThestudycategorizedthechallengesthatrespondentsexperiencedintothefollowinginter-relatedgroups:economicability;achallenginghealthcareenvironment;personalorindividualcharacteristicssuchasilliteracy,pooreyesightandlossofmemory;culturalinfluence;lackofpoliticalgoodwill.Table5isasummaryofthechallengesthatrespondentsexperienced,andthecopingstrategiesthattheyused.CHALLENGESANDCOPINGSTRATEGITABLE5:CHALLENGESANDCOPINGSTRATEGIES

FactorsEffectsCopingstrategies1.Economicabilitylowincomeunemploymentinsufficientfundstomeetallneedsunabletopurchasecurrentinformationunabletokeepappointmentssoughtfinancialhelpfromfamilyandfriendswaiteduntilfundswereavailablecontinuedtouseoldinformation2.Healthcareenvironmentlackofgeriatricserviceslackofspecificallydesignatedplacesforelderlypeoplelongqueueslesslimitedtimeofinteractionbetweenmedicalstaffandelderlypeoplesometimesencounteredimpatientstaffpoorcommunicationbetweenstaffandelderlypeoplestrainedrelationshipbetweenstaffandtheelderly,discouragementtocontinueaccessinginformationfrompublichealthcarefacilities.accompaniedtohospitalbyarelativetotakeinstructionsfromstaffsoughtCAMtreatmentcontinuedtousepublichealthcarefacilitiesbecausetheywereaffordable.TABLE5:CHALLENGESANDCOPING3.Individualcharacteristicsilliteracyandotherlanguagedifficultieslackoftimetodevotetosearchingforinformationphysicalchallengese.g.limitedmobility,pooreyesightandhearingetc.unabletoaccessinformationusinglimitedinteractionwithinformationenvironmentsoughthelpfromfamily,friendsandcolleagues;reliedonoralcommunication;reliedonshapes,sizesandcolourofdrugs;accessedinformationbycoincidence;reliedonhealthinformationfromthemedia.4.Culturalinfluencesagegapgenderbeliefinuseofherbalmedicineuseofmetaphoriclanguageobstructedflowofinformationbetweenstaffandelderlypeopleusedoldermembersofstafftosharewithelderlypeopleinformationforhealthcareusedstaffofsamegenderorethnicbackgroundtotalktoelderlypeople;stafflearntsomeofthemetaphorsusedinhealthcaretobe