Park Elizabeth, Masupe Tiny, Joseph Joseph, Ho-Foster Ari, Chavez Afton, Jammalamadugu Swetha, Marek Andrew, Arumala Ruth, Ketshogileng Dineo, Littman-Quinn Ryan, Kovarik Carrie
School of Medicine, Boston University, Boston, MA, USA.
Faculty of Medicine, University of Botswana, Gaborone, Botswana.
Int J Med Inform. 2016 Nov;95:8-16. doi: 10.1016/j.ijmedinf.2016.07.013. Epub 2016 Jul 27.
Since the UN Human Rights Council's recognition on the subject in 2011, the right to access the Internet and information is now considered one of the most basic human rights of global citizens [1,2]. Despite this, an information gap between developed and resource-limited countries remains, and there is scant research on actual information needs of workers themselves. The Republic of Botswana represents a fertile ground to address existing gaps in research, policy, and practice, due to its demonstrated gap in access to information and specialists among rural health care workers (HCWs), burgeoning mHealth capacity, and a timely offer from Orange Telecommunications to access Wikipedia for free on mobile platforms for Botswana subscribers.
In this study, we sought to identify clinical information needs of HCWs of Botswana and their perception of Wikipedia as a clinical tool.
Twenty-eight facilitated focus groups, consisting of 113 HCWs of various cadres based at district hospitals, clinics, and health posts around Botswana, were employed. Transcription and thematic analysis were performed for those groups.
Access to the Internet is limited at most facilities. Most HCWs placed high importance upon using Botswana Ministry of Health (MoH) resources for obtaining credible clinical information. However, the clinical applicability of these materials was limited due to discrepancies amongst sources, potentially outdated information, and poor optimization for time-sensitive circumstances. As a result, HCWs faced challenges, such as loss of patient trust and compromises in patient care. Potential solutions posed by HCWs to address these issues included: multifaceted improvements in Internet infrastructure, access to up-to-date information, transfer of knowledge from MoH to HCW, and improving content and applicability of currently available information. Topics of clinical information needs were broad and encompassed: HIV, TB (Tuberculosis), OB/GYN (Obstetrics and Gynecology), and Pediatrics. HCW attitudes towards Wikipedia were variable; some trusted Wikipedia as a reliable point of care information resource whereas others thought that its use should be restricted and monitored by the MoH.
There is a demonstrated need for accessible, reliable, and up-to-date information to aid clinical practice in Botswana. Attitudes towards Wikipedia as an open information resource tool are at best, split. Therefore, future studies are necessary to determine the accuracy, currency, and relevancy of Wikipedia articles on the health topics identified by health care workers as areas of information need. More broadly speaking, future efforts should be dedicated to configure a quality-controlled, readily accessible mobile platform based clinical information application tool fitting for Botswana.
自2011年联合国人权理事会认可该主题以来，访问互联网和信息的权利如今被视为全球公民最基本的人权之一[1,2]。尽管如此，发达国家与资源有限国家之间的信息差距依然存在，且针对工作者自身实际信息需求的研究甚少。博茨瓦纳共和国是弥补研究、政策及实践中现存差距的理想之地，因为该国农村医护人员在获取信息和专家资源方面存在明显差距，移动医疗能力不断发展，且Orange电信及时提供了让博茨瓦纳用户在移动平台上免费访问维基百科的服务。
在本研究中，我们试图确定博茨瓦纳医护人员的临床信息需求以及他们对维基百科作为临床工具的看法。
我们组织了28个有主持人引导的焦点小组，参与者为博茨瓦纳各地区医院、诊所和卫生站的113名不同职级的医护人员，并对这些小组进行了转录和主题分析。
大多数机构的互联网接入受限。大多数医护人员高度重视利用博茨瓦纳卫生部的资源获取可靠的临床信息。然而，由于信息来源存在差异、信息可能过时以及对时间敏感情况的优化不足，这些资料的临床适用性有限。因此，医护人员面临诸多挑战，如失去患者信任和影响患者护理质量。医护人员提出的解决这些问题的潜在方案包括：多方面改善互联网基础设施、获取最新信息、将知识从卫生部传授给医护人员，以及提高现有信息的内容和适用性。临床信息需求的主题广泛，涵盖：艾滋病毒、结核病、妇产科和儿科。医护人员对维基百科的态度不一；一些人信任维基百科是可靠的即时护理信息资源，而另一些人则认为卫生部应限制并监督其使用。
事实表明，博茨瓦纳需要可获取、可靠且最新的信息来辅助临床实践。对于维基百科作为一种开放信息资源工具的态度，充其量也是存在分歧的。因此，有必要开展进一步研究，以确定维基百科上与医护人员确定为信息需求领域的健康主题相关文章的准确性、时效性和相关性。更广泛地说，未来应致力于构建一个适合博茨瓦纳的、质量可控且易于访问的基于移动平台的临床信息应用工具。
