Dissemination of health information by public libraries in the Khomas region,Namibia

Public libraries in the Khomas region

The Khomas region is one of the 14 regions in Namibia and it is where Windhoek, the capital of Namibia, is located. According to the latest Namibia Population and Housing Census conducted by the Namibia Statistics Agency (2021), the population of Windhoek has grown to an estimated 431,000. The region comprises 10 electoral constituencies. In response to Vision 2030, the 5th National Development Plan, Agenda 2063 and the Harambee Prosperity Plan, the Ministry of Education, Arts and Culture operates a network of 65 public libraries around the country under the Directorate of the Namibia Library and Archives Service. The Khomas region has seven public libraries – namely, Greenwell Matongo Community Library, Windhoek Public Library, Rossing Katutura Public Library, Otjomuise Public Library, Rossing Khomasdal Public Library, Maxwilili Public Library and Khomasdal Katutura Children Library (Namibia Library and Archives Service, 2017).

The primary functions of public libraries in Namibia are to provide information services and support research, deal with employment-related information inquiries and supply daily livelihood information to all community members. According to Zaid (2016), providing useful information can help to improve the quality of life in society. Generally, public libraries are considered to play an important role in disseminating information to the public. They are expected to play a major role when it comes to the dissemination of health information to community members. Furthermore, a public library serves as a local information centre, making all kinds of knowledge and information easily accessible to its users. Thus, public libraries should also advocate for a healthy, literate society (Ntlotlang and Grand, 2016). This study focused only on the seven public libraries based in the Khomas region of Namibia. School learners and tertiary students are the primary users of public libraries in the Khomas region. They mostly use public libraries as study spaces, as well as resources for information, particularly textbooks, to study and complete their homework, assignments and projects. In addition, members of the public use these libraries for a variety of purposes, such as photocopying services, access to information and communications technology equipment and facilities, reading local daily newspapers, looking for job opportunities, health information and other related information that responds to their socio-economic needs (Ntlotlang and Grand, 2016).

This study therefore investigated the dissemination of health information by public libraries to community members in the Khomas region and identified gaps in the health information services provided by these libraries. The study identified current problems and challenges in the dissemination of health information and provides recommendations on how to improve the effectiveness of public libraries in disseminating health information to the public.

Statement of the problem

Access to reliable, up-to-date health information resources is critical for improving health care in Namibia, but health information services are scarce and often inadequate in meeting people’s needs. According to a report by the World Health Organization (2018), health information services are poorly developed and fragmented in Namibia, resulting in limited access to quality health information. Additionally, the current method of disseminating health information through public libraries is inefficient and ineffective, with access to general disease information being challenging due to various factors, such as inadequate road infrastructure, poor living conditions and the lack of electricity (Namibia Library and Archives Service, 2018).

Moreover, several disease outbreaks, such as Hepatitis E, Congo fever, meningitis and other non-communicable diseases, have affected many people in Namibia, particularly in the Khomas region. The first case of Hepatitis E was reported in Katutura Hospital in Windhoek in 2017 and, in March 2020, the first two cases of COVID-19 were detected in Namibia (World Health Organization, 2020). Therefore, public libraries must disseminate timely and relevant health information to the public to raise awareness about disease transmission, prevention measures and treatments. However, even if health information services were available in public libraries, many individuals in Namibia are illiterate, uninformed and unable to use relevant health information effectively (United Nations Development Programme, 2019). This underscores the need for public libraries to increase the accessibility of health information to the communities they serve, particularly in the Khomas region.

Community members in the Khomas region of Namibia face a range of health challenges, including outbreaks of Hepatitis E, cholera, Coronavirus (COVID-19), sexually transmitted diseases and HIV/AIDS. While there have been studies on the transmission of health information throughout Africa and other parts of the world, there appears to be limited literature on the dissemination of health information by public libraries in the Khomas region. To address this gap, this study investigated the role of public libraries in disseminating health information during pandemics or disease outbreaks in the Khomas region of Namibia. The study also examined the perceptions of community members regarding the role of libraries in promoting health literacy and disseminating health information. By exploring the potential of public libraries as a source of reliable health information, this study aimed to contribute to efforts to address health challenges in the Khomas region of Namibia.

Objectives

This study investigated the dissemination of health information by public libraries in the Khomas region of Namibia. In addition, the study looked at the following specific research objectives:

To explore how public libraries in the Khomas region are disseminating health information to community members.

Significance of the study

Access to accurate, up-to-date, trustworthy health information is essential in improving health-care outcomes in Namibia. However, health information services are rare and ineffective in meeting people’s health information needs. This study investigated the dissemination of health information by public libraries to community members in the Khomas region and identified the current gaps in health information services provided by public libraries in the region. The study is significant as it has identified the problems and challenges in the dissemination of health information in the Khomas region and provides recommendations on how to improve the effectiveness of public libraries in disseminating health information to the public. The study helps to raise awareness about the role of public libraries in delivering health information about various diseases and contributes to the body of knowledge in public libraries about health information. Moreover, the information gathered in this study can be used to develop a standard for how health information should be presented in public libraries. Ultimately, the study will benefit the public, health-care providers, policymakers, public libraries and other stakeholders involved in improving the health outcomes of the Namibian population.

Dissemination of health information by public libraries

Public libraries are recognised as valuable resources for providing access to a wide range of information, including health-related materials. Kwon and Kim (2009, cited in Tu-Keefner et al., 2017: 27) note that public libraries can effectively intervene in delivering health information services to the public. Rutten et al. (2005) further emphasise the importance of access to reliable and relevant health information at every stage, from prevention to end-of-life care, in empowering people to make informed health-related decisions and engage in behaviours that improve their well-being.

Given the critical role of health information in disease prevention and public health, it is incumbent on public libraries to disseminate health information to their communities. Morgan et al. (2016) note that public libraries are trusted institutions with a broad reach and untapped potential to improve population health. Wagacha (2007, cited in Nannon and Nanono, 2018: 18) highlights the role of appropriate health information provision in promoting healthy living and effective decision-making. In this context, public libraries must provide accessible and reliable health information resources and services for their users (Orban, 2005).

However, promoting and disseminating health information is not solely the responsibility of public libraries; library staff play a crucial role in this process. For instance, a study by Nassimbeni and Shabangu (2015) underscores the importance of information provision in preventing HIV and AIDS, while Rubenstein’s (2016) study on two public libraries in Oklahoma found that many staff felt ill-equipped to handle health information queries from users. Similarly, in Namibia, Kapitako’s research (cited in Shikuni, 2020: 1) highlights the prevalence of obesity, which contributes to cardiovascular diseases and diabetes among the population. These findings underscore the need for public libraries to work with other institutions and invest in staff training to ensure the effective dissemination of health information to their communities.

Types of health information disseminated

Public libraries are universal institutions that provide information services and educate, support and promote development in communities’ daily lives. Ntlotlang and Grand (2016) concur that there is a need for public libraries to provide relevant information to make the public aware of the threat of non-communicable diseases and other health issues. Nannon and Nanono (2018: 337) stress that appropriate information provision about various diseases, disease prevention, and treatment and care services can result in proper decision-making with regard to healthy living.

Ntlotlang and Grand's (2016) study found that public libraries were striving to provide accurate and useful health information to members of the community by collecting and disseminating both print and electronic health information resources. The findings of their study further indicate that public libraries had marketing programmes, which they used to raise awareness of health information among their users. Ntlotlang and Grand state that marketing programmes should include outreach activities, library brochures or leaflets, newsletters and library exhibitions. A study carried out by Leonard and Ngula (2015: 220) recommends that libraries implement outreach programmes by means of taking services to the people, marketing their library services, and raising awareness about the importance of the community. In Namibia, according to Shikuni (2020), the Outapi Regional Library in the Omusati region provides a valuable service to its community beyond books and information. The library hosts physical activity sessions for its members, thereby responding to a need for accessible and affordable fitness programmes. The region's only gym had closed, leaving community members with few options to stay fit and healthy. The librarian in charge recognised the need and saw an opportunity to use the library's available space for community activities. This initiative showcases how libraries can be innovative and adaptable to changing community needs. By providing physical activity sessions, the library has addressed a need in the community and is promoting a healthier lifestyle. The programme also helps to break down the stereotype of libraries being quiet and stuffy places, highlighting the potential of libraries to be lively and active community spaces. This example highlights the importance of libraries as community centres that offer a variety of programmes and services to meet the needs of their users. Such initiatives can help promote the library as a valuable resource and increase community engagement with the institution. It also demonstrates how libraries can contribute to the well-being of their users by addressing issues that affect their daily lives.

One way of disseminating health information sources is via communication channels that carry knowledge and information, which include interpersonal media, mass media, and promotional and new media and technologies (Akhtari-Zavare et al., 2015). Akhtari-Zavare et al. (2015) further state that people such as health providers, family or friends are related to face-to-face communication. Mass media channels include television, magazines, newspapers and radio; promotional media includes brochures and flyers; and new media and technologies can include Internet-based channels such as websites, blogs and social media (Ghanbari-Baghestan et al., 2009; Kratzke et al., 2014, cited in Akhtari-Zavare, 2015: 1337). The present study focused on how public libraries in Namibia use these channels to disseminate health information.

The results of another Namibian study, conducted by Nengomasha et al. (2015), on the health information literacy of students at the University of Namibia found that the majority of the respondents strongly believed that health information is important, and they were able to seek health information. The participants in this study further strongly agreed that they knew where to seek health information and liked to get health information from a variety of sources. However, they indicated that they were more comfortable getting information from the Internet than from print sources. While the study by Nengomasha et al. (2015) focused on university students, the current study examined how public libraries in Namibia disseminate health information to diverse community members, including their use of both print and digital resources.

Challenges and opportunities faced by public libraries in the dissemination of health information

Many public libraries have encountered various challenges in disseminating health information. Nengomasha et al. (2015) revealed a gap in health information literacy, as evidenced by their respondents’ difficulties in deciding who to believe with regard to health issues, thus implying difficulties in critically evaluating health information and sources. Furthermore, their survey found that while University of Namibia students appeared to be informed about various health-related topics, some gaps needed to be filled. Similarly, Ankamah et al. (2021) discovered some major problems in finding health information, including Internet connectivity, a lack of time and the inadequacy of information. In contrast, the present study explored the role of public libraries in addressing these challenges by facilitating access to reliable health information and collaborating with health institutions to enhance information dissemination.

A 2020 report by the National Information Workers Association of Namibia found that when it comes to disseminating health information to the public during a pandemic, the digital gap poses the greatest barrier. For instance, working from home posed a variety of challenges for most library staff during the COVID-19 lockdown period ‘as there were no measures in place to provide staff members with technological equipment and facilities such as computers and internet connectivity devices for staff to execute their duties while working from home’ (National Information Workers Association of Namibia, 2020: 5). Not every member of the community has the necessary equipment to access the Internet and obtain information. In contrast to the aforementioned report, this study focused on how public libraries mitigated the digital divide by using traditional media such as pamphlets, posters and community outreach to ensure that health information reached underserved people during the pandemic.

Several obstacles prevent public libraries from successfully disseminating health information and fulfilling their function. These include limited resources, a lack of time to search for information, the lack of skills to search for information on the Web, and the unwillingness of library staff to assist users and retrieve information (Ankamah et al., 2021: 13). According to Ncube and Tsvuura (2020), the lack of centres disseminating information, such as libraries and information centres, has a major impact on access to health information by community members. While Wallace (2022) claims that public libraries are well suited to disseminate health information because of their resources and experienced information experts, it appears that providing clear and accessible online health and immunisation information remains a struggle. The present study expanded these findings by examining how public libraries in Namibia address these barriers through collaboration with local health institutions, leveraging print resources and conducting targeted health information outreach to ensure that even those without Internet access could receive critical health information.

Research design

A multiple case study research design was chosen for this study because it allowed for an in-depth and holistic examination of a specific phenomenon across several real-life contexts. In this case, the focus was on the dissemination of health information by public libraries in the Khomas region and how members of the public access this information through these libraries. By using a multiple case study approach, the researchers gathered rich and detailed data about the experiences of public library staff and patrons in different libraries within the region. Additionally, this approach allowed for the exploration of complex interactions between various factors related to the dissemination of health information across multiple libraries, which may not have been easily visible with other research designs.

Data collection methods

The study utilised a combination of semi-structured interviews and content analysis to collect and analyse data on the dissemination of health information. Semi-structured interviews were conducted with library staff to gain an in-depth understanding of their experiences, perspectives and attitudes regarding the dissemination of health information. The interviews were guided by a set of open-ended questions but also allowed for follow-up questions and prompts to gather more detailed information. This approach provided a rich and detailed account of the participants’ experiences and insights into the dissemination of health information.

In addition to the interviews, the study used content analysis to identify patterns and themes within the data. The content analysis involved systematically coding and categorising the data to identify key ideas, concepts and themes related to the dissemination of health information. This approach enabled the researchers to identify commonalities and differences across the data set, and gain a deeper understanding of the underlying meanings and interpretations of the content.

By combining these methods, the study obtained reliable and insightful information on the dissemination of health information. The semi-structured interviews provided a detailed and nuanced understanding of the participants’ experiences, while the content analysis assisted the researchers in identifying broader patterns and themes within the data. Together, these methods provided a comprehensive understanding of the research topic and helped to inform future strategies for the dissemination of health information.

Population

The study focused on library employees working in the seven public libraries located in the Khomas region of Namibia. The population included a total of 18 staff members – five senior librarians, one librarian, eight assistant librarians and four administrative officers. To select the participants for the study, the researchers established criteria for inclusion and exclusion based on factors such as the employees’ involvement in the dissemination of health information and the number of hours worked per week. Potential participants who met the criteria were approached and invited to participate in the study. The researchers obtained ethical clearance and informed consent from the participants before conducting the study.

Sample

A sample is a portion or subset of the population of a study, where a certain number of participants are chosen from the population to be questioned or interviewed for the study's data (McCombes, 2019). The population for this study consisted of 18 library staff members involved in the dissemination of health information. Given that the total number of staff members was 18, a census was used, meaning that all of the library staff members who met the criteria for inclusion based on their involvement in health information dissemination and the number of hours worked per week were selected to participate in the study. As such, no sampling technique was necessary since the entire population was included in the study. This approach allowed the researchers to gather detailed, in-depth data directly from the entire population of interest.

Research instruments

For this study, the researchers used an interview guide as the primary data collection instrument. This approach enabled the researchers to gather qualitative data directly from the participants, thus allowing them to gain an in-depth understanding of the participants’ perspectives and experiences related to the dissemination of health information in public libraries. In addition to administering the interview guide, the researchers conducted interviews with key informants who had specialised knowledge and expertise in the field of health information dissemination. Overall, the combination of the interview guide and key informant interviews provided a deep understanding of the dissemination of health information in public libraries.

Reliability and validity

Since the study was qualitative in nature, it was essential to ensure the trustworthiness of the research instrument and data to produce credible and dependable findings. This was achieved through means other than statistical reliability and validity, such as establishing credibility and dependability. The primary data collection instrument in this study was the interview guide. To ensure trustworthiness, the study conducted pilot testing, obtained feedback from the participants and kept detailed notes of the data collection process. Member-checking was used to verify the accuracy of the data. Overall, ensuring the trustworthiness of the research instrument and data was crucial for producing high-quality qualitative research findings that are credible and dependable.

Procedure

To ensure that the study was conducted ethically and legally, permission was sought from the Directorate of Education, Arts and Culture, which is responsible for public libraries in the Khomas region. A formal letter describing the research objectives, outcomes, proposed dates and specific libraries to be visited was submitted to the director's office. After permission was granted, appointments were made with the library staff for the interview sessions. Ethical clearance was also obtained for the study. According to Babbie (2010: 64), ethics is typically associated with morality and concerns matters of right and wrong. The researchers completed the ethical clearance application and submitted it, together with the research instruments, to the Directorate of Education, Arts and Culture, Ministry of Education, Namibia research ethics committee for approval.

Data analysis

The purpose of data analysis is to make sense of the data that has been collected. This process involves consolidating, reducing and interpreting the information the researcher has collected and making sense of what the participants said (Merriam, 2009). The analysis of the interview data was undertaken using thematic content analysis.

Dissemination of health information by public libraries

The objective of this study was to investigate how health information is disseminated in public libraries in the Khomas region of Namibia. In keeping with the study's research objectives, the findings revealed that many of the participants reported connecting with people from various backgrounds daily who were searching for health-related information. Of the 12 participants, eight claimed that their tasks included assisting researchers and identifying, arranging and making information available to users. This is in line with the findings of other studies, such as those of Rubenstein (2017) and Yi (2015), who found that librarians needed to understand their users better to plan services for them, thereby suggesting a broader trend in the field.

In terms of the most frequently arising health-related issues, four of the participants reported that female immunisation, male circumcision and infant immunisations were the most popular topics. However, three indicated that users were seeking information about sexually transmitted diseases, notably HIV/AIDS and syphilis, as well as other related issues, such as condoms, teen pregnancy and sexual reproduction. Additionally, three other participants stated that users had inquired about general health issues such as COVID-19 and other outbreaks, midwifery, nutrition classes, nursing programmes, diabetes, blood pressure, weight loss and mental health. These findings are consistent with previous research by Rubenstein (2017) and Yi (2015), which also highlights the diverse range of health-related topics sought by library users.

When asked about the accuracy of the information provided by library staff, the participants gave the following responses: four mentioned that they believed the information provided to users was accurate because it originated from health pamphlets, posters, flyers and brochures obtained from clinics, the Ministry of Health and Social Services and library resources. One participant noted that their library utilised interlibrary loans to access resources on health-related topics or referred users to specific libraries for necessary materials. Additionally, two participants stated that they relied on information sourced from platforms such as Medline Plus, PubMed and ClinicalTrials.gov, as well as journals, books and booklets on health information provided by the Ministry of Health and Social Services. These findings echo the results of previous studies, such as those conducted by Philbin et al. (2019) and Zaid (2016), which also highlight the importance of utilising diverse sources and ensuring the accuracy of health information provided by libraries.

Seven participants mentioned that they collaborated with local health institutions such as the National Health Training Centre, Katutura Health Centre, Ministry of Health and Social Services, and Ministry of Gender. They also indicated that they collaborated with organisations such as Project Hope, the Namibia Planned Parenthood Association and the City of Windhoek. These findings are consistent with Zaid's (2016) study, which concludes that, for the residents of Lagos State, Nigeria, librarians should collaborate with other stakeholders to organise seminars, exhibitions and other related events, such as World Health Day celebrations, as well as actively participate in the free distribution of publications dealing with high blood pressure. Five participants did not specify their involvement with local health organisations or the government.

When asked about the health topics that were of the greatest interest to patrons, nine participants mentioned the following: diabetes and blood pressure, hygiene, family planning, HIV/AIDS, teenage pregnancy, male circumcision, drug and alcohol abuse, mental health and stress management. Three participants did not respond to this question.

Types of health information disseminated

Out of the 12 participants, four indicated that they had disseminated various types of information through pamphlets, magazines, newspapers and books, while six focused on disseminating information about teenage pregnancy and immunisation, HIV/AIDS, condom use, circumcision, tuberculosis, stress and depression, abortion and family planning, diabetes and blood pressure, breast cancer and alcohol consumption. Two participants did not provide any information on their dissemination activities. These findings are consistent with those of Zaid (2016), who concluded that awareness about high blood pressure can be increased through education and the dissemination of information from a variety of sources, including family doctors, libraries, librarians, posters, outdoor medical outreach, the mass media, family and friends, the Internet and pharmacies.

Three of the participants stated that they considered the user's level of knowledge and age when determining how to transmit information. One participant mentioned that their library conducted needs assessments on an annual basis to assist staff in determining what health information should be provided to patrons. This aligns with the findings of previous studies – for example, Rubenstein (2017) and Yi (2015) discovered that librarians needed to better understand their users to plan services for them. In addition, one participant noted that knowledge can be transmitted through a variety of methods, from traditional media to emerging forms like the Internet. Three participants reported that most users still preferred print resources and they thus focused on sharing information about print resources. Four respondents chose not to answer the question.

Challenges and opportunities faced by public libraries in the dissemination of health information

Only five participants answered this question. Two of the respondents stated that there are insufficient health books in public libraries and, even when available, the content and level of these books is not suitable for the intended audience. One participant noted that public libraries now subscribe to health databases through EBSCOhost, but many articles are not full text, which hinders the availability of sufficient and relevant information resources to meet user demands. Additionally, one participant attributed the challenges to a lack of collaboration among libraries in the region, while another mentioned delays in receiving new consignments from suppliers as a barrier to providing health information to users. These findings are consistent with those of Ankamah et al. (2021), who identified various obstacles hindering public libraries from effectively disseminating health information. These obstacles included limited resources, insufficient time to search for information, the lack of skills in searching the Web, and a reluctance among library staff to assist users and retrieve information.

Scope and limitations of the study

The scope of this study was limited to the library staff at seven public libraries located in different constituencies in the Khomas region due to funding and time constraints. The study’s findings cannot be generalised to other public libraries in different regions of Namibia.

Implications

This study has revealed that public libraries actively disseminate health information to the population, which is critical for promoting public health literacy. The findings indicate that while libraries are efficiently employing multiple channels to distribute health-related information, there are still issues that must be addressed to enhance their effectiveness. From an academic standpoint, this research contributes to the expanding body of literature on the dissemination of health information in public libraries. It has multiple implications. First, by examining how libraries disseminate health information, other public libraries may adopt best practices and improve their health information outreach initiatives. Second, the study's findings can guide governments in providing stronger support for public libraries, including increased financing, staff training and resources to improve health information dissemination. Third, the study underscores the importance of closer collaboration between libraries and health facilities. Such partnerships can ensure that the public has easy access to accurate, current and relevant health information. Finally, while public libraries already play a significant role in disseminating health information, this study highlights the importance of ongoing investment and collaboration to ensure that they remain effective in addressing the community's evolving health information needs.

Recommendations

Based on the findings of this study, the following recommendations are made:

Public libraries should disseminate health information to communities using various resources, such as pamphlets, brochures, leaflets, posters and books. Additionally, libraries should actively inform communities about the availability of health information resources within their facilities.