Results: Bibliometric insight and analysis
The revised literature research primarily focused on research articles (28) and reviewed articles (2) within the required field while not considering other article types such as book Chaps. (7 published) and encyclopaedia (2 published) from the period of Poverty information theory inception in 1984 until April 2023. It is worth mentioning that, in certain years, no publications, review articles, or research articles were identified as relevant. However, out of the 30 targeted publications (28 research articles and 2 review articles), the authors successfully accessed and downloaded 28 articles for more detailed analysis (see Table 1 above).
Examining the publication frequency per year, only one article was published recently, from January to April 2023. In 2022, there were five articles published, while in 2020, four articles were published. In 2019, 2018, and 2017, only two publications were published in each year. In 2016, three articles were published; in 2014, 2009, 2006, 2005, 2001, 2000, 1991, and 1984, one publication was published each year. Additionally, two articles were published in 2003. No articles were published in other years between 1984 and 2023. This indicates an increasing interest in the subject in recent years, as more authors published articles within this field.
Regarding publication titles, "Library & Information Science Research" had the highest number of publications with 11 articles. "The Lancet," "Information Processing & Management," "The International Information & Library Review," and "Investigación Bibliotecológica: Archivonomía, Bibliotecología e Información" each published two articles each within the identified period. Several other journals published one article each, including the "Journal of Adolescent Health," "International Journal of Information Management," "Progress in Planning," "Social Science & Medicine," "BJOG: An International Journal of Obstetrics and Gynaecology," "Midwifery," "Government Publications Review," "Academic Paediatrics," "International Journal of Africa Nursing Sciences," "Journal of the National Medical Association," and the "Journal of Migration and Health." Therefore, the majority of articles were published in information sciences and library journals, followed by health and medicine journals.
Considering the subject areas covered by the 30 articles, it is important to note that an article may fall under one or more subject areas. Of the 30 articles, 23 were classified under Social Sciences, nine under Medicine and Dentistry, two under Computer Science, two under Nursing and Health Professions, one under Business, Management and Accounting, and one under Psychology.
The approach employed in selecting articles during the second phase of the literature review varied based on each article's content and specific objectives. In certain cases, a preliminary assessment based on the title and/or abstract sufficed to finalise selection In other cases, a more detailed reading of additional sections, such as the introduction, methods, and conclusions, was necessary to determine inclusion or exclusion. The year of publication was also taken into consideration during this process. These steps aided the authors in establishing the purpose and primary aims of the articles, enabling them to decide whether to include or reject them as part of the search for drawing discussion points and conclusions from the findings.
Given that the focus of this study centred around misinformation or decision-making linked to the problems of Information Poverty, lack of information, and misinformation are clearly related, the study then narrowed its scope to the more recent years of 2019 to 2023 in the hopes of identifying relevant studies that explored subject matter most allied to the recent COVID-19 pandemic. This yielded five articles that appeared relevant and were published between 2019 and April 2023. Subsequently, the authors also revisited articles that might be relevant to the topic prior to the pandemic. Out of 13 articles examined, seven were deemed to address issues related to information behaviour in settings involving previous health concerns such as diabetes and HIV/AIDS. Consequently, Table 2 presents an overview of these articles’ discussions and findings reported in the 12 articles selected across these two subsections.
The researchers contend that the distinction between article findings before and after the COVID-19 pandemic may not differ significantly. Notably, the pandemic emerged only towards the end of 2019 and significantly impacted most countries from 2020 onwards. Yet, the researchers believe that despite the 2019 pandemic, no studies have readily utilised the Theory of Information Poverty to comprehensively understand aspects of information miscommunication, decision-making and behaviour confirming the “problems of Information Poverty, lack of information, and misinformation are related”.
Results from phase two: 12 documents selected to draw discussions
In academic research, Chang and Huang (2020) highlight the inclination of individuals to conform to group norms, particularly when facing the threat of an imminent life-threatening virus. They emphasise the significant influence of information sources on individuals' decision-making behaviour. Similarly, Hicks (2020) emphasises the interconnectedness of information-seeking activities and the process of self-discovery, specifically in relation to identity within the field of information behaviour research.
Regarding adolescent health, Homere et al. (2022) reveal that healthcare providers often lack adequate training to address the unique needs of adolescents. They also identify a scarcity of trauma/violence education targeted at this vulnerable group. Importantly, Homere et al. (2022) find that while family, friends, and teachers are common sources of health information, doctors are the preferred choice across all health topics.
Shifting the focus to the role of social media in health information seeking, Frey et al. (2021) emphasise the increasing reliance of parents on social media platforms. They argue that social media facilitates the exchange of timely and tailored health information, fostering significant social support among users. Additionally, they stress the importance of effective health literacy education to ensure safe and effective social media navigation for health information seeking.
Zhang and Yang (2023) argue that Information Poverty extends beyond mere economic scarcity or limited access to information sources. They emphasise the multifaceted nature of Information Poverty. Reid et al. (2018) highlight the need to improve community awareness, promote self-management, and empower healthcare providers through relevant training to implement effective health dialogue strategies. They also point out that meeting the information needs of healthcare providers in the developing world may be hindered by factors such as limited internet connectivity, leading to "Information Poverty." Furthermore, they suggest that improving the availability and use of relevant and reliable healthcare information has the potential to enhance healthcare significantly.
Savolainen (2016) discusses the adverse impact of socio-cultural barriers on information seeking, which arise from social norms and cultural values. These barriers restrict access to information sources and give rise to negative emotions. Additionally, Savolainen (2016) emphasises that barriers to information-seeking are significant contextual factors determining individuals' access to information sources.
Gray et al. (2005) find that the internet is the primary general information source for many individuals, including young people, who compare internet information with other sources. They also note that some adolescents verify information received from personal sources through internet searches. However, caution is exercised regarding health advice from unknown online individuals, whereas known lay contacts are deemed more credible.
Pink and Cole (2001) observe that health information is accessed through informal channels, with physicians playing a crucial role in low-income communities as informal and formal information sources. Gibson and Kaplan (2017) argue that an equity approach, instead of equal information access, focuses on understanding individuals' information needs, their capacity to seek information, and the necessary measures to meet those access needs.
Maitrayee Ghosh (2006) highlights the perceived need for public libraries to raise community awareness of HIV/AIDS threats. The challenge lies in reinventing public libraries to respond effectively to community needs. The Indian national and state governments are identified as underutilising public libraries for disease prevention, which could play a significant role in providing timely information on control, prevention, and care.
Pettigrew et al. (1993) assert that their potential may be limited if internet technologies fail to fulfil individuals' needs for effective support and social interaction during information seeking. Chang and Huang (2020) argue that the value placed on information-seeking within a community directly influences individuals' motivation to seek or acquire knowledge. Disadvantaged and marginalised communities often exist as isolated "information worlds," leading individuals into Information Poverty.
Reid et al. (2018) note that in developing countries, many healthcare workers lack access to basic, practical information and opportunities to update their knowledge or skills. Consequently, they rely heavily on observation, advice from colleagues, and empirical experience gained through their treatment successes and failures. Gray et al. (2005) recognise the concerns raised by medical researchers about the quality of health information on the internet. However, their study participants demonstrate sophisticated critical appraisal skills and employ strategies to test reliability, such as seeking information from credible institutions.
Horton (2000) emphasises the importance of information transfer in medicine, as exemplified by the controversial debate in South Africa regarding the use of antiretroviral drugs for HIV treatment. The lack of a strong information base to prevent such fluctuations in public opinion, with potentially detrimental public health consequences, is underscored.
Gibson and Kaplan (2017) find that individuals of colour often have unmet needs within larger communities. Some cope by seeking information outside their local or information-poor communities, shifting their information-seeking to broader spheres. Pettigrew et al. (1993) propose that people continually seek and construct information from various resources or ideas to bridge knowledge gaps encountered throughout life. Sense-making, viewed as a construction process from the user's perspective, rests on the assumption of discontinuity and recognises communication and information use as integral components.
Therefore, this collection of academic research identifies as important the conformity to group norms, the influence of information sources on information-seeking behaviour, self-discovery and identity, adolescent health needs, the role of social media, Information Poverty, barriers to information seeking, the internet as an information source, the importance of community awareness, equity in information access, the role of public libraries, the impact of information in medicine, and the dynamic nature of seeking and constructing information.
Contribution to the Theory of Information Poverty
The central focus of this review article is the interplay around technology access and health information, the issues of misinformation and inadequate data for decision-making during health emergencies, and the uncertainty that results. Specifically, the article examines how individuals seek and utilise information and whether communities develop novel strategies to enhance their information-seeking practices.
Information Poverty is the deprivation of the “right to information” due to various factors, including lack of access, information overload, and self-imposed information deprivation (Sweetland, 1993). Britz (2004) describes Information Poverty as a situation in which individuals and communities within a specific context lack the necessary skills, abilities, or material resources to access, interpret, and apply information efficiently. Considering these perspectives, this article employs Information Poverty Theory to elucidate the challenges faced in obtaining and interpreting information and the prevailing community norms regarding sharing or withholding such information (Lingel and Boyd, 2013).
According to Britz (2004), Information Poverty manifests as a deficiency in accessing crucial information, and even when it is available, individuals may struggle to derive appropriate meaning from it. Access alone does not encapsulate the concept of Information Poverty, as other factors can disengage people from information. Goulding (2001:109) describes Information Poverty as the outcome of a divide between those who can easily access abundant information and those who lack knowledge or resources on how and where to find it. They may even fail to recognise the value of information and its potential benefits in their daily lives. So, to some extent, the article explores the complex dynamics of misinformation, limited data for decision-making in emergencies, and the concept of Information Poverty within the context of health information.
The concern regarding inequality in information access, particularly in relation to education and literacy, emerged as early as the 1960s (Yu, 2006). During this period, it became increasingly evident that certain individuals were disadvantaged in accessing information due to a lack of essential skills and knowledge. Information inequality was thus influenced by factors such as inadequate literacy and digital skills, limited educational opportunities, and insufficient training. According to Yu (2006), the 1990s marked a significant shift in information dissemination due to advances in ICTs. This shift further exacerbated imbalances in more general social participation due to the uneven distribution of information. As ICTs continue to advance, the dissemination and access to information remain disrupted, perpetuating the issue of information inequality in society.
With the transition to the current information era, the concept of Information Poverty has taken on a new dimension. This transition, facilitated by the development of ICTs, has given rise to a globalised information-driven economy known as the knowledge economy, based on intellectual and intangible assets (Freeman, 2001). ICTs have emerged as one of the most influential and transformative technologies of the 20th and present centuries, generating significant interest across various disciplines as they intersect with the discourse on the digital divide (Yu, 2011). The relentless growth of ICTs has led to a remarkable expansion of knowledge industries in developed countries, but it has also deepened the gap between wealthy and impoverished nations (Britz, 2004). While ICTs have played a dominant role in creating divisions between those with access to information and those without, it is important to recognize that Information Poverty is not solely confined to a single technology or digital divide (Britz, 2004). It is a multi-faceted phenomenon encompassing factors such as cultural and linguistic diversity, educational levels, and the ability or inability to access and benefit from information (Britz, 2004).
This study focuses on the quality of health information and the resources needed to access information to examine the dynamics of Information Poverty as well as misinformation, especially in developing countries. In many underdeveloped and developing nations, not all communities and households possess equal resources to access information. The significance of this study lies in the ongoing disruption of communication processes by ICTs, which in turn affects the transmission of information and data between individuals using internet-focused computing and smartphone devices. Moreover, the study is conducted at a time when there is a growing understanding of various health issues and pandemics. The paper asserts that rural communities, particularly poor households, face challenges in accessing information and are more likely to experience Information Poverty. This study seeks to shed light on these disparities and their implications.
In a developing country, Information Poverty is characterised by complexity and heterogeneity, necessitating collaboration among the various stakeholders. Numerous challenges developing nations face, such as inadequate literacy skills, social inequality, limited analytical capabilities, difficulties in comprehending information, and poverty, contribute to Information Poverty. It is crucial to recognise that Information Poverty extends beyond mere access to resources for information retrieval and encompasses the ability to derive meaning from the obtained data. Information Poverty encompasses multiple attributes related to information, including (a) access to resources, (b) knowledge, (c) social standing, and (d) a certain level of search skills to navigate information, amongst numerous others effectively. As a result, certain communities and households may be deprived of the opportunity to access data due to the lack of social enabling infrastructure and adequate digital skills. Moreover, as noted by Sweetland (1993), being information-rich entails having sufficient resources to access information easily and possessing the capacity to retrieve information, assess it, and process it intellectually. Therefore, Information Poverty entails the availability of adequate resources for access and the cognitive ability to analyse and comprehend data and information.
Information and digital inequality and pre-existing social inequality have been significantly influenced by unequal access to resources like internet connection points. However, it is important to note that access to enabling resources is not the sole factor contributing to Information Poverty (Lingel and Boyd, 2013; Jaeger and Thompson, 2004; Goulding, 2001). While lack of access to information tools and services is a clear aspect of Information Poverty, it can also stem from a lack of research or technological skills needed to retrieve information and a dearth of accurate guidance for accessing information (Sweetland, 1993). According to Lingel and Boyd (2013), Information Poverty is more related to the inability to effectively use technologies for personal advantage rather than simply having access to technology itself, which can lead to social exclusion. In the current internet-driven society, where individuals are exposed to an overwhelming amount of information, Information Poverty can arise from both an excess and a scarcity of information (Jaeger and Thompson, 2004). Consequently, Information Poverty impacts not only the "information poor" but also those overwhelmed by excessive information, referred to as the "information burdened" (Goulding 2001:111).
The Theory of Information Poverty focuses on understanding information behaviour in disadvantaged or unequal situations and determines the concerns of social integration concerning access and participation (Buchanan and Tuckerman, 2016). So, the theory is relevant for this study as it addresses the abovementioned attributes.
The link between the attributes of the Theory of Information Poverty and the present study are:
• Disadvantaged situations
Poor communities on the receiving end of health services, as well as health professionals and various health organisations, find themselves at a disadvantage due to the rapid onset of health conditions and diseases. This disadvantage is not a matter of choice but rather a consequence of the general situation in which the world, particularly poorer communities, finds itself. Many communities rely on information shared through various ICT tools and platforms to understand more about their health concerns. Therefore, communities and health bodies are often unprepared for such eventualities. Furthermore, poorer communities are further disadvantaged by not having ready access to information about health matters, in contrast to those living in more affluent communities who can afford to use ICTs.
This digital divide results in significant disparities in health outcomes. Poorer communities, lacking access to timely and accurate health information, are less equipped to take preventive measures or seek appropriate treatment. This leads to higher morbidity and mortality rates in these areas. Additionally, the health sector is disadvantaged by having to play catch-up to understand more about sudden health emergencies quickly. This situation applies particularly to new viruses or diseases that spread rapidly, necessitating declarations of global, regional, or local pandemics by organisations like the WHO.
• Information overload and misinformation
Another crucial attribute of the Theory of Information Poverty is the challenge of information overload and misinformation. In today's digital age, the sheer volume of available health information can be overwhelming, and not all are accurate or reliable. Poor communities, with limited access to high-quality information sources and lower levels of health literacy, are particularly vulnerable to misinformation. This misinformation can lead to poor health decisions, such as the refusal of life-saving treatments or adherence to harmful practices.
The spread of misinformation is exacerbated by the same ICT tools intended to provide reliable information. While useful for disseminating health information quickly, social media platforms also serve as breeding grounds for false information. People in poorer communities, who may rely on these platforms for information, are at a higher risk of encountering and believing misinformation. This misinformation can have dire consequences, such as spreading preventable diseases or rejecting effective medical interventions.
• Concerns around social integration
Addressing the issue of more general inequalities that blight the globe remains a problem. Countries, particularly households with financial means, can acquire the relevant ICTs needed to access information. Technology infrastructure distribution inequality requires a collective effort to support those countries and/or communities with poor or no infrastructure access. So, extending existing ICT infrastructure or rolling it out where it does not exist can help provide a more level playing field. In this way, disadvantaged people and communities will be better integrated into the information society where affordable access and use are not such a constraint. Nevertheless, problems related to religion, class, community practices, and differences in values and cultural beliefs also contribute to challenges related to social integration. It is essential to understand these internal and external factors impacting social integration. Inequalities in technology infrastructure distribution are examples of external factors that may hinder who has access to information and to what information.
Health organisations and professionals working in these communities face similar challenges. They may have limited access to up-to-date medical information and research, hindering their ability to provide the best care. This lack of resources also affects their ability to communicate effectively with the communities they serve, as they may not have the tools or training needed to convey complex health information in an accessible and understandable way.
• Information behaviour
Humans require information that will assist them in developing knowledge and the capacity to achieve new goals. In this instance, we are looking at information behaviour in the context of acquiring knowledge about health and related diseases. The ability to adequately search for information requires certain skills and resources acquired on life’s journey. For instance, understanding behaviour in this context is complex. It is necessary to look beyond the search and consumption of information. The researcher believes that having access to published information and data is not enough. We should, in turn, acknowledge that the quality of information and how it is interpreted, as well as issues around the resources needed to access it, is the reality in many people’s lived experiences.
This study aims to apply the Information Poverty Theory to health information in a developing world context. Figure 1 below demonstrates how the Information Poverty Theory can lead to unsatisfactory outcomes where the theory’s context remains unchanged. Misinformation around the problems of Information Poverty, lack of information, and misinformation, together with poor information interpretation and decision-making phenomena, can result in undesirable outcomes. Ultimately, it is necessary to understand that people carry their prior knowledge and interpretations derived from their lived experiences. This outcome may apply equally to organisations. Thus, the relationship between information and data and lived experiences may not always be objective.
This diagram illustrates how different combinations of access to health interventions and the quality of health information can influence decision-making outcomes. It highlights the broader issues of Information Poverty, lack of information, and misinformation in various health contexts. For example, Individuals with access to health interventions and reliable information are more likely to make informed decisions about their health. This optimal scenario represents a situation where people can receive the necessary treatments and understand their benefits, leading to positive health outcomes and trust in the healthcare system. On the other hand, some individuals may have sufficient access to accurate health information but lack the availability of necessary health interventions, which also hampers effective health decision-making. In this scenario, while people are well-informed about their health needs and potential treatments, the unavailability of those treatments poses a major barrier to achieving positive health outcomes.
In communities where health interventions are not readily available and there is a lack of accurate health information, individuals face compounded challenges in making informed health decisions. This represents a significant disadvantage, where the absence of physical and informational resources severely limits the ability to manage health effectively, often exacerbating health disparities. Even when health interventions are accessible, misinformation can lead to poor decision-making and health outcomes. This scenario highlights the danger of inaccurate or misleading information, which can cause individuals to make health choices that are not in their best interest, despite having access to the necessary interventions.
By addressing these broader issues of information poverty and misinformation, we can enhance the capacity of individuals and communities to make better-informed health decisions, ultimately improving public health outcomes. Ensuring equitable access to health interventions and accurate information is crucial for fostering informed decision-making and reducing health disparities across different populations.