vol. 13 no. 4, December, 2008
The detailed title of the project is 'The value creating network in preventive health care. Medical doctors as information providers and knowledge producers in counselling in the context of obesity, metabolic syndrome and diabetes type 2.'
The aim of the research is to explore how the value-creating health care network is set up to prevent obesity and its health consequences by counselling and what is the role of the medical doctors and medical knowledge in this network. The purpose of this study is to add knowledge about existing practices in medical consultations in the context of preventive health care and to increase understanding of people's information behaviour within networked environments. The theoretical background of the research is based on the social network theory and the framework of value constellation (Normann and Ramirez 1994) extending the theories of knowledge management complemented with every day information seeking theory of Chatman (1991; 1996; 1999; Huotari and Chatman 2001; Huotari and Iivonen 2004, 2005).The outcomes of this research may have an impact on practice by improving the effectiveness of interventions in lifestyle counselling by identifying the boundary processes of the different professionals involved in preventive health care.
The epidemic of obesity poses one of the most serious public health challenges in the WHO Europe region (WHO 2006). The health consequences range from increased risk of premature death to serious chronic conditions such as metabolic syndrome, diabetes type II and cardiovascular diseases. Lifestyle interventions focusing on changes in dietary and exercise habits have been shown to be effective in the prevention of type 2 diabetes among high risk subjects. (Tuomilehto et al. 2001; Yamaoka and Toshiro 2005; Dale et al. 2007). The information provided especially by medical doctors is considered to be trustworthy and most patients feel that physicians have a significant role in weight management (Eriksson-Backa 2003; Tan et al. 2006).
Information is crucial in preventive health care. Medical research has focused on how the diseases were developed, what kind of changes they cause, and how to treat them. Less attention has been paid to prevention of metabolic syndrome and obesity in general, to compliance with health regimens in particular, and to what the role of information is in compliance and support provided for patients by health care professionals. The impact of information should be a major concern in preventive health care and support for patients in counselling. Effectiveness requires comprehensive understanding for how health and related information are mastered in the health risk groups.
A rich flow of information and improved knowledge are not the same as good health behaviour. Research on knowledge management indicates that information is not synonymous with knowledge, neither is the transformation of knowledge into behaviour a simple or linear process. Many different highly educated health care professionals work in the primary health care but the responsibility of the care of the patient is shared, not collective. The health care organizations are divided into many actors and multiprofessional collaboration is limited. (Sinervo and Lindström 1992, Saaren-Seppälä 2006: 330.) The value-creating network, constructed by activities of a number of stakeholders involved in joint information and knowledge processes (Normann and Ramirez 1994), is a potent conception to analyze this complexity. According to Jaana Parviainen (2006: 156-157) the construction of collective knowledge is useful to both the professionals and to the organization. The collective knowledge is more than the knowledge of individuals.
This research is a subproject of the Health information practice and its impact. The context of metabolic syndrome and obesity project conducted at the Information Studies Unit, University of Oulu and at the Department of Information Studies, åbo Akademi University, which received an grant from the Academy of Finland for 2008-2011.
The framework of this dissertation is based on the theories of knowledge management and on the small world-theory in everyday life information seeking (ELIS) by Chatman (Huotari and Chatman 2001, Huotari and Iivonen 2005, Chatman 1991, 1996, 1999), on the social network theory and on the idea of value creating networks presented by Normann and Ramirez (1994).
Organizations, including health care organizations, are social networks consisting of health care professionals and e.g. administrative and assisting personnel. Each individual is an actor of the network with links or ties to other actors inside the organization and also outside the organization. The patient and his or her own social networks are linked to the health care organizations networks. Health care organizations are highly knowledge-based. The knowledge is embodied in the experts, embrained and encoded in patient records, databases and documents, embedded in routines and ways to function and also encultured in the organizational culture and social and intellectual capital of the organization.
Value is created in the network by knowledge sharing and combining and creating new knowledge. The knowledge processes can be divided into three categories: generative, productive and representative. (Huotari and Iivonen 2005). The density of the network is an essential attribute in knowledge sharing. In the context of preventive health care the created value to be considered is health information that has an impact on the patient's knowledge of health behaviour which can lead to healthier choices in lifestyle related issues.
Organizational culture describes the attitudes, experiences, beliefs and values of an organization. It is a collection of values and norms that is shared by people and groups in an organization and that controls the way they interact with each other and with stakeholders outside the organization. The information behaviour in the organizations can be inspected with the concepts of Chatmans´ small world theory (Chatman 1991, 1996, 1999). Social norms allow members of the organization to approach or ignore information. Worldview is a shared outlook on life and it shapes the value systems and beliefs of the members. Categorizing people to social types such as insiders and outsiders define to the members of the social network whom to trust or distrust as an information source.
The aim of the research is to add knowledge about the existing practices in the medical consultations concerning counseling in the context of preventive health care.
The main research questions are:
The empirical study will be performed in collaboration with the Nursing Science and Medical Science at the University of Oulu and it is based on a qualitative approach and triangulation of research methods. The information and knowledege processes related to preventive health care and counselling will be indentified trough social network analysis and interviews with different professionals involved in the preventive health care and possibly completed with a questionnaire for the patients receiving counselling. Guidelines for research ethics in humanities, nursing sciences and medical science will be carefully followed.
I started as a doctoral student at the University of Oulu in January 2008 and so far I have been doing the research only part time, so the work is still at its beginning. The dissertation proposal and a poster have been presented in the doctoral workshops of the international conferences USE 2008, in Oulu, Finland 24-25 June 2008 and in ISIC 2008 Vilnius, Lithuania 16-19 September 2008. This year I have been working with the literature review and designing the research plan and my intention is to start a pilot study in the beginning of 2009 at the Paediatric Department of the Oulu University Hospital, which has been developing a regional treatment chain consisting of different health care professionals for the care of obese children. The gathering of data and writing of the thesis is planned to take four years.
The preliminary schedule:
Jan 2008-Dec 2008: Up-dated literature review, designing the final research plan
Jan 2009-Dec 2009: Data collection, starting data analysis writing the first article, starting the second article
Jan 2010-Dec 2010: Data analysis, reporting the findings, writing the second and third article
Jan 2011->: Writing the fourth article, finishing the dissertation, presenting findings in conferences.
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