Although the investigation of information needs in relation to health problems and health information services is part of information science in general, the subject has been investigated by numerous researchers in the health disciplines, publishing in journals in their own specialisms. This makes the field, on the one hand, very productive of ideas and theories, but on the other hand, difficult to review, because of the diversity of sources. Our aim, however, is not to review the subject in depth, but to extract those ideas that will be of value in elaborating a general model of information-seeking behaviour.
To begin with, we find the same division into cognitive and affective information needs as suggested in Wilson's 1981 model. Thus, Johnson & Meischke (1991a) note that:
In terms of cancer-information seeking, the individual's need for cancer information can either consist of cognitive needs (obtaining more factual information about cancer prevention, detection, and/or treatment) or affective needs (obtaining information which will aid in dealing with cancer emotionally).
One can readily understand that affective needs will be very prominent in health-related information-seeking, where the emotional impact of life-threatening diseases or operations is very obvious. In fact, the emotional reaction to medical conditions has led to a significant amount of work on the stress/coping model.
The fact that purely cognitive drives cannot explain information-seeking behaviour is attested to by the fact that, even in critical circumstances, people do not always seek medical information, even when the gaps in their knowledge are evident. van Zuuren & Wolfs (1991) point out that the very information that might enable a person to deal with a problem can be threatening in itself.
Thus, theories of stress and coping have featured strongly in the health information field, with two cognitive states being proposed as central to understanding an individual's response to an adverse situation. These are: attention, or orientation towards the threat; and cognitive avoidance, or turning attention away from the threat (Krohne, 1993). These basic dimensions of the situation have been given other names by various researchers but, essentially, they are working with concepts that at least overlap. Thus, Krohne has also used the term vigilance instead of attention; and Miller & Mangan (1983) have used the polar opposites sensitization and repression.
Miller & Mangan (1983) have also used the terms monitoring and blunting to signify the behavioural counterparts of the cognitive terms and this formulation has also been used (among others) by Steptoe & O'Sullivan (1986), van Zuuren & Wolfs (1991), and Baker (1995).
Miller & Mangan (1983) studied forty gynaecologic patients who were about to undergo an intrusive diagnostic process (colposcopy). The patients were divided into two groups, monitors and blunters, according to their scores on the Miller Behavioral Style Scale (MBSS). This Scale divides people into the two categories, '...based on their self-reported preferences for information or distraction in a variety of naturalistic stress situations'. The aim of the work was, as the subtitle of the piece indicates, to answer the question, 'Should the Doctor tell all?'
The results were consistent with the theory that monitors prefer a high information input before a stressful event and suffer less psycho-physiological arousal when they have information, while blunters prefer less information and suffer more arousal when they have a high information input. As the authors note, 'When blunters are left to their own devices, they prefer not to scan for threat-relevant information.'
Steptoe & O'Sullivan (1986) also used the MBSS with women about to undergo gynaecological surgery and found support for Miller's work. Specifically, '...monitors will engage in more vigorous health-related information-seeking behaviours.'
van Zuuren & Wolfs (1991) used the MBSS with 47 introductory psychology students and found the expected association between monitoring and problem-focused coping. However, they found no relationship between monitoring and blunting and students' perceptions of their real-life behaviour. Exploring this issue further, they discovered that monitoring was positively related to the perceived degree of threat in a situation, that is, the higher the perceived threat the more information would be sought. They also show that monitoring is related to unpredictability (confirming the two-dimensional model of coping shown in Figure 3 above).
One of the few information scientists to use this model, Baker (1995) studied the information preferences of women with multiple sclerosis, using the MBSS to divide her sample. She notes, '...regardless of format, monitors were more interested in information about MS than were blunters and further, that their interest occurred earlier in the disease than did the interest of blunters.'
Overall, we can say that the stress/coping theory, together with the
MBSS behavioural measure, constitutes a useful tool for exploring information-seeking
behaviour in relation to health and may have wider application.