ADDIS ABABA UNIVERSITY

SCHOOL OF GRADUATE STUDIES

Joint Program between School of Public Health and Information Science

Health informatics

Assessment of the health information Seeking

Behavior of people on ART in Addis Ababa, Ethiopia

By:
Tilahun Deribe

Advisor:
Wubegzier Mekonnen (BSC, MA)

A Thesis Submitted to the School of Graduate Studies of Addis Ababa

University in Partial Fulfillment of the Requirements for the Degree of
Masters in Health Informatics

Addis Ababa, June 2009

 ADDIS ABABA UNIVERISTY
SCHOOL OF GRADUATE STUDIES

Assessment of the health information Seeking

Behavior of people on ART in Addis Ababa, Ethiopia

By:
Tilahun Deribe

Approved by the Examining Board

________________________________________________
Chairman, SPH. Graduate Committee

________________________________________________
Advisor(s)

_______________________________________________
Examiner(s)
 Acknowledgement

I am highly grateful to my advisor Ato Wubegzier Mekonnen for providing me with guidance
and direction through out the progress of my work. My sincere gratitude also goes to Addis
Ababa University School of Public Health, Department of Informatics, and Addis Ababa Health
Bureau for providing me with an unwavering support. I would also like to extend my foremost
gratitude to the coordinators of the ART facilities in Zewditu memorial, Yekatit 12, Ras Desta,
Minilik, Ghandi, Betezata, Zenbaba hospitals and Arada, Teklehaimanot, Lideta and
Beletshachew health centers who have provided me with the required support during data
collection. Moreover, I would also like to acknowledge all data collectors and supervisors who
participated in the interview with out whom my efforts could have been fruitless. Last but not
least, my final gratitude goes to no else but to all the respondents who have participated in the
study and provided me with valuable and accurate information.
 Table of Contents
LIST OF TABLES ........................................................................................................................................... iii
LIST OF FIGURES ......................................................................................................................................... iv
ACRONYMS ................................................................................................................................................... v
ABASTRACT ................................................................................................................................................. vi
INTRODUCTION ........................................................................................................................................... 7
RATIONALE OF THE STUDY........................................................................................................................ 7
LITERATURE REVIEW .................................................................................................................................. 8
OBJECTIVES ................................................................................................................................................ 14
General Objective ................................................................................................................................. 14
Specific objectives ................................................................................................................................ 14
METHODS.................................................................................................................................................... 15
Study Area ............................................................................................................................................ 15
Study Design ........................................................................................................................................ 15
Source population ................................................................................................................................ 15
Study Population .................................................................................................................................. 15
Sample size ........................................................................................................................................... 16
Sampling Procedures ........................................................................................................................... 16
Data Collection Procedures .................................................................................................................. 17
Measurement ....................................................................................................................................... 18
Data Analysis procedures ..................................................................................................................... 18
Ethical considerations .......................................................................................................................... 19
RESULTS...................................................................................................................................................... 19
Demographic characteristics ................................................................................................................... 19
Information source use ............................................................................................................................. 22
Association between Information Source Use and Demographic Variables........................................... 23
Health professionals ............................................................................................................................. 25
HIV positive peer educators ................................................................................................................. 25
Families, Friends and Neighbors .......................................................................................................... 26
The Internet .......................................................................................................................................... 26
Television .............................................................................................................................................. 27
Telephone hotline ................................................................................................................................ 28
Radios ................................................................................................................................................... 28
Books .................................................................................................................................................... 29
Magazines ............................................................................................................................................. 29
Newspapers .......................................................................................................................................... 30
Religious places .................................................................................................................................... 31
Traditional Healers ............................................................................................................................... 31
Local Clubs (Edir) .................................................................................................................................. 32
PLWHA associations ............................................................................................................................ 33
Barriers to Information Use ...................................................................................................................... 33
Evaluation of source characteristics ......................................................................................................... 35
Information Seeking Actions .................................................................................................................... 40
DISCUSSION ............................................................................................................................................... 41
STRENGTH AND LIMITATION OF THE STUDY ....................................................................................... 43

i
 Strengths .................................................................................................................................................. 43
Limitations................................................................................................................................................ 43
CONCLUSION.............................................................................................................................................. 44
RECOMMENDATIONS ................................................................................................................................ 44
REFERENCES............................................................................................................................................... 46
Annex 1: Questionnaire (English) ......................................................................................................... 49
Annex 2: Questionnaire (Amharic) ....................................................................................................... 54
Annex 3: consent form (English) .......................................................................................................... 57
Annex 4: consent form (Amharic) ........................................................................................................ 59
Annex 5: detailed tables showing the association between socio demographic variables and and the
use of information sources .................................................................................................................. 59

ii
LIST OF TABLES
Table 1: Information-seeking activities by mode of information seeking ................................................... 10
Table 2: The demographic profile of people on ART in selected facilities in Addis Ababa, June 2009....... 20
Table 3: Adjusted Odds Ratios and significant associations between socio demographic variables and use
of information sources by people on ART in selected health facilities in Addis Ababa, June 2009 .... 24
Table 4: Table showing the most common barriers to information use of people on ART in selected
facilities in Addis Ababa, June 2009. .................................................................................................... 34
Table 5: Table showing information seeking actions of people on ART in selected health Facilities in Addis
Ababa, June 2009. ................................................................................................................................ 40
Table 6: Table showing the association between socio demographic variables and use of health
professionals as a source of health information by people on ART in selected health facilities in Addis
Ababa, June 2009 using logistic regression. ........................................................................................ 60
Table 7: Table showing the association between socio demographic variables and use of peer educators
as a source of health information by people on ART in selected health facilities in Addis Ababa, June
2009. ..................................................................................................................................................... 61
Table 9: Table showing the association between socio demographic variables and use of family, friends
and neighbors as a source of health information by people on ART in selected health facilities in
Addis Ababa, June 2009. ...................................................................................................................... 62
Table 10: Table showing the association between socio demographic variables and use of the internet as
a source of health information by people on ART in selected health facilities in Addis Ababa, June
2009. ..................................................................................................................................................... 63
Table 11: Table showing the association between socio demographic variables and use of television as a
source of health information by people on ART in selected health facilities in Addis Ababa, June
2009. ..................................................................................................................................................... 64
Table 12: Table showing the association between socio demographic variables and use of telephone
hotline as a source of health information by people on ART in selected health facilities in Addis
Ababa, June 2009. ................................................................................................................................ 65
Table 13: Table showing the association between socio demographic variables and use of radios as a
source of health information by people on ART in selected health facilities in Addis Ababa, June
2009. ..................................................................................................................................................... 66
Table 14: Table showing the association between socio demographic variables and use of books for
health information by people on ART in selected health facilities in Addis Ababa, June 2009 .......... 67
Table 15: Table showing the association between socio demographic variables and use of magazines as a
source of health information by people on ART in selected health facilities in Addis Ababa, June
2009. ..................................................................................................................................................... 68
Table 16: Table showing the association between socio demographic variables and use of newspapers for
health information by people on ART in selected health facilities in Addis Ababa, June 2009 .......... 69
Table 17: Table showing the association between socio demographic variables and use of religious places
as a source of health information by people on ART in selected health facilities in Addis Ababa, June
2009. ..................................................................................................................................................... 70
Table 18: Table showing the association between socio demographic variables and use of traditional
healers as a source of health information by people on ART in selected health facilities in Addis
Ababa, June 2009. ................................................................................................................................ 71
Table 19: Table showing the association between socio demographic variables and use of local clubs (
EDIR) as a source of health information by people on ART in selected health facilities in Addis
Ababa, June 2009. ................................................................................................................................ 72
Table 20: Table showing the association between socio demographic variables and use of PLWHA
associations as a source of health information by people on ART in selected health facilities in Addis
Ababa, June 2009 ................................................................................................................................. 73

iii
LIST OF FIGURES
Figure 1: Comprehensive model of information seeking- adopted ............................................................... 9
Figure 2: Sampling Flow Chart ..................................................................................................................... 17
Figure 3: graph showing use of information sources by people on ART in selected health facilities in Addis
Ababa, June 2009. ................................................................................................................................ 22
Figure 4: Graph showing the number of respondents who obtained useful and encouraging health
information from number of sources shown. ...................................................................................... 23
Figure 5: Graph showing usefulness of information sources as rated by people on ART in selected health
facilities in Addis Ababa, June 2009 ..................................................................................................... 36
Figure 6: Graph showing Availability of Information Sources as rated by people on ART in selected health
facilities in Addis Ababa, June 2009 ..................................................................................................... 37
Figure 7: Graph showing Understandability of Information Sources as rated by people on ART in selected
health facilities in Addis Ababa, June 2009.......................................................................................... 38
Figure 8: Graph showing Trustworthiness of Information Sources as rated by people on ART in selected
health facilities in Addis Ababa, June 2009.......................................................................................... 39

iv
ACRONYMS

AIDS - Acquired Immuno-Deficiency Syndrome

AOR- Adjusted Odds Ratio
ART- Anti Retroviral Treatment
ARV- Anti Retro-Viral
CI- Confidence Interval
HAART- Highly Active Anti Retroviral Treatment
HIV - Human Immunodeficiency Virus
PMTCT- Prevention of Mother To Child Transmission
NGO- Non Governmental Organization
OR- Odds Ratio
PLWHA- People Living With HIV/AIDS
UNAIDS - The joint United Nations program on HIV/AIDS
UNICEF - United Nations Children’s Fund
VCT- Voluntary Counseling and Testing (for HIV)
WHO- World Health Organization
ICE – Information Education and Communication
ICT- Information Communication Technologies
AAU- Addis Ababa University
ARC- Aids Resource Center
FMOH- Federal Ministry of Health
HAPCO- HIV/AIDS Prevention and Control Office
IRB- Institutional Review Board
MDG- Millennium Development Goal
NGO- Non Governmental Organization
SPH- School Of Public Health
SPSS- Statistical Package for Social Science
USA- United States of America

v
ABASTRACT

Managing information is an important part of coping with illness. Studies have shown that people
living with HIV/AIDS have a common desire for AIDS related information and use various sources
to meet their information needs. This study intends to provide an insight on the information
seeking behaviors of people on ART in a developing country context.

Objectives: the objective of this study is to investigate the information seeking behavior of People on
ART in Addis Ababa.

Methods: the study design is a cross-sectional survey using an anonymous interview

questionnaire conducted by health professionals working in the health facilities. The study is
conducted in selected health facilities providing ART services in Addis Ababa. Association
between variables is evaluated using odds ratios and binary logistic Regression.

Result: of the 787 respondents the majority (98.1 %) have obtained useful information from
health professionals. The married are more likely to get useful and encouraging information from
many sources, including health professionals, television, magazines and newspapers. The more
educated are more likely to obtain information from electronic and print media such as television,
the internet, books, magazines, and newspapers, while the less educated are more likely to get
useful and encouraging information from peer educators, religious places, traditional healers, and
local clubs and PLWHA associations. Health professionals, television and radio are the most
highly rated information sources in terms of utility. About 29.7% of the respondents cited the
availability of too much information as the main barrier to information use. Most respondents
agree or strongly agree that learning new HIV information helps them to be healthy (92.3%). Only
48.8 % of the respondents don’t feel overwhelmed by the available information, while the rest
agree to feel overwhelmed or are neutral.

Conclusion: The most widely used sources of information are health professionals followed by
radio and television. There is significant association between source use and demographic and
socio economic variables. People on ART have a desire for health information and take various
actions to seek health information.

vi
INTRODUCTION

An estimated 33 million people worldwide were living with HIV in 2007(1). Other 2.7 million were newly
infected and 2 million lost their lives due to HIV related causes. Sub-Saharan Africa remains the worst
affected region in the world. A little more than one-tenth of the world's population lives in sub-
Saharan Africa, however, it is home to almost 67% of all people living with HIV (1).

The HIV/AIDS epidemic in Ethiopia continues to pose a threat to the lives of its people. 977,394 people
live with the virus resulting in 71,902 HIV related deaths in 2007(3).
Currently, there are 139,494 people on ART in 441 health facilities in Ethiopia and about 300,000 need
ART. About 38, 136 patients are currently on ART in 47 sites in Addis Ababa (3). Both prevalence (7.5)
and incidence (1.52) are the highest in Addis Ababa as compared with the rural regions (3).

Information Behavior is the totality of human behavior in relation to sources and channels of
information, including both active and passive information seeking, and information use (3). Active and
passive refers to whether or not the information-seeking activity is actively sought out or passively
received. Information Seeking Behavior is the purposive seeking for information as a consequence of a
need to satisfy some goal (3).

Managing information is an important part of coping with illness and includes communicative and
cognitive activities like seeking, avoiding, providing, appraising, and interpreting information [5].
Considerable research has been done on how people living with HIV/AIDS (PLWHA) manage
information in the developed countries (6). Increased access to health information can educate patients
about their condition, motivate patients to participate in their care, foster social support, evaluate
treatment options, and build effective coping strategies (7).

RATIONALE OF THE STUDY

People living with HIV/AIDS have a common desire for HIV related information and many use various
sources to meet their information needs (8). Therefore it will be essential to investigate their
information source preferences, their perception about these sources and their information seeking
actions. Understanding the association between the demographic and socio-economic characteristics
of users and the information sources will also help in designing effective information interventions for
better health outcomes.

Despite the large size of the affected population, studies on the information seeking behavior of people
on ART or PLWHA are lacking in sub-Saharan Africa in general and Ethiopia in particular. Additionally,

7
the information seeking behavior of people on ART in Ethiopia is expected to differ from that of the
developed countries due to cultural differences, availability of information sources and language and
literacy barriers. Studies on the information seeking behavior of PLWHA or people on ART need to be
conducted in the local context as the cultural and socio economic variables create a different setting in
information seeking behavior.

The results of this study provide an insight on the information seeking behaviors of people on ART in
the local context to contribute to the design of effective information interventions for better health
outcomes.

LITERATURE REVIEW

Information can be defined as stimuli from a person's environment that contributes to his or her
knowledge or beliefs. Information management includes communicative and cognitive activities such
as seeking, avoiding, providing, appraising, and interpreting those environmental stimuli (9). For
example, information can be used to decrease uncertainty that is distressing, to increase uncertainty
that allows for hope or optimism, and to invite reappraisal of uncertainty. Information can also increase
stress-producing certainty or uncertainty.

Information Seeking Behavior models

Information science has produced numerous models of information seeking (10). Most of these models
are comprehensive general purpose model related with the general information behavior of people.
Wilson (1997) for example, has developed a universal information behavior model that includes
information need, activating mechanisms, intervening variables, and information seeking behaviors.
This is one of the more general models related with information behavior in general. Dervin’s (1999)
sense making is another interesting model that focuses more on the purpose and driver of information
seeking than on seeking behavior. According to Dervin, humans make sense individually and
collectively as they move: from order to disorder, from disorder to order which she referred to this
process as sense-making. A gap between one’s understanding of the world and one's experience of the
world becomes barrier to sense making and a prompt for action such as information seeking.

The information seeking behavior model widely cited by information seeking literature; ‘‘the
Comprehensive Model of Information Seeking’’ (CMIS), by Johnson was developed as model for
investigating the information seeking behavior of cancer patients. It is more relevant in investigating
information seeking behavior of people with chronic diseases such as HIV/AIDS (11).

8
Figure 1: Comprehensive model of information seeking- adopted

The following paragraphs are dedicated to further describe and elaborate the components in Johnson’s
CMIS.

Health – related (Antecedent) Factors

In Johnson’s CMIS, the antecedent factors motivate a person to seek information. Demographics and
experience are grouped together under the label of ‘‘background factors’’. These include one’s age,
gender, and ethnicity, along with socioeconomic variables like education, occupation, wealth, etc. A
key concept under the heading of experience is the ‘‘social network’’ of the individual with an
information need: ‘‘who do I know who might know the answer to my questions or know how to find
out?’’.
The third and fourth fall under the heading of ‘‘personal relevance’’ category. Personal relevance factors
include ‘‘beliefs’’ about the topic invoked and the ‘‘salience’’ of information about it. Both depend on a
person’s degree of knowledge or, conversely, his state of ignorance about the topic. Salience is the
importance of the information to create a state of concern about the health issue and to result in
positive health activities.

9
Information Carrier Factors
The second column of Johnson’s model, ‘‘information carrier factors,’’ is the ‘‘characteristics’’ and
‘‘utility’’ of the information channels seekers select and use. As Johnson highlights, what information
seekers are concerned about is the content of the information, not the channel through which it arrives.
However, people have preference over sources of information based on the characteristics of the
source and their own background. Regarding the utility of channels, Johnson says that they are
selected on the basis of their match with the seeker’s needs and expectations regarding likely
satisfactions to be obtained. Potential utility is equated with ‘‘interest, usefulness and importance for
achieving one’s goals’’. Johnson cites studies suggesting that ease of accessibility often wins out over
authoritativeness (the latter implying better utility).

Information Seeking Actions

The final components of Johnson’s model are ‘‘information-seeking actions.’’ Searches for information
involve conscious choices among channels and sources but also imply processes, feelings, and a whole
host of other behavioral and cognitive elements. Johnson notes that among the more general
difficulties inherent in studying the actions people take when they look for information is a distinction
between active and passive acquisition. Table I summarizes information seeking activities by mode of
information seeking using different information sources.

Boyd identifies information seeking activities by mode of information seeking and argues the on the
fuzzy nature of information seeking. He states that Information seeking is a personal and situation
dependent activity that is determined by access to information and the strength of the information
source. Since multiple factors can influence information seeking activities, the various influences must
be taken into account when researching information seeking behaviors. He further asserts that it is a
mistake to believe that information-seeking models are bivalent, or black and white, in nature. In fact,
information seeking as an activity is multivalent, or “fuzzy”, relying on “maybe”, “sometimes” and “it
depends” and other degrees of grey rather than simple black or white, yes or no, answers(12).

10
Table 1: Information-seeking activities by mode of information seeking

Mode of Information Seeking activity

Seeking
Active Passive
Directed Searching Monitoring
Television Television
Outbound telephone Radio
Magazine and newspapers Fact to face
Books, journals, etc. Web sites
Web sites Magazine and newspapers
Face to face Books, journals, etc.
E-mail Web sites
Mail
Undirected Browsing Being aware
Inbound telephone Inbound telephone
Face to face Television
Web site Radio
Television Advertising and signage
Radio Unsolicited (e)mail
Unsolicited (e)mail
Point of purchase

Health information seeking

Most health information seeking behavior studies including the few conducted in sub Saharan Africa
are quantitative surveys that focus on the health information seeking preferences and practices of
consumers covering their demographic characteristics, the types of information they searched,
information sources they used and why and for whom they searched for information (13,14,15,16). A
study on the information seeking behavior of rural women in Botswana has reported that health
information was the most prevalent information need expressed by over 30% of the respondents in the
study. The women wanted to have an understanding of diseases, causes of diseases, how they are
contracted, and how they can be treated at home. The women also indicated that they needed
information concerning home-based care and better health services for their family members (14). A
study conducted in Nigeria reveals that health consumers use informal sources of information such as
spiritual institutions than formal sources. The study ranks colleagues/friends, medicine stores, health

11
officers, radio, television, spiritual institutions/healing homes as the top main sources of information
(17).

A study conducted in the African American community in the United States reported that most
respondents (45.3%) sought health information from a health service professional; 14.5 percent from a
Web site and 9.8% from another source. No statistically significant difference exists between men and
women in their health information source. However, older respondents were more likely to have looked
and obtained health information as compared to younger respondents. In addition, younger
respondents were more likely to have sought health information from a Web site, while older
respondents tend to rely on health service professionals (17).

Health Information Seeking on the Internet

A large number of studies focus on the use of the internet for health information (7, 19, 20, 21, 22, 23).
These studies are conducted in developed countries to investigate the health information seeking
behavior people on the internet.

Health Information Seeking and Chronic Illnesses

Others studies have been conducted to investigate the information seeking behavior of people affected
by specific chronic illnesses such as cancer and HIV/AIDS (9, 20, 21, 24, 25, 26).

Health information seeking behavior of PLWHA

Hogan and palmer have used a mailed questionnaire to investigate the information seeking behavior of
people living with HIV/AIDS (11). They have reported that PLWHA preferred getting information from
people including health professionals, family, and friends and considered people the most trustworthy,
useful, understandable, and available information sources (6). They have investigated the demographic
and other characteristics of the respondents (Gender, Ethnicity, Age, education, Sexual orientation,
Injection drug use (IDU), Co-infection, Location or place of domicile), the use of sources (Doctors HIV-
positive peer educators ,Nurses, Case managers, Friends and peers, Newsletters, Community-produced
brochures, Magazine articles, The Internet, Drug company-produced brochures, Advertisements) by
the respondents and the characteristics (usefulness, understandability, trustworthiness , and
availability) of the sources. They have also studied the barriers to use information and their information
seeking and sharing practices. A 5 point scale is used to measure information seeking and sharing
behavior including active searching, feeling about new information, confidence, avoidance, overload,
and advising others. However no statistical analysis has been reported to investigate the association

12
between demographic and socio-economic characteristics of the users and the use of information
sources.

In this study conduced across the United States, in private and public clinics, of the 662 respondents
forty-three percent selected doctors as their most preferred source. The Internet was not rated highly
overall but was preferred by those with more education or living in metropolitan areas. Seventy-two
percent said they actively search for HIV/AIDS-related information, and 80% said they give advice or
tell others where to get such information. However, 71% agreed that it is easy to feel overwhelmed by
information, and 31% agreed that not seeking information can be beneficial.

A similar study on the information seeking behavior of cancer patients and their carers is reported by
James et al. (2527). The participants were asked to list the types of information source used to find out
more about cancer and how this information was chosen. Hospital doctors (96.1% and 94.6%), leaflets
(56.1% and 74.8%) and family (49.4% and 71.3%) were the most frequently cited sources of information
for the patients and carers, respectively.

Health information seeking on the internet and PLWHA

Kalichman et al have investigated internet access among people living with HIV/AIDS and its relation to
health. The survey of 175 men and 68 women included an investigation of their demographic
characteristics, internet use, HIV disease and treatment knowledge , knowledge of HIV related status,
treatment status , adherence ,self efficacy and adherence strategies and health status. They have used
odds ratios and logistic regression to investigate the association between internet use and
demographic characteristics, disease and treatment related knowledge, HIV treatment and treatment
adherence, and personal health status (29).

According to this study, Health-related Internet use was associated with HIV disease knowledge, active
coping, information-seeking coping, and social support among persons who were using the Internet.
The findings suggest an association between using the Internet for health-related information and
health benefits among people living with HIV/AIDS.

A study conducted in Toronto, Canada, to determine in what ways PLWHA collaborate to meet
treatment information needs and the role of the Internet, has shown that a variety of resources were
used to learn about HIV/AIDS treatment information. All participants were communicating with others,
primarily in person, and most desired anecdotal treatment information.

People living with HIV/AIDS have a common desire for HIV related information and many use various
sources to meet their information needs (8). Therefore, it will be essential to investigate their

13
information source preferences, their perception about these sources and their information seeking
actions. Understanding the association between the demographic covariates of users and the
information sources will also help in designing effective information interventions for better health
outcomes.

Similar studies on the information seeking behavior of PLWHA or people on ART need to be conducted
in the local context as the cultural and socio economic variables create a different setting in information
seeking behavior.

Though many studies have been conducted on the health information seeking behavior of People living
with HIV AIDS, a detailed investigation on the use of information sources and their association with
socio demographic covariates is widely done on the use of the internet alone. Such studies in a
developing country context have not been sited to the best of my knowledge.

This study intends to fill this gap by investigating the association between the use of the major
information sources and socio demographic covariates, common barriers to information use,
characteristics and utility of information sources and information seeking actions of people on ART in a
developing country context.

OBJECTIVES

General Objective: the general objective of the study is to investigate the information seeking behavior of
people on ART in Addis Ababa.

Specific objectives:

• Identify and study the characteristics of information sources used by people on ART for more than 6
months in Addis Ababa.

• Investigate the health information seeking actions of people on ART in Addis Ababa.

• Investigate how the demographic and socio economic characteristics of people on ART in Addis
Ababa are associated with information sources they use.

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METHODS

Study Area

The study is conducted in Addis Ababa among adult people on ART in selected health facilities
including government hospitals, health centers, and paying (private) hospitals.

Addis Ababa is the capital city of the country with a population of 2,738,248 as of 2007. It is also the
largest city in Ethiopia and is populated by people from different regions of the country (33). The city
consists of 1,304,518 men and 1,433,730 women. It consists of 23.8% of all urban dwellers in Ethiopia.
Almost all Ethiopian ethnic communities are represented in Addis Ababa due to its geographic location
and its position as capital of the country. Major ethnic groups represented are the Amhara (47.1%),
Oromo (19.5%), Gurage (16.3%), and Tigray (6.2%), while other nationals constitute 7.4% of the
population. About 74.4 % of the populations are Orthodox Christians, 16.2% Muslims, 7.8 %
Protestants, 0.5% Catholics, while the remaining 0.6% are followers of other religions (33).

Currently, there are 139,494 people on ART in 441 health facilities in Ethiopia and about 300,000 need
ART. About 38, 136 patients are currently on ART in 47 sites in Addis Ababa (3). Both prevalence (7.5)
and incidence (1.52) are the highest in Addis Ababa as compared with the rural regions (3). The national
prevalence is at 2.1 %.

Study Design

The study design is a cross sectional survey that identifies the socio-demographic covariates ,
information channels users select and use and the practices of people on ART for 6 or more months in
Addis Ababa.

Source population

The source population for the study is “people living with HIV and are on ART in the Addis Ababa
metropolitan area.”

Study Population

The study population is “People Living with HIV/AIDS and are on ART for six or more months in selected
health facilities in Addis Ababa.”

15
Sample size

The minimum sample size required assuming 95 % confidence interval with 5% margin of error and
proportion of 50% for information sources users select is 384. However as the sample procedure is a
multistage quota sampling, to compensate for the design effect of the two stages and a 20% non
response rate a sample size of 921 was used for the study. Since people on ART might not be willing to
provide information in fear of stigma and discrimination, we assumed a 20% non response rate which is
normally large in size.

The sample size is calculated using the formula

Where n= sample size

Zα/2=1.96
P= 0.5
d = 0.05 (5% margin of error)
n=384
To compensate for design effect:
The sample size S= (384X2) + 0.2(384X2) = 921

Sampling Procedures

A multi stage proportional quota sampling method is used for the study. Central referral, NGO and
other special health facilities are excluded from the study due to the fact that the patients in these
facilities could come from a different source population. Regional public hospitals, health centers and
for profit (private) health facilities are included in the study. Initial a quota was assigned to public
regional hospitals, health centers and private hospitals proportional to the number of people getting
services in each group. All regional public hospitals in the city were selected as most of the services are
provided in these hospitals. Four health centers with good coverage were also selected to get
reasonable number of respondents in each facility. Two private hospitals which provide services to the
majority of patients were also selected. The proportional quota assigned to each group is further
proportionally assigned to the respective facility based on its coverage. All patients who have visited
the facilities during the data collection period and have been on ART for six or more months were
invited and all those who volunteered replied to the anonymous interview until quota samples sizes are
reached. The following flow chart summarizes the sampling procedures.

16
Figure 2: Sampling Flow Chart

Health facilities in Addis Ababa (regional public hospitals, health centers and
for profit facilities
N=43

Regional Health centers For profit

hospitals N2= 25 centers
N1=5 N3=13

Selected Selected Selected

Regional Health centers For profit
public N=4 facilities
hospitals N=2
N=5

Selected Selected Selected

people on Health centers For profit
ART n2=233 facilities
n1=577 n3=111

Data Collection Procedures:

Data was collected using anonymous interview questionnaire conducted by health professionals working
in the health facilities with volunteer respondents who are refilling their ARV drugs in selected facilities.
Training was provided to data collection personnel on the use of the anonymous questionnaire. Proper
response to the questionnaire items was ensured by the data collection personnel. Quality checks were
conducted by trained supervisors.

Additionally,

• Each questionnaire was given uniquely identifying code.

17
 • Each questionnaire was checked for data quality by supervisors assigned in the health facilities by
reviewing filled questionnaires. In addition the principal investigator reviewed the filled
questionnaire for completeness and validity of responses.

• At least 5% of the questionnaires was re-filled by supervisors

Measurement

Demographic and socio economic characteristics

Participants were asked on their sex, age, ethnicity, education, religion, marital status, and occupation,
Sero-discordance of spouse, family size and presence of other PLWHA in the family.

Experience

Participants were asked the time they have been on ART which will provide an indication of the
experience they have with the information sources, the disease and the medications.

Information sources and characteristics

The participants were asked whether they have used information sources (Health professional HIV-
positive, peer educators, Family, Friends and neighbors ,Internet, Television, Telephone hotline, Radio,
Books, Magazines, Newspaper ,religious places, traditional healers, local clubs(edir) and PLWHA
associations ), and how they evaluate the usefulness, availability, accessibility , and trustworthiness of the
source on a 3 point likert scale.

Information seeking behavior

Participants were asked to evaluate their own behavior on active information searching, regular reading,
feeling overloaded, advising others, feeling about new information and avoidance on a 5 point Likert
Scale.

Data Analysis procedures

The Data collected with the questionnaires was coded and entered in EPI6. All missing and outlier data
was coded as missing during coding and disregarded during analysis. Non categorical data (age, months
on ART and family size) were coded as categorical data using categories defined in similar studies as a
reference. The data was further cross tabulated described using tables and graphs.

As the variables are all categorical data (treated as categorical data), association between patient
demography and seeking behaviors are evaluated using odds ratios in binary logistic regression. Ninety

18
five percent confidence intervals of crude and adjusted odds ratios for each of the covariates included in
the model are used to test statistical significance of the association with the use of the information
sources. Non parametric tests specifically fisher exact and Cochrane tests are also used when expected
values are equal or less than five. SPSS for windows version 15 is used for data analysis.

Ethical considerations

The Addis Ababa university medical faculty institutional review board (IRB) reviewed and approved the
study. The Addis Ababa health bureau ethical review board has also reviewed and approved the study. A
written consent form was used to get informed consent of the participants. The researcher ensured
protection to personal data and confidentiality of the information.

RESULTS

Demographic characteristics

The majority of the respondents (43.9%) were between 30 -39 years of age and the mean age was 36.13
years. the minimum was 14 and the maximum 67 years. The respondents were 58.5% female, 49.1
married, 52.5 % Amhara, 77.2 % Orthodox Christians , 62.4 % have above secondary education and 47.6%
are working for private and government organizations. 78.2% have been on ART for more than one year
(mean 34.8 months, minimum 6 months and max 164 months). About thirty seven percent were Sero-
discordant and the average family size was 3.29.

19
Table 2: The demographic profile of people on ART in selected facilities in Addis Ababa, June 2009.

Characteristics Number (%)

Age

18-29 168(22.8)

30-39 323(43.9)
40-49 180(24.5)

>50 65(8.80)

Gender
Men 324(41.5)
Women 457(58.5)
Marital Status
single 182(23.2)
married 385(49.1))
separated 45(5.7)
divorced 81(10.3)
widowed 91(11.6)
Education
No formal education 81(10.3)
primary 214(27.3)
secondary 312(39.7)
Diploma and above 178(22.7)
occupation
Employee 372(47.6)
House wife
118(15.1)
Business persons 85(10.9)
Unemployed 146(18.7)
Student 20(2.6)
Other 37(5.1)
religion
Orthodox 607(77.2)
Catholic 19(2.4)
Protestant 101(12.8)

20
Characteristics Number (%)
Muslim 59(7.5)
Ethnicity
Amhara 401(52.5)
Oromo 170(22.1)
Tigre 100(13.0)

Gurage 70(9.1)
Other 27(3.5)
Months on ART
<12 months 164(21.4)
13-36 months 342(44.5)
37-60 months 172(22.4)
>60 months 90(11.7)
Family Size
<2 305(42.1)
2-4 240(33.1)
>4 180(24.8)
Sero-discordance of spouse
Concordant 335 (62.9)
Discordant 198 (37.1)
Presence of HIV positive family member
no 577(79.4)
yes 150(20.6)

21
Information source use

Respondents were asked whether they have obtained encouraging information that helps them to cope
with the disease from specified sources. The most widely used sources of information are health
professionals (98.1%) followed by radio (89%) and television (85.2 %). Print media including books (64%),
magazines (68.4%) and newspapers (67.9%) are in the middle falling behind the electronic media.
Traditional healers, local clubs (EDIR) and the internet are rated as the least used information sources.

Figure 3: graph showing use of information sources by people on ART in selected health facilities in Addis
Ababa, June 2009.

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er
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22
All the respondents have obtained helpful and encouraging information from at least 1 source. Only 3
respondents (0.38%) have obtained useful and encouraging health information from all the sources. The
mean number of sources from which the respondents have obtained useful and encouraging health
information is 7.56.

Figure 4: Graph showing the number of respondents who obtained useful and encouraging health
information from number of sources shown.

100

75
Frequency

50

25

10 18 45 51 67 84 107 103 103 62 52 26 20 3

0
1 2 3 4 5 6 7 8 9 10 11 12 13 14

Number of Sources Used

Association between Information Source Use and Demographic Variables

The association between the use of the various information sources and the socio demographic variables
was analyzed using odds ratios and binary logistic regression. Non parametric test (fisher exact test) has
also been used in places where expected values are less than five. The following table (table 3)
summarizes the adjusted odds ratios and significant associations between economic & socio-
demographic variables and information source use. Tables showing detailed information including both
crude odds and adjusted odds ratios are included in the annex.

23
Table 3: Adjusted Odds Ratios and significant associations between socio demographic variables and use of information sources by
people on ART in selected health facilities in Addis Ababa, June 2009

Variables

Health
Professionals
Peer educators
Family , friends
and neighbors
internet
Television
Telephone
Hotline
Radio
Book
Magazine
Newspaper
Religious
places
Traditional
healers
Local clubs
PLWHA Assoc.

Age 18-29 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0
30-39 .81 .957 .60 .64 .86 .71 .6** .79 .71 1.24 .89 1.38 .88
40-49 .70 .71 .68 1.26 .76 .74 .60 .70 .62 .88 1.25 1.37 1.03
>50 .33** .81 .60 .64 .36* .89 .42* .51 .46** .80 .65 1.04 .52
Gender Men 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.00 1.0 1.00 1.0 1.0
Women 1.1 1.07 1.14 .40* 1.00 .76 .57 .77 .87 .73 1.23 1.42 1.12 1.04
Marital Currently not married 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0
Status married 3.8** 1.24 1.20 1.17 2.33* 1.13 1.47 1.2 1.7** 1.55** .96 .69 1.04 1.12
Education Elementary and below 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0
High school & above .42 .48** 1.09 2.27* 1.79** .93 1.31 3.2** 3.6** 2.95** .45** .20* .34** .56*
occupation Employee 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0
House wife .84 .58** .55 1.04 .49* 1.04 .59 .57 .63 1.27 .38 .63 .741
Business persons .86 .95 .60 .96 .57 .65 1.01 1.27 1.43 .59** 1.78 .55 .61
Unemployed 1.24 .64 .09* .64 .51* .48** .76 .68 .73 1.11 .99 .79 .97
religion Orthodox 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0
Protestant .90 1.10 1.29 1.19 .947 .82 1.13 1.05 1.04 .53** 2.04 1.55 1.02
Muslim 1.68 .77 1.59 1.55 2.39* .65 1.24 1.09 .72 .33** 2.28 1.57 1.48
Ethnicity Amhara 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0
Oromo .88 1.21 .96 1.05 1.21 1.36 1.18 1.26 1.14 1.14 1.66 .86 .67
Tigre 1.11 1.13 1.03 2.17 1.79* 1.96 1.35 1.82 1.46 2.14 1.19 .84
Gurage 1.10 1.26 .86 .53 .97 .89 .49** .59 1.1 1.68 1.17 1.16
*=significant with p value<0.025, **= significant with p value <0.050

24
Health professionals

Three variables have expected values greater than five namely sex, marital status and education.
Therefore, logistic regression has been used to investigate the association of use of health
professionals with sex, marital status and education only. Marital status is significantly associated
with the use of health professionals. Married respondents are 3.8 times more likely to get useful
information from health professionals than the “currently not married”, AOR=3.384; 95% CI (1.053,
13.67); p=0.042.

As the expected values for the other variables are less than five, neither binary logistic regression nor
χ2 tests can be used to test the significance of any associations. Other non parametric tests are not
also possible as there are cells of the tables with zero values. However, groups for religion has been
recoded as Christian and Muslim, age group of >50 and 40-49 age range merged as >40, and the
Gurage ethnic group has been excluded from the analysis. The fisher exact test was used to test the
associations of use of health professionals with age group, occupational status, and ethnicity (χ2
=5.915, 0.678 and 1.1.87 respectively), while Cochrane test was used to test the association of use of
health professionals with religion (χ2 =1.275). No significant associations exist between the use of
health professionals as a source of health information by the respondents and these variables.

HIV positive peer educators

Without adjusting for any of the covariates, there is significant association between the use of HIV-
positive peer educators as a source of health information by people on ART and their age, gender,
education and occupation. Those who are above 50 years of age and those between 40-49 years of
age are significantly different from those who are between 18-29 years of age, OR=0.425 and 0.563;
95% CI(0.237, 0.763) and (0.367.0.864). Females are about 1.5 times more likely to get useful and
encouraging health information from HIV positive peer educators than males while those who have
high school or above high school education are by 49% less likely to get useful and encouraging
health information from HIV positive peer educators than those who have elementary or less
education. However, the association between use of HIV-positive peer educators and sex disappears
when adjusted for the covariates.

The use of HIV-positive peer educators for health information was significantly associated with age
and education even after adjusting for all the covariates. Respondents above 50 years of age are less
likely to get useful information from peer educators as compared with respondents of 18-29 years of
age, AOR=0.333; 95% CI (0.166, 0.670). People on ART of 30-39 years of age and 40-49 years of age

25
are not significantly different from people on ART of 18-29 years of age in relation to the use of HIV
positive peer educators as a source of health information. Respondents with high school and above
education said that they get useful formation from peer educators by 51 % less than elementary and
less educational status respondents, AOR=0.483; 95% CI (0.328,0.712). The use of HIV positive Peer
educators as a source of health information by people on ART is not significantly associated with their
sex, marital status, occupation, religion and ethnicity.

Families, Friends and Neighbors

Normally, the use of families, friends and neighbors is not significantly associated with any of the
socio demographic variables. No significant difference is observed between the different age groups.
No significant difference also exists between males and females, between the married and the “not
currently married”. Those who have high school or above high school education are not also
significantly different from those who have elementary or less education in relation to the use of
‘families, friends and neighbors’ as a source of health information. Neither is there a significant
difference between the employed and the business persons, the housewives and the unemployed.
The orthodox are not also significantly different from the protestant and the Muslims. The different
ethnic groups are not significantly different. No significant difference exists between the Amhara, the
Oromo, the Tigre and the Gurage.

However, when controlled for all the covariates, a new significant association appears between
occupation and the use of families, friends and neighbors as a source of health information.
Housewives are by 42 % less likely to get useful information from families, friends and neighbors as
compared with employed respondents, AOR=0.578; 95%CI (0.338,0.988). The Unemployed and
businesspersons are not significantly different from the employed. No significant associations exist
between the use of families, friends and neighbors for health information by the respondents and
their age, sex, education, marital status, religion and ethnicity.

The Internet

The use of the internet is significantly associated with sex, education and occupational status. Before
adjusting for the covariates, females are less likely to get useful health information from the internet
by 65% than males. Study subjects with high school and above educational status are about 3.2 times
more likely to use the internet than subjects with elementary and less educational status.
Additionally, significant difference exists between the different occupation groups and the employed
ones; the unemployed are likely to use the internet as a source of health information than their

26
employed counterparts by 89%. Business persons are less likely to get useful and encouraging
information from the internet by 48% than the employed and housewives are less likely by 76%.

on the other hand, when adjusted for the covariates, Females are by 60% less likely to obtain useful
information from the internet when compared with males, while at the same time subjects with high
school and above education are about 2 times more likely to use and get useful information from the
internet than subjects with elementary and less educational status, AOR=0.401 and 2.275; 95% CI
(0.241, 0.665) and (1.305, 3.963) respectively. Unemployed subjects are about 91% less likely to get
useful information from the internet when compared with employed subjects AOR=0.088; 95%CI
(0.o27, 0.288). Housewives and business persons are not significantly different from employed ones.
No significant associations are visible between the use of the internet as a source of health
information and age, marital status, religion and ethnicity.

Television

Looking at the crude odds ratios, there is a significant association between the use of television as a
source of health information and marital status, education, and occupation. There is significant
difference between the married and the currently not married; between those who have secondary
and above education and those who have elementary and less education; between the employed and
the housewives, the businesspersons and the unemployed. The married are 1.2 times more likely to
get useful health information from television than the currently not married. Those who have high
school or above education are 1.1 times more likely to get useful health information from television
than those who have elementary or less education. The unemployed are by 72% less likely to get
useful health information from television; the business persons by 64% and the housewives by 62 %
less likely to get useful health information from television when compared with the employed.
However, this significant association between the use of television as a source of health information
and occupation disappears when adjusted for the covariates.

After adjusting for the covariates, both marital status and educational status are significantly
associated with the use of television. Married couples are about 2.3 times more likely to get useful
information from television than the currently not married AOR=2.327; 95%CI (1.384, 3.914). Those
who have secondary or above education are 1.7 times more likely to get useful information from
television than those with elementary or below educational status AOR=1.789; 95%CI (1.044, 3.066).
There is no significant difference between the different age, religious and ethnic groups on the use
of television as a source of health information by People on ART.

27
Telephone hotline

Before adjusting for any of the covariates, the use of telephone hotline as a source of health
information by the respondents is significantly associated with age, occupation, religion and
ethnicity. Those who are above 50 years of age are less likely to get useful information from
telephone hotline when compared with those who are between 18 and 29 years of age. Housewives
and the unemployed are also less likely to get useful and encouraging health information from
telephone hotlines when compared with the employed. Muslims obtained 1.8 times more than the
orthodox Christians, while the Oromo obtained 1.4 times more than the Amhara.

After adjusting for the covariates, those who are more than 50 years of age are by 64% less likely to
get useful health information as compared with those who are between 18 and 29 years of age,
AOR=0.357; 95% CI (0.160, 0.800). No significant difference exists between respondents of 18-29
years of age and 30-39 years of age and respondents of 18-29 years of age and 40-49 years of age.

Both House wives and unemployed respondents are also less likely to get useful health information
from telephone hotlines, AOR=0.486 and 0.516; 95% CI (0.265, 0.981) and (0.305, 0.861) respectively.
No significant difference exists between the employed and businesspersons. Muslims 2.3 more likely
to use hotlines when compared with Orthodox Christians and Tigray 1.8 times more likely to get
useful information from hotlines when compared with Amharas, AOR=2.391 and 1.791 ; 95% CI
(1.182,4.837) and (1.043,3.075) respectively. No significant difference is visible between the Amhara
and the Oromo.

Radios

If we investigate the association between the use of radios for health information and the socio
demographic variables separately, many significant associations are visible. The associations with
sex, marital status, education and occupation are significant separately. Females are significantly
different from males; the married significantly different from the currently not married, those who
have secondary or above education significantly different from those who have primary or less
education and the unemployed significantly different from the employed. Females are by 42 % less
likely to use and get useful and encouraging information from radios than males. Those who have
high school or more education are about 1.6 times more likely to get useful and encouraging health
information from radios than those who have elementary or below elementary education. The
unemployed are by 61 % less likely to get useful information from radios than the employed. Business
persons and housewives are not significantly different from the employed.

28
However, when adjusted for all the covariates, the use of radios as a source of health information for
people on ART is significantly associated with occupational status only. The associations with sex,
martial status and education become statistically insignificant associations when controlled for all the
socio demographic variables in the model.

When all covariates are included and controlled, the unemployed are by 52% less likely to get useful
health information from radios than the employed, AOR=0.479; 95% CI (0.245, 0.937). The
insignificant difference between the employed and housewives and the employed and
businesspersons continues to persist after the adjustment.

Books

Before adjusting for any of the variables, the use of books as a source of health information by people
on ART is significantly associated with age group, sex, marital status, education, occupation and
religion.

The association with sex and occupation disappears when controlled for all the covariates, while a
new association with ethnicity emerges as significant.

After controlling for the covariates, the use of books is significantly associated with age, education,
and ethnicity. Respondents from 30 to 39 years of age are less likely to obtain useful information from
books as compared with respondents of 18-29 years of age, while at the same time respondents
above 50 years of age are also less likely to obtain useful information from books, AOR =0.595 and
0.415; 95% CI (0.367, 0.964) and (0.202, 0.855) respectively. There is no significant difference
between respondents of 18-39 years of age and 40-49 years of age.

Respondents with high school and above education said that they have obtained useful information
from books 3.2 times more than respondents of elementary and less educational status, AOR =3.151;
95% CI (2.124, 4.674) ; P=0.000, and Gurages by 50% less likely than Amharas, AOR = 0. 499; 95 % CI
(0.263, 0.946). No significant difference exists between the Amhara, the Oromo and the Tigre.

No significant associations are visible between the use of books as a source of health information by
the respondents and their sex, marital status, occupation and religion.

Magazines

When we investigate the crude odds ratios, the use of magazines as a source of health information
for people on ART is associated with age, sex, marital status, education, occupation, religion and
ethnicity. Those who are above 50 years of age are by 48% less likely to get useful and encouraging

29
health information from magazines than those who are between 18 to 29 years of age, while females
are less likely by 49% than males. At the same time the married are about 1.4 times more likely to get
useful and encouraging health information from magazines than the ”currently not married”. Those
who have high school or above educational status are about 3.3 times more likely to get useful and
encouraging health information from magazines than those who have elementary or less educational
status. However, housewives and the unemployed are less likely to get useful and encouraging health
information from magazines as compared with the employed ones. The Muslim and the Gurage are
also less likely to get helpful and encouraging health information from magazines.

After adjusting for all the covariates, the use of magazines is significantly associated with marital
status and education. The married are 1.7 times more likely to get useful and encouraging health
information from magazines than the “currently not married”. Those with high school education and
above educational status are 3.5 times more likely to get useful and encouraging health information
from magazines than those who have elementary or less educational status. The Gurage are also
about 2 times less likely to get useful information from magazines.

Newspapers

Before adjusting for any of the socio demographic variables, there is significant association between
the use of newspapers as a source of health information and age, sex, marital status, education,
occupation, religion and ethnicity. Those above 50 years of age are significantly different from those
who are between 18-29 years of age. Males are significantly different from females and the married
are significantly different from the “not currently married”. Those who have high school or above
educational status are significantly different from those who have elementary or less educational
status. Housewives and the unemployed are also significantly different from the employed, while
Muslims are significantly different from orthodox Christians and the Gurage are significantly different
from the Amhara.

However after adjusting for all the covariates, the significant associations that remain are the ones
between the use of newspapers as a source of health information and age group, educational and
marital status.

Respondents of more than 50 years of age are about by 54% less likely to use newspapers as a source
of health information when compared with respondent of 18-29 years of age, AOR=0.464;
95%CI(0.221,0.971). No significant difference exists between respondents of both 30-39 and 40-49
years of age and 18-29 years of age.

30
The married are 1.5 times better users of newspaper health information than the “not currently
married” AOR=1.551 95%CI (1.062, 2.265).

Respondents with high school and above education have responded that they have obtained useful
information from newspapers about 2.9 times more than respondents with elementary and less
educational status, AOR = 2.945; 95%CI (1.966, 4.413). No significant association exists between the
use of newspapers as a source of health information by people on ART and their sex, occupation,
religion and ethnicity.

Religious places

Before adjusting for the covariates, there is significant association between the use of religious places
as a source of health information and sex, education, occupation and religion. However, the
association with sex disappears when controlled for the covariates.

Education, occupation and religion are the significant differentials in obtaining useful information
from religious places by the respondents. Respondents with high school and above education are
about 2 times less likely to get useful information from religious places as compared with elementary
and less educational status respondents, AOR=o.451; 95% CI (0.304,0.670). Businessman/woman
respondents are also less likely to obtain useful information from religious places as compared with
employed respondents, AOR=0.585; 95% CI (0.343, 0.998). Unemployed and housewife respondents
aren’t significantly different from employed respondents in the use of religious places for health
information.

The Protestant and the Muslim don’t believe to get useful and encouraging information from
religious places as much as the orthodox Christians. Orthodox Christians are more likely to get useful
and encouraging health information from religious places about 2 times more than protestants and
about 3 times more than Muslims, AOR =0.531 and 0.329; 95% CI (0.311, 0.908) and (0.160, 0.673)
respectively.

No significant associations exist between use of religious places to get useful and encouraging health
information from religious places by the respondents and their age, sex, martial status, and ethnicity.

Traditional Healers

Without controlling for the associated variables, the use of traditional healers as a source of health
information by people on ART is significantly associated with education, occupation, religion and
ethnicity. People on ART with high school and above education are less likely to get useful

31
information from traditional healers. Business persons are 3.5 times more likely to get useful
information from traditional healers than the employed ones while Muslims are about 4 times more
likely to get useful and encouraging health information from traditional healers than Orthodox
Christians. Nevertheless, there is no significant difference between orthodox Christians and
Protestants in the use of traditional healers as a source of useful and encouraging health information.

when we consider the association with ethnicity, the Gurage are 3.3 times more likely to get useful
and encouraging health information from traditional healers as compared with the Amhara; OR=
3.298 ; 95% CI (1.407,7.731). However, there is no significant difference between the Amhara and the
Oromo and the Amhara and the Tigray with regard to the use of traditional healers as a source of
useful and encouraging health information by people on ART.

This association between information use of traditional healers and ethnicity disappears after
adjusting for education and occupational status.

after adjusting for all the covariates, when compared with those who have elementary and less
educational status, those with high school and above education are about 5 times less likely to get
useful information from traditional healers, AOR= 0.202; 95% CI(0.095, 0.429). Education remains to
be the only significantly associated covariate for the use of traditional healers as a useful source of
health information for the people on ART.

Local Clubs (Edir)

Before adjusting for any of the variables, the use of local clubs is significantly associated with
education alone. No significant difference exists between the different age groups. There also no
significant difference between males and females. however those who have high school or above
educational status are by 58 % less likely to get useful and encouraging health information form local
clubs(edir) as compared with those who have elementary or less educational status; OR= 0.419, 95 %
CI (0.284,0.618). Nonetheless, there is no significant difference between the employed and
housewives, business persons, and the unemployed in the use of local clubs as a source of useful and
encouraging health information for people on ART. There is also no significant difference between
Orthodox Christians and Protestants. Similarly, no significant difference also exists in the use of local
clubs as a source of useful and encouraging health information between the orthodox Christians and
the Muslims. No significant difference is neither observed between the Amhara and the Oromo; the
Amhara and the Tigray and the Amhara and the Gurage.

32
This significant association between the use of local clubs (Edir) and education continues to persist
even after adjusting for the major socio demographic variables. people on ART with high school and
above education are by 56% less likely to get helpful information from local clubs as compared with
those who have elementary and less than elementary educational status AOR= 0.344; 95% CI(0.210,
0.565). No significant association is observed between the use of local clubs and age groups, sex,
marital status, occupation, religion and ethnicity after controlling for the covariates.

PLWHA associations

Age group, gender , educational and occupational status have significant association with the use of
PLWHA associations as a source of useful and encouraging health information for people on ART
when each of this variables are investigated separately. Those who are above 50 years of age are less
likely to get useful and encouraging health information from PLWHA associations as compared with
those who are between 18-to 29 years of age ; OR=0.538 , 95% CI (0.293, 0.988). At the same time
females are more likely to get helpful and encouraging health information from PLWHA associations
than males; OR= 1.378; 95% CI (1.027, 1.851). Those who have high and more than high school
education are less likely to get useful and encouraging health information from PLWHA associations
as compared with those who have elementary and less than elementary education including the
illiterate. The Gurage are about 1.3 times more likely to get useful and encouraging information from
PLWHA associations when compared with the Amhara.

However, when adjusted for all the covariates the significant association with sex and ethnicity
become insignificant while the association of the use of PLWHA associations as a source of useful and
encouraging health information for people on ART and education continues to persist as a significant
association.

Educational status only is the significantly associated with the use of PLWHA associations after
controlling for all the covariates. People with elementary and less educational status have responded
that they get useful information from PLWHA associations about 1.8 times more than those with
secondary and above educational status AOR= 0.561; 95% CI(0.383, 0.824). No significant
associations are observed between the use of PLHWA associations as a source of health information
and age group, sex, marital status, occupation, religion and ethnicity.

Barriers to Information Use

The most common barriers highly rated by the respondents are information is too much and
information is not interesting. Twenty nine point seven percent (29.7%) of the respondents have

33
responded yes to a question that asks if the information they get is too much to clearly identify and
use the relevant and useful information from the unrelated and non useful information. Twenty five
point four percent (25.4%) of the respondents don’t find the information they get as interesting or
encouraging that motivates them to take actions that result in better health outcomes.
Understandability of available information is rated as the least common barrier to use information for
coping with the disease.

Table 4: Table showing the most common barriers to information use of people on ART in selected
facilities in Addis Ababa, June 2009.

Barrier Yes (%) NO (%)

1. Information is hard to understand 104 (13.3) 678 (86.7)
2. Information is contradictory 120 (15.3) 662 (84.7)
3. Information is hard to find 119 (15.2) 662 (84.8)
4. Information is not motivating 177 (22.7) 603 (77.3)
5. Information is not interesting 198 (25.4) 580 (74.6)
6. Information is not applicable 164 (21.2) 610 (78.8)
7. Information does not provide clear action steps 149 (19.4) 621 (80.6)
8. Information is too much 230(29.7) 544(70.3)

34
Evaluation of source characteristics

Health professionals, television and radio are rated highly by the respondent’s in terms of usefulness.
About 84.7% of the respondents have said that health professionals are a lot useful, 94.4 % a lot
available, 93.7 % a lot understandable and 93.2 % a lot trustworthy information sources. This shows
that health professionals are the primary usable sources of information for people on ART.

The other most useful sources are television, radio and religious places. The least useful sources, as
rated by the respondents, are traditional healers, local clubs and telephone hotline.

The most available sources are again health professionals, radio and religious places. However, print
media are outdone by family, friends and neighbors, religious places and HIV–Positive peer educators
in terms of availability.

In terms of understandability HIV positive peer educators are rated as the most understandable
information sources followed by health professionals. On the other hand, religious places are the
second most trustworthy source of information next to health professionals.

35
Figure 5: Graph showing usefulness of information sources as rated by people on ART in selected health facilities in Addis Ababa, June 2009

How Available/ accessible is the source?

100% 0.4% 1.5% 1.9% 2.6% 2.6%
5.5% 5.5% 3.1% 3.7%
11.6% 12.6%
15.0% 16.1% 14.5%
90% 15.7% 15.4% 16.4%
17.9%
24.9% 29.8% 31.3% 34.9%
80% 30.7%
24.5%
29.9%
70% 25.9%

40.9%
60%
20.9% Not at all (%)
50% A little (%)

Percent
A lot (%)
84.6% 82.7% 82.7%
40% 81.0%
76.7%
69.6%
A
67.5% 65.6% 65.6% 63.9%
30% 58.0% 57.5%

44.5% 44.2%
20%

10%

0%
al o rs s e er t r) s
di on es or in ok ns ne ne di er
on isi ac hbo at az pap Bo io er tli (E al
si Ra v pl c g s i at t ho s e
es le ig u a w c in e b lh
of Te us ne ed M so on lu na
pr io d er Ne as l C io
th e
il g an A eph ca it
al R s pe H l ad
e W Te Lo Tr
He nd itiv
rie PL
F pos
,
ily V-
a m HI
F
Source

36
Figure 6: Graph showing Availability of Information Sources as rated by people on ART in selected health facilities in Addis Ababa, June 2009

How useful is the source?

0.1%
Not at all (%)
100% A little (%) A lot (%)
1.8% 3.2% 1.6% 3.8% 2.3% 2.4% 2.2%
5.5% 6.2%
9.7% 10.5%
13.5% 14.7% 17.0%
90% 13.0% 16.0%
18.1% 15.7% 22.5% 24.8% 25.8%
18.6% 35.4%
80% 17.9%

21.2%
70%
33.0%

60%
14.6%
Not at all (%)
50% A little (%)
94.4%

Percent
A lot (%)
84.7% 83.8% 82.5%
40% 78.1% 78.0%
75.2% 72.9% 72.0% 71.7% 71.6%
64.1%
30%
50.0% 50.0%
20%

10%

0%
al io es on s s ok e er et ns ne ir) s
on ad si or or in ap rn tli er
s i R ac vi c at hb Bo az p e tio (Ed eal
pl e i g ag s i nt ia ho bs
es us el du M ew oc ne lu lh
of io T re ne N s na
pr ig e d as ho lC tio
th el pe an A p c a i
al R e s H le ad
v nd W Te Lo Tr
He iti ie
os r PL
p ,F
I V- ily
H m
Fa
Source

37
Figure 7: Graph showing Understandability of Information Sources as rated by people on ART in selected health facilities in Addis Ababa, June 2009

0.5%
100% 0.3% 2.1% 1.2% 3.1% 2.4% 1.8% 2.3%
6.3% 7.7% 5.2%
10.9% 7.2% 14.1%
90% 14.4% 15.6% 14.8% 15.6%
19.0% 27.4% 29.0% 28.9% 31.0%
80% 21.4% 29.5%
70% 28.2%
41.3%
60%
23.8% Not at all (%)
50% A little (%)
93.2% 92.0%

Percent
40% 83.5% 83.1% 82.1% A lot (%)
75.8%
70.2% 69.1% 68.8% 67.8%
30% 63.3%
57.7%
45.2% 43.1%
20%

10%

0%
rs al n io s e r t e rs r)
to io es or ok in pe ns ne lin le di
a i on is ad l ac hb Bo az a tio r t a E
uc s v R p ig s p a te ho e s(
es le ag ci in e lh ub
r ed rof Te us ne M ew so n a l
e p gio d N as ho on C
i an iti al
pe lth el s A l ep d c
e ea R H a Lo
tiv H nd W Te Tr
o si ir e PL
-p ,F
IV ily
H m
Fa
Source

38
Figure 8: Graph showing Trustworthiness of Information Sources as rated by people on ART in selected health facilities in Addis Ababa, June 2009

How trustworthy is the source?

0.1%
100% 2.1% 1.3% 1.2% 2.6% 2.7% 3.0%
6.2% 4.2% 4.6% 7.1%
9.4%
13.7% 13.0%
90% 14.7% 19.3% 20.5%
19.9% 20.0% 27.3%
18.8% 30.8% 30.5% 37.2%
80% 28.6%
27.4%
70%
47.2%
60%
Not at all (%)
50% 23.3% A little (%)
93.7%

Percent
A lot (%)
40% 83.2%
79.3% 78.3% 75.9% 75.4%
71.7% 70.1%
66.5% 66.5% 64.3%
30% 59.0%

20% 39.8% 39.5%

10%

0%
al io s rs r et i r) s
es on or ns ok pe i ne rn ne er
i on ac si ad at bo tio Bo a az e tli (Ed al
s pl evi R c gh ia sp nt ho s e
es l du i ag i b l h
of us Te e ne s oc ew M ne lu
p r io d N ho l C na
ig er as p i tio
lth el pe an A le ca
ea R s H Lo ad
H ve nd W Te Tr
iti r ie PL
os
-p ,F
IV ily
H m
Fa
Source

39
Information Seeking Actions

Most respondents agree or strongly agree that learning new HIV information helps them to be
healthy (92.3%). Additionally, 80.8% agree or strongly agree about feeling good when they
seek for new HIV information. 83.5 % are confident that they will get the information they
need. 16.5% are not confident that they will get the information they need. Only 48.8 % of the
respondents don’t feel overwhelmed by the available information, while the rest agree to feel
overwhelmed or are neutral. Avoiding seeking more HIV/AIDS information was agreed or
strongly agreed upon by 15.8 percent of the respondents an indication of information
avoidance. Regularly readings things that help to learn more about HIV/AIDS is agreed or
strongly agreed upon by 78.2% of the respondents. Thirteen percent of the respondents don’t
think it is a good idea to give advice about HIV/AIDS or tell where to get the information to
friends and acquaintances.
Table 5: Table showing information seeking actions of people on ART in selected health
Facilities in Addis Ababa, June 2009.

Strongly Disagree Neutral (%) Agree (%) Strongly

disagree (%) (%) agree (%)
Learning new HIV information 9 (1.2) 9(1.2) 42(5.4) 127(16.3) 591(76.0)
helps to keep me healthy.

I feel good about myself when I 4(0.5) 8(1.0) 51(6.6) 172(22.2) 540(69.7)
seek out new HIV information.

I am confident that I can find the 6(0.8) 34(4.4) 86(11.2) 251(32.8) 388(50.7)
HIV information I want and need
It is easy to feel overwhelmed by 32(4.2) 124(16.4) 233(30.9) 166(22.0) 199(26.4)
AIDS/HIV information
At times it is better not to seek 191(25.1) 347(45.7) 102(13.4) 64(8.4) 56(7.4)
more AIDS/HIV information
I actively search for new HIV 14(1.8) 17(2.2) 91(11.9) 247(32.2) 397(51.8)
information.
I regularly read things that help 18(2.4) 34(4.5) 122(16.0) 225(29.6) 362(47.6)
me learn more about HIV.
I try to give friends advice about 47(6.2) 52(6.8) 116(15.2) 198(26.0) 348(45.7)
HIV or tell them where to go to
get more HIV information.
DISCUSSION
The use of health professionals as the major source of information for people on ART is larger
than other similar studies (6). This could be a difference in methods and lack of other
alternative source of information. Hogan and palmer asked respondents to put the numbers
“1,” “2,” and “3” next to their top three choices instead of a yes or no question and the result
was 70% of the respondents rated doctors as their number 1 choice and 21% rated nurses as
their number 1 choice. Additionally, they listed doctors, nurses and HIV positive counselors
separately. The list does not also include electronic media such as radio and television. The
other main reason could be the involvement of health professionals in conducting the
interview; the main instrument for data collection. This will bias the respondents to provide
agreeable response to the health professional. As HIV/AIDS and ART service is an active
campaign area in Ethiopia, it would also indicate the level of emphasis and service provided to
people on ART in the health facilities. One of the major determinants to information source use
is education. It has been difficult to compare the results of this study with other similar studies
as most of the literature on determinants of information source use focuses on the use of the
internet alone. According to this study, those who are above 50 years of age are less likely to
get useful and encouraging information from telephone hotlines and books. The main reason
could be loss of reading habits. Additionally, those who are between 30-39 years of age are also
less likely to get health information from books. Those who are between 18-29 years of are
more probably going to school, and have access to books in addition to active reading skills and
habits.
Moreover, males are more likely to use the internet more than females. On the other hand the
married are more likely to get useful and encouraging information from many sources,
including health professionals, television, magazines and newspapers. Additionally, the more
educated are more likely to obtain information from electronic and print media such as
television, the internet, books, magazines, and newspapers, while the less educated are more
likely to get useful and encouraging information from peer educators, religious places,
traditional healers, local clubs and PLWHA associations.
Housewives are less likely to get helpful information from “families, friends and neighbors” and
telephone hotlines, while the unemployed are less likely to get helpful information from the
internet, telephone hotlines and the radio. Muslims and Protestants are less likely to use
religious places as an encouraging source of information. However Muslims are more likely to
get useful information from telephone hotlines. The Tigre are less likely to get helpful
information from telephone hotlines while the Gurage are also less likely to get helpful
information from books and magazines. This might be partially due to lack of books and
magazines written in their native languages. Less educated patients have the disadvantage of
not making use of many information sources especially print media. Unemployed and
uneducated patients are even more disadvantaged due to lack of resources. Employed
respondents will have the opportunity of using their employers’ telephone lines and internet
access at the workplace.
The less educated are more likely to use informal sources that are not dependable or
authoritative health information sources such as traditional healers. This might expose them to
unexpected health risks and poor adherence to their drugs.

As one of the major problems identified is too much information, people on ART need to get
well organized information. It is also one of the top three major problems reported by Hogan
and palmer (6). Information overload is one of the facets of the information age. Service
providers need also to look into efficient and organized ways of providing HIV related
information to patients in addition to the health service. Information overload is a perception
on the part of the individual (or observers of that person) that the flow of information
associated with work tasks is greater than can be managed effectively and a perception that
overload in this sense creates a degree of stress for which his or her coping strategies are
ineffective. Information overload has been found to yield profound physical, mental, emotional
and social effects including physical illness, analysis paralysis and difficulty in identifying and
selecting relevant information (36). This has been evidenced by the lack of confidence by some
of the respondents in getting the information they need and feeling of being overwhelmed by
HIV information.

Health professionals are highly rated for usefulness, availability, understandability and
trustworthiness by all patient groups. This indicates the level of emphasis and service provided
to People on ART to combat the calamitous impacts of the disease. However, it also indicates
the burden on the limited health professionals working in the area. The somehow lower but
similar rating for radio and television is also an encouraging finding. However the low rating for
local clubs (Edir), and telephone hotline even when compared with print media is highly

42
alarming as these institutions are closest to the majority of patients and can play a major role in
providing useful information.

The majority of the respondents have strongly agreed or agreed for active information search,
feeling of desire for and wellbeing with information, and information sharing. This indicates the
common desire of People on Art for HIV Information. Information professionals need to ensure
access to HIV health information including those who have fewer resources and options (8).

However, substantial number of the respondents lack the confidence in getting the
information they need and feel overwhelmed by HIV information. This indicates that, even
though, information is available in large quantities from many sources, some of the patients are
unable to obtain information that is relevant to their need, easily in an organized way. These
results about information seeking actions show a similar trend with that of Hogan and palmer
(6).

STRENGTH AND LIMITATION OF THE STUDY

This study, like many other studies has its own strengths and limitations. While it is impossible
to identify all strengths and limitations of any particular study, the following are the major
strengths and limitations identified in this study.

Strengths
This is study is primarily conducted to obtain relevant information that provides an insight t0
the information seeking behavior of people on ART in Addis Ababa. By using a multi-stage
sampling design, the sample size has been made large enough to increase the power of the
study. The other strength of this study is that it tried to investigate many facets of information
seeking behavior; association between source use and demographic variable, barriers,
evaluation of the characteristics and utility of sources and information seeking actions.
Additionally it has investigated the association between the major information sources and the
socio demographic covariates. The study is also the first of its kind to be conducted in Ethiopia.

Limitations
Though this study has much strength, it has also its limitations. The major limitation of the
study the use of health professionals in conducting the anonymous interview which was the
main instrument of the study for data collection as it was imperative due to confidentiality. This
could bias the respondents to provide responses that are agreeable with health professionals. A

43
certain level of the rating in the use of health professionals and their evaluation in terms of
usefulness, availability, understandability and trustworthiness could be a result of this bias.

CONCLUSION

Health professionals are the most commonly used source of information to cope with the
illness. There is significant association between source use and demographic and socio-
economic variables. Educational and occupational statuses are the most common determinants
of source use. Information overload is one of the major barriers to information use. Health
professionals, television and radio are the most highly rated information sources in terms of
utility. However, PLWHA associations, telephone hotline and local clubs are rated low. Even
though people on ART have a strong desire for information, they are faced with the challenge
of obtaining relevant and usable information in an organized way.

RECOMMENDATIONS

Many studies have demonstrated the importance of information in coping with chronic illnesses
including HIV AIDS. This study and many others have also shown the strong common desire of
people living with HIV for HIV related information.

As uneducated and unemployed patients have fewer options and lack sufficient resources to
find information, health professionals need to give special attention to this disadvantaged
group in providing health information. Government institutions and NGOs need to combine
resources to provide efficient information services to meet information needs of these groups.
Information must be organized and presented in understandable way targeting the specific
audience. Further investigation is needed to determine the type of information sought by
people on ART and in what ways it can be best met. Another area for further investigation is the
association between health seeking behaviors and health outcomes or health status.

Most information needs of people on ART can be best met through PLWHA associations, local
clubs and telephone hotlines. Efforts should be made to improve the utility of PLWHA
associations, local clubs and telephone hotlines. This could be done either by strengthening
their capacity or educating patients on the utility of these sources.

Studies have shown that the use of the internet is associated with better disease knowledge,
drug adherence and health status. Patient education on health information consumer skills and

44
the usefulness of the internet would be desirable in addition to providing access to the internet
to increase its utility. This would even be more desirable considering the vulnerability of the
patients to misinformation and false claims.

Further detailed investigation of the information seeking behavior of people on ART at a

national level including the types of health information needed, the association between
information source use and health outcomes is highly recommended as it will uncover
important findings that aid in designing effective informational interventions.

45
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48
Annex 1: Questionnaire (English)

Addis Ababa University

School of public health

Department Of Health Informatics

Information Seeking Behavior Survey

Dear respondent,

You are kindly invited to respond to this survey. The purpose of the survey is to investigate the
information seeking behavior of people leaving with HIV-AIDS. The results of the survey shall
be kept anonymous and will not be used for any other purposes whatsoever. Thank you in
advance for taking the time and effort to respond to this survey.

1. Your sex

Male Female

2. What was your Age at your last birth day? ___________________________

3. Ethnic background

Amhara Oromo Tigre Other

4. Educational background

No formal education Elementary High school complete Diploma or above

5. What is your occupation?

Government employee businessman employed in private organization house wife

unemployed student other

6. Your Religion

Orthodox catholic Muslim protestant

7. Your Marital status

Married Single Widowed Divorced Separated

Which of the following people and information sources ‘‘encourage and support you to take
positive actions to deal with your HIV? Please tick your choice.

Source Yes NO

8. Health professional

9. HIV-positive peer educators

10. Family, Friends and neighbors

11. Internet

12. Television

13. Telephone hotline

14. Radio

15. Book

16. Magazine

17. Newspaper

18. Religious places/holy waters

19. Traditional Healers/Faith healers

20. Local clubs(Edir)

21. PLWHA associations

50
 Which of the barriers prevent you from using information you find from the sources?

Barrier Yes NO
22. Information is hard to
understand
23. Information is contradictory
24. Information is hard to find
25. Information is not motivating
26. Information is not interesting
27. Information is not applicable
28. Information does not provide
clear action steps
29. Information is to much
How do you evaluate the information sources? Please make a tick mark in the box of your preference.
How Available/
accessible is the How understandable is How trustworthy is the
How useful is the source? source? the source? source?
Not at all A A lot Not at A A lot Not at A A lot Not at A little A lot
little all little all little all

Health professional 30. 31. 32. 33.

HIV-positive peer 36.

educators 34. 35. 37.
39. 40.
Family, Friends and
neighbors 38. 41.
internet 42. 43. 44. 45.
Television 46. 47. 48. 49.
50.
Telephone hotline 51. 52. 53.
Radio 54. 55. 56. 57.
Book 58. 59. 60. 61.
Magazine 62. 63. 64. 65.
Newspaper 66. 67. 68. 69.
Religious places 70. 71. 72. 73.
Traditional healers 74. 75. 76. 77.
Clubs(edir) 78. 79. 80. 81.
PLWHA associations 82. 83. 84. 85.
How do feel about the following statements. Please make a tick mark in circle of your choice.
Strongly disagree neutral agree Strongly
disagree agree

86. Learning new HIV

information helps to keep
me healthy.

87. I feel good about myself

when I seek out new HIV
information.

88. I am confident that I can

find the HIV information I
want and need

89. It is easy to feel

overwhelmed by
AIDS/HIV information

90. At times it is better not to

seek more AIDS/HIV
information

91. I actively search for new

HIV information.

92. I regularly read things

that help me learn more
about HIV.

93. I try to give friends advice

about HIV or tell them
where to go to get more
HIV information.

52
94. If you are married, is your spouse HIV positive?

YES NO

95. How much is your family size? ______________________

96. Is there any other person who is HIV positive in your family?

YES NO

97. Do you share information with the HIV positive person in your family?

YES NO

98. How long have you taken ART? ________________years __________months

53
Annex 2: Questionnaire (Amharic)

1.

2. ?
3.

4.

5.

6.
/ / / / /
7.

8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.

22.

54
23.
24.
25.
26.
27.

28.

29.

? ? ?
] ] ] ]

30. 31. 32. 33.

36.
34. 35. 37.
Ò 39. 40.
38. 41.
/
42. 43. 44. 45.
46. 47. 48. 49.
50.
51. 52. 53.
54. 55. 56. 57.
58. 59. 60. 61.
62. 63. 64. 65.

66. 67. 68. 69.

70. 71. 72. 73.

74. 75. 76. 77.

78. 79. 80. 81.

82. 83. 84. 85.

55
 ?

86.

87.

88.

89.

90.

91.

92.
.
93.

94. ?

95. ?___________________________
96. ?

97. / ?

98. ?________ _______

Annex 3: consent form (English)

Addis Ababa University

Faculty of Medicine

School of Public Health

Written Consent Form (ENGLISH)

Introduction

This survey questionnaire is prepared by a student at AAU Faculty of Medicine, School of Public
Health and princpal investigator of the research, Tilahun Deribe.

Title of the study:

Information seeking behavior of people on ART in Addis Ababa

Reason for the study/ purpose of the study:

Managing information is an important part of coping with illness. Increased access to health
information can educate patients about their condition, motivate patients to participate in their
care, foster social support, evaluate treatment options, and build effective coping strategies.
The results of this study are expected to provide an insight on the information seeking
behaviors of people on ART in the local context to contribute to the design of effective
information interventions for better health outcomes.

How you were identified:

You have been randomly selected for the study

Your Part in the Research Study:

You will be asked to respond to a survey. Your participation in this study is completely based on
your will and there is no penalty for refusing to take part. You can discontinue at any time you
want to do so. You can ask any question related with the study.

Confidentiality:

All the records of the survey shall be kept anonymous and will not be used for any other
purposes. You will be asked to respond to an anonymous survey questionnaire. The investigator
will protect any personal information that might be used by any one for other purposes.
Consent:
I have read this form and the research study has been explained to me. I have been given the
opportunity to ask questions and my questions have been answered. I agree to voluntarily
participate in this survey. I agree to participate in the research study described above and, by
responding to the survey, give my consent to participate.

58
Annex 4: consent form (Amharic)

“ ”
::

,
, ,
::

::

::
::

::

::
::

Annex 5: detailed tables showing the association between socio demographic variables and the use
of information sources

59
 Table 6: Table showing the association between socio demographic variables and use of health professionals as a
source of health information by people on ART in selected health facilities in Addis Ababa, June 2009 using logistic
regression.

95 % 95 %
Confidence Confidence
OR interval AOR interval
yes no lower upper Lower Upper
Age* 18-29 1.0 1.0
166 2
30-39
320 3
40-49
173 7
>50
65 0
Male 1.0 1.0
Gender 318 6
Female 0.936 0.331 2.665 1.077 .362 3.206
448 9
currently Not
Marital 1.0 1.0
married
Status 388 11
Married 3.610 .999 13.04 3.834** 1.053 13.967
382 3
Elementary
1.0 1.0
and below
Education 291 4
High school
0.599 0.189 1.897 .420 .114 1.548
and above
479 11
Employee 1.0 1.0
Occupation 364 8
Housewife
* 117 1
Business
persons
85 0
Unemployed
144 2
Orthodox 1.0 1.0
595 12
Religion* protestant
98 3
Muslim
59 0**
Ethnicity* Amhara 1.0 1.0
392 9
Oromo
169 1**
Tigray
98 2
Gurage
68 2
* = variables have expected values less than five, logistic regression is not applicable.

60
Table 7: Table showing the association between socio demographic variables and use of peer educators as a source
of health information by people on ART in selected health facilities in Addis Ababa, June 2009.

OR 95 % Confidence AOR 95 % Confidence

interval interval
yes no lower upper Lower Upper
Age 18-29 1.0 1.0
102 65
30-39 .761 .520 1.115 .805 .518 1.250
172 144
40-49 .563 .367 .864 .704 .421 1.177
84 95
>50 .425 .237 .763 .333** .166 .670
26 39
Male 1.0 1.0
Gender 148 172
Female 1.532 1.148 2.043 1.068 .719 1.585
257 195
Currently not
Marital 1.0 1.0
married
Status 204 190
Married 1.085 .818 1.438 1.239 .882 1.739
205 176
Elementary
1.0 1.0
and below
Education 182 108
High school
.516 .383 .694 .483** .328 .712
and above
226 260
Employee 1.0 1.0
179 187
Occupation Housewife 1.358 .891 2.071 .843 .490 1.449
65 50
Business
1.020 .636 1.636 .859 .508 1.452
persons
42 43
Unemployed 1.888 1.271 2.806 1.238 .771 1.987
94 52
Orthodox 1.0 1.0
312 287
Religion protestant .723 .472 1.107 .898 .533 1.511
44 56
Muslim 1.440 .833 2.489 1.676 .817 3.440
36 23
Ethnicity Amhara 1.0 1.0
205 189
Oromo 1.102 .767 1.581 .876 .583 1.317
92 77
Tigray 1.082 .697 1.681 1.113 .661 1.874
54 46
Gurage 1.468 .873 2.470 1.099 .588 2.054
43 27

*=significant with p value<0.025, **= significant with p value <0.050

61
Table 8: Table showing the association between socio demographic variables and use of family, friends and neighbors as a
source of health information by people on ART in selected health facilities in Addis Ababa, June 2009.

95 % 95 %
Confidence Confidence
OR interval AOR interval
lower upper Lower Upper
yes No
Age 18-29 1.0 1.0
71 95
30-39 1.281 .878 1.868 .957 .624 1.467
156 163
40-49 .921 .600 1.414 .714 .431 1.183
73 106
>50 .976 .545 1.750 .806 .411 1.581
27 37
Male 1.0 1.0
Gender 141 181
Female 1.065 .799 1.421 1.137 .772 1.676
205 247
currently Not
1.0 1.0
Marital Status married
171 224
Married 1.125 .847 1.493 1.202 .862 1.676
176 205
Elementary
1.0 1.0
and below
Education 123 168
High school
1.177 .878 1.578 1.086 .748 1.577
and above
225 261
Employee 1.0 1.0
176 192
Occupation Housewife .782 .512 1.193 .578** .338 .988
48 67
Businessman/
.970 .605 1.555 .949 .567 1.587
woman
40 45
Unemployed .748 .507 1.105 .638 .401 1.014
59 86
Orthodox 1.0 1.0
266 335
Religion protestant 1.364 .893 2.085 1.090 .649 1.829
52 48
Muslim .770 .442 1.340 .769 .388 1.525
22 36
Ethnicity Amhara 1.0 1.0
171 225
Oromo 1.211 .844 1.738 1.207 .808 1.804
81 88
Tigray 1.053 .676 1.640 1.133 .676 1.900
44 55
Gurage 1.243 .747 2.068 1.256 .687 2.298
34 36
*=significant with p value<0.025, **= significant with p value <0.050

62
Table 9: Table showing the association between socio demographic variables and use of the internet as a source of
health information by people on ART in selected health facilities in Addis Ababa, June 2009.

95 % Confidence 95 % Confidence
OR interval AOR interval
lower upper Lower Upper
yes No
Age 18-29 1.0 1.0
35 133
30-39 .924 .581 1.470 .601 .335 1.076
62 255
40-49 1.201 .724 1.993 .675 .346 1.315
43 136
>50 .950 .466 1.938 .595 .244 1.452
13 52
Male 1.0 1.0
Gender 96 227
Female .356 .248 .512 .401* .241 .665
59 392
currently Not
Marital 1.0 1.0
married
Status 73 322
Married 1.224 .861 1.741 1.174 .761 1.810
83 299
Elementary
and below
Education 29 261
High school
3.200 2.074 4.936 2.275* 1.305 3.963
and above
128 360
Employee 1.0 1.0
114 256
Occupation Housewife .240 .124 .464 .552 .248 1.231
11 103
Business
.521 .290 .936 .600 .317 1.137
persons
16 69
Unemployed .113 .051 .249 .088* .027 .288
7 139
Orthodox 1.0 1.0
113 488
Religion protestant 1.364 .825 2.254 1.293 .694 2.411
24 76
Muslim .990 .498 1.966 1.588 .648 3.895
11 48
Ethnicity Amhara 1.0 1.0
74 322
Oromo 1.220 .783 1.901 .964 .573 1.624
37 132
Tigray 1.300 .765 2.208 1.033 .533 2.001
23 77
Gurage 14 56 1.088 .575 2.059 .857 .369 1.986
*=significant with p value<0.025, **= significant with p value <0.050

63
Table 10: Table showing the association between socio demographic variables and use of television as a source of
health information by people on ART in selected health facilities in Addis Ababa, June 2009.
95 % Confidence 95 % Confidence
OR interval AOR interval
lower upper Lower Upper
yes No
Age 18-29 1.0 1.0
144 24
30-39 .862 .510 1.456 .643 .339 1.223
269 52
40-49 1.317 .698 2.484 1.255 .548 2.875
158 20
>50 .736 .344 1.576 .641 .248 1.656
53 12
Male 1.0 1.0
Gender 281 42
Female .766 .509 1.152 .998 .558 1.783
379 74
Currently not
Marital 1.0 1.0
married
Status 324 74
Married 1.849 1.229 2.781 2.327* 1.384 3.914
340 42
Elementary
1.0 1.0
and below
Education 236 57
High school
1.752 1.178 2.606 1.789** 1.044 3.066
and above
428 59
Employee 1.0 1.0
328 42
Occupation Housewife .697 .384 1.266 1.043 .461 2.356
98 18
Business
.709 .362 1.389 .960 .425 2.171
persons
72 13
Unemployed .471 .283 .785 .640 .340 1.203
114 31
Orthodox 1.0 1.0
510 92
Religion protestant 1.034 .572 1.869 1.193 .498 2.859
86 15
Muslim 1.150 .528 2.503 1.550 .555 4.328
51 8
Amhara 1.0 1.0
345 54
Oromo 1.046 .614 1.780 1.052 .575 1.924
147 22
Tigray 1.409 .690 2.875 2.166 .813 5.774
Ethnicity 90 10
Gurage .686 .352 1.337 .533 .240 1.186
57 13

*=significant with p value<0.025, **= significant with p value <0.050

64
Table 11: Table showing the association between socio demographic variables and use of telephone hotline as a
source of health information by people on ART in selected health facilities in Addis Ababa, June 2009.

95 % Confidence 95 % Confidence
OR interval AOR interval
lower upper Lower Upper
yes No
Age 18-29 1.0 1.0
57 110
30-39 .960 .646 1.427 .863 .546 1.364
105 211
40-49 .812 .516 1.277 .764 .444 1.315
53 126
>50 .445 .220 .901 .357* .160 .800
12 52
Male 1.0 1.0
Gender 110 210
Female .782 .575 1.063 .757 .499 1.147
131 320
currently not
Marital 1.0 1.0
married
Status 119 274
Married 1.111 .820 1.505 1.130 .788 1.620
124 257
Elementary
1.0 1.0
and below
Education 87 202
High school
1.087 .793 1.491 .931 .619 1.401
and above
155 331
Employee 1.0 1.0
134 234
Occupation Housewife .510 .314 .829 .486* .265 .891
26 89
Business
.699 .416 1.174 .568 .320 1.007
persons
24 60
Unemployed .642 .420 .982 .512* .305 .861
39 106
Orthodox 1.0 1.0
178 419
Religion protestant 1.042 .660 1.648 .947 .542 1.655
31 70
Muslim 1.855 1.077 3.192 2.391* 1.182 4.837
26 33
Ethnicity Amhara 1.0 1.0
111 283
Oromo 1.491 1.017 2.186 1.213 .787 1.868
62 106
Tigray 1.434 .902 2.280 1.791* 1.043 3.075
36 64
Gurage 1.601 .943 2.717 .965 .496 1.876
27 43
*=significant with p value<0.025, **= significant with p value <0.050

65
Table 12: Table showing the association between socio demographic variables and use of radios as a source of health
information by people on ART in selected health facilities in Addis Ababa, June 2009.

95 % Confidence 95 % Confidence
OR interval AOR interval
lower upper Lower Upper
yes No
Age 18-29 1.0 1.0
118 49
30-39 .929 .504 1.714 .709 .361 1.393
208 111
40-49 .853 .433 1.679 .735 .328 1.646
117 62
>50 .939 .370 2.382 .893 .289 2.757
33 32
Male 1.0 1.0
Gender 226 96
Female .575 .354 .933 .565 .296 1.076
269 184
currently Not
Marital 1.0 1.0
married
Status 250 147
Married 1.534 .971 2.423 1.467 .857 2.513
248 133
Elementary
1.0 1.0
and below
Education 133 158
High school
1.592 1.014 2.498 1.305 .730 2.330
and above
365 123
Employee 1.0 1.0
267 101
Occupation Housewife .661 .331 1.323 1.041 .448 2.419
54 62
Business
.498 .242 1.025 .648 .286 1.465
persons
54 31
Unemployed .390 .219 .695 .479** .245 .937
87 59
Orthodox 1.0 1.0
378 224
Religion protestant 1.083 .537 2.186 .819 .356 1.885
71 29
Muslim .578 .279 1.197 .652 .251 1.697
32 27
Ethnicity Amhara 1.0 1.0
257 140
Oromo 1.407 .750 2.639 1.357 .692 2.659
119 50
Tigray 1.029 .511 2.069 1.956 .732 5.226
64 36
Gurage .614 .307 1.231 .894 .377 2.117
36 34
*=significant with p value<0.025, **= significant with p value <0.050

66
Table 13: Table showing the association between socio demographic variables and use of books for health
information by people on ART in selected health facilities in Addis Ababa, June 2009

95 % 95 %
Confidence Confidence
OR interval AOR interval
yes No lower upper Lower Upper
Age 18-29 1.0 1.0
117 49
30-39 1.099 .727 1.663 .595** .367 .964
231 88
40-49 .912 .576 1.445 .604 .344 1.063
122 56
>50 .489 .271 .882 .415* .202 .855
35 30
Male 1.0 1.0
Gender 240 82
Female .610 .444 .836 .772 .500 1.192
289 162
Currently not
Marital 1.0 1.0
married
Status 257 139
Married 1.398 1.031 1.896 1.181 .818 1.704
274 106
Elementary
1.0 1.0
and below
Education 142 147
High school
4.120 2.992 5.672 3.151** 2.124 4.674
and above
390 98
Employee 1.0 1.0
284 84
Occupation Housewife .334 .215 .519 .590 .335 1.037
61 54
Business
.698 .412 1.183 1.006 .561 1.802
persons
59 25
Unemployed .449 .297 .677 .758 .462 1.243
88 58
Orthodox 1.0 1.0
407 194
Religion protestant 1.430 .881 2.320 1.125 .621 2.040
75 25
Muslim .587 .340 1.012 1.237 .591 2.589
32 26
Ethnicity Amhara 1.0 1.0
268 128
Oromo 1.357 .907 2.030 1.184 .753 1.863
125 44
Tigray 1.291 .792 2.106 .888 .504 1.564
73 27
Gurage .567 .339 .949 .499** .263 .946
38 32
*=significant with p value<0.025, **= significant with p value <0.050

67
Table 14: Table showing the association between socio demographic variables and use of magazines as a source of
health information by people on ART in selected health facilities in Addis Ababa, June 2009.
95 % Confidence 95 % Confidence
OR interval AOR interval
yes No lower upper Lower Upper

Age 18-29 117 49 1.0 1.0

30-39 231 88 .981 .651 1.480 .790 .480 1.301

40-49 122 56 .904 .572 1.430 .701 .391 1.257

>50 35 30 .524 .290 .948 .514 .245 1.078

Gender Male 240 82 1.0 1.0

Female 289 162 .589 .430 .808 .865 .546 1.370

currently Not
Marital Status 1.0 1.0
Married 257 139

Married 274 106 1.443 1.065 1.955 1.709** 1.160 2.518

Elementary and
1.0 1.0
Education below 142 147

High school and

3.297 2.407 4.516 3.545** 2.354 5.337
above 390 98

Occupation Employee 284 84 1.0 1.0

Housewife 61 54 .360 .233 .555 .570 .317 1.025

Business persons 59 25 .905 .531 1.543 1.267 .664 2.417

Unemployed 88 58 .534 .354 .804 .679 .408 1.132

Orthodox 407 194 1.0 1.0
Religion
protestant 75 25 1.426 .879 2.314 1.048 .556 1.973

Muslim 32 26 .460 .268 .787 1.085 .509 2.310

Amhara 268 128 1.0 1.0
Ethnicity
Oromo 125 44 1.136 .768 1.681 1.261 .783 2.030

Tigray 73 27 1.484 .895 2.462 1.350 .729 2.499

Gurage 38 32 .572 .342 .957 .486** .252 .936

*=significant with p value<0.025, **= significant with p value <0.050

68
Table 15: Table showing the association between socio demographic variables and use of newspapers for health
information by people on ART in selected health facilities in Addis Ababa, June 2009

95 %
95 % Confidence
Confidence
OR AOR interval
interval
lower upper Lower Upper
Yes No
Age 18-29 1.0 1.0
116 49
30-39 .981 .651 1.480 .708 .432 1.161
223 96
40-49 .904 .572 1.430 .623 .350 1.110
122 57
>50 .524 .290 .948 .464** .221 .971
36 29
Male 1.00
Gender 239 82
Female .589 .430 .808 .731 .466 1.147
285 166
currently Not
Marital 1.0 1.0
married
Status 252 142
Married 1.443 1.065 1.955 1.551** 1.062 2.265
274 107
Elementary
1.0 1.0
and below
Education 149 140
High school
3.297 2.407 4.516 2.945** 1.966 4.413
and above
379 108
Employee 1.0 1.0
274 92
Occupation Housewife .360 .233 .555 .630 .354 1.119
60 56
Business
.905 .531 1.543 1.432 .755 2.716
persons
62 23
Unemployed .534 .354 .804 .726 .438 1.204
89 56
Orthodox 1.0 1.0
406 193
Religion protestant 1.426 .879 2.314 1.035 .559 1.917
75 25
Muslim .460 .268 .787 .717 .345 1.489
29 30
Ethnicity Amhara 1.0 1.0
268 129
Oromo 1.136 .768 1.681 1.135 .717 1.796
118 50
Tigray 1.484 .895 2.462 1.819 .959 3.451
74 24
Gurage .572 .342 .957 .594 .311 1.132
38 32

*=significant with p value<0.025, **= significant with p value <0.050

69
Table 16: Table showing the association between socio demographic variables and use of religious places as a
source of health information by people on ART in selected health facilities in Addis Ababa, June 2009.
95 % 95 %
Confidence Confidence
OR AOR
interval interval
yes No lower upper Lower Upper
Age 18-29 1.0 1.0
406 193
30-39 1.139 .780 1.664 1.237 .791 1.934
75 25
40-49 .880 .576 1.345 .878 .520 1.483
29 30
>50 .804 .451 1.433 .802 .399 1.612
406 193
Male 1.0 1.0
Gender 268 129
Female 1.436 1.076 1.917 1.234 .827 1.841
118 50
currently
Marital 1.0 1.0
married Not
Status 74 24
Married .839 .632 1.114 .956 .677 1.350
38 32
Elementary
1.0 1.0
and below
Education 160 158
High school
.481 .356 .651 .451** .304 .670
and above
269 185
Employee 1.0 1.0
193 172
Occupation Housewife 1.534 .999 2.354 1.272 .726 2.228
74 43
Business
.594 .368 .960 .585** .343 .998
persons
34 51
Unemployed 1.502 1.012 2.228 1.112 .688 1.798
91 54
Orthodox 1.0 1.0
363 238
Religion protestant .463 .301 .714 .531** .311 .908
41 58
Muslim .336 .191 .591 .329** .160 .673
20 39
Ethnicity Amhara 1.0 1.0
224 174
Oromo 1.115 .773 1.607 1.135 .746 1.727
99 69
Tigray 1.087 .692 1.708 1.435 .829 2.484
56 40
Gurage .777 .467 1.292 1.089 .578 2.054
35 35

*=significant with p value<0.025, **= significant with p value <0.050

70
Table 17: Table showing the association between socio demographic variables and use of traditional healers as a
source of health information by people on ART in selected health facilities in Addis Ababa, June 2009.
95 % 95 %
Confidence Confidence
OR interval AOR interval
lower upper Lower Upper
yes No
Age 18-29 1.0 1.0
13 155
30-39 .676 .320 1.427 .893 .392 2.034
17 300
40-49 1.097 .506 2.381 1.250 .495 3.160
15 163
>50 .994 .340 2.907 .649 .158 2.668
5 60
Male 1.0
Gender 17 303
Female 1.400 .766 2.561 1.424 .633 3.206
33 420
Not currently
Marital 1.0 1.0
married
Status 30 365
Married .710 .399 1.263 .685 .343 1.370
21 360
Elementary and
1.0 1.0
below
Education 36 254
High school and
.224 .120 .417 .202* .095 .429
above
15 472
Employee 1.0 1.0
Occupation 18 349
Housewife 1.257 .511 3.089 .376 .118 1.202
7 108
Business persons 3.501 1.642 7.464 1.783 .709 4.484
13 72
Unemployed 1.736 .814 3.702 .992 .406 2.424
12 134
Orthodox 1.0 1.0
33 566
Religion protestant 1.083 .442 2.655 2.041 .746 5.579
6 95
Muslim 3.931 1.869 8.265 2.284 .790 6.602
11 48
Ethnicity Amhara 1.0 1.0
17 380
Oromo 1.875 .889 3.953 1.656 .735 3.729
13 155
Tigray 1.965 .823 4.695 2.139 .806 5.678
8 91
Gurage 3.298 1.407 7.731 1.679 .567 4.972
9 61

*=significant with p value<0.025, **= significant with p value <0.050

71
Table 18: Table showing the association between socio demographic variables and use of local clubs ( EDIR) as
a source of health information by people on ART in selected health facilities in Addis Ababa, June 2009.
95 %
95 % Confidence
Confidence
OR interval AOR interval
lower upper Lower Upper
yes No
Age 18-29 1.0 1.0
25 143
30-39 1.201 .718 2.009 1.383 .764 2.505
55 262
40-49 .972 .536 1.761 1.373 .688 2.738
26 153
>50 1.458 .694 3.064 1.040 .416 2.598
13 51
Male 1.0 1.0
Gender 48 272
Female 1.142 .771 1.693 1.124 .657 1.924
76 377
currently Not
Marital 1.0 1.0
married
Status 63 332
Married 1.024 .698 1.502 1.039 .660 1.635
62 319
Elementary
1.0 1.0
and below
Education 69 222
High school
.419 .284 .618 .344** .210 .565
and above
56 430
Employee 1.0 1.0
56 310
Occupation Housewife 1.521 .899 2.574 .633 .313 1.279
25 91
Business
.910 .464 1.785 .549 .246 1.223
persons
12 73
Unemployed 1.144 .683 1.916 .789 .424 1.467
25 121
Orthodox 1.0 1.0
89 511
Religion protestant 1.013 .560 1.834 1.546 .777 3.077
15 85
Muslim 1.786 .941 3.390 1.572 .688 3.590
14 45
Ethnicity Amhara 1.0 1.0
59 338
Oromo 1.049 .635 1.732 .857 .488 1.507
26 142
Tigray 1.188 .658 2.145 1.185 .593 2.365
17 82
Gurage 1.432 .749 2.737 1.167 .541 2.518
14 56

*=significant with p value<0.025, **= significant with p value <0.050

72
Table 19: Table showing the association between socio demographic variables and use of PLWHA
associations as a source of health information by people on ART in selected health facilities in Addis
Ababa, June 2009

95 % Confidence 95 % Confidence
OR interval AOR interval
lower upper Lower Upper
yes no
Age 18-29 1.0 1.0
76 92
30-39 .820 .562 1.196 .878 .568 1.357
128 189
40-49 .766 .499 1.176 1.032 .620 1.720
69 109
>50 .538 .293 .988 .517 .254 1.051
20 45
Male 1.0 1.0
Gender 114 205
Female 1.378 1.027 1.851 1.044 .699 1.561
197 257
Not currently
Marital 1.0 1.0
married
Status 163 233
Married .932 .700 1.242 1.118 .794 1.574
150 230
Elementary
1.0 1.0
and below
Education 142 147
High school
.563 .419 .758 .561* .383 .824
and above
172 316
Employee 1.0 1.0
143 224
Occupation Housewife 1.067 .697 1.634 .741 .430 1.276
47 69
Business
.729 .441 1.205 .605 .346 1.058
persons
27 58
Unemployed 1.422 .965 2.095 .973 .608 1.556
69 76
Orthodox 1.0 1.0
233 366
Religion protestant 1.030 .669 1.585 1.024 .601 1.744
40 61
Muslim 1.325 .774 2.270 1.477 .746 2.926
27 32
Ethnicity Amhara 1.0 1.0
165 231
Oromo .811 .560 1.176 .671 .441 1.021
62 107
Tigray .822 .523 1.293 .843 .495 1.437
37 63
Gurage 1.360 .815 2.270 1.163 .629 2.151
34 35
*=significant with p value<0.025, **= significant with p value <0.050

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