Constructing “Sense” From Evolving Health Information:
A Qualitative Investigation of Information Seeking and
Sense Making Across Sources
Shelagh K. Genuis
Centre for Health Promotion Studies, School of Public Health, University of Alberta, 3-094 Edmonton Clinic
Health Academy (ECHA), 11405 87 Avenue, University of Alberta, Edmonton, AB, Canada T6G 1C9. E-mail:
genuis@ualberta.ca
Focusing on information behavior in a context where
medical evidence is explicitly evolving (management of
the menopause transition), this investigation explored
how women interact with and make sense of uncertain
health information mediated by formal and informal
sources. Based on interviews with 28 information
seekers and 12 health professionals (HPs), findings
demonstrate that participants accessed and valued a
wide range of information sources, moved fluidly
between formal and informal sources, and trust was
strengthened through interaction and referral between
sources. Participants were motivated to seek informa-
tion to prepare for formal encounters with HPs, evaluate
and/or supplement information already gathered, estab-
lish that they were “normal,” understand and address
the physical embodiment of their experiences, and
prepare for future information needs. Findings revealed
four strategies used to construct sense from health
information mediated by the many information sources
encountered and accessed on an everyday basis:
women assumed analytic and experiential “postures”;
they valued social contexts for learning and knowledge
construction; information consistency was used as a
heuristic representing accuracy and credibility; and an
important feature of sense making was source comple-
mentarity. Implications for health information literacy
and patient education are discussed.
Introduction
When the respected Journal of the American Medical
Association published the news that the Women’s Health
Received December 21, 2011; revised March 2, 2012; accepted March 5,
2012
© 2012 ASIS&T • Published online 29 June 2012 in Wiley Online Library
(wileyonlinelibrary.com). DOI: 10.1002/asi.22691
JOURNAL OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE AND TECHNOLOGY, 63(8):1553–1566, 2012
Initiative (WHI) study had been prematurely halted due to
health concerns (Rossouw et al., 2002), the news reverber-
ated through medical and consumer communities and
was subsequently discussed and debated in hundreds of
articles and editorials (Naughton, Jones, & Shumaker,
2005). Analysis of a stratified random sample of medical
and consumer articles published before and after the
release of WHI results raised questions about “how real
people access, use, and interpret information about contro-
versial or changing areas of medical practice” (Genuis,
2006, p. 983). These questions are widely relevant
because, facilitated by rapid communication of research
findings via the Internet and in the popular press, consum-
ers are confronted on a regular basis with new and evolv-
ing medical evidence (Consumer Reports, 2006). Consider,
for example, hopeful media coverage of a new cancer
treatment (Woloshin, Schwartz, & Kramer, 2009), new
findings and subsequent controversy about medical treat-
ment for depressed children and adolescents (Bower,
2006), and contradictory media messages about the safety
of fish consumption (Vardeman & Aldoory, 2008). In light
of these and other findings and the fact that people access
a wide range of information sources within the context of
everyday health information seeking, this investigation was
guided by the question: How do people respond to, make
sense of, and use (or not use) uncertain and/or evolving
health information mediated by formal and informal infor-
mation sources? (Genuis, 2011).
Although scholars within Library and Information
Science (LIS) “point toward feelings of uncertainty, ambi-
guity, or uneasiness as the root cause of information
needs” (Case, 2007, p. 81), information behavior (IB) in
situations where information is explicitly emergent and
provisional has received little attention. Dervin (1999) sug-
gests that humans struggle with incomplete understanding
of reality. Through a process of sense making, people engage
in various IBs to bridge gaps in their understanding and
achieve an end product that comprises knowledge, opinion,
intuition, evaluation, and affective response (Dervin 1992).
However, questions remain as to the strategies used to con-
struct sense when information itself is uncertain. Because of
this research gap within LIS, and because health care is an
area in which evidence-based decision making is a key
concern, study of health IB within the context of uncertainty
is timely.
Focusing on IB in a situation where medical evidence is
explicitly evolving—health management during the meno-
pause transition—facilitated exploration of how women
interact with, integrate, and construct sense from uncertain
health information. To gain insight into specific strategies
used to make sense of health information in this context,
deeper understanding of women’s experiences with and
motivations for seeking menopause information is critical.
The following research questions are therefore addressed in
this article:
1. What are the experiences and motivations of women as
they respond to, make sense of, and use uncertain and/or
evolving information about hormone therapy (HT) and
menopause?
2. What strategies do women use to construct and make
sense of uncertain and/or evolving health information
mediated by formal and informal information sources?
All aspects of the study received ethics approval from the
Health Research Ethics Board (REB) and the Education,
Extension, Augustana REB at the University of Alberta.
Covenant Health Administrative Approval was also received
for menopause clinic recruitment.
Literature Review
A Case Study for Exploring Evolving and Uncertain
Health Information
Precipitated by the unexpected 2002 publication of the
WHI (Rossouw et al., 2002) and its exhaustive coverage in
the consumer and medical press (Genuis, 2006; Naughton
et al., 2005), management of the menopause transition has
undergone dramatic and rapid change in recent years.
Peterson and colleagues (2004) note, “rarely has one study
had the impact that the Women’s Health Initiative trial has
had on the prescribing and use of HT” (p. 2010). Subse-
quent to the WHI, for example, the majority of physicians
radically modified their clinical approach to management
of this life transition, with menopausal prescription of HT
declining significantly (Blumel et al., 2004; Buist et al.,
2004; Hersh, Stefanick, & Stafford, 2004). This was
accompanied by widespread uncertainty about menopause
management among women (Barber, Margolis, Luepker, &
1554 JOURNAL OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE AND TECHNOLOGY—August 2012
DOI: 10.1002/asi
Arnett, 2004; Rigby, Ma, & Stafford, 2007; Sawka et al.,
2004).
While studies have focused on health IB in situations
where there are complex information needs (Ariail, Watts,
& Bowen, 2006; Burrows, Malley, Nettleton, & Watt, 2004;
Cappiello, Cunningham, Tish Knobf, & Erdos, 2007; Neal
& McKenzie, 2011), this study draws attention to a context
in which both consumers and HPs are aware that health
evidence is emergent, incomplete, and provisional (Upshur,
2001). Not only were standards of practice related to meno-
pause management unexpectedly and dramatically rendered
outdated by the WHI, but also uncertainty about translating
these new findings into practice persists (Holloway, 2010;
Wathen, 2006a). Furthermore, although practice guidelines
suggest that HT for menopausal symptom relief is safe for
up to five years (Pines, 2009), reputable sources contest the
safety of these guidelines (Heiss et al., 2008; National
Institutes of Health, 2008). Ongoing confusion about man-
aging this life transition has resulted in the view that HPs
are not meeting women’s needs for information and guid-
ance (Ma, Drieling, & Stafford, 2006) and women are
turning to other information sources, including the media
and the Internet (Archer, 2007). Uncertainty in this context
is, therefore, based not only on information complexity but
also on the view that medical evidence represents “a tran-
sient moment in an indeterminate process of stabilization
and destabilization” (Wood, Ferlie, & Fitzgerald, 1998, p.
1730).
Women and Health Information Behavior
Women’s health is not only a major area of study within
health fields, women’s health IB has been identified as
a developing area of study within LIS (Case, 2007).
Research demonstrates that women are active information
agents who gather, seek, and store health information for
both themselves and others and who interact with an array
of information sources (for example, Macias, Lewis, &
Shankar, 2004; Wathen & Harris, 2006). Women are
increasingly engaged in health IBs “either before, instead
of, or unrelated to a visit to a doctor” (Warner & Procac-
cino, 2004, p. 714). Moreover, valued sources of health
information include not only HPs and health organizations
but also informal sources such as books or magazines, the
Internet, and interpersonal relationships (for example,
Suter et al., 2007; Warner & Procaccino, 2004; Wyatt,
Henwood, Hart, & Smith, 2005). Although figures within
individual studies vary, primary sources of information
about menopause, the WHI, and HT include physicians,
the media, friends and family, and the Internet (Castelo-
Branco et al., 2006; Ekstrom, 2005; MacLennan, Taylor, &
Wilson, 2004; Theroux, 2005).
Although some scholars suggest that people are seeking
health information from informal sources because
physician-provided information is not meeting patients’
information needs (Hoffmann, Lindh-Astrand, Ahlner,
Hammar, & Kjellgren, 2005; Macias et al., 2004), other
factors also contribute to women’s reliance on informally
mediated health information. Online information seeking
has been transforming traditional models of health commu-
nication (Fox, 2005), with women identified as one of the
groups most likely to access online health information
(Fox, 2005; Madden & Fox, 2006). Mass media have also
had a dramatic influence on decision making for women
experiencing the menopause transition (Archer, 2007).
Furthermore, sociocultural influences, such as the focus
on individual responsibility for physical well-being and
health-related decisions (Cangelosi & Markham, 1994),
play an important role in IBs and knowledge construction
(Spink & Cole, 2006). Women now commonly include
aspects of nutrition, fitness, family relationships, and more
within the parameters of health and wellness (Fox, 2005;
Macias et al., 2004; Wathen & Harris, 2006) with the inevi-
table result that health information is drawn from a greater
range of sources.
With the rapid communication of new health information
in public forums, women’s use of informal information
sources, and the emphasis on shared decision making in
health fields (American Medical Association [AMA], n.d.;
Canadian Medical Association [CMA], 2010; Légaré &
Brouillette, 2009; Salkovskis & Rees, 2004), nuanced
understanding of how women interact with and make sense
of uncertain health information derived from both formal
and informal sources is critical.
Research Methods
Qualitative methods, which accept “people’s knowledge,
views, understandings, interpretations, experiences, and
interactions” as meaningful properties of the reality being
researched (Mason, 2002, p. 63), were used to explore how
women experienced and made sense of changing health
information mediated by formal and informal sources.
Semistructured interviews were conducted with a sample of
women involved in IBs related to the menopause transition,
and with a smaller sample of health providers acting as
information providers for this population of women. The
study focused on women’s experiences, IBs, and knowledge
construction. Interviews with HPs focused on themes
emerging from interviews with the primary participants and
HPs’ perceptions of their roles as information providers.
Selection of populations and sampling was theoretically
informed.
Definitions
The following definitions informed this study:
• The menopause transition refers to the stage of life which
incorporates perimenopause, menopause and, for those
women who continue to experience menopause symptoms,
postmenopause. Because investigation focused on women’s
experiences and perceptions, women who self-identified as
seeking information related to this life transition were
included in the study.
JOURNAL OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE AND TECHNOLOGY—August 2012
• Because the term of hormone replacement therapy (HRT)
represents the view that postmenopausal women suffer from
a deficiency disease that requires remediation (Worcester &
Whatley, 1992), this article uses the neutral term, hormone
therapy (HT). This term has come into widespread use
since the 2002 publication of the WHI results and is applied
to a range of menopausal treatment regimens using exog-
enous hormones.
• In this article, formal information sources include HPs,
medical or professional associations, and established medical
institutions or consumer health associations. Informal sources
include personal contacts, the media, lay publications, and
online sources. It should be noted that women also accessed
hybrid sources (Warner & Procaccino, 2004). The Internet,
for example, provided access to both formal (e.g., the Mayo
Clinic Web site) and informal (e.g., interactive discussion
lists) sources.
• Finally, the term participants is used to refer to the
primary study sample (women navigating the menopause
transition). HP participants are identified as HP(s) or HP
participant(s).
Theoretical Framework
Based on a social constructionist approach and notions of
meaning making that incorporate an active, process-oriented
view of IB (Dervin, 1992), this study identified “general
sense-making practices on the basis of which people
orientate themselves in their everyday and working lives”
(Talja, Keso, & Pietilainen, 1999, p. 761). Interviews with
participants were viewed as “reality-constructing, meaning-
making occasions” where meaning was “actively and com-
municatively assembled in the interview encounter”
(Holstein & Gubrium, 1995, p. 4). Additional theory was
incorporated during analysis to facilitate exploration and
contextualize emerging themes. Although not the focus of
this article, social positioning theory (Davies & Harré, 1990)
facilitated exploration of the dynamic aspects of information
encounters (Genuis, in press).
Context
The study was conducted in Canada, where there is pub-
licly funded health care. Although this might suggest greater
participant access to formal health information, comparisons
between Canadians and insured Americans indicate that
these populations are equally likely to report unmet health
needs (Blendon et al., 2004), with cost being a barrier in the
United States and wait times for care being a primary barrier
in Canada (Canadian Institute for Health Information,
2006).
Sampling
Sample 1: Women. Twenty-eight women who had been
or were engaged in information gathering and/or deci-
sion making related to menopause management were
interviewed. The goal of sampling was to gather rich
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DOI: 10.1002/asi
TABLE 1. Age of women participants (n = 28). TABLE 3. Health professional participants (n = 12): Summary of
demographics.
Age range Number of women
Gender Discipline Employment
40–44 years 2
45–49 years 6 10 – female 4 – Family physicians 5 – Community
50–54 years 7 2 – male 2 – Dieticians 5 – Menopause clinic
55–59 years 6 2 – Nurses 1 – Academic/community
60–64 years 4 2 – Pharmacists 1 – Retired
65–69 years 2 1 – Alternative health practitioner
70–74 years 1 1 – Specialist physician

TABLE 2. Self-reported menopause status.
Self-reported menopause
status Number of women
Post-menopause 17
Perimenopause 8
Premenopause 1a
Unsure 2b
a
During preinterview e-mails this participant identified as entering
menopause and described seeking menopause information; her interview
narrative suggested that she was likely premenopause.
b
Two participants stated that they were “unsure” of menopause status
because of HT’s impact on menses.
qualitative data from women with varying approaches to
menopause management. Sampling was purposive: re-
cruitment occurred in the community (n = 18) and at a
hospital-based, publicly funded menopause clinic (n = 10).
Participants also volunteered and/or were invited to give
the investigator’s name to other interested parties. Partici-
pants lived in one Canadian province. Final sample size
was guided by theoretical saturation and sufficiency:
participants reflected a reasonable range of approaches
that might be found within the targeted population “so
that others outside the sample might have a chance
to connect to the experiences of those in it” (Seidel, 1998,
pp. 47–48).
Interviewed women ranged from 43 to 72 years of age,
with the majority (n = 19) being between 45 and 60 (see
Table 1). Menopause status was based on self-report
(see Table 2). Three participants had immigrated to North
America from other continents, and, based on census data,
participants were better educated than average (E-Stat,
2006).
Sample 2: Health professionals. To strengthen findings
derived from theoretically informed population selection
and sampling, data from primary interviews (women
experiencing the menopause transition) were triangulated
with data gathered from interviews with a smaller sample
(n = 12) of HPs (Creswell, 1998). These latter interviews
illuminated and confirmed themes arising from interviews
with women. HPs were recruited from two hospital-based
menopause clinics, through personal contacts and by
referral. Interviewed HPs included members of the North
American Menopause Society, who were certified meno-
pause practitioners (North American Menopause Society,
2011), practitioners focused on providing care for this
population of women, and HPs with diverse practices
that included women in this life transition. The sample
was purposive: both community and clinic practitioners,
as well as a range of disciplines, were represented (see
Table 3).
Interview Approaches
All participants took part in one, audio-recorded inter-
view that took place in a mutually agreeable location that
was amenable to recording (participants’ homes, places of
work, or public spaces). General strategies such as neutral
agreement, asking for additional information, summarizing,
and paraphrasing were used to encourage dialogue and
clarification (Schensul, Schensul, & LeCompte, 1999).
Interviews are viewed as sites for social construction and
meaning making (Holstein & Gubrium, 1995). Within 24
hours of each interview, field notes were recorded. (Author
may be contacted for interview guides.)
Interviews with women. Interviews with women lasted 40
to 80 minutes (mean, approximately 60 minutes). Two
interview strategies were used to yield rich descriptive
data. A semistructured, narrative approach was primarily
used, giving participants “scope to articulate their experi-
ences in their own terms” (Petersen, 2006, p. 34) and
facilitating constructive processes as participants related
and explained their experiences (Becker, 1997; Petersen,
2006). “In the moment” elicitation (Johnson & Weller,
2002) was then used to elicit women’s emotive responses
to and tacit understanding of contrasting media-mediated
health information. Chosen on the basis of national read-
ership data (Canadian Media Directors’ Council, 2007–
2008) and with attention to readers’ age and gender, three
articles containing contrasting information about Vitamin
D and midlife women (CBC, 2007a, 2007b, 2008) were
sequentially presented to participants. Discussion focused
on how women made sense of the articles and integrated
media-sourced health information with other sources of
health information.

1556 JOURNAL OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE AND TECHNOLOGY—August 2012
DOI: 10.1002/asi
Interviews with health professionals. Semistructured inter-
views with HPs (approximately 30 minutes in length) were
initiated after 17 of the interviews with women were com-
pleted. HP interviews focused on themes arising from
women’s interviews, on HPs’ views of women’s health IB,
and on HPs’ roles as information providers.
Data Analysis
Interviews were transcribed verbatim and NVivo 8
software facilitated data organization and identification
of emerging themes and coding. Analysis incor-
porated directed content analysis guided by theory (Hsieh
& Shannon, 2005) and grounded theory’s constant-
comparative method, interactive close reading, and exami-
nation of texts for conformity and variation from emerging
themes (Glaser & Strauss, 1967). Descriptive, interpretive
and discursive approaches to data analysis were utilized
and theoretical perspectives from a range of disciplines
were used to illuminate and develop themes emerging from
analysis.
Analytic rigor was enhanced by a robust sample size
(Kvale, 1996; Miles & Huberman, 1994) and triangulation,
which served to “corroborate, elaborate or illuminate
the research in question” (Marshall & Rossman, 2006,
p. 202). Three forms of triangulation were incorporated:
triangulation of interview approaches (narrative and
elicitation) allowed in-depth exploration of women’s expe-
riences and sense making; data source triangulation
(women and HPs) facilitated confirmation and augmenta-
tion of themes; and theory triangulation (Patton, 1990) illu-
minated analysis. Measures were also taken to strengthen
credibility: identification and exploration of negative
instances; debriefing with experts in the field and peers;
and careful documentation at all stages of the research
process.
Study Limitations
Findings are limited by the study context and popula-
tions sampled; however, ongoing uncertainty about meno-
pause management suggests that this context was, for
women and HPs, representative of evolving health informa-
tion. Limitations are associated with sampling. Participa-
tion may have had greater appeal for women experiencing
health challenges and for those self-identifying as informa-
tion seekers. HPs self-identifying as information providers
may have been more likely to participate. Chosen methods
pose limitations: Meaning was constructed from personal
narratives and selected elicitation articles may have specifi-
cally shaped participants’ responses. Finally, as noted
earlier, research was conducted in a setting where health
care is funded, which may limit generalizability in contexts
where individuals are without or have limited health care
coverage.
JOURNAL OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE AND TECHNOLOGY—August 2012
Results and Discussion
Women’s Experiences in Response to Uncertain and
Evolving Health Information
Women participating in this qualitative study engaged in
a range of IBs as they explored concerns about health and
wellness during the menopause transition. Data analyses
demonstrate that, for these participants, information seeking
was strongly associated with the experience of uncertainty.
This was demonstrated by active information seeking, which
incorporated a variety of formal and informal information
sources and which was motivated by a range of factors and
circumstances.
Uncertainty and information behaviors. Uncertainty
about menopause as a life stage and about menopause
management in the absence of definitive research evidence
was integral to women’s IB. In response to uncertainties
related to initial experiences attributed to this life transi-
tion, 13 of the interviewed women immediately engaged
in autonomous information seeking, “I really started
reading up on it a lot” (Sue; pseudonyms used throughout);
10 consulted HPs, “I went straight to my doctor” (Thea);
and three sought information from interpersonal contacts,
“First of all I listened to what my sisters had went
through” (Dana). Twenty-six of the interviewed women
consulted an HP at some point as they sought to make
sense of their menopause experience. All of the women
noted that the Internet was an important source of
health and menopause-related information. “Lived experi-
ence” was also critical to interviewed women. This
was demonstrated not only by interaction with personal
contacts, but also by information gathered via other
mediums. Jill, for example, searched online for factual
information about menopause, but she also noted: “Then I
went and scrolled down into some of the comments of the
people that lived through that. And to me, that’s a big
source right there too. Talk to people that lived through
that.”
Not all of the interviewed women were familiar with
the WHI, but all were aware that the evidence base in this
area of clinical care is evolving and contested. Anita, who
sought specific information about HT risk, exemplified the
frustration experienced as a result of the uncertain evi-
dence base: “Problem is that the doctors never know. Most
of the time they have no idea.” Largely based on the view
that HPs could not offer definitive information about man-
aging this life transition, all of the interviewed women
described information gathering that incorporated multiple
sources. Paula, for example, respected and liked her phy-
sician, but she explained that if he wanted to prescribe a
medication, she would first seek information independently
(via the Internet, library, and interpersonal sources) before
making a decision about recommended treatments. And
Roslyn described consultation with many sources as she
searched for menopause information:
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DOI: 10.1002/asi
 I had magazines, books, the Internet, listened to other people,
what they had gone through, what they’d tried to help them-
selves at that point. And I borrowed a bunch of books from a
friend of mine who had also gone through menopause and had
a really tough time.
These examples demonstrate that participants used mul-
tiple resources, moved fluidly between sources, and did
not explicitly differentiate between formal and informal
information.
Women’s perception of sources as mutually enhancing
was supported by the value participants placed on direct
or indirect referral between sources. The following
examples are representative: Lisa related that she tended
to read books recommended by trusted Web sites, and
Vicky emphasized the importance of health resources rec-
ommended by trusted interpersonal contacts. Furthermore,
11 of the interviewed women noted that HPs pointed
them to supplemental health information. This was particu-
larly valued not only because it augmented HP-patient
information exchange, but also because women perceived
that information referral demonstrated that HPs recognized
the uncertain nature of menopause information and were
open to information from other sources. Nicole was not
alone in expressing increased trust in her physician
because of this HP’s use of supplementary sources: “She
provided actual print information. . . . So, I thought, ‘Okay.
This is somebody I relate to, this is somebody I have
respect for. I think I want to head in this direction, at least
right now.’ ”
All of the interviewed HPs acknowledged the uncer-
tainty associated with menopause management. HP Con-
nie’s comments were representative: “I think one of the
main things we try and get across to women is that
hormone therapy isn’t—it’s not a recipe.” Although only
some of the interviewed HPs shared secondary information
sources with women (e.g., HPs working in menopause
clinics provided prepared consumer health resource lists),
most acknowledged the value of referring women to
supplementary information, particularly to reputable online
resources. HP participants working in the community,
however, felt less prepared for this activity. HPs Wanda
and Clare, for example, cited their own knowledge
deficit when explaining why they avoided referral to Inter-
net sources. This lack of engagement as information
providers may represent a lost opportunity: HP referral
to supplemental information sources is not only contingent
on trust (Brown, Carroll, Boon, & Marmoreo, 2002),
but data from this study suggest that it may play a role
in building trusting relationships between women and
HPs.
It is important to note that although women’s meno-
pause experiences varied from relatively unremarkable
to life disrupting, their IBs were likely influenced by the
fact that menopause is common to all women, is usually
experienced over a period of years, and generally involves
noncrisis health management. Twenty-six of the 28 women
1558 JOURNAL OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE AND TECHNOLOGY—August 2012
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spoke of gathering information for a period of time in
excess of one year. For the two exceptions, one reported
discussing menopause-related issues at one medical
appointment after which other life circumstances assumed
priority. In the second case, the participant actively inves-
tigated formal and informal resources; however, she deter-
mined that she was not yet in this life transition and
therefore suspended information gathering.
Motivation for information seeking. Women’s IBs were
motivated by a range of factors and circumstances. Partici-
pants sought information in preparation for formal encoun-
ters with HPs, and they explored additional sources to
evaluate and/or supplement information they had already
gathered. Women were also motivated to seek information to
establish that they were “normal,” and to understand and
address the physical embodiment of menopause, particularly
the symptom experience. Finally, they gathered information
for potential future use (see Table 4).
TABLE 4. Motivation for information seeking.
In preparation for encounters with health professionals
• ‘It always worked for me, first of all, looking for information. . . .
Books. The Internet. So before I meet with the doctor I already know
or have an idea about the things that are happening.” (Anita)
• “Unless I’m in a great deal of pain, I don’t want to go to a doctor first.
I’d rather do my own reading so I get a little bit educated, or talk to
some other people.” (Faye)
To evaluate, confirm, and/or supplement previously acquired
information
• “I was looking first for a confirmation of what [the doctor] had said.
Expansion of the information because she hadn’t given me or I hadn’t
taken in thoroughly the information. Because I kind of went away and
said, ‘What about this?’ You know, and, ‘Why is this?’ ” (Christy)
• “That was the end of the appointment. And I was sort of standing
there. Okay, so at that point I went to the computer to look up [the
diagnosis] to see what that was.” (Roslyn)
To normalize experience
• “I guess I look up on the Internet to see if, ‘Oh yeah, it seems like
that’s normal for most people my age to go through something like
this.” (Laura)
• “I found I’d be talking to women, you know, peers, friends, relatives
[asking them], ‘Does this seem normal?’ ” (Dale)
To understand physical embodiment of this life transition
• “So I went to the library and looked [menopause] up and got whatever
articles I could from the library and read [them] over. And decided that
I was having menopause symptoms, and what I needed to do was ask
my doctor to do the hormone testing thing so that he could see whether
or not—what my body was producing. And that would tell him that I
was having menopause symptoms.” (Muriel)
• “I feel that I was driven in trying to solve those symptoms, for sure.
[My symptoms] were really taking over my whole enjoyment factor in
life.” (Thea)
To prepare for potential future information need
• “I read everything that I can on everything [related to health]. . . . I
guess I file it. I file it in my mind.” (Dana)
• When I see information in the Journal [newspaper] or the paper, I sort
of scan it and it sits somewhere.” (Naomi)
 Although 13 of the participants specifically stated that
they gathered health information to prepare for formal
encounters with HPs (primarily physicians), narratives indi-
cated that most interviewed women gathered information
prior to seeing an HP. Many participants went to HPs only
after exhausting personal information-finding capabilities or
when access to a specific medical service was desired (e.g.,
hormone level assessment). Interviews with HPs confirmed
this motivation. HPs, however, were likely to position them-
selves as interpreters of the health information women
derived from other sources.
HP Denise commented, “They’ll come in with an
array of information and not know sometimes how to
interpret it or what to do with it.” HP Francis’s comments
exemplified the view that HPs are arbitrators of health
information: “[Women] talk and they argue and they say
‘Well, can you find something else for me? Are you sure
that this is the best way?’. . . . I’d say to myself, ‘Why [is]
the patient coming to see me if she already made up
her mind that she is not going to listen to my advice?’”
Francis’s frustration with women’s questions about pre-
sented treatment options was, perhaps, grounded in notions
of shared decision making, which are found in the medical
literature: Information and treatment options are commu-
nicated to patients by HPs, who then help patients under-
stand the presented options and make treatment choices
(Légaré & Brouillette, 2009). This contrasts with the
perspective expressed by the majority of interviewed
women who positioned themselves as independent and
self-directed information seekers and decision makers
with respect to menopause management (Genuis, in
press).
While all of the interviewed women consulted more
than one source for menopause information, 22 specifically
noted that they looked for health information to evaluate
and supplement previously acquired information. Women’s
familiarity with menopause management uncertainty con-
tributed to their motivation to seek supplemental informa-
tion. Participants not only confirmed and supplemented
HP-provided information in other sources, they also sought
information from HPs to verify and supplement informa-
tion gathered via informal mediums. The Internet and
interpersonal contacts were primary sources for confirming
or supplementing information from HPs.
Plunged into physical experiences that were commonly
unexpected, women were motivated to seek and gather
information that confirmed that their experiences were
“normal.” This provided women with significant comfort,
even before they took steps to alleviate distressful symp-
toms. Scholars suggest that empowerment in health matters
is symbolic of a healthier life (Ginman et al., 2003). In the
case of these participants, confirmation that their physical
manifestations of this life transition fell within the range of
“normal” not only served to affirm the reality of their
experiences, but it was also empowering as it represented a
first step toward problem resolution. While 10 women
reported IB motivated by a need to normalize their
JOURNAL OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE AND TECHNOLOGY—August 2012
menopause experiences, five identified situations where
they did not seek information because they believed that
their experiences were not “normal”: “I don’t think that I
recall having those conversations with other women about
it. In part, because there probably weren’t too many in that
general network who would have been in the same situa-
tion as me” (Christy).
Although menopause is uneventful for many women,
interviews demonstrated that the desire to understand and
address the physical embodiment of this life transition
powerfully motivated participants’ IB. Twenty-six of the
interviewed women prominently situated the discussion
of symptoms within their menopause “stories,” with 20
discussing symptoms within the first few sentences of
their narratives. Muriel’s and Thea’s statements (see
Table 4) illustrate the association between symptoms and
information need. Interviews with HPs confirmed this
association. HP Amy observed, “For the most part
[women seen at the clinic have] been struggling with their
symptoms for a while, so they’ve often looked for
information.”
Finally, similar to the “just in case” strategy that
women used for managing and physically storing health
information within their households (Moen & Brennan,
2005), women were motivated to collect and mentally
“file” health information to prepare for potential future
need. This theme emerged from interviews with nine
women and was supported by HP interviews. HP Sonya
related:
That’s the other thing that’s amazing with health information
and women, they’ll read something and I think they rip it out
and put it somewhere. Or a phone number or something. And
then months later they’ll say, “Oh, I read that article.” And
they’ll follow up with it. . .. Or, even if we do an interview in the
[newspaper], you’ll get calls even a year later saying, “I saw that
in the paper.”
Although information gathering has been noted as a
means of improving self-efficacy prior to encounters
with HPs (Wathen, 2006b), the nuanced purposes that
emerged from the current data empowered participants
as primary stakeholders in their health and wellness.
Macias and colleagues (2004) observed that access to
online health information gave women greater control over
their health and contributed to a changing balance in
women’s relationships with HPs. Although this may
threaten traditional authority structures within health care,
increasing focus on patient-centered care and shared
decision making (AMA, n.d.; CMA, 2010) suggests that
patient information gathering should be viewed as a posi-
tive contribution to patient-HP relationships. Furthermore,
participants’ strong motivation to gather information and
their appreciation for HPs who point them to secondary
information sources suggest an opportunity for HPs. By
making high-quality, personally relevant information avail-
able to women, HPs will facilitate individual responsibility
1559
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for health and well-being and will foster positive
HP-patient relationships.
Constructing “Sense” From Formal and Informal
Health Information
Although women consulted many sources as they
responded to uncertainties associated with menopause and
menopause management, they did not view sources in iso-
lation from one another. Rather, they constructed knowledge
by integrating health information gathered from the wide
range of sources that they encountered and sought. Monica’s
approach was typical: “I’d go to various places. I’d go to the
Internet, I suppose. I would ask around. Talk to my doctor.
And then, you know, pull [the information] together. I
wouldn’t go to just one source.” This draws attention to the
second research question: What strategies do women use to
construct and make sense of uncertain and/or evolving
health information mediated by formal and informal infor-
mation sources?
Findings suggest that upheavals in conventional medical
knowledge increased women’s feelings of responsibility
not only for information seeking and decision making, but
also for making sense of uncertain and potentially conflict-
ing menopause information. While the notion of sense
making is frequently a “given” within IB research, results
provide textured understanding of how participants con-
structed sense from informally mediated and formally
mediated health information. Analysis revealed that women
assumed analytic and/or experiential “postures,” sought
social contexts for learning and knowledge construction,
used information consistency as a heuristic for trustworthi-
ness, and viewed information sources as complementary.
Analytic and experiential “postures.” Interviewed women
made sense of uncertain health information by adopting
analytic and/or experiential approaches to menopause
information. This finding builds on the notion of two inter-
acting modes of information processing (Epstein, 1994).
The psychological notion of mental processing, however,
does not incorporate comprehensive understanding of
IB as illuminated in LIS (Case, 2007; Fisher & Julien,
2009; Wilson, 2000). Within the context of this explora-
tion, therefore, the term posture (“a stance, an attitude”;
“OED Online,” 2010) is used as it more accurately
describes participants’ conscious and unconscious ap-
proaches and dispositions as they made sense of health
information.
Analytic posture was demonstrated by the following:
women focused on finding logical connections as they
explored and gathered health information, they described
actions which were based on conscious considerations and
linking of information from different sources, and they
used different forms of evidence to justify information use
(or nonuse). These characteristics, described in part by
Slovic et al. (2004) were exemplified by Camille and
Sylvia who made connections between different kinds of
1560 JOURNAL OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE AND TECHNOLOGY—August 2012
DOI: 10.1002/asi
TABLE 5. ‘Postures’: Approach and disposition when constructing sense.
Analytic posture: Illustrations
Camille: What I would do is build up a sleep debt after about
three nights and then I’d take a sleeping pill. Because I didn’t want to
be doing that every night, right? So that’s what I would do, if I went
on without a good sleep for two, three nights, a third night I’d take a
pill.
Interviewer: Did someone tell you to do that or did you . . .
Camille: No. That’s just what I thought. I mean, because I realize that if
I take a pill every night then I’m [going to] need one to get to sleep.
So I would just kind of accrue this debt and then, poof.
Interviewer: Then how did you decide to do that?
Camille: I don’t know. I just did. I just thought about it and
thought, Well, that’s the part that makes the most sense. And my
doctor said be careful to not – or he said, “Try not to take this more
than two or three times a week.” I mean, I had a friend who was
taking two a night. Every night. So, and I don’t like to take a lot of
medication.
“On the Internet, I looked up gallbladders and hormone replacement
therapy and what I did find is that hormone replacement therapy
concentrates the bile. And I was not eating a lot of fat. So I thought,
I’m going to start eating a tablespoon of peanut butter every
morning and see what happens. Sure enough. I haven’t had any of
those symptoms again. Soon as I forget, it comes back.” (Sylvia)
Experiential posture: Illustrations
“Menopause’s going to be what I experience, not from what I read
from a book. . . . I’m not even going to give my mind a chance to
even excuse certain behavior [because of] what I read.” (Jill)
“I think that’s probably one of the reasons I just turned off on the
HRT stuff. There was just So. Much. Stuff. And, I was, as I said,
satisfied with where I was going, with where my body was going.”
(Nicole)
“It’s hard to explain [how I make sense of menopause information].
My gut feeling; I listen to that. My instinct; I listen to that.” (Lisa)
information and then inductively extrapolated to manage
their menopause symptoms (see Table 5).
Women from this sample also adopted experiential pos-
tures, which incorporated intuition and affect. This posture
is oriented toward “more rapid processing” (Slovic et al.,
2004, p. 313) and was demonstrated by women who drew
attention to information that made sense according to their
physical experiences and/or intrapersonal health knowl-
edge (see Table 5). Ten of the interviewed women, for
example, used words and phrases, such as “intuition,” “my
gut,” “instinct,” and “inner spirit,” which, upon closer
questioning, identified an intrapersonal and experientially
based knowledge source. For this sample of women, an
experiential posture frequently served as a filter for infor-
mation from other sources, thus influencing knowledge
construction and decision making.
Assumed postures were neither static nor mutually
exclusive; both approaches facilitated sense making. This
was exemplified by Christy, who assumed analytic and
experiential postures during the course of her interview,
with each posture facilitating information integration.
When seeking to verify information heard from a friend,
for example, Christy adopted an analytic stance. She con-
ducted an online search and found both “old wives’ tales”
and citations to the medical literature. In light of her
own knowledge, Christy then assessed the gathered infor-
mation and established a rational basis for adopting the
information mediated by her interpersonal contact. When
this participant encountered information about the WHI,
however, she became concerned about what she was physi-
cally “feeling.” In this instance, Christy assumed an expe-
riential posture and, without further information seeking or
medical investigation, concluded that HT was causing
undesired physical consequences.
Examination of analytic and experiential postures con-
tributes to understanding of health IB and sense making.
It also has relevance for patient education. Consumer
health resources have been “designed, almost exclusively,
to evoke analytic processing” (Hibbard & Peters, 2003,
p. 428). This study, however, illuminates the sense making
functions of both analytic and experiential postures, thus
highlighting the importance of health information and
communication that provokes both cognitive and experien-
tial response (Dunlop, Wakefield, & Kashima, 2010).
Social contexts. A second and prominent theme that
emerged from the interviews was that social contexts play
an important role for women as they construct sense from
information about this life transition. At the same time as
acknowledging a need for biomedical knowledge, inter-
viewed women viewed research-based evidence as only
one part of decision making (this is also recognized in the
literature; for example, McCormack et al., 2002; Rycroft-
Malone et al., 2002). Perhaps because of the universal
nature of this life transition for women and existing uncer-
tainty about the evidence base for menopause manage-
ment, interactive contexts were viewed as empowering
opportunities which facilitated sense making, integration of
formal and informal information, and effective manage-
ment of personal health. For these participants, useable
knowledge was, at least in part, “a communicative con-
struct which [was] produced in a social context” (Tuom-
inen & Savolainen, 1997, p. 89).
Interviewed women found interactive contexts in a variety
of ways with the most apparent (noted by all interviewed
women except one) being that created by interpersonal infor-
mation sharing. Naomi’s comments were representative:
We do talk about [menopause] at work, and we do have those
conversations, and people have come up with different solu-
tions and other people have tried them. Or they recommend
one product over another product and I think that that is very,
very helpful for everybody. . . . Sometimes you have to talk
quite a bit about it before you can wrap your head around
certain things.
Social contexts were also experienced within online
environments and, notably, via the media. Anita, for
JOURNAL OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE AND TECHNOLOGY—August 2012
example, was one of seven participants who explicitly
valued the learning that occurred between television show
host Oprah and her audience. This participant highlighted
what she learned about menopause from this celebrity:
“You’re not alone. You’re not crazy. You can get help if
you want. You have different options.” HP Sonya also
noted the influence of mediated social contexts: “I think
this whole sort of interest in bioidenticals is Oprah. One
woman talking to another woman. Even though it’s an
audience of 30 million or whatever.” Participants’ reflec-
tions suggest that interaction within social contexts consti-
tuted more than information transfer; the process of
interaction itself “construct[ed] and produce[d]” knowl-
edge (Tuominen & Savolainen, 1997, p. 92).
An unexpected finding was that 19 of the interviewed
women expressed explicit appreciation for learning and
constructing knowledge in social contexts. Eleven of these
women specifically identified a preference for the learning
that occurs in formally or informally organized groups.
(Only one interviewed woman belonged to such a group.)
When Paula, for example, was asked to envision an ideal
way for women in this life transition to learn about health,
she responded:
Women’s health center . . . a place that women could share.
Like, maybe there are menopause support groups. I don’t know,
‘cause I never went to one, but by women sharing with each
other and having that common thread . . . knowing that you’re
not alone. Whether it’s menopause, cholesterol, or whatever it
may be. I seriously believe that it’s important for women to
share that information.
Information consistency. Information consistency was
used as a heuristic that represented information accuracy
and credibility. In other words, participants not only
were motivated to seek information that allowed them to
evaluate and supplement previously acquired information
but also constructed knowledge by comparing and compil-
ing information across sources. Just as parallel evidence
found in similar, but not identical, studies improves the
“strength” of evidence (Howick, Glasziou, & Aronson,
2009), women viewed parallel information as enhancing
the “strength” of a given conclusion or course of action.
While data analysis suggests that this heuristic was intrin-
sic to most participants’ sense making, Muriel was repre-
sentative of the 10 women who explicitly drew on this
heuristic. She explained that she evaluated and made sense
of health information based on “cumulative information.”
This heuristic was highlighted by those noting multiple
occurrences of similar information within a single type of
source and by those who looked for similar information
across sources (see Table 6). Use was particularly promi-
nent among women seeking online health information. It
was, however, also used by participants making sense of
information from interpersonal sources and those integrat-
ing information from formal and informal sources. At the
same time as information consistency suggested informa-
tion sufficiency and was therefore viewed as a reasonable
1561
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TABLE 6. Information consistency as a heuristic for accuracy and
credibility.
Multiple instances of similar information within a source
“I will look at a variety of sites. So I will look at – you know university
based sites, or Mayo clinic sites, things such as that. And look at them
with a great deal of care and try and see if all of them are in
agreement. Because sometimes they aren’t. Sometimes their
information is somewhat different. Or sometimes it’s the same
information but there’s a slight twist in the interpretation.” (Nicole)
“There’s two verifications right there [confirmation from two people that
an over-the-counter product provided symptom relief] and I’m the
third because I did it and it worked. That’s pretty good. Pretty – then I
can trust that.” (Lisa)
Similar information across sources
“I go to the library, I look at self-help books. I go to [name removed]
Bookstore, I get lay people books as well as Mayo Clinic or
professional journal articles. And I talk to friends. And then I figure
out where things are overlapping and what makes sense. . . . [I] read
really broadly until I figure out, until I started to see overlaps of
information. And then I can start saying, ‘Okay, here’s the reliable
stuff and here’s just the stuff that everybody’s saying.’ ” (Faye)
“I try and definitely cover more than one source so I can compare
information as well. One might contradict another; [then I] try and find
another to see what they say.” (Dale)
basis for decision making, information inconsistency
proved to be an impetus for ongoing information seeking.
Interviewed HPs confirmed that consistency facilitated
information use and decision making. HP Amy observed:
What we have found on many occasions is that it’s helpful for
the patient to hear a message from more than one [HP], and that
it takes hearing it from more than one person before [women]
kind of, you know, decide, “Oh, okay, here’s what’s happening
and it probably would be beneficial.”
Furthermore, this theme is supported in the literature.
Brashers (2001) notes that although information reduces
uncertainty, “correct” information is not required, only
perceptions of coherence. In addition, Lankes (2008), in an
exploration of online information seekers’ understanding of
credibility, highlights a shift from traditional “authority”-
based credibility to a “reliability” approach where
cohesion and consistency is sought among sources. For
interviewed women, source consistency was a prominent
heuristic that facilitated the construction of uncertain
health information as credible, and thus as a basis for
information use.
Source complementarity. Health information sources are
frequently conceptualized as being in competition for
the limited time or allegiance of the information seeker/
patient. Interviewed women, however, tended to seek and
monitor menopause information across media. This sug-
gests that a predominant feature of participants’ IB was
complementarity, not competition or displacement. This
construct, first elucidated as media complementarity theory
1562 JOURNAL OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE AND TECHNOLOGY—August 2012
DOI: 10.1002/asi
(Dutta-Bergman, 2004), suggests that enduring interest in
a specific subject area motivates IBs across media, with
diverse sources fulfilling individuals’ information needs in
complementary ways. Data from the current study suggest
that complementarity theory offers nuanced and unique
insight into the sense making of participants.
Complementarity was demonstrated in a number of
ways: interviewed women moved fluidly between a range of
sources; they valued sources which directly or indirectly
pointed to other information sources; participants described
seamless integration of online and offline information
seeking; and they viewed media-mediated health informa-
tion as a valuable awareness tool and “springboard” for
information seeking via other mediums. Given the novel
application of this theory, a specific illustration of comple-
mentarity as demonstrated in this study follows.
Most interviewed HPs expressed concerns about the
competing influence of media-sourced health information,
with three quarters specifically noting the influence
of Oprah. Women’s reactions to Oprah’s discussions of
menopause management (Kosova, 2009), however, provide
a compelling illustration of complementarity. While HP
Gail positioned the North American Menopause Society
and Oprah as conflicting information sources, Sue and
Camille explicitly valued information from both Oprah and
a menopause clinic guided by North American Menopause
Society standards. Camille, furthermore, highlighted a rela-
tionship between Oprah’s television show and interper-
sonal information gathering among women: “It kind of
opened up the dialogue and stuff. Because we’d say, ‘Oh,
did you see that Oprah?’” HP Amy provided support for
complementarity between the Oprah show and other infor-
mation sources: “I guess the good thing is that it does get
the conversations started, you know. Like certainly more
women are coming forward and looking for help.”
Complementarity was further illuminated by a HP working
in a menopause clinic:
I can’t believe the influx of calls we’ve had from that Oprah
show. I really can’t. We’ve over 200 women waiting to see us
now . . . whereas before our wait list, before the Oprah show,
. . . we were down to about, you know, maybe 40 or 50 at our
peak times of people waiting. Now we have over 200 women
waiting to be seen.
While interviewed HPs were unenthusiastic about Oprah
as a purveyor of health information, these observations
clearly illustrated complementarity: Many women who
gathered health information from Oprah were also motivated
to seek information about menopause from formal sources.
Findings from this study are both supported by and
extend previous considerations of complementarity. First
established as a feature of news consumption across tradi-
tional and new media (Dutta-Bergman, 2004), complemen-
tarity has been established between modes of interpersonal
crisis communication (Dutta-Bergman, 2006), and between
mass media and visits to HPs (Tian & Robinson, 2008).
Whereas published literature on this topic appears to be
limited to secondary analysis of quantitative data (Dutta-
Bergman, 2004; Nguyen & Western, 2006; Tian & Robin-
son, 2008), results from this study provide insight into the
way women experience complementarity and illuminate its
constructive role as women make sense of uncertain health
information.
Implications
The current emphasis on patient-centered care and
shared decision making (AMA, n.d.; CMA, 2010) has
brought focus to the critical role of patient education and
health information literacy. While research and practice
have primarily focused on facilitating consumer/patient use
of empirically derived authoritative resources, this study
draws attention to women’s perspectives and demonstrates
that it was the interaction between and integration of both
formal and informal health information which met partici-
pants’ information needs and enabled sense making. This is
a challenging proposition as health and information profes-
sionals tend to be leery of informal health information, par-
ticularly experiential knowledge, knowledge constructed in
social contexts, and media-provided or Internet-mediated
information.
Findings suggest that this dilemma can be addressed.
Deeper understanding of what motivates information
seeking and the strategies women employ when making
sense of uncertain health information will allow researchers
and professionals to develop effective patient education
practices that incorporate the range of sources that women
actually use when making decisions about health manage-
ment. Instead of ignoring or vilifying nontraditional sources,
discussion of health information derived from all sources
should be encouraged to better understand consumers’ con-
texts and needs, illuminate the ways in which different
sources address the diverse needs of individuals, and facili-
tate sense making.
This study also illustrates the ways in which theory can
illuminate understanding of complex, real-world situations.
Although the notion of sense making is well established
within LIS, analysis of interview data provided nuanced
insight into the different strategies participants used as they
constructed knowledge. Use of theoretical perspectives
drawn from other disciplines validated and extended
research findings by rooting themes in previous research and
demonstrating “theoretical elaboration in new contexts”
(Vardeman & Aldorry, 2008, p. 286).
Future Research Directions
Health information is not only inherently provisional
and emergent, but there is always a measure of uncertainty
as population-based findings are applied within individual
contexts. This study, an exploration of how one population
experienced and made sense of uncertain health informa-
tion, represents a first step in the investigation of health
JOURNAL OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE AND TECHNOLOGY—August 2012
information as a provisional construct and sense making in
the context of evolving health information. Future research
should engage with the notion of health information as
emergent and provisional and explore how other popula-
tions respond to and construct knowledge from uncertain
health information. Exploration of how HPs themselves
experience, make sense of, and then communicate provi-
sional and evolving health information will also make an
important contribution to the study of IB and patient-HP
communication.
Furthermore, despite the acceptance of sense making as
an intrinsic component of IB, greater understanding of the
specific strategies people use as they bridge information
gaps will contribute to a nuanced understanding of sense
making. Four sense-making strategies emerged from this
qualitative study. These constructs hold promise for illumi-
nating further the multifaceted information worlds that
women inhabit. Investigation of these constructs in other
populations will add both theoretically and practically to
understanding of health-related IB. Exploration of how
patient education and health information literacy instruction
can be informed by participants’ sense-making strategies is
also warranted.
Conclusion
With the rapid communication of health knowledge via
the Internet and media, consumers are being informed on a
regular basis of new and changing medical evidence and
reliance on both formal and informal information sources
has become an everyday reality. Information needs are
deeply contextual and to understand health IB, researchers
and professionals need to understand how people engage
with evolving health information, the specific needs which
motivate information seeking, and the strategies people use
to make sense of the vast amount of formal and informal
health information incidentally encountered and deliberated
sought.
This study focused on women’s experiences and sense
making when navigating evolving and uncertain menopause
information. Interviews with HPs were used to triangulate
and confirm emerging themes. Findings demonstrated that
women were motivated to seek information to (a) prepare
for formal encounters with HPs; (b) evaluate, confirm,
and/or supplement information they had already gathered;
(c) establish that their experiences with this life transition
were “normal”; (d) understand and address the physical
embodiment of menopause, particularly the symptom expe-
rience; and (e) prepare for potential future information
needs. Because women did not perceive that HPs could
offer definitive information about managing this life transi-
tion, interviewed women felt responsible for not only
seeking but also making sense of encountered and gathered
information.
Analysis of interview data revealed four primary
strategies that women utilized to construct sense from uncer-
tain and evolving health information: (a) women assumed
1563
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analytic and experiential “postures” as they assessed and
integrated information from different sources; (b) they
explicitly valued social contexts for learning and knowledge
construction; (c) information consistency was used as a heu-
ristic which represented information accuracy and served
as a basis for information use; and (d) whereas HPs tended
to view formal and informal information as competing
influences, findings provide support for complementarity
theory—women viewed formal and informal information
sources as mutually enhancing. Although each of these
strategies add “texture” to the notion of sense making,
they all demonstrate that, in the context of evolving and
uncertain health information, it was the synergistic inter-
action between both formal and information sources which
met women’s information needs and enabled knowledge
construction.
Acknowledgments
Sincere gratitude to Dr. Heidi Julien and Dr. Brenda
Cameron for their valuable guidance and encouragement, to
the women and health professionals who so generously
shared their thoughts and experiences, and to funders,
including the Social Sciences and Humanities Research
Council of Canada and the Medical Library Association.
Thanks are also due to the anonymous reviewers who pro-
vided helpful suggestions for improving this article.
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