Social mediators and inclusive information: communication flow of healthcare information among adolescents in vulnerable communities

Introduction

The Library and Information Science studies based on the role of social mediators within the complex phenomenon of information behaviour -both in urban and rural communities- are scarce and do not follow a constant line of research.

This presentation is centred on a specific investigation carried out from an interpretive perspective, addressing a research project in the context of that line. Such investigation, which started in 2008, intends to achieve permanence and consolidation. As a feature of the approach, it is worth noting the concern for those public information policies focused on the most disadvantaged and vulnerable citizens: the so called "Ni Ni" (young people and teenagers who neither study nor work). It aims to contribute to the creation of local information services.

The aim of the research is to help and promote the appropriation of valuable knowledge by young people and adolescents who are not ‘socialized’.

The topic to investigate considers a broad scope and concentrates on the research subjects: citizens in vulnerable situations as users of healthcare information and the different mediators participating in the communication and information flow, particularly healthcare staff.

As it has already been analyzed and discussed in publications of the Project, this is an issue which arouses great interest given the recent implementation of the Integrated National Health System in the country, together with the development of health services in primary care, especially centred on these social sectors. (Sabelli et al., 2013, 2014).

We were able to identify the following specific problems that served as a guide  to our research: a) the unequal access to information by those young people and adolescents who neither study nor work -and who live in vulnerable communities- thus lacking the necessary access to valuable, friendly and reliable data; b) the fact that the existing information resources regarding healthcare present in the country are scarce and inadequate for the target population, whilst generally unknown to them; c) the ignorance of the role of the healthcare personnel as potential mediators of information between information resources and the Ni Ni who use the services of primary health within the Integrated National Health System (health centers and polyclinics located in different neighborhoods).

This is currently a global cause of concern which still needs to be addressed in many countries. Thus, we do not only refer to Latin America, Africa and other regions with unfavourable contexts, but also to Europe–where recently the problems of people in vulnerable social conditions have become common, such as the ones regarding to those immigrants from regions with critical political conflicts. Undoubtedly, to make access, use and appropriation of information possible for these populations is a humanitarian commitment to our professions and academic communities.

Information policies towards the community present unequal development and practices around the world, with shortcomings and irregular approaches in most Latin American countries. The concepts and debates of the 1990’s promoted, others, by Ian Rowlands (1996, 1997) , Mairéad Browne (1997a, 1997b) and Nick Moore (1993, 1997, 1998), are significant due to the interpretation and understanding of the role of social mediators, thus promoting the transfer of information from its sources to our ‘Ni Ni’ adolescents in order to incorporate information into the design and implementation of public information policies.

The present research has been carried out since 2008 through research projects that have disseminated their findings in books (Sabelli and Rodriguez Lopater, 2012; Sabelli and Rasner, 2015) and chapters of books (Sabelli et al., 2013; Sabelli et al., 2014) specifically highlighting the role of information mediators within social institutions (Sabelli, 2012a; Sabelli, 2012b; Sabelli, 2015a and Sabelli, 2015b).

The purpose of this communication is to analyze and discuss part of the study carried out during the years 2014-2015 by the Research Group on Information and Communication for Social Inclusion and Integration (GIISUR, according to its acronym in Spanish). More information at www.prodic.edu.uy.

The above mentioned research took place in a small city in the North of the country (Paysandú), in order to make a comparative analysis with the project implemented in the capital city of Montevideo (2010- 2012). It aims to collect data with the support of teachers and students.). The GIISUR’s interdisciplinary team moved to the campus of the University of the Republic at the University Centre of Paysandú, during several periods.   

The comparison between the results of the two projects is based on the similarities and differences of these results, as well as in the diverse points of view of the interdisciplinary research team.

We will therefore expose the part of the study which focuses on the roles of mediators of healthcare services as social mediators of information within the flow of information and communication between health information and adolescents from disadvantaged neighborhoods in a small city (76,429 inhabitants). Finally, as it was mentioned above, we will compare the results with those obtained between a 2010-2012 project implemented in a deprived area of Montevideo (1,300,000 inhabitants), the capital city which accounts for almost half of the population of the country.

In sum, the health personnel of the Health Centre and clinics in the selected area are considered as both real and potential social mediators of health information.

Both projects aimed to study the subjects – mediators of healthcare services (family practitioners and doctors at community clinics, psychologists, physiotherapists, social workers and administrative assistants) – as social mediators of information by using the following research questions:

How they perceived themselves as mediators of information regarding Ni Ni adolescents and their spaces in the territory?; what are the barriers and motivations for communication that they identify?; which people they perceive as potential disseminators of information in their workplaces?; what are the main health problems of the adolescents and the types of data connected to them?; what are the desirable characteristics of resources and information channels to be designed?; how they perceive the access and use of computers and the Internet and the potential of these tools in the process of health information appropriation?

As a result of the first investigation (Montevideo Project) emerged the following question: What role can teenagers have as a potential mediators of information between peers?

Antecedents of the research problem

The three axes that guided our line of research - centered on the information behaviour of young people living in poor neighborhoods and into poverty of information –are: a) the information policies aimed at the community; b) the role of social mediators as ‘transmission belts’ between adolescents and inclusive information resources, and c) everyday life information seeking (ELIS) and the ‘small worlds’ of young people. The main references to the theoretical background that support this study are presented in the next section of the paper.

Information policies towards the community

Our approach to information policies adhere to the always valid concepts and debates of the 1990’s promoted, among others, by Ian Rowlands (1996), Mairéad Browne (1997a, 1997b) and Nick Moore (1993, 1997, 1998), before ICTs became central to theories regarding information policies, i.e. policies for the information society. The aforementioned theoreticians reflected upon a holistic view of the study of the information policy and its concepts, in order to discover critical paradigms that would bring both maturity and consolidation to this discipline.

We would like to point out the approaches and models on which the analyses are based on: the reviews on reductionist approaches as well as the introduction by Rowlands of the paradigm-critical and value-critical approaches (Rowlands, 1996, pp.40-44; 1997, pp.21-23); the information transfer models (‘information life-cycle’) by Browne, which ‘shows a cycle which begins with the generation of ideas and their composition into different forms, along with the standard processes around collection and storage, organization, retrieval and so on ‘(Browne, 1997a, p.271) and ‘the newer approaches to understanding phenomena are critical for information policy, given their capacity to show events through the eyes of the actors in situations within a public world of norms, conventions and rules’ (Browne, 1997b, p.342)

Along the same line, Moore’s ideas regarding the roles of the major stakeholders apart from the information professionals (Moore, 1993) and his views whereas ‘the neo-liberal approach does not seem to have served us well’, concluding: ‘the holistic approach that is characterized by the Dirigist model seems more appropriate’ (Moore 1997, 1998). 

Therefore, these theoretical orientations accompanied by the rich Anglo-Saxon traditions -especially from the UK- with regards to information policies for citizens as well as a vast literature which includes M.Kendall and S. Wilkinson (1998), R. Marcella and G. Baxter (1999a, 1999b; 2000a, 2000b, 2000c, 2000d); D. Muddiman et al. (2001); M. Dutch, and D. Muddiman (2001) and the development of plans and programs of public libraries and information services, sustain the need to integrate the social mediator to the community in the information and communication flow.

The role of social mediators as ‘transmission belts’ between adolescents and inclusive information resources

The Library and Information Science research focused in social information mediation presents a significant background with reference to the study of gatekeepers expressed by P. Sturges (2001), and more recently, in the so-called information mediators. In this regard, it is worth noting the subject reviews of Case (2012, pp.338-340), Lu (2007) and the doctoral thesis of Yang (2013, pp.40-47).

Karen Fisher and her colleagues have incorporated the concept of ‘lay information mediaries’, enriching both the line and the research projects. Such mediaries ‘are defined as those who seek information in a non-professional or informal capacity on behalf (or because) of others without necessarily being asked to do so, or engaging in follow-up’ (Abrahamson and Fisher, 2007), and were studied in several projects she presented in valuable papers along with co-authors (Fisher et al., 2004, 2006; Abrahamson and Fisher, 2006; Abrahamson and Fisher, 2007; Abrahamson et al. 2008). Their contribution on ‘information grounds ’and on the role of the ‘spaces’ related to the casual interactions of our adolescents is also relevant. In this sense Williamson and Roberts (2010) present a significant investigation based on the ideas regarding the ‘social information’ in ‘spaces’ where interpersonal information sources and networks coexist. At the same time, Veinot introduces studies centred on the conceptualization of the ‘community’ (Veinot and Williams, 2012), as well as on the ‘places’ (Wolf and Veinot, 2015).

Despite the existence of research on information behaviour within vulnerable social groups, we consider it is necessary to bring such issues closer to the academic community. As an example, we can mention the recent and current the research with regard to the refugees’ difficulties in Australia (Qayyum et al., 2014).

Everyday life information seeking (ELIS) and the ‘small worlds’ of young people

The information mediators or lay information mediators are particularly essential to bind sectors which are not socially integrated –such as the Ni Ni , who also exist throughout the world outside this small country.

The insider-outsider factor in the search for information, as well as the information poverty theory are invaluable contributions from the vision of Elfreda Chatman. We adhere to her concepts of small worlds and life in the round (Chatman, 1988, 1996, 1999). Therefore, these concepts are also included in the theoretical foundations of the line of research of both projects.

Nonetheless, it is imperative to remember the relationship with the social capital she exposes in one of her last papers:´Members of a particular small world will accept some information from those they know and can reasonably trust. Although not quite central to the concept, gaining trust involves some degree of social capital…’ (Houtari and Chatman, 2002, p.353). Past the discussion about the different approaches to the social capital, we agreed with the definition of Warschauer: ‘social capital can be defined as the capacity of indivuals to accrue benefits by dint of their personal relationships and membership in particular social networks and structures’ (Warschauer, 2003, p.6).

Therefore, our vision of social mediators as potential ‘insiders’ participating in scenarios where objects and subjects of research coexist and exchange information, coincides with theories of Chatman and other theorists regarding the existence of ‘insiders’ and ‘outsiders’ on those ‘small worlds’. Breaking down the borders of the territorial and virtual spaces of the Ni Ni is a challenge to overcome by the mediators, as well as gaining their trust. Primary healthcare service personnel are close to the subjects, and also gradually becoming integrated to the everyday life information seeking (ELIS) of the Ni Ni. The valuable contributions of Reijo Savolainen to both, theory and research regarding library and information science, sustain this statement and the analysis of the results of this study (Savolainen, 2004, 2005, 2008a, b).

Finally, let's not forget to mention the numerous contributions of Professor Tom Wilson, who continues to guide research in Information Science through his models of Information Behaviour (Wilson, 1981, 1999a, b),and his so innovative INISS (Wilson and Streatfield, 1977). Even though it is impossible to cite all his contributions and academic production through these past 40 years, as an example of its usefulness to our studies, we can mention some of his works -published in the recent years- which nowadays continue influencing and inspiring our line of investigation in this field (Wilson, 2006a, b, 2010).

Methods

The study, which used qualitative methods, is based on in-depth interviews to the healthcare personnel, following lines that were similar to the ones of the first project (Montevideo Project). Eight respondents were interviewed by the main investigators of the team : three physicians, a psychologist, a physiotherapist, a social worker, an administrative assistant and a community health specialist of the University Center of Paysandú, three men and five women between 35 – 45 years old. Among the main topics that emerged according to the guidelines applied in the aforementioned interviews it is worth mentioning the perception of respondents about: the perceptions of the healthcare personnel as possible mediators of information; the space of adolescents in the selected area; the principal health problems and the types of data connected to them; the adolescent’s needs and search strategies related to health information; the access and use of computers and the Internet and the potential of these tools in the process of health information appropriation.

Interviews were recorded and then transcribed. Every text quoted in the analysis has a code assigned to each respondent as a way to preserve anonymity.

According to the roles played by the mediators, the respondents of the two studies are distributed as follows:

The use of a similar strategy confirmed the appropriateness in the selection of the methods and techniques which facilitated the validation of the comparison of the results.

Discussion of the results

The spaces and the mediators to disseminate information

The central role of spaces in the theoretical perspectives of the research line is consolidated in the results of the projects carried out since 2008, and it re-appears in this comparative study. In response to the questions:

• To involve teenagers in the construction and dissemination of healthcare knowledge, what strategy could be useful to summon them, as well as to keep them interested?
• At what level, time, or in what space could adolescents be involved in the organization, design, production and testing of a website they could feel as their own?

Adolescents are perceived by the social mediators as actors interacting with each other, with different degrees of integration between peers and few exchanges with the rest of the community. A confinement within the territory is perceived, in their space, -mainly located at the square, at the bus stop, or on the corner. In Casa Joven [Youth House], they observe:

... adolescents frequently meet at the square, or at the sports square ... they go there a lot because of the swimming pool or the basketball court, they have many activities there. And the pool works wonderfully. (RP2)Outside [the polyclinic] we would have to see the places where adolescents meet ... For example, at the bus stop... (RP5)

A reference to the public pool is present in the answers of most respondents in the Montevideo Project, where there is pool located close by, accessible and commonly used by adolescents. The difference we found between the two projects is that in Paysandú there is no swimming pool in the area, thus the usual place is the closest bus stop to the institution they attend (Casa Joven).

At the Montevideo Project there are certain references to street corners, entrance of discos, and public squares:

These adolescents are the ones who create ‘round the corner social networks’ since there are no social spaces that integrate them and promote social relationships. Such networks become favorable, territorial places, which are probably unique spaces (despite being labeled as the third place by some theorists who consider home as the first place and the workplace as the second) to exchange the so-called information ground among adolescents and young people who neither study nor work. Undoubtedly, this type of information inherent to humans living in society is extremely important to our subjects - objects of investigation. (Sabelli, 2015a, p.120)

However, the adolescents’ confinement in their neighborhoods is somehow surprising if we consider the small size of the cities of the countryside. The distance of the study area to the city center is small -about a 15-minute walk. As exposed by RP1: ‘Confinement ... is a problem, adolescents say they do not go to the center because they do not feel comfortable there, they marginalize themselves.’

Mediators express their desire to deal with this adolescents’ self-exclusion through actions:’ we are working against that ... we organized a field trip to the sports square, to the beach, downtown, to have ice cream or eat some pizza ... ‘(RP1). They emphasize the importance of an exclusive space for them, their own space, where the hostage phenomena can emerge:

An exclusive space for them, with an extensive schedule and adults who were prepared to have a fluent dialogue, where they could feel "this is my second home",  where they could go either to play ball, to present a problem that took place in the neighborhood or to deal strictly with healthcare issues.(RP6)

Consistently, the study results in Montevideo concluded that 

the atmosphere at the healthcare offices -its formality-creates distance between adolescents and the staff.  It would be better for teenagers to have something they could "appropriate" of, a place reserved only for information (Sabelli, 2015a, p.113)

Fisher and her colleagues specifically mention these spaces, which can be so unfamiliar, by making reference to ‘some information grounds (which) qualify as "hostage phenomena", i.e. settings in which one has little choice but to be present, e.g. medical offices’. (Fisher, Laundry and Nauman, 2006)

The Adolescent Space (Espacio Adolescente) appears as the institutional setting created in the services of primary healthcare, within the State Health Services Administration (ASSE). Nonetheless, inconsistencies regarding the number of spaces in relation to the policies oriented toward the adolescents are mentioned. Also, the location of these spaces is questioned:

It is essential to have a space. If not, you cannot work. If not, teenagers don’t like it. As you can see, they are all sitting outside…we also need a "real time". Personnel are also required. As we worked there, a social worker, a psychologist, a teacher ... we have an adolescent space to cover all Paysandú, it is a joke! ... I think it would be better to have the adolescent space outside the polyclinic. It is an almost utopian idea, but it would be necessary to count with at least one per neighborhood. Otherwise, adolescents do not come... (RP1)

The questions ‘Whose roles are crucial in the center to centralize and disseminate information?, Who would also be good candidates for that, as a consequence of being in contact with many users, or for having access to information?’ intend to deepen into the role of healthcare mediators. The family practitioner (RP1) refers to the necessary features for a space for adolescents, where the flow of information and communication would be encouraged:

I'm trying to create an adolescent space ... we are fighting because we have a room, and have had a little money from the Participatory Budget [a grant given by the municipal government of Paysandú] for two or three years, but they do not give it to us. We are trying to see if we get the money to refurbish the premises.

To sum up: the need for a place that adolescents can share with mediators, and also feel as their own, is regarded as vital: It is essential to have activities in a real space (RP1). However, such place must observe certain conditions that allow its permanence, as well as counting with the human resources necessary to sustain it.

In comparison with the perceptions of the Montevideo Project informants, we observe that more relevance is given to the interdisciplinary work at polyclinics and healthcare centers, and to the specific role of the waiting rooms. It is also emphasized the importance of multidisciplinary healthcare teams focused on the control and early diagnosis of problems such as substance abuse. Even though the discouraging fact that results can only be noted in the long term, consensus was reached in conceiving these spaces as excellent places to work in -if appropriately used- performing simple activities and applying group techniques (Sabelli, 2015a, p.120). In the case of Paysandú, the emphasis is placed on external healthcare services, or on spaces which can provide a clear and definite independence to adolescents.

Both in Paysandú and Montevideo, the Casa Joven is considered another space where information flows in a reliable and friendly atmosphere:

Casa Joven is a space for young people in vulnerable conditions created by the Government of Paysandú [municipal government], which is also a good place to work because various activities such as computer studies, art and music are taught. In addition to receiving information, adolescents feel contained, and they like it... (RP4)

Respondents refer to successful personal experiences in spaces where they could get to know and understand each other better. The family practitioner (RP1) recalls experiences in a social non-profit organization:

... the experience we went through working on Tatuses Sur [a social nonprofit organization working with young people from poor neighborhoods] was positive. We had concentrated almost most of the kids with problems ... we reached adolescents more. It was when we worked that way, knowing them and allowing them to know us, trying to use a technical but clear vocabulary. It was the best way. When you are able to "seize" kids’ attention towards a workshop, you invite 100 but only 15 show up, and the ones that usually come are those with less problems.

Workshops are questioned by the social worker, who comments on her way of working with adolescents: ‘Workshops are important but we must not bore them.’ She emphasizes the importance of reaching adolescents and their interests within the context of their community:

It is good to visit the neighborhoods, get together, see the different interests, seek information, use the interests of adolescents and find a way to make contact. Sometimes, just talking outdoors or being there working, seeing what interests they have…there are thousands of things to do. (RP4)

In conclusion, the work of interdisciplinary teams with adolescents from the healthcare area, embedded in social organizations and / or public social programs that have close contact with the community, is perceived as a desirable strategy to promote the access and appropriation of information. The Montevideo Project considered that the strategies to motivate adolescents are based on their need to feel involved and listened to. Respondents mention: going where adolescents meet, consider their needs and priorities, as well as asking them about these. Therefore, the necessity of teenagers to be heard, their receptivity when a good dialogue is established, and their affinity to ludic approaches are features incorporated in group dynamics (Sabelli, 2015a, p.123-125).

In this sense, the underlying concept goes beyond the places. Relevance is placed on the personal, face to face relationship, or, as the physiotherapist claims: in the personal contact (RP2) which occurs in different places within the education system: high schools, sports institutions and polyclinics, there is where communication occurs. As expressed by the family practitioner quoted above: knowing them and getting them to know us.

These findings and discussions are not far from the theoretical framework and empirical studies of Kirsty Williamson and Julie Roberts based on a study which investigated the reasons for the high population turnover in the Northern territory of Australia, by focusing on social information. The authors consider that it is ‘the kind that helps people connect to a community, the argument being that this is still a very important form of information. Part of such proposition implies that the social information exchange is inextricably linked to social networking’ (Williamson and Roberts, 2010, p.282)

Mediators and young people as potential informants among their peers

An existing innovation in research is the awareness of the role adolescents can play as disseminators of information. As RP6 states: ‘diffusion which takes place between peers is better than all the ‘blows in the head’ (metaphorically speaking) that we give them.’ The respondent reached such conclusion after the workshops with Your Health Site of the Montevideo Project (Sabelli, 2014, 2015b). On the other hand, research in Paysandú reflects a policy of information and training created and executed by the State Health Services Administration (ASSE). In this context a training program called Promotores de Salud (Health Promoters) aimed at adolescents and working with young people- trained in healthcare information to run workshops to their peers- was recently created. Contrary to the Montevideo Project, two of the Paysandú respondents knew about the program and highlighted the relevance of these trained young people as mediators. This mediation is certainly related with some of the conclusions mentioned in the report of such project (Sabelli and Rasner, 2015, p. 255).

When asked about her experience with them, the physiotherapist emphasizes their role and training:

… adolescents are healthcare promoters because they had a workshop ran by doctors, gynaecologists, nutritionists, dentists ... they are volunteers to provide information and run workshops, or to visit those schools, high schools, or educational centers where they are needed  (RP4).

The family practitioner of a polyclinic reflects on the significance of their peer condition, since speaking the same language of the population, being trained to handle basic problems, is the best way to relate to any of the different populations we work with. (RP6).

Working in an interdisciplinary way, for example from the emotional, is relevant to some respondents, the family physician (RP6) notes:

... We liked that for two consecutive years two practitioners of the School of Psychology accompanied me to control. Our work was more related to the emotional, having to do more with each adolescent.  Along with the practitioner, we considered that we needed a track record, or a separate space to discuss certain issues that concerned the adolescent....

Therefore, an innovative result of the research would be the possibility to consider and investigate adolescents as mediators of information among their peers.

Barriers and motivators for communication

When asked: What problems or barriers to communication and information do you perceive? , respondents consider that the relationship between the mediator and the other (the adolescent) needs time, an understandable language and trust to allow mutual understanding. As RP1 points out:

 for you to be able to transmit things to adolescents you need to spend time with them, you need them to know you and trust you, while RP5 recognizes: I don’t know much about the new words they use. That's a difference. They talk to you and you have to ask what they mean. I do not know what it is. But I learn with them.

The doctor RP3 also states that ‘barriers exist, and sometimes we don`t know how to break them down. It involves education.’ When asked: ‘What can motivate adolescents to become interested and to use information?’ He replies:’It's the million dollar question! How to help? I don’t know! It may depend on how you deal with each problem and on your own charisma. On trying to be participatory.’

Generally, respondents agree on the need of a policy aimed strongly at the dialogue and face to face communication with adolescents in order to merge interests, needs and prevention. ‘On attempting to use a technical -but explained- vocabulary’ (RP1) and ‘on presenting it in an understandable way’ (RP3).

Nevertheless, it becomes difficult when tools are scarce in critical situations, especially to provide follow-up measures regarding violence, or in relation to the law of interrupted pregnancy. In this regard, the respondent concludes, ‘we are working well, but it seems like something is missing’ (RP4) and RP5 critically expresses the discordance between the potential user of the information and the answer offered by the services

 ... sometimes we complain that some plans or programs are made "from the desk", this also happens here, some ways of work are thought from a place which is not the adolescents ‘one. So, sometimes what you want them to be interested in is not what they need or think they need.

The main obstacles to communicate and inform adequately, are the shortcomings and difficulties concerning the literacy level of healthcare services users. These are present in the concepts expressed by the respondents at the Montevideo Project:

We must learn to listen to people. The more we listen and learn about who we are working for, the better we will meet their needs.

For over fifty years theoretical cognitive psychology applied to education emphasized the importance of language as a support for conceptualization. It is through it that concepts are channeled to be expressed and transmitted. The assigned meaning may differ depending on the social experiences of each individual and on the context in which they are expressed. Therefore, we must learn to listen to people and learn to convey the valuable information they require.  (Sabelli, 2015, p.114)

It is also confirmed in both projects, that the needs and interests for access and use of information are related to the motivations which emerge from the adolescents’ everyday life and family contexts. RP4 clearly expresses:

... everything seems to be like a circle, because if something motivates them, it is because they are motivated, because they are in a place which encourages this. So, they need to find more information to read -whether it comes from a brochure, from a book, or from the Internet. But they have to feel ... they should be within a contained space, where they could also feel the support, the feedback.

If we compare the results with those regarding the Montevideo Project and the research on young women (Sabelli and Rodriguez Lopater, 2012), we find that the main difficulties lie in the lack of lifelong projects in an environment that does not facilitate the identification with the neighborhood and the sense of belonging and self-esteem of adolescents in contexts of vulnerability. These conclusions are consistent with the major theoretical perspectives on information practices advocated by R. Savolainen and his Finnish colleagues. Theories inserted within the social constructivism.

Main problems perceived with regards to the health of adolescents 

When asked: Which are the main health problems in relation to adolescents? What themes would be a priority?, respondents find the most important information about health related to those issues that appear during the interviews: drugs and alcohol consumption and addiction, sexuality, sedentary lifestyles, poor eating habits, and domestic violence -of all kinds and among young people. As RP6 states when talking about how to promote the access and use of information: ‘they frequently feel alone, emotionally alone, they do not have anyone to talk to.’

The information to be elaborated and disseminated should especially take into account the following items: sexual and reproductive rights, the right to education, preventive healthcare, trust in the healthcare personnel and encouragement of the use of services.

Information resources and desirable characteristics of the information

When considering the perception about the resources adolescents use in order to find information on healthcare issues (Do you perceive if adolescents use any strategies to find information regarding healthcare? What information resources do they count with? Are they appropriate? How could these be improved? ) respondents refer to the materials used to disseminate information. Unlike the mediators of the Montevideo Project, they are aware of the essential participation of the recipients: ‘Materials have improved a lot ... in many years of work we always learn a little. I think the best brochures and things we created, were done with the kids‘ (RP1). Besides, they rely on the ‘"word of mouth", to have a conversation in a waiting room’ (RP6). RP5 words are also representative of the mediators’ perception: ‘The material is for adolescents, but it’s not created or thought for them. We must try to get closer to their age.’

However, both investigations agree in the requirements to be fulfilled by information resources (billboards, brochures): an attractive and colorful design, simplicity, and clarity of messages. The message must immediately call the attention and be easily accessible, the same as the digital environment of adolescents.

In sum, the need to provide clear, concise and highly graphical information is pointed out, taking into account audiovisual and entertainment media as information resources.

Perceptions of respondents regarding PC and Internet access and ability of such tools in relation to the desired change

ICTs and their different and innovative modalities are perceived as the main channels of access and resources for adolescents. Mobile telephony is their regular mean of communication and it outweighs computers in the case of adolescents in vulnerable contexts. All respondents recognize adolescents’ ability to deal with the digital media.

Respondent R2 comments that they ‘juggle with their cell phones’. Either way, agreement exists on the fact that this means of information transmission should be exploited in order to achieve a better benefit both for the system and the recipients themselves –an aspect which is perceived as underdeveloped given its enormous potential due to the intensive way in which adolescents use social networks. Some doubts with regards to the use of Internet to find information arise; in general, the assertion of RP1 is shared: ‘Adolescents often use computers without problem, but what we see is that they mainly use them to play’ RP4 comments: ‘They go straight to what they find easier because it saves them time. They can record, print, and even carry material.’ Social networks, especially Facebook, are regarded as possible channels of communication and information because all adolescents use them -as well as the email.

Uruguay’s advantageous position with reference to computers and Internet access in unfavorable contexts is considered in several publications of the GIISUR Group. Specific research on ICTs was addressed and disseminated in two workshops, both with adolescents interacting with a web site designed especially for them (Your Health Site), as one of the activities of the Project (Sabelli, 2014; Sabelli, 2015b, p.215-241).

Conclusions and perspectives

This comparative research confirms and intends to deepen into the results obtained in a line of investigation centered on the information behaviour of communities in unfavorable contexts. The projects focused on adolescents -males and females- in Paysandú (2014-2015) and Montevideo (2010-2012), but also on the results obtained in a Project centred on young women and adolescents (2008-2010). In this sense, researchers seem to complete a cycle of studies by including both women and male adolescents from poor neighborhoods of the capital city and a small town in the countryside. Investigations comprise the theoretical and methodological basis of the disciplinary development in the field of the 2000s human information behaviour.

This fact allows for its use in comparative studies with other countries which present similar realities. We believe it can contribute to the debate and growth of this line of research, based on the results regarding the following aspects:

a) the interpretative approach based on the perspectives of the subjects / objects of investigation; b) the in-depth interviews taken as a means to collect qualitative data, approach the subject and, at the same time, become a collaborative and participatory way of research ; c) the necessity to follow up the results of such qualitative studies in subsequent investigations, involving a larger population (surveys); and d) the analysis of various types of social mediators of information, including the recipients themselves as disseminators among their peers.

Finally, the social mediators of information we have studied for seven years show their strengths and weaknesses, their commitments, absences and concerns in relation to the flow of information and communication. The emphasis placed on mediators belonging to the healthcare personnel is relevant, as it frequently constitutes the only socializing bridge for the Ni Ni, not only in Uruguay but in a large part of the world.

In this sense, national and local policies of information need to be designed. Such policies could find sufficient elements in the current analysis in order to define strategies and to implement information services aimed at the community, inserted in those places which can be appropriated by adolescents. Services should integrate both social and professional mediators of information: information points in healthcare centers; training courses for the healthcare personnel regarding resources / sources of information for the young users of primary healthcare services, or participatory workshops in the places where young people meet. As a consequence, the design of adequate digital tools and their incorporation into social networks with the help of the potential young mediators acting together with their peers will be promoted.In sum, to design sources, resources and information channels for the Ni Ni adolescents and other vulnerable sectors, allowing them to become socially and culturally included into the rest of our society -either in large cities or in urban and rural communities.

All the above mentioned is part of the social commitment of the information and communication disciplines, as well as of the theoretical-methodological growth in the field of human information behavior in areas barely addressed, which also present a weak impact on public information policies.

Acknowledgement

The author would like to thank the research participants for their willingness to become part of the study, sharing their perceptions. She would also like to acknowledge the significant support of the anonymous reviewers for their useful and perceptive comments. She would also like to thank her colleague Andrea Cristiani for the help in reviewing the writing style of this paper.

About the author

Martha Sabelli received her Ph.D. in Documentation in 2004 from the University of Alcalá, Spain. She is a Senior Researcher and head of the Information and Society Department, Information Institute, at the Faculty of Information and Communication, of the University of Republic, Uruguay. She can be contacted at martha.sabelli@fic.edu.uy