'The transfer of information through word of mouth is powerful': interpersonal information interactions

Introduction

With the discursive construction of health professionals as enablers of patient choice (Hvas and Gannik, 2008) and an emerging consensus that patients should participate in shared decision-making (Légaré and Brouillette, 2009; Salkovskis and Rees, 2004), health information seeking has become 'an important survival tool for individuals' (Johnson and Case, 2012, p. xi). Health information behaviour has thus emerged as an important area of investigation in health fields and in Library and Information Science. Although increasing use of the Internet in all walks of life has focused attention on online health information seeking (for example, Hart et al., 2004; Marton and Choo, 2012; Yoo and Robbins, 2008), research continues to suggest that interpersonal information behaviour plays an important role in the management of personal health challenges. This is particularly evident in the context of women's health (for example, Ramírez, 2013; Wathen and Harris, 2006; Yeoman, 2010).

This paper addresses the questions: how do interpersonal information sources contribute to participants' understanding of uncertain and evolving health information? And, what are the tensions experienced by women as they make sense of uncertain health information mediated by formal and informal information sources? I examine the relational dimensions of health information behaviour by drawing on a study that explored the experiences of women as they responded to, made sense of and used (or did not use) uncertain and evolving health information (Genuis, 2012). Information behaviour in a context of explicit uncertainty - in this case, health management during the menopause transition - is an important area for exploration not only because uncertainty has been identified as an incubator for information seeking (Case, 2007; Dervin 1999; Wilson 1994), but also because health evidence is inherently emergent and incomplete (Upshur, 2001; Wood et al.1998), and thus uncertain.

Findings provide in-depth, nuanced understanding of the critical role that face-to-face information exchange played for women seeking to make sense of information about the menopause transition. The paper identifies and illuminates themes emerging from formal (health professionals) and informal (family, friends, acquaintances and colleagues) interactions. It also highlights the key contribution of interpersonal information behaviour and narrative to meaning construction and health management decisions.

Background

Study context

Just over ten years ago, unanticipated findings from the Women's Health Initiative Study challenged the safety of a routine practice in North America, the use of long-term hormone therapy for the prevention of disease in healthy menopausal women (Rossouw et al., 2002). These findings were exhaustively covered in the medical and consumer press (Genuis, 2006; Naughton et al., 2005) and, as a result, the medical management of this life transition, particularly the prescribing and use of hormone therapy, has undergone dramatic and rapid change (Tsai et al., 2011). These changes have been accompanied by widespread and ongoing uncertainty among health professionals and consumers about the appropriate management of health during this life transition (Holloway, 2010; Rigby et al., 2007; Sawka et al. ,2004).

Women and health information behaviour

Women are active information agents who seek and store health information for both themselves and others (Macias et al., 2004; Wathen and Harris, 2006; Yoo and Robbins, 2008). They have been identified as important sources of health information (McKenzie, 2002; Wyatt et al., 2005), as information gate-keepers within their personal networks (Harris and Wathen, 2007) and as primary information managers who gather and manage health information for their households (Moen and Brennan, 2005).

A handful of studies contrast the health information behaviour men and women. Wyatt et al. (2005), for example, found that women have much more diffuse networks than do men. Whereas men talk about health primarily with their physicians and partners, women draw on their social networks of family, friends, neighbors and colleagues. Other studies report that women are more involved in gathering health information and health-related decision-making than are men (Kahn, 2001; Macias et al., 2004). Urquhart and Yeoman (2010), however, note that while sex - the biological and physiological characteristics of men and women (World Health Organization, 2014) - appears to be associated with health information behaviour, this is influenced by the social construction of women's responsibilities for contraception and childrearing and by the medicalization of pregnancy and menopause.

Interpersonal health information behaviour

A central tenet of information science is that people tend to seek easily accessible and interpersonal information sources (Case, 2007; Harris and Dewdney, 1994). These people sources have been identified as facilitating more positive search outcomes (Johnson, 2007); enabling information exchange and dialogue (Davies and Bath, 2002); and providing context and validation for personal experiences (Veinot, 2010; Yeoman, 2010). Although studies of online consumer health information behaviour indicate that relational dimensions also play a central role in the Web environment (for example, Abrahamson et al., 2008; Fox, 2011; Neal and McKenzie, 2011), the primary importance of face-to-face interactions with health practitioners for women seeking information during the menopause transition (Castelo-Branco et al., 2006; Ekstrom, 2005; Genazzani et al., 2005) suggests that these in-person encounters retain value for women seeking authoritative medical information. The proliferation of authoritative online sources and the increasing use of the Internet for consumer health information seeking therefore raises questions about the place of face-to-face health information behaviour in a networked world.

Method

All aspects of the study received ethics approval from the Health Research Ethics Board at the University of Alberta, Canada. Pseudonyms are used where participant quotations are identified. An overview of methods is provided in this paper; additional details can be found elsewhere (Genuis, 2012).

Theoretical framework

Sociocultural discourses related to women's, patients' and consumers' rights have played an important role in changing attitudes towards paternalism in health care (Rodriguez-Osorio et al., 2008; Tomes ,2007) and the increasing imperative for collaborative decision-making between patients and health professionals (American Medical Association,2012; Canadian Medical Association, 2010; Department of Health, 2010). While not drawing explicitly on information science theory, these changes position patients as 'thinking, self-controlling human being[s]' and construct health information as something that is shaped by patient perspective (Dervin, 1983, p. 169).

Based on a social constructionist approach and an active, process-oriented view of health information behaviour (Dervin, 1992), this paper identifies 'general sense-making practices on the basis of which people orientate themselves in their everyday … lives' (Talja et al., 1999, p. 761). Sense is accepted as knowledge, opinion, intuition, evaluation and/or affective response (Dervin, 1992); interviews are viewed as 'reality-constructing, meaning making occasions' (Holstein and Gubrium, 1995, p. 4). Information behaviour is used to describe the multifaceted ways in which women interact with health information as they seek to manage personal health during this life transition (Savolainen, 2007). Although not the focus of this paper, social positioning theory (Davies and Harre, 1990; van Langenhove and Harre, 1999) provided a lens for exploring the dynamic aspects of information encounters (Genuis, 2013). In addition, channel complementarity theory was incorporated during analysis to contextualize and enrich emerging themes (Dutta-Bergman, 2004a; 2006).

Sampling and recruitment

Semi-structured interviews were conducted with a sample of women who had been or were engaged in information gathering and/or decision-making related to menopause management (n=28). Sampling was theoretical and purposive: recruitment took place in the community (n=18) and at a hospital-based, publically-funded menopause clinic (n=10). The goal of sampling was to gather rich qualitative data 'so that others outside the sample [but in the target population] might have a chance to connect to the experiences of those in it' (Seidel, 1998, p. 47-48). Sample size was guided by principles of theoretical saturation and sufficiency.

Interviewed women were 43 to 72 years of age; the majority (n=19) were between 45 and 59. Based on the latest available census data at the time of interviews (2006), participants were better educated than average Canadians (Statistics Canada, 2011). Participants resided in one Canadian province; three were immigrants to North America. Because 'women's perception of symptoms and where they were in the menopausal transition … have a stronger influence on behavior than menstrually defined stage' (Huston et al., 2006, p. 60), menopause status was self-reported.

To strengthen findings, data from the primary interviews with women information-seekers (referred to as participants) were illuminated and augmented by subsequent interviews with a smaller heterogeneous sample (n=12) of health professionals (Creswell, 1998). These latter participants (referred to as health professional participants) were recruited from two hospital-based, multidisciplinary menopause clinics, by referral and through personal contacts. Clinic and community contexts, as well as a range of disciplines were represented (see Table 1). Interviewed professionals worked directly with women seeking information and assistance as they navigated this life transition. This paper focuses on the experiences of the primary sample of participants (women navigating the menopause transition).

Interviews

All participants took part in one in-depth audio-recorded interview conducted in a mutually acceptable location (work and public spaces, homes). Qualitative interviewing strategies were used to facilitate rich data gathering (Rubin and Rubin, 2005). Field notes were written within 24 hours of each interview.

Semi-structured interviews with participants utilized both a narrative approach (Petersen, 2006) and in-the-moment elicitation (Johnson and Weller, 2002). During the narrative part of the interview, participants were invited to share personal accounts of their menopause experiences and related health information behaviour. Elicitation provided insight into women's emotive reactions and tacit understanding of media-mediated health information. Three contrasting articles (Canadian Broadcasting Corporation, 2007a, 2007b, 2008), selected on the basis of national Canadian readership information and with attention to age and gender (Canadian Media Directors, 2007-2008), were sequentially presented to and discussed with participants. Participant interviews lasted an average of 60 minutes (range: 40-80 minutes).

Interviews with health professional participants lasted approximately 30 minutes and were initiated after 60% of the primary interviews were completed. Health professional interviews focused on themes emerging from interviews with primary participants, professionals' perspectives on women's information seeking and their roles as information providers.

Analysis

Interviews were recorded verbatim; NVivo 8TM software facilitated data organization, theme identification, memoing and coding. Analysis incorporated directed content analysis guided by theory (Hsieh and Shannon, 2005) and grounded theory's constant-comparative method, interactive close reading, and examination of texts for conformity and variation from emerging themes (Glaser and Strauss, 1967). Descriptive, interpretive and discursive approaches were incorporated as transcripts were analyzed (Genuis, 2011). Analytic rigor was enhanced through robust sample size and triangulation of interview approaches (narrative and elicitation) and data sources (women and health professionals). The following measures were taken to strengthen credibility: identification and exploration of negative instances; discussion and debriefing with peers; and careful documentation at all research stages. Rich description of findings and theoretical implications facilitates transferability.

Results and discussion

This paper focuses on themes emerging from participants' formal and informal face-to-face interactions. Findings bring attention to contrasting themes (health professionals as both information experts and barriers; and the importance of informal contacts for both experiential and biomedical expertise), as well as to additional factors influencing interpersonal information behaviour (the influence of sex and gender on interactions with health professional; and the powerful informing role of mothers). Findings highlight interpersonal information exchange as a strategy for making sense of uncertain health information and the role of narrative in meaning-making.

Although participants consulted and relied on a range of information sources as they navigated this life transition, interpersonal face-to-face information seeking was noted by almost all participants as being critically important as they sought to make sense of menopause information. Twenty-six of the 28 women discussed their interactions with health professionals (formal interpersonal), and 27 drew attention to their interactions with family, friends, colleagues or other acquaintenances (informal interpersonal).

Formal interpersonal information behaviour

Information experts

Health professionals, particularly physicians, were viewed by most participants as foremost medical authorities. Almost all of the women interacted directly with a health professional at some point as they navigated menopause. A very small number relied almost exclusively on the expert knowledge of professionals.

The majority of participants looked for information autonomously via informal interpersonal contacts, the internet or books before seeking input from a professional. When confronted with conflicting media articles during the elicitation portion of the interviews, however, half of the women said that they would talk to their doctors. Sue was representative of these participants:

I would probably then take [the news article] to the doctor or somebody to do with menopause and say, 'What do you think of this?'. Health professional Sonya confirmed this finding: 'Health professionals still carry a lot of credibility in most people's mind…[People] read these headlines in newspapers but I think a lot of [women] still vet it by a health professional'

Data analysis highlighted the critical role of trust in mediating women's confidence in and use of the information provided by professionals. Roslyn, for example, reluctantly acquiesced to a physician's suggestion that she use hormone therapy; she explained, 'I just thought I could trust her…she believed that it was worth the risk'. The importance of a trusting relationship was further demonstrated by the value women placed on dialogue with practitioners. Women frequently used words such as 'partnership' or 'conversation' to describe effective relationships with health professionals. This study found that when participants perceived that information exchange and collaboration was valued by the health professional, participants were also more likely to trust and act on information provided by that professional.

'Perceived knowledge and helpfulness' has been identified critical to women's trust of health professionals, with willingness to discuss a range of information sources and treatment alternatives being a sign of both helpfulness and a lack of bias (Huston et al., 2009, p. 152). In this study willingness to help women 'sort out' information from other sources as well as referral to other information sources (for example, referral to websites or articles) contributed to women's relationships with and trust in professionals. The mediating influence of trust was acknowledged by many of the interviewed professionals ('I think the biggest thing is getting that sense of trust…[without trust] it doesn't always work as well').

Information barriers

A contrasting theme, which also brings attention to the relational aspects of clinical encounters, was the notion that health professionals can act as information barriers: 'I've found that the biggest drawback to finding out information has been actually the doctors themselves' (Monica). Unsatisfactory interactions were precipitated by health professionals who did not take time with patients ('[Doctors] just give you brief information and tell you to see the specialist. And even the specialists don't seem to have the time') and by those who positioned themselves as exclusive experts with the right information. In both of these situations, women were less likely to view patient-clinician communication as a collaborative venture.

Participants discussed their experiences as they navigated the tension between health professionals as information experts and as information barriers. Many used specific strategies to manage the barriers they experienced within this context. While some women took responsibility for soliciting needed information ('I have learned to bring very specific questions') or treatment ('I insisted, 'You have to give me an ultrasound'), almost half prepared for interaction with a health professional by first gathering health information from other sources ('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'). Other participants managed the tensions of uncertain information and patient-clinician relationships by positioning professionals as hired consultants ('The doctor is someone that I pay to help me') and positioning themselves as unique interpreters of their own bodies and experiences ('No one knows your body better than you do'). Based on the authority of their embodied experiences women felt empowered to adopt or reject the authority of health professionals.

Despite the value women placed on professional expertise, this investigation confirms earlier findings. Poor communication led to a lack of confidence in health professionals as information providers (Ma et al., 2006); and women looked for alternative information sources when they perceived that health professionals did not have time to meet their information needs (Warner and Procaccino, 2004).

The influence of sex

Participants commonly attributed health professionals' information-sharing practices to sex (WHO, 2014). For example, Gwen noted, 'Her being a female doctor, I really like that. Because she goes through the same kind of things. So she…gives a lot of good ideas'. This notion was reinforced by female health professionals: 'I think the phase of life that I'm in, being in that same age frame…I get the question, "What would you do?"' (health professional Denise). Even without identifying life stage, participants commonly used the words female and/or male as discursive signals that identified the contrast between information-sharing, helpful health professionals and those who do not meet women's information needs. Thea exemplified this finding: 'I think there's women [health professionals] now willing to listen to me versus these men'.

Careful analysis of data from this current study suggest, however, that when participants highlighted the sex of a health professional, they were frequently identifying gender - the socially constructed behaviours, communication styles and general attributes that are ascribed to men or women (WHO, 2014). This was most vividly demonstrated by negative incidents. Two participants described being berated aggressively by physicians. In each case the physician was female; however, this was disclosed indirectly through the participants' pronoun use. Similarly, participants who had trusting relationships with male health professionals did not explicitly identify their clinician as being either female or male. Participant narratives suggest that while women valued both female and male health professionals who fostered trust and collaboration, their relational expectations were shaped by sex-based assumptions. These findings are supported by studies demonstrating that bedside manner and communication style primarily influence patient satisfaction (Liang et al., 2006; Plunkett et al., 2002) and, more specifically, by Christen et al. who found that when patient-centred communication style is controlled for, physician sex is 'no longer important for patient satisfaction and compliance' (2008, p. 1480)

Informal interpersonal health information behaviour

Experiential knowledge

Interviewed women explicitly valued experiential knowledge: 'wisdom and know-how gained through reflection upon personal lived experience' (Schubert and Borkman, 1994, p. 228-229) - gathered during interpersonal information interactions. Participants deliberately sought input from family, friends, colleagues and others in order to normalize their experiences, gather practical information about navigating the uncertainties of this life stage, make sense of health information available from other sources and tap into an informal system of referral to resources, products and health professionals. For example, a participant who experienced health challenges in her early 40s was alerted by friends that her symptoms suggested early onset menopause; and another participant related that, on the recommendation of a colleague, she had experimented with a Wild Yam cream (reported to be a natural progesterone product). Interviewed health professionals confirmed the importance of experiential peer knowledge for women in this life transition. One health professional noted, 'I think what [women navigating menopause] tend to believe most is probably what they hear from…a friend or a family member who's gone through it'.

A prominent theme in this study was participants' construction of lived experience as a valid form of evidence that played an influential role in decisions about personal health management. This experientially-based evidence was shared and reinforced through informal interpersonal interactions. Many participants, for example, explained that although they explored information about the pros and cons of hormone therapy (most found the uncertainty about this therapy to be frustrating and confusing), it was the lived experiences of other women that primarily influenced their decisions about symptom management. Similar to patients with chronic disease (Oliphant, 2009), experiential knowledge provided a rationale for treatment decisions among women in this investigation.

Biomedical authority

Although participants placed great value on experiential knowledge, the importance of biomedical authoritative knowledge was demonstrated by the many women who sought and relied on information from informal contacts who had biomedical qualifications. One participant noted that when she came across conflicting health information she would check with 'my friends who are public health nurses'; another explained that since she had several relatives working in health professions, she would seek their advice about health concerns before consulting her personal physician. Relationship and trust remained critical in these exchanges. Joyce, for example, positioned trust in the interpersonal relationship as a prerequisite for trusting the biomedical expertise of her friend: '[We] had to be friends first'.

Emphasis on the biomedical expertise of interpersonal contacts allowed women to draw on category entitlement (Potter, 1996) to defend decisions about personal health management. Laura, for instance, defended vitamin supplementation by relating a relative's perspective on the topic and adding, 'She's in the nutrition field'. While other investigations of patient expertise have found substantial difference between the medical expertise of health professionals and experiential expertise offered by peers (for example, Hartzler and Pratt, 2011; Dasch and Kendall, 2007), women in this study specifically sought information from interpersonal contacts with biomedical expertise, thus blurring authority lines between formal and informal contacts.

The influence of mothers

A salient finding was the informing role of mothers for women navigating the uncertainties of this life transition. With only a few exceptions, participants noted their mothers' experiences. Some women spoke of how childhood observations framed adult perceptions ('I wasn't looking forward to menopause…given what I thought my mother was going through'). Others sought information directly from their mothers ('I wanted to find out if she experienced this [symptom]'). And others related how their mothers' management strategies shaped their decision-making ('My mom was on estrogen only. And had been for quite a long time. But I didn't think that was the right way to go now'). Participants commonly expressed an expectation that their experiences would be similar to their mothers' experiences ('I was told that whatever your mother went through, you followed that path').

How women's menopause experiences are defined and interpreted through the lens of their mothers' experiences has received very limited attention in the literature (Dillaway, 2007; Yeoman, 2010). Health professional participants, however, noted the powerful information role of mothers in this context. Health professional Clare observed, 'I think that people value my opinion but…they might value their mother's opinion as much as mine'.

Constructing sense through interpersonal interaction

All of the women and health professionals who participated in this study were aware that the evidence base in this area of clinical care is evolving and contested. Making sense of health information and making decisions about personal health management were thus important challenges for interviewed women. In order to meet these challenges, participants interacted with a complex array of information sources ('I had magazines, books, the Internet, listened to other people, what they had gone through, what they'd tried to help themselves'). They described seamless integration of online and offline information, and of formal and informal information sources. Moreover, women viewed sources as being complementary. They used different information mediums to fulfill varying information needs. The Internet, for example, was identified by all participants as an important source of information that facilitated active information seeking; the media served as a valuable awareness tool; and libraries and/or books were viewed as trusted starting points for investigation (Genuis, 2011). For this sample of women, interpersonal interactions played a key role in helping participants make sense of health information that was mediated by a wide variety of sources and which they frequently perceived to be conflicting and/or uncertain.

Interpersonal interactions therefore provided opportunities for constructive processes (Tuominen and Savolainen, 1997); meaning and plans for personal health management were created by dialogue between people. Naomi, for example, described how women discussed health challenges, knowledge gaps and potential management strategies:

We do talk about [menopause] at work, and we do have those conversations, and people have come up with different solutions and other people have tried them. Or they recommend one product over another product. 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.

Brasher (2001) supports the importance of interpersonal information interactions, particularly in contexts of uncertainty: 'Supportive others act upon uncertainty management processes by providing direct or indirect assistance as sources of information, collaborators in information gathering, evaluators of information, or buffers against information' (485).

Perhaps because of the uncertainty women felt about this life transition and about associated health management strategies, a large majority of participants identified a preference for learning about and making sense of menopause in a socially interactive setting. Furthermore, eleven women stated a specific preference for learning in a formal or informal group setting. When Paula, for example, was asked to describe an ideal learning context, she recommended a 'women's health centre' where women could share with each other. Similarly, another participant suggested a 'support group' and noted that navigating the uncertainty of this life transition was better achieved as 'a team effort'.

Formal interpersonal interactions also represented key opportunities for making sense of health information. This was demonstrated by women's strong preference for practitioners who viewed the clinical encounter as a collaborative information-sharing opportunity. Sense-making through collaboration with professionals was exemplified by Lisa:

'They're using my information to help them find a cause [for symptoms]; and I'm using their information to say, 'Yeah, I've tried that and this is what happened'…It's a back and forth constantly'.

Interviews with health professionals supported the notion that interpersonal interactions mediate understanding. For example, one health professional participant noted the importance of 'face-to-face conversations', while another noted, 'The transfer of information through word of mouth is quite powerful'. Although the sample of practitioners was small, interviews suggest that, for these participants as well, interpersonal exchange served as an important strategy for constructing sense from uncertain information. Health professional Mark, for example, related that because of medical uncertainty about the safety of hormone therapy during menopause, 'I talked to a lot of my colleagues…I depended a lot on what other people were saying'. This finding is in keeping with scholars who highlight health professionals' reliance on human information sources (Dee and Stanley, 2005; Gorman, 1995).

Constructing sense through shared stories

Interviews demonstrated that participants constructed sense by listening to and telling stories of personal experience. Interviews provided participants with an opportunity to use stories to 'organize, display, and work through their experiences' (Becker, 1997: 25). One participant, for example, related the series of health and information challenges she had experienced while navigating this life transition. Later in her interview she reflected on her own story and summarized, 'I am feeling more and more that I need to advocate for myself'. Narratives thus facilitated meaning construction by allowing information interactions to be 'seen as one chapter in an individual's ongoing engagement with, and construction of, their life-world' (Olsson 2005, p. n.p.).

The value of story-telling for people experiencing health challenges has been identified as 'a key feature of e-health' (Ziebland and Wyke 2012). In the current study, however, online information seeking was highly valued for its immediacy and access to a range of perspectives. A few participants talked about the personal health-related narratives they read online, but the vast majority identified stories exchanged during face-to-face interaction with family, friends and colleagues.

Interviews with health professionals confirmed that narratives offered opportunities for women to explore and make sense of personal experience. Interviewed professionals brought focus to the notion that lived experience cannot be separated into isolated incidents; rather, 'illness unfolds in stories' (Charon and Wyer 2008, p. 297). In addition to the sense-making benefits derived from telling and listening to stories, stories provided health professionals with deeper understanding of patient circumstances and values (Goyal et al., 2008; Lockwood, 2004). One participant, for example, described childhood interactions with health professionals, her experiences as a mother with a very sick infant and her menopause-related health challenges. Her narrative revealed a person with close ties to the medical community and yet someone who, without hesitation valued individual authority and initiated independent information seeking in order to make sense of uncertainty.

Implications

Despite active information seeking via the Internet, face-to-face information interactions played an important role for this sample of women seeking to make sense of health management during the menopause life transition. This has both practical and theoretical implications.

Unlike maladies that might be experienced in relative isolation from those in one's immediate environment, this study was contextualized by a life transition shared eventually by all women. Perhaps as a result of social availability, face-to-face interactions provided empowering opportunities for participants as they made sense of and used evolving menopause information and as they made decisions about health management. Moreover, participants valued face-to-face encounters with health professionals as opportunities for information exchange and shared decision-making. Participants specifically identified interpersonal interactions as preferred contexts for interactive learning about this life transition. This suggests that while online resources played an important informing role, personal interactions retained importance for these women who were constructing sense from the wide range of menopause information that is available. This has implications for health professionals. While patients are likely to gather health information from multiple sources, collaborative patient-practioner interactions provide key opportunities for knowledge construction and collaborative decision-making.

With the ongoing evolution of social media and other emerging technologies, findings have implications for scholars exploring the relational dimensions of online environments. For example, results raise questions about familiarity versus anonymity when seeking health information. In what circumstances do information seekers prefer the familiarity of face-to-face interaction or the anonymity offered online? Are these preferences based on personal characteristics, comfort with technology or the nature of the information need?

Findings also have theoretical implications. Health and information professionals have a tendency to view information from informal interpersonal sources as being in competition with authoritative health information. This study found, however, that informal interpersonal information gathering was most commonly accompanied by information seeking from health professionals. This supports channel complementarity theory - the notion that an enduring interest in a specific subject area will motivate information behaviour across mediums, with different sources fulfilling individuals' information needs in complementary ways (Dutta-Bergman, 2004a; 2006). While research on channel complementarity is, to my knowledge, limited to secondary analysis of quantitative data (for example, Dutta-Bergman, 2004b; Nguyen and Western, 2006; Ruppel and Rains, 2012), this study demonstrated that participants who discussed personal health management with informal contacts also discussed this topic with health care professionals, as well as reading about it online and in the media. This suggests that instead of viewing information sources as good or bad, information sharing and collaborative decision-making will be fostered by health professionals who recognize that information gained from formal and informal interpersonal relationships, as well as from other sources, all contribute in complementary ways to personal health management.

Limitations

Primary limitations relate to study context and sampling. The study was conducted in Canada, a country with publically funded health care. This may limit generalizability. In addition, participation may have had greater appeal for women experiencing health challenges and for those self-identifying as information seekers. Similarly, health professionals identifying as information providers may have been more likely to participate. Finally, increasing use of social media since data collection is influencing patterns of interpersonal communication for some individuals. This may impact the role of face-to-face information encounters, particularly for those suffering from rare or stigmatized conditions and for those who do not have peers in their immediate social circles.

Conclusion

Although much research is focused on the influence of new technologies on health information behaviour, this study found that face-to-face interpersonal interactions played an important role for women seeking to make sense of uncertain information related to health management during the menopause transition. Formal interpersonal interactions were explicitly valued for their expert knowledge and as a means for navigating of conflicting information from media sources. Relational dimensions, particularly trust and a collaborative communication style, mediated participants' confidence in and use of information provided by health professionals. Informal interpersonal contacts were important for both their experiential and biomedical knowledge, with the experiences of mothers playing an influential role in women's interpretation of their own experiences.

It is noteworthy that in this study participants valued formal and informal interpersonal contacts for overlapping reasons. Interviewed women valued the biomedical expertise of both health professionals and interpersonal contacts. They highlighted the experiential knowledge of peers but also appreciated health professionals going through similar life experiences. Moreover, collaborative information-sharing predicated on trust was presumed among peers and highly valued when encountered in professional-patient relationships.

Results demonstrate that participants preferred interpersonal, interactive contexts when learning about this life transition and that sharing personal narratives helped participants construct sense from their experiences and information seeking. Findings support channel complementarity theory and, in this context of uncertain health information, situate interpersonal information behaviours as a critical means of constructing sense and making decisions about personal health management.

Acknowledgements

Sincere gratitude to the interviewed women and health professionals who so generously shared their thoughts and experiences; to Dr. Heidi Julien and Dr. Brenda Cameron for their valuable guidance and encouragement; and to funders, including the Social Sciences and Humanities Research Council of Canada. Thanks are also due to the anonymous reviewers who provided helpful suggestions for improving this article.