3.1 Study Design
In this study, cross-sectional descriptive study was use by the researcher. Cross sectional because the study was conducted in one place, which is Ademasajida, at one
do not necessarily reflect the views of UKDiss.com.
Chapter 1: Introduction
According to Groff and Jones, Knowledge Management can be defined as “The tools, techniques, and strategies to retain, analyse, organize, improve, and share business expertise” (Groff and Jones, 2003). It involves the collection, management and apportionment of the tacit as well as explicit knowledge throughout the organization. Moreover, in this case study, the knowledge management has been used to improve the learning and performance of the professionals through the concept of Knowledge Life Cycle and the Critical Incident Analysis framework in a walk-in software help desk situated in a research university. For an organisation, the knowledge base of its employee is the key for the competitive edge and this case study shows how the management of knowledge in an organisation will help their employees in identifying the critical incidents and share the information related to it with the team. Such an approach will increase the effectiveness of the team to deal with the unknown incidents and improve their responsiveness towards it.
Chapter 2: Literature Review
The objective of this chapter is to give an overview of the literature surrounding the concepts of this study. The theory of knowledge and the knowledge life cycle are studied as well as the supporting concepts focused on the Theory of Organisational Knowledge Creation by Nonaka, Takeuchi and Tokama. The critical success factors related to the management of knowledge life cycle are discussed. Moreover, a vital concept that lays the foundation for this study is the literature surrounding how knowledge should be studied in organisations, so the chapter ends with the HPT model and its relationship with IDT. It also covers the study related to the Critical Incident Technique (CIT).
Definitions of Knowledge
Many definitions of knowledge proposed by several authors exist and they all emphasize on relationship between knowledge and information, how they are not synonymous or interchangeable. According to Kerssens-Van Drongelen, De Weerd-Nederhof, and Fisscher (1996) define knowledge as “information internalized by means of research, study or experience that has value for the organization”. Davenport, De Long and Beers (1998) give a more detailed definition that defines knowledge as “information combined with experience, context, interpretation, and reflection; a high value form of information that is ready to apply decisions and actions”. Hence, Knowledge can be defined as the meaningful set of information that adopts a pragmatic view of knowledge focused on the organisational context (Nonaka & Van Krogh, 2009).
Knowledge Life Cycle
According to Fahey and Prusak (1998), knowledge can be viewed as a flow. As a flow, it is apparent that the knowledge is changing and can be embedded in the day to day activities of the organisation. In relation to this, several authors have proposed that knowledge can be viewed as a life cycle. The complexities of all the model varies but they all start from “create” phase and provide a way to break down how knowledge flows through an organisation. Three representations of knowledge life cycle will be examined in this discussion:
Haney’s Model. Haney (2006) proposes that knowledge be viewed as a life cycle with seven phases (see figure 1). The first two phases are to create or learn and identify. They initiate the start of the knowledge life cycle through acquisition. Before or after acquisition, identification of what is important and useful to organisation is done. The third phase is to organise and codify the knowledge and can be stored in secured and easily accessible location. The final three phases involve distribution, usage and maintenance of the knowledge. Maintaining also involves monitoring the usage of knowledge and training & support for users (Haney, 2006).
Brikinshaw and Sheehan’s Model. This model represents the knowledge life cycle as a S-curve where knowledge cycles through four stages, “creation, mobilization, diffusion and commodization”. Time is an added variable in this knowledge life cycle because as knowledge progresses through the various stages of the life cycle, the people who have access to it increases.
Creation is the stage where an idea is conceived and the knowledge is in the individual’s head. This is considered as an abstract insight gained through experience and experimenting. Mobilization is where the idea moves from the individual’s head and takes a form which can be shared and tested. Diffusion is where the idea is fully developed if it survives the mobilization phase. Now the idea is publicly available for others to learn and replicate. Lastly, commodization is where the idea becomes a part of a discipline that it becomes a common knowledge. Moreover, the speed of flow of knowledge varies in different contexts. Factors like competition stealing information, information leakage, and intentional documentation and sharing increases the rate of knowledge flow while factors like intellectual property rights and the extend that the knowledge is hard to imitate, decreases the rate of flow.
Salisbury’s Model. Salisbury (2008) presents a more simplistic view of knowledge as a life cycle which consist of three phases, create, preserve and disseminate. Salisbury’s Model emphasize on the problem solving, thus makes it suitable for this case study as the study seeks to examine the flow of knowledge that evolves from critical incidents. Creation occurs when a new or unique problems are solved holistically, Preservation involves the documentation of the problem and how it was solved while Dissemination involves the knowledge sharing among employees as well as the stakeholders affected.
The next iteration of the ongoing knowledge life cycle will help create new knowledge when it is used to solve future problems which will further improve the competence of the organisation.
Types of Knowledge
Throughout the knowledge life cycle, knowledge takes different forms and functions. However, explicit and tacit are among the most widely used classifications of knowledge (Gourlay, 2006; Rosenberg, 2012). Explicit knowledge can be articulated and documented, which makes it easy to share. This knowledge can be found in books or manuals and is used in formal training as well (Nonaka, 1994; Nonaka & Takeuchi, 1995; Rosenberg, 2012; Smith, 2001). However, Tacit knowledge is the knowledge that is in people’s heads. It comprises of intuition and common sense. It is not verbalized but plays a vital role in how people solve problems or devise solutions. It is best developed and shared in informal ways, through work experiences, interacting with co-workers or coaching (Smith, 2001). Nonaka and Takeuchi (1995) categorised tacit knowledge in two dimensions: technical and cognitive. They used the phrases like “know-how” and “how-to-pin-down” to describe the technical dimension while cognitive dimension refers to the perceptions and innate patterns of thinking.
The transformation of tacit knowledge into explicit knowledge is crucial because it provides an organisational view of knowledge rather than an individual view, which benefits the entire community. This is one of the key objective of the knowledge management. Thus, “knowledge management is the process of controlling or directing the creation, identification, organization, storage and dissemination, and maintenance of knowledge to support strategic goals” (Haney, 2006, p. 620). Such a KM environment in an organisation encourages the flow of knowledge among the employees and help them maintain a competitive advantage. This supports organisational learning and facilitate the flow of knowledge (Birkinshaw & Sheehan, 2002; Haney, 2006; Salisbury, 2008).
Organisational Knowledge: Evolution and Creation
The study of organisational knowledge is not a new discipline. Classical works of economists such as Edith Penrose and Fredrick Hayek and philosophers such as Michael Polanyi focused on the team work and the importance of organisational members’ knowledge to a firm’s economic processes (Easterby-Smith and Lyles, 2011). The most popular work emerges from the work of Nonaka and colleagues in the Theory of Organisational Knowledge Creation (Nonaka, 1994; Nonaka & Takeuchi, 1995; Nonaka, Toyama, et al., 2001). Their theory is based on the interaction of between tacit and explicit knowledge and that the organisational knowledge creation is derived from the interrelationship between the tacit and explicit. It emphasizes on knowledge creation on varying levels within an organisation such as individual, group and organisational. Nonaka and Takeuchi proposed a knowledge creating spiral and the knowledge conversion process to capture the individual knowledge and assimilate it to organisational knowledge.
Knowledge Conversion Model. According to Nonaka and colleagues, knowledge is created through the interaction between the explicit and tacit knowledge in four knowledge conversion processes referred as SECI model (Socialisation, Externalisation, Combination and Internalisation). This model illustrates how personal knowledge gets transformed into the organisational knowledge. That is, from tacit knowledge to tacit knowledge (Socialization), from tacit knowledge to explicit knowledge (Externalization), from explicit knowledge to explicit knowledge (Combination), and from explicit knowledge to tacit knowledge (Internalization).
Knowledge Spiral. Knowledge conversion is not a linear process, it is a continuous dynamic spiral through the four modes of knowledge conversion. Nonaka and Takeuchi refers elevation and movement of knowledge as the “cross-levelling” of the knowledge and they assert that the spiral starts from the socialisation through interaction. This build something where members of the organisation can share experiences and schema. Then through dialogue, externalisation happens where members express the tacit knowledge. Then the combination mode is activated by connecting previous and newly formed explicit knowledge. Then all the newly formed knowledge is applied and integrated in practice. Internalisation is triggered by “learning by doing”.
Tripartite layered model of knowledge creation. The SECI model is now part of a tripartite layered model of knowledge creation where all the elements must interact to form a spiral of knowledge creation (Nonaka, Toyama, et al., 2001; Nonaka, Toyama, & Konno, 2000). The other components of the model are “(b) ba, platforms for knowledge creation; and (c) knowledge assets, or the inputs, outputs and moderator of the knowledge creation process” (Nonaka, Toyama, et al., 2001, p. 493). Ba. According to Nonaka and colleagues (Nonaka & Konno, 1998; Nonaka, et al., 2001; Ikujiro Nonaka, Ryoko Toyama, & Noboru Konno, 2000), ba is a Japanese concept that basically means “place” in English and evolved out of the work of Japanese philosopher Kitaro Nishida and was later expanded by Shimizu. However, in the context of the tripartite model ba is defined as, “a context in which knowledge is shared, created, and utilized, in recognition of the fact that knowledge needs context in order to exist” (Nonaka, Toyama, et al., 2001, p. 499). Ba is crucial to the knowledge creation process and emphasize the importance of teams in creating shared context and it is through interaction in this shared context that new knowledge 28 emerges and knowledge moves from the individual to the organization (Ikujirō Nonaka & Hirotaka Takeuchi, 1995). Ba refers to place in the most generic sense and is not limited to a physical space, but includes virtual and mental space, as well as a combination.
Critical Success Factors
Studies (Cho, 2011; Gold, Malhotra, & Segars, 2001; Haney, 2006; Nonaka & Takeuchi, 1995; Nonaka, Toyama, et al., 2001) have identified several success factors that foster an organization’s effective iteration and management of the knowledge life cycle. These factors tend to span a wide range of organizational areas from people, culture, to technology. According to Haney (2006), there are seven critical success factors that must be considered when managing the knowledge life cycle: people, culture, technology, processes, structure, leadership, and measurement. Gold et al. (2001) proposed similar factors in the form of knowledge 35 capabilities. They group many of the factors mentioned by Haney (2006) under two broad categories of knowledge capabilities: Knowledge Infrastructure Capability (technology, structure, culture) and Knowledge Process Capability (acquisition, conversion, application, protection). Cho (2011) modified the KM capabilities framework proposed by Gold et al. (2001) by adding incentive under knowledge infrastructure capability. Nonaka and Takeuchi (1995) refer to the success factors as enabling conditions and posit that an organization must foster these conditions for knowledge to spiral effectively through the knowledge life cycle. The enabling conditions are intention, autonomy, fluctuation and creative chaos, redundancy and requisite variety.
HPT (Human Performance Technology) and IDT (Instructional Design and Technology)
Some definitions of IDT allow one to see a clear distinction between the two fields, with IDT being focused on instructional solutions and HPT being more general to performance improvement (Gustafson & Branch, 2002; Smith & Ragan, 1999). However, other definitions incorporate HPT into the definition of instructional design making it difficult to see a distinction (Rothwell & Kazanas, 2008). This could be since “trainers are transitioning away from their traditional role of emphasizing instructional solutions and moving toward solutions designed to address the root causes of performance problems” (Rothwell, Hohne, & King, 2007, p. 13). The International Society for Performance Improvement defines HPT on their website as: A systematic approach to improving productivity and competence uses a set of methods and procedures — and a strategy for solving problems — for realizing opportunities related to the performance of people. More specific, it is a process of selection, analysis, design, development, implementation, and evaluation of programs to most cost-effectively influence human behaviour and accomplishment. It is a systematic combination of three 39 fundamental processes: performance analysis, cause analysis, and intervention selection, and can be applied to individuals, small groups, and large organizations. (ISPI, 2012) In defining HPT Klein (2010) highlights the link to IDT by stating that, “human performance technology (HPT) expands the scope of instructional design and technology (IDT) by employing the systems approach to address a problem or realize an opportunity” (p.135).
HPT model. The HPT model (see Figure 8) is proposed by researchers (Haney, 2006; Massey et al., 2005; Schwen et al., 1998) as an effective framework to study KM practices in a 40 organization and has been successfully used to study knowledge flow, structure and patterns in organizations. The HPT model was initially designed by Deterline and Rosenberg and was published in 1992 by the International Society for Performance Improvement (ISPI). The model acts as a guideline for practitioners, providing them with specific things to do, illustrating feedback loops, and focusing on examining the interrelationships that exist among various organizational factors (Van Tiem, Moseley, & Dessinger, 2000).
Performance analysis of need or opportunity. The performance analysis of need or opportunity stage, as the current HPT model (Figure 8) illustrates, includes organizational analysis, environmental analysis, gap analysis and, cause analysis. In performance analysis, the HPT practitioner investigates the current situation in the organization. This involves learning about the organization’s culture, policies, processes, and exactly what is happening. The practitioner also tries to capture the desired situation and expectations. Therefore, the performance analysis phase focuses on three primary areas: ascertaining the current performance state of the organization, the desired 43 performance state and the gaps between desired and actual performance (Rothwell, 2000; G. Rummler & Brache, 1995; Van Tiem et al., 2000). Environmental factors are also examined, since they impact performance as well.
Critical incident technique. CIT is a cognitive task analysis method (Crandall et al., 2006; Hanson & Brophy, 2012). CIT has its roots in Industrial Organizational Psychology since World War II where it was developed by John Flanagan who used it to analyze 50 success and challenges of aviation training (Butterfield, Borgen, Amundson, & Maglio, 2005; Flanagan, 1954; Hettlage & Steinlin, 2006). Since its inception over fifty-years ago, CIT has evolved and is recognized as a very reliable and valid tool for qualitative investigations (Butterfield et al., 2005; Chell, 2004; Chell & Pittaway, 1998). CIT does not refer to a strict specific set of rules, but the methodology is governed by principles that must be adjusted to meet the needs of the context and subject being studied (Flanagan, 1954) The main principles are that facts surrounding an incident can be effectively studied through collection of various perspectives, and data should only be collected regarding activities that have proven to have a significant impact on what is being studied (Flanagan, 1954). CIT also helps with eliciting authentic information; as interviewees become immersed in their narratives they tend to give detailed responses and not what they think the interviewer would like to hear and in the process, tacit knowledge is evoked (Hettlage & Steinlin, 2006).
Chapter 3: Review of KMS
Studying SHD through the lens of the knowledge life cycle approach allowed for a detailed understanding of the flow of knowledge and the identification of the KM gaps. This case study therefore, validates using this approach for other organizational case studies that aim to investigate knowledge flow within an organization. The iterative and interconnected nature of the knowledge life cycle was confirmed, as well as the importance of systems and processes that facilitate the entire knowledge life cycle. All phases must be facilitated for efficient KM to occur and by extension organizational learning (Alavi & Leidner, 2001; Argyris & Schön, 1996; Dalkir, 2011; Nonaka, 1994; Salisbury, 2008, Van Tiem et al., 2012). The knowledge life cycle is enabled by both individual and environmental factors in a system that integrates KM and its core work processes (Dalkir, 2011; Nonaka, 1994; Salisbury, 2008; Van Tiem et al., 2012). The process of “making” connections through the knowledge life cycle is quite like the principles of the Theory of Organizational Knowledge Creation (Nonaka, 1994; Nonaka & Takeuchi, 1995; Nonaka, Toyama, et al., 2001).
Knowledge life cycle and the theory of organizational knowledge creation. The knowledge life cycle as observed in SHD, is a constantly renewing cycle where existing knowledge is built on to form new knowledge. The way the flow of knowledge occurred through making internal and external connections within a shared space, or as a “connecting platform,” aligns with Nonaka and colleagues’ (Nonaka, 1994; Nonaka & Takeuchi, 1995; Nonaka & Konno, 1998; Nonaka et al., 2000; Nonaka, Toyama, et al., 2001) SECI conversion model and the concept of ba. The SECI conversion model is based on the premise that knowledge is created through various conversion modes between tacit and explicit knowledge (socialization, externalization, combination, and internalization), as individuals interact with each other within a shared space called ba. The whiteboard was very central to the knowledge flow of SHD and enabled all the knowledge conversion modes which facilitated movement along the knowledge life cycle.
- It was evident that the technicians had a lot of tacit knowledge. In trying to explain the problems, they could articulate the reasons behind the actions. This is a form of what Nonaka & Takeuchi (1995) call externalization, where tacit knowledge is converted to explicit.
- Externalization was also seen whenever a technician wrote on the whiteboard.
- An example of Nonaka & Takeuchi’s (1995) idea of internalization (explicit to tacit) was when a technician wrote something on the whiteboard and another technician integrated that knowledge to solve a new problem or even connected the ideas to what was already done to find a solution. This is also an example of the knowledge life cycle occurring, with the application of preserved knowledge that has been disseminated being used to create new knowledge. This indicates the iterative and interconnected nature of the knowledge life cycle.
- Combination (explicit to explicit) was evidenced when information was combined on the whiteboard and then used to create a website tutorial or add to the wiki, enabling creation, dissemination and preservation.
- Socialization was also evident; Nonaka and colleagues highlight that for socialization to occur, there must be some shared experience and this is in fact where the knowledge creating spiral begins. Working on trying to solve critical incidents together created a shared experience for SHD members and having the whiteboard and an open area in which to work, their “ba”, fostered this. The comment by the supervisor that he had learned more from the technicians than he had from any explicit source aligns with socialization.
It also highlights that not all knowledge can be captured explicitly in an organization, but by having a shared space or environment that connects members with various expertise in the organization knowledge flows (Dalkir, 2011; Rosenberg, 2012; Salisbury, 2008). In the context of SHD, this worked through asking for help and extending help, which were influenced by awareness of expertise. As Salisbury (2008) points out, organizational knowledge is complex and platforms are needed to connect people for organizational learning to occur. Salisbury (2008) asserts that organizations can manage the knowledge through “direct connection [emphasis added] between two or more people or by facilitating processes where those who need to know something can be connected [emphasis added] to those who know it”. From the discussion above a relationship between the knowledge life cycle and the Theory of Organizational Knowledge Creation (Nonaka, 1994; Nonaka & Takeuchi, 1995; Nonaka, Toyama, et al., 2001) was established. This relationship was hinted on in Salisbury’s (2008) article where he proposed a Collaborative Cognition model that integrated the knowledge life cycle as an extension of the SECI knowledge conversion model (socialization, externalization, combination, internalization).
Moreover, the Theory of Organizational Knowledge Creation (Nonaka, 1994; Nonaka & Takeuchi, 1995; Nonaka, Toyama, et al., 2001) useful in explaining the “how” of the knowledge life cycle confirms that viewing an organization’s KM activities through the lens of the knowledge life cycle is not sufficient on its own to describe the dynamics of KM in an organization, as Dalkir (2011) points out: From a practical perspective, in order to manage knowledge, it is also necessary to have an organizing principle-a framework-to classify the different activities and functions needed to deal with all the knowledge-related work within and between organizations. This framework is often encapsulated in the form of a theory or model of KM. Thus, organizations and/or researchers wishing to use the knowledge life cycle approach to study an organization should be sure to complement it with a KM theory or model that matches the context studied.
Impact of individual and environmental factors. Several authors have posited that KM involves multiple factors to be effective, which include, culture, leadership, and technology, as well as others (Cho, 2011; Haney, 2006; Mertins et al., 2001; Nonaka & Takeuchi, 1995; Rosenberg, 2012). The findings from this study indicate that complementary individual and environmental factors are needed for effective KM to occur. Nonaka and Takeuchi (1995) specifically address five enablers to navigating the knowledge life cycle: intention, autonomy, fluctuation and creative chaos, redundancy and, requisite variety. SHD exhibited intention and autonomy through its culture, mission, vision, and leadership. For example, SHD’s visions of having a system for “consolidating” their knowledge, is an example of intention. The culture proved to be a positive one that enabled the workers to work together and exercise a level of autonomy which led to knowledge creation. Nonaka and Takeuchi (1995) speak of fluctuation and creative chaos as vehicles for creating knowledge. One characteristic of this is to have some form of structure, but with room for comfort with ambiguity. SHD has a systematic way of doing things, as seen in their various processes. However, by dealing with critical incidents, fluctuation is created and creative chaos begins, thus leading to knowledge creation. Nonaka and Takeuchi (1995) emphasize that creative chaos can only work if people are reflecting while acting and this may explain why SHD did not go in a state of panic whenever a critical incident occurred, as the whiteboard system allowed them to “reflect while in action.” According to Nonaka and Takeuchi (1995) redundancy refers to organizational members having a shared repertoire through repeated engagement in similar activities. This was evidenced through the training sessions, and access to the wiki and other knowledge bases. Redundancy was also created through disseminating information on the whiteboard which was visible and central. The other enabler is requisite variety, which refers to having varying skillsets among workers. This was the case for SHD; all the workers had the basic technical knowledge and skillset that was needed in addition to their varying skills. It is commendable that both environmental and individual factors that enable movement along the knowledge life cycle were evidenced in SHD. This is in line with the literature that purports that these factors will influence how knowledge flows and will affect any implementation of a KM system or changes to an existing one (Cho, 2011; Gold, Malhotra, & Segars, 2001; Haney, 2006; Nonaka & Takeuchi, 1995; Nonaka, Toyama, et al., 2001).
Alignment between core work processes and the knowledge life cycle. For knowledge to spiral through an organization, the connecting platform must not only connect the workers and their processes, but should also ensure that the processes of the knowledge life cycle are connected (Dalkir, 2011; Heisig, 2001; Rosenberg, 2012; Salisbury, 2008). SHD’s biggest challenge, as seen from the data, is tying the phases together. If the phases are fragmented then the value is lost. This situation is not unique to SHD. According to Heisig (2001), KM activities are integrated in the day to day activities and so it is not normal for tools and processes to be geared towards creating, disseminating, and preserving knowledge, rather they are designed to accomplish various work related task. Heisig (2001) provides an example of the results of such disconnection between the knowledge life cycle and core work tasks that is applicable to SHD, that of a database being built, but not used by members or lessons learned are not generated from the application of knowledge. The whiteboard worked for SHD as it provided the interconnectivity between the core processes and the knowledge life cycle. One core process of SHD is to find solutions for computer problems and the whiteboard provided a way for that knowledge to be created, disseminated and temporarily preserved. However, it was not as effective as it could be, due to limitations of space and permanence. Birkinshaw and Sheehan (2002) highlight that there is value in studying organizational knowledge from a life cycle perspective because it gives an opportunity to see where the strengths and weaknesses of an organization are and strategize accordingly. The results of such an analysis would reveal the level of connectivity and identify gaps between KM strategies and core processes of the organization. Based on the evidence provided, SHD does a very excellent job at creating knowledge, but its weakest area was preserving knowledge in a form that could be integrated with its existing processes, so that it can be applied and fed back into the knowledge life cycle. Knowledge was preserved in the “heads” of organizational members. However, because these are student workers and some workers are temporary, there is a risk that information may not be passed on. As Argyris and Schön, (1996) point out, organizational knowledge gets lost if the only holding place is in the heads of its members; preventing true organizational learning from occurring. SHD’s most pressing need seems to be environmentally related in the form of a technology tool. Although there could be possible improvements with regards to individual capability such as searching for information more effectively, the technicians demonstrated that they possessed the dominant knowledge, skills, and capabilities to effectively perform their tasks. All the intersecting fields of this research: KM, IDT, HPT, and organizational learning share the tenet that technology should not be selected without first examining the context in which the system will be used.
Chapter 4: Critical Discussion
SHD was the population for this case study and thus by working for SHD all consenting employees were potential participants of this study. This case study adopted a phasic approach and participants varied primarily by participation in the Critical Incident Analysis, and Understanding the System phases of this study. Significant amount of the contextual information was collected from the leadership team comprised of the director of information technology, the manager of information systems and the SHD supervisor. In the framework influenced by HPT that was used for data collection and analysis of this study, the Understanding the System phase was broken down into Organizational Analysis and Environmental Analysis. Organizational Analysis aimed primarily at ascertaining the vision, mission, goals and strategies of SHD and more specifically the vision as it pertains to KM, while Environmental Analysis zoomed in on the reality of SHD and how things are done especially with regards to KM.
Organizational analysis summary. SHD is a growing organization with visions of expanding services. One of their distinguishing features is that they ensure that all problems are fixed; if they can’t fix it they will refer the student to someone who will fix it. Their motto of “to work on it until it’s fixed” helps them in meeting their measure of success, which is that students have technology they can use in class. The leadership structure may be described as middle-top down as the supervisor reports to the manager and the manager reports to the director. Despite varying hierarchal levels the director, supervisor, and manager work as a team. Planning is done together in a form of brainstorming meeting. Regarding KM, SHD has a vision of using technology to integrate their KM processes and make the process more seamless and efficient
Environmental analysis. The main body that influences the operations of SHD is the college’s council that determines the computer requirements. They have an input in determining the requirements and the director is a member of the council. A genuine interest in helping others and autonomy and input were two dominant themes that emerged in describing SHD’s culture and was seen at all hierarchical levels of the organization. SHD ensures that the technicians hired are in line with their culture and possess more than just technical skills. SHD has several technology and non-technology resources in place that enable them to work efficiently. Among the technology resources/systems are a log in system and file server, and among the nontechnology resources/systems are two whiteboards and an information sheet.
Summary of Critical Incident Analysis. For the Critical Incident Analysis phase of this study data was collected using CIT for a focus group session, in Summer, 2013, and for individual interviews with technicians in Fall, 2013. The focus group session provided baseline data of previous experiences with critical incidents. In Fal1, 2013 11 critical incidents were reported and a total of 19 individual reports were collected for the 11 incidents. The nature of the uncommon problems varied in complexity. Eight technicians and the supervisor participated in the Fall, 2013 Critical Incident Analysis 111 interviews. Fifty percent of the technicians who participated were involved in 2 or more incidents. From the descriptive coding analysis of the sub-codes for each category of the knowledge life cycle (create, preserve, disseminate) it was revealed that SHD’s primary way of creating knowledge was through “going about connections” which included making deductions using heuristics, technical knowledge, and so on. Other means included consulting with other technicians, brainstorming on the whiteboard, searching online, and getting more information from the customer. The descriptive coding analysis also revealed that the primary means of preserving knowledge were through using the information sheet and the whiteboard. The primary means for disseminating knowledge was via “word of mouth” and the whiteboard. The close relationship between preservation and dissemination was the whiteboard ranked high for both categories.
SHD’s primary way of going through the knowledge life cycle was through making connections. With the technician being the unit, those connections may be internal, which refers to the cognitive steps of connecting prior experience and technical skills to solve a problem and/or external, which involves other technicians and other sources of information. The move from internal to external usually takes place by asking for or seeking for help as well as extending help. Asking for or seeking help is an action generated by the technician that is dealing with the problem and extending help is an action that is generated from another technician. Despite the method of connection, there is usually a process of making deductions that lead to the solution. These processes primarily describe the creation phase of the knowledge life cycle; however, the process was iterative and evidence was seen of new knowledge being built on old knowledge; in this case those connections were made primarily through dissemination of previous knowledge that was preserved in the “heads” of technicians that were around when the relevant knowledge was generated. On a bigger scale, with the organization being the unit, distinct phases of the knowledge life cycle were connected through various platforms. The whiteboard was the predominant one where knowledge was created, disseminated and preserved. When the whiteboard was not used, the office space acted as a connecting platform, but primarily for creation and dissemination. The wiki was used primarily for knowledge preservation with an intention for long term dissemination. Email and the website were primarily used to disseminate information to outsiders as deemed necessary and on some occasions to the technicians. Figure provides a visual representation of how the technicians went through the knowledge life cycle through making internal and external connections which were facilitated by various connecting platforms.
SHD’s driving forces may be divided into individual and environmental factors. Individual factors refer to the technicians’ knowledge, skills and capacity. The technicians had sufficient knowledge and skills to effectively solve uncommon problems; additional, they were intrinsically motivated to go through the knowledge life cycle processes. Environmental factors include SHD’s culture and mission, leadership, resources, tools, and processes. The mission of SHD is for all students to have technology they can use in class. Their motto, “to work on it until it’s fixed” supports the mission and dictates that students with complicated or uncommon problems will not be turned away during “rush”, thus triggering the creation phase of the knowledge life cycle. The culture of genuine interest in helping others is in alignment with SHD’s mission and not only refers to technicians helping students, but also helping each other which facilitated external connections with each other to solve a problem. With regards to leadership, having a supervisor for the office who was actively involved with the day to day operations drove the flow of knowledge along the knowledge life cycle, as knowledge was disseminated to him in many cases when it was not disseminated to anyone else. In addition, supervisor was the main person that added items to the wiki, so in this case, in the capacity of supervisor, he also acted as knowledge manager. The resources, tools, and processes drove the flow of knowledge along the knowledge life cycle as they acted as connecting platforms where knowledge could be created, preserved, and disseminated. Having a systemic way of going about the knowledge life cycle resulted in a shared understanding and thus increased the likelihood that the cyclic nature of the knowledge life cycle would occur.
SHD’s restraining forces to going through the knowledge life cycle during rush primarily fell under the category of environmental factors, with a lack of time and a fragmented system being major restraining forces. Time dictated the extent that the solution for a problem was pursued and it also influenced how the knowledge was disseminated and preserved, if at all. Although the whiteboard proved to be the most effective system for knowledge creation, dissemination, and to some extent preservation, it had limitations, in terms of space and organization. The whiteboard got full, sometimes the information was erased, and at other times it was hard to locate a specific issue. In addition, the whiteboard was mostly used for certain types of problems. The other KM systems included the information sheet and the wiki. These systems were primarily used for preservation, and had limitations as well. Since they were not easily accessible, and information was not easily retrieved, they were not used often by the technicians. At no point did these systems intersect, resulting in a fragmented system. The biggest challenge that the technicians reported was a lack of a system that documented what previous technicians did in a way that was easily retrievable.
Chapter 5: Conclusion
KM is indeed a complex issue for professionals who would like to make an impact as well as the organizations they work with. This study highlighted the value of studying knowledge in the context of an organization. Using the knowledge life cycle approach and the Theory of Organizational Knowledge Creation (Nonaka, 1994; Nonaka & Takeuchi, 1995; Nonaka, Toyama, et al., 2001) to guide the inquiry resulted in an in-depth understanding of the knowledge flow as it relates to critical incidents. The system/ tool that was most effective for SHD was the one that was most accessible and convenient. Importantly, the system/tool was also the one that was involved in the technicians’ core work process of finding solutions to problems, and facilitated their core method of making internal and external connections. This emphasizes the importance of integrating the KM system with the work processes of the organization, and ensuring that environmental constraints are accounted for, like a lack of time due to high demand for service. For SHD, KM challenges were seen with system restraints that were not accessible, and that did not effectively consolidate information from one source to another, with the biggest need being for a system that complements the core work process and links information that customers provide with the technicians’ knowledge solutions and troubleshooting processes. SHD did not seem to exhibit many of the cultural and organizational barriers that are seen in many organizations; however the fact that evidence was seen of where these factors acted as driving forces for the knowledge life cycle may provide examples to other organizations of how to develop an organizational environment that fosters knowledge flow, such as having a culture that encourages working together or “helping others”, a KM intention or vision, and hiring workers who are intrinsically motivated and value the mission of the organization. KM professionals can use these findings to inform solutions for similar environments. This study also acts as a model for similar studies that would like to investigate how knowledge flows within organizations.
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time. The study was descriptive because it seeks to describe the knowledge of the community members (population of reproductive age) towards prevention of STI as it exists at the time of study. It was also aimed at gathering data without any manipulation of the research context. Its non-intrusive and was with naturally occurring phenomena; the community attitude towards prevention of STIs.
3.2 Study Area
The study was carried out in Ademasajida town, Ademasajida location. This is a residential and a commercial area where local residents reside. According to the National census 2009, Ademasajida had a population 23432 of which majority are youth.
3.3 Study Population
The study population included men and women of reproductive age who are residents of Ademasajida town.
3.4 Inclusion and Exclusion Criteria
3.4.1 Inclusion Criteria
The study included men and women of reproductive age (15-49) who are residents of Ademasajida Town who consented to participate in the study. According to the last 2009 Census the number of people at the ages of 15-49 stands at 7921.
3.4.2 Exclusion Criteria
Those excluded from the study was men and women who are above reproductive age and who are not residents of Ademasajida Town or those not willing to participate in the study.
3.5. Sample Size and Sampling Technique
3.5.1 Sample Size
The sample size will be calculated using the standard sample size calculation formula by Mugenda and Mugenda, (2003). nf= N1+Nn Where: N = z2 pqd2 nf = desired sample size where population is less than 10,000 P = The proportion of the target population estimated to have a particular characteristics being measured in this case proportion of men and women with STIs taken as 40% (0.4) z = Standard normal deviation which is 1.96 at 95 % level of confidence. q = 1 – p = 1-0.4 = 0.6 d = Degree of accuracy desired is 0.08 N = 1.962×0.4× 0.60.082 = 150 Therefore nf = 1501+1507921 = 147.20 = 147 respondents
3.5.2 Sampling Technique
The sampling technique used was simple random sampling. This was to ensure there was no bias as it’s based on statistical methods and can be subjected to statistical analysis thus giving reliable results.
3.6 Study variables
The dependent variable was the measures taken by men and women of reproductive age (15-49 years) in prevention of STIs The independent variables include: Age, level of education, beliefs and occupation.
3.7 Data collection procedures
A questionnaire was be used to collect data. The questionnaire entails close ended questions. The questions are based on the specific objectives to ensure that the researcher meets the broad objective of the study.
The questionnaire was pre-tested in Ndege- Wajir South where 15 community members (10% of the sample) was given the questionnaire to fill. This is because Ndege has a similar population as Ademasajida Town. Adjustments will be done to ensure validity and reliability of the questionnaire.
3.7.3 Data Collection Process
This employed both self-administered and researcher administered methods. In self-administered the community members was given the questionnaire to fill and then return upon completion. The researcher administering questionnaires was appropriate to ensure that community members of the different levels of education were catered for including those who can’t read for themselves. The researcher took the initiative of ensuring that translation was done for the respondents who can’t read for themselves.
3.8 Data Management and Analysis
Presentation of quantitative information was done using statistical packages (tables and pie charts). Data categorization and coding was be carried out during preparation of questionnaires. Each data collected was entered, coded and keyed into variables using Microsoft office Excel. Quantitative and qualitative data was analyzed using Microsoft Office Excel.
3.9 Study Limitations
Financial constraints which led to selection of a small sample size which may not be a true representation of the whole population. This was countered by using a good sampling technique that ensured equal chances of respondent selection.
3.10 Ethical Considerations
- A letter of introduction from Kenyatta University was obtained by the researcher from the Environmental Health department.
- Permission from the Ademasajida sub-location chief who was informed about the study.
- Informed consent was obtained from Ademasajida community members fitting in the research study.
- Confidentiality and respect was maintained throughout the research process.
- Feedback was given after the study was over to the relevant administration.
CHAPTER 4: DATA ANALYSIS AND PRESENTATION
The purpose of this study was assessment of knowledge status on Prevention of sexually transmitted infections among population in Reproductive age in Ademasajida town Wajir West Sub County. The respondents were aged between 15-49 years.
The researcher administered 147 questionnaires to Ademasajida town residents and 136 respondents returned the questionnaires after filling. This represented 92% response rate to the study. This chapter represents the study findings. The data was analyzed using Microsoft Office excel and the data findings were presented in form of tables, pie charts, bar graphs, line and circle graphs. Percentage calculations on the responses were also done to clearly bring out comparisons on answers to the questions that were being asked during the study. Respondents comprised of 81 male respondents and 55 female respondents. Eleven respondents did not return the question papers used for data collection process. The Table below shows respondents met during the study. Table 4.1 Respondents Sex
Source: field data( December 2016) It was observed the male respondents met are larger in number than their female counterparts, which may indicate the number of male population is higher than female in Ademasajida town . It can be also deduced that the workforce of Ademasajida Town are male dominated.
4.1.1 Age Demographics
The majority Fifty two percent (n=71) of the respondents met were between ages of 15-25 years. 34% (n=46) of respondents were between ages 26-35 and ages 36-49 had 14%. (n=19) of total respondents. . Source: field data( December 2016) Figure 4.1.1 Age of the respondents
4.1.2 Marital Status
On marital status, majority 54% (n=73) of the respondents were single. Those married were 23% (n=31) while 12% (n=17) were separated and 11% (n=15) were widowed. Most of the residents of Ademasajida are youths who cited lack of job as a big role in this people’s inability to marry. Some are still students who are committed in studies and have no time to marry. Source: field data( December 2016) Figure 4.1.2 Marital status of respondents
On religion, majority of Ademasajida Town profess Muslim faith. The areas situated in North Eastern region of Kenya is usually dominated by the Muslims. Of the total respondents, 81% (n=110) indicated that they were Muslims .Catholics account for 10% (n=14,) Protestants were 4% (n=5) while 5% (n=7) said they were neither of the above faiths. Source: field data( December 2016) Figure 4.1.3 the religious status of respondents.
4.1.4 Level of Education
Literacy level is high among the respondents and stands at 92% (n=125) . This area is quite accessible to the education facilities since independence. There are many schools(primary and secondary schools) either public or private situated close or in the area. Those with post-secondary school qualification( diploma and degree) studied from distant places like Nairobi and other towns with higher institutions like colleges and universities. Most of those with post-secondary school qualification are working in the county government as accountants ,health workers,etc . Those who said they have never gone to school were older people involved in shop keeping and casual works mostly aged above 35 years. 23 percent (n=31) of the respondents indicated that they had graduated from secondary school while 21% percent (n=29) are either pursuing or graduated with Diploma and those with Degree are 6 %( n=8). Only 8% (n=11) of the respondents said they did not go to school and 42 %( n=57) reached primary level. Source: field data( December 2016) Figure 4.1.4 level of education of the Respondents
Majority of the respondents said they are not employed 54% (n=73) and the self employed are 26% (n=36) and those employed by other people are 20 %( n=27) Source: field data( December 2016) Figure 4.1.5 Occupation of the Respondents
4.2.0 HEALTH KNOWLEDGE ON STIs.
To find out health knowledge on STI, the study used various questions directed to gather information whether the community have an understanding of STI and its health risks. Those who responded positively to the question whether they have heard or aware of the Sexually Transmitted infection conditions are 82% (n=112) those who said they are not aware of STIs are 16 % (n= 24) Source: field data( December 2016) Figure 4.2 Awarenesson STI
4.2.1 Response of transmission routes of STIs
All respondent knew the way in which STIs is transmitted from one person to another. This is again influenced by the level of education of the youth. The main route of STIs transmission cited by the youth was unprotected sexual intercourse with an infected person (65%). This knowledge makes the youth to avoid unprotected sexual intercourse hence contributing to the prevention of STIs. This was followed by having many sexual partners (21%). The youth were aware that engaging sexual relation with many sexual partners is a risky behavior of contracting STIs hence they tend to avoid it and instead have one sexual partner. Having many sexual partners is a risk behavior for contracting STDs easily (Kann and Kinchen, 1999). The youth had little knowledge on other ways in which STIs is transmitted. This included blood transfusion (15%), infected needles (13%) and mother to child transmission (8%). Table 4.2.1 Response on Transmission routes
|ROUTES||Number of times each box was ticked||PERCENTAGE|
|Unprotected sexual intercourse||89||65%|
|Mother to-baby transmission||11||8%|
|Many sexual partners||28||21%|
Source: field data( December 2016)
4.2.2 Source of information on STIs
The percentage of respondents who said they got the information on STIs from Books are 23 %( n=31) while those who get their information form hospital staff and brochures are 10 %( n=14). 16% said the vital information is shared with them by friends which are 22 respondents. Media account for the largest sources of information 51% which stand for 69 respondents. Source: field data( December 2016) Figure 4.2.2 Source of information on STIs
4.2.3 The various sexually transmitted infections known by the respon dents.
Table 4.2.3 STIs known to the respondents
|DISEASE||Frequency out of 136 respondents||Percentage|
|Human papilloma virus||8||31%|
Source: field data( December 2016)
4.2.4 Asked whether the respondents have ever suffered from STI
Majority 54% (n=73) responded they have never suffered from the various disease ,but 46% said they caught the disease. Table 4.2.4 Whether respondents have ever suffered from STI
4.2.5 Number of times respondents suffered from any STI infections in the last 5 years
The study seeks to know how many times those who responded they have suffered, had suffered from the infection in the previous 5 years. Those who said suffered once are the majority 27%(n=18) while those who responded twice 20%(n=13) .14% (n=9) suffered three times, 21%(n=14) had the disease 5 times while more than 5 times stand at 18%(n=12) which bring total of those who suffered in the last 5 times to 66. Those not applicable to respond are 73 in number. Source: field data( December 2016) Figure 4.2.5 Frequency suffered in the last 5 years from STIs
4.2.6 Symptoms suffered by those respondents who said they had STI previously
Table 4.2.6 Symptoms of STIs suffered
|RASH IN THE GENITALS||10||11%|
|ITCHING IN THE PRIVATE PARTS||12||15%|
|DISCHARGE FROM THE GENITALS||9||11%|
|PAIN DURING THE SEX||11||13%|
Source: field data( December 2016)
4.3 Preventive measures against STIs
Majority of the respondents said they employ all the preventive measures mentioned combined like abstinence, use of condoms, knowing partners status and finally being faithful to partners. Those who said they prefer abstinence before marriage are 26%, while those who used condoms are 20%. Being faithful to partners and knowing partners status garnered 12% and 14% respectively Source: field data( December 2016) Figure 4.3 Preventive Measures used by Respondents
4.3.1 Frequency of checking STI status at the clinic
32% of the respondents stated that they check their status once in a year while 22% of the respondents confirmed to check their status more than twice in a year. 14% scarcely check their status posing risks of STIs. Some of the respondents check their status whenever they suspect symptoms of STIs(13%) and 19% of the respondents can’t remember the frequency they check their status. Table 4.3.1 Frequency of checking STI status at the clinic
|Frequency||Number of people||Percentage|
|Once in a year||43||32%|
|More than twice a year||31||22%|
|Whenever I suspect the symptoms of STI||17||13%|
Source: field data( December 2016)
4.3.2 Is there any Campaign done regularly to Educate the public on STIs
Those who said Yes are 72% (n= 98) and those who claimed there are no enough campaign done to educate the public are 28% (n=38) Source: field data( December 2016) Figure 4.3.2 Response if there is regular campaign done
4.3.3 Who spearhead the campaign to teach the public against STIs
Majority believe that government agencies should spearhead campaign against STIs(33%), Non-Governmental Organizations is preferred by 15% of the respondents, 13% chose CBOs, Health workers got the nod of 21%, educational institutions such as universities was selected by 6% of the respondents while 12% of the respondents chose other appropriate agencies like religious leaders to spearhead the campaign against STIs. Table 4.3.3 Who should spearhead the campaign to teach the public against STIs
|Who should do the campaign||Number of people who responded out of 111||Percentage|
Source: field data( December 2016)
4.3.4 Whether knowledge given on prevention of STI is adequate
Majority have disagreed (30%) that adequate knowledge given to the youth in Ademasajida Town area, with 15% agreed and 24% strongly disagreed. 15% agreed with the statement and 14% strongly agreed while 17% are not sure how adequate is the teaching campaign done. Source: field data( December 2016) Figure 4.3.4 Whether knowledge given on prevention of STI is adequate
4.3.5 (a) Ever lost a colleague to STI
For those who responded Negatively to this question are 68 %( n=92). Those who responded positively are 44 people which represent 32%. Source: field data( December 2016) Figure 4.3.5 Ever lost a colleague to STI (b) If yes from which infection 40 people responded and 4 avoided ticking the questionnaire. 33% of the respondents stated that they lost a colleague to HIV/AIDS, Gonnorhea(15%), syphilis was represented by 13%, Trichomanalis 21%, vaginalis was selected as the killer by 6% and chancroid 12% Table 4.3.5 Lost a colleague from STI infection
|Infections||Number of people responded out of 40||Percentage|
Source: field data( December 2016)
4.3.6 Who do you confide in?
It’s understood that sexually related infection are stigmatized and the victims tend to keep close to their heart to avoid embarrassment. Most respondents said that they are comfortable to confide in health workers (32%), spouse (22%), siblings (15%) and parents (15%).those that had close ties and believe in the input of peers and religious leaders tied at 8% apiece. Source: field data( December 2016) Figure 4.3.6 Who do you confide in
4.3.7 Which complications have you heard STI lead to?
Source: field data( December 2016) Figure 4.3.7 complications you have heard STI lead to
4.3.8 Most vulnerable groups
Most of the respondents belief the most vulnerable groups are sex workers which account for 53 %( n=72) and Adolescents at 17%. College students 10% and slum dwellers are 11%. Uncircumcised male and health workers are believed by respondents to be least vulnerable groups to be victims of the infectious disease scoring 3% and 6 % respectively. Source: field data( December 2016) Figure 4.3.8 Most vulnerable groups
4.3.9 Who will lead the campaign against STIs?
When asked of opinion who should lead the campaign in effective public education, the respondents are divided on the best route to be used. Majority preferred Media outlet 46 %( n=63) as the best channel. 19% belief that political leaders can play much bigger role than religious leaders, which got the nod of 8%. Others belief youth groups 13% and teachers 8% can involve in the teaching of different groups of the community and parents role represents 6% Source: field data( December 2016)
Figure 4.3.9 Who will lead the campaign
CHAPTER 5: DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS
According to the results established for this study, most of the population in reproductive age who participated in this study were between 15 and 25 years, majority were Muslims (81%), single (54%), unemployed (54%) and had gone up to primary school (42%).The socio-demographic status had some influence on young people’s knowledge on prevention about sexually transmitted infections . Most of the young people who had gone up to post primary school had more information about the infection, symptoms, complications and medico-conservative management ; they had gotten the information from their media(51%) and through reading from books 23% both syllabus and health information publications.
5.1.1 The ways that contribute to transmission of infection from one person to another among population in Reproductive age
The research showed that the major transmission routes are through unprotected sexual intercourse from infected person to healthy person which account for 65%. 21% of respondents pointed out that many sexual partners also play a bigger role in the spread of the disease. Blood transfusion from an infected donor to a recipient, before thorough screening of the blood at the laboratory during blood transfusion doesn’t help either. Not using condom, misuse or re-use of it can compromise its effective prevention of the disease. Mother to baby transmission during delivery and breastfeeding has led to spread of the disease in the younger generation. Infected needles used at the hospital for injection and poor hygienic body conditions are the least cause of the disease may be due to careful sterilization of the needles and observation of hygiene by the young people. Hygiene on the reproductive organs are very important as well as it’s vital on the whole body like skin, oral cavities etc. Lack of enough hygiene care can cause skin disease skin and other bacterial infections that colonize the mucosal membranes. Maintainace of cleanness is important in women in reproductive ages during menstrual flow, during pregnancy and post delivery time. Pre and post sex hygiene care is vital for couples during intimate sexual intercourse actions.
5.1.2 Source of information for STIs and the STIs known to the respondents
The study found out that most young people get information from media(51%) on the update of the breakout of the disease ways of avoiding and its symptoms. Most of the media network had been informative bringing programs on health matters and interview with specialist on the various infections and disease. 100% of the respondents understand the disease and the enormous consequences of catching HIV/AIDS and its implication on the health of individual, society and the economic impact on the country. Gonorrhea 87% and syphilis 73% follow the list-of-the-known as the diseases most understood after HIV/AIDS. Most of the people who have not pursued any medical courses do not understand much about the disease like Human Papilloma Virus (HPV) 31%, Vaginalis 6%, Chancroid 10% and chylamiydia 7%.Government agencies and health workers remain vital source of information which combines their effort to rack up to 54% in the responses belief. Community based organization and Non-governmental organization 13% and 15% have scored below par belief with respondent though they are the institution which could have been close to the grassroots which clearly indicate that there is a gap in community cohesion. They are indispensable in spearheading in educating the community members on such important topic. A key part of prevention efforts is to offer HIV testing so that people can know their status and take steps to protect themselves and others. If they are negative, they can be counseled about safer sex and the need for regular screening for HIV and other STIs. If positive, they can receive counseling and swift referral for medical monitoring and discussion about the benefits of starting treatment for their personal health. Another benefit of treatment is that it reduces the amount of HIV in a person’s blood and genital fluids, thus reducing their sexual infectiousness. Social networking- The popularity of electronic social networking sites and so-called smartphones has resulted in the growth of virtual communities that are ripe for communicating messages about healthier living, including STI prevention. Such sites and technologies are used by some people to find sexual partners, therefore they are of growing importance for the encouragement of healthy behaviours.
5.1.3 The symptoms suffered by those infected by sexually transmitted infections
Usually the symptoms alert the sick individual to seek medical attention from the nearest hospital. The symptoms are also useful in diagnosing the condition and separating from the differentials that may cause confusion in the right diagnosis. The ability to identify the specific symptoms from any other disease can help the young people to seek the specific treatment and avoid development of complications. Fever 29% is the symptoms that the respondents said affect them because of the inflammation as the result of the immunity ‘fight back’ of the body. Rash in the genitals , itching in the private parts are some of the sensitive responses respondent had to make .pain during sex 13% are ticked by those who had married and agreed to have suffered the infections. Discharge from the genitals and rash in the oral cavity are some of the symptoms the study found out to be out there affecting young people who are infected. STIs are spread through contact with: infected body fluids, such as blood, vaginal secretions, or semen infected skin or mucous membranes – for example, sores in the mouth
5.1.4 Complications that arise as a result of STI infections among young men and women in the reproductive age
According to the findings from this research study, Among the complications as a result of STI infections is that it causes severe pelvic pain(11% of the respondents) and pain during intercourse as a result of inflammation(according to 30% respondents). In the longtime the complications cane lead to infertility (21%) which can cause mental problems(7%). The infertility can cause divorce as lack of children tends to strain the relation between couples. Severe complication can cause suicide. Urine incontinence can cause embarrassment and low self esteem. Stigma also play role in slowing health seeking behavior. chlamydial infection can affect neonates: many delivered vaginally become infected, developing conjunctivitis or, less often, chlamydia pneumonia
5.1.5 The most vulnerable groups to STIs
The research established that majority (53%) of the community believe sex workers are the most vulnerable group while 17% believe adolescents are the second most vulnerable due to curiosity and inability for the society to open on the topic of sexuality. Most of the respondents believe the media should be utilized to disseminate information to the young people. Because most of them are techno savvy, and are very much connected on the social sites like face book and twitter.
STIs remain global challenge. Sexually transmitted infections (STIs) contribute largely to the burden of health especially in Sub-African. It is equally evident from this research study that STIs remain a major threat to human health and to the economy of any country. STIs prevalence has led to the death of young and working population depriving the country of human resource force hence decline in economy and decline in general development. Complications that result from disabilities and mental problem results to creation of many people who are not able to work for themselves leading to increase to dependency ratio in a given area. Therefore based on the findings from this research, there is need to put a lot of interventions to minimize STIs cases and reduce the burden of STIs, The most effective way of preventing STIs is by not having sex. Some vaccinations may also decrease the risk of certain infections including hepatitis B and some types of HPV. Safer sex practices such as use of condoms, having a smaller number of sexual partners, and being in a relationship where each person only has sex with the other also decreases the risk. The government of Kenya should create jobs to get rid of dangerous activities such as commercial sex that ultimately led to spread of STIs. By creating jobs, employment opportunities will be available for many young women, hence eliminating commercial sex , this greatly minimizes cases of STIs. To save young people who are sexually active, it needs a collaborative interplay from all stakeholders in the community. These include men, women, girls, religious leaders, political leaders, circumcisers among other stakeholders. The government and non-governmental organizations need also to play their role in educating the community and in law enforcement.The key decision makers on the youth should be targeted. These were the parents, youth groups, spouse, peers and religious leaders.
It is therefore recommended that:
- The Ministry of health should design health education and promotion program on STI prevention with the aim of sensitizing the locals on the same.
- The locals of Ademasajida Town especially teenagers, adolescents and women of reproductive age should be educated on measures of STI prevention with the aim of increasing prevention practices among the population in reproductive age.
- There is a need for widespread and serious health education efforts through the mass media (especially radio and television) as well as through brochures and face to face encounters. Such efforts should provide information on the causes, symptoms and predisposing factors and how to prevent its occurrence.
5.4 FUTURE RESEARCH
Results of this study indicate other areas that need further study, these includes:
- Study findings have shown that abstinence is the best and surest preventive measure of STIs. Therefore a study on why it is difficult for the youth to abstain despite believing that it is the best way of preventing STIs is necessary.
- Another area of study could be an assessment of the effectiveness of the three initials for STI prevention, that is, ABC. A-abstinence, B-being faithful and C-condom use.
Askew, M. et. al., (2004). “A multi-sectoral approach to providing reproductive health information and services to young people in Western Kenya: Kenya Adolescent Reproductive Health Project”. Frontiers in Reproductive Health/Population Council Bertrand, J.T., Anhang, R (2006) The effectiveness of mass media in changing HIV/AIDS related behaviour among young people in developing countries. In: Preventing HIV/AIDS in young people: A systematic Review of the Evidence from Developing Countries. WHO Technical Report Series 938 , pp 205-339 Bloodindex, (2007). Comprehensive sex education is more effective at stopping the spread of HIV infection; Society views on AIDS/AIDS; ‘Posted by Ran, P’ Clark, L.R., Jackson, M., Allen-Taylor, L. (2002). Adolescent knowledge about sexually transmitted diseases; “sexually transmitted diseases” 29(8); 436-443. CDC 1993 “ Sexually Transmitted Diseases Surveillance Report” CDC 2008. “ Sexually Transmitted Diseases treatment guidelines ’’. Morbidity and Mortality Weekly Report; 55( RR-11) DeJong, J., Shepard, B., Roudi-Fahimi, F., Asford, L (2007). Young People’s Sexual and Reproductive Health in the Middle East and North Africa. Population Reference Bureau; pp 2 Gottvall et al ( 2009) “ HIV/AIDS- information and knowledge about its transmission” Jejeebhoy, S.J., (2006). Sexual and Reproductive Health of Young People: Expanding the Research and Program Agenda. Prepared for the David and Lucile Packard Foundation; Population Program Review Task Force. Keating, J., Meekersand, D., Adewuyi, A. (2006). Assessing effects of a media campaign on HIV/AIDS awareness and prevention in Nigeria: results from the VISION Project. BMC Public Health. 6: 123. Ministry Of Health (MOH) [Kenya] 1999. Strategic plan for the Kenya national HIV/AIDS/STIs control programme for 1999-2004. Nairobi: MOH. National Council for Population and Development, Nairobi (2009) “ Adolescent Reproductive Health and Development Policy for STI Managenment” National AIDS/STI Control Programme (NASCOP), Kenya.2009. 2007 Kenya AIDS indicator survey: final report. Nairobi: NASCOP. Piot, P (2008). Preventing new HIV infection is key to reversing the epidemic in Africa. The World Bank’s Commitment to HIV/AIDS in Africa: Our Agenda for Action 2007-2011 Population Council, Nairobi (1998) “ Improving the management of STIs among MCH/FP clients at Nakuru Municipal Council Health Clinics’’ Temin, M .J. et al, (1999). “Kaufman Perceptions of Sexual Behavior and Knowledge About Sexually Transmitted Diseases Among Adolescents in Benin City”, Nigeria.International Family Planning Perspectives, Vol. 25, No. 4, pp. 186-190 World Health Organization.(1998) The second decade: improving adolescent health and development. Geneva. Adolescent Health and Development Programme, WHO et al (2001) “ Sexually Transmitted Diseases amongst adolescents in the developing world’’, GENEVA( Draft Report) WHO ( 2001) “ Global Prevalence and incidence of selected curable Sexually Transmitted Infections ’’ GENEVA WHO (2007) “ Global Strategy for the prevention and control of Sexually Transmitted Infections, breaking the chain of transmission – 2006-2015” Geneva
APPENDIX I: INFORMED CONSENT FORM
I am a fourth year student in the school of Public Health. In partial fulfillment of the degree course, I have to submit a research project. Therefore, I am requesting for your consent to participate in this study. The study is on the knowledge assessment of sexually transmitted infections (STIs) prevention among the population in Reproductive age in Ademasajida Town. The information that you will give us in this study will contribute towards the development of STIs prevention programmes for the population in reproductive age. In addition, the information will also benefit you and upcoming population in the said age bracket to be protected from contracting STIs. In participating in this study, you will be required to fill in a questionnaire that will take 10-15 minutes to answer. No names will be used on the questionnaire and individual responses will be kept confidential. Only the researcher and the research supervisor will have access to them. There are no risks associated with this study and your participation is important for the development of STIs prevention programmes specific for Ademasajida Town people. The participation is voluntary, and you are free to withdraw from the study if you wish with no resultant penalties. If you are interested to participate in this study, please sign the consent form provided and then respond to the questionnaire given. Participant I have agreed to participate in this study. I understand that all information will be confidential and anonymous. I have been given the opportunity to answer questions and know that I am free to withdraw my consent at any time. Signature:…………………………………….. Date:………………………………………….
APPENDIX II: QUESTIONNAIRE
INSTRUCTIONS Please tick ( ) in the boxes representing the most appropriate response. Comment can also be made in appropriate spaces provided. DATE STARTED ____________________ DATE ENDED ________________ Demographic data
- Age: 15-25 [ ] 26-35 [ ] 36-49 [ ]
- Marital Status: Married [ ] Single [ ] Separated[ ]
- Religion: Catholic [ ] protestant [ ] Muslim [ ] others [ ]
- Education level: never gone to school [ ] primary [ ]
Secondary [ ] diploma [ ] Degree [ ]
- Occupation: Self-employed [ ] Employed [ ]
Not employed [ ] Knowledge on Sexually transmitted disease
- Do you know what sexually transmitted is? Yes [ ] No [ ]
- If yes, choose ways of transmitting infections from one person to another that you know. Tick all that apply.
a) Blood transfusion [ ] b) Infected needles [ ] c) Unprotected sexual intercourse [ ] d) Mother to-baby transmission [ ] e) Many sexual partners [ ]
- How did you get to know?
- From friends [ ]
- Hospital [ ]
- Books [ ]
- Through media [ ]
- Others (specify) ……………………………….
- Which of the following sexually transmitted Diseases do you know? Tick all you have heard or read about
A) HIV/AIDS [ ] B) Syphilis [ ] c) Gonorrhea [ ] d)chancroid [ ] e) Human papilomavirus HPV [ ] f) vaginalis [ ] g)chylamida [ ] 5. Have you ever suffered from sexually transmitted infection? Yes [ ] No [ ] 6. If yes, how many times did you suffered in the last 5 years a) Once [ ] b) Twice [ ] c) Thrice [ ] d) 5 times [ ] e) More than 5 times [ ] 7. Which symptoms did you suffered? a) Fever [ ] b) Rash in the genitals [ ] c) Itching in the private parts [ ] d) Discharge from the genitals [ ] e) Pain during sex [ ] f)others(specify) ………………………………… 8. Which preventive measures do you use to protect yourself from sexually transmitted diseases? a)Abstinence [ ] b)Using condoms [ ] c) Knowing the status of your partner before having intercourse [ ] d) Being faithful to your partner [ ] e) All of the above [ ] 9. How often did you check your status at the clinic? a) Once in a year [ ] b) More than twice a year [ ] c) Scarcely [ ] d) Whenever I suspect the symptoms of STI [ ] e) Can’t remember [ ] 10. Is there a campaign done regularly by agencies to teach youth on the prevention? Yes [ ] No [ ] 11. If yes by whom? a) Government agencies [ ] b) NGOs [ ] c) Community based organization CBOs [ ] d) Health workers from local health centers [ ] e) Educational institutions [ ] f) Others (specify)………………………………. 12. Do you think the knowledge on prevention of STI infection given to youth among your area is adequate? a) Agree [ ] b) Strongly agree [ ] c) Disagree [ ] d) Strongly disagree [ ] e) Not sure [ ] 13. Have you ever lost a colleague to STI? Yes [ ] No [ ] 14. If yes, from which infection? a) HIV/AIDS [ ] b) Gonorrhea [ ] c) Syphilis [ ] d) Trichomonalis [ ] e) vaginalis [ ] f) chancroid [ ] g) NA [ ] 15. Who do you confide to, in case you suffer sexually transmitted? (Tick all that apply) (a) Parents [ ] (b) Spouse [ ] (c) Your religious leader [ ] (d) Health workers [ ] (e) Siblings [ ] (f) Peers [ ] (f) Others (specify)……………………………….. 16. Which of the following complications have you heard STI can lead to? (Tick all that apply). (a) Pelvic pain [ ] (b) Pain during intercourse [ ] (c ) infertility [ ] (d) Death may result [ ] (e) Impaired mental status [ ] (f) Excessive bleeding [ ] (g) Caesarean section [ ] (h) Painful menstruation [ ] 17. Who do you think is the most vulnerable group to sexually transmitted infections? (a) College students [ ] (b) Adolescents [ ] (c) sex workers [ ] (d) Health workers [ ] (e) Uncircumcised male [ ] (f) Slum dwellers [ ] 18. Why do you think STI prevention effort should be prioritized if we want a healthy population? a) it’s one of the largest killer diseases [ ] b) It affects the younger population [ ] c) Its preventable disease [ ] d) Authorities have ignored [ ] e) Prevention is better than cure [ ] 19. In case you agree STI is rampant and need to be stopped, who do you think should lead the campaign in teaching the public? (Tick all that apply) (a) Media [ ] (b) Youth groups [ ] (c) Parents [ ] (d) Teachers [ ] (e) Religious leaders [ ] (f) Political leaders [ ] Thank you for participating in this survey.
APPENDIX III: LETTER FOR DATA COLLECTION