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Intl J Health Recs & Info Mgt. Jan – Dec 2021;4(1):16-23
Research article Print ISSN 2645-2464; E ISSN 2695-1770
COVID-19 knowledge and perceptions among health information management
professionals in Nigeria: implications for health data management
Benson Macaulay Oweghoro1, Ibrahim Taiwo Adeleke2,3*, Qudrotullaah Bolanle Suleiman-Abdul4,
Tunrayo Elizabeth Oluwole5, Abimbola Eniola Afolabi6, Oluseye Abiodun Ogundele6
1Department of Library, Archives and Information Studies, University of Ibadan, Ibadan, Nigeria; 2Editor-in-Chief,
International Journal of Health Records & Information Management; 3Department of Health Records, Federal Medical
Centre, Bida; 4School of Health Information Management, University of Ilorin Teaching Hospital, Ilorin, Nigeria;
5Department of Health Records, University College Hospital, Ibadan, Nigeria; 6Department of Health Records, Federal
Teaching Hospital, Ido-Ekiti, Nigeria
Corresponding author*: E-mail: aitofiseyin@yahoo.com
ABSTRACT
Background/Objective: Coronavirus disease 2019 (COVID-19), a public health emergency of international
concern has given rise to the generation of huge health data directly from the source of crisis and it has exposed
health care systems to the reality and necessity of digital health. This study attempted to understand the
perceptions of health information management (HIM) professionals and the attendant implications for managing
health data amid the pandemic. Methods/Design: A cross-sectional survey using stratified sampling to recruit
123 HIM professionals from three Nigerian public tertiary hospitals, which include Federal Medical Centre, Bida,
University College Hospital, Ibadan and Federal Teaching Hospital, Ido Ekiti. The study used a 27-item
questionnaire that elicits data on participants’ socio-demographic characteristics, knowledge, attitude and
perceptions on COVID-19 infection and related healthcare data management. SPSS was used to analyze the data
with specifics in descriptive and Chi square test Results: More than half (66, 57.4%) of participants were
between ages 30 and 50 years and 84 (73%) of them were holders of diploma certificates. Social media was the
major (43, 37.4%) source of information about COVID-19, 79 (68.7%) participants believed COVID-19 can be
contacted through handling of patients’ folders and participants’ workplace was statistically significant (p-value
0.024) with their opinion. The majority (70, 60.9%) had attended at least a training program on safe use of PPE
and would always cover their mouth when coughing or sneezing. More than half (63, 4.8%) were not so confident
to attend to patients at the heat of the pandemic and this apprehension was high (66, 57.4%) during patient
documentation. Post COVID-19, not many (45, 39.1%) would be able to adjust in their dispositions and an
overwhelming majority (90, 78.3%) admitted that the pandemic would affect their HIM practice going forward.
Conclusion: COVID-19 pandemic has necessitated a new order of generating and managing health data and a lot
more is required of HIM professionals to really make health data work for care quality improvement in Nigeria.
Keywords: COVID-19; Health data; HIM professionals; Medical confidentiality; Patient documentation
Edited by Bello AO; submitted on 09.10.2020; peer reviewed by M Achinbee, AA Adebisi, LM Ogundiran, TC Anamah;
accepted 23.07.2021; published 29.08.2021.
Please cite as: Oweghoro BM, Adeleke IT, Suleiman-Abdul QB, Oluwole TE, Afolabi AE, Ogundele OA. COVID-19
knowledge and perceptions among health information management professionals in Nigeria: implications for health data
management. Int J Health Recs & Info Mgt. 2021;4(1):XX-XX.
Conflict of interest: None declared.
Funding disclosure: No funding was solicited for nor obtained for this study
INTRODUCTION
Coronavirus disease 2019, technically
known as SARS-CoV-2 and popularly known as
COVID-19, is an infectious disease that has
caused an outbreak of respiratory illness1. The
infection was first identified in December 2019 in
Wuhan, the capital of China’s Hubei Province1,2.
Following the severity and spread of the disease,
the World Health Organization (WHO), on
January 30th, 2020, declared COVID-19 a public
Intl J Health Recs & Info Mgt. Jan – Dec 2021;4(1):16-23 Oweghoro et al.: COVID-19 knowledge and perceptions of HIM professionals
2
health emergency of international concern and it
was declared a pandemic by the same body
(WHO) on 11th March, 20201. Ever since the
WHO’s declaration of this pandemic, there have
been thousands of confirmed cases of COVID-19
spread to other parts of the world, including the
United States, Europe, Africa and especially,
Nigeria in spite of the African mentality of
automatic-heat remedy2. The disease is spreading
rapidly with a rising death toll and transmission
rates3. In Nigeria for instance, the incidence rate at
the onset was lower and it graduated to almost a
thousand per day. Nevertheless, the rate
diminished toward the end of August 2020 and the
total figure of confirmed cases by the Nigerian
Centre for Disease Control (NCDC) by 30th
August 2020 was 53, 865 and total deaths of 1,
013. Mainly, COVID-19 spread during close
contact with an infected person, who produces
droplets (aerosol) when coughing, sneezing,
talking or even breathing1.
Globally, the pandemic has given rise to
the generation of huge health data directly from
the source of crisis and it has exposed health care
systems both in the developed and developing
nations to the reality and necessity of digital
health3,4. Sources of these statistics include
medical diagnosis, hospitalization statistics,
infection rate, co-morbidity mapping, drug allergy,
incidence rate, fatality rate, and other subtle
metadata4. The rapidity and fatality of the disease
with hike in the demands to generate and manage
huge volume of health data brought to light the
absence of proper data management and
information sharing3,5. The prevailing traditional
paper-based health records system especially in
Nigeria and other developing nations has posed
inability to organize a centralized databank. Also,
inefficient control system may lead to data
distortion during information exchange in an
epidemic like that of COVID-193,5. Challenges of
health data management during the pandemic
include data inconsistency, changing criteria, a
large diversity of sources, non-comparable metrics
between countries, delays, and so on1,6. Timely
and accurate information to assess disease
burdens, track emerging outbreaks and support
disease prevention and control measures is
essential in epidemic response7. Interestingly,
digital technologies are playing a prominent role
in the global COVID-19 pandemic response6,8.
Though patients were concerned about reduced
confidentiality with their records held on
computer, keeping patients’ health records on
computers or other technologically-driven media
has offered the patients invaluable advantages9.
Health information management (HIM) is
the discipline that has historically focused on the
management of medical records10. It is the
profession dedicated to the effective management
of patient health information and healthcare data
needed to deliver high- quality treatment and care
to the public. Health information management
professionals are healthcare providers responsible
for improving the quality of healthcare by insuring
that the best information is available for making
any healthcare decision by managing healthcare
data and information resources11. They are trained
and are experienced in the intersection of clinical
and management sciences as well as
knowledgeable about data quality, which has
equipped them with the capability to maintain the
integrity and accessibility of health information12.
In Nigeria, there is observed suboptimal adherence
to documentation standards, healthcare providers
especially HIM professionals lack adequate IT
skills though have used the technologies for some
years. Generally, a health information system in
Nigeria is preponderantly, paper-based5,13-18. HIM
professionals, like other healthcare providers are
confronted with exposure to the pathogen in
addition to the observed stressful working
Intl J Health Recs & Info Mgt. Jan – Dec 2021;4(1):16-23 Oweghoro et al.: COVID-19 knowledge and perceptions of HIM professionals
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condition and psychological distress19. They
therefore require adequate moral and
psychological support while they too should
ensure they self-monitor for signs and symptoms
of the infection20.
Çalışkan et al reported that the majority of
health workers were concerned about becoming
infected with COVID-1922. Similarly, da Silva et
al noted that frontline healthcare professionals
who work with symptomatic patients fear for the
condition of their health and that of their
families23. In a study of dentists, most participants
considered themselves and their collaborators to
be exposed to a high risk due to their jobs and they
were afraid of infecting their relatives14. This
indicates that healthcare providers had the
perception of being at higher risk than the general
public, due to their close contact with
suspected/confirmed COVID-19 cases21. In terms
of knowledge, studies have shown that Nigerians
are highly knowledgeable about COVID-19 and
their premier sources of information about the
pandemic are the traditional media24. A study
established that the majority of healthcare workers
had good knowledge and positive attitude toward
COVID-1925, Ekpenyong et al equally found that
knowledge about COVID-19 preventive
guidelines was high among eye care experts26.
Bhagavathula et al reported official government
websites as a primary source of information about
COVID-19 among healthcare professionals
regarded27. This indicates that the COVID-19-
related updates posted online by official
government health authorities had positive
implications for improving healthcare providers’
knowledge levels21. There is dearth of studies in
identifying COVID-19 knowledge and attitude
among HIM professionals therefore, this current
study aims to determine knowledge level and
perceptions of Nigerian HIM professionals toward
COVID-19 and related healthcare data
management.
METHODS
Study setting
This study was carried out in three public tertiary
health facilities in Nigeria. These include Federal
Medical Centre, Bida, Federal Teaching Hospital,
Ido-Ekiti and the premier University College
Hospital, Ibadan between 16th September and 7th
October, 2020.
Study design
The study design deployed was cross-sectional.
Study population
There are 67, 37 and 75 HIM professionals in the
services of Federal Medical Centre, Bida, Federal
Teaching Hospital, Ido-Ekiti and the premier
University College Hospital, Ibadan, respectively
as at the time of this study. This gives a total of
179 HIM professionals as target population for the
study.
Sample size
A total sample size of 123 was computed using the
online sample size calculator, Raosoft. The
formula reads thus:
ss =
Z 2 * (p) * (1-p)
c 2
Where:
Z = z- value (e.g. 1.96 for 95% confidence level)
p = percentage picking a choice, expressed as
decimal
(.5 used for sample size needed)
c = confidence interval, expressed as decimal (e.g.,
0.04 = +or- 4)
From the computed sample size of 123 and
deploying stratified sampling method, there were
46, 25 and 52 samples to Federal Medical Centre,
Intl J Health Recs & Info Mgt. Jan – Dec 2021;4(1):16-23 Oweghoro et al.: COVID-19 knowledge and perceptions of HIM professionals
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Bida, Federal Teaching Hospital, Ido-Ekiti and
University College Hospital, Ibadan, respectively.
Sampling technique
The study deployed stratified sampling method. Of
the 123 sample size computed, Federal Medical
Centre, Bida with target population of 67 of 179
has 46 sample; Federal Teaching Hospital, Ido
Ekiti with 37 has 25 and University College
Hospital, Ibadan with 75 has 52 samples.
Data collection tools
The study used a 27-item questionnaire that elicits
data on participants’ socio-demographic
characteristics, knowledge, attitude and
perceptions on COVID-19 infection and related
healthcare data management. It was a self-
administered structured questionnaire, validated
through a pre-test among ten members of a
homogenous group.
Data analysis and management
The statistical software SPSS version 16 was used
to compute the data. Analysis done include;
descriptive and the use of chi square to elicit
relationships. Tables and charts were used for
illustrations.
Ethics
The ethics approval to conduct this study was
obtained from the Health Research Ethics
Committee of Federal Medical Centre, Bida.
Permission was sought from authorities in other
centres based on the initial ethics approval from
Bida. Informed consent was obtained from all
participants having given vivid explanation in the
information sheet.
RESULTS
,
Of the 123 participants recruited, nearly all
(115, 93.5%) returned completed questionnaires.
Of the 115 participants, more than half (66,
57.4%) were between the ages of 30 and 50 years,
greater portion (75, 65.2%) were females, nearly
every three in five (67, 58.3%) were health records
officers by cadre and most of them (84, 73%) were
holders of diploma certificates (HND, ND & PD).
In all, there were 47 (40.0) HIM professionals
from FMC, Bida, 46 (40%) from UCH, Ibadan and
22 (19.1%) from FTH, Ido-Ekiti. Social medical
was the major (43, 37.4%) source of awareness
about COVID-19 among HIM professionals.
Fig 1: Source of awareness of COVID-19
On basic knowledge of COVID-19, the
majority of participants understand that COVID-
19 can be transmitted through aerosol (92, 80%)
and through objects like patient folder (79,
68.7%). The majority of participants often cover
their mouth when coughing or sneezing (101,
87.8%) and wash their hands regularly
(99.86.1%). and Most participants (70, 60.9%) had
attended training(s) on personal protective
equipment for safety during the pandemic. Nearly
half of the participants (57, 49.6%) had the
confidence to attend to patients at risk of COVID-
19 and an overwhelming majority (101, 87.8)
confidently opined that COVID-19 would change
their practice of health information management.
Intl J Health Recs & Info Mgt. Jan – Dec 2021;4(1):16-23 Oweghoro et al.: COVID-19 knowledge and perceptions of HIM professionals
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Table 1: General knowledge and perceptions about
COVID-19 among HIM professionals in Nigeria
Item
Positive
response
Negative
response
Indiff
erent
N(%)
N(%)
N(%)
Knowledge and attitude
COVID-19 can be contacted
through droplets of aerosol
92(80)
9(7.8)
14(12.2)
COVID-19 can be contacted
through contaminated objects
such as patient folder
79(68.7)
23(20)
13(11.3)
Attended training on safe PPE
amid COVID-19
70(60.9)
41(35.7)
4(3.5)
Regular covering of mouth when
coughing or sneezing
101(87.8)
0
14(12.2)
Regularity of hand washing
99(86.1)
19(16.5)
3(2.6)
Perceptions
Too much unnecessary worry has
been made about COVID-19
outbreak
92(80)
12(10.4)
11(9.6)
Did you have confidence
attending to patient during the
heat of the pandemic?
62(53.9)
50(47.5)
3(2.6)
How confident do you feel
attending to a patient or at risk of
COVID-19 during patient
documentation?
57(49.6)
54(47)
4(3.5)
Post COVID lockdown, how
confident would you feel
attending to any patient?
86(74.8)
24(20.9)
5(4.3)
How much would COVID-19
change the way you practice
HIM?
11(9.6)
101(87.8)
3(2.6)
How satisfied are you with the
amount of health information
available about COVID-19?
60(52.2)
46(40)
9(7.8)
Do you have confidence in the
way NCDC managed health data
confidentiality during the
pandemic?
50(43.5)
47(40.9
18(15.7)
Are you satisfied with the
statistics being released daily by
NCDC?
38(33)
63(54.8)
14(12.2)
How do you feel about the public
image of HIM professionals as
frontline health workers
96(83.5)
13(11.3)
6(5.2)
Not many (50, 43.5%) were confident in the way
NCDC handled medical confidentiality during the
pandemic and the majority (96, 83.5%) were
enthusiastic in the public image of HIM
professionals as frontline healthcare providers.
Chi square test reveals that workplace was
significantly associated with knowledge about
contaminating objects (0,024); source of
awareness (0.007); confidence in attending to
patient at risk (0.007); changing ways of practice
(0.006); public image (0.017) and satisfaction with
NCDC statistics. It is noteworthy that attendance
at workshops had no significant association with
knowledge and perceptions of participants.
DISCUSSION
HIM professionals have their rightful place
in the management of health data even in the heat
of COVID-19 pandemic in Nigeria. Participants’
workplace played a vital role in determining their
knowledge and perceptions of COVID-19 and
related health data management practices.
Whereas, their COVID-19 related training has no
impact in their knowledge and perception. A
considerable majority of HIM professionals in this
study have good knowledge of COVID-19. This is
an improvement on a study, where healthcare
providers are said to have poor knowledge of the
disease27. Social medial was the main source of
awareness of COVID-19 among participants. This
is in congruent with a study by Bhagavathula et al
where most participants used social media as the
major source of COVID-19 information27. This
calls for a concern as health authorities and
scientists have warned against accessing COVID-
19 information from social media as such
information are unverified and malicious and
could be detrimental to medical confidentiality
and effective health care service delivery31,32.
Intl J Health Recs & Info Mgt. Jan – Dec 2021;4(1):16-23 Oweghoro et al.: COVID-19 knowledge and perceptions of HIM professionals
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Not many of the participants were
comfortable in the way NCDC manage
confidentiality of COVID-19 data. This may not
be unconnected with the fact that knowledge and
attitude of Nigerian healthcare providers about
medical confidentiality has been inadequate as
they are not conversant with their respective
responsibilities toward confidentiality28,29. Related
to this, when health data management is handled
by other workers other than HIM professionals,
medical confidentiality is subjected to some level
of breach and threats30. Their concerns may
equally be linked to the high demand for data in
the wake of COVID-19, which might be a threat to
medical confidentiality4. Although many HIM
professionals in the study area would do better
post COVID-19, many of them find it difficult to
document patients at the risk of the infection for
the fear of being infected. This finding is in
agreement with a study of Portuguese healthcare
professionals who were afraid they could be
infected while providing health care services to
patients at risk of the infection21. Most participants
in this study were not comfortable with the
volume of health statistics turnout by the NCDC.
Their perception on large volume of data is
unfounded as studies have shown that the
pandemic has given rise to the generation of huge
health data directly from the source of crisis3,4.
Given the role HIM professionals play in the
health care system as frontline data managers,
their rightful engagement in the management of
COVID-19 will be resourceful11.
Study limitations
First, the study was limited to HIM
professionals in only three out of the 54 existing
public health hospitals owned by the Federal
Government of Nigeria, leaving the barrage of
other tertiary health facilities by state
governments, private organizations and other
facilities at the secondary and primary level. For
this reason, generalization may be an issue.
CONCLUSION
COVID-19 pandemic has necessitated the
generation of large volume of data and a new
order of generating and managing health data,
however, HIM professionals in Nigeria have been
left to only data generation with much left to be
done about dissemination and meaningful use. As
frontline health data managers therefore, a lot
more is required of HIM professionals to really
make health data work for care quality
improvement in Nigeria.
Recommendation
i. HIM professionals should be proactive and
alive to their responsibilities;
ii. They should ensure high quality data
collection and timely dissemination of data
for informed public health decision
making;
iii. There is a need for Government
intervention for more employment
opportunities for HIM professionals;
iv. Adequate funding for health information
systems;
v. Policy formulation on health information
management;
vi. Engagement of HIM professionals in
health information systems policy
framework such as deployment to NCDC;
vii. Provisions for continuing capacity building
for HIM professionals in Nigeria.
Acknowledgement
The authors wish to thank Mr Olufemi A.
Omolade of School of Health Information
Management, University College Hospital, Ibadan,
for his assistance during data collection. All the
115 HIM professionals, who participated in the
study are hereby appreciated.
Intl J Health Recs & Info Mgt. Jan – Dec 2021;4(1):16-23 Oweghoro et al.: COVID-19 knowledge and perceptions of HIM professionals
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Authors Contribution:
OBM conceived of the study, participated in literature search, data abstraction and collection, analysis and
coordination. AIT initiated its design, participated in literature search, data abstraction and collection, analysis and
coordination and drafted the manuscript. SQB, OTE, AAE, and OAO participated in the design, literature search,
technical process, data analysis and coordination and reviewed the final manuscript.
Article available
online at
www.ahrimpn.com
