3.1. Health Information Behavior

Information behavior, also known as human information behavior, is the field that studies the way humans interact with information. Broadly speaking, it is an area that explores human interactions with information in terms of the fulfillment of needs, searching, and using information in specific contexts and situations. Information behavior in the health field covers two areas: (1) professional information behavior, which relates to the way doctors, nurses, nutritionists, or any other medical professionals acquire information and fulfil their need for knowledge and competency to improve medical measures for patient care; and (2) personal information behavior, which is undertaken by individuals seeking information to meet their own information needs in relation to preventive action and healthcare (Case & Given, 2016; Robinson, 2010). Information behavior models that have been used to examine health information behavior include the Wilson Model, the Kuhlthau Model, and the Sensemaking Model (Andalibi & Garcia, 2021; Das & Sarkar, 2014; Warner & Procaccino, 2004).

Health information behavior, according to Lambert and Loiselle (2007), includes health-related knowledge searching with regard to risks, diseases, and health protection activities. In terms of scope, the study of health information behavior takes in the strategies used by people in tackling their health concerns, individuals’ active involvement in their own medical decision-making, and changes in behavior and preventive health techniques. These are all investigated, moreover, as factors that influence the purpose of individual information seeking (Lambert & Loiselle, 2007; Zimmerman & Shaw, 2020). The development of information technology such as smartphones and social media has expanded the focus of research into current health information behavior, which has been facilitated by digital technology (Percheski & Hargittai, 2011; Wang et al., 2021). In addition to the health information behavior of information seeking, some individuals actively avoid health information because of uncertainty, confusion over how to manage the information, or the possibility of the available sources causing them emotional distress (Barbour et al., 2012).

According to Weaver et al. (2010), there are three main motives behind why people look for health information. These can be described in the following terms: (1) curative health information seeking: This involves any kind of looking for information about how to control or treat diseases or health problems; (2) preventive health information seeking: This includes looking for information on such topics as individual and public hygiene, environmental health, appropriate diet, or exercise; and (3) a combination of curative and preventive health information seeking, which involves looking for information about both preventive and curative health measures; survivors of serious illnesses often undertake this kind of information seeking.

Wilson (2020) developed a multiple decision model to describe individuals’ decision-making in their information behavior. This model sets out the process of decision-making performed by individuals who have already understood their own information needs. Factors influencing this model include the principle of minimum effort by individuals, and patterns of information behavior that are designed to reduce stress. Ultimately, individuals may choose to seek information, avoid information, or even exhibit non-seeking behavior by limiting their own information exposure.

3.2. Sensemaking Perspective

Sensemaking is a metatheory that describes the processes used by individuals in understanding their surrounding environment through meaning-making. Sensemaking takes in the individual’s active efforts to identify, interpret, internalize, and respond to information to fill in their own knowledge gap (Case & Given, 2016). This concept has been applied in a number of studies relating to health information as a way of understanding and addressing the various challenges involved. The sensemaking process aims to build a sense of identity and help individuals overcome any life disruptions (Naveh & Bronstein, 2019; Ruthven, 2019). Sensemaking can be viewed as a holistic approach to problem solving.

Sensemaking in health information behavior can be based upon individual or social understanding in relation to personal health. Westbrook and Fourie (2015) showed that factors such as environment, body condition, and lifestyle can become information sources for medical decision-making in the individual sensemaking process. Mamykina et al. (2015a) made the point that building understanding via sensemaking is not only done individually, but also takes place socially, through discussion, negotiation, and conflict resolution, as in the diverse opinions and information found in online forums.

In the framework for chronic disease management developed by Mamykina et al. (2015b), the sensemaking process consists of classification activities, information monitoring, dealing with new experiences relating to personal health and wellness, developing and utilizing internal representations that can serve as a basis for choosing appropriate health actions, and the habitual performing of daily activities that respond to the newly received health information. According to Dervin (1983; 2015) the sensemaking process can consist of four components, namely:

3.3. COVID Societies and Local Knowledge

The COVID-19 pandemic changed every aspect of society. Social distancing, mask usage, and the need to get COVID-19 vaccination were new situations that people had to deal with, in order to prevent infection and avoid the adverse effects of catching COVID-19. Lupton (2022) refers to such a society, faced with the threat of a long-term global health crisis and the risk factors posed by a mysterious viral infection in relation to social life, economics, inequality, possible stigma, and mortality, as a COVID society. In order to understand the changes that occurred at this time, Lupton and Willis (2021) conducted an analysis from a socio-material perspective of political responses, health systems, and pandemic policies in different parts of the world, highlighting the differences in representations and in the experiences of different social communities during the pandemic.

Indonesia is known as a society with a close-knit collective culture, factors which were all beneficial for social resilience during the pandemic (Putra, 2022). Suwignyo (2020) argued that Indonesian collective culture, with its love of gatherings and daily sharing of information and knowledge, was challenged during the pandemic due to social distancing, which hindered any large gatherings between groups for local knowledge exchange. Montesi (2021) suggested that information researchers should investigate the role of the information shared by family, neighbors, and co-workers, which is a form of “implicit knowledge” — knowledge accumulated over time and shared by community members within a particular place. This is also in line with research that has been conducted into the adaptations in information behavior in families and local knowledge during the health crisis (Montesi, 2023; Pan et al., 2020).

Local knowledge itself is unique knowledge accumulated by a community in a specific location over generations, which is utilized by the community in decision-making, and in forming strategies for coping or adapting to situations that are constantly changing. Local knowledge is made up of knowledge, practices, and beliefs. Other terms for local knowledge found in the literature are “traditional knowledge” and “indigenous knowledge” (Naess, 2013, p.100). This, including religious information with cultural and local dimensions, is part of the “information environment” as considered by Caidi (2019). In this research, “local knowledge” refers to a set of information limited to a specific geographical area and time, obtained through social and cultural practices within the local community. The local knowledge encompasses information gained from interactions with the surrounding environment, information from friends or family, and information derived from local cultural traditions, especially regarding self-care and situations of health crises.

The COVID-19 pandemic led to a fear of infection, to feelings of loneliness as it became increasingly difficult for people to meet physically, and to various other negative emotions as people’s lives ground to a halt (Gan & Fu, 2022; Luchetti et al., 2020; Luo et al., 2021). To understand COVID society, Lupton (2021) identified six different phases of the pandemic, viewed from a risk perspective, as set out below:

5.1. Distant Threat Phase

The initial phase commenced in late December 2019, marking the onset of the discovery of mysterious pneumonia cases in Wuhan City, China, until the end of February 2020, characterized by the identification of COVID-19 pandemic cases outside of China. The information then spread quickly to the rest of the world. During this phase, the risk posed by the virus was still confined to a local level. Almost all the participants (eight people) knew about the beginning of the COVID-19 pandemic in January 2020, while Budi (36, male [M]) and Indah (25, female [F]) had started following this news at the end of December 2019. Budi (36, M) commented:

Meanwhile, Indah (25, F) remarked:

The participants received the news from various information sources, including social media, online news portals, and in some cases, television (four people). This shows how important digital information sources are, especially social media, in spreading information. In the distant threat phase, the participants felt that the risk of infection was low in Indonesia, and doubted the possibility of the virus entering the country, while still keeping an eye on the situation.

The participants felt some negative emotions, such as fear, due to the spread of “panic” videos relating to the virus, which they found on social media, especially Twitter, Instagram, and TikTok, or as shared videos in WhatsApp groups. According to Ayu (25, F), she felt “Lowkey panic when I received the news, the spread was fast, and I was worried if it would become widespread. But at that time I was not as panicked as when it entered Indonesia, it was still in China.” Some participants avoided information during this phase, especially in view of the surge in false news and hoaxes; this was the approach taken by Dewi (26, F), Budi (36, M), Rini (31, F), and Butet (29, M) to the ongoing situation. The educational background of the participants, who had all reached university level, helped them to search for more information to discover what was actually going on, fill in their knowledge gaps, and validate the various sources of information they obtained. In the words of Dewi (26, F):

5.2. National Lockdown Phase

When the Indonesian government officially announced the first case of COVID-19 in Indonesia, this highlighted in the minds of the public the increased risk, and there was a particular focus on the risk of infection through physical contact with contaminated objects. This phase spanned from March 2020 until the end of April 2020. The participants received the news about the first positive case in Indonesia via social media. This also aligns with Rini’s (31, F) statement: “I think I heard the information from social media, to begin with, and then browsing through the news on TV or online.”

In this phase, the participants had to adapt to overcome the new challenges and deal with the restrictions on daily activities. They began to switch to using various forms of digital media to interact. This change in their usual habits initially felt quite tricky. However, after a little time, they began to get used to the different technology. In the words of the participant Butet (29, M): “Actually it was hard at first, because I am not from an era where I frequently use various social media platforms to interact, such as Zoom.” Sunbathing in the morning also became a new habit for some participants during the lockdown. Guntur (25, M) described Indonesians’ indifference to the initial spread of COVID-19, up to a thousand confirmed cases. He began wearing a mask due to public warnings and faced difficulty visiting certain areas.

Indah (25, F) experienced a similar situation:

During this phase, the participants searched for information on how to prevent transmission and how to boost immunity through nutrition and vitamins, including the consumption of “jamu,” which is a traditional Indonesian herbal beverage known for its efficacy in boosting the immune system to prevent diseases. They followed tips for maintaining health taken from social media or appeals from the health authorities, as well as guidance on religious worship during the lockdown period. Rini (31, F) described the information she received in these terms:

5.3. COVID Zero Phase

The COVID Zero phase in Indonesia was known as Large-Scale Social Restrictions, or Pembatasan Sosial Berskala Besar (PSBB), and the Enforcement of Restrictions on Community Activities, or Pemberlakukan Pembatasan Kegiatan Masyarakat (PPKM), spanning June 2020 to January 2021. With the risk of infection from inhaling virus particles in the air (aerosol transmission) now recognized, this phase introduced the mandatory wearing of masks for daily activities, and the avoidance of any activities that would involve a crowd. During this phase, there were numerous Indonesians who were not yet familiar with the use of health protocols. In relation to this, Budi (36, M) remarked: “From the beginning of the pandemic, yes, our people have shown a low level of obedience in following the rules, socializing and such like; at least, that is how I see it, around me.”

The collective nature of Indonesians contributes to non-compliance, possibly due to their inclination towards gathering and socializing.

The participants’ strategies to meet their information needs included searching for information about symptoms, how to prevent transmission, restrictions on people’s mobility, mortality trends, and self-isolation. Indah (25, F) described the way she fulfilled her own information needs at this time in these terms: “During the activity restrictions, the number one thing was to search about how to manage COVID, what to do if infected, the medicines that could be used, other than the standard drugs, and vitamin supplements, any supplement that could suppress the virus.” Ulfah (25, F) and Rini (31, F) also searched for information about foods and vitamins that could boost immunity and prevent transmission. Dewi (26, F) noted that her information browsing took in various information sources, including Google searches, online news sites, telemedicine, and fact-checking or information evaluation sources for paramedics. Susi (26, F) described the trust she placed in the information provided by the health authorities when browsing for information:

A similar situation was described by Budi (36, M), who referred to all the information he found about conspiracy theories, the need he felt to verify it, and how he eventually sought to avoid such information:

5.4. Vaccine Dilemma Phase

This phase was distinguished by the faster virus transmission caused by the new variant of COVID-19 and by the beginning of a mass vaccination campaign for the population as a means to end the pandemic, which took place from February 2021 to May 2021. The information needs of the community had changed, as the COVID-19 vaccination policy was implemented to reduce transmission and the number of cases. Apart from the potential side effects, the halal status of the vaccine was a specific concern for the majority of participants. This reflects apprehensions related to the religious aspects or beliefs regarding the vaccine’s usage. This phase was also characterized by the spread of various hoaxes and misinformation about vaccines that were introduced into the community. Hasan (24, M) looked for information relating to the vaccines, from the different types to the side effects: “I looked for the side effects of the vaccine on the receivers, using trusted sites, the indication of the vaccines, and also information about which type of vaccine had been sent to different countries. That’s what I looked at.”

Indah (25, F) also wanted as much information as possible about the vaccine before receiving one: “I needed a lot of information to understand about the vaccine.” Ayu (25, F) said that in order to remove her doubts about vaccination, she looked for additional information to make sure the vaccine was safe: “At that time, I was still hesitant about vaccines. We know that vaccines are a weakened virus injected into our body. The virus enters our body, so it makes us immune automatically. However, what if we’re not immune? I started overthinking like this at this time.” The participants agreed that the vaccines were one of the things that made it possible to live a normal life again. Dewi (26, F) stated that her reason for getting vaccinated was so she would be able to restart normal activities:

In similar terms, Butet (29, M) commented:

When the campaign started, there was some misinformation encountered by the participants. For example, Dewi (26, F) commented: “Probably the most intense ones I avoided were what people call the anti-vaccine groups.” Hasan (24, M) also avoided information that suggested people should not get vaccinated: “I avoided information relating to vaccine denial. For example, things that said that vaccines are dangerous, vaccines cause death, and vaccines have a microchip in them. I immediately avoided this. I don’t believe it anyway.” Guntur (25, M) described his strategies for limiting his exposure to vaccine misinformation before getting vaccinated: “I largely avoided this information before getting vaccinated, because such information could make me reluctant. But in the end, I couldn’t help but look for vaccine information, because I didn’t want to spread the disease either.”

5.5. Delta Response Phase

In this phase, the risks that were current related to the surge in daily infection numbers and deaths in the community brought about by the Delta variant of COVID-19. This phase took place from June 2021 and subsided by September 2021. This mainly infected people who had not been vaccinated. Thus, the vaccination campaign was intensified at this time, in response to the increasing number of confirmed cases and deaths. The kinds of health information the participants encountered during this phase differed greatly from the previous phase, especially with regard to appeals to follow health protocols, and the obligation to participate in the vaccination program.

During this phase, even though they had received the vaccine, the participants were concerned about being infected by the Delta variant because it had more severe symptoms than the previous variant. The most dangerous risk was infecting family members and causing their death. Rini (31, F) voiced her experience of losing her friends: “I was worried at this time, there were a lot of victims, and many of my friends from the same year, my close friends, passed away.” Guntur (25, M) noted that the information he avoided was the rise in the mortality rate after the arrival of the Delta variant. Speaking about the situation with the Delta variant, Dewi (26, F) remarked:

The participants also explained that they avoided information during this phase in order to keep their emotional stability. They also recognized the severe risks in ignoring the appeal to implement health protocols. This is what Hasan (24, M) had to say:

5.6. Living with COVID Phase

In this phase, people started going back to their normal activities; they were not looking for all the latest information as intensely as before, and were no longer avoiding information. This phase extended from October 2021 until December 2022, characterized by the relaxation of health protocols and the spread of the Omicron variant, which resulted in mild symptoms for COVID-19 patients. The participants only focused on what guidance needed to be followed when the situation got back to normal with the return of crowd activity in the community. Ulfah (25, F) referred to the moment she realized normal activity had returned by commenting, “I could do my activities normally again, yeah, in the middle of 2022.” On the other hand, Dewi (26, F) felt that the normal situation where people were gathering on the streets or in markets only returned at the end of 2022:

Butet (29, M) compared the new normal situation with the return of crowds and added the changes in people’s behavior of using masks to the time before the pandemic occurred: “I think life is back to normal, because some activities that were prohibited before are now allowed, and we can also finally do stuff directly face-to-face; and the use of masks has loosened, we don’t always have to wear a mask.” The changes in behavior in this phase of living with COVID-19 were described as a normal situation, because people had adapted to the various new habits. This was commented on by Guntur (25, M) and Susi (26, F). According to Guntur (25, M):

Similarly, Susi (26, F) commented:

In this phase, the participants were not as engaged in searching for or avoiding information, because their information needs were changing due to the pandemic situation. They preferred to utilize the information they had already gathered, mainly about the health protocols that were still applicable. Ayu (25, F) indicated that the pandemic had taught her to familiarize herself with a new set of habits, such as utilizing digital media, like Zoom meetings: “We’re used to Zoom meetings, and work from home, nowadays doing activities this way just feels normal.” Finally, the participants referred to the way different risks had occurred at different times during the pandemic. In the words of Rini (31, F), “Looking back to the beginning of COVID, this was really a period of uncertainty, because we still didn’t know, the world didn’t understand how to deal with it.”

6.1. Information Behavior When Faced with COVID-19

The information behavior strategy of the participants changed significantly as the pandemic situation and the level of risk they faced also changed. Initially, people were looking for information to understand this new and uncertain situation. The participants relied on primary information sources such as health authorities (specifically, the Ministry of Health and the World Health Organization) and news outlets to get guidelines and all the latest information. This aligns with the findings of Andalibi and Garcia (2021) about information needs mainly being fulfilled by health authorities.

Information needs significantly influenced the participants’ information behavior strategies during each phase of the pandemic, and these were also influenced by changes in the health protocols and recommended preventive actions. Individuals started to look into information about vaccines, dosage, side effects, and availability the moment they entered the Vaccine Dilemma phase. The spread of the Delta variant also triggered an increased need for information on threats relating to this variant. During this phase, individuals also avoided some information and limited their information exposure, which served as a practical approach for protecting themselves from information they could not handle, as has also been seen among cancer patients (Jensen et al., 2022).

Throughout the pandemic, the participants continued to adapt their information behavior strategies. They needed accurate and reliable information to be able to make informed health decisions. This strategy reflected people’s need to keep up-to-date with the development of the pandemic. The change in information behavior strategy, which was random at the beginning of the pandemic but later became increasingly organized, was due to the way the knowledge gap of the participants was filled as the pandemic went on. This is reflected in a comment by one of the participants that the uncertainty of the situation gradually became clearer as events progressed.

The participants made use of considerable information from the Internet and social media. This evoked the principle of carefulness in choosing information validity, with the need to take into account the authority of the writer, quality, relevance, and objectivity influencing the participants in their search for and use of information during the pandemic. This finding is in line with Sbaffi and Rowley (2017)’s research regarding web-based information seeking, and the way the credibility level and trustworthiness of the information available on a website page influence this interaction of participants. This also applies to information seeking on social media, where the information behavior strategy needs to consider the credibility factor of the information sources themselves (Osatuyi, 2013; Soroya et al., 2021).

Based on further analysis, we found that participants developed various information behavior strategies, which we categorized into two core categories during the COVID-19 pandemic. There are two frameworks of information behavior strategies: (1) Pandemic Crisis Understanding: This framework provides an overview of the recurring information behavior strategy cycle of participants, starting with understanding the evolving situation and risks before the crisis occurs (phase 1), during the crisis (phases 2 to 5), and after the crisis (phase 6) until the situation returns to normal; and (2) Information Behavior Needs and Strategies: Individual understanding ultimately creates an information need, which is part of the process of identifying individual knowledge gaps caused by changes in threats and health protocols during the ongoing health crisis.

6.2. Local Knowledge and Sensemaking Process Amid the COVID-19 Pandemic

The sensemaking process in relation to the COVID-19 pandemic involves an individual’s active behavior in understanding, identifying, interpreting, internalizing, and responding to information to resolve their knowledge gap during this period. The participants utilized information from various channels to understand the situation that was occurring. The right information behavior strategy helped individuals to understand the ever-changing nature of the pandemic quickly. In each phase, all of the participants recognized the situation and their relevant information needs, such as information about virus transmission, nutrition, health protocols, or vaccination. Interpreting new information alongside their existing knowledge base helped them to respond to the changes that occurred throughout the six phases of the pandemic, whether in terms of preventive measures, persuasive measures, or both. Moreover, they internalized and responded to the information in order to make the best health decisions for themselves.

Paying attention to their own knowledge gap, the participants moved as the situation changed from an active sensemaking process when their knowledge base was not met, to a habitual mode when their information needs had been met, and less effort was required in relation to any health actions. This again reflects work by Mamykina et al. (2015b). This is also in line with Wilson (2020)’s position that individuals choose to make the minimum effort and consider emotional factors in deciding their information behavior strategy. In addition, the sensemaking process undertaken by the participants was one of information seeking and avoidance, which ensure a sense of normality in a situation full of uncertainty. The participants were faced with events that shook their beliefs about when they could return to normal activities, and involved various health-related decisions, such as wearing masks, getting vaccinated, or avoiding the news about deaths.

The participants utilized local knowledge as their information source to help them recognize the dangers and improve their understanding of the situation and security risks during the pandemic. This included information on the mortality rate and the number of positive cases at the time, the crowd situation in the streets or markets, or the level of mask usage in the geographical neighborhood where they lived. In addition, they also shared information about herbal remedies, especially traditional herbal concoctions or “jamu,” to strengthen the body’s immunity during the pandemic. The participants received this local knowledge not only through direct observation, but also from family, friends, and coworkers, which is a standard information-sharing practice among Indonesians. This is also in line with the findings of Montesi (2023)’s study in Madrid of the “new normal” situation of the pandemic, which examined changes in perceptions of the situation and the risks of the pandemic in terms of people’s responses to their local environment and their use of information exchange.

In interviews, participants depicted a high level of solidarity in the community, where mutual assistance is a common experience. Participants undergoing self-isolation at home often received support in the form of food, vitamins, and daily necessities from neighbors, creating an atmosphere of mutual care. This practice supports the care of those who are unable to leave their homes freely during the pandemic.

As the population with the largest Muslim population in the world, during the pandemic, Indonesian society paid significant attention to religious information related to the ongoing pandemic situation. Muhtadi and Soderborg (2023) indicate that the level of fear and behavior during the pandemic was closely associated with religious factors among Indonesians. As described by the participants, in addition to following health authorities, they underscored the importance of religious information from the Indonesian Ulema Council (Majelis Ulama Indonesia or MUI) or local religious organizations in making health decisions. This includes considerations regarding the permissibility (halal status) of vaccines, procedures for burial during pandemic situations that are different from normal conditions, and directives against gathering and the use of masks during worship, as responses to the prevailing health protocol guidelines.

Based on further analysis in the sensemaking process, we developed two core categories that explain how participants engaged in the sensemaking process: (1) Crisis Knowledge Sources: In meeting these needs, individuals are prompted to address existing knowledge gaps using various strategies of search, avoidance, limitation, use, and evaluation of information by exploring available information resources, supported by processes of interpretation, internalization, and response to available local knowledge throughout the ongoing pandemic; and (2) Outcomes for Deciding Health Actions: Consequently, this results in outcomes to fill knowledge gaps as a stage of internalization, and continued alternating processes of sensemaking and habitual modes to make appropriate health decisions. These were random at the beginning of the pandemic but became more regular in later phases. This was influenced by the “knowledge gap fulfillment” and “use of local knowledge.”