Nancy D. Zionts, Jan Apter, Julianna Kuchta, and Pamela K. Greenhouse
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According to a market survey showing that the public library is the first place many turn when seeking health information, librarians are the front-line workers in consumer health literacy. A consumer health literacy initiative has been undertaken throughout the Pittsburgh public library system to help librarians assure meaningful access to consumers seeking health information. This initiative, the Health Information Fellowship, through which librarians attain their Consumer Health Information Specialist certificate from the Medical Library Association, has had numerous outcomes, including:
- the creation of a new consumer health database and related Web information;
- the design of a staff training module;
- the development of a presentation for consumers, including brochures and pathfinders; and
- positive participant ratings regarding improved familiarity and preparedness with consumer health information in multiple dimensions.
The fellowship is replicable and is currently being spread regionally.
Over the past decade, the United States has experienced a move toward greater consumer involvement in health care.1 Health care consumers have become more interested and involved in understanding their health issues and needs and in making decisionsregarding treatment options and services.2 At the same time, the growth of technology provides a mechanism through which consumers have unprecedented access to health information. The British Medical Journal reported in 1998 that there were a minimum of 100,000 health-related websites available.3 That number has grown exponentially in the ensuing years; a current Internet search for health-related websites with a commonly used search engine provided 268,000,000 sites. While not everyone has access to a computer in the home, it is estimated that between 75 and 85 percent of Internet users have looked online for health information.4 The downside to the availability of computers and the accompanying easy access to abundant health information is that not all of the available information is credible, pertinent, or correct. Furthermore, even high-quality information brings with it a need for the consumer to be able to understand and apply the information to their benefit.
Libraries provide computer access for consumers who do not have home computer access; librarians, with the proper training, present an opportunity for consumers to receive help in locating desired health information and in evaluating website credibility, relevance, and applicability.
The Institute of Medicine (IOM) and the U.S. Department of Health and Human Services (HHS) define health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”5 As is pointed out in HHS’s “Quick Guide to Health Literacy and Older Adults,” health literacy requires a number of skills beyond reading, including listening, analysis, and the ability to apply the information that has been acquired to health situations—for oneself or for others.6 Knowing where and how to locate health information electronically requires a degree of technical savvy and baseline health care knowledge that many people do not have. The IOM estimates that 90 million people in the United States have difficulty understanding and using health information.7 According to the American Medical Association, poor health literacy is “a stronger predictor of a person’s health than age, income, employment status, education level, and race.”8 Public libraries provide a no-cost, convenient way to access computers and, potentially, personnel to help the consumer navigate both the technology and the health information accessed. Yet too few public librarians have the training necessary to provide optimal help to consumers who would benefit from such help.
There is a considerable amount of literature describing consumer behavior in searching for health information and describing barriers to locating health information, which include access limitations and the inability to evaluate received information. In a 2002 British Medical Journal study, participants were observed retrieving health information from the Web in a usability laboratory setting. In this study, “no participants checked any ‘about us’ sections of websites, disclaimers, or disclosure statements. In the post-search interviews, it emerged that very few participants had noticed and remembered which websites they had retrieved information from.” The authors concluded that a focus on “guiding consumers to high quality health information on the web” is needed.9
Linnan et al., writing in Health Promotion Practice in 2004, found that while two-thirds of adults visit a library yearly, “the interests and training needs of public librarians for assisting the public in accessing health information have not been addressed.”10 In this random survey, conducted in a county in North Carolina, 84 percent of librarians that completed a questionnaire indicated that they answer “more than 10 health-related questions per week, feel moderately comfortable answering thesequestions, and are very interested in receiving additional training for addressing health related questions.”11 Linnan et al. concluded that creating public library–public health partnerships can enhance the ability of consumers to procure health information.
In 2005, Borman and McKenzie looked at barriers in the reference transaction between librarians and consumers.12 Their literature review found that “between 6 and 20 percent of total reference requests in public libraries were health-related,” and that “librarians report spending significantly more time with consumer health information (CHI) requests than with other types of reference questions.”13 Among the barriers specific to consumer health information, they found that some users are unaware of the services the library provides, users may encounter staff members who are uncomfortable providing assistance regarding health information, and librarians may not be confident about making referrals to community agencies.
Roma Harris and Nadine Wathen, in the 2007 piece “If My Mother Was Alive I’d Probably Have Called Her,” explored how women living in a rural Canadian county located health information.14 They found that most of the women interviewed seek information from a wide variety of sources, including the Internet, and that the interviewees place great value on the “quality of the relationship with those to whom they turn for assistance.” For these women, “helpers’ perceived effectiveness seemed to depend largely on how well they express care when information is exchanged.” Harris and Wathen proposed that merely expanding the availability of Internet-based health information would not adequately meet the needs of the health information seekers studied; rather, helping local libraries become a health information resource would be a better strategy because of librarians’ potential to provide “an empathetic, listening ear.” Harris and Wathen, in discussing the considerable barriers to improving health through electronic sources (lack of skills, access, trust in sources, interesting presentation of material, and so on) pointed out that while public libraries could have a role in facilitating consumer access to health information, “not all public libraries have specific health information centers, and some librarians feel inadequately prepared to respond to health information requests.”15
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