Consumer Health: Best Practices for Public Libraries

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Workshop designed to introduce MLIS students to public library best practices when it comes to providing consumer health information reference and programming services.

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  • So as far as health information literacy goes, what our literature searches have identified that it is one of the most important aspects of health information seeking, and that it should always be included in any discussion of best practices for librarians. There are many benefits to health information literacy, but maybe the most important is that the evidence suggests it does improve patient outcomes. The StatsCan report from 2010 identified that 64.1% of Canadians used the Internet to research their health or medical information, but as we all well know, it's more than likely that Google searches and the like are the most popular way of searching for this info. To maximize the benefits of seeking health information, our best practice as librarians is to educate our patrons about how they can evaluate the accuracy, currency and appropriateness of the info they are finding online. That's mostly all we want to say regarding health information literacy in this presentation - we'll refer back to its importance as part of our best practices, but we don't want to get too heavily into what health information literacy is, or what it involves, because we know that will be something other groups are presenting on in the weeks to come.
  • This is of course something that we touch on in any discussion about reference interviews and providing information to patrons, but in discussions about health information disclaimers become not just important but absolutely essential, for our own protection and the protection of our patrons. This is the MLA statement regarding disclaimers. I'm going to begin showing you some of the general adult health resources we found, which we would include in any list of resources for best practices in a public library, but I just want to briefly state the criteria for selecting these as the best resources. In order to be considered the best, we are looking for things like accuracy, currency of information - for example, how often is the site updated? - sponsorship - for example, who is on the board of directors? does the url of the site end in .com or .gov or .edu? - and many of the other criteria, which again, we don't want to get into too extensively, as this presentation is not about health information literacy.
  • This website is considered by health librarians and professionals to be the “mecca” of all consumer health websites. It is the official consumer health site for the American National Institutes of Health, and is produced by the National Library of Medicine. It is completely free to use this site. As it states in the “about” section of the site, “you can use Medline Plus to learn about the latest treatments, look up information on a drug or supplement, find out the meanings of words, or view medical videos or illustrations. You can also get links to the latest medical research on your topic or find out about clinical trials on a disease or condition”. The site is clearly organized, there are a variety of ways to look up whatever information you might be looking for – and one of the really cool features is the videos of common surgeries. What it does not have, and this is a feature of all the websites I'll be showing you, is advertisements or commercials - there are no private interests here.
  • Another resource that is useful and trusted for general health info is the Mayo Clinic website. The Mayo Clinic is a hospital with locations in Arizona, Florida and Minnesota. Their site is great, very easy to navigate, with a symptom checker, tests and procedures A-Z, links to expert blogs, and even an online store.selling books, newletters and videos. The primary site that you might want to avoid is WebMD - this is a very popular consumer health website with general info, and while there is probably lots of good information on the site, health professionals prefer sites such as Medline Plus and the Mayo Clinic because their info is based on clinical trials and research (evidence-based), rather than anecdotal evidence, which is sometimes the case with WebMD.
  • This site does not have much to offer in the way that the previously mentioned American sites do, i.e. there is not a lot of consumer health info about particular illnesses and conditions. Unfortunately, there is really not an equivalent site in Canada that is of the same calibre of the Medline and Mayo Clinic sites. The Health Agency site does offer some useful information though, primarily in the areas of public health initiatives. There is lots of info about travel safety, vaccines, food safety, etc. all of which is going to probably be important to the average Canadian citizen at some point.
  • The Health Canada and Health Ontario websites also have some good information on them, although they too are somewhat lacking when compared with the American sites that are available. The most important aspect of these is the drug database on the Health Canada site. - product-specific information on over 15,000 drug products approved for use in Canada. - links to fact sheets with detailed information. - detailed Search Tips with examples, Terminology section that explains vocabulary, and FAQs - updated nightly - possibly a little daunting for the average health consumer.
  • And now I'll turn it over to Ashley, who's going to talk about resources for teens and for parents and children.
  • Consumer Health: Best Practices for Public Libraries

    1. 1. Consumer Health Information Services in Public Libraries Melissa Harris, Ashley D'Andrea, Sarah Schmidt, Anastasia Bush
    2. 2. Agenda Health Information Literacy Disclaimers Resources for General Adult Info Seekers Considerations for Specific Audiences • Teens • Immigrants • Seniors Summary: "Take Aways" Reference Interview Activity
    3. 3. Health Information Literacy • Health information literacy benefits information seekers in many ways, but perhaps most importantly, it appears to improve patient outcomes. • Statistics Canada reported in 2010 that 64.1% of Canadians used the Internet to research health or medical information. • To maximize the benefits of seeking health information, our best practice as librarians is to educate patrons about how to evaluate information found online.
    4. 4. Disclaimers It's essential to preface all consumer health- related reference interviews with a disclaimer. "Disclaimers inform patrons that libraries do not provide medical advice and do not interpret information for patrons. Patrons are referred instead to their health care providers to discuss their questions regarding health information." - MLA
    5. 5. General Information for Adults Medline Plus • Website most recommended by physicians • considered the ultimate trusted resource for consumer health info by many health professionals • American, offered by NIH and NLM, free site • offers info regarding treatments, drugs and supplements, research and clinical trials about diseases or conditions • medical dictionary, videos and illustrations
    6. 6. General Information for Adults Mayo Clinic • Second-most highly recommended site among many health professionals • Hospital with locations in AZ, FL and MN • Site is very user-friendly and clearly organized • Has an online store selling recommended books, newsletters and videos
    7. 7. General Information for Adults Public Health Agency of Canada • Primary Canadian resource • Unfortunately Canada does not have a site of the same calibre as Medline Plus • This site offers info on travel health, food safety, vaccines, disaster protocols, lab safety and biosecurity, and other health and wellness public initiatives
    8. 8. General Information for Adults Health Canada • and embedded Drug Database • Again, these sites are not comprehensive health information providers in the same way that US sites are, but there is some useful information • The most specific information that may be of use for Canadians is the drug database.
    9. 9. General Information for Adults Healthy Ontario • Or the provincial equivalent • Sponsored by ON Ministry of Health and Long-Term Care • Very useful for helping patrons to negotiate the health care system specific to where they live • More concerned with preventive health initiatives in the province than with providing general health information resources
    10. 10. Best Practices for Adult Materials • Online resources that will provide the most current and accurate information • A smaller collection of print or a/v/e resources regarding common or prevalent diseases or conditions (ex. books about living with cancer, managing diabetes, etc.) • A secondary collection of print or a/v/e resources dealing with lifestyle issues • Communication or partnership with health professionals
    11. 11. Reference Questions • I'm interested in alternative management of breast cancer. Can you recommend some resources about this? • My doctor recommended Botox injections for migraine headaches, but I don't want plastic surgery! Can you help me find out more about this? • I heard there is a pill you can take in the US that will prevent HIV. Is this pill available yet in Canada?
    12. 12. Health Information and Youth Teens are emphasizing the need for accessible, high-quality, understandable and personally relevant information. Most teenagers favour taking an active-role in learning about their health. (Smart et. al, 2012, p.379)
    13. 13. Teens and Health Information Needs Adolescents regularly seek health information and often have unmet health concerns which indicates that this group of people is not receiving the health information they need (Smart et. al, 2012, p. 379)
    14. 14. What Type of Health Info are Teens Seeking? Surveys from the 1990s and from the 21st century identify that teens often search for information about medical diseases, body image and nutrition, sexual health, mental health and violence. (Smart et. al, 2012, p. 380)
    15. 15. How are Teens Looking for Health Info? • Personal Communication • The internet When teens are asked what method they prefer, they say "it depends". Three variables influence their method: 1. Attributes of health info 2. quality of the relationship with source
    16. 16. Teens and their Feelings Towards Seeking Health Info • Often feel embarrassed due to nature of health information need Eg. Sexual health, STDs • State that going to the library is like broadcasting their needs and they don't feel comfortable • Believe that their relationship between health information should be private and confidential • Need a source that is trustworthy and non-
    17. 17. Most Common Active-Approaches for Seeking Health Info • Communication with doctors, teachers and health professionals in person or online. • Teens most commonly prefer online sources provided by school web pages or other websites, newsletters from hospitals and pamphlets. • Seeing information visually is highly
    18. 18. Public Libraries and Teen Health Information Public libraries have a long history of providing health information and many have developed websites specifically for teenagers. Examples: Calgary public Library Brockville Public Library
    19. 19. What Sites are Libraries Linking to? The number of health-related websites recommended range from 1 – 93 with an average of 7. • non-profit organizations • government agencies • professional associations • community organizations • universities • hospitals • public television stations • advocacy groups
    20. 20. Factors to Consider with Public Library Access 1. Lack of young adult librarians 2. Filters and Censorship 3. Quality of Information 4. Low Visibility and Findability Subscription Databases Go Ask Alice!
    21. 21. Youth Librarians as Facilitators of Health Information Approaches: • Appear at school events • Write educational columns for school websites, newsletters and newspapers • Suggest local health resources and events • Class field trips to the library • Create awareness about library's role in accessing health information
    22. 22. Public Library Best Practices for Teen Health Info • Community based approaches and partnerships • Collection development • Evaluation of information • Develop health information programs • Work with advocacy organizations • Participate in and lobby for research on teen health literacy
    23. 23. Resources for Librarians Identification of Best Teen Health Resources: • The Public Library and School Library Media Center Role • Teenspace (The Internet Public Library) • Health on the Net Foundation (Principles and codes reliability/credibility)
    24. 24. Resources for Librarians Evaluation of Sources: • Evaluating Health Information, MedLine Plus • Ten Things to Know About Evaluating Medical Re
    25. 25. Websites for Teens http://teenshealth.org/teen/ http://www.brainpop.com/health/ http://www.iemily.com/
    26. 26. Handbooks for Teens Adolescent Health Sourcebook. Chad T. Kimball, ed. Detroit, Omnigraphics, 2002. 685p. Health Matters! William M. Kane, ed. Danbury, Conn., Groiler, 2002. 8v.
    27. 27. Sample Teen Health Reference Questions What should I do if I am suffering from anorexia? I am pregnant and my boyfriend uses drugs, can this harm me or the baby?
    28. 28. Parents and Health Information (Khoo et.al., 2008, p.421)
    29. 29. Resources for Parents AboutKidsHealth, Sick Kids Hospital Kidshealth.org Parents2parents.ca Caringforkids.cps.ca
    30. 30. Sample References Questions from Parents Seeking Health Information Where can I look up symptoms my child has that is trustworthy so I can avoid misdiagnosis? I am concerned about my 14 year old son's sexuality, where can I read up on teenage development?
    31. 31. Health Information for Immigrants Why is Health Information so important for the Canadian Immigrant Population? • The new immigrant communities are vulnerable to many health disparities due to: o Past health care in country of origin and/or o Current state of livelihood in Canada • Effective health information and communication is needed to help this portion of the population who are at a greater risk for potential health problems
    32. 32. Immigrant Population in Canada • According to Canada’s 2006 census there are 6,186,950 immigrants now residing as 19.8% of the Canadian population. (Statistics Canada, 2001 and 2006). • In 2011 Statistics Canada reported that between 1991 to 2006, the average number of immigrants to Canada annually was 229,000. (Statistics Canada, 2011)
    33. 33. Diversified Immigrant Population Immigrants in Canada have diversified over the years in their country of origin, creating a different composition culturally in the immigrant population. •In the past 10 years o 62% of immigrants are of European origin, o 74% are immigrants from Asian, Latin American, African origin, primarily from non- English speaking countries. (Stampino, 2007)
    34. 34. Identified Health Information Needs of Immigrants • • Knowledge and understanding of the health care system • Proper personal health care • Eligibility for medical coverage • How to find and access other health services (mental health, long-term care) • Improving health literacy • Nutrition and wellbeing advice Pregnancy and natal care
    35. 35. Common Health Concerns of Immigrants • HIV/Aids • Cancer • Diabetes • Strokes • Depression • PTSD • Anxiety • Cardiovascular Illness • Anemia • Respiratory Illnesses • STD's • Dental Problems • Hepatitis • Tuberculosis
    36. 36. For immigrants, their access to health services and information are often affected by three main types of health barriers: • Socio-economic • Culture-linguistic • Systemic (Sasso and Stanger, 2005) Barriers to Health Information and Care Faced by Immigrants
    37. 37. Why do immigrants resort to health information services in the public library? • As a result of the barriers, immigrants are often motivated to learn further to satisfy their health information needs in non-medical settings. • Immigrants use the library due to a misconception and fear often shared by immigrants that by contacting health care providers their immigration status will be jeopardized. (Waxler-Morrison N et al) • Limited time by health professionals to spend with patients and limited English health literacy has created a need to seek and understand health information in the library (where there is no cost)
    38. 38. Implications in Providing C.H.I. Services to Immigrants Librarians, and health information professionals may face additional challenges in trying to assist the immigrant community with their consumer health information needs: • Translating C.H.I. resources are time consuming and complex due to diversity of languages • Wrong translations of health information can create miscommunications between immigrants and librarians • Local community libraries must work to identify their patrons’ particular health information needs and the barriers that are preventing them from meeting those needs.
    39. 39. Best Practices Diversity in culture and language among immigrants which is now ever present in Canadian society requires a variety of approaches to improving the health literacy in multilingual and immigrant communities. • Multilingual resources o Print (primarily) o Online • Interactive and Adaptive Communication • Tailored Resources and Services • Public Outreach and Community Partnerships • Communication Development and Workshops for Librarians, Library workers, and Health Professionals
    40. 40. Health Information Distribution Methods in Public Library Once resources are tailored to the immigrant community that the library serves, the best methods of distributing health information to a multicultural and multilingual audience in a public library includes: • Print Media • Audio and Visual Media • Interpersonal Communication • Electronic and Online Resources
    41. 41. Evaluating Resources Unfortunately the majority of resources available are not as accessible to an immigrant audience. Medical Library Association- Evaluating Health Information Canadian Medical Association- Clinical Practice Guidelines Evaluating Web Resources Checklist MedlinePlus- EvaluatingHealth Information
    42. 42. Online Health Information Resources for Libraries http://www.nhchc.ca/index.php http://www.vaughanpl.info/newcomers http://www.ala.org/rusa/resources/guidelines/guidemultilingual
    43. 43. Online Health Information Resources for Immigrants http://ethnomed.org/ http://www.nlm.nih.gov/medlineplus/languages/languages.html http://www.health.gov.on.ca/en/common/system/languages.aspx http://www.settlement.org/topics.asp?section=HE http://www.hhsc.ca/body.cfm?id=1786 http://www.hc-sc.gc.ca/hl-vs/jfy-spv/immigrants-eng.php
    44. 44. Sample Reference Interview Questions How do I find a family doctor? What kind of health care can I get, how do I know that I am covered? What immunizations are required for my child to go to school?
    45. 45. Special considerations for seniors By 2041, 25% of Canadians will be 65+ o More health concerns o More socially isolated: 1/3 widowed, no longer working o More diverse: ethnically, culturally, needs, interests Why seniors? Percentage of Canadian population aged 65 or older, 1921-2005, and projections to 2056 Sources: Statistics Canada, Censuses of Canada; Population projections for Canada, provinces and territories.
    46. 46. Why seniors? Soon, most Canadians will be either a senior, or caring for a senior. Schellenberg, G. & Turcotte, M. (2007). A portrait of seniors in Canada. http://www.statcan.gc.ca/ads- annonces/89-519-x/index- eng.htm
    47. 47. Common health concerns of seniors Hypertension Arthritis Diabetes mellitus Heart disease Cancer Stroke Hip fracture High cholesterol Low vision/hearing Related concerns • Depression • Anxiety • Reduced mobility • Fixed income • Computer literacy • Social isolation • Grieving Which of these are chronic, which acute? Why does that matter?
    48. 48. ALA/CLA Guidelines for Library and Information Services to Older Adults 1. Assess community needs. 2. Reflect those needs in collections, programs, and services. 3. Physical library must be safe & inviting for older adults. 4. Be a focal point for info services to seniors. 5. Target older adults for programming. 6. Reach out to older adults. 7. Train library staff to work with seniors.
    49. 49. Best practices for older adults • Outreach to homebound & retirement homes • Assistive technology o low vision equipment o keyboard/mouse for limited mobility o wheelchair accessible computer station • Facilities (AODA) o low vision signage o wider aisles • Regular programs o computer training o health info literacy
    50. 50. Best practices for older adults (cont.) • Volunteer opportunities o senior advisory board • Study guides on health topics • Collections o large print o audio books, e-books o health topics • Reference services o privacy, seating o hearing loss, vision loss, o magnifying glass
    51. 51. Reference Services (Bopp & Smith, 2011) 1. Referral info about community resources. 2. Collections: health care system, common health issues, centralized reference collection. 3. Access: offer reference service by telephone to homebound and institutionalized elderly; train bookmobile staff/care facility staff. 4. EbscoHost Ageline: 200 journals, books, reports for professionals & consumers. 5. Computer training.
    52. 52. Computer Training Smith, Knight & Joines (2005). Improving the health of seniors: A partnership between a public library and an academic health sciences library. • Users requested • Seniors' Health Information on the Net • Series of classes • Held at public library computer lab • Trainers from health library, hands-on assistance from public librarians
    53. 53. Computer Training (Smith, et al. 2005) Three sessions focused on researching health topics using online sources: 1.Learned rules for evaluating websites "CARES FOR U" 2.Introduced to MedlinePlus 3.Completed online health survey from howsyourhealth.org 4.Introduced to clinicaltrials.gov 5.Explored online resources available through public and health libraries.
    54. 54. Deliver quality consumer health information for older adults 1. Seniors' Health Info on the Net workshops. 2. Study guides, see National Institutes for Health, Senior Health section. 3. Staff sensitivity training: frontline, facilities, and administration. How about appointing a staff member to coordinate senior services?
    55. 55. Sample Reference Question My doctor recently prescribed warfarin for my heart. I'm concerned that it might interact with other medications I'm taking. How can I find out information about that? Warfarin: MedlinePlus
    56. 56. Summary: Best Practices for Public Libraries 1. Create partnerships and collaborations. 2. Improve digital literacy. 3. Remove systemic barriers in the library. 4. Respond to diversity in the user population.ALA announces new trend? (Oct, 2012) First ever in U.S.A.: a nurse in the public library http://azstarnet.com/news/science/health-med- fit/library-nurses-look-after-those-in- need/article_6ee73756-17a6-50ff-afb1- d3921b85e8b2.html Questions? Comments?
    57. 57. Reference Questions These are real health questions fielded at the public library reference desk: 1.Do you know what a lice looks like? 2.What does HPV mean? 3.How can I find a family doctor? 4.What is the DSM-V and how do I use it? 5.How can I find information about Coumidin? 6.Or... an example from your own experience.
    58. 58. References Hughes-Hassell, S. et. al. (2008). Urban teenagers, health information, and public library websites. Young Adult Library Services, 35-40. Lukenbill, B.W & Immroth, B. (2007). Health information for youth: The public library and school library media resource center role. Westport, CT: Libraries Unlimited. Smart, A.K. et. al. (2012). Speaking up: Teens voice their health information needs. The Journal of School Nursing, 28 (5), 379-388.

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