New roles of health librarians

Introduction

The Library Service at Innlandet Hospital Trust has since 2009 conducted literature searches for evidence-based clinical procedures, pathways and care plans. All of the searches are published on the Internet. Innlandet Hospital Trust follows the principle of transparency and publishing literature searches is one of our contributions. The structure of the literature search is based on Brian Haynes’ 6S Knowledge Pyramid. The search for pre-appraised evidence is essential because this literature have gone through a filtering process to include high quality studies that are regularly updated (1). Innlandet Hospital Trust has developed a search engine called the Knowledge Egg (2) based on Brian Haynes’ Knowledge Pyramid. The Library Service’s goal is to make the result page for the literature searches as user friendly as possible, and to look like the Knowledge Egg. We have learned from oral feedback that the employees associate the egg with the pyramid. There have been major challenges in relation to the hospital’s firewalls regarding publishing literature searches. The conclusion in 2009 was to use Google Sites to publish the searches outside the firewalls. Once made, the pages worked well behind the firewalls. Early 2012, the Library Service plans to create a new look for the results pages because it is now possible to move the literature searches behind the firewalls. The new web platform is SharePoint. 

Question

What is the most user-friendly interface for literature searches conducted for evidence-based clinical procedures, pathways and care plans? We used the SPICE model to structure the question formulation (3).

Methods

The method to find out what the empoyees wanted was an anonymous user survey (4). Both quantitative and qualitative research method was used in this survey. They were asked to compare two result pages (5, 6) and to express specifically what they wanted in the new result page. The user survey was sent by e-mail to 34 employees. 19 of the employees answered, which represent 55.88 %. Based on the results from this survey the Library Service created a new result page appearance. In addition to the survey a systematic literature search was performed. 25 databases were searched (7).

Results

The literature search gave no interesting findings. From the survey it turned out that the employees liked the egg shaped result page best. Some suggested minor changes. We followed up 5 out of 7 suggestions for changes. Based on these results we designed a new result page to use in SharePoint.

Discussion

The new result page was first made as a single web part in SharePoint with pictures of an egg formed in a table for best possible stability. When working in SharePoint we work inside the hospital’s portal using a VPN client for Mac computers. The VPN client is highly unstable and sometimes we used hours trying to access. When we first entered the hospital’s portal, our supplier of SharePoint also is very unstable. We got kicked out every 5-20 minute, which made us quite stressed while working. This was not a good solution. The framework will still be in the hospital’s web platform SharePoint but the actual literature searches needed another format. The solution was a presentation made in Keynote, Apple’s answer to PowerPoint. When converting the Keynote presentation into PDF all of the links followed correctly and we didn’t need any expensive software (8). In SharePoint we uploaded the PDF files, a process that went smoothly. The clickable PDF files works well in Internet Explorer, Safari and Firefox. This solution turned out to be time-saving. The Keynote main template of the result page could be worked on offline. To prepare for a literature search we only needed to copy the main template. When working with a search, we could easily work on the Internet outside the hospital’s firewalls. Approximately, we save 1 hour or more per literature search. It was also important to consider that documenting literature searches should be easy to learn for other librarians. Keynote is much less complicated to learn than SharePoint. At the new start page in SharePoint for the literature searches, we present the searches by subject and alphabetically. We expect to use this interface in 2-3 years.

Introduction

Cancer related information grows at an exponential rate. However, it varies in validity and quality. Thus, the assessment and selection of appropriate resources can be difficult and overwhelming for patients and their caregivers. Libraries in cancer centres offer access to crucial health resources to those who seek informational support. This includes segments of the population who may be underserved or encounter barriers when seeking information. Librarians have criteria for assessing the suitability of consumer health information; the quality of resource, language level, author credibility and currency. However, these criteria may vary across centres. The Princess Margaret Hospital (PMH) in Toronto, Canada and the Centro di Riferimento Oncologico (CRO) in Aviano, Italy both have formal protocols that librarians use to inform collection development. The purpose of this study was to: (1) examine the formal guidelines and collection development policies used for resource selection, and (2) describe the resource review and selection experience of librarians at both cancer centre libraries. Differences found across sites were also described.

Methods

This study was conducted using transcendental phenomenology where the focus was on the description of the librarians’ experiences rather than those of the researchers’ interpretations. Bracketing was also used to reserve the researcher’s experience and views from influencing those collected from the participants. Before the study began, the researchers wrote a report documenting their own experience and impressions of the resource review and selection process, and attempted to answer their own research question, as a way of applying bracketing.

Participant recruitment provided a total of four participants; two librarians from the Patient and Family Library at PMH and two from the Patient Library at CRO. A package of four resources was sent to each librarian consisting of two online treatment information resources and two paper-based supportive care resources. The package was available in English for librarians at PMH and in Italian for those at CRO. Participants were asked to independently evaluate each resource and document their assessment. Following the independent review, a 60-minute, semi-structured telephone interview was conducted and recorded with each participant, in their preferred language (i.e., English, Italian). This was followed by a 15 to 30 minute questionnaire about their library collection and approach to its development. Formal documentation of the library collection guidelines and/or development policies were also collected and analyzed. Methods and criteria used to vet and select resources were also compared to those outlined in the formal document. Interview recordings were transcribed in their respective languages. The Italian transcriptions underwent English translation by a certified medical interpreter for analysis. Data analysis and interpretation was conducted by two researchers. Method of analysis followed the general phenomenological analysis approach which consists of identifying significant statements that depict the phenomenon in the transcript (horizonalization), which will be grouped into themes (clusters of meaning). The clusters will guide the written descriptions of the reported resource vetting and selection experience (textural description) and the context that influenced how the librarians experienced the phenomenon (structural description). Textural and structural descriptions verified between the two researchers were used to formulate the compiled description. A summary of the researchers’ own experience during the investigation and the context that may have influenced their experience were also reported in the discussion section. Calculations showed inter-rater reliability was established which can assist in solidifying findings because saturation was not reached. In addition, all results were presented back to the participants for validation.

Results

Preliminary results indicate that both centres use similar formal criteria in evaluation. Two of which had the most consideration included credibility and timeliness of the resources. When vetting resources, librarians placed importance on the accuracy of resource content and a clearly stated source of information, such as the organization and/or the name of the author(s). They also express confidence in resources that were clearly dated which reflects how current the information is.

However, informal criteria varied significantly between centres. The variation was based on the types of images presented, the presentation of the concept of cancer and discussion of death and dying. These informal criteria were influential in the librarians’ determination of whether a resource was suitable for inclusion in the library collection.

Discussion

As explained by Jasper (1994), the generalizability in a phenomenological study is to generate theories and provide descriptive data so that they may be used to further prospective investigation of the phenomenon. Findings from this study present preliminary insight into (1) the review and selection of resources for health centre libraries, and (2) how vetting guidelines and collection development policies are implemented in that process. The results indicated credibility and timeliness as being key criteria and often the initial starting point for assessment.

The study also found that context was a major informal criteria that determined a resource’s inclusion in the library collection. Based on these results, cancer related health information (including use of language and images), vetted by librarians must be of high validity and quality while being supportive and assistive to the cancer patients and their families. A good way for empowering the patient education, is to share with cancer patients’ and their family attending the libraries, the key criteria for assessing health information. This is important for three reasons: a) to help patients in their own research of reliable information; b) to avoid the upset due to a bad managing of uncertainty; c) assist patient with navigating their way through the health care system to properly access to procedures and consultation.

Without careful consideration for the context patients are in, selection of resources may include materials that may cause unwanted effects such as discomfort, uneasiness and anxiety. It is suggested that selection of consumer health information for health centre libraries should include careful consideration and sensitivity to how content is presented and how it could be perceived by patients and family members.

Introduction

In 2011 the Jagiellonian University Medical Library staff entered a strategic multidisciplinary scientific project (SYNAT) financed by the Ministry of Science and Higher Education in Poland. This project has been developed in the years 2010-2013 by 16 Polish universities and Polish Academy of Sciences institutes and its aim is to integrate already existing, dispersed resources, both content and infrastructural, develop a technological support system for a better knowledge transfer (mainly from Polish resources) to the scientific community (virtual scientific environment), and create a universal, unified, and friendly access to the information services.

Librarians, and among them medical librarians are engaged in development of a knowledge base (PASSIM) of contemporary science and technology. The integrated PASSIM system will enable acquisition of information from disseminated and heterogeneous databases to support scientists, researchers, lecturers, reviewers, students of all levels and scientific publishers in their work.

Objectives

The purpose of our presentation is to discuss participation of the Jagiellonian University medical librarians in implementation of the SYNAT/PASSIM project.

The Jagiellonian University Medical Library is the only SYNAT partner dealing with medicine, so our tasks have been related to medical science (research-analytical team of about 25 specialists in scientific medical information with various educational background and different skills and abilities. The tasks were divided according to the participants’ skills and preferences.

Our main role has been to register the Polish and foreign resources of biomedical and health-related information and to analyze the structure and content of the digital resources of the Polish archives in order to determine if they can be included into the PASSIM system and shared with researchers as basic source data both in the harvesting model and the main database of the developed system.

Methods

We have focused on the search, identification, expansion, and analysis of the existing resources, analysis of the availability of dictionaries, thesauri, ontologies, web pages, and databases. Our analyses will also include estimation of the resources sizes, determination of the access types (all Web, OAI-PMH, internal format), description of the metadata formats and applications of the copyright law to open access.

Results

The expected results of this project include:

• Development of an integrated system which will enable acquisition of information from disseminated and heterogeneous databases,
• Creation of a multifunction repository of raw data dedicated to safe, long-term storage and distribution of digital initial objects,
• Universal, open, hosting and communication, repository platform, which enables the exploitation of individual application software and sharing of information and services available from the servers of hosting organisation/s

Our team analysed carefully the selected collections, extracted metadata, and developed guidelines to support work in the following fields:

• Analysis of the present state of cataloguing and the access to digitalised doctoral and habilitation dissertations in medicine prepared in Poland and abroad. The database of full-text doctoral theses was supplemented with 786 new records (MeSH) and migrated from the alfresco platform to dLibra.
• Analysis of the cataloguing systems and the access to full-text bibliographic, bibliometric, and factual databases in biomedicine, in Poland and abroad. The database of the publications of researchers of the Jagiellonian University Medical College was supplemented with 4855 new records and contains 50402 records now. Over 3000 records were linked with the full texts with the use of 360 Link tool.
• Analysis and classification of the Polish and foreign reference resources and cataloguing of medical e-books. The most important achievement in this field is full adaptation of 25 NLM classification tables and their use in arrangement of printed books on the shelves and in structuring a collection of 5548 bibliographic records on virtual shelves. Cataloguing has been performed according to the NLM classification, Cutter-Sanborn tables and MeSH.
• Analysis of the state of cataloguing of biomedical special collections and XIX prints collection in catalogue systems and digital platforms in Poland and abroad. 983 bibliographic records of XIX books and 298 bibliographic records of 1901-1945 printed materials were catalogued A strategy of digitalization and conservation works of the old books was planned.
• Analysis and structuring of Polish reference resources and nomenclature systems in connection with the UMLS ontology and other international semantic networks of health-related sciences.
• Continuation of efforts to standardize the Polish version of Medical Subject Headings, which has been developed in two variants: of university libraries (MeSH-Pl) and the Main Medical Library (Tez-MeSH).
• Continuation of the development of Multilingual Thesaurus of Public Health.
• Analysis of Internet resources in medicine and related sciences. We searched web pages of all Polish universities and colleges offering training in medical occupations, medical libraries with their catalogues and other bibliographic lists, medical journals and popular medical magazines, publishing houses (including small, found via Internet bookshops or other web pages), medical or health-related scientific institutions, organizations, governmental agencies, nongovernmental and not-for-profit organizations, health or social insurance agencies, medical or health-related learned associations and professional corporations, web pages containing Polish laws and regulations related to health. We also searched numerous popular medical services and portals: services for patients, web pages for particular conditions or diseases, portals of medical manufacturers or health services providers, and many other commercial web pages. Furthermore, we catalogued some foreign resources: of commonly known international organizations as UE or WHO of which Poland is a member. We assessed web pages according to reputable organizations certificates, e.g. HONCode http://www.hon.ch/home1_pl.html or Internet tools measuring popularity of certain web pages, e.g. www.alexa.com . The main criterion of a resource quality was its expected usefulness for the future users. The popular websites were evaluated according to guidelines included in „Europe 2002: Quality Criteria for Health Related Websites”. The commercial or popular web pages addressed to all Internet surfers were selected according to e-health criteria: transparency, authority, data protection, information updating, accountability, and accessibility but we neglected the assessment of websites formats, graphic solutions or “user-friendly features”. The web pages of professional institutions were grabbed unquestioningly. We assumed that the authority of these organizations was sufficient recommendation.
• Structuring and cataloguing of the Internet resources: Polish and foreign portals, services, and information systems in all medical specialties. 1762 records were created in RefWorks, with links to web pages, portals, services, textbooks, papers, databases, films, social networking services (blogs, forums, discussion groups). These resources were catalogued according to the general standards (Dublin Core metadata standard) and standards applied in health sciences (MeSH).

Discussion

Participation in the SYNAT project is very advantageous for the Jagiellonian University Medical Library, particularly for the development and improvement of the tools of formal and subject cataloguing:

• Polish version of MeSH
• Adaptation of the NLM classification tables
• Ontological analysis of the UMLS system

We will acquire new skills:

• Various methods of the information retrieval
• Assessment of the quality of Internet resources
• Standardization of the description of the retrieved resources
• Collaboration with other, non-medical librarians in development of virtual scientific environment

The magnitude of our library databases will significantly expand (catalogue, digital library, born-digital resources). SYNAT is an advanced IT project; for the libraries it is a step into the future of scientific information.

According to a survey performed by the National Library of Poland (within the SYNAT project) on various user groups, the vast majority of respondents agreed that the scientific information was the best in medicine and health-related sciences, mainly owing to the complex and universal character of the Medline database. Development of the SYNAT/PASSIM platform will expand the possibilities of the medical information retrieval.

Introduction

In the last few decades the specialized libraries have developed new services and now focus more on expanding, collaborating and disseminating information, in addition to the traditional management of specialized information and classic library services (such as cataloguing, interlibrary loan, bibliographic searches, etc.).

In short, the main objective of today’s Health Sciences libraries is to facilitate the access to medical information, especially to researchers, clinicians and in general health workers. In the last few years 2.0 tools became very useful to achieve this, because they allow libraries to offer new ways and more information services, using the Internet for collaborative and interactive applications.

Objectives

We started looking for the kind of tools that are being used in our field and the amount of biomedical libraries that are using it. In a first approach we found that this information was not collected anywhere. Giving this, we considered as our main objective the development of a National Catalogue of Web 2.0 Resources in Health Sciences libraries in Spain, in order to fill this gap. We expect this catalogue to allow us to monitor the level of Web 2.0 tools used in medical libraries in our country.

Secondary objectives are to determine whether these resources are authored by the institution itself, which means the library, or by an individual librarian, and also to check if there is official support to the use of these tools and if the institution provides policies and guidelines for it.

Methodology

We performed a descriptive study, as it reports on the findings of an online survey. The steps we took were as follows:

Firstly we decided the kind of institutions to be analysed, and to start we based this investigation on all kind of Hospital Libraries (public or private hospital libraries, hospital consortium libraries and university hospital libraries) and also on the major Spanish Regional Virtual Health Libraries found in the Serials Union Catalogue of Spanish Health Sciences Libraries (C17). We excluded medical Libraries from Universities or Public Research Entities (OPIs).

Secondly we made an on line questionnaire to collect information about the Web 2.0 tools used by the selected libraries and sent this questionnaire by e-mail to the persons in charge of these libraries (addresses were obtained from the C17 Serials Union Catalogue of Spanish Health Sciences Libraries mentioned above). Moreover we disseminated the questionnaire among specialized internet forums in the field as Bib-Med.

The questionnaire consisted of 17 questions between multiple choice questions, open questions and closed questions and was launched through the online survey site Encuesta facil (http://www.encuestafacil.com/). Despite the fact that we gave the librarians the possibility to indicate their usage of other tools as for example Netvibes, Slideshare, Youtube or Delicious amongst others, we decided to focus our analyse only on the three most common Web 2.0 tools in our context: blogs, Facebook and Twitter.

Results

A total of 180 libraries were initially selected for the survey, and we received the contribution of 59, which indicates a slightly higher percentage than 30%.

The results show that the use of 2.0 tools by the Spanish hospital libraries and regional virtual libraries taken part of our study is still low and reaches between 28% and 35% depending on the tool. Twitter is the most popular, being used by the 35% of the libraries; Facebook is used by the 28% of the libraries and a total of have almost 34% blogs.

The distribution of the analysed tools regarding the time of its implementation shows that the oldest tool being used is the blog (about the 40% of the blogs are older than two years). The use Facebook is more recently and increased at most in the last year (about a 35% of the profiles are younger than one year). As regards Twitter, which is the tool most used in our context, the accounts were between 1 and 2 years old. Finally, we found that in the last year the use of other tools 2.0 has increased, around 45% of this were younger than one year.

Regarding the authorship of the studied 2.0 tools, results show that the library (meaning the institution) is mostly the author talking about Facebook and the other new tools, whereas blogs and Twitter accounts are managed by the librarian individually.

With regard to the official support of the institution, the survey shows almost the 55% receives this support, but at the same time, 62% of the institutions don’t provide the library with official of the respondents use the web 2.0 tools with, only 17% of the institutions have official guidelines for using them. We found also quite interesting that about 20% of the librarians that were responding to the survey, couldn’t answer either of the questions.

Finally, comparing the type of library, we found that this kind of tools are more recent in the regional virtual libraries –all of them has being used since less than two years–,  than in hospital libraries. The reason could be that in general the virtual libraries are much younger and less well established. We received information from 8 regional virtual libraries and the 2.0 tools used are only 2 blog, 2 Facebook profile and 3 Twitter account. However it is remarkable that in all of them the authorship is attributed to the library as an institution and in more than 80% counts on the official support of the institution.

Conclusions

Web 2.0 tools have begun to be used regularly in Spanish health sciences libraries, albeit normally with a very limited institutional support. The study showed that although participants pointed out that ‘time’ and ‘staff adaptation’ are the major obstacles using web 2.0, new technologies could facilitate information and knowledge sharing when the staffs becomes familiar with it. The institutional official support is quite outstanding but only a few institutions have developed guidelines for the use of these tools, it would be important to do it in order to strengthen this support.

The results show also that there is not a big difference between the usage of the three main studied tools: blogs, Facebook and Twitter, however their implementation has been gradual over time, beginning with blogs and being latest the creation of Facebook profiles.

We should also remark two important limitations on our study: First, due to the small sample size we consider not to have an enough good set of data that allows us extrapolate the results to the Spanish hospital libraries as a whole. Second, it is not really possible to make generalisations about the patterns of Web 2.0 because we worked on a random sampling instead on a convenience sampling. A more large scale study would be needed to reach stronger conclusions. Nevertheless, we can conclude that establishing web 2.0 within an organization requires lots of input, such as human resources technologies, time for its implementation and user training.

In the future, we would like to extend this study to other health libraries from universities or other kinds of research centres in order to obtain a map of 2.0 tool usage in the Spanish health libraries and we will disseminate the results in the library community.

Introduction

The purpose of this paper is to present the preliminary results of the “Health Literacy and Health Education” partnership, funded by the European Commission within the Grundtvig Learning Partnership-Lifelong Learning Program.

The Grundtvig Learning Partnership Program is a framework for small-scale cooperation activities among organizations that work in the field of adult education in the broadest sense.

Health literacy was defined in Health People 2010 report of the U.S. Department of Health and Human Services 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". Health literacy and health education empower patients and citizens to participate to the full in their health care and to communicate on eye level with their health professionals, possibly overcoming health inequalities caused by social determinants of health.

Recent initiatives of the European Parliament foster the importance of advancing health literacy in all member states. In this context, librarians and information specialists are in a position to play a key role in retrieving, validating and disseminating health information for the general public.

The “Health Literacy and Health Education” partnership, which will last from 2011 to 2013, fosters health literacy as an important part of adult and continuous education.

The four partnership organizations involved in this project are:

• Frauengesundheitszentrum – Women’s Health Centre – Graz, Austria www.fgz.co.at

• Komiteen for Sundhedsoplysning – Danish Committee for Health Education  – Copenhagen, Denmark www.sundkom.dk

• Careum – Zurich, Switzerland www.careum.ch

• Istituto Superiore di Sanità –  National Institute of Health – Rome, Italy www.iss.it .

Objectives

This learning partnership aims at offering an opportunity to get to know and work together with staff of European adult education organizations, NGO and public institutions, in order to build up alliances for advocating health literacy at a national and a European level. Furthermore, this learning partnership aims at raising intercultural skills among participants, as well as at enhancing knowledge and expertise on health literacy as a central issue in lifelong learning. It gathers experts, practitioners, researchers, advocacy groups and allows getting to know how colleagues from across Europe approach health literacy. Participants are able to discuss challenges and issues to advance health literacy at a national level with colleagues, and may compare approaches and find solutions.

More specifically, the learning partnership objectives are:

• getting in touch with European adult education organizations, NGOs and public institutions experienced in health literacy;
• discussing different approaches, strategies and policies advancing health literacy across European countries;
• sharing skills, experiences and ideas;
• exchanging and discussing various national target group-specific training programs for improving health literacy;
• strengthening long-term partnerships and networks among European adult education organizations to build a critical mass of stakeholders promoting health literacy among European citizens.

Methods

The partnership core consists of four face to face meetings, planned, organized and hosted by the four partnering organizations in their respective European countries (Austria, Denmark, Switzerland and Italy) in Autumn 2011, Spring 2012, Autumn 2012 and Spring 2013.

The meetings bring together staff members of the involved organizations, working on health literacy and health education.  The methodology adopted in the meetings is to use the resources of all participants by distributing work packages such as giving presentations, organizing communications, taking over methodological parts and sharing skills and experiences.

The partners have therefore the possibility to learn from each other and benefit from the collaboration with organizations coming from the public and private sector, research and training sector; as a consequence, they may be able to transfer models of good practice to their home country and to incorporate new strategies and policies into their ongoing activities.

Results

Two meetings were held in November 2011, Graz  and April 2012, Copenhagen.

The first meeting, whose topic was “Health literacy and health education”,  was aimed at getting to know each other, by the presentation of each organization activities in these fields. The health literacy status in the partnering countries was deeply discussed, together with the role that each organization plays to foster health literacy and health education in its country. Examples of public health campaigns and interventions addressed to citizens were examined by the participants, together with possible evaluation methods of such initiatives.

The second meeting  focused on “Training programs for patients and general public”. Each country presented the initiatives developed, e.g. training programs for young people on the subject of substance abuse and alcohol drinking; a women health training program; a training program on orphan drugs targeted to patients’ associations and families of patients with rare diseases. Different training methods used by participants of different countries were compared and analyzed.

The third and fourth meeting, to be organized in Zurich and Rome, will respectively focus on “Health information and guidelines available on the Internet”, and on “ Strategies and models of good practice for advancing health literacy”.

Discussion

The expected impact of the partnership at the end of the project in 2013 is primarily to get new impulses for all areas of participants work, and strengthen their role as organizations advocating health literacy. Furthermore, the possibility of comparing and refining  training activities addressed to consumers and patients may contribute to improve program outcomes, as well as personal skills in building capacities for user-oriented programs in the health care and social sector.

At meetings, partnership members have already had the opportunity of learning  from different approaches, strategies and models of good practice and of raising their intercultural skills. At the end of the project they might be able to build  up alliances for advocating health literacy at a national and a European level.