Academic
Exchange Quarterly
Spring
2003: Volume 7,
Issue 1
Promoting Health Information
Literacy
Collaborative
Opportunities for Teaching and Academic Librarian Faculty
Chiehwen Ed Hsu, Ph.D., Lynn F. Johnson, MSIS and Ann N. Brooks, MLS, MBA
Department of Health Management and Policy, School of
Public Health
and Gibson D. Lewis (GDL) Health Science Library
University of North Texas Health Science Center
3500 Camp Bowie Blvd
Fort Worth, Texas 76107
Tel: 817-735-5134
Fax: 817-735-0446
Keywords and
Phrases:
Health Information Literacy, Public Health Informatics
Please address correspondence to:
C. Ed Hsu, Ph.D
Assistant Professor of Health Management and Policy
University of North Texas HSC, School of Public Health
3500 Camp Bowie Blvd. ME1-740.
Fort Worth, TX 76107
Tel: (817) 735-5134
Fax: (817) 735-0446
Email: chhsu@hsc.unt.edu
C. Ed Hsu is
assistant professor of health management and policy, University of North Texas
School of Public Health, where he coordinates the Master of Public Health in
Health Informatics. He received PhD, MS and MPH from the University of Texas at
Houston.
Lynn F. Johnson
is the special projects librarian with the GDL Library and an instructor in the
Department of Education. She serves as Project Director for the OSTMED®
database project. She received the MS in Information Science in Medical
Informatics from the UNT.
Ann N. Brooks is assistant professor with
the department of education and associate director of public services for the
GDL Health Science Library. She earned the Master of Library Science from
University of Pittsburgh and MBA from Texas Christian University.
Abstract:
The recent
development of public health informatics as an interdisciplinary field, and the
dissemination of this body of knowledge, have brought forth new opportunities
for collaboration between the faculty of health sciences and academic library.
This paper explores the potential areas for collaboration, describes empirical
collaborative projects between these two parties in enhancing the information
literacy of public health discipline in a major health science center, and
discusses the lessons learned, including the opportunities and challenges
associated with the collaboration.
Background
1.1 Information literacy and health literacy
According to the Association of College
and Research Libraries, information literacy is a set of competencies that
enables individuals to recognize needs for information, and have the ability to
locate, evaluate, and use the needed information effectively.[1] General information literacy is an important
attribute in achieving lifelong learning, because it contributes to informed
decisions based on critical reasoning and thinking. On the health spectrum and
as a subset of information literacy, health literacy relates to the degree to
which people can obtain, understand and process basic health information and
services, and then act on appropriate health decisions. It is one of the
crucial, enabling capabilities that could contribute to the realization of the
goals of Healthy People 2010 as stipulated by the Center of Disease Control and
Prevention (CDC).[2] By comparison, both
definitions of literacy address the acquisition
of information when needed, assessment
of information with scientific facts and expert advice as the knowledge base,
and utilization of the results of the
combined actions to execute knowledge-based strategies leading to informed
decisions, such as the choice of a healthy lifestyle.
1.2 Public Health Informatics
Closely related
to health information sciences, the National Library of Medicine (NLM) defines
public health informatics as the systematic application of information and computer
sciences to public health practice, research, and learning.[3] The literature suggests that effective
dissemination of public health literacy play an important role in the decision
of the general public in seeking preventive health measures and healthcare
services. For seeking preventive health, one study found that patients who had
inadequate reading skills did not know that mammography was associated with
diagnosing breast cancer. Conversely,
women with adequate literacy skills who read on at least a 9th grade level
appeared to be adequately informed about mammography.[4] Another study
found that increased access to self-care books, telephone advice nurses, and
Internet-based health information was associated with decreases in reported
pediatric healthcare utilization.[5]
In terms of
literacy and health care, research results of two separate hospital studies
have suggested that the literacy skills of patients with diabetes,
hypertension, and asthma were the strongest correlates of knowledge about their
illness and disease management skills, even after statistical adjustments were
made for conventional sociodemographic co-variables.[6][7], The
results of the studies also suggest that the interventions (of enhanced health
literacy) were associated with a decreased reliance on health professionals for
information. These findings suggest that
improved literacy is a critical component in improving public well being, and
in the context of public health, improved literacy is crucial in the pursuit of
preventive health and appropriate management of diseases.
Public health
informatics is a discipline that applies information technology to public
health science.[8] By this definition, the
faculty of the School of Public Health (SPH) conducts teaching, research and
community services widely involving public health informatics. These may
include using relational databases to store the results of survey questions,
presenting epidemiological data using the Geographic
Information Systems (GIS), analyzing various potential socio-biological
risk determinants of health disparities, and recommending scarce health
resources allocation based on computer-assisted analysis.
For formally
structured graduate courses, the training modules of health informatics are
usually prepared for graduate students in a classroom setting. The training
modules are not specifically designed to transform discipline-specific
attributes of knowledge to general competencies, nor to deliver the
terminology-ridden scientific research to an audience of general literacy
level. Therefore, it is desirable to
strengthen the collaboration between full-time public health faculty and
library faculty, in order to disseminate technically-oriented training modules
to a wider audience.
1.3 Collaboration: bridging the great divides
By convention, classroom faculty members have not been interacting with
academic library faculty at an extensive level until recently. Articles have
been written about the “tension” between academic librarians and classroom
faculty. Carpenter [9] contends that an “enmity” exists between classroom
faculty and academic library faculty.
Kotter [10]
claims that the tension and the lack of interaction are the “great
divides” to be bridged. In seeking potential causes of such tension, Ren [11]
observes that the phenomenon arises from classroom faculty perceiving library
faculty as inexperienced in conducting research and teaching and not as
“academic equals” at work. Owusu-Ansah [12] attributes
the “latent tension” in the relationship to the observation that teaching
faculty “would have little to do with the library and have little respect for
the academic librarians”.
Notwithstanding
these contestable arguments, collaboration could expand the synergistic
opportunities that would further the mission of academic enterprise. In his
proposal to “bridge the great divide”, Kotter [10] suggests that the improved
association between faculty and library faculty would enhance librarians’
ability to promote and support research among classroom faculty, while allowing
the librarians to actively participate in the enterprise of scholarship. Farber
perceives that the true benefits of collaboration are the mutually reinforced and shared visions between
classroom faculty and librarians.[13] The classroom faculty objectives are
to help students attain a better understanding of the course subject
matter. The library faculty objectives
are to enhance the students’ ability to find and evaluate information which in turn enhances the students’ understanding of the
subject matter and contributes to their life long learning skills.
2.
Public Health Informatics Literacy In Action: Two Recent Initiatives
This section
examines two essential competencies of information literacy, namely the
acquisition and assessment of health information. It describes how these competencies are
addressed in the public health informatics discipline, and explores the
opportunities for interdisciplinary collaboration.
2.1 Web Portals
of Health Information
According to Ferguson, the increased adoption of Internet technology affords at
least four major sources of health information that take advantage of the
information highway.[14] These include commercial services,
on-line mailing lists, Internet newsgroups (also known as USENET newsgroups)
and the World Wide Web. The expanded channels for distributing health information
have introduced new challenges and opportunities. A recent study sought to characterize
health-related portal websites has found that while many Internet users are
surfing the Web, they are likely to encounter advertisements that are usually
promoting products that are unsupported by scientific research, such as those
of “weight-loss supplements”.[15]
Therefore, a major challenge confronting consumers in the acquisition of
health information, is herhaps how to distinguish accountable health
information from mis-information (or info-mercials).
One case
illustrating opportunities to enhance health information acquisition and
assessment on the information highway is the recent proliferation of public
health “portal websites” or “toolboxes”.
At the federal level, there are several initiatives of health literacy
portal websites pertinent to general consumer health or thematic health
interests. Among these productions, CDC
Wonder, healthfinder.gov and health.gov are examples of current general health
portals to the websites of a number of multi-agency health initiatives and
activities, including those of the U.S. Department of Health and Human Services
and other federal agencies. Other websites have been produced for specific
public health interests. For example, in
response to the recently heightened alert of potential terrorist activities,
CDC [16] produced the “bioterrorism” portal
website to provide information associated with frequently asked questions on
bioterrorism agents and preparedness, organizations that are dedicated to
readiness training advisories, alert and bulletin, and on late-breaking news.
Similarly, the University of North Carolina produced a “toolbox” website as a
repository of public health data management instruments.[17][i]
The National
Library of Medicine (NLM) and medical librarians have also recently focused
attention on the public’s need for health information. As mentioned previously,
portal websites have been developed that provide reliable health information
from the government. In addition, NLM
provides free access to MEDLINE plus® that
includes MEDLINE and quality, up-to-date drug information, encyclopedias,
dictionaries, directories and clinical trials.
To emphasize consumer health information, NLM provides consumer health and
public health information grants through its National Networks of Libraries of
Medicine (NN/LM), a network of 4,500 health science libraries. NLM’s online training programs prepare
medical librarians to use its products and services and in turn the medical
librarians train others – public health professionals, hospital medical staff,
residents and interns, and public librarians.
Portal
websites/toolboxes offer convenient access to reliable health information at the
users’ fingertips, as they provide “one-stop-shopping” convenience for
accessing and acquiring accountable health information with ease. These websites allow quick updates on
reliable and time-sensitive health information. These strengths are particularly
crucial in time of urgency, and may therefore reduce the public’s anxiety in
the events of uncertainty.
2.2 Community health monitoring systems
Community
health monitoring systems demonstrate another initiative in promoting health
information literacy. Community Health
Monitoring System (CHMS) are a continued set of performance measurement
activities that involve the selection and use of quantitative measures of
health program capacities, processes, and outcomes to inform the public or a
designated public agency about critical aspects of a program.[18] Performance monitoring has evolved over the
past 20 years and has been termed in the literature as: Community Health Monitoring Systems (CHMS),
Community Health Information Networks (CHINs), Community Health Information
Management Systems, Community Health Information Systems (CHIS), Community
Health Report Cards, Community Care Networks, and Health Information
Networks,[19] among other derivative appellations with a similar focus on
community health.
In the United
States, concerted interests are matched by rigorous efforts to develop health
information systems for monitoring purposes at both the national and local
levels. According to Furukawa, there
were about 500 Community Health Information Networks that closely monitored
health across the nation in 1996.[20] A
survey conducted by the UCLA Center for Healthier Children indicated that
nationwide at least 115 Community Health Report Cards were profiling community
health in 1999,[21] including the Community Health
Status Indicators that are provided by CDC.[22]
To make the community health profile more accessible to the general
public, some CHMS also present health outcomes in a Web-based or GIS-enabled
format (examples include Community Health Information Systems of Houston[23] and MICA in Missouri[24]). CHMS emphasize various determinants of health
ranging from environmental factors, income, and race to motor vehicle crash
prevalence.[25] The CHMS intend to provide accountable health
information, including health indicators and outcome measures to quantify
community health performance and to promote public awareness. The systems help the public to access
community health profiles, provide a knowledge-base for community health
initiatives, and seek to narrow health disparities in the nation.
2.3 Areas of collaboration for health librarians and faculty
The
collaboration between public health faculty and academic library faculty seems
both logical and intuitive. Both focus on public interest, and seek to fulfill
teaching and service roles to enhance health literacy delivery and
utilization. The relationship between
both parties may be improved by joint involvement in promoting health
informatics literacy in at least three levels of professional interactions:
curriculum development, instructional design, and classroom instruction. In
delivery of public health informatics literacy, faculty members are qualified
content-providers in their respective subject disciplines, so they can focus on
the information assessment. Librarians
can contribute professional assistance in instructional design, such as
polishing course modules to be more content-and-setting specific, and
clarifying the vocabulary and concepts for the general public to digest and
utilize.
Thus, the
aforementioned two public health informatics initiatives underline the need and
opportunity for a collaborative effort:
in acquiring accountable health information and the production of portal
websites/toolboxes, faculty members may serve as content-providers; while many
academic librarians are comparatively well-versed with web-authoring
technology, they may provide assistance on instructional design, such as web
development and maintenance. In the case of producing CHMS, faculty members may
be responsible for assessing health data and conducting analysis, while
academic librarians may assist in teaching the outcomes databases, querying
data or results in response to users’ request, prioritizing and presenting
information in a content-specific and culturally-appropriate manner to the
general public. In terms of utilization,
librarians also may facilitate the process of information delivery. The goal of
a public service librarian is to identify pertinent information based on the
specific consumer requests and supply the most relevant materials regardless of
format, as well as current bibliography of additional items for the consumers’
judgment.
3. Collaborative projects in action in a
health science center
The following outlines two collaborative projects between SPH
faculty and academic library faculty in a major Health Science Center
(HSC). The collaboration intends to make
health information more accessible to the general public and to strengthen existing
graduate programs.
3.1 Center for Health Informatics and MPH in Health Informatics
In 2001, the HSC President requested that the HSC plans an initiative to create
a Center for Health Informatics. This collaborative project involved a team of
health information practitioners, including faculty in the Library and SPH
faculty members. The purpose of the
Center is to support teaching, interdisciplinary research, and community
services of the academic enterprise. The
Center seeks to improve student education by articulating and efficiently
fulfilling their information needs, and to augment current instruction efforts
at HSC by offering separate courses in information seeking and
informatics. The Center seeks innovative
methods of information integration and provision, and serves as a focal point
for collaboration between the Library, Graduate School of Biomedical Sciences,
Medical School and SPH. The Center serves as a community outreach center for
other organizations in the Dallas-Ft. Worth Metroplex area, and as a center for
health informatics research and outreach in a multistate region.
In addition to
the Center, an MPH program with a concentration in health informatics was
established in SPH. The new MPH program
joins thirteen other health informatics programs in this country. This program
enrolled its first cohort of students in fall 2002. Major teaching and research areas include
public health data analysis and interpretation, the GIS and spatial analysis in
public health, and the design and evaluation of hospital information systems.
Central to the program is the adoption of the courses jointly offered by the
SPH and the Library.
3.2 Information Access for public health professionals
In the summer of 2002, the Library, SPH, Office of Professional and Continuing
Education (PACE), and local health department responded to a National Library
of Medicine (NLM) RFP (“Information Access for Public Health Professionals”)
with a proposal to improve public health information literacy. The project proposal seeks to assess the needs
of public health professionals who would be best served by NLM and CDC
products, to enhance the accessibility of health information through training
development and delivery, and to produce a public health website portal.
·
Needs Assessment
In this project,
a statistically significant sample of public health department directors in
target Public Health Regions will be surveyed to assess users’ familiarity and
accessibility of NLM, CDC and other public health databases. The survey will 1)
establish what information resources are of interest, and 2) if users are
interested in a free or low cost training program targeted at public health
officials focusing on accessing reliable and authoritative health information
and research. The survey will serve to
publicize the development of the Public Health Informatics Training Program and
to build enthusiasm among relevant parties.
The survey will be jointly developed by PACE, SPH, and will be conducted
by the local health department.
·
Training Program Development and Delivery
A training program will be developed based on the
results of the needs assessment.
Different educational formats that incorporate adult learning principles
will be included in the curriculum. The Library, PACE, and local health department
will jointly develop the program. Once developed, the training modules will be
offered to health departments throughout north Texas. The four hour session will be conducted at
departments with training centers and incorporated into PACE activities. A suitable education facility will be sought
for departments without training centers, and three sites will be chosen. Training activities will be accredited to
award continuing education credit for certified health educators, registered
sanitarians, physicians and nurses by PACE.
·
Web-based Portal
A web portal
will be developed to provide access to all databases and resources discussed in
the Training Program. The web portal
will allow registration into an optional email list and monitored bulletin
board. Those participating in the email
list will receive updates and notices about the website and will be emailed
continuing education vignettes that will require visiting the website to claim
credit. Officials from the local health
department, SPH faculty members and others will create training
emails/alerts. The first will cover NLM
and CDC resources. The monitored
bulletin board will allow registered professionals the ability to post
questions related to public health and to receive replies from pre-screened and
authorized health officials. The local
health department will monitor the bulletin board and the web portal will be
maintained beyond the project period by PACE.
·
Training Program Promotion/Publicity
The Public
Health Informatics Training Program will allow information access for public
health professionals. It will be
promoted through 1) the initial Needs Assessment Survey interaction, 2)
exhibits and educational sessions at Public Health Meetings, 3) listing on the
PACE website and calendar, 4) letters of invitation to Public Health Department
Directors, 5) the elective Track in selected CE activities by PACE, 6) existing
Health Alert Networks, 7) Department of Health “Resources and Information
Digest”, and 8) health educators email lists.
4. Lessons learned: opportunities and challenges
The above examples demonstrate recent initiatives in
promoting public health informatics, and illustrate how faculty and academic
library faculty may work together to enhance information acquisition and
assessment. After completing the
collaborative projects, we identified additional areas for collaboration and
potential challenges in practice. One potential area includes adding literacy
programs such as introductory informatics courses for first year students of
health sciences. Another includes the
need for establishing a Writing Center to prepare students in academic
communication and to assist local health authorities to prepare for grant
writing. The functions may be efficiently carried out with a faculty-librarian
synergistic collaboration. Challenges are primarily the motivation for faculty
involvement. In designing collaborative activities, consideration needs to be
given to the tenure and promotion criteria (i.e., teaching, research or community
services) of faculty members so that faculty participation as an institutional
commitment can be assured, and sufficient release time be requested and
dedicated to participation.
In summary, the enhancement of public health informatics
literacy is an endeavor of substantial magnitude. Since health literacy has
been shown to be associated with population health outcomes, it therefore
warrants strengthened collaborative effort between academic librarians and
classroom faculty to address the unmet needs.
The collaborative projects are mutually-rewarding, and hold promise to
take the health information literacy and well-being of the general public to
the next level.
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