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

1. Consumer Health Information
Services in Public Libraries
Melissa Harris, Ashley D'Andrea,
Sarah Schmidt, Anastasia Bush

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Resources for Librarians
Evaluation of Sources:
• Evaluating Health Information, MedLine Plus
• Ten Things to Know About Evaluating Medical Re

25. Websites for Teens
http://teenshealth.org/teen/
http://www.brainpop.com/health/
http://www.iemily.com/

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. 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. Parents and Health Information
(Khoo et.al., 2008, p.421)

29. Resources for Parents
AboutKidsHealth, Sick Kids Hospital
Kidshealth.org
Parents2parents.ca
Caringforkids.cps.ca

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.