The Holyoke
Consumer Health Library Project:
Enhancing
Consumer Access to Electronic Health Information
Final Report for Period:
September 1, 2004 Ð April 30, 2006
Contractor: National Library of
Medicine, NN/LM New England Region
Principal
Investigator:
Sandra N. Ward, MLS, President
Holyoke Consumer Health Library, Inc.
56 Nonotuck St
Holyoke, MA 01040-2666
Telephone: 413-532-4306
Email: sward@mtholyoke.edu
Lead
Institution:
Holyoke Public Library Corporation
Holyoke Public Library
335 Maple St, Holyoke, MA 01040
Community
Partners:
Holyoke Public Library
Holyoke Health Center
Providence Prenatal Center
Girls Incorporated of Holyoke
Holyoke Council on Aging
Nuestras Ra’ces
Dated submitted:
April 28, 2006
Summary:
Identification and Description of Target Population:
The specific target populations for the HCHL project were the staff and clients of these participating Community Partners: Holyoke Public Library, Holyoke Health Center, Providence Prenatal Center, Girls Incorporated of Holyoke, Nuestras Ra’ces, and the Holyoke Council on Aging. Each of these Holyoke organizations routinely contacts segments of the Holyoke community, including the general public, low-income Hispanics, women seeking health care, pregnant and parenting teenagers, teens at the Holyoke Teen Center, and older residents who come to the Senior Center for meals, activities, and services. All residents of Holyoke are potential beneficiaries of the enhanced health information services provided in this project.
Methodology:
A Consumer Health Information Coordinator was hired to train staff at each Partner site to use National Library of Medicine consumer health databases. The Coordinator worked with staff to plan and conduct health information workshops (especially MedlinePlus training) appropriate to their needs and circumstances. Internet access and computers were provided by the Partner agencies, which already had 25 public access computers and approximately 150 staff workstations at time of grant application (June 2004). We purchased portable equipment (laptop, projector, screen, printer) for the Coordinator to use while teaching workshops in various locations.
The Coordinator also assisted each Partner in implementing the modular library service, with these components:
á A virtual library (our website www.holyokehealth.info with links to NLM databases and other reliable information sources)
á A reference shelf containing a few essential books (dictionaries, guides, atlases of the human body)
á Training and mentoring in the use of virtual and reference material
Results:
As a result of this NLM-funded project, 73 people at five partner sites received training in the use of MedlinePlus.gov and other NLM databases (e.g., Clinical Trials.gov, and NIH Senior Health) as appropriate to their needs. An additional 10 people (one reference librarian and 9 pregnant teens) attended briefer sessions that demonstrated MedlinePlus, but did not provide hands-on training. Beyond these 83 people, hundreds more attended outreach events and picked up MedlinePlus promotional handouts from our HCHL Coordinator or other HCHL librarians (volunteers). Health reference books were added to each partner site, providing not only a physical reminder of ÒHolyoke Consumer Health LibraryÓ service, but also a useful starting place for health inquiries. As HCHL librarians learned more about the needs of our partners and their clients, we worked to improve sections of our virtual library www.holyokehealth.info in response. For instance, our teen health page was significantly revised. We also added a Guides section as a place to distribute curricular materials such as the ÒCriteria and Tips for Evaluating Health Web SitesÓ handout prepared by our Coordinator.
These accomplishments and the challenges (impediments) involved are discussed in the following sections:
1. Training
2. Collection Development (Reference Shelf and Virtual Library)
3. Outreach and publicity
4. Evaluation and Conclusion
1. Training
A total of 22 training workshops (reaching 73 people in 5
sites) were conducted. In the first quarter, the Coordinator
designed a customized curriculum focusing on challenges to providing health
information in the various partner contexts as well as a comprehensive review of
MedlinePlus, Clinical Trials.gov, and NIH Senior Health. This
curriculum was based heavily on existing NLM and
NN/LM training models, but tailored for our Holyoke partners using information
provided by our key contacts and by staff surveys. We have received
positive evaluation forms after each training, and have heard since that people
like MedlinePlus, are using it, and have found it useful with their clientele.
At the Holyoke Public Library (HPL) we achieved our goal of providing training to all staff working in public service. At the Holyoke Teen Center we trained the Peer Education Coordinator. At Providence Prenatal Center (PPC) we trained 8 staff in spring 2005 and provided a refresher in August, catching a few new staff in the process. At the Council on Aging (CoA) we trained the Health Outreach coordinator, an RN who is now an outspoken advocate for MedlinePlus and HCHL. She now uses MedlinePlus often. It has really helped her serve her clients at the Senior Center. She prefers it to all the pamphlets she used to stock and hand out. People come in asking her to do searches, so she knows word has spread that the Senior Center has access to good health information.
At the Holyoke Health Center (HHC) we trained 42 staff, far exceeding our initial expectations. The workshops taught in May 2005 were so well received that additional workshops were quickly scheduled for June and July. HHC HIV/AIDS Program Manager Gail Gramarossa coordinated the sign-up process and scheduling of staff to be trained. Gail reported that some staff told her they now use MedlinePlus on a daily basis. Gail was extremely pleased with the training and excited about the implications for HHC staff development. Gail and the HHC administration decided in June 2005 to hire the HCHL Coordinator for additional hours under one of their existing grants and to work with HCHL in applying for an additional grant to improve health information access for HIV/AIDS care providers in Holyoke.
Impediments (Training):
á Staff turnover at Partner organizations. All our partners were hiring or re-assigning staff at various points during the project. This impacted our project in many ways, especially by causing long delays in the scheduling of trainings. The new hires had to learn their own jobs first and have some weeks (or months) to settle in before they could be expected to take on this extra training for health information outreach.
á Staff shortages, especially at HPL. Pay is low and people leave in search of better options. Remaining employees work extra shifts, become stressed, and get sick. Keeping the HPL front desk staffed is a constant struggle. Releasing an employee from the desk to attend a scheduled training ought to be possible, but in practice proved very difficult to accomplish.
á HPL layout. We considered the idea of training individual staff at the front desk during lulls in business, but there was a major impediment: no access to the Internet at that desk. Computers there are dedicated to the C/W MARS library system. The front desk is really a Circulation desk, not set up to function as a Reference desk, although it is the most obvious place where people ask questions. A separate Reference desk exists in the adjacent Reference Room, with Internet access, but it is rarely staffed.
á Schedule challenges at HPL. In view of the staff shortages, the Library Director requested that staff be trained one-on-one or in very small groups. Nine separate trainings and one demo were involved to reach 15 staff, many of them part-timers on different schedules. Some scheduled trainings had to be rescheduled due to illnesses or snowstorms that closed the library.
á Schedule challenges at other sites. Urgent staff meetings sometimes trumped our training, or a contact person had forgotten to note the training on a calendar. Sometimes it seemed we spent more time scheduling trainings than actually doing any training. At one site an oft-requested follow-up training about how to evaluate health websites never happened, despite several preparations for it.
á Technological challenges. Computer viruses on the Teen Center computers (and lack of staff there to deal with the problem) closed the computer lab for months. This would have been an excellent hands-on lab for online training. At CoA the public access computers were old and only one of them worked (slowly); CoA waited many months for the City to upgrade the equipment. At PPC there was also long delay waiting for IT staff (from headquarters in another city) to relocate the computer intended as the public access search station. At HHC we sometimes experienced problems with equipment and connections in their training room. (We later bought our own projector after frustrations with theirs.)
á Disruptions,
relocation or remodeling of partner sites. PPC had to move from one building
(which had been sold) to a smaller place; several staff, including a key
contact for our project, were laid off. Fortunately she was hired back months
later. At HHC a huge construction project was underway, with relocation of most
units in early 2006. The new HHC
spaces are impressive and thereÕs a new training room, but it opened too late
to be used in this project.
á One
partner changed its role. In
Spring 2005 Nuestras Ra’ces (NR) remodeled
their building space to accommodate expanding programs. The former library room, which had
housed HCHLÕs pilot library for two years, became an office for two staff. Thus
NR was no longer able to provide public access to the library and its computer,
nor to participate actively in this project. We left some books to serve the needs of the NR staff, but
we did not train any of their staff to search NLM databases. [Fortunately we did reach some of NRÕs clientele
indirectly in February 2006. A group of teens participated in a nutrition class
at NR taught by a ÒCommunity FellowÓ from Mount Holyoke College, and the MHC
Science Librarian conducted a workshop for them. She taught MedlinePlus, our
HCHL website, and how to evaluate websites. She also encouraged the teens to
visit HPL for Health Information Week, which we were hosting.]
á Turnover
in our Coordinator position. At the end of the first year, just when relations
with our partners were becoming stable and trainings were rolling along well,
our Coordinator took a fulltime job elsewhere. Our Project Manager stepped in
to do one training, and then hired a new Coordinator, who needed orientation to
Holyoke and to the project and all the partners. We lost momentum and continuity for a while.
2. Collection Development (Reference Shelf and Virtual
Library)
We selected, acquired, and
distributed core health reference books to each of our Community Partner sites
during fall 2005. We developed, in
consultation with partners, wish-lists for future acquisitions. We designed a spreadsheet to keep track
of which titles have been ordered for or desired by each site. We acquired a few additional books in
early 2006 in response to priorities of our partners. Our total budget for books was meager (limited to 2% of this NLM funding plus whatever HCHL
raised from donors); we aimed to provide approximately $500 worth of books per
site. We deliberately delayed implementing the Reference Shelf idea until after
key staff had experienced MedlinePlus and our virtual library, so they would
realize what types of information were easily available online before they
considered what books to request.
The Consumer Health Information Coordinator worked closely
with staff at some sites to development lists of recommended resources for
purchase by THEIR funds. For instance, she prepared a
list of recommended nutrition books and cookbooks for the Senior Center. For the Teen
Center, she evaluated videos and posters, as well as websites and books
appropriate for teens or staff serving teens.
The Coordinator not only evaluated
teen health websites, but also posted an annotated list of the recommended
sites on our website; see http://www.holyokehealth.info/young.html We
updated our website as we discovered improved resources. Usage
statistics for the HCHL website (www.holyokehealth.info/stats/) rose significantly throughout this project.
As librarians we advised or
assisted our partners in maintaining or managing their collections of
information resources. These activities were not specifically part of this
NLM-funded project, but were valuable in building good relations with partners.
We worked with Holyoke Public Library staff to weed and shift portions
of the reference collection. We
worked with the Council on Aging, rearranging and marking the reference section of their
Caregivers Resource Library, which had been expanded to include the health
books we purchased. The Coordinator also helped update the spreadsheet used to
track the inventory of their library.
For Providence Prenatal Center she analyed the Krames OB/GYN software
(which PPC already owned) and discussed how it related to and might be used in
conjunction with MedlinePlus and other information resources. At Nuestras
Raices, we culled out-of-date pamphlets from the shelves and removed many
health books no longer needed there. (These books were re-distributed to other
partners, thereby stretching our budget.)
Impediments (Collection Development):
á Limited budget for books. HCHL did not raise as much money as planned in this period (no time or effort was devoted to fundraising).
á Lack
of an Acquisition dept. All processing of orders was done by the Project
Manager (as volunteer) in her home. She learned how labor-intensive and
space-consuming this aspect of library work can be (a dis-incentive to raise
money to buy MORE booksÉ).
á
Uncertainty about best location for the health
reference books at some sites. Our
vision of a network of consumer health access stations throughout Holyoke
--each with at least one computer with Internet access and a nearby shelf of
reference booksÑ has been hard to implement. For example, Holyoke Health Center
recently opened a newly remodeled facility, but without a designated space for
a physical library, nor yet any computer search stations for their public. [Some spaces are still
underdevelopment, so this is a work in progress.] For now the books are on a
shelf in one small consultation room in the Education & Support Services area
on 3rd floor. HHC staff
(over 150 and increasing) have ready access to computers in their workspaces
and we know that many are using MedlinePlus in helping their clients.
á At
the Teen Center, which seemed to have an ideal setup (Health room with bookcase
space near a computer lab), the computers werenÕt working and the Health room
at times is closed for private counseling, so the staff wisely moved some of
the reference books into a recreation room to increase accessibility and use.
á One challenge in all our sites is limited availability of public access computers on which to use MedlinePlus or other online health resources. The power of our virtual library service is diminished when there are barriers to access. We have tried to encourage our partners to provide good access, but we have had to be patient with the many delays and obstacles involved. At PPC, a single public computer was eventually installed near the new reference books, but for security reasons this area is only accessible to staff, or patients accompanied by staff.
á The
Public Library provides many computers, but people often have to wait for an
available one and use policies are restrictive (only once per day, only 1 hour
per day).
3.
Outreach and Publicity
In summer 2005 we took advantage
of many outdoor festivals and community gatherings in Holyoke, building
relations with other agencies and people who might be receptive to MedlinePlus
training in the future. For example, a Health Fair hosted by the Light of
Restoration Ministries, the
Holyoke FarmersÕ Market, the Caribbean Nights festivals, and Open Houses at
Providence Ministries for the Needy and at Tapestry Health. The Senior Center invited us to
participate in the health fair at the Holyoke SeniorFest picnic. This turned
out to be a hugely successful outreach effort. Hundreds of seniors stopped by the HCHL table and eagerly
picked up MedlinePlus promotional items that Michelle Eberle, NN/LM, had sent
us. While one HCHL volunteer
staffed the table, another circulated around the room and distributed
MedlinePlus brochures to people at other information tables (e.g., nurses at
Holyoke Medical Center and at Holyoke Board of Health).
In fall 2005 we actively promoted MedlinePlus to the public at an Education fair (at invitation of the Holyoke Family Literacy Coalition) and at a Health Fair in Springfield (sharing a table with the Holyoke Health Center). We estimate that at least 125 people talked with us and/or took information promoting MedlinePlus at those fairs.
In January 2006 we attended
luncheons with the seniors at the Council on Aging, displayed MedlinePlus
promotional material, and offered individual help in the library after lunch.
We held a two-hour ÒOpen HouseÓ on Friday January 27. Although we sent out press releases in advance, only a few
radio and web announcement occurred; no newspapers publicized or covered the
event. We were more successful in
gaining attention for our next open house, at the
Holyoke Public Library:
ÒHealth Information WeekÓ during the February school vacation period brought excellent publicity. ABC Channel 40 sent a news team and the Republican newspaper published a photo and article ("Online health data offered" page 17, HolyokePlus section, The Republican, February 22, 2006). One woman arrived with this article in her hand, seeking information to help a family member with a health crisis. MedlinePlus proved to be very helpful; she was relieved to find relevant information, including a doctor's explanation of a surgical procedure, in easily understandable language. Meanwhile, the ABC40 cameraman skillfully captured images of the new books, HCHL website, MedlinePlus, and a closeup of MedlinePlus in Spanish, which displayed well on the evening news, with Coordinator Kathleen Packard explaining how one can move easily from the English to Spanish pages. The broadcast lasted just over 2 minutes, and aired twice, during 5pm and 11pm news February 22. ABC40 reporter Lori Shamroth did an excellent job of portraying health information services at the Holyoke Public Library.
Kathleen designed a handout highlighting where to find
health information resources, both online and print, at the HPL. It is in the form of an 8.5Ó x 3.75Ó
rack card with title ÒHealth Information for You and Me.Ó
Photos of Health Information Week, including a few still shots of the TV
broadcast and a closeup of the rack card, are posted at http://sward.smugmug.com/gallery/1229947. We considered the week a success, even though
attendance was low. We distributed MedlinePlus promotional materials, the rack
card, a fact sheet about our project to approximately 35 visitors. The Public
Library staff were pleased with our presence and delighted with the good
publicity for public library services.
On April 12, 2006 we hosted a party (catering paid for by HCHL volunteers) to thank our Partners, donors, and friends and show them what we had accomplished during this project. A Powerpoint show created by the Coordinator ran on the laptop during this event. A copy of this Powerpoint will be submitted as an appendix to this report.
Impediments (Outreach and Publicity):
á In the beginning, we deliberately delayed publicity about the project, wishing first to complete training of the public service staff at the Holyoke Public Library, so they would be ready to respond. This made sense at the time, but was perhaps a mistake, given that it took 18 months to catch all the public service staff.
á
The HCHL volunteer who had offered to do press releases
throughout the project was too busy to do much. None of the rest of us had
experience in PR.
4. Evaluation and conclusion
Did we meet our original objectives? How well did we accomplish what we set out to do?
1)
Six community-partners will be connected to the NLM
databases (especially MedlinePlus) and local consumer health-related sites in
the greater Holyoke area through the HCHL website, and will provide their
clients with at least one accessible consumer health access workstation.
[virtual library]
a.
Health information resources and referral services will
be embedded into six, high-traffic community health and human service
organizations.
b. This project will raise awareness among strategically-placed people / community leaders and staff of key organizations who reach diverse populations on a daily basis. The project will bring health information resources to places where people are already seeking information or health care, and enhance the ability of staff to answer client questions. The information will be provided in a familiar context, at the point of need.
2)
Key staff in each of the six community partner agencies
(Holyoke Public Library, Holyoke Health Center, Mercy WomenÕs Health Center,
Nuestras Ra’ces, Girls Incorporated of Holyoke, and the Holyoke Council on
Aging) will become familiar enough (through training and ongoing mentoring)
with the NLM databases (especially MedlinePlus), the HCHL website, and associated
health information references to provide clients with appropriate health care
information and to facilitate and promote the use of the consumer health
workstation at their sites.
3)
An Electronic Health Information Access training
curriculum will be customized for Holyoke and be available for future training
as new staff need training.
4)
Clients from targeted populations will have access to a
collection of printed reference materials appropriate to the community-partners
service audience [reference shelf in each site].
5)
Key staff in each partner agency will be oriented to
the reference materials so that each can effectively refer clients to health
information.
We met most, but not all, of these objectives.
1) All six community partners have connections to our website and the links to NLM databases. Only three Òprovide their clients with at least one accessible consumer health access workstation.Ó All six have workstations where staff can assist their clients in using online resources, but these are not Òself-serveÓ computers. Only the Public Library and the Senior Center currently have publicly accessible self-serve search stations. We definitely met objective 1) b.
2) We trained key staff in all sites except Nuestras Ra’ces.
Except for the withdrawal of one site, we succeeded far beyond our
expectations, training 73 staff
--far above the minimum target of at least one person per site. We especially focusing on MedlinePlus,
which was very well received. Evaluation forms collected after each training
were positive. We did not do much
training beyond NLM databases and general cautions about confidentiality, etc.
in helping people find consumer health information.
3) We did customize the training
for Holyoke. In fact, we often adapted training for individuals, since we did
so much one-on-one training. We
did not create a formal curriculum as a ÒproductÓ. We did add a ÒGuidesÓ
section to our website with links to the valuable NLM curriculum resources from
which we drew.
4) Each of our six partners has at
least a reference shelf of appropriate health books.
5) Although we did not conduct
formal orientations to the reference works, at most sites at least one staff
member (often more) became excited whenever we delivered new books. They spent
time examining the books, educating themselves about the content, and often
commented to us about the usefulness of the selected volumes.
We are satisfied that most of these stated objectives have
been met, especially considering the many challenges and impediments
encountered, and the turnover of our Coordinator mid-way through the
project. In the brief interval
between Coordinators, the Project Manager stepped forward and improvised,
taking advantage of some informal opportunities for outreach beyond the specific
written objectives of this project. Those outreach activities were surprisingly
effective and fun, opening new eyes to the potential of MedlinePlus. The
bilingual interface is especially important and well-received in Holyoke, where
Spanish is the preferred language for many residents. From then on, we watched for and took
advantage of opportunities for outreach to the public. We began to keep a count
and report the outreach contacts; we promoted MedlinePlus and our virtual
library (website) to hundreds of passers-by. We are also pleased that the
February 2006 TV publicity reached so many and highlighted the Spanish side of
Medline so well.
Organizationally, during this project HCHL transitioned from a volunteer-run pilot library at one site (Nuestras Ra’ces) to a virtual library service with modules at multiple sites and a Òroving librarianÓ providing training, encouragement, and professional selection of books and websites tailored to the needs of various populations. For the general public, the Holyoke Public Library is the most visible and accessible HCHL site.
It is hoped that each of the partner sites will continue to use MedlinePlus, the health reference books, and our website of health information resources.
Appendix: Powerpoint: Holyoke Consumer Health Library, Inc. NLM Grant: ÒEnhancing Consumer Access to Electronic Health InformationÓ September 2004 - April 2006