17 Health Literacy in Public Libraries

Tiegan Ziegler

There are various reasons users seek out health information – whether it is for themselves, someone they know, or they just heard about a local public health concern. A good source of information people turn to is the public library. This paper discusses how librarians can work to decrease barriers to health information literacy and better help patrons access the information they need. Many barriers that are encountered in the public library during health information interactions are defined. Then possible solutions to decrease those barriers are discussed. Not all solutions fit with every library, so librarians can decide which ones they would like to implement to better serve their community in health related questions.

Health literacy has become increasingly important in public libraries, because public libraries are where people go to find health information. Some motivation for this phenomenon is that “…consumers likely perceive public libraries as an ‘unobtrusive and inexpensive channel’ for finding valuable information. …[t]hrough these channels consumers learn more about their health issues, improve communication with their health care providers, make informed treatment decisions, and obtain emotional support to help alleviate their anxiety regarding health concerns” (Yi 46). Public libraries, then, are good sources of information for those who have health questions, because they offer many different sources of information – databases, librarians, books, and journals. Yi (2015b) found that “…about 6% of American adults perceive public libraries as their primary or valuable source for health information” (17). The reason for this perception stems from the internet access public libraries provide, as well as medical books and journals. Librarians are also good sources for help finding information – usually. But it is not enough to just provide these materials to library patrons – librarians should also provide some healthcare contacts to help patrons find answers to their questions, because there is difficulty in understanding health jargon. “The [Institute of Medicine] estimates that 90 million people in the United States have difficulty understanding and using health information” (Zionts et al. 351). This means “…a focus on ‘guiding consumers to high quality health information on the web’ is needed” (Zionts et al. 351), and there are many options out there for librarians to help patrons find quality information.

The National Network of Libraries of Medicine (NNLM) defines health literacy as the “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (National Network of Libraries of Medicine). This definition is one librarians should know to better help patrons develop their health literacy skills. Being able to make these distinctions and help patrons learn these skills is important because “…today people are becoming increasingly proactive about their health care” (Yi 46). “Without access to quality information and education, consumers are unable to make appropriate and informed decisions about their health and how their health care dollars are spent” (Hessler 335). This an issue librarians should seek to eradicate by helping library users with health literacy – it has become a library issue because “…within public libraries 47% of users who accessed the Internet used it to search for health information. … Consumers also look for health information in libraries’ collections and databases” (Yi 47). But these are not the only places consumers go to for help with health information. Librarians are a big resource people like to utilize. “[L]ibrary users seek health information through face-to-face reference interviews, virtual reference services, and phone or e-mail reference services” (Yi 47).

Barriers to Health Information Literacy

Librarian Barriers

There quite a few barriers in public libraries that have caused problems with patrons’ access to and understanding of health information. “Interviewees expressed difficulties understanding health care terminology, locating and accessing information, and asking a librarian for assistance” (Yi 53). One of the most significant issues is that librarians may be insufficiently trained in helping patrons find quality health information, because they are often unaware of the resources available (Hessler 339). Training is important, because it helps librarians become better equipped in helping solve patrons’ confusion. In one study by Yi (2015a), interviewees expressed concerns over the help librarians were or were not able to provide when looking for health information. One interviewee even stated “‘I believe librarians need to get specific health training or [have a medical] background to be able to direct people’ (Interviewee 6)” (Yi 54). This is a valid concern for patrons who are searching for answers to their health questions and are not able to get satisfactory help from a librarian.

Patron Barriers

There are also plenty of barriers that stem from the patron and how they communicate with the librarian. These include “language/cultural differences, inadequate literacy (including information, technology, and health literacy), sensitivity and emotional issues (e.g., mental illness), age-related issues (e.g., problems seniors have with accessibility or technological literacy), and physical difficulty (e.g., accessibility)” (Yi 48). It is also hard for some to ask a librarian for help finding information on a health question that is personal – people have quite a fear of being judged and don’t want to talk to a stranger about something so personal. On the other hand, these barriers can be faced in nearly any interaction with a librarian. While these issues can make it difficult to understand the patron’s question enough to find the right information, it is not impossible. It is helpful if librarians can maintain patience in order to better help the patron get the information they need, no matter the difficulties that arise in the transaction.

Library Barriers

Libraries present barriers of their own by way of the materials they hold in their collections. In the study by Yi (2015a) referenced above, “[h]alf of the interviewees mentioned limited resources” (Yi 53). This means that half of the interviewees from Yi’s (2015a) study were not satisfied with the amount of health resources available in a public library. This is a very valid concern, and certainly does play a part in the problem of finding quality information. Some ways to help this are to partner with healthcare organizations and have a list of contacts for patrons to utilize to get their questions answered. Among the information that patrons can access there are problems in understanding the terminology used. This can be helped by librarians who have a fair understanding of health jargon and can explain some of it to patrons. It might also help to have some lists for healthcare professionals to contact for help with the terminology. Libraries could also provide access to some medical dictionaries so patrons can find definitions on their own.

Web Barriers

All of the barriers discussed stem from needs expressed by patrons. Another important barrier related to the availability of high quality information is the need for access to health information. “The downside to the availability of computers and the accompanying easy access to abundant health information is that not all of the available information is credible, pertinent, or correct” (Zionts et. al 350). While it is easy to find health information online, it is not easy to find quality information from authoritative authors – this is where librarians come in. “[L]ibrarians, with the proper training, present an opportunity for consumers to receive help in locating desired health information and in evaluating website credibility, relevance, and applicability” (Zionts et. al 351). This same issue presented itself in the study conducted by Yi (2015b). “Study participants rated higher on their ability of ‘how to find helpful health information in the library’ than the abilities of ‘where to find helpful health information in the library,’ or knowledge of ‘what health resources are available in the library,’ which asked more specific abilities” (Yi 22). It is then important for librarians to demonstrate health literacy skills to help patrons learn where to find quality information and what information is available in the library and what needs to be sought elsewhere (i.e., healthcare professionals).

It is critical for libraries to improve access to online materials – both in the library and remotely (Hessler 340). Having access to materials online is important in this digital age, when more and more people expect to find the information they need on the internet. Individuals may expect to be able to access that information wherever they want, rather than needing to go into the library to use databases. This means that libraries should work to provide online access to health information, while maintaining an online presence – through chat reference or email help – to answer patrons’ questions. This ensures that people know they can turn to a librarian for help in answering questions, or at least guiding them towards sources that can answer their questions. “Online access is a critical need for those seeking health information. The results of a 2013 Pew study revealed that nearly 60% of U.S. adults have looked online for health information in the previous year, and 35% circumvented the medical establishment, at least initially, by looking online to try to determine what may be ailing them” (Hessler 336).

While many people want to access information online, some individuals also feel that print materials are good sources, and a lot easier to navigate. “[T]he users reported that printed books were easy to browse, and printed journal articles were appropriate resources to get in-depth health information” (Yi 26). It can also be easier to assess authoritative authors and high quality information when using print resources, because it take some work to be published, whereas it is easy to provide information online. When choosing the type of resource to guide a patron toward, it is important to assess the type of question the patron has, because “…most of the interviewees who preferred short and quickly readable health information, as found in magazines, were healthy or reported that they did not have serious health issues; their concerns were age-related, such as a joint problem or macular degeneration. They did not need in-depth or specific health information” (Yi 53). In contrast, “…interviewees who had severe health issues reported looking at printed medical textbooks, journals, and particular websites for authentic and in-depth health information” (Yi 53).

There are various reasons users seek out health information – whether it is for themselves, someone they know, or they just heard about a local public health concern. “[U]sers seek health information in order to ‘identify, alleviate, and remedy diseases and ailments; … to preserve health and prevent disease; and … to access supporting services in their communities that can assist them in coping with the financial, social, and economic impact of illness’” (Yi 19). When people are able to better inform themselves, they can help inform others, making for a more cohesive community. When the library plays a role in providing patrons with health information and contacts, it becomes an important part of the community by helping connect people with information and other key organizations in the community.

When it comes to health literacy, there are some things librarians want to keep in mind about their patrons. The first is the difference between female and male patrons in searching for health information. In the study conducted by Yi (2015b), it was found that “…the difference in health literacy ability between males and females is statistically significant. …female users were likely to have greater health literacy abilities than male users” (21). Yi (2015b) did not state why this difference might occur, but it is something to keep in mind when working with patrons. Female patrons searching for health information may not need as much help, and may be better at determining quality information. This is not always the case, and there are male patrons who have good health literacy skills, as well. This is just some information to keep in mind when helping patrons find health information. Not as surprising, Yi (2015b) also found that “…college graduates are likely to have higher health literacy ability than high school graduates” (22). Finally, Yi (2015b) found “…there is no significant association between health literacy ability and age” (22). This last piece of patron information is something to keep in mind regarding any type of literacy. Once someone has been taught the skills, they are able to conduct research on their own. While it may take some more time with older patrons, – it is necessary to teach them how to use a computer and navigate the internet and the library databases – once those skills have been taught, anyone can conduct research.

Recommendations for Libraries and Librarians

Collaboration

In order to remedy the problems that arise when searching for health information in public libraries, there are many possible solutions that public libraries can implement in order to better prepare librarians’. One possible solution is collaboration with health agencies. “In order to lower the barriers to assessing the quality of health information, public libraries need to seek out collaboration among all types of libraries and organizations in a community, thereby integrating the community’s health information services” (Yi 60). This not only helps improve librarians’ ability to help patrons find quality health information, it also helps libraries be connected to their community. “Collaboration with national or state level agencies like the regional [National Network of Libraries of Medicine] or any cooperative medical libraries in the vicinity of the public library can be a boon for public libraries and their users” (Hessler 339). Not only are libraries connected to important organizations in the community, but they are also helping connect their patrons to good sources of information, because “…creating public library-public health partnerships can enhance the ability of consumer to procure health information” (Zionts et al. 351).

The Medical Library Association (MLA) is a good organization for librarians to connect with to help provide their patrons with information. “Networking through the MLA, particularly one’s regional branch, connects public librarians with a plethora of resources and contacts” (Hessler 339). Access to those resources and contacts is crucial for patrons seeking health information that cannot be found in the public library. Also, having at least one librarian on staff who is a member of the MLA is good for the library. “MLA membership indicates specialized consumer health information training and provides credibility to libraries with an MLA member on staff” (Zionts et al. 354). Patrons then know that library has a librarian on staff who is well-versed in health literacy and can help guide them toward quality information, as well as being able to help connect them with professionals who can provide them with health care advice. This allows patrons to feel better about their library, because librarians are skilled at connecting patrons with health information or healthcare professionals who can answer their health questions.

Expanding the Collection

Librarians can also look into other materials for healthcare information. “While medical reference and MedlinePlus are a good start, there are other materials we do not often consider. The memoirs of someone living with a disease, for example, can be more helpful to a user than a series of densely written articles” (Hessler 340). There are plenty of routes librarians can take to find health information. While memoirs are not an obvious choice, they really can be helpful if a patron is looking for information because someone they know will be experiencing this health issue. Memoirs are more personal experiences and are easier to read than a medical textbook or journal – there is much less jargon that can be hard to understand for someone unfamiliar with the medical field. A librarian can recommend memoirs to patrons looking for health information as first-hand experiences that give personal information that will not be found in a medical textbook or journal. Librarians can also create book displays of memoirs written around health issues, so patrons can more anonymously interact with the material if they wish.

Many patrons do not require in-depth research articles or textbooks for answers to their health questions, but would benefit much more from a simple, concise fact sheet. These can be easily prepared by librarians on “hot topic” health questions – i.e. providing fact sheets on the swine flu. “When it comes to such ‘hot topics,’ users prefer clear and fast facts to assuage anxiety and be better prepared” (Hessler 340). Keeping up with popular health questions can help librarians prepare these fact sheets, so they can provide patrons with them. Quick fact sheets are extremely useful, and even help answer questions some people might not know they had about a “hot topic” health question. These can easily be presented in spots around the library, so patrons will see them and can access them anonymously.

Training

There are also a lot of options out there for librarians to learn health literacy skills. “Resources, websites, webinars, and manuals are available to librarians, covering patron needs, effective strategies for overcoming reference barriers, and general health literacy information to improve the librarian’s own understanding of health and wellness” (Hessler 340). The Medical Library Association has a Professional Development page that links to a lot of sources for librarians to utilize to increase their health literacy skills. There are webinars and online classes, continuing education courses, a discussion group program, an independent reading program that counts for continuing education credit, specialization courses, and mentoring opportunities. The American Library Association (ALA) also has Health and Medical Reference Guidelines available through the Reference and User Services Association (RUSA). Taking initiative to develop health literacy skills is good professional development. It helps the library continue to be a place people can count on for being helpful and providing them with good information. Beyond helping patrons find high quality information, “…appropriate assistance from someone who could guide them, thus helping to manage their anxiety and resolve the confusion, would be ideal” (Yi 60). This really stems from the fact that “…a librarian’s role is not answering their health or medical questions … neither should they interpret the health information for users nor give health care advice to users based on their personal knowledge” (Yi 27). A librarian should not give health advice, but should merely guide patrons to good information and provide them with healthcare contacts who can give health advice.

Focus Groups

Another suggestion for librarians is to lead community focus groups in order to open up a conversation with patrons. “Neighborhood or community focus groups can illuminate the specific needs of local health information users” (Hessler 341). Including the community in the conversation on health literacy is really important. It gives them a chance to talk about their needs and give suggestions on how librarians can help meet those needs. Some of those suggestions might even include that “…public libraries could develop on-site support groups to encourage health information seeking and sharing and help reduce anxiety and uncertainty. They could also develop health literacy workshops and seminars with health care professionals” (Yi 60). Bringing healthcare professionals into the library to lead seminars on health questions is a good way to get patrons health questions answered by someone who can legally answer them. This also helps connect patrons to healthcare professionals who are open to being contacted, answering health questions, and providing patrons with more health information that they won’t find in a public library.

Online Reference

Libraries should maintain an online presence for users who either cannot or do not want to come in to the library to ask their health related questions. Being able to use chat services helps with a patron’s anonymity, as well as providing them with quick directions on how to use databases and find information. Having access to these kinds of services is nice for patrons who want to keep their privacy, but also want a librarian’s help in finding health information online. This helps ensure that patrons know they can turn to a librarian for help in answering questions, or at least that a librarian can guide them to a source that can answer their health questions – whether that is an article or a healthcare professional.

Conclusion

Health literacy is an important skill for librarians to have and be able to teach in public libraries. There are many ways for librarians to prepare themselves for helping patrons find high quality information and connecting them with healthcare professionals who can answer their health questions. It is important for librarians to hone their health literacy skills because, without preparation patrons feel as though they receive inadequate help, which causes a barrier between the patron and the library. Librarians need to be able to help patrons with health questions, because many people see the public library as the place to go to find information. Partnering with healthcare organizations in the community helps connect people with healthcare professionals who can answer their health questions. This also helps ensure that the library continues to be a place people can rely on as an institution that can connect them with quality information. Overall, it is important for librarians to remain engaged with their community, to be able to search for quality health information, and to teach patrons health literacy skills so they can search on their own and assess the quality of the information they find.

References

Hessler, K. E. (2015). Health literacy and law: Empowering libraries to improve access to consumer health information and ACA compliance. The Serials Librarian, 69(3), 334-346. doi: 10.1080/0361526X.2015.1105767

Medical Library Association. 2016. Professional Development. Retrieved from: http://www.mlanet.org/p/cm/ld/fid=43

National Network of Libraries of Medicine. 2013. “Health Literacy?” Retrieved from: https://nnlm.gov/outreach/consumer/hlthlit.html

Reference and User Services Association. 2015. Health and Medical Reference Guidelines. Retrieved from: http://www.ala.org/rusa/resources/guidelines/guidelinesmedical

Yi, Y. J. (2015a). Health literacy and health information behavior of Florida public library users: A mixed methods study. Journal of Librarianship and Information Science, 47(1), 17-29. doi: 10.1177/0961000614531159

Yi, Y. J. (2015b). Consumer health information behavior in public libraries: A qualitative study. Library Quarterly, 85(1), 45-63. doi: 10.1086/679025

Zionts, N. D., Apter, J., Kuchta, J., & Greenhouse, P. K. (2010). Promoting consumer health literacy: Creation of a health information librarian fellowship. Reference & User Services Quarterly, 49(4), 350-359.