Evaluation of rural public libraries to address telemedicine inequities.

Access to home-based telemedicine is inequitably distributed in the United States due to the limited reach of fixed broadband in rural areas. Public libraries typically offer patrons free access to broadband. Libraries, particularly those in rural regions, need to be evaluated as sites for patients to connect to a health care provider over a video visit. The purpose of this research was to evaluate the technological readiness of public libraries to provide telemedicine support and to determine differences in readiness between rural and urban public libraries. We distributed a survey to Virginia librarians to evaluate technological readiness of their libraries to support telemedicine. Respondents from 39 libraries completed the survey, approximately one third of which were in rural or small urban areas. All reported fixed broadband, at least four computers, and staff to assist with technology. Eighty-five percent of surveyed libraries reported sufficient broadband speed and a private room available to patrons. There were no significant differences between rural and urban status for any of the library characteristics. Virginia public libraries may have infrastructure necessary to support patrons connecting to telemedicine. Libraries may benefit from systematic guidelines for collaborating with health providers to support telemedicine implementation across geographic and socioeconomically diverse areas.

Adapting a health video library for use in Afghanistan: provider-level acceptability and lessons for strengthening operational feasibility.

BACKGROUND: Community health workers (CHWs) in Afghanistan are a critical care extender for primary health services, including reproductive, maternal, neonatal, and child health (RMNCH) care. However, volunteer CHWs face challenges including an ever-expanding number of tasks and insufficient time to conduct them. We piloted a health video library (HVL) intervention, a tablet-based tool to improve health promotion and counseling by CHWs. We qualitatively assessed provider-level acceptability and operational feasibility. METHODS: CHWs implemented the HVL pilot in three rural districts of Balkh, Herat, and Kandahar provinces. We employed qualitative methods, conducting 47 in-depth interviews (IDIs) with male and female CHWs and six IDIs with community health supervisors. We used semi-structured interview guides to explore provider perceptions of program implementation processes and solicit feedback on how to improve the HVL intervention to inform scale-up. We conducted a thematic analysis. RESULTS: CHWs reported that the HVL increased time efficiencies, reduced work burden, and enhanced professional credibility within their communities. CHWs felt video content and format were accessible for low literacy clients, but also identified challenges to operational feasibility. Although tablets were considered easy-to-use, certain technical issues required continued support from supervisors and family. Charging tablets was difficult due to inconsistent electricity access. Although some CHWs reported reaching most households in their catchment area for visits with the HVL, others were unable to visit all households due to sizeable populations and gender-related barriers, including women's limited mobility. CONCLUSIONS: The HVL was acceptable and feasible for integration into existing CHW duties, indicating it may improve RMNCH counseling, contributing to increased care-seeking behaviors in Afghanistan. Short-term challenges with technology and hardware can be addressed through continued training and provision of solar chargers. Longer-term challenges, including tablet costs, community coverage, and gender issues, require further consideration with an emphasis on equitable distribution.

Mixed-methods library evaluation integrating the patron, library, and external perspectives: The case of Namibia regional libraries.

The article presents a mixed-methods evaluation of regional libraries in Namibia, which incorporates three perspectives: the patron perspective (library users), the library perspective (library staff, management, and related officials), and the external perspective (including evaluators and monitoring data). Seven data collection methods were used: patron surveys, patron panel studies, focus group discussions, key informant and staff interviews, secondary data analysis, media analysis, and observations. The goal of the evaluation was to assess library performance for both formative and summative purposes by addressing evaluation questions on areas such as library services, use, and operations. Building upon the literature review of how mixed-methods approaches can contribute to library evaluation, the aim of this article is to show how a mixed-methods evaluation can be designed to examine multi-faceted library performance and to illustrate how the evaluation design allows information complementarity and can be utilized to present diverse viewpoints of the above three perspectives. The evaluation design, analysis process, and lessons learned from this study may be useful to evaluators engaged in evaluation of public services or programs (including public libraries) that examine multiple aspects of service performance and involve a variety of stakeholders.

A partnership between academic and public librarians: "What the Health" workshop series.

BACKGROUND: Public librarians are in a unique position to assist the general public with health information inquiries. However, public librarians might not have the training, detailed knowledge, and confidence to provide high-quality health information. CASE PRESENTATION: The authors created and delivered three workshops to public librarians in Suffolk County, New York, highlighting several National Library of Medicine resources. Each workshop focused on a different topic: general consumer health resources, genetics health resources, and environmental/toxicology resources. At the end of each workshop, participants were asked to complete the Training Session Evaluation form provided by the National Network of Libraries of Medicine (NNLM). All participants reported that they learned a new skill or about a new tool, that their ability to locate online health information improved, and that they planned to use the knowledge they gained in the future. Online tutorials covering the major resources from each workshop were created and made accessible to the public on several organizations' websites. Virtual reference services were initiated for public librarians who need further assistance with these resources and will continue to be provided on an ongoing basis. Financial support for the equipment and software utilized in each of these tasks was awarded by NNLM. CONCLUSIONS: Based on attendance and participant feedback, this model of health information outreach appears to have been successful in furthering the educational needs of public librarians and may be useful to others in creating a similar program in their communities.

Provision of consumer health information in Alberta's Rural Public Libraries.

BACKGROUND: Access to health services is a major challenge in many rural communities within Canada. Rural public libraries can serve as centres for health resources. OBJECTIVE: The aim of this exploratory study was to analyse the manner in which Alberta's rural libraries provide health information to their patrons. METHODS: A questionnaire including closed ended and open ended questions was sent to the 285 rural libraries across the Canadian province of Alberta. Descriptive statistics and thematic analysis techniques were used for the data analysis. RESULTS: The findings indicate that in three quarters of Alberta's rural libraries, about 10% of requests for assistance were related to health issues. The provision of health information in these libraries is hampered by the lack of Internet, private space for reference interviews, and staff and volunteer training. Library staff members were inexperienced in conducting reference transactions and reported lacking confidence in meeting patrons' needs and ethical standards. DISCUSSION: Addressing these challenges will require the recruitment of more qualified librarians in rural library systems, possibly through incentive measures, and a comprehensive education and training programme for both staff and volunteers combined with the necessary resource support for the rural libraries. CONCLUSION: When human and material resources are adequate, rural libraries can contribute to improving the health literacy of their communities.

Living libraries: Nurse integration in interprofessional homeless health care team.

BACKGROUND: Despite an increase in national health care service utilization, entry into the health care system remains inequitable. This disparity in health care access disproportionately affects those experiencing homelessness. Because the homeless population faces significant financial and nonfinancial barriers, health care system engagement with these individuals must be reconsidered. OBJECTIVE: This article will describe the piloting of an interprofessional model within an urban library to address barriers to health care access that homeless individuals face. DESIGN: The library's unique status as a community hub presents an opportunity for partnership in addressing this population's health care access issues. This community-based model is the first recorded to utilize three distinct professions-nursing, social work, and library science-in a public library. RESULTS AND CONCLUSIONS: The implementation of this pilot project resulted in a high retention rate of referrals to community health services for those unstably housed and facilitated a system of warm transfers. Although opportunities to improve generalizability exist, this initiative sets the stage for discussion around co-location of health and social services in a nontraditional community-based setting to achieve equitable access to health care.

Public Libraries: A Community-Level Resource to Advance Population Health.

Policy makers and public health practitioners rarely consider public libraries to be part of the health system, even though they possess several characteristics that suggest unrealized potential to advance population health. This scoping review uses an adapted social determinants framework to categorize current health-related work conducted by public libraries in the United States and to discuss libraries' potential as 'meso-level' community resources to improve population health. Our discussion of libraries contributes to scholarship on place-based health disparities, by emphasizing the potential impact of institutions that are modifiable through social policy-e.g., parks, community centers, schools-and which have a conceptually clear or empirically documented relationship to health.

Can patients be trained to expect shared decision making in clinical consultations? Feasibility study of a public library program to raise patient awareness.

INTRODUCTION: Shared decision making (SDM) is a process whereby decisions are made together by patients and/or families and clinicians. Nevertheless, few patients are aware of its proven benefits. This study investigated the feasibility, acceptability and impact of an intervention to raise public awareness of SDM in public libraries. MATERIALS AND METHODS: A 1.5 hour interactive workshop to be presented in public libraries was co-designed with Quebec City public library network officials, a science communication specialist and physicians. A clinical topic of maximum reach was chosen: antibiotic overuse in treatment of acute respiratory tract infections. The workshop content was designed and a format, whereby a physician presents the information and the science communication specialist invites questions and participation, was devised. The event was advertised to the general public. An evaluation form was used to collect data on participants' sociodemographics, feasibility and acceptability components and assess a potential impact of the intervention. Facilitators held a post-workshop focus group to qualitatively assess feasibility, acceptability and impact. RESULTS: All 10 planned workshops were held. Out of 106 eligible public participants, 89 were included in the analysis. Most participants were women (77.6%), retired (46.1%) and over 45 (59.5%). Over 90% of participants considered the workshop content to be relevant, accessible, and clear. They reported substantial average knowledge gain about antibiotics (2.4, 95% Confidence Interval (CI): 2.0-2.8; P < .001) and about SDM (4.0, 95% CI: 3.4-4.5; P < .001). Self-reported knowledge gain about SDM was significantly higher than about antibiotics (4.0 versus 2.4; P < .001). Knowledge gain did not vary by sociodemographic characteristics. The focus group confirmed feasibility and suggested improvements. CONCLUSIONS: A public library intervention is feasible and effective way to increase public awareness of SDM and could be a new approach to implementing SDM by preparing potential patients to ask for it in the consulting room.

Public Libraries As Partners for Health.

INTRODUCTION: Public libraries are free and accessible to all and are centers of community engagement and education, making them logical choices as partners for improving population health. Library staff members routinely assist patrons with unmet health and social needs. METHODS: We used a 100-question, self-administered web survey sent to all library directors listed in the Pennsylvania Library Association database (N = 621), to investigate staff interactions with library patrons to address social determinants of health. We conducted statistical comparisons of quantitative responses and a content analysis of open-ended responses. RESULTS: Respondents (N = 262) reported frequently interacting with patrons around health and social concerns - well beyond those related to literacy and education - including help with employment (94%), nutrition (70%), exercise (66%), and social welfare benefits (51%). Acute emergencies were not uncommon in Pennsylvania's public libraries, with nearly 12% of respondents having witnessed a drug overdose at the library in the past year. Most respondents felt that their professional training left them inadequately prepared to assist patrons with health and social issues. Although at least 40% of respondents offered some health programming at their library branch, their offerings did not meet the high level of need reflected in common patron inquiries. CONCLUSION: The challenges library staff members experience in meeting their patrons' information needs suggest opportunities for public libraries to advance population health. Library staff members need additional training and resources and collaboration with public health and health care institutions to respond to community needs through effective, evidence-based public health programming.

Health Libraries Group Conference 2018.

It's conference time again! There is an exciting programme in prospect in this year's biennial Health Libraries Group (#HLG2018) conference covering key elements of library and information workers' daily practice. Uppermost in everyone's mind is the importance of ongoing personal and professional development with the Health Libraries Group Continuing Professional Development Panel putting this into practice as they host regional peer support sessions for presenters in the period leading up to the conference. As the official journal of the Health Libraries Group, the Health Information and Libraries Journal is similarly keen to support presenters in the practical task of translating their presentations into papers. Do get in touch if you would like advice on what to do next.

Preserving 50 Years of Physician Assistant History.

Physician assistants (PAs) have been making history for 50 years. For the past 15 years, the PA History (PAHx) Society has been working to make sure this history is not lost. The Society began in 2002 as a membership organization based at Duke University and since 2011 has been a supporting organization of the National Commission on Certification of Physician Assistants (NCCPA). Highly visible and active in the PA community, the Society encourages all PAs to understand their professional history and embrace it as a part of their professional identity. The Society, through the work of its board of trustees, historians, and staff, tells the story of the collective efforts of physicians, PAs, nurses, lawyers, educators, and policy makers to create a human innovation that has changed how medicine is practiced in the United States and, more recently, in other countries. The Society provides PA faculty and students access to a growing collection of historically relevant and primary source materials that can be used for educational, research, and literary purposes.

Development and Dissemination of the El Centro Health Disparities Measures Library.

PURPOSE: This report describes the development and dissemination of a library of English measures, with Spanish translations, on constructs relevant to social determinants of health and behavioral health outcomes. The El Centro Measures Library is a product of the Center of Excellence for Health Disparities Research: El Centro, a program funded by the National Institute on Minority Health and Health Disparities of the U.S. National Institutes of Health. The library is aimed at enhancing capacity for minority health and health disparities research, particularly for Hispanics living in the United States and abroad. DESIGN: The open-access library of measures (available through www.miami.edu/sonhs/measureslibrary) contains brief descriptions of each measure, scoring information (where available), links to related peer-reviewed articles, and measure items in both languages. Links to measure websites where commercially available measures can be purchased are included, as is contact information for measures that require author permission. Links to several other measures libraries are hosted on the library website. Other researchers may contribute to the library. METHODS: El Centro investigators began the library by electing to use a common set of measures across studies to assess demographic information, culture-related variables, proximal outcomes of interest, and major outcomes. The collection was expanded to include other health disparity research studies. In 2012, a formal process was developed to organize, expand, and centralize the library in preparation for a gradual process of dissemination to the national and international community of researchers. FINDINGS: The library currently contains 61 measures encompassing 12 categories of constructs. Thus far, the library has been accessed 8,883 times (unique page views as generated by Google Analytics), and responses from constituencies of users and measure authors have been favorable. CLINICAL RELEVANCE: With the paucity of availability and accessibility of translated measures, behavioral nursing research focused on reducing health disparities can benefit from repositories of research instruments such as the El Centro Measures Library.

Beyond Books: Public Libraries As Partners For Population Health.

Public libraries are not usually included in discussions about improving population health. They are, however, well positioned to be partners in building a culture of health through programming that addresses the social determinants of health. The Healthy Library Initiative, a partnership between the University of Pennsylvania and the Free Library of Philadelphia (the public library system that serves the city), has undertaken such efforts in Philadelphia. In this article we report findings from an assessment of how ten highly subscribed programs address the social determinants of health, as well as results of interviews with community residents and library staff. Of the 5.8 million in-person Free Library visits in 2015, 500,000 included attendance at specialized programs that addressed multiple health determinants, such as housing and literacy. Library staff provided intensive support to vulnerable populations including homeless people, people with mental illness and substance use, recent immigrants, and children and families suffering from trauma. We found that public libraries are trusted institutions that have broad population reach and untapped potential to improve population health.

Evolution of an academic-public library partnership.

A partnership to improve access to health information via an urban public library system was established in St. Louis, Missouri, in 2011. A multiyear project was outlined that included an information needs assessment, a training class for public library staff, information kiosks at library branches for delivering printed consumer health materials, and a series of health-related programming. The partnership evolved to include social service and community organizations to carry out project goals and establish a sustainable program that met the health and wellness interests of the community.

Feasibility of retrofitting a university library with active workstations to reduce sedentary behavior.

BACKGROUND: Libraries are an inherently sedentary environment, but are an understudied setting for sedentary behavior interventions. PURPOSE: To investigate the feasibility of incorporating portable pedal machines in a university library to reduce sedentary behaviors. METHODS: The 11-week intervention targeted students at a university library. Thirteen portable pedal machines were placed in the library. Four forms of prompts (e-mail, library website, advertisement monitors, and poster) encouraging pedal machine use were employed during the first 4 weeks. Pedal machine use was measured via automatic timers on each machine and momentary time sampling. Daily library visits were measured using a gate counter. Individualized data were measured by survey. Data were collected in fall 2012 and analyzed in 2013. RESULTS: Mean (SD) cumulative pedal time per day was 95.5 (66.1) minutes. One or more pedal machines were observed being used 15% of the time (N=589). Pedal machines were used at least once by 7% of students (n=527). Controlled for gate count, no linear change of pedal machine use across days was found (b=-0.1 minutes, p=0.75) and the presence of the prompts did not change daily pedal time (p=0.63). Seven of eight items that assessed attitudes toward the intervention supported intervention feasibility (p<0.05). CONCLUSIONS: The unique non-individualized approach of retrofitting a library with pedal machines to reduce sedentary behavior seems feasible, but improvement of its effectiveness is needed. This study could inform future studies aimed at reshaping traditionally sedentary settings to improve public health.