library literacy paper
Dissertations into Practice
Abstract
This paper is based on Rachel Butler’s dissertation carried out at the University of Sheffield as part of the MA Library and Information Services Management. The study examines people’s online health information seeking skills, with the specific aim to identify how libraries and health services can work together in supporting digital and health literacy. A survey approach is used to explore online searching habits as well as librarian and health professionals’ views on health literacy. The key findings indicate that whilst the majority of respondents consider themselves to be health literate, there was an overall agreement that effective education and support could be achieved through the collaboration between libraries and health services, and specifically to signpost information and to provide targeted education. The limitations of the research for dissertation are recognised leading to recommendations that further study focuses on the impact of signposting and education on health literacy.
F.J.
Keywords: health literacy; information seeking behaviour; internet access; librarians
Health information seeking behaviour: the
librarian’s role in supporting digital and health
literacy
Rachel Butler Keyll Darree Library, Keyll Darree Education Centre, Braddan, Isle of Man E-mail: rachel.butler@gov.im Twitters: @butlerrachel2
Background and context
Health information is available in many different formats, and research suggests that over two thirds
of adults are now using the Internet to discover answers to their health information needs (Dutton & Blank, 2013; Fox & Duggan, 2013). It is crucial that people know how to identify and search for credible health information and the purpose of the dissertation was to look at how this can be addressed by librarians. Educating users on health literacy would inform their information seeking behaviour and their skills should be considered when creating and designing health information online (Estacio, Whittle, & Protheroe, 2017). If health services want to encourage users to browse and interpret information effectively, it is critical to think about user’s digital and health literacy skills and how they can be educated to enhance their online experience. Ultimately, the aim was to potentially reduce the need to visit health services and therefore saving the government money long term. There are inequalities with people’s Internet access (Dobransky & Hargittai, 2012), and this can impact on how they support their health information needs. The aim of the research was to identify how
people find health information and the reasons for their choices. Furthermore, the study analyses how libraries can work with health services to support users’ health information seeking and help improve their health literacy and to examine the ways in which the digital divide could be tackled.
Literature review
There were four key themes identified during the literature review, which informed the data collection for the research. These were online health information, lay user’s perceptions, the role of librarians and health literacy and inequality. The availability of online health information was reviewed to understand how people gain trust in the credibility of online information (Mun, Yoon, Davis, & Lee, 2013). Dutton and Blank (2013)
© 2019 Health Libraries Group 278 Health Information & Libraries Journal, 36, pp. 278–282
DOI: 10.1111/hir.12278
discovered that 69% of the UK population look for health information online. This then led to considering user’s views of the Internet and its reliability. Factors that influence user’s information seeking behaviour regarding health information online include reassurance, second opinion, better understanding and lack of access to conventional health information (Powell, Inglis, Ronnie, & Large, 2011). Recognising the increase in the population (Dutton & Blank, 2013) using the Internet for health related information needs highlights the importance that they can identify credible information and to enable this that the information is available in layman’s terms. As the aim of the dissertation was to identify how librarians can support users, it was essential also to look at the role of librarians. Lucassen and Schraagen (2011) point out that librarians have the expertise and resources to support users, and Flaherty (2015) suggests that if they collaborated with health professionals and other organisations, they could help develop and deliver health literacy education to support users searching for credible and up to date health information. However, it was evident in the literature that there were barriers to health information regarding Internet access and education (Dobransky & Hargittai, 2012). The health inequality also highlighted a digital divide, in particular with the older generation and the vulnerable who may not have access to or choose not to use the Internet (Choi & DiNitto, 2013).
Methodology
The research used a mixed methods approach. An online survey was sent out in June 2018 to friends, colleagues and a UK librarian network distribution list and was aimed at anybody who looks for health information online. As such, no particular group or demographic was targeted. There were a total of 10 questions (see Table 1), a mix of close and open ended questions designed to evaluate how people viewed their health literacy and how they looked for health information online, whether they used libraries and whether they required health literacy education. The close ended questions aimed to identify how people find health information online and the reasons for their
choices, and the open ended questions focused on identifying how and why people search for health information on the Internet. The survey results were used to produce quantitative data on how users viewed their own health literacy and information seeking behaviour. Semi-structured interviews were undertaken with
librarians to seek their views on users and how they could support and provide health literacy education. Six librarians from the Isle of Man were approached with backgrounds variously in academic, health and public libraries. The questions asked were to focus on how libraries could partner up with health services, garner views on health literacy and discuss the digital divide. The interviews were recorded and transcribed, and then, a thematic analysis (Braun & Clarke, 2013) was used to identify emerging themes. The five main themes that emerged from the interviews were health experiences, signposting, technology, collaboration and education. The data from the survey and interviews were analysed separately and then compared and reviewed to identify commonalities.
Findings
There were 76 survey respondents, and half of them did not use the library for their health information needs. It was found that over three quarters of respondents used NHS Choices to find health information online. Most respondents
Table 1 Survey questions
1 I agree to take part in the research project as
described above
2 What is your gender?
3 Which is your age bracket?
4 Which of the following websites do you use to find
health information?
5 Have you used the library to obtain health
information?
6 Why do you look for health information online?
7 How would you rate your health literacy?
8 How do you search for health information online?
9 Do you think you need educating on how to evaluate
health information online?
10 Do you think health information online could be used
instead of visiting the doctor?
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Dissertations into Practice 279
looked for health information online for advice followed by symptoms. There were a variety of other reasons given including looking for friends and family, speed and research. 72.37% of respondents used a search engine to find the information. Respondents were asked to rate their health literacy with 65.79% rating themselves as good or excellent. Over half felt that they did not need educating on finding health information online. The quantitative data indicated that people are cognizant with regard their health information needs. Whilst this is a relatively small sample, it suggests that a wider distribution of the survey could be carried out to obtain more conclusive results. Interviews were undertaken with six librarians
and five themes emerged from the qualitative data, which built a picture of the role librarians can play in providing health literacy education and support to users. These were as follows:
Health experiences
It was acknowledged in the interviews that people used books and resources to find out more about specific health issues and other people’s experiences. The participants commented on the resources they provided, the role of support groups and charities and things they can do to help manage people’s health. The participants believed that libraries should provide health information resources to support users.
Signposting
This was classed as ‘information management’ by one participant and reflects how health information is displayed in the library. This includes providing up to date information, availability and format of resources and highlighting their online presence.
Technology
It was clear from the librarian’s point of view that it is not just about user’s Internet access but their decision to actively reject the Internet. One participant noted that there were ‘two approaches in terms of those who don’t have access or require it’. This indicates that solely providing health information online would be problematic because
it might not be available to users due to Internet access, personal choice or technical ability.
Collaboration
Most of the librarians interviewed confirmed that they were already working with external organisations to provide their users with health information and resources. These included charities, doctor’s surgeries and public health. Although all the participants were proactive in working with external partners, some suggested that more could be done ‘if we handled information better and partnered better I think that we’d have more impact I guess on both the public and health care professionals’.
Education
Although the participants agreed that providing user education would be beneficial, a few said they just did not have the time and resources. The participants suggested that their priority would be their own users. Librarians agree that training users on health literacy skills would help them in the long term, as users would be able to find reliable health information online.
Discussion
Both the quantitative and qualitative results provided an array of responses for why people search for health information online and as one participant comments ‘it is very easy to Google a condition’. If people are looking for reassurance and knowledge about their health, this highlights the need to ensure that they are able to search for credible health information online. The participants highlighted that some people choose not to use the Internet, which concurs with the literature in that providers need to consider such factors when digitising health information (Estacio et al., 2017). Some of the librarians interviewed confirmed that users do not often ask them for advice on their health information needs which collates with survey respondents. This indicates that this is an area that could be worked on in the future. Libraries, schools and public health cannot be solely responsible for teaching health literacy, and
© 2019 Health Libraries Group Health Information & Libraries Journal, 36, pp. 278–282
Dissertations into Practice280
there should be a strategy that involves all these organisations and knowing what to target and when. Users need to have a certain level of health literacy if they are going to be encouraged to rely on the Internet for health information needs and advice in the future. Survey respondents were not asked about the
digital divide but it is clearly something that needs to be considered in future research as it can be interpreted in different ways. One librarian commented that ‘the digital divide, yes there is one that’s down to social, economic, age and health’. If libraries and health services partnered up, they could work together to address this issue and find ways to provide health information to all regardless of their status or literacy skills.
Implications for practice
There were a few limitations and issues raised from the research. The main limitation was the amount of time available for the survey and the audience it was available to. If it had been made available to library users across the Isle of Man, it may have provided a truer picture of whether they think the library has a role to play. Also a lack of time and resources meant the survey was capped at 100 responses so it would be worth sending out to more people and paying out for a more extensive survey package. However, the main value of the study lies in its
identification that in health information seeking some people actively choose to not use the Internet and that this is something that needs to be considered by practitioners. It is clear that health information will have to continue to be provided in a variety of formats to support different user needs. The survey results highlighted that people look for health information online because it was quick, accessible and in layman’s terms. Health information provision should therefore mirror this in both physical and digital formats. The implication for practice whilst focusing on
the importance the role of the librarian in providing training in health literacy is understanding the user’s reasons for using (or not) the Internet and/or the library as well as dealing with the lack of resources and time in providing an effective service. The
librarians interviewed stated that they offer specific group training sessions but they have low attendance. The reason for this is probably due to the users requiring training or help at a time that is more convenient to them. Librarians cannot always provide that support for an on demand service which is why a coordinated approach with public health would help address what the public need.
Conclusion
The data collected from users showed that they are most likely to use search engines to find health information online. The interviews with librarians furthermore suggested opportunities to support users with their health literacy. These included proactively providing and delivering relevant and targeted training sessions and liaising with health organisations to ensure that they provide the most up to date information. Further suggestions were made to work with external organisations such as public health and local charities to signpost users to health information and ensure that it is engaging. Research into people’s health information seeking indicates that users will have different levels of health literacy and that training needs to be targeted and appropriate. An additional point raised in this study was that
there are people who do not want to or cannot use the Internet due to personal choice, disability and accessibility. Therefore, libraries should provide free Internet access without any limits to support users in an increasingly digital society and continue to provide health information in non-digital formats to meet different user needs as well as training, even in challenging contexts in which levels of education and learning abilities are unknown. The provision of health literacy training and Internet access should be tackled by society as a whole. Therefore, if libraries, public health and government worked together, they could support, train and signpost people to find relevant health information.
References
Braun, V., & Clarke, V. (2013). Successful qualitative research: A practical guide for beginners. London, UK: Sage Publications Ltd.
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*For details on how to contribute to this feature please contact:
Frances Johnson Manchester Metropolitan University
Department of Languages Information and Communication
Geoffrey Manton Building Rosamond Street
West Manchester M15 6LL Tel:+44(0)161 2476157
Email: f.johnson@mmu.ac.uk
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