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PubMed2005

Inside outreach: a challenge for health sciences librarians.

OBJECTIVE: Like medical and health sciences libraries throughout the country, the Lamar Soutter Library (LSL) at the University of Massachusetts Medical School is dealing with ever-increasing outreach needs in times of diminishing funding. With the goal of reshaping the library's outreach program to better serve our patron groups, the Outreach Study Group was formed to investigate existing models of outreach. METHODS: The group initially examined the current literature and subsequently conducted a nationwide survey of medical and health sciences libraries to identify trends in outreach. This article details the methods used for the survey, including establishing criteria for selecting participants, determining the focus, and developing and conducting the survey. RESULTS: Of the 40 libraries invited to participate, 63% completed the survey. An analysis of the data revealed successes, problems, and trends. The group's conclusions led to recommendations for the LSL's future outreach efforts. CONCLUSIONS: Analysis of the data revealed key findings in the areas of strategic planning, funding, and evaluation. A thoughtful definition of outreach ensures that outreach activities are expressions of the library's mission. Funding shifts require flexible programs. Evaluation provides data necessary to create new programs, sustain successful ones, and avoid repeating mistakes.

Community-Institutional Relations↗
PubMed2005

Avoiding versus seeking: the relationship of information seeking to avoidance, blunting, coping, dissonance, and related concepts.

QUESTION: How have theorists and empirical researchers treated the human tendency to avoid discomforting information? DATA SOURCES: A historical review (1890-2004) of theory literature in communication and information studies, coupled with searches of recent studies on uptake of genetic testing and on coping strategies of cancer patients, was performed. STUDY SELECTION: The authors' review of the recent literature included searches of the MEDLINE, PsychInfo, and CINAHL databases between 1992 and summer of 2004 and selective, manual searches of earlier literature. Search strategies included the following subject headings and key words: MeSH headings: Genetic Screening/psychology, Decision Making, Neoplasms/diagnosis/genetics/psychology; CINAHL headings: Genetic Screening, Genetic Counseling, Anxiety, Decision Making, Decision Making/Patient; additional key words: avoidance, worry, monitoring, blunting, cancer. The "Related Articles" function in MEDLINE was used to perform additional "citation pearl" searching. MAIN RESULTS: The assumption that individuals actively seek information underlies much of psychological theory and communication practice, as well as most models of the information-seeking process. However, much research has also noted that sometimes people avoid information, if paying attention to it will cause mental discomfort or dissonance. Cancer information in general and genetic screening for cancer in particular are discussed as examples to illustrate this pattern. CONCLUSION: That some patients avoid knowledge of imminent disease makes avoidance behavior an important area for social and psychological research, particularly with regard to genetic testing.

Adaptation, Psychological↗
PubMed2005

Community-based organizations' perspective on health information outreach: a panel discussion.

OBJECTIVE: A panel was convened to elicit guidance for librarians in initiating and implementing community-based health information outreach. PARTICIPANTS: Participants included a panel of individuals from communities or community organizations who represented the types of groups with which librarians or information specialists need to interact and an audience who represented health sciences libraries, public libraries, academic institutions, government agencies, funding agencies, and community-based organizations and could contribute to a discussion on community-based health information outreach. PROGRAM: The panel was presented with a hypothetical community setting and asked to respond to a series of questions: What do librarians need to learn about the community before they make their visits? What methods of outreach have been successful in your work? How would you implement and sustain a health information program in your community? How would health information interventions reduce racial and ethnic disparities in health? MAIN RESULTS: The panel helped to frame many of the issues that may confront librarians as they initiate information-related programs in communities. CONCLUSION: There is clear consensus on the need for librarians to make the effort to reach out into the community, to make the contacts, to seek to understand the community, to talk with leaders, and to respect the community as they promote and teach the use of health information resources. It was confirmed that librarians and libraries have an important role in diminishing health disparities by improving access to health information.

Community-Institutional Relations↗
PubMed2005

"Smallball" evaluation: a prescription for studying community-based information interventions.

OBJECTIVES: This paper argues that focused evaluation studies of community-based informational interventions conducted over the life-cycle of the project ("smallball" studies) are more informative and useful than randomized experiments conducted only at the project's conclusion ("powerball" studies). METHOD: Based on two contrasting strategies in baseball, smallball and powerball studies are compared and contrasted, emphasizing how the distinctive features of community-based interventions lend advantage to smallball approaches. RESULTS: Smallball evaluations have several important advantages over powerball evaluations: before system development, they ensure that information resources address real community needs; during deployment, they ensure that the systems are suited to the capabilities of the users and to community constraints; and, after deployment, they enable as much as possible to be learned about the effects of the intervention in environments where randomized studies are usually impossible. IMPLICATIONS: Many in informatics see powerball studies as the only legitimate form of evaluation and so expect powerball studies to be done. These expectations should be revised in favor of smallball studies.

Community Health Planning↗
PubMed2005

Community outreach: from measuring the difference to making a difference with health information.

BACKGROUND: Community-based outreach seeks to move libraries beyond their traditional institutional boundaries to improve both access to and effectiveness of health information. The evaluation of such outreach needs to involve the community in assessing the program's process and outcomes. PURPOSE: Evaluation of community-based library outreach programs benefits from a participatory approach. To explain this premise of the paper, three components of evaluation theory are paired with relevant participatory strategies. CONCEPTS: The first component of evaluation theory is also a standard of program evaluation: use. Evaluation is intended to be useful for stakeholders to make decisions. A useful evaluation is credible, timely, and of adequate scope. Participatory approaches to increase use of evaluation findings include engaging end users early in planning the program itself and in deciding on the outcomes of the evaluation. A second component of evaluation theory seeks to understand what is being evaluated, such as specific aspects of outreach programs. A transparent understanding of the ways outreach achieves intended goals, its activities and linkages, and the context in which it operates precedes any attempt to measure it. Participatory approaches to evaluating outreach include having end users, such as health practitioners in other community-based organizations, identify what components of the outreach program are most important to their work. A third component of evaluation theory is concerned with the process by which value is placed on outreach. What will count as outreach success or failure? Who decides? Participatory approaches to valuing include assuring end-user representation in the formulation of evaluation questions and in the interpretation of evaluation results. CONCLUSIONS: The evaluation of community-based outreach is a complex process that is not made easier by a participatory approach. Nevertheless, a participatory approach is more likely to make the evaluation findings useful, ensure that program knowledge is shared, and make outreach valuing transparent.

Community Health Planning↗
PubMed2005

Using evaluation to adapt health information outreach to the complex environments of community-based organizations.

OBJECTIVE: After arguing that most community-based organizations (CBOs) function as complex adaptive systems, this white paper describes the evaluation goals, questions, indicators, and methods most important at different stages of community-based health information outreach. MAIN POINTS: This paper presents the basic characteristics of complex adaptive systems and argues that the typical CBO can be considered this type of system. It then presents evaluation as a tool for helping outreach teams adapt their outreach efforts to the CBO environment and thus maximize success. Finally, it describes the goals, questions, indicators, and methods most important or helpful at each stage of evaluation (community assessment, needs assessment and planning, process evaluation, and outcomes assessment). LITERATURE: Literature from complex adaptive systems as applied to health care, business, and evaluation settings is presented. Evaluation models and applications, particularly those based on participatory approaches, are presented as methods for maximizing the effectiveness of evaluation in dynamic CBO environments. CONCLUSION: If one accepts that CBOs function as complex adaptive systems-characterized by dynamic relationships among many agents, influences, and forces-then effective evaluation at the stages of community assessment, needs assessment and planning, process evaluation, and outcomes assessment is critical to outreach success.

Community Health Planning↗
PubMed2005

Disseminating relevant health information to underserved audiences: implications of the Digital Divide Pilot Projects.

OBJECTIVE: This paper examines the influence of the digital divide on disparities in health outcomes for vulnerable populations, identifying implications for medical and public libraries. METHOD: The paper describes the results of the Digital Divide Pilot Projects demonstration research programs funded by the National Cancer Institute to test new strategies for disseminating relevant health information to underserved and at-risk audiences. RESULTS: The Digital Divide Pilot Projects field-tested innovative systemic strategies for helping underserved populations access and utilize relevant health information to make informed health-related decisions about seeking appropriate health care and support, resisting avoidable and significant health risks, and promoting their own health. IMPLICATIONS: The paper builds on the Digital Divide Pilot Projects by identifying implications for developing health communication strategies that libraries can adopt to provide digital health information to vulnerable populations.

Community-Institutional Relations↗
PubMed2005

Libraries reaching out with health information to vulnerable populations: guidance from research on information seeking and use.

OBJECTIVE: Two branches of applied social science have devoted substantial attention to researching information seeking and use. One branch is the field of communication, with its emphasis on the design of messages to effectively transmit expert information. The second is the field of library and information science, with its emphasis on meeting user needs. This paper is an overview and comparison of what is known about information seeking and use based on these two bodies of research, particularly as it applies to serving the needs of racial and ethnic minorities. DATA SOURCE: This paper is informed by three in-depth literature reviews of the two fields and of the difficulties of bringing findings from disparate fields to bear on the same phenomena. CONCLUSIONS: Twenty-five broad brushstroke propositions are extracted in a way that allows both commonalities and contradictions to be informative, particularly as they relate to how the flexibilities offered by electronic technologies may allow experts to serve user needs more effectively and efficiently. Remarkably, while both fields have approached their studies from separate viewpoints without much overlap, both have struggled with the baggage imposed on their research by information-as-transmission assumptions and both have moved toward approaches that focus on information-as-communication.

Community-Institutional Relations↗
PubMed2005

Library outreach: overcoming health literacy challenges.

OBJECTIVE: This paper examines the powerful influences of consumer health literacy on access to and use of relevant health information. METHOD: The paper describes how widespread problems with health literacy significantly limit effective dissemination of relevant health information in society, especially to many vulnerable populations where health literacy challenges are especially pervasive. RESULTS: The paper examines strengths and weaknesses of different programs for addressing health literacy problems, including educational programs, message design programs, and strategic communication training and intervention programs. IMPLICATIONS: The paper evaluates strategies that can be implemented throughout the modern health care system to address problems of health literacy by improving health information access, processing, and understanding. It concludes by examining several strategies that libraries can adopt to overcome many health literacy challenges.

Community-Institutional Relations↗
PubMed2006

How do primary care physicians seek answers to clinical questions? A literature review.

OBJECTIVES: The authors investigated the extent to which changes occurred between 1992 and 2005 in the ways that primary care physicians seek answers to clinical problems. What search strategies are used? How much time is spent on them? How do primary care physicians evaluate various search activities and information sources? Can a clinical librarian be useful to a primary care physician? METHODS: Twenty-one original research papers and three literature reviews were examined. No systematic reviews were identified. RESULTS: Primary care physicians seek answers to only a limited number of questions about which they first consult colleagues and paper sources. This practice has basically not changed over the years despite the enormous increase in and better accessibility to electronic information sources. One of the major obstacles is the time it takes to search for information. Other difficulties primary care physicians experience are related to formulating an appropriate search question, finding an optimal search strategy, and interpreting the evidence found. Some studies have been done on the supporting role of a clinical librarian in general practice. However, the effects on professional behavior of the primary care physician and on patient outcome have not been studied. A small group of primary care physicians prefer this support to developing their own search skills. DISCUSSION: Primary care physicians have several options for finding quick answers: building a question-and-answer database, consulting filtered information sources, or using an intermediary such as a clinical librarian.

Australia↗