Prenos prvotne priloge

Working On Public Health Information in Public Libraries 

Trzan-Herman Nada, Becele Mirjana 
Ministry of Health, Ljubljana, Zaloška 29, Slovenia

(trzan.herman@gmail.com)  
 

Abstract 

Objectives: to develop consumer’s health awareness for preventive actions to stay in good health, to intensify patients' compliance with medical treatment and pharmacotherapy and to promote the importance of health information literacy and how to acquire it.

Design: This is a pilot study – a part of our new project “Public library for public health” - aiming to find out the most frequent health related questions. There were three public presentations about medicine and pharmacy (an overview) and three more will follow by the end of this year. After these presentations, attendees were invited to ask questions regarding their health problems. Based on this result, a project is developed on how to equip public libraries to best serve people's needs.

Participants in a pilot study: We have got 43 questions from the public (about 80 people) who attended the conducted lectures.

Main outcome: Citizens need additional places for finding answers on health related issues and the public library will make further steps to offer a new service on public health information.

Conclusions: Public health literacy seems to be confusing. People read a lot of promotional material but they do not understand it completely. There is not enough time to discuss with physicians and pharmacists about all “marginal” questions which can turn out to be very important. Central Public Library in Celje is willing to establish an additional service where healthcare professionals (volunteers – physicians, pharmacists, nurses) will be available for a few hours per week to answer questions on health problems. Adequate independent information sources will be available and the health care professionals will be trained on how to use these information sources. We realize that many questions will not be answered immediately but our aim is to advise people on where medical help can be found. The patient’s rights will also be promoted. 
 

Introduction 

Public libraries which provide active service on public health issues contribute a lot to the better health of citizens – so called “good” citizens. A “good” citizen is one who is interested in a healthy lifestyle and reflects this through choosing to participate in activities such as searching for information about his/her health and the health of loved ones.

PubMed search results on public libraries and health information literacy (89 articles were found and studied) show that more and more public libraries take actions to develop health information literacy and support activities that promote public health. These activities introduce a new role of public libraries and with this; librarians become one of the primary agents in malady prevention and good health in society. When starting with such new services it is extremely important that public librarians learn new skills from experts who work in the field of health information or in medical libraries.

Collaborations between health science or medical librarians and members of the public health workforce may stimulate thinking on how to form a partnership between members of these two kinds of libraries.

A public library with experts in health information searching can build bridges and fill gaps in information needs from library users who do not spontaneously approach health care professionals but have a generalized unexpressed need to be informed (1). Consumerism can be blamed many times for health information available to the general public being unevaluated, misleading or even dangerous. Citizens require health information that is timely, relevant, reliable and easy to understand. Health information of good quality is also essential for greater patient involvement in health care. In Europe, direct-to-consumer promotion for prescribed medicines is not allowed because this delicate information must be presented with special care to end users. On the other hand, there is a need to provide this kind of information via high quality “channels” e.g. pharmacies. Public libraries can develop these valuable services in some extension, too. Nowadays, people use the Internet for getting answers to their health problems. Analysis of consumers’ searches showed that a significant number of people have problems in query formulation and efficient selection from results listed (2). Public libraries can play an educational role to inform them about high quality information sources on the Internet (e.g. web sites with a HON sign: Health on the Net - medical information you can trust; HTA – Health Technology Assessment etc.).

The extent of information desired differs by various groups of citizens; older people, for instance, are interested in better health but they are not interested in searching and studying the problem. From these findings, both a disease and patient’s age have the principal influence on desires for health related information.

As knowledge of evidence-based health searching grows, expert searchers in health related areas will play an increasingly important role as guides in public libraries.  The most important characteristic for an expert searcher in public health is the willingness to continually and quickly develop expertise in new subjects and resources as public health priorities change. One of the most important issues is how to translate “public medical” vocabulary to the right medical vocabulary to perform good quality searches. For this purpose the co-operation of medical professionals (physician, pharmacist, nurse etc.) is essential.

Public libraries are the “best neighbours on the spot”. People like to go there and because of the pleasant atmosphere they can speak more openly about their health related questions.

Modern national health care systems have to implement strategies to address problems of health literacy by improving health information access, processing, and understanding. So, the most important strategy comprises of public libraries offering these kinds of services (3). There is also a WHO initiative for promoting patients' rights – adequate to states’ legislations as well as EPHA’s (European Public Health Alliance) effort to put citizens' health at the heart of Europe.  
 

A new project “Public library for public health” in Central public library in Celje  

Central Public Library in Celje started a complete renovation of its building in 2009. In this new building some new services will be implemented and one of them refers to public health.  This paper presents the key elements of the project aiming to achieve better public health and to increase the library’s reputation among citizens. 

What needs to be done to reach the goals is:

  • to inform Ministry of Health and Medical library about our project and ask them for a support,
  • to have adequate good quality health  information sources,
  • to train at least two librarians for health related matters,
  • to invite healthcare professionals to volunteer for a few hours per week as consultants.

 

When starting with this project a pilot study about public interest in health issues was performed. First we searched via the Internet for monthly programs of events in Slovenian public libraries and most of the events referred to geography, history and psychology and alternative medicine. Only 10% of the events in public libraries referred to health promotion and discussion of health problems.

In October 2008 we started a pilot study – designed as short presentations about medicine and pharmacy (an overview). The presentation lasted about twenty minutes. After the presentation, attendees were invited to ask questions regarding their health problems. The general discussion lasted about an hour each time. There have been about 80 participants all together. These events were organised by the Red Cross. After three sessions we had 43 questions; some of them were answered later by post or via telephone. Sessions were performed by a health information specialist (a pharmacist). Brochures about patient’s rights were presented and citizens were interested in reading them.

Analysis of the result of this pilot study has shown that there is an interest in health information. People like to talk openly about health problems and it seems that there is not time enough for consultation with physicians and pharmacists. Participants were mostly elderly people but they were asking also about their children’s and grand children’s problems. 

The majority of questions were related to weight loss and medicinal products that are advertised against obesity (7 questions). The next group of questions (6 questions) dealt with taking prescription medicines together with herbal teas. Another group of questions refer to prescription medicinal products and food or dietary supplements or OTC medicinal products which are allowed to be taken together.  Changes from brand medicinal products to generic products were also questioned (Table 1).

We are aware that the results of this study cannot be objective because the sample is too small but we shall continue with this study.

In general we have found out that people would like to improve their health conditions and they buy different products that are advertised in magazines, television, internet…. But many times, they are confused because there are too many advertisements. In the pharmacy, they get some clarifications and instructions when and how to use the products but often they need more time to discuss their health conditions and medicines than they are already taking. When they receive a deeper explanation their compliance with entire therapy is better.

On the other hand, a healthcare professional’s (volunteer’s) role in a public library is delicate because he is asked to give advice on products which are sometimes nearly identical. A lot of scientific documentation must be compared to be able to give a real independent answer. Independent information sources have to be used (4) and the Slovenian drug information centre (FIC - http://www.sfd.si/images/splosne_informacije.pdf) is also available for more sophisticated questions. 

Table 1: Questions and answers that were collected during the pilot study.

QUESTION

ANSWER

INF.SOURCES

No.

Obesity problems – e.g. asking about various advertised tablets

Explanation

good quality web sites and brochures

7

Rx medicines  and herbs (e.g. crategus and enalapril together)

Explanation, advice

Martindale, SmPC

6

Rx medicines and food (e.g. olive oil and warfarin) or dietary supplements

Explanation, advice

SmPC, MD Consult, good quality internet sites

4

Rx medicines and OTC drugs (e.g.: ephedrin and atihypertensive drugs

Explanation, advice

Martindale, SmPC

4

Changing the brand for generic medicinal products

Explanation

SmPC, Martindale

4

Health problems description - asking for instruction (e.g.: pains in knees, arms…)

General advice and instruction to visit a physician.

MD consult

3

Pharmacotherapy compliance (e.g.: Aspirin 100mg ;3-per week instead of every day)

Explanation, advice

SmPC, MD consult

3

Gastrointestinal problems after antibiotics therapy, Candida etc.

Explanation, advice and instructions to visit a physician.

MD Consult, Martindale

3

Changing pharmacotherapy within the same ATC group

Explanation

SmPC, Martindale

3

Dietary supplements for children and adults

Explanation, advice

good quality web site

2

Incontinence

Explanation of various methods/protocols

good quality web site

2

Lupus erythematosus

Explanation of various methods of therapy

Martindale, Dermatology-journals via SciDirect

1

Cancer and taking  vitamins, minerals

Explanation - very careful - and instruction to discuss question with his/her oncologist.

good quality web site e.g.: http://ods.od.nih.gov/index.aspx

1

TOTAL

 

 

43

 
 

Other essential elements of the project “Public library for public health” are the following: 

  1. Public libraries in the whole Celje region will offer lectures on healthy lifestyles and the promotion of specific health related matters; e.g. healthy food, body fitness, protection from exposure to UV rays, stress, various addictions. After the lectures, adequate books, brochures and leaflets on these topics will be disposed for lending or taking free of charge.

 

  1. Leaflets and brochures of various “patients' groups” (e.g. diabetes) will be collected and displayed to visitors who could take them.

 

  1. Various activities will be organized (not only lectures but presentations with active visitors’ participation) to educate people on how to be active in everyday life (e.g. Pilates, Nordic walking presentation).

 

  1. Network of “patients’ groups” will be built. Central Public Library in Celje will become a central point for exchanging information between them on a local level. This service means building a special internet portal within the “Library portal” - http://www.ce.sik.si/ . The aim is to reach people who already visit this library web site. Such a service will provide possibility for exchanging citizens' experience and helping each other.

 

  1. A list of internet health information sources of good quality will be prepared – also those in Slovenian.

 

  1. A separate room for consultation with an expert on health informatics will be offered where citizens could ask questions and perform searches under his/her supervision.

 

  1. A separate room for a consultation with a healthcare professional (volunteer) will be provided where citizens (completely anonymous) could receive advice on various health related topics.

 

  1. Healthcare professionals will be supplied with all needed health information sources and prior to this they will be trained on good quality health information and patients’ rights legislation. We would like to point out that a kind of such training is already performed by the Slovenian National Institute of Health (5). Such training will be enriched by additional subjects like learning the legislation on patients’ rights in Slovenia and using FIC (http://www.sfd.si/images/splosne_informacije.pdf) -Slovenian Drug Information Centre, which gives information only to healthcare professionals. 

 
 

Conclusion 

Our pilot study has confirmed that there is a need for applying additional public library services related to health information; therefore, we shall continue with the activities listed. We have realized that invitation of healthcare professionals (volunteers) as consultants is an innovative step to increase the role of public library among our citizens. 

Acknowledgement

The authors gratefully acknowledge the support and suggestions of Martina Rozman-Salobir, Deputy Director of Central Public Library in Celje.  
 

References 

  1. De Castro P, Marquardt L, Luzi AM, Colucci A, Rossi AM. Libraries as a meeting place for health promotion: the experience of a collaboration with the Italian aids help line.

http://www.eahil.net/conferences/helsinki_2008/www.terkko.helsinki.fi/bmf/EAHILpapers/Paola_De_Cast

  1. Toms EG. How consumers search for health information. Health Informatics J. 2007 Sep; 13(3):223-35.
  2. Marshall JG, Haynes RB. Patient education and health outcomes: implications for library service. Bull Med Libr Assoc. 1983 July; 71(3): 259–62.
  3. Trzan-Herman N. Information for pharmaceutical care. http://www.zbmed.de/fileadmin/pdf_dateien/EAHIL_2002/trzan-herman-proc.pdf
  4. Berger T. Teaching experienced family physicians EBM approach to practice. Proceedings: 8th EAHIL Conference, Cologne, 2002, 90.