May 19: cemetery records, Hubble pictures, Webby winners, and more.

1. Go where it is
   
2. The answer depends on the question
   
3. Research is a multi-stage process
   
4. Ask a Librarian
   
5. Information is meaningless until queried by human intelligence

A HOSPITAL LIBRARY OUTREACH PROJECT: TEACHING SENIORS TO FIND HEALTH INFORMATION ON THE NET

I thought you'd be interested in an innovative outreach program I've been working with for the last month, sponsored by Trinity Medical Center in Rock Island, Illinois as a logical extension of its mission "to use our resources in order to provide care for our patients and improve the health of our community."

Jeanne Gittings, Health Sciences Librarian, wrote a proposal and was awarded a National Library of Medicine grant to set the program up. The reasoning was that "access to reliable health information improves the patient-physician relationship"; that 60 million adults are already using the internet for health information"; and that, while older adults would especially benefit from access to such information, government figures indicated that older Americans were least likely to have internet access.

Trinity discovered from its own survey of Quad City residents 55 years and older that barriers to seniors' use of the internet included a general lack of interest in computers, the cost of computers, the cost of internet access, and lack of knowledge of how to use the technology. In spite of this, 24% of the seniors said they would like to learn to use the Internet.

The grant program was created in cooperation with Trinity's own Prime Time program for seniors, two retirement communities (one in Davenport, Iowa, one in Rock Island, Illinois) and an adult day center in Rock Island. The grant paid for the wiring of the three locations and the installation of computers, printers, and monitors there as well as in Trinity's Health Sciences Library, creating a total of 15 workstations, each of which can seat two people side by side during training sessions. One two and a half hour session was scheduled for each location once a week during the initial period, April through June. All were fully enrolled by enthusiastic seniors soon after the program was announced, but the grant period extends through June of 2001, and many more sessions are planned.

The advantage of keeping the sessions small and intimate -- a maximum of 8 learners per workshop -- is that the trainers, Jeanne Gittings and I, can work with the seniors at whatever level of knowledge and experience they come in with. When our seniors all know how to use a computer and a mouse already, we plunge directly into examining the health information on the net, but if we have to teach them how to use a mouse, navigate around the screen, and move back and forth between screens, turn the computer on and off, that's where we start, cutting out some of the medical content to accommodate. Over the course of the workshops, Jeanne and I have come to know each other's spiels, but we have literally never conducted the same workshop twice; what we cover varies in accordance with the computer ability and interests of each group.

My first challenge in working with this program was constructing a web page for it, selecting the most valuable web resources for seniors' health. You can view the page at http://marylaine.com/seniors.html. Of course, before you can select web sites, you need to think about what kinds of sites would be most valuable. I focused on

1. Sites for newbies
2. Evaluating health information (a clear sticking point for those who HAD been on the net already)
3. All purpose health sites for seniors
4. Sources of journal articles (both the state of Iowa and the state of Illinois pay for full-text journal databases for their citizens)
5. Disabilities information
6. Nutrition and fitness information
7. FAQ files
8. Financial and personal assistance
9. Online medical reference books
10. Support groups
11. Search engines and how to use them
12. All purpose web directories

Altogether, I chose about 110 sites, though obviously I could only demonstrate a few of them in any depth. I explained to our seniors that medical information on the net came at three levels of expertise: doctors talking to doctors (medical journals); doctors talking to patients (FAQ files from hospitals, NIH sites, and organizations such as the American Heart Association), and patients talking to patients, and that they might, at different times, want to draw on all three of those levels. I also thought it was important for them to understand that the net was not just web sites, but was also a communications medium -- e-mail, usenets, bulletin boards, listservs -- and a delivery medium for resources like journal articles and government documents.

The sites we chose to emphasize were Medline Plus (http://medlineplus.gov/), which not only provides links to excellent basic information for patients on each topic but also links to recent Medline searches on that issue, the journal databases provided by Iowa and Illinois (which tend to include everything from consumer health magazines through medical journals), and SupportGroup.com (http://support-group.com), which is especially helpful in identifying key personal resources such as usenet groups, bulletin boards, and local support groups, as well as FAQ Files and local support groups. We also recommended that all of them identify the key organizations for their topic (both Medline Plus and SupportGroup.com do this) and visit those sites regularly for news updates, discussion forums, and listserves.

One of the key goals of the grant was to teach seniors how to evaluate health information, so we focused particularly on the principles of the HON Code of Conduct for medical sites (http://www.hon.ch/HONcode/Conduct.html?
HONConduct719879), and on identifying fraudulent schemes and treatments, using Quackwatch (http://www.quackwatch.com/) as a primary resource.

Two medical reference sites I knew they would find particularly useful were the HealthGate Guide to Medical Tests (http://www3.healthgate.com/mdx-books/
tests/index.asp) and RXList (http://www.rxlist.com/). Few doctors have the time to explain to patients everything they want to know about a test that's going to be run on them, but the HealthGate guide explains it all -- what the test is, how long it takes, how much it costs, things the doctor needs to watch out for, a detailed description of what the patient will experience during the test, and how long before the results are available. All our seniors loved the idea of knowing this beforehand.

RXList is a site that can literally save lives by showing people the contraindications for using various drugs, as well as side effects and dangerous drug interactions. Since seniors often have several doctors, each prescribing different medications, we worry that these drug interactions might not be caught, and RXList is a powerful tool for identifying potential problems. However, Jeanne and I stressed that patients should never act independently on any medical information they found, but instead print out copies to take to their doctors, complete with the address of the web site where they found the information.

I usually finish off by showing them how to search the same topic through several search engines, and point out the different results and different search engine features. Because understanding all of this ultimately requires finger knowledge, my web page ends with a "test drive," where I offer seven health questions, tell our seniors what web sites to click on, what buttons to push, where to click, and what to type in to get answers to their questions. The seniors are encouraged to visit their computer room whenever they want to practice on the machines.

Other features of the grant program included the library's commitment to obtaining any journal articles the seniors request, and providing continuing assistance by phone or e-mail. Trinity Medical Center also created a web-based e-mail system so that any seniors who wished could set up free e-mail accounts.

We've been doing this for over a month, now, and initial evaluations have been very positive, which didn't surprise us; in such an intimate teaching setting, we can see how the seniors are reacting, and can immediately respond to their questions and concerns, and we can see the lively interest on their faces. A second round of evaluations will be conducted after the seniors have had a chance to practice using the net, since the proof of the pudding is not in what we taught, but in what they learned. Ultimately, the goal is to get them using the net to meet their information needs.

It seems to me this program is an excellent example of how a library can perform its mission more effectively through vigorous outreach. I am pleased and proud to have been a part of making it happen.

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COOL QUOTE

I have always imagined that Paradise will be a kind of library.

Jorge Luis Borges

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Ex Libris: an E-Zine for Librarians and Other Information Junkies.
http://marylaine.com/exlibris/
Copyright, Marylaine Block, 2000.