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Researchers and information literacy

May 4th, 2012 by Todd Vandenbark

Vitae, an organization in the UK dedicated to enhancing researchers’ skills and employability, has recently released two publications on the relevance of information literacy (IL) to research:

  • a short booklet aimed at researchers explaining the relevance of information literacy to their work, and
  • a two-page pamphlet version of key information from the booklet.
SCONUL 7 pillars of information literacy

click to enlarge

Included in these materials is a diagram of “Information literacy lens on the Vitae Researcher Development Framework using the SCONUL Seven Pillars of Information Literacy.” IL for the researcher involves the ability to:

  • Identify an information need for answering a research question,
  • know the Scope of gaps in their current knowledge that need filling,
  • Plan strategies for finding needed data and information,
  • Gather data, information and other needed resources,
  • review and Evaluate the research process and resulting data
  • Manage information so it is organized both professionally and ethically,
  • apply and Present research results by synthesizing new and old information to create new knowledge, and disseminate it in multiple ways

As discussions in our regular “Librarians Meeting” indicate, academic libraries supporting research need to move from a ready-to-help-librarian model, to a partnership with researchers where we bring our expertise at organizing and finding information to the research planning process. Our challenge is to build collaborative relationships with researchers at our institutions so that as they begin planning research, we can facilitate the process so research information and results are well-organized, and packaged for reuse. Eccles Library is dedicated to supporting the medical research community, and has on staff a dedicated Research Librarian, Abby Adamczyk.

Are you a researcher planning a new endeavor? Have you ever considered partnering with a librarian during the planning process? Tell us about it!

Jargon-free doctor-patient communication: Ask Me 3

May 3rd, 2012 by Todd Vandenbark

Health literacy logoBeginning in medical school, healthcare professionals are trained in medical jargon that serves as a shorthand for concise communication with colleagues and coworkers about patients they serve. Practically speaking, it is a “language” all its own that physicians (with 20 years of education) not only use, but assume patients understand as well. Yet the average patient does not have this level of education, and need health information provided at a lower level, anywhere from 8th grade on down. As one physician blogger noted:

Health care professionals must become “medically bilingual,” that is, learn to speak both medical jargon and plain language. I like to ask myself, “How would I explain this to my mother?”

When a physician is explaining her/his findings and recommendations, if the patient does not understand, he/she may not even ask for clarification out of fear of appearing ignorant. While medical schools are working to train doctors to speak using everyday language, patients can take some simple steps to avoid making this mistake: ask three simple questions:

  1. What is my main problem?
  2. What do I need to do?
  3. Why is it important for me to do this?

And if your physician answers in a way that is confusing or loaded with unintelligible jargon, stop her/him and ask for them to explain in simpler language.

The National Patient Safety Foundation (NPSF) created the Ask Me 3TM patient education program “to promote communication between health care providers and patients in order to improve health outcomes.” When patients clearly understand health information and instructions, they make fewer mistakes and can better manage their own healthcare. The NPSF offers patient brochures and other reference materials, and created this video to assist in improving patient-doctor communication.

While it is important that patients ask questions, and doctors answer using understandable language, it is also important to acknowledge that the current health system does not reward physicians for taking time to speak with patients. Regulation needs to be enacted or changed so that physicians can be reimbursed by health insurance, Medicare, Medicaid and other plans for the time spent. It will likely save the system money in the long run as well.

What other steps can be taken to improve doctor-patient communication? Tell us about it!

Home visitation, depression and health literacy

May 2nd, 2012 by Todd Vandenbark

Health literacy logoParents’ health literacy level strongly affects their child or children’s health, and having a depressed parent only increases the risk of adverse health outcomes. The Center for Health Literacy Promotion teamed up with the Department of Health Services at the University of Washington to study whether depression impairs health literacy and impedes efforts to promote health literacy through home visitation.1

From 2006 – 2008, families in a six-site nationwide study participated in a program to enhance parenting skills. Participating parents were monitored for “depression, health- and healthcare-related practices, and surrounding family conditions at baseline and 6-month intervals for up to 36 months.” Data from this study, available in a publicly-funded AHRQ/NIH database, was recently analyzed, and while participants began with reduced health literacy skills, “after 1 year of enhanced home visitation, vulnerable parents were better able to manage personal and family health and healthcare, especially if depressed.” While the sample size (2,572 parent/child dyads) was modest, the findings demonstrate one way we can improve parental health literacy levels even among depressed parents.

In addition to demonstrating the benefits of home visitation in improving health literacy, this study provides support for those that argue for making publicly-funded research data available to all. While no less important back then, health literacy was not the burning topic in 2006-2008 as it is today. Principal investigators had no idea that their work could or would be used in this way. If this data was locked behind a publisher’s pay-wall, this study might never have happened. Because it was publicly available, it could be re-used to test new ideas and ways to help people today.

Researchers must have open access to as many data sources as possible in order to find new ways to help those in need. Access must take precedence over ownership and control when the health outcomes of vulnerable populations (in this case, children) is at stake.

What data sources should be made accessible that are not available right now? Or, what publicly available data/studies/etc. would you like to see analyzed in new and creative ways? Tell us about it!

Reference:

1.    Smith SA, Moore EJ. Health Literacy and Depression in the Context of Home Visitation. Maternal and child health journal. Nov 26 2011.

Who can and should have access to research?

April 30th, 2012 by Todd Vandenbark

Open Access logoIn a recent article in The Economist magazine, it makes the argument that “When research is funded by the taxpayer or by charities, the results should be available to all without charge.” The article goes on to point out the huge profits (and increases in profits) by publishers, and how scientists are making this possible by providing their research free-of-charge in exchange for publication.

This is not a call to break up or bring down big-name publishers. They provide services that libraries have come to depend on. But if research is funded by public funding — gathered through taxes or charitable contributions — then the public should have complete and prompt access to its results, good or bad.

Publishers counter with (among many claims):

  • Their work provides added value to the research, and
  • The current one-year embargo is not enough time to recoup the investment made in adding value.

In testimony before Congress, one publisher argued

“The cutting-edge research in psychology published by APA is rarely obsolete within a year and may have a shelf life of five to 10 years or more. Furthermore, only 16 percent of the eventual ‘lifetime’ usage of APA journal articles—in the form of downloads—occurs within the first year after publication.”

The best rebuttal to this argument actually came in the form of a comment on the article in the Chronicle of Higher Education: publishers “neither pay for the intellectual content they publish (authors get no payments including no royalties), nor do they pay for the intellectual effort of the peer-reviewers – all of that professional/academic expertise is given to them for free.”

In addition, is the “added value” anywhere close to the prices publishers charge for access to this information? Now there is an area ripe for research!

One argument for open access is seldom, if at all, being made, and for this author, it is the most compelling: lives may hang in the balance. Some people cannot wait one, five or ten years for the publication of research that will lead to life-saving medical advances. Loosely described, building up collected knowledge of research is like arranging a box of dominoes so they are all standing on end, and next to one another. Arrange them all in the right way, and a single tap will send them all cascading into one another, until all are knocked down.  Researching and determining steps to treatments to take down conditions such as diabetes, various cancers, treatment-resistant diseases, and a myriad of other maladies should occur promptly, and benefit the many, not be delayed for the profit of a few.

Addressing health literacy gaining traction

April 26th, 2012 by Todd Vandenbark

Health literacy logoAs mentioned previously, health literacy is “the ability to get information, understand it, and use information to lower risk and better health.” People “with low health literacy are more likely to report poor health, have an incomplete understanding of their health problems and treatment, and are at greater risk of hospitalization” (Pawlak, 2005). Many organizations, groups and political entities are seeking to address this issue. This weekend, Iowa will host its first health literacy conference, “Health Literacy in Iowa: Partnering to Change Research into Action” (Villanueva-Whitman, 2012).

Looking for resources to improve health literacy and communication at your medical practice? The Health Literacy section of the AMA’s website toolkits, patient safety tip cards, and other resources to assist providers. Also, the Agency for Healthcare and Research Quality (AHRQ) of the U.S. Department of Health and Human Services has resources for addressing health literacy and cultural competency.

What tools have you found helpful in improving patient health literacy? Tell us about it!

 

Reference:

Pawlak, R. (2005). Economic considerations of health literacy. Nurs Econ, 23(4), 173-180, 147.

Villanueva-Whitman, E. (2012). Communication is key to better health care  Retrieved April 26, 2012, from http://www.DesMoinesRegister.com/article/20120410/LIFE/304100053

Doctor’s Toolbag: an evidence based clinical decision support app

April 25th, 2012 by Todd Vandenbark

Doctor's Toolbag app for iPhone and iPod touchAs reviewed recently in iMedicalApps, the BMJ Group has created The Doctor’s Toolbag, an iPhone app designed to assist doctors in following clinical prediction rules for diagnosis and prognosis. contains information on 74 common clinical prediction tools, along with evidence summaries for each tool with links to the relevant literature. It can be customized to provide one-click access to your most-frequently used tools, and has an adjustable font size to make reading easier on the iPhone’s small screen. It costs $6.99, plus an update subscription of $14.99 for one year.

Do you use an app or other software to assist in making clinical decisions? What do you like and dislike about it? Tell us!

Breast cancer online decision tool

April 24th, 2012 by Todd Vandenbark

According to JAMA, a women’s lifetime risk of contracting breast cancer is 1 in 8, and the presence of a particular mutation “in breast cancer susceptibility gene 1 or 2 (BRCA1/2) significantly increases the risk of breast and ovarian cancer.” The Cancer Institute at Stanford has developed an online tool for helping women with this genetic mutation evaluate her risks and benefits for different interventions. It is not intended to replace proper medical care, but instead to “inform discussion between providers and patients about options for reducing cancer risk.”

screenshot of decision tool

When talking about cancer or any other life-threatening medical condition, numbers about risk, results, etc. can begin to blur for any patient. Having a tool like this to provide a clear visualization can help any woman and her doctor think through medical decisions more carefully. The website does note that the calculations this tool is based on ” calculations result from a computer simulation model, not a clinical trial.” Long-term validation studies of this tool are needed to confirm its accuracy.

But a woman facing important decisions about breast cancer risk and prevention needs the best information available now, and this tool appears to be a good way to help visualize the risks and benefits of treatment options and timing, in consultation with a physician. And being online, rather than in print, it is free and immediately available. Kudos to Standford for developing this important resource!

Catching up: a few select article of note

April 23rd, 2012 by Todd Vandenbark

Health literacy logoThis past week a number of articles worth noting have been posted, and rather than devote an entire post to each one, I will offer a summary and encourage readers to visit ones that interest them.

First, the Center for Health Literacy Promotion Blog has a great story about “Esther,” a woman in the 1830′s whom the author calls “ahead of her time.” Too sick a 21 to help on the family farm or marry, she became a servant in a convent. When she became too sick to work there, she was sent home, where she founded a school, taught others to be teachers (who then started other schools), and broke social norms of the time to teach boys and girls together. At age 40, she and her teachers were recognized by the Catholic Church, becoming the Order of the Sisters of Saint Anne. While it may seem far afield to mention religious education in this context, closing words from the post make it a bit more relevant:

Aunt Esther was born two hundred years ahead of her time. Today her vision of literacy as the foundation for health, an escape route from poverty and the key to the advancement of women and society is an idea whose time has come. She inspires my work at the intersection of health and literacy.

The second item worth noting is a wiki created by researchers at the University of Michigan that is a catalog of more than 100 medical devices and technologies that can be used in poorer areas of the world. Example include:

  • Pedal-powered nebulizer for asthma treatments
  • Using a hand-cranked salad spinner as a centrifuge for blood samples
  • Small, wax-filled sleeping bags that could be used to keep premature babies warm

Finally, an article in the Wall Street Journal asks some challenging questions about mobile devices and the future of medicine. In short, with all of the add-ons that are being created for smartphones, how will this transform the practice of medicine? The author offers these examples:

You can get an add-on to a smartphone which does eye refraction and then texts [the prescription] to get your glasses made. If you’re an optometrist, you might be worried about that. Or you can get your skin lesion scanned and get a text back quickly that there’s nothing to worry about. If you’re a dermatologist, that’s a big part of your practice. You will be able to take a DNA sequence on a USB port and pop it into your smartphone and get data out of it. It just goes on and on.

For patients that live a distance from a specialist in one area of medicine or another, online appointments could be used to maintain communication and improve patient outcomes. And many yet-to-be-invented uses of technology will radically alter how medicine is practiced. Yet medicine, as a profession, is slow to change. Will technology change that, or will it leave traditional medicine behind?

What do you think of these different stories and what they have to offer? Tell us!

Critical health literacy: a review and critical analysis

April 16th, 2012 by Todd Vandenbark

Health literacy logoIn a recent article published in the journal Social Science and Medicine, author Deborah Chinn (2011) notes that while there is increasing interest in the topic of health literacy,

“there has also been criticism that this concept has been poorly defined, that it stretches the idea of “literacy” to an indefensible extent and more specifically, that it adds little to the existing concerns and intervention approaches of the better established discipline of health promotion.”

She goes on to select one definition of health literacy (Nutbeam, 2000) and using the concept of “critical health literacy” to determine its usefulness in improving the health of communities and individuals. This article concludes that the concept of critical health literacy connects ideas across multiple domains, yet retains “a key focus on the interaction between individuals and information about health” and how information can be used to improve health outcomes.

While much of the research around the topic of health literacy has be quantitative in measure, qualitative research is also needed to address the “socially situated nature of health literacy, involving interpersonal relationships, emotional involvement, and issues of power and resistance” (Chinn, 2011). Knowing how people utilize their personal networks to assemble an understanding of their health situation has the potential to increase the effectiveness of health literacy outreach efforts.

But we cannot stop there. It is also important to know what individuals and organizations benefit from poor health literacy, and what roadblocks and hurdles – legal, political, and more – are being put or kept in place to maintain the status quo.

What questions do you think researchers should be asking about critical health literacy? Where should academic institutions, libraries, non-profit organizations and others be focusing their resources to address this timely issue? Tell us about it!

References:

Chinn, D. (2011). Critical health literacy: a review and critical analysis. Soc Sci Med, 73(1), 60-67. doi: 10.1016/j.socscimed.2011.04.004

Nutbeam, D. (2000). Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. [Article]. Health Promotion International, 15(3), 259.

Pitfalls and positives of social media in medicine today

April 13th, 2012 by Todd Vandenbark

logos of social mediaA new study in the Journal of the American Medical Association (JAMA) “surveyed the 68 executive directors of all medical and osteopathic boards in the United States and its territories about violations of online professionalism reported to them.” Of those that responded, 92% indicated at least one of a list of online professional violations had been reported to their board. The following graph depicts the number of state medical boards reporting violations, not the number of violations themselves:

bar graph of study results

The number of incidents, when compared to the total number of disciplinary actions taken by medical boards, is small, but can be expected to grow as more physicians embrace and use social media.

In contrast, at Ohio State University (OSU), instructors recognize that today’s learners rely more heavily on technology to gain knowledge for a future career. A pilot study showed how social media (in this case, Twitter and Facebook) can be used to “push” helpful information to students on a daily basis. More than half of the participants had not used Twitter previously, and upwards of 80% found it a useful and helpful addition to their course.

Any tool can and will be used and misused, social media included. What is important is to learn from our mistakes, and remain open to new and novel ways to benefit all.