Google, Yahoo!, Bing, and Ask.com are by and large effective search engines for helping lay users get health and medical information. Nevertheless, the current ranking methods have some pitfalls and there is room for improvement to help users get more accurate and useful information. We suggest that search engine users explore multiple search engines to search different types of health information and medical knowledge for their own needs and get a professional consultation if necessary.

Researchers searched for “breast cancer” using the four top search engines, combined the top 200 non-redundant results from each source into a list, and then gave that list to eight volunteers to evaluate, scoring there relevance to research on a scale of 0-10 (low to high). Volunteers were all highly educated, most of them with backgrounds in science. They were provided with six “gold standard” sites for information on this topic to compare against before making their determination:

1. U.S. National Cancer Institute
2. American Cancer Society
3. Mayo Clinic
4. MedicineNet
5. Wikipedia
6. Susan G. Komen for the Cure

The volunteers tended to score the popular science and personal websites the highest overall, while scoring corporation and advertising websites the lowest. Researchers conclude that search engines do provide good information overall, though their sample is small, both in number of participants and topics searched.

This study has a number of serious flaws in it, and begs the question: is a little bit of mediocre research better than no research at all? First, the high education levels of the volunteer evaluators, plus their choices to score popular science websites above commercial websites indicate high levels of information literacy. Yet other research shows that over 90 million adults in the U.S. (36% of the population) have poor health literacy. How would people like this evaluate and select the right sources using a search engine? As any librarian watching patrons search will tell you, most people never look beyond the first three search results, let alone the first page of results. And search engines like Google employ algorithms to customize search results based on your previous searches, which may or may not give you the best resources.

Next, the researchers note the shortcomings of search engines in “ranking the websites according to their usefulness,” and recommend that “users apply multiple search engines when looking for medical and health information online, instead of using only a single search engine.” As a librarian and past computer consultant, I’ve learned that many people cannot distinguish between “the Internet” and a web browser, let alone utilize and critically evaluate search engines and the search results they generate. Librarians and researchers are the professionals best suited to handle that task.

Finally, while the “gold standard” sites probably contain all the basic information on breast cancer from the view of their medical expert, how readable and understandable is their content across different groups and ability levels? Had the researchers chosen to include a librarian on their team, she or he could have provided important insight and evaluation of these sites in this area. And why was a site like MedicineNet included while MedlinePlus was excluded from the short list? MedlinePlus is advertisement-free, offers information in Spanish and other languages, and is written at a level that can be understood by a wider audience.

While search engines will, generally speaking, help end users find helpful health and medical information, the will inevitably lead some people to inaccurate or misleading information. And with so many people having low information and health literacy skills, it is imperative that they be directed to quality, evidence-based resources for answers to their questions. This study does nothing to assist in that endeavor.

References:

Kutner, M. (2007). Literacy in everyday life: Results from the 2003 National Assessment of Adult Literacy.

Wang, L., Wang, J., Wang, M., Li, Y., Liang, Y., & Xu, D. (2012). Using Internet Search Engines to Obtain Medical Information: A Comparative Study. Journal of medical Internet research, 14(3).

• 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.

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!

This practice can be applied to the clinical setting as well. When prescribing medication or other treatments, physicians can ask their patients to tell them what they’ve just learned. The Amednews blog gives one example of how to make this happen, as offered by one physician:

“The way I do it is to ask, ‘When you get home tonight, your husband or wife will probably want to know what happened. What are you going to tell him or her about what you and I agreed to in the office today?’ ” Dr. Zeitz says.

“If they can’t tell me what it is they need to do in the format of talking to their spouse, that means they’re not in command of the material, and I haven’t gotten them to successfully understand it. If I see they’re not in command, then I take another crack at it.”

This post goes on to cite data that should give physicians pause before assuming that all patients understand instructions received:

• Nearly 90% of U.S. adults are less than proficient in reading medical information.
• 3 of 4 of people with limited literacy do not tell their doctors about it.

Are you a physician or clinician who faces these challenges? If so, how do you help patients understand complex information? Tell us about it!

Reference:

O’Reilly, K. B. (2012). amednews: The ABCs of health literacy. March 19, 2012  Retrieved March 20, 2012.

“Providing users with good information literacy skills is an important function of library services, and most health libraries carry out some level of user education activity” (Stevenson, 2012).

Stevenson goes on to point out that while the learner can usually demonstrate what they’ve learned in class, there is no assurance this knowledge will be applied in daily work activities. Training takes place in a social context, which can have a significant effect on whether or not such training is applied. Stevenson recommends viewing training and library services as part of a larger system: is the environment conducive to implementing newly-acquired skills? What barriers are in place?

Testing the learner at the end of the training is a commonly used method of evaluation. Stevenson points out that such tools probably haven’t been tested for validity or reliability, and suggests using validated tests such as the Fresno test (Tilson, 2010). While not tested to this standard, incorporating evidence-based information literacy instruction into the curriculum is one way to demonstrate whether students at least understand how to find answers based on research.

Our Education Team currently offers embedded information literacy instruction to third year medical students during the obstetrics and gynecology rotation of their clerkship. Each student is given a clinical question that must be answered using evidence provided by medical and other research. For two, 2-hour sessions, students learn about different evidence-based resources, and present what they’ve learned to their peers. The exercises also help them to research the answer to their question. During the third week, librarians and medical faculty meet individually with students to check on their progress, and help them translate their findings into a ten-minute PowerPoint presentation. The following two sessions are spent presenting these findings, and receiving feedback from medical and library faculty, and peers. Presentations are graded and archived, and though we do not use a “validated” testing instrument, it is clear from interactions with students at the end that they have gained some appreciation for the importance of research in evidence-based medicine.

Does your medical library provide information literacy instruction for students? What form(s) does it take, and how do you evaluate learning? Tell us about it!

References:

Stevenson, P. (2012). Evaluating educational interventions for information literacy. Health Information & Libraries Journal, 29(1), 81-86. doi: 10.1111/j.1471-1842.2011.00976.x

Tilson, J. K. (2010). Validation of the modified Fresno test: assessing physical therapists’ evidence based practice knowledge and skills. BMC Med Educ, 10, 38. doi: 10.1186/1472-6920-10-38

The Guardian’s campaign to improve the teaching of computer science and IT kicks off with a live Q&A featuring experts from Microsoft, the Open University, Cardiff Metropolitan University, e-skills UK, and the Computing at School Working Group.

The presentation took place January 10, 2012, on a “live blog” with guest speakers from Google, teachers and experts from higher education, and a “live Q & A” session.

Efforts to teach information literacy with a focus on news are also taking place here in the U.S., as mentioned previously in this column. This kind of outreach can have lasting effects only if the students have access to computers and the Internet not just in the classroom, but at home as well.

Do you know of similar outreach efforts by news and other organizations? Have your kids had this kind of instruction? What benefits have you seen? Tell us what you think!

Watch News Literacy Project Trains Young People to Be Skeptical Media Consumers on PBS. See more from PBS NEWSHOUR.

With health literacy being taught in inner-city schools, and now news literacy as well, perhaps it is time for a school curriculum to be built around information literacy as a whole. What if a librarian were in charge of the curriculum? In an age where the quality of information is critical to everyday life, perhaps it is time for librarians to step forward and take the lead in educating our young people.

What dreams and ideas for helping people learn to be effective consumers of information do you have? Tell us about it!

Fortunately for the newspaper’s readers, the journalist goes on to include a response from Geni Alexander, public information officer for the Columbia/Boone County Department of Public Health and Human Services, who said, “We would be very careful basing” programs “strictly off that study” because it makes the case for technology that TeleVox sells. The article goes on to cite other quality resources that support some of the study’s findings while not endorsing the TeleVox healthcare product line, which includes automated messaging systems, website hosting, and other tools “not just stay in touch but actually engage their patients while saving money in the process” (from the company website).

Health sciences libraries are in the business of helping patrons find evidence-based health and medical information. Here at Eccles Library, we can point you to quality information resources — websites, journals and more — on everything from health statistics, to personal/consumer health, to sites that address rumors and hoaxes on the Web. Got a question? Just ask!

While this quiz appears to be well-researched and informative, is it from an organization committed to providing reliable health information on the Web? Looking at HealthEd’s website, none of the people listed on its “Leadership” page have an M.D. or medical Ph.D. degree (at the time of this writing).

Information literacy includes having the skills to evaluate online information to determine its accuracy, relevance, source, etc. One way to do this is to apply the C.R.A.A.P. Test: try to determine the information’s:

• Currency: timeliness of the information.
• Relevance: importance of the information for your needs.
• Authority: source of the information.
• Accuracy: reliability, truthfulness, and correctness of the informational content.
• Purpose: reason the information exists.

One way to sort through the tsunami of health information is to look for the HONcode logo (at left). The Health on the Net Foundation “was founded to encourage the dissemination of quality health information for patients and professionals and the general public, and to facilitate access to the latest and most relevant medical data through the use of the internet. The HONcode certification is an ethical standard aimed at offering quality health information. It demonstrates the intent of a website to publish transparent information. The transparency of the website will improve the usefulness and objectivity of the information and the publishment of correct data.”

Other sites that can provide reliable health information include MedlinePlus, major academic medical institutions, and other trusted sources.

What reliable online resources for medical information do you use? Tell us about it!

• First, students don’t go to the library and they don’t use library resources.
• Second, they overestimate their ability to do research and evaluate resources.
• Third, if they searched something other than Google, they didn’t know how to search it (using a Google type search), and they often searched databases that would not be recommended for their topic.
• Finally, they don’t go to the librarian for help with research, they go to their professor.

And about faculty:

• First, faculty have low expectations for librarians. Libraries are seen as a purchasing agent.
• Second, faculty assume students have a much higher level of research skills and knowledge than they in reality.

And in the view of most students, if libraries and librarians “register on the radar of students and professors, their perception of us is not good nor is it conducive to helping with research.”

From this author’s perspective, a large part of the responsibility for this situation falls on the shoulders of higher education as a whole. Long ago, when libraries moved books from librarian-access only to open stacks, disintermediation of access to information and learning began. But many areas in traditional higher education still follow an educational model that views learning as requiring the intermediation of a learned person (the professor/instructor) and a textbook or similar sets of materials. And though instructors assign research projects and the like, they assume what they are teaching in class will be a sufficient filter for sifting out relevant, scholarly resources for each assignment. But the deluge of information obtained in a single search is typically more than a pragmatic student can sift through quickly and effectively without some training or coaching. Kind of like trying to stop a tsunami with a bed sheet.

Second, as the comments in the original Inside Higher Ed article hint at, more attention needs to be paid to primary and secondary education by college and university faculty and librarians. If all young students do is learn to take the first Google search result as valid and valuable, trying to change that behavior when a student is becoming an independent young adult is difficult at best, and at worst like trying to launch a 757 with a single rubber band.

School districts around the country are closing their libraries, or drastically curtailing services. And students are being herded into larger and larger class sizes, where learning is less personalized and less effective. Instead of just putting pressure on local school districts to “just do something” about such skills deficits, educators and librarians at the college and university level need to add their voices to those working for sufficient resources and support for education throughout a student’s academic experience.

Are you a college or university educator working to improve primary and secondary education? Tell us your story!

Satish Misra, MD, of the iMedicalApps blog has a two-part series of posts examining this issue, and asking for opinions from readers. The first posting points out:

In the past ten years, there has been a growing movement to restrict marketing of drugs to physicians by pharmaceutical companies. As a result of programs like the PharmFree project, traditional marketing avenues like free samples, sponsored dinners, and so on have become far more limited. And so naturally, pharmaceutical companies have looked to new avenues through which to reach physicians.

Using Epocrates as an example, Misra evenhandedly explains how free medical apps allow pharmaceutical companies to support physicians in their work while doing market research and sales at the same time. In his second article, Misra briefly examines Skyscape and several of its free apps that allow “life science companies…to reach thousands of HCPs in a new venue and format.”

As a library working with students in the healthcare professions (medicine, nursing, pharmacy, etc.), one of our goals is to help them develop information literacy skills: the ability to critically evaluate information provided via the Web and other electronic formats. When presented with information, it is important to apply a certain set of evaluative principles, as represented by the term “the C.R.A.A.P. Test:”

• Currency: timeliness of the information
• Relevance: importance of the information for your needs.
• Authority: source of the information
• Accuracy: reliability, truthfulness and correctness of the content.
• Purpose: the reason this information exists

Such an evaluation system should be applied to “free” medical apps as well.

The Eccles Health Sciences Library has a list of free and fee medical apps for all of the major mobile platforms. Do you have a favorite application? Tell us about it!

Here is a screenshot of her guide:

Eccles Health Sciences Library has begun using this service as well. Campus Guides is the larger, campus-wide version of LibGuides, and our guides cover topics ranging from anatomy to toxicology. Course-specific guides can easily be created as well; check out one created for Suzanne Stensaas’ “Dental Neuroanatomy” class. Faculty and others interested in creating their own course-specific guide are encouraged to contact the Library, or you can post a comment on this blog.

Update 9/14/11: the blog post cited at the beginning of this article is no longer available. You can browse their current guides, find one you like, and then contact them to get a copy.