 So today's webinar is entitled Providing Health Information Services, and we have two speakers. So I'm going to introduce them, and then we'll hand over and share their screen. The first speaker is Kerry Audison, who is the Community Engagement and Health Literacy Librarian at the UNC Chapel Hill Health Sciences Library. In her position, Kerry works to advance the library's community engagement activities and manages and develops health literacy, consumer health and patient education resources and services for health professionals and students. She also provides outreach to the citizens of North Carolina through NC Health Info. Sarah Zhong is the Research and Instruction Librarian for Science at Wake Forest, the Smith Reynolds Library. She is the subject specialist responsible for course-integrated research instruction, research metrics, and consultation, related to research consultation for undergraduates and graduate students and collection management. And she is one of the original section editors of NC Health Info. So thank you both, and we're going to just hand over the presentation real quick. I have been in my new role here at UNC Chapel Hill for about eight months. Previously I worked for the National Network of Libraries of Medicine. So today I'm going to talk about an overview of consumer health and health information-seeking behaviors. And then I'm going to talk about some challenges for patrons and librarians alike, the uniqueness of the medical information reference interview, and then some core competencies for providing consumer health information services at your library, and then a few additional resources. And it's really great that so many of you are interested in this and are attending today, especially from other states and all around the state of North Carolina, and it looks like we have a wide variety of library types as well-represented. So this is very exciting. We'll also take questions throughout, and Linda can let us know if there are questions as we go along. But of course we'll also have time for questions at the end. So we know that today's healthcare environment is really challenging, and it requires people to take a more active role in their medical care than they ever had before. And patients are taking responsibility for learning about how to live healthier, understanding their treatment options, and then actually communicating more effectively with their doctors. And I really think public libraries are vitally important for helping these health consumers find the information they need, not only for receiving better healthcare from their providers, but for enabling better self-care as well. Some of these library patrons may seek information when they're just beginning to contemplate a behavior change, and some are already on the path to wellness but want more in-depth knowledge. And then others may need to know how to live well with an illness, particularly chronic illnesses. Now the Pew Research reports that 80% of internet users, so about 93 million Americans, have searched for health-related information online. And despite the idea that health is a topic that affects literally every community member, most of the materials you can find out there on the web are above a particular reading level, above the national average, so it's often very difficult to get information that's easily understood. So libraries have really been embracing this as an opportunity to offer a unique value to their communities, and to help them gain the skills they need to find, evaluate, and use health-related information. And nearly a quarter of libraries offer classes about accessing online health and wellness information, and lots of libraries have been doing some interesting things in terms of health, and they're extending their reach-up, try their walls, they're forging partnerships with hospitals and parks, and they're also doing different health activities like high-key, or yoga, or even loaning bicycles out to the public. So all of this creates a really great environment for challenging yourself and providing this type of service at your library. And we know that with the greater burden of chronic health conditions like diabetes and high blood pressure, many with these chronic conditions are using the internet to help with that health management. And it's also widely known in studies that health literacy actually is the best indicator of anyone's health status. So I think that librarians can be a big help to people as they try to navigate the health care system. Now, I know I'm also not alone in searching my symptoms online. Lots of people use, as is called, Dr. Google. But it's also important to be able to understand that some of that health information seeking behavior can actually make it still worse and can lead to a condition called ciberchondria so that you can become overly worried and some of the information you find is not quality. So when you're trying to help people find health information, it's important to direct them to reliable sites run by governments or medical societies. And in today's presentation, I'm going to mostly focus on medlineplus.gov. And at the end, I will also give you a few additional resources. And as Linda mentioned, there will be a handout with even more resources for you to use. So this graph is from a study in which participants reported where they sought information first, the most recent time they looked for information about health. And interestingly, searching the internet for health information has been increasing and a greater percentage of participants reported using the internet is the first place they go for health information compared to family, friends, coworkers, even healthcare professionals and traditional media. Now, it wasn't too long ago that this was different in terms of where people reported getting their information first. So it's actually declining in some of the other places. So it's really important that we're aware of the information that we're finding on the internet and that we help people to find reliable and authoritative information. So why is medical information unique? You might want to consider sharing your thoughts in the chat box, but medical information is unique. I think of it as a life and death type of question sometimes, but sometimes public librarians are hesitant to provide this type of information. So I'm going to talk a little bit about how you can provide this information in a way that you're not providing advice, which is very important to remember. So we know also that public libraries are often the first place people consult. In fact, health information is one of the top five or top 10 topics of interest to public library users. And many of you might reflect on how much you get in terms of questions at your library for health. It depends a lot on your community and the people that use your library. Now the Institute of Medicine estimates that 90 million people in the United States have difficulty understanding and using health information. And a lot of this has to do with that gap between the type of health materials and information available and then the average reading level of the public. And only about 36% consider doctors their primary source of health information. And again, this is something that has changed over the years. We used to think of doctors like my grandparents would have never thought of asking their doctor questions. In fact, they would leave the doctor's office not really knowing what they were supposed to do. And they wouldn't have really thought to question or ask questions of their doctors. But now people are really no longer passive recipients of this health care. In fact, in order to be a good health care consumer these days, you really need to be able to ask questions and be an active recipient and communicate with your health care provider. There's also this huge growing demand for consumer health information and participatory medicine, which is the idea of the patient and their families being in participation with their health care providers to make sure that that health care meets the particular needs of that individual. So some of the barriers for the public. Some of it is an unreasonable expectation. Sometimes people want a straightforward answer to a complex medical question, when in reality this kind of information may be difficult or impossible to find. For example, if someone has two simultaneous conditions, chances are finding information that pertains to both of those and within the individual is going to be tough to find. Consumers also might be concerned about confidentiality or being anonymous. I'm from a very small town in Virginia, and I know many of you are in small libraries in small towns. We know that people know a lot about each other, so it's really important to be able to provide privacy and to respect confidentiality within that type of environment. I know a lot of libraries are short on space as well, but whatever you can do to try to provide a private environment, sometimes I used to bring people into my office, you know, if there was a confidential medical information that they'd like to find. People are also worried about their personal health information being transmitted electronically, and sometimes consumers are confused about the role of the librarian, and they might assume that the librarian can advise them on making healthcare decisions. Sometimes it's also interesting because when you're a health sciences librarian and you're helping healthcare providers like doctors and nurses, they know exactly what they are asking for in terms of information, but when the public sometimes comes to you, they might not have the complete information. They might not know the spelling of the condition. For example, some of them are sound-alike or look-alike. One of the examples I used to use in my classes was someone asking about fireballs in the Eucharist, which actually turned out to be hybrids in the Eucharist. So it's really important to do a thorough medical reference interview when you're helping people, and if you're not completely sure, you can refer them back to their healthcare provider to get the exact diagnosis to be able to help. So some barriers for librarians are libraries. Public librarians are fantastic generalists. They know a little about everything and they get questions on this wide variety of topics. And sometimes they lack opportunities for training when it comes to providing health information. A survey of 83 different public librarians in North Carolina found that they rated their knowledge in accessing health information as merely a 3.4 on a 5-point scale. And in a more recent study, the librarian cited the lack of knowledge about available medical and health information sources, and that's one of their top challenges when it comes to answering consumer health questions. So the core competencies, this is from a toolkit called Finding Health and Wellness at the Library, a consumer health toolkit for library staff. It was recently updated in March of this year, and you can look at that for all types of good information when it comes to providing consumer health information. But basically the set of core competencies begins with knowing your community. So there are various resources that can be consulted to find out about the top health conditions in your community. Sometimes it's a matter of calling your local hospitals and finding out the top diagnoses for that community. But there's lots of resources to find out like the average age and et cetera of people in your area. Knowing the health consumer, this is knowing that there are different levels of healthcare consumers, students, health practitioners, and you need to be able to respond to the different issues by all of those different health information seekers. Knowing the resources and subject matter takes a little bit of time, but it can be, you know, the more you consult these resources in your toolbox, the more that you discover where to go for a particular question. And I tell people never to be afraid to tell people that you need a little time to gather that information for them. Also knowing how to evaluate health information and to teach others how to evaluate the health information they find on the internet, there's a nice set of criteria to look at in terms of bias, currentness, and whereas one criteria might not make that much of a difference combined, they can really give you a good idea of the quality of the information on a website. There's also the idea of communicating, providing reference and instruction on all of these for your patrons at the library and knowing about the ethical and legal issues surrounding the medical information. The patrons need to know the right to privacy when to be able to apply disclaimers. There's lots of good disclaimers available so that you can provide both written and verbally that you are not a health professional and that they should seek out further information from their health professionals even after they're given the information from you. So the medical information reference interview, some of the things that you need to know is who the information is for. So for example, age level, whether the information is for a child or a senior adult makes a difference in where you would seek that information. You might need to know the exact diagnosis. And again, if they don't know that, you would ask them to either call their doctor or nurse and come back when they know that. You definitely don't want to give the wrong information. As I say, some conditions or diseases have very similar sounding names so you would never want to guess. You would also want to know where that person had looked already or when they're having the test or procedure done. Also how much information they want. Some people, particularly I've noticed librarians, myself included, we want to know everything. We want all of it at once and then we can digest it as needed whereas other people, too much information increases their stress level. So this is something you'd want to ask in your reference interview, you know, what courses they've already consulted or if this is their first time seeking information for the topic. Particularly if someone has just gone and been, you know, recently diagnosed, they might be overwhelmed, they might be emotional at the time. So it's really important to ask those clarifying questions to figure out just how much information is needed in that particular situation. It's also important to show compassion. The use of body language is important and your facial expression. I used to work with someone that would sigh very, very loudly once you had asked to come out to do a reference question and it was completely clear to the person asking the question that she was not pleased to be there. So it's really important to show that just as it is with any reference question at the library to show that you're neutral, that you're not judging the person. And again, you should offer a range of options, suggest the person that you can email them or call them or they can come back in and set up an appointment with you to be able to go over that information completely. And again, never be afraid to refer that person with any vague or incomplete question back to their healthcare provider. So some of the strategies that you can do in terms of health information is to collaborate and to partner. Public libraries have been the focus of the National Network of Libraries of Medicine, which is the outreach arm of the National Library of Medicine. And there's lots of good information on that side about how to partner with those others in your community to provide health information services. Sarah will also talk about this a little later as well. And at the end, we will. But UNC Chapel Hill, the Health Sciences Library, has an ask us feature that is also on NCHealthInfo.org that Sarah will be talking about. And I welcome any questions, even if you run into a sticky health question, you can always ask us for assistance or for health. There's also the Consumer and Patient Health Information section of the Medical Library Association. And this is specifically librarians that are interested in providing consumer health information. There's also the idea of getting a focus group together in your community and ask what type of services or classes that people are interested in. And you can kind of get an idea of the type of those questions that are of interest by keeping track of requests in terms of health information. And there's also the idea of providing online reference as well. So, selected resources, MedlinePlus.gov, even if I hadn't worked for the organization previously, MedlinePlus.gov is the go-to first place to consult. I would recommend in terms of consumer health. It's only links to reputable health organizations and information. No advertisements are allowed. And all of it is reviewed by health professionals and librarians. There's also hundreds of reputable health organizations that you can refer people to to get more information on their condition, like the American Diabetes Association. And then all of us in the state of North Carolina have access to NCLive, which has a nice set of databases in terms of consumer health, and we should take advantage of that. And then I talk about a small print collection occasionally that could be in public libraries, but we all know that medical books are really expensive. Some people talk about buying the physician's desk reference every year, which years ago was quite expensive, so I'm sure it's even more now. But instead, I recommend buying a Mosby's nursing drug handbook, for example, that could be purchased every year and is usually under $40. Also, I would discourage you from purchasing things that are meant to be, you know, exaggerated, like all those diseases. They don't want you to know about that type of thing, because again, that stuff becomes very dated. So instead, I would suggest some practical disease self-management books or diets for particular conditions. But I was able to provide reference in a hospital library with zero budget just using recommended websites online, including MedlinePlus.gov and NCHealthInfo.org. So briefly here is if you have not visited the MedlinePlus site, or if you have, but haven't recently, you can notice a lot of that on the homepage. There are over a thousand different health topics here, information on drugs and supplements. There are also tutorials, videos, health check tools. There is now a lab test information, a medical encyclopedia. There's a way to stay connected, so you can sign up for email updates there. There's links to clinical trials and more on this website. And then lower on the page, I wanted to point out across, almost across the bottom, there is a link to easy-to-read materials, which is great for anyone, because even if you have a high degree of health literacy, when you want health information, you want it in a straightforward, easy-to-read manner. There's also a link to organizations and directories near the bottom. There's also over 40 different languages on the site. Everything is available in Spanish, but there is additional, some information available, enough to 40 different languages. And it's a great starting place, as I said, for any health information search. Here is what the easy-to-read material pages look like, starting with A. So you can see that all of the links, some of them are videos, but all of them link to reputable institutions and organizations. And here's what the organizations page looks like. And again, you can go alphabetically, but also notice that you can look up organizations by topic as well. Here's what the directories page looks like. So you can find a library. You can find doctors and dentists. I will say a caveat there. You might be surprised that there isn't a lot of information out there on doctors. You can find out where they went to school, where they did a fellowship, how long they've been in practice, et cetera. But some states are better than others in providing any information regarding, for example, lawsuits or malpractice. North Carolina happens to be one that provides a great deal of information, so that is one place to look. You can also find facilities, clinics, and an unbelievable list of other types of information to look up. So you can check that out. Here's an example of a health topic page. If you were helping somebody and they were recently diagnosed with asthma, you can notice on the right-hand side about midway down. Any time that person would like to be notified of new information on that topic, they can just enter their email in, and they will automatically be updated. Each health topic page has a nice summary of what the condition is, and then a really great feature which says Start Here. So this is excellent for people who are recently diagnosed. But you can see that it gives a nice overview here of the topic. Also notice under Research, there's a link to journal articles, and I will talk more about that in just a moment. Further down on the same page of asthma, you can see that there are different sections, statistics and research, any clinical trials going on in asthma, and journal articles. Now this is a great way. If you've ever gone on to PubMed, which is the health professional database for the medical literature, it's not an easy database to search. And it takes years of practice for health sciences librarians to be fantastic searchers in it. But you might have a patron that's highly sophisticated in terms of health information, and they've already looked at everything in the consumer health side, and they want to see what the health professionals are reading. Well if you click on journal articles, and then the one at the end that says asthma see more articles, that actually, that link will take you all the way to PubMed, perform the search for you so you don't have to know how, and you can see the most recent articles in the professional literature on that topic, which I think is a great feature. Notice that you can also find an expert in terms of asthma, and this is all on that health topic page. So here's what that search would look like, and you can see on the right-hand side are the search details. So I didn't need to know how to find the medical subject heading. I didn't need to know how to reduce it to just English articles, just adults, review articles, or clinical guidelines. It was all done for me, and you can see there are 68 articles there on asthma, and these are the most recent in terms of professional literature. And finally, as I mentioned, this will be on your handout as well, but some other resources of interest when you're providing health information. One is lab tests online. This is a great way to find out what a normal value range when you have a lab test and what the test is searching for, et cetera. Genetics home reference is the only resource I know that attempts to put genetic information at an eighth grade reading level or below. It's really important when you're helping someone and you realize that the topic they're looking for is genetically related. That's another great place to help you locate more information about that conclusion. Another great site that I like is FamilyDoctor.org. There's also the full text of the Merck Home Manual online, as well as clinicalpriles.gov. So people thinking of participating in a clinical trial can go on there and get more information about that. Or if they have a condition that they've tried everything else and they want to maybe participate in some of the trials to find new medications, they can get the information there. And then finally, of course, are the sites when we put in a search in Google for any kind of supplement or alternative medicine, a lot of what you get back is just junk. It's people trying to sell you a product. So the National Center for Complimentary and Integrative Health is a great site to look at those types of alternative medications, you know, like melatonin or garlic pills, that kind of thing. So I know that was a lot of information in a short time, so I'm going to pause and see if we have any questions. And then I'm going to turn it over to Sarah. Okay, hello. My name is Sarah. John, can everyone hear me okay? I am going to talk about NC Health Info. Actually, before I became a librarian at Lake Forest University, I've been here 15 years now. It's hard to believe. I was actually working at Cone Hospital Library during graduate school, and I was trained in medical reference, and I have a heart for public health. My first job out of college was at the task force for child survival and development in Atlanta, Georgia, and I worked in global health and helped on projects for sub-clarin Africa and Latin America. So when the opportunity came up to become a volunteer editor, I just jumped on it. Although I've dealt my career in being a science librarian, I have taught library instruction every year for epidemiology students and nutrition students and even biomechanics students and in the health and exercise science department at Lake Forest University. But to talk about some state level of resources, NC Health Info was first launched in 2003 as part of the GO Local Initiative of the National Island of Madison. It was discontinued in 2010, and so the foresight of a group of librarians from academic health sciences and public libraries really paid off because they formed a planning group in 2005 to develop ways for libraries to work together to ensure improved access to health information for North Carolinians. So my former protege, who was a graduate student and did a practicum with me, she was on this planning committee after she graduated and since graduation she became a librarian at the Duke Medical Library. So she asked me to volunteer to be an editor when it was launched in 2006, and I agreed. Actually the State Library of North Carolina should be credited for NC Health Info because using the Library Services and Technology Act grant funding, they supported this effort as well as the development of a portal of health information pages to be added to NC Health Info. So the portal is easy to use with reliable health information pages and current health news on topics important to North Carolinians. But I think that this could be a model for other states and that we have other audience members from other states and you can find reliable health information here too. So today NC Health Info is the fully supported service of the Health Sciences Library at the University of North Carolina at Chapel Hill. It provides links to information about researching illness, choosing a doctor, evaluating health information, medications, even about healthcare policy and health insurance questions, even about the privacy of medical records and electronic medical records. And you can also find information on healthcare professionals through the North Carolina Licensing Board's website and also patient and family issues such as treatment and procedures as well as information on more than 50 health concerns and issues. The providers and services section is really useful to understand the various kinds of medical providers that are available to manage many health conditions and provide links to directories to help locate them. And health topics are covered. This is a list of the health topics covered best curated by volunteer editors throughout the state of North Carolina. And they cover a variety of key and chronic diseases as well as environmental health such as tick-related diseases, with those who hike a lot such as me this time of year, never had that, knock on wood. But not only for patients but also for this site is really useful for caregivers and cancer survivors too for support groups. This is an example of the breast cancer health topic that I am responsible for editing. This is the website that I took on when it was first launched. I have a personal story. My sister-in-law is a 10-year breast cancer survivor. And I have had a long-standing interest out of her. She was just an inspiration to me with her story of how she survived a Stage 3 breast cancer diagnosis treatment. So when I was asked to be a volunteer editor, I just jumped at the chance because I wanted to help others in North Carolina to empower patients and survivors with North Carolina resources for support groups and forums. Another feature on the lower right are mobile apps and tools, and they're featured on every health topic page. The uniqueness of NC Health Info is not only about researching illness but it also covers wellness tips from exercise to falls prevention, from motor vehicle safety to healthy eating. I've explored, I've been a long-time editor. I took a little break but I'm back. And the USDA has a great, if you go to the healthy eating page, they have a great mobile app called Ask Karen for food safety information. If you're a novice chef like me, then it could be useful. And this is another example of a wellness page that I, a wellness topic that I edit on managing stress. I also included resources on coping with workplace stress, which we can all relate to. But I do welcome your suggestions. Feel free to email me. Our email addresses will be at the end of this presentation to add to the stress management page. And there's also a mobile apps and tools too, such as briefs to relax and meditation apps and mindfulness apps. Medications and therapies is another great resource, including complementary and alternative therapies, herbs and supplements, and lab tests information. Another unique feature of NC Health Info are the health and wellness tips from various demographic groups. They cover seniors' health, information on Medicare when you're eligible, women's health and topics such as osteoporosis, and even veterans' health if you're looking for health insurance, and more. And wellness pages are also inclusive of diverse populations, such as gay, lesbian, bisexual, and transgendered populations, and children's and teen health issues, and also covers health disparities in North Carolina, America. The how-to guides could be very helpful, not only for finding reliable health and drug information, but also for how to find and understand clinical trial phases. There's a great link to a short video on the different phases of clinical trials and to understand what drugs are being developed and if you'd like to participate in a clinical trial. And also more information on safeguarding mobile privacy if you use mobile apps. And also this page is great. It's a curated list of mental health resources, as well as disability rights in North Carolina, which is an important topic for empowering those who need to go on short-term or long-term disabilities. And this slide is in Spanish. Nancy Health Info is available in English and Spanish, and the pages are compiled and reviewed bi-annually twice a year by volunteer librarians. This is, I just want to acknowledge the many librarians across North Carolina who volunteer their time and expertise to select the best information sources for you. And I'd like to acknowledge just this long list, as you can see. Even my colleague at Wake Forest Medical Library, Carpenter Library, is one of the editors. And other editors are from the East Carolina University Health Sciences Library and even the Levine Cancer Institute. And of course UNC Chapel Hill Health Sciences Library, many librarians are editors. So NC Health Info also links users with answers to their health questions through the Health Sciences Library at Chapel Hill through the Ask a Librarian service. Now, Cari will conclude by telling you about the NC Health Info Ask a Librarian service. Thank you so much, Sarah. You might have noticed on every slide that Sarah had that there's a yellow Ask Us button on just about every page on NC Health Info. And we really mean it. You know, librarians, we like to answer questions. So if a consumer health question comes into us, they're usually referred to me, but I can also get the help of experienced systematic reviewers here. Librarians that have a great deal of experience in the health professional literature as well. So if I don't know the answer, I can find somebody who does know the answer, hopefully. But also, this is for you as librarians, please, you know, send your questions. Like I said, if you run into a difficult reference question or you can even point your library patrons to this service. Oh, did you have additional things to say, Sarah? I just wanted to acknowledge the leadership team, Diana and Linda Johnson. Diana and with Duffy and Linda Johnson. Yeah. And also, Cari, I just wanted to acknowledge the other partners to Duke, Park and the Library, Forest, and EC. We are grateful for all of the volunteer editors that we couldn't do this site without you. I'm going to end them. And then I will put up Sarah and I's email, and we'll take any questions in my tab. One question that came in was, can people outside interview North Carolina use the chat function? Yes. We have not restricted it. I will answer anything, you know, any questions for anyone. I noticed that when I started the job here, we even respond to those nice telemarketers that want us to, you know, buy their services to optimize our website. We even respond to them. So, yes, that's open to anyone. Lisa had a question. Is there a good print resource for understanding lab tests if you have a condition? That's a great question. When I was a baby librarian, it used to be so frustrating to try to find that information because you can imagine lab tests are for a wide variety of conditions. So, I would have to try to look that up in the appropriate, you know, body of knowledge within that particular field of medicine. So, no. Not that I, I mean, it would be prohibitively expensive to try to get a resource that would cover all of them. And I think as soon as you purchase that print, it would be out of date. So, my best recommendation is to use labtestonline.org or to try the lab test information that is now on Medline Plus. Great. Any other questions? I'm sorry. And if any question occurs to any of you later on, please do get in touch with either Sarah and I, and we really appreciate you all coming today in your interest. I also would be available if you wanted to consult with me on providing some type of instruction for a group of public librarians or really anybody that's interested in providing consumer health information services. Yes, and for those of you who work in academic libraries, as I do, I'm available to provide consultation for library instruction for pre-med students, pre-allied health students. Great. Well, thank you very much. I'm sure if you have any questions, feel free to contact Sarah and Jerry. Thank you very much, and I hope everyone has a wonderful rest of their week. And thank you again, Sarah and Sarah. Thank you. Thank you.