DOI: 10.1111/hir.12065

Dissertations into practice

Abstract This article is only the second in the Dissertations into Practice series to highlight the role of public libraries in health information. It is the result of an investigation into the provision of health information in East Sussex Library and Information Service, which formed the basis of Anneliese Ingham’s dissertation for her MA in Information Studies at the University of Brighton. At the time Anneliese was doing her research, the service was experimenting with different ways of providing healthcare information at one of its main libraries, and they were interested in the impact of this. The provision of health information to the public is one of my own research interests, and I was Anneliese’s dissertation supervisor. I thought she produced a very good piece of work, and the results she highlights in this article are applicable to all public library authorities. Anneliese graduated with an MA in 2012 and worked for East Sussex Library and Information Service, which she joined whilst she was still studying. AM

Anneliese Ingham Assistant Information Adviser University of Brighton, Queenwood Library, Eastbourne, UK [email protected]

dissolution of Primary Care Trusts, public health information is now the responsibility of local councils1–4 and public health policy has become focussed on personal empowerment and 5–8 responsibility. At the same time, the volume of health information (of variable quality) available to the public has increased dramatically – a great deal of it from the Internet.9,10 Libraries, as the public face of their parent local authority, have used this opportunity to work more closely with public health teams since the change. They have been able to promote their role in providing supported access to good quality health information and health-related services, including Books on Prescription schemes and specialist reading groups. Furthermore, the first unified national launch of the Books on Prescription scheme in 2013 and the growing interest in bibliotherapy have prompted many library services to evaluate their provision of health information.11,12 East Sussex Library and Information service is no exception. This study was undertaken at the request of two senior members of staff in East Sussex, the Equal Access Manager and the Head of Information and Local Studies who wanted to improve the service and the resources available. This study investigated how service users felt about the provision of health books and information provided by the Library Service, and the types of resources customers thought were most reliable and felt comfortable using. The library service has 24 libraries spread across the county: this number includes large central libraries and smaller branch libraries. It also serves more rural communities with two mobile libraries and two village libraries and provides a library service at Lewes Prison. This investigation was conducted at all the county’s libraries except Lewes prison.

Dissertation context

Literature review

Heath information is an increasingly important part of the public library offer to users. Following the

The literature review had four dominant threads: public health information policy and health

Keywords: health information needs; Internet, libraries, public, public health

Can your public library improve your health and well-being? An investigation of East Sussex Library and Information Service

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© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Group Health Information & Libraries Journal, 31, pp. 156–160

Dissertations into practice

information literacy2–4,6,8; previous research into public library provision of health information including the Bibliotherapy and Books on Prescription schemes; the impact of health information on health and the role of the information professional in this scenario.9,10,13–21 The recurrent themes established by the literature review were that public libraries have difficulty in gathering evidence that health information actually improves health and well-being18 and that studies on schemes such as Books on Prescription have found it hard to prove their effectiveness, mainly because the schemes have been run so differently across the country, making comparisons difficult.22–24 A further theme was the continuing trend for health promotion messages to focus on self care and personal empowerment.5–7,25 Dissertation methods A mixed methods approach was adopted, using including surveys and follow-up interviews, with surveys being the key tool. Both methods were employed to gain an understanding of customer perception of improvement to health and well-being rather than any objectively definitive improvement to health. They were also used to discover who was using the resources; what resources were being used and which resources were regarded as most trustworthy. Survey The survey took place over 6 weeks from the start of October to 12 November 2011. Paper and online surveys were available or advertised in all the county’s libraries. The online survey was available on the County Council website and promoted via social media. Surveys have the benefit of gathering a wide range of user opinions efficiently, and the anonymity of the survey format allowed customers to share their thoughts on a sensitive subject like health more easily. 26 SNAP software was used for collation and analysis, allowing a bigger sample to be processed than one researcher would normally be able to manage. Question design As questionnaires were selected as the main way of gathering data from customers and interviews

were conducted to supplement this, the questions had to be designed carefully in order to gather the most useful data. Ordinarily questions used in surveys should be tailored to suit the target group, but the purpose of this research was to draw responses from the widest range of library users possible. By their very nature, public library users are a very diverse group. Therefore, the survey was deliberately short and used straightforward language to allow users of varying levels of literacy to participate whilst having boxes for further comment for respondents who wanted to elaborate their points. Interviews Interviews were conducted by telephone with those participants who indicated in their surveys that they were happy to participate further, and the interviews were used to complement the survey results and allow for triangulation. Action research The study also contained elements of action research owing to the circumstances under which the study was conducted. As the researcher is an employee of the library service, they were asked to make stock suggestions for health information books, participate in a stock buying trip and rearrange and change the signage in the health section in one library, all whilst the survey was running. However, the survey was conducted in all the County’s libraries, and the researcher was only asked to make these changes in one library, minimising the impact on the data whilst being able to react to the survey results and try out new ideas. Results and discussion The majority (77%) of survey respondents were female and most were looking for information for themselves, although a significant number were looking for information for someone else. The majority of respondents visited the library to look for health information because they were already aware that the library offered health information. A small number of those surveyed identified

© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Group Health Information & Libraries Journal, 31, pp. 156–160

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Finding the information

themselves as either awaiting or undergoing treatment for the health issue they were researching, although most were not. The responses showed a fairly low use of the online health resources available directly from the library service pages. Customers were less confident about looking for online health information and judging its quality than searching for health information in books. Customers who said that they used the Internet to search for health information tended to stick to well known websites and recognised ‘brands’ of health information. NHS Choices27 was overwhelmingly the most popular website. Eighty four percent of respondents either agreed or strongly agreed that the quality of information that they found in the library was good. A number of customer comments highlighted the fact that some books were out of date and that medical books that are more than 3 years old are of little use. The results also highlighted the fact that books about some common ailments were not available. However, during the course of the study, East Sussex libraries did allocate money to refreshing the health information stock and new books started to arrive whilst the study was taking place. Customers indicated they were uneasy about being too critical of their library service because of the current public sector cuts, in case this had a negative impact on the service.

Customers participating in this study placed a high degree of trust in the books they found in their library. Customer comments such as ‘Quality information available in library selected by qualified staff’ exemplify the faith that East Sussex library users had in the information they found. Books on lifestyle subjects such as nutrition and exercise were popular, whilst books on terminal – as opposed to chronic – conditions were less frequently consulted overall. Books about pain management and mental health issues were some of the most popular titles. Some library customers in the study did not use the Internet for health information because they did not want to use a computer at all. However, some customers who were happy to use the Internet for other things did not like using it to look for health information.

Who is using the resources?

Did the resources improve their wellbeing?

Most of those who responded to the survey were very familiar and comfortable with the library environment, even if they were not all regular library users. A number had come at the suggestion of a friend or relative. A few were there at the suggestion of a health professional, showing that some health professionals are aware of what the library service offers and are suggesting it to patients. None of the respondents identified themselves as having had a book prescription. Twenty-five percent of respondents who were looking for health information identified themselves as having a disability of some kind. Most customers looking for health information were over 35 but the peak age of those surveyed was 55–59.

Seventy-three percent of people who completed the survey thought that using the resources improved their health and well-being to some degree.

In total, 94% of the library users surveyed found some or all of the health information they were looking for. The feedback on the layout and organisation of the health information was almost entirely positive, and respondents were generally able to browse in comfort and find what they wanted. What type of information are customers using and are they happy with the quality of it?

Implications for practice From the perspective of the Senior Managers in East Sussex Library and Information Service, the research has been very helpful, both in terms of advocating resource provision with health partners and for planning the development of health provision within the libraries. The research found, for example, that many people visited the library to research a condition before visiting a health practitioner. An NHS programme of behaviour

© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Group Health Information & Libraries Journal, 31, pp. 156–160

Dissertations into practice

change training called Making Every Contact Count28 is being rolled out to health practitioners nationally and within that there is an information gathering phase. When talking to health partners, the Equal Access Manager has been able to highlight how the library service now has evidence to prove that people use public library resources at this stage. She is then able to suggest that practitioners promote the public library as a place to do this type of research when they are working with their clients or other members of the public. The Equal Access Manager commented: ‘In terms of planning the health resource provision in the libraries, as a result of the research the library service are planning to roll out more health and well-being areas in libraries, particularly in our new libraries, bringing all the related resources together to make them easier for customers to access.’29 Furthermore, the fact that some customers said that the resources improved their well-being has also been a helpful point to raise in meetings with health professionals. ‘The value of having done local research in this area cannot be underestimated as it shows us as actively engaged in evaluating our service delivery and providing a local evidence base.’29 On a general note, library staff have noticed slightly more book prescriptions being used, as the scheme has been more heavily promoted since the study. One aspect of the promotion has been for library staff to target health workers other than doctors, and the uptake by nurses, mental health workers and health visitors has been good. Conclusion The shift of responsibility for public health information from the health service to local authorities provides an opportunity for public library services to reinforce and expand their role as reliable information providers. They are perceived as offering a comfortable and informal setting for the public to access health information.

Libraries can build on the fact that many people visit libraries for health information before or instead of engaging with health professionals. References 1 Cilip. 2011. Healthy Lives, Healthy People Consultation. Response of the Chartered Institute of Library and Information Professionals [Online]. Accessible at: http:// www.cilip.org.uk/get-involved/policy/responses/Documents/ Healthy%20Lives-Response-0311.pdf (Accessed 9 May 2012) 2 Department of Health. The New Public Health System: Summary. London: Department of Health, 2011. 3 Health Protection Agency. 2012. Minutes of the Meeting of the HPA Board. Enclosure HPA 12/32. 28 March 2012. London. [Online]. Accessible at: http://www.hpa.org.uk/ webc/HPAwebFile/HP Aweb_C/1317133325615 (Accessed 15 April 2012) 4 H.M. Government. Healthy Lives, Healthy People: Our strategy for public health in England. London: HMSO, 2010. 5 Harris, R., Wyatt, S. & Wathen, C. N. Configuring Health Consumers: Health Work and the Imperative of Personal Responsibility. Basingstoke: Palgrave Macmillan, 2010 6 The Lancet. Public health in England: from nudge to nagThe Lancet [online], 2012, 379 (9812), 194. Accessible at: http://www.thelancet.com/journals/lancet/article/ PIIS0140-6736%2812%2960082-8/fulltext (Accessed 11 May 2012) 7 Lemire, M., Sicotte, C. & Pare, G. Internet use and the logics of personal empowerment in health. Health Policy, 2008, 88, 130–140. 8 Walters, S. 2006. Public Libraries Demonstrating Impact: the Gateshead Experience [Online] Accessible at: http:// www.bibliotheksverband.de/fileadmin/user_upload/ Kommissionen/Kom_Management/Fortbildung/ 2006-11-30_RoundTable_Walters.pdf (Accessed 10 June 2011). 9 Gillaspy, M. Factors affecting the provision of consumer health information in public libraries: the last five years. Library Trends, 2005, 53, 481–495. 10 Brewster, L. & Sen, B. ‘Quality signposting’: the role of online information prescription in providing patient information. Health Information and Libraries Journal, 2010, 28, 59–67. 11 Nother, M. Read yourself well. Public Library Journal, 2011, Spring, 26, 20–21. 12 The Reading Agency, 2013. Reading Well Books on Prescription Launches [Online] Accessible at: http:// readingagency.org.uk/news/media/ reading-well-books-on-prescription-launches.html (Accessed 15 February 2014) 13 Anton, S. Briefing 8: Promoting Health Literacy in Libraries. London: Museums, Libraries and Archives Council, 2009.

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Dissertations into practice 14 Borman, C. B. & McKenzie, P. J. Trying to help without getting in their faces: public library staff descriptions of providing consumer health information. Reference & User Services Quarterly, 2005, 45, 33–146. 15 Brewster, L. Books on prescription: bibliotherapy in the United Kingdom. Journal of Hospital Librarianship, 2009, 9, 399–407. 16 Dervin, B. Libraries reaching out with health information to vulnerable populations: guidance from research on information seeking and use. Journal of the Medical Library Association, 2005, 93(4) Supplement, S74–S80. 17 Frude, N. Book Prescriptions: a strategy for delivering psychological treatment in the primary care setting. Mental Health Review Journal, 2005, 10, 30–33. 18 Burdett, S., Harris, R., Henwood, F. & Marshall, A. M. “I’m Not Sure If That’s What Their Job Is”: consumer health information and emerging “healthwork” roles in the public library. Reference & User Services Quarterly, 2010, 49, 239–252. 19 Hicks, D., Creaser, C., Greenwood, H., Spezi, V., White, S. & Frude, N. Public Library Activity in the Areas of Health and Well-Being. London: Museums, Libraries and Archives Council, 2010. 20 Naylor, C. & Bell, A. Mental Health and the Productivity Challenge: Improving Quality and Value for Money. London: The King’s Fund, 2010. 21 Vallgarda, S. Nudge: a new and better way to improve health? Health Policy, 2012, 104, 200–203. 22 Shiner, A. ‘Books on prescription’: an example of collaborative working in North Derbyshire. Health Libraries Group Newsletter, 2007, 24, 14–19. 23 Chamberlain, D., Heaps, D. & Robert, I. Bibliotherapy and information prescriptions: a summary of the published evidence-base and recommendations from past and on-going Books on Prescription projects. Journal of Psychiatric and Mental Health Nursing, 2008, 15, 24–36.

24 Hicks, D. An Audit of Bibliotherapy/Books on Prescription Activity in England. London: Museums Libraries and Archives Council, 2006. 25 Kent, P. Information’s role in reducing healthcare costs. Managing Information, 2011, 18, 20–22. 26 SNAP. SNAP Surveys, 2010–14. Accessible at: http://www. snapsurveys.com (Accessed 20 February 2014) 27 National Health Service. NHS Choices, nd. Accessible at: http://www.nhs.uk (Accessed 20 February 2014) 28 National Health Service Yorkshire & Humber. Making Every Contact Count, 2012. Accessible at: http://www. makingeverycontactcount.co.uk (Accessed 20 February 2014) 29 Luthmann, A. ([email protected]) Dissertations into Practice. Email to: Ingham, A (Anneliese. [email protected]) 6 February 2014.

For details on how to contribute to this feature please contact: Audrey Marshall Senior Lecturer School of Computing, Engineering and Mathematics University of Brighton Watts Building Lewes Road Brighton BN2 4GJ UK Tel: +44 (0)1273 642420 Email: [email protected]

© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Group Health Information & Libraries Journal, 31, pp. 156–160

Can your public library improve your health and well-being? An investigation of East Sussex Library and Information Service.

This article is only the second in the Dissertations into Practice series to highlight the role of public libraries in health information. It is the r...
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