Health Start! is an integrated program that unites in partnership the Touro-Harlem Medical Library, the Touro College of Pharmacy (a program served by the library), Project Aspire (a not-for-profit public health initiative of the Children’s Health Education Foundation at Touro College), and P.S. 197 in New York City.  It seeks to improve pharmaceutical health literacy and general health literacy in pre and early readers (generally children between the ages of 4 and 7) by developing a sustainable and reproducible program to educate children in the target group and their parents.

The planning phases of the project involved creating medication safety/health literacy curricula and lessons plans; developing teaching and learning tools that supported the curricula, including an animated video; providing training for the teachers at P.S. 197, who would use these tools in the classroom; and conducting a pre-assessment of K-2 students from P.S. 197 to gauge their knowledge of pharmaceutical safety and health information literacy.

The lessons were delivered to students at P.S. 197 in March 2010, followed by a post-assessment instrument.  As part of the continuing education aspect of this project, and to stay in touch with the Harlem community, the “PharmInfo” HealthStart! e-mail information line was established and is in use.  A reminder gateway for parents and the community was developed in the form of a refrigerator magnet whiteboard that includes emergency numbers for Poison Control,   and the URLs for MedLine Plus and other trustworthy sites.

A HealthStart! outreach event was planned for parents and the community, but has been rescheduled for a future date due to poor publicity and low attendance for the initial event.  The feedback received thus far has been very positive, as evidenced by teachers’ comments and by the students’ ability to recite from memory the lyrics from the video soundtrack.  The creation of educational materials and media resulted in successful products that can be used in similar settings.

Shelly Warwick
Touro-Harlem Medical Library

During this award period, the MAR Leadership Institute (MAR-LI) planning committee offered four in-person leadership institutes: Developing Leaders Among Us (16 attendees), Writing for Leaders (15 attendees), Advocacy for Leaders (68 attendees), and Present with Confidence: Tips & Tricks for Spontaneous and High Impact Speeches (35 attendees), one more institute than originally planned. MAR-LI also maintained a webpage during the award period. Unfortunately, the planning committee was not able to implement the learning community as originally planned. In order to facilitate the planning and presentation of the fourth institute, and due to conflicts that arose for two members of the planning committee, the planning committee was expanded to include three additional members from NN/LM MAR member libraries.

Participants in MAR-LI institutes represented a variety of geographic areas: Delaware, Maryland, Minnesota, New Jersey, New York, Pennsylvania, Tennessee, Virginia and Toronto, Canada. Participants also represented a variety of health affiliations: academic health sciences libraries, hospital libraries, public health libraries, public libraries, doctoral granting university libraries, and library services organizations. Six attendees represented minority populations. Positive evaluations suggest the institutes were successful. The programmatic activities enhanced skills necessary to improve participants’ leadership effectiveness. Participants learned techniques to improve effectiveness as supervisors and as direct reports; the impact of writing; their ability to advocate successfully on behalf of themselves, their staff, and their library; and the effectiveness of a spontaneous/planned “5 minute elevator speech.” Participants also had opportunities to network with each other, learn about events in the MAR service area, and even to volunteer to join the MAR-LI planning committee. The MAR-LI planning committee continues to pursue additional topics and funding for future leadership events.

Cristina Pope, Director
UPSTATE University Health System, Health Sciences Library

This project, funded via an NN/LM MAR Outreach to Unaffiliated Health Professionals Award, focused on building a collaborative relationship between the Columbia University Medical Center Health Sciences Library (CUMC) and the Institute for Family Health (IFH), a federally qualified health clinic in New York City.  The physicians, nurses, and other health professionals at IFH lack direct access to high-quality electronic health sciences information, especially in the current periodical literature, as well as training on utilizing these resources and finding quality health information online.  An NN/LM MAR resource library, CUMC licenses a rich collection of electronic resources and has a full complement of health sciences librarians on staff.  Given this, the two primary goals of the project were as follows:

1. Publisher negotiation: CUMC would approach publishers to negotiate a license agreement that would allow IFH to have access to CUMC licensed electronic resources at IFH sites.
2. Reference and education services:   Reference and instruction librarians from CUMC would provide remote training (at an hourly rate) on resources that IFH staff can access through the publisher agreements.

The initial plan was to obtain many journals from one or two vendors and to gauge usage of those materials.  Instead, CUMC developed a survey for IFH staff that would enable CUMC to pursue access for highly desirable resources based on user needs.  After completion of the user survey, it was clear that IFH personnel uniformly requested access to four major journals: New England Journal of Medicine (NEJM), Journal of the American Medical Association (JAMA), American Family Physician, and American Journal of Public Health (AJPH). Ultimately, only the American Academy of Physicians was willing to discount American Family Physician significantly in recognition of the needs of IFH staff.  CUMC also purchased JAMA, NEJM, AJPH, The American Journal of Nursing, Social Work in Health Care, and Journal of Health Care for the Poor and Underserved for access by IFH, but prices were near retail. Evaluation of the resources will be based on usage statistics gathers after six months and one year of use.  In a further effort to provide access to the periodical literature, CUMC also entered into an agreement to provide Loansome Doc services for IFH staff.

A total of ten training sessions were completed during the award period, with a total of 100 people attending.  All sessions were conducted virtually by CUMC librarians and dealt with the use of free and fee-based online resources.  The sessions were conducted using the GoToWebinar software and were recorded for future posting on the New York State Area Health Education Center website: http://www.ahec.buffalo.edu/

Michael Koehn
Columbia University Medical Center
Health Sciences Library

The primary purpose of this project was to develop a curriculum for health professionals and providers with practical solutions for improving health communications in their own practice settings.  The project continues the collaboration initiated by the Public Health Information Partners Project, expands the health literacy efforts at New York Medical College and in the Hudson Valley region, and work with participants from a 2007 health literacy conference.

A cohort of trainees was planned with each trainee expected to train others, use or share applications, and participate in a moderated health literacy wiki or blog.  A total of 200 participants was targeted, including: health professionals, providers of direct patient care, community leaders and librarians working in health care settings.  Leaders included professional employees in public health departments, nurses, health/medical faculty and educators, and medical libraries from the NN/LM MAR.

The project’s four objectives were as follows:

1. Complete a preliminary needs assessment of professionals in the Hudson Valley region.
2. Implement a “train the trainer” model for participating health professionals.
3. Create a regional health literacy wiki or blog to foster effective communications and networking among health professionals with an interest in health literacy.
4. Evaluate the use of specific strategies and tools in clinical or professional practice.

The needs assessment confirmed that there was a high level of interest in health literacy programming, and that a focus on practical strategies was desired.  Subsequent research informed the development of a training curriculum. By April 30, 2011,  three training events were scheduled using reputed health communication and health literacy experts.  The program descriptions, handouts, and photos are available here.  A total of 276 participants attended one or more events.

The health literacy wiki was created next.  By June 15, 2011, a total of 29 users were registered, with 296 users of the toolkit.

Evaluation of the project continues, but results show that we have successfully created a cohort of health professionals interested in honing their communication skills with patients/consumers and have provided them with the practical tools and strategies that they value and wish to continue to enhance.

Dianna Cunningham
New York Medical College Health Sciences Library

The overall goal of this project was to encourage health literacy by developing a culturally and educationally appropriate intervention that was convenient and tailored to the topics covered in a pregnancy program at a federally qualified health center in Philadelphia, PA.  The intervention consisted of a series of text messages enhanced with embedded URLs for websites that were selected for credibility and relevance to the educational topics covered in program sessions.  These tailored messages were  delivered twice weekly to participants’ cell phones and have been collected into a library that can be pre-loaded intro a text-messaging program to be sent out at designated dates and times.

During the project period, we provided this intervention to 36 women in five cohorts.  We also developed a short training program on information seeking in collaboration with the Health Sciences Library at Drexel University. This program was offered five times to the general patient population at the center and was delivered by a Drexel health sciences librarian; it demonstrated how to search for health information on the Internet and featured examples of credible, reliable websites, including MedlinePlus.  In keeping with our observation that for this population the most popular mode of Internet access is via cell phone, we offered participants the use of iPod Touch devices to mimic the experience of web searching on a cell phone.

Monthly survey data revealed that almost all patients reported receiving the messages, reading them, and found them to be informative and supportive. Most also accessed the websites.   Participants in the training session were enthusiastic about being able to find trustworthy health information online.  The center has expressed interest in investigating further the health literacy and health information literacy of their patients, particularly as it may impact patient engagement.

Prudence W. Dalrymple
Institute for Healthcare Informatics
Drexel University

The purpose of this project, funded under an NN/LM MAR Historical Collections Award to the New York Academy of Medicine (NYAM), was to hold a one-day conference for librarians and curators of historical collections and archives in the MAR.  The conference goals were to develop a cooperative plan to ensure preservation and access to historical materials in the MAR and a to form a working group to oversee the implementation of the plan.

The conference was held at NYAM on March 25, 2011.  The original intent was to have the directors and curators of the 27 known historical and/or archival collections in the MAR attend the conference.  Due to various scheduling conflicts, a total of 36 attendees were present, including two representatives each from the NN/LM MAR offices and the National Library of Medicine (NLM), four staff from the New York Academy of Medicine, and a guest speaker.

Naomi Adelman, Associate Director of the Library and Special Collections at NYAM, welcomed the attendees and provided an overview of the conference goals.  Constance Malpas, Program Officer at OCLC, then delivered a talk entitled, “Managing Print in the Mass-Digitized Library Environment: The Role of the Regional Print Repository.”   Her presentation explored the particular challenges of preserving print collections as a regional resource against the backdrop of large-scale library digitization programs and the ongoing reconfiguration of academic print collections.  She described how an emerging evidence base suggests that a progressive realignment of library investment towards cooperative management will be needed to ensure the long-term survival of legacy print collections.  She then raised issues for the attendees to consider, such as what kinds of inter-institutional agreements would be needed to achieve these goals, and how such coordinated approaches to print management can ensure system-wide efficiencies without compromising individual libraries’ fundamental stewardship mandate.

After Malpas’s talk, attendees introduced themselves and talked about the status of their collections in regard to some of the issues raised.   Discussion  ensued about the development of a print-retention plan within the MAR: specifically, who could and should participate in the effort and how to identify materials for retention.   The group agreed that more direction from NLM would be required to progress on these issues.  Martha Fishel, Chief, Public Services Division at NLM, gave a brief summary of print-retention initiatives in two other NN/LM regions.  She then recommended waiting until after the May 2011 MLA conference to proceed with this work.

A working group was established before the closure of the conference:  Naomi Adelman (NYAM), Leslie Czechowski (University of Pittsburgh), Barbara Cavanaugh (University of Pennsylvania), and Linda Lohr (University of Buffalo).  This group will work with the RML to survey libraries in the MAR about their print-retention needs and their willingness to participate in a cooperative plan.   Their work is expected to begin in June 2011.

Naomi Adelman
Associate Director, Library and Special Collections
New York Academy of Medicine

Under the auspices of an NN/LM MAR Outreach to Unaffiliated Health Professionals Award, the Schaffer Library of Health Sciences at Albany Medical College worked with the Queensbury Family Health Center in the Hudson Headwaters Health Network (HHHN), a not-for-profit system of health centers in New York State, to provide training sessions to health care providers that serve adult patients with Type II diabetes.  Over 3,000 patients are currently being treated for diabetes throughout the HHHN; approximately 10 percent are cared for at the Queensbury location.

Four teaching sessions were conducted. At the end of session one, participants were able to

• perform a basic PubMed search
• focus search results using PubMed limits
• use the PubMed MeSH database to select terms and subheadings
• create a MyNCBI account to customize search results, save searches, set alerts, and share data
• access free full-text journal articles in PubMed Central
• acquire fee-based material using Loansome Doc

At the end of session two, participants were able to

• list criteria to evaluate web-based patient information
• identify reliable sources of patient health information
• apply Google search techniques and tools to refine results
• locate material suitable for patients with low literacy levels

By the end of session three, participants were able to

• explain how mobile devices can assist healthcare providers at the point of care
• differentiate between commonly used mobile devices in the medical field
• explain basic mobile device functionality
• identify mobile medical software products that are freely available to download

Session four demonstrated the application of the content covered in the first three sessions through the use of case studies.  The clinical orientation was at the request of the health care providers.  The goal was to integrate the objectives of the previous sessions with a point-of-care approach.  By the end of the session participants were able to:

• use clinical resources during a patient encounter
• locate patient education materials on the web
• evaluate patient education materials on the web

Loansome Doc accounts were established for ten health care providers, facilitating their retrieval of full-text articles.

Participants were appreciative and valued the content presented.  They indicated that they would incorporate their knowledge into their practice.

Enid Geyer
Schaffer Library of Health Sciences
Albany Medical College

The St. John’s Riverside Hospital/Cochran School of Nursing Medical Library serves close to 200 associate degree nursing students and nursing faculty, as well as over 1,000 physicians, nurses, and allied health professionals that make up the Riverside Health Care System. Our library, in recent years, had gone through great effort to develop a strong collection and establish a comprehensive electronic catalog using Surpass software. Although our catalog was excellent, our patrons had no direct way to access it. In their search for books, they had to rely on random, visual inspection of the shelves or elicit the aid of our limited library staff every time they required a resource. This was an ineffective process for both staff and patron alike.

An NN/LM MAR Technology Improvement Award enabled us to purchase the computer server that was required to install Surpass Safari and, thereby, set up an OPAC that enabled our patrons to manage their own accounts and search our library catalog independently, as well as remotely.

Upon completion of the project, we administered a survey to a variety of students, faculty, and clinicians among our patrons. The level of interest and excitement generated exceeded our expectations. One hundred percent of the respondents expressed that the new resource would be “highly useful” and they would “recommend it to other colleagues/students.” We plan to schedule training sessions for our nursing students and organize library staff visits to various locations and departments that make up our institution in order to demonstrate use of the new system to the hospital employees. I believe that MAR has not only given us the ability to improve our level of library service, but allowed us a unique opportunity to become a central, unifying force within our organization.

Paul Hersh, Director of Libraries
St. John’s Riverside Hospital/Cochran School of Nursing Medical Library

The Southeastern New York Library Resources Council (SENYLRC) received a Technology Immersion Award from NN/LM MAR to develop and provide web-discovery portals and enhanced catalog systems to health sciences libraries in the Hudson Valley region in New York. By incorporating two-open source solutions (Koha Integrated Library System and the Drupal Content Management System) and successfully implementing both for two pilot libraries, SENYLRC is positioned to offer these same, centrally hosted and much improved services to the remaining health science libraries in the region. SENYLRC can also serve as a model for the delivery of low-cost, high-tech solutions to other consortia and multi-site institutions.   Through the improved platforms developed with the help of this award, SENYLRC member libraries will be better able to meet hospital user needs and have a new web-based discovery service which libraries could not achieve on their own.  Librarians, health-care professionals, staff, and patients will have a much improved searching and retrieval capability and therefore enhanced access to licensed, library-developed, and librarian-identified, free internet medical information resources.

Librarians from the Nathan Kline Institute Health Science Library and Vassar Brothers Medical Center Medical Library worked closely with SENYLRC staff and contracted programmers to develop additional functionality, test and evaluate the Koha integrated library system software, and to create new Drupal-based library website templates. The project resulted in two separate instances of a discovery platform, allowing each of the pilot libraries to better target the needs of their unique and very different user communities. The templates can be adapted and customized, and will allow librarians to generate their own content with a limited amount of training.

Through this pilot project, SENYLRC staff acquired the necessary experience with open source software to continue expanding the project implementations to additional hospital and special libraries in the region and perhaps beyond. The administrative module maintained by SENYLRC staff was not migrated to Drupal open-source as initially envisioned. Contracted web developers and SENYLRC staff lacked time, resources, and the needed experience to recreate the existing PHP based software within the framework of this project; thus, they decided to continue to use, but improve upon, the existing customized software module, rather than replace it.

Overall the process of technical development was far more time-consuming and challenging than anticipated.  With the addition of a three-month extension to the project, we accomplished the initial project goals, supplemented TIG funds with LSTA funds through IMLS and the New York State Library to engage a professional cataloger’s assistance, and, throughout the project, gained experience with the process and some of the problems with open source development.   SENYLRC staff continues to acquire expertise with both open-source systems. SENYLRC will create training materials for participating librarians as well as migrate all member hospital libraries to the new platforms in 2011. The project and the work, as well as evaluation, continue.

These applications of open source software and the documentation will be made freely available to the medical library community. The code modifications to Koha will be announced to the Koha community and posted on the SENYLRC website. One of the pilot libraries, Nathan Kline Institute, plans to utilize Koha’s circulation module. While this was not fully accomplished during the award period, it is in process and scheduled for 2011, while other modules may also be implemented in the future.

Patricia Carroll-Mathes
Hospital Library Program Manager
Southeastern New York Library Resources Council

The University of Medicine and Dentistry of New Jersey (UMDNJ) Libraries, in conjunction with the University Hospital and two health literacy fellows from Global Health Corps (GHC), have spearheaded the rollout of the “Ask Me” patient advocacy campaign within the clinical environment of the Newark campus.  The program is based upon the “Ask Me 3″ program that has been used successfully throughout the country.  Funds from an NN/LM MAR Health Literacy Award were secured to assist with the initiation and expansion of the “Ask Me” training materials to community members and patients beyond the University Hospital.

UMDNJ partnered with Covenant House Newark via a series of educational sessions. The young adults who live at Covenant House were a small, ideal target group on which to focus and assess the “Ask Me” training.   UMDNJ/GHC fellows designed an intervention to educate Covenant House’s clients about the “Ask Me” campaign using a multimedia approach.

The intervention consisted of the following steps:

1. Gathering baseline data: UMDNJ/GHC fellows prepared and administered a pre-interview survey to participants. Survey were anonymous and helped gather information about the participants’ previous patient experiences, specifically about their level of understanding of the information healthcare providers gave them.
2. Intervention: UMDNJ/GHC fellows and Covenant House/GHC fellows  led a group discussion on participants’ experiences with healthcare providers, specifically about their feelings about interacting with healthcare providers and their understanding of what they need to do when they leave the provider’s office.  The fellows used a laptop and projector purchased through the award to record and categorize responses. They then introduced the “Ask Me” program  through print brochures and multimedia elements. This was followed by role-playing sessions, wherein participants enacted a doctor/patient visit using the “Ask Me” tools.
3. Evaluation: Participants completed a free-form response card to provide feedback on the session. Fellows planned to meet with the participants’ before their next healthcare appointment to review the “Ask Me” campaign. Participants’ would then attend the appointment and fill out a post-intervention survey questionnaire.

All of the participants in the intervention program identified it to be a very useful session for future encounters with physicians.  Feedback from interviews with the Covenant House residents reinforced the premise that encouraging patients to question their health providers results in improved confidence and understanding of personal health issues.  The acquisition and dissemination of patient folios to house materials obtained during health provider visits encourages compliance. This enables patients to store relevant materials (referrals, maps, directions, instructions, “Ask Me” brochures, Patient Bill of Rights, and other disease-specific information) in one place.

Judith Cohn
Associate VP for Scholarly Information/University Librarian
University of Medicine and Dentistry of New Jersey