Levels of Response to Information Seeking Behaviors in a Specialized Consumer and Patient Health Information Service
Handout from a Medical Library Association Poster Session
May 21, 1990
Presented by:
Rosalind F. Dudden, MLS
Health Sciences Librarian
National Jewish Medical and Research Center
1400 Jackson Street, Denver, Colorado 80206
Voice: 303-398-1483
FAX: 303-270-2149
duddenr@njc.org
http://Library.NationalJewish.org
As part of the preparation to open a specialized consumer and patient health information service at National Jewish Medical and Research Center, the information seeking behavior of the future library user was analyzed through observation, based on the programs in place at National Jewish. It was observed that some potential users of the system were more aggressive and possibly in more need of information. However, some users, who were less aggressive, might still need information but be more hesitant to ask. There also needed to be a balance between what the user was hand-delivered and what he or she had to search for with some determination. It was assumed that hand-delivered information would take more library money and staff time to organize. At each level, certain barriers are either imposed or occur naturally. A naturally occurring barrier might be the inability to read technical information. An imposed barrier might be a fee or a very complicated access system.
Given these propositions, we developed seven levels of perceived information seeking behaviors of potential users and the library's response to those levels. The levels reflect a degree of ease of access to the information needed. This means the information seeker would find level 1 to be the easiest way to get information.
Levels 1 through 3 are all simple. The seeker is handed information from a system that gives them specific information quickly and directly. With Levels 4-7, the seeker must have a stronger need to know more about the illness of interest. They must figure out indexes and locate materials, most of the time on their own with written instructions. By allowing limited access to the medical collection, the user does not sense an administrative barrier. The technical barrier is still there but that is more personal and tolerable to the user.
The following chart outlines what resources a patient can expect to find at each information level and opposite, the library issues involved in providing that service.
| Information levels for patients seeking information on their condition | Issues involved in the library's response to these information needs |
| Level 1: Information from your doctor or nurse: The most specific information about YOUR condition. | |
| Your Doctor or Nurse will provide you with specific information about your diagnosis or your treatment. This information comes only from your doctor or your nurse, and would not be found in the HealthInfo Center | The librarian needs to bring the existence of the HealthInfo Center to the attention of the Medical, Nursing, and Rehabilitation staff so that they can directly refer patients they feel may be interested in using it |
| Level 2: The PRIDE Program, an interdisciplinary patient education and pulmonary rehabilitation program. | |
| The PRIDE program and the pediatric parent education program have a set curriculum to give you information in a classroom setting or on a one-to-one basis. This level includes an extensive notebook and audiovisuals. This is more than enough information for most people. | The librarian needs to coordinate with the patient educators and let them know what is happening in the HealthInfo Center. The existence of the HealthInfo Center needs to be mentioned in classes and the nurses informed about it enough to put the 20 minute orientation to the HealthInfo Center on the patient's PRIDE Program schedule. |
| Level 3: The HealthInfo Center Pamphlet File and Book Collection. | |
In the HealthInfo Center, there is a file of over 80 fact sheets and pamphlets, all of which are published by National Jewish. You can help yourself to this supplementary written information (top drawer of the file cabinet). The HealthInfo Center card catalog helps you locate books on the shelf. You can check out and return the books by registering at the library circulation desk. A reference shelf is also available in the HealthInfo Center with dictionaries and general texts. |
The library staff and volunteers need to stock this file. It takes about 2 hours a week and requires a storage area for inventory. It cost about $1000 a year to purchase the materials. The medical library technical staff catalogs the books and checks in the journals. The public services staff circulates the materials and assists with patient questions. All these activities take up staff time and thereby cost money. The journals cost about $250 and the books $1250. Losses are heavy. The journals are specially processed to attempt to prevent loss. Three to 5 copies of all the respiratory books need to be purchased or else there are never any on the shelf. |
| Level 4: The HealthInfo Center Index to materials for patients on respiratory and immunological topics. | |
The HealthInfo Center Index is in process at this time. When finished, it will allow you to access materials published by National Jewish, the American Lung Association, the American College of Allergy and Immunology, and other related organizations on respiratory and immunological topics. You will be able to select from a list and pay for copies of the material. |
Creating this "simple" index, using Pro-Cite, has taken over 18 months. Over 500 items have been indexed. Data was organized by the librarian and input by volunteers. Even with volunteer help this has been a very expensive project in terms of the librarian's time. We hope, however, that the end product will be useful to patients who want to know more specific details about various respiratory diseases. After completion of the Index, the indexed material needs to be protected from loss. This system is in development. Once the materials are made available to the patients, it will take more staff time to provide it to them than the materials at level 3. This is an example of how organizing materials for easy access costs more and is still difficult to access. |
| Level 5: Clinical Medicine Reference Shelf and consumer newsletters | |
For more technical information, you can use the Clinical Reference Collection of the Tucker Library. There you can read and/or copy information you have located using the indexes of the books. There is one recent book in every general medical area. You can use the Consumer Health and Nutrition Index or the CINAHL Index. Article citations found would probably not be available here. You could find some of them at your public library. Consumer health materials can be retrieved on local interlibrary loan. For other materials, there is an $8.00 fee per article for this service. |
Using any of these materials usually involves staff time to show the patient where things are and explain somewhat how to use them. Although this is available, less than 1 in 20 consumer health library users avail themselves of these resources and services. The cost of interlibrary loan is a barrier to gaining information but has been imposed because of possible abuse of the service. |
| Level 6: The Medical Library card catalog and book collection | |
| You may use the Tucker Library card catalog. In there, you can locate books and monographic journal issues on topics of interest to you. This information would be more technical and difficult to read. The information can not be checked out and would have to be photocopied at 10¢ a page. | Using any of these materials usually involves staff time to show the patient where things are and explain somewhat how to use them. Although this is available less than 1 in 20 consumer health library users avail themselves of these resources and services. There is also a risk of book loss by letting the patients look at the medical books. |
| Level 7: The Index Medicus and computerized searching. | |
You may use the Index Medicus and the journal collection. You would need to spend some time in doing this research and locating the materials. With some questions, involving very rare or very specific interrelationships, a MEDLINE computerized search could be run with a specific order from your doctor. There is a form at the desk requiring the doctor's signature. Articles retrieved at this level can be photocopied at 10¢ a page. Articles not available in the library could be retrieved on interlibrary loan. There is an $8.00 fee per article for this service. |
Patients who seem interested in the Index Medicus are given a brief introduction to it by the staff, usually less than 10 minutes. Two or less people a month seem interested so the staff time is not very intense. Doing MEDLINE searches for the patient is a very touchy subject. By requiring the doctor's signature and conferring with him or her before giving any results to the patient, usually both sides are satisfied and don't feel denied or threatened. Less than 6 searches a year are executed using this procedure. |