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Medical Reference Services Quarterly Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wmrs20
Community Needs Assessment to Reach Out to an Underserved Population a
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Misa Mi , Jill Stefaniak & Nelia Afonso
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Medical Library , Oakland University William Beaumont School of Medicine , Rochester , Michigan , USA b
Department of STEM Education & Professional Studies , Darden College of Education, Old Dominion University , Norfolk , Virginia , USA c
William Beaumont Health System , Oakland University William Beaumont School of Medicine , Sterling Heights , Michigan , USA Published online: 14 Oct 2014.
Click for updates To cite this article: Misa Mi , Jill Stefaniak & Nelia Afonso (2014) Community Needs Assessment to Reach Out to an Underserved Population, Medical Reference Services Quarterly, 33:4, 375-390, DOI: 10.1080/02763869.2014.957075 To link to this article: http://dx.doi.org/10.1080/02763869.2014.957075
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Medical Reference Services Quarterly, 33(4):375–390, 2014 Published with license by Taylor & Francis ISSN: 0276-3869 print=1540-9597 online DOI: 10.1080/02763869.2014.957075
Community Needs Assessment to Reach Out to an Underserved Population
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MISA MI Medical Library, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
JILL STEFANIAK Department of STEM Education & Professional Studies, Darden College of Education, Old Dominion University, Norfolk, Virginia, USA
NELIA AFONSO William Beaumont Health System, Oakland University William Beaumont School of Medicine, Sterling Heights, Michigan, USA
A community-based participatory research project was conducted to identify health information needs of clients (an underserved population) at a homeless shelter. Staff at the shelter, medical students, and public librarians were sought as outreach partners; their needs and challenges in accessing health information resources to serve underserved populations were also assessed. The community needs assessment yielded results that helped shape a medical library’s efforts in supporting medical students’ service-learning activities related to humanistic education. The resulting data also informed library decisions on health information education outreach programs tailored to vulnerable, underserved populations and community partners serving the specific populations in the communities. KEYWORDS Community-based participatory research, community outreach, consumer health, health information literacy, health sciences libraries, medical students, needs assessment, service-learning, underserved populations # Misa Mi, Jill Stefaniak, and Nelia Afonso Received: November 22, 2013; Revised: March 5, 2014; Accepted: April 26, 2014. Address correspondence to Misa Mi, Medical Library, Oakland University William Beaumont School of Medicine, 130 Kresge Library, 2200 North Squirrel Road, Rochester, MI 48309. E-mail: [email protected] 375
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INTRODUCTION ‘‘Humanism in medicine describes relationships between physicians and their patients that are respectful and compassionate. It is reflected in attitudes and behaviors that are sensitive to the values, autonomy, cultural and ethnic backgrounds of others.’’1 Medical schools and the community of health profession educators increasingly stress the importance of integrating humanistic values into health professions education in order to achieve a more socially engaged, compassionate, and humanistic workforce. Health sciences librarians have been actively involved in developing and offering evidence-based medicine programs or instruction.2 It should be noted that the growing attention to and influence of humanistic education afford abundant opportunities for librarians to play an important role in developing the medical curriculum that would ‘‘build a well-rounded student body.’’3 Megan Curran advocated for librarians’ increased support for medical humanities, which is one of many ways to make librarians indispensible to library users.3 Humanism in medicine recognizes the ‘‘rebalance of the dual pillars of medicine and humanism.’’1 It provides a fertile ground for librarians to contribute to the goal of medical education in developing medical students’ humanistic skills. This article will demonstrate a medical library’s involvement in students’ service-learning through library community outreach efforts.
BACKGROUND The Oakland University William Beaumont School of Medicine (OUWB) is a new medical school in Rochester, Oakland County, Michigan. OUWB has implemented an innovative, integrated curriculum that features service-learning experiences woven into several preclinical courses to inspire students to work as partners with patients and communities. Service is one of the seven important attributes or traits that a humanistic doctor embodies. It is defined as ‘‘sharing of one’s talent, time and resources with those in need; giving beyond what is required.’’1 South Oakland Shelter (SOS), a nonprofit, community-based, organization located in the same county, works together in partnership with 67 congregations to operate a rotating shelter system to house and feed the homeless population, the SOS clients. It has assisted individuals and families in seeking stabilization and self-sufficiency through counseling services, career development classes, and educational seminars. OUWB has established a partnership with SOS to develop service-learning experiences. One goal of these experiences is to help students develop an awareness of the health care needs of a more vulnerable patient population. Through their work at SOS, students have an opportunity to integrate their knowledge and
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skills with real-life experiences in the communities early in their medical training. The purpose of the study was to identify health information needs of SOS clients. Staff at SOS, medical students at OUWB, and librarians in public libraries in Oakland County were sought as outreach partners. Their needs and challenges in accessing health information to serve underserved populations were also assessed. The ultimate goal of the needs assessment was to identify outcomes that would help the medical library develop future outreach programs to meet specific needs of underserved populations and community partners. These programs may include (a) developing and distributing educational materials to vulnerable and underserved populations to improve their health information literacy; (b) designing and delivering online or face-to-face training programs to increase community partners’ awareness of credible, trusted consumer information resources from the National Library of Medicine (NLM); and (c) enhancing the ability of community partners to find and use quality health information effectively so that they can better serve the specific populations and meet their information needs.
METHODS Participants Targeted outreach populations recruited to participate in the community needs assessment included a convenience sample of SOS clients and staff, first- and second-year medical students at OUWB, and librarians from public libraries in Oakland County. The clients that SOS serves represent a diverse range of people in need, including first-time homeless individuals and families, chronically homeless individuals, veterans, domestic violence victims, as well as people battling substance abuse, mental health issues, and frequently, both.
Needs Assessment Surveys The community needs assessment was conducted with four needs assessment surveys administered to the four target outreach groups. The needs assessment was conducted by following the standard methods recommended in the literature.4,5 When developing the surveys for clients and staff at SOS and public librarians, a collaborative partnership approach was attempted to engage community partners in the research process. All project collaborators worked together to construct the surveys. Suggestions and comments about the surveys were solicited from two SOS directors, two public library directors, and one public librarian; revisions were made to improve the surveys based on their input.
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The survey for SOS clients included a set of questions on clients’ demographic information and their health information literacy level as well as questions that assessed clients’ needs and skills in accessing and using health information resources and technologies. The survey for SOS staff identified staff’s needs in serving and educating clients about NLM consumer health information resources. The survey for public librarians assessed public librarians’ awareness of these resources as well as the level of computer access and current status of health information access by the public in individual libraries. The needs assessment survey administered to medical students comprised seven questions that determined students’ awareness and use of quality consumer health information resources. The survey for SOS clients was conducted as a structured interview, while the other three surveys were administered to participants online via SurveyMonkey.
Procedures Clients who used SOS services during the period from March 2013 to the first week of April 2013 were recruited to participate in the needs assessment survey. One key research personnel (research assistant) scheduled on-site visits to identify and approach clients for the survey participation. Given that SOS clients may have varying levels of literacy, the research assistant conducted each interview by reading aloud survey questions to each participant. For SOS staff, an e-mail message was sent to a SOS director who forwarded it to all 15 staff. The e-mail message included a link to the online needs assessment survey. Thirty-five public libraries located in Oakland County were identified, and a directory of contact information for all directors was complied. Each director was contacted by e-mail about the needs assessment. Those who agreed to participate were sent a URL link to the online survey to be forwarded to their library staff. As of conducting this project, only two cohorts of medical students (124) were matriculated in the medical school. The needs assessment survey was distributed to the students by e-mail. E-mail reminders were sent to each group following the initial recruitment message.
Data Collection and Analysis Data collected from the surveys for SOS staff, public librarians, and medical students were downloaded from SurveyMonkey to Excel for descriptive statistical analysis. Responses from the structured interview with SOS clients were imported to SurveyMonkey manually and downloaded for descriptive statistical analysis.
RESULTS A total of 22 SOS clients participated in the interview. Of 15 SOS staff, 10 provided responses to the survey. Twenty-eight librarians from 17 out of
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35 public libraries in Oakland County responded to the survey. Of 124 medical students, 41 (a response rate of 33%) submitted their responses to the survey.
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SOS Clients SOS client participants included 10 females and 12 males ranging in age from 35 to 64 years old. Of 22 participants, half were white, and half were African American. They possessed varying levels of education, as shown in Table 1. More than half of participants (52.38%) expressed their unmet health information needs. Health or medical information was needed on such topics as prescription review, blood pressure monitoring, diabetes, dental care, mental health (anxiety, depression), asthma, eye care, gynecological care, leg joint issues, and obesity. A majority of participants sought health or medical information from health care providers or the Internet if they themselves or someone close to them had a health-related question as illustrated TABLE 1 Demographic Information on SOS Clients Demographic information on SOS clients What is your gender? (n ¼ 22) Female Male What is your age? (n ¼ 22) 18 to 25 26 to 34 35 to 44 45 to 54 55 to 64 65þ What is the highest level of education you have completed? (n ¼ 22) No schooling completed Pre-K to 8th grade Post graduate Less than high school High school=GED Vocational=technical training College graduate Some college Not sure What is your ethic origin (or race)? (n ¼ 21) White Hispanic or Latino Black or African American Native American or America Indian Asian=Pacific Islander Other
Number of participants
Percentage
10 12
45.45 54.55
0 0 6 10 6 0
0 0 27.27 45.45 27.27 0
0 0 0 2 8 3 3 10 0
0 0 0 9.09 36.36 13.64 13.64 45.45 0
11 0 11 1 1 1
52.38 0 52.38 4.76 0 4.76
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in Table 2. Other resources from which they sought health information included neighbors, the United Way, WebMD, Mom, caseworkers from Americorp, free clinic, and pharmacists. Among all the sources listed, health care providers were perceived as the most useful, followed by the Internet. The United Way, public library, and pharmacists were also considered as useful to them. The easiest to access for them was the Internet, followed by health care providers. The United Way, caseworkers from Americorp, and pharmacists were also perceived as easy to access. The survey also assessed SOS clients’ access to a computer as well as their ability to use a computer or the Internet to find health or medical information. Of the 22 participants, 20 had access to a computer; 18 of the 22 had access to the Internet. The majority of participants felt very comfortable or comfortable in using a computer or the Internet to find health medical information, whereas one-fourth of respondents (6 out of 22) expressed their difficulties in accessing and using online health or medical information. These difficulties included firewalls at SOS, not being able to access WebMD due to firewalls, limited hours with Internet access due to a lack of a personal computer, or lack of expertise in using a computer.
SOS Staff The majority of staff participants reported answering clients’ questions related to health issues and health or medical information (see Table 3). Seven participants reported accessing health or medical information from the Internet. Other resources of information used to meet clients’ health or medical information needs included free=local clinics, mental health providers, prescription discount programs, case managers, Google searches, and local hospitals. Resources deemed to be most helpful to SOS staff in assisting and serving SOS clients were free or low-cost care and prescriptions, medical services in Oakland County, a less expensive way to transport clients to the hospital for non-emergencies, signs, symptoms and treatment options for common conditions affecting the homeless. Regarding the adequacy of health-related TABLE 2 Resources Used for Health or Medical Information by SOS Clients Resources Health care provider Health fair Newspaper=magazines=books TV=radio Internet Family or friends South Oakland shelter Local public library
Number of participants
Percentage (n ¼ 16)
13 2 5 2 13 6 6 5
65 10 25 10 65 30 30 25
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TABLE 3 Frequency With Which SOS Staff Answered Questions Related to Health Issues and Health or Medical Information Answer choices
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Once a day A few times a week Once a week Several times a month Once a month Not at all
Number of participants
Percentage (n ¼ 10)
2 2 1 2 2 1
20 20 10 20 20 10
resources for serving SOS clients, four staff members felt that the resources were not adequate at all. Five reported that they were somewhat adequate, whereas only one staff member indicated that they were adequate. Regarding barriers to using and accessing online health or medical information, three staff offered the following comments: .
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‘‘Often I don’t know where to begin; also, when you find out information about free or low-cost care or clinics for uninsured people, they often have qualifications=stipulations=procedures=barriers that they don’t put right on their website, which makes it hard to know if I am suggesting appropriate resources for clients or just sending them on a wild goose chase.’’ (Staff A) ‘‘A lot of the clients do not know how to seek out quality information on the Internet opposed to myths about health care information.’’ (Staff B) ‘‘I do not encounter these problems but I see the clients having problems wording searches and knowing what to call a specific problem for a search.’’ (Staff C)
Public Libraries A majority of participants (85.18%) reported serving individuals from an underserved population daily. More than half of participants (81.77%) reported answering questions related to health issues and health or medical information on a regular basis (see Table 4). A few participants (7 out of 27) TABLE 4 Frequency With Which Public Librarians Answered Questions Related to Health Issues and Health or Medical Information Answer choices More than once each day Once a day A few times a week Once a week Several times a month Several times a year Never
Number of participants (n ¼ 27)
Percentage
6 1 10 4 5 1 0
22.22 3.7 37.04 14.81 18.52 3.7 0
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indicated that they never used the NLM consumer health information resources such as MedlinePlus. Circulating books, reference books, and online resources were three top choices of resources used frequently to answer medical reference questions. Over half of participants (66.66%) felt they were excellent or very good at accessing reliable health or medical information on the Internet. Diabetes, mental health, and dementia=Alzheimer’s disease were the top three common health problems that librarians were asked to search for (see Table 5). Other health topics inquired about included cancer, substance=drug abuse, alcoholism, sleep disorder, and unusual conditions=diseases which patrons did not know how to spell. A number of participants perceived seniors and the uninsured=economically disadvantaged as two groups of health information users most in need for outreach in their own libraries. They felt that outreach programs on issues of interest to seniors, mental health resources for low-income people, and resources for finding low-cost=free=affordable health care or insurance plans would be most helpful in their work with these groups. The following comments made by participants reflected barriers faced by public librarians to serve underserved populations: . . . . . . . .
Fear of being asked and of misunderstanding of what they were told about the illness; Inability to understand or access available resources; Finding clearly written and up-to-date material, and knowing where to look for information; Countering Dr. Oz or the latest cure in the popular media; Mental limitations of requestors; Poor personal hygiene of requestors; Requestors not thinking of the library as a resource; and Need for lengthy reference interview to understand what patrons want.
A few participants alluded to other challenges that could arise in serving patrons from underserved populations. These patrons may have a very low TABLE 5 Information Searched for Common Health Problems by Public Librarians Information searched for common health problems
Number of participants (n ¼ 27)
Percentage
Diabetes Prescription review Asthma, COPD Blood pressure monitoring Frost bite Dehydration Dementia=Alzheimer’s Mental health Other
21 10 2 3 0 0 13 15 12
77.78 37.04 7.41 11.11 0.00 0.00 48.15 55.56 44.44
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level of learning ability or reading level, be unemployed without insurance, or unable to grasp complex health concepts and to understand the technical terms contained in some health information resources.
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Medical Students at OUWB Among student participants, 22 of them (55%) were first-year students and 18 (45%) were second-year students. An equal number of female and male students responded to the survey. One survey question was intended to identify resources used by medical students for quality health information. UpToDate (17 out of 40 students) was ranked as the top choice of resources, followed by PubMed (see Table 6). Five students used MedlinePlus; one student mentioned PubMed Health from the National Institutes of Health; and six selected Google. Other online information resources mentioned included DynaMed, AccessMedicine, MD Consult, and Micromedex. Regarding their experience in using NLM consumer health information resources such as MedlinePlus, 70% participants (28 out of 40) reported using it. For challenges in accessing NLM consumer health information resources such as MedlinePlus, eight students reported no challenges; five were unsure about it due to lack of experience with it. A few others mentioned the following challenges in accessing the resources:
TABLE 6 Resources Accessed for Quality Health Information Resources by Medical Students Resources UpToDate PubMed OUWB library website Dynamed Google Micromedex MedlinePlus Mayo Clinic NIH website Wikipedia AccessMedicine MD Consult CDC The Internet PubMed Health Surgeon General.gov Medscape Medline WebMD
Frequency of resources accessed (n ¼ 40) 17 16 8 6 6 5 5 4 4 2 2 2 2 2 1 1 1 1 1
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‘‘Narrowing down the information to what is relevant to what I am looking for is my biggest challenge.’’ (Student A) ‘‘Finding the right keywords for the disease process I am searching for is a challenge.’’ (Student B) ‘‘Sometimes, the disease process, including the name, is simplified on consumer pages making it difficult for me to find what I am looking for.’’ (Student C) ‘‘They are not as easy to navigate and get to as some websites.’’ (Student D) ‘‘It is often too simplified.’’ (Student E) ‘‘Not being able to easily search for what I specifically want’’ (Student F) Two students commented on their use of Google versus MedlinePlus:
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‘‘I often start with a Google search regarding my topic and if MedlinePlus appears, I will check out the information. For some reason I seldom start at MedlinePlus, though, and instead use Google as the launching pad.’’ (Student G) ‘‘It is not always the top response on Google, and I don’t usually think to go to MedlinePlus first.’’ (Student H)
Student participants also anticipated various challenges encountered by physicians in educating underserved populations: patient compliance, language barriers, literacy levels, cultural barriers, racism, follow-up, poverty, trust, and inability to afford health care. They suggested the following sources of information as the most helpful in educating underserved populations: . . . . . . . .
direct communication with their doctor, brochures, educational videos, handouts from their doctor’s office or free clinics, easy-to-read and easy-to-understand materials, health fairs, verbal instructions with accompanying pamphlets with a lot of pictures, and information on where they can call or go to receive help for health-related issues.
DISCUSSION The success factor most commonly cited for outreach projects in both current literature and responses to a survey of medical and health sciences libraries is to understand customer needs.6 The needs assessment afforded an
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opportunity for the OUWB Medical Library to collaborate with SOS in assessing information needs of its staff and clients. Another success factor for outreach projects is networking or building relationships with the targeted groups.6 Public librarians and medical students were sought as outreach partners in educating underserved populations about NLM consumer health information resources for the needs assessment. This allowed us to examine and identify unique and specific resource needs of SOS staff, public librarians, and medical students. It also identified barriers that community outreach partners faced in serving vulnerable and underserved populations. For SOS clients, health care providers and the Internet were ranked as the top choices of sources used to seek health or medical information. However, a health care provider was considered the most useful resource while the Internet was considered the easiest to access. Today, valuable Internet resources are available for health information (e.g., NLM consumer health information resources via MedlinePlus). Nonetheless, many sites provide poor, inaccurate, or unsubstantiated health information to nonsavvy consumers.7–9 Since the Internet was identified as the easiest means to access health information, medical librarians could collaborate with public librarians, SOS, other local agencies, and organizations to provide workshops or outreach activities (e.g., a health fair) for underserved populations to guide their use of online health information and to help them use the information to make healthy choices. Survey results reveal that some SOS clients had unmet health information needs related to ‘‘problems of daily survival.’’ A few clients reported no access to high-speed Internet or a personal computer. When using computers at SOS, some clients expressed their frustration with computer firewalls that prohibited them from accessing certain websites (e.g., WebMD). Most of SOS staff did not refer their clients to the local public library for getting health or medical information. The survey results suggest that most public librarians were already serving the underserved population and answering questions related to health issues and health or medical information on a daily basis. Over half of public librarians had the ability to access reliable health or medical information on the Internet. Public libraries have been a popular place to access a computer or the Internet.10 It is advisable for homeless shelters to partner with a local public library and to refer their clients to public librarians who are positioned to play a role in educating and meeting the needs of underserved or economically disadvantaged people with no access to a personal computer or no skills in searching the Internet for quality health information. It should be noted that nearly one-third of participating public librarians were unaware of NLM consumer health information resources (e.g., MedlinePlus). Seniors and the uninsured=economically disadvantaged were perceived as two groups of health information users most in need for outreach in public libraries. Clearly, medical librarians are presented with great opportunities to take the lead in caring for underserved populations by working in collaboration with SOS staff and public librarians to educate and serve
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identified outreach groups. Future outreach training programs and education material (e.g., customized information pamphlets, one-page information sheet) could be developed to help SOS staff meet clients’ immediate information needs and better guide them to sources of credible and trustworthy health information. Outreach programs could be developed and extended to public librarians to assist them in reaching out to underserved populations and becoming ‘‘better sources of health information for the public.’’11 Medical students at OUWB were another group of outreach partners targeted in the community needs assessment. ‘‘Medical students represent a vast and efficient source of enthusiasm and energy for public outreach endeavors.’’12 Medical students as a valuable resource could be recruited as volunteer health educators in outreach programs. When researching and teaching others about different health topics, students have the opportunity to engage in servicelearning experiences, apply and improve their content knowledge, and heighten their awareness of these topics.12–15 A large number of student participants in the survey reported accessing online quality information resources through PubMed, UpToDate, DynaMed, AccessMedicine, MD Consult, Micromedix, and MedlinePlus. It was not surprising that a number of participants were aware of NLM health information resources as well as some resources licensed by the OUWB Medical Library since information literacy instruction was integrated into their first-year curriculum. Nevertheless, the needs assessment results showed existing gaps in students’ knowledge of and skills in using NLM resources, especially MedlinePlus. A number of students (30%) reported no experience with MedlinePlus; a few reported using Google as a launching pad for health or medical information. Continuous efforts are needed to teach students information literacy=skills in the medical curriculum. The ability to identify, access, and use health information resources is an important, self-directed, life-long learning skill for students as future physicians in caring for underserved populations in specific and patients in general. The challenges perceived by medical students in educating underserved populations will inform future library planning on information literacy instruction as well as outreach efforts in support of students’ service-learning related to medical humanities.
LIMITATIONS There are several inherent limitations in the study. The response rate to the needs assessment survey by medical students was low. Medical students were surveyed for a variety of purposes in the new medical school (e.g., course evaluations, various educational research projects, service-learning activities, and other events). The students may have developed survey fatigue that might contribute to the low response rate for the online survey; therefore, the findings reported here should be viewed cautiously as they do not represent those who chose not to respond to the survey.
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Another limiting factor for the needs assessment (a major challenge in the study) was the inability to sample a large number of SOS clients. This was due to scheduling constraints and client hesitation to participate. SOS operates a shelter system that lodges and feeds displaced households. It has the capacity to provide supportive services for about 30 clients monthly. The number of clients who visit SOS fluctuates from day to day. As a result, the service usage pattern affected the recruitment of a large sample of clients for the needs assessment within a short period of time. A larger sample from multiple homeless shelters would provide a stronger basis for generalizing results. Furthermore, the nature of the needs assessment survey is self-report; participants self-selected based on their interest in the survey.
FUTURE PLANS New clients utilize SOS services each month. These clients arrive with various challenges, health information needs, and information literacy levels. OUWB librarians will continue to work with the primary care physician to examine and monitor differential information behaviors and needs of SOS clients. Doing so will enable OUWB librarians to stay mindful of client needs and to develop strategies tailored to SOS staff who can in turn better facilitate SOS clients’ access to NLM online information resources. Meanwhile, librarians will further the integration of information literacy instruction into the medical curriculum to equip medical students with information competence and to enhance their service-learning experiences in both working with underserved populations and educating them about various health issues. To better serve the specific population, SOS staff, and public libraries, the OUWB Medical Library could collaborate to create a referral system that would enable SOS staff to refer clients to local public libraries. Medical librarians could provide in-depth references and consultations for public libraries in Oakland County. They could also develop, organize, and facilitate outreach programs for SOS staff and public librarians. These programs could focus NLM consumer health resources or be devoted to a specific disease or condition, since the most successful outreach programs were those developed with a disease-specific approach.11 Through concerted efforts from all parties involved, a wiki website could be constructed to contain an online directory of contact information of agencies, community organizations, clinics, and educational institutions. This website would provide free=low cost health care as well as information resources most useful for underserved or economically disadvantaged individuals and senior citizens. The results of the needs assessment demonstrate a dire need for such information. The needs assessment conducted with a collaborative approach suggests an implication for health sciences librarians interested in getting
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involved in medical students’ humanistic education. Collaboration is a key to satisfactory outcomes in a community outreach project. It is necessary to examine the context for any community outreach efforts and to engage all outreach partners in the research process. It is equally important to recognize that each of the partners could share a commitment to and responsibilities for health education and promotion. All partners can contribute to the success of future health education programs to improve health outcomes and to reduce health disparities and inequalities.
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CONCLUSION The valuable information yielded from the community needs assessment is not only assisting the OUWB Medical Library in providing health information outreach education tailored to underserved populations but also shaping the library’s efforts in educating medical students about credible and trusted consumer health information resources. The needs assessment served as a great first step for medical librarians in developing a relationship with community partners who would otherwise operate in silos in their own efforts to serve underserved populations in the communities. Medical librarians can be an integral part of educational endeavors in helping medical students becoming ‘‘holistic physicians,’’ who are caring, socially engaged, and compassionate. Librarians’ outreach to communities enhances the institutional mission and supports the integration of humanism into the medical curriculum. The emphasis of the needs assessment on serving underserved populations and educating community partners about credible and trusted health information resources contributes to the Healthy People 2020 goal of improving health outcomes and reducing health disparities and inequalities.
FUNDING This project has been funded in whole or in part with federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract No. HHSN-276-2011-00005C with the University of Illinois at Chicago.
REFERENCES 1. The Arnold P. Gold Foundation. ‘‘What Is Humanism in Medicine?’’ Accessed March 1, 2014. http://www.humanism-in-medicine.org/index.php/aboutus/what_ is_humanism_in_medicine. 2. Li, P., and L. Wu. ‘‘Supporting Evidence-Based Medicine: A Survey of U.S. Medical Librarians.’’ Medical Reference Services Quarterly 30, no. 4 (October-December 2011): 365–381.
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3. Curran, M. ‘‘A Call for Increased Librarian Support for the Medical Humanities.’’ Journal of the Medical Library Association 100, no. 3 (July 2012): 153–155. 4. Witkin, B.R., and J.W. Altschuld. Planning and Conducting Needs Assessments: A Practical Guide. Thousand Oaks, CA: Sage Publications, 1995. 5. National Library of Medicine, Outreach Evaluation Resource Center. ‘‘Planning and Evaluating Health Information Outreach Projects Booklet.’’ Accessed November 12, 2013. http://nnlm.gov/evaluation/booklets. 6. Fama, J., D. Berryman, N. Harger et al. ‘‘Inside Outreach: A Challenge for Health Sciences Librarians.’’ Journal of the Medical Library Association 93, no. 3 (July 2005): 327–337. 7. Stephenson, P.L., B.F. Green, R.L. Wallace, M.F. Earl, J.T. Orick, and M.V. Taylor. ‘‘Community Partnerships for Health Information Training: Medical Librarians Working with Health-Care Professionals and Consumers in Tennessee.’’ Health Information and Libraries Journal 21, Supplement 1 (June 2004): 20–26. 8. Cooper, J.D., and H.M. Feder. ‘‘Inaccurate Information About Lyme Disease on the Internet.’’ Pediatric Infectious Disease Journal 23, no. 12 (December 2004): 1105–1108. 9. Crocco, A.G., M. Villasis-Keever, and A.R. Jadad. ‘‘Two Wrongs Don’t Make a Right: Harm Aggravated by Inaccurate Information on the Internet.’’ Pediatrics 109, no. 3 (March 2002): 522–523. 10. Information School of University of Washington. ‘‘Opportunity for All: How the American Public Benefits from Internet Access at U.S. Libraries.’’ Accessed March 1, 2014. http://files.eric.ed.gov/fulltext/ED510740.pdf. 11. Wood, F.B., B. Lyon, M.B. Schell, P. Kitendaugh, V.H. Cid, and E.R. Siegel. ‘‘Public Library Consumer Health Information Pilot Project: Results of a National Library of Medicine Evaluation.’’ Bulletin of the Medical Library Assocation 88, no. 4 (October 2000): 314–322. 12. Kamell, J.M., W. Rietkerk, K. Lam et al. ‘‘Medical Students Educate Teens About Skin Cancer: What Have We Learned?’’ Journal of Cancer Education 26, no. 1 (March 2011): 153–155. 13. Olm-Shipman, C., V. Reed, and J.G. Christian. ‘‘Teaching Children About Health, Part II: The Effect of an Academic-Community Partnership on Medical Students’ Communication Skills.’’ Education for Health (Abingdon) 16, no. 3 (November 2003): 339–347. 14. Wong, V.S., and G.S. Naguwa. ‘‘The School Health Education Program (Shep): Medical Students as Health Educators.’’ Hawaii Medical Journal 69, no. 3 (March 2010): 60–64. 15. Robak, O., J. Kulnig, F. Sterz et al. ‘‘CPR in Medical Schools: Learning by Teaching Bls to Sudden Cardiac Death Survivors – a Promising Strategy for Medical Students?’’ BMC Medical Education 6 (April 2006): 27.
ABOUT THE AUTHORS Misa Mi, PhD, MLIS, AHIP ([email protected]) is Associate Professor and Medical Librarian, Medical Library, Oakland University William Beaumont School of Medicine, 130 Kresge Library, 2200 North Squirrel Road, Rochester, MI 48309. Jill Stefaniak, PhD, CPLP ([email protected]) is Assistant Professor,
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Department of STEM Education & Professional Studies, 228 Darden College of Education, Old Dominion University, Norfolk, VA, 23529. Nelia Afonso, MD ([email protected]) is Associate Professor, Director of Art and Practice of Medicine, Assistant Dean for Community Integration & Outreach, William Beaumont Health System, Oakland University William Beaumont School of Medicine, 44300 Dequindre Road, Sterling Heights, MI 48314.
Medical Reference Services Quarterly Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wmrs20
Community Needs Assessment to Reach Out to an Underserved Population a
b
Misa Mi , Jill Stefaniak & Nelia Afonso
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Medical Library , Oakland University William Beaumont School of Medicine , Rochester , Michigan , USA b
Department of STEM Education & Professional Studies , Darden College of Education, Old Dominion University , Norfolk , Virginia , USA c
William Beaumont Health System , Oakland University William Beaumont School of Medicine , Sterling Heights , Michigan , USA Published online: 14 Oct 2014.
Click for updates To cite this article: Misa Mi , Jill Stefaniak & Nelia Afonso (2014) Community Needs Assessment to Reach Out to an Underserved Population, Medical Reference Services Quarterly, 33:4, 375-390, DOI: 10.1080/02763869.2014.957075 To link to this article: http://dx.doi.org/10.1080/02763869.2014.957075
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Medical Reference Services Quarterly, 33(4):375–390, 2014 Published with license by Taylor & Francis ISSN: 0276-3869 print=1540-9597 online DOI: 10.1080/02763869.2014.957075
Community Needs Assessment to Reach Out to an Underserved Population
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MISA MI Medical Library, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
JILL STEFANIAK Department of STEM Education & Professional Studies, Darden College of Education, Old Dominion University, Norfolk, Virginia, USA
NELIA AFONSO William Beaumont Health System, Oakland University William Beaumont School of Medicine, Sterling Heights, Michigan, USA
A community-based participatory research project was conducted to identify health information needs of clients (an underserved population) at a homeless shelter. Staff at the shelter, medical students, and public librarians were sought as outreach partners; their needs and challenges in accessing health information resources to serve underserved populations were also assessed. The community needs assessment yielded results that helped shape a medical library’s efforts in supporting medical students’ service-learning activities related to humanistic education. The resulting data also informed library decisions on health information education outreach programs tailored to vulnerable, underserved populations and community partners serving the specific populations in the communities. KEYWORDS Community-based participatory research, community outreach, consumer health, health information literacy, health sciences libraries, medical students, needs assessment, service-learning, underserved populations # Misa Mi, Jill Stefaniak, and Nelia Afonso Received: November 22, 2013; Revised: March 5, 2014; Accepted: April 26, 2014. Address correspondence to Misa Mi, Medical Library, Oakland University William Beaumont School of Medicine, 130 Kresge Library, 2200 North Squirrel Road, Rochester, MI 48309. E-mail: [email protected] 375
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INTRODUCTION ‘‘Humanism in medicine describes relationships between physicians and their patients that are respectful and compassionate. It is reflected in attitudes and behaviors that are sensitive to the values, autonomy, cultural and ethnic backgrounds of others.’’1 Medical schools and the community of health profession educators increasingly stress the importance of integrating humanistic values into health professions education in order to achieve a more socially engaged, compassionate, and humanistic workforce. Health sciences librarians have been actively involved in developing and offering evidence-based medicine programs or instruction.2 It should be noted that the growing attention to and influence of humanistic education afford abundant opportunities for librarians to play an important role in developing the medical curriculum that would ‘‘build a well-rounded student body.’’3 Megan Curran advocated for librarians’ increased support for medical humanities, which is one of many ways to make librarians indispensible to library users.3 Humanism in medicine recognizes the ‘‘rebalance of the dual pillars of medicine and humanism.’’1 It provides a fertile ground for librarians to contribute to the goal of medical education in developing medical students’ humanistic skills. This article will demonstrate a medical library’s involvement in students’ service-learning through library community outreach efforts.
BACKGROUND The Oakland University William Beaumont School of Medicine (OUWB) is a new medical school in Rochester, Oakland County, Michigan. OUWB has implemented an innovative, integrated curriculum that features service-learning experiences woven into several preclinical courses to inspire students to work as partners with patients and communities. Service is one of the seven important attributes or traits that a humanistic doctor embodies. It is defined as ‘‘sharing of one’s talent, time and resources with those in need; giving beyond what is required.’’1 South Oakland Shelter (SOS), a nonprofit, community-based, organization located in the same county, works together in partnership with 67 congregations to operate a rotating shelter system to house and feed the homeless population, the SOS clients. It has assisted individuals and families in seeking stabilization and self-sufficiency through counseling services, career development classes, and educational seminars. OUWB has established a partnership with SOS to develop service-learning experiences. One goal of these experiences is to help students develop an awareness of the health care needs of a more vulnerable patient population. Through their work at SOS, students have an opportunity to integrate their knowledge and
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skills with real-life experiences in the communities early in their medical training. The purpose of the study was to identify health information needs of SOS clients. Staff at SOS, medical students at OUWB, and librarians in public libraries in Oakland County were sought as outreach partners. Their needs and challenges in accessing health information to serve underserved populations were also assessed. The ultimate goal of the needs assessment was to identify outcomes that would help the medical library develop future outreach programs to meet specific needs of underserved populations and community partners. These programs may include (a) developing and distributing educational materials to vulnerable and underserved populations to improve their health information literacy; (b) designing and delivering online or face-to-face training programs to increase community partners’ awareness of credible, trusted consumer information resources from the National Library of Medicine (NLM); and (c) enhancing the ability of community partners to find and use quality health information effectively so that they can better serve the specific populations and meet their information needs.
METHODS Participants Targeted outreach populations recruited to participate in the community needs assessment included a convenience sample of SOS clients and staff, first- and second-year medical students at OUWB, and librarians from public libraries in Oakland County. The clients that SOS serves represent a diverse range of people in need, including first-time homeless individuals and families, chronically homeless individuals, veterans, domestic violence victims, as well as people battling substance abuse, mental health issues, and frequently, both.
Needs Assessment Surveys The community needs assessment was conducted with four needs assessment surveys administered to the four target outreach groups. The needs assessment was conducted by following the standard methods recommended in the literature.4,5 When developing the surveys for clients and staff at SOS and public librarians, a collaborative partnership approach was attempted to engage community partners in the research process. All project collaborators worked together to construct the surveys. Suggestions and comments about the surveys were solicited from two SOS directors, two public library directors, and one public librarian; revisions were made to improve the surveys based on their input.
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The survey for SOS clients included a set of questions on clients’ demographic information and their health information literacy level as well as questions that assessed clients’ needs and skills in accessing and using health information resources and technologies. The survey for SOS staff identified staff’s needs in serving and educating clients about NLM consumer health information resources. The survey for public librarians assessed public librarians’ awareness of these resources as well as the level of computer access and current status of health information access by the public in individual libraries. The needs assessment survey administered to medical students comprised seven questions that determined students’ awareness and use of quality consumer health information resources. The survey for SOS clients was conducted as a structured interview, while the other three surveys were administered to participants online via SurveyMonkey.
Procedures Clients who used SOS services during the period from March 2013 to the first week of April 2013 were recruited to participate in the needs assessment survey. One key research personnel (research assistant) scheduled on-site visits to identify and approach clients for the survey participation. Given that SOS clients may have varying levels of literacy, the research assistant conducted each interview by reading aloud survey questions to each participant. For SOS staff, an e-mail message was sent to a SOS director who forwarded it to all 15 staff. The e-mail message included a link to the online needs assessment survey. Thirty-five public libraries located in Oakland County were identified, and a directory of contact information for all directors was complied. Each director was contacted by e-mail about the needs assessment. Those who agreed to participate were sent a URL link to the online survey to be forwarded to their library staff. As of conducting this project, only two cohorts of medical students (124) were matriculated in the medical school. The needs assessment survey was distributed to the students by e-mail. E-mail reminders were sent to each group following the initial recruitment message.
Data Collection and Analysis Data collected from the surveys for SOS staff, public librarians, and medical students were downloaded from SurveyMonkey to Excel for descriptive statistical analysis. Responses from the structured interview with SOS clients were imported to SurveyMonkey manually and downloaded for descriptive statistical analysis.
RESULTS A total of 22 SOS clients participated in the interview. Of 15 SOS staff, 10 provided responses to the survey. Twenty-eight librarians from 17 out of
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35 public libraries in Oakland County responded to the survey. Of 124 medical students, 41 (a response rate of 33%) submitted their responses to the survey.
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SOS Clients SOS client participants included 10 females and 12 males ranging in age from 35 to 64 years old. Of 22 participants, half were white, and half were African American. They possessed varying levels of education, as shown in Table 1. More than half of participants (52.38%) expressed their unmet health information needs. Health or medical information was needed on such topics as prescription review, blood pressure monitoring, diabetes, dental care, mental health (anxiety, depression), asthma, eye care, gynecological care, leg joint issues, and obesity. A majority of participants sought health or medical information from health care providers or the Internet if they themselves or someone close to them had a health-related question as illustrated TABLE 1 Demographic Information on SOS Clients Demographic information on SOS clients What is your gender? (n ¼ 22) Female Male What is your age? (n ¼ 22) 18 to 25 26 to 34 35 to 44 45 to 54 55 to 64 65þ What is the highest level of education you have completed? (n ¼ 22) No schooling completed Pre-K to 8th grade Post graduate Less than high school High school=GED Vocational=technical training College graduate Some college Not sure What is your ethic origin (or race)? (n ¼ 21) White Hispanic or Latino Black or African American Native American or America Indian Asian=Pacific Islander Other
Number of participants
Percentage
10 12
45.45 54.55
0 0 6 10 6 0
0 0 27.27 45.45 27.27 0
0 0 0 2 8 3 3 10 0
0 0 0 9.09 36.36 13.64 13.64 45.45 0
11 0 11 1 1 1
52.38 0 52.38 4.76 0 4.76
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in Table 2. Other resources from which they sought health information included neighbors, the United Way, WebMD, Mom, caseworkers from Americorp, free clinic, and pharmacists. Among all the sources listed, health care providers were perceived as the most useful, followed by the Internet. The United Way, public library, and pharmacists were also considered as useful to them. The easiest to access for them was the Internet, followed by health care providers. The United Way, caseworkers from Americorp, and pharmacists were also perceived as easy to access. The survey also assessed SOS clients’ access to a computer as well as their ability to use a computer or the Internet to find health or medical information. Of the 22 participants, 20 had access to a computer; 18 of the 22 had access to the Internet. The majority of participants felt very comfortable or comfortable in using a computer or the Internet to find health medical information, whereas one-fourth of respondents (6 out of 22) expressed their difficulties in accessing and using online health or medical information. These difficulties included firewalls at SOS, not being able to access WebMD due to firewalls, limited hours with Internet access due to a lack of a personal computer, or lack of expertise in using a computer.
SOS Staff The majority of staff participants reported answering clients’ questions related to health issues and health or medical information (see Table 3). Seven participants reported accessing health or medical information from the Internet. Other resources of information used to meet clients’ health or medical information needs included free=local clinics, mental health providers, prescription discount programs, case managers, Google searches, and local hospitals. Resources deemed to be most helpful to SOS staff in assisting and serving SOS clients were free or low-cost care and prescriptions, medical services in Oakland County, a less expensive way to transport clients to the hospital for non-emergencies, signs, symptoms and treatment options for common conditions affecting the homeless. Regarding the adequacy of health-related TABLE 2 Resources Used for Health or Medical Information by SOS Clients Resources Health care provider Health fair Newspaper=magazines=books TV=radio Internet Family or friends South Oakland shelter Local public library
Number of participants
Percentage (n ¼ 16)
13 2 5 2 13 6 6 5
65 10 25 10 65 30 30 25
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TABLE 3 Frequency With Which SOS Staff Answered Questions Related to Health Issues and Health or Medical Information Answer choices
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Once a day A few times a week Once a week Several times a month Once a month Not at all
Number of participants
Percentage (n ¼ 10)
2 2 1 2 2 1
20 20 10 20 20 10
resources for serving SOS clients, four staff members felt that the resources were not adequate at all. Five reported that they were somewhat adequate, whereas only one staff member indicated that they were adequate. Regarding barriers to using and accessing online health or medical information, three staff offered the following comments: .
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‘‘Often I don’t know where to begin; also, when you find out information about free or low-cost care or clinics for uninsured people, they often have qualifications=stipulations=procedures=barriers that they don’t put right on their website, which makes it hard to know if I am suggesting appropriate resources for clients or just sending them on a wild goose chase.’’ (Staff A) ‘‘A lot of the clients do not know how to seek out quality information on the Internet opposed to myths about health care information.’’ (Staff B) ‘‘I do not encounter these problems but I see the clients having problems wording searches and knowing what to call a specific problem for a search.’’ (Staff C)
Public Libraries A majority of participants (85.18%) reported serving individuals from an underserved population daily. More than half of participants (81.77%) reported answering questions related to health issues and health or medical information on a regular basis (see Table 4). A few participants (7 out of 27) TABLE 4 Frequency With Which Public Librarians Answered Questions Related to Health Issues and Health or Medical Information Answer choices More than once each day Once a day A few times a week Once a week Several times a month Several times a year Never
Number of participants (n ¼ 27)
Percentage
6 1 10 4 5 1 0
22.22 3.7 37.04 14.81 18.52 3.7 0
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indicated that they never used the NLM consumer health information resources such as MedlinePlus. Circulating books, reference books, and online resources were three top choices of resources used frequently to answer medical reference questions. Over half of participants (66.66%) felt they were excellent or very good at accessing reliable health or medical information on the Internet. Diabetes, mental health, and dementia=Alzheimer’s disease were the top three common health problems that librarians were asked to search for (see Table 5). Other health topics inquired about included cancer, substance=drug abuse, alcoholism, sleep disorder, and unusual conditions=diseases which patrons did not know how to spell. A number of participants perceived seniors and the uninsured=economically disadvantaged as two groups of health information users most in need for outreach in their own libraries. They felt that outreach programs on issues of interest to seniors, mental health resources for low-income people, and resources for finding low-cost=free=affordable health care or insurance plans would be most helpful in their work with these groups. The following comments made by participants reflected barriers faced by public librarians to serve underserved populations: . . . . . . . .
Fear of being asked and of misunderstanding of what they were told about the illness; Inability to understand or access available resources; Finding clearly written and up-to-date material, and knowing where to look for information; Countering Dr. Oz or the latest cure in the popular media; Mental limitations of requestors; Poor personal hygiene of requestors; Requestors not thinking of the library as a resource; and Need for lengthy reference interview to understand what patrons want.
A few participants alluded to other challenges that could arise in serving patrons from underserved populations. These patrons may have a very low TABLE 5 Information Searched for Common Health Problems by Public Librarians Information searched for common health problems
Number of participants (n ¼ 27)
Percentage
Diabetes Prescription review Asthma, COPD Blood pressure monitoring Frost bite Dehydration Dementia=Alzheimer’s Mental health Other
21 10 2 3 0 0 13 15 12
77.78 37.04 7.41 11.11 0.00 0.00 48.15 55.56 44.44
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level of learning ability or reading level, be unemployed without insurance, or unable to grasp complex health concepts and to understand the technical terms contained in some health information resources.
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Medical Students at OUWB Among student participants, 22 of them (55%) were first-year students and 18 (45%) were second-year students. An equal number of female and male students responded to the survey. One survey question was intended to identify resources used by medical students for quality health information. UpToDate (17 out of 40 students) was ranked as the top choice of resources, followed by PubMed (see Table 6). Five students used MedlinePlus; one student mentioned PubMed Health from the National Institutes of Health; and six selected Google. Other online information resources mentioned included DynaMed, AccessMedicine, MD Consult, and Micromedex. Regarding their experience in using NLM consumer health information resources such as MedlinePlus, 70% participants (28 out of 40) reported using it. For challenges in accessing NLM consumer health information resources such as MedlinePlus, eight students reported no challenges; five were unsure about it due to lack of experience with it. A few others mentioned the following challenges in accessing the resources:
TABLE 6 Resources Accessed for Quality Health Information Resources by Medical Students Resources UpToDate PubMed OUWB library website Dynamed Google Micromedex MedlinePlus Mayo Clinic NIH website Wikipedia AccessMedicine MD Consult CDC The Internet PubMed Health Surgeon General.gov Medscape Medline WebMD
Frequency of resources accessed (n ¼ 40) 17 16 8 6 6 5 5 4 4 2 2 2 2 2 1 1 1 1 1
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‘‘Narrowing down the information to what is relevant to what I am looking for is my biggest challenge.’’ (Student A) ‘‘Finding the right keywords for the disease process I am searching for is a challenge.’’ (Student B) ‘‘Sometimes, the disease process, including the name, is simplified on consumer pages making it difficult for me to find what I am looking for.’’ (Student C) ‘‘They are not as easy to navigate and get to as some websites.’’ (Student D) ‘‘It is often too simplified.’’ (Student E) ‘‘Not being able to easily search for what I specifically want’’ (Student F) Two students commented on their use of Google versus MedlinePlus:
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‘‘I often start with a Google search regarding my topic and if MedlinePlus appears, I will check out the information. For some reason I seldom start at MedlinePlus, though, and instead use Google as the launching pad.’’ (Student G) ‘‘It is not always the top response on Google, and I don’t usually think to go to MedlinePlus first.’’ (Student H)
Student participants also anticipated various challenges encountered by physicians in educating underserved populations: patient compliance, language barriers, literacy levels, cultural barriers, racism, follow-up, poverty, trust, and inability to afford health care. They suggested the following sources of information as the most helpful in educating underserved populations: . . . . . . . .
direct communication with their doctor, brochures, educational videos, handouts from their doctor’s office or free clinics, easy-to-read and easy-to-understand materials, health fairs, verbal instructions with accompanying pamphlets with a lot of pictures, and information on where they can call or go to receive help for health-related issues.
DISCUSSION The success factor most commonly cited for outreach projects in both current literature and responses to a survey of medical and health sciences libraries is to understand customer needs.6 The needs assessment afforded an
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opportunity for the OUWB Medical Library to collaborate with SOS in assessing information needs of its staff and clients. Another success factor for outreach projects is networking or building relationships with the targeted groups.6 Public librarians and medical students were sought as outreach partners in educating underserved populations about NLM consumer health information resources for the needs assessment. This allowed us to examine and identify unique and specific resource needs of SOS staff, public librarians, and medical students. It also identified barriers that community outreach partners faced in serving vulnerable and underserved populations. For SOS clients, health care providers and the Internet were ranked as the top choices of sources used to seek health or medical information. However, a health care provider was considered the most useful resource while the Internet was considered the easiest to access. Today, valuable Internet resources are available for health information (e.g., NLM consumer health information resources via MedlinePlus). Nonetheless, many sites provide poor, inaccurate, or unsubstantiated health information to nonsavvy consumers.7–9 Since the Internet was identified as the easiest means to access health information, medical librarians could collaborate with public librarians, SOS, other local agencies, and organizations to provide workshops or outreach activities (e.g., a health fair) for underserved populations to guide their use of online health information and to help them use the information to make healthy choices. Survey results reveal that some SOS clients had unmet health information needs related to ‘‘problems of daily survival.’’ A few clients reported no access to high-speed Internet or a personal computer. When using computers at SOS, some clients expressed their frustration with computer firewalls that prohibited them from accessing certain websites (e.g., WebMD). Most of SOS staff did not refer their clients to the local public library for getting health or medical information. The survey results suggest that most public librarians were already serving the underserved population and answering questions related to health issues and health or medical information on a daily basis. Over half of public librarians had the ability to access reliable health or medical information on the Internet. Public libraries have been a popular place to access a computer or the Internet.10 It is advisable for homeless shelters to partner with a local public library and to refer their clients to public librarians who are positioned to play a role in educating and meeting the needs of underserved or economically disadvantaged people with no access to a personal computer or no skills in searching the Internet for quality health information. It should be noted that nearly one-third of participating public librarians were unaware of NLM consumer health information resources (e.g., MedlinePlus). Seniors and the uninsured=economically disadvantaged were perceived as two groups of health information users most in need for outreach in public libraries. Clearly, medical librarians are presented with great opportunities to take the lead in caring for underserved populations by working in collaboration with SOS staff and public librarians to educate and serve
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identified outreach groups. Future outreach training programs and education material (e.g., customized information pamphlets, one-page information sheet) could be developed to help SOS staff meet clients’ immediate information needs and better guide them to sources of credible and trustworthy health information. Outreach programs could be developed and extended to public librarians to assist them in reaching out to underserved populations and becoming ‘‘better sources of health information for the public.’’11 Medical students at OUWB were another group of outreach partners targeted in the community needs assessment. ‘‘Medical students represent a vast and efficient source of enthusiasm and energy for public outreach endeavors.’’12 Medical students as a valuable resource could be recruited as volunteer health educators in outreach programs. When researching and teaching others about different health topics, students have the opportunity to engage in servicelearning experiences, apply and improve their content knowledge, and heighten their awareness of these topics.12–15 A large number of student participants in the survey reported accessing online quality information resources through PubMed, UpToDate, DynaMed, AccessMedicine, MD Consult, Micromedix, and MedlinePlus. It was not surprising that a number of participants were aware of NLM health information resources as well as some resources licensed by the OUWB Medical Library since information literacy instruction was integrated into their first-year curriculum. Nevertheless, the needs assessment results showed existing gaps in students’ knowledge of and skills in using NLM resources, especially MedlinePlus. A number of students (30%) reported no experience with MedlinePlus; a few reported using Google as a launching pad for health or medical information. Continuous efforts are needed to teach students information literacy=skills in the medical curriculum. The ability to identify, access, and use health information resources is an important, self-directed, life-long learning skill for students as future physicians in caring for underserved populations in specific and patients in general. The challenges perceived by medical students in educating underserved populations will inform future library planning on information literacy instruction as well as outreach efforts in support of students’ service-learning related to medical humanities.
LIMITATIONS There are several inherent limitations in the study. The response rate to the needs assessment survey by medical students was low. Medical students were surveyed for a variety of purposes in the new medical school (e.g., course evaluations, various educational research projects, service-learning activities, and other events). The students may have developed survey fatigue that might contribute to the low response rate for the online survey; therefore, the findings reported here should be viewed cautiously as they do not represent those who chose not to respond to the survey.
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Another limiting factor for the needs assessment (a major challenge in the study) was the inability to sample a large number of SOS clients. This was due to scheduling constraints and client hesitation to participate. SOS operates a shelter system that lodges and feeds displaced households. It has the capacity to provide supportive services for about 30 clients monthly. The number of clients who visit SOS fluctuates from day to day. As a result, the service usage pattern affected the recruitment of a large sample of clients for the needs assessment within a short period of time. A larger sample from multiple homeless shelters would provide a stronger basis for generalizing results. Furthermore, the nature of the needs assessment survey is self-report; participants self-selected based on their interest in the survey.
FUTURE PLANS New clients utilize SOS services each month. These clients arrive with various challenges, health information needs, and information literacy levels. OUWB librarians will continue to work with the primary care physician to examine and monitor differential information behaviors and needs of SOS clients. Doing so will enable OUWB librarians to stay mindful of client needs and to develop strategies tailored to SOS staff who can in turn better facilitate SOS clients’ access to NLM online information resources. Meanwhile, librarians will further the integration of information literacy instruction into the medical curriculum to equip medical students with information competence and to enhance their service-learning experiences in both working with underserved populations and educating them about various health issues. To better serve the specific population, SOS staff, and public libraries, the OUWB Medical Library could collaborate to create a referral system that would enable SOS staff to refer clients to local public libraries. Medical librarians could provide in-depth references and consultations for public libraries in Oakland County. They could also develop, organize, and facilitate outreach programs for SOS staff and public librarians. These programs could focus NLM consumer health resources or be devoted to a specific disease or condition, since the most successful outreach programs were those developed with a disease-specific approach.11 Through concerted efforts from all parties involved, a wiki website could be constructed to contain an online directory of contact information of agencies, community organizations, clinics, and educational institutions. This website would provide free=low cost health care as well as information resources most useful for underserved or economically disadvantaged individuals and senior citizens. The results of the needs assessment demonstrate a dire need for such information. The needs assessment conducted with a collaborative approach suggests an implication for health sciences librarians interested in getting
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involved in medical students’ humanistic education. Collaboration is a key to satisfactory outcomes in a community outreach project. It is necessary to examine the context for any community outreach efforts and to engage all outreach partners in the research process. It is equally important to recognize that each of the partners could share a commitment to and responsibilities for health education and promotion. All partners can contribute to the success of future health education programs to improve health outcomes and to reduce health disparities and inequalities.
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CONCLUSION The valuable information yielded from the community needs assessment is not only assisting the OUWB Medical Library in providing health information outreach education tailored to underserved populations but also shaping the library’s efforts in educating medical students about credible and trusted consumer health information resources. The needs assessment served as a great first step for medical librarians in developing a relationship with community partners who would otherwise operate in silos in their own efforts to serve underserved populations in the communities. Medical librarians can be an integral part of educational endeavors in helping medical students becoming ‘‘holistic physicians,’’ who are caring, socially engaged, and compassionate. Librarians’ outreach to communities enhances the institutional mission and supports the integration of humanism into the medical curriculum. The emphasis of the needs assessment on serving underserved populations and educating community partners about credible and trusted health information resources contributes to the Healthy People 2020 goal of improving health outcomes and reducing health disparities and inequalities.
FUNDING This project has been funded in whole or in part with federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract No. HHSN-276-2011-00005C with the University of Illinois at Chicago.
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ABOUT THE AUTHORS Misa Mi, PhD, MLIS, AHIP ([email protected]) is Associate Professor and Medical Librarian, Medical Library, Oakland University William Beaumont School of Medicine, 130 Kresge Library, 2200 North Squirrel Road, Rochester, MI 48309. Jill Stefaniak, PhD, CPLP ([email protected]) is Assistant Professor,
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Department of STEM Education & Professional Studies, 228 Darden College of Education, Old Dominion University, Norfolk, VA, 23529. Nelia Afonso, MD ([email protected]) is Associate Professor, Director of Art and Practice of Medicine, Assistant Dean for Community Integration & Outreach, William Beaumont Health System, Oakland University William Beaumont School of Medicine, 44300 Dequindre Road, Sterling Heights, MI 48314.
