Utilizing the Newest Vital Sign (NVS) to Assess Health Literacy at a Regional Academic Medical Center's Family Medicine Clinic.

Researchers examined the correlation between the physician's subjective assessment of health literacy rates and actual health literacy rates among patients as determined by the Newest Vital Sign (NVS). A sample of n = 150 patients, 18 years of age or older, were verbally interviewed using NVS tool before seeing their physician. After the physician met with the patient, the physician was asked to measure that patient's level of health literacy on a Likert-type scale and a "yes/no" scale. Frequency and percentage statistics were performed in SPSS to describe the distributions of patient and physician responses. Between-subjects statistics were used. Analysis of the patient surveys revealed one in 4 patients has a high likelihood of low health literacy. Analysis revealed there were significant positive correlations between physician response to perception of a patient's low health literacy risk and NVS survey responses. Despite the risk of limited literacy, 97.3% of physicians perceived the patient to understand what the physician was saying. Physicians should use teach-back and other health literacy principles with each patient, regardless of perceived risk.

The significance of the library's physical space: how COVID-19 impacted a consumer health service.

Background: During the beginning of the COVID-19 pandemic, many consumer health libraries were forced to close their doors to patrons. At the Health Information Center in Knoxville, Tennessee, the physical space closed, while health information services continued to be provided via phone and email. To examine the impact of lack of access to a physical library for consumer health information, researchers analyzed the number of health information requests pre-COVID-19 pandemic compared to during the initial phase of the pandemic. Case Presentation: Data from an internal database was collected and analyzed. Researchers divided the data into three time periods: March 2018 to February 2019 (Phase 1), March 2019 to February 2020 (Phase 2), and March 2020 to February 2021 (Phase 3). Data was de-identified and duplicate entries were removed. The type of interaction and request topics were reviewed in each phase. Conclusion: In Phase 1, there were 535 walk-ins to request health information and 555 walk-ins in Phase 2. In Phase 3, there were 40 walk-ins. The number of requests through phone and email varied but remained steady. There was a 61.56% decrease in requests between Phase 1 and Phase 3 while there was a 66.27% decrease between Phase 2 and Phase 3 due to the lack of walk-in requests. The number of phone and email requests did not increase despite the closure of the physical library space to the public. Access to the physical space plays a significant role in providing health information requests to patients and family members.

Medical librarians and little free libraries: Connecting rural communities to health information.

BACKGROUND: Consumer health libraries connect communities to reliable and accurate health information while Little Free Libraries (LFL) provide communities globally with access to free books with a 'take one leave one' type policy. OBJECTIVES: To discuss how medical librarians used already established LFLs as outreach opportunities to provide consumer health books to rural locations in East Tennessee's Appalachia region in the United States. METHODS: Researchers reviewed the population's literacy levels, the Index of Medical Underservice scores, and the availability of established LFLs. Twenty-two established LFL locations were selected and one new LFL was built for an eye clinic. Eleven health books were purchased for each established LFL, and 33 books were purchased for the new LFL. RESULTS: Researchers went back to each location 5 months after delivery. 90% of the books were taken from the already established LFLs. Ten books were taken from the new LFL. DISCUSSION: Using already established LFLs is a great opportunity to provide relevant health information to rural communities. The new LFL allowed for a partnership between the library and a rural eye clinic. CONCLUSION: By distributing health books to already established LFLs, researchers brought relevant health information books to rural and medically underserved communities.

The status of scholarly efforts of librarians on health literacy: a bibliometric analysis.

Objective: In order to determine the status of scholarly efforts on health literacy by librarians, researchers examined the characteristics of health literacy publications authored by librarians from 2000 to 2020. Methods: Bibliometric analysis was used to assess the indicators of productivity, affiliation, collaboration, and citation metrics of librarians in health literacy-related research. Data were collected using the Scopus database; articles were screened for inclusion before importation into Microsoft Excel for analysis. SPSS software was used to run basic descriptive statistics. Results: Of 797 search results, 460 references met the inclusion criteria of librarian authorship. There was a significant linear trend upward in publications since 2001 with an average increase of 1.52 papers per year. The number of publications per year peaked in 2019 (n=59). Journal of Consumer Health on the Internet was the most prolific journal. The majority of references were authored by at least two authors and by multidisciplinary teams. Nineteen percent (n=107) of the librarian authors were responsible for more than one publication, and 84.1% of publications were cited at least once. Conclusions: In the last two decades, librarian involvement in health literacy publications has exponentially increased, most markedly in the years following 2014. The productivity, multidisciplinary collaboration efforts, and consistent growth in literature indicate that librarians are engaged in health literacy scholarship. Further research is needed to explore the work of librarians whose impacts on health literacy may not be reflected within well-indexed, peer-reviewed publications.

Collaborative updating of an organizational health literacy tool confirms medical librarians' leadership roles.

BACKGROUND: A librarian led task force at the University of Tennessee Medical Center sought to evaluate their medical centre's health literacy attributes utilizing a widely used tool. This research ultimately led to the update of the tool. OBJECTIVES: To discuss the evaluation of health literacy attributes of health care organizations and detail the process of updating the Health Literacy Environment of Hospitals and Health Centers (HLEHHC) tool. METHODS: Subsequent to utilizing the HLEHHC, the task force was invited to assist in updating the tool. A collaborative was formed between the original author and task force. The collaborative performed an extensive literature review focused on emerging health literacy issues, reviewed each section and formulated changes. RESULTS: The collaborative update process yielded an improved instrument for assessing the extent to which a health care organization accommodates low health literacy patients. DISCUSSION: Through editing, creating new questions and rearranging the format, the HLEHHC was improved and updated. CONCLUSION: The assessment conducted by the health literacy task force is helping shape changes in the organization. Medical librarians acted in leadership roles in the collaborative process of developing the new institutional assessment tool for health literacy (HLE2).

Determining COVID-19's impact on an academic medical library's literature search service.

Objective: At many institutions, literature search services are an important aspect of health science librarianship. This exploratory study analyzes how the COVID-19 pandemic impacted the use of an academic hospital medical library's literature search service. Methods: To evaluate the pandemic's impact on literature searching at The University of Tennessee Medical Center's Preston Medical Library, data were analyzed for changes from the year before the pandemic (March 1, 2019 to February 29, 2020) to the first year during the pandemic (March 1st, 2020 to February 28, 2021). This was accomplished using LibWizard, a library feedback and assessment application, to review literature search data during the two periods. Variables of interest included total searches, purpose of searches, affiliation of the searcher, and searches with a pandemic-related research question. Results: A 36.6% drop in literature search service usage was reported from the pre-pandemic year to the during-pandemic year. There was a 55.3% decrease in searches intended for research, as well as significant decreases in the number of searches requested by all patron affiliations. After March 2020, 10% of all searches concerned a COVID-related topic. Conclusion: The overall decrease in literature search requests, decrease in research searches, decrease in searches among all patron affiliations, and increase in searches on a COVID-related topic suggest that healthcare worker and institutional priorities changed during the pandemic. The results revealed research interests during the first year of the pandemic, as well as an overall change in library service functionality.

Mind like Water: Flexibly Adapting to Serve Patrons in the Era of COVID-19.

The ability to be flexible and adapt quickly to changing circumstances is a crucial skill for librarians to develop in a world increasingly characterized by rapid change. It can take a crisis to learn how effective librarians have become in developing the needed adaptive behaviors, including a willingness to change workstyles, experiment with new technologies and readily move on from failed experiments. In this paper, librarians from the Preston Medical Library at the University of Tennessee Graduate School of Medicine, prompted by the crisis of COVID-19, present their response. Beginning with a description of how services were provided prior to the pandemic, librarians detail their response in several key areas and show how they implemented new approaches to teaching, collaboration, and mutual support, working together to handle patron issues and pursue scholarly activities.

Confronting the opioid crisis with consumer health information: a look at East Tennessee.

BACKGROUND: Starting in the 1990s, health care providers began prescribing opioids to patients as pain relievers, believing they were safe. However, many patients became addicted to these pills. In 2017, the US Department of Health and Human Services declared a public health emergency to fight the opioid epidemic. This crisis was prevalent in East Tennessee, where many residents were prescribed opioids. CASE PRESENTATION: Librarians at an academic medical center library in East Tennessee analyzed the health information requests related to pain, mental health, and addiction over the last fifteen years. We reviewed the pattern of requests related to these topics, the counties requesting this information, and the impact that these hospital policies had on these requests. CONCLUSIONS: From 2005 to 2014, there were few requests about mental health, pain, and substance abuse. However, once the library moved into the hospital and there was an increase in awareness of opioid addiction, requests on those topics increased. Most of the requests were about pain, with the height occurring in 2017, during which year the public health emergency to fight the epidemic was declared. Additionally, 2017 was the year the hospital implemented visitor limitations for patients with infections associated with intravenous drug use, which might explain the drastic drop in substance abuse information requests in 2018. Future outreach will target counties that have a high opioid prescription rate.

Influence of library relocation and marketing: examining zip codes and health disparities to serve consumers in East Tennessee.

BACKGROUND: In 2014, the Preston Medical Library underwent a radical change, moving from an academic office building to the main floor of a regional medical center. While the library had previously served the public, health information requests have substantially increased in volume due to the new location. Researchers analyzed request data to see if the service's reach has expanded to counties that previously had not used the service, to see which counties have requested the most health information, and to ascertain whether more requests are from counties with higher poverty rates. CASE PRESENTATION: Each health information request is logged with the subject nature and patron contact information. Consumer health request data were downloaded from the library database. Names and other identifying data were removed. Request forms were sorted and reviewed by zip code and county, comparing number of requests as well as poverty levels. Tableau was utilized to create maps, visually showing patron concentrations and poverty levels. CONCLUSIONS: There were 3,141 health information requests from September 21, 2014, to May 31, 2019. The majority of requests were from local counties. Requests were also received from counties that had not been previously reached and counties with elevated poverty levels. Collecting data on patron interactions is not only critical for institutional reporting, but also for community outreach. Understanding that data require taking additional steps to filter the information, assess local demographics, and customize library services. Researchers anticipate being able to better tailor services to the community based on the results.

How One Library's Health Information Center Expanded Its Marketing Plan.

When Preston Medical Library moved inside the Medical Center in September 2014, the new patient library, called the Health Information Center (HIC), was added. This addition is a patient focused, consumer health library that, among other things, offers health information and books. After the initial marketing plan was implemented, a task force was created to focus specifically on marketing the consumer health library and its resources. This article discusses how the task force revamped the marketing strategy to include outreach into the medical center's waiting rooms and other opportunities for collaboration.

Librarians Promoting Changes in the Health Care Delivery System through Systematic Assessment.

Patient engagement in health care decisions largely depends on a patient's health literacy and the health literacy attributes of the health care organization. Librarians have an established role in connecting patients with health information in the context of their care. However, librarians can play a larger role in helping to make changes in their organization's health literacy attributes. This article discusses one medical library's process of leading systematic assessment of their organization's health literacy attributes. Included in this discussion is the institutional support, timeline, assessment tool, the results for five areas of health literacy, marketing and the event-planning process to disseminate results. The systematic assessment process described employs the Health Literacy Environment of Hospitals and Health Centers document, which provides assessment tools for Print Communication, Oral Communication, Navigation, Technology, and Policies and Protocols.

Taking the Pulse of the University of Tennessee Medical Center's Health Literacy Knowledge.

Low health literacy is well documented in East Tennessee. Before addressing the issue, librarians at the Preston Medical Library, University of Tennessee Medical Center in Knoxville, Tennessee, conducted a needs assessment of hospital staff to determine their knowledge of health literacy and the need for training. As a follow-up, library staff conducted training sessions for nurses through classes, small group meetings, and staff huddles. The result is an increased dialogue of health literacy at the hospital, along with new research projects, a forum, and a summit meeting.

Computerized versus hand-scored health literacy tools: a comparison of Simple Measure of Gobbledygook (SMOG) and Flesch-Kincaid in printed patient education materials.

OBJECTIVE: The research compared and contrasted hand-scoring and computerized methods of evaluating the grade level of patient education materials that are distributed at an academic medical center in east Tennessee and sought to determine if these materials adhered to the American Medical Association's (AMA's) recommended reading level of sixth grade. METHODS: Librarians at an academic medical center located in the heart of Appalachian Tennessee initiated the assessment of 150 of the most used printed patient education materials. Based on the Flesch-Kincaid (F-K) scoring rubric, 2 of the 150 documents were excluded from statistical comparisons due to the absence of text (images only). Researchers assessed the remaining 148 documents using the hand-scored Simple Measure of Gobbledygook (SMOG) method and the computerized F-K grade level method. For SMOG, 3 independent reviewers hand-scored each of the 150 documents. For F-K, documents were analyzed using Microsoft Word. Reading grade levels scores were entered into a database for statistical analysis. Inter-rater reliability was calculated using intra-class correlation coefficients (ICC). Paired t-tests were used to compare readability means. RESULTS: Acceptable inter-rater reliability was found for SMOG (ICC=0.95). For the 148 documents assessed, SMOG produced a significantly higher mean reading grade level (M=9.6, SD=1.3) than F-K (M=6.5, SD=1.3; p<0.001). Additionally, when using the SMOG method of assessment, 147 of the 148 documents (99.3%) scored above the AMA's recommended reading level of sixth grade. CONCLUSIONS: Computerized health literacy assessment tools, used by many national patient education material providers, might not be representative of the actual reading grade levels of patient education materials. This is problematic in regions like Appalachia because materials may not be comprehensible to the area's low-literacy patients. Medical librarians have the potential to advance their role in patient education to better serve their patient populations.