Characteristics of project management at institutions sponsoring National Library of Medicine MedlinePlus Go Local.

OBJECTIVES: Through interviews with the National Library of Medicine's MedlinePlus Go Local collaborators, an evaluation team sought to identify process characteristics that are critical for long-term sustainability of Go Local projects and to describe the impact that Go Local projects have on sponsoring institutions. METHODS: Go Local project coordinators (n = 44) at 31 sponsor institutions participated in semi-structured interviews about their experiences developing and maintaining Go Local sites. Interviews were summarized, checked for accuracy by the participating librarians, and analyzed using a general inductive methodology. RESULTS: Institutional factors that support Go Local projects were identified through the interviews, as well as strategies for staffing and partnerships with external organizations. Positive outcomes for sponsoring institutions also were identified. CONCLUSIONS: The findings may influence the National Library of Medicine team's decisions about improvements to its Go Local system and the support it provides to sponsoring institutions. The findings may benefit current sponsoring institutions as well as those considering or planning a Go Local project.

National survey of pediatric residency program directors and residents regarding education in palliative medicine and end-of-life care.

PURPOSE: To determine how palliative and end-of-life care can best be incorporated into the training of pediatric residents. METHODS: From 2001 to 2002, we surveyed 246 directors and 235 residents of pediatric residency programs. We elicited responses regarding (1) perceived relevance of pediatric palliative care, (2) residents' exposure to palliative medicine, (3) competency of faculty and matriculating residents in palliative care, (4) core palliative medicine competencies, and (5) the best teaching/learning format for palliative care. RESULTS: Fifty-five directors (22.4%) and 98 residents (42.0%) responded. More than three quarters of directors (78.1%) agreed with the statement that palliative care as a competency is "somewhat" to "very" important. Approximately one third (32.7%) agreed with the statement that their residents were not clinically exposed to end-of-life care; 99.0% of the residents indicated participation in such care. Almost one third of directors (27.3%) indicated that they had no faculty available to teach palliative care. Only 38.2% agreed with the statement that matriculating residents are competent in palliative medicine while many residents indicated having limited or no training in core palliative care competencies. DISCUSSION/CONCLUSIONS: For palliative care principles to be better incorporated into pediatric practice, they must be incorporated into residency education, optimally through informal teaching and during rounds. Finding ways to teach residents palliative medicine during clinical "teachable moments" and standardizing didactic curricula should become a priority in palliative and end-of-life care education.

MedlinePlus and the challenge of low health literacy: findings from the Colonias project.

OBJECTIVE: To explore the potential of a community-based health information outreach project to overcome problems associated with health literacy in low-income Hispanic communities along the Texas-Mexico border. METHODS: Using a train-the-trainer approach, community outreach workers known as promotoras were trained by a health information outreach team to search English and Spanish versions of MedlinePlus. These 15 promotoras submitted written examples on a weekly basis of the topics they helped residents explore on MedlinePlus and the ways in which the residents used the information. These weekly reports, along with verbal interviews with promotoras and others in the communities, allowed development of a database of 161 incidents ("stories") demonstrating how community residents used MedlinePlus. These stories were thematically analyzed to explore how the program benefited participants. RESULTS: The database of stories included examples of community residents becoming better informed about their illnesses, resolving to visit doctors, making decisions about recommended treatments, reducing their anxiety about health conditions, committing to healthy or preventive behavior, and assisting family members. CONCLUSION: With the help of paraprofessionals like promotoras, community-based health information outreach projects may improve the ability of community residents to understand their health conditions and to participate actively in their health care.

Becoming better health care providers: outcomes of a primary care service-learning project in medical school.

Medical educators have begun to embrace service-learning as a method for teaching medical students to be more socially responsible, patient-oriented practitioners. However, research documenting the learning outcomes of service-learning in medical education is limited. In this paper, written documents generated through evaluation of a mandatory, structured community service-learning experience were analyzed qualitatively to discover the diverse learning outcomes among 24 students who participated in the experience. Preliminary findings indicate that students developed skills and attitudes directly related to competencies of concern in most U.S. medical programs. These preliminary findings may help other programs articulate learning outcomes for their service-learning programs. Further, these preliminary findings may stimulate more systematic research (qualitative and quantitative) in this area.

Health information Hispanic outreach in the Texas Lower Rio Grande Valley.

PURPOSE: This paper provides an overview of the two-year Texas Lower Rio Grande Valley Health Information Hispanic Outreach (HI HO) project. The project included a needs assessment, four pilot projects, and focus groups on the use of MedlinePlus and MedlinePlus en español. The needs assessment included a survey of physicians' information usage and a review of the circuit librarian program that had been established in 1989. The pilot projects were located at a high school, a rural health clinic, an urban health clinic, and a community center. Diffusion of innovation theory provided a framework for interpreting the results of the pilot projects. METHODS: The survey of physicians' information usage partially replicated a similar 1990 survey. The review of the circuit librarian program included usage statistics, interviews of administrators, and a survey of participants. Pilot project methodology varied by site. At the high school, four students were trained to instruct their peers in the use of MedlinePlus. At the two clinics, a computer workstation was installed for patients to access MedlinePlus. At the community center, staff were trained to use MedlinePlus en español to train community residents. Project evaluation included surveys, focus groups, and interviews. Indicators of success included increased level of consumer use of MedlinePlus, reports by key informants and consumers of how MedlinePlus was used, reports about training, and development of self-sustaining activity. RESULTS: The physician survey documented usage of health information resources in 2002 compared to 1990. The review of the circuit librarian program documented the change in program usage between 1989 and 2003. The pilot project at the high school was the most successful of the four pilot projects in introducing MedlinePlus to a large number of people, followed by the community center project. In the high school and community center projects, the participating institutions had reinforcing educational missions and paid staff who were highly motivated to achieve the project goals. The computer workstations projects at the two clinics were less successful, due in part to limited staff commitment and conflicting priorities. CONCLUSIONS: The HI HO project tested methods of reaching the Hispanic community in the Lower Rio Grande Valley region of Texas. The four HI HO pilot projects varied in achieving their stated objectives. But taken as a whole, the HI HO project significantly contributed to a better understanding of health information outreach to the Hispanic community, knowledge that should be useful to others with similar outreach activities.

Using evaluation to adapt health information outreach to the complex environments of community-based organizations.

OBJECTIVE: After arguing that most community-based organizations (CBOs) function as complex adaptive systems, this white paper describes the evaluation goals, questions, indicators, and methods most important at different stages of community-based health information outreach. MAIN POINTS: This paper presents the basic characteristics of complex adaptive systems and argues that the typical CBO can be considered this type of system. It then presents evaluation as a tool for helping outreach teams adapt their outreach efforts to the CBO environment and thus maximize success. Finally, it describes the goals, questions, indicators, and methods most important or helpful at each stage of evaluation (community assessment, needs assessment and planning, process evaluation, and outcomes assessment). LITERATURE: Literature from complex adaptive systems as applied to health care, business, and evaluation settings is presented. Evaluation models and applications, particularly those based on participatory approaches, are presented as methods for maximizing the effectiveness of evaluation in dynamic CBO environments. CONCLUSION: If one accepts that CBOs function as complex adaptive systems-characterized by dynamic relationships among many agents, influences, and forces-then effective evaluation at the stages of community assessment, needs assessment and planning, process evaluation, and outcomes assessment is critical to outreach success.

High school peer tutors teach MedlinePlus: a model for Hispanic outreach.

OBJECTIVES: The objective was to introduce the MedlinePlus Website to the predominantly Hispanic residents of the Lower Rio Grande Valley region of Texas by partnering with a health professions magnet high school (known as Med High). METHODS: Community assessment was used in the planning stages and included pre-project focus groups with students and teachers. Outreach methods included peer tutor selection, train-the-trainer sessions, school and community outreach, and pre- and posttests of MedlinePlus training sessions. Evaluation methods included Web statistics; end-of-project interviews; focus groups with students, faculty, and librarians; and end-of-project surveys of students and faculty. RESULTS: Four peer tutors reached more than 2,000 people during the project year. Students and faculty found MedlinePlus to be a useful resource. Faculty and librarians developed new or revised teaching methods incorporating MedlinePlus. The project enhanced the role of school librarians as agents of change at Med High. The project continues on a self-sustaining basis. CONCLUSIONS: Using peer tutors is an effective way to educate high school students about health information resources and, through the students, to reach families and community members.

Use of focus groups in a library's strategic planning process.

The use of focus groups to determine patron satisfaction with library resources and services is extensive and well established. This article demonstrates how focus groups can also be used to help shape the future direction of a library as part of the strategic planning process. By responding to questions about their long-term library and information needs, focus group participants at the University of Texas Southwestern Medical Center at Dallas Library contributed an abundance of qualitative patron data that was previously lacking from this process. The selection and recruitment of these patrons is discussed along with the line of questioning used in the various focus group sessions. Of special interest is the way the authors utilized these sessions to mobilize and involve the staff in creating the library's strategic plan. This was accomplished not only by having staff members participate in one of the sessions but also by sharing the project's major findings with them and instructing them in how these findings related to the library's future. The authors' experience demonstrates that focus groups are an effective strategic planning tool for libraries and emphasizes the need to share information broadly, if active involvement of the staff is desired in both the development and implementation of the library's strategic plan.