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V, Issue 3, June 28, 2007 |
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Consumer Health Websites as a Platform for Teaching Evaluation of Internet Content in a Library Instruction CourseRobin M. Sabo, Reference Librarian/Health Sciences Bibliographer, Park Library, Central Michigan University Academic institutions are increasingly concerned with preparing students to critically evaluate information sources, and librarians play a key role in this process. In parallel, the public health system has recognized the need for health literacy in order for consumers to make appropriate healthcare decisions. Finding healthcare information is the third most common use of the Internet, and approximately 75% of students report searching for health information online. Furthermore, previous research shows that students have difficulty determining whether health websites are trustworthy. At Central Michigan University’s Park Library, the librarians teach an undergraduate library instruction course which includes a section on evaluation of Internet sites. Consumer health websites were used as a platform to teach website evaluation skills. In addition to specifics on using consumer health websites in a general undergraduate library instruction course, a review of the literature showing how information literacy and health literacy objectives can be combined, are discussed. IntroductionAs the healthcare system becomes more consumer-driven, patients are expected to assume greater responsibility for medical decision-making. Recent reports measuring health literacy, however, show that “nearly half of all American adults – 90 million people – have difficulty understanding and acting upon health information” (Nielsen-Bohlman, Panzer & Kindig, 2004, p 1). The costs of inadequate health literacy in the United States are estimated at $50 - $73 billion per year (Weiss, 2003, p.5). While persons with college degrees have greater levels of health literacy, only 27% of bachelor’s degree graduates were judged to have “proficient” health literacy (Kutner, Greenberg, Jin, Paulsen & White, 2006, p 14). In addition, competing sources of medical information, including the Internet, have led to the need for ever increasing levels of health literacy (Nielsen-Bohlman et al., 2004). Colleges and universities are also charged with preparing students to be life-long learners and teaching information literacy skills is therefore a key concern. The Association of College and Research Libraries published Information Literacy Competency Standards for Higher Education (Association of College and Research Libraries [ACRL], 2000), and academic librarians have taken an active role in developing instructional programs with information literacy objectives. Central Michigan University librarians have taught a one-credit hour course, Introduction to Library Research, for more than 30 years. Searching and evaluation of Internet sites is one of the key topics covered in this course (Macleod, 2005). Consumer health websites were used to teach students criteria for evaluating health-related materials on the Internet. Health LiteracyHealth literacy as defined by Ratzan and Parker (2000) (and cited in Nielsen-Bohlman et al., 2004, p.32.) is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Many public health initiatives have begun in the past few years to assess and/or improve levels of health literacy. From the Federal Government, health literacy goals were included in Healthy People 2010 objectives (U.S. Department of Health and Human Services, 2000), and the U.S. Department of Education, Institute of Education Sciences released The Health Literacy of America’s Adults - Results from the 2003 National Assessment of Adult Literacy (Kutner et al, 2006). The Committee on Health Literacy of the Institute of Medicine published a comprehensive book entitled, Health Literacy: A Prescription to End Confusion (Nielsen-Bohlman et al., 2004). From the private sector, pharmaceutical company, Pfizer commissioned a white paper on Eradicating Low Health Literacy: The First Public Health Movement of the 21st Century (Pfizer, 2003). In addition, professional societies have begun health literacy initiatives including the American Medical Association who published Health Literacy A Manual for Clinicians (Weiss, 2003). In 2003, the National Library of Medicine partnered with the American College of Physicians to pilot, Information Rx, a program to encourage physicians to refer their patients to MedlinePlus, a consumer health information website from the National Library of Medicine (National Library of Medicine [NLM], 2007). Most recently, a new Information Rx pilot program co-sponsored by the National Library of Medicine and the American Osteopathic Association targets several states including Michigan (NLM, 2007).
One of the difficulties with health literacy is that people may be unaware or reluctant to admit that they have deficits in this area. The results of a Roper poll (Health literacy and the prescription drug experience, 2002) (as cited by Pfizer, 2003, p. 4), found that “only 17% of patients reported that they sometimes or very often had trouble reading or understanding medical instructions”, however 79% reported that many other people had difficulty doing so. In a study investigating the health information literacy of college students at Central Michigan University, researchers found that students’ self-perceptions of their abilities were higher than there actual abilities (Ivanitskaya, O’Boyle & Casey, 2006). Eighty-four percent of the students reported that their research skills were good, very good or excellent (Ivanitskaya et al., 2006, p. 2). Furthermore, they reported that self-reported skill levels were only weakly correlated with actual abilities (Ivanitskaya et al., 2006, p. 2). These authors concluded –
Health information literacy has been determined to be a major problem in the United States, and reluctance by many people to self-identify or admit that they have problems with finding and evaluating health information further compounds the problem. Consumer Health Information on the InternetAccording to the Pew Internet and American Life Project, 80% of American adults who use the Internet report searching for health-related information online and college graduates are one of the demographic groups most likely to look for health-related information on the Web (Fox, 2006). In fact, searching for health information online is the third most common use of the Internet (Fox & Fellows, 2003). A recent survey of college students (American College Health Association, 2006) reported that the Internet was ranked second, after parents as the most used source for obtaining health-related information. Search engines are the most frequently used method for locating health information. Fox (2006) reported 75% of Internet users between ages 18 and 29 started their search with a search engine, and Escoffery et al. (2005) reported similar findings with 73% of college students studied using a search engine to access health information. This dependence on search engines for finding information, as opposed to going directly to reliable websites, increases the probability that consumers will find unreliable information. It may also result in them missing good sources which are part of the invisible web. Although the Internet is used frequently as a source of health information, there is concern over the quality of the information that consumer’s find and their ability to properly evaluate that information. A recent systematic review of studies assessing the quality of consumer health information on the Internet reported that 70% of the studies “concluded that quality is a problem on the Web.” (Eysenbach, Powell, Kuss & Sa, 2002, p. 2691). There are also questions regarding consumers’ abilities to critically evaluate the information they find. For example, only 15% of those searching the Internet for health information, report “always” checking the source and date of the webpage (Fox, 2006, p. 11). Universities and Information LiteracyIn 1989, the American Library Association published the Presidential Committee on Information Literacy’s Final Report (Association of College and Research Libraries [ACRL], 2000). This report highlighted the importance of information literacy as a survival skill in the information age and of life-long learning in an age where the half-life of information is rapidly shrinking. According to the American Library Association, information literacy is the ability to recognize when information is needed along with the skills to locate, evaluate, and effectively use that information. (American Library Association [ALA], 1989). Among the Association of College and Research Libraries’ Information Literacy Competency Standards for Higher Education is the ability to find information effectively and efficiently and the skills to critically evaluate information for reliability, validity, accuracy, authority, timeliness, and point of view or bias (ACRL, 2000) To promote information literacy many universities have included library instruction in their curricula with some academic institutions teaching for credit courses (Jacobson, & Mark, 2000). Incorporating Health Information with Library Information/Literacy InstructionOne of the recommendations made by the Institute of Medicine report on information literacy was that educators should integrate “health-related tasks, materials and examples into existing lesson plans” (Nielsen-Bohlman et al., 2004, p. 161). Using consumer health Internet sites as a platform for teaching students how to find and evaluate websites ties key skills required for information literacy and health literacy. Librarians at Central Michigan University teach a one-credit course entitled Introduction to Library Research. This 50-minute class meets twice a week for eight weeks and is limited to 25 students per class. The “hands-on” classes are held in a modern library classroom with each student having access to a computer workstation. As part of this class, sessions on Internet searching and evaluation of materials on the web are included. These sessions focus on the information locating and evaluation portions of information literacy skills. As a pilot, consumer health information websites were used to teach these concepts during two class periods. During the first class, brief statistical information on how the Internet is being used to search for health information was presented including how students use the Internet to search for health information and the most frequent health topics searched. Several examples of unreliable health websites were shown and examples of high quality consumer health websites were reviewed. Students received a list of reliable sources for locating consumer health information on the Internet including websites sponsored by -
Several features of top websites were pointed out. These include - MedlinePlus - health topics, drugs and supplements and medical dictionary; Mayo Clinic - disease and condition center; and American Medical Association -Doctor Finder. At the end of the class, students were given a five question worksheet and asked to locate the answers from the demonstrated websites. Questions included - What is cat scratch fever? What side effects might occur with the use of the herbal supplement, Echinacea? Find the name of a pediatrician in a specific zip code. During the second class a Checklist for Evaluating Internet Sites was presented including the following criteria:
High quality health Internet sites such as the American Diabetes Association were used to demonstrate examples of how criteria from the checklist were presented. The class was then divided into groups of four or five students, and each group was presented with two different websites. The Internet sites distributed to the students ranged from hoax sites to high quality sites. The students were asked to evaluate the sites using the checklist and to determine whether they would recommend this site. After the small groups met for 20 minutes, they discussed their findings with the rest of the class. For the most part, the students were able to use the criteria to successfully evaluate the websites. Working in groups appeared to facilitate their learning and to improve their evaluation of the websites. Meola (2004) argues that checklists for teaching evaluation of Internet sites have limitations. He calls for a contextual approach to teaching website evaluation including-“Promoting and explaining reviewed resources; Comparison and Corroboration” (p. 8). Perhaps having students compare and contrast various consumer health websites, along with attempting to corroborate the information found from additional online or print sources, would further enhance the students’ critical evaluation skills. In conclusion, health literacy has been identified as a major problem in the United States, and public health experts are urging educators to incorporate health information into existing curricula. Since students frequently use the Internet to seek out health-related information, using consumer health websites as a platform for teaching evaluation of Internet content makes sense. In addition to teaching information literacy skills, librarians also have an opportunity to improve their students’ health literacy skills. ReferencesAmerican College Health Association (2006). American College Health Association National College Health Assessment (ACHA-NCHA) Spring 2005 reference group data report (abridged). Journal of American College Health. 55(1), 5-16. Association of College and Research Libraries (2000). Information literacy competency standards for higher education. Chicago: American Library Association. Retrieved February 26, 2007, from http://www.ala.org/ala/acrl/acrlstandards/standards.pdf. American Library Association (1989). Presidential Committee on information literacy. Retrieved December 21, 2006, from http://www.ala.org/acrl/legalis.html. Eysenbach, G., Powell, J., Kuss, O. & Sa, E. (2002). Empirical studies assessing the quality of health information for consumers on the World Wide Web – A systematic review. Journal of the American Medical Association. 287(20), 2691-2700. Escoffery, C., Miner, K., Adame, D., Butler, S., McCormick, L & Mendell, E. (2005). Internet use for health information among college students. Journal of American College Health, 53(4), 183-188. Fox, S. (2006, October 29). Online health search 2006. Pew Internet & American Life Project. Retrieved February 27, 2007, from http://www.pewinternet.org/pdfs/PIP_Online_Health_2006.pdf. Fox, S. & Fellows, D. (2003, July 16). Internet health resources. Pew Internet & American Life Project. Retrieved March 5, from http://www.pewinternet.org/pdfs/PIP_Health_Report_July_2003.pdf. Ivanitskaya, L., O’Boyle, I. & Casey, A. (2006). Health information literacy and competencies of information age students: Results from the interactive online Research Readiness Self-Assessment (RRSA). Journal of Medical Internet Research, 8(2), e6). Retrieved October 23, 2006, from http://www.jmir.org. Jacobson, T. & Mark, B. (2000). Separating wheat from chaff: Helping first-year students become information savvy. Journal of General Education, 49(4), 256-278. Kutner, M., Greenberg, E., Jin, Y., Paulsen, C. & White, S. (2006). The health literacy of America’s adults: Results from the 2003 National Assessment of adult literacy (NCES 2006-483). U.S. Department of Education. Washington, D.C.: National Center for Education Statistics. Retrieved February 27, 2007, from http://nces.ed.gov/pubs2006/2006483.pdf. Macleod, B. (2005). A successful credit course in library instruction. MLA Forum, 4(2). Meola, M. (2004). Chucking the checklist: A contextual approach to teaching undergraduates web-site evaluation. Portal: Libraries and the Academy 4(3), 331-344. Retrieved October 9, 2006, from http://muse.jhu.edu/journals/portal_libraries_and_the_academy/v004/4.3meola.html National Library of Medicine (2007, January 18). NLM launches “Health Information Rx pilot project” with Osteopathic physicians. Retrieved January 26, 2007, from http://www.nlm.nih.gov/news/inforx_osteopathic07.html. Nielsen-Bohlman, L., Panzer, A. & Kindig, D. (Eds.). (2004). Health literacy: A prescription to end all confusion. Washington, D.C.: The National Academies Press. Pfizer (2003). Eradicating low health literacy: The first public health movement of the 21st century –White paper. Partnership for Clear Communication. Retrieved February 27, 2007, from http://www.askme3.org/pdfs/white_paper.pdf U.S. Census Bureau. (2007). Statistical abstract of the United States: 2007 (126th Edition).Washington, D.C. Retrieved February 27, 2007 from, http://www.census.gov/compendia/statab/education. U.S. Department of Health and Human Services (2000). Healthy people 2010. 2nd Ed. with understanding and improving health and objectives for improving health. 2 vols. Washington, DC: U.S. Government Printing Office. Retrieved February 27, 2007 from, http://www.healthypeople.gov/Document/tableofcontents.htm#volume1 Weiss, B.D. (2003). Health literacy: A manual for clinicians. American Medical Association Foundation. Retrieved February 27, 2007, from http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf.
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