Health Information Disparities Research Articles

Developing a Japanese version of the Digital Health Literacy Instrument

Objectives The Internet has made it possible to search for, obtain, transmit, and share information. Accordingly, the ability to use health information and skills related to interactivity taken from the Internet have become important in the medical and health fields. However, there is no scale to evaluate these abilities. Therefore, this study was conducted to assess the validity and reliability of the Digital Health Literacy Instrument (DHLI) and examine the association of digital health literacy (DHL) with the characteristics of the study participants.Methods The Japanese version of the DHLI was developed using the basic guidelines for scale translation. The participants included 2,000 Japanese adults (men: 50.0%, mean age: 40.7±12.0 years) who responded to an Internet-based cross-sectional survey. The Japanese version of the DHLI, attributes, sources of health information, contents of health information taken from the Internet, and eHealth Literacy Scale (eHEALS) scores were obtained using a questionnaire. Confirmatory factor analysis and correlation with eHEALS scores were used to assess construct and criterion validities. Cronbach's alpha and correlation coefficients were computed for internal consistency and test-retest reliability. Differences in DHLI scores for each attribute and variables related to health information were examined using the analysis of variance and t-test.Results Confirmatory factor analysis revealed a goodness-of-fit index of .946, a comparative fit index of .969, and a root mean square error of approximation of .054, confirming that the Japanese version has the same seven-factor structure as the original version does. A significant positive correlation was found between DHLI and eHEALS scores (r=.40, P<.001). Cronbach's alpha was .92, and test-retest reliability was r=.88 (P<.001). DHLI scores were mainly associated with household income, health status, frequency of information searches on the Internet, and devices used. The subscale scores found difficulties in evaluating reliability, determining relevance, and adding self-generated content. Differences in DHL were observed among some sources and contents of health information on the Internet.Conclusion The Japanese version of the DHLI was a sufficiently reliable and valid instrument for assessing DHL among Japanese adults. Our results suggest that low DHL may lead to health information disparities. Therefore, it is necessary to consider support strategies for individuals who need to improve their DHL and for skills that need to be strengthened.

Reliance on Social Networks and Health Professionals for Health Information in the U.S. Adult Population.

The subpopulation of adults depends on non-online health information sources including their social networks and health professionals, to the exclusion of online sources. In view of the digital divide and health information disparities, the roles of race/ethnicity and digital skills are yet to be explored. A nationally representative sample of 6,830 adults from the Program for the International Assessment of Adult Competencies (PIAAC) was analyzed, using binary logistic regression. Black adults and adults with higher digital skills were less likely to be reliant on non-online health information sources, compared to White adults and those with lower digital skills, respectively. Differences in non-online health information source reliance by race/ethnicity and digital skills might be further nuanced by the relevant demographic and socioeconomic characteristics. Increasing digital skills may expand one's health information sources to include reliable online sources and empower adults to promote their health.

Maternal Health Information Disparities Amid Covid-19: Comparing Urban and Rural Expectant Mothers in Ghana

The Covid-19 pandemic disrupted mothers’ access to credible and reliable health information from their healthcare providers. However, the impact of the pandemic on maternal health information access among rural and urban mothers has not been studied, especially in the Global South. Guided by the channel complementarity theory, we examined the sources of maternal health information rural and urban Ghanaian mothers used during the pandemic. Specifically, we analyzed the role access to technology plays in determining the quantity and quality of maternal health information expectant mothers had during the pandemic. Through purposive and snowball sampling techniques, we recruited and conducted in-depth interviews with 15 mothers, eight from rural communities and seven from urban communities in Ghana. We thematically analyzed the data and found that rural and urban mothers used medical and non-medical sources to obtain maternal health information. While medical sources remained the most credible information source even amid the pandemic, the mothers equally appreciated the immense benefits of other sources, particularly the internet. Our findings also suggest that the motivations for using maternal health information sources complementarily were not limited to the mothers’ functional needs, level of interest, and source characteristics but also covered the mothers’ location, resources, and health information literacy levels.

Combining Intergroup Dialogue and Sociotechnical Infrastructure Design: Addressing Social and Technical Determinants of Health Information Disparities with the Latinx Community

This transdisciplinary research project employed a multi-method approach to address health information inequities in Kentucky’s Fayette County during the COVID-19 pandemic. We drew from the study of Sociotechnical Infrastructures, Health Inequities, and Community-Based and Intergroup Dialogue (IGD) to co-create an Alternative Sociotechnical Infrastructure to facilitate information sharing among three stakeholder groups: (1) Latinx community members, (2) civil society organizations, and (3) government officials. Our research design included a combination of methodologies that addressed the technical and, more importantly, the underlying social causes of information access disparities. Focus groups helped identify Information Communication Technology (ICT) use, preferences, barriers, and information-sharing strategies. Community dialogues highlighted information barriers, existing resources, and proposed community-based solutions. The findings informed development of a web-based platform prototype that will facilitate information sharing during a crisis among all stakeholders. The methodology used also allowed the emergence of community champions among Latinx people who need to be invited to the table for these initiatives. We found that combining participatory action research (PAR) principles with critical dialogic methods fosters an environment of trust that enhances collaboration among stakeholders and consequently makes the design of information infrastructures more equitable and sustainable. As Information Communication Technologies embody social relations, we recommend emphasizing dialogic competencies and knowledge around racism/difference while valuing differences, collaboration, equality, and inclusions.

Information and communication technology, educational attainment, and disparity in health information from one's personal social network: The J-SHINE 2017 cross-sectional study.

Previous studies suggested that accessibility to others with useful health information depends on one’s educational background. While Information and Communication Technology is thought to affect health information disparities, it remains unclear whether it widens or narrows them. We aimed to examine how four types of communication media—face-to-face/telephone, E-mail, LINE, social network service (SNS)—modify the association between educational background and accessibility to useful health information in the personal network of Japanese adults. We used data from the third-wave Japanese Study on Stratification, Health, Income, and Neighborhood (J-SHINE) survey conducted in 2017, which targeted middle-aged adults living in four municipalities within Japanese metropolitan areas. The results demonstrated that SNS use moderated the gap between educational backgrounds, suggesting that SNS can be an interventional leverage to close a health-related information gap between socioeconomic positions.

Regular Healthcare Provider Status Does Not Moderate Racial/Ethnic Differences in Human Papillomavirus (HPV) and HPV Vaccine Knowledge.

Background: Racial/ethnic minorities generally have a lower knowledge of human papillomavirus (HPV) and the HPV vaccine than non-Hispanic Whites. They are also less likely to have a regular healthcare provider (HCP). Given the role of HCPs in disseminating health information, we evaluated whether racial/ethnic disparities in HPV knowledge are moderated by regular HCP status. Methods: Data from the Health Information National Trends Survey Five (HINTS 5) Cycles One and Two (2017–2018) were analyzed. HPV and HPV vaccine knowledge were compared by regular HCP status across race/ethnicities. Independent partially-adjusted multivariable logistic regression models were used to assess the association between race/ethnicity and knowledge after controlling for sociodemographic characteristics. The resulting adjusted odds ratios were compared to those from fully-adjusted models that included HCP status. Results: After adjusting for regular HCP status, differences in knowledge persisted between racial/ethnic groups. Compared to Whites, Hispanics and Other race/ethnicities had significantly lower odds of having heard of HPV. Blacks, Hispanics, and Other race/ethnicities had significantly lower odds of having heard of the HPV vaccine. Conclusion: Racial/ethnic minorities had significantly lower levels of knowledge despite HCP status. These data suggest the need to address disparities in health information and strengthen provider–patient communication regarding HPV and the HPV vaccine.

Staying connected during COVID-19: The social and communicative role of an ethnic online community of Chinese international students in South Korea

Abstract As the public health threat posed by the COVID-19 pandemic is still evolving globally, many linguistic minorities are struggling to obtain accurate and timely health information about the disease and its prevention and treatment in their native language. This study argues that existing ethnic online communities can play an important role in dealing with such health information disparities in the wake of the COVID-19 pandemic. By analyzing the activities and postings on an online community of Chinese international students in South Korea, this paper illustrates that the community functions as a virtual hub that produces and disseminates up-to-date and essential information about COVID-19 and provides a platform for users to share experiences and emotions accompanying the unprecedented situation. This study points out that the participation of Chinese international students in the online community is voluntary and based on established infrastructure because of the presence of a greater number of Chinese students in South Korea. Thus, it urges the government and local authorities to be more aware of the importance of providing adequate support and guidance to linguistic minorities in such uncertain and frightening times.

Abstract D009: Racial/ethnic disparities in knowledge of human papilloma virus (HPV) and the HPV vaccine among individuals with a regular healthcare provider: Results from the Health Information National Trends Survey, United States, 2017-2018

Abstract Introduction: Racial/ethnic (R/E) minorities have been shown to have lower knowledge of Human Papillomavirus (HPV) and the HPV vaccine when compared to R/E majorities. They are also less likely to have a regular healthcare provider (HCP). Given that having a regular HCP is associated with higher knowledge of HPV, the HPV vaccine, and higher vaccine completion rates, we sought to evaluate whether R/E disparities in HPV knowledge are attenuated among individuals with a regular HCP. Methods: Weighted data from the Health Information National Trends Survey (HINTS) 5 cycle 1 and 2 (2017-2018) were analyzed using SAS Version 9.4. Self-reported race/ethnicity was used to categorize participants as R/E minority (Black/African American, Hispanic, and Other) or majority (White). Wald chi-square tests were performed to assess the association between R/E minority status and knowledge of HPV and the HPV vaccine. Multivariate logistic regression was used to assess these associations after controlling for pertinent sociodemographic factors (gender, age, education, income, health insurance, geographic area, census region, ever having cancer, and use of the internet). The same associations were assessed in stratified analyses comparing those with and without a regular HCP. Results: Overall, knowledge of HPV and the HPV vaccine was significantly lower among minorities than among majorities (57.62% and 52.51% vs 65.39% and 66.38%). A lower percentage of minorities reported having a regular HCP (52.20%) when compared to majorities (72.71%). While knowledge of HPV and the HPV vaccine was generally higher among individuals with a regular HCP (62.94% compared to 57.84% among those without a regular HCP), differences by R/E status persisted. Specifically, a lower proportion of minorities with a regular HCP had ever heard of HPV (61.40%) or the HPV vaccine (55.14%), when compared to majorities (67% and 67.89%, respectively). In multivariate analyses, minorities had a 35% lower odds of having heard of HPV (odds ratio [OR] = 0.65, confidence interval [CI] = 0.50 – 0.84) and a 45% lower odds of having heard of the HPV vaccine (OR = 0.55, CI = 0.42 – 0.73) when compared to majorities after adjusting for sociodemographic factors. Furthermore, among individuals with a regular HCP, minorities had a 37% (OR = 0.63, CI = 0.48 – 0.83) lower odds of having heard of HPV and a 49% (OR = 0.51, CI = 0.39 – 0.68) lower odds of having heard of the HPV vaccine when compared to majorities after adjusting for sociodemographic factors. Conclusion: These analyses show that R/E minority groups have disparately lower knowledge of HPV and the HPV vaccine when compared to the R/E majority group. Additionally, minorities who had a regular HCP still reported significantly lower levels of HPV and HPV vaccine knowledge than their majority counterparts. These analyses suggest the need to address disparities in health information and strengthen provider-patient communication regarding HPV and the HPV vaccine. Citation Format: Jane Montealegre. Racial/ethnic disparities in knowledge of human papilloma virus (HPV) and the HPV vaccine among individuals with a regular healthcare provider: Results from the Health Information National Trends Survey, United States, 2017-2018 [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D009.

Focus group interview regarding the accessibility of health information for people with disabilities and means of improving this accessibility in the future.

This study concerns the accessibility of health information for people with disabilities. More specifically, by interviewing policy elites who have backgrounds in this area, we seek to obtain their opinions regarding the type of information people with disabilities require, and people with disabilities overall awareness of such information. Based on the information obtained, we also aim to identify methods of improving this accessibility.A focus group interview was conducted involving policy elites who had previously participated in decision-making processes for health policy. These elites were sourced from the fields of academia, medicine, and government. Content analysis was performed using NVivo 10, which is a computer-assisted/aided qualitative data-analysis software.The focus-group participants felt that relevant information for people with disabilities is provided in a fragmentary manner through several channels that have relatively low reliability, which creates difficulties for a significant portion of the target recipients. Discussions regarding the type of health information required by people with disabilities yielded the following topic clusters: information regarding health-care providers who specialize in specific disability types and regarding health behaviors for certain lifecycles, and information that helps people with disabilities return to society. Further, the focus group recommended 2 means of providing essential health information to PWDs in the future. As short-term strategies, the participants proposed simplifying the existing, fragmented information channels and the creation of a comprehensive web-based information portal with an associated call center. As a long-term strategy, they proposed the development of smart-device-based information services that are tailored to the needs of individuals.Efforts to reduce the disparities in health information for people with disabilities are essential for addressing the existing inequality regarding the availability of health information.

Abstract LB-180: Underreporting of race in genomic sequencing studies increases cancer health information disparities

Abstract Purpose: Minorities are often underrepresented in clinical cancer research and the frequency of reporting of race in genomic sequencing studies of cancer is unknown. Disproportionate reporting of race can widen health information disparities and impair clinical decision-making in the underrepresented minority populations in whom cancer disease burden is greatest. This study determined the extent to which race is reported as a clinical variable in sequencing studies of cancer in the United States, the factors associated with reporting of race, and the participation rates of minority populations. Methods: PubMed was systematically searched from January 1, 2010 through November 15, 2018 and a total of 9,410 non-duplicated studies were assessed for eligibility. Publications reporting whole genome or exome sequencing data for patients with one of the ten most common cancers in the United States at sufficient depth to identify rare variants were included in this study. Results: 234 publications containing sequencing data from 16,358 unique patients met inclusion criteria. 36% of studies reported race as a clinical variable compared to 84% of studies reporting age and 83% of studies reporting gender. Reporting of race was associated with cancer type, cohort size, sequencing method, and tissue acquisition date. Minority populations were significantly underpowered to detect recurrent mutations in the majority of cancer types due to small sample size. Conclusion: Race is underreported as a clinical variable in whole genome and exome sequencing studies of cancer in the United States. As the patient populations represented in research studies directly inform clinical decision-making and outcomes, substantially increased efforts are needed to sequence patients from underrepresented populations in order to reduce health disparities in patients of non-European ancestry. Citation Format: Adrienne Nugent, Kelly R. Conatser, Llaran L. Turner, James T. Nugent, Esther May Sarino, Luisel J. Ricks-Santi. Underreporting of race in genomic sequencing studies increases cancer health information disparities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr LB-180.

Sexual health information disparities between heterosexual and LGBTQ+ young adults: Implications for sexual health

Most studies on young adults' sources of sexual health information and confidence in sexual health practices have focused primarily on heterosexual university students. This study sought to bridge this gap in the literature by exploring where emerging adults, including LGBTQ+ individuals and those who do not pursue postsecondary education, obtain their sexuality information and how this relates to sexual self-efficacy. A total of 386 adults between the ages of 18 and 25 were divided into higher education (n=306) versus high school (n=80) groups and heterosexual (n=215) versus LGBTQ+ (n=171) emerging adults. Participants completed measures of sexual health information sources, as well as self-efficacy with regard to sexual health practices. Heterosexual participants obtained significantly more information from school/university courses and less from educational websites/news outlets than LGBTQ+ participants. Heterosexual participants were significantly more confident in their sexual health practices than LGBTQ+ participants. Different sources of information helped predict sexual self-efficacy across these four groups. Acquiring more information from significant others was the only significant predictor of sexual self-efficacy for all four groups. This study suggests that sexual health information should be discussed within a more relational or interpersonal framework, and that LGBTQ+ issues should be further incorporated and integrated in sex education curricula. Implications for healthcare providers, public health policy, sex educators, clinicians and future research are discussed.

Where Do U.S. Adults Who Do Not Use the Internet Get Health Information? Examining Digital Health Information Disparities From 2008 to 2013

With more people turning to the Internet for health information, a few questions remain: Which populations represent the remaining few who have never used the Internet, and where do they go for health information? The purpose of this study is to describe population characteristics and sources of health information among U.S. adults who do not use the Internet. Data from 3 iterations of the Health Information National Trends Survey (n = 1,722) are used to examine trends in health information sources. Weighted predicted probabilities demonstrate changes in information source over time. Older adults, minority populations, and individuals with low educational attainment represent a growing percentage of respondents who have looked for health information but have never used the Internet, highlighting trends in digital information disparities. However, 1 in 10 respondents who have never used the Internet also indicate that the Internet was their first source of health information, presumably through surrogates. Findings highlight digital disparities in information seeking and the complex nature of online information seeking. Future research should examine how individuals conceptualize information sources, measure skills related to evaluating information and sources, and investigate the social nature of information seeking. Health care organizations and public health agencies can leverage the multifaceted nature of information seeking to better develop information resources to increase information access by vulnerable populations.

Does Online Searching Cause or Enforce Health Information Disparity?

A growing number of people are seeking health information on the Internet. To meet demands, healthcare providers are increasingly disseminating information online. While online health information has enhanced the dissemination of health information and improved people's health-related knowledge, critics posit that such dissemination has widened knowledge disparities in health information and health benefits as a result. Drawing on existing studies, this study identified the main causes of such disparity, namely education, health literacy, computer self-efficacy (CSE) and usage of health-related social media. The finding showed that education resided at the centre of the disparity and impacted other elements. An interesting finding is although individuals possess high levels of CSE, the efficacy does not highly impact their health benefits, meaning that computer does not directly cause health information disparity but is the tool to promote health-related knowledge disparity.

Improving an outreach service by analyzing the relationship of health information disparities to socioeconomic indicators using geographic information systems

INTRODUCTIONThe use of geographic information systems (GIS) withUS Census data provides libraries with the power tocombine, analyze, and present information in newways. GIS is a valuable tool capable of ‘‘capturing,storing, analyzing, and displaying geographicallyreferenced information’’ [1]. GIS software combinesmaps with layers of associated data to provide avisual picture that allows greater understanding andanalysis than static figures and tables. Although thesoftware was expensive in the past, GIS has becomeincreasingly more affordable for libraries since it hasbecome available in web-based applications, includ-ing open source options [2].Libraries began incorporating US Census data withGIS when the 1990 census materials were given tothe US federal depository libraries as Topological-ly Integrated Geographic Encoding and Reference(TIGER) files [3]. TIGER files are a set of geographicbase files that contain features of the United Statesdown to the street level and census boundaries forcensus statistical areas. TIGER files are designed foruse with GIS software and include geographic codesthat can be linked with demographic and socioeco-nomic data from American Fact Finder (AFF) and theAmerican Community Survey (ACS) [4, 5]. All TIGER,AFF, and ACS files and data are free to the public.Combined with US Census data, GIS is particularlyuseful for libraries in the area of service planning. Forexample, the Public Library Geographic Databasehas compiled US Census demographics on all 16,000public libraries in order to assist decision makers inlibrary planning [6]. Other examples of the use of GISand US Census data include analyzing service mapsfor proposed branches [7], mapping service areas [8],analyzing demographics of populations surroundingthe library [9, 10], analyzing market segmentation[11], and establishing a public library consumer healthcollection [12].In 2011, the Preston Medical Library, in Knoxville,Tennessee, conducted research using GIS and USCensus data. Our goal was to analyze demographicand socioeconomic patterns in order to improvehealth literacy information outreach through our freetelephone-based Consumer and Patient Health Infor-mation Service (CAPHIS). The library’s free tele-phone-based CAPHIS has been in place for overtwo decades, and call data are maintained in an SQLdatabase. The library staff responds to calls to theCAPHIS by mailing packets of health information atthe appropriate literacy level to the caller. The Pres-ton Medical Library provides a useful alternative forthose individuals who do not have Internet access ormay need additional assistance because of limitedhealth literacy and socioeconomic disparities.Several studies have examined the relationship ofsocioeconomic factors and limited health literacy toincreased health costs, chronic disease, and morbidity[13–16]. Health information through libraries is valu-able and can affect consumer health care decisions.Consumers who use libraries for health informationreport positive health actions such as lifestyle changesand compliance with physician instructions [17, 18].However, consumers with low health literacy andcompounding socioeconomic factors are often notaware of the services provided by libraries. Outreachis conducted by libraries to address these disparitiesand provide information services to those surround-ing communities most in need.RESEARCH BACKGROUNDIn 2003, an SQL database was created that containsinformation regarding consumer calls to CAPHIS.Data on calls from 1998 to the present include thecaller’s name, address, and health information re-quest. Although the names and addresses are kept inseparate tables for privacy, the zip codes of theaddresses can be used to establish geographic localitythat can be plotted on a state map and calculated toestablish a rate and area of calls by zip code. Therequested health topics, which are in keyword forminitially, are subsequently indexed by library staffusing the National Library of Medicine’s (NLM’s)Medical Subject Headings (MeSH) in order to becross-referenced with existing information regardingprevalence of diseases in the state that is madeavailable by the Tennessee Department of Health [19].

Abstract A53: Disparities in health information needs among long-term cancer survivors

Abstract Understanding the role of follow-up care on information needs in long-term cancer survivors is an important and understudied area for research and intervention. We examined health information needs in 1157 cancer survivors 4–14 years post-diagnosis from a population-based survey: the Follow-up Care Use among Survivors (FOCUS) study. Endorsement of six information needs categories (tests/treatments, side effects/symptoms, health promotion, interpersonal/emotional, insurance, and sexual functioning/fertility), total number of needs, and information self-efficacy were regressed on socio-demographic and clinical variables, quality of recent follow-up care, receipt of treatment summary, type of main follow-up doctor, and perceived social support. In the multivariate models, survivors who were younger, African American, and those with lower support (P &amp;lt; 0.05) reported a significantly higher number of needs. Non-whites expressed significantly higher interpersonal/emotional and insurance information needs (P &amp;lt; 0.05). Survivors who did not receive but wanted a written treatment summary were more likely to indicate higher needs in side effects and symptoms (odds ratio: 2.74, 95% CI: 1.54–4.87) than those who had received a treatment summary. After adjustment, number of information needs was inversely related to information self-efficacy (P &amp;lt; 0.05). The pattern of needs reporting suggests persistent health disparities in access to important health information in long-term survivors. Findings also suggest the need for survivorship care planning to equip survivors with comprehensive health information and to consider tailored approaches for communicating this information to diverse survivor populations. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A53.

Diffusion of Social Media Among Public Relations Practitioners in Health Departments Across Various Community Population Sizes

This study reports findings from a survey of 281 public relations practitioners in public health departments serving 4 distinct sizes of communities—urban, suburban, large town, and rural—in 48 states. Based on diffusion of innovations theory, the overall purpose of the study is to examine the extent to which social media are adopted within public health agencies and moderators of adoption. Findings demonstrate overall low adoption rates for social media tools. However, significant differences were observed for adoption based on size of communities, with urban communities exhibiting highest adoption rates, followed by suburban, large town, and rural communities. The most frequently cited barrier practitioners named for why they don't think constituents would benefit from health information distributed online was lack of home access to the Internet. Among the 17 percent of practitioners who indicate they use social media to disseminate health information, the most commonly used tools are social networking sites followed by the new media release, blogs, and discussion boards. Rural areas, although lowest in overall social media use, report highest use of podcasting. Implications regarding health and health information disparities are discussed, a potentially new motivation for innovation adoption is introduced, and future studies to follow the S-shaped adoption curve are proposed.

Health information disparities? determining the relationship between age, poverty, and rate of calls to a consumer and patient health information service

Growth and demand for consumer health information services has been well documented [1–4]. In the past twenty years, medical librarians have transitioned from cautious providers of consumer and patient health information to leaders of outreach programs in which they coordinate with medical professionals and public librarians to serve their communities' health information needs. So prevalent are these services that the Medical Library Association provides guidance on its Consumer and Patient Health Information Section (CAPHIS) website [5], and the American Library Association has issued a policy to guide the growing number of services in providing consumer health information [6]. Beginning with a grant from the Tennessee State Library and Archives, Preston Medical Library, located in Knoxville, Tennessee, has provided a free telephone-based consumer health information service for area citizens and University of Tennessee Medical Center patients and their families since 1989. Despite the wide availability of the Internet, a recent survey of consumers in Tennessee funded by the National Network of Libraries of Medicine (NN/LM), Southeastern/Atlantic Region, to which 233 individuals responded, showed that the inability to identify reliable sources was the single most important stumbling block to finding health information. In the same survey, 37% of respondents ranked libraries as one of their top 3 sources of health information along with doctor's office (61%); Internet and magazines (54%); and newspapers, magazines, and books (25%) [7]. A recent Pew report on the demographics of Internet users shows that while 71% of all adult Americans go online, only 32% of those over 65 and just 55% of those living in households with less than $30,000 in annual income have Internet access [8]. Because a library-based telephone reference service is a low technology way to obtain health information and libraries are a trusted source of health information, populations who are not using the Internet are an important target for the Preston Medical Library's consumer health service. Preston markets its service in various ways. Brochures in physicians' offices and flyers sent to public health departments promote the service to outpatients. In the hospital, information is provided in new patient packets. The library website includes a page describing the Preston Consumer and Patient Health Information Service and suggests other reliable consumer health sites. Preston partners with Knox County Public Library to distribute brochures and provide train-the-trainer classes to staff. Librarians exhibit at community events and speak to consumer groups. This project was undertaken to analyze the demographics of those who called the service in order to assess outreach methods, and change them if needed, and was designed to reach two target groups without Internet access: the elderly and those living below the poverty level. Demographic information could also be helpful in obtaining additional funding to reach these target groups.

A Community-Based Participatory Health Information Needs Assessment to Help Eliminate Diabetes Information Disparities

This article describes the participatory research process, results, action plan, and implications of the community health information needs assessment conducted within the African American community in two South Carolina counties. The REACH 2010: Charleston and Georgetown Diabetes Coalition library program is a partnership among community organizations, public and health sciences libraries, and lay community health advisors. A planning committee studied digital divide issues related to health information, designed and implemented a survey, held focus groups, analyzed data, identified needs and assets, and formulated an action plan to increase the dissemination of diabetes information. Key survey findings show that older (older than 60) and less educated (fewer than 12 years of education) African Americans in Charleston and Georgetown counties lack skills to access Internet and library services and suffer disparities in health information. Based on assessment evidence, the community plans to increase Internet access points and provide a train-the-trainer program to teach people skills for using Internet and library resources to get high-quality information about diabetes and its complications. This process taps community resources, builds local capacities and technical skills, educates about health, and empowers participants as active partners in their own health and their community's health.