H1N1 Information Needs: Serving Health Care Organizations During a

Pandemic

Robin Featherstone, MLISMcGill University Health Centre

Gabriel Boldt, MLIS London Health Sciences Centre

Nazi Torabi, MLISUniversity of Western Ontario

Shauna-Lee Konrad, MLIS London Health Sciences Centre

April 29, 2009• 0 emails on H1N1

April 30 – March 4, 2009• 12 “swine flu” emails on April 30th alone• Information received from Gale, Ovid,

Thomson Reuters, Ebsco, CABI, PNAS, NAHRS (MLA), university administration, library administration, department of health sciences…

Snapshot from a Canadian University

March 5, 2009• Distributed survey to members of:

‐ SOHLIN: Southwestern Ontario Health Libraries Information Network

‐ WOHKN: Western Ontario Health Knowledge Network

• Collected details of H1N1 questions: ‐ When were they received? When was information

needed? ‐ Who was asking? ‐ What type of information was required? What sources

were used to answer the request?

Pilot Survey Findings

• Senior Administrators as audience• News media, organizational and governmental

websites as information sources

• Pandemic information needs are different!

Agenda/Outline

• Introduction – Case series research project• Methodology• Findings• Discussion• Conclusions & Recommendations• Future directions

Provision of Pandemic Information by Health Sciences Librarians: A Multi-

Site Comparative Case Study• Objectives:

1. Identify information needs of health professionals during a pandemic

2. Examine technology’s role in pandemic information provision

3. Define health librarians’ roles during a pandemic

• Goals: 1. Anticipate pandemic information needs2. Educate and support librarians

Methodology

• Conducted a literature review• Received Ethics Approval from the University of

Western Ontario• Recruited & screened cases• Conducted semi-structured interviews• Collected supporting evidence (emails, web stats, etc.)• Coded transcripts using NVivo• Compared coded sections within 8 themes• Analyzed content to compare cases• Summarized findings

Case Subject(s) Requestor/Audience Project

23 Academic health sciences librarian

-Self-initiated-For audience of clinicians and nurses

Monitored, selected and shared H1N1 information sources via social software

36 Team of hospital librarians

-Client-initiated (incident management team for an urban hospital system)

Supported administrative decision-making by providing H1N1 statistics and relevant news items via daily email updates

56 Medical librarian

-Self-initiated-For audience of health sciences librarians

Monitored, selected and shared H1N1 information sources via social software

92 Outreach librarian at an academic center

- Client-initiated (government public health department)

Supported clinical and administrative decision-making by providing high-quality evidence from the literature

Cases

Analysis/Coding Themes

1. Time2. Communication3. Technology 4. Evaluation5. Personnel6. Organizational Structure7. Information Request8. Information Gathering

Findings - Time

• Intense demand for information between late April and June, 2009

• Declining information need between June and November, 2009

• Self-initiated project work (cases 23 & 56) took place during “off hours”

• More work hours allocated for client-initiated project work (cases 36 & 92)

Findings – Time (continued)

• In all cases demand for information was immediate/ high

• Client-initiated projects required additional support from colleagues

Findings – Communication

• Self-initiated projects “Pushed” information using social software

• Clients defined communication methods:– Case 36: Emails formatted for

Blackberries (plain text with html links)

– Case 92: Emails and face-to-face interviews

Findings - Technology

• Self-initiated projects used Wikis, blogs, Twitter, RSS, Facebook, etc.

• All projects utilized alerting services (Google Alerts, PubMed email alerts, RSS) to monitor information

• All projects lacked time to adequately test and implement technology solutions

Findings – Evaluating the Service

• Self-initiated projects collected feedback through informal methods

• Librarians tracked webpage metrics • One client-initiated project utilized a formal

evaluation

• All participants evaluated their services to be “useful,” if not “essential.”

Findings – Evaluating the Evidence

Challenges - Locating high quality evidence during the initial stages of a pandemic

- Preventing information overload

Opportunities - Identifying the highest quality information quickly from available sources

- Evaluating information to meet the needs of particular audiences

Findings – Information Request

• Health administrators sought librarian assistance

• Audience included health providers “in the field”

• One library’s involvement had been formalized in their institution’s pandemic plan

Findings – Information Requested

• Clinical questions during the peak period• Critical news alerts during the peak period• Canadian, American and international

mortality and morbidity statistics during the peak and decline

• Research questions during the decline and after the pandemic

Clinical H1N1 Questions

• Effectiveness of antiviral agents? Protective agents (masks, gloves)? H1N1 vaccine?

• Effects of H1N1 on immunosuppressed or immunocompromised patients? Pregnancy?

• Are there adverse reactions to taking the H1N1 vaccine? Under which conditions?

• Relapse possible after taking antivirals? Other medications?

Research H1N1 Questions

• H1N1 in Aboriginal populations?• Socioeconomic factors related to H1N1?• Epidemiological reviews of H1N1 and influenza?• Reviews on Tamiflu and H1N1?• Usefulness or effectiveness of H1N1 public health

surveillance?• Household transmission of H1N1?• Pandemic modelling studies?

H1N1 Information SourcesGov’t or NGO Websites News Sites

Canada -Public Health Agency of Canada-Health Canada-Regional Centers for Disease Control-Ministry of Health and Long Term Care-Provincial health agencies

-CBC-CTV-The Globe and Mail-Calgary Herald-Vancouver Sun

North America -US Centers for Disease Control (Morbidity and Mortality Weekly Report)

-CNN

International -World Health Organization-Pan American Health Organization-European Centers for Disease Control

-BBC-The Guardian

H1N1 Information SourcesDatabases -PubMed

-Scopus

Clinical tools -BMJ Clinical Evidence-UpToDate (Epidemiology, clinical manifestations, and diagnosis of swine H1N1 Influenza A; Treatment and prevention of swine H1N1 influenza)

Journals -American Journal of Public Health-Annals of Internal Medicine-BMJ-CMAJ (Canadian Medical Association Journal)-JAMA-NEJM (H1N1 Influenza Center)-Nature

Search Engines -GoogleScholar

Discussion – Study Limitations

• Lack of generalizability – small number of cases

• Bias of self-reporting• Recall error

• Reduced researcher bias through triangulation

Conclusions & Recommendations

• Strategic communication methods consider audience capacity and use appropriate technologies

• Alerting services are essential for information providers during a pandemic

• Projects that use social software to “push” pandemic information are difficult to evaluate

Conclusions & Recommendations (continued)

• Pandemic information projects benefit from prior planning

• Proactive librarians offer services and are integrated into organizational planning teams

• Librarians’ skills to evaluate and disseminate information prove essential during the early stages of a pandemic

Future Directions

• Recognize uniqueness of pandemic information needs

• Develop best practices for information services based on case evidence

• Formally evaluate future pandemic information provision

Questions

Robin Featherstone, MLISMcGill University Health Centrerobin.featherstone@muhc.mcgill.ca

Gabriel Boldt, MLIS London Health Sciences Centre

Nazi Torabi, MLISUniversity of Western Ontario

Shauna-Lee Konrad, MLIS London Health Sciences Centre

paninfostudy@uwo.ca