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TL v65n1: Linking Health Literacy and Libraries in Tennessee
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Linking Health Literacy and Libraries in Tennessee

Alexandria C. Quesenberry


Information literacy is an issue at the front of most librarians’ minds, and health literacy is equally as important. Health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information services needed to make appropriate health decisions” (Glassman, 2013).  Numerous studies show the magnitude of problems with low health literacy.

One study in particular found that 88% of the population in the United States falls below the ‘proficient’ ranking in health literacy (Glassman, 2013). Low or limited health literacy has an impact on one’s health levels in a variety of ways, including not being capable of taking the correct dosage of medication or having communication issues with healthcare professionals.

Libraries have the means to improve health literacy through initiatives like consumer and patient health information services (CAPHIS) and/or education on relevant health topics. A survey conducted by an outreach hospital librarian shows that 94.5% of respondents want libraries to be involved with health issues (Malachowski, 2014, p. 5). The aforementioned survey results illustrate the desire for increased health literacy information, but, more importantly, it shows that there is also a need. A 2011 study done by the Institute of Museum and Library Services (IMLS) reveals that “twenty-eight million people (37% of public access technology users) sought information or carried out tasks related to health and wellness” (Becker et al., 2011, p. 10). 47% of library users nationwide reported to the Pew Research Center that they used digital library services to find health information (Zickuhr, Rainie, & Purcell, 2013, p. 34). Clearly, the need is there, but how should libraries go about connecting to the public? Do those methods work? Over the last ten years, libraries across the nation have implemented health literacy programs. Tennessee, in particular, has risen to the challenge of improving health literacy.

National Libraries and Health Literacy

Within the last ten years, libraries of all specialties have responded to the need for increased health information literacy with new programs and outreach. A family and child-centered hospital library in New Jersey encompasses information access for parents and families with play areas for the young patients. This welcoming combination space has resulted in parents “independently” seeking health information, as well as “improved family and patient participation at all levels of care” (Forsberg, 2010, p. 85). Similarly, a Michigan community health library that offers resources like circulating books, health models, internet access, and wellness programs found that “consumers overcome barriers to finding and using health information” once they become more information literate after using the library (Allen, 2004, p. 68). A study sponsored by the Medical Library Association and the National Library of Medicine shows that a librarian-taught health information literacy curriculum helps to raise awareness about the issue and increases both the use of National Library of Medicine consumer health resources and referrals to librarians for health information literacy support (Shipman, Kurtz-Rossi, & Funk, 2009).

Libraries are also adjusting to new and popular technology advances in order to reach the widest possible audience. Due to the convenience and prominence of smart phone technology, health apps are entering the conversation about health literacy. Libraries and communities are turning to apps in order to find information quickly and efficiently. A study showed that individuals more interested in taking care of themselves are more likely to use health apps than individuals less conscious of their health (Cho, 2014, p. 1).

Another study used a survey to show the positive impacts that a consumer health library can have. While this study was published in 1997, the conclusions drawn from it are still too important to exclude from this review of health literacy within the last ten years. The Delaware Academy of Medicine started a health library in 1992 and it includes a consumer service that mails requested health information to consumers. Those consumers were then sent a questionnaire which shows that the overwhelming majority of respondents’ knowledge of health information improved (Pifalo, 1997, p. 19). In addition, over half of the consumers felt like their stress levels were reduced and they also shared the information to better communicate with their healthcare professional (Pifalo, 1997, p. 19). 20% of respondents even made a lifestyle change related to the information received (Pifalo, 1997, p. 19). This library, like others across the nation, demonstrates the difference that health information literacy programs make in a community.

Tennessee Libraries and Health Literacy

Tennessee has many libraries that have recognized the need for improved health literacy. The most prominent are the hospital and/or academic libraries focused on the health sciences, but these libraries also partnered with proactive public libraries in various ways to promote health literacy. Through a project funded by the National Network of Libraries of Medicine and the Southeastern Atlantic Regional Medical Library, Memphis-area health sciences libraries taught seniors how to locate, evaluate, and use trustworthy and quality health information (Wu, Cunningham, Grayson, & Stephenson, 2006, p. 12). Assisting librarians went to senior health centers to instruct them on how to navigate the online world of health information using a website specifically designed for this purpose. The public were not only provided health information, but were also shown how to search and judge the quality. This is an example of core health literacy instruction since the curriculum empowered people to seek information independently and successfully.

At East Tennessee State University Quillen College of Medicine Library (ETSU QCOML) in Johnson City, librarians began an outreach program sponsored by the Southeast/Atlantic Region of the National Network of Libraries of Medicine that allowed them to go to local public libraries, regional public health departments, and rural hospitals to promote health literacy instruction (Carter & Wallace, 2007, p. 2). Later, this project was re-funded and ETSU QCOML partnered with Preston Medical Library at the University of Tennessee Graduate School of Medicine and University of Tennessee Medical Center for the Simple Plan Extended (Earl & Vaughn, 2010). This opportunity also gave ETSU QCOML the chance to advertise for their phone-based consumer health information service, called HealthInfoExpress. ETSU QCOML also partnered with the Remote Area Medical Group (RAM), a national organization devoted to providing healthcare to those in remote areas, to provide health information for the public at RAM expeditions in East Tennessee. ETSU QCOML librarians served at these expeditions, along with librarians that they recruited from public libraries, academic libraries, and hospital libraries, to provide health information to over 1,300 people (Woodward & Wallace, 2012, p. 23).

In the middle of the state in Davidson County, a MedlinePlus® kiosk was added to the University of Tennessee/Baptist Hospital to promote health literacy (Teolis, 2010, p. 127). Easily accessible, the kiosk provides MedlinePlus® tutorials that allow for operation by consumers of all technology literacy levels. Since the majority of Americans do not possess proficient health literacy, the materials available from MedlinePlus® are typically written at a 5th-8th grade level (MedlinePlus®, 2012). By having access to health information, people have the opportunity to become more involved with their own healthcare, which can lead to improved health and better patient/doctor communication (Glassman, 2013).


Figure 1. This is a table of Tennessee libraries that serve health care consumers. This chart is adapted from the National Network of Libraries of Medicine’s Member Directory database by doing a search for only institutions that serve health care consumers.

Preston Medical Library and Health Literacy

No description of libraries and health literacy in Tennessee would be complete without addressing the innovations and projects done at the Preston Medical Library, which now has a brand-new Health Information Center for consumers, patients, family, and friends of the University of Tennessee Medical Center. “Beginning with a grant from the Tennessee State Library and Archives (TSLA), 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” (Oelschlegel, Earl, Muenchen, & Taylor, 2009, p. 225). Preston Medical Library’s CAPHIS program was the first of its kind in Tennessee and grew to not only include telephone requests, but e-mails and walk-ins as well. A recent data collection revealed that 66% of Preston CAPHIS users felt the information received through the service helped them to better communicate with their healthcare professionals (Earl, Oelschlegel, & Breece, 2012, p. 197). In 2004, Preston Medical Library was awarded the U.S. National Commission on Libraries and Information Science Blue Ribbon Consumer Health Information Recognition Award for Libraries (Lewis, Oelschlegel, & Earl, 2011). In 2005 and 2006, the director of Preston Medical Library came together with ETSU QCOML and the Memphis Public Library and Information Center, the first consumer health library in Tennessee, to head the Tennessee Outreach State Planning and Evaluation Team to determine the state’s health information needs. This project was funded through the National Libraries Network of Medicine. At the two meetings, nearly 20 health-related institutions from across Tennessee were represented. The current practices and issues were documented and evaluated in order to make future improvements for statewide health literacy. As a result, the Simple Plan initiative started at ETSU QCOML in three regions of the TSLA’s rural public library system (Earl & Vaughn, 2010). This Plan was expanded to include the rest of the state. ETSU QCOML and Preston Medical Library assisted public library staff with taking one to four classes on the use of the National Library of Medicine’s consumer health databases. Those who completed all four classes attained Consumer Health Information Specialization certification.

In 2011, Preston Medical Library began a partnership with the hospital’s Skylight service, an in-room television service for patients to request health information. The information is delivered to the health unit coordinator, taking customer service to the next level. Due to the success and positive outcomes from the CAPHIS and Skylight service, both of which address the improvement of health literacy, the new Health Information Center was built (Vaughn, Leonard, & Oelschlegel, 2014, p. 9).

The Health Information Center and Preston Medical Library are located in the heart of University of Tennessee Medical Center along with a new consumer resource collection, computer-access, and seating space for patients, family, and friends. The book collection in the Health Information Center is designed to promote health literacy with varied reading levels. The new facility includes regular health information classes, including one devoted wholly to health literacy, and the most popular one is “Healthy Smartphone,” using apps to improve health.  Since opening in mid-September 2014, the statistics for the Health Information Center already show an impressive increase in public use of resources. Figure 2 shows the reference statistics with the public based off on the type of question for a typical day in 2013 versus 2014.


Figure 2. This chart shows an average day in the 4th Quarter to highlight the increase of public interactions from 2013 in the old location to 2014 in the new location with the Health Information Center.

In 2013, there were a total of 275 requests made through the CAPHIS. In 2014, 350 information requests were made. Based off of the trends from the new location, information requestsare on track to nearly triple in 2015. The new Health Information Center and change of location for Preston Medical Library make the library’s services more visible and accessible.

Through these innovations, the Health Information Center and Preston Medical Library will continue to improve health literacy for the community. In conclusion, health literacy is an integral and unique component of information literacy. Health literacy changes user attitudes and health practices. Tennessee continues to be a leader for health literacy advocacy.


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Alexandria C. Quesenberry is a Masters of Information Sciences Candidate at the University of Tennessee, and a Graduate Research Assistant at the Preston Medical Library and Health Information Center, University of Tennessee. She can be reached at


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