Increasing Access to Online Information about Health: A Program for Inner-City Elders in Community-Based Organizations

Article excerpt

An addition to traditional social services.

With the support of the National Library of Medicine, we are endeavoring to develop a robust and sustainable community-based program, Increasing Inner City Access to Health Information, to enable low-income older adults to develop the skills they need to obtain information about health online via the World Wide Web.

Much of the information older people and others need to participate effectively in management of their own health is increasingly available on the Internet, from detailed descriptions of illnesses and medical therapies to the locations of doctors and hospitals, lists of governmental support agencies, and discussions of medical insurance complexities. Yet despite the recent growth of the Internet as a valuable resource for health information, fer fewer adults over the age of 65 use the Web than do those of any other age group (Fox, 2005). Our effort-a collaboration between the New York Academy of Medicine (NYAM), Columbia University's Department of Biomedical Informatics, and three community-based organizations in East Harlem-is addressing this situation by adding a health-information outreach component to existing social services programs in these organizations.

NYAM, long concerned with public health issues, has a superb medical library that has been open to the public since 1878. Librarians there have developed a training curriculum, "Health Information on the Internet," which we are taking directly into community-based social services organizations in the institute's East Harlem neighborhood. With classes in accessing the Internet based on this curriculum, we hope to reduce disparities in access to health information for inner-city elders who do not come to libraries. We provide initial training for staff and volunteers affiliated with these organizations, so that they in turn can train the older people who come to the organizations for other programs. Our results so far are quite encouraging.

WORKINGS OF THE PROGRAM

The project has three specific aims: first, to develop a bilingual (English and Spanish) "train the trainer" program; second, to create a website to support the project; and third, to evaluate and characterize changes in health information-seeking behavior by participants as a result of the training. The program provides two sets of classes: train-the-trainer classes, which are taught by a bilingual NYAM consumer-health librarian and are designed for the community-based organizations' employees or volunteers, and consumer health classes for older people, which are taught by train-the-trainer graduates.

Our plan for a stable paradigm for implementing such classes in different community-based organizations relies on three interdependent objectives: (i) to develop and refine materials for classes of both kinds; (2) to refine methods of evaluation, especially for characterizing changes in health information-seeking competencies; and (3) to develop strategies for facilitating implementation.

Toward the first objective, we have already developed two workbooks consisting of text, images, and exercises that provide guidance to both trainers and students. To achieve the second objective, we are employing both quantitative and qualitative measures of skills needed for seeking online information about health. These first two objectives are obviously central to the specific aims of the project, but the third, though instrumental in the success of the program, is often overlooked. Briefly, successful implementation must include the following: coordinating both sets of classes with the administrators of the community-based organizations; selecting candidates for the train-the-trainers class and, from among them, actual trainers for the consumer-health classes; ensuring that the consumer-health participants have at least basic computer skills (though these skills are technically a prerequisite for participants, in practice we have found it necessary to provide the instruction as part of the course) ; and, finally, making certain that the computing facilities are adequate. …