Benedetti pointed out that even though public librarians are in a position to provide CHI-related reference service, libraries cannot afford to expand their medical and CHI-related collections, and librarians are afraid of providing incorrect medical advice.⁵ Librarians who have received sufficient training can manage information resources and provide reference service in almost all areas, but, nevertheless, they are experiencing difficulties in answering CHI-related questions.

Therefore education programs for librarians need to be studied and developed. The Carnegie Library of Pittsburgh (CPL), for example, planned a librarian education program for CHI service improvement that focuses on consistent and high-quality consumer health assistance. Clark briefly explained that CPL put priority on staff education related to consumer health information, studied demand from both the staff and local community, and provided an education to meet the identified needs.⁶ In addition, he showed that staff competence had improved after the education and gave an analysis of the educational contents and curriculum developed for the training.

The National Network of Libraries of Medicine (NNLM) developed education resources and outreach services for those who want to know how to find CHI efficiently and for librarians who seek to educate library users. The NNLM website provides various information sources related to CHI and free training programs including information about Regional Medical Libraries (RMLs). The Educational Clearinghouse database also provides educational materials related to bio-medical and health problems.⁷

There have been many cases of different types of libraries cooperating for librarian education. The project conducted by the Texas Woman’s University and the Dallas Public Library (DPL) is an example of a collaboration effort for CHI resources in public libraries. The purpose of this project was to meet the educational needs of public librarians and library users by supporting the development of web-based educational materials and providing training programs. The training was designed and implemented for practical and web-based education; public library reference librarians received education and support for providing users with CHI services. Snyder, Huber, and Wegmann analyzed this program, which provided DPL staff with high-quality CHI training, and found that the project represented a successful cooperation between public and university libraries that contributed to the identification and resolution of cultural, linguistic, and practical problems in the CHI field.⁸

There have also been many cases of different types of libraries cooperating to develop online CHI resources, or librarians from different types of libraries working together to improve the effectiveness of librarian education. In February 2000, the Health Sciences Library System (HSLS) of the University of Pittsburgh conducted an NLM-funded project for developing a CHI electronic resource, which could be accessed by the general public. This Access to Electronic Health Information project, which offered CHI training to librarians from public libraries in 16 counties, aimed to (1) improve consumer knowledge about CHI and the accessibility of CHI, (2) improve CHI literacy by educating users on how to search for reliable and authoritative CHI resources, and (3) clarify the role of MedlinePlus and PubMed in the CHI search. Wessel, Wozar, and Epstein evaluated this program and concluded that the university medical libraries contributed to the local community by offering CHI-related education.⁹

In 1998, the librarians from the L. Sharp Health Sciences Library at Cooper Hospital/University Medical Center started to develop webpages as a tool for their class Consumer Health Resources on the Web. These webpages, containing CHI-related information sources as well as teaching tips, were expanded and revised to support various additional classes and now form an essential resource for educating patients and staff.¹⁰ The reference librarians who participated in this program are from public, university, and medical libraries.

Treadwell Library in the Massachusetts General Hospital established the Consumer Health Reference Center (CHRC), which enables cooperative service between librarians and allows librarians to use the system regardless of their library type. The system provides practical information, newsletters, website information, print and electronic resources, continuing education workshop information, CHI-related frequently asked questions, and various statistical information.¹¹

The objective of CHI-related user education is to improve user’s health information literacy. Users with good health information literacy skills can locate and understand appropriate CHI sources, and make the right decision on health-related issues.

Parker and Kreps emphasized the effect of users’ health information literacy on their usage of CHI sources.¹² They analyzed the problem within a vulnerable social group, surveyed advantages and disadvantages of various CHI programs, and proposed a strategy to improve health literacy. Burnham and Peterson suggested that public libraries can participate in the circulation of health information written in understandable language through case studies and concluded that libraries and librarians can contribute to their local community by improving users’ health information literacy and continually discussing the relevant issues.¹³ Kloda surveyed the current status of health literacy education in Canada.¹⁴ In 2006, McGill University also conducted a phone survey on whether CHI-related education and activities are provided to Medical school students and found that 14 out of 17 universities are providing CHI-related education programs.¹⁵

There have also been some large-scale, library-level CHI literacy improvement projects. Kaleida health libraries conducted Seniors Connect: A Health Information Project in cooperation with the Buffalo and Erie County Public Library and supported by the Community Foundation for Greater Buffalo. The objective was to teach seniors, especially African Americans and Hispanics, how to search for precise and comprehensible high-quality CHI on the Internet. Over the course of 14 lessons, the participants learned how to distinguish high-quality CHI from inaccurate, questionable, and fraudulent sources. Moreover, the Senior Connect program offered education on public health services available in the local community, a demonstration of proper CHI searching on the Internet, information on treatment methods for high blood pressure and diabetes, and opportunities to interact with health service providers and librarians. The program was highly rated by participants and recognized as an attractive program for senior citizens.¹⁶

Other examples of large scale database development for literacy improvement are (1) Web Health for Seniors in 2002, in the United States, supported by NNLM and Southeastern Atlantic Regional (SE/AR) Medical Library of University Maryland;¹⁷ (2) the Consumer Health Database Searching Seminar (CHDSS) series designed by Brigham and Women’s Hospital to educate patients, patients families, and caregivers; (3) Health Information Literacy Outreach project conducted in 2008 by the nonprofit organization River Valley Healthy Communities Coalition (RVHCC) to improve health information accessibility and health literacy;¹⁸ and (4) Healthy websites (Healthnet) developed as a result of the Health Information Literacy Outreach project by local public libraries to provide high-quality health information to Connecticut residents, among others.¹⁹ From careful analysis of the above education programs for librarians and users as well as the related research, the researchers have derived the following implications. First, public libraries that are interested in CHI service put emphasis on the librarian’s role as a CHI evaluator and provider and provide CHI education programs for librarians to improve their CHI-related ability. Second, they cooperate with other types of libraries such as university libraries and medical libraries to provide CHI-related education. Third, the Medical Library Association directly supports librarian education by providing free training, educational databases, and CHI workshop series and websites. Fourth, medical libraries often educate reference librarians from various other types of libraries, and their education materials are often developed and provided as websites. The Treadwell Library in Massachusetts General Hospital, especially, provides newsletters, website information, print and electronic collections, continuing education workshop information, CHI-related frequently asked questions, and various statistical information. Fifth, a number of CHI-related education program development projects have been implemented, and education programs as well as health-related websites are provided to increase health-related information accessibility. Finally, various forms of education are available such as Consumer Health Database Searching Seminars, Healthnet, and WebHealth for Seniors.

Considering that CHI-related topics are not well-known and there has been no consensus on CHI services provided by public libraries in Korea, the researchers chose relatively simple topics for the education curriculum. The education topics were selected based on several discussions between researchers and lecturers. The lectures were prepared and advertised for about two years.

The educational topics covered for librarians were the definition of CHI service, reasons for public libraries to provide CHI service, the current status and examples of CHI service, both in Korea and abroad, and the use of more than 10 different CHI resources. The topics covered for users were: an introduction to easily accessible CHI resources, an explanation of their use, and actual practice using them.

The researchers chose a seminar and discussion format as the education method for the librarians. After an instructor’s talk, participants had a discussion on what CHI-related service public libraries should be providing and how librarians can improve users’ CHI literacy. The instructors were three librarians who have a particular interest in health. The user education sessions were offered by librarians who had experience and training in CHI.

The education program used as a text a four-book series and website on health-related information resources developed for this project (www.healthportal-korea.net),²⁰ 10 CHI-related web information source manuals, and lecture notes provided by the instructors (see table 1).

For the education program, the researchers developed, for the first time in Korea, a CHI portal site HealthPortal-Korea (HPK), to provide high-quality CHI services in libraries (see figure 1). This site is designed to systematically collect CHI sources and to play the role of CHI medium. It introduces domestic and overseas health information sources and provides relevant books, papers, and educational materials. Its health information resource section provides 111 domestic health information sources and 80 overseas health information sources along with a 5-star consumer rating function. Its books and papers section introduces health-related book and papers, and the educational materials section provides resources for librarian and user education. The site also has community tools which enable librarians and users to exchange CHI-related questions and answers.

The researchers measured the effect of the librarian and user education programs by comparing participants’ responses to surveys before and after the program. To have a meaningful comparison, the researchers provided the educational program to librarians who had an interest in the topic and a desire to participate in the development of education programs. Moreover, their libraries had to be equipped to provide such an experimental program with the proper amount of space and time, director approval, and staff interest.

To determine librarians who had an interest in the topic, the researchers (1) analyzed 129 public library homepages which provide CHI service out of 748 registered in the 2010 Korean Library Year Book;²¹ (2) surveyed reference librarians from those 129 libraries, and 56 librarians responded;²² (3) assumed that the 56 librarians were the most interested in participating in CHI education and asked them to participate via phone call—12 librarians agreed; and (4) Since this program is the first CHI training for public librarians, the researchers selected “CHI Service Movement in Korean Libraries” as the motto, and advertised the program in various media to highlight its meaning and significance. More specifically, the researchers actively advertised the program twice through a mailing list for librarians and other information professionals, “Domeri,” which has more than 10,000 members, including librarians, students, and professors, and students who were taking reference information resources classes were also given the opportunity to participate.

As a result, more than 16 librarians and more than 40 undergraduate and graduate students participated in the seminar. The survey was conducted only for the public librarians and 12 of them responded.

The survey asked the 12 librarians whether they could provide CHI education to users in their library, given both their individual skills and library conditions. Initially, four librarians replied that they could provide the education in their libraries to aid the study, but two of them were eventually forced to cancel despite their best efforts due to unavoidable circumstances. To recruit user participants for CHI education programs, the researchers posted a link to the CHI portal developed for this research on the main pages of the participating libraries’ websites as well as posters on the bulletin boards in those libraries (see figure 2). The promotion period for this was about 2 months.

Sixty user participants attended the sessions in total, but the researchers performed analysis on responses from only 42 participants, those who attended all the sessions without absences.

The questions used in this research were developed based on a variety of survey questionnaires measuring the effectiveness of CHI service education from previous research as well as their results. The papers analyzed to develop the librarian survey were work by (1) Wu et al., which introduced various education methods using web-based, workshop, education toolkit, and video education;²³ (2) Snyder, Huber, and Wegmann, which evaluated and studied a successful cooperation program between public libraries and university libraries;²⁴ and (3) Wessel, Wozar, and Epstein, which provided and evaluated CHI training for public librarians in 16 counties in Pennsylvania.²⁵ The final survey questionnaire contains questions about the current status of CHI service, the effect of CHI education and issues for improvements, and respondents’ demographic characteristics.

The papers analyzed to develop the user survey were about (1) deducing demand for CHI education service;²⁶ (2) surveying the current status of health information literacy education;²⁷ and (3) analyzing performance of the health information website Healthnet.²⁸ The final survey questions include the current status of CHI usage, the effect of CHI education and issues for improvements, and respondents’ demographic characteristics.

Sixteen public librarians participated in the librarian education portion of this research along with 40 college students taking a course about reference information resources. Among these, 12 librarians took the preeducation survey and 14 did the post-education survey. To measure the effects of the program, the study excluded the two librarians who did not respond to the preeducation survey from. The researchers did not survey the college students either, since the training was designed only for currently active librarians and it was felt that their results would not accurately reflect the realities of the workplace. The students were allowed to participate only for their own educational purposes. Of the surveyed librarians, the gender proportion was 16.7% males and 83.3% females. The age distribution across the group is as follows: 20 to 29 years, 16.7%; 30 to 39 years, 33.3%; 40 to 49 years, 25%; 50 to 59 years, 16.7%; nonrespondents, 8.3%. The distribution of degree level in library and information science was: doctorate degree, 8.3%; master’s degree, 25%; bachelor’s degree, 50%; non-respondents, 8.3%. Their positions in the library were defined as the two positions in which they have spent the longest time, both reference service and management/planning were the highest percentage with 41.7%.The other categories represented were: acquisition at 33.3%, user education at 25%, and classification and cataloging at 16.7%.The user education program had 63 total participants. The length of the program was 3 weeks, and the subjects of analysis were the 42 users who participated for the entire program without absence (66.67% percent of the total). The gender proportion was 26.2% males to 71.1% females (1 nonrespondent). The age group distribution was as follows: 20 to 29 years, 28.6%; 30 to 39 years, 21.4%; 50 to 59 years, 4.8%; 60 to 69 years, 11.9%; 70 to 79 years, 14.3%. To identify their individual Internet usage behavior, the survey asked how many hours they spent on the Internet per day, and those who answered 1 to 2 hours had the highest proportion (40.5%) followed by less than 1 hour (28.6%). On the education post-survey, the proportion who answered 2 to 3 hours increased slightly. User participants were also asked how frequently they use the Internet to search for health information, and those who answered “1 or 2 times” had the highest proportion and “never” had the second highest. However, after the education, the proportion of “never” had decreased from 45.2% to 28.6%. The education significantly increased the proportion of users who use the Internet to search for health information (p = 0.0377).

The researchers developed 10 questions to measure the effects of the CHI education program. The same questions were asked before and after the program. Some of the questions were the same for the librarians and users, while others were not.

CHI education provided for public librarians and users is not a common occurrence in Korea, and CHI services and education provided by public libraries are largely unknown to the general public. The education provided by this research was a basic introductory level course, and the lectures and instructors were not highly qualified. Therefore, identifying ways to improve CHI education quality will be a cornerstone for future CHI education development.

After the education programs, the researchers measured the following aspects of efficiency: appropriateness of program level, interest of educational contents, usefulness of the information provided in the sessions, and necessity of including CHI education in the regular curriculum for public librarians and users:

• 75 percent of the librarians and 69 percent of the users answered that the level the programs were taught at was proper.
• 91 percent of the librarians and 76.2 percent of the users answered that the contents were interesting.
• 76.2 percent of the librarians and 91.7 percent of the users answered that the contents were useful. One of those users even answered that the contents were very useful.
• 50 percent of the librarians and 59.5 percent of the users indicated that it would be useful to include a CHI education program in the regular curriculum for public librarians and users