Back in May at the 2008 Medical Library Association meeting in Chicago, a group of health care administrators presented a panel discussion titled “Connecting with Leaders: What Do They Expect?” in which they provided their perspectives regarding their expectations for the health sciences library. This was a group of library supporters and their comments revealed their expectations that library leaders need to think broadly and creatively about their libraries’ roles. Suggestions included:

• Participate in community outreach to serve the greater good of the institution and its communities
• Work with IT to find ways that the library complements IT
• Develop allegiances; although forming partnerships isn’t easy, a fundamental component of administration is relationship building
• Stay connected and aligned with operational opportunities and priorities
• Participate! In the “journey” toward magnet status; in research to improve patient care; in the institution’s constant staff retooling and retraining; in instructional delivery; in grant proposal creation; in benchmarking to learn what similar institutions have and what admired institutions have
• Think in terms of dollars but remember other values

This session was on Monday, May 19 at 10:35am and, if you have access to the MLA ‘08 CD-ROM, it’s definitely a worthwhile listen.

Skinner, H.A.; Maley, O.; Norman, C.D. “Developing Internet-based ehealth promotion programs: The Spiral Technology Action Research (STAR) Model.” Health Promotion Practice 2006; 7(4):406-417.

The STAR model combines technology development with community involvement and continuous improvement through five cycles: listen, learn, plan, do, study, act. The “listen” cycle corresponds to community assessment: learning about needs and opportunities, and building partnerships and stakeholder buy-in. The “plan” and “do” cycles involve identification of objectives and strategies followed by prototyping and design to address identified community needs. The “study” cycle corresponds to process evaluation of web sites or prototypes, followed by the “act” cycle in which decisions are made and actions taken based on evaluation results (promotion, ongoing feedback collection and continued refinement, and sustainability). This article presents a case study of using the model plus methods for approaching each of the five cycles.

Hinyard, L.J.; Kreuter, M.W. “Using narrative communication for health behavior change: a conceptual, theoretical, and empirical overview.” Health Education & Behavior 2007; 34(5):777-792.

This article advocates use of narrative communication in motivating people to change their health behaviors, pointing out that “understanding any situation involves storing and retrieving stories from memory.” The authors speculate that narrative ways of learning and knowing may be especially useful when addressing issues for which reason and logic have limitations, such as morality, religion, values, and social relationships. Narratives can help overcome resistance to a message, facilitate observational learning, and provide identification with characters. Stories can be combined with more “scientific” methods to achieve optimum results.

Robinson, K.L.; Driedger, M.S.; Elliott, S.J.; Eyles, J. “Understanding facilitators of and barriers to health promotion practice.” Health Promotion Practice 2006; 7:467-476.

The authors state that although the “field of health promotion has shifted to embrace a socioecological model of health recognizing the role of environmental and contextual factors on health promotion practice and health outcomes,” most health promotion research “continues to focus on behavioral or risk factor outcomes.” Published studies of health promotion facilitators and barriers have tended to focus on one of the three linked stages of health promotion practice: capacity building for planning and development; delivery of health promotion activities; and evaluation and/or research. Barriers to evaluation and research include: health promotion activities rarely have simple, direct cause-effect relationships to test; health interventions involve many factors and processes that cannot easily be quantified; monitoring in rural areas or at the community level poses significant logistical and financial barriers; and tension exists between “scientific rigor” and participatory evaluation processes that aim to influence practice.

The article characterizes facilitators and barriers to health promotion practice as internal (leadership, staffing, resources, priority/interest, infrastructure, and organization of teams and groups) and external (community buy-in, turnover of local contacts, partnerships or collaboration, socioeconomic/demographic/political contexts, and funding opportunities or cuts).

Valente, T.W.; Pumpuang, P. “Identifying Opinion Leaders to Promote Behavior Change.” Health Education & Behavior 2007; 34:881.

This article begins by listing how opinion leaders can help with health promotion efforts:

• Provide entree and legitimation
• Provide communication from their communities
• Act as role models for behavior change
• Convey health messages
• Contribute to sustainability after a specific program has ended

Programs that use peer opinion leaders are generally more effective. Opinion leaders influence behavior in their communities through awareness-raising, persuasion, norm establishment/reinforcement, and resource leveraging. Opinion leaders are also known as champions, lay health advisors, health advocates, promotoras, behavior change agents, peer leaders, and community leaders. The best methods for identifying opinion leaders will vary depending on a project’s characteristics and setting; this article presents ten methods:

1. Celebrities (recruit people who are nationally, regionally, or locally known)
2. Self-selection (solicit volunteers)
3. Self-identification (administer questionnaire with a leadership scale)
4. Staff selected (project staff select leaders based on community observation)
5. Positional (community members who occupy leadership positions)
6. Judge’s ratings (knowledgeable community members identify leaders)
7. Expert identification (trained ethnographers study community)
8. Snowball (ask who people go to for advice, then interview them in turn)
9. Sample sociometric (randomly selected respondents nominate leaders; those receiving frequent nominations are chosen)
10. Sociometric (all respondents are interviewed and those receiving frequent nominations are selected)

Ideally, a health promotion project would use multiple methods to find and select opinion leaders. Once they are identified and recruited, training and support are essential.

How can benchmarking, ROI, and other metrics illustrate value to users and stakeholders?  This standing-room-only session at the Special Libraries Association meeting featured analysts from Outsell shared benchmarking results and suggested combining such comparative data with “Market Penetration” (the ratio of your actual to potential users).  Panelists also discussed the difference between “Operational Metrics” (measures needed for daily library management activities) and “Strategic Metrics” (measures that show the library’s value to the organization).  They described strategic assessment–in which 6-8 strategic actions that support the organization’s critical strategies are identified through user and stakeholder research combined with group brainstorming.  After strategic actions are selected, metrics are determined, and ownership is assigned.  Stakeholder research includes needs assessment, client satisfaction studies, and return on investment/cost-benefit analysis.  Outsell panelists also advocated use of a combination of qualitative and quantitative research, since “numbers alone do not tell the story,”  and attention to organization-wide standards (such as Balanced Scorecard and/or Total Quality Management).

This bright and early morning session on 6/16/08 was hosted and organized by the Special Libraries Association’s Government Information Division.  Librarians in the audience shared their challenges and best practices for applying metrics to quantify and justify their operations.   The PowerPoint from Outsell should be available soon at the division’s web site.

SurveyMonkey’s April newsletter reports their new Bounce Report feature:

“Sometimes when sending survey invitations through our collector, the email addresses may bounce the message back to you because the email is invalid, the receiving server is too busy, the receiving email inbox is full, and so on.

Now when sending your survey invitations through our Email Invitation collector, the messages are delivered by our email server. If the message is undeliverable, the email will be considered a Hard Bounced email in the Edit Recipients portion of the collector.

You now have the ability to do the following:

• View the Bounced emails.
• Export them from the list.
• Remove them from the list.

This will help to ensure that your lists are current and contain valid emails for future survey response collections.

To learn more about the new Bounce Report feature, please refer to the following Help Topics:
Check Bounced Emails
Hard Bounce Tutorial“

The American Evaluation Association held its annual meeting in Baltimore this year and, as usual, the workshops were great and the program was packed with useful information aimed at evaluators with varied levels of expertise. Baltimore itself was wonderful; somehow they managed to provide very nice weather even in November! Of the sessions I attended, my very favorites were the ones with Brian Yates from American University, who is a sort of evangelist about “cost-inclusive” evaluation. Apparently, his outlook that “costs are at least as important to measure as outcomes” is not universally accepted amongst all evaluators. His theme is that all outcomes have costs and some outcomes are monetary. One of his presentations was about starting a cost study, the other was titled “Costs Are All That Matters.” I also took some workshops:

Quantitative Methods I spent two days in this workshop, which was quite fast-paced–the instructor claimed to be providing us with a semester’s worth of information! Participants who had never had methods courses were scrambling a bit to keep up; I have had methods courses but not since the last century, so I experienced the workshop as a challenging review. One of the main things that I took from the workshop was the instructor’s delightful phrase, “reasonable people will disagree.” It turns out that statistics can be so complicated that not even the statisticians always agree about when and how to use which approaches. For example, there is controversy about whether hypothesis testing is the best way to improve knowledge. Our instructor suggested that, since it’s established tradition for research, we should combine hypothesis testing with other approaches. Here are some other, probably more useful points I noted:

• One person’s “6″ might be another person’s “3″
• More than 10 choices will be hard for a respondent to manage. With fewer response choices, results tend to be more reliable
• Always label the middle in a range of rating choices (and the two ends, also)
• Variance in program outcomes can be very important to stakeholders; evaluators are looking to find out whether a program actually had an effect or whether an observed change was simply due to chance (or due to something other than the program)
• Inferential statistics, which are used to generalize to populations of interest (ie, should I bring more people into my program?) are based on the assumption that the population in question is normally distributed
• A number of statistical tests have their origins in agricultural research and were never really intended for use with humans

Our instructor ended the 2-day session with this warning: “I’ve taught you enough now that you’re really dangerous. Don’t try to do this without expert guidance.” True enough, but a class like this will help to communicate with experts.

Online Survey Research This was a half-day class that the instructors had not taught before. I empathized with them as they ran out of time and expressed the realization that it should have been a full-day class. Some of my notes:

• Survey objectives are not the same as program objectives. Surveys can’t fix problems with programs
• The instructors cited a 27% response rate as a “very good” one
• Research has shown that people write longer responses to open-ended questions in online questionnaires than they do on printed ones

SurveyMonkey has recently introduced three short tutorial videos that are open to anyone to view, without need for passwords or logging in. Their plan is to introduce more videos over the upcoming months. (These videos, by the way, are really nice examples of how Camtasia can be used)

These first three tutorials demonstrate the following areas of SurveyMonkey:

• Getting Started (the fundamentals and a tour of the website)
• Survey Design (the basics of designing a survey using SurveyMonkey)
• Using Collectors (how to collect responses; use of settings and restrictions)

A lot of what these videos cover will already be known to those who have used SurveyMonkey, but they can serve as a good resource for classes or for introducing newbie colleagues to the resource. I did learn some very useful items from the tutorials, though, such as:

• the difference between the “exactly one” and “at least one” settings for multiple-choice questions
• how to use rating questions to force respondents to rank their choices
• the bad news about what happens when respondents leave a SurveyMonkey survey uncompleted and return to it later

(…and that bad news is that the information about the partially-completed survey is cookie-dependent, stored by the web browser on the respondent’s computer. To go back and complete a survey, the respondent must be using the same browser on the same computer–and not have cleared the cookies!)

Perley CM, Gentry GA, Fleming S, Sen KM. Conducting a user-centered information needs assessment: the Via Christi Libraries’ experience.  J Med Libr Assoc  2007 Apr; 95(2):173-181.

This article provides a good example of a needs assessment using multiple evaluation methods. Librarians at the Via Christi Libraries in Wichita, Kansas, provide information services to all employees of the Via Christi Regional Medical Center (VCRMC) and needed to develop a strategic plan to meet the expanding use of their services and increasing cost of providing access.  This article provides detailed descriptions of how the researchers used a self-administered survey, telephone survey, and focus groups to gather information of increasing depth among users, and includes appendices with survey and focus group questions. The samples used in the project were not random, but the researchers used many venues to capture a solid cross section of their user population; and the multi-method approach allowed them to corroborate findings across different perspectives.  They also described how they used the findings to develop a strategic plan and listed their “lessons learned” about doing needs assessment.  This is not a “how to conduct a needs assessment” article and the findings are the main point of the piece.  But their concrete description of their methods provides added value to their article.