Research Article
Public Libraries and Health Promotion
Partnerships: Needs and Opportunities
Noah Lenstra
Associate Professor of
Library & Information Science
University of North Carolina
at Greensboro
Greensboro, North Carolina,
United States of America
Email: lenstra@uncg.edu
Joanna Roberts
Graduate Research Assistant
University of North Carolina
at Greensboro
Greensboro, North Carolina,
United States of America
Email: jyroberts871@gmail.com
Received: 21 Sept. 2022 Accepted: 17 Nov. 2022
2023 Lenstra and Roberts. This is an Open Access article
distributed under the terms of the Creative Commons‐Attribution‐Noncommercial‐Share Alike License 4.0
International (http://creativecommons.org/licenses/by-nc-sa/4.0/),
which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly attributed, not used for commercial
purposes, and, if transformed, the resulting work is redistributed under the
same or similar license to this one.
DOI: 10.18438/eblip30250
Abstract
Objective – Across North America, public libraries have increasingly served their
communities by working with partners to connect patrons to essential healthcare
services, including preventative. However, little is known about the extent of
these partnerships, or the need for them, as seen from the perspective of
public library workers. In this study, we set out to address the following
research question: What needs and opportunities are associated with health
promotion partnerships involving public libraries?
Methods – Using snowball sampling techniques, in September 2021, 123 library
workers from across the state of South Carolina in the United States (US)
completed an online survey about their health partnerships and health-related
continuing education needs; an additional 19 completed a portion of the survey.
Results – Key findings included that library capacity is limited, but the desire
to support health via partnerships is strong. There is a need for health
partnerships to increase library capacity to support health. Public libraries
already offer a range of health-related services. Finally, disparities exist
across regions and between urban and rural communities.
Conclusion – As an
exploratory study based on a self-selecting sample of public library workers in
a particular state of the US, this study has some limitations. Nonetheless,
this article highlights implications for a variety of stakeholder groups,
including library workers and administrators, funders, and policy makers, and
researchers. For researchers, the primary implication is the need to better
understand, both from the public library worker’s perspective and from the
(actual or potential) health partner’s perspective, needs and opportunities
associated with this form of partnership work.
Introduction
On November 21,
2022, the Canadian Journal of Community Mental Health published the
research article “Supporting Mental Health in a Public Library Context: A Mixed
Methods Brief Evaluation” (Oudshoorn et al., 2022). The authors explored the
potential for a collaboratively constructed mental health wellness hub situated
in a Canadian urban library, finding that this form of co-location was desired
by patrons, mental health hub staff, and library staff.
As discussed
below, the topic of public libraries and public librarians as health promotion
partners has been increasingly explored by a range of scholars representing a
range of disciplines. Despite an increase in calls to better understand the
current potential of public library participation in health promotion (Flaherty
& Miller, 2016), most studies on this topic have either been case studies
of particular communities (as in Oudshoorn et al., 2022), or focused
exclusively on single topics, such as consumer health at the library reference
desk (e.g., Arnott Smith, 2011) or mental health (Oudshoorn et al., 2022).
To give one
example: there is a growing literature on social workers in public libraries
(Ogden & Williams, 2022), which suggests that this integration is neither
easy, nor inevitable, but instead requires different actors and stakeholders
getting to know each other and find common ground (Wahler et al., 2022).
Library workers recognized the need for someone like a social worker, but
perhaps that need could also be filled by other forms of partnership not being
explored in any sort of broad-scale way. For instance, Baum et al. (2022), the
authors of a recent study on the topic of social work-public library
partnerships from the U.S. state of Florida, found that:
All seven branch managers [interviewed] expressed enthusiasm when
discussing the trend of social workers in libraries, noting patron struggles
with food insecurity, homelessness, immigration, substance misuse, mental
health challenges, and overall economic disadvantage as major motivating
factors behind their support for including them in public libraries. (p. 14)
The range of
social and health needs identified by these public librarians pointed to the
need for a complementary range of partnerships, not only with social workers,
but also with others in the health and social services sectors. Nevertheless,
we lack a broader understanding of the current state of needs and opportunities
associated with public library participation in community health partnerships.
With this study, we sought to begin to fill this gap.
Literature Review
Discussions of health
promotion in public libraries are as old as the profession of public
librarianship itself (Mon, 2021; Rubenstein, 2012). Most public library-based
health promotion partnerships have been highly localized, involving librarians
working with local health partners to develop innovative solutions to local
problems, such as the example of a bookmobile in rural Georgia transporting a
county nurse in the 1940s (Rubenstein, 2012). In the 1960s, some urban
libraries started developing community information and referral systems to
refer patrons in need to the services of other agencies, including health
agencies (Arnott Smith, 2011). More recently, in 1992, a public librarian in
Stratford, CT, developed a partnership with a local teen counseling group and
an aerobics instructor to develop a physical and mental health support group
for teenagers at the library (Lenstra, 2018).
Through this
literature review, we identified three themes in recent literature on this
topic:
- The library as community space for access to health-related
services
- The library as a space for social workers and health workers
- The critical, if understudied, role of library workers in these
partnerships.
The Library as Community Space for Access to Health-Related
Services
The idea of the
public library as a community space has become more prominent (e.g., Klinenberg, 2018; Mattern, 2007), shaping discussions
of how health promotion activities occur in public libraries. As shown in a
state-wide survey of Pennsylvania library directors, health services in public
libraries include, in different places, access to social workers, summer meals,
bathrooms, a respite from the elements for individuals experiencing
homelessness, nutrition classes, telehealth, and a range of other health and
social services (Whiteman et al., 2018). This trend
continued during the COVID-19 pandemic, when libraries were framed as
convenient spaces to distribute tests, host immunization clinics, support
access to telehealth, and even assist in efforts to address food insecurity
(e.g., State of Wisconsin, 2022; Virginia Department of Health, 2021).
An additional
facet of the literature on library as space has been research on libraries as
crucial nodes in disaster response (Liu et al., 2017;
Tu-Keefner, 2016), particularly research on libraries in areas prone to
hurricanes (Hamilton, 2011; Jaeger et al., 2006; Mardis
et al., 2020; Veil & Bishop, 2014). This trend has continued during the
COVID-19 pandemic, with research published on the roles of public libraries and
librarians during this emergency (Smith, 2020).
Another notable
trend was that of the public library as a support for child and family health.
Studies have been done on libraries as hosts of summer meal programs (De La
Cruz et al., 2020; Sandha & Holben, 2021), nutritional education classes
(Freedman & Nickell, 2010), physical activity classes (Bedard et al.,
2020), oral health programs (Woodson et al., 2011), and more generally as
institutions that support health, including mental health, among vulnerable teenagers
and youth (Banas et al., 2020; Campana et al., 2022; Grossman et al., 2021;
Winkelstein, 2019).
Providing direct
medical support for adults through telehealth was a newer option being
explored. Santos (2021) provided a case study of this effort in a small rural
library in Pottsboro, Texas. DeGuzman et al. (2021) found great potential for
libraries to become hubs for providing health access to rural populations with
little or no broadband access.
The Library as a Space for Social Workers and Health Workers
There has also
been interest in placing social workers and other health workers in public
libraries since the San Francisco Public Library began the practice in 2009 (Esguerra, 2019). This work emerged in part due to an
increasingly public realization that public libraries were sites of public
health incidents, including drug overdoses. Feuerstein et al. (2022) surveyed
five states (n=356) for information on instances of substance abuse on library
property, and how libraries planned and prepared for this occurrence. The
researchers found that alcohol and drug use was common on library property, but
most libraries did not have on-site medical help, such as Naloxone. They also
found that librarians would like more training on how to handle these situations.
Giesler (2021)
studied perceptions of social workers in public libraries, finding differences
in how the position was utilized across library systems. Social workers might
be primarily focused on training other library staff to recognize and empathize
with specific patron populations, such as homeless populations. They could also
interact directly with library patrons to offer services. Gross and Latham
(2021) also found this benefit in staff training by the six library
administrators who already employed social workers in the Southeast US (n=52).
Johnson (2021) and Wahler et al. (2022) described the components of “readiness”
required for both a public library and the participating university when
considering a social work student internship at a library.
Other health
liaisons have been found to be helpful for library staff assisting patrons with
complex needs. Homeless patrons often used the library for various reasons, as
described by Adams and Krtalić (2021). They found that the presence of a
community health worker focused on the needs of the homeless population helped
the library and its staff to better understand and provide for those needs by
reducing barriers to services.
Other
researchers considered alternative models of placing health liaisons in
libraries. Both interprofessional student internship models and the training of
library staff in health information have been the focus of research.
Pandolfelli et al. (2021) considered the lessons from different experiential
learning opportunities for students (n=21) from a variety of professions:
general health courses at the undergraduate level, and masters’ level social
worker, library science, and public health students. This study of a joint
training experience for the students allowed for both support and building
common ground between professions and the students involved when working in a
library setting. This sort of inter-professional training model has been
deployed at the University of Missouri, where Library & Information Science
students took courses on public health as part of an experimental, federally
funded project (Bossaller et al., 2022).
Draper (2021) conducted a feasibility study to explore
the potential for collaboration between nutrition educators and public
libraries. Draper found that while there were extensive overlapping goals
between U.S. Department of Agriculture’s Supplemental Nutrition Assistance
Program Education program (SNAP-Ed)—which is an evidence-based program that
helps people lead healthy, active lives by partnering with state and local
organizations—and public libraries, library staff had little knowledge of the
federal program, with only 1 of the 14 participants having any understanding of
SNAP-Ed and how it could support libraries.
In Spring 2022,
the Texas-based St. David’s Foundation announced a new $1.5 million initiative
to support what they are calling Libraries for Health. The foundation is
collaborating to broaden access to mental health services for rural residents
by placing non-clinical mental health workers at the public libraries in
Central Texas. The non-clinical mental health worker initiative is modeled on
peer navigator programs found in some urban libraries across the country.
Crucially, the program includes a strong evaluation component, led by The Rand
Corporation (Carey, 2022).
The Under-Studied Role of Library Workers
As public libraries were increasingly seen as
opportune spaces for health promotion services, the roles of library workers in
administering these services were sometimes overlooked. The absence of library
workers from these discussions could sometimes lead to burnout and staff
feeling overwhelmed, as they felt they were being asked to take on more and
more in their daily work (Freeman & Blomley, 2019).
This perception increased during the COVID-19 pandemic, when many librarians
suffered trauma as front-line workers (Comito & Zabriskie, 2022). The
question of what capacity public library workers have to participate in
community health partnerships remains under-studied.
When library workers were mentioned in research on
this topic, researchers tended to focus on how to most effectively train
library workers to field reference questions related to consumer health
information in ways analogous to the work done by medical or health sciences
librarians. Derosa et al. (2021) described a partnership between Weill Cornell
Medicine library and the city of Brooklyn, New York, focused on using a
train-the-trainer model for library workers by providing training in how to
better serve patrons requesting information about health issues. Other
researchers have focused on the preparedness of public library workers to
support patrons in crisis. Wong et al. (2021) reported on the ability of Pennsylvania
public librarians (n=100) to provide health information on substance abuse
issues over the phone and found that there was a wide variation between
libraries. Brus et al. (2019) surveyed public library staff in Australia and
found a lack of confidence in dealing with patrons with complicated social
issues such as mental health and homelessness. Malone and Clifton (2021)
explored this idea in a five-year study of the Oklahoma public library system
(n=106 staff, n=67 libraries) to certify existing public library staff in
specialized training from the Medical Library Association. Fewer researchers
have focused on how to foster cross-sector collaborations most effectively
between public librarians and those working in the community health sector
(Lenstra & McGehee, 2022).
Aims
In this study, we set out to address the following
research question: What needs and opportunities are associated with health
promotion partnerships involving public libraries?
We framed this question from the perspective of public
library workers. Future research on this topic could investigate the question
from the perspective of actual or potential public library partners.
Methods
To understand the needs and opportunities associated
with South Carolina public library participation in health initiatives, we
designed a survey through a collaborative process that included the following
steps:
1.
A review of survey instruments used in previous
surveys of the topic of public libraries and community health, including those
in Bertot et al. (2015), Feuerstein-Simon et al. (2020), and Whiteman et al.
(2018).
2.
Codifying the range of health partnerships involving
public libraries discussed in previous literature to ensure the survey inquired
about different partnership configurations.
3.
An alignment of the research instrument with the
priorities of the South Carolina Center for Rural & Primary Healthcare (SC
CRPH), a partner in this study.
4.
Coordination with the State Library of South Carolina
around framing this topic.
After development and testing, the research methods were approved by the
Institutional Review Board of the University of North Carolina at Greensboro
(Study #IRB-FY22-71).
There is no comprehensive directory of public library employees in South
Carolina, either at the state or local levels. According to the U.S. Institute
of Museum & Library Services (IMLS), in FY2019 – the most recent year for
which data was available at the time of this writing – the total staff of all
public libraries in South Carolina is 2,112 (Pelczar, 2021). This number
includes 514 credentialed librarians and 1,598 other employees, including
paraprofessionals, groundskeepers, and security staff, among others. There are
42 public library systems in the state. Although we were most interested in
hearing from librarians, the survey was designed such that it was open to any
employee of a public library in South Carolina.
To reach these employees, the researchers used a form of snowball
sampling in which individuals and institutions that were pillars of the public
library community in South Carolina were asked to distribute the survey to
their networks on behalf of the researchers. These institutions included the
State Library of South Carolina, the Network of the National Library of
Medicine, the South Carolina Library Association, and the SC CRPH itself.
The survey was distributed over four weeks in September 2021, an extremely
difficult moment in South Carolina and in the world. For logistical reasons,
the survey had to be distributed during this moment in time. September 2021 was
in the middle of the global pandemic. These logistical reasons centered around
the temporal constraints of the South Carolina Center for Rural & Primary
Healthcare, which wished to better understand this topic prior to releasing
financial awards in Spring 2022 to South Carolina public libraries wishing to
embark on novel health partnerships in their communities.
During the four weeks the survey was open, the researchers monitored the
response rate, generating a weekly map of where respondents were coming from,
at the county level. This response rate informed subsequent snowball sampling
techniques, which focused on attempting to secure complete saturation across
all counties in the state of South Carolina. More information on recruitment
and sampling can be found in Lenstra and Roberts (2022).
Analysis
Descriptive
statistics were calculated for all closed-ended survey responses, while
thematic coding was conducted to analyze open-ended responses. To further
analyze the data and to generate regional and other trends, the researchers
used the demographic information respondents provided about their job titles
and library locations to generate comparisons. Following federal practices established by the IMLS, rural and urban
differences were established using the procedures set by the National Center
for Education Statistics, a unit of the U.S. Department of Education.
We organized
this article around the sections of the survey that centered on partnerships
that included public librarians and actors in the health and social service
sectors, including results that helped indicate why such partnerships would or
would not be desirable. The survey included a range of questions on the broader
topic of needs and opportunities associated with public libraries as
institutions embedded within community health ecosystems. Readers interested in
accessing broader survey results, including the dataset itself and the results
of the thematic coding of open-ended responses, may do so at the open access
white paper published by Lenstra and Roberts (2022).
Limitations
As with any nonprobability sampling technique, there were limitations to
this approach, which centered around the fact that statistical generalization
to the broader population studied is impossible. Nonetheless, we chose
nonprobability sampling as the best way to secure a broad sample of the South Carolina
public library community within the timeframe of the project.
Additional limitations derived from the survey format itself. It was
possible that different respondents may have interpreted some of the survey’s
prompts in different ways. For instance, the survey did not specify what was
meant by “access to health literacy,” and thus this prompt and others like it
may have been interpreted in different ways. Despite these limitations, this
survey and its results provided an unprecedented window into perceptions,
needs, and opportunities associated with public library and health
partnerships.
Results
In general
terms, the sample of respondents roughly aligned with the distribution of
public libraries across South Carolina. Figure 1 shows that the distribution of
the 123 respondents who fully completed the survey roughly aligned with the
distribution of South Carolina libraries. The number of “completed responses” refers to the number of library
workers who totally completed the survey. There were 21 additional respondents
who gradually dropped out of the survey after completing only a portion. All
those who dropped out did so after completing at least a full page of
questions. More information on the sample appeared in Lenstra and Roberts
(2022), and the number of respondents for individual questions can be found in
the Appendix.
Figure 1
Survey response
distribution compared to the distribution of public libraries across the state
of South Carolina.
The vocabulary
used in Figure 1 corresponds to the three ways that the IMLS used to assess the
geographical distribution of public libraries across the nation: 1) Library
branches (outlets, in the nomenclature of the IMLS) referred to library
branches and bookmobiles, 2) Library systems (Administrative Entities MOD in
the nomenclature of the IMLS) referred to the geographic spread of multi-branch
library systems, and 3) Library headquarters (Administrative Entities ADD in
the nomenclature of the IMLS) referred to the locations of the headquarters of
multi-branch library systems.
The Desire to Collaborate with Health Workers is Strong, But Capacity is Limited
Nearly every
respondent reported a need for a health worker or a health liaison to help them
serve the public in their library: over 90% said that if outside help were
available, they could see a need for a health or social worker at their
libraries.
However, when
respondents were asked if they would like to have specific types of health
workers or health liaisons available at their libraries, interest diminished.
Only 74% of respondents were interested in, or currently had available, social
workers at their libraries. Social workers were the most desired type of health
liaison (Table 1).
Table 1
Public Library
Worker Interest in Having Health Professionals Available to the Public at their
Libraries
|
Health Professional (n=126) |
Not interested |
Offered |
Interested – Not Offered |
|
Social
workers |
26% |
23% |
51% |
|
Nurses |
37% |
12% |
51% |
|
Health
educator |
25% |
27% |
48% |
|
Medical
students |
48% |
4% |
48% |
|
Community
health workers |
29% |
24% |
47% |
|
Social
work students |
44% |
13% |
43% |
|
AmeriCorps
or other volunteers |
40% |
21% |
39% |
|
Other
health-related professional |
69% |
8% |
23% |
One reason for
this perceived need may relate to the prevalence of health-related incidents
that occur on library property. Nearly 80% of respondents reported that people
experiencing homelessness used their public libraries as day shelters, and
between 10-50% reported a range of other incidents on library properties,
including drug deals, physical violence, and overdoses. Librarians also wrote
open-ended comments about health-related incidents they had witnessed at their
libraries, including seizures and heart problems (Figure 2).
Figure 2
Medical and
health related incidents occurring on public library property. (n=127)
City librarians
were most likely to report all the incident types asked about, except for drug
deals (Figure 3). Data suggested, however, that these sorts of incidents
occurred in public libraries across the state. Less than 30% of rural
respondents said no health-related incidents had occurred at their properties.
As open public spaces, health issues occurring in communities tended to also
occur in public libraries.
Figure 3
Medical and
health related incidents occurring on public library property, by type of
community served. (n=127)
In any case, one
reason for the difference between perceived need for outside help in general,
and perceived need for specific forms of outside help, related to limited
library capacity to develop new initiatives. As one respondent wrote in an
open-ended comment: “We do not have enough staff and really cannot handle any
more programs. Even when partnering with others, it takes staff time, and we
just cannot do it anymore due to not enough staff.”
A Need for Health Partnerships to Increase Library Capacity to Support Health
Respondents did not always have the partnerships that
would enable them to bring other types of health services to their libraries,
or to refer library patrons to appropriate health or social service agencies.
Public libraries typically had close connections with agencies that support the
social determinants of health (SDoH), including educational institutions, parks
& recreation units, and non-profits. These reported close relationships
could position public libraries to effectively facilitate community
conversations on health needs in ways that would bring more voices into local
health planning and policy making.
Librarians also reported offering a range of services
that support addressing the SDoH, including access to technology, literacy,
education, food, legal aid, and employment. Across the state, many public
libraries have hosted a wide array of services that support public health and
the SDoH, with more than 40% reporting they have hosted everything from food
drives to fitness classes, farmers’ markets, summer meals, health fairs, and
blood drives.
Less robust were the relationships between public
libraries and agencies specifically in the health sector, and less common were
library services that directly supported access to healthcare. Less than 50% of
respondents reported close relationships with any organization in the
health sector (Table 2).
Table 2
Closeness of
Relationships Between Public Libraries and Potential Partners (n=127)
|
Department/Institution |
Very close or somewhat close |
Not very close |
|
K-12
Schools |
89% |
11% |
|
Early
education providers, including daycares |
88% |
12% |
|
Local
non-profit organizations |
85% |
15% |
|
Parks
& Recreation Unit |
61% |
39% |
|
Colleges
or universities |
60% |
40% |
|
Health
department |
44% |
56% |
|
Hospital
or healthcare system(s) |
41% |
59% |
|
Health
coalition or alliances |
41% |
59% |
|
SNAP-Ed
implementing agency |
41% |
59% |
|
Department
of Justice / |
31% |
69% |
|
WIC
Clinics |
29% |
71% |
Despite being
less common currently, there existed a sizable number of early adopters and
health champions within the South Carolina public library sector who reported
already working closely with health partners. Around one quarter of respondents
said they have had health liaisons and telehealth services available at their
libraries. Around one-third of respondents reported the presence of a health
champion employed within their libraries, someone who championed health
services and partnerships and could be utilized as an entry point for programs
and partnerships.
Responsive Health Services in South Carolina Public Libraries
Nevertheless,
most respondents thought that individuals in their communities look to the
library as a safe and trusted space, used both to access health literacy and to
access health services, and most librarians saw health equity as a priority for
their libraries.
The most common
way in which public librarians themselves directly supported health centers was
around information access, with 75% of respondents saying their libraries
supported access to health information in general, 63% supporting health
literacy, and 57% reporting they provided help identifying and using local
health resources. Less commonly reported were informational referrals to
appropriate health or social service agencies (43%). More than 60% of
respondents said their libraries supported access to related services during
the COVID-19 pandemic, including 42% who offered immunization clinics for
COVID-19, and 29% who offered COVID-19 testing services. In the context of the
ongoing opioid crisis, over 20% of urban librarians, and over 10% of rural
librarians, reported having naloxone available at their libraries.
Regional and Rural/Urban Disparities
In general
terms, rural librarians were broadly interested in doing more to support
health, and compared to their more urban peers, have had fewer opportunities,
and less capacity, to do so. For instance, most rural librarians reported
interest in offering mental health first aid trainings, while most urban
librarians had already offered these trainings.
Rural librarians
were also those least likely to have had formalized health partnerships, with
50% reporting no partners in programmatic or funded health initiatives, meaning
they were less likely to have partnerships to support health. Given this
situation, rural respondents were broadly interested in whatever resources they
may be able to bring to their communities. Thinking about what kind of health liaison
would be the best fit for a public library, respondents across the state
articulated a preference for fully credentialed health liaisons, rather than
for students, volunteers, or other health workers in training. Rural
librarians, however, were broadly interested in whatever health liaisons they
could bring to their libraries, regardless of credentials.
Continuing Education and Support Needs
Only 10% of respondents reported no barriers to
supporting health at their libraries, suggesting a need for more robust
continuing education and sustained support. Top priorities for continuing
education as reported by survey respondents included how to get started
supporting health at public libraries, how to sustain these efforts, and how to
build partnerships around this topic. Major barriers to supporting health
included a perceived lack of expertise and funding. Librarians reported wanting
to learn more about this topic from other librarians who have directly dealt
with these issues at their libraries.
Looking to continuing education needs, urban
librarians had markedly different continuing education priorities, with
sustainability and evaluation coming out on top (Table 3). In contrast, for all
other parts of the state, there was more interest in introductory topics, with
how to get started and how to partner rated as top priorities for continuing
education. It appeared that urban libraries had, in general, already started
these partnerships, and were looking to better sustain and evaluate them, while
all other libraries were looking to get started with these types of
partnerships.
Although it was not always identified as a top
priority for continuing education, evaluation emerged as a significant
obstacle. Most respondents indicated that they were not doing anything to
evaluate or track the impacts of their libraries on health. One respondent
wrote:
We don't really
have a way to track this info. We did weight loss programs, but the partner
tracked progress and no long-term info available. We have done nutrition and
health programs with our hospital targeting diabetes and heart disease,
distributed food during 2020, have had exercise programs for seniors, walking
programs, etc. We have sponsored CPR training courses for the public.
An effective evaluation system would need to consider
the myriad and evolving ways in which public libraries support health. Due to
an absence of evaluation systems, the contributions of public libraries to
community health were often invisible, and thus underappreciated and under-supported.
Table 3
Top Priorities
for Library Continuing Education, by Community (n=121)
|
Urban (n=20) |
Suburban (n=24) |
Town (n=50) |
Rural (n=27) |
|
Sustainability (70%) |
How to get started (54%) |
How to get started (62%) |
How to get started (59%) |
|
How to evaluate (65%) |
How to partner (tied) (54%) |
How to partner (56%) |
How to partner (tied) (59%) |
|
How to get started (60%) |
Sustainability (tied) (54%) |
Marketing (48%) |
Marketing (56%) |
|
How to partner (50%) |
Marketing (38%) |
Sustainability (46%) |
Sustainability (48%) |
|
Marketing (30%) |
How to evaluate (21%) |
How to evaluate (36%) |
How to evaluate (tied) (48%) |
Discussion
Most respondents to this survey saw a role for their
public libraries in health promotion, equity, and access. Nevertheless,
obstacles large and small prevented the South Carolina public library workforce
from doing as much as they would have liked to support health. In urban South
Carolina, funding, sustainability, and evaluation were major challenges, while
more rural areas were challenged in discovering how to get started and how to
build partnerships. Throughout the state, respondents saw a need for help
weaving health into the operations of a public library without overwhelming or
over-burdening the library staff. Librarians needed technical assistance, as
well as support for funding and evaluation, to make their community-based
health initiatives sustainable and impactful over the long-term.
In this study, we identified a handful of library
systems that have embraced health services and partnerships at their libraries,
including in their strategic plans. The Charleston County Public Library is one
example (CCPL, 2021). Their strategic plan explicitly called for the library to
“empower learners of all ages to manage their lifelong physical and mental
health,” “empower individuals with the knowledge to make healthy food choices,”
and “empower individuals to obtain and understand basic health information”
(CCPL, 2021). Finding ways to meaningfully enable these early adopters and
their leadership teams to share their successes and challenges with other
libraries could potentially drive innovation forward.
To extend this trend, these library health champions
could share best practices, advocate for promising partnerships, and share
common successes and challenges through the peer-to-peer infrastructure that
exists for professional development and continuing education among public
librarians.
There is a strong tradition of training programs for
public librarians focused on increasing their comfort and confidence with
health information. This training has been, historically, offered by medical
and academic health science librarians (e.g., Malone & Clifton, 2021). The
successful deployment of peer-to-peer training among public librarians, perhaps
in a learning cohort, could provide public librarians with a different type of
training program, one focused less on comfort and confidence with health information
sources, and more on comfort and confidence working collaboratively with
community health partners.
Our goal should be to find ways to enable the health
and public library workforces to mutually build each other up, with the two
workforces adding value to each other, and adding capacity to their abilities
to support the communities they serve together.
A second promising practice would be to find ways to
better connect library directors to local health leaders and to other library
leaders. These connections could be made not only at the library executive
director level, but also at the deputy director and branch/division manager
levels. Survey results suggested these library middle managers were less
connected to local health partners than library directors. In any case, at the
leadership level, the focus is less on cultivating library health champions,
and more on how we make these partnerships work, administratively.
Library directors and leaders need help understanding
how to integrate health into library services in ways that avoid the burnout of
their staff, and that are sustainable over time. They also need help
integrating timely topics, such as telehealth, into their libraries. Evaluation
is a perennial issue in public libraries, and thinking strategically about
health in public librarianship is another need.
Evaluation of how public libraries support health is
also essential. A starting point for developing this type of evaluation should
be a discussion between health organizations and public libraries that promotes
understanding of the different structures and needs of each group. Finding ways
to embed documentation into these partnerships is crucial for their long-term
viability.
Conclusion
In this
exploratory study, we highlighted implications for a variety of stakeholder
groups, including those working in the health sector at both local and state
levels, as well as library workers and administrators, funders and policy
makers, and researchers.
Given the
limited and self-selecting sample, comparisons between rural and urban public
library workers remained tentative. Additional research using a randomized
sampling model that employs cluster sampling to ensure a strategically selected
distribution of public library workers representing the rural-urban continuum
could enable a more nuanced understanding of the unique needs of public library
workers within different types of communities.
We are only
beginning to understand needs and opportunities associated with public library
participation in community health initiatives. Additional research must also
consider this topic from the perspective of community health partners. How
ready are community health workers and social workers to partner with public
librarians? This topic also needs to be addressed to holistically understand
this topic.
More generally,
many of the findings of this survey deserved more nuanced explanation through
interview-based research. The survey results showed what was happening in South
Carolina’s public libraries; it cannot answer why things were the way they
were. For instance, the survey found that in one-third of respondents’
libraries, a health champion was employed. How did these health champions
within the public library workforce come to be? What policies, practices, and
community forces led to health champions working at these libraries? These are
topics interview-based and case study research could help to illuminate.
Although
tentative, the findings from this project unambiguously demonstrated interest within
the South Carolina public library workforce to support health, particularly
though partnerships that would bring health workers to their libraries.
Although additional research is needed to build up our understanding of this
topic, this survey showed a great potential for impacts associated with public
library health partnerships.
Author Contributions
Noah
Lenstra: Conceptualization, Formal analysis, Funding
acquisition, Investigation, Methodology, Supervision, Writing – review &
editing Joanna Roberts: Data curation, Formal analysis, Investigation,
Project administration, Validation, Visualization, Writing – original draft
Acknowledgment
This research was made possible in part by the South
Carolina Center for Rural & Primary Healthcare grant #22-0035. We would
also like to thank our reviewers for their thorough critique of the manuscript,
which improved the manuscript in significant ways. We also want to say thank
you to the South Carolina public library and public health communities, who
shared feedback on early findings from this project at a South Carolina State
Library webinar and the South Carolina Public Health Association conference,
respectively.
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Appendix
Survey Instrument
|
Survey Questions |
Number of respondents |
|
Do
you understand the consent information provided above and agree to
participate in the study? |
|
|
Part 1. Demographics |
|
|
What is the zip code* where
your library is located? *Having this information
will allow us to incorporate data from other sources, including the US Census. |
142 |
|
What is the name of the library
or library branch where you work? |
142 |
|
What is your job title? |
142 |
|
How long have you worked at
your library? |
142 |
|
Part 2. Health
Services at the Library |
|
|
We would like to know how your
library supports health.
Please indicate what
types of health-related services or programs your library has, to your knowledge,
offered, as well as what types of topics you would
like to learn more about in the future. (Select all that apply) |
|
|
Access to health
information in general |
142 |
|
Access to health
literacy |
142 |
|
Access to
primary healthcare |
142 |
|
Access to
preventative health services |
142 |
|
Access to health
insurance |
142 |
|
Access to mental
health or behavioral health |
142 |
|
Access to
reproductive health |
142 |
|
Access to
services for substance use disorders |
142 |
|
Access to
COVID-19 related services |
142 |
|
Access to food |
142 |
|
Access to
nutrition |
142 |
|
Access to physical
activity |
142 |
|
Access to
support with chronic disease(s) |
142 |
|
Access to
services related to healthy aging |
142 |
|
Access to
reentry services for those previously incarcerated |
142 |
|
Access to
housing |
142 |
|
Access to
transportation |
142 |
|
Access to
employment |
142 |
|
Access to early
childhood services |
142 |
|
Access to
education (Adult) |
142 |
|
Access to
education (Pre-K) |
142 |
|
Access to
education (K-12) |
142 |
|
Access to legal
aid |
142 |
|
Access to
economic development opportunities |
142 |
|
Access to
technology |
142 |
|
Access to
literacy |
142 |
|
Part 3. Library in the
Community |
|
|
How would you rate the
following: [Options included Strongly agree, Slightly agree, Slightly
disagree, Strongly disagree] |
|
|
My library routinely
offers off-site programs or services |
136 |
|
Library staff
often participate in community meetings or coalitions |
136 |
|
Organizations in
general typically look to the library as a partner |
136 |
|
Health
organizations, specifically, look to the library as a partner |
136 |
|
Individuals in
the community typically see the library as a safe and trusted space to
access health literacy |
136 |
|
Individuals in
the community typically see the library as a safe and trusted space to
access health services |
136 |
|
My library sees
health equity as a priority |
136 |
|
My library
serves as a space where people can meet new people in
the community.. |
136 |
|
My library
serves as a space where social connections are affirmed |
136 |
|
Individuals in
the community typically see the library as a safe and trusted space for all
ages |
136 |
|
Individuals in
the community typically see the library as a safe and trusted space for all
ages |
136 |
|
Library staff
are typically well versed in the pressing issues facing the
community |
136 |
|
Library staff
are typically able to work collaboratively with other individuals and
organizations to address pressing community issues |
136 |
|
Part 4. The Library
and Community Health |
|
|
Have library staff and/or
partners ever offered any of the following at your library, or off-site with library
participation? (Select all that apply). "Partners"
here includes all individuals or organizations that are not directly affiliated with the library |
|
|
Immunization
clinics, in general (e.g. for vaccinations) |
129 |
|
Immunization
clinics, specifically for COVID19 |
129 |
|
COVID-19 testing |
129 |
|
Health screening
services: Blood pressure |
129 |
|
Health screening
services: Obesity |
129 |
|
Health screening
services: Mammography |
129 |
|
Health screening
services: other |
129 |
|
Assistance with
mental health issues (e.g. social, behavioral, emotional
needs) |
129 |
|
Referrals to
appropriate health and/or social service agencies |
129 |
|
Locating and evaluating free health information
online |
129 |
|
Using
subscription health database(s) |
129 |
|
Identifying
health insurance resources |
129 |
|
Understanding
specific health topics |
129 |
|
Identifying or
using local health resources |
129 |
|
Offering fitness
classes |
129 |
|
Offering
nutrition classes |
129 |
|
Summer meals |
129 |
|
Other ways of
distributing free food (community fridge, food boxes) |
129 |
|
Health fairs |
129 |
|
Farmer’s Markets |
129 |
|
Blood drives |
129 |
|
Food drives |
129 |
|
Mental health
first aid trainings |
129 |
|
Telehealth
services |
129 |
|
Have any of the following
health-related groups ever met at your library?
(Select all that apply) |
|
|
Health
coalitions |
127 |
|
Health
department task forces |
127 |
|
Area Agency on
Aging |
127 |
|
Other
health-related groups (please describe) |
127 |
|
None of the
above |
127 |
|
To your knowledge, have any of
the following ever occurred at your library, or on
property owned by your library (e.g. parking lot)? |
|
|
Drug overdose |
127 |
|
Drug deal |
127 |
|
Alcohol or
tobacco use against library policy |
127 |
|
Individuals
experiencing homelessness using library as de facto day
shelter |
127 |
|
Violence that
requires intervention from security staff or law enforcement |
127 |
|
Other health
related incidents (please describe) |
127 |
|
None of these |
127 |
|
Do any of your library staff
have access to the following on-site at your library?
(Select all that apply) |
|
|
Naloxone |
127 |
|
Epipen |
127 |
|
Automated
external defibrillator (AED) |
127 |
|
Other health-related
equipment (please describe) |
127 |
|
None of the
above |
127 |
|
Part 5. Staffing for
Health |
|
|
Does your library currently, or has your library ever had, any of the following
types of individuals available to the public? |
|
|
Social workers |
126 |
|
Social work
students |
126 |
|
Community health
workers |
126 |
|
Health educator |
126 |
|
Nurses |
126 |
|
AmeriCorps or
other volunteers |
126 |
|
Other
health-related professional (describe) |
126 |
|
If your library has any
health-related professionals currently available to the
public, about how often do these individuals typically provide services at your library? |
|
|
Daily |
126 |
|
Weekly |
126 |
|
Monthly |
126 |
|
Less than once a
month |
126 |
|
Not applicable |
126 |
|
If your library could have
any health-related professionals available to the
public, about how often do you think the services
of such individual(s) would be
needed at your library? |
|
|
Daily |
126 |
|
Weekly |
126 |
|
Monthly |
126 |
|
Less than once a
month |
126 |
|
Not applicable |
126 |
|
To your knowledge, does your
library have someone on staff who you would
characterize as a “champion” for health-related programs, services,
or partnerships? |
|
|
Yes |
126 |
|
No |
126 |
|
If yes, could you please
briefly describe what your library’s health champion(s)
do to support health-related programs, services, or partnerships? |
|
|
Part 6. Health
Partnerships and Funding |
|
|
Has your library ever worked
with or received funding from any of the following, specifically to offer health related
services or programs? |
|
|
SC Center for
Rural and Primary Healthcare |
123 |
|
Hands on Health
SC |
123 |
|
National Network
of Libraries of Medicine (NNLM) |
123 |
|
Institute of
Museum and Library Sciences |
123 |
|
Regional
healthcare systems |
123 |
|
Foundations |
123 |
|
Food Share SC |
123 |
|
South Carolina
State Library |
123 |
|
Clemson
Cooperative Extension |
123 |
|
Other
organizations (please describe) |
123 |
|
None of the
above |
123 |
|
Thinking about your local
community, how would you characterize the relationship
between your library and the following organizations? |
|
|
Health
department |
123 |
|
Hospital or
healthcare system(s) |
123 |
|
Health coalition
or alliances |
123 |
|
SNAP-Ed
implementing agency |
123 |
|
Local non-profit
organizations |
123 |
|
Colleges or
universities |
123 |
|
K-12 Schools |
123 |
|
Parks &
Recreation Unit |
123 |
|
Early education
providers, including daycares |
123 |
|
WIC Clinics |
123 |
|
Department of Justice
/ Department of Corrections |
123 |
|
Part 7. Health
Priorities |
|
|
What barriers, in your opinion,
stand in the way of your library being able
to participate in efforts to support health? (Select all that apply) |
|
|
No barriers |
122 |
|
Not sure where
to start |
122 |
|
No one has asked
us to help, or to participate in community efforts |
122 |
|
Funding |
122 |
|
Lack of
expertise on topic |
122 |
|
Lack of partners |
122 |
|
Lack of space |
122 |
|
Doesn't fit
within the mission of our library |
122 |
|
Other (please
specify) |
122 |
|
Thinking of future continuing
education opportunities, what are priorities
for you in terms of library support for health? (Select all that apply) |
|
|
How to get
started with health-related services or programs |
121 |
|
How to market
the availability of health-related services or programs |
121 |
|
How to sustain
health-related services or programs |
121 |
|
How to expand
health-related services or programs |
121 |
|
How to partner
with community collaborators |
121 |
|
How to evaluate
health-related services or programs |
121 |
|
Other (please
describe) |
121 |
|
None of the
above |
121 |
|
Thinking of future continuing
education opportunities, how would you most
like to learn more about the topics addressed in this questionnaire (select one) |
|
|
From a SC public
library worker who has directly worked on these topics at their
library |
122 |
|
From a SC public
library administrator who has supervised work on
these topics at their library |
122 |
|
From a medical
or health sciences librarian with expertise on this topic |
122 |
|
From a staff
member at the South Carolina Center for Rural and Primary
Healthcare |
122 |
|
From a person in
your community (e.g. local health department) |
122 |
|
From someone
else (please specify) |
122 |
|
Thinking about the topics
addressed in this questionnaire, is there anything else
you would like us to know? |
|
|
If you would be potentially
interested in participating in an interview or focus group
about these topics, please insert your email address here |
|
|
Please include your email
address to receive a $10 Amazon Gift Card |
|