Medical and Health HIB

From Class: How do medical professionals and patients seek information? What needs to they have?
Rural Physicians

• Needs arise from: patient care (answering questions while patient is in the room); Needing to stay current on medical research; preparing to give a lecture


• Sources: Colleagues, Books & Journals, Consultants


• They are low on time and don't have access to a lot of things, they don't use the library because they dont' think it will provide them an answer fast enough.

Medical Students

• They often learn by problem-based learning and evidence-based practice


• They won't learn to use resources unless they have to


• For questions of judgement, they turn to colleagues


• At Yale, each med. student was given a personal librarian who was involved in curriculum and one-on-one instruction-- Good idea!

Nursing Students and Nurses

• Topics of interest: Drug info, Diesease info, Diagnostic info, Literature searching, Support group info., Clinical trial info.


• Use the computer heavily for daily job tasks


• Need to reach out to nurses so they know they can use the library too-- also, help them with computer skills because they use them so much

Patients

• Many use the internet before and after a doctor visit to be more well informed or get clarification


• Older people subtly express their needs, and sometimes deny problems because of fear of institutionalization


• Coping styles: Monitoring-- willing to recieive information; vs. Blunting-- Doesn't want to know about it at all.


• Coping styles and state of being a seeker, reciever, or rejector, change over time for the individual

Caregivers

• Needs change over time and space-- highest level of need comes just after diagnosis


• In later stages, seek more detailed information


• Feelings of anxiousness often accompany caring for a sick loved one-- need to remember this when helping these people, so we can be compassionate

Synthesis
Medical information is extremely critical for anyone involved in the medical field, either from the care-taking side or the patient side. Peoples' lives and quality of life are at stake in situations of serious illnes, and this must be taken into account when dealing with peoples' medical informaton needs. We need to remember that physicians and nurses are more concerned with caring for their patients adequately than learning new sources (even though the latter might help with the former). They are very busy people crunched for time who rely on collegues because they view them as trusted peers who understand their situations. Patients and caregivers often have no medical training, so it is important to find information for them that is not too technical. We also need to remember that illness effects the mind and emotions as well as the body, and in order to cope with the reality of illness, people can blunt information as well as seeking or simply monitoring for it. But, just because someone is blunting today doesn't mean they'll continue to do so-- individuals drift from mode to mode as they move through time and space.

Reading: Info Seeking in Context-- Cool, Dervin, Talja et al.

Notes:
Cool (2001): Situation in Information Science
There are different Ideas of "Situation" in Information Science Research:

• Problematic Situation: Focuses on the cognitive level; people discover a lack of information where information is needed, or that their knowledge is potentially incorrect, and when this lack of information is keeping them from achieving a goal, they act on it.[Schutz & Luckman, Wersig, Belkin]


• Social Interation Theory: sociocognitive perspective; people behave based on their own perception as well as their concern about how others will percieve them; this effects who we feel comfortable asking for information; the intermediary and the user both have their own ideas of how they are supposed to act in their roles in an IS situation and behave accordingly; intermediaries have to deal with the problem of, "calibrating the degtree of intersubjective alliance between oneself and the creators of infomration items" (19) in order to encourage the negotiation between user and information producer.[Goffman]


• Situated Action: People don't just make a plan and stick with it, they change their behavior based on the feedback and cues given to them by the technology or people they are working with; is a rather vague concept-- almost to vague to be useful.[Suchman]


• Person in Situation: Combines ideas about how individuals function with those of how situation affects their functioning; people's personalities affect the way in which they deal with situations. [Reid, Snow, Pervin]


• Situation as information environment: Based on viewing the situation as the physical environment[Taylor, Algon]

Dervin: A Context by Any Other Name (1997)

• "A context is a label for a site of struggle" (15).


• Themes: "Knowledge is partial & temporary; reality is discontinous, gap filled, changeable across time-space; the knower and the known are inextricably bound; context is not usefully conceptualized as independent entity; context requires a focus on process; focus must be placed on the dialtectical relationships between products and process; focus must be placed on multiple interdependencies; context is a neccessary source of meaning"

Tajla, et al.-- Metatheoretical view of production of context (1999)

• Behaviorist: how groups seek information; researches "the individual and his action as part of a specific group;" etic fiew of constructed concepts; aims to identify "general processes of information seeking."


• Social Constructionist: how is meaning constituted?; studies social constructions, cultural narratives, etc; constructed concepts viewed from an emic perspective; trying to, "Identify historical and local structures of meaning or discursive practices"

Summary
Situation and context have varied meaning depending on the framework from which one approaches them. Cool points out several variations on the study of situation, and Dervin seeks to find some cohesive definition drawn from the range of definitions given of context. Tajla, et al. give a good summary of the difference between the behaviorist and social constructionist approach to context.

Behavior Modification

Here is the question: whose behavior should we modify-- the behavior of the user, or the behavior of the library system?

If we are trying to help people fulfill information needs critical to carrying on with their lives, why should we make it difficult for them? Trying to modify their behavior will not encourage them to come back to us the next time they have a question, and don't we want them to feel comfortable returning? Otherwise, what is the point of having a library at all? It is easier to blame the user for not complying with the system's requirements-- it takes more work to really find out the way users behave and change the system to suit their behavior. Just because modifying the system is easier doesn't make it the best way to do things.

Maybe we should follow a model in which we see ourselves as trying to "sell" library services to our patrons. If a business wants to sell something, they don't ask the consumer to adapt their lifestyle around the product, they try to find out what would fit in to the consumer's lifestyle and design the product around that. It's too easy to get comfortable when we don't have a profit-based business in which we go out of business if the consumer doesn't like our product. But are we really still "in business" if people don't feel comfortable using our services? I don't think so.

Reading: Kuhlthau, Tuominen & Savolainen, Talja

Summary:
Kuhlthau: The User's Perspective

• Emphasizes importance of viewing information retrieval as a process ending in the "transformation of information into meaning" for the user, rather than ending in the output of words matching those that the searcher entered.
  


• Uses holistic perspective to evaluate user's information use
  


• "Since people have a limited capacity for assimilating new information, they purposefully construct meaning by selectively attending to that which connects with what they already know" -- Much like Ross's Girls and Drugs.
  


• The search process creates physical, emotional, and intellectual reactions which should all be taken into account when attempting to assist the user.
  


• Six stages of ISP: (1) Initiation, (2) Selection, (3) Exploration, (4) Formulation, (5) Collection, (6) Presentation. All are accompanied by a progression of feelings, thoughts, actions, and appropriate tasks.



• Task Perception:The user's idea of appropriate tasks differed from the original model. Many people start writing or composing without a focused idea of the topic. A difficulty remains enabling/ encouraging people to develop their own argument, rather than leaning heavily on that of the author whom they are researching, which does not seem to me would result in the desirable goal of constructing meaning from the information found.


• Kulthau's conclusions: we need to make systems that can adapt to the different stages of the ISP-- this can include adaptations made by the intermediary.
  

Tuominen and Savolainen: Social Constructionism and Info. Use as Discursive Action

• First, I had to look up discursive to get a clearer picture of what the authors were addressing: the definition from dictionary.com is: "proceeding to a conclusion by reason or argument rather than intuition."


• We all have a version of reality unique to us, and, "When we talk and write, we produce and organize our social reality."-- communication is a means of constructing social mores, etc., and information use is an agent in this construction


• Conversation (either written or verbal) is a method by which individuals combine and adjust their internal thoughts/feelings with the external social world.


• Facts and reliable information are constructed as such by social discourse, rather than being "real" facts or neutrally reliable sources. There is no neutrality because everything is affected by the social world in which it is encountered, reacted to, employed, and modified.



• Information is used within a social context and should also be studied within that context.

Talja: Knowledge Formations

• Knowledge produced through language-- objective truth is a myth
  


• Knowledge is "intersubjective"-- we all share a set of meanings that inform the knowledge we produce


• Researching users is really researching how knowledge is "made"

Analysis
These researchers focus on the construction of knowledge and how information behavior fits into that construction. They seem to focus on social relationships and constructions, rather than the inner world of the individual. This approach appeals to me because of my background in gender studies which is heavily grounded in social constructionism. However, I think that taking the perspective that there is no value to the cognitive approach is not useful either. The two clearly interact-- how does a user integrate the social "realities" that have been constructed into his/her own life experiences, habits, and personal preferences? Just because we all live in the same society does not mean our realities are the same. This is what Kulthau seems to be pointing out when she says that individuals adjust their internal ideas of the world as the external social world changes.

I also think that these ideas have application to library land. Can we construct a social environment in the library that creates the perception of openness and helpfulness? Can we attempt to adjust our institutions to better fit into the user's idea of the information he/she needs? I think we can, but I'm not sure exactly how it can be accomplished. I suppose first we must intimately understand the social world in which our users exist in order to deal with them in a more compassionate and informed way. This is especially important in areas like New Jersey with such a large immigrant population. People coming from other cultures often live in very different social worlds from those who've grown up in the U.S. If we don't understand their worlds, how can we expect to serve them well?

Groupwork Notes

A log of group project discussion so far: Arts & Letters

• Members: James, Ariel, Kate, Romina. emails: jpeek, azcooke, katander@camden, rominagu


• Who will we explore?: Artists/Art History, Philosophers, Literature Scholars, Writers (of prose & poetry), Journalists


• I will explore writers, journalists, & lit. scholars


• As of last week we all have perused general humanities-related articles and this week will delve further into individual areas

Hey you guys...

Having lived in Virginia for 6 years, I am partial to the phrase "y'all." Since we don't have any gender neutral pronoun in standard English, this southern word works well instead. Some even extend it by saying "all y'all," which essentially translates into "each and every one of you" -- again, a useful abbreviation. So, having just emerged from the "y'all" region, into the "you guys" region, I was greatly amused by the conversation in yesterday's class.

Another part of my amusement came from my background in women's/gender studies. In fact, our discussion reminded me of an article by feminist theorist Judith Butler, "Imitation and Gender Insubordination."* Butler argues that all gender is performance, and the fact that we must reinforce it through clothing and learned behavior means that as a non-social, neutral entity it doesn't truly exist. She sums it up near the end of her article: "If gender is drag, and if it is an imitation that regularly produces the ideal it attempts to approximate, then gender is a performance that produces the illusion of an inner sex or essence or psychic gender core; it produces on the skin, through the gesture, the move, the gait (that array of corporeal theatrics understood as gender presentation), the illusion of an inner depth" (1997: 312). I believe Butler's argument embodies the social constructionist viewpoint Ross was illustrating in class. Why don't we refer to people in gender neutral terms? Because our linguistic stance must reinforce the gender division or it might not be so clear-- we are expressing the scripts used to establish gender difference. This explains the adverse reaction Ross has to women being referred to as "guys." The disruption in his socially derived conception of the gender divide is uprooted when in his mind someone is being referred to by the wrong gender term. If we just start calling everyone by the same pronoun, we might begin to lose the scripts necessary for gender performance, and then by gosh the whole world will be turned upside down!

I would argue that the world needs to be turned upside down. I would not necessarily argue that calling everyone by the male-identified pronoun is the right way to do it (as some suggested in class). Women have always been a linguistic afterthought; after all woman is really just man with a womb. And just because the womb is added to the male word, does not indicate that linguistic history recognizes us as being men with additional positive qualities. There are so many examples of derogatory words with implicit feminine identification I can't even count them all. Here is one example: the root word hyster, used to form "hysteria" but also "hysterectomy" simultaneously means womb, and signifies womb as a source of insanity. Words shape our social relations because we cannot communicate in order to form societal connections and norms without language. I believe that language adapts to reflect society -- just look at the words used to describe other minority groups in the past in contrast to the terms used today. So when our society finally emerges out of its complete obsession with gender dichotomy as an essential social organizing mechanism, a gender neutral pronoun will emerge.

I believe I've rambled on enough about social constructions of gender. It isn't directly related to human information behavior, but it is how I relate to social constructionist theory.


*Butler, J. (1997). "Imitation and Gender Insubordination." The Second Wave: A Reader in Feminist Theory. Ed. Linda Nicholson. New York: Routledge, pp. 301-315.

Negotiating a Dialog

I work in a learning center on campus as an academic coach/writing assistant for undergraduates. I meet with students to provide them study, reading, and note-taking strategies tailored to their individual requirements. As a writing assistant, I help them work through the brainstorming and structuring of papers. These students come to me seeking a specific type of information, and expect to use me as an authoritative source (yikes, that's a scary thought!). What strikes me though, in light of our discussion of Taylor in today's class, is that when I discuss academic issues with my students, I am engaging in just the sort of negotiation that Taylor addresses. Students come to me because they have an assignment due, or a test approaching, and they want to know how they can do a better job of preparing. At least this is how they first present their query in our discussions. Inevitably this is not the only issue they want to talk about with me.

I cannot discuss an individual example for confidentiality reasons, but I will aggregate my experiences with multiple students into a fictional student named "Susan." Susan comes to me and says, "I don't know if I'm studying enough, and I'm reading all of my readings twice, but really I just want to know how much time exactly I should spend studying for each of my classes.” This is the "compromised" need in Taylor's model -- the need expressed how Susan thinks I want her to express it to me as the information provider/ intermediary. I ask Susan how often she studies, where she does it, what her weekly routine is like, how well she thinks her current habits are working, and why. Susan tells me about all of these factors, explaining that she goes to a quiet place to study and has an established routine with scheduled study times, but thinks something about her routine is not working well. This negotiation occurs in a much more drawn-out way that I've summarized, but this would be an outline of our discussion. While Susan is talking about why she doesn't think her study habits are effective despite her efforts to follow all of the advice she's gotten in the past about study environments, etc, she brings up the issue of Attention Deficit Disorder. At this point I think to myself, "Ahh, this may be why she is really here. She thinks she might have ADD." Of course I am in no way even remotely qualified to tell her whether or not she has ADD. In order to address her inquiry, I can recommend a pre-screening for ADD given by my supervisor. In doing this I am directing Susan to an appropriate source of information that might help her bridge the “gap” (Dervin) in her world.

Why didn't Susan just come right out and say, "I think I might have ADD?" Well, maybe she didn't realize this was the root of her query until I engaged her in discussion about her experience of attempting to study with no avail. Maybe she was embarrassed to tell anyone that she wasn't doing well. Or perhaps she was resistant to admit that she thought she might have a learning disability because of the negative associations she has with the learning disabled. In any case, had I listened to initial query and told her, "Well, you should study three hours a week for every class credit you're taking," I probably would have failed to help her get on with her life using the information needed to make sense of her situation, to use Dervin’s terms again. The gap in her experience of the world -- "I am putting myself in the right study environment and allotting appropriate time, but I am not able to cover the material required" -- had a complicated need behind it that required Susan to bring up what was assuredly a sensitive issue for her, and one she may not have consciously articulated for herself before.

In Taylor's framework, Susan began with the "visceral" need to find out how she could concentrate better and thus succeed academically. Her conscious description of the need may or may not have recognized her questions about ADD, which would explain the fact that her initial query did not specifically include this issue. I engaged her in a negotiation using open-ended questions and dug down in to at least one of her information needs.

The conversations I have with my students are a process of discovery for both of us. I attempt to understand their current situations as they relate to their need for academic assistance. As we discuss their situations, they begin to articulate what they want from me. In more cases than I would have expected, as the student begins to articulate this need throughout our conversation, he/she becomes visibly emotional. To me this illustrates how truly important a supportive and open dialog between the intermediary and information seeker is, especially when the information need is a sensitive one. I also believe it is critical not to divorce people's intellectual selves from their emotional selves. Often a student coming to me for help with concentration or time-management is dealing with difficult personal issues, and I have to be sensitive to that in order to best help them become superior students and move on through the semester.

Searching for a Topic

Here is how my initial dive into the term project went:

• Thought it would be interesting to look for info. on learning disabled students.


• Went to DIALOG to execute search and found it difficult to retrieve information on this because most articles seemed to be about students with physical disabilities, which I was not interested in.


• Felt frustrated and wondered if my search skills just weren't good enough to find what I was looking for.


• Resorted to Google, which lead me to a bibliography on minority student groups created by the ALA.


• Browsed the bibliography and did some citation chasing from items on it.


• I am interested in becoming an academic librarian, so the items relating to "mature" university student groups interested me, and there appeared to be many articles.


• Did a cursory scan of three potential references to make sure they looked promising.


• Came away fairly satisfied with what I'd gotten, but not incredibly inspired by the topic.

Sources so far:

Blaxter, L. and Tight, M., 1994. Juggling with time: How adults manage their time for lifelong education. Studies in the
Education of Adults 26 2, pp. 162–179.

Chatman, E., 1996. The impoverished life-world of outsiders. Journal of the American Society for Information Science 47 3,
pp. 193–206

Given, L.M., 2002. The academic and the everyday: Investigating the overlap in mature undergraduates' information-seeking
behaviors, Library & Information Science Research, 24 1, pp. 17-29. Retrieved October 3, 2005 http://
www.sciencedirect.com/science/article/B6W5R-4550876-3/2/6cc96594c5c24c4fa795564693887bd7