Confronting Free Market Romanticism: Health Care Reform in the Least Likely Place

Health policy experts long have argued that a combination of budgetary constraints, lack of legislative expertise, and parochial attitudes make it unlikely that the U.S. states will contribute significantly to health care reform. This is particularly true of states like Texas, which ranks last or near-to-last in virtually every measure of public health, and is dominated by conservative politics and libertarian, free market ideology. Yet, in 1997 the Texas legislature enacted the first Patient's Bill of Rights. This article examines the political and rhetorical processes that led to successful reform, and discusses the implications that success in "the least likely place" holds for the making of health care policy.     

Managing Health Care in Oregon: The Search for a Civic Bioethics

Managed health care deliberations in Oregon point to a "civic bioethics" model to resolve allocation issues through publicly articulated community values and priorities that influence legislative action. Communication practices in the Oregon experiment provide data to develop an evaluative framework to assess public moral deliberation in value-laden contexts such as health care distribution. The Oregon experience also points to dialogical virtues to heighten citizens' ethical sensibilities and political will, discursive tools to inform ethical communication practices in a civic bioethics model.     

Negotiating Language in Transnational Health Care: Exploring Translingual Literacy through Grounded Practical Theory

An increased interest in studying the nature of communication in health care and the use of interpreters has revealed the need for more collaboration and understanding of multilingual health-care practices. Theory and practice concerning cross-cultural health-care communication can benefit from examining the intersections between translingual literacy and transnational programs through hybrid interpretive strategies. In this study, I argue that these strategies move across, between, and among different languages, dialects, and nonverbal gestures to develop mutual understanding. To account for literacy practices that might engage this hybridity in health care, I use grounded practical theory to analyze a case study of participants who ran temporary medical and dental clinics in the Dominican Republic. This analysis finds that hybrid strategies with English–Spanish and Spanish–Spanish interpretation are used to overcome problems with balancing efficiency and rapport-building. By integrating ethnographic methods and grounded practical theory, this study's practical implications emerge in the negotiations of language employed by participants to connect translingual theory and practice in health-care communication.     

Quality Improvement and Health Care

W. Edwards Deming's theories of continuous quality improvement, using statistical analysis to identify problems or errors in operational processes, are in the early stages of development in service organizations after substantial success in industry, especially in Japan. Information on continuous quality improvement for libraries is sparse. The articles in this annotated bibliography will help interested readers learn more about this theory and its application in the health care business.     

A Comparative Study of Sources of Health Information and Access to Preventive Care Among Low Income Chronic Drug Users

Much of health research that examines patterns of health utilization for chronic drug users fails to account for the role of media use and health information seeking. This paper suggests that the nature of drug use is associated with a decreased health orientation that is manifested in media selection and consumption. A comparative analysis was conducted to examine: (1) the differential health perceptions as a function of drug use, (2) the sources of information used, and (3) the relationship between sources of information and primary health care access among chronic users of illicit drugs and socio-demographically similar persons who are not chronic drug users. Results point to both common as well as differential patterns of health information sources. Logistic regression analysis found that medically related sources such as doctors and pamphlets are important sources associated with increased primary care. Important implications are discussed.     

Confronting Free Market Romanticism: Health Care Reform in the Least Likely Place

Health policy experts long have argued that a combination of budgetary constraints, lack of legislative expertise, and parochial attitudes make it unlikely that the U.S. states will contribute significantly to health care reform. This is particularly true of states like Texas, which ranks last or near-to-last in virtually every measure of public health, and is dominated by conservative politics and libertarian, free market ideology. Yet, in 1997 the Texas legislature enacted the first Patient's Bill of Rights. This article examines the political and rhetorical processes that led to successful reform, and discusses the implications that success in "the least likely place" holds for the making of health care policy.     

The Women's Health Movement

The contemporary Women's Health Movement (WHM), which began in the early 1970s, has significantly influenced the lives and health care of women throughout the United States. A direct outgrowth of dissatisfaction with paternalistic male dominance of women's health care, the WHM hoped to regain control over their bodies and medical decision-making by educating women to become knowledgeable, involved health consumers. Periodicals, particularly newsletters, have played a significant role in the empowerment process, by drawing together networks of women with common, often disease-oriented health interests. Over 35 contemporary WHM periodicals and evolving topics are identified.     

Tensions in Community Health Improvement Initiatives: Communication and Collaboration in a Managed Care Environment

Between the years 1993 and 2000, the W. K. Kellogg Foundation sponsored the Comprehensive Community Health Models (CCHMs) Initiative in three Michigan counties. CCHMs was comprised of three closely related community initiatives carried out in the midst of a failed national health care reform effort and the continued penetration of managed care arrangements into many health care systems. This experimental initiative set out to test the hypothesis that traditional healthcare system animosities and exclusionary practices could be overcome by stakeholder participation in an ongoing, structured, collaborative dialogue about improving access to health services. In the process of collecting data through surveys, interviews, content analysis, and observation, we were struck by the occurrence of several overarching tensions that we perceive to exist in our data. The present article elucidates five such tensions and suggests how third parties such as communication researchers, evaluators, and practitioners can facilitate community health improvement initiatives and better their own data interpretation by acknowledging and understanding these tensions.     

Tensions in Community Health Improvement Initiatives: Communication and Collaboration in a Managed Care Environment

Between the years 1993 and 2000, the W. K. Kellogg Foundation sponsored the Comprehensive Community Health Models (CCHMs) Initiative in three Michigan counties. CCHMs was comprised of three closely related community initiatives carried out in the midst of a failed national health care reform effort and the continued penetration of managed care arrangements into many health care systems. This experimental initiative set out to test the hypothesis that traditional healthcare system animosities and exclusionary practices could be overcome by stakeholder participation in an ongoing, structured, collaborative dialogue about improving access to health services. In the process of collecting data through surveys, interviews, content analysis, and observation, we were struck by the occurrence of several overarching tensions that we perceive to exist in our data. The present article elucidates five such tensions and suggests how third parties such as communication researchers, evaluators, and practitioners can facilitate community health improvement initiatives and better their own data interpretation by acknowledging and understanding these tensions.     

Perceived Information Exchange and Health Control Expectancies as Influenced by a Patient's Medical Interview Situation

The purpose of this study was to examine how a patient's medical interview situation influences the relationship between the health locus of control and information exchange. Participants included 537 people who completed the Multidimensional Health Locus of Control Scale and the patient version of the Medical Communication Competence Scale in reference to their last health care visit. The results indicated that the situation surrounding the medical interview influenced the relationship between the health locus of control and information exchange.     

Managing Health Care in Oregon: The Search for a Civic Bioethics

Managed health care deliberations in Oregon point to a "civic bioethics" model to resolve allocation issues through publicly articulated community values and priorities that influence legislative action. Communication practices in the Oregon experiment provide data to develop an evaluative framework to assess public moral deliberation in value-laden contexts such as health care distribution. The Oregon experience also points to dialogical virtues to heighten citizens' ethical sensibilities and political will, discursive tools to inform ethical communication practices in a civic bioethics model.     

Examining care navigation: librarian participation in a team-based approach?

Objective

This study investigated responsibilities, skill sets, degrees, and certifications required of health care navigators in order to identify areas of potential overlap with health sciences librarianship.

Method

The authors conducted a content analysis of health care navigator position announcements and developed and assigned forty-eight category terms to represent the sample''s responsibilities and skill sets.

Results

Coordination of patient care and a bachelor''s degree were the most common responsibility and degree requirements, respectively. Results also suggest that managing and providing health information resources is an area of overlap between health care navigators and health sciences librarians, and that librarians are well suited to serve on navigation teams.

Conclusion

Such overlap may provide an avenue for collaboration between navigators and health sciences librarians.     

Librarians Promoting Changes in the Health Care Delivery System through Systematic Assessment

Patient engagement in health care decisions largely depends on a patient’s health literacy and the health literacy attributes of the health care organization. Librarians have an established role in connecting patients with health information in the context of their care. However, librarians can play a larger role in helping to make changes in their organization’s health literacy attributes. This article discusses one medical library’s process of leading systematic assessment of their organization’s health literacy attributes. Included in this discussion is the institutional support, timeline, assessment tool, the results for five areas of health literacy, marketing and the event-planning process to disseminate results. The systematic assessment process described employs the Health Literacy Environment of Hospitals and Health Centers document, which provides assessment tools for Print Communication, Oral Communication, Navigation, Technology, and Policies and Protocols.     

Creating an Evidence-Based Culture Within the Schools of Public Health and Medicine

Information technology is having a huge influence on health care. With ease of access and an abundance of information, today's health care personnel are expected to practice and develop policies or programs based upon evidence in order to avoid inefficiency and ineffectiveness. Our library has the responsibility to serve the needs of students, faculty, and practitioners of medicine and public health and strives to create an information literate workforce. In this article, the authors reflect on the library's instruction program and evaluate and plan for the future order to determine if the library's instruction program is properly developing an evidence-based medical and public health workforce.     

The Health Information Literacy Research Project

Objectives:

This research studied hospital administrators'' and hospital-based health care providers'' (collectively, the target group) perceived value of consumer health information resources and of librarians'' roles in promoting health information literacy in their institutions.

Methods:

A web-based needs survey was developed and administered to hospital administrators and health care providers. Multiple health information literacy curricula were developed. One was pilot-tested by nine hospital libraries in the United States and Canada. Quantitative and qualitative methods were used to evaluate the curriculum and its impact on the target group.

Results:

A majority of survey respondents believed that providing consumer health information resources was critically important to fulfilling their institutions'' missions and that their hospitals could improve health information literacy by increasing awareness of its impact on patient care and by training staff to become more knowledgeable about health literacy barriers. The study showed that a librarian-taught health information literacy curriculum did raise awareness about the issue among the target group and increased both the use of National Library of Medicine consumer health resources and referrals to librarians for health information literacy support.

Conclusions:

It is hoped that many hospital administrators and health care providers will take the health information literacy curricula and recognize that librarians can educate about the topic and that providers will use related consumer health services and resources.

Highlights

• Health care providers responded positively to a health information literacy curriculum offered by librarians and to related resources and services, namely MedlinePlus and the information referral system known as Information Rx.
• Participation in a curriculum increased health care providers'' knowledge of health information literacy, awareness of available consumer health information, and referral of patients to the library for additional assistance.
• Librarian involvement in health information literacy increased the profession''s visibility and perceived value.

Implications

• Consumer health information services and resources offered by librarians can improve the health information literacy skills of health care providers and their patients.
• Training by librarians can increase knowledge of the importance of health information literacy and usage of MedlinePlus and Information Rxs.
• Hospital-based administrators and health care providers can be champions in support of health information literacy and consumer health information services offered by libraries.

     

Structuring and Disciplining Apology: A Structurational Analysis of Health Care Benevolence Laws

Health care benevolence laws, a form of tort reform law, mandate statements of sympathy or apology by health care providers and facilities in cases of medical mistakes. These laws create a shared language and sense of meaning for individuals involved in the legal aftermath of medical mistakes. Structuration theory guides this textual analysis to explore how benevolence laws discursively create and structure shared meaning about apology. This analysis highlights how benevolence laws structure apology and discursively discipline medical practitioners, underscoring the importance of ambiguity in law interpretation.     

Streamlining How We Deliver Public Health Information Online: From CHN to PHAC

The desire to consolidate resources into one website, that of the Public Health Agency of Canada, was behind the decision to close the Canadian Health Network (CHN) in April 2008. Although CHN set new standards in online health information, this decision was made for a variety of reasons, including to better reach both a professional audience and the general public. The Public Health Agency of Canada recognizes the contributions made to the CHN from librarians and has committed to work closely with all of the CHN's stakeholders and partners to consider new ways to provide health information online.     

Enacted Goal Attention in Family Conversations about End-of-life Health Decisions

Most extant research on end-of-life communication in families has been based on the assumption that more communication is better communication. We used a multiple goals theoretical perspective to demonstrate that the quality of communication about end-of-life decisions matters. Members of 121 older parent/adult child dyads (N = 242) engaged in an elicited conversation about end-of-life health choices and reported their assessments of the conversation. Using multilevel linear modeling, we found that outside ratings of a person's communication quality (i.e., attention to task, identity, and relational goals) as well as outside ratings of the partner's communication quality were positively associated with the person's reported conversational satisfaction and hopefulness and negatively associated with the person's hurt feelings and relational distancing.     

Shopping for Health Information

ABSTRACT

In this time of ongoing health care changes, consumers need to become better informed to actively participate in their health care decisions. As a result, hospital libraries are being challenged to address this need. Scottsdale Healthcare's Health Sciences Libraries have responded to this challenge by establishing a Health Information Center at the premiere shopping mall in the area. Implementing a Health Information Center at a mall is a unique way to bring medical information to the community. The purpose of this paper is to describe the planning process, the implementation, and the future vision of the Health Information Center at Scottsdale Fashion Square.