AZHealthInfo: a collaborative model for supporting the health information needs of public health workers, public librarians, consumers, and communities in Arizona *

The national Turning Point [1] program was launched by the Robert Wood Johnson Foundation and the W. K. Kellogg Foundation with a vision to transform and strengthen the public health system in the United States by promoting community-based and collaborative processes. In Arizona, three projects were selected for funding by the national Turning Point program, including the only project nationwide that envisioned public libraries as part of the solution. 
 
AZHealthInfo, a state-focused health information Web resource developed for public health consumers and communities in Arizona, grew out of this proposal [2]. The initiative described a plan “to build community leadership through training and information dissemination … to establish centers for public health in public libraries, public health departments and tribal service centers” [3]. It was modeled on an earlier program to develop Economic Development Information Centers (EDIC) [4, 5] in public libraries around the state to support the local business community and improve the economic climate.


INTRODUCTION
The national Turning Point [1] program was launched by the Robert Wood Johnson Foundation and the W. K. Kellogg Foundation with a vision to transform and strengthen the public health system in the United States by promoting community-based and collaborative processes. In Arizona, three projects were selected for funding by the national Turning Point program, including the only project nationwide that envisioned public libraries as part of the solution.
AZHealthInfo, a state-focused health information Web resource developed for public health consumers and communities in Arizona, grew out of this proposal [2]. The initiative described a plan ''to build community leadership through training and information dissemination . . . to establish centers for public health in public libraries, public health departments and tribal service centers'' [3]. It was modeled on an earlier program to develop Economic Development Information Centers (EDIC) [4,5] in public libraries around the state to support the local business community and improve the economic climate.

TARGET POPULATIONS
From its beginnings in 2003, AZHealthInfo was intended as an online health information resource that would provide easy access to reliable and authoritative public health information and address the needs of public health workers, public librarians, and consumers and communities. Rather than create yet another Web page with relevant national data, AZHealthInfo focuses on Arizona-specific information.

SIGNIFICANT ISSUES
There was general consensus that while both the State Department of Health Services and the fifteen counties in Arizona had valuable information and data they were willing to share, the information itself was elusive and hard to find. For example, the State Department of Health Services is not mandated to make its information available to the public and could not spend the money needed to make that information more readily accessible. County health departments were known to write health education materials that could be used in a wider venue if their existence was known and access was easily available. Public libraries knew they answered a multitude of health-related questions and needed to know the best places to look for answers. Health departments also worked with the public to provide public health information. Could some positive synergies be achieved by working collaboratively? The committee felt strongly that librarians and public health officials had much to offer each other. The local public library was seen as a place where people went for information, and the local public health department had information to disseminate to citizens in a timely manner.

INTERVENTION
The steering committee consisted of representatives from each partner organization noted above. The committee realized early on that one of the assumptions underlying the original proposal, that each public library in Arizona would need or want a computer dedicated to public health in their reference areas, was now outdated. Virtually all public libraries in the state had public use computers with broadband Internet connectivity. Thus, the first task facing the steering committee was to provide a new vision and objectives: Ⅲ make health information that citizens need readily available Ⅲ improve access to the particular kinds of health information that public health professionals use Ⅲ foster partnerships between public librarians and public health professionals by focusing on what each group had in common, the delivery of reliable health information to individuals and the wider community Ⅲ provide resources that communities can use to build their capacity to organize effectively to address public health issues in their own neighborhoods To achieve these objectives, the committee negotiated a contract with the Arizona Health Sciences Library (AHSL) [6] of the University of Arizona in Tucson to carry out the plan and focused its efforts on three areas: developing a Website that facilitated access to elusive, Arizona-specific consumer and public health information; providing training to public librarians and public health professionals in all fifteen counties; and fostering a partnership between public librarians and local public health officials with the intention of taking mutual responsibility for making local health information readily available. AHSL's earlier experience in developing the Consumer Health Information Links for Everyone (CHILE) [7], a collaborative consumer health information effort between AHSL and the Tucson-Pima Public Library, was a key factor in AHSL's selection to head up this project. Work began on creating the Website in the summer of 2003.
The project also included instruction as a key component of its strategies. In the spring and summer of 2004, AHSL's outreach staff traveled to all fifteen Arizona counties and presented workshops on using the AZHealthInfo Website. Attendees were also introduced to PubMed, MedlinePlus, and a variety of other topics. Each training site decided what was important to its constituents, and mini-workshops were devised. Initially, mini-workshop topics included bioterrorism, diabetes, obesity, reference interviewing, and Spanishlanguage resources and lasted approximately one hour. By the end of the training period, more than thirty topics were developed and presented.

EVALUATION
Anecdotal feedback indicated that the AZHealthInfo Website and subsequent training were warmly received by the public librarians and public health workers who frequently answer consumer health questions. The site has been promoted at several regional and national conferences (both health provider-and library-oriented), including the Arizona Public Health Association (AZPHA), Arizona Rural Health Association, American Public Health Association, Arizona Library Association, Joint Meeting of the Medical Library Group of Southern California and Arizona and Medical Library Group of Northern California and Nevada, Medical Library Association, and American Library Association. In recognition of the educational mission of the site, the Education Section of the AZPHA awarded AZHealthInfo the 2005 HEMMY award. Additionally, usage data showed total hits to the site nearly doubled between 2005 and 2006 ( Figure 1).
No strategy was developed beforehand for fostering continued collaboration between local libraries and health departments. To accomplish this goal, whenever possible, training was scheduled concurrently so that both groups could meet, discern what each group had in common, and talk about how to move forward working together. To what extent that was helpful is unknown as it was not formally investigated, though workshop presenters observed that this strategy provided a beneficial alliance for some participants.

RESULTS
In 2005, the AZHealthInfo Website was redesigned to provide an expanding collection of focus pages targeted on issues that address health concerns in Arizona. Each focus page contains a narrative description of a condition, pertinent statistics, and an array of links, primarily to Websites featuring Arizona information. Preformulated MEDLINE searches are also included. While there are links to MedlinePlus and other national sites, the intention is not to recreate what MedlinePlus and others have done, but to facilitate access to Arizona information.
The role of collaboration was key in this project. The partners and stakeholders provided expertise and knowledge about their professional groups, a vision for their clientele, and funding support; promoted the project; gave exhibit space at conferences and health fairs; and provided instructional time on the agendas of their quarterly meetings and conferences. The variety of funding sources-which included the Arizona Turning Point Program (Robert Wood Johnson and W. K. Kellogg foundations) administered by the Maricopa County Department of Public Health, the Library Services and Technology Act from the State Library, and National Library of Medicine through the Pacific Southwest Region-exemplified the key role that collaboration played in the initiative.

FUTURE DIRECTIONS
Several additional developments are planned for AZHealthInfo. These include creating modules on tracking legislation and community capacity building, incorporating the separately developed Arizona Go Local site [8], providing a refined searching mechanism utilizing Google search engine technology to assist in the discovery of Arizona-focused information, and developing a public advisory group. The development of a sustainability plan to maintain and update the data was funded in 2006 with funds from the Library Services and Technology Act of the State Library. Finally AZHealthInfo will be promoted (along Public health outreach with the opportunities for training) to agencies and voluntary health organizations, a process that will allow the project team to broaden the partnership pool and hopefully assure its value and sustainability over the long term.