Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and your host of Health Literacy Out Loud.

In these podcasts, you get to listen in on my conversations about health literacy with some really amazing people.

Today, I’m talking with Amy Six-Means, who is on the librarian team at Children’s Health in Dallas, Texas. She worked at two other consumer health libraries prior to that.

Amy started as an elementary school teacher, later going back to school for a degree in library science. Along the way, Amy discovered the connection between medical librarianship and health literacy, and she has been a passionate advocate every since.

Over the years, Amy and I have met a few times in person, and we’ve certainly communicated online. I was extra inspired to do this podcast after reading her excellent article, “Health Literacy’s Influence on Consumer Libraries.”

Welcome, Amy.

Amy Six-Means: Thank you, Helen.

Helen Osborne: Consumer health librarian, that’s what you are. That’s what you do. Put it into context for all of us. What does that specific term mean?

Amy Six-Means: Specifically, it means we work with patients and their caregivers, loved ones and families to find health information about a condition, medication or supplement that they can understand so that they can have a more informed conversation with their doctors, and they better understand how to take care of themselves.

Helen Osborne: That sounds like it’s all in very much of a medical setting. Is that the case? Is that where more consumer health libraries tend to be, in hospitals or maybe outpatient clinics?

Amy Six-Means: It is, and it started out of medical librarianship and it has also moved into the realm of public libraries. Public librarians can actually now get a specialization in consumer health to help them become more aware of some of the resources that medical librarians have already known about.

Helen Osborne: It really spans that gap from the people who are so sick or in the hospital, all the way to the community and the public health library. I know, wearing my clinical hat, that’s where an awful lot of healthcare takes place now, outside of hospitals.

Amy Six-Means: Especially now that people are going online. There are more people looking for health information online than ever before, and they’d get confused. For a lot of people, their first place to go is the public library, which is why the MLA made this specialization for them.

Helen Osborne: MLA means?

Amy Six-Means: I’m sorry. It’s the Medical Library Association.

Helen Osborne: We have listeners from around the world and have all backgrounds, so thanks for that.

We’ve got consumer health libraries. Is that mainly in the US or is that worldwide? Do you know?

Amy Six-Means: I really don’t know. I know that it’s still an evolving role here. Even in the US, there are not a lot of hospitals that have it, but more and more hospitals have a consumer health librarian on staff. I’m pretty sure it’s up in Canada, but I don’t know worldwide.

Helen Osborne: I know one little clue is I was in Mumbai, India, a few years ago, speaking about health literacy, and they had a health education library right there in Mumbai, and justifiably were very proud of what they’re doing.

It may not be called the same thing worldwide, but I think that there’s a movement to help educate people for it.

I’m intrigued. You talked about online. How in the world do you intervene when someone’s doing a search?

Amy Six-Means: That’s a lot of what we do. We have resources on our computers for people who like to search on their own to guide them to websites that we know are good. The National Library of Medicine put together one called MedlinePlus that we particularly encourage our patrons to use, but we also have others.

The tendency is people go online and they say, “I can do my own searching,” and they google. Who knows what they’re getting?

A lot of times, I will ask them if they have a particular site in mind, and if they don’t, then I will suggest some sites, such as MedlinePlus or the CDC. The National Institutes of Health have a whole wealth of websites devoted to all sorts of populations and conditions.

For a lot of people, the health literacy issue that really comes out with consumer librarians is you get a new diagnosis or a family member gets a diagnosis and you’re just overwhelmed with the diagnosis itself. For a lot of people, they just don’t know where to go, how to start looking or what they even need to look for.

Helen Osborne: My family recently went through something like that, a diagnosis that seemed to come out of the blue. It was scary and not a very common one.

I don’t think that the next step they thought of was going to a library. I think that they were so caught up in the whole medical system and that wasn’t on their radar. How would a librarian get involved and help out?

Amy Six-Means: One of the first things I know I do, and a lot of other consumer librarians I know do, is we spend a little time just talking with the patron. We find out what’s going on, how they are feeling and what they need to know at that particular moment.

We recognize that a lot of us have a background in becoming aware of health literacy and being informed, so we know that, as time goes on, people might be able to handle more, but in the beginning, they just want to know basically what’s going on.

We talk with them, and we sit down and we try to help them to focus a little bit on what their need in that particular moment is.

Then what I do is I will sit people down beside me if they’re especially looking for internet resources, and we will look together. I will take them to MedlinePlus or the CDC.

Depending on the condition, if I can’t find anything in MedlinePlus, I will take them to Google and I will show them how to evaluate a website, what to look for and how to know if this is a site that they can trust.

Helen Osborne: I am hearing so many parallels with the clinicians. Again, that was my world. You somehow get introduced to the patient and you become part of the process.

It sounds like you have this way of identifying what the needs, strengths and goals are. You have your own terms for that, but it sounds as though you’re looking in terms of information and resources.

You’re diagnosing those learning needs in that way, and then you’re trying to do that intervention in there. I really love that beauty of sitting next to someone, being peers as you’re going through this one.

I know when I go to the library, if I ask the librarian for something, the librarian is always sitting and I’m standing, which is the opposite in a medical situation because the patient is always sitting and the clinician is always standing. I love the way you set that physical environment of “we’re in this together.”

Amy Six-Means: I really try to emphasize that, by having them sit with me, I’m with them. If they’re just standing across the desk from me, there’s a separation between us.

One of the things consumer health librarians really do is build that rapport with the patrons who come in. It really helps to open up. The other thing that happens is a lot of patrons are really hesitant to talk about what their actual needs are.

Having them sit down with us and really having that conversation helps to develop a relationship, which allows them to feel more comfortable in sharing information that they’re looking for.

Helen Osborne: I just feel all these parallels there with the clinical work in there. You developed a relationship. But is this a relationship just in that moment and then it’s gone, or is this an ongoing one?

Amy Six-Means: Actually, I have quite a number of repeat customers, or patrons, I should say, because of that very thing. We establish relationships and they know that they can come back here and we’ll really delve into even more research.

In all of my libraries, I had quite a number of patrons who continually come back, call me or send me an email.

Helen Osborne: That’s great that you’re so accessible. I love librarians. I think that that’s coming through. I think of you and I just appreciate the expertise librarians have for accessing and organizing information, and we need to do this together.

Amy, you’ve been talking about that hospital model, but we both know just a small percentage of care happens there. How do consumer health libraries work in the community?

Amy Six-Means: We have historically, even now as the ACA has come out . . .

Helen Osborne: The Affordable Care Act.

Amy Six-Means: Yes. We have worked with clinics, public librarians, public health and literacy programs to really go out into the neighborhoods to groups that those particular organizations work with to talk about issues of health.

For instance, we’ll talk with the clinics about the Affordable Care Act. While the clinics can talk about insurance and how it affects the patient’s experience at the clinic, we can also talk about some websites where they can find even more information about it.

Applying to the Affordable Care Act is all done online. There’s a lot of information that’s online and, again, it’s very confusing because of the amount of information.

We not only can work with the clinics in classes that they hold for their patients, but we can refer some sites to the clinics on some easy-to-read handouts or forms for their patients to look at before they actually go online and sign up.

Helen Osborne: I was just thinking about that because you go online, and we’re talking about all this information.

Amy Six-Means: Ugh.

Helen Osborne: What are you sighing about? It’s all word-based.

Amy Six-Means: It is.

Helen Osborne: What about all the people we’re advocating for on their behalf, who struggle to read, struggle with English and barely want to even try the computer? How do you get beyond those hurdles?

Amy Six-Means: Exactly. Fortunately, a lot of the clinics, at least around here in Denver, have navigators who help those particular patients to sign up.

Before they even can get to that, there’s the signage in the clinic and the handouts that they give, so we have been able to, as I said before, share some easy-to-read information.

There are some really great podcasts that Missouri Health Literacy has put together that are short and really speak to the various issues of the Affordable Care Act. We can share that.

When the clinics are having classes to teach their patients about the Affordable Care Act, they have some resources that are a little more developed in guidance with the potential literacy and limited health literacy needs of the patients.

Helen Osborne: I’m really sensing this interaction overlap between advocating for health literacy and the needs of all of us, whatever we bring to our learning situation, and the resources there. It sounds like an amazing glue that can hold us all together.

I know you are an incredible advocate for health literacy. Can you tell us some stories about how consumer health librarians can help advocate for health literacy?

Amy Six-Means: One of the things that many consumer health librarians that I know do is they advocate within their organization. That can come across in various ways.

They can be part of a health literacy committee that does initiatives within the hospital. That really furthers health literacy awareness of the limited health literacy potential of patrons, but also the skills that clinicians and nurses need in order to really communicate better with their patients and to provide them with information that they can understand.

Another thing that some consumer health librarians are doing that I know of is they are actually teaching classes to nurses, physicians and residents about things like clear communication, how to write a document using plain language guidelines and those things that will, once again, help to reinforce the communication between the clinicians, nurses, patients and their caregivers.

Helen Osborne: Those are great examples.

Amy Six-Means: Those are just two of the things that I know consumer health librarians are doing to really advocate for health literacy within their organization.

Helen Osborne: I’ve got a couple other ideas too. Something you did was you wrote this very interesting article. We’ll have a link on your Health Literacy Out Loud web page to the abstract of your article. You’re bridging the gap there too.

This podcast, I hope, is serving that purpose as well. I hope a lot of librarians are listening, but I assume it’s more clinicians, public health folks, academics and literacy teachers, all of us doing that work of direct communication. I hope that this podcast helps bridge that gap, too.

On your wish list, what would you want Health Literacy Out Loud listeners to do with this information about consumer health librarians?

Amy Six-Means: It would be really fantastic if there were even more collaborations between consumer health and/or medical librarians who are doing consumer health and organizations and the public.

While consumer health librarians and medical librarians do a lot of reaching out to the community, it would be really fantastic if members of the community would reach out to us.

Helen Osborne: We’re all in it together.

Amy Six-Means: Yes, we are. There’s so much that is part of health literacy, and we each have different skills that we bring to it. We recognize that, which is why we go to folks in public health and adult literacy and we go to the clinics.

On my wish list would be that those folks would really recognize the skill set that we bring, and they would come to their hospital medical librarians who are also doing consumer health.

Helen Osborne: You’re wonderful, Amy. That’s why I’ve so enjoyed getting to know you over the years. A phrase I often use is that health literacy is bigger than any one person, profession or program.

Amy Six-Means: Absolutely.

Helen Osborne: It takes all of us to make things better. Thank you so much for doing all you do and for sharing it with us on Health Literacy Out Loud.

Amy Six-Means: Thank you, Helen.

Helen Osborne: As we just heard from Amy Six-Means, it’s important to include a whole team when it comes to health literacy.

For help clearly communicating your health message, please visit my Health Literacy Consulting website at www.HealthLiteracy.com. While you are there, please sign up for the free monthly e-newsletter, What’s New in Health Literacy Consulting.

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Did you like this podcast? Even more, did you learn something new? I sure hope so. If you did, tell your colleagues and tell your friends. Together, let’s tell the whole world why health literacy matters.

Until next time, I’m Helen Osborne.

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