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Since first proposed in a 2000 Annals of Internal Medicine editorial , the informationist role has been well described in the health sciences library literature. Informationist now typically refers to an individual with a thorough understanding of both a health care domain and information seeking and appraisal, who employs that combination of expertise as part of a health care or research team. Authors have explored informationists' ability to select relevant evidence , lingering ambiguity of the role , training plans , integration of in-context practice with informatics applications , evaluation of a clinical informationist service [6, 7], and development of an informationist-staffed “evidence based answering service” . Other papers about the role have investigated potential implementations [9–13] and education and practice models [14–20].
The concept of this new role also met with controversy in the field of librarianship. Some librarians have regarded the informationist role as simply a repackaging of current practice or as a way to discount the value of their contributions to an organization as information providers [21–23]. Clinician reactions have also been mixed, advocating, for example, drug information specialist pharmacists as the optimal information providers on clinical teams and the need for physicians to develop their own literature searching and appraisal skills rather than rely on another professional [24–26].
While typically discussed in the clinical or bioinformatics domains, the informationist role may also be useful in any information-intensive or information-driven environment [18, 27]. To emphasize this potential applicability of the informationist role to multiple domains, the Medical Library Association (MLA) began referring to the role as the information specialist in context (ISIC) in 2002/03 .
To further explore the role, MLA and MLA's Task Force on the Information Specialist in Context (Appendix A) sought a consultant in 2003 to report on, among other issues, the state of ISIC implementations, librarians' thinking on the concept, and potential ways to move forward with ISIC work. The Eskind Biomedical Library (EBL) at Vanderbilt University Medical Center (VUMC) was selected for the project and completed a comprehensive report in 2005 .
The EBL team employed a multifaceted approach combining a literature review, surveys of librarians and health care professionals, focus groups with librarians, and interviews with practicing ISICs to explore opinions of and work in the concept. This multifaceted method allowed the team both to raise awareness of the topic and to generate exploratory data about how the role was viewed.
The full Envisioning the Information Specialist in Context report includes detailed findings about librarians' and health care and research professionals' perceptions of the ISIC role, their views of the education needed for such a professional, and their views about the future of the role. The research results presented here highlight findings from librarian respondents to the survey regarding potential barriers to the widespread implementation of ISIC roles. The complete Envisioning the Information Specialist in Context report is available on the MLA member Website .
The team designed a Web-based survey to facilitate reaching a large national sample of librarians and health care professionals. The project was approved by the VUMC Institutional Review Board.
The survey questions focused on exploring attitudes toward and perceptions regarding the ISIC role. The team developed a set of scenarios or practice models depicting ISICs in various settings to introduce respondents to potential ISIC roles and to solicit input on the skills and education needed (Figure 1 online).
Rating scales employed in the survey instrument included Likert scales for ordinal data (e.g., degree of agreement or disagreement, priority ratings), categorical answers (e.g., yes, no, not sure), and lists of items with multiple response options. The survey also included a number of open-ended questions to capture additional issues and commentary from respondents. The survey questions that related to barriers used lists of items and open-ended questions to allow respondents to add barriers not addressed in the response lists (Appendix B).
The investigators developed the questions around key concepts and issues surrounding the ISIC role gleaned from EBL's own ISIC experience [5, 14, 30] and the relevant literature. These concepts and issues included required skills and education, liability and authority concerns, implementation barriers, and likelihood that this role will be more widely implemented. With this set of scenarios and questions, the team sought to further establish content validity by submitting the survey to three panels of reviewers:
The project team further tested the survey for clarity and ease of response with a development sample drawn from EBL staff. This sample of twelve librarians completed the pilot version. The investigators incorporated comments from these reviewers and the pilot testers to address issues of content validity and to refine the clarity and readability of the survey items.
No formal sampling methods were used to select the national sample of survey recipients; the team used convenience sampling of information professionals in the health sciences. The Web-based survey was targeted primarily at biomedical librarians in the United States. Librarians were invited to participate in the survey via health sciences–related mailing lists such as MEDLIB-L and regional MLA chapter mailing lists, during focus groups conducted as part of the study, and through word of mouth and MLA communication vehicles such as MLA-FOCUS and the MLA News. While no concerted efforts were made to reach non-US librarians, the survey invitation distribution did include mailing lists such as the Aliahealth list for health librarians in Australia and New Zealand. The survey remained open for approximately four months, and multiple reminders were sent to potential respondents via these mechanisms.
The survey software counted each time the survey was opened, thus the team was able to track accesses to the survey as well as actual responses. Respondents were free to leave the survey at any time, and not all respondents completed all questions. The investigators analyzed data for all respondents up to the point that they elected to discontinue the survey.
Fisher's exact test with Bonferroni correction for multiple comparisons  was employed to examine potential differences in the barriers selected among the different subgroups of respondents (by institution type, librarian years of experience, library position). A corrected α < 0.05 was used as the threshold for statistical significance.
Though hit counts (n = 321) provided by the survey software indicated that more individuals accessed the survey and perhaps read the scenarios or other sections, only 274 librarians responded to portions of the survey. Table 1 provides a summary of demographic data for the librarians who responded to the survey. The survey did not require participants to include their country of origin, but based on findings such as British spellings in some of the comments, the team believes that only a small number of these responses came from librarians outside the United States.
When queried regarding the likelihood of widespread ISIC implementation over the next 10 years (n = 128), librarian respondents assigned a mean likelihood rating of 3.0 (SD 1.0) on a scale ranging from 1 (not likely) to 5 (highly likely). The 132 librarians responding to the question about 9 potential barriers to widespread implementation of the ISIC role selected a median of 4 items (range 1–9).
A high number of respondents felt funding was a significant barrier to widespread implementation of ISIC practice (89%; n = 117). High percentages of librarian respondents also selected the challenge of acceptance on the health care or research team (67%; n = 89), lack of formal training or education programs (56%; n = 74), health care professionals' lack of interest (55%; n = 73), and lack of qualified candidates (52%; n = 69) as barriers to the concept's spread (Table 2).
Despite some apparent superficial differences between the academic and hospital subgroups in the selection of barriers (Table 3), there were no statistically significant differences in barrier selection among librarians from various institution types, with varying years of experience, or with different levels of library responsibility.
Respondents were also free to describe additional barriers. These comments generally dealt with organizational support, financial and time constraints, cultural change in the library and institution, and lack of skilled candidates for the role. Table 4 includes representative additional barriers listed by librarian respondents.
This brief report has focused on librarian responses regarding perceived barriers to ISIC implementation. The small number of responses from health care professionals (n = 39) precluded a statistical analysis of their portion of the data. Though a much smaller number of health care and research practitioners completed the survey, the study was an important step toward raising awareness among librarians and health care professionals of the potential of the ISIC role. The study also provided a snapshot of librarians' views of the ISIC role several years after the initial discussion about the idea had subsided. The mean rating of 3.0 and standard deviation of 1.0 regarding the likelihood of widespread ISIC implementation in the next 10 years indicated both a general lack of strong feeling and a range of librarian opinions on the issue. This ambivalence might be partly explained by the large number of librarian-perceived barriers to implementation.
Librarians who responded to the survey saw multiple barriers to the spread of the role, among which funding and the challenge of integration in a health care team were selected most frequently. These respondents also noted barriers such as the lack of organizational support, defined models, and demonstrated outcomes. While proof of concept and model programs are undoubtedly necessary, it is important to keep in mind that ISIC implementations will vary from organization to organization and what works in one setting may not apply in others. Future research is needed to investigate which factors constitute success for an ISIC program as well as which parameters, such as top level buy-in and influential champions, may be critical for success [32, 33].
A number of the additional barriers suggested by librarians also dealt with the idea of cost, including training costs, salaries, and opportunity costs given other library duties. The primacy of these funding-related issues, coupled with comments regarding a need for demonstrated models and outcomes, seems to indicate that overcoming these proof of concept barriers will be critical for further ISIC implementations. Of course, this can put libraries in a “catch 22” situation: how can the benefits of an ISIC be demonstrated without first putting some resources toward developing an ISIC? There may be no easy solution, but the team's recommendations in the full report include demonstration models such as training centers. Several funded training sites could be a step toward standardizing a curriculum and expectations for the ISIC role. Moreover, the financial support for any new ISIC service could potentially come from avenues beyond typical extramural sources, including, for example, new library program funding combined with funding from a specific department or unit such as a health department or clinical department in an academic medical center.
One limitation of the survey is that the list of potential barriers (Appendix B) was developed largely from discussions in the literature and the experience of the EBL team. Other barriers likely exist. Similarly, the additional perceived barriers noted by respondents also may not accurately reflect actual barriers to implementation. Further research is needed to understand what actual barriers are faced across institution types or how accurately individual perceptions of barriers reflect the true state of practice. Further research should also investigate potential methods to overcome the identified barriers.
In addition, the low number of responses from both librarians and health care or research professionals may indicate a lack of interest in or awareness of the role, another potential barrier. Though the generalizability of the survey is limited by factors such as the low response rate, nonresponse bias, convenience sampling, and limitations of email delivery, the survey was a useful tool for continuing to assess the health sciences library community's perceptions of the ISIC. While ISICs were not widespread at the time of the survey and the role does not appear anecdotally to be more widely implemented at present, it may be that ISIC-type work is beginning to penetrate the practice of health sciences information provision in more subtle ways. The researchers believe that this type of permeation is critical to the continuing relevance of health sciences librarians.
With other important shifts in the biomedical information environment—such as the move toward ubiquitous computing and ubiquitously available electronic resources, intuitive search interfaces, increasingly technologically savvy user base, and growing number of point-of-care tools providing synthesized information for more common conditions—the researchers believe that traditional roles for librarians, and even the role of the librarian as expert searcher, must evolve. ISIC-type work has the potential to become the norm rather than the exception as technology absorbs more day-to-day work that can be automated. Human intelligence, however, remains critical for assessing information and recognizing patterns and connections in information that lead to knowledge. Librarians can contribute this intelligence and can help ensure that the profession continues to be a vital force for informing high-quality health care and biomedical research, education, and policy.
The authors gratefully acknowledge the support of the Medical Library Association and the input of MLA's ISIC task force into the project's design and report presentation. We particularly thank Carla J. Funk, CAE, and Jean Shipman, AHIP, for their feedback and for ensuring that the work of MLA and the ISIC task force was appropriately represented. We also thank EBL staff, many of whom contributed to the survey design and data analysis, the EBL Advisory Board, and Gary Byrd, AHIP, for serving as guest editor for this paper, given the authors' affiliation with the Journal of the Medical Library Association.
*This research (and the larger Envisioning the Information Specialist in Context report) is based on a Medical Library Association research project, and all data are the property of the association.
Supplemental Appendixes A and B; Tables 2, 3, and 4; and Figure 1 are available with the online version of this journal.