The City of Richmond has 192,913 residents (62% nonwhite) and is part of a metropolitan area with a population of almost 1.2 million [9
]. COIN comprises 4 consumer health information centers and has holdings in multiple languages and formats. COIN provides access to print materials and the Internet and offers face-to-face and telephone reference assistance as well as a virtual reference service that allows users to interact electronically with a medical librarian. A COIN website [10
] posts information about local resources and provides “quick links” to reliable health information in English and Spanish. As a group, the COIN centers have provided health information to almost 31,000 individuals since 2002. Moreover, use of COIN center services has been increasing; for example, in 1 center, website usage has exceeded the desired annual growth rate of 7.5%.
The largest of the network's centers, the Community Health Education Center (CHEC), is located in the lobby of a teaching hospital in an inner-city business district. CHEC has 3,370 print books and pamphlets, 24 magazine subscriptions, 7 computers with Internet access, anatomical models, and children's materials. Some materials are tailored for people with low literacy levels or visual impairments. CHEC is staffed by a professional medical librarian, who is a faculty member of the Virginia Commonwealth University Libraries. She is often joined by 1 of several trained volunteers or a student intern. CHEC is an organizational unit of the Virginia Commonwealth University Health System (VCUHS) and is financed and operated by a partnership that includes the VCUHS, the Medical College of Virginia Hospitals Auxiliary of the VCUHS, and the VCU Libraries.
CHEC strives to provide health information that is accurate, current, understandable, and relevant to people in central Virginia who have no health insurance, are underinsured, or are publicly insured. In 2006, this center had a total of 5,653 visitors (3,062 females and 2,591 males); of whom, over 1,000 were children and 2,726 were repeat visitors. According to routinely maintained records, 1,098 users reported learning CHEC existed when they walked by, and 693 reported referrals from VCU Libraries staff and health care providers. The CHEC Internet site [11
] had 62,443 hits in 2006, and 11,281 website visitors went beyond the home page.
The Linen Powell Resource Library (LPRL), the second COIN center located on the downtown VCU Medical College of Virginia Campus, is part of VCU's Massey Cancer Center. It has materials on cancer topics only (1,295 books and some videotapes and audiotapes) and refers general health questions to CHEC. LPRL distributes an average of 2,060 information packets annually. Some patients are referred to this center by their health care providers, but most receive center materials directly from health intermediaries. LPRL is staffed by a certified health educator, who is an employee of the VCU Massey Cancer Center and is occasionally assisted by volunteers.
The Patient Resource Center (PRC), a smaller cancer library, and the Charlotte K. Roberts Women's Health Resource Center (WHRC) are located at the suburban VCUHS Stony Point Clinic. The PRC (which distributes 250 cancer-related information packets to provider-referred patients each year) is staffed part-time by volunteers, and the WHRC (which is open to the public during business hours even when unstaffed) employs a part-time information specialist. Both centers offer some print and video materials as well as Internet access.
At the time of the data collection reported here, COIN had already been advertised in newspapers, and gatekeepers such as the Urban League of Greater Richmond, the SeniorNavigator network, and pharmacists had been asked to promote the network's services. CHEC alone conducted more than a dozen promotional programs in 2006. Facility tours were conducted for teen hospital volunteers. The center hosted classes on maternal/infant health for Hispanic mothers and smoking cessation workshops. CHEC served as the resource center for the Urban League for Greater Richmond's “Lift Every Voice,” a diabetes education program, and Central Virginia Care Connections for Children. CHEC also provided space for meetings, lectures, and classes to health professional groups including VCUHS clinical staff and residents. Finally, CHEC launched a news blog that featured reviews of health information materials. Some of these promotional efforts spurred temporary spikes in individual center usage, but excess service capacity remained.