NIH Senior Health and Web Accessibility

A 2009 study on the effects of education intervention on health information literacy in low socioeconomic senior citizens explored how information literacy training could improve their online searching skills. The study explained that physical, hearing, and visual impairments, which often increase with age, were some of the barriers to many senior citizens attempting online searches for health information. (1, p. 12)

The NIH SeniorHealth web site (http://nihseniorhealth.gov/) is a prime example of web accessibility. Though the website has colorful images, they are presented in a very uncluttered manner. Not only can the text be magnified, but contrast can also be set to create a black background with yellow writing. Speech can also be turned on to have all text read aloud within the browser. Information is arranged in an easy-to-navigate manner and all text is an easy-to-read level of comprehension.


(1) Chu A, Huber J, Mastel-Smith B, Cesario S. Partnering with Seniors for Better Health: computer use and Internet health information retrieval among older adults in a low socioeconomic community. J Med Libr Assoc 2009 Jan;97(1):12-20. doi: 10.3163/1536-5050.97.1.003

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Deaf Health Education Partnership: University of Pittsburgh HSLS & Western Pennsylvania School for the Deaf

Seeking to improve the health information literacy, the Health Sciences Library System (HSLS) at the University of Pittsburgh partnered with the Western Pennsylvania School for the Deaf (WPSD) in project also supported in part by the National Library of Medicine. Reference Librarians from the University of Pittsburgh worked with WPSD health educators and the learning center director to create  health eduction curriculum for the students which covered Internet health searches, health website evaluation, and an introduction to MedlinePlus.

Communication barriers to health information in the Deaf community can arise not only due to the hearing disability proper, but also in translating English to ASL (American Sign Language) and explaining complicated medical terminology. The partnership created a valuable exchange for all involved. WPSD staff educated the University Reference Librarian in techniques to improve communication with the Deaf, while the librarian instructed both staff and students to conduct authoritative Internet searches for health information.


Gregg AL, Wozar JA, Wessel CB, Epstein BA. Designing a curriculum on Internet health resources for deaf high school students. J Med Libr Assoc 2002 Oct;90(4):431-436. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC128959/

Universal Design for Learning

Introduction to UDL (Center for Applied Special Technology)

The Center for Applied Special Technology (CAST) leads the Universal Design for Learning movement based upon their research to improve instruction to children with special needs. UDL takes into account various learning styles of individuals in education and instruction. Universal Design for Learning considers neurological differences in the recognition, strategic, and affective networks in the brain, providing multiple means of representation (recognition network), action and expression (strategic network), and  engagement (expression network) in instructional strategies. The concepts of UDL can be applied to both health and information literacy in any biomedical library, and could be especially useful for those in academic health sciences libraries.


Center for Applied Special Technology. About UDL. [cited 2011 December 8]. Available at: http://www.cast.org/udl/index.html.

The Universal Design Movement

Initially, the term “Universal Design” was coined by architect, Ronald L. Mace, a graduate and affiliate of North Carolina State University. Universal Design (UD) is “the idea that all new environments and products to the greatest extent possible should be usable by everyone regardless of age, ability, or circumstance.” (1) His work eventually led to founding the Center for Universal Design based at NCSU.

The seven principles for Universal Design are:

  1. Equitable Use
  2. Flexibility in Use
  3. Simple and Intuitive Use
  4. Perceptible Information
  5. Tolerance for Error
  6. Low Physical Effort
  7. Size and Space for Approach and Use (1)
A 2009 article by  Ann S. Williams, PhD, RN, CDE  in Diabetes Education, encourages the adoption of UD principles not only in medical devices used to monitor diabetes, but also in Diabetes Self-Management Education (DSME), emphasizing a strategy to accommodate not just the 90% of average users, but as close to 100% as possible (2, p. 2)

As an illustration, consider a DSME class that contains persons with hearing loss, visual impairment, and ADD, as well as those without current disability. If essential material is simultaneously presented in both audible and visual formats – for example, using colorful illustrations in a slide presentation with detailed verbal description from the instructor – persons with hearing loss, visual impairments, and ADD will be better able to perceive, attend, and understand it. Adding a lively participatory game will enhance the attention of the person with ADD. Making all classroom materials available in printed handouts, and also in audio-recordings or digital format ensures that persons with visual impairment or ADD can review the information at their own pace and in their own way. (2, p. 5-6)

UD presents principles that are applicable to the biomedical field as a whole, and can be integral in overall health literacy and efforts in all biomedical libraries. As William proposes, if we begin new strategies with Universal Design principles in mind, we can potentially eliminate the need to add “adaptations or special design” at a later date. (2, p. 7)

(1) North Carolina State University, Center for Universal Design. 
The Principles of Universal Design. 2011; [cited 2011 December 7] Available at: http://www.ncsu.edu/project/design-projects/udi/center-for-universal-design/.

(2) Williams AS. Universal design in diabetes care: an idea whose time has come. Diabetes Educ 2009 Jan-Feb;35(1):45-57. doi:10.1177/0145721708329700

Rural Public Health Nurses and Barriers to Serving the Special Needs Population

A study of health information needs of rural Oregon nurses published in 2008 indicates that there is a need to expand health literacy resources for the rural special needs population:

In addition to general nursing care resources, home visiting nurses wanted detailed resources for caring for patients with disabilities.  (p. 337)

For patients with disabilities that do not live in larger, urban areas access to special needs resources can be extremely limited. This lack of resources can also be extended to the local public health nurses that serve the population. Rural nurses and caretakers face the same barriers as their isolated community, including limited information resources, internet access, and training. (p. 336) Through their interviews, the authors noted that numerous rural public health nurses experienced frustration while attempting to use online database for their information needs. Reasons stated included frustration with restricted login access to databases and patient information that was too advanced for the reading level of their patients. (p. 339).

There is a need to improve access and training to the rural medical community across the board. However, those with special needs already have numerous barriers to health literacy resources and assistive technology. Therefore, when their public health nurses are also facing barriers to information resources, these barriers are magnified.


Turner AM, Stavri Z, Revere D, Altamore R. From the ground up: information needs of nurses in a rural public health department in Oregon. J Med Libr Assoc 2008 Oct;96(4):335-342. doi:  10.3163/1536-5050.96.4.008

MLA Guide to Health Literacy

MLA Guide to Health Literacy
The Medical Library Association Guide to Health Literacy is a comprehensive introduction to the topic of health literacy in both the public and hospital library, including service to special populations. Included in the discussion of special populations is “Health Literacy for People with Disabilities” by Shelley Hourston.

Hourston discusses the barriers to health literacy facing the special needs population along with a brief overview of various disabilities: physical disabilities, developmental disabilities, brain injury, low vision or blindness, low hearing or deafness, mental health disabilities, and learning disabilities. Hourston notes that health literacy can be especially important for those with disabilities as they also tend to have an increased use of medication (p. 119).


Kars M, Baker L, Wilson FL,. The Medical Library Association guide to health literacy. New York: Neal-Schuman Publishers; 2008.