Dr. Skemp is Director, Global Health Initiatives, John A. Hartford Center of Geriatric Nursing Excellence, and Associate Professor, Adult and Gerontological Nursing, Ms. Ko is a doctoral candidate, The University of Iowa College of Nursing, Mr. Missen is Director, WiderNet Project, and Professor, School of Library and Information Science, and Ms. Peterson was a graduate student, The University of Iowa, Iowa City, and is currently Owner, Daily Dimensions Computer Services, Cedar Rapids, Iowa.
The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity. The WiderNet Project is supported in part by Intel Corporation, The Rockefeller Foundation, and Seagate International.
Address correspondence to Lisa E. Skemp, PhD, RN, Associate Professor, Adult and Gerontological Nursing, The University of Iowa College of Nursing, 488 NB, Iowa City, IA 52242; e-mail: firstname.lastname@example.org.
Global aging is an issue for both developed and developing countries. The increased proportion of older people in the population is particularly relevant for developing countries and rural areas in the United States that have not had the opportunity to prepare for this rapid population shift (Institute of Medicine [IOM], 2008; Kinsella & He, 2009; World Health Organization [WHO], 2006). While a larger proportion of older adults in the population brings opportunities for promoting active participation in society and the building of balanced and healthy communities, there is also an associated increase in chronic noncommunicable health conditions (WHO, 2002).
Chronic noncommunicable diseases now account for 85% of the burden of disease in high-income countries and 44% in low- to middle-income countries (National Institute on Aging, 2007). If not addressed, the lack of prevention or poor management of chronic health conditions and the resulting concomitant disabilities will lead to worse population health outcomes. Additionally, in developing countries and the rural United States, aging is of particular concern because of a growing health care workforce shortage and unequal access to health information (Rogers, 2002; U.S. Department of Agriculture [USDA], 2009; WHO, 2006).
Access to Knowledge
Knowledge is a main driver of improved health outcomes (IOM, 2009). Deaton (2004) contended that while income is one of the determinants of population health,
the transmission of health related knowledge is more important.... The health and life expectancy of the vast majority of mankind, whether they live in rich or poor countries, depends on ideas, techniques, and therapies developed elsewhere, so that it is the spread of knowledge, that is the fundamental determinant of population health.
Information and communication technologies (ICT) facilitate access to knowledge and information and create an excellent opportunity for nursing intervention and leadership (Abbott & Coenen, 2008). When health care providers, patients, and families need information, they are increasingly using websites to access health care information (Harrison & Lee, 2006). A recent Google™ search on “aging” elicited 48,900,000 sources, and 130,000 sources were identified for “healthy aging.”
Access to the Internet, however, does not ensure that users know how to navigate websites to get the best evidence-based and culturally appropriate information. Furthermore, four of five people worldwide do not have any or dependable access to the Internet, according to the International Telecommunications Union (2010), with Internet penetration being less than 1% in the world’s poorest countries. One mechanism to address this inequity in information access is to deploy offline information storage that requires no Internet.
The purpose of this article is to describe the eGranary Digital Library, an offline information resource that mimics the Internet by mirroring more than 1,200 websites, and discuss the ongoing development of a focused healthy aging and gerontology portal on eGranary. The gerontology portal and eGranary are part of the larger WiderNet Project at The University of Iowa. Opportunities for participation by gerontological nurses are highlighted.
Widernet Project and Onsite Digital Libraries
The WiderNet Project is a service organization based out of The University of Iowa School of Library and Information Science. It provides resources, coaching, training, computers, and educational materials to schools, clinics, libraries, and homes with poor digital communication resources in dozens of developing countries, as well as regions in the United States where information access is poor (WiderNet, n.d.). The concept of the eGranary was born while one of the authors (C.M.) was working with villagers in Africa who identified a need and “hunger” for current information. Similar to how a granary stores seeds for the next planting season of crops that provide the food to sustain survival of villagers, the eGranary Digital Library stores electronically captured information for people to use to improve health, education, and social welfare. Currently, the eGranary Digital Library is installed at more than 350 hospitals, clinics, and schools worldwide, serving close to 1 million patrons.
The eGranary Digital Library is a collection of more than 14 million electronic files, including copies of websites, textbooks, journals, multimedia presentations, and an array of digital resource materials on a wide range of topics. These materials come from thousands of credible sources and organizations, including more than 1,000 authors and publishers who have contributed copyrighted material to this collection. Librarians at The University of Iowa work with stakeholders to identify, copy, and catalog content pertinent to their topics and research programs. All of this information is easily searchable and is contained on a computer disk drive that is physically delivered to institutions in developing countries where there is no Internet connection, or at best, a very limited and/or expensive connection. eGranary Digital Library resources are immediately available 24 hours per day, every day of the year, at virtually no cost to the user. The eGranary can be installed in many ways, ranging from a simple single-user (USB) disk drive to a server-based version that, via a local area network, can serve thousands of information seekers simultaneously. The library materials can be updated using a number of methods (e.g., CD) (WiderNet, n.d.).
The eGranary contains specific collections, called portals, which make it easy for certain patron groups to find specific information. Current portals include the Zambia Nursing and Midwifery, Medical, and Public Health Portals; the Ponseti Club Foot Portals for providers and family members; and an Accident and Injury Prevention Portal. There are also general education portals in early childhood education, math, children’s literature, religious studies, and Spanish language resources.
Beyond these specific portals, the users may use a built-in search engine and catalog to search the eGranary for content from organizations such as the WHO, the U.S. Centers for Disease Control and Prevention (CDC), and the Health Resources and Services Administration websites. To address a critical need for access to gerontology information, we are creating the Gerontology Healthy Ageing Portal (GHAP).
Gerontology Healthy Ageing Portal
The GHAP is a special collection of screened resources for providers, researchers, educators, policy makers, and community members who are interested in learning about aging and gerontology. There are three general categories of materials available:
- Web-based gerontology resources.
- Evidence-based/best practice resources.
- Other resource materials.
Decision criteria for inclusion in the GHAP were developed by the authors and vary by category.
Web-Based Gerontology Resources
The GHAP digital library contains more than 98 web servers including The University of Iowa Hartford Center of Geriatric Nursing Excellence ( http://www.nursing.uiowa.edu/hartford), the U.S. Administration on Aging ( http://www.aoa.gov), the CDC ( http://www.cdc.gov), the National Library of Medicine (NLM; http://www.nlm.nih.gov), and the WHO ( http://www.who.int). These are examples of web-based resources that have given permission for us to copy their site for use on the eGranary and met the NLM basic evaluation criteria for inclusion. According to the NLM (2010) criteria for evaluating the reliability of Internet health information sites, four essential criteria must be available on the site: provider, funding, quality, and privacy.
First, the website providers must be readily available. To identify the provider, we look at the main page or the “about us” page as well as site maps. The website must provide information about identities of experts on the website and contact information such as an e-mail address, mailing address, and/or telephone number. In addition, the mission statement must be clearly stated as to why they are providing the website.
Second, we evaluate funding. Information about how the site is funded should be readily available and advertisements clearly labeled and distinguished from information content. Sites must clearly identify and differentiate information that is provided from the products and services offered at a cost.
In addition to the NLM criteria, although not essential for inclusion on the GHAP, we check reliability by identifying whether the “HON Code” certificate is listed on the website. The Health On the Net Foundation (HON) ( http://www.hon.ch) is a nongovernmental organization, established in 1995, for the purpose of evaluating and disseminating helpful and reliable Internet information. Similar to the NLM, the HON does not rate quality of information but provides a set of standard rules for website developers to use and obtain HON Code certification on the basis of authority, complementarity, confidentiality, attribution, justifiability, transparency, financial disclosure, and advertising criteria (HON, 2010).
Currently, the GHAP contains 38 evidence-based gerontological nursing practice guidelines from The University of Iowa John A. Hartford Center of Geriatric Nursing Excellence. In nursing, evidence-based practice (EBP) is defined as:
a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved.
A key point is that EBP resources are held to an additional EBP “rating schema” for inclusion, in addition to the NLM criteria. A variety of methods may be used to rate the quality of EBP resources. The GHAP reviews EBP for a clear description of how the resource was rated to determine the level of evidence. This “rating schema” description provided is either within the content of the resource or is supplementary to the content. For example, the EBP guidelines published by The University of Iowa College of Nursing Gerontological Nursing Interventions Research Center (GNIRC) clearly identifies within each protocol the rating schema as follows:
- A1 = Evidence from well-designed meta-analyses or well-done systematic reviews with results that consistently support a specific action (e.g., assessment, intervention, treatment).
- A2 = Evidence from one or more randomized controlled trials with consistent results.
- B1 = Evidence from a high-quality EBP guideline.
- B2 = Evidence from one or more quasi-experimental studies with consistent results.
- C1 = Evidence from observational studies with consistent results (e.g., correlational, descriptive studies).
- C2 = Inconsistent evidence from observational studies or controlled trials.
- D = Evidence from expert opinion, multiple case reports, or national consensus reports.
Other Resource Materials
In addition to websites, the GHAP includes other formatted information such as published articles, Microsoft® PowerPoint® presentations, training materials, music, and photos. These resources are evaluated for inclusion as follows: The resources need to be clearly labeled as to copyright permission, authors, date, purpose, funding, and intended use. The authors are clearly identified and contact information provided. If the materials, such as a CD for education or assessment tools, are created to advertise specific products, this must be clearly identified within the resource. Materials that provide knowledge information as well as products and services for sale are reviewed to assure the products and services are clearly labeled and differentiated from knowledge information. The GHAP does not screen the products and services offered at a cost.
Finally, the GHAP provides ready links on the portal homepage to resources in the larger eGranary Digital Library, where users are then able to access more than 14 million electronic files. These files are a broad collection of websites, textbooks, journals, multimedia presentations, and an array of digital resource materials on a wide range of topics from math to literature to learning how to play an instrument.
Permission for Use
In concert with the WiderNet Project, the creators of the GHAP purposefully search websites and other modalities for resources. When identified, permission letters are sent to providers of the website or authors of other formatted information resources (Figure). Providers of websites or authors of other formatted information resources identify the specific content for which they give permission. This may be full permission (donate requested materials and updates as they become available) or partial permission (donate only materials specified). For example, websites that offer resources at a cost may choose to offer the resources free of charge only to those in developing countries without access to the Intranet. We then create a link that directly accesses the identified products. This decision is up to the providers.
Figure. Permission Letter Used by the Widernet Project’s Gerontology Healthy Ageing Portal for Obtaining Internet Resources.
The levels of permission include:
- Allow mirroring (copying) of the materials for the eGranary Digital Library.
- Allow distribution of the materials only to participating educational institutions via offline storage devices.
- Allow project participants to make the materials available to their community via their local internal intranets (but not on the Internet).
- Allow the GHAP to archive a copy of the material on our password-protected intranet server for use in the event that the publicly available link ceases to function.
The materials appear in the GHAP within the eGranary Digital Library without modification, retaining all citations, copyright information, author information, and credits—exactly as they appear on the Internet or other formatted information.
How to Contribute And/or Identify Materials
Access to information and health knowledge can improve health outcomes (IOM, 2009). Yet, globally, with only one of five people having access to the Internet, there remains disparity in the access to information. McDaniel and Travis (2010), in a recent guest editorial, explained that technology in health care is here to stay and urged gerontological nurses to “get on board” with ICT innovations. One way for gerontological nurses to become involved is to participate in the development of the GHAP. The mission of the GHAP is to address the gap in gerontological information and promote information sharing for all.
Participants can assist in many ways, from identifying stellar resources they use in their day-to-day practice, to editing a topic area, to advocating with publishers and colleagues to contribute their resources. Much of the work of portal volunteers can be done online and after hours. For more information on getting involved, e-mail email@example.com.
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- Kinsella, K. & He, W. (2009). An aging world 2008: International population reports (Publication No. P95/09-1). Retrieved from the U.S. Census Bureau website: http://www.census.gov/prod/2009pubs/p95-09-1.pdf
- McDaniel, J.G. & Travis, S.S. (2010). Embracing technology. Journal of Gerontological Nursing, 36(3), 3–4. doi:10.3928/00989134-20100202-08 [CrossRef]
- Melnyk, B.M., Fineout-Overholt, E., Stillwell, S.B. & Williamson, K.M. (2010). Evidence-based practice. Step by step: The seven steps of evidence-based practice. American Journal of Nursing, 110(1), 51–53.
- National Institute on Aging. (2007). Why population aging matters: A global perspective (Publication No. 07-6134). Retrieved from http://www.nia.nih.gov/NR/rdonlyres/9E91407E-CFE8-4903-9875-D5AA75BD1D50/0/WPAM.pdf
- National Library of Medicine. (2010). Evaluating internet health information: A tutorial from the National Library of Medicine. Retrieved from http://www.nlm.nih.gov/medlineplus/webeval/webeval.html
- Rogers, B. (2002). Health care costs and quality—A balance. AAOHN Journal, 50, 441–442.
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