Impacts of educational interventions of librarian instruction on health information seeking attitudes and behaviors in an employee wellness program




health literacy, instruction techniques, employee wellness, health promotion, library partnership, academic library


Objective: Health literacy and its potential impacts on the wellbeing of patrons remain a highly regarded objective among health science and medical librarians when considering learning outcomes of patron communities. Librarians are positioned to champion literacy instruction activities. This study aimed to examine health information seeking attitudes and behaviors in an academic-based employee wellness program before and after health literacy workshops were developed and facilitated by an academic health sciences librarian.

Methods: The intervention included instruction informed by Don Nutbeam’s Health Literacy Framework and the Research Triangle Institute’s Health Literacy Conceptual Framework. Sixty-five participants obtained through convenience sampling attended workshops and were invited to respond to pre- and post-session surveys. Using a quantitative quasi-experimental methodology, surveys collected health literacy indicators including preferred sources and handling practices of in-person and online health information.

Results: Findings indicated workshops influenced information seeking behaviors as participants documented a decrease in social media use for health and wellness information (-36%) and medical information (-13%). An increase in the usage of consumer health databases (like Medline Plus) was also indicated post-workshop for health and wellness information (18%) and medical information (31%).

Conclusions: Favorable impacts are evident in this small-scale study; however, more research is needed to confirm the influence of these methods on larger and more diverse populations. Librarians should continue to develop and disseminate theory informed tools and methods aimed at engaging various communities in constructive health information seeking practices. 

Author Biography

Colleen Marie Foy, Research and Instruction Librarian for the Sciences, Zachary Smith Reynolds Library, Wake Forest University, Winston-Salem, NC

Research and Instruction Librarian for the Sciences, Zachary Smith Reynolds Library, Wake Forest University, Winston-Salem, NC


Centers for Disease Control and Prevention. Health literacy talking points [Internet]. Centers for Disease Control and Prevention. 2021 [cited 2022 Sep 19]. Available from:

Department of Global Communication. UN tackles ‘infodemic’ of misinformation and cybercrime in COVID-19 crisis [Internet]. United Nations. 2020 [cited 2023 Feb 24]. Available from:

Global Wellness Institute. Wellness Industry Research: Featured Reports [Internet]. Global Wellness Institute. 2023 [cited 2023 Dec 11]. Available from:

Pielot M, Church K, de Oliveira R. An in-situ study of mobile phone notifications. In: Proceedings of the 16th international conference on Human-computer interaction with mobile devices & services [Internet]. New York, NY, USA: Association for Computing Machinery; 2014 [cited 2023 Feb 23]. p. 233–42. (MobileHCI ’14). Available from:

Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int [Internet]. 2000 Sep 1;15(3):259–67. Available from:

National Institutes of Health. Health literacy [Internet]. National Institutes of Health (NIH). 2021 [cited 2022 Jul 2]. Available from:

US Department of Health and Human Services. History of healthy people [Internet]. Healthy People Initiative. 2021 [cited 2023 May 30]. Available from:

Centers for Disease Control and Prevention. What is health literacy? Take action. Find out. [Internet]. Centers for Disease Control and Prevention. 2022 [cited 2023 Mar 3]. Available from:

US Burean of Labor Statistics. American Time Use Survey Summary - 2022 A01 Results [Internet]. 2023 [cited 2023 Dec 11]. Available from:

World Health Organization. Tackling NCDs: “best buys” and other recommended interventions for the prevention and control of noncommunicable diseases. 2017 [cited 2023 Dec 11]; Available from:

Burton WN, Chen CY, Li X, Schultz AB, Kasiarz D, Edington DW. Evaluation of a comprehensive employee wellness program at an organization with a consumer-directed health plan. J Occup Environ Med [Internet]. 2014 Apr;56(4):347–53. Available from:

Jia J, Levy DE, McCurley JL, Anderson E, Gelsomin ED, Porneala B, Thorndike AN. Health literacy, numeracy, and health promotion: a secondary analysis of the choosewell 365 workplace trial. Am J Prev Med [Internet]. 2022 Jul 1;63(1):93–101. Available from:

Cherniack M. Integrated health programs, health outcomes, and return on investment: measuring workplace health promotion and integrated program effectiveness. J Occup Environ Med [Internet]. 2013 Dec;55:S38. Available from:

Luta X, Hayoz S, Gréa Krause C, Sommerhalder K, Roos E, Strazzullo P, Beer-Borst S. The relationship of health/food literacy and salt awareness to daily sodium and potassium intake among a workplace population in Switzerland. Nutr Metab Cardiovasc Dis NMCD [Internet]. 2018 Mar;28(3):270–7. Available from:

Mills PR, Kessler RC, Cooper J, Sullivan S. Impact of a health promotion program on employee health risks and work productivity. Am J Health Promot [Internet]. 2007 Sep 1;22(1):45–53. Available from:

Zoellner J, You W, Almeida F, Blackman KCA, Harden S, Glasgow RE, Linnan L, Hill JL, Estabrooks PA. The influence of health literacy on reach, retention, and success in a worksite weight loss program. Am J Health Promot [Internet]. 2016 Mar 1;30(4):279–82. Available from:

Addy JM. The art of the real: fact checking as information literacy instruction. Ref Serv Rev [Internet]. 2020 Jan 1 [cited 2023 Dec 8];48(1):19–31. Available from:

Ma J, Stahl L, Knotts E. Emerging roles of health information professionals for library and information science curriculum development: a scoping review. J Med Libr Assoc JMLA [Internet]. 2018 Oct [cited 2023 Dec 8];106(4):432–44. Available from:

Lavallee-Welch C, Baltimore L, Midkiff S, Sprenkle P, Kudwa EB, Croft VF, Zegar Judkins D, Bigwood D, Donald R. Librarians as Subject Specialists. In: Townsend Kane L, editor. Working in the Virtual Stacks: The New Library and Information Science [Internet]. Chicago, United States: American Library Association; 2011 [cited 2023 Dec 11]. p. 12–52. Available from:

Squiers L, Peinado S, Berkman N, Boudewyns V, McCormack L. The health literacy skills framework. J Health Commun [Internet]. 2012;17 Suppl 3:30–54. Available from:

Shipman JP, Lake E, Weber AI. Improving health literacy: health sciences library case studies. Ref Serv Rev [Internet]. 2016;44(2):206–14. Available from:

Barr-Walker J. Health literacy and libraries: a literature review. Ref Serv Rev [Internet]. 2016;44(2):191–205. Available from:

Swanberg SM, Bulgarelli N, Jayakumar M, Look E, Shubitowski TB, Wedemeyer R, Yuen EW, Lucia VC. A health education outreach partnership between an academic medical library and public library: lessons learned before and during a pandemic. J Med Libr Assoc [Internet]. 2022 Apr;110(2):212–21. Available from:

Howe CJ, Brennan L, Adame T. Is your weblitlegit? Finding safe and good health information on the internet. Health Lit Res Pract [Internet]. 2022 Apr;6(2):e151–8. Available from:

Mayo A, Tooey MJ. Successful collaborations at the local and national level build teenagers’ skills to advocate for improved health: project share. In: Shipman JP, Tooey MJ, editors. Strategic Collaborations in Health Sciences Libraries [Internet]. Chandos Publishing; 2019. p. 95–107. Available from:

Nöhammer E, Stummer H, Schusterschitz C. Improving employee well-being through worksite health promotion? The employees’ perspective. J Public Health [Internet]. 2011 Apr 1;19(2):121–9. Available from:

Wilson AQ, Wombles C, Heidel RE, Grabeel KL. The status of scholarly efforts of librarians on health literacy: a bibliometric analysis. J Med Libr Assoc [Internet]. 2022 Apr;110(2):166–73. Available from:

Wake Forest University. Fact Book: Faculty & Staff [Internet]. Office of Institutional Research. [cited 2023 Oct 25]. Available from:

Brodsky JE, Brooks PJ, Scimeca D, Todorova R, Galati P, Batson M, Grosso R, Matthews M, Miller V, Caulfield M. Improving college students’ fact-checking strategies through lateral reading instruction in a general education civics course. Cogn Res Princ Implic [Internet]. 2021 Mar 31 [cited 2023 Oct 27];6(1):23. Available from:

Caufield M. SIFT (The Four Moves) [Internet]. Hapgood. 2019 [cited 2023 Oct 27]. Available from:

Liu H, Zeng H, Shen Y, Zhang F, Sharma M, Lai W, Zhao Y, Tao G, Yuan J, Zhao Y. Assessment tools for health literacy among the general population: a systematic review. Int J Environ Res Public Health [Internet]. 2018 Aug;15(8):1711. Available from:

Global Wellness Institute. 2022 The Global Wellness Economy: Country Rankings [Internet]. Global Wellness Institute. 2022 [cited 2022 Jul 21]. Available from:

Nutbeam D, McGill B, Premkumar P. Improving health literacy in community populations: a review of progress. Health Promot Int [Internet]. 2018 Oct 1;33(5):901–11. Available from:

Kim HY. Statistical notes for clinical researchers: Chi-squared test and Fisher’s exact test. Restor Dent Endod [Internet]. 2017 May [cited 2023 Oct 31];42(2):152–5. Available from:

Mahmood K. Do people overestimate their information literacy skills? A systematic review of empirical evidence on the dunning-kruger effect. Commun Inf Lit [Internet]. 2016 Dec 29;10(2). Available from:

Diviani N, Putte B van den, Giani S, Weert JC van. Low health literacy and evaluation of online health information: a systematic review of the literature. J Med Internet Res [Internet]. 2015 May;17(5). Available from:

Office of Civic and Community Engagement. Home: Community Engagement [Internet]. Office of Civic and Community Engagement. [cited 2023 Nov 2]. Available from:

Michou M, Panagiotakos DB, Costarelli V. Low health literacy and excess body weight: a systematic review. Cent Eur J Public Health [Internet]. 2018 Sep;26(3):234–41. Available from:

James DCS, Harville C, Efunbumi O, Martin MY. Health literacy issues surrounding weight management among African American women: a mixed methods study. J Hum Nutr Diet [Internet]. 2015 Feb 1 [cited 2022 Jun 27];28(s2):41–9. Available from:

Tsai TI, Tsai YW, Lee SYD. Health literacy and weight management – Results of a nationwide survey in Taiwan. Chronic Illn [Internet]. 2021 Sep 28 [cited 2022 Jun 27];17423953211039770. Available from:

Truong M, Fenton SH. Understanding the Current Landscape of Health Literacy Interventions within Health Systems. Perspect Health Inf Manag [Internet]. 2022 Mar 15 [cited 2023 Nov 8];19(Spring):1h. Available from:

Pleasant A. Advancing Health Literacy Measurement: A Pathway to Better Health and Health System Performance. J Health Commun [Internet]. 2014 Dec 2 [cited 2023 Nov 8];19(12):1481–96. Available from:






Original Investigation