Meeting Information Needs through Global Partnerships: A Roadmap to Becoming a Global Health Sciences Library

Abstract

Supporting global health priorities through the development of robust health science librarianship partnerships is of significant importance. Increased demand for synthesizing evidence-based information, collating quality resources, and increasing research productivity to improve human health requires integration of library and information science skills and expertise. The Health Sciences Library (HSL) at the University of North Carolina at Chapel Hill (UNC), exists to be an indispensable partner in health information and knowledge, teaching and learning, and research. As global efforts at UNC expanded, the HSL sought to ensure that our global engagement strategy and integration were aligned with campus priorities and partner needs. The HSL created a global research partnership plan: identify resources that improve efficiency, increase access to information, build in-country capacity and expertise—all while strengthening collaborations across multiple countries. Creating a meaningful and sustainable engagement strategy was central to envisioning our path forward and can be used as a framework for consideration by librarians in similar settings.

Keywords:

• Global health
• health sciences librarianship
• capacity building
• international collaboration
• outreach
• partnership
• program development

Introduction

The need for libraries to support global health initiatives is increasingly important. Given the current COVID-19 public health crisis, as WHO Director-General has shared, “we are not just fighting an epidemic, we’re fighting an infodemic” (Zarocostas, 2020). The explosion of misinformation occurring on a global scale is detrimental to the public, illustrates the extent to which we are connected on a global scale from all information domains, and is a distinct area where libraries can play a vital role. For libraries, especially health science libraries, seeking to contribute to global initiatives, identifying places where information expertise can directly address information gaps or can help build capacity is an excellent place to start envisioning areas of collaboration. The Health Sciences Library (HSL), part of the University Libraries at the University of North Carolina at Chapel Hill (UNC-CH), has as its mission to be an indispensable partner in connecting people with knowledge and information to help make informed health care decisions, teach and learn effectively, and conduct vital research that contributes to improving the human condition. Areas where HSL focuses are in academic and clinical engagement, research and informatics, and health literacy and community engagement in both local and global arenas. In terms of global engagement, our team collaborates with UNC global health researchers, faculty, and staff to identify information needs and provide support for global research and teaching. As global efforts at Carolina expanded, the library sought to ensure our global engagement strategy and forms of integration were aligned with campus priorities and project partner needs. More recently, the HSL set a vision of becoming a global research library partner: identifying resources that improve efficiency, increasing access to information, pinpointing mechanisms to build in-country capacity and expertise, and nurturing growth of in-country libraries and programs—all while strengthening collaborations in multiple countries. Creating an engagement strategy that was meaningful and sustainable was central to envisioning our path forward.

Literature review

Given the increase in global health programs and global initiatives in universities in recent years, there is a corresponding need and opportunity for librarians to engage as partners through assessing information needs, selecting resources, providing instruction, and supporting research initiatives (Murphy, 2009). The United Nations 2030 Agenda for Sustainable Development established 17 Sustainable Development Goals (SDGs) that span economic, environmental, and social development which recognize the importance of libraries as key partners in achieving these goals (IFLA, 2020). The International Federation of Library Associations (IFLA) participated in the creation of the SDGs and outlined ways that libraries (by improving access to information) can drive progress of each goal. In particular, health sciences libraries are well-positioned to support SDG 3, “Ensure healthy lives and support well-being for all at all ages” and SDG 4, “Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all” through providing access to information and research to support education and health care providers’ practice (IFLA, n.d.). As Pakenham-Walsh and Bukachi (2009) note, improving access and use of quality health care information has the potential to improve healthcare worldwide. Health sciences libraries are responding to these global health demands, although there is limited published literature on librarians’ involvement in global initiatives and partnerships. In the existing literature, there is evidence of academic health sciences librarians engaging in global health projects, through pre-departure training, teaching on global health resources, collection development and resource provision, and working with librarian counterparts at global partner institutions, although more is needed.

The Taubman Health Sciences Library at the University of Michigan provides pre-departure training for students in medicine, nursing, and public health to support their global health research and international clinical experiences (Rana, 2014). Librarians at the University of Michigan have provided training on global health resources, country-specific data sources, and literature searching through course-integrated instruction, individual consultations, and online resources and subject guides (Rana, 2014). Similarly, at Washington University in St. Louis, a medical librarian partnered with faculty of a global health program to assess medical residents’ need for, and interest in, global health library resources and services (Patel et al., 2017). The assessment resulted in appointing a designated global health liaison librarian, creating a comprehensive online information guide, and providing instruction around using library resources while abroad and global health statistics and data.

Other health sciences libraries have supported their global librarian colleagues to meet information needs at their institutions. Librarians at the UNC-CH HSL collaborated with a librarian at UNC’s global health research and training site at UNC Project-Malawi to plan the Project-Malawi Library, identify information needs, and acquire books and resources formed a lasting collaboration between these libraries that continues to the present (Lackey et al., 2014). The University of Maryland, Baltimore’s Health Sciences and Human Services Library partnered with the University of Nairobi’s College of Health Sciences Library through a program under the US President’s Emergency Plan for AIDS Relief (PEPFAR) to strengthen library capacity (Mayo, 2014). They established a plan to develop librarians’ professional skills through continuing education and invest in technology tools like LibGuides, with the goal of improving medical students’ education and lifelong learning skills in Kenya. A recent systematic review of pre-departure training for global health electives identified travel preparation competencies, but did not include familiarity with global health information resources or mention librarians’ involvement as partners (Kalbarczyk et al., 2019). This knowledge gap indicates a need for outreach by librarians at global health-focused institutions to share their skillsets and raise awareness of library expertise and how it contributes to global health. This article aims to provide a case study in how libraries can build partnerships and engage in meaningful and sustainable global health programs.

Health Sciences Library—University of North Carolina

History of global engagement at UNC

Global engagement on the campus of UNC-CH goes back several decades. One particular initiative established between the UNC-CH and the Malawi Ministry of Health in 1999, sought to “identify innovative, culturally acceptable, and affordable methods to improve the health of the people of Malawi, through research, capacity building, and care” (Where We Work: Malawi, n.d.). Situated on the campus of Kamuzu Central Hospital, in Lilongwe, Project-Malawi strives to address areas including, but not limited to, HIV/AIDS, sexually transmitted infections, infectious diseases, oncology, and obstetrics and gynecology. In the early 2000s, the HSL partnered with the School of Medicine’s Institute of Global Health and Infectious Diseases (IGHID) to help support the UNC Project-Malawi initiative by collaborating with IGHID to form a physical library in Lilongwe, an extension of the HSL, that could be used by Project-Malawi staff and students to support information access and retrieval (UNC Project-Malawi, 2017). Elements related to the physical library where HSL was involved included developing a robust print collection of resources and providing training on use of resources for research and clinical care purposes. Later, HSL connected with IGHID to partner with UNC Project-China where librarians provided instruction on conducting systematic reviews and provided literature support (including systematic review searching) for researchers.

Needs assessment for supporting global health work

Although the HSL had been involved in global programs to varying extents for years, in 2016, library leadership wanted to ensure decisions for future integration were aligned with partner needs, institutional goals, and the library vision. To address this vision and strategic priority, the library created a new global health engagement position to support and proactively scope information needs of UNC global programs and projects. In 2020, UNC-CH released Carolina Next, a strategic planning effort around eight strategic initiatives, one of which is to “Globalize” which incorporates providing a global education for all students, strengthening partnerships and enhancing campus-wide international programing, and increasing impact and scaling select global initiatives (The University of North Carolina at Chapel Hill, 2020). Keeping this global strategy in mind and the desire to further library global partnerships with our campus, the HSL combined campus priorities, United Nations SDGs (Goals 3 and 4), and library goals around global engagement to create a global engagement strategy (United Nations, n.d.). The first step toward creating a strategy was to conduct a needs assessment of the UNC global health training programs and research sites in Zambia and Malawi from October 2018 to May 2019, focusing on their known and unknown information, technology, and instruction needs (Where We Work: Malawi, n.d., Where We Work: Zambia, n.d.). We selected these two global sites and their corresponding UNC programs as areas for our needs assessment based on their growth in research and student engagement and opportunities for expanded HSL collaborations. Our goal was to identify how the HSL could better engage with these existing global health programs to improve access to information, integrate library expertise, and provide education on information literacy and evidence-based practice. The needs assessment would serve as a benchmarking tool by which we could better understand and measure both our global partners’ awareness of HSL’s services and expertise, and HSL’s current level of global engagement.

We spent fall 2018 on the early stages of the needs assessment: forming a team, completing background literature searching, setting the scope and goals, and holding initial exploratory meetings with global health stakeholders at UNC-CH. In spring 2018 we carried out the remaining steps of the needs assessment, including holding additional exploratory meetings with stakeholders across all UNC-CH health affairs schools (Figure 1), surveying global health leaders on their knowledge of and preferences for library services and partnerships, setting up meetings with stakeholders in Malawi and Zambia, creating informational materials to share at meetings, traveling to the UNC global health sites, and thematically analyzing the results from all the meetings.

Figure 1. Campus view of HSL partners engaging around global health.

The HSL needs assessment team consisted of four health sciences librarians who brought together leadership in health sciences librarianship, expertise in global health research and education, and connections to global health researchers, educators, and clinicians at UNC-CH and at UNC’s global sites. HSL Team members were Nandita Mani, PhD, MLIS, Associate University Librarian for Health Sciences and Director of the HSL; Michelle Cawley, MLS, MA, Head of Clinical, Academic, and Research Engagement; Rebecca Carlson, MLS, Liaison to the Eshelman School of Pharmacy and clinical librarian; and Megan Fratta, MLS, Community Outreach and Global Health Librarian.

Preparation for site visits (fall 2018 through spring 2019)

We began our needs assessment with literature searches to identify existing literature on academic libraries’ needs assessments of global health initiatives. We found a lack of literature on comparable projects; generally, the literature on health sciences libraries’ support of global health initiatives largely consists of project reports of individualized, non-generalizable needs and solutions. We developed a framework to guide our initial exploratory stakeholder meetings that focused on assessing the information, technology, and instruction needs of UNC-affiliated individuals, departments, and institutions for education, clinical practice, and research in Zambia and Malawi.

In our initial information gathering, we met with key stakeholders from UNC’s IGHID who have longstanding leadership in the UNC global sites in Zambia and Malawi and scheduled discussion meetings around a set of questions and topics related to our information gaps and areas of priority. At these initial meetings, we discussed the current clinical, education, and research projects and topics in Malawi and Zambia; plans for the near future; scale of clinicians, researchers, and trainees located in-country; on-site information, technology, and instruction status quo; and potential opportunities for library collaboration. We also scheduled subsequent meetings with other stakeholders identified by our initial contacts. Fortuitous timing allowed us to meet with three key team members from Project Zambia, including the in-country director who were visiting UNC in fall 2018. During this meeting we learned more about the project scope, infrastructure, and staffing as well as some of their information and research needs.

Information gathered from these meetings gave us an initial sense of the settings, individuals, and structures at the UNC sites in Zambia and Malawi and enabled us to make informed decisions regarding next steps. In early 2019 we met with each global health administrator in the five UNC health affairs schools to identify additional research or education programs happening in Malawi and Zambia and potential stakeholders on-site that we could include in our visit itinerary. Overall, these meetings provided a high-level view of the global health endeavors occurring in the UNC health affairs schools and in the UNC Medical Center and allowed us to be strategically inclusive in our approach to planning the trip to Malawi and Zambia

Informed by the fall and spring stakeholder meetings, the team developed a short survey (Appendix B) using Qualtrics that was distributed to core faculty and staff for each project site. One of the themes we noticed from the initial meetings was that knowledge about HSL’s areas of expertise, services, and resources varied widely. To raise awareness and position HSL as a global partner, the survey listed nine areas of HSL staff expertise and available resources and asked participants to identify the extent to which each area is beneficial to their global health work. The capability areas included identifying and evaluating information, subject guides, pre-departure training on resources, news and information resources, data visualization, grant seeking resources, plain language support, information management, and systematic reviews. Survey respondents were also asked to list their top three priority areas for the year and which groups (i.e., clinicians, researchers, students and residents) would benefit most from library information resources and services.

One theme that emerged from our interviews with UNC-based stakeholders and survey responses was the opportunity for supporting the grant process. Stakeholders shared that they rely heavily on grants to support their global work and could benefit from librarian expertise in identifying grant opportunities including through email alerts from a variety of funding sources. Stakeholders were also interested in the support HSL can provide in the research process, including literature searching, search alerts for new articles, and identifying journals to submit manuscripts. Another topic that emerged from the on-campus meetings was the interest in instruction on library resources available as part of pre-departure training for students and residents before they travel to UNC’s global sites, as well as a need for general information literacy and searching instruction for project staff. In the weeks leading up to our site visits, the team developed a two-page handout which we distributed electronically to key stakeholders at UNC Project-Malawi and UNC Global Projects Zambia (UNC-GPZ) (Appendix A) ahead of our visit. Based on our initial stakeholder meetings and survey responses, we developed a handout to explain the goals of our needs assessment and highlight the expertise of HSL librarians and staff in enabling efficient research, managing and visualizing data, and supporting education and research. We found that raising awareness of library expertise and using the handout to highlight partnership opportunities served as a jumping-off point for conversations with our global partners.

Site visits in Zambia and Malawi (April 2019)

The HSL team visited UNC’s sites in Lusaka, Zambia and Lilongwe, Malawi in the first week of April 2019. We spent two days at each site touring facilities and meeting with program leadership, key stakeholders, and project partners. In Lusaka, staff from UNC-GPZ hosted the HSL team and set up meetings with stakeholders from UNC-GPZ, University of Zambia (UNZA), and University Teaching Hospital (UTH). During this time, we also had an opportunity to tour multiple libraries and meet with staff at the UNZA School of Medicine Library, Main Campus Library, and a clinic which serves as a study site for UNC-GPZ studies. The team then spent two days in Lilongwe, Malawi hosted by staff from UNC Project-Malawi where we met with Project-Malawi leadership and clinicians as well as administrators from the College of Medicine, Kamuzu College of Nursing, and Kamuzu Central Hospital (KCH). The team also toured multiple libraries and met with librarians from UNC Project-Malawi, Kamuzu College of Nursing, and College of Health Sciences. Conversations with administrators, UNC faculty and trainees, information professionals, and UNC-GPZ and UNC Project-Malawi staff mirrored those we had during the campus portion of the needs assessment while also allowing us to explore the nuances of information, technology, and instruction needs in-country.

In total, we met with more than 30 individuals over the course of four days in Lusaka and Lilongwe. From these conversations multiple themes emerged around how HSL can partner with Project-Malawi and UNC-GPZ, including around research engagement and dissemination, impact measurement and visualization, and building capacity. Identifying grant opportunities, facilitating communication and flow of information, building capacity to provide information services, synthesizing evidence, and increasing information literacy were specific needs expressed in addition to access to information and resources generally. Understandably, access to research held behind paywalls for individuals lacking an affiliation to UNC was cited as an issue in multiple conversations. Throughout these conversations it was evident that stakeholders from all sites that we visited, in both Lusaka and Lilongwe, have an incomplete understanding of the expertise held by HSL librarians and the ways in which we can partner on teams to improve efficiency and access to information. This was unsurprising as we encountered similar perceptions from stakeholders based in North Carolina. For example, our expertise in bibliometrics can be an asset in demonstrating research impact, identifying potential collaborators (both institutional and individual), and analyzing grant opportunities. This signals a need for targeted outreach and promotion of resources and services.

Current and past HSL integration with global health partners

We continued to formulate HSL's global roadmap by considering what we learned through the needs assessment and reviewing current and past integration with global health partners. The HSL’s integration with global health partners dates to 2000 and includes support around collection development and information access, instruction, research, and clinical practice. In recent years engagement has increased in Malawi and Nicaragua and begun in Zambia (Figure 2). In some instances, the HSL’s level of engagement has been reduced as we have supported capacity building allowing in-country expertise to increase. This is the case in China around expertise for conducting systematic reviews.

Figure 2. Type and level of HSL global engagement from 2000 to present. Collections refers to collection development and access to information. (Maps by FreeVectorMaps.com)

Collection development and information access

HSL partners with UNC’s global projects to support collections and information access for students, faculty, staff, and project partners. One area of focus is on the provision of resources and information access onsite at Project-Malawi. Project-Malawi’s library is a key partner in supporting the research, education, and clinical practice at this site and the Global Health Librarian and HSL team are working closely with the Project-Malawi Librarian to build capacity in collection development. The Project-Malawi Library’s collection had not been weeded nor new materials purchased for several years prior to the creation of the Global Health Librarian position. HSL librarians helped order new core texts for the collection and, working closely with the Project-Malawi Librarian, developed collection development and weeding policies and procedures to guide maintenance of the collection.

The HSL is also working closely with IGHID faculty to make essential medical texts and resources available to students and faculty at partner institutions at the UNC Program in Nicaragua. UNC faculty have partnered with the University of Nicaragua (UNAN) in Léon since 1999 with funded research initiatives focusing on gastrointestinal disease epidemiology, childhood rotavirus vaccine, and most recently Zika virus (Where We Work: Nicaragua, n.d.). UNC medical students and residents have also performed clinical electives at the University Hospital (HEODRA) as part of the partnership. The Global Health Librarian is working closely with IGHID to develop a website to serve as a central information access point for faculty, staff, and students at Project-Malawi and UNC Program in Nicaragua. The Nicaragua team identified key websites, clinical practice guidelines, and core medical textbooks in Spanish to include on the portal for reference. The Global Health Librarian communicated with publishers to facilitate purchase of the e-books and investigated the usefulness of a clinical point-of-care tool. In addition to linking to key resources, the website has the potential to be useful for workflow by incorporating key documents such as clinical guidelines, study protocol, and links to frequently referenced resources.

Instruction

Librarians provide instruction for UNC students, faculty, and staff as well as researchers and trainees connected to UNC global projects on a variety of topics. UNC is a part of the UJMT Fogarty Global Health Fellows Program that offers mentoring and training in global health research and one-year research opportunities at global health research sites across three continents (Fogarty Global Health Fellowship, 2018). The training opportunities include an annual webinar series in which experts present on topics relevant to early career researchers. Librarians teach sessions in this series each year on tips and tools for oral and poster presentations, identifying funding sources, and conducting systematic reviews. Librarians have also worked one-on-one with Global Women’s Health (GWH) fellows as well as trainees in other global health groups to provide instruction on various aspects of the research lifecycle.

UNC Project-China is a collaboration between UNC-CH and Chinese partner organizations that aims to “conduct innovative research on non-communicable diseases, HIV and STIs, maternal and child health, and other global health areas” (UNC Project-China, n.d.). In 2015, HSL Librarians traveled to Guangzhou Province to attend and participate in a UNC Project-China conference and workshop on sexual health. Librarians co-taught a class on literature searching to Chinese researchers and medical students from three institutions, held information consultations with several junior STD/HIV investigators in the region regarding access, retrieval, and storage of information, and offered guidance on presenting research topics.

HSL librarians also support the information and educational needs of UNC researchers working in Nicaragua. In collaboration with UNAN, UNC faculty received a grant from the National Institutes of Health to train and mentor Nicaraguan scientists to investigate infectious diseases in Nicaragua (UNC Department of Family Medicine, 2020). The Global Health Librarian provided an online instruction session for Nicaraguan PhD students on developing search strategies and searching the medical literature in PubMed. As this project progresses additional opportunities for future training may arise.

Research and clinical engagement

The HSL has collaborated on many global health research projects over the past two decades. For UNC Project-China, the HSL has provided research instruction and partnered on literature synthesis research projects with Project-China faculty and staff. Since the partnership began, the UNC Project-China team has been commissioned to write seven distinct systematic reviews for World Health Organization (WHO) guidelines; librarians have collaborated on these research efforts and contributed their expertise in comprehensive searching, review methodologies, and citation data management. The HSL continues to support the Project-China team through development and dissemination of systematic reviews, some of which are considered in national policy decisions by the UK's National Health Service.

The HSL historically supported the clinical departments of the UNC School of Medicine and Medical Center but did not directly support the global health research and practice initiatives of these departments. After the HSL set forth a vision of becoming a global research library partner in 2016, the library’s collaborations became more intentionally global health focused. The Department of Obstetrics and Gynecology’s (OBGYN) Global Women’s Health (GWH) division has a large, active research presence in several countries (UNC Department of Obstetrics & Gynecology, n.d.). The HSL added a dedicated clinical librarian liaison for OBGYN in 2017 and as part of the librarian’s embedded role, they have worked with GWH and has been involved in systematic review and guideline teams. These literature-based research publications provide evidence syntheses on topics of global importance and contribute to UNC’s leadership in global health research. Projects have included guideline updates for the WHO and CDC and various systematic reviews on emerging technologies and best practices in diagnoses and medical and surgical therapies. Clinical librarians at the HSL also work with other clinical departments in the School of Medicine and UNC Medical Center on global health research, including the Department of Surgery whose Global Surgery Program has long been active in Malawi. The clinical librarian for the department of surgery has worked with residents, fellows, and faculty on global health research projects.

Clinical researchers in global health are in Chapel Hill and at university global health sites across the world, so the librarians for these clinical departments have worked locally and remotely with faculty to provide literature search services for various research projects. Librarians add value through their knowledge of systematic review processes and standards, experience in comprehensive literature searching and citation management, access to search and screening decision tools, and overall ability to save research teams time and effort throughout the process of a review or guideline. Similar to the work of librarians with UNC Project-China, the clinical librarian service connects the expert searching skills of an embedded librarian with the information needs of clinical researchers, saving them time in developing search terms, choosing potential sources of information, searching across multiple bibliographic databases, selecting the best available evidence, and collecting citations into citation management software. The librarian partners with clinical faculty to improve evidence-based practice or research outcomes at the point of need and into the future, providing search strategies and search alerts that can be used on an ongoing basis.

After the 2019 needs assessment and site visit, the HSL has collaborated on more research with the UNC Project-Malawi team, partnering on systematic reviews, developing literature searches and research alerts, and supporting research impact and visualization of the scholarly output of Project-Malawi. In 2018, Project-Malawi reached a publication milestone with 124 publications, 26 of which had a Malawian first author (Institute for Global Health and Infectious Diseases, 2019). Measures of this research impact and visualizations of the research topics and collaborations are valued by Project-Malawi staff and others across UNC Global.

HSL also supports research and clinical support through training and capacity-building of librarian peers. During the site visit at Project-Malawi, the Global Health Librarian connected with the Project-Malawi Librarian around the library collection, services provided, and users’ needs leading to improved understanding of the library operations and capacity and a strengthened working relationship. Working with the Project-Malawi Librarian, the team formulated a training plan to build his capacity in collection development as well as literature searching skills. The Global Health Librarian meets with him regularly to review search strategies across several databases including PubMed, with the goal of developing his capacity to support the literature searching and research needs of faculty, staff, and students in-country. These projects and partnerships were made possible through the connections formed during the visit to Project-Malawi and there is great potential for future collaborations.

Future opportunities for further integration

When considering ways in which the library can further integrate in the global work of our campus partners, we will use objectives outlined in the UNC Carolina Next Strategic Initiative 7: Globalize, to formulate our approach to contributing to student success, the research enterprise, and areas where we can benefit society locally and globally (The University of North Carolina at Chapel Hill, 2020). Some areas in which we anticipate growth are shown in Table 1.

Table 1. Global Health Sciences Library roadmap for integration in Global Programs.

Strategic area
UNC Libraries - HSL	UNC global
Student and faculty success	Guarantee that a global education is available to all students. Expand global opportunities for graduate and professional students.
	Library integration around: Assisting with literature searches.  Instruction on point-of-care resources for trainees.
Research engagement and dissemination	Bring the world to North Carolina with strengthened partnerships and enhanced campus-wide international programing. Increase impact abroad and at home by scaling select global initiatives
	Library integration around: Locating funding sources and conducting background literature reviews. Selecting optimal journals for publication. Drafting abstracts to ensure research is discoverable (e.g., PubMed MEDLINE) by leveraging librarian knowledge on proper keywords and indexing terms. Supporting complex literature searches and systematic reviews.
Impact measurement and visualization	Bring the world to North Carolina with strengthened partnerships and enhanced campus-wide international programing. Increase impact abroad and at home by scaling select global initiatives.
	Library integration around: Using visualization to identify existing and potential researcher, project, and institutional collaborations. Mapping core funding sources including how sources have changed over time and how they compare to similar institutions. Identifying core research areas that have been investigated over time.
Capacity building	Increase impact abroad and at home by scaling select global initiatives.
	Establishing sustainable information support systems through in-country partnerships. Training on systematic reviews and information organization. Providing instruction for Evidence Based Practice (EBP).

Using this global library roadmap will allow us to delve deeper into current partnerships and identify new opportunities for engagement. As an example, in early 2018, the Library formed a partnership with the UNC School of Medicine, Global Women’s Health (GWH) Division, which was awarded a Gates Foundation grant to help improve pregnancy-related outcomes in resource limited settings (UNC-Chapel Hill Media Relations, 2019). These multi-year studies offer significant opportunities for HSL collaboration with researchers on high-impact investigations that are data-intensive and can integrate the skills of librarians ranging from conducting systematic reviews to applying metadata schema, knowledge management, and research impact and visualization expertise. As part of this partnership, the GWH team is housed in the HSL, reflecting the aligned values and vision of what we hope to accomplish with improving global health outcomes and creating opportunities to integrate and build library expertise alongside project partners. Other areas for potential integration of library expertise relate to UNC partnerships in the Galapagos, Kings College, and UNC Project-Vietnam (King’s College London, n.d.; Universidad San Francisco de Quito, n.d.; Where We Work: Vietnam, n.d.). In these areas, we foresee a variety of opportunities to assist in demonstrating research impact through bibliometrics and visualization, contribution to systematic review training and capacity building, enabling collections of instructional materials for inter-institutional use, and provision of health literacy training for communities and community partners.

Another opportunity for global engagement is around health literacy. HSL librarians have expertise in this area and currently provide support to the public and health care providers. HSL librarians provide training for the public focused on developing skills to find and assess the quality of health information. They also provide instruction for health care providers and students in the health affairs schools on strategies to improve communication with patients, both verbally and in writing (Ottosen et al., 2019). Low health literacy/health information fluency (Ottosen et al., 2019; Mani, 2004) is a global issue, which is reflected in Goal 3 of the United Nation’s Sustainable Development Goals (SDG-3), “Ensure healthy lives and promote well-being for all at all ages” (United Nations, n.d.). Popoola (2019) identifies ways in which libraries can work to promote and improve health literacy in developing countries, including providing access to health information, advocating for health, partnering with health care providers, and collaborations with librarians in the developed world. The HSL, in collaboration with clinical faculty and students, could seek opportunities to partner with local health care providers to build awareness of health literacy best practices and promote health literacy in communities.

Reflections

As we progress from the stage of developing global engagement to collaborating as partners, it will be essential to continue to assess our efforts to measure our progress and plan for future engagement. Our needs assessment served as an essential first step in benchmarking our partners’ needs and awareness of the various ways they can partner with HSL. As we move forward, robust assessment efforts will build upon these baseline findings to gauge how our partners’ knowledge and utilization of services change, ascertain new ways in which information expertise can be provided to meet partner needs, measure satisfaction with information services, and identify new ways of collaborating that support student success and the research enterprise.

Initial efforts to monitor and assess HSL progress toward achieving our global engagement goals include tracking statistics (e.g., number of consultations or number of attendees we reach via workshops or other training) and regular check-ins with project partners to gauge the extent to which the HSL is meeting needs. In addition, we also want to collect information to allow us to craft a narrative around HSL’s global engagement. Similar to how annual reports are used to illustrate progress related to library priorities and/or goals, our team is monitoring our global roadmap using a global engagement dashboard to track involvement with our global projects. Our global projects dashboard metrics/elements include thematic areas of engagement (instruction, search requests, visualization or impact measurement, search alerts, etc.), identification of new project partners, and examples of project outcomes based on our engagement with a global program. Data collected can provide a snapshot of the range of global work in which HSL is engaging to allow for trend analysis related to the groups and global sites we are reaching. It also helps to illustrate the nature of work being conducted which will help us to prioritize future collaborations and outreach.

Successes

A positive outcome of undertaking the needs assessment and developing our global health collaborations is our ability to increase equity in providing services to teams and collaborators working both on and outside of our campus. Through our meetings with stakeholders from all five health affairs schools as well as the teams at Project-Malawi and Global Projects Zambia, we increased visibility and awareness of HSL’s expertise and services, and have started to collaborate with groups that previously may not have benefited from our resources and services.

Challenges

Now that we have expanded global collaboration to multiple countries and various groups, a challenge that has emerged includes keeping track of new and ongoing global projects. Creating an internal Global Projects Dashboard has helped to address this by providing a central place for HSL staff to record and provide updates on their projects. The global health librarian is overseeing data collection, making sure it is current and detailed, and along with HSL leadership will use this data to analyze current projects and inform future activities.

Our knowledge of what other academic and health sciences libraries are doing around global engagement is limited to what has been published in the literature. At the time of writing, we are not aware of a comparable multi-faceted global health program by a health sciences library. As global health engagement grows among libraries, we look forward to opportunities to learn from other libraries' global health programs and potentially partner with them.

Although we do not have similar programs to compare global engagement against, there are several areas in which our global engagement stands out. First, our success in building and strengthening our global collaborations has been driven by HSL administration’s forward thinking, sustainability-minded, and collaborative approach to building our global engagement portfolio. In today’s interconnected world, global is local, a fact that has been embraced by both HSL and UNC as a whole. We view supporting global collaborations as an inherent part of everyone’s work at HSL. As such, working with UNC’s global health teams and researchers is now a regular part of the work of many HSL librarians and staff. For example, the school of nursing librarian has partnered with faculty from the School of Nursing and University of West Indies to conduct a publication analysis of the nursing research landscape in the Caribbean. Supporting global research and education is a team effort and HSL can reach more groups through this approach. Additionally, we did not find examples of other libraries providing research impact measurement and visualization services as part of their approach to global engagement. HSL’s global impact measurement and visualization projects serve to highlight and amplify the research being conducted by the diverse research teams with whom we partner.

Recommendations for pursuing global partnerships and engagement

The journey of global engagement in the HSL at UNC-CH is a case study in how a long-term vision to support global health information needs can come to fruition with administrative advocacy and support, strategy, resources, and long-term commitment. With ubiquitous technology and availability of information, the need for libraries to combat misinformation, synthesize information for evidence-based decision making, and build capacity around information skills is ever more important. For administrators seeking to advocate and forge a path toward global engagement, prior to moving forward with a strategic roadmap it is helpful to reflect on a few questions/issues such as:

1. How does global engagement address the mission of the organization?

2. What would be the impact or risk if the organization did not pursue global partnerships?

3. What does it mean to be ‘global’?

4. What would a successful global partnership entail?

5. What type of impact would you hope to see by pursuing global partnerships?

These are the types of questions administrators need to reflect upon to determine if the path toward engaging globally is sustainable, strategically aligned, and reflect the values held by the organization. The exercise of aligning priorities with vision and values and addressing the question of why this area is integral to the mission of the organization, places administrators in a better position to identify resources needed to support a global program or initiative, mobilize staff to participate, and garner community/partner interest. Administrators pursuing new or complex initiatives need to provide ample support and vision throughout the design, development, implementation, and evaluation stages in a formative manner which include: determining the long-term sustainability of a program, illustrating what success looks like, determining how resources will be obtained and/or re-distributed to sufficiently support the program and its staff, creating a realistic timeframe for meeting specific milestones, finding ways to encourage diversity of thought and experience as the program develops and is being implemented, developing checkpoints throughout the program to ensure resources and expertise are being used in the most efficient and effective manner, and identifying mechanisms to share program results and impact. Taking the time to delve into these areas upfront and throughout the process can help staff ensure a new program can reach its full potential. In the HSL, working collaboratively in teams across domains is encouraged and strongly supported; we see this as a way to help bring diversity of thought and experience to projects which increases our ability to integrate varied expertise to the benefit of our partners and provides opportunities for staff to learn from one another. Since this is important to the formulation of our teams, from an administrative standpoint, support has been provided to work collaboratively in a matrixed manner. The more barriers administrators remove that encourage collaboration and working across domains; the better. Another pitfall in which new programs can succumb occurs when new opportunities arise and out of fear of losing a potential partner, administrators say “yes” to taking on a new opportunity which could then create a capacity problem amongst staff, lead to minimal results, and create confusion as to where the program is heading. This should be avoided at all cost. Being realistic and ensuring that as new opportunities arise, you are true to your values, mission, and have the resources to provide long-term support, will help in avoiding failure, confusion, or lack luster results. Another area where administrators can have a positive impact is in ensuring there are ways to highlight staff contributions such that their impact to the larger goal is clearly shared. This may be accomplished through newsletters, stories, or blogs, which all help to promote the work of the libraries and increase awareness amongst the community in which you serve.

The importance of libraries and information-centric work to global development initiatives and the many opportunities for libraries to engage in global partnerships are reflected in the UN SDGs, which include providing access to information, increasing literacy, protecting peoples’ cultural heritage, and improving information and communication technologies (IFLA, 2020). Libraries of all types can contribute to increasing awareness of and finding mechanisms to grapple with copious amounts of information that exist in the complex information era in which we live. Using an iterative approach to develop our global roadmap enabled the flexibility needed to modify and formulate services, change our approach to building awareness of library expertise, shift priorities based on partner needs, and respond to creating new partnerships based on campus priorities. Core areas to consider when developing a global library roadmap include aligning library and institutional goals, identifying funding opportunities and resource allocation, setting realistic expectations, and creating a mechanism to monitor program progress and share results.

Taking time at the onset to build relationships with entities on campus that have shared values and vision of what engaging in global programs entails is critical to success. With a better understanding as to what schools and units are hoping to accomplish, the library is in a better position to meaningfully contribute as a partner in integrating library expertise where it will be most impactful. Having a thorough understanding of campus projects and associated goals helps to determine the resources and personnel needed to move forward with a global roadmap. At our institution, based on relationships we cultivated, it was clear that a new position needed to be created that would continuously explore global project needs. Without this level of engagement, we felt that library integration would be limited and possibly misaligned. For example, the UNC Gillings School of Global Public Health has as one of its goals, the Gillings Global Guarantee that aims to enable “every residential Master of Public Health student have a funded global experience as part of their course of study” (Gillings School of Global Public Health, 2019). Knowing this is a goal for one of our schools helps to formulate ways in which the library could partner, including to collate resources for students, offer pre-departure training and post-reflection opportunities, or provide a mechanism for students to share their experiences through a collection of student impact stories or an exhibit. Linking library priorities to the goals of our campus partners helps to establish a strongly aligned vision for how global engagement may occur.

Pursuing global initiatives can oftentimes require additional funding, especially if conducting a needs assessment or if visiting partners are part of the library approach. Ensuring availability of the required budget for a team to travel and visit project partners was critical in conducting our needs assessment. We were successful in attaining support from campus partners including IGHID and UNC Global (through the successful granting of a UNC Global Partnership Award). This multi-partnership approach to our funding bodes well to how the Libraries are viewed on our campus as a global partner. Seeking institutional awards and partnering with campus entities on funding opportunities helps further establish campus partnerships as well as the ability of the library to contribute to larger goals. In addition, creating a dedicated position(s) or including goals pertaining to global engagement in other position portfolios such that they are interwoven into primary responsibilities of librarians, helps ensure global priorities are addressed on an ongoing basis. This also helps build a sense of engagement and purpose for those involved.

Engaging partners can involve intricacies in setting expectations around roles and responsibilities, approaches to solving problems, or identifying ways to integrate into the work of a project. Through our experience, we cannot overstate the importance of not over promising on what you can deliver in terms of resources and services. When ascertaining needs or understanding the workings of a project, being clear about your goals, level of engagement, allocation of resources or personnel, and how you plan on sustaining effort, is important when establishing trust in a partnership. An approach that was key to our global engagement included connecting with current partners in their global efforts and through those connections, finding opportunities to build capacity amongst our partners that would improve efficiency and effectiveness. As we think about sustainability, it is important to note, that if effectively designed, as one builds capacity, it may diminish levels of engagement in certain areas or shift to other areas of need, which is a positive outcome of building capacity.

Tracking progress and sharing results are important ways to keep your library team, administration, and project partners aware of how global goals are being addressed. Establishing a tracking system helps to demonstrate how the library is engaged in specific areas, the extent to which identified needs were met, whether additional resources were required, what additional outreach mechanisms needed to be employed; and ultimately, helps to elucidate in what ways our program could be improved. While tracking progress for internal use is helpful in the areas previously mentioned, it is equally important to maximize the effect of work that has been accomplished and share those results with project partners. Through our relationship with IGHID, we now seek opportunities to share short stories and updates related to how the library is partnering with their programs. For example, as part of a newsletter distributed to Project-Malawi staff, we shared a story of a project we completed using research metrics and visualization that further exemplified to our partners the array of expertise held by library staff and how the library was able to respond to needs of our project partners.

Conclusion

Pursuing global library engagement is a journey that takes time, energy, and commitment. Libraries of all types can contribute to addressing information gaps, increasing awareness, and providing mechanisms to grapple with copious amounts of information that exist in the complex global information era in which we live. Global collaborations between academic libraries in the United States and health programs in low and middle income countries (LMICs) provide an important opportunity to advance UN SDGs. In particular, staff expertise present in U.S. academic health sciences libraries can be extended with relatively low overhead to LMICs to build capacity in resource-limited settings. This knowledge transfer has potential to provide outsized impact in these settings, meaning relatively few resources from U.S. research libraries may be needed to make a much larger impact than would otherwise be expected. Further, the knowledge transfer is in line with the mission to provide access to information and help build skills to support lifelong learning. Our roadmap provides a starting place for other academic libraries to consider how their library mission may further UN SDGs.

Identifying partners that have similar goals, aspirations, and values is critical to envisioning how a library can engage in meaningful and sustainable ways. Using the UN SDGs as a basis for how the library engages in global work can guide strategic planning, as all SDGs have aspects to which libraries can contribute and these goals are central to the work of many potential global partners. Using the SDGs as a framework, in conjunction with local, institutional priorities and global partner needs, can also provide a pathway for measuring impact, sharing lessons learned, and modifying methods of engagement in an iterative manner to meet needs. Being thoughtful about scalability of services, identifying opportunities to build capacity, and fostering partnerships locally and globally to achieve mutual goals is essential to the successful partnership between libraries and global programs and partners. Ultimately, we need to create an information ecosystem where reliable information is integrated and shared to improve the human condition. This is a pivotal time for libraries as we are evermore connected globally in all information domains. At Carolina, where global engagement is and has been a priority, we believe that a great global public research university needs a strong global public research library, and we intend to make this a reality.

Appendix A:

HSL handout for global needs assessment

Appendix B

Needs assessment survey

Global Health in Zambia and Malawi: Health Sciences Library Information Inquiry: Survey Questions

 

Question 1: Please enter your Name, Title, and Department:

Question 2: To what extent are the following beneficial to the global health partnership in which you are engaged?

Table

	Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree
Identifying/Evaluating Information (automation of searches, identifying journals for submission, topic/ author/ collaboration tracking)
Pre-departure Training (Instruction on available information resources & services)
Subject Guides (Global Women's Health)
News & Information Resources (e.g., Statistical resources, Tropical Disease Bulletin)
Data Visualization (e.g., World Bank Open Data, Topic/author/grant collaboration)
Grant Seeking (e.g., SPIN Database, auto alerts, Fogarty International Center)
Plain Language Support (e.g., patient education materials, brochures, writing abstracts for publication)
Information Management (e.g., creating an inventory and cataloging/classifying information)
Systematic Reviews (Connecting to tools to increase efficiency, searching multiple databases and gray literature, writing methods section)
Other

Question 3: From the list above, what are the 3 most important components the Health Sciences Library should consider prioritizing over the next year?

Question 4: Which group would benefit from library information resources and services? Select all that apply.

□ Clinicians

□ Researchers

□ Students/Residents

Question 5: If you have additional thoughts on how the Health Sciences Library can partner with you, please share that with us here: