Widening Panoramas: Retrospective
A journal is shaped by many factors—its editors, readers and publisher, as well as national and international trends. A review of the HILJ archive demonstrates that the journal's contents over the past 25 years reflect changes in health care, patient expectations, clinical education, and advances in technology. This section investigates how the boundaries of the journal have been re-drawn over the past 25 years to take account of globalization and the increasing use of information and communication technologies in health care.
A Journal with ambitions
When Health Libraries Review (HLR) was launched in 1984 the European Association for Health Information and Libraries (EAHIL) did not exist. The first editor, Shane Godbolt, saw the journal's role as assisting in the development of medical librarianship in Europe.1 The strategic plan in 1998 was to turn HLR into a truly Europe-wide Journal, the European equivalent of the Bulletin of the Medical Library Association (USA).2 At the beginning of the 21st century, the journal set out to adopt a more international perspective. A key driver was the rise of the Internet which is bringing together professional communities on a global scale, none more than library and information professionals.3 When the journal name was changed in 2001 it was anticipated that the new title, Health Information and Libraries Journal, would attract a wider readership and encourage a broader range of contributors. Judy Palmer emphasized the importance of strengthening links with European colleagues and initiating closer contact with librarians in the Americas and other countries. In her farewell editorial, Palmer commented on the success of this approach:
We are now receiving contributions from many professionals who work outside libraries and our scope is truly international with an increasing proportion of submissions coming from countries other than the United Kingdom (2002, 19, pp. 187–88).4
Under Graham Walton's editorship, the international profile of the journal has been high on the agenda; aiming to encourage submissions from academic and practitioner authors from across the world. In 2007, a new feature was introduced, International Perspectives and Initiatives, to highlight global developments in health information and libraries. Regional Associate Editors have also been appointed to increase the profile of the journal and to boost international submissions.
From the earliest days the journal sought to promote dialogue and provide opportunities for librarians from developed and developing countries to share their experiences. Jean Shaw, in particular, has championed the importance of looking at health information problems on a global scale.5
Reviewing the evidence
Has the journal succeeded in these ambitions? Has it championed a European perspective? Is there any evidence that the journal is becoming more international in its coverage? And how much content is devoted to developing countries?
Since the publishers have only collected data about the country of authors for the last four years, I carried out electronic searches and manually scanned the tables of contents for the period 1984–2008. I focused mainly on original articles, but have included some content from Brief Communications, Short Reports and Meeting Reports. The figures in Table 1 (authors by region) are rough approximations as my search method will inevitably have missed some non-UK authors.
| Region | Number of articles | Number of countries |
|---|---|---|
| Europe | 46 | 20 |
| North America | 18 | 2 |
| Africa | 14 | 6 |
| Australia–New Zealand | 14 | 2 |
| Far East | 8 | 3 |
| South-east Asia | 7 | 5 |
| South-Central America; Caribbean | 3 | 3 |
| Middle East | 2 | 2 |
Looking at contributions over time, we find that the absolute number of submissions from outside the UK has increased over the decades.
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1980s–20 articles;
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1990s–38 articles; and
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2000s–72 articles.
These data suggest that the majority of articles emanating from outside the UK have indeed been written by European authors. However, if we delve a bit deeper it becomes clear that the input across Europe has been uneven with the Netherlands and Scandinavian countries (apart from Denmark) being much more represented than Southern European states. The last few years, however, has seen a steady increase in articles from the Accession States (Poland, Hungary, etc.). Another point worth noting is that from the outset the journal has attracted authors from the USA, Canada, Australia and New Zealand. As regards the developing world, the journal has regularly reflected the interests and problems of developing countries. The very first such article (on Nepal) appeared in 19846 and over the years there have been nine case studies describing the environment of librarians in the Third World. In all, fourteen articles relate to African countries. In 1998, Petrak and Shaw edited a special issue (March 1998—Vol. 15 Issue 1) devoted to international co-operation, featuring reports from a variety of developing countries.7 Madge and Plutchak (2005) later wrote an article which surveyed international trends and activities in health librarianship.8
We have chosen to re-print an article which details the problems of accessing health information in Zambia (Hoppenbrouwer & Wamunyima Kanyengo, 2006). Two librarians with a long history of collaboration with African colleagues, Jean Shaw and Shane Godbolt, provide a practitioner commentary.
One final observation concerns citations. Of the top 20 most cited articles, 3 are by non-UK authors and one relates to globalization.9 So, congratulations to all three editors for their vision of a truly international journal. In moving forward we need to continue to adhere to this vision and make an effort to attract authors from regions which have hitherto not published in HILJ (e.g. the Middle East, South and Central America, and the Caribbean).
Health informatics coverage in the Journal
The primary readership for the journal is health librarians but the editors have sought to make it relevant to a broader audience of health information professionals. The journal has provided regular coverage of library automation through columns and original articles. Recent policy to incorporate more health informatics content has been signalled by the re-naming of the journal (2001) and the launch of a new feature (2007).
What is the rationale for widening the scope of the journal? Has the journal succeeded in attracting contributions with an informatics theme? Are such articles of interest to its readers?
If we adopt Stead's simple definition of health informatics (‘the science that deals with health information, its structure, acquisition and use’),10 clearly health informatics has much in common with information science and health librarianship. A growing literature (mostly American) makes the case for the domains of health informatics and health librarianship to work collaboratively:
Boundaries are disappearing between the sources and types of and uses for health information managed by informaticians and librarians.11
This symbiotic relationship provides a justification for extending the boundaries of the journal to include health informatics topics.
Method
Has the journal achieved this goal? To answer the question I again carried out searches of the archive and scanned the tables of contents to determine the amount of health informatics material, the type of articles published and whether coverage had increased over the life of the journal. The results were not what I expected. I assumed that there would have been very little health informatics content for the first two decades. My searches found that although there has been a substantial increase in the amount of health informatics content in the current decade, there was a considerable amount of health informatics material in the first two decades.
Findings
In all, 241 articles had a health informatics theme (Table 2), 29 in the 1980s, 61 in the 1990s and 151 in the current decade. In the very first year (1984) eight articles addressed health informatics issues—five dealt with consumer health informatics topics (one a review article12) and two concerned information management in health care.13,14 One special issue was devoted to Medical Informatics, edited by Bruce Madge in 1994.15
| Topic | Percentage (%) |
|---|---|
| Consumer health informatics | 29 |
| Information retrieval | 18 |
| Education, training, professional development | 17 |
| Information needs analysis | 10 |
| National policy/strategy | 6 |
| Health science librarianship in the digital age | 6 |
| Information management | 4 |
| Knowledge management | 4 |
| Medical informatics | 4 |
| Other | 1 |
Another unexpected finding was that many of the most read and most cited articles for the last three years have an informatics theme. Four of the 20 most read articles relate to health informatics; and 10 out of 20 of the most cited articles deal with informatics issues (see journal website for details of most read, most cited articles in recent years. http://www.blackwell-synergy.com/loi/HIR).
Reflecting on these trends
What is noteworthy is how the journal has anticipated some of the major developments in health informatics. Sixteen years before the International Medical Informatics Association or the American Medical Informatics Association recognized Consumer Health Informatics as a subspecialty, librarians such as Robert Gann were highlighting the importance of understanding the information needs of patients. For fourteen years Gann edited a column devoted to Patient Information.16 Ray Jones was the first HILJ author to use the term ‘consumer health informatics’ in 2000.17 David Nicholas and his colleagues have led the way in evaluating the use of technology to deliver patient information (e.g. touch screen kiosks, digital interactive television, the Internet).18,19
Journal content also acknowledges the importance of education and training in information literacy. Medical librarians play a key role in developing and evaluating methods of providing education and training in information literacy and the journal has provided a useful platform for disseminating their results.20–22 Looking at the trends in the 21st century, the first articles on knowledge management appeared23 and articles dealing with information retrieval began to adopt a more rigorous, empirical approach.24 Another significant development has been a flurry of contributions reflecting on the role of the health librarian in the post digital information age, highlighting the common ground between librarians and informaticians.25,26 The meeting point is not so much technology but more a shared interest in user needs and how users intend to use information.
One aspect of health informatics neglected in the journal is analysis of the impact of national policy initiatives on information professionals and end users. Although implicit in many articles, there is a dearth of those that engage in explicit policy analysis and critique.
In conclusion, the journal has successfully incorporated health informatics into its coverage. The Editorial Board needs to find a way to alert the wider world of health information professionals to HILJ's rich seam of material relating to the ‘soft side’ of health informatics—research into user needs (especially those of patients), studies of user information seeking behaviour, investigations into the quality of health information, and methods of providing education, training and professional development to improve information literacy.
At the end of this section Professor Reinhold Haux provides his thoughts on Current Status & Future Prospects. As President of the International Medical Informatics Association (IMIA) and editor of two important publications (IMIA Yearbook of Medical Informatics and Methods of Information in Medicine) he is well placed to comment on where we are and where we are heading.
Conflicts of interest
JM has declared no conflicts.
