The Partners in Information Access for the Public Health Workforce: a collaboration to improve and protect the public’s health, 1995–2006

Objective: The paper provides a complete accounting of the Partners in Information Access for the Public Health Workforce (Partners) initiative since its inception in 1997, including antecedent activities since 1995. Methods: A descriptive overview is provided that is based on a review of meeting summaries, published reports, Websites, project reports, databases, usage statistics, and personal experiences from ofﬁces in the National Library of Medicine (NLM), six organizations that collaborate formally with NLM on the Partners initiative, and one outside funding partner. Results: With ten years of experience, the initiative is an effective and unique public-private collaboration that builds on the strengths and needs of the organizations that are involved and the constituencies that they serve. Partners-supported and sponsored projects include satellite broadcasts or Webcasts, training initiatives, Web resource a collection expansion from collaboration between the public health community and health Conclusions: With and

• The Partners in Information Access for the Public Health Workforce (Partners) is a focal point for providing access to and use of important information and tools that are useful for improving population health. • The Partners collaboration has grown over its tenyear existence from its original four members to twelve and has evolved incrementally, primarily through ongoing development of its Website and through sponsorship of selected, strategic projects.

Implications
• Health sciences librarians can form successful alliances with public health agencies to inform and improve the health of communities. • Partners-funded initiatives have developed evidencebased information resources and services that support the public health mission to improve health outcomes for all populations in society.

HISTORY OF THE PARTNERS COLLABORATION
The Partners in Information Access for the Public Health Workforce (Partners) collaboration was formally inaugurated in 1997 with the objective of developing a coalition of public health-related organizations to provide information resource training to the public health workforce. Other papers in this focus issue [1][2][3] have amply described the challenges of information access for this population. The Partners collaboration addresses those challenges through multiple projects. This paper describes the origins of the Partners program and reviews a sampling of projects.

Origins
A series of four key meetings led to and influenced the development of the Partners collaboration, beginning with a 1995 US Public Health Service-sponsored conference held at the National Library of Medicine (NLM). Leaders in the National Information Infrastructure (NII) and population health communities came together to explain their work, delineate the barriers to applying NII technologies to the information problems of population-based public health, and lay out a comprehensive strategy for moving forward. Following the conference, the report, Making a Powerful Connection: The Health of the Public and the National Information Infrastructure, was issued recommending that the US Department of Health and Human Services: form a strategic partnership between [the Centers for Disease Control and Prevention] CDC, state and local public Designed to assess the health information needs with regard to disaster preparedness and bioterrorism threats, streamline access to relevant documents and guidelines by creating and distributing a regularly updated Web-based resource guide that links users to reliable sources of health-related preparedness information, and leverage existing information and outreach resources. The searchable guide provides a single point of access to linked full-text resources in public health preparedness, selected by information specialists and reviewed by subject experts from a wide range of disciplines www.phpreparedness.info health associations, NLM, and the National Network of Libraries of Medicine [NN/LM] to train state and local public health officials in the use of currently available information resources that are applicable to public health (section 9.2). [4] A second conference in 1997-including government agencies, major associations representing the public health workforce, and NN/LM-established basic program objectives and major elements and identified a set of immediate action items, including the formation of a steering committee to direct the partnership. The newly appointed steering committee held its first meeting in May 1997 at CDC. Comprising staff from CDC, NLM, NN/LM, the Association of State and Territorial Health Officials (ASTHO), and the National Association of County and City Health Officials (NACCHO), the committee developed a work plan for the Partners that focused on: Ⅲ Web links (among the participating organizations and to useful public health sites) Ⅲ publicizing of existing programs (e.g., NLM's Internet connections grants, AIDS outreach projects, and informatics training programs as well as NLM and NN/LM services) Ⅲ an AIDS-focused training presentation on what public health departments can gain from the Internet and ways NN/LM can help public health departments A fourth and seminal meeting, cosponsored by the New York Academy of Medicine (NYAM) and NLM in March 1998, further informed the Partners plans. Proceedings of this conference, Accessing Useful Information: Challenges in Health Policy and Public Health, are available in the Journal of Urban Health [5][6][7][8][9][10][11][12][13][14][15]. Table 1 describes major milestones for the Partners project.

Development of PHPartners.org
Following a major nine-month redesign effort [18] and a name change to reflect the diversity of public health and the inclusive goals of the Partners collaboration, an expanded Partners in Information Access for the Public Health Workforce Website [19] premiered March 2003. PHPartners.org includes ten information categories (Health Promotion and Health Education, Literature and Guidelines, Health Data Tools and Sta- An additional component of the redesign effort focused on how the Partners could function more effectively in pursuing mutual goals. To address this component, steering committee members completed the partnership self-assessment tool [20], which allowed members of a health-oriented partnership to indicate anonymously the strengths and weaknesses they derived from the partnership. Results from this assessment informed an October 2003 strategic plan. Recently, PHPartners.org work has focused on expanding the number of links available on the site (Figure 1), developing an electronic current awareness mailing list to keep users informed about additions to the site, and developing new resources and a series of topic-specific pages that premiered in 2006. These special topic pages are being developed to assist users in finding authoritative information related to a certain public health topic (e.g., bioterrorism). Selection of topics is based on careful analysis of topic pages accessible on Partners members' Websites. In the two years for which data are available, usage of the site has grown significantly ( Figure 2).

Strategic realignment
In October 2003, the Partners steering committee developed a new strategic plan with an expanded mission and goals. The mission, helping the public health workforce find and use information effectively to improve and protect the public's health, is achieved through five goals: Ⅲ organize and deliver public health resources so they are easier to find and use Ⅲ identify and develop collaborative projects to meet the information needs of the public health workforce Ⅲ increase the visibility of the partnership with librarians and the public health workforce Ⅲ increase the information literacy of the public health workforce Ⅲ strengthen the collaboration among the Partners The multiyear strategic plan identified specific activities under each goal. Example projects developed under this plan are described in the rest of this paper.

SAMPLE PARTNERS-SPONSORED PROJECTS
In fiscal years (FYs) 2004-2005, NLM funded nearly $462,000 in Partners-sponsored projects; an additional $160,000 in funding was awarded in FY2006. The 8 sample projects (Table 2) presented here include training initiatives, Web resource development, a collection of historical literature, and strategies for workforce enumeration and expansion of public health systems research (PHSR).

The Healthy People 2010 information access project
Healthy People 2010 (HP2010) [21] provides a framework for monitoring and measuring improvements in health status. Developing and implementing plans that are likely to be successful in achieving specific HP2010 objectives depend on gaining access to reliable information about what to do and how to do it.
The HP2010 Information Access Project (HP2010 IAP) [22] originated as a pilot project under the direction of the Public Health Foundation (PHF) in 2003. The purpose of the pilot was to determine the feasibility, utility, and potential costs and benefits of:

Figure 3
HP2010 information access project usage Ⅲ improving access to and use of NLM's collection of literature and databases Ⅲ reducing time and increasing precision of user-conducted searches for evidence-based information and guidelines to achieve HP2010 objectives Ⅲ assisting practitioners in interpreting HP2010 literature search findings and identifying related online resources Preformulated PubMed searches were developed for selected objectives from each of six HP2010 focus areas selected for the pilot: ''Access to Quality Health Services,'' ''Disability and Secondary Conditions,'' ''Food Safety,'' ''Public Health Infrastructure,'' ''Respiratory Diseases,'' and ''Environmental Health.'' Searches were developed by NLM librarians and critically reviewed by subject experts identified by PHF.
HP2010 IAP quickly became the most heavily used section of PHPartners.org. Based on these statistics and other positive feedback, NLM recruited public health librarians to work on the remaining focus areas with subject experts from the HP 2010 Work Group coordinators.* By mid 2005, all HP2010 focus areas had 3 or more selected objectives with links to a total of 231 preformulated PubMed searches as well as links to related resources. Evaluations have improved the utility and ease of access of the resource [23]. HP2010 IAP continues to be the most heavily used section of PHPartners.org, and usage continues to rise ( Figure 3).

Public health information and data
In late 2002, the Partners' Public Health Training Workgroup, with representatives from state and local health departments and academic health sciences centers, analyzed an inventory of training materials and identified a gap in training tools in NLM's public health resources. In June 2003, members of the training workgroup were directed to develop a basic training package to fill this gap. The package was to build on existing materials when possible and relate learning objectives to public health competencies. The initial target audience for the training package was state-level * See http://phpartners.org/hp/#Contributors for a list of librarians and subject experts who participate in this project. public health workers. NN/LM librarians would be trainers.
Public Health Information and Data: A Training Manual [24] was completed in May 2004. The teaching methods include case-based learning with examples and exercises relevant to the diversity of public health practice. While many of the highlighted resources are from NLM and the National Institutes of Health, others are from CDC and other government agencies, foundations, and nonprofit organizations. The manual is available from PHPartners.org and has been downloaded more than 30,000 times. The authors encourage its widespread use and adaptation for training purposes.
In addition to being the most downloaded file on PHPartners.org, the tutorial has received extremely positive reviewer and trainee evaluations. The Partners decided that the material had a wide audience and so, in collaboration with the University of Michigan Public Health Library and Informatics Division, converted the paper-based manual to an electronic distance learning tutorial. Approximately 15,000 visitors have accessed the Public Health Information and Data Tutorial [25] since its premiere in May 2005. The tutorial Public health outreach helps public health workers use and manage extensive information available from myriad sources. From its modules, users can learn how to build a plan to stay informed about public health developments and events, find reliable and authoritative consumer-oriented materials to support health education, retrieve statistical information, access public health datasets, and use information to support evidence-based practice.
The manual and tutorial are examples of collaboration between the public health community and health sciences libraries. With ties to competencies, the material introduces information resources and information search strategies that are useful for resolving common information needs in public health practice.

CDCynergy
Access to credible and relevant information to inform planning and decision making for the public health workforce is critical, and, as technology and informatics advance, so are training and experience with accessing electronic health information and utilizing computer and telecommunications technology. Since 2002, SOPHE has delivered CDCynergy training through its national network of CDCynergy trainers, composed primarily of health education and health communications professionals [26]. CDCynergy, a multimedia-based communications planning tool developed by CDC, systematically guides users through the process of designing health communication interventions and incorporates fundamental public health principles, including needs assessment, program planning, and program evaluation.
In 2005, NLM partnered with SOPHE to jointly train health librarians and health educators in health communications planning and health information resources. The overall project goal is to improve public health by expanding the cadre of CDCynergy trainers who can teach public health workers to improve health communications planning, implementation, and delivery. A secondary goal is to build collaborative relationships among health librarians and health education specialists to improve planning, implementing, and evaluating disease prevention or health promotion programs in their regions.
This collaborative project represents a unique opportunity to strengthen the partnership between library science and health education in the use of health information and tools for purposes of improving population health. Health librarians' expertise in the content and format of information resources and the ability to critically evaluate, select, and filter them lends itself to assisting public health educators in planning, implementing, and evaluating evidence-based interventions. Training in CDCynergy positions librarians to serve as key conduits between the identification of information and resources and their application in health communications programs in their immediate communities.
SOPHE convened a two-day CDCynergy train-thetrainer workshop for health librarians and educators in August 2005. Twenty-seven health educators and librarians participated in the workshop, more than doubling the size of the trainers network. Workshop participants were encouraged to partner with another trainer (health educator and librarian partnerships) in the delivery of at least one CDCynergy training, both as a means to develop greater comfort teaching CDCynergy and to help health educators and librarians forge new relationships that will better enable them to support and conduct disease prevention or health promotion activities in their regions. Engaging librarians in this project has already brought a new perspective to the value and application of the CDCynergy tool, including uncovering particular strengths of CDCynergy, potential new audiences who could benefit from training, and areas in which the tool could be expanded or improved to increase accessibility and usability. SOPHE, NLM, and CDC are exploring options for incorporating and implementing these suggestions.
As a direct result of the workshop, CDCynergy training materials and activities were updated and disseminated to the entire network of CDCynergy trainers. Small groups of seasoned and new trainers are working together with SOPHE to update and improve additional materials and to create training models and activities that will allow a broader audience access to CDCynergy tools or training. Future activities include the development of new CDCynergy Web pages and resources (housed on the SOPHE Website), specific tools to assess the impact of joint training and collaborative opportunities between health librarians and health educators, communication about and dissemination of the overall project and lessons learned, and ongoing promotion and facilitation of relationshipbuilding between health education or health communication and library science professionals.

''Partnering for Public Health: Information, Librarians, and the Public Health Workforce''
''Partnering for Public Health: Information, Librarians, and the Public Health Workforce,'' an MLA satellite teleconference and Webcast, was offered March 9, 2005. The goal of the two-hour program was to enhance knowledge of and encourage participation in providing information about public health by health sciences librarians [27]. The objectives were to: Ⅲ provide fundamental knowledge about public health Ⅲ explore the information needs of the public health workforce Ⅲ present a sample of resources currently available to meet their information needs Ⅲ demonstrate collaboration between health sciences librarians and the public health workforce Seventy-five viewing sites registered for the broadcast along with 35 individual registrants. All participants were asked to fill out a short evaluation of the program consisting of questions concerning the instructors' subject knowledge, preparation, organization, and effectiveness; adequacy of answers to audience questions; and relevance or usefulness of the in-structional materials or handouts. The responses were rated on a 4-point scale (4 ϭ high/most to 1 ϭ least/ worst). The mean score from the evaluations was 3.45.

Strategies for Enumerating the Public Health Workforce
Workforce enumeration data are vital to describing demographics, identifying shortages and surpluses, tracking trends over time, forecasting future needs, and advocating for resources, yet no current estimate of the size and composition of the public health workforce exists [28]. Counting workers presents challenges to many occupations and industries; these challenges have been met in different ways over the last five years. The ASTHO project, Strategies for Enumerating the Public Health Workforce, captures valuable lessons learned from outside areas to inform enumeration strategies for the public health workforce.
Strategies for Enumerating the Public Health Workforce [29] includes findings from a literature search of workforce enumeration in a set of ten professions, occupations, or industries and results of a May 2005 focus group conducted with representatives from six of the ten, representatives from public health, and a representative from the Bureau of Labor Statistics. The report also includes profiles of the selected ten groups, a matrix describing lessons learned for public health, and a detailed focus group meeting summary.
The recommendations of the focus group emphasized the importance of a thorough planning and preparation process prior to enumeration. Focus group members offered five priority action items for public health to consider: Ⅲ Mine prior work: Looking at prior workforce enumeration policy and program research on national, state, and local levels will benefit future enumeration. Better use of existing data will facilitate new efforts. Ⅲ Begin with a clear purpose: A vision is critical. What question should the enumeration ultimately answer? What information needs are highest priority? Ⅲ Define public health and public health workers: Enumeration efforts should reference a good, but not necessarily perfect, definition of public health. Ⅲ Set boundaries: Regardless of how public health workers are defined, resources will limit the detail of data that can be collected. Pick a realistic point at which priority needs can be met with definitions, data collection methods, and strategies chosen. Ⅲ Count regularly: Regular counting is the only way to describe workforce trends and estimate future needs.

Public Health Reports: Historical Collection 1878-2005
In December 2005, Public Health Reports, the official journal of the US Public Health Service, published a special issue, Public Health Reports: Historical Collection 1878. Published with Delta Omega, the public health honorary society, this special issue coincided with the inclusion of the complete archives of Public Health Reports in PubMed Central. It also contributed to Delta Omega's efforts to preserve and make available public health classics [30].
Public Health Reports: Historical Collection 1878-2005 features reproductions of 35 seminal articles published in Public Health Reports during the past 127 years. The articles are by such pioneering authors as Joseph Goldberger, Charles Wardell Stiles, Benjamin S. Warren, Wade Hampton Frost, and C. Everett Koop. The chronologically arranged articles address significant public health issues such as plague, Rocky Mountain spotted fever, typhus fever, influenza, milk sanitation, immigration, Salk polio vaccine, smoking, and AIDS. Articles are prefaced by commentaries written by current public health experts. The special issue also includes original photos, charts, tables, and graphs.
This historical collection has been received with enthusiasm by the public health community. It provides a rare look back at the history of the journal and a great deal of perspective on the field of public health itself. Faculty from educational institutions have expressed interest in using the historical collection as a tool to teach public health to both undergraduate and graduate students.

Data from the 2005 National Profile of Local Health Departments †
The National Profile of Local Health Departments (Profile) is an effort to characterize local governmental public health infrastructure and practice. The Profile questionnaire is distributed by NACCHO to every local health department (LHD) in the United States. NACCHO conducted previous profiles in 1997NACCHO conducted previous profiles in , 1993NACCHO conducted previous profiles in , and 1989. The Partners provided funding for mining data from the 2005 Profile (which was funded by CDC) to gather information about the information technology capacity and needs of LHDs and to assist NN/LM in identifying LHDs who could benefit from the technical assistance and training they provide.
The 2005 Profile questionnaire was administered largely in a Web-based format and included a core questionnaire sent to every LHD (n ϭ 2,864) and 3 modules. Each module was sent to a random sample (stratified by population served) of approximately 550 LHDs. No LHD received more than 1 module. Questionnaires were completed by 2,300 LHDs, for a response rate of 80%.
Questions related to information technology and management were included in both the Profile core and one of the modules. The core included questions about availability of technology (e.g., computers, highspeed Internet access, cellular phones) to LHD staff and about control of various aspects of LHD information management (e.g., software selection, data management, system security). A module included several additional questions about information management, including LHD Websites; level of awareness or implementation of several information technology applications; LHD use of databases and electronic data exchange in various program areas; and informaticsrelated training needs for LHD staff.
The information about informatics-related training needs has been provided directly to NN/LM for use in identifying organizations that could benefit from training and technical assistance. This information will also benefit other organizations that focus on providing training to the public health workforce.
Much of the rest of the information has been summarized in the main study report, 2005 Profile of Local Health Departments [31], and a supplemental report [32] on informatics at LHDs. A few of the key findings include: Ⅲ 93% of all LHDs have continuous high-speed access to the Internet. Ⅲ 30% of all LHDs employ information technology (IT) professionals. Ⅲ 70% of LHDs have a Website. Ⅲ 29% of LHDs report that they have an IT disaster management plan. Ⅲ 37% of LHDs provided training in locating evidence-based information on the Internet in the prior year.

Expansion of resources for public health systems research
The usefulness and availability of datasets that can be used to answer some of the most important questions in PHSR is not well known [33]. The Robert Wood Johnson Foundation (RWJF)-and NLM-funded PHSR Project addresses these gaps and builds primarily on NLM's Health Services and Sciences Research Resources (HSRR) [34], a free searchable database of information about research datasets, instruments, and software. In addition, this project will contribute to NLM's HSRProj database [35] of citations to research in progress that is funded by federal, state, private organization, and foundation grants and contracts.
The cataloging and development of data sources for PHSR is a key objective of the RWJF strategy in PHSR. The PHSR Project has identified 120 datasets; key information about the datasets is maintained in NLM's HSRR database. The project is also funding 6 small PHSR studies using 1 of these datasets. These studies and others that are identified as part of the search for datasets will be added to HSRProj. In addition, the papers commissioned as part of the 6 studies will be submitted for publication to key journals, including Health Affairs, Health Services Research, American Journal of Public Health, and Journal of Public Health Management and Practice.
Organizations that fund public health services or systems research or principal investigators (PIs) who are conducting public health services or systems research have been solicited by the project team. The organizations and PIs have been asked to submit descriptions of their current projects, including date of research, number and description of variables, sample size, and methodology. When available, a research in-strument or questionnaire containing the operational definitions of all measures is also solicited. Links to download the dataset are also collected and included in the HSRR site.
Additionally, organizations and PIs have been directed to an online form [36] to send project information to include in the HSRProj database. Research projects that adhere to the following two criteria will be selected for HSRProj: Ⅲ A research project must be in the field of health services or public health systems research. Ⅲ A research project must be ongoing or the project's end date must fall within six months of the date the project will appear in the NLM database.
The purpose of including new datasets in HSRR is to enhance access to data available for research. Similarly, gaining access to information in HSRProj about ongoing research projects before the results are available in a published form can be especially valuable to public health policy makers and other researchers.
The PHSR Project will help diminish barriers in the study of public health by advancing knowledge and availability of data that are appropriate for research on public health organization, delivery, and workforce.

CONCLUSION
These projects provide evidence of the breadth of research funded by the Partners and run the gamut from one-time publications to ongoing Web-based resources as well as collaborative training projects. The scope of projects and activities is representative of the needs of a diverse public health workforce, a workforce that has been characterized as receiving education and training in a wide range of disciplines, coming from a variety of professions, working in many types of settings, and engaging in numerous kinds of activities [37].
At the end of its first decade, the Partners have developed into an effective and unique public-private collaboration that builds on the strengths and needs of the organizations that are involved and the constituencies that they serve. Program evaluations have been conducted or are being planned for individual Partners projects. Completed evaluations have shown or suggest that information alliances between health sciences librarians and public health practitioners, educators, and researchers can be rewarding and beneficial.
Plans are under consideration for a formal evaluation of the Partners but are not yet fully developed. The Partners will continue to seek opportunities for collaboration, especially opportunities with potential to inform and help strengthen the effectiveness of the public health system, as well as suggestions for relevant resources for PHpartners.org.
As the Partners collaboration embarks on its second decade, it remains committed to demonstrating that by working together, public health practitioners, researchers, and health sciences librarians can be a powerful force for positive change in developing and using information tools and resources to improve and protect the public's health.