using print and online content: the information seeking and reading habits of physicians: a case...

Using Print and Online Content: The Information Seeking and Reading Habits of Physicians: A Case Study of Pediatricians

Michael Clarke

Executive Editor, Pediatrics

Online Information & Education Conference 2005

Development of Electronic Journals

MainframeComputing

WWWSearch EnginesHTMLPubMed

SGMLUNIXElectronicDatabases

PCWindowsInternet

Algorithmic SearchXMLCrossRefDOIs

1960s 1980s 1990s1970s 2000s

The Launch ofE-Journals

Development of Electronic Journals

Launching online journals and getting 100% of journal content online and searchable

2003 20052004

1st Phase of ElectronicJournals

•Critical mass of legacy archives online•Development of a truly integrated search of all scholarly literature (i.e. Google Scholar)

2006 2007 2008 2009

Incremental improvements for searching and filtering vast amounts of information

2nd Phase of Electronic Journals

2006 2007 2008 2009

Methods Used to Analyze Readership

Reader Surveys

Focus Groups/ User Studies

Usage & Citation Analysis

Readers?Readers?

Methods: Reader Survey

• Survey design and analysis conducted in collaboration with Professors Carol Tenopir & Donald King

• 4,000 surveys sent out by snail mail Spring 2004• 2 versions, each sent to 2,000 readers• Surveys sent to AAP members• $1 incentive• Return postage paid• 1 follow-up letter

Methods: Reader Survey

• Version 1: PEDIATRICS Journal Survey 685 returned questionnaires (34.25%)

• Version 2: Critical Incident Survey 666 returned questionnaires 33.3%

Methods: Questionnaires

• 2 brief questionnaires (sent to different sample groups of 1000 at different times)

• 34% & 31% response rates• Conducted by Research USA• Blinded data collection• Sample of Table of Contents• Purpose was to determine whether specific

articles were read in print or online

Methods: Focus Groups

2 focus groups were held in May 2004:

• Focus Group 1: Researchers PAS, May 2, 2004, San Francisco

• Focus Group 2: Clinicians AAP Practical Pediatrics Course, May 14,

2004, Sante Fe

PEDIATRICS: Vital Signs

• Published monthly

• “Early Release” articles published on 1st and 15th of every month

• Impact factor: 3.781 (1st in field)

• Total citations: 25,691 (1st in field)

• Original science articles: ~700 annually

• 62,000 subscribers (English edition)

Pediatrics Print and Online

AAP Mem bers

87%

Institutional Subscribers

6%Non-Mem berIndividuals

7%

Journal Subscription Profile

Total Subscriptions = 62,000

Represent a much greaterpercent of total readers

Demographics: Practice Setting of Individual Subscribers

Government4%

Other7%

Industry0%

Private Practice25%

Hospital21%

Group Practice21%

University20%

HMO2%

Spring Reader Survey

PEDIATRICS Electronic Pages

• Began in 1997 (first online-only section of a medical journal)

• Articles freely accessible (“open access”) from day of publication

• Same peer review process as printed articles• Final, edited, redacted version only• 30-40 percent of research articles published

in e-pages

Pediatrics Electronic

Electronic Pages

Electronic Abstracts

Why do you read PEDIATRICS? (print)

• 78.8% Keep current

• 36.7% Find specific information

• 20.2% Know what my colleagues are up to

• 12.0% Learn about other subspecialties

Spring Reader Survey

What Sections of PEDIATRICS Do You Read Regularly?

Abstracts 71%

Policy Statements 56%

TOC on Cover 39%

Articles 32%

Commentaries 29%

TOC Inside Journal 18%

Green Pages 18%

Spring Reader Survey

What Sections of PEDIATRICS Do You Read Regularly?

Abstracts 71%

Policy Statements 56%

TOC on Cover 39%

Articles 32%

Commentaries 29%

TOC Inside Journal 18%

Green Pages 18%

“The abstracts in the Green Pages are difficult to read. The green paper makes it harder to read and the abstracts are formatted poorly. I often read on the exercise bike, and I just give up when I get to the green section.”

—Focus Group Participant

Spring Reader Survey

“The abstracts in the Green Pages are difficult to read. The green paper makes it harder to read and the abstracts are formatted poorly. I often read on the exercise bike, and I just give up when I get to the green section.”

—Focus Group Participant

What Sections of PEDIATRICS Do You Read Regularly?

Abstracts 71%

Policy Statements 56%

TOC on Cover 39%

Articles 32%

Commentaries 29%

TOC Inside Journal 18%

Green Pages 18%

“I get the journal in the mail. I look at the cover, circle the articles I am interested in, and then set it aside for when I have time to come back to it.”

—Focus Group Participant

Spring Reader Survey

Indicate your agreement with the following statements (print)

(Strongly agree = 5/Strongly disagree= 1)

• It is easy for me to read 4.08

• It is easy for me to use 4.07

• I like it because it is portable 4.06

• It is convenient for me 3.88

• It is easy for me to find things 2.95

• Using it is time consuming 2.88

Spring Reader Survey

Indicate your agreement with the following statements (electronic)(Strongly agree = 5/Strongly disagree= 1)• Can search comprehensively 3.42• Online features are valuable 3.29• It is easy for me to find things 3.16• The navigation makes sense 3.14• It is convenient for me 3.08• The interface is cumbersome 2.94• Using it is time consuming 2.94

Spring Reader Survey

Which features of the electronic edition do you use?

Advanced searching 14.2%

Links to Medline 12.1%

Most-Read Articles 8.9%

Topic Collections 5.4%

E-mail Alerts 4.7%

E-Letters 4.7%

Free Reference Links 4.5%

Spring Reader Survey

What electronic features would you be likely to use if added?

CME 56%

Download Figures to PowerPoint 56%

Publish Ahead of Print 41%

Full-text & Search on PDA 32%

Citation Reporting by Article 27%

Usage Reporting by Article 15%

Spring Reader Survey

What format do you prefer to receive PEDIATRICS in?

• 59.3% Print only

• 8.2% Electronic only

• 33.6% Both print & electronic

• 92% Wish to continue to receive print

Spring Reader Survey

And Yet…PEDIATRICS electronic usage…

0

2,000,000

4,000,000

6,000,000

8,000,000

10,000,000

12,000,000

14,000,000

1999 2000 2001 2002 2003 2004 2005*

Year

Ac

ce

ss

es

PDF

HTML

Abstract

*projected based on year-to-date statistics

Indicate your agreement with the following statements (e-only articles)(Strongly agree = 5/Strongly disagree= 1)

• e-articles are reviewed

as strictly as print3.21

• e-articles are as useful as print 2.84

• e-articles are second class 2.71

Spring Reader Survey

e-Articles vs Articles, 1999 – 2005

*projected based on year-to-date statistics

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

1999 2000 2001 2002 2003 2004 2005*

Year

Ac

ce

ss

es

e-articles

articles

Most-Read Articles, July 2004

Reported via Survey Reported via Usage Statistics

1. Hyperbilirubinemia & Kernicterus… 1. Hyperbilirubinemia in the Newborn…

2. Assessment of Sleep Apnea… 2. Neonatal Hyperbilirubinemia (e)

3. Violent Television Viewing… 3. Nocturnal Cough & Sleep Quality (e)

4. Gastrointestinal Disorders… 4. Hymenal Measurements

5. Hyperbilirubinemia in the Newborn… 5. Multivitamin Supplementation

6. SIDS: Definitional Approach… 6. Imperforate Hymen (e)

7. Trial of Multivitamins… 7. Predicting Obesity (e)

8. Neonatal infections… 8. Attention-Deficit Disorder (e)

9. Food Allergy and Asthma… 9. Reduced Unnecessary Antibiotic…

10. Habitual Snoring in Children… 10. Use of Practice Guidelines (e)

July Questionnaire

Most-Read Articles, July 2004

Reported via Survey Read in Print Read Online

1. Hyperbilirubinemia & Kernicterus… 46.2% 1.3%

2. Assessment of Sleep Apnea… 44.6% 1.3%

3. Violent Television Viewing… 44.6% 0.6%

4. Gastrointestinal Disorders… 43.0% 0.6%

5. Hyperbilirubinemia in the Newborn… 42.4% 0.6%

6. SIDS: Definitional Approach… 41.1% 0.3%

7. Trial of Multivitamins… 37.9% .06%

8. Neonatal infections… 36.0% 1.3%

9. Food Allergy and Asthma… 35.6% 1.0%

10. Habitual Snoring in Children… 35.6% 1.0%

July Questionnaire

Top e-Articles, July 2004Reported via Survey Read Abstract

in PrintRead Article Online

1. Azithromycin for Petussis 20.4% 3.2%

2. Once-a-Day Aminoglycosides… 9.2% 2.5%

3. Beordetella Pertussis Infections and … 16.6% 2.2%

4. Conscious Sedation of Children with… 14.6% 2.2%

5. Neonatal Hyperbilirubinemia… 18.2% 1.9%

6. Vaccine Safety Concerns 16.2% 1.9%

7. Levels After Otitis Media… 12.4% 1.9%

8. Children with ADHD… 18.5% 1.6%

9. Atomoxetine in Childhood ADHD… 16.9% 1.6%

10. Predictors of Asthma Care Quality… 9.2% 1.6%

July Questionnaire

Comparisons: PEDIATRICS Readers to Other Scientists

• King and Tenopir have surveyed ~25,000 respondents since 1977

• Medical, physical, and social scientists in all settings

• Data from 2001-2004 reported today

Number of Articles Reader per Year Article Read

• Univ. medical• Univ Scientists• All Scientists• Soc Sci/Psych• Engineers• Pediatricians

• ~322 articles/year• ~216 articles/year• ~130 articles/year• ~191 articles/year• ~111 articles/year• ~180 articles/year

Spring Reader Survey Compared with Data from King & Tenopir

ElectronicPrint

Form of Reading

Astronomers

80%

20%

Medical Faculty

75%

25%

University Faculty

63 %

37 %

Pediatricians

16%

84%

Spring Reader Survey Compared with Data from King & Tenopir

Paper

Electronic92.6%

7.5%

Form of Final Reading: PEDIATRICS Readers

Spring Reader Survey Compared with Data from King & Tenopir

Article Separates

Personal Subscriptions

Library Copies

Sources of Readings

Astronomers Medical FacultyUniversity Faculty

44 %

21.4 %

36 %

22%

62%

72 %

12 %

Pediatricians

21 % 16%

16%

16%

49% 36%

Spring Reader Survey Compared with Data from King & Tenopir

1 year 2-5 years > 6 years

Pediatricians Scientists Astronomers

81%

17 %

2 %

64 %

13 %

Age of Last Article Read

17 %21 %

69 %

10 %

23 %

Spring Reader Survey Compared with Data from King & Tenopir

Principal Purpose of ReadingReasons Pediatricians Univ.

Medical

Current Awareness 50.0 22.1

Treatment 18.2 -

Diagnosis 10.7 -

Teaching 5.3 16.9

Research 5.1 36.4

Consulting 3.4 3.9

Other 5.8 9.0

Writing 1.6 11.7Spring Reader Survey Compared with Data from King & Tenopir

Location Percentage

Home 50.5

Office 36.8

Hospital/Clinic 6.2

In transit 3.1

Other 2.5

Library 1.1

Location when reading

Spring Reader Survey Compared with Data from King & Tenopir

Conclusions – e-articles

• E-articles are read more online because that is the only place they can be found

• Perception of e-articles as second-class articles has diminished, but still lingers “I sometimes wonder, why wasn’t this

one printed?”

Conclusions – e-articles

• Due to rising tide of manuscripts and costs of print/postage, e-only articles are necessary

• ~50% in 2005 and as high as 80% in near future

• Necessity of reader education on benefits of and reasons for e-only articles

Conclusions—PEDIATRICS Readers

• Pediatrics has a bifurcated readership: AAP members who receive print & read

primarily print Non-members who read the online edition

largely via institutional subscriptions

• Those who receive print, go online for specific reasons: searching, looking up a specific article, reading e-articles, etc.

Conclusions—PEDIATRICS Readers

• Those members who do use the online edition seem to like it, but it is still not as convenient for most as print due to: Portability Paper is easier to read It shows up in their mailbox

• Members indicate they may use electronic journals more in the future, particular for online-only features such as CME, obtaining figures for PowerPoint lectures, publish ahead of print, etc…

Thoughts for Libraries Serving Physicians:

• Physicians may not be entirely comfortable yet with electronic journals (they are migrating slower than other scientists)

• The role of the librarian is critical in educating physicians in using electronic journals Tutorials Instructional material Web sites designed with physicians in mind