The Status of Information Literacy Instruction in Medical Libraries of Pakistan: An Appraisal

Midrar Ullah

This study aims to identify the factors which hinder the implementation of IL instructions programmes or prevent their systematic development in Pakistani medical institutions. This study adopted a two-phase, sequential mixed method research design. In first phase, head librarians of all (114) academic medical institutions in Pakistan were surveyed. Response rate was 61.5 %. In second phase, 20 purposively selected head librarians were interviewed. There was a consensus between the head librarians employed at public and private sector medical institutions that out of 12 barriers identified in this study, " lack of training opportunities for IL instruction for librarians " and " lack of policy regarding IL instruction in the medical institutions " were the two most significant barriers to IL instruction programmes in medical institutions. These findings suggest future direction for pre-and in-service education of librarians to prepare themselves to provide IL instruction. A clearly stipulated IL policy may be formulated and implemented in all medical institutions. The findings of this study are expected to enable medical librarians to be more aware of the barriers while planning and providing IL instruction in medical institutions.

The paradigm shift in medical academic practices in Pakistan is becoming a challenge for medical librarians. Majority of medical schools in Pakistan have started problem based learning, undergrads medical research program and Postgraduate programs. This quantitative study aims to investigate the information literacy program in medical libraries situated in the Khyber Pakhtunkhwa (KP) province of Pakistan. The questionnaire administered with in 20 medical colleges libraries using Google Forms as an instrument for data collection and distributed link among all medical college librarians of the province. Findings of the study revealed that majority medical libraries are providing informal information literacy using orientation, bibliographic instructions and occasional lectures as method. The target audience of the information literacy was newly inducted Students. The effectiveness and importance of information literacy program for medical students considered by (87.50%) librarians. This study by large will contribute to modify the current practices of information literacy by the medical libraries.

The purpose of this study was to find out medical librarians' perceptions towards the importance of information literacy (IL) skills. A structured questionnaire, consisting of eight IL skills, was administered to the head librarians of all academic medical institutions in Pakistan. The respondents were asked to rate the importance of IL skills for their users on a 5-point Likert scale (1-Least important to 5-Most important). A total of 69 (60.5 %) usable questionnaires were returned out of 114 disseminated to the respondents. The IL skills about " accessing the needed information effectively and efficiently " , " identifying relevant, authoritative and reliable information sources " , " recognizing the need for information " , "verifying the relevance and quality of information sources " and " using information ethically and legally " got mean scores exceeding four from head librarians of both public and private sector medical institutions. However, IL skill "evaluating the information critically " received mean score less than four i.e., 3.94 from public sector medical librarians and IL skills "organizing information collected or generated in a logical way" and "using the selected information effectively to accomplish a specific task" although considered important but got lower mean scores (3.97 each) from private sector medical librarians. Respondents from both public and private sector medical institutions had considered all the eight IL skills important for their library users, meaning that library users must be adequately equipped with information competencies.

THE STATUS OF INFORMATION LITERACY INSTRUCTION IN MEDICAL LIBRARIES OF PAKISTAN: AN APPRAISAL By Midrar Ullah Supervisor Dr Kanwal Ameen A THESIS SUBMITTED TO THE UNIVERSITY OF THE PUNJAB IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN LIBRARY AND INFORMATION SCIENCE DEPARTMENT OF INFORMATION MANAGEMENT UNIVERSITY OF THE PUNJAB LAHORE, PAKISTAN 2015 CERTIFICATE This is to certify that the research work described in this thesis is the original work of the author and has been carried out under my direct supervision. I have personally gone through all the data/results/materials reported in the manuscript and certify their correctness/authenticity. I further certify that the material included in this thesis has not been used in part or full in a manuscript already submitted or in the process of submission in partial/complete fulfilment of the award of any other degree from any institution. I also certify that the thesis has been prepared under my supervision according to the prescribed format and I endorse its evaluation for the award of Ph.D. degree through the official procedures of the University. Professor Kanwal Ameen (PhD) ii DEDICATION I dedicate this work to my teachers, parents, wife and children for their endless love, support and encouragement. iii ABSTRACT The purpose of this study was to appraise the status of information literacy (IL) instruction in medical libraries of Pakistan. The focus was on probing the perceptions of medical librarians towards the importance of IL skills, current practices of IL instruction, the barriers while advocating or providing IL instruction, and IL instruction training needs of medical librarians. Suggestions from the head librarians regarding the strategies to be adopted for the effective implementation of IL instruction programmes in medical libraries of Pakistan were also obtained. Moreover, differences between libraries at public and private sector medical institutions were also explored. This study adopted sequential mixed methods research design based on quantitative data collection followed by qualitative data collection. In the first phase, a semi-structured questionnaire was mailed to the head librarians of all 114 academic medical libraries in Pakistan. Response rate was 60.5 %. During the second phase of the study, qualitative data were gathered through semi-structured in-depth interviews. Twenty head librarians were purposively selected to obtain their detailed perspective related to the significant results of quantitative phase. The results were consolidated at the interpretation stage. The results have demonstrated that the respondents from both public and private sector medical institutions considered all the eight IL skills important for their library users. The study revealed that 74 % of the respondents had offered some types of IL instruction in their institutions during the previous year, ranging from library orientation to research-level skills. IL instruction is typically only offered to new students or first-time library users or on demand. A majority of the respondents developed IL instruction programmes without faculty involvement. Librarians were primarily responsible for offering IL instruction in medical institutions. Face-to-face instruction in computer labs or lecture halls and individual iv instruction at reference desks were identified as the most common IL instruction delivery methods. The data indicated that oral feedback, written feedback and searching in a computer lab were the most popular assessment methods that medical librarians used. All the interviewees opined that library orientation and instruction in basic information skills were not enough for medical library users. They suggested that medical library users must be trained in advanced information skills. It was identified that "lack of training opportunities for IL instruction for librarians” and “lack of policy regarding IL instruction in the medical institutions” were the most significant barriers to IL instruction programmes in both public and private sector medical institutions. The respondents were very much interested in the development of their IL instruction proficiencies in the eight areas (developing IL course contents, IL instruction need assessment, IL teaching methods, promoting IL instruction programmes, presentation skills, integrating IL instruction into the curriculum, IL instructional design skills and developing online IL tutorials) mentioned in the questionnaire. However, they were less interested in the development of their evaluation and assessment skills due to voluntarily attendance in the IL instruction sessions being not integrated into the curriculum. The respondents revealed that library users were not well versed with information skills due to traditional education system of reading text books and class notes only. The respondents identified workshops/seminars and formal in-class teaching as part of the main curriculum as the most effective IL instruction delivery methods. Majority of the respondents were in favour of integrating IL instruction into the curriculum as an independent and credit course. An overwhelming majority of the respondents was of the opinion that librarians and faculty should collaborate in designing IL instruction. v ACKNOWLEDGEMENTS First and foremost, I am extremely thankful to Almighty “Allah” for giving me strength to chase my dreams. I would like to express my profound gratitude to my supervisor Dr Kanwal Ameen, Professor at Department of Information Management, University of the Punjab, Lahore, who has been a source of encouragement and inspiration throughout my postgraduate studies. Special thanks for her hours of reflecting, reading, guiding, and most of all being patient throughout the entire period. There are a number of people without whom this study might not have been completed, and to whom I am greatly indebted. I owe my sincere gratitude to Dr. Mumtaz Ali Anwar, Dr Khalid Mahmood, Dr Shaheen Maqsood, Dr Salman Bakhtiar and Mr M. Najeeb Khan, who were so generous with their expertise and precious time. Special thanks go to the staff members of Army Medical College Library, Rawalpindi for their continued support. I wish to expand my utmost gratitude to the panel of experts for their assistance in reviewing the data collection instruments. I am thankful to all my friends and class fellows for their unconditional support during hard times. I hereby express my special gratitude to my loving mother for her constant prayers for my success. I have no words to express my gratitude to my wife for her constant moral support and my kids for their smiles and affection that worked as energy and kept me going through the difficult task of thesis writing. I would not be what I am today without the help of all of you. Midrar Ullah vi TABLE OF CONTENTS ABSTRACT…………………………………………...……...……………………………...iv ACKNOWLEDGEMENTS………………………….………………….……………….....vi LIST OF ABBREVIATIONS & ACRONYMS……...…………………………………..xiii LIST OF TABLES…..……..……………………………………………...…………….....xvi LIST OF FIGURES…...……..…………………………………………………………...xviii CHAPTER 1 - INTRODUCTION….…….……..…………………………………………..1 1.1 Background of the study…………………………...………………………….1 1.1.1 Medical Education in Pakistan………………………………………...1 1.1.2 Medical Librarianship in Pakistan………………………………….....1 1.1.3 Information Literacy..............................................................................2 1.2 Theoretical Framework – Information Literacy………………………………4 1.3 Statement of the Problem……………………………………………………...9 1.4 Research Objectives…………………………………………………………...9 1.5 Research Questions…………………………………...……………………...10 1.6 Rational and Significance of the Study………………………………………10 1.7 Limitations and Delimitations………………………………………………..11 1.8 Definition of Terms…………………………………………………………..12 1.9 Organization of the Study……………………………………………………12 CHAPTER 2 - LITERATURE REVIEW…………………………………...……………14 2.1 2.2 Information Literacy…………………………………………………………14 2.1.1 The Concept of Information Literacy………………………………..16 2.1.2 Information Literacy Instruction……………………………………..17 2.1.3 Information Literacy Standards……………………………………...18 2.1.4 Information Literacy Models………………………………………...19 Studies on Status of Information Literacy Instruction……..………………...21 2.2.1 Studies in Pakistan………………..………………………………….21 2.2.2 Studies in the Developing Countries…………………………………22 2.2.3 Studies in the Developed Countries..………………………………...26 2.3 Perceptions of Different Stakeholders towards the Importance of IL Skills...28 2.4 Barriers to IL Instruction Programmes………………………………………30 vii 2.5 Practices of Information Literacy Instruction………………………………..32 2.5.1 IL Delivery Methods…………………………………………………32 2.5.2 IL Course Contents…………………………………………………..33 2.5.3 IL Assessment Methods……………………………………………...35 2.5.4 Integration of IL Instruction into the Curriculum……………………38 2.5.5 Librarian-Faculty Collaboration……………………………………..39 2.6 IL Instruction Training Needs of Instructional Librarians…………………...41 2.7 Strategies for the Effective Implementation of IL Instruction Programmes…43 2.8 Studies on IL Instruction in Medical Libraries………………………………45 2.9 Chapter Summary……………………………………………………………49 CHAPTER 3 - RESEARCH DESIGN AND METHODOLOGY……………………….51 3.1 Research Design……………………………………………………………...51 3.2 Research Method…………………………………………………………….53 3.3 Phase I – Quantitative………………………………………………………..53 3.3.1 Questionnaire Development…………………………………………53 3.3.1.1 Literature review…………………………………………….54 3.3.1.2 Draft questionnaire…………………………………………..54 3.3.1.3 Expert scrutiny………………………………………………54 3.3.1.4 Pilot testing………….……………………………………….55 3.3.1.5 Scale used……………………………………………………56 3.3.2 Population……………………………………………………………57 3.3.3 Data Collection………………………………………………………57 3.3.3.1 Follow up……………………………………………………58 3.3.4 3.4 Data Analysis………………………………………………………...58 Phase II – Qualitative………………………………………………………...61 3.4.1 Development of Interview Schedule…………………………………61 3.4.1.1 Expert review………….……………………………………..61 3.4.1.2 Pilot interviews………………………………………………61 3.4.2 Sampling of Interview Participants………………………………….62 3.4.3 Interview Process…………………………………………………….63 3.3.4 Analysis of Qualitative Data…………………………………...…….63 viii 3.5 Validity and Reliability…………………………………………...………….64 3.6 Chapter Summary……………………………………………………………65 CHAPTER 3 - ANALYSIS OF QUANTITATIVE DATA………………………………67 4.1 Survey Response Rates………………………………………………………68 4.2 Demographic Information……………………………………………………68 4.3 Findings of the Study………………………………………………………...70 4.3.1 Perceptions of Medical Librarians towards the Importance of IL Skills…………………………………………………………………70 4.3.1.1 Independent samples t-test results……..…………………….73 4.3.1.2 One-way ANOVA results……………….…………………...73 4.3.2 Current Practices of IL Instruction in Medical Libraries…………….73 4.3.2.1 IL instruction activities…….………………………………...73 4.3.2.2 Types of IL instruction offered……………………….……...76 4.3.2.3 Topics covered in IL instruction programmes……….………79 4.3.2.4 IL instruction recipients……….……………………………..80 4.3.2.5 Approaches of Providing IL Instruction……………………..81 4.3.2.6 IL instruction delivery venues…..…………………………...82 4.3.2.7 IL instruction delivery methods…………..………………….82 4.3.2.8 Assessment of IL instruction effectiveness……….………….83 4.3.2.9 Integration of IL instruction into the curriculum….…………85 4.3.2.10 Librarian and faculty collaboration………………..………..86 4.3.2.11 Staff responsible for running IL instruction programmes...………….…………………………………...87 4.3.3 Barriers When Advocating or Providing IL Instruction……………..88 4.3.3.1 Independent samples t-test results……………..…………….91 4.3.3.2 One-way ANOVA results……………………….…………...91 4.3.4 IL Instruction Training Needs of Medical Librarians…….………….91 4.3.4.1 IL instruction training received by the head librarians…........91 4.3.4.2 Knowledge of IL instruction areas…..……………………….93 4.3.4.3 Interests in developing IL instruction proficiencies…..……...95 ix 4.3.5 Strategies for the Effective Implementation of IL Instruction Programmes………………………………………………………….99 4.3.5.1 Perceptions of head librarians regarding IL skills of their library users………...………..……………………………...100 4.3.5.2 Perceptions of head librarians regarding effective methods for imparting IL instruction……………......…………………...103 4.3.5.3 Teaching IL to medical students……….…………………...106 4.3.5.4 Integration of IL instruction into the curriculum...….……...109 4.3.5.5 Mode of integration of IL instruction into the curriculum.....111 4.3.5.6 Responsibility for designing IL instruction curriculum….....115 4.3.5.7 Responsibility for delivering IL instruction….…….……….115 4.4 Chapter Summary…………………………………………………………..118 CHAPTER 5 - ANALYSIS OF QUALITATIVE DATA……………………………….121 5.1 Demographic Profile of Interviewees………………………………………121 5.2 Analysis of Interview Data…………………………………………………122 5.2.1 Perceptions of Medical Librarians towards the Importance of IL Skills………………………………………………………………..122 5.2.1.1 Importance of “evaluating the information critically”…...…123 5.2.1.2 Importance of “organizing information collected or generated in a logical way”…………....……………………125 5.2.1.3 Importance of “using the selected information effectively to accomplish a specific task”…………....…………………127 5.2.1.4 Reasons for not considering three IL skills very important….………………………………………………...129 5.2.2 Current IL Instruction Practices in Medical Libraries……………..130 5.2.3 Barriers When Advocating or Providing IL Instruction…………...140 5.2.4 IL Instruction Training Needs of Medical Librarians……………...142 5.2.5 Strategies for the Effective Implementation of IL Instruction Programmes…………………………………………………….…..147 5.2.5.1 IL skills of library users…...…………………………….….147 5.2.5.2 IL instruction methods………….………………………..…150 x 5.2.5.3 Integrating IL instruction into the curriculum….…………..152 5.2.5.4 Responsibility for designing IL curriculum………..…..…...152 5.2.5.5 Responsibility for delivering IL instruction…….……...…...154 5.2.6 5.3 Other Comments………………………………………………..…..156 Chapter Summary……………………………………………………..……157 CHAPTER 6 – DISCUSSION……………………………………………………………160 6.1 Perceptions of Medical Librarians towards the Importance of IL Skills………………………………………………………………………..160 6.2 Current Practices of IL Instruction in Medical Libraries …………………..162 6.3 Barriers When Advocating or Providing IL Instruction……………………165 6.4 IL Instruction Training Needs of Medical Librarians………………………166 6.5 Strategies for the Effective Implementation of IL Instruction Programmes………………………………………………………………...168 6.6 Chapter Summary…………………………………………………………..170 CHAPTER 7 - SUMMARY, CONCLUSIONS AND RECOMMENDATIONS……...172 7.1 Research Design and Demographics……………………………………….173 7.2 Summary of Findings……………………………………………………….174 7.2.1 Perceptions of Medical Librarians towards the Importance of IL Skills…………………………………………………………….….174 7.2.2 Current Practices of IL Instruction in Medical Libraries …………..176 7.2.3 Barriers When Advocating or Providing IL Instruction……………177 7.2.4 IL Instruction Training Needs of Medical Librarians………………178 7.2.5 Strategies for the Effective Implementation of IL Instruction Programmes………………………………………………………...181 7.3 Conclusions…………………………………………………………………183 7.4 Recommendations…………………………………………………………..185 7.5 Recommendations for Further Research……………………………………186 REFERENCES………………………………………………………………….…………187 APPENDICES……………………………………………………………………….…….201 A. PANEL OF EXPERTS FOR SCRUTINY OF THE DRAFT INSTRUMENT AND INTERVIEW SCHEDULE………………………………………………201 B. COVERING LETTER SENT WITH THE DRAFT INSTRUMENT…………202 xi C. PILOT STUDY PARTICIPANTS……………………………………………..203 D. COVERING LETTER SENT WITH THE PILOT INSTRUMENT…………..204 E. SURVEY INSTRUMENT……………………………………………………..205 F. COVERING LETTER SENT WITH THE SURVEY INSTRUMENT……….212 G. LIST OF INSTITUTIONS INCLUDED IN THE SURVEY………………….213 H. COVERING LETTER SENT WITH THE DRAFT INTERVIEW SCHEDULE……………………………………………………………………217 I. LIST OF PILOT INTERVIEW PARTICIPANTS…………………………….229 J. INTERVIEW SCHEDULE…………………………………………………….220 K. LIST OF INTERVIEW PARTICIPANTS……………………………………..223 L. COVERING LETTER SENT WITH THE INTERVIEW SCHEDULE………224 xii LIST OF ABBREVIATIONS AND ACRONYMS AAHE American Association of Higher Education AASL American Association of School Librarians ACRL Association of College and Research Libraries AECT Association of Educational and Communications Technology ALA American Library Association ANOVA Analysis of Variance BI Bibliographic Instruction CAUL Council of Australian University Librarians CD- ROM Compact Disk - Read Only Memory CHELSA Committee for Higher Education Librarians of South Africa CIL Communications in Information Literacy CILIP Chartered Institute of Library and Information Professionals CINAHL Cumulative Index of Nursing and Allied Health Literature CPSP College of Physicians and Surgeons Pakistan E8 Empowering 8 ECIL European Conference on Information Literacy EMBASE Excerpta Medica Database ERIC Educational Resources Information Center FET Fisher’s Exact Test HEC Higher Education Commission ICT Information and Communications Technology IFLA International Federation of Library Associations and Institutions IIA Information Industry Association IL Information Literacy xiii ILIAC Information Literacy Instruction Assessment Cycle ISTE Information Society of Technology in Education IT Information Technology ITES Information Technology Education Association JIL Journal of Information Literacy K-12 Kindergarten through 12th Grade (US) KENET Kenya Education Network Trust LILAC Librarians’ Information Literacy Annual Conference LIPs Library and Information Professionals LIS Library and Information Science LISA Library and Information Science Abstracts LISTA Library, Information Science and Technology Abstracts MCQs Multiple Choice Questions MEDLINE Medical Literature Analysis and Retrieval System Online MELAP Medical Library Association of Pakistan MLA Medical Library Association NCBI National Center for Biotechnology Information NEPAD New Partnership for Africa’s Development NFIL National Forum on Information Literacy NLM National Library of Medicine NLP National Library of Pakistan OEIS Online Electronic Information Skills OPAC Online Public Access Catalogue PGMIs Postgraduate Medical Institutes PM&DC Pakistan Medical and Dental Council xiv Pub Med Public/Publisher MEDLINE R&D Research and Development SAQA South African Qualifications Authority SCONUL Society of College, National and University Libraries SD Standard Deviation SEE South-East Europe SPSS Statistical Product and Service Solutions TAFE Technical and Further Education UK United Kingdom UNESCO United Nations Educational, Scientific and Cultural Organization USA United States of America WOS Web of Science xv LIST OF TABLES Table 3.1 Table 4.1 Table 4.2 Table 4.3 Table 4.4 Table 4.5 Table 4.6 Table 4.7 Table 4.8 Table 4.9 Table 4.10 Table 4.11 Table 4.12 Table 4.13 Table 4.14 Table 4.15 Table 4.16 Table 4.17 Table 4.18 Table 4.19 Table 4.20 Table 4.21 Table 4.22 Table 4.23 Table 4.24 Table 4.25 Table 4.26 Table 4.27 Table 4.28 Reliability Results of the Pilot Study…………………………………………...57 Demographic Information of Respondents……………………………………..69 Perceived Importance of IL Skills Along With t-test Results…………………..71 Provision of IL Instruction in Public and Private Sector Institutions…………...75 Provision of IL Instruction in Different Types of Institutions………………….76 Difference between Sector of Institutions and Types of IL Instruction Offered..................................................................................................................77 Difference between Types of Institutions and Types of IL Instruction Offered..................................................................................................................79 Frequency Distribution of Topics Covered in IL Instruction Programmes…......80 Frequency Distribution of IL Instruction Recipients…………………………...81 Frequency Distribution of Approaches of Providing IL Instruction……………82 Frequency Distribution of IL Instruction Delivery Venues…………………….82 Frequency Distribution of IL Instruction Delivery Methods…………………...83 Difference between Sector of Institutions and Their Assessment Activities…...84 Difference among Types of Institutions and Their Assessment Activities……..84 Frequency Distribution of IL Instruction Assessment Methods………………..85 Level of IL Instruction Integration into the Curriculum………………………..86 Barriers to IL Instruction Programmes Along With t-test Results……………..89 Self-Perceived IL Instruction Knowledge of Respondents Along With t-tests Results…………………………………………………………………………..94 IL Instruction Proficiencies Along With t-test Results…………………………97 Perceived Level of Library Users’ IL Skills Along With t-test Results……….101 Perceived Effective Methods for Imparting IL Instruction Along With t-test Results…………………………………………………………………...…….104 Effective IL Methods: Multiple (Pos hoc) Comparisons……………………...106 Difference between the Opinions of Respondents Regarding Teaching IL Skills to Medical Students Based on Sector of Institution…………………….108 Difference between the Opinions of Respondents Regarding Teaching IL Skills to Medical Students Based on Types of Institutions……………....……109 Difference between the Opinions of Respondents Regarding Integrating IL in the Curriculum Based on Sector of Institutions…………………………110 Difference between the Opinions of Respondents Regarding Integrating IL Instruction into the Curriculum Based on Types of Institutions……….......….111 Difference between the Opinions of Respondents Regarding Integrating IL Instruction into the Curriculum Based on Sector of Institutions……………..112 Difference between the Opinions of Respondents Regarding Integrating IL Instruction into the Curriculum Based on Types of Institutions……………..113 Difference between the Opinions of Respondents Regarding Responsibility xvi Table 4.29 Table 4.30 Table 4.31 Table 5.1 Table 5.2 Table 5.3 Table 5.4 Table 5.5 Table 5.6 Table 5.7 Table 5.8 Table 5.9 Table 5.10 Table 5.11 Table 5.12 Table 5.13 Table 5.14 Table 5.15 Table 5.16 Table 5.17 Table 5.18 Table 5.19 Table 5.20 for Designing IL Curriculum Based on Sector of Institutions………….……..114 Difference between the Opinions of Respondents Regarding Responsibility for Designing IL Curriculum Based on Types of Institutions…………………115 Diff``erence between the Opinions of Respondents Regarding Responsibility for Delivering IL Instruction Based on Sector of Institutions……………..…..117 Difference between the Opinions of Respondents Regarding Responsibility for Delivering IL Instruction Based on Types of Institutions…………………117 Demographic Information of Interviewees………………………..…………..122 Importance of “Evaluating the Information Critically”……………………….124 Importance of “Organizing Information Collected or Generated in a Logical Way”…………………………………………………………………………..126 Importance of “Using the Selected Information Effectively to Accomplish a Specific Task”…………………………………………………………………128 Reasons for not Considering Three IL Skills Very Important………………...129 Reasons for not Offering Advanced or Research-Level Skills at Undergraduate Level…………………………………………………………..133 Reasons for not covering plagiarism, citation and copyright during IL instruction……………………………………………………………………...134 Reasons for using Face-to-Face IL Delivery Method…………………...…….136 Reasons for not Using Online or Web-based Tutorials………………………..137 Reasons for not Using Formal Assessment Methods………………………….139 Barriers When Advocating or Providing IL Instruction…………………….…141 Reasons for Inadequate IL Instruction Knowledge of Head Librarians……….143 Suggestions to Improve the IL Competencies of Medical Librarians…………144 Reasons for Lack of Interest among Librarians Regarding Development of their Assessment of IL Instruction Effectiveness Skills…...……………….146 Reasons Identified for Lack of IL Skills among Library Users……………….148 Suggestions to Improve the IL Skills of Library Users………………………..149 Reasons for Librarian and Faculty Partnership in Designing IL Curriculum…153 Reasons for IL Delivery by Librarians Only………………………………….154 Reasons for Involvement of Faculty in IL Delivery…………………………..155 Other Comments by Interviewees……………………………………………..157 xvii LIST OF FIGURES Figure 1.1 Figure 4.1 Figure 4.2 Figure 4.3 Figure 4.4 Figure 4.5 Figure 4.6 Figure 4.7 Figure 4.8 Figure 4.9 Figure 4.10 Figure 4.11 Figure 4.12 Figure 4.13 Sequential Explanatory Design………………………………………………...52 Status of IL Instruction Activities……………………………………………...74 Types of Information Literacy Instruction Offered……………………………77 Assessment of IL Instruction Effectiveness…………………………………....83 IL Instruction Integrated into the Curriculum………………………………….85 Librarian and Faculty Collaboration…………………………………………...87 Staff Responsible for Running IL Instruction Programmes…………………...88 Studied IL Instruction as a Part of Their LIS Curriculum……………………..92 Short Course or Workshop Attended on IL Instruction………………………..93 Teaching IL Skills to Medical Students………………………..……………..107 Integration of IL Instruction into the Curriculum…………………………….110 Mode of Integration of IL Instruction into the Curriculum…..........................112 Responsibility for Designing IL Instruction Curriculum………………..……114 Responsibility for Delivering IL Instruction…………………………………116 xviii CHAPTER 1 INTRODUCTION This chapter introduces the study and covers background, theoretical framework, statement of the problem, research objectives, research questions, rationale and significance of the study, limitations and delimitations, definition of the terms used and organization of the study. 1.1 Background of the Study 1.1.1 Medical Education in Pakistan Medical education in Pakistan is a six-year programme comprised of five-year teaching followed by one-year house job (internship). The pre-requisite is higher secondary school certificate (a twelve-year program). For postgraduate training, medical students enrol in postgraduate medical institutes (PGMIs) such as the College of Physician and Surgeons Pakistan (CPSP). Master and Doctoral programmes are offered in medical universities. 1.1.2 Medical Librarianship in Pakistan There were only two medical libraries in 1947 at the time of independence, both attached to medical colleges. Presently, there are more than 100 medical libraries, mostly attached to medical colleges (schools), medical universities, and postgraduate medical institutes. These are all headed by professional librarians, since the “Pakistan Medical and Dental Council” (PM&DC), a regulatory body for medical education, requires professional staff to "supervise the library and information services, and provide instruction in accessing resource[s] to the users" (Pakistan Medical & Dental Council, 2012, p. 54). A recent study by Ullah and Anwar (2013) revealed that the library and information services for medical professionals and patients in hospitals that are not affiliated with any academic medical 1 institutes are almost non-existent in Pakistan. Head librarians are responsible for information literacy (IL) training and orientations, as no instructional librarian positions currently exist in these libraries. 1.1.3 Information Literacy Since dawn of the 21st century significant initiatives have been taken in the developed world by library and information professionals (LIPs) and various organizations for the adoption and promotion of IL (Webber & Johnston, 2014). International organizations such as the United Nations Educational, Scientific and Cultural Organization (UNESCO); the International Federation of Library Associations and Institutions (IFLA); the Association of College and Research Libraries (ACRL), the Chartered Institute of Library Information Professionals (CILIP) have developed standards and special chapters to promote IL (Lau, 2007). The Alexandria Proclamation of 2005 describes IL and lifelong learning as: …the beacons of the Information Society, illuminating the courses to development, prosperity and freedom. Information literacy lies at the core of lifelong learning. It empowers people in all walks of life to seek, evaluate, use and create information effectively to achieve their personal, social, occupational and educational goals. It is a basic human right in a digital world and promotes social inclusion in all nations. (Garner, 2005, p. 3) Lately, this area has got attention of information professionals in the developing countries also. In Pakistan, the literature of library and information science (LIS) had mention of “user education” in the past (Anwar, 1981). The literature also shows that LIPs offer “library orientation” and “guided library tours” to new entrants to make them aware of 2 the library services and resources and guide them to find information from these resources (Bhatti, 2010). Nonetheless, the concept of IL (which has a much wider connotation than user education) is quite recent in Pakistan. IL instruction was included in the LIS curriculum for the first time in the University of the Punjab in 2008 as a three-credit hour compulsory course. In 2009, the Higher Education Commission (HEC) of Pakistan included a three-credit hour optional course on IL in the LIS curriculum (Higher Education Commission of Pakistan, 2009). However, IL has not yet found a place in the curriculum of all twelve LIS schools in Pakistan. The first significant, writing with the term IL in local perspective was published by Ameen and Gorman (2009). Nevertheless, the subject has lately attracted researchers, and studies are being conducted on the subject. Gorman (2003) emphasized that the rapid expansion of information resources on the Internet makes it essential for people to be information literate. The HEC has been spending millions of dollars on providing for free access to the online books and journals through its digital library programme (www.digitallibrary.edu.pk) to faculty members, students, and researchers of academic institutions and non-profit research and development (R&D) organizations. However, many studies has reported low usage of these resources (Ameen & Gorman, 2009; Ansari & Zuberi, 2010; Arif & Kanwal, 2009; Bhatti, 2010; Khan & Ahmed, 2013; Ullah, 2007; Warriach & Ameen, 2010; Warriach & Tahira, 2009). The obstacles identified were lack of awareness regarding these resources, and poor ICT and IL skills among potential users of these resources. Therefore, there appears a serious need to improve understanding of the most effective way to make sources accessible and useful to those who need them (Bhatti, 2012). Librarians have a key role in helping users to improve their ability 3 to find and use information (Ameen & Gorman, 2009). In a fast emerging knowledge society, the provision of IL instruction has become a professional obligation for those who work in all types of libraries. This is true for medical librarians in Pakistan as well; they are required to offer IL instruction to their library users (Pakistan Medical & Dental Council, 2012). Health professionals now have access to the Internet and online databases on their desktop, and thus are not entirely dependent on the medical library to get information. Therefore, medical librarians are required to evolve and ensure that their services meet the medical education and research requirements. Medical librarians have an opportunity to assume new roles to ensure facilitation between information and its clients. Moreover, medical librarians have an obligation to foster IL competencies among medical professionals and students for lifelong learning. Training of medical librarians is an area, which has been emphasized in the literature (Ullah & Anwar, 2013; Ullah, Ameen & Bakhtiar, 2011/2012). IL instruction encompasses both these roles. Once IL skills are identified, and strategies are assessed, medical librarians can begin to develop and implement IL instruction programmes for their library users. IL instruction refers to the training programmes designed to make a person information literate. Medical librarians need to develop IL instruction programmes with reference to international standards and models that have been developed in different environment, and rethinking the concept of IL in the context of medical organizations. 1.2 Theoretical Framework - Information Literacy The American Library Association [ALA] (1989) Presidential Committee on Information Literacy has defined IL as a “set of abilities requiring individuals to recognize when information is needed and have the ability to locate, evaluate, and use effectively the 4 needed information” (p.1). This definition extended the concept of IL, which was introduced by Paul Zurkowski in 1974, to a theoretical framework. However, Dorner and Gorman (2006) believed that the US definition of the concept might not be applicable to the developing world. Dorner and Gorman highlighted the limitations of the aforesaid definition of IL when it is applied to the developing countries and provided following definition of the concept: The ability of individuals or groups:  To be aware of why, how and by whom information is created, communicated and controlled, and how it contributes to the construction of knowledge.  To understand when information can be used to improve their daily living or to contribute to the resolution of needs related to specific situations, such as at work or school.  To know how to locate information and to critique its relevance and appropriateness to their context.  To understand how to integrate relevant and appropriate information with what they already know to construct new knowledge that increases their capacity to improve their daily living or to resolve needs related to specific situations. (Dorner & Gorman, 2006, p. 284) Later, in the context of South Asian countries, the Empowering Eight (E8) IL model was developed in Sri Lanka in a workshop sponsored by UNESCO. The eight components of this model are: “the abilities to identify, explore, select, organize, create, present, assess and apply information to address an issue or a problem” (Wijetunge & Alahakoon, 2005, p.1). An operational definition of IL based on these eight abilities was used for this study (see p. 12). 5 Many alternative terms have been used in the literature as information and digital literacy, information skills, information competency, library and information literacy, information and research skills, information fluency etc. However, information literacy is the most commonly used and internationally established term to describe the concept (Virkus, 2011). Bruce (1997a) conceived IL as being composed of separate elements: computer literacy, information technology literacy, library skills, information skills and learning to learn. In a similar way Rader (2003) conceived IL as being combination of different literacies: library literacy, media literacy, computer literacy, Internet literacy, research literacy and critical thinking skills. Theoretical framework developed by Bruce (1995) for imparting IL instruction in the institutions of higher education has been used as a guide for this study, addressing following three areas of primary concern:  The possible outcomes of information literacy education (through outlining the characteristics of information literate people)  The nature of information literacy education  The potential roles of stakeholders (including information services, faculty, staff developers and learning councillors) in helping staff and students to be information literate. (p. 159) The aforementioned definitions of IL present characteristics of an information literate person. Likewise, Doyle (1992) defined an information literate person as one who:  recognizes the need for information;  recognizes that accurate and complete information is the basis for intelligent decision making; 6  identifies potential sources of information;  develops successful search strategies;  accesses sources of information, including computer-based and other technologies;  evaluates information;  organizes information for practical application;  integrates new information into an existing body of knowledge, and;  uses information in critical thinking and problem solving. (p.2) The Association of College and Research Libraries (ACRL) Task force on Information Literacy Standards and the American Association for Higher Education (AAHE) approved the “Information Literacy Competency Standards for Higher Education.” These standards become popular in the higher education institutions and influenced the information literacy instruction. These standards describe that the information literate student:  Determines the nature and extent of the information needed.  Accesses needed information effectively and efficiently.  Evaluates information and its sources critically and incorporates selected information into his or her knowledge base and value system.  Individually or as a member of a group, uses information effectively to accomplish a specific purpose.  Understands many of the economic, legal, and social issues surrounding the use of information and accesses and uses information ethically and legally. (ACRL, 2000, p. 1) 7 Later, the ACRL (2008) also realized the importance of professional development of instructional librarians and developed a list of proficiencies for them. It included “administrative skills, assessment and evaluation skills, curriculum knowledge, information literacy integration skills, instructional design skills, leadership skills, planning skills, presentation skills, promotion skills, subject expertise, and teaching skills” (p. 5). IL instruction is obligatory for both staff and students. They should develop IL competencies over the course of study or through IL training to use formal and informal sources of information available through any medium. Teachers, librarians and other stakeholders must accept responsibility for IL instruction. Collaboration between all stakeholders is imperative for the implementation of IL instruction programmes in academic institutions at all levels. Leaders in education must create appropriate environment to replace traditional lecture and tutorial-based education to the problem-based and evidence-based learning (Bruce, 1994; Bruce, 1995; Bruce, 2004). According to Kuhlthau (1993) “information seeking is a process of learning that began with vague thoughts and low confidence, and closed with significant clarification of thoughts and increased confidence” (p. 57). Later, Kuhlthau (1996) presented “information seeking process theory” which was based on the cognitive science and constructivist learning. Bruce (1997b) identified three approaches to IL: (a) the behaviourist approach, emphasizing on measurable sills; (b) the constructivist approach, based on problem-based activities; (c) the rational approach, based on describing a phenomenon in term of the in which it is experienced. The combination of learning theory, information seeking behaviour and library skills provided a theoretical base for IL instruction (Kuhlthau, 1987). The theories constructed by 8 Carol Kuhlthau and Christine Bruce contributed to the theoretical framework of this study. Many IL standards and models have been developed and are followed by IL instructors across the world, which are discussed in the next chapter under section 2.1.3 and 2.1.4. 1.3 Statement of the Problem The concept of user education has been expanded from library instruction to information literacy instruction. Ullah & Anwar (2013) found that IL competencies are important for medical librarians in order to make library users efficient, effective and independent information user. The literature on the IL instruction practices of medical librarians, in developing countries, is limited. No study on the status of IL instruction in medical libraries has been carried out in Pakistan. Therefore, it was important to appraise the status of IL instruction in medical libraries of Pakistan. The present explanatory and exploratory study aimed to do so. 1.4 Research Objectives The main objectives of this two-phase, sequential, mixed method study were to explore the status of IL instruction in medical libraries of Pakistan. The focus was on probing the perceptions of medical librarians about the importance of IL skills, current practices of IL instruction, the barriers to IL instruction programme, and IL training needs of medical librarians. The study also aimed to suggest strategies to be adopted for the effective implementation of IL instruction programmes in medical libraries of Pakistan. It aimed to explore differences between libraries at public and private sector medical institutions. These libraries differ in terms of the level of students and curriculum as well as the amount of funding provided. 9 1.5 Research Questions Consistent with the aforementioned research objectives, the study answered the following research questions: 1. What are the perceptions of medical librarians in Pakistan towards the importance of IL skills? 2. What are the current practices of IL instruction (course contents, methods of delivery and assessment, level of integration in the curriculum, level of collaboration with teaching staff) in medical libraries of Pakistan? 3. What are the barriers when advocating or providing IL instruction in medical institutions? 4. What are the IL instruction training needs of medical librarians? 5. What are the strategies to be adopted for the effective implementation of IL instruction programmes in academic medical institutions of Pakistan? 1.6 Rationale and Significance of the Study The existing education system in Pakistan is largely non-participative, dependent on lectures, prescribed textbooks and class notes. It does not prepare the professionals as independent learners with creative thinking for problem solving in modern world (Ameen, 2006). Ameen and Gorman (2009) asserted that lack of IL skills among academia becomes a barrier in the growth of individuals and society. Research and professional practices in the world show that IL instruction plays a crucial role in increasing critical thinking and problem solving skills of health professionals, faculty members, researchers and students. During last decade many organizations have made significant efforts and initiatives for promotion and advocacy of IL. Despite these efforts many countries including Pakistan have made minimal 10 necessary progress in that direction. In order to make medical library users information literate, the status of IL instruction in medical libraries of Pakistan need to be explored so that proper planning and strategies could be adopted for the effective and successful implementation of IL instruction programmes in medical institutions. The current study would assist LIS schools and professional associations that are responsible for the education and training of librarians through regular continuing professional training programmes. It can serve as baseline study, and the results may be of assistance to accreditation bodies such as the HEC and the PM&DC. It is also hoped that this study would be a significant contribution to the literature on IL, especially in the field of medical librarianship in Pakistan. The findings may carry value for other sister countries. 1.7 Limitations and Delimitations The concept of IL is quite new in Pakistan and IL instruction practices are not very common. The knowledge of medical librarians regarding IL may, therefore, be limited. This limitation was avoided to some extent, by selecting only the head librarians. Furthermore, the respondents might also be inclined to overstate their IL instruction practices because of the professional pressure to actively conduct instructions. The study is confined to the viewpoints of head librarians of academic medical institutions in Pakistan. The views of other stakeholders such as management, faculty, and students are not covered in this study. 11 1.8 Definition of Terms Information Literacy (IL) It is “the ability to identify, locate, evaluate, organize, and effectively create, use and communicate information to address an issue or a problem” (Wijetunge & Alahakoon, 2005, p.1). Information Literacy Instruction It is the formally designed instruction (user education) sessions held by librarians to educate library clients/users on those skills which have been mentioned in the definition of IL given above. Medical Library “A library maintained by a medical college/university/institute, a hospital or a medical research organization” (Ullah, 2011, p. 11). Medical Librarian A librarian who works in a medical library in a position that requires at least a master degree in Library and Information Science. Head Librarian A librarian in-charge of a medical library. 1.9 Organization of the Study This study is organized into seven chapters. References and appendices are provided at the end. The first chapter introduces the study and covers background and theoretical framework, statement of the problem, research objectives, research questions, rationale and significance of the study, limitations and delimitations of the study and definition of terms. 12 The second chapter reviews the existing literature pertaining to the status, theory and practices of IL instruction. The review also identifies the gap in the past literature that this study aims to bridge. The third chapter describes the research design of the study, research methods, development of instruments, target population, data collection and analysis procedures used in this study. The fourth chapter presents the data analysis of the quantitative data collected through a semi-structure questionnaire survey. The fifth chapter enunciates analysis of interview data. The sixth chapter interprets both quantitative and qualitative findings of the study and analyses the significance of the study by comparing the findings in the existing literature on IL instruction. The seventh chapter narrates summary, conclusions, and recommendations including suggestions for future studies. 13 CHAPTER 2 LITERATURE REVIEW This chapter reviews the selected literature pertaining to the status, theory and practices of information literacy (IL) instruction, published before February 2015. Main features of relevant studies have been presented under several headings. The review also identifies the gap in the existing literature that this study aims to bridge. Voluminous literature is available on theory and practices of IL instruction in different geographical areas and specific institutions. Aharony (2010) reviewed 1966 publications (published during 1999 to 2009) in Web of Science (WOS) database. Aharony found that most of those publications (75 %) were articles in English language from the USA, England, Australia and Canada. The contribution from other countries was less than 2 %. Sproles, Detmering and Johnson (2013) examined 3,527 articles on library instruction and IL published from 2001-2010 and found that most of those were from the USA, but articles from Asia and Africa also figured in frequently. There are three journals, “Journal of Information Literacy” (JIL), “Nordic Journal of Information Literacy in Higher Education” and “Communications in Information Literacy” (CIL), dedicated to IL only. In addition, conferences are also held in the world on IL, among them the “European Conference on Information Literacy” (ECIL) and the “Librarians’ Information Literacy Annual Conference” (LILAC) are the most prominent, held regularly every year. The following sections review selected studies and literature on the subject. 2.1. Information Literacy Paul Zarkowski, the president of the Information Industry Association (IIA) coined the term information literacy (IL) and formulated the strategies for promoting IL in 1974 14 (Lwehabura, 2007). Actually, this term has transcended bibliographic and library instruction. Formally IL instruction practices were started with release of the final report by the “Presidential Committee on Information Literacy” of the American Library Association [ALA] (1989). According to the report libraries must provide information and training so that library users are able to access information without the help of someone else. They recommended that students at school and college levels be taught to make them information literate. The USA based organisations and professional associations have been playing a leading role in advocating the concept of IL since 1970s. The organizations like the American Library Association (ALA), the Information Technology Education Association (ITES), the American Association of Higher Education (AAHE), the American Association of School Librarians (AASL), the Association of College and Research Libraries (ACRL) and the Information Society of Technology in Education (ISTE) are very active in this regard. United Kingdom, Australia and other countries also reacted to the concept with enthusiasm. Therefore, instruction in IL has become the global education movement (Wen & Shih, 2008). The president of USA Barack Obama, proclaimed the month of October in 2009 as “National Information Literacy Awareness Month” to highlight the importance of IL for all the Americans in this information age (Obama, 2009). The International Federation of Library Associations and Institutions (IFLA), Information Literacy Section and the United Nations Educational, Scientific and Cultural Organization [UNESCO] (n. d.) has compiled a comprehensive directory of resources on IL, with primary purpose to share and promote IL instruction in all types of libraries and information centres. The IFLA has also provided guidelines for running IL programmes for 15 different categories of information users (Lau, 2007). UNESCO (2011) has mission of fostering information and media literate societies by encouraging the development of national information and media literacy policies and integrating it in the curriculum at all levels. They are also providing the appropriate pedagogical methods, trainings and curriculum. 2.1.1 The Concept of Information Literacy There is no standard definition of IL so far (Virkus, 2011); however, many national and international organizations have posited definitions for this term. To mention a few, “it is a set of abilities requiring individuals to recognize when information is needed and have the ability to locate, evaluate, and use effectively the needed information” (ALA, 1989, p.1). Many organizations and scholars expanded the definition of the ALA and included the social and ethical consideration in their definitions. UNESCO has defined IL as a means to “empower people in all walks of life to seek, evaluate, use and create information effectively to achieve their personal, social, occupational and educational goals” (Horton, 2007, p. i). However, the Council of Australian University Librarians (CAUL) has defined IL as “the ability to define, locate, access, evaluate and use information to help resolve personal, jobrelated or broader social issues and problems, as part of a life learning strategy” (Aharony, 2010, p.261). While the Chartered Institute of Library and Information Professionals [CILIP] (2004) has defined IL as “knowing when and why you need information, where to find it, and how to evaluate, use and communicate it in an ethical manner”. The National Forum on Information Literacy [NFIL] (n. d.) has defined IL as “...the ability to know when there is a need for information, to be able to identify, locate, evaluate, and effectively use that information for the issue or problem at hand.” 16 Health Information Literacy has been defined as "the set of abilities needed to: recognize a health information need; identify likely information sources and use them to retrieve relevant information; assess the quality of the information and its applicability to a specific situation; and analyze, understand, and use the information to make good health decisions” (Medical Library Association [MLA], 2005, p. 1). McClure (1994) mentioned the four dimensions in his definition of IL. These were traditional literacy, computer literacy, media literacy and network literacy. While Parang, Raine and Stevenson (2000) revealed that IL is a combination of different concepts: “library literacy, computer literacy, media literacy, information ethics, critical thinking, and communication skills.” 2.1.2 Information Literacy Instruction The concept of IL instruction is not new in developed world it is discussed extensively in literature since the late 1980s. Librarian designs and offers IL instruction to their library users to transform the information society of today into learning society of tomorrow. IL instruction needs to be offered as a part of the curriculum in academic organizations from primary to doctoral level to ensure that students have the abilities to access, evaluate and use information in legal way (Bruce, 2004). IL instruction has a significant impact on academic achievement and is a catalyst for lifelong learning and critical thinking. Providing information and communications technology (ICT) is not enough, to use the ICT infrastructure for educational and research purposes, the learners have to be transformed into empowered learner to take their place in information society through IL instruction (Elmborg, 2006). The education system needs to foster IL competencies among students to use the real world resources along with the 17 textbooks and lectures for problem solving in civic, professional and personal life (Ameen & Gorman, 2009). 2.1.3 Information Literacy Standards IL standards are established to measure the IL level; to identify what needs to be learnt for promoting IL skills and abilities in applying information technology (IT), to become a self-learner, and to increase the effectiveness of learning, teaching and problem solving by information users. The impartation of IL instruction has been devised in the form of some peculiar standards, which have been developed by various organizations. The ACRL of the ALA published the “information literacy competency standards for higher education” in 2000. This document includes five standards with performance indicators and learning outcomes. It began to influence the higher educational institutions of all countries stressing the essential need for students to be information literate (ACRL, 2000). The ACRL standards are now under revision based upon threshold concepts in IL (ACRL, 2014). The ACRL also developed IL standards for different disciplines such as science, engineering and nursing etc. The American Association of School Librarians [AASL] and the Association of Educational and Communications Technology [AECT] (1998) developed "information literacy standards for student learning" for K-12 education of the USA, having nine IL standards. These were republished after expansion and restructuring in 2007 as "standards for 21-st century learner" (American Association of School Librarians, 2007). The Ministry of Education of Taiwan also established “information literacy competency standards” in 1998 for school teachers. These standards were updated and published in 2008 as “Information literacy competence standards for elementary and high school teachers”. The three levels of 18 these standards included, basic standards, main indicators and secondary indicators (Wen & Shih, 2008). Australians standards for IL were published in 2001 and its second edition was published in 2003, titled "Australian and New Zealand information literacy framework: principles, standards and practices" to support IL programmes at all levels. These included six standards along with learning outcomes and examples (Bundy, 2004). “Information Literacy Section of the IFLA” has also compiled “Guidelines on Information Literacy for Lifelong Learning” for academic libraries (Lau, 2006). 2.1.4 Information Literacy Models Many IL teaching, learning, research and information problem solving models, based on various learning theories have been developed by scholars mostly from the USA, UK and Australia. These models provide a series of processes, stages or steps that information users are likely to go through, when solving an information problem. Following are some famous models described in chronological order (Lwehabura, 2007; Bond, 2011). Stripling and Pitts Research Process Model: This thoughtful learning cycle model was developed by Stripling and Pitts in 1988 and included following six level of student's research: fact findings, asking/searching, examining/organizing, integrating/concluding and conceptualizing. It provides a base for IL instruction on how students learn best and how new learning occurs when they incorporate this learning in the previous knowledge already acquired. The Big6: The Big6 information skills model was developed by Eisenberg and Berkowitz in 1990. This model is most widely used for teaching IL in the world. It includes 19 following six basic steps: task definition, information seeking strategy, location and access, use of information, synthesis and evaluation. Information Search Process Model: Kuhlthau developed this model in 1993 using cognitive and constructivist theories. This model has following seven phases: task initiation, topic selection, exploration, formulation, collection, presentation and assessment. Pathway to Knowledge: This model was developed by Pappas and Tipe in 1997. It has following six steps: Appreciation, pre search, search, interpretation, communication and evaluation. Research Cycle Raceway: This inquiry based model was developed by J. Mckenzie in 1995. It has following seven steps: questioning, planning, gathering, sorting and sifting, synthesizing, evaluation and reporting. Seven Faces of Information Literacy: This model was developed by Bruce in 1997. Seven stages of this model are: information technology conception, information source conceptions, information process conception, information control conception, knowledge construction conception, knowledge extension conception, and the wisdom conception. The Seven Pillars of Information Literacy: This model was developed by the Society of College, National and University Libraries (SCONUL) in 1999 and has been updated and expanded in 2011. It considered following seven information and IT skills necessary for IL literate persons: recognition of information needs; devising ways of addressing gaps; construction of strategies for locating; location and access; comparison and evaluation of information; organization, application and communication of information; and synthesis and creation of information. 20 Empowering 8 (E8): This model was developed in Sri Lanka keeping in view the perspective of South Asian countries. It presents the required competencies of an information literate person in eight components as: Identification, exploration, selection, organization, creation, presentation, assessment, and application of information (Wijetunge & Alahakoon, 2005). InFlow: Information flow (InFlow) is an IL instruction model, designed to be integrated in the curriculum. Teachers throughout Europe adopted this model during the Innovative Technologies for Engaging Classrooms (iTEC) project. This model consists of following eight learning activities: Map, explore, ask, make, reflect, imagine, show and collaborate (McNical & Shields, 2014). 2.2 Studies on Status of Information Literacy Instruction The following sections review the selected literature on status of IL instruction in different geographical locations. 2.2.1 Studies in Pakistan The first study on highlighting the need for IL instruction was addressed by Ameen and Gorman (2009). The authors suggested that information and digital literacy should be integral part of the curriculum at all the levels. Anwar (1981) stated that user education is not a new subject; however, it lacks systematic approaches. Bhatti (2010) surveyed ten universities to evaluate their state of user-education programmes and found that only 40% libraries offered formal user education programmes to their users. Library orientation and guided tour of new entrants were the most frequently mentioned activities. She suggested that user education programme should be designed in accordance with the needs of library users. Bhatti (2012) also reviewed the literature to 21 assess the state of IL instruction in university libraries of Pakistan. She found that university libraries did not have any formal IL policies. She proposed creating a national committee on IL composed of all stakeholders for improving the situation. Kousar (2010) conducted a questionnaire survey to know the perception of engineering faculty towards M. Phil. and Ph.D. students’ IL skills, using ACRL standards for assessment. She found that faculty perceived Ph.D. students better than M. Phil. students in information skills. She also revealed that faculty was willing to work with librarians for the improvement of students’ IL skills. Batool and Mahmood (2012) surveyed the teachers of three private schools located in Lahore city, to find out their perceptions of IL skills of their 3rd grade students. They found that the teachers’ perceived IL skills of their students as good or adequate. They recommended that IL instruction might be improved by providing proper learning facilities and infrastructure at the school level. Mahmood (2013) discovered that students at the University of the Punjab had basic computer and Internet skills but lacked specialized searching skills. Rafique (2014) also found that faculty members of the University of Lahore were not successful library users. 2.2.2 Studies in the Developing Countries Kurbanoglu (2004) revealed that the importance of IL is overlooked in Turkey and emphasized that a national plan on IL should be prepared and implemented. Tzu-Heng (2009) analysed the IL courses of 164 universities in Taiwan and found that only 38 (23.2 %) of them offered IL courses. The contents focused on use of library services and resources. Tzu-Heng concluded that the contents covered by universities were required to be strengthened in accordance with the "ALA Information Literacy Competency Standards for Higher Education". This shows that there is a big room for development of IL instruction in 22 Taiwan. Diep and Nahl (2011) explored the status of IL instruction in four Vietnamese universities. They distributed online questionnaire among library administrators, faculty and instructional librarians. They also conducted focus group interviews with selected participants. This exercise revealed that most of them considered IL to be the domain of librarians only. Lectures and workshops were the most common mode of IL instruction in Vietnamese institutions. Tilvawala, Myers and Andrade (2009) analysed the three projects in Kenya: New Partnership for Africa's Development (NEPAD), launched to improve the education through use of ICT in African schools; Kenya Education Network Trust (KENET) established to promote the use of ICT in teaching, learning and research; and Pasha Centres, to provide the Internet services to the public especially in the rural areas. They found that these projects mainly focused on promotion of ICT infrastructure and development of IT skills. The concept of IL was also addressed to some extent. However, all the dimensions of IL were not addressed in the projects. They suggested that awareness regarding IL might be created in the public and also recommended the development of IL-based curricula in the academic institutions. It shows that IL skills are important for best utilization of ICT in developing countries. Lwehabura (2007) investigated the status and practices of IL instruction in four Tanzanian universities by distributing questionnaire among faculty, librarians and students followed by interviews with the university and library management. Lwehabura found that librarians were delivering IL instruction in one form or the other, using orientation lectures, hand on practice, or online tutorial methods. However, students were still lacking adequate IL skills. The status of IL training is better in South African university libraries as compared to other developing countries. The Committee for Higher Education Librarians of South 23 Africa (CHELSA) conducted information literacy survey of 22 university libraries in 2011 which revealed that all (100%) university libraries offered IL instruction programmes. However, majority of them had not integrated IL into the curriculum and most of IL programmes are not South African Qualifications Authority (SAQA) accredited (Pearce, 2011). Spiranec and Pejova (2010) examined the status of IL instruction in South-East Europe (SEE). They reviewed the outcomes of the UNESCO co-sponsored workshops in Ljubljana, Slovenia and Ankara, Turkey. They found variation in IL practices in SEE and revealed that overall the level of IL awareness was low and the state of IL instruction was also unsatisfactory. Edzan (2008) looked at initiatives taken in Malaysian academic institutions for development of IL instruction programmes. Edzan found that educational institutions at all levels were offering some sort of IL programmes. Maitaouthong, Tuamsuk, and Tachamanee (2012) surveyed 42 university librarians in Malaysia through questionnaire and focus group to study the role of university libraries in supporting the integration of IL instruction in the general education courses. They concluded that university librarians were playing an important role in planning, developing and teaching IL instruction for faculty and students. They suggested that library administrators might develop the library infrastructure and resources required for integration of IL instruction into the general education courses. Moreover, librarians should be trained to run IL programmes effectively. Ranaweera (2010) analysed and evaluated the status of IL instruction programmes in the five Sri Lankan universities. Ranaweera revealed that all the five universities were running some sort of IL programmes ranging from library orientation to credit-based 24 programmes. However, most of the programmes were at lower level. Singh and Klingenberg (2012) described the IL initiatives in India and Germany. They found that instructional activities of librarians in India were limited to library orientation lectures to new entrants only in conventional institutions. Karisiddappa & Rajgoli (2008) reported the same situation of IL instruction in higher educational institutions at Banglore, India. However, Singh and Klingenberg (2012) found that the situation was better in the agriculture universities as they were modelled on American land grant pattern universities. These universities had integrated IL instruction into the curriculum but required more refinement. Many German universities offered IL instruction though not credit-based and were considering to integrate IL instruction into the curriculum. Islam and Tsuji (2010) assessed the IL skills of LIS students at the University of Dhaka, Bangladesh. They found that IL competencies of LIS students were weak as IL was not covered in the LIS curriculum. Likewise, Islam and Rahman (2014) also revealed that students of Arts faculty had limited knowledge of IL at that university. Shuva (2004) also found that the overwhelming majority of people in Bangladesh were not clear about the term “information literacy” and they were not getting most of the information from the Internet. Ashoor (2005) reported that “library-orientation,” “library-user program,” “library integrated English courses” and “the information searching skills course” were offered in the King Fahd University of Petroleum and Minerals (KFUPM), Saudi Arabia. Awadhi and Rehman (2012) conducted focus group discussion with university students and faculty in Kuwait to explore the effectiveness of an IL course. They found that students considered IL course helpful in developing their library and research skills. However, the course contents were required to be updated to bring it at par with developed countries. 25 Baro and Zuokemefa (2011) conducted a survey of 36 university libraries in Nigeria and revealed that IL instruction ranged from “library tours/orientations sessions” to “database searching skills.” Baro and Keboh (2012) conducted a survey of the five leading African universities and found that all the five universities provided “library tour/orientation sessions,” “introductory information skills” and “advanced information skills” while three universities also provided “research-level skills.” In Israeli academic libraries, IL instruction was found in its infancy (Simon, 2013). Jabeen, Yun, Rafique, Jabeen and Tahir (2014) investigated the status of IL instruction practices in universities and research organizations of China, using a concurrent mixed-methods research design. Jabeen, et al found that library orientation, library tours and instruction in introductory information skills were the most popular activities and IL instruction was integrated into few subjects only in the universities. They also revealed that university libraries performed better than research libraries in providing IL instruction. Sanches (2014) found that the IL instruction activities of Portuguese librarians in the higher educational institutions were mostly focused on information searching and retrieval while the processing and communication of information was rarely addressed. 2.2.3 Studies in the Developed Countries Johnston and Webber (2003) reviewed the status of IL instruction in the USA, UK and Australia. Johnston and Webber found that a single course in IL was not sufficient for students. They recommended that a framework for IL instruction throughout the career of students was required. Berry, Carmichael, Niemeyer and Shaw (2004) conducted a survey of faculty and students of the University of Missouri St. Louis. Survey results revealed that majority of faculty and students got benefits from bibliographic instruction (BI) sessions and recommended to strengthen the BI programmes. Wong, Chan and Chu (2006) reported that 26 usually one-shot IL session of 50 to 80 minutes was offered to the whole community of the Hong Kong University of Science and Technology. The most widespread overview of IL trends around the world was presented in a report compiled by the “Information Section” of the IFLA titled “Information literacy State-of The-Art Report”. UNESCO funded this dedicated project and it covered the available IL resources, IL publications, organizations that support IL instruction, training programmes for IL facilitators, IL trends, sample IL tutorials and national policies in the USA, Canada, UK, Australia, South Africa, Nordic countries, Latin America, French speaking countries and English speaking African countries (Lau, 2007). Hapke (2008) gave an overview of the situation of IL instruction in Germany. Hapke stated that the concept of IL became popular in Germany by the end of nineties and IL was integrated into the curriculum as a credit course in many universities of North-Rhine Westphalia. IL instruction were offered in the German universities in three following modes: Independent course/workshop of about 90 minutes; one-shot session, integrated in regular study courses; the Bologna process in which the universities were asked to offer extra credit courses in IL for whole terms of study with one or two hours every week. Hapke also discussed different projects of online IL tutorials initiated in Germany and use of web 2 for IL instruction delivery. Fafeita (2006) presented the findings of a project in which a web based questionnaire was distributed among the “Australian Technical and Further Education (TAFE)” librarians, to know their practices of IL instruction. The findings revealed that the TAFE librarians provided IL instruction ranging from introductory to advanced-level information skills; however, few provided research-level IL programmes. McGuinness (2009) presented an 27 encouraging situation of IL instruction in the higher education institution in Irish Republic. McGuinness conducted a national survey of national higher institutions and revealed that 70 per cent librarians were heavily involved in IL instruction practices. Phelps, Senior and Diller (2011) reported that IL sessions taught at Orbis Cascade Alliance libraries in the USA varied enormously while one-shot sessions were very frequent. Julien, Tan and Marillat (2013) reported the results of a national survey regarding status of IL instruction in academic libraries. They revealed that overall 89% of academic libraries offered IL instruction in Canada. The situation was better in university libraries as 98% mentioned that they offered formal IL instruction. Forty five per cent libraries had written statement of objectives and 29% had full time instructional librarians. 2.3 Perceptions of Different Stakeholders towards the Importance of IL Skills Librarians, faculty and students are the major stakeholders of IL. Therefore, they must appreciate its importance in order to initiate and develop IL instruction programmes in academic institutions (ALA, 1989; ACRL, 2001). IL instruction is one of the core mandates of librarians which is also supported by international LIS associations (AASL, 2007; ACRL, 2001; ALA, 1989; Bundy, 2004; CILIP, 2004; Lau, 2007; MLA, 2005). Therefore, it is essential for librarians to recognize the importance of IL skills to prepare themselves for imparting IL instruction programmes (Chan, 2003; Julien & Boon, 2004). McGuinness (2009) revealed that 77 per cent librarians of higher education institutions in Irish Republic considered IL instruction as “very important” or “absolutely essential” part of their professional services. Aharony and Bronstein (2014) conducted a mixed method study to explore the perceptions of Israeli academic librarians of IL. According to them respondents believed that teaching IL was more 28 a library role than of the teaching faculty. Davis, Lundstorm & Martin (2011) found that the IL model employed (either for credit course or course integrated IL instruction) by the American librarians and their perceptions towards campus environment, effectiveness and their self-identification as teacher were significantly correlated. Hofer, Townsend and Brunetti (2012) conducted a qualitative survey of instruction librarians in the USA and identified following threshold concepts for IL: (a) Find (database structure, metadata, web organization), (b) Evaluate (authority, format, information cycle) and (c) Use (intellectual property, citation & plagiarism, research purpose). Many studies (Blau, 2012; Bury, 2011; Dubicki, 2013; Gullikson, 2006; Leckie & Fullerton, 1999; Lwehabura, 2007; Lwoga, 2013; Mcguinness, 2006; Nilsen, 2012 August; Saunders, 2012) have been conducted around the world on the faculty perceptions of IL skills. In general, these studies found that faculty deemed IL skills important for their students and supported development of IL skills and knowledge among students. Nilsen (2012 August) revealed that postsecondary teaching faculty in Canada ranked IL skills of their students as poor to fair. Moreover, teaching faculty rated IL skills and instruction as very important for their students. They also believed that IL instruction should be provided by librarian or both librarian and teaching faculty. However, it was interesting that about 50% teachers did not request librarians to provide IL instruction to their students. Morrison (1997) conducted a focus group study at the College of Alberta, Concordia University, to explore perceptions of undergraduate students of IL skills. The students perceived locating, evaluating and effectively using information as valuable skills; however, they did not consider “recognizing a need for information” an actual skill. Gross and Latham (2009) interviewed the undergraduates to know their perceptions of IL skills. They found that 29 all the participants of the study were quite ignorant about “information literacy”, however, they were proficient in IL competencies. The students might be able to find information, but lack the ability to assess quality and accuracy of information and ethical and legal use of information. Suleiman (2012) found that students of the International Islamic University Malaysia considered IL skills useful and supportive in their education and research. Although IL is considered an important skill for the digital age, very limited studies have been conducted in Pakistan on the subject. Therefore, this study sought to assess the perceptions of medical librarians towards the importance of IL skills, to obtain empirical findings that may support delivery of IL instruction at higher learning institutions with particular focus on medical institutions. 2.4 Barriers to IL Instruction Programmes Implementation of IL instruction programmes in academic institutions demand a paradigm shift in educational system. Barnard, Nash and O’ Brien (2005) noted that “...there are also difficulties in establishing the necessary momentum for change amongst educators who may already feel over-burdened with on-going tasks and over-increasing responsibilities in a resource-poor environment” (p. 9). Johnston and Webber (2003) found that lack of teaching and assessment skills among librarians, less influence of librarians in curriculum designing, and limited time for IL instruction were the most significant problems in imparting IL instruction in developed countries. Fafeita (2006) revealed that insufficient resources; lack of interest of management, teachers and students; lack of training facilities; and lack of IL awareness among teachers were the main barriers to IL instruction in Australian TAFE libraries. McGuinness (2009) found that Irish librarians faced many obstacles while embedding IL instruction within curricula. The most common among those 30 were lack of IL policy in most of the institutions, lack of IL training and use of traditional instruction methods. O’Brien and Russell (2012) expressed that the absence of national cohesive strategy for IL at the highest level, lack of collaborative thinking among all stakeholders, and lack of understanding about IL outside the library arena were the main challenges for IL development in Ireland. Barriers to IL instruction programmes identified in earlier surveys carried out in developing countries included: limited resources (such as budget, facilities, suitable staff), lack of information literacy policy, deficiencies in staff training, lack of basic IT skills, lack of guidance, difficulties in obtaining support from management and teaching faculty, government disinterest, etc. (Baro & Zuokemefa, 2011; Islam & Rahman, 2014; Lwehabura & Stilwell, 2008; Jabeen, Yun, Rafique, Jabeen & Tahir, 2014; Jiyane & Onyanchas, 2010; Karisiddappa & Rajgoli, 2008; Ranaweera, 2010). Ashoor (2005) identified “traditional education system,” low literacy rate” and “low level of publishing” as the major problems of developing countries while developing IL programmes. Ameen and Gorman (2009) identified lack of IL trained library staff and less emphasis of policymakers on IL skills as compared to ICT infrastructure were the main barriers to IL instruction programmes in Pakistan. Bhatti (2012) identified that lack of IL policy, lack of assessment of user’s information needs, inadequate IL training of librarians and lack of research on IL, low interest of faculty and students, and lack of dedicated budget for IL instruction were the main barriers in execution of IL programmes in Pakistani universities. However, no study on barriers to IL instruction in medical institutions is carried out in Pakistan so far. 31 2.5 Practices of Information Literacy Instruction 2.5.1 IL Delivery Methods The findings of research on IL instruction indicate that LIPs are engaged in IL instruction activities by different means like orientation lectures, short training programmes, guiding library users at reference desk, online self-learning tutorials and co-teaching in class rooms (Maitaouthong, Tuamsuk, & Tachamanee, 2012). There are many methods for delivering IL instruction to library users. These IL delivery methods can be divided into three modes such as in-person, workshop and online tutorial. While different types of IL instruction methods are: one time standalone session, several sessions, integrated or embedded with subject matter and generic library contents (Grassian & Kaplowita, 2001). Karisiddappa and Rajgoli (2008) documented that librarians in Banglore, India used face-to-face, individual instruction, printed training manuals, lectures/demonstrations, seminars/workshops and online tutorials methods for delivering IL instruction. Edzan (2008) reported the same trends in delivery of IL programmes at Malaysian higher learning institutions. McGuinness (2009) found that “library orientation tour,” “paper-based methods,” “one-shot lecture,” “hands-on training sessions in computer laboratory,” and “individual instruction” were the popular methods for teaching IL skills in the Irish higher education institutions. While “course embedded sessions,” “online tutorials” and fullyintegrated IS modules” were the least favoured methods despite their importance in the current scenario. Klaib (2009) documented that private universities in Jordan delivered IL instruction through library tour, workshops, pathfinders, and individualized instruction. Ranaweera (2010) revealed that the most popular delivery method of IL instruction was through research guides in Sri Lankan universities. However few were also delivering IL 32 instruction through workshops and IL instruction programmes integrated into the lessons conducted by faculty. The trend of individualized instruction, web tutorials and credit course were the most popular instructional methods in Canada (Julien, Tan & Marillat 2013). However, librarians in health sciences institutions provided IL instruction by using a mix of lectures and practical exercises along with online IL guides, accessible through library website (Clairoux, Desbiens, Clar, Dupont, & St-jean, 2013; Jiri, 2014). Many studies also reported that academic librarians preferred face-to-face IL instruction delivery method (Baro & Keboh, 2012; Baro & Zuokemefa, 2011; Bhatti, 2000; Jabeen, Yun, Rafique, Jabeen & Tahir, 2014; Lwehabura, 2007; Starkey, 2010: Vijay & Satish, 2010). In India, Pakistan, and other developing countries focus is on one-shot orientation lecture and guided library tours at the start of the academic years in academic libraries. 2.5.2 IL Course Contents IL instruction programmes should cover contents of “recognizing and articulating information needs,” “developing awareness of range of information sources,” “finding information in the library” “ searching the Internet,” “critically evaluating information,” and ethical and legal use of information” in a holistic way (McGuinness, 2009). Ranaweera (2010) found that following contents were most commonly covered in the IL programmes at Sri Lankan universities: (a) library tours, (b) library orientation lectures, (c) guide to locate information, (d) OPAC, (e) online databases, (f) online journals, (g) web searching skills, (h) evaluation of information and (i) reference styles. Only one university mentioned about the plagiarism and academic writings. Haines and Horrocks (2006) revealed that the King’s College London addressed following areas in their IL programmes: overview of nature of health information, information retrieval and its role in evidence–based practice, published 33 and unpublished sources of information and its importance, hierarchy of research-based evidence, effective searching and advanced-level search strategy formulation on biomedical databases, i.e., PubMed, EMBASE, Biosisetc, use of clinical websites and search engines and evaluation of retrieved information and use of reference management software. Karisiddappa and Rajgoli (2008) reported that librarians in the higher education and R&D organization had covered following topics during IL instruction: catalogue, library website, Internet search, ejournals, databases, evaluation of information, citing e-information, search engines. Klaib (2009) found that private universities in Jordan mostly covered library catalogue, library use in general, use of printed materials, Internet/web, CD ROM indexes, classification systems, e-databases of book and journals and audio-visual materials during IL instruction. Pearce (2011) surveyed the 22 universities in South Africa and revealed that library orientation/basic library skills, using OPAC, Internet, e-databases, referencing and plagiarism are covered in the IL instruction in more than 90% of the universities while 47.6% mentioned that identifying information sources and keywords, search strategy and evaluation of information were included in the IL instruction course contents. Starkey (2010) found that the instructional librarians wished to cover the contents that were in accordance to the IL standards defined by ALA. Clairoux, Desbiens, Clar, Dupont, and St-jean (2013) revealed that in a Canadian health sciences institute librarians offered workshops on “introduction to library resources,” “Searching MEDLINE database,” “evidence-based practice,” “introduction to reference styles and reference management software EndNote,” “practical implications of copyright law,” “fair use of license resources,” “plagiarism,” “introduction to pharmaceutical patents searching,” “NCBI databases.” 34 2.5.3 IL Assessment Methods IL instruction and assessment are inseparable. Assessment is very important to articulate the IL instruction learning outcomes, for the understanding of user’s weaknesses and strengths and improvement of the IL instruction programmes (Oakleaf, 2009; Warner, 2003). Furthermore, assessment provides evidence of the effectiveness of IL instruction programmes (Gross, 2009). Buchanan (2003) reported the baseline data of “assessing students learning outcomes project” of ACRL. They used following six instruments or activities for the assessment of IL instruction outcomes: (a) “preliminary questionnaire (prior to instructional intervention)”, (b) “follow-up questionnaire (same questions as preliminary)”, (c) “website evaluation assignment with accompanying grading criteria”, (d) “self-Assessment, (e) “peer assessment” (f) “instructor assessment”. They recommended that assessment should be part of IL instruction planning process and LIPs and faculty should collaborate to design and implement the evaluation tools for the assessment of IL instruction outcomes. Knight (2006) used the rubric method for the assessment of IL instruction outcomes of undergraduate students. Knight found the scoring rubric as a useful method to analyse and compare the IL instruction learning outcomes. Fafeita (2006) found that the most common IL assessment methods in Australian TAFE libraries were "collaborative learning exercises", "short answers", and "peer and self-review". Kurbanoglo, Akkoyunlu and Umay (2006) developed a 40-item scale to assess the IL self efficacy. The respondents were required to indicate their level of confidence, using seven-point Likert scale given against each IL skill. The items in this scale were related to defining, finding, selecting, interpreting, using and communicating the information. This 35 scale also had items related to learning through experience. The Cronbach’s value of 40-item scale was 0.84; however, the scale was refined into 28-items with a Cronbach’s value of 0.92. Wong, Chan and Chu (2006) carried out a questionnaire survey after providing IL instruction for four to eight weeks. They found that library users retained and successfully used the IL skills learned during IL instruction sessions. Haines and Horrocks (2006) reviewed the IL assessment models used in King’s College London. They have been using multiple choice questions (MCQs) and searching skills assessment. They found that completing an online workbook at the end of IL instruction programme worked well as an assessment method. However, they considered assessment of IL instruction outcomes a problematic issue and needed more efforts to discover more appropriate and effective methods like assessment tools designed with automatic checking of answers. In Irish Republic, “informal feedback” and “feedback questionnaire” were found to be the most favourite IL instruction assessment methods while use of formal assessment tools was almost non-existent (McGuinness, 2006, 2009). Sonley, Turner, Myer, and Cotton (2007) used the portfolio method for the assessment of IL skills and found it as valid, economical and efficient assessment method. Oakleaf (2009) presented a model “Information literacy instruction assessment cycle (ILIAC)” for the North Carolina State University (NCSU). That cycle included following seven stages: (a) “review learning goals”, (b) “identify learning outcomes”, (c) “create learning activities”, (d) “enacting activities”, (e) “gather data to check learning”, (f), “interpret data” and (g) “enact decisions”. ILIAC provided a conceptual framework for the assessment of IL instruction learning outcomes in higher education institutions. Walsh (2009) reviewed the literature to seek the different methods being used by LIPs for assessment of IL competencies. Walsh searched the LISA, 36 LISTA, ERIC and CINAHL databases and identified 127 articles on IL assessment methods. Walsh found nine types of tools/methods being used by IL instructors, documented in the literature. The four most popular assessment methods were multiple choice questions, analysis of bibliography, quiz/test and self-assessment. The other four methods rarely used were portfolio, essay, observation and final grades. The assessment methods identified in this study can be used for the development of assessment tools by the IL instructors in their institutions. Gross (2009) analysed the three IL assessment methods and found that “pre/post-test questionnaire was not reliable method, however, “reflective essay” and “experiential research task final exam.” were more valid methods for assessing of student success. The majority of South African university libraries did the IL assessment via a generic assignment with MCQs. The other assessment methods used were formal test, a formal discipline specific assignment or a self-marking quiz results sent to the lecturers/librarians (Pearce, 2011). Kinsley and Kinsley (2009) used the research assignment for the assessment of IL skills of first year dental students. Clairoux, Desbiens, Clar, Dupont, and St-jean (2013) used “scoring features of literature search” and “user satisfaction surveys” for assessing learning outcomes of medical students after delivering a series of IL workshops in Canada. In Nigeria and other African universities, “collaborative learning exercises in class,” “short answer” and MCQs were the most commonly used assessment methods (Baro & Keboh, 2012; Baro & Zuokemefa, 2011). Jabeen, Yun, Rafique, Jabeen and Tahir (2014) revealed that Chinese university and research librarians practiced exercises, MCQs, quizzes, essays, short answers and self-reviews for evaluation of IL instruction outcomes. In developing countries, formal evaluation of IL instruction is minimal or non-existent (Karisiddappa & Rajgoli, 2008; Lwehabura, 2007: Vijay & Satish, 2010). Formal assessment 37 is crucial means of indicating the significance of IL instruction programmes to the educational mission of an institution and to ensure that learning has occurred. 2.5.4 Integration of IL Instruction into the curriculum Integration of IL instruction into the curriculum means that "the development of [IL] skills and knowledge is integrated into the teaching, learning and assessment of curriculum objective and content. Provision is made for developmental progression throughout the course" (Wallace, Shorten, Crookes, McGurk & Brewer, 1999, p. 137). This approach makes the students to develop as well as apply the learned skills in a meaningful way for solving problems and completing tasks (Kinsley & Kinsley, 2009; Larkin, & Pines, 2005; McGuinness, 2009). While in standalone IL courses offered outside the main curriculum the students learn skills out of the context and feel difficulties while applying it in the real world problems. In this context Wallace, Shorten, Crookes, McGurk and Brewer (1999) described the curriculum-integrated model developed by librarians in collaboration with faculty for nursing courses at bachelor level in the University of Wollongong, Australia. They also mentioned that resistance from faculty, lack of sufficient time and low IL instruction skills of teaching staff were the major challenges in integrating IL into the nursing curriculum. Fafieta (2006) revealed that most of the librarians recommended integration of IL instruction into the courses to improve IL practices in TAFE libraries. Ford, Foxlee and Green (2009) found that integration of IL instruction into the curriculum of first year oral health students improved their IL competencies. Ford, et al. concludes that IL instruction for students is mandatory not optional. Rasaki (2008) found that IL skills were taught as for credit course in three African universities with more emphasis on library and reading skills and less emphasis on ICT skills. Gowalt and Adams (2011) described an IL course developed 38 for first-year chemistry and biochemistry students. Gowalt and Adams exposed that the course was developed by both librarians and teaching faculty in coordination. It was also improved in response to assessments and feedback received during five years. The course was integrated into the major curriculum and had positive impact on students learning. Rehman and ALAwadhi (2013) reported that integration of a 3-credit hour IL course into the social sciences curricula at Kuwait University significantly improved the IL competencies of undergraduate students. In developed countries, many studies reported successful integration of IL instruction into the health sciences curriculum (Brown & Nelson, 2003; Clairoux, Desbiens, Clar, Dupont, & St-jean, 2013; Demczuk & Gottsschalk, 2009). Li (2007) opined that integration of IL into the curriculum in coordination with the faculty is the most effective way of making the students information literate. However, in developing countries librarians face challenges while integrating IL instruction into the curricula and working with faculty (Islam & Rahman, 2014; Klaib, 2009). Clairoux, Desbiens, Clar, Dupont, and St-jean (2013) elucidates that integration of IL instruction within curricula requires professional development of librarians, enough time, resources and close collaboration with teaching faculty. 2.5.5 Librarian-Faculty Collaboration The prime inference drawn from the findings of research on IL instruction in academic institutions is that collaboration and cooperation between librarians and teaching faculty is imperative for success and effectiveness of IL instruction (Bruce, 2004; Clairoux, Desbiens, Clar, Dupont, & St-jean, 2013; Fafeita, 2006; Hart & David, 2010; Islam & Rahman, 2014; Lwehabura & Stilwell, 2008; McGuinness, 2006, 2007, 2009; Starkey, 2010; Zanin-Yost, 2012). Fafeita (2006) reported low level of teacher involvement in IL activities 39 in TAFE libraries due to lack of time and interest. Li (2007) examined the model of librarian–faculty collaboration for integration of IL into the curriculum of five Ohio colleges. Li discussed the different models, symposiums and workshops organized for developments of IL skills in faculty and IL tutorials developed by librarians and faculty together. He found that the collaboration was fruitful and faculty members were willing to collaborate with librarians in designing, teaching and implementing IL courses. Hart and Davids (2010) recommended that more periods should be allocated to IL instruction in time table and that faculty should recognize the educational role of librarians. The goals of IL instruction cannot be achieved by librarians alone. Collaboration and partnership between librarians and academic staff as well as support from management will be needed to accept librarians as facilitator of IL instruction. IL instruction should be part of the institution’s policy. The responsibility of the IL institution programmes as part of the educational strategy of the institution thus goes further than the library. It needs to bring changes in curriculum design, policy development, staff development, research and class room teaching (Bruce, 2004). 2.6 IL Instruction Training Needs of Instructional Librarians The rebirth of bibliographic instruction (BI) movement in 1967 raised the need for specialized education and training for librarians. Contents on BI were included in the LIS curriculum and conferences, workshops, seminars, in service trainings were organized to prepare the librarians to plan and implement it (Willingham, Carder & Millson-Martual, 2006). The instructional role of librarians has been increased due to introduction of IL instruction in the libraries during the past two decades. Walter (2006) observed that “... even after thirty years of discussion and debate, teachers’ training is still a relatively minor part of 40 the professional education for librarians even as it becomes an increasingly important part of their daily work” (p. 218). It is the need of the hour to train the LIPs for teaching role in a structured manner (Sproles, Johnson & Farison, 2008). Librarians have been receiving training through conferences, seminars, workshops, consultation with colleagues and on a “trial and error” basis (McGuinness, 2009). Karisiddappa and Rajgoli (2008) found that most of the LIS professionals in India did not receive any IT training which is essential for IL instruction programmes. McGuinness (2009) revealed that the IL instruction training facilities for LIPs in Ireland were extremely limited and only one third of academic librarians, involved in IL instruction, received some sort of training through one-shot course, seminars, and workshops. Baro (2011) found that only few LIS schools offered standalone IL instruction course in their curricula due to lack of IT facilities and qualified faculty to teach IL instruction. Only 15 % mentioned that instructional training were part of their LIS curriculum. Elmborg (2006) noted that “instructional librarians require extensive knowledge of pedagogies and of the culture and discourse communities of higher education.” (p. 198). Selematsela (2005) proposed following job contents for instruction librarians: (1) “The promotion of IL to the institution,” (2) “the organization of IL programmes,” (3) “the presentation of appropriate IL instruction skills,” (4) “the course design and development of IL programmes in collaboration with academic departments and learner developers,” (5) “the continuous evaluation of IL programmes in collaboration with academic departments and learner developers,”(6) “the design of policies and procedures governing the IL programmes,” (7) “the participation in the selection, evaluation and recommendation of ICTs to be used in instruction,” (8) “the maintenance of internal and external relationships with stakeholders or partners imparting on IL instruction such as the students bodies, Dean of 41 students office, peers at other institutes etc,” (9) “to keep up to date with the e-learning environment and electronic resources,” (10) “to keep up to date with the learning methodology and pedagogy.” The ACRL (2008) identified “41 core proficiencies for instruction librarians and 28 additional proficiencies for instruction coordinators”. These proficiencies were divided into following 12 categories: “Administrative skills,” “assessment and evaluation skills,” “communication skills,” “curriculum knowledge,” “information literacy integration skills,” “instructional design skills,” “leadership skills,” “planning skills,” “presentation skills,” “promotion skills,” “subject expertise,” and “teaching skills.” Starkey (2010) conducted an electronic survey of 84 academic instruction librarians working in colleges and universities within state of Kansas to investigate their professional development needs. The respondents considered training opportunities in "teaching skills", "instructional design skills", "assessment and evaluation skills", "information literacy integration skills", and "presentation skills" as beneficial for their professional development. Moselen and Wang (2014) documented an IL integration professional development programme for librarians at the University of Auckland, New Zealand to support their teaching and other IL activities. The programme covered following modules: (a) “IL introduction,” (b) “understanding and working with faculty: the basics of IL Integration,” (c) understanding the faculty curriculum,” (d) “IL integration and curriculum design,” (e) IL assessment and evaluation: an overview.” Moselen and Wang suggested that other institutions should also “cater for the professional development of their librarians in terms of teaching and other IL activities.” (p. 122). Therefore, it is important to identify the IL instruction training needs of medical librarians in Pakitan. 42 2.7 Strategies for the Effective Implementation of IL Instruction Programmes It is important to adopt a vision and systematic plan for IL instruction within the library and rest of the academic institution as well (Selematsela, 2005). Leckie and Fullerton (1999) explored the perceptions of science faculty regarding their students’ IL skills, their own IL pedagogical practices and role of librarians in IL instruction in two Canadian universities. They found that a large majority of faculty considered IL instruction “important” for their students. Most of the (79%) health sciences faculty showed interest in workshops to be arranged for them. However, most of them (61%) supported the in-class lectures by librarians on IL skills in the IL instruction courses for first and second year students. Cox and VanderPol (2005) discussed the IL orientation workshop developed for faculty at the University of Nevada, Las Vegas (UNLV). During the workshop, the focus was on helping teachers in designing assignments that would develop IL skills of their students. This strategy was successful for gaining support and participation of teachers in IL instruction programmes at the university. Lwehabura (2007) revealed that integration of IL programme, developed after involvement of teaching faculty, as compulsory and credit earning course would be the most effective strategy for teaching IL in the higher learning institutions. Diehm and Lupton (2012) revealed that students of an Australian university tried to learn IL skills using “learning by doing, trial and error and interacting with other people” strategies. They recommended that librarians and faculty should adopt proper strategies for improvement of students’ IL skills. The development of IL competencies are critical for lifelong learning in medical professionals, therefore, innovative IL instruction strategies are required to be defined for medical institutions. However, the development and 43 implementation of IL instruction programme at national level is an intimidating task. IL strategies should be in accordance with the economic and socio-cultural conditions of the country. Resultantly, no universal strategies for IL exist so far (Ponjuan, 2010). McGuinness (2007) suggested that the librarians should adopt a top-down strategy for integration of IL instruction into the curricula. Moreover, IL instruction should be part of institutional educational mission. Librarians need to bring a broader change in the institution’s culture through promotional activities and networking for sustainable collaboration with faculty. CHELSA prepared a draft of guidelines for basic IL instruction programme Esterhuizen & Kuhn, 2010). The librarians also felt the need for development of a common IL instruction course for universities and to find ways to integrate the developed course into the mainstream academic curriculum (Corrall, 2007; Derakhshan & Singh, 2011; Esterhuizen & Kuhn, 2010). The ACRL (2001) prepared “guidelines for instructional programs in academic libraries” for implementation of effective IL instruction programmes in 2003 which were updated in 2011. The first part of these guidelines consists of following components regarding “programme design”: (a) The IL instruction programme should have a mission statement in black and white, (b) libraries should identify course content aligned with the “ACRL ‘s information literacy competency standards for higher education” as well as local institution standards, (c) the mode of instruction should be consistent with the goals of IL instruction and multiple instructional styles/modes should be used whenever required, (d) the programme structure should show co-relationship among components of the programme, (e) evaluation and assessment should be based on IL instruction goals and mission. The second part of these guidelines is regarding the support for IL instruction programmes and includes 44 instructional support facilities; financial support; support for continuing education, training and development and human resources required. Short-term and long-term strategies at national level in collaboration with major stakeholders are required to be devised for creation of awareness about value of IL inside and outside libraries (O’Brien & Russell, 2012; Webber & McGuinness, 2007). This study aims to suggest strategies for the effective implementation of IL instruction programmes in medical institutions of Pakistan. 2.8 Studies on IL Instruction in Medical Libraries Considerable work has been published on IL instruction in medical libraries mostly in developed countries. Aharony (2010) revealed that IL publications in Web of Science (WOS) database mainly focused on subjects like “health and medicine” and “education”. In following paragraphs, selected publications on the subject under study are briefly reviewed. Over a period of time medical education has been transformed from traditional transmission of fixed body of knowledge to problem-based and case-based learning caused by rapid technological advances and tangible developments in the scientific knowledge (Schardt, 2011). Furthermore, the traditional hit and trial practice of health care has also been changed to evidence-based practice. This change in the education and health care practices demands the students and professionals to be educated in information skills (McGowan, 1995; Shanahan, 2007). Orr, Wallin and Hinton (1999) discussed a model developed to deliver IL instruction to bachelor students of the Central Queensland University (CQU), Sydney, using video conferencing (distance mode) facility. They evaluated the outcomes of the course through informal observations and found distance education quite effective in developing IL skills among students. 45 The Medical Library Association [MLA] (2005) formed “Health Information Literacy Task Force” to identify the MLA activities regarding health information literacy. As a result, a working definition of health information literacy and communication plan was developed. The task force recommended that the MLA should carry on existing advocacy of health information literacy by further developing the education courses for health sciences librarians. Haraldstad (2002) reported that IL instruction was integrated to the medical curriculum in Norway ranging from “library orientation/guided tour” and “introduction to literature searching and source criticism” to “advanced clinical literature searching techniques/Evidence Based Medicine” from first year to second year. Oberprieler, Masters and Gibbs (2005) recommended the integration of IL instruction into the medical curriculum/courses. Cullen (2005) suggested that health sciences librarians should educate the patients to access reliable and valuable health information from the Internet. Haines and Horrocks (2006) discussed a model for promotion of IL in the King’s College, consisting of following three parts: IL training as a part of curriculum; training programme for research students; and IL training as part of IT and information retrieval courses. They found the model useful but required revision to include online tutorials in the model. Shanahan (2007) documented the designing and implementation of an “Online Electronic Information Skills (OEIS)” intervention to develop IL skills of the Radiography students. Shanahan found that OEIS intervention was effective and enabled the students to retrieve and use information for their assignments. Cobus (2008) reviewed the role of librarians in the integration of IL competencies into the public health education. They found that collaboration between librarians and public health faculty could improve public health education. Kloda (2008) revealed that Canadian 46 health sciences librarians were aware of the importance of integration of IL instruction into the medical curriculum. However, most of the medical students lacked IL competencies. Kloda recommended that further research should be conducted to make health IL instruction more effective. Shipman, Kutz-Ross and Funk (2009) surveyed the administrators and health care professionals of nine hospitals in the USA and Canada, to evaluate the outcome of one of the IL curriculum developed by them. They found that health professionals considered IL curriculum useful and also believed that the curriculum had raised their awareness regarding the National Library of Medicine (NLM) resources and services. It was also found that the IL curricula had also increased the use of the NLM resources and library services. Kingsley and Kingsley (2009) designed a research assignment to assess the IL skills of first year dental students. They found that all the students responded correctly to content specific (technology-independent) portion of the assignment and more than half of the students failed to respond correctly to web-based (technology-dependent) portion of the assignment. This established the need for designing IL instruction courses for undergraduate students and its integration into the curriculum. Demczuk and Gottschalh (2009) discussed the outcome of an IL course, having nine modules, developed at the University of Manitoba (anaesthesia department) in collaboration with health sciences libraries and was integrated into the anaesthesia curriculum. This IL course was based on the ACRL standards and the CanMed competencies. They concluded that integration of IL instruction into the curricula is essential for competency-based education. Baro, Endouware and Ubogu (2011) investigated the IL skills of students in the College of Health Sciences in the Niger Delta University. They found that students mostly relied on print resources and rarely used online resources due to poor searching skills and 47 lack of awareness regarding online resources. They recommended that librarians and faculty should collaborate to integrate the IL instruction into the curriculum. Dinkelman, Viera and Bickett-Weddle (2011) determined the status of IL instruction in veterinary medical libraries of the USA, using qualitative method. They found that one time presentation to each course was a very common practice of librarians. Moreover, IL was not well integrated into the curriculum. They recommended collaboration among faculty, administration and faculty to integrate IL skills into the courses. Schardt (2011) opined that health IL improved the awareness among public to access the quality information to make appropriate health decisions. Hodgens, Sendall and Evans (2012) examined the IL skills of postgraduate students before and after completing an online tutorial. They used a self-assessment tool and found that the students considered the tutorial beneficial for IL skills improvement. However, some students continued to have problems with information retrieval, referencing and plagiarism issues. Weiner, Pelaez and Change (2012) found that nursing students liked modules such as “planning your project,” “topic exploration,” “types of information,” “search tools,” and “copyright, plagiarism and citations” included in the online IL tutorial. However, they suggested to add “how to use library databases,” “Microsoft Excel,” “how to evaluate the quality of information,” “how to cite references” and “how to find statistics” modules in the tutorials. Kleyman and Tabaei (2012) determined the effect of IL workshops at graduate-level health sciences education and found a significant improvement in students IL skills after attending the workshop. Bond, Friel and Lahoz (2013) illustrated a programme to develop health information literacy skills among 6th grade students of various institutions. They 48 found that the 6th grade students had been able to access and use health information from the NLM website after participating in the programme. Clairoux, Desbiens, Clar, Dupont, and St-jean (2013) documented the positive outcomes of integrating a series of workshops in health sciences curricula. They suggested that professional development of health sciences librarians is essential for the success of IL instruction programmes. Jiri (2014) noted that the creation of web IL courses was time consuming and also required many facilities. However, e-learning saved the time of librarians, enhanced their prestige at the university and increased the IL competencies of medical students. Vincent, Martinez-Silveira and Camacho (2014) believed integrating IL instruction within the medical curriculum would address ICT skills, evidence-based medicine and independent learning. In Pakistan, Ullah, Ameen and Bakhtiar (2010/2011) interviewed 16 medical librarians to explore their professional activities and found that they were not running any formal IL programmes. However, they were delivering orientation lectures to new entrants. Ullah and Anwar (2011) identified and validated the competencies for medical librarians in Pakistan and found that user education/IL competencies were important for medical librarians. Little is known with respect to medical librarians’ IL instruction practices in Pakistan. Medical profession is amongst the highly valued professions and demands high standards of IL services. Therefore, the research reported here aims to bridge this gap by exploring the current status of IL instruction in medical libraries of Pakistan. 2.9 Chapter Summary The literature review demonstrates that IL instruction has received considerable research attention. It also indicates that a growing amount of research is being conducted to 49 determine the status and practices of IL instruction in different countries and institutions. There is a dearth of literature that focuses on IL instruction in medical libraries in the developing countries. Therefore, this study was important to appraise the status of IL instruction in medical libraries of Pakistan to contribute in the existing body of research. Chapter 3 describes the research design and methodology used in this research study. 50 CHAPTER 3 RESEARCH DESIGN AND METHODOLOGY The study intended to explore the status of information literacy (IL) instruction in medical libraries of Pakistan. The focus was on investigating the perceptions of medical librarians towards the importance of IL skills, current IL instruction practices, the barriers to IL instruction programmes, and IL instruction training needs of medical librarians. Suggestions from the head librarians regarding the strategies to be adopted for the effective implementation of IL instruction programmes were also obtained. This chapter describes the research design and methodologies employed for this study, including development of research instruments, target population, data collection, and data analysis techniques used in the study. 3.1 Research Design Two-phase, sequential mixed methods research design was followed to meet the objectives of the study through collecting opinions of the subjects under investigation. The mixed methods research is an approach to inquiry that combines or associates both qualitative and quantitative forms. It involves philosophical assumptions, the use of qualitative and quantitative approaches, and the mixing of both approaches in a study. Thus, it is more than simply collecting and analyzing both kind of data; it also involves the use of both approaches in tandem so that the overall strength of a study is greater than either qualitative or quantitative research. (Creswell, 2009, p.4) A mixed methods design is used to exploit the strengths of both the qualitative and quantitative data. Moreover, to avoid biases inherent in any single method could neutralize or 51 cancel the biases of other method (Teddlie & Tashakkori, 2009). While Creswell (2009) described that: The Sequential mixed methods procedures are those in which the researcher seeks to elaborate on or expand on the findings of one method with another method. This may involve beginning with qualitative data interview for explanatory purpose and follow up with quantitative data survey method with a large sample so that the researcher generalize results to population. Alternatively, the study may begin with a quantitative method in which a theory or concept is tested, followed by a qualitative method involving detailed exploration with a few cases or individuals. (p.14) This study was in two phases, the sequence was from quantitative to qualitative. In first phase the quantitative data was collected from the population through semi-structured questionnaire. The quantitative data was analysed and on the basis of these results interview schedule was developed to collect qualitative data through interviews from a sample of participants. More weight age was given to the first phase (quantitative data). Questionnaire survey resulted in a large sample for the study, while interviews provided detail insight of the experiences of participants on the most significant results of questionnaire survey. Quantitative and qualitative data was combined at the interpretation phase, presented in chapter 6 (discussion) of this study. Figure 1 explains the mixed method model used. QUAN QUAN Data Collection qual QUAN Data Analysis qual Data Collection qual Data Analysis Interpretation of Entire Analysis Figure 1: Sequential Explanatory Design (Creswell, 2009, p.209). 52 3.2 Research Method The survey method was used to conduct this study based on a sequential (QUANqual), mixed methods research design. The self-completed, semi-structured questionnaire and semi-structured in-depth interviews were used as data collection instruments. A descriptive survey has been the most commonly and successfully used research method in previous studies (Baro & Keboh, 2012; Baro & Zuokemefa, 2011; Bhatti, 2010; Diep & Nahl, 2011; Fafeita, 2006; Lwehabura, 2007; Lwehabura & Stilwell, 2008; Maitaouthong, Tuamsuk & Tachamanee, 2012; Ranaweera, 2010; Starkey, 2010). Therefore, this method was employed in this study to achieve the objectives of the study. 3.3 Phase I – Quantitative Quantitative data was collected and analysed in the first phase. A questionnaire was developed and administered upon the target population for this purpose. A questionnaire is easy and cheaper to administer as compared to other techniques of data collection. It also accommodates a large sample scattered in a wide area. The respondents also find sufficient time to think through the questions and can answer these when they found spare time. It collects quantitative data which is simple to analyze. Its findings are also dependable, reliable and can be generalized (Gay & Airasian, 2003). Therefore, it was decided to use the same technique for collecting data in the first phase. 3.3.1 Questionnaire Development The survey questionnaire was designed using an extensive literature review, expert scrutiny and a pilot testing as detailed below. 53 3.3.1.1 Literature review. To understand the various theoretical and practical aspects of the study a comprehensive search of relevant literature was conducted. At the first stage, different aspects of IL instruction such as status, perceptions of different stakeholders, IL standards, IL models, course contents, teaching methods, evaluation and assessment methods, barriers to IL instruction programmes, and IL instruction strategies were explored. 3.3.1.2 Draft questionnaire. A tentative draft questionnaire was prepared after an extensive literature review. Most of the questions were derived from the questionnaires successfully used in previous research studies (Baro & Keboh, 2012; Baro & Zuokemefa, 2011; Bhatti, 2010; Diep & Nahl, 2011; Fafeita, 2006; Lwehabura, 2007; Lwehabura & Stilwell, 2008; Maitaouthong, Tuamsuk & Tachamanee, 2012; Ranaweera, 2010; Starkey, 2010) conducted in this field. The initial draft of questionnaire was revised several times in order to merge similar questions and statements and to reduce their number. This exercise resulted in a draft instrument containing two sections. Section I with five parts and 23 questions, while section II with five questions to collect demographic information of respondents for cross tabulation. 3.3.1.3 Expert scrutiny. The draft instrument was submitted to a panel of 12 experts (Appendix A), consisting of four LIS faculty members (who has M.Phil./Ph.D. degrees and taught IL instruction to the LIS students or published research on IL), four information literacy experts (librarians actively involved in IL instruction practices in higher education institutions) and four medical librarians (having IL instruction experience in medical organizations), along with a covering letter (Appendix B), to strengthen the content validity of the instrument. The members of the expert panel suggested many changes and improvement in the survey instrument. The questionnaire was revised in response to 54 feedback received from the panel of experts and was resubmitted to them again for final examination. During this exercise some questions and response options were added to the questionnaire, and some were removed, keeping in view the comments of panel of experts. The language of questionnaire, sequence of questionnaire items and rating scale used in the questionnaire were also refined in light of the changes suggested by the panel of experts. 3.3.1.4 Pilot testing. The revised questionnaire approved by the panel of experts was tested in a pilot study using 10 medical librarians (Appendix C), other than the respondents of this study. The researcher contacted the subjects by phone or e-mail to get their consent regarding participation in the pilot study. The questionnaire along with a covering letter (Appendix D) was sent by post or e-mail to those individuals who agreed to participate. An e-mail reminder was sent to the participants after ten days. The pilot study yielded a 100% response rate. The revised questionnaire was amended in response to ambiguities identified by the participants of the plot study. They also identified some technical terms used in the questionnaire which needed to be explained in common language. The pilot study resulted in final survey instrument (Appendix E) having two sections. Section I contained 23 questions divided into five parts: Perception of medical librarians towards the importance of IL skills; current practices of IL instruction; barriers when advocating or providing IL instruction; IL instruction training needs of medical librarians; and strategic to be adopted for the effective implementation of IL instruction programmes. Section II obtained required demographic information regarding: gender, LIS education, age, professional experience, status and type of medical institution in which respondents were employed. The demographic information 55 was to be used for cross-tabulation. A covering letter (Appendix F) was attached to each questionnaire introducing the study, its importance, and the researcher. 3.3.1.5 Scale used. Following 5-point Likert / Numerical rating scales (endpoints are labelled) were used to know the opinions/perceptions of the respondents. 1. Least Important 1 2 3 4 5 Most Important 2. Very Weak 1 2 3 4 5 Very Strong 3. Strongly Disagree 1 2 3 4 5 Strongly Agree 4. Least Interested 1 2 3 4 5 Most Interested 5. Least Effective 1 2 3 4 5 Most Effective Cronbach's alpha analysis was made to estimate the reliability between the items. Responses of pilot study participants were entered in the Statistical Product and Service Solutions (SPSS). Cronbach alpha’s for individual construct used in the questionnaire survey are listed in Table 3.1. 56 Table 3.1 Reliability Results of the Pilot Study Questions Reliability Co-Efficient In your opinion, how important are the following IL skills for your library users? 0.893 Number of Statements/Items 8 From you experience, how strong or weak are your library users’ IL skills in the following areas? 0.901 8 How do you agree or disagree with the following statements about barriers when advocating or providing IL instruction in medical libraries? 0.738 12 Please rate your knowledge of the following aspects of IL as fairly as possible. 0.908 5 How interested are you in developing your skills in the following areas of IL instruction? 0.947 11 In your opinion, how effective will be the following methods for imparting IL instruction? 0.722 5 The results revealed that the instrument is reliable for the larger survey. 3.3.2 Population A list of 114 academic medical libraries (Appendix G) was prepared using listings of the recognized medical colleges (schools), postgraduate medical institutes (PGMIs) and medical universities available from the Pakistan Medical & Dental Council (PM&DC) website. The PM&DC is a regulatory body of medical and dental education in Pakistan. All head librarians of the academic medical institutions in Pakistan, established till August 2013 and recognized by the PM&DC were the target population of this study. 3.3.3 Data Collection The questionnaires along with covering letters and self-addressed, stamped envelopes were distributed to all members of the population (head librarians of academic medical institutions) through post in the last week of August 2013. The postal addresses of the 57 subjects were obtained from the official websites of medical institutions. The respondents were requested to return the filled in questionnaire within two weeks i.e., September 10, 2013. The researcher received only 26 self-completed questionnaires till the mentioned date. 3.3.3.1Follow up. The mailing was augmented by follow-up telephone calls, e-mail messages and personal visits to the non-respondent medical libraries to speed up the data collection process and ensure better response. Telephone numbers and e-mail addresses of the head librarians of non-respondent medical libraries were searched, using the official websites of medical institutions/libraries, personal contacts and message archives of four mailing groups of librarians in Pakistan viz a viz., the Medical Library Association of Pakistan (MELAP@yahoogroups.com), the Pakistan Library Automation Group (http://groups.yahoo.com/group/plagpk), the Pakistan Library Cooperation Group (http://groups.yahoo.com/group/libcoop), and the Pakistan Librarians Welfare Group (http://groups.yahoo.com/group/librarianwelfare). When the non-respondent medical librarians were contacted, it was found that some respondents had not received questionnaire due to one reason or the other. Some had lost the questionnaire or forgotten to fill it. The researcher sent another copy of questionnaire to such respondents through email. The above mentioned three tiered strategy used for follow up, produced significant results and was helpful to get a good response. 3.3.4 Data Analysis SPSS version 20 was used for analysis of quantitative data (Green, Salkind & Akey, 2000). The data obtained from head librarians survey was entered in the SPSS. Descriptive and inferential statistics were used to analyse the quantitative data. 58 In case of interval data, mean scores, standard deviations (SD) and rank of both groups of respondents from public and private sector medical institutions were calculated separately for each statement/item to report the results. The statements/items have been ranked from highest to lowest according to the mean score of respondents. If there was a tie, then the statement/item with the lowest standard deviation has been ranked first. Mean is the most commonly reported statistical calculation and standard deviation was calculated to describe the distribution of data. Independent samples t-tests were applied to determine if the head librarians from public and private medical institutions significantly differed in their opinions or perceptions about each statement/item. The criterion of 0.05 was used for the purpose of significance. For each statement/item the value of t-test significance (p value) has been reported. One-way ANOVA was applied on the average mean score to determine if the head librarians employed in three types of institutions (medical colleges, postgraduate medical institutes and medical universities) differed significantly from each other. The criterion of 0.05 was used for the purpose of significance. F value and its level of significance were reported. If a significant difference was found it was further analysed using post hoc (LSD) test of one-way ANOVA, to see the significant difference between all possible pairs. The categorical data was also analysed, using both descriptive and inferential statistics. Descriptive statistics were used “to summarize the data collected in tables and graphs” (Agresti & Finlay, 2009, p. 4). To present descriptive statistics for this study, bar and pie charts and cross tabulation has been used. Bar and Pie charts are the main graphical presentation tools for such nature of data; therefore, these were used to present the frequency and percentage of individual information. Cross tabulation was used to present the variables 59 and sample characteristics. Moreover, cross-tabulation was used to link the variables and the sampled population. Pearson’s chi-square tests and Fisher’s Exact Tests (FET) were used to explore the differences in frequency distributions between the categorical data collected from the closedended survey questions. For comparative purposes, results were organized according to institution sector (public and private) and institution type (medical colleges, medical universities, and postgraduate medical institutes), which created 2 x 2 and 2 x 3 contingency tables as required. Phi (in case of 2 x 2 contingency table) and Cramer’s V (in case of 2 x 3 contingency table) were used to determine the strength of the difference between sector of institution and types of institutions. The chances of a type I error occurring were there due to the variances within the number of respondents from each type of institution (81 from medical colleges, 21 from postgraduate medical institutes, and 12 from medical universities). However, the researcher took the risk because the population included all the head librarians of academic medical institutions. Pearson’s chi-square tests were used if the following three conditions were fulfilled: (1) each participant contributes data to only one cell. The researcher accounted for this assumption by ensuring that the sum of the cell frequencies equalled the total number of participants in the study; (2) the expected frequencies should be equal to or greater than five; (3) The number are respondents are not less than 50. On occasions when the aforementioned conditions were violated, Fisher’s Exact Tests (FET) were performed as “it goes with all sample size” (Agresti & Finlay, 2009, p. 228). 60 3.4 Phase II – Qualitative Quantitative data were collected and analysed in the first phase of the study. The most significant findings required to be explored in detail; therefore, it was decided to conduct indepth interviews with the selected head librarians. Interviews aimed to gain a deeper understanding and detailed comments about significant findings of the questionnaire survey. Qualitative data also helped to interpret the findings of the study that were primarily quantitative. Further, the purpose of interviews (QUAL strand) was to describe the QUANT exploration and enable the researcher to answer the research questions in a more comprehensive and valid manner by using both quantitative and qualitative approaches. 3.4.1 Development of Interview Schedule On basis of the findings of questionnaire survey (QUAN strand), a draft interview schedule was prepared. The draft interview schedule was refined after expert review and was pre-tested before the interviews were actually conducted. 3.4.1.1 Expert review. Interview schedule was sent through email to the panel of experts (Appendix A) for review along with a covering letter (Appendix H). The experts suggested many changes in the interview schedule; most of which were related to grammar and sentence structure. One of the experts also suggested that demographic information might not be asked again and the same could be collected from filled questionnaire of the participants. 3.4.1.2 Pilot interviews. Interview schedule approved by a panel of experts was then pre-tested on a group of four participants (Appendix I). Before conducting pilot interviews the interview schedule approved by the panel of experts was sent to the pilot interview participants. The pilot interviews were conducted with the acquaintances (who did not 61 participate in the actual research study) to become completely comfortable with the questions to be asked and to increase the conversational aspects of the interview. The pre-testing helped in refining the questions and interview process. Final interview schedule (Annexure J) was comprised of 16 questions including a concluding question that asked interviewees to add any comments that they wished to share regarding IL. In each question, interviewees were first apprised about the results of the questionnaire survey and then asked to give their views and comments on the findings. Interview schedule consisted of open-ended construct questions to ensure reliability of responses. 3.4.2 Sampling of Interview Participants It was decided to conduct interviews of those head librarians who had comparatively better understanding of IL and were involved in some kind of IL instruction. The filled questionnaires helped out to identify the interview participants. It was also confirmed from filled survey questionnaires that they had provided advanced or research-level IL instruction to their library users in the previous year. It helped to include participants who provided much insight on the topic under investigation. The attention was given to ensure diversity of the sample and representation of participants from three types of medical institutes (medical colleges, postgraduate medical institutes and medical universities) and funded by both public and private sectors. Twenty three head librarians were identified as the expected interviewees. They were contacted through telephone and 20 head librarians (Appendix K) gave the consent to be interviewed. 62 3.4.3 Interviews Process Interview schedule was emailed to each interview participants, along with a covering letter (Annexure L) for confirmation of the date and time of the face-to-face or phone interview. Providing interview schedule prior to the interview allowed head librarians to reflect their experiences and to prepare for the interview. The interview participants were briefed about the nature and overall structure of the interview before its commencement. This orientation proved very helpful in creating a meaningful interviewing environment. The interviewees were given option to speak in English or Urdu to avoid language barrier in the pursuance of the real insight from interviewees. All face-to-face and phone interviews were audio taped, with prior consent, as a primary source of data. Researcher informed interviewees that the recording of the interview was for purposes of this study only and no part of the conversation would be disclosed to anyone. The semi-structured interview process allowed the researcher to ask questions from interview schedule while other questions were improvised as the interview progressed. Each interview session lasted between 35 and 55 minutes. Interviews were conducted between April and June 2014. 3.4.4 Analysis of Qualitative Data The interviews were transcribed from the digital recording. Interviews conducted in Urdu language were translated into English language. Transcripts of interviews were sent through email to each of the interviewees for clarification of any miscommunication. Interviewees made necessary changes in the draft and sent the email back to the researcher. The transcripts were revised in response to the changes suggested by the interviewees. Textual data were organized and summarized after reading each transcript attentively. Close attention was paid to the words being used by the interviewees. After reading summary of 63 each transcript several times a list of codes was developed. The process was repeated for each of the interview transcript. The codes developed for the first interview served as foundation for the following interviews while supplementary codes that emerged inductively from the data were added as needed. The emergent themes and subthemes obtained from the interviews were presented with frequency of their occurrences along with interpretation and comments. Quotes from the transcripts were used where needed to strengthen the arguments. The uses of in-depth descriptions, provided from the interviews, were used to explain significant results of the questionnaire survey (Creswell, 2009). 3.5 Validity and Reliability This study employed mixed-methods approach using both a questionnaire survey and semi-structured interviews with experts for collection of data. This triangulation of data sources aided to the internal validity of the study. The questionnaire was distributed to the whole population and clear operational definitions were also provided in the questionnaire at the beginning. Internal content validity for the quantitative phase of the study has been controlled by having the survey instrument reviewed by a panel of experts to determine if the survey is asking appropriate question based on the research problem. Cronbach's alpha analysis was used to estimate the reliability between the items as a measure of the instrument's internal consistency. Cronbach’ alpha values ranged from 0.722 to 0.947 (Table 3.1). This is an acceptable alpha for this study as in general researchers consider Cronbach’ alpha of 0.70 or higher an acceptable determinant of an instrument’s reliability (Connaway & Powell, 2010). To ensure the credibility of qualitative data, after completion of interviews and transcription, the researcher get reviewed the transcripts of the interviews from each of the 64 participants for accuracy. It helped in clear up any miscommunication and wrong interpretation of the data. This process also ensured that participants approved the contents of the recording before the data appeared in the study. In addition, low-inference descriptors of the data were used during the coding and presentation phases of the data. The use of direct quotes and exact terms when coding and developing themes allow for greater credibility (Creswell, 2009). The interview questions provided another means for enhancing validity and reliability. The questions, along with well-planned probes or prompts, allowed the researcher to cover all the aspects and focused on the topic. To ensure reliability, the researcher allowed participants to express their experiences in their own words, without leading or emphasizing any content presented by the participants. 3.6 Chapter Summary The survey method was used to conduct this study based on a sequential (QUANqual), mixed methods research design. In the first phase, quantitative data were collected from the head librarians of medical institutions, established till August 2013 and recognized by PM&DC, using semi-structured questionnaire. The questionnaire was prepared based on prior studies. It was reviewed by a panel of experts for content validation and was also pilot tested on a group of medical librarians. The questionnaire was delivered by postal mail to the head librarians of all (114) academic medical institutions in Pakistan. The data were analysed by using SPSS. Qualitative data were gathered through semi-structured, in-depth interviews with 20 head librarians of academic medical libraries in Pakistan. Interviews were conducted between April and June 2014. The participants were selected (using purposive sampling) from the filled survey questionnaires. Interviews were utilized to gain a deeper understanding and 65 detailed comments on the most significant results of the questionnaire survey. An interview schedule was developed and followed during interviews. All face-to-face and phone interviews were audio recorded, with prior consent, as a primary source of data and transcribed. The textual data was content-analysed and coded. The emerged themes and subthemes were presented with frequency of their occurrences along with interpretation, comments, and quotes from the transcripts. Chapter 4 presents analysis of quantitative data. 66 CHAPTER 4 ANALYSIS OF QUANTITATIVE DATA The purpose of this two-phase, sequential mixed methods study was to find out medical librarians’ perceptions towards the importance of information literacy (IL) skills, explore current practices of IL instruction in medical libraries, identify barriers when advocating or providing IL instruction in medical institutions, assess IL instruction training needs of medical librarians, and to propose strategies for the effective implementation of IL instruction programmes in medical institutions of Pakistan. Differences between libraries at public and private sector medical institutions were also explored. In the first phase, quantitative data were collected from the head librarians of medical institutions, established till August 2013 and recognized by Pakistan Medical and Dental Council (PM&DC), using semi-structured questionnaire. This chapter encompasses of data collection process, survey response rates, demographic information of respondents of the study, analysis and interpretation of quantitative data. A semi-structured questionnaire comprising of 23 questions, divided into five parts was developed after extensive literature review, expert scrutiny and pilot testing for conducting a descriptive survey. The questionnaire was originally mailed to 114 head librarians, 58 (50.9 %) of whom worked in the public sector, while the remainder (56, 49.1 %) served in private medical institutions. The majority (81, 71.1 %) of the head librarians were employed in medical colleges, 21 (18.4 %) in postgraduate medical institutions and 12 (10.5 %) in medical universities. The survey instruments were marked with identification codes, before mailing, for further follow up. 67 4.1 Survey Response Rates Initially 26 questionnaires were returned out of 114. The initial mailing was augmented by follow-up e-mail messages, telephone calls and personal visits to libraries. After these efforts 70 (61.4 %) head librarians responded to the survey. During the follow-up process, it was found that no professional librarians were employed in three of the medical libraries; clerical staff was running these libraries. Two head librarians refused to participate in the study. One questionnaire was discarded, as it was carelessly completed. Therefore, 69(60.5 %) usable responses of head librarians were analysed. 4.2 Demographic Information Section II (questions one through six) of the questionnaire collected the demographic data for this study. The demographic information of respondents is presented below in Table 4.1. 68 Table 4.1 Demographic Information of Respondents (N = 69) Demographics Gender Male Female Frequency Percentage 52 17 75.4 % 24.6 % Highest LIS Education Attained MLIS M. Phil. Ph.D. 66 02 01 95.7 % 2.9 % 1.4 % Age Group Up to 25 years 26-35 years 36-45 years 46-55 years 56 years an above 09 21 20 08 11 13.0 % 30.4 % 29.0 % 11.6 % 16.0 % Experience Up to 5 years 6-10 years 11-15 years 16-20 years 21-25 years More than 25 years 15 17 13 07 05 12 21.7 % 24.6 % 18.8 % 10.1 % 7.2 % 17.4 % 31 38 44.9 % 55.1 % 44 11 14 63.8 % 15.9 % 20.3 % Sector Public Private Types of Institutions Medical Colleges Medical Universities Postgraduate Medical Institutes Table 4.1 depicts that an overwhelming majority of survey respondents were holding a Master of Library and Information Science (MLIS) degree and only three respondents possessed a research degree in Library and Information Science (LIS). Majority of respondents (50 or 72.5 %) were less than 46 years old and 19 (27.5%) were more than 45 years old. Forty-five (65.2 %) respondents reported having less than 16 years of work experience and the remaining 24 (34.8 %) had worked for more than 15 years. 69 Table 4.1 reveals a balanced response rate both from public sector institutions (44.9 %) and private sector institutions (55.1 %). Majority of the respondents were employed in the medical colleges (44, 63.8 %). It is aligned with the fact that majority of the medical libraries exist in medical colleges in Pakistan. The second largest group of respondents were from postgraduate medical institutes (14, 20.3 %), followed by medical universities (11, 15.9 %). 4.3 Findings of the Study The findings of the study are presented in the following five segments as represented in the survey instrument. Each segment consisted of a number of questions. 4.3.1 Perceptions of Medical Librarians towards the Importance of IL Skills Librarians need to appreciate the importance of information literacy (IL) skills. Therefore, this segment sought to answer the first research question of this study i.e., what are the perceptions of medical librarians in Pakistan towards the importance of IL skills? A list of eight IL skills was presented to the respondents in the questionnaire. Each IL skill was followed by a 5-point Likert scale (1 = least important to 5 = most important). The respondents were asked to select one of the values to express their opinion towards the importance of those IL skills for their library users. The perceptions of head librarians from public sector and private sector institutions about each IL skills in the form of mean, standard deviation (SD) and rank are presented separately in Table 4.2. The IL skills were ranked from highest to lowest according to the mean score. In case of a tie, the IL skills with the low standard deviation were ranked higher. Independent samples t-tests were applied on each statement to examine whether there were significant differences in the opinions of head librarians employed in public and private sector medical institutions. Table 4.2 also provides the t-test significance value (p value). 70 Table 4.2 Perceived Importance of IL Skills Along With t-test Results S. No IL Skills Sector n Rank Mean SD Sig. (2-tailed) 1 Accessing the needed information effectively and efficiently Public Private 30 38 1 2 4.40 4.45 .724 .760 .795 2 Identifying relevant, authoritative and reliable information sources Public Private 31 37 2 1 4.39 4.54 .803 .605 .373 3 Recognizing the need for information Public Private 30 38 3 4 4.33 4.32 .802 .809 .929 4 Verifying the relevance and quality of information sources Public Private 31 38 4 3 4.29 4.32 .864. 662 .890 5 Using information ethically and legally Public Private 31 38 5 5 4.19 4.18 .792 .955 .965 6 Organizing information collected or generated in a logical way Public Private 31 37 6 8 4.13 3.97 .806 .833 .438 7 Using the selected Public information effectively to Private accomplish a specific task 29 38 7 7 4.07 3.97 .923 .822 .657 8 Evaluating the information critically 31 38 8 6 3.94 4.11 .998 .831 .443 Public Private Table 4.2 shows that all the eight IL skills got a mean score higher than 3.90 from both public and private sector respondents and were therefore considered important for their library users. Most of the IL skills got high rating from respondents of public sector institutions with seven IL skills receiving mean score exceeding four. IL skill “accessing the needed 71 information effectively and efficiently” received the highest mean score of 4.40 and was ranked first, closely followed by “identifying relevant, authoritative and reliable information sources” ranked second with a mean score of 4.39 and “recognizing the need for information” ranked third with a mean score of 4.33. The other four IL skills (S. Nos. 4 to 7) got mean scores of 4.29, 4.19, 4.13 and 4.07. It indicates that respondents from public sector institutions rate seven IL skills of high importance for their library users. One IL skill “evaluating the information critically” got a mean score of less than four i.e., 3.94 and was ranked last. Therefore, it was the only skill that respondents from public sector institutions rated of moderate importance for their library users, in spite of the fact that this skill is integral part of all IL definitions. Six IL skills got a mean score exceeding 4 from respondents employed in private sector institutions. IL skill “identifying relevant, authoritative and reliable information sources” was considered the most important, with a mean score of 4.54. The other five IL skills “accessing the needed information effectively and efficiently”, “verifying the relevance and quality of information sources”, “recognizing the need for information”, “using information ethically and legally” and “evaluating the information critically” received a mean score of 4.45,4.32, 4.32, 4.18 and 4.11 respectively. It shows that respondents from private sector institutions rated six IL skills of high importance for their library users. Two IL skills “using the selected information effectively to accomplish a specific task” and “organizing information collected or generated in a logical way” got a mean score of less than four i.e., 3.97 each (Table 4.2). The respondents from private sector institutions rated these two IL skills of moderate importance for their library users in spite of the fact that the 72 abilities to organize and use information are also very important for library users to accomplish their communication goals. 4.3.1.1 Independent samples t-test results. Independent samples t-tests were run to assess differences between the perceptions of head librarians working in the public and private sector medical institutions on the importance of each IL skill. The results reveal that the difference between the mean scores of two groups of head librarians on all eight IL skills were not significant at the alpha level of 0.05 (Table 4.2). It implies that no significant differences exist in the perceptions of public and private sector head librarians. 4.3.1.2 One-way ANOVA results. One-way ANOVA was applied (as the groups were more than two) on composite mean scores of respondents, to know whether there were significant differences in the perceptions of head librarians belonging to three groups based on type of institutions (medical colleges, medical universities and postgraduate medical institutes). The result reveals that differences among the perceptions of three groups of head librarians were not significant (F (2) = 1.042, Sig = .358). This means that no significant differences exist in the perceptions of head librarians employed in three types of institutions. 4.3.2 Current Practices of IL Instruction in Medical Libraries The questionnaire included 11 questions to answer the second research question: What are the current practices of IL instruction (course contents, methods of delivery and assessment, level of integration in the curriculum, level of collaboration with teaching staff) in medical libraries of Pakistan? 4.3.2.1 IL instruction activities. The respondents were asked if they offered some kind of IL instruction in their institutions. Fifty-one (73.9 %), the overwhelming majority of the respondents, replied “Yes” (Figure 4.1). 73 Yes 18 (26.1 %) No 51 (73.9 %) Figure 4.1: Status of IL instruction Activities (n = 69) 4.3.2.1.1 Pearson’s chi-square results. Pearson’s chi-square test was run to examine difference between the respondents employed in public and private sector medical institutions. Twenty-two (71.0 %) of 31 public sector head librarians reported providing IL instruction, compared to 29 (76.3 %) of 38 head librarians in private sector medical institutions. This difference was not significant, indicating similarities in the overall availability of instructional activities in public and private sector medical libraries (Table 4.3). 74 Table 4.3 Provision of IL Instruction in Public and Private Sector Institutions Provides IL Instruction Sector Yes No Total n (%) n (%) Public 22 (71.0 %) 9 (29.0 %) 31 Private 29 (76.3 %) 9 (23.7 %) 38 Total 51 (73.9 %) 18 (26.1 %) 69 Value Asymp. Sig. Phi (2-sided) 0.253 0.615 > 0.05 0.061 However, there were significant differences among respondents employed in medical colleges, medical universities, and postgraduate medical institutes in delivery of IL instruction (Table 4.4). To further explore the difference between all possible pairs of the subpopulations and their IL instruction activities, three post hoc chi-square tests were run to examine differences between: medical colleges and medical universities, medical colleges and postgraduate medical institutes, and medical universities and post graduate medical institutes. Thirty-four (77.3 %) out of 44 medical college libraries, 10 (90.9 %) out of 11 medical university libraries and 7 (50 %) out of 14 postgraduate medical institute libraries reported providing IL instruction. The results from the three post hoc chi-square tests (Table 4.4) indicated that only the difference between medical universities and postgraduate medical institutes, in term of offering IL instruction, was significant. A Phi value of 0.435 indicated a moderate difference existed between medical universities and postgraduate medical institutes. 75 Table 4.4 Provision of IL Instruction in Different Types of Institutions Provides IL Instruction Yes No n (%) n (%) Sector Total Value Asymp. Sig. (2-sided) Cramer’s V 6.057 0.048* 0.296 Medical Colleges 34 (77.3 %) 10 (22.7 %) 44 Medical Universities 10 (90.9 %) 1 (9.1 %) 11 Postgraduate Medical Institutes 7 (50.0 %) 7 (50.0 %) 14 Total 51 (73.9 %) 18 (26.1 %) 69 * The difference is significant at the 0.05 level. Note. Post hoc chi-square tests results: medical colleges and medical universities (χ2 (1) = 1.023, p = .312 > .05; Phi = 0.136); medical colleges and postgraduate medical institutes (χ2 (1) = 3.813, p = 0.051 > .05; Phi = 0.256); medical universities and postgraduate medical institutes (χ2 (1) = 4.738, p = .030 <0.05; Phi = 0.435). 4.3.2.2 Types of IL instruction offered. The respondents who said they offered IL instruction in their institutions were asked to indicate the types of IL instruction they had provided in the previous year in order to determine the range of IL instruction offered. Respondents were asked to choose one or more of five types of IL instruction: library orientation, guided library tour, introductory information skills (e.g., catalogue instruction, introduction to the library website), advanced information skills (e.g., database training, advance Internet searching) and research-level skills (e.g., literature searches and information management, reference styles, citation management software training, scholarly publishing, etc). Respondents offered a wide range of IL instruction, from library orientation to research-level skills. “Library orientation” was the most popular type of IL instruction offered, followed by “introductory information skills”, advanced information skills” and “guided library tour”. Fewer respondents offered research-level skills (Fig. 4.2). 76 45 41 (80.4 %) 40 33 (64.7 %) Frequesncy 35 30 (58.8 %) 28 (54.9 %) 30 21 (41.2 %) 25 20 15 10 5 0 Library Orientation Introductory Advanced Guided Library Information Skills Information Skills Tour Research-Level Skills Figure 4.2: Types of Information Literacy Instruction Offered (n = 51) There were no significant differences in type of IL instruction between public and private sector medical institutions (Table 4.5). Table 4.5 Difference between Sector of Institutions and Types of IL Instruction Offered S. No. Types of IL Instruction Value df Sig. (2-sided) Phi 1 Library orientation 0.50 1 1.000 .031 2 Guided library tour .375 1 .540 .086 3 Introductory information skills .534 1 .465 .102 4 Advanced information skills 2.855 1 .091 .237 5 Research-level skills 1.399 1 .237 .166 However, there were significant differences between medical colleges, medical universities and postgraduate medical institutes in terms of providing instruction in 77 “advanced information skills” and “research-level skills” (Table 4.6). Further analysis revealed a significant difference between medical colleges and medical universities in the delivery of “advanced information skills”. A Phi value of 0.296 indicated minor difference existed between them. The difference between medical colleges and postgraduate medical institutes in delivery of “advanced information skills” was also significant. A Phi value of 0.463 indicated moderate difference between them. However, no significant difference was found between medical universities and postgraduate medical institutes (Table 4.6). More medical university libraries (9 out of 10, 90.0 %) and postgraduate medical institutes libraries (6 out of 7, 85.7 %) reported providing “advanced information skills”, compared to medical college libraries (15 out of 34, 44.1 %). There was a statistically significant difference between medical colleges and medical universities in delivery of “research-level skills” (Table 4.6). A Phi value of 0.386 indicated a moderate difference existed between them. The difference between medical colleges and postgraduate medical institutes in delivery of research-level skills was also significant. A Phi value of 0.313 indicated moderate difference between them. However, no significant difference was found between medical universities and postgraduate medical institutes in delivery of research-level skills (Table 4.6). More medical university libraries (6 out of 10, 60.0 %) and postgraduate medical institute libraries (6 out of 7, 85.7 %) reported offering “research-level skills”, compared to medical college libraries (9 out of 34, 26.5 %). 78 Table 4.6 Difference between Types of Institutions and Types of IL Instruction Offered 1 Library orientation Fisher’s Exact Test Value 3.200 2 Guided library tour 1.387 2 0.489 0.165 3 Introductory information skills 3.530 2 0.201 0.262 4 Advanced information skills 8.879 2 0.009* 0.423 5 Research-level skills 10.231 2 0.004* 0.448 S. No. Types of IL Instruction df Cramer's V 2 Exact. Sig. (2-sided) 0.178 0.248 * The difference is significant at the 0.05 level. Note. Post hoc Fisher’s exact tests results: Advanced information skills: medical colleges and medical universities (p = 0.012 <0.05; Phi = 0.296); medical colleges and postgraduate medical institutes (p = 0.006 <0.05; Phi = 0.463); medical universities and postgraduate medical institutes (p = 0.338 >0.05; Phi = 0.278). Research-level skills: medical colleges and medical universities (p = 0.013 <0.05; Phi = 0.386); medical colleges and postgraduate medical institutes (p = 0.045 <0.05; Phi = 0.313); medical universities and postgraduate medical institutes (p = 1.000 >0.05; Phi = 0.065). 4.3.2.3 Topics covered in IL instruction programmes. A list of 15 topics was presented to those respondents who indicated that they offered IL instruction. They were asked to check the specific skills addressed in their IL instruction programmes. Space was provided to list additional topics if needed. Seven of 15 topics addressed in IL instruction programmes were mentioned by more than 50 % of the respondents (Table 4.7). Eight topics were mentioned by 47.1 % - 27.10 % of the respondents. An additional eight topics (literature searching for systematic reviews, writing of technical abstract, presentation skills, communication skills, information and communications technologies skills, effective use of social media, effective use of mobile 79 technologies, and identification of Medical Subject Headings) were added to the list by respondents. Table 4.7 Frequency Distribution of Topics Covered in IL Instruction Programmes (n = 51) S. NO IL Topics 1 Introduction to library resources, services and Frequency Percentage* 46 90.2 % policies 2 Online searching techniques 41 80.4 % 3 Use of medical databases 40 78.4 % 4 Use of Higher Education Commission (HEC) Digital 39 76.5 % Library 5 Identification of their own information needs 37 72.5 % 6 Use of search engines 37 72.5 % 7 Evaluation of information 28 54.9 % 8 Library website introduction 24 47.1 % 9 Plagiarism awareness/ethical use of information 20 39.2 % 10 Citation of information (Referencing styles) 20 39.2 % 11 Online public access catalogue (OPAC)/library 17 33.0 % catalogue introduction 12 Copyright 16 31.4 % 13 Scholarly publishing 15 29.4 % 14 Theory and practice of evidence-based medicine 14 27.5 % 15 Use of citation management software (Endnote, 14 27.5 % Refwork, etc.) *Respondents could choose more than one option, so results will not add to 100%. 4.3.2.4 IL instruction recipients. Respondents were asked to indicate for whom they provided IL instruction programmes. Fifty-one respondents answered this question. Fortyfour (86.3 %) respondents provided IL instruction to undergraduate students. This finding is to be expected, because the majority of respondents were from medical colleges, which 80 largely have undergraduate medical students. Thirty-six of the respondents (70.6 %) offered IL instruction for faculty, 30 (58.8 %) for postgraduate students and 22 (43.1%) for practitioners. IL instruction was also provided to paraprofessionals and staff (8 respondents, 15.7 %) and the Sri Lankan dengue team (1, 0.02 %) was mentioned by a respondent in the open-ended option for this question (Table 4.8). Table 4.8 Frequency Distribution of IL Instruction Recipients (n = 51) S. NO IL Instruction Recipients Frequency Percentage* 1 Undergraduate students 44 86.3 % 2 Faculty 36 70.6 % 2 Postgraduate students 30 58.8 % 3 Practitioners 22 43.1 % 4 Para-professionals/staff 8 15.7 % 5 Sri Lankan dengue team 1 0.02 % *Respondents could choose more than one option, so results will not add to 100%. 4.3.2.5 Approaches of providing IL instruction. The survey also questioned respondents about the mode or approach used to provide IL instruction at their institutions. Results showed that IL instruction was most commonly provided to first-time users, followed by “whenever asked to do so”. The other options were chosen less frequently (Table 4.9). 81 Table 4.9 Frequency Distribution of Approaches of Providing IL Instruction (n = 51) S. NO IL Instruction Approaches Frequency Percentage* 1 To new session / first time users 44 86.3 % 2 Whenever asked to do so 37 72.5 % 3 At specific time after the installation or acquisition of a new system or information sources IL is a required course for students 16 31.4 % 13 25.5 % 4 *Respondents could choose more than one option, so results will not add to 100%. 4.3.2.6 IL instruction delivery venues. Results indicated that the respondents offered IL instruction in a computer lab, library training room or lecture hall outside the library. It is interesting to note that 11 (21.6 %) mentioned that they used the library reading room for this purpose in an open-ended option for this question (Table 4.10). Table 4.10 Frequency Distribution of IL Instruction Delivery Venues (n = 51) S. NO IL Delivery Venue Frequency Percentage* 1 In computer lab 24 47.1 % 2 In lecture hall outside the library 22 43.1 % 3 In library training room 22 43.1 % 4 In library reading room 11 21.6 % *Respondents could choose more than one option, so results will not add to 100%. 4.3.2.7 IL instruction delivery methods. Respondents were asked to indicate IL instruction delivery methods used in their institutions. The most popular IL instruction delivery method was "face-to-face," followed by "individual instruction at reference desk" and "workshops and seminars". Respondents did not frequently select online or web-based tutorials (Table 4.11). 82 Table 4.11 Frequency Distribution of IL Instruction Delivery Methods (n = 51) S. NO IL Instruction Delivery Methods Frequency Percentage* 1 Face-to-face 44 86.3 % 2 Individuals instruction at the reference 36 70.6 % desk 3 Workshops / seminars 21 41.2 % 4 Printed training manuals 12 23.5 % 5 Combination of online and face-to-face 5 9.8 % 6 Online / web based tutorials 2 3.9 % *Respondents could choose more than one option, so results will not add to 100%. 4.3.2.8 Assessment of IL instruction effectiveness. Thirty-four (66.7 %) respondents reported that they assessed the effectiveness of their IL sessions (Figure 4.3). There were no differences in frequency of assessment between public and private institutions (Table 4.12) or among colleges, universities and postgraduate institutes (Table 4.13). Yes No 17 (33.3 %) 34 (66.7 %) Figure 4.3: Assessment of IL Instruction Effectiveness (n = 51) 83 Table 4.12 Difference between Sector of Institutions and Their Assessment Activities (df = 1) Sector Assessed IL Instruction Effectiveness Yes No n (%) n (%) Total Value Sig. (2-sided) Phi 0.999 0.318 > 0.05 0.140 Public 13 (59.1 %) 9 (40.9 %) 22 Private 21 (72.4 %) 8 (27.6 %) 29 Total 34 (66.7 %) 17 (33.3 %) 51 Table 4.13 Difference among Types of Institutions and Their Assessment Activities (df= 2) Assessed IL Instruction Effectiveness Yes No n (%) n (%) Sector Total FET Value Exact. Sig. (2-sided) Cramer's V 0.410 0.906 > 0.05 0.075 Medical College 23 (67.6 %) 11 (32.4 %) 34 Medical University 6 (60.0 %) 4 (40.0 %) 10 Postgraduate Medical Institute 5 (71.4 %) 2 (28.6 %) 7 Total 34 (66.7 %) 17 (33.3 %) 51 4.3.2.8.1 Assessment methods. Those who performed an evaluation were asked a follow-up question with eight options about the evaluation methods. Oral and written feedbacks were the most common approaches used to evaluate the effectiveness of IL instruction programmes (Table 4.14). Only a few respondents used more formal assessment methods. 84 Table 4.14: Frequency Distribution of IL Instruction Assessment Methods (n = 34) S. NO IL Instruction Assessment Methods Frequency Percentage* 1 Oral feedback 22 64.7 % 2 Written feedback 16 47.1 % 3 Assessment through practical searching 11 32.4 % in computer lab 4 Assignment 10 29.4 % 5 Short answers 7 20.6 % 6 Collaborative learning exercise in class 4 11.8 % 7 Quizzes 4 11.8 % 8 Multiple Choice Questions (MCQs) 4 11.8 % *Respondents could choose more than one option, so results will not add to 100%. 4.3.2.9 Integration of IL instruction into the curriculum. Respondents were asked whether IL instruction was integrated into the curriculum. Thirteen (26.0 %) of the 50 respondents responded "Yes"(Figure 4.4). 13 (26.0 %) Yes No 37 (74.0 %) Figure 4.4: IL Instruction Integrated into the Curriculum (n = 50) 85 4.3.2.9.1 Level of IL instruction integration into the curriculum. The 13 respondents who indicated that IL instruction was integrated into the curricula of their institutions were asked at which level it was integrated and if the IL instruction was integrated as a credit or non-credit course. IL instruction was integrated in nine medical institutions at undergraduate level and in 12 institutions at postgraduate level as non-credit courses. None of the institutions provided IL instructions as a for-credit course (Table 4.15). Table 4.15 Level of IL Instruction Integration into the Curriculum IL Instruction Integrated into the Curriculum Yes No n (%) n (%) IL instruction integration Level N Undergraduate level 11 9 (81.8 %) Postgraduate level 12 11 (91.7 %) As a credit course As non-credit course 2 (18.2 %) Nil 9 (100.0 %) 1 (8.3 %) Nil 11 (100.0 %) 4.3.2.10 Librarian and faculty collaboration. To identify faculty involvement in the development of IL instruction programmes, respondents were asked whether they developed IL instruction programmes in collaboration with faculty. Surprisingly, only 40 respondents responded to this question. Of the 40, 18 (45.0 %) responded “Yes” (Figure 4.5).It shows that majority of the head librarians develop IL instruction programmes without involvement of medical faculty. 86 Yes 18 (45.0 %) No 22 (55.0 %) Figure4.5: Librarian and Faculty Collaboration (n = 40) 4.3.2.11 Staff responsible for running IL instruction programmes. Respondents were asked who had responsibility for the IL instruction programmes in their institution: librarians, faculty, or both faulty and librarians in collaboration. Thirty-three (66.0 %) respondents mentioned that only librarians were providing IL instruction programmes, 17 (34.0 %) indicated that librarians and faculty collaborated and only five (10.0 %) indicated faculty were solely responsible for proving the IL instruction programmes at their institutions (Figure 4.6). 87 35 33 (66.0 %) 30 Frequency 25 20 17 (34.0 % 15 10 5 (10.0 %) 5 0 Librarians Faculty Both Faculty and Librarians in Collaboration Figure 4.6: Staff Responsible for Running IL Instruction Programmes (n = 50) 4.3.3 Barriers When Advocating or Providing IL Instruction This segment was designed to answer the third research question of this study i.e., what are the barriers when advocating or providing IL instruction in medical institutions? Respondents were presented with a list of 12 pre-defined barriers and an open-ended "any other barriers" option at the end. They were asked to indicate their level of agreement with the possible barriers when advocating or providing IL instruction in medical institutions on a scale of 1 (strongly disagree) to 5 (strongly agree). The purpose of this question was to identify the factors hindering implementation of IL instruction programmes in medical institutions or preventing their systematic development. The perceptions of head librarians from public and private sector medical institutions about each barrier in the form of mean, standard deviation (SD) and rank are presented separately in Table 4.16. The statements were ranked from highest to lowest according to the mean score. In case of a tie, the IL skills with the low standard deviation were ranked higher. 88 Independent-samples t-test was applied to examine whether there were significant differences in the opinion of head librarians employed in public and private sector medical institutions. Table 4.16 also provides the t-test significance value (p value). Table 4.16 Barriers to IL Instruction Programmes Along With t-test Results S. No Barriers Sector n Rank Mean SD Sig. (2-tailed) 1 Lack of training opportunities for IL instruction for librarians Public Private 31 38 1 2 4.39 4.11 .715 .863 .150 2 Lack of policy regarding IL instruction in the medical institutions Public Private 31 37 2 1 4.23 4.30 .762 .520 .649 3 Lack of collaboration between librarians and medical faculty Public Private 29 38 3 4 4.07 3.84 .961 .916 .329 4 Management is interested Public more in developing Private 30 38 4 5 4.03 3.66 .928 .966 .110 physical infrastructure than IL skills development 5 Lack of awareness regarding the importance of IL instruction among the medical community Public Private 31 38 5 7 3.94 3.61 .929 .946 .150 6 Shortage of library staff to provide IL instruction Public Private 31 38 6 6 3.90 3.66 1.012 1.072 .336 7 IL instruction is not part of the curriculum Public Private 31 37 7 3 3.74 4.00 1.094 .913 .293 8 Lack of IL expertise among medical librarians Public Private 31 38 8 8 3.68 3.58 1.013 1.030 .692 9 Lack of time by librarians due to professional work Public Private 9 11 3.65 3.18 1.199 1.136 .107 31 38 89 S. No Barriers Sector n Rank Mean SD Sig. (2-tailed) 10 Lack of commitment among librarians for IL instruction Public Private 31 37 10 9 3.45 3.35 1.028 1.184 .713 11 Lack of interest by the users Public Private 30 38 11 10 3.37 3.34 1.033 1.047 .923 Library being part of administration not academics Public Private 27 32 12 12 3.19 3.03 1.178 1.062 .600 12 All the respondents agreed with 12 statements regarding barriers to IL instruction programmes, however, head librarians from public sector institutions strongly agreed to following four statements: “lack of training opportunities for IL instruction for librarians”, “lack of policy regarding IL instruction in the medical institutions”, “lack of collaboration between librarians and faculty” and “management is interested more in developing physical infrastructure than IL skills development” and were ranked first, second, third and fourth respectively. The other eight statements (S. No. 5 to 12) got mean score ranging from 3.94 to 3.03. The head librarians from private sector medical institutions strongly agreed to only three statements (S. No. 1, 2, 7) and other nine statements received mean scores between 3.84 and 3.03. There was a consensus between the public sector and private sector respondents that "lack of training opportunities for IL instruction for librarians" and "lack of policy regarding IL instruction in the medical institutions" were the two most important barriers to IL instruction programmes in medical institutions. 90 4.3.3.1Independent samples t-test results. Independent samples t-tests were run to assess differences between the perceptions of head librarians working in the public and private sector medical institutions. The results reveal that the difference between the mean scores of two groups of head librarians on all 12 barriers were not significant at the alpha level of 0.05 (Table 4.16). It means that no significant differences exist in the perceptions of public and private sector head librarians. 4.3.3.2 One-way ANOVA results. One-way ANOVA was applied on composite mean scores of respondents, to know whether there were significant differences in the perceptions of head librarians belonging to three groups based on type of institutions (medical colleges, medical universities and postgraduate medical institutes). The results reveals that differences among the perceptions of three groups of head librarians were not significant (F (2) = .762, Sig. = .471). It means that no significant differences exist in the perceptions of head librarians employed in three types of institutions. 4.3.4 IL Instruction Training Needs of Medical Librarians This segment sought to answer the fourth research question of this study i.e., what are the IL instruction training needs of medical librarians? Four questions were asked from the respondents to find out IL instruction education and training that head librarians got, their knowledge of IL instruction and IL instruction training needs of medical librarians. 4.3.4.1 IL instruction training received by the head librarians. Respondents were asked if they had studied IL instruction as a part of their LIS curriculum. Out of the 66 respondents, 42 (63.6 %) revealed that they did not study IL instruction as a part of their LIS curriculum while 24 (36.6 %) responded "Yes" (Figure 4.7). Apparently, few LIS schools in 91 Pakistan offer IL instruction course for graduating librarians, therefore, most of the medical librarians lack formal pedagogical training. 24 (36.4 %) Yes No 42 (63.6 %) Figure 4.7: Studied IL Instruction as a Part of Their LIS Curriculum (n = 66) Respondents were also enquired whether they had attended any short course or workshop on IL instruction in the previous year. It was learned that out of the 65 respondents 41 (63.1 %) did not attend any short course or workshop on IL in the previous year (Figure 4.8). It shows that most of the medical librarians lack IL instruction training. 92 24 (36.9 %) Yes No 41 (63.1 %) Figure 4.8: Short Course or Workshop Attended on IL Instruction (n = 65) 4.3.4.2 Knowledge of IL instruction areas. The respondents were presented with a list of five IL instruction areas and were asked to rate their knowledge as fairly as possible on a scale of 1 (very weak) to 5 (very strong). This question was important to assess the existing knowledge of head librarians and to identify their weak areas. Mean, SD and rank (from highest to lowest according to the mean score) of the perceptions of head librarians from public and private sector institutions about each IL instruction area were computed and are presented separately in Table 4.17. For each IL instruction area value of t-test significance (p value) is also reported in Table 4.17. 93 Table 4.17 Self-perceived IL Instruction Knowledge of Respondents Along With t-test Results S. No IL Instruction Areas Sector n Rank Mean SD Sig. (2-tailed) 1 Core concepts of IL instruction Public Private 31 36 1 2 3.52 3.44 1.029 .998 .774 2 Awareness raising and advocating need for IL instruction Public Private 31 37 2 1 3.42 3.49 .886 .870 .754 3 Designing IL instruction programme for your patron Public Private 31 35 3 3 2.94 3.20 1.063 1.132 .333 4 Knowledge of different IL standards e. g. ACRL Information Literacy Competency Standard, IFLA IL standards, etc. Public Private 31 37 4 4 2.68 3.00 1.166 1.179 .263 5 Knowledge of different IL models e. g. Big6, empowering 8, etc. Public Private 31 37 5 5 2.35 2.68 1.082 1.056 .221 All the five IL instruction areas got a mean score of less than four from both group of head librarians. It suggests that overall IL instruction knowledge of head librarians is inadequate. Two IL instruction areas “core concepts of IL instruction”, ranked first and “awareness raising and advocating need for IL instruction”, ranked second got a mean score of more than three, i.e., 3.52 and 3.42 respectively from public sector head librarians while four IL instruction areas (S. No 1 to 4) received three or higher mean score from private sector head librarians. The knowledge of different IL models was identified as the weakest IL instruction area by both groups of head librarians. Public sector head librarians also perceived their knowledge of designing IL instruction programme for patrons and knowledge of different IL standards as weak (Table 4.17). This situation cannot be fair to the clients of 94 IL instruction, nor can it lead to effective delivery of IL instruction. Unfortunately, it also raises serious questions about the professionalism of librarians. In order to address this issue the need is strongly felt to design a well-structured system promoting professional development of LIS professionals. 4.3.4.2.1 Independent samples t-test results. Independent samples t-tests were run to assess differences between the perceptions of head librarians working in the public and private sector medical institutions. The results reveal that the differences between the mean scores of two groups of head librarians on all five IL instruction areas were not significant at the alpha level of 0.05 (Table 4.17). It implies that no significant differences exist in the perceptions of public and private sector head librarians. 4.3.4.2.2 One-way ANOVA results. One-way ANOVA was applied on the composite mean scores of respondents to know whether there were significant differences in the perceptions of head librarians belonging to three groups based on type of institutions (medical college, medical university and postgraduate medical institutes). It results reveal that differences among the perceptions of three groups of head librarians were not significant (F (2) = 1.486, Sig. = 0.234). It implies that no significant differences exist in the perceptions of head librarians employed in three types of institutions. 4.3.4.3 Interests in developing IL instruction proficiencies. Medical librarians require certain expertise to run IL instruction programmes in their respective institutions and to cultivate IL in their library users. It was important to identify the competencies for medical librarians for implementation of IL instruction programmes effectively in the medical institutions. The respondents were presented with a list of 11 IL instruction proficiencies followed by a 5-point Likert scale 1 (least interested) to 5 (most interested). The respondents 95 were asked to select one of the values to express their interest in the IL instruction proficiencies. The interests of head librarians from public and private sector institutions in 11 proficiencies in the form of mean, standard deviation (SD) and rank are presented separately in Table 4.18. The statements were ranked from highest to lowest according to the mean score. In case of a tie, the IL skills with the low standard deviation were ranked higher. 96 Table 4.18 IL Instruction Proficiencies Along With t-test Results S. No IL Instruction Proficiencies Sector n Rank Mean SD Sig. (2-tailed) 1 Developing IL course contents Public Private 30 38 1 2 4.27 4.29 .691 .732 .896 2 Developing need assessment of IL instruction at your institution Public Private 31 38 2 6 4.23 4.13 .956 .623 .624 3 IL teaching methods Public Private 30 38 3 5 4.20 4.24 .887 .852 .862 4 Developing and promoting IL instruction programme in the institution Public Private 29 38 4 3 4.17 4.26 .928 .724 .654 5 Presentation skills Public Private 31 38 5 1 4.13 4.42 1.056 .599 .153 6 Integrating IL instruction into the curriculum Public Private 30 38 6 9 4.03 3.95 .809 .868 .678 7 IL instructional design skills Public Private 31 37 7 4 4.03 4.24 .948 .641 .280 8 Developing online IL tutorials Public Private 29 37 8 8 4.00 4.03 1.035 .833 .907 9 Planning skills to continuously run and improve IL programmes Public Private 31 38 9 7 3.87 4.03 1.024 .716 .462 10 Administrative skills for running IL instruction programmes Public Private 31 38 10 11 3.84 3.82 1.098 .982 .927 11 Evaluation and assessment skills Public Private 31 38 11 10 3.81 3.82 1.078 .896 .969 97 Table 4.18 shows that the respondents were interested in professional development opportunities designed to strengthen their abilities in each of the eleven IL instruction proficiencies listed in the table, all receiving mean score of higher than three. The IL instruction proficiency “developing IL course contents” got the highest mean scores (4.27) from public sector librarians and was thus ranked first. “Developing need assessment of IL instruction at your institution” (mean score of 4.23) and “IL teaching methods” (mean score of 4.20) were ranked second and third by public sector head librarians. While “presentation skills” (mean score of 4.42), “developing IL course contents” (mean score of 4.29), “developing and promoting IL instruction programme in the institution” (mean score of 4.26) were ranked first, second and third respectively by private sector head librarians. Eight (S. No 1 to 8) out of 11 IL instruction proficiencies received four or more mean scores from public sector head librarians. While eight IL instruction proficiencies (S. No 1 to 5 and 7 to 9) got mean scores of higher than four from private sector head librarians. “Administrative skill for running IL instruction programmes” and “evaluation and assessment skills” were ranked lowest by both groups of respondents. Surprisingly, “integrating IL instruction into the curriculum” also got less than four i.e., 3.95 mean score from private sector head librarians and was ranked ninth. The results suggest a range of IL instruction proficiencies in which medical librarians are interested. LIS schools that are truly committed to prepare their MLIS graduates for professional roles in today’s libraries should address these proficiencies in their curriculum. These proficiencies may also provide guidance to LIS associations and other training agencies in designing their courses. 98 4.3.4 .3.1 Independent samples t-test results. Independent samples t-tests were run to assess differences between the interests of head librarians working in the public and private sector medical institutions. The results reveal that the differences between the mean scores of two groups of head librarians on all 11 IL instruction proficiencies were not significant at the alpha level of 0.05 (Table 4.18). It implies that no significant differences exist in the interest of public and private sector head librarians. 4.3.4.3.2 One-way ANOVA results. One-way ANOVA was applied on composite mean scores to know whether there were significant differences in the interest of head librarians belonging to three groups based on type of institutions (medical college, medical university and postgraduate medical institutes). The results reveal that differences among the perceptions of three groups of head librarians were not significant (F = 0.762, Sig. = 0.471). It implies that no significant differences exist in the interests of head librarians employed in three types of institutions. The findings from the t-tests and one-way ANOVA suggested that future professional development opportunities in all the eleven IL instruction knowledge and skills (Table 4.18) should be designed to support the needs of the total population as no significant differences between the sub-populations on this measure were found. 4.3.5 Strategies for the Effective Implementation of IL Instruction Programmes This segment of the questionnaire was designed to answer the fifth research question of the study i.e., what are the strategies to be adopted for the effective implementation of IL instruction programmes in academic medical institutions of Pakistan? Six questions were asked to seek each respondent’s opinion on information literacy (IL) skills of their library 99 users, effective IL teaching methods, approaches suitable for IL mainstreaming and suitable staff to be involved in IL instruction curriculum designing and teaching. 4.3.5.1 Perceptions of head librarians regarding IL skills of their library users. Respondents were asked to rate eight IL skills of their library users on a 5-point Likert scale 1 (very poor) to 5 (very strong). The underlying premise of the question was since librarians interact with their users during the information search process, their observations should be important in determining the user’s IL skills. The responses (rank, mean and standard deviation) of public and private sector head librarians regarding each IL skill are presented separately in Table 4.19 along with the value of t-test significance (p value). 100 Table 4.19 Perceived Level of Library Users’ IL Skills Along With t-test Results S. No IL Skills Sector n Rank Mean SD Sig. (2-tailed) 1 Locating relevant information sources in the library Public Private 31 38 1 1 3.77 3.53 .884 .862 .224 2 Identifying Public authoritative/reliable Private information sources, such as journals articles 30 38 2 3 3.47 3.39 1.008 .755 .738 3 Using print and online resources legally and ethically Public Private 30 38 3 7 3.27 3.16 .980 .886 .633 4 Searching online databases Public Private 30 37 4 2 3.17 3.41 1.177 .865 .342 5 Formulation of search strategy using keywords to search information from the Internet Public Private 30 38 5 5 3.00 3.21 1.017 .905 .370 6 Evaluation of information for authenticity, currency and accuracy Public Private 30 36 6 6 2.93 3.17 .980 .811 .294 7 Citing sources appropriately Public Private 30 35 7 8 2.87 2.91 1.008 .818 .834 8 Use of OPAC/library catalogue Public Private 27 36 8 4 2.81 3.28 1.241 1.003 .107 None of the IL skills received a mean score exceeding four from both public and private sector respondents, which is an indication of low level of perceived IL skills of library users. 101 The respondents from public sector institutions believed that five IL skills of their library users (S. No. 1 to 5) were of moderate level and got mean scores in the range of 3.77 and 3.00. The IL skills “locating relevant information sources in the library” was ranked first, followed by “identifying authoritative/reliable information sources such as journals articles”, ranked second and “using print and online resources legally and ethically”, was ranked third. However, three IL skills of library users viz., “evaluation of information for authenticity, currency and accuracy”, “citing sources appropriately” and “use of OPAC/library catalogue” got mean scores less than three and were perceived by respondents as weak. The respondents from private sector medical institutions rated their user’s IL skills as moderate in the seven areas (S. No. 1 to 6 and 8). The IL skill “locating relevant information sources in the library” got a mean score of 3.53 and was ranked first, followed by “searching online databases” ranked second (mean 3.41) and “identifying authoritative/reliable information sources” was ranked third (mean 3.39). The other four IL skills (S. No. 3, 5, 6, 8) got mean score in the range of 3.28 and 3.16. The IL skill “citing sources appropriately” was the only that was considered weak by private sector respondents as it got a mean score of less than three i.e., 2.91. The results suggest that IL skills in all the eight areas are required to be improved by offering IL instruction to library users. 4.3.5.1.1 Independent samples t-test results. Independent samples t-tests were run to assess differences between the perceptions of head librarians working in the public and private sector medical institutions. The results reveal that the difference between the mean scores of two groups of head librarians on all eight IL skills were not significant at the alpha 102 level of 0.05 (Table 4.19). It implies that no significant differences exist in the perceptions of public and private sector head librarians. 4.3.5.1.2 One-way ANOVA results. One-way ANOVA was applied to know whether there were significant differences in the perceptions of head librarians belonging to three groups based on type of institutions (medical colleges, medical universities and postgraduate medical institutes). The results reveal that differences among the perceptions of three groups of head librarians were not significant (F = 0.762, Sig. = 0.471). It implies that no significant differences exist in the perceptions of head librarians employed in three types of institutions. 4.3.5.2 Perceptions of head Librarians regarding effective methods for imparting IL instruction. The respondents were asked to rate the effectiveness of five IL instruction delivery methods, enlisted in the questionnaire, on a 5-point Likert scale of 1 (least effective) to 5 (most effective). The purpose of this question was to identify the most effective IL instruction methods for medical institutions. The results are presented in Table 4.20 after computing mean, standard deviation (SD) and rank of head librarians’ perception working in public sector and private sector medical institutions separately. The significant difference between the two groups of head librarians was also examined, using independent samples ttests and p values are also reported in Table 4.20. 103 Table 4.20 Perceived Effective Methods for Imparting IL Instruction Along With t-test Results S. No Methods Sector n Rank Mean SD Sig. (2-tailed) 1 Workshops and seminars Public Private 29 38 1 2 4.28 4.05 .797 .769 .251 2 Formal class teaching as part of the main curriculum Public Private 30 38 2 1 3.97 4.26 1.033 .828 .193 3 One-shot group session for new entrants Public Private 30 37 3 5 3.33 2.97 1.124 .957 .161 4 Web tutorials Public Private 30 37 4 4 3.47 3.27 1.008 .932 .411 5 As an extracurricular course Public Private 30 38 5 3 3.30 3.47 .915 .725 .386 The respondents from public sector medical institutions considered “workshops and seminars” as the most effective method for IL instruction delivery and ranked it first with a mean score of 4.28. The other four methods (S. No 2 to 5), although considered effective, got mean score of less than four (Table 4.20). The respondents from private sector medical institutions believed that “formal class teaching as part of the main curriculum” (ranked first with a mean score of 4.26) and “workshops and seminars” (ranked second with a mean score of 4.05) were the most effective IL instruction delivery methods. Two IL instruction delivery methods “as an extracurricular course” (mean score 3. 47) and “web tutorials” (mean score 3.27) got mean score of less than four from private sector respondents. However, they did not consider the “one-shot group session for new entrants” (mean score 2.97) as an effective method for IL instruction delivery. A respondent also mentioned of “through posters displayed in the library hall and on notice boards as it is difficult for students to spare time due to tough routine of classes and wards” in the open-ended (other methods) option. 104 4.3.5.2.1 Independent samples t-test results. Independent samples t-tests were run to examine differences between the perceptions of head librarians working in the public and private sector medical institutions. The results reveal that the differences between the mean scores of two groups of head librarians on all five IL instruction methods were not significant at the alpha level of 0.05 (Table 4.20). It implies that no significant differences were found in the perceptions of public and private sector head librarians. 4.3.5.2.2 One-way ANOVA results. One-way ANOVA results (F = 3.345, Sig. = 0.041) show that F value is significant at 0.05 level of significance. It reveals significant differences in the perceptions of head librarians employed in three types of institutions (medical colleges, medical universities and postgraduate medical institutes). 4.3.5.2.3 Multiple (post hoc) comparisons results. Further analysis using post hoc (LSD) test of one-way ANOVA (Table 4.21) shows significant differences of opinion regarding effectiveness of IL methods between medical universities and medical colleges (p = .012) at the 0.05 level. The composite mean score (4.05) of respondents from medical universities is significantly higher than of composite mean score (3.55) of medical colleges. 105 Table 4.21 Effectiveness of IL Methods: Multiple (Post hoc) Comparisons Multiple comparison Mean Difference Sig. (p value) (I – J) (I) Type of Institution (J) Type of Institution Medical Universities Medical Colleges 0.50303* 0.012 Postgraduate Medical Institutes Medical Colleges 0.11374 0.523 Medical Universities Postgraduate Medical Institutes 0.38929 0.099 * The mean difference is significant at the .05 level. 4.3.5.3 Teaching IL skills to medical students. It was very important to learn respondents’ opinion regarding integration of IL instruction into the curriculum; therefore, they were asked how IL skills should be taught to medical students: "as an extracurricular course" or "as part of main curriculum/integrated into the curriculum". Majority of the respondents were in favour of integrating IL instruction into the curriculum (Figure 4.9). 106 As an extra curricular course As part of main the curriculum 28 (40.6 %) 41 (59.4 %) Figure 4.9: Teaching IL Skills to Medical Students (n = 69) 4.3.5.3.1 Pearson’s chi-square test results. Pearson’s chi-square test and Phi measures (due to 2 x 2 contingency table) were utilized to explore the difference between the opinions of sub-populations (respondents from public and private sector medical institutions) regarding teaching IL skills to medical students. Table 4.22 shows that there was no significant difference between the respondents in public and private sector medical institutions indicating similarities in their opinions. 107 Table 4.22 Difference between the Opinions of Respondents Regarding Teaching IL Skills to Medical Students Based on Sector of Institutions (n = 69) Teaching IL Skills to Medical Students Sector As an As part of main the Total Asymp. Sig. Phi  extracurricular curriculum/Integrated (2-sided) course into the curriculum n (%) n (%) Public 15 (48.4 %) 16 (51.6 %) 31 Private 13 (34.2 %) 25 (65.8 %) 38 Total 28 (40.6 %) 41 (59.4 %) 69 1.423 0.233 > 0.05 0.144 4.3.5.3.2 Fisher’s exact test (FET) results. Fisher’s exact test (data had less than 5 counts) and Cramer’s V measures (due to 2 x 3 contingency table) were utilized to explore the differences between the opinions of sub-populations (respondents from medical colleges, medical universities and postgraduate medical institutes) regarding teaching IL skills to medical students. Table 4.23 illustrates that there were no significant differences among respondents in three types of institutions indicating similarities in their opinions. 108 Table 4.23 Difference between the Opinions of Respondents Regarding Teaching IL Skills to Medical Students Based on Types of Institutions (n = 69) Types of Institutions Teaching IL Skills to Medical Students As an As part of main the extracurricular curriculum/Integrated course in the curriculum n (%) n (%) Total FET Value Exact Sig. (2-sided) Cramer’ V 2.692 .276> 0.05 .200 Medical Colleges 20 (45.5 %) 24 (54.5 %) 44 Medical Universities 2 (18.2 %) 9 (81.8 %) 11 Postgraduate Medical Institutes 6 (42.9 %) 8 (57.1 %) 14 Total 28 (40.6 %) 41 (59.4 %) 69 4.3.5.4 Integration of IL instruction into the curriculum. The respondents who opined that IL skills should be taught to medical students as part of the main curriculum/integrated into the curriculum were further queried about how IL should be integrated into the curriculum: as an independent course or part of another course. The majority of respondents (28 or 70.0 %) opined that IL should be integrated into the curriculum as an independent course and 12 (30.0 %) supported it as part of another course (Figure 4.10). 109 As an idependent course Part of another course 12 (30 %) 28 (70 %) Figure 4.10: Integration of IL Instruction into the Curriculum (n = 40) 4.3.5.4.1 Fisher’s exact test (FET) results. Table 4.24 shows that there was no significant difference between the opinions of sub-populations (respondents from public and private sector medical institutions) regarding integration of IL instruction into the curriculum, indicating similarities in their opinions. Table 4.24 Difference between the Opinions of Respondents Regarding Integrating IL Instruction into the curriculum Based on Sector of Institutions (n = 40) Sector Integrating IL Instruction into the Curriculum As an independent Part of another course course n (%) n (%) Total FET Value Exact Sig. (2-sided) Phi 0.020 1.000 > 0.05 0.022 Public 11 (68.8 %) 5 (31.2 %) 16 Private 17 (70.8 %) 7 (29.2 %) 24 Total 28 (70.0 %) 12 (30.0 %) 40 110 Table 4.25 shows that there were no significant differences among the opinions of sub-populations (respondents from medical colleges, medical universities and postgraduate medical institutes) regarding integrating IL instruction into the curriculum, indicating similarities in their opinions. Table 4.25 Difference between the Opinions of Respondents Regarding Integrating IL Instruction into the Curriculum Based on Types of Institutions (n = 40) Integrating IL Instruction into the Curriculum Type of As an Part of another Total FET Exact Sig. Cramer’ V Institution independent course Value (2-sided) course n (%) n (%) Medical College 18 (75.0 %) 6 (25.0 %) 24 Medical University 6 (75.0 %) 2 (25.0 %) 8 Postgraduate Medical Institute 4 (50.0 %) 4 (50.0 %) 8 Total 28 (70.0 %) 12 (30.0 %) 40 1.903 .404> 0.05 .218 4.3.5.5 Mode of integration of IL instruction into the curriculum. The respondents who opined that IL instruction should be taught to medical students as part of the main curriculum/ integrated into the curriculum were further asked how IL instruction should be integrated in the curriculum: either as a credit course or as a non-credit course. The majority of the respondents opined that IL instruction should be integrated into the curriculum as a credit course (Figure 4.11). 111 As a credit course 10 (24.4 %) As a non-credit course 31 (75.6 %) Figure 4.11: Mode of Integration of IL Instruction into the Curriculum (n = 41) 4.3.5.5.1 Fisher’s exact test (FET) results. Table 4.26 reveals that there is no significant difference between the opinions of respondents in public and private sector medical institutions regarding mode of integration of IL instruction into the curriculum indicating similarities in their opinions. Table 4.26 Difference between the Opinions of Respondents Regarding Mode of Integration of IL Instruction into the Curriculum Based on Sector of Institutions (n = 41) Mode of Integration of IL Instruction into the Curriculum Sector As a credit course As a non-credit Total FET Exact Sig. n (%) course Value (2-sided) n (%) Public 13 (81.2 %) 3 (18.8 %) 16 Private 18 (72.0 %) 7 (28.0 %) 25 Total 31 (75.6 %) 10 (24.4 %) 41 0.453 0.712 > 0.05 Phi 0.105 112 There were also no significant differences of opinions among respondents in medical colleges, medical universities and postgraduate institutes (Table 4.27) regarding mode of integration of IL instruction into the curriculum indicating similarities in their opinions. Table 4.27 Difference between the Opinions of Respondents Regarding Mode of Integration of IL Instruction into the Curriculum Based on Types of Institutions (n = 41) Mode of Integration of IL Instruction into the Curriculum Types of As a credit As a non-credit Total FET Exact Sig. Cramer’ V Institutions course course Value (2-sided) n (%) n (%) Medical Colleges 18 (75.0 %) 6 (25.0 %) 24 Medical Universities 5 (55.6 %) 4 (44.4 %) 9 Postgraduate Medical Institutes 8 (1.00 %) 0 (0.0 %) 8 Total 31 (75.6 %) 10 (24.4 %) 41 4.347 0.109> 0.05 0.333 4.3.5.6 Responsibility for designing IL instruction curriculum. Respondents were queried about who they believed should be responsible for designing the curriculum for IL instruction: faculty, librarian or both. An overwhelming majority replied that both librarian and faculty should be responsible for this, only five respondents mentioned of the librarian only, and none of the respondents believed that only faculty should be responsible for designing the curriculum of IL instruction (Figure 4.12). It suggests interaction between librarians and faculty to bring mutually agreed upon approaches to IL instruction designing. 113 5 (7.5 %) Librarian Both Librarian and faculty 62 (92.5 %) Figure 4.12: Responsibility for Designing IL Instruction Curriculum (n =67) 4.3.5.6.1 Fisher’s exact test (FET) results. There was no significant difference in the opinions of respondents from public and private sector medical institutions regarding responsibility for designing IL instruction curriculum (Table 4.28) indicating similarities in their opinions. Table 4.28 Difference between the Opinions of Respondents Regarding Responsibility for Designing IL Instruction Curriculum Based on Sector of Institutions (n = 67) Responsibility for Designing IL Instruction Curriculum Sector Librarian Both librarian Total FET Value Exact Sig. Phi and faculty (2-sided) n (%) n (%) Public 3 (10.0 %) 27 (90.0 %) 30 Private 2 (5.4 %) 35 (94.6 %) 37 Total 5 (7.5 %) 62 (92.5 %) 67 0.506 0.650 > 0.05 0.087 114 However, there were significant differences among the opinions of respondents in medical colleges, medical universities and postgraduate institutes (Table 4.29) regarding responsibility of delivering IL instruction, indicating differences in their opinions. However, post-hoc comparison did not show these results to be significantly different between all the sub-populations (Table 4.29). Table 4.29 Difference between the Opinions of Respondents Regarding Responsibility for Designing IL Instruction Curriculum Based on Types of Institutions (n = 67) Type of Institution Responsibility of Designing IL Instruction Curriculum Librarian Both librarian and faculty n (%) n (%) Total FET Value Exact Sig. (2-sided) Cramer’s V 5.494 0.048*<0.05 0.341 Medical Colleges 2 (4.7 %) 41 (95.3 %) 43 Medical Universities 3 (27.3 %) 8 (72.7 %) 11 Postgraduate Medical Institutes 0 (0.0%) 13 (100 %) 13 5 (7.5 %) 62 (92.5 %) 67 Total * The difference is significant at the 0.05 level. Note. Post hoc Fisher’s exact tests results: medical colleges and medical universities (p = 0.052 >0.05; Phi = 0.314); medical colleges and postgraduate medical institutes (p = 1.000>0.05; Phi = 0.106); medical universities and postgraduate medical institutes (p = 0.082>0.05; Phi = 0.411). 4.3.5.7 Responsibility for delivering IL instruction. Respondents were asked who they think should be responsible for delivering IL instruction: librarian, faculty, or both of them. Sixty-seven respondents responded to this question. A little more than half said both librarian and faculty should be responsible for this, while a little less than half believed only 115 the librarian should be responsible (Figure 4.13). None of the respondents opted for only faculty and did not exclude librarian from this role entirely. There was a clear division among respondents and they were undecided about the role of faculty in imparting IL instruction. Librarian Both librarian and Faculty 35 (52,2 %) 32 (47.8 %) Figure 4.13: Responsibility for Delivering IL Instruction (n = 67) 4.3.5.7.1 Pearson’s chi-square test results. There was no significant difference between the opinion of respondents in public and private sector medical institutions regarding responsibility of delivering IL instruction (Table 4.30) indicating similarities in their opinions. 116 Table 4.30 Difference between the Opinions of Respondents Regarding Responsibility for Delivering IL Instruction Based on Sector of Institutions (n = 67) Responsibility of Delivering IL Instruction Sector Librarian Both librarian Total Value Asymp. Sig. Phi and faculty (2-sided) n (%) n (%) Public 11 (36.7 %) 19 (63.3 %) 30 Private 21 (56.8 %) 16 (43.2 %) 37 Total 32 (47.8 %) 35 (52.2 %) 67 2.680 0.102 > 0.05 0.200 4.3.5.7.2 Fisher’s exact test (FET) results. There were also no significant differences among the opinions of respondents from medical colleges, medical universities and postgraduate medical institutes regarding responsibility for delivering IL instruction (Table 4.31) indicating similarities in their opinions. Table 4.31 Difference between the Opinions of Respondents Regarding Responsibility for Delivering IL Instruction Based on Types of Institutions (n = 67) Responsibility for Delivering IL Instruction Type of Librarian Both librarian Total FET Exact Sig. Cramer’s V Institution and faculty Value (2-sided) Medical Colleges 23 (53.5 %) 20 (46.5 %) 43 Medical Universities 5 (45.5 %) 6 (54.5 %) 11 Postgraduate Medical Institutes 4 (30.8 %) 9 (69.2 %) 13 32 (47.8 %) 35 (52.2 %) 67 Total 2.070 .356 > 0.05 .177 117 4.4 Chapter Summary This chapter has presented analysis of quantitative data collected in the first phase of this study, using semi-structured questionnaire. Sixty nine (60.5 %) useable questionnaire were received out of total 114 distributed among the head librarians of academic medical institutions in Pakistan through postal mail. Out of 69 respondents, 52 (75.4 %) were males and 17 (24.6 %) were females. A total of 31 (44.9 %) were from the public sector and 38 (55.1 %) from the private sector medical institutions. Forty-four (63.8 %) respondents were employed in medical colleges, 14 (20.3 %) in postgraduate medical institutes and 11 (15.9 %) in medical universities. The results have demonstrated that respondents from public sector medical institutions considered the seven, out of eight IL skills presented to them in the questionnaire, as “very important” for their library users. However, they did not consider the IL skill of “evaluating the information critically” as “very important” for their users and got mean score of less than four. Respondents from private sector medical institutions considered six IL skills as “very important” for their library users. However, they did not consider the two IL skills “using the selected information effectively to accomplish a specific task” and “organizing information collected or generated in a logical way” as “very important” for their library users as it got mean score of less than four. No significant differences were found in the perceptions of sub-populations. The study has revealed that 74 % of the respondents had offered some kind of information literacy (IL) instruction in their institutions during the past year, ranging from library orientation to research-level skills. Chi-square results revealed that more medical university libraries and postgraduate medical institute libraries reported offering “advanced 118 information skills” and “research-level skills” as compared to medical college libraries. Topics like plagiarism awareness, copyright, citation of information, and OPAC/library catalogue were covered by less than 40% of the respondents in IL instruction programmes. IL instruction is typically only offered to new students or first time library users or on demand. Majority of the respondents developed IL instruction programs without involvement of faculty. Primarily librarians were responsible for offering IL instruction in medical institutions. While face-to-face instruction in computer lab or lecture hall and individual instruction at reference desk were identified as the most common IL instruction delivery methods. The data conceded that an oral feedback, written feedback and assessment through practical searching in computer lab were the most popular assessment methods used by medical librarians. It was disclosed that "lack of training opportunities for IL instruction for librarians” and “lack of policy regarding IL instruction in the medical institutions” have been identified as the most significant barriers that hinder development of IL instruction programme in medical institutions. No significant differences in the perception of the sub-populations were found. The study has revealed that most of the head librarians lacked IL instruction education and training, therefore, their knowledge of IL instruction was not very good while their knowledge of IL standards and models was weak. The respondents were very much interested in the development of their IL instruction skills in the nine areas (developing IL course contents, IL instruction need assessment, teaching methodologies, developing and promoting IL instruction programmes, presentation skills, integrating IL instruction into the curriculum, IL instructional design skills, developing online IL tutorials and planning skills) 119 mentioned in the questionnaire. However, the results have revealed that medical librarians were not very much interested in the development of their assessment/evaluation skills to measure learning outcomes of the participants and administrative skills for running IL instruction programmes. No significant differences were found among the sub-populations. The results reveal that IL skills of library users have been perceived by the head librarians as inadequate. Respondents identified workshops/seminars and formal in-class teaching as part of the main curriculum as the most effective IL instruction delivery methods. Majority of the respondents were in favour of integrating IL instruction into the curriculum and desired that IL should be integrated into the curriculum as an independent and credit course. An overwhelming majority of the respondents was of the opinion that both librarian and faculty should design IL curriculum. However, respondents were divided and undecided regarding role of the faculty in imparting IL instruction. Chi-square and FET results show that there were no significant differences in the opinions of the sub-populations. Chapter 5 presents analysis of qualitative data. 120 CHAPTER 5 ANALYSIS OF QUALITATIVE DATA This chapter presents analysis of the qualitative data, gathered through semistructured in-depth interviews with 20 head librarians of academic medical libraries in Pakistan. Interviews were conducted between April and June 2014 to gain a deeper understanding and detailed comments on the most significant results of the questionnaire survey. The participants were selected (using purposive sampling) from the filled survey questionnaires and only those (head librarians) were chosen who had comparatively better understanding of information literacy (IL) and provided advanced or research-level of IL instruction to their library users in the previous year. An interview schedule was developed and followed during interviews. All face-to-face and phone interviews were audio recorded, with prior consent, as a primary source of data and were transcribed. A summary of analysis was extracted from the interview transcripts. The textual data was content-analysed and coded. The emerged themes and sub-themes were presented with the frequency of their occurrences in the interview transcripts. Quotes from the transcripts were used where needed to strengthen the arguments. 5.1 Demographic Profile of Interviewees Demographic distribution of the participants, derived from their respective questionnaires, shows diversity (Table 5.1). 121 Table 5.1 Demographic Information of Interviewees (N = 20) Demographics Gender Male Female Frequency Percentage 15 05 75 % 25 % Highest LIS Education Attained MLIS M. Phil. Ph.D. 18 01 01 90 % 05 % 05 % Age Group Up to 25 years 26-35 years 36-45 years 46-55 years 56 years an above 05 02 06 04 03 25 % 10 % 30 % 20 % 15 % Experience Up to 5 years 6-10 years 11-15 years 16-20 years 21-25 years More than 25 years 05 02 03 04 03 03 25 % 10 % 15 % 20 % 15 % 15 % 12 08 60 % 40 % 11 04 05 55 % 20 % 25 % Sector Public Private Types of Institutions Medical Colleges Medical Universities Postgraduate Medical Institutes 5.2 Analysis of Interview Data 5.2.1 Perceptions of Medical Librarians towards the Importance of IL Skills All the interviewees were first informed about the results of the questionnaire survey, carried out in the first phase of this study. These results revealed that head librarians from both public and private sector institutions had rated five IL skills as very important for their library users with a mean score of more than four. However, three IL skills got mean scores 122 of less than four from a group of respondents. The skill of “evaluating the information critically” obtained a mean score of less than four from public sector institutions. While “organizing information collected or generated in a logical way”, and “using the selected information effectively to accomplish a specific task”, scored less than four from private sector institutions. Due to this apparent difference in opinions between public and private sector head librarians, interview participants were asked about importance of these three IL skills. Interview participants were also asked to indicate the possible reasons why a group of the respondents did not consider these skills highly desired for their library users. It was important to probe their real and in-depth opinion on these IL skills because these are integral part of IL set of skills. The replies of participants were analysed and have been presented in the following sections. 5.2.1.1 Importance of “evaluating the information critically”. Participants unanimously stated with tremendous conviction that “evaluating the information critically” was very important skill for their library users. They expressed their feelings with phrases like “very important”, “the most important”, “absolutely important”, “of a paramount importance”, “very necessary”, “of course very important” and ‘essential”. Further, some participants contended that any information retrieved must be critically examined. One head librarian noted, “…evaluation of information is key [skill] to me.” One interviewee stated, “The basic concern of IL is evaluation of information.” While another described, “It is the most important competency amongst all… It should be on the top priority in IL instruction.” This suggests that in their opinion library users must have the ability to evaluate the information critically. 123 Participants provided different parameters/criteria to determine the suitability of information. The same are presented in Table 5.2 along with the frequency of the themes occurrence in the interview transcripts. Table 5.2 Importance of “Evaluating the Information Critically” Criteria Frequency Reliability 14 Relevancy 9 Authenticity 6 Current or up-to-date 5 Validity 4 Accuracy 4 Scholastic value 3 Effectiveness 2 As can be seen from Table 5.2, the majority of the participants believed that it was important to retrieve the information from reliable sources. One participant stated, “…to me as a medical librarian, this [evaluation skill] is the most important [skill] for the users of my library, because I find them incorporating the retrieved information from Wikipedia, blogs and other unreliable sources in research and patient treatment.” Similarly another stated, Generally it is observed that medical researchers cite information from Wikipedia in CPSP [College of Physicians and Surgeons Pakistan] dissertations in spite instructions from CPSP that the information in Wikipedia are unreliable, unprofessional and should not be incorporated in their dissertation. It is pretty much banned from being used and mentioned. This shows that the users cannot evaluate 124 the information and they need to be educated in this regard so that they could evaluate the reliability of information. One participant suggested, “They [library users] should only search those websites which are internationally recognized and reliable. A lot of junk material is available on the Internet. Every junk material is not reliable.” Another warned, “…information collected from unreliable source can be dangerous when used for patient care in clinics.” It indicates that library users should be aware of the authentic and reliable sources of medical information. The other most frequently mentioned parameters for evaluation of information were the relevancy, authenticity and currency while only few mentioned about validity, accuracy, scholastic value and effectiveness of information. One participant opined, “Evaluation of information is very important because it lets you know that how much the retrieved information is relevant, effective and reliable… Until you do not confirm the authenticity of information, how can you apply or use it?” One interviewee suggested, “Library users must be educated about sources which are authentic and provide current information”. Another stated, “If library users have this skill [evaluation of information] they can retrieve quality, scholarly, valid and current information… Collecting irrelevant material will waste their time, creates confusion and also affects the results of the research.” Another stressed, “… in medical sciences it is important to get the most recent information.” All these quotes show that the information gathered should be evaluated critically to judge its reliability, relevancy, authenticity, currency, validity, accuracy, scholastic value and effectiveness. 5.2.1.2 Importance of “organizing information collected or generated in a logical way.” Majority of participants (n = 18) opined that “organizing information collected or generated in a logical way” was a very important skill for their library users. They 125 emphasized their feelings with words like “it is necessary to organize information”, “it is very important to organize information logically”, “information retrieved must be organized in a logical way”, “it is of basic importance”, “it is necessary to organize information in a meaningful way”, “definitely it is very important to organize information for timely use”, “absolutely important”, “library users must know how to organize information”. Conversely, a couple of participants opined that it is not very important. One participant stated, “Organizing information is less important as compared to other IL skills.” Another commented, “It is important but not very important because no standard systems and mechanisms are available for organizing information.” On the other hand, those who opined that this IL skill i.e., “organizing information collected or generated in a logical way” was very important for library users were also asked why this IL skill is very important for your library users. Table 5.3 presents the themes from the replies of the interviewees along with the frequency of their occurrence in the interview transcripts. Table 5.3 Importance of “Organizing Information Collected or Generated in a Logical Way” Themes Frequency Saves time, energy and efforts 12 Easily retrievable 9 Only organized information is useful 5 Organization for maximum utility 3 Organized information can be communicated effectively 1 As can be seen from Table 5.3, the majority of participants indicated that organizing information in a logical way will save time, energy and efforts of library users. Some participants also mentioned the other reasons such as it will make their work easy and they 126 can retrieve their information when required in future. The participants said things like “if information is haphazard they will face difficulties… If information is not organized it cannot be used effectively”. Similarly, one respondent stated, “The scattered information cannot be useful. If you are not targeted it will be like finding a needle in the hay stack.” Another noted, “When library users collect information and also organize it, they can easily locate it in future without wasting time and energy.” One head librarian emphasized, “Library users must be able to organize the retrieved information for future use.” Another explained, “…world is full of unorganized information. Only that information which is well organized is useful and effective.” When asked how library users should organize information in a logical way, several participants were unclear. However, few of them mentioned about organizing information in a chronological order, subject wise, according to common themes, alphabetically according to author or title. Few participants also suggested that library users must be trained in use of MS Word, endnote and Mendeley (a free reference manager and PDF organizer) to organize their bibliographies and full text documents. Another mentioned, “Library users must have concept of social tagging in the digital world.” One interviewee explained, “Librarian cannot organize information for each individual user but they can teach them the skills, which when learnt will be useful for them forever.” 5.2.1.3 Importance of “using the selected information effectively to accomplish a specific task”. Participants unanimously and overwhelmingly agreed that use of information is very important for their library users. They emphasized their feelings with phrases like “very important”, “obviously very important”, “absolutely important”, and ‘essential”. One head librarian noted, “This skill is valuable to complete the task.” The participants were 127 further inquired that why this skill is so important. Table 5.4 presents the themes from the replies of the interviewees along with the frequency of their occurrence in the interview text. Table 5.4 Importance of “Using the Selected Information Effectively to Accomplish a Specific Task” Themes Frequency Achievement of specific objectives 8 Useless to retrieve, evaluate and organize information if could not be used 3 Everyone cannot use information properly 2 Successful application of information 2 Decision making 2 Solution of a problem 2 Ultimate goal is to use information 1 As can be seen from Table 5.4, the participants indicated that using the selected information effectively to accomplish a specific task is very important skill to achieve the specific objective. Some participants also mentioned the other reasons such as successful application of information is very important for decision making and solution of a problem. One participant explained, “These skills are interconnected as only organized information can be used and usage is dependent on evaluation of information.” Another noted, “Only collecting and organizing information is not the purpose. We do all this to use information. If we do not use information the prior steps are useless.” One interviewee noted, “One has to use information to be successful in the task.” Another explained, “It is the most important skill. The library users are task oriented if they do not achieve the task it will be wastage of energy to collect information and the person who can use information is a real scholar.” One head librarian stated, “When we collect information and do not know how to use it 128 effectively we will not be able to achieve the specific objectives and complete the task.” Another explained, It is the most important skill because he [library user] has passed through a long process in retrieving, evaluating and organizing information so he should have the skill to use this information. When we collect information we have a problem in the background so we have to use the information to the solve problem. 5.2.1.4 Reasons for not considering three IL skills very important. It was important to explore the reasons behind disparity in the perceptions of survey respondents regarding the importance of above mentioned three IL skills. Therefore, the participants were asked about their opinion on not considering these skills very important by a group of respondents. Table 5.5 presents the themes from the replies of the interviewees along with the frequency of their occurrences in the interview transcripts. Table 5.5 Reasons for not Considering Three IL Skills Very Important Reasons Frequency Librarians themselves are deficient in IL skills 12 Librarians lack exposure and experience in using IL skills being new concept in Pakistan 5 Librarians do not take interest to learn and teach these skills to users 5 They may not understand the depth of these skills. 2 The horizon of librarians is not very broad 1 Librarians do not feel the need for training 1 Medical librarians themselves have not adopted these skills 1 Medical librarians are out of touch with web resources 1 They may think that library users already know all these skills 1 English language may be a barrier in understanding 1 129 As can be seen from Table 5.5, the lack of exposure, experience and knowledge about these IL skills among medical librarians being a new area in Pakistan were the most frequently mentioned reasons, for not considering the three IL skills very important by one group of survey respondents. One head librarian of private sector medical institute indicated, The librarians of public sector medical institutions and their users in Sind and Karachi lack IL skills. In a private sector medical library where I was employed, librarians and library users know much about IL skills. In public sector universities, users do not know even about PubMed. They might rate these IL skills low and they do not realize its importance due to lack of awareness that’s why statistically its mean is low. Another head librarian stated, “The reason may be that librarians are not aware about tools and databases used to organize information and they may do not know how to use information.” Similarly, one head librarian noted, “IL is new concept and medical librarians are not abreast with these skills.” One participant mentioned, “Actually environment is not good, first there should be awareness among professionals about IL then they will realize the importance of IL skills.” Another stated, “All IL skills are interrelated if one is overlooked the other becomes ineffective. Therefore all skills are important.” One head librarian stated, “They may not understand the depth of these skills.” Another stated, “Actually medical librarians themselves have not adopted these skills or do not know very much about IL.” It suggests that librarians need to be apprised with the importance of IL skills. 5.2.2 Current IL Instruction Practices in Medical Libraries Interview also aimed to find out the reasons behind the prevailing practices of offering only introductory level of user education to the clients. Question two asked the head 130 librarians to give their views on the findings of questionnaire survey which have revealed that most of the medical librarians offered library orientation and introductory information skills to their library users while few offered advanced information skills or research-level skills mostly in medical universities and postgraduate medical institutes. All the participants opined that library orientation and instruction in basic information skills are not enough for medical library users. They suggested that medical library users must be trained in advanced information skills. One participant stated, “If they [librarians] are not teaching advanced or research-level skills they are not accomplishing their task and are not fulfilling medical library objectives.” Another noted, A lot of online resources are available through HEC digital library programme but these resources are underutilized due to lack of IL competencies among library users and medical students rely on Google and Wikipedia for information. They need to be aware of reliable and quality information sources, and should be capable to access and use information in an ethical and legal manner. One interviewee suggested, “Advance information skills help the users to get the right information at the right time… Librarians serving in the universities and postgraduate institutes interact with the researchers and due to research environment they learn and offer research level skills.” Participants also highlighted the fact that IL is new concept for librarians in Pakistan and librarians are not trained to teach and conduct research. One respondent contended, “Librarians’ lack of pedagogical and research skill is the hurdle in moving beyond library orientation to advanced level skills…. We need to facilitate and support IL instruction through awareness and professional development.” The other 131 participants also attributed the problems to a number of reasons mentioned in the next section of this chapter regarding barriers to IL instruction programmes. Participants were asked whether advanced information skills and research-level skills should be addressed at undergraduate level. They opined that advanced information skills should be addressed at both undergraduate and postgraduate levels. However, a couple of participants were of the opinion that the syllabi at both levels should be structured to meet their respective requirements. These respondents said things like “undergraduate students do need to learn research-level IL skills because they are the future researchers. They must be taught these skills so that they are well versed and ready to use these skills,” and “at undergraduate level they need to be taught research skills but the components of IL instruction may be different from postgraduate level.” Similarly, one participant stated, “Medical students should be apprised about IL instruction at the commencement of their course if they learn the research skills they will not face problems when they start practice.” When asked why advanced information skills or research-level skills are not offered at undergraduate level, the participants identified many reasons. The same are enlisted in Table 5.6 in descending order according to the frequency of occurrence. 132 Table 5.6 Reasons for not Offering Advanced or Research-Level Skills at Undergraduate Level Reasons Frequency Student are too busy in academic and practical learning 5 Undergraduate students are not expected to conduct research. 5 Mostly the emphasis of undergraduates is on text books 4 Lack of research culture/environment at undergraduate level 3 Teachers do not give assignments or projects to undergraduate students 3 The importance of librarians and libraries in research process is not realized by LIS professionals and faculty 3 The concepts of evidence-based learning could not be implemented effectively in medical institutions 2 Our education system does not require advanced or research-level IL skills. 1 The head librarians supported systematic delivery of IL instruction at undergraduate level. However, tough academic schedule, lack of research activities at undergraduate level and their dependency on text books was the most frequently mentioned hurdles in the development of IL instruction programme in the medical colleges at undergraduate level (Table 5.6). Question 3 asked the interviewees about possible reasons for not covering topics like plagiarism, citation, copyright and OPAC/library catalogue by most of the respondents during their IL instruction sessions. All the participants opined that plagiarism, citation and copyright are the most important topics and should be essential part of IL instruction programmes. They indicated many reasons for not covering topics related to plagiarism, citation and copyright during IL instruction sessions by most of the libraries, with some of them mentioning multiple reasons (Table 5.7). 133 Table 5.7 Reasons for not Covering Plagiarism, Citation and Copyright During IL Instruction Reasons Frequency Librarians lack awareness and expertise about these concepts 13 Lack of awareness or demand from faculty 6 Plagiarism, citation management and copyright are not included in the LIS curriculum at masters level 6 Lack of research culture 5 Most of the medical journals and institutions do not implement plagiarism policy effectively 4 These topics are addressed at postgraduate level only 3 No copyright policy exists in the institutions 2 Copyright laws are not followed in Pakistan 2 Psychological barrier is there to learn these skills 1 The most frequently mentioned reasons for not covering above mentioned topics during IL sessions were librarians’ lack of awareness and expertise, as these topics were not taught in-depth in the LIS curriculum at master level. Additionally, library users also do not demand for these topics to be taught in the IL sessions (Table 5.7). In the interviews, a participant said, “Basically these topics are not covered in-depth in the LIS curriculum at master level; therefore, librarians themselves are less aware about these concepts.” Another participant stated, “Because they are ill-trained, the training they have is outmoded now, so they do not know the importance of these skills… The mental barrier is there to learn these skills.” Third participant indicated, “Plagiarized assignments, thesis and papers are accepted in the universities and journals and people are not conscious about copyright laws which are not followed in Pakistan. E-books are copied and photocopying of books is carried out without caring for copyrights.” One head librarian of a well reputed private university in Pakistan gave detailed comments on copyright: 134 Copyright awareness is very little in our society. It is also highlighted in newspapers and media. We as a nation are not very much aware about copyright and due to lack of awareness we rarely follow it. There are no copyright offices in the institutions in Pakistan. Recently we in our university have created a position of copyright officer. We are implementing it slowly and have implemented it to some extent. When you are going to use any digital content first you have to get the clearance of the copyright officer whether this content which you are delivering to your students is copyright protected or not. Copyright Officer also educates the faculty regarding copyright issues. One participant highlighted, “…even after doing PhD medical professionals cannot give proper references it is due to copy paste culture in Pakistan… Only those scholars are aware about plagiarism who publishes their research in the journals having high impact factors.” However, participants were optimistic and hoped that situation is getting better with the passage of time and people are getting aware of these concepts. All the participants said that most of the libraries did not have OPAC; therefore, it is obvious that they will not cover it in the IL instruction. A head librarian of a postgraduate medical institute explained, “I surveyed medical libraries and found that OPAC was not available in 80 % of medical libraries.” Another participant stated, “Most of the software being used in Pakistan for automation were not web-enabled, now some libraries are using web-enabled software KOHA but again they do not have IT infrastructure to launch online catalogue.” An interviewee stated, “They [librarians] may not be aware of importance of catalogue for library users.” 135 Questionnaire survey revealed that most of the medical librarians used face-to-face method for delivery of IL instruction while online or web based tutorials were mentioned by two respondents only. Interviewees were asked in question 4 to specify reasons for this inference. Participants identified many reasons for using face-to-face IL instruction delivery method, which are enlisted in Table 5.8. Table 5.8 Reasons for Using Face-to-Face IL Instruction Delivery Method. Reasons Frequency It is the best method for delivery of IL instruction 5 Participants’ queries are taken care of in a better way 4 Easy to understand and interact 3 It is the only method used here 2 Body language makes it meaningful 2 Cross questions can be asked 1 Face-to-face method is very effective in our environment 1 As seen in Table 5.8, participants were of the opinion that face-to-face method is the best and most effective for delivery of IL instruction, as it is interactive and students’ queries can be addressed immediately. One head librarian noted, “In face-to-face method one can clarify things easily and cross questions are addressed quickly.” Another stated, “Lecturing method is the only method in vogue in medical institutions in Pakistan.” Participants also identified many reasons for not using online or web-based tutorials by most of the head librarians. The same are enlisted in Table 5.9. 136 Table 5.9 Reasons for not Using Online or Web-based Tutorials Reasons Frequency No trend of e-learning and web tutorials in medical institutions 6 Computer skills of most of the medical students are weak 3 Libraries do not have websites or web portal to put tutorials on it 3 Facilities are not available for creation of web tutorials 3 Librarians do not have awareness and skills of web tutorials 3 Internet services are not compatible 2 Internet facility is not available to most of the library users 2 Web tutorials are useful in multi-campus institutions 1 Web tutorials are not very effective 1 As seen in Table 5.9, interviewees opined that medical librarians did not use online or web-based tutorials due to lack of e-learning trend in medical institutions, weak IT skills of library users and lack of facilities and skills for creation of online tutorials. One head librarian stated, “Web tutorials will not be useful for those library users whose IT skills are weak. Web tutorials also need better IT infrastructure. It also requires technical skill to create web-tutorials.” Another commented, “We put some tutorials on library website but they were underutilized.” One head librarian of public sector medical college stated, “Medical institutions lack basic IT infrastructure… Online tutorials can only be used in a setup where Internet facility is available to all students.” In addition, few participants mentioned about poor Internet services, lack of required skills among librarians and less effectiveness of online or web-based tutorials in the current environment. One interviewee noted, “Internet services are not available across Pakistan, if it is available its quality is not good and services are poor.” 137 In question 11 of the interview schedule, interviewees were first apprised about the results of the questionnaire survey, which had revealed that 66.7 % of the respondents evaluated their IL instruction outcomes mostly using oral and written feedbacks instead of formal assessment methods. The interviewees were then asked to give possible reasons for the use of informal methods of assessment by the participants of the questionnaire survey. Eighteen out of the 20 participants were of the opinion that oral or written feedback was not effective and formal assessment may be used to assess learning outcomes after offering IL instruction sessions. They expressed the importance of formal assessment with phrases like “to improve IL instruction”, “it is the only way to know what is the outcome of IL instruction”, “to know the output of IL sessions”, “to find what participants have learned during IL instruction”, “to find out instruction were useful or not”, “to find weaknesses in the IL program”, “to identify shortcomings in the IL instruction”, and “weak areas can be identified and addressed through formal assessment.” Two of the 20 respondent said that feedback is quite enough because formal assessment may irritate the participants and it may discourage them to attend the IL sessions. To avoid this feedback should be taken. As countered by one head librarian, “I do not recommend giving the formal type test to participants. We should give them practical task.” Participants identified many reasons for not using formal assessment methods which are enlisted in Table 5.10 in descending order of their occurrence in the interview text. 138 Table 5.10 Reasons for not Using Formal Assessment Methods Reasons Frequency IL instruction offered are not of that level to be assessed 9 IL is not taught as a credit course 5 Librarians do not want to put extra burden on students 3 Librarians are not trained in evaluation skills 2 Formal assessment is time consuming 1 Lack of resources and infrastructure for assessment 1 Higher authorities do not cooperate in this regard 1 Assessment may discourage participant to attend IL sessions 1 Reluctance at the part of participants 1 As can be seen in Table 5.10, most of the participants were of the view that IL instruction imparted were not of that level which required assessment. To conduct formal assessment the IL instruction should be offered in a formally designed way. One participant opined, “The IL instruction is limited to library orientation and these [IL instruction] are not of that level that assessment could be done… Assessment should be done but it depends on how much importance is given to IL instruction in the curricula.” Similarly, another reported, “Librarians do not assess because they deliver one lecture only.” In addition, few participants mentioned about lack of evaluation skills among librarians, inadequate infrastructure and resources, and reluctance from students and higher authorities as the hurdles in using formal assessment methods for assessment of IL instruction outcomes. One participant mentioned, “Librarians are not trained in teaching methodology which is essential for assessment and evaluation of IL instruction out comes. They need to learn teaching methodology first.” 139 5.2.3 Barriers When Advocating or Providing IL Instruction Participants were asked in question seven to give their comments on the results of the questionnaire survey which had revealed that “lack of training opportunities for IL instruction for librarians” and “lack of policy regarding IL instruction in the medical institutions” were the top two barriers that hinder the development of IL instruction programmes in medical institutions. Participants were also asked to enlist other barriers that hinder IL instruction in their institutions. All the participants opined that most of the medical librarians had inadequate knowledge of IL due to limited IL training opportunities in Pakistan. As one head librarian stated, “I think that No. 1 is the training of the librarians that is of paramount importance. If librarians are themselves not trained, how they can tutor the faculty and educate their users.” Another stated, “Librarians do not learn new skills and are not updated.” Some interviewee acknowledged that many librarians had not attended any course in IL. Participants were of the opinion that lack of an IL policy in medical institutions is an obstacle for development of IL instruction. All the participants emphasized that an IL policy might be formulated that could provide guidelines and direction for implementation of IL instruction in medical institutions. One participant stated, “At present there is no [IL] policy in most of the institutions, the librarians need to stress upon administration and the designers of the curriculum to formulate it.” Another acknowledged, “Neither the librarians nor the end users are well versed with the importance of IL skills, until they are apprised about it. IL policy cannot be formulated.” One interviewee criticized, “Many medical institutions even do not have permanent library policy, what to talk about IL… IL policy is crucial to the success of IL programmes.” 140 In response to the question regarding the barriers affecting IL instruction in their respective institutions, interviewees very openly discussed the obstacles and barriers in this regard. These barriers are presented in Table 5.11 along with frequency of their occurrences in the interview transcripts. Table 5.11 Barriers When Advocating or Providing IL instruction (N = 20) Barriers Frequency Lack of support from the management 7 Shortage of professional library staff 6 Neither the faculty nor students are aware with the importance of IL skills 5 Librarians indulge in non-professional work or administrative duties 3 Medical students are already overworked and do not have time for IL instruction 3 Non-faculty status of Librarians 2 Lack of resources and infrastructure 1 Librarians are not involved in curriculum designing 1 Librarians are not expected to run IL instruction 1 Public sector institutions want to maintain status quo 1 The analysis of responses (Table 5.11) revealed that participants faced many barriers while offering IL instruction in their institutions. They have been unsuccessful in convincing and getting support of management needed in this regard. Very few institutions employee library staff required for the PM&DC recognition. Even the PM&DC practices for recognition of medical institutions and inspection criteria have not done much in this regard. Hence shortage of library staff has added to the non-effectiveness of IL instruction. Few of the interviewees have also mentioned that they are given assignments in addition to their actual duties due to which their attention is diverted so they cannot concentrate on their professional tasks. One head librarian of public sector institution stated, “…our institution 141 does not have library staff which is required for the PM&DC recognition, I am the only librarian and has to perform all duties… I can hardly spare time for IL instruction.” Another head librarian simply stated, “…I am the only librarian in our institution and mostly perform general administrative duties other than library work.” In addition, Lack of awareness regarding importance of IL skills on the part of librarians, management, medical faculty and students, heavy load of academic and clinical activities among medical students also affects the IL instruction programme. Lack of resources, non-faculty status of librarians, lack of librarian’s involvement in curriculum designing and status quo at the public sector institution are also barriers in IL instruction. The qualitative data strengthens the questionnaire survey results and confirm that the above mentioned obstacles hinder the implementation of IL instruction programmes in medical institutions of Pakistan. 5.2.4 IL Instruction Training Needs of Medical Librarians Question eight of the interview schedule, asked the participants about possible causes of inadequate IL instruction knowledge of the survey respondents. They were also asked to give suggestions for the improvement of IL instruction competencies of medical librarians. The reasons mentioned by interviewees for inadequate IL instruction knowledge of medical librarians have been listed in Table 5.12 in descending order according to their frequency of occurrences. 142 Table 5.12 Reasons for Inadequate IL Instruction Knowledge of Head Librarians Reasons Frequency Lack of coverage in LIS curriculum at master level 15 On-job IL professional development opportunities are limited 6 Librarian do not realize/recognize the need to learn and offer IL instruction 4 Medical librarians have poor reading habits 2 The concept of IL is new in LIS circle 2 It is difficult for aged librarians to learn new skills 1 LIS faculty is not prepared to teach courses on IL instruction 1 No pressure from higher authorities on librarians to learn and offer IL instruction 1 Research methodology courses are weak at MLIS level 1 The analysis of responses (Table 5.12) indicated that majority of the participants held LIS schools responsible for inadequate IL knowledge of medical librarians. Many of them felt that IL instruction is not covered properly in LIS curriculum at master level. One participant noted, “Most of the LIS schools do not offer courses on IL instruction.” Another stated, “…research methodology is also not covered in-depth at master level.” One interviewee criticized, “…even the LIS faculty is not prepared to teach IL courses to LIS students. Therefore, LIS students are not well prepared at entry level to run IL instruction programme.” Many participants opined that continuing professional development opportunities were also limited for medical librarians. One participant stated, “The concept of IL is new in Pakistan and our LIS associations do not run courses particularly on IL.” Another stated, “There is no pressure on medical librarians from higher authorities to offer IL instruction; 143 therefore, they do not realize the need to develop their knowledge and skills required for IL instruction.” Additionally, poor reading habits and status quo among librarians certainly contribute to the factors that impede development of IL knowledge and skills of medical librarians. When asked how IL competencies of medical librarians can be improved, the participants came up with many suggestions. The same are presented in Table 5.13. Table 5.13 Suggestions to Improve the IL Competencies of Medical Librarians Suggestions Frequency MELAP and PLA should offer continuing professional development courses on IL instruction 14 LIS departments (schools) need to include IL in the curriculum at master level 9 Senior librarians should take initiative to train new comers 4 Medical librarians should develop their IL instruction competencies through self-learning 4 Medical librarians should get research degrees 2 Medical librarians may be motivated to learn IL instruction skills 2 National Library of Pakistan should organize workshops and seminars for LIS professionals 2 Online IL courses/webinars for librarians may be developed 2 Leading medical institutions such as CPSP and medical universities should conduct workshops on IL instruction 1 Medical libraries should share their best practices with each other 1 IL instruction should be implemented effective in medical institutions 1 Participants identified (Table 5.13) professional associations and organizations such as the Medical Library Association of Pakistan (MELAP), the Pakistan Library Association (PLA), the College of Physicians and Surgeons Pakistan (CPSP), the National Library of Pakistan (NLP) and medical universities for the continuing professional development of 144 medical librarians. Participants also suggested that all library schools should include a course on IL instruction in the LIS curriculum at master level and should strengthen the research methodology course. One participant stated, “There are two sources of training, these are LIS schools and LIS associations. LIS schools should incorporate IL instruction into the curriculum and LIS associations should run workshops and seminars [on IL] for serving librarians.” In addition, few participants suggested that medical librarians can improve their IL competencies by self-learning, consulting online tutorials and sharing their experiences/practices with each other. One interviewee noted, “It is responsibility of librarians to learn and develop their IL competencies by reading literature on IL.” In question 10 participants were enquired the possible reasons that survey respondents being not very much interested in the development of their assessment and evaluation skills. Most of the participants were of the opinion that formal assessment is important for the improvement of IL instruction programmes. Participants identified various reasons for lack of interest amongst the survey respondents in the development of their assessment and evaluation skills. These are presented in Table 5.14 in descending order according to the frequency of occurrence. 145 Table 5.14 Reasons for Lack of Interest among Librarians Regarding Development of their Assessment of IL instruction Effectiveness Skills Reasons Frequency Librarians do not assess IL instruction outcomes 6 Lack of awareness regarding importance of assessment among librarians 5 People are afraid of or hesitate to take examinations 4 IL instruction practices are at initial stages/orientation level 3 Lack of teaching/assessment training 2 Librarians think assessment may create disinterest among participants 2 Librarians mostly rely on feedback 1 Assessment is the domain of faculty only 1 The analysis of responses (Table 5.14) revealed that the most frequently mentioned reasons were librarians do not assess the IL instruction outcomes and lack of awareness amongst them about the importance of assessment. Moreover, hesitation on the part of library users was the next most common reason enunciated by the participants. One participant mentioned, “Librarians do not have the concept of assessment methods and are not aware of its importance.” Another explained, “Library users’ hesitate to undergo formal assessment, they think this way they will be exposed.” Few participants also indicated that IL is not part of curriculum as a credit course, therefore, there is no demand of assessment due to which librarians are not interested in the formal assessment and they rely on feedback. One interviewee explained, “IL instruction is limited to library orientation, as we are not offering that level of IL instruction which could be assessed.” In addition, participants also believed that librarians lacked teaching or assessment skills and are also not expected to assess the participants of IL sessions. Librarians also think 146 that the formal assessment may discourage the library users to participate in the IL instruction programmes as IL instruction is not mandatory for library users. One participant opined, “There is no culture of assessment and environment is not conducive for assessment.” 5.2.5 Strategies for the Effective Implementation of IL Instruction Programmes One of the objectives of the study was to suggest strategies that could be adopted for the effective implementation of IL instruction programmes in medical libraries in Pakistan. In this regard, five questions were asked from interviewees to get detailed comments on the most significant findings of the questionnaire survey. The analysis and interpretation of the interview data is presented below. 5.2.5.1 IL skills of library users. Question 11 sought the views of participants on the findings of the questionnaire survey which revealed that generally librarians perceived the IL skills of their library users as inadequate. Participants were asked to throw light on the possible reasons for this, and how IL skills of library users could be improved. The replies of participants have been analysed and presented in the following paragraphs. All participants stated that overall IL skills of their library users were inadequate or weak. One participant noted, “It is true, the reason is simple they are not well versed with IL skills” and “…they are not trained in IL skills.” Another stated, “We have postgraduate students but they are poor in using computers and are unable to search relevant information from the Internet. They even cannot download full text papers from the Internet.” One interviewee said, “Obviously, because they come to library for relevant books and not to learn IL skills.” Another related IL skills level with the economic condition and background as said, 147 It depends on their family background and the institutions from which they got early education. The IL skills of students in public sector institutions are weak; however, students of private medical institutions come from good financial background so they have laptops or iPads and are comparatively better. Few participants opined that at the time of joining the medical school, students were very weak; however, gradually they learned some skills of finding information themselves by consulting different sources. Participants were then asked to mention the possible reasons for lack of IL skills among library users. They identified many reasons which are enlisted in Table 5.15 in descending order according to the frequency of occurrences. Table 5.15 Reasons Identified for Lack of IL Skills Among Library Users Reasons Frequency Librarians do not offer formal IL instruction programmes 12 Traditional education system (reading text books or class notes only) 8 Learning IL skills is not the priority of library users 6 IL is not integrated into the curriculum 5 Medical curriculum lacks potential to encourage research, innovation and creativity 4 Computer skills of most of the medical students are weak 3 Lack of information and research resources in medical institutions 2 Poor reading habits of library users 1 Students are not taught IL skills at secondary and higher secondary levels 1 As can be seen in Table 5.15, many head librarians believe that medical library users largely lack the competencies associated with IL due to lack of IL instruction, traditional education system in medical institutions and lack of interest of library users. One participant 148 noted, “The major responsibility lies on librarians they could not reach the users to equip them with IL skills.” Another explained, “Our education system does not require IL skills and students come to library for text books only. Many students have no knowledge of librarians’ job assignments or librarians are there to teach them IL skills.” Few head librarians held responsible the traditional medical curriculum, weak computer skills and lack of access to online information resources in the medical institution for the weak IL skills of library users. One participant stated, “Many students do not know how to use the computer to search academic databases.” Another opined, “Access to online research resources is not available to all students.” When asked how IL skills of library users can be improved, the participants come up with many suggestions. The same are presented in Table 5.16. Table 5.16 Suggestions to Improve the IL Skills of Library Users Suggestions Frequency Continuous IL training by librarians 13 Development/designing of IL courses in coordination with medical faculty by the librarians 11 IL courses as part of medical curriculum 9 Promotion of Evidence-Based Medicine in the medical institutions 7 Workshops on IL should be arranged frequently 5 Management and faculty should be convinced regarding importance of IL skills 5 One-on-one interaction between librarians and library users 3 Designing of IL sessions for small groups 2 Training of faculty members as first step 2 Training in computer skills for library users as first step 2 Promotion of research culture 1 Face-to-face and online tutorials 1 149 In summary, participants suggested (Table 5.16) that library users might be trained through continuous and mandatory IL instruction programmes, designed in coordination with faculty. One participant noted, “When we deliver IL instruction once they will forget with the passage of time, therefore, library users may be trained again and again at regular interval.” Many participants also suggested restructuring of teaching methodologies and introduction of evidence-based learning. Participants also suggested different modes of IL instruction such as IL as part of curriculum, workshops/seminars and one-on-one interaction between librarians and library users. A couple of participants also suggested IL sessions for small group of participants. One interviewee perceived, “IL skills are dependent on computer skills. Therefore, they should be taught computer skills first.” Few participants highlighted the importance of creating awareness amongst faculty members and management to support IL instruction programmes. 5.2.5.2 IL instruction methods. It was revealed in questionnaire survey results that workshops/seminars and formal in-class teaching were considered the most effective IL instruction methods. The interviewees were asked to opine on this inference. All participants unanimously and overwhelmingly stated that workshops/seminars are the most effective IL instruction method for faculty and clinicians. One participant noted, “…for faculty and clinicians workshops and seminars is the only way to deliver IL instruction as they are not enrolled in any academic course.” Another stated, “…clinicians have limited time and can hardly spare an hour for a short course.” A large majority of participants (n = 14) believed that for students, formal in-class teaching as part of the main curriculum would be the most effective IL instruction method. One participant stated, “I think if it is part of the syllabus, this will increase students’ 150 motivation and self-regulation… Librarians will employ more strategic approach to teaching IL.” Another commented, “Integration of IL into the curriculum is more effective than workshops and seminars as in workshops or seminars more emphasis of participants is on chatting and socialization rather than learning.” Three participants believed that both were equally effective. One participant stated, “…both are effective, whichever is feasible.” Another participant noted, “In fact, these two are the most effective methods but it should be ensured that the knowledge is surely being transferred to the target audience, the questions and confusions of the target groups are taken care of and IL instruction are offered to all students.” A small number (n = 3) opined that workshops are the most effective delivery method for students as well. One participant expressed, I will not recommend it as part of main curriculum, as this way it will become more theoretical than practical. In workshops they learn practically. Workshops allow hands-on learning by groups of students. They need more practice than theory. If it [IL instruction] becomes part of the curriculum the focus of students will be to learn it just to secure marks and to clear examinations. Workshops are better as it imparts practical based knowledge. Another participant noted, “Workshops are better because they are already overburdened, but workshops must be compulsory for all.” The comments from the participants affirm that the medical librarians should arrange workshops for faculty and clinicians while for students, class-based instructions along with practical are more effective. 151 5.2.5.3 Integrating IL Instruction into the curriculum. Head librarians were asked to give their views on the survey findings that IL instruction might be integrated into the curriculum and taught as an independent and a credit-based course. Majority of the participants (n = 17) supported integration of IL instruction into the curriculum as an independent and credit-based course. One stated, “…at this stage it will be difficult but in future it can be done through persistent efforts.” Another stated, “Librarians have to create awareness first and need support from administration to allow this integration.” One interviewee further explained, “Ideally it should be a credit course. They [students] will learn throughout the academic course but the contents must be reflective of their needs.” The remaining (n = 3) participant did not agree with this perception and noted that IL instruction should be delivered through workshops or non-credit courses. One head librarian stated, “I have totally another opinion, it [IL instruction] should be delivered in workshops and not as a part of curriculum. Curriculum means theory.” Another explained, “I do not think that it should be included as credit course as they are having a lot of other courses in their syllabi there is no need to put an extra burden on them.” A couple of participants recommended it as part of computer or research courses. 5.2.5.4 Responsibility for designing IL instruction curriculum. The participants were asked in question 14 to give their views on who should design the IL instruction curriculum as an overwhelming majority (92.5 %) of the questionnaire respondents was of the opinion that both librarians and faculty should design IL instruction curriculum. All 20 head librarians opined that IL curriculum should be designed by mutual consultation of librarians and faculty. One head librarian commented, “…collaboration with 152 faculty is the spirit of IL programme.” Participants were also asked to give reasons for supporting involvement of faculty in designing of IL curriculum. Their reasons have been listed in Table 5.17 in descending order by frequency of occurrences in the interviews. Table 5.17 Reasons for Librarian and Faculty Partnership in Designing IL Curriculum Reasons Frequency Faculty knows the needs of their students better 11 Success of IL instruction depends on collaboration between librarians and faculty 8 Faculty should be involved in developing effective IL curricula 5 Faculty can give better input on the contents of the IL curricula 3 Faculty knows the research projects carried out in their institutions 3 Faculty has expertise in designing of curricula 2 Librarians lack knowledge of medical sciences 2 Librarian-faculty collaboration is the spirit of IL programmes 1 Avoidance of duplication of contents in the curricula 1 IL curricula should be designed according to the needs of faculty 1 As seen in Table 5.17, data illustrates that involvement of medical faculty is important in designing of IL curriculum to determine the kind of knowledge, skills and health resources to be taught to students as they know the needs of their students better. The involvement of faculty is also important for development of effective IL curricula and is essential for the successful IL programmes. It was also found that collaboration provides opportunities of sharing ideas and expertise in this field. These findings reinforce the results of questionnaire survey that close coordination between librarian and faculty is necessary for successful designing of IL curriculum. 153 5.2.5.5 Responsibility for delivering IL instruction. In question 15 of the interview schedule participants were asked to give their views on the responsibility for delivering IL instruction as medical librarians were divided and undecided regarding the role of the faculty in imparting IL instruction. Thirty-five (52.2 %) questionnaire survey respondents felt that IL instruction should be delivered by both faculty and librarians, while 32 (47.8 %) were of the opinion that only librarians should be responsible for this. Again, half of the interviewees (N = 10) were of the opinion that librarians should be solely responsible for delivering IL instruction and provided many reasons for this (Table 5.18). Table 5.18 Reasons for IL Delivery by Librarians Only Reasons Frequency Librarians can educate the users in a better way 7 It is librarians’ domain being IL experts 6 IL instruction is the responsibility of librarians 3 Librarians are the major stakeholders of IL instruction and they should justify their presence 2 Faculty can sit as an observer in the IL sessions, it will improve IL skills of faculty as well 2 Faculty is not well versed with the IL skills 1 Coordination with faculty during development of IL courses is sufficient 1 Faculty is busy in teaching and research work 1 Librarians can develop a perfect combination of IL, computer and research skills for instruction 1 The analysis of interviews (Table 5.18) revealed that most of the participants who were of the opinion that only librarians should deliver IL instruction think that delivery of IL instruction is the domain and responsibility of librarians and they can better deliver IL 154 instruction being expert of IL. As one respondents noted, “IL instruction should be delivered by librarians as they are major stakeholders.” In addition, few also think that faculty itself is not well verse with IL skills and do not have time for IL instruction. One participant noted, “Once they [librarians] have developed IL course in coordination with faculty it is sufficient to get an input of faculty.” Another opined, “It is a full time job and faculty is already busy in teaching and research.” Eight participants supported involvement of faculty in delivery of IL instruction due to the reasons presented in Table 5.19. Table 5.19 Reasons for Involvement of Faculty in IL Delivery Reasons Frequency Some topics should be taught by librarians and some by teaching faculty 6 To make IL programme more effective 4 Collaboration between faculty and librarians is necessary to cover all contents of the IL course 3 Librarians are not well verse with medical terminologies 3 It will develop better working environment between faculty and librarians 2 Both faculty and librarians will learn from each other 2 It will decrease communication gap between teaching faculty and librarians 1 As Table 5.19 reveals, participants who supported the involvement of teaching faculty in the delivery of IL instruction were of the opinion that librarians and teaching faculty should divide the topics of their interest to make IL instruction more effective because topics should be taught by the subject experts. One participant explained, “In our college, we divide the topics between research department and library. For example, topics 155 related to research methodology and EBM are taught by faculty members and how literature search is to be done, is covered by librarians.” In addition, participants think that involvement of faculty in delivery of IL instruction will create better working relationship between librarians and faculty and it will greatly improve faculty-librarian collaboration. The presence of faculty in the class room may also effect the environment positively. As one participant mentioned, “The presence of teaching faculty in the class room will have a positive effect on students because they have greater regard for faculty than librarians.” Another noted, “It is the age of association, consortium and coordination. Librarians are good in IL skills and teaching faculty in teaching skills. Therefore, both will learn from each other.” An interviewee argued, “As librarians are not medical professionals so they are not well versed with medical terminologies and are not capable to jell IL skills with medical sciences for better outcome.” A couple of interviewees were of the view that anybody either a librarian or from faculty can deliver IL instruction provided he/she has a command on the subject. As one participant noted, “It should be decided according to the situation and environment.” and “If librarians are incapable to deliver IL instruction or lack teaching and presentation skills then faculty can deliver it. Actual thing is delivery of contents.” Hence, the opinion remained limited. 5.2.6 Other Comments Finally, interviewees were asked to give any other comments that were not covered in the interview, but only seven head librarians added. Table 5.20 presents the themes from the replies of the interviewees along with the frequency of their occurrence in the interview transcripts 156 Table 5.20 Other Comments by Interviewees Themes Frequency IL Standards for medical institutions may be formulated 3 Librarians should be given faculty status 2 Medical institutions should hire instruction librarians in addition to existing library staff. 1 Librarians should document their best practices as they can benefit from shared experience. 1 Analysis of interview text (Table 5.20) reveals that three participants mentioned the need for laying out IL standards so that the IL instruction practices in medical institutions in Pakistan can be standardized. Two head librarians recommended faculty status for librarians to play an effective role. One participant proposed that instructional librarians may be employed in medical libraries. Another participant articulated the importance of sharing IL instruction experiences among medical librarians by publishing their best practices. 5.3 Chapter Summary Interviews with 20 head librarians revealed their opinion that library users must be trained to: critically evaluate the information abundantly available online, organize it in a logical way for future convenience, and use it to accomplish a specific task. It was also acknowledged that IL is a new concept in Pakistan and it is still not part of LIS curriculum at all schools. Moreover, training opportunities for medical librarians in Pakistan are very limited in this area. Participants suggested that medical students of both postgraduate and undergraduate level must be trained in advanced and research-level IL skills. They identified lack of time due to tough academic and clinical schedule, traditional education system, and lack of research culture at undergraduate level as the possible reasons for not providing 157 advanced and research-level skills in most of the medical colleges. Interviewees exposed that most of the librarians lack knowledge of plagiarism, copyright and citation. They also opined that OPAC was not available in most of the medical libraries. Therefore, these topics were not covered in the IL instruction sessions. Interview participants considered face-to-face method as the most effective IL delivery method being interactive and only method in vogue in Pakistani medical institution. Web-based tutorials were not used due to lack of e-learning culture and facilities. Interviewees disclosed that formal assessment methods were not used due to voluntarily attendance in IL instruction being not integrated into the curriculum. Participants were in agreement that lack of IL training opportunities for librarians and an IL policy in medical institutions is an obstacle for development of IL instruction. The analysis of responses indicated that majority of the participants held LIS schools responsible for inadequate IL learning of medical librarians. Participants suggested that LIS association and organization should offer continuing professional development in the field of IL instruction. Participants also suggested that all library schools should include a course on IL instruction in the LIS curriculum at master level and should improve the research methodology course. Librarians also lack awareness regarding the importance of assessment methods. Respondents identified workshops/seminars and formal in-class teaching as part of the main curriculum as the most effective IL instruction delivery methods. Majority of the respondents desired that IL should be integrated into the medical curriculum as an independent and for credit course. All interviewees were of the opinion that both librarian and faculty should design IL curriculum. Interview participants explained that library users were not well verse with information skills because librarians did not offer formal IL 158 programmes in their respective institutions. Traditional education system based on reading text books and class notes was also considered as one of the possible reason for inadequate IL skills amongst library users. Interviewees suggested that library users might be trained in information skills through continuous IL instruction. All the interview participants supported collaboration between librarian and faculty for the development of IL instruction curriculum. They thought success of IL programmes depends on librarians-faculty partnership as faculty knows better the needs of students. Therefore, they can give better feedback in this regard. Interview participants opined that IL instruction should be delivered by librarians only or both librarian and faculty in collaboration. Chapter 6 discusses findings of the study. 159 CHAPTER 6 DISCUSSION This chapter interprets both quantitative and qualitative findings of the study presented in Chapter 4 and 5. Furthermore, it analyses the significance of the study by comparing the findings in the existing literature on information literacy (IL) instruction. 6.1 Perceptions of Medical Librarians towards the Importance of IL Skills Library and information professionals are expected to organize IL instruction programmes for their library users due to significant growth of online information. They should be more aware of the importance of IL skills. Therefore, perceptions of medical librarians towards the importance of IL skills are critical to the success of IL instruction programmes. The findings of the questionnaire survey presented in the Chapter 4 revealed that a mean score of higher than three about all eight IL skills proved that all the respondents considered them important for their library users. The results also revealed that there were no significant differences in the perceptions of head librarians employed in public and private sector medical institutions as well as in three types of medical institutions (medical colleges, postgraduate medical institutes and medical universities). It demonstrates a consensus regarding importance of IL skills among head librarians employed in different types of institutions and funded by public and private sectors. However, the ranking of IL skills show that private sector has a different priority from public sector as IL skill “organizing information collected or generated in a logical way” was ranked sixth by public sector head librarians while the same was ranked eighth by private sector head librarians. On the other hand the IL skill “evaluating the information critically” was ranked eighth by public sector head librarians and sixth by private sector head librarians. 160 Medical librarians employed in both public and private sector medical institutions considered most of the IL skills regarding recognition of the need for information, identification of information sources, ability to access information, verifying the relevance and quality of sources, and legal and ethical use of information very important for their library users. However, three IL skills regarding evaluation (by public sector institutions), organization and use of information (by private sector institutions) were rated a little bit low by one group of respondents. This anomaly between public and private sector medical institutions was further explored in detailed interviews with head librarians. The qualitative data revealed that the above mentioned three IL skills were also very important for library users. The interview participants opined that library users must be skilled to: critically evaluate the information abundantly available online, organize it in a logical way for future convenience, and use it to accomplish a task and achieve the specific objectives. Qualitative data also revealed that IL is a new concept in Pakistan and it has not found proper place in the LIS curriculum so far. Moreover, training opportunities for medical librarians in Pakistan are also very limited in the field of IL (Ullah & Anwar, 2013). Therefore, one possible reason identified for rating these IL skills low appears to be that many respondents might lack experience and knowledge about these skills. The results of present study are in line with previous studies which also considered IL skills vital to the success in education, any profession and routine life (Ameen & Gorman, 2009; Batool & Mahmood, 2012; Bhatti, 2012; Bruce, 2004; Dubicki, 2013; Horton, 2007; Julien & Boon, 2004; Kousar, 2010; McGuinness, 2009; Suleiman, 2012). Therefore, the library users need to be educated with regards to the abilities to identify, search, evaluate, organize and use information. Hence the findings suggest that IL skills need to be introduced 161 among the library users by librarians as it has become essential part of their professional services (Aharony & Bronstein, 2014; Bruce, 2004; Lwoga, 2013). These findings have significant implications for development of library users’ IL skills in medical institutions. Moreover, the findings are also consistent with the IL abilities mentioned in the Empowering eight (E8) model developed in Sri Lanka for developing countries (Wijetunge & Alahakoon, 2005). 6.2 Current Practices of IL Instruction in Medical Libraries Survey results indicate that most of the medical libraries in Pakistan offer library orientation and introductory information skills. Fewer respondents provide instruction in research-level skills. Unfortunately, these basic programmes are insufficient to support lifelong learning, critical or creative thinking and problem solving, all of which require more well-developed skills and thus more extensive instruction in information retrieval (Ameen & Gorman, 2009). IL instruction practices were found to be at a basic level, the interview participant also agreed that library orientation and instruction in basic IL skills were not enough for medical library users. Previous studies have reported very similar IL practices in other developing countries (Baro & Keboh, 2012; Baro & Zuokemefa, 2011; Diep & Nahl, 2011; Fafeita, 2006; Karisiddappa & Rajgoli, 2008; Lwehabura, 2007; Ranaweera, 2010; Starkey, 2010). Quantitative results showed a moderate association between medical universities and medical colleges as well as between postgraduate medical institutes and medical colleges on the delivery of advanced-level information skills and research-level skills. More medical librarians employed in medical universities and postgraduate medical institutes offered advanced-level information skills and research-level skills, compared to librarians at medical 162 colleges. These results were expected as medical colleges mostly offer undergraduate medical education, which may not require "advanced-information skills" or "research-level skills," whereas medical universities and postgraduate medical institutes offer postgraduatelevel education, requiring students to use a more advanced and research-level of information skills. However, interview participants suggest that medical students of both postgraduate and undergraduate level must be trained in advanced and research-level IL skills. They identified lack of time due to tough academic and clinical schedule, traditional education system, and lack of research culture at undergraduate level as the possible reasons for not providing advanced and research-level skills in medical colleges. Medical librarians covered multiple content areas during IL instruction. Introduction to library resources, services policies; searching techniques and use of medical databases were the most commonly covered areas. Few respondents reported addressing plagiarism, copyright, citation management and Evidence-Based Medicine. More attention needs to be paid to these areas, as the Association of College and Research Libraries (ACRL) standards state that the information literate student “understands many of the economic, legal, and social issues surrounding the use of information and accesses and uses information ethically and legally” (ACRL, 2000). Interview participants exposed that most of the librarians did not offer topics such as plagiarism, copyright and citation during IL instruction due to the reason that librarians themselves lacked expertise in these areas. They also revealed that OPAC was not available in most of the libraries. Medical librarians indicated that they preferred traditional face-to-face instructional delivery in a computer laboratory; lecture hall or individual instruction at reference desk over online or web based tutorials, rather than using online settings. This might reflect the absence 163 of the required information technology (IT) skills, support, and facilities in these medical institutions that are needed to develop such tutorials as revealed by interview participants. Providing these medical libraries with the facilities needed to develop online tutorials, would expand their ability to reach the students who may never have the opportunity to experience face-to-face IL instruction. Online or web-based tutorials can be used any time at any place (Jiri, 2014; Su & Kuo, 2010). Interview participants considered the face-to-face IL delivery method as the most effective being interactive and only method in vogue in Pakistani medical institutions. Some respondents also offered IL instruction in the library reading room, possibly because libraries are mostly housed in a single room in medical colleges. IL instruction is typically only offered to new students or first time library users or on demand. Only 26 % medical institutions had integrated IL instruction in the curriculum as a non-credit course. Integrating IL instruction into the curriculum cannot be done by the library alone. Medical librarians will need support from students, faculty and administrators; which requires a sustained effort, negotiation and communication (Oberprieler, Masters & Gibbs, 2005). Medical librarians used oral or written feedback to assess the effectiveness of their IL instruction sessions; few respondents used formal assessment methods. Interview participants disclosed that formal assessment methods were not used due to voluntarily attendance in IL instruction programmes being not integrated into the curriculum. Assessment is important; IL instructors need to determine how effective their IL instruction program is in terms of students achieving learning outcomes so that they may improve those programs. Assessment also provides evidence of effectiveness to faculty and administration which can assist in obtaining monetary and policy support for IL instruction programmes. 164 The results demonstrated that most of the medical institutions lacked collaboration between librarians and faculty; only one-third of the respondents collaborated with faculty in their IL instruction programmes. Many studies have demonstrated a lack of cooperation between faculty and librarians, and acknowledged the need for collaboration between them in order to enhance the teaching and learning process (Baro & Keboh, 2012; Baro & Zuokemefa, 2011; Diep & Nahl, 2011; Fafeita, 2006; Lwehabura, 2007; Ranaweera, 2010; Starkey, 2010). At the same time, findings also indicated that medical librarians were predominantly responsible for running IL instruction programmes, and IL instruction seemed to be one of their core mandates. This mandate is also supported by international LIS associations such as ACRL, the Medical Library Association, the American Association of School Libraries, IFLA and CILIP (ACRL, 2000; Lau, 2007; Medical Library Association, 2005). Aharony and Bronstein (2014) also found that Israeli academic librarians believed that teaching IL is more a library role than a teaching faculty role. 6.3 Barriers when Advocating or Providing IL Instruction In Pakistan, the problems besetting the IL instruction are many. Both quantitative and qualitative findings disclosed that lack of policy regarding IL instruction in the medical institutions and lack of training opportunities for IL instruction librarians are the most important barriers that may continue to impede IL initiatives in Pakistani academic medical institutions. In these regards, the findings of this study are similar to those revealed in the studies carried out in Irish Republic and Tanzania (Lwehabura, 2007; McGuinness, 2009). Moreover, other barriers such as lack of librarian-faculty collaboration, more emphasis of management in developing physical infrastructure than IL instruction, shortage of library staff, IL instruction being not part of the medical curriculum, lack of time and lack of pro 165 activeness and strong advocacy for IL among librarians is also creating impediments to IL activities. These barriers are consistent with the impediments identified by many scholars in other developing countries (Ashoor, 2005; Baro & Zuokemefa, 2011; Karisiddappa & Rajgoli, 2008; Lwehabura, 2007; Ranaweera, 2010). Ameen and Gorman (2009) reported the same barriers in Pakistani academic institutions along with more emphasis of government on ICT infrastructure than IL. Bhatti (2012) also highlighted the barriers such as lack of IL policy, lack of assessment of user’s information needs, inadequate IL training of librarians and lack of research on IL, low interest of faculty and students, and Lack of dedicated budget for IL instruction in Pakistani universities. There are many factors which are responsible for not implementing IL instruction programmes in academic medical libraries and preventing their systemic development. The first step in seeking solutions is finding out the causes of our problems, so that they can be gradually rooted out. However solutions are not always easy to arrive at as many times they involve factors and issues which are beyond our own control. If we look at our education system as a whole the conditions are not conducive for imparting IL instruction to the end users. Therefore, a brief analysis of these conditions, I think, will help in analyzing these constraints in the way of IL instruction programmes. Constraints are to be found in all activities and in most cases they serve as stimulants to improvements. It is important that people must seek solutions and not get discouraged. However, without clear policy guidelines the road will always be jumpy (Bruce, 2004). 6.4 IL Instruction Training Needs of Medical Librarians IL is a neglected area in the LIS curriculum at master level in Pakistan. LIS professionals also have limited on-job IL professional development opportunities. Moreover, 166 lack of IL instruction training opportunities for librarians was identified as the major barrier that effect development of IL instruction programme in medical institutions. Most of the librarians did not receive any IL instruction training. The findings of this study are in line with a previous study (McGuinness, 2009) revealing that instructional librarians in Irish Republic learn through experience and on “trial and error” basis. When planning the Continuing Professional Development (CPD) programmes, it is important that programme organizers bear in mind the needs of the participants and their interests. Furthermore, CPD organizers need to consider relevant educational issues when planning and conducting CPD activities so that the participants find the activities beneficial. IL instructors need to be aware of the current trends in the field of IL instruction and also to be capable to face new challenges in imparting IL instruction (Moselen & Wang, 2014). These objectives can be achieved through advanced training programmes, short skilled courses, seminars and workshops. The findings of this study indicated that the head librarians were very much interested in development of their IL instruction proficiencies such as development of course contents, need assessment, teaching methods, promotion skills, presentation skills, integration into the curriculum, instructional design, developing online tutorials, planning skills. These findings support the results of Starkey (2010) and are also in line with a set of proficiencies developed by ACRL (2008) for instruction librarians. The quantitative results also indicated that no differences were found between the preferences of the sub-populations. These findings will assist LIS schools, LIS associations and those who wish to plan and conduct CPD activities in setting priorities for future professional development trainings and workshops in the field of IL instruction. 167 However, most of the questionnaire survey respondents were not very much interested in development of their assessment and evaluation skills. Interview participants identified that most of the librarians were not aware of the importance of assessment and librarians are also not practicing it due to the reason that IL was not integrated into the medical curriculum. There is a dire need that LIS associations such as the Medical Library of Pakistan (MELAP), the Pakistan Library Association (PLA), the National Library of Pakistan (NLP), the College of Physician and Surgeons of Pakistan (CPSP) and medical universities should offer meaningful IL instruction training and CPD programmes for medical librarians to create and improve IL instruction activities in medical institutions. All LIS schools need to incorporate the IL instruction modules in the LIS curriculum and strengthen the research methodology courses. LIS professionals should be trained for instructional role at entry level to keep their knowledge and skills current so that they can deliver the high quality of instructional services that meet the expectation of library users and requirement of their profession (Lau. 2006; Selematsela, 2005). CPDs help the professionals to make meaningful contribution to the profession and the person become more effective in the workplace. It also helps in advancing career and move into the new positions where an individual can lead, manage, influence, coach, and mentor other professionals (Sproles, Johnson & Farison, 2008). The present study is an important step in that direction. 6.5 Strategies for the Effective Implementation of IL Instruction Programmes Students must be information literate to be successful in their higher education, research and lifelong learning goals. They must be well versed with the information and research skills for evidence-based learning and practices (Bruce, 2004). Nonetheless, this 168 study shows that medical library users are not adequately equipped with the skills called information literacy. The findings in this aspect are in accordance with Mahmood (2013) and Rafique (2014), although these studies were carried out on university students. Interview participants unveiled that due to traditional education system, most of the librarians does not offer in-depth IL instruction to students. These results suggest that IL skills in all the areas required improvement by offering IL instruction to library users. Therefore, a proper strategy must be devised to ensure that medical students achieve IL prior to entering practical life. Head librarians considered formal classroom teaching as part of the main curriculum and workshops/seminars as the most effective methods for imparting IL instruction. IL instruction as a part of the curriculum will be the most effective strategy for students. In this study, the pattern emerging from the data suggests that workshops and seminars should be conducted for those who are not enrolled in any course. These findings are in confirmatory with Leckie and Fullerton (1999) that science faculty was interested in workshops to be arranged for them and in-class teaching for their students. The integration of IL instruction into the curriculum for students can only be possible when awareness of IL instruction is created among higher administration, and strategies are developed with mutual coordination between all stakeholders. Librarians trying to integrate IL instruction in the curriculum will have to convince their often sceptical administrators first, which is an “up-hill battle” (Derakhshan & Singh, 2011). The Pakistan Medical and Dental Council (PM&DC), an accrediting agency for medical institutions in Pakistan, can play a vital role in this regard. IL should be part of the academic policy / mandate of the institution. The respondents rated the effectiveness of web-based tutorials as low for IL instruction delivery. The possible reasons 169 identified by interviewees were the inadequate facilities and resources for creation and implementation of such tutorials. Although the role of librarians is central in imparting IL instruction, still the liaison of medical librarians with teaching faculty is a key contributor to IL instruction programmes. The key areas identified in this study are consistent with the literature published, particularly integrating IL instruction into the main curriculum, and collaborating with faculty (Barnard, Nash & O’ Brien, 2005; Bruce, 2004; Corrall, 2007; Diep &Nahl, 2011; Derakhshan & Singh, 2011; Dubicki, 2013; Esterhuizen & Kuhn, 2010; Ford, Foxlee & Green, 2009; Gowalt & Adams, 2011; Horton, 2007; Kingsley & Kingsley, 2009; Larkin & Pines, 2005; Li, 2007; Lwehabura, 2007; McGuinness, 2006, 2007, 2009; Spiranec & Pejova, 2010: Starkey, 2010; Zanin-Yost, 2012). The results of Pearson’s chi-square and Fisher’s exact tests suggest that this strategy should be adopted in all types of academic medical institutions in both public and private sectors, as no significant differences in the opinion of respondents between the subpopulations were found. The findings may be of value to other types of academic institutions. 6.6 Chapter Summary Medical library users must be information literate to be successful in their higher education, research and lifelong learning goals. Library orientation and training in basic information skills are insufficient to support lifelong learning, critical or creative thinking and problem solving, all of which require more well-developed skills and thus more extensive instruction in IL. LIS associations and organizations should develop the IL instruction competencies among librarians to prepare them for instructional role. IL policy must be formulated that could provide guidelines and directions for implementation of IL 170 instruction in medical institutions. Workshops and seminars are the most effective IL delivery methods for medical faculty, clinicians and researchers. While medical students must be trained through continuous and mandatory IL instruction programmes, designed in coordination with teaching faculty. Chapter 7 presents summary of findings, conclusions and recommendations. 171 CHAPTER 7 SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS This two-phase sequential mixed methods study was conducted to appraise the status of information literacy (IL) instruction in medical libraries of Pakistan so as to suggest strategies for the effective implementation of IL instruction programmes in academic medical institutions. In addition, this study also found out the perceptions of medical librarians towards the importance of IL skills, barriers (when advocating or providing IL instruction), and IL training needs of medical librarians. Five explored research questions were: 6. What are the perceptions of medical librarians in Pakistan towards the importance of IL skills? 7. What are the current practices of IL instruction (course contents, methods of delivery and assessment, level of integration in the curriculum, level of collaboration with teaching staff) in medical libraries? 8. What are the barriers when advocating or providing IL instruction in medical institutions? 9. What are the IL instruction training needs of medical librarians? 10. What are the strategies to be adopted for the effective implementation of IL instruction in academic medical institutions of Pakistan? This chapter summarizes the results presented in chapter 4 and 5, draws conclusions from the findings, makes recommendations about the implication for practice, and future research. 172 7.1 Research Design and Demographics This study adopted sequential mixed methods of research design and used quantitative and qualitative data collection methods. In the first phase, using semi-structured questionnaire, quantitative data were collected from the head librarians of medical institutions, established till August 2013 and recognized by Pakistan Medical and Dental Council (PM&DC). The questionnaire comprising of 23 questions, divided into five parts was developed after extensive literature review, expert scrutiny and pilot testing for conducting a descriptive survey. The questionnaire was delivered by postal mail to the head librarians of all (114) academic medical institutions in Pakistan, 58 (50.9 %) of whom worked in the public sector, while the remainder (56, 49.1 %) served in private medical institutions. The majority (81, 71.1 %) of the head librarians were employed in medical colleges, 21 (18.4 %) in postgraduate medical institutions and 12 (10.5 %) in medical universities. Sixty-nine useable responses were received with 60.5 % response rate. Out of 69 respondents 52 (75.4 %) were males and 17 (24.6 %) were females. A total of 31 respondents (44.9 %) were from public sector medical institutions and 38 (55.1 %) were from private sector medical institutions. Forty-four (63.8 %) respondents were employed in medical colleges, 14 (20.3 %) in postgraduate medical institutes, and 11 (15.9) in medical universities. The data were analysed by using SPSS. Qualitative data was gathered through semi-structured in-depth interviews with 20 head librarians of academic medical libraries in Pakistan. Interviews were conducted between April and June 2014. The participants were selected (using purposive sampling) from the filled survey questionnaires and only those (head librarians) were chosen who had comparatively better understanding of IL and provided advanced or research-level IL 173 instruction to their library users in the previous year. Out of 20 interviewees 15 were males and 5 were females; 12 were employed in private sector and 8 in public sector medical institutions; 11 were working in medical colleges, 5 in postgraduate medical institutes and 4 in medical universities. Interviews were utilized to gain a deeper understanding and detailed comments on the most significant findings of the questionnaire survey. An interview schedule was developed and followed during interviews. All face-to-face and phone interviews were audio recorded, with consent, as a primary source of data and were transcribed. The textual data was content-analysed and coded. The emerged themes and subthemes were presented with frequency of their occurrences along with interpretation, comments, and quotes from the transcripts. 7.2 Summary of Findings This study tried to answer the five research questions. Major findings regarding the research questions are presented in the following sections. 7.2.1 Perceptions of Medical Librarians towards the Importance of IL Skills Research question 1 explored the perceptions of medical librarians in Pakistan towards the importance of IL skills. The quantitative results had demonstrated that respondents from public sector medical institutions considered the seven (“accessing the needed information effectively and efficiently”, “identifying relevant, authoritative and reliable information sources”, “recognizing the need for information”, “verifying the relevance and quality of information sources”, using information ethically and legally”, “organizing information collected or generated in a logical way” and “ using the selected information effectively to accomplish a specific task) out of eight IL skills, presented to them in the questionnaire, very important for their library users, and obtained a mean score of 174 more than four on a 5-point Likert scale (1 = least important, to 5 = most important). However, they did not consider “evaluating the information critically” very important for their users and obtained a mean score of less than four i.e., 3.94. Respondents from private sector medical institutions considered six IL skills very important for their library users. However, they did not consider “using the selected information effectively to accomplish a specific task” and “organizing information collected or generated in a logical way” very important skills for their library users, and each of them obtained a mean score of less than four i.e., 3.97. Independent sample t-tests and one-way ANOVA did not find any significant differences in the perceptions of sub-populations (respondents from public and private sector medical institutions, and medical colleges, postgraduate medical institutes and medical universities). The apparent anomaly in responses with regard to evaluation, organization and use of information skills between public and private sector head librarians prompted us to ask the interviewees again about the importance of these three IL skills. The qualitative results revealed that all 20 of the interview participants viewed “evaluating the information critically” as very important skill for their library users. Participants explained that information retrieved must be reliable. Furthermore, the relevancy, authenticity, currency, accuracy, validity and quality of information should also be evaluated. Majority of the interviewees also rated “organizing information collected or generated in a logical way” as very important skill for their library users. They clarified that organizing information was important to save time and energy of users and organized information can be easily retrieved when required in future. All participants considered “using the selected information to accomplish a specific task” very important skill as well for their library users. They 175 elucidated that library users must learn this skill to accomplish the task and to achieve the ultimate goal. The participants articulated that those who rated low the above three IL skills, might lack knowledge of IL or interest in learning and teaching IL skills to their library users. 7.2.2 Current Practices of IL Instruction in Medical Libraries In research question 2, current practices of IL instruction in medical libraries were appraised. The quantitative findings had revealed that 74 % of the respondents had offered some types of IL instruction in their institutions during the previous year, ranging from library orientation to research-level skills. Chi-square results revealed that more medical university libraries and postgraduate medical institute libraries reported offering “advanced information skills” and “research-level skills” as compared to medical college libraries. Topics like plagiarism awareness, copyright, citation of information, and OPAC/library catalogue were covered by less than 40% of the respondents in IL instruction programmes. IL instruction is typically only offered to new students or first time library users or on demand. Majority of the respondents developed IL instruction programs without involvement of faculty. Primarily librarians were responsible for offering IL instruction in medical institutions. While face-to-face instruction in computer lab or lecture hall and individual instruction at reference desk were identified as the most common IL instruction delivery methods. The data conceded that an oral feedback, written feedback and assessment through practical searching in computer lab were the most popular assessment methods used by medical librarians. All the interviewees agreed that library orientation and instruction in basic information skills were not enough for medical library users. They suggested that medical students of both postgraduate and undergraduate level must be trained in advanced and 176 research-level IL skills. Lack of time due to tough academic and clinical schedule, traditional education system, and lack of research culture at undergraduate level were identified as the possible reasons for not providing advanced and research-level skills in medical colleges. Most of the librarians did not offer topics such as plagiarism, copyright and citation during IL instruction due to the reason that librarians themselves lacked expertise in these areas. OPAC was not available in most of the libraries. Face-to-face IL delivery method was considered as the most effective in imparting IL skills, being interactive and only method in vogue in Pakistani medical institutions. The facilities for development of online tutorials were not available in medical institutions. Formal assessment methods were not used due to voluntary attendance and moreover IL instruction was not part of the curriculum. 7.2.3 Barriers When Advocating or Providing IL Instruction Research question 3 identified the barriers when advocating or providing IL instruction in medical institutions. It was disclosed that "lack of training opportunities for IL instruction for librarians” and “lack of policy regarding IL instruction in the medical institutions” have been identified as the most significant barriers that affect development of IL instruction programmes in both public and private sector medical institutions. Respondents from public sector institutions also strongly agreed that lack of collaboration between librarians and faculty, and more interest of management in developing physical infrastructure than IL instruction also impeded the IL instruction programmes. While respondents from private sector institutions strongly agreed that IL being not part of the curriculum is the barrier. The other barriers such as “lack of awareness regarding the importance of IL instruction among medical community”, “shortage of library staff to provide IL instruction”, lack of IL expertise among medical librarians”, lack of time by 177 librarians due to professional work”, “lack of commitment among librarians for IL instruction”, lack of interest of users” and “library being part of administration not academics” got a mean score of less than four and greater than three on a scale of 1 (strongly disagree) to 5 (strongly agree) from both public and private sector medical institutions. Independent sample t-tests and one-way ANOVA did not find any significant differences in the perceptions of sub-populations (respondents from public and private sector medical institutions, and medical colleges, postgraduate medical institutes and medical universities). The interviewees explained that training of medical librarians is of paramount importance. Medical librarians are inadequately trained in IL instruction competencies due to limited IL training opportunities in Pakistan. They also opined that medical institutions had no formal IL policy. Therefore, lack of IL training opportunities for Librarians and lack of policy regarding IL are the top two barriers that impede the development of IL instruction in medical institutions. The other barriers, enumerated by participants were lack of support from management, shortage of library staff, lack of awareness among faculty and students regarding importance of IL skills, and non-faculty status of librarians. 7.2.4 IL Instruction Training Needs of Medical Librarians In research question 4, IL instruction training needs of medical librarians were explored. It was revealed that most of the head librarians (63.6 %) did not study IL instruction during MLIS and 63.1 % also did not attend any short course or workshop on IL instruction in the previous year. It shows that most of the medical librarians lack IL instruction training. All the five IL instruction areas got mean score less than four from head librarians in both public and private sector on a scale of 1 (very weak) to 5 (very strong). It suggests that the overall IL instruction knowledge of head librarians is inadequate. Two IL 178 instruction areas, “core concepts of IL instruction” and “awareness raising and advocating need for IL instruction” got a mean score of more than three from both public and private sector head librarians. While two IL instruction areas (“designing IL instruction programmes for your patron” and “knowledge of different IL standards”) also received three or higher mean score from private sector head librarians. The knowledge of different IL models was identified as the weakest IL instruction area by both groups of head librarians. Public sector head librarians also perceived their knowledge of “designing IL instruction programme for your patron” and “knowledge of different IL standards” as weak. Independent samples t-tests and one-way ANOVA did not find any significant differences in the perceptions of subpopulations (respondents from public and private sector medical institutions, and medical colleges, postgraduate medical institutes and medical universities). This situation cannot be fair to the clients of IL instruction, nor can it lead to effective delivery of IL instruction. The respondents were very much interested in the development of their IL instruction skills in the eight areas (developing IL course contents, need assessment, teaching methods, developing and promoting IL instruction programmes, presentation skills, integrating IL instruction into the curriculum, IL instructional design skills and developing online tutorials) mentioned in the questionnaire. These IL instruction areas received mean score higher than four from both public and private sector head librarians on a scale of 1 (least interested) to 5 (most interested). However, the results have revealed that medical librarians were not very much interested in the development of their evaluation and assessment skills to measure learning outcomes of the participants and administrative skills for running IL instruction programmes and got a mean score of less than four from both group of head librarians. Public sector head librarians were also not very much interested in planning skills, while the 179 same got mean score higher than four from private sector head librarians. Independent samples t-tests and one-way ANOVA did not find any significant differences in the responses of sub-populations (respondents from public and private sector medical institutions, and medical colleges, postgraduate medical institutes and medical universities). Interview participants identified many associations and organizations such as the Medical Library Association of Pakistan (MELAP), the Pakistan Library Association (PLA), the College of Physicians and Surgeons of Pakistan (CPSP), the National Library of Pakistan (NLP) and medical universities, for the continuing professional development of medical librarians. Participants also suggested that all library schools should include a course on IL instruction in the LIS curriculum at master level and should strengthen the research methodology course as well. In addition, few participants suggested that medical librarians can improve their IL competencies by self-learning, consulting online tutorials and sharing their experiences/practices with each other. Most of the participants were of the opinion that formal assessment is important for the improvement of IL instruction programmes. Participants identified various reasons for lack of interest in the development of assessment and evaluation skills amongst medical librarians. Such as librarians were not aware of the importance of assessment and library users also hesitate to take examinations. Few participants also indicated that IL is not part of curriculum as a credit course; therefore, there is no demand of assessment. Resultantly, librarians are not interested in the formal assessment and they rely on feedback. In addition, participants also believed that librarians lacked teaching or assessment skills and were also not expected to assess the IL instruction outcomes of participants. Librarians also opined that the formal assessment may discourage 180 the library users to participate in the IL instruction programmes as IL instruction is not mandatory for library users. 7.2.5 Strategies for the Effective Implementation of IL Instruction Programmes In research question 5, the strategies for the effective implementation of IL instruction programmes in medical libraries were explored. The questionnaire survey results revealed that IL skills of library users had been perceived by the head librarians as inadequate because all the eight IL skills got a mean score of less than four from both public and private sector respondents on a scale of 1 (very poor) to 5 (very strong). The IL skills identifying and locating authoritative information sources, using print/online resources legally and ethically, searching online databases, formulation of search strategy, obtained a mean score of higher than three from both public and private sector institutions. Evaluation of information and use of OPAC/library catalogue also got a mean score of more than three from private sector head librarians. However, these two IL skills got a mean score of less than three from public sector head librarians. Citing sources appropriately was the weakest area and obtained a mean score of less than three from both group of head librarians. Independent samples t-tests and one-way ANOVA did not find any significant differences in the perceptions of sub-populations (respondents from public and private sector medical institutions, and medical colleges, postgraduate medical institutes and medical universities). Respondents identified workshops/seminars and formal in-class teaching, as part of the main curriculum as the most effective IL instruction delivery methods. Majority of the respondents were in favour of integrating IL instruction into the curriculum. Majority of the respondents desired that IL should be integrated into the curriculum as an independent credit course. An overwhelming majority of the respondents was of the opinion that both librarian 181 and faculty should design IL curriculum. However, respondents were divided and undecided regarding role of the faculty in imparting IL instruction. Chi-square tests and FET results show that there were no significant differences in the opinions of the sub-populations. Therefore this strategy can be applied to all types of medical institutions in public and private sectors. Interview participants explained that library users were not well versed with information skills because librarians did not offer formal IL programmes in their respective institutions. Traditional education system of reading text books and class notes was also considered as one of the possible reason for inadequate IL skills amongst library users. Interviewees suggested that library users might be trained in information skills through continuous IL instruction. Evidence-based learning and practices also need to be promoted in medical institutions. Participants unanimously and overwhelmingly agreed that workshops/seminars would be the most effective methods for delivering IL instruction to faculty and clinicians. However, most of the participants recommended integration of IL instruction at both undergraduate and postgraduate levels. Majority of participants also supported its integration as an independent and mandatory credit course. They believed integration of IL instruction will provide an opportunity to the students to learn information skills throughout the academic course. All the interview participants supported collaboration between librarian and faculty for the development of IL instruction curriculum. They thought success of IL programmes depends on librarian-faculty partnership as faculty understands the needs of students better. Resultantly, they can give better feedback in this regard. Interview participants opined that IL instruction should be delivered by librarians only or both librarian and faculty. Those who 182 supported librarians only, were of the opinion that librarians are the experts in IL and it is their domain. While those who supported both librarians and faculty believed that topics may be divided amongst librarians and faculty to cover all the areas and to make it more effective. Few participants also believed that coordination in delivery of IL instruction will improve the relationship between librarians and faculty. 7.3 Conclusions Based on the findings of the study, following conclusions are drawn: 1. Head librarians of medical libraries in Pakistan have acknowledged the importance of information literacy (IL) skills for their library users, meaning that all medical library users must be adequately equipped with information competencies. 2. IL instruction activities in medical libraries of Pakistan are in their infancy. Medical librarians need to conduct IL instruction programmes in a more systematic and effective manner. There is a need to develop educational partnership with faculty in order to integrate IL instruction into the mainstream curriculum, to teach it at a more in-depth level, and to provide better assessment. 3. Lack of IL training opportunities for librarians and lack of IL policy in medical institutions are the huge barriers that need to be breached. Lack of collaboration between librarians and faculty; lack of interest and awareness regarding importance of IL instruction among management, faculty and students; and lack of pro-activeness among librarians also impede the delivery of IL instruction in medical institutions. These impediments potentially have significant consequences for the long term sustainability of IL instruction in medical institutions. The findings of the present study suggest that leaders in the medical information services should take 183 responsibility, for overcoming the impediments, to train their library users more effectively. If they do not show pro-activeness, the sustainability of their health information services in the current environment will be lost. 4. IL knowledge of medical librarians is inadequate as most of them did not study IL instruction in the LIS curriculum and also had not attended any short course or workshop on IL instruction in the previous year. Medical librarians need to equip themselves with the necessary IL instruction competencies to achieve success in future. Head librarians were interested in development of their IL instruction proficiencies in following areas: developing IL course contents, developing need assessment of IL instruction, IL teaching methods, developing and promoting IL instruction programme, presentation skills, integrating IL instruction into the curriculum, IL instructional design skills, developing online IL tutorials, planning skills, administrative skills for running IL instruction programmes, and evaluation and assessment skill. LIS schools and associations can use this list of proficiencies to develop IL instruction skills of librarians. 5. In Pakistan, medical library users have not attained the competencies in various IL aspects to be considered as information literate. Therefore, library users' IL competence level needs to be developed and improved through regular workshops and seminars. IL should be integrated into the medical curriculum as an independent, mandatory credit course for students. The IL curriculum should be designed by both librarian and faculty. IL instruction should be delivered by either a librarian only or undertaken collaboratively by both librarian and faculty. This strategy can be implemented in all types of medical institutions both in public and private sector. 184 7.4 Recommendations Following recommendations are made about the implication for practice on the basis of conclusions of the study: 1. Librarians need to adopt proactive approach regarding creating an in-depth awareness about importance of IL skills among various stakeholders such as management, faculty and students. 2. A clearly stipulated IL policy may be formulated and implemented in all medical institutions. In this regard, accrediting agencies such as the HEC and the PM&DC can play a pivotal role. 3. The designers of future training programmes for librarians should incorporate some of the IL training needs, identified in this study, in the curricula. 4. A course on IL instruction of at least three-credit hours may be included in the LIS syllabus at master level in all LIS schools in Pakistan. 5. LIS schools and library associations should conduct regular continuing professional development courses, seminars, workshops and conferences on IL proficiencies identified in this study. 6. Medical librarians should design a systematic and comprehensive IL course in collaboration with teaching faculty that would ensure continual education and training of library users in terms of IL. 7. Medical institutions should integrate an IL course of at least two-credit hours into the main curriculum to foster adequate IL knowledge and skills among students. 8. Workshops and seminars should be conducted for the faculty, medical practitioners, and researchers and for all those who are not enrolled in any academic course. 185 7.5 Recommendations for Further Research Based on the results and limitations of this study, the following recommendations are put forth for future research: 1. Similar studies can be conducted to explore the status of IL instruction in other types of libraries. 2. Further studies should be conducted about perceptions of faculty and students regarding importance of IL skills. 3. Research can be undertaken to support the development of IL standards in conjunction with the HEC and the PM&DC. 4. 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Dr Khalid Mahmood, Professor, Department of Library and Information Science, University of the Punjab, Lahore, Pakistan. 2. Dr Mumtaz A. Anwar, Professor, Department of Library and Information Science, University of the Punjab, Lahore, Pakistan. 3. Dr Shaheen Majeed, Associate Professor, Division of Information Studies, Wee Kim Wee School of Communication and Information, College of Humanities, Arts, & Social Sciences, Nanyang Technological University, Singapore. 4. Ms. Syeda Hina Batool, Assistant Professor, Department of Library and Information Science, University of the Punjab, Lahore, Pakistan. Information Literacy Experts 5. Dr Mirza Naseer, Assistant Professor, Institute of Space Technology (IST), Islamabad 6. Mr. Muhammad Anwar. Direction Library, Institute of Business Administration (IBA), Karachi, Pakistan 7. Mr. Muhammad Farooq, Director Library, Riphah International University, Islamabad, Pakistan. 8. Ms. Bushra Almas Jaswal, Associate Professor, Forman Christian (FC) College University, Lahore, Pakistan. Medical Librarians 9. Dr Farzana Shafique, Assitant Professot & Director of Libraries (Female), University of Dammam, Saudi Arabia. 10. Dr. Muhammad Ijaz Miraj, Librarian, Punjab Institute of Cardiology, Lahore, Pakistan. 11. Mr. Syed Adnan Adil, Library Services Manager, National Health Services, London. 12. Ms. Azra Qureshi, Ex-Librarian, Faculty of Health Sciences Library, Agha Khan University, Karachi, Pakistan. 201 Appendix B COVERING LETTER SENT WITH THE DRAFT INSTRUMENT Dear Sir/Madam, Subject: Expert Opinion on Draft Questionnaire I am conducting a doctoral research on "the status of information literacy instruction in medical libraries of Pakistan: an appraisal" under the supervision of Professor Dr Kanwal Ameen, Department of Library and Information Science, University of the Punjab, Lahore. The study intends to explore the status of information literacy (IL) instruction in medical libraries of Pakistan. The focus is on probing the perceptions of medical librarians about the importance of IL skills, current practices of IL instruction, the barriers to IL instruction programmes and IL training needs of medical librarians. Suggestions from the head librarians regarding the strategies to be adopted for the effective implementation of IL instruction programmes in medical libraries of Pakistan will also be obtained. It is assumed that the findings will help to introduce and improve the IL instruction programmes in the medical libraries of Pakistan. A questionnaire has to be prepared to collect data before it is sent to the respondents. An extensive literature review has been conducted to prepare the attached draft questionnaire. A panel of experts has been selected to review this initial questionnaire. You are among one of the experts identified for the said purpose considering your personal profile and experience in this area. The draft questionnaire is attached for your valued input. You are requested to comment on the quality of contents, language, sequence and appropriateness of questions for this study in the questionnaire. Kindly return the enclosed instrument duly completed in two weeks' time. I will be highly grateful for your valuable feedback/comments. Yours sincerely, Midrar Ullah (PhD scholar at University of the Punjab) Librarian & LSO Army Medical College (NUST) Abid Majeed Road, Rawalpindi Cell: 03325584132 Email: midrarullah2007@yahoo.com Dated: June 21, 2013 202 Appendix C PILOT STUDY PARTICIPANTS 1. Mr. Hafiz Waseem Riaz, Ex- Librarian, Islamic International Medical College (IIMC), Rawalpindi. 2. Mr. Ikram-ul- Haq, Librarian, Armed Forces Postgraduate Medical Institute (AFPGMI), Rawalpindi. 3. Mr. Imtiaz Khan, Ex-Assistant Manager, Islamic International Medical College (IIMC), Rawalpindi. 4. Mr. Salamat Ali, Assistant Librarian, Pakistan Institute of Medical Sciences, Islamabad. 5. Mr. Muhammad Raza Qadeer, Senior Librarian, Shoukat Khanum Memorial Cancer Hospital & Research Centre, Lahore. 6. Mr. Muhammad Shafqat, Ex-Librarian, Yusra Medical College, Rawalpindi. 7. Mr. Murad Ali, Assistant Librarian, Ayub Medical College (AMC), Abbottabad. 8. Mr. Zahid Iqbal, Assistant Manager (Information Services Department), Islamic International Medical College (IIMC), Rawalpindi. 9. Ms. Mehvish Ara, Ex-librarian, CMH Medical College, Lahore. 10. Ms. Safina Kausar, Librarian, Rehman Medical Institute (RMI), Peshawar. 203 Appendix D. COVERING LETTER SENT WITH THE PILOT INSTRUMENT Dear Colleagues, I am conducting a Ph.D. study on “the status of information literacy instruction in medical libraries of Pakistan: an appraisal” under the supervision of Professor Dr Kanwal Ameen. Various initiatives have been taken in the developed world by library and information professionals (LIPs) and organizations for the adoption and promotion of information literacy (IL). Lately this area has got attention of information professionals in the developing countries. However, Pakistan has made some progress in this direction. Moreover, there is little empirical research about medical librarian’s IL instruction practices in Pakistan. This study is very significant with reference to medical libraries of Pakistan in particular and other academic libraries in general. To collect the data in this regard, a questionnaire has been prepared in the light of extensive literature review and experts’ opinion. Before its distribution to all respondents it is now being pilot tested. Therefore, your response is vital for the further improvement in the attached questionnaire. You are requested to kindly complete it, and if necessary, feel free to give comments on the separate sheet attached using the serial number of the related questions. I assure you that all responses will be used strictly for the purpose of this research project and no information will be disseminated to anyone for any other purpose. Kindly send back the enclosed questionnaire duly completed by August 05, 2013 in the attached stamped and addressed envelope. I will be highly obliged for your help. Regards Midrar Ullah (PhD scholar at University of the Punjab) Librarian & LSO Army Medical College (NUST) Abid Majeed Road, Rawalpindi Cell: 03325584132 Email: midrarullah2007@yahoo.com Dated: July 20, 2013 204 APPENDIX E. SURVEY INSTRUMENT The Status of Information Literacy Instruction in Medical Libraries of Pakistan: An Appraisal Important: please read the following text before filling in the questionnaire. Information Literacy (IL) is defined as "the ability to identify, locate, evaluate, organize, and effectively create, use and communicate information to address an issue or a problem". Information Literacy Instruction means the formally designed instruction (user education) sessions held by librarians to educate library clients/users on those skills which have been mentioned in the definition of IL given above. SECTION I Part 1. Perceptions of Medical Librarians towards the Importance of Information Literacy Skills 1. In your opinion, how important are the following IL skills for your library users? Please encircle the number which matches your opinion most closely. S.No 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Information Literacy Skills Recognizing the need for information Identifying relevant, authoritative and reliable information sources Verifying the relevance and quality of information sources Evaluating the information critically Accessing the needed information effectively and efficiently Organizing information collected or generated in a logical way Using information ethically and legally Using the selected information effectively to accomplish a specific task Least Important 1 2 3 4 5 Most Important 1 1 2 2 3 3 4 4 5 5 1 2 3 4 5 1 1 2 2 3 3 4 4 5 5 1 2 3 4 5 1 1 2 2 3 3 4 4 5 5 Part 2.Current Practices of Information Literacy (IL) Instruction 2. Do you offer some kind of IL instruction in your institution? ☐Yes ☐No If yes, then please answer the following questions as well. Otherwise skip questions 3 to 12. 205 3. Please tick the types of IL instruction your library has provided during the last one year. Tick all that apply. ☐Library orientation ☐Guided library tour ☐Introductory information skills (e.g., catalogue instruction, Introduction to the library website) ☐Advanced information skills (e.g., database training, advance Internet searching) ☐Research-level skills (e.g., conducting literature search and managing information, reference styles, citation management software training, scholarly publishing, etc.) 4. Please tick the topics covered in IL instruction programmes. Tick all that apply. ☐Introduction to Library resources, services and policies ☐OPAC/library catalogue introduction ☐Library website introduction ☐Identification of their own information needs ☐Online searching techniques ☐Use of medical databases ☐Use of search engines ☐Use of Higher Education Commission (HEC) Digit Library ☐Evaluation of information ☐Plagiarism awareness/ethical use of information ☐Copyright ☐Citation of information (Referencing styles) ☐Use of Citation Management Software (Endnote, Refwork, etc.) ☐Theory and Practice of Evidence Based Medicine ☐Scholarly publishing ☐ Other topics (please specify) _______________________________________________________ 5. For whom your library offers IL instruction programme? Tick all that apply. ☐Faculty ☐Undergraduate students ☐ Practitioners ☐ Postgraduate students ☐ Other (please specify) _____________________________ 6. When is IL instruction provided? Tick all that apply. ☐Whenever asked to do so ☐To new session/ first time users ☐ IL is a required course for students ☐At specific time after the installation or acquisition of a new system or information sources ☐Other (please specify) _______________________________________________________ 7. Where do you provide IL instruction? ☐In library training room ☐In lecture hall outside the library ☐In computer lab ☐ Other (please specify)________________________ 206 8. Which of the following methods do you use for IL instruction? Tick all that apply. ☐Face-to-face ☐Workshops / Seminars ☐Online/web-based tutorials ☐Combination of online and face-to-face ☐Printed training manuals ☐Individual instruction at the reference desk ☐ Other (please specify)____________________________________________________ 9. Do you assess the effectiveness of your IL instruction session? ☐Yes ☐No If your answer is “Yes”, than which of the following methods do you use for assessing effectiveness of your IL instruction session? Tick all that apply. ☐Quizzes ☐Multiple Choice Questions ☐Short answers ☐Written Feedback ☐Oral Feedback ☐Assignment ☐Assessment through practical searching in computer Lab ☐Collaborative learning exercise in class ☐Other methods (please specify) _______________________________________________ 10. Is IL integrated or embedded in the curriculum? ☐Yes ☐No If your answer is “Yes”, at which level IL instruction is integrated or embedded in the curriculum? a. Undergraduate level: ☐Yes ☐No If yes, how is it integrated? ☐As credit course ☐As non-credit course b. Postgraduate level: If yes, how is it integrated? ☐Yes ☐As credit course ☐No ☐As non-credit course 11. Are IL instruction Programmes developed in consultation with teachers? ☐Yes ☐No 12. Who runs the IL instruction programmes in your institution? ☐Librarians ☐Faculty ☐Both librarians and faculty in collaboration ☐ Other (please specify) _____________________________________________________ 207 13. From your experience how strong or weak are your library users’ IL skills in the following areas? Please encircle the number which matches your opinion most closely. S.No 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9 IL Skills Identifying authoritative/reliable information sources, such as journal articles Formulation of search strategy using key words to search information from the Internet Use of OPAC /library catalogue Locating relevant information sources in the library Searching online databases Evaluation of information for authenticity, currency and accuracy Citing sources appropriately Using print and online resources legally and ethically Other skills (please specify) Very Weak 1 2 3 4 5 Very Strong 1 2 3 4 5 1 2 3 4 5 1 1 1 1 2 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 Part 3. Barriers When Advocating or Providing Information Literacy Instruction 14. How do you agree or disagree with the following statements about barriers when advocating or providing IL instruction in medical libraries? Please encircle the number which matches your opinion most closely. S.No 14.1 14.2 14.3 14.4 14.5 14.6 14.7 14.8 14.9 14.10 14.11 14.12 14.13 Barriers Lack of IL expertise among the medical librarians IL instruction is not part of the curriculum Lack of policy regarding IL instruction in the medical institutions Shortage of library staff to provide IL instruction Lack of commitment among librarians for IL instruction Lack of awareness regarding the importance of IL among the medical community Lack of training opportunities for IL instruction for librarians Lack of time by librarians due to professional work Lack of collaboration between librarians and medical faculty Management is interested more in developing physical infrastructure than IL skill development Lack of interest by the users Library being part of administration not academics Other barriers (please specify) Strongly Disagree 1 2 3 4 5 Strongly Agree 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 1 1 2 2 3 3 4 4 5 5 1 2 3 4 5 1 2 3 4 5 1 1 2 2 3 3 4 4 5 5 1 2 3 4 5 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 208 Part 4. Information Literacy Instruction Training Needs of Medical Librarians 15. Did you take a course in IL as a part of your LIS education? ☐ Yes ☐ No 16. Have you attended any short course or workshop on IL during the last two years? ☐ Yes ☐ No 17. Please rate your knowledge of the following aspects of IL as fairly as possible. Please encircle the number which matches your opinion most closely. S.No 17.1 17.2 17.3 17.4 17.5 17.6 Information Literacy Areas Core concepts of IL instruction (introduction to the principles, concepts, and practices of information literacy, including the critical thinking skills necessary to identify, search, evaluate, organize and use information effectively). Awareness raising and advocating need for IL instruction Knowledge of different IL standards e.g. ACRL IL Competency Standards , IFLA IL Standards, etc. Knowledge of different IL models e.g. Big6, empowering 8, etc. Designing IL instruction programme for your patrons Other IL areas (Please specify) Very Weak 1 2 3 4 5 Very Strong 1 2 3 4 5 1 1 2 2 3 3 4 4 5 5 1 2 3 4 5 1 1 2 2 3 3 4 4 5 5 18. How interested are you in developing your skills in the following areas of IL instruction? Please encircle the number which matches your opinion most closely. S.No 18.1 18.2 18.3 18.4 18.5 18.6 18.7 18.8 18.9 18.10 18.11 18.12 Skills Developing need assessment of IL instruction at your institution Developing IL course contents Integrating IL instruction into the curriculum IL instructional design skills Presentation skills IL Teaching methods Developing online IL tutorials Developing and promoting IL instruction programme in the institution Administrative skills for running IL instruction programmes e.g., schedule, venue, resource person, required facilities, etc. Planning skills to continuously run and improve IL programmes Evaluation and assessment skills to measure the learning outcomes of participants Other skills (please specify) Least Interested 1 2 3 4 5 Most Interested 1 2 3 4 5 1 1 1 1 1 1 1 2 2 2 2 2 2 2 3 3 3 3 3 3 3 4 4 4 4 4 4 4 5 5 5 5 5 5 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 209 Part 5. Strategies to be adopted for the Effective Implementation of Information Literacy Instruction Programme 19. In your opinion how effective will be the following methods for imparting information literacy instruction? Please encircle the number which matches your opinion most closely. S.No 19.1 19.2 19.3 19.4 19.5 19.6 Methods Formal class teaching as part of the main curriculum (Integrated or embedded into the curriculum) As an extracurricular course One-shot group session for new entrants Web tutorials Workshops and seminars Other methods (please Specify) Least Effective 1 2 3 4 5 Most Effective 1 2 3 4 5 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 20. How should IL be taught to medical students? ☐As an extracurricular course ☐As part of the main curriculum/Integrated in the curriculum 21. If your answer to question No 20 is "As part of the main curriculum/Integrated in the curriculum", then please give your opinion regarding the following: a. How IL instruction should be accommodated in the curriculum? ☐As an independent course ☐Part of another course b. How IL instruction should be integrated in the curriculum? ☐As a credit course ☐As a non-credit course 22. Who should be responsible for designing the curriculum for IL instruction? ☐Faculty ☐Librarian ☐Both librarian and Faculty 23. Who should be responsible for delivering IL instruction? ☐Faculty ☐Librarian ☐Both librarian and Faculty 210 Section II Demographic Information 1. Gender: ☐ Male ☐ Female 2. Highest level of LIS education that you have attained: ☐ MLIS ☐ M.Phil. ☐ Ph.D. ☐ Other (please specify) _______________ 3. Your age group: ☐ Up to 25 years ☐26 - 35 ☐ 36 - 45 ☐ 46 - 55 ☐ 56 years or more 4. Your professional experience in years: ☐Up to 5 years ☐ 21 - 25 ☐6 - 10 ☐ 11 - 15 ☐ more than 25 years ☐ 16 - 20 5. What is the status of your institution? ☐ Public Sector (Government/Semi-government/Autonomous) ☐ Private Sector 6. In which type of medical institution are you currently employed? ☐ Medical College ☐Medical University ☐ Postgraduate Medical Institute Thank you very much for your time and support. Please return the questionnaire to: Midrar Ullah, Library Officer, Army Medical College Library, Abid Majeed Road, Rawalpindi. Ph: 03325584132, Res: 051-91859533, Office: 051-9240945. Email: midrarullah2007@yahoo.com This questionnaire is copyright protected. 211 Appendix F COVERING LETTER SENT WITH THE SURVEY INSTRUMENT Dear Colleagues, I am conducting a Ph.D. study on “the status of information literacy instruction in medical libraries of Pakistan: an appraisal” under the supervision of Professor Dr Kanwal Ameen. Various initiatives have been taken in the developed world by library and information professionals (LIPs) and organizations for the adoption and promotion of information literacy (IL). Lately this area has got attention of information professionals in the developing countries. However, Pakistan has made some progress in this direction. Moreover, there is little empirical research about medical librarians’ IL instruction practices in Pakistan. This study is very significant with reference to medical libraries of Pakistan in particular and other academic libraries in general. To collect the data in this regard, a questionnaire has been prepared after extensive literature review, expert scrutiny, and a pilot study. Your response is vital to understand the state of IL instruction in medical libraries of Pakistan. You are requested to fill in the attached questionnaire. I would be highly grateful for your time and effort in filling the attached questionnaire and assure you that all responses will be kept strictly confidential and the data provided will be used for the purposes of the research only. Kindly send back the enclosed questionnaire duly completed by September 10, 2013 in stamped and self-addressed envelope. I will be obliged for your help. Regards Midrar Ullah (PhD scholar at University of the Punjab) Librarian & LSO Army Medical College (NUST) Abid Majeed Road, Rawalpindi Cell: 03325584132 Email: midrarullah2007@yahoo.com Dated: August 27, 2013 212 Appendix G LIST OF INSTITUTIONS INCLUDED IN THE SURVEY S. No Institutions 1. Abbottabad International Medical College, Abbottabad. 2. Akhtar Saeed Medical & Dental College, Lahore. 3. Al-Razi Medical College, Peshawar. 4. Allama Iqbal Medical College, Lahore. 5. Al-Nafees Medical College, Islamabad. 6. Al-Tibri Medical College, Karachi. 7. 8. Ameer-ud-Din Medical College/Postgraduate Medical Institute (PGMI), Lahore. Amna Inayat Medical College, Sheikhupura. 9. Armed Forces Postgraduate Medical Institute, Rawalpindi. 10. Army Medical College, Rawalpindi. 11. Avicenna Medical College, Lahore. 12. Ayub Medical College, Abbottabad. 13. Azad Jammu & Kashmir Medical College, Muzaffarabad, AJK. 14. Aziz Fatima Medical and Dental College, Faisalabad. 15. Azra Naheed Medical College, Lahore. 16. Bacha Khan Medical College, Mardan. 17. Bahria University Medical & Dental College, Karachi. 18. Bannu Medical College, Bannu. 19. Baqai Institute of Haematology, Karachi. 20. Baqai Institute of Health Sciences, Karachi. 21. Baqai Medical University/Baqai Medical College, Karachi. 22. Baqai Postgraduate Medical Institute, Karachi. 23. Bolan Medical College, Quetta. 24. Central Parks Medical College, Lahore. 25. Chandka Medical College, Larkana. 26. CMH Lahore Medical College, Lahore. 213 27. College of Physicians & Surgeons Pakistan, Karachi. 28. Continental Medical College, Lahore. 29. Dow International Medical College, Karachi. 30. Dow University of Health Sciences/Dow Medical College, Karachi. 31. Faculty of Medicine & Allied Medical Sciences/Isra University, Hyderabad. 32. Fatima Jinnah Medical College for Women, Lahore. 33. Fatima Memorial Hospital (FMH) College of Medicine & Dentistry, Lahore. 34. Federal Medical & Dental College, Islamabad. 35. Foundation University Medical College, Rawalpindi. 36. Frontier Medical College, Abbottabad. 37. Ghulam Mohammad Maher Medical College, Sukkur 38. Gomal Medical College, Dera Ismail Khan. 39. Gujranwala Medical College, Gujranwala. 40. Gulab Devi Postgraduate Medical Institute, Lahore. 41. Hamdard College of Medicine & Dentistry, Karachi. 42. Hashmat Medical & Dental College, Gujrat. 43. Health Services Academy, Islamabad. 44. Independent Medical College, Faisalabad. 45. Institute of Child Health/ Children’s Hospital, Lahore. 46. Institute of Public Health, Lahore. 47. Islam Medical College, Sialkot. 48. Islamabad Medical & Dental College, Islamabad. 49. Islamic International Medical College, Rawalpindi. 50. Jinnah Medical & Dental College, Karachi. 51. Jinnah Medical College, Peshawar. 52. Jinnah Postgraduate Medical Centre, Karachi. 53. Kabir Medical College/Gandhara Institute of Medical Sciences, Peshawar. 54. Karachi Medical & Dental College, Karachi. 55. Khawaja Muhammad Safdar Medical College, Sialkot. 56. Khyber Girls Medical College, Peshawar. 214 57. Khyber Medical College, Peshawar. 58. Khyber Medical University, Peshawar. 59. King Edward Medical University/King Edward Medical College, Lahore. 60. KUST Institute of Medical Sciences, Kohat 61. Lahore Medical & Dental College, Lahore. 62. Liaquat College of Medicine & Dentistry, Karachi. 63. Liaquat National Medical College, Karachi. 64. Liaquat University of Medical & Health Sciences, Jamshoro. 65. Mohiuddin Islamic Medical college, Mirpur, AJK. 66. Muhammad Medical College, Mirpurkhas. 67. Muhtarma Benazir Bhutto Shaheed Medical College, Mirpur, AJK. 68. Multan Medical & Dental College, Multan. 69. National Institute of Cardiovascular Diseases, Karachi. 70. National Institute of Child Health, Karachi. 71. Nawaz Shairf Medical College, Gujrat. 72. Nishtar Medical College, Multan. 73. Ojha Institute of Chest Diseases, Karachi. 74. Pak International Medical College, Peshawar. 75. Pak Red Crescent Medical & Dental College, Lahore. 76. Pakistan Institute of Community Ophthalmology, Peshawar. 77. 78. Pakistan Institute of Engineering & Applied Sciences (PIEAS), Nilore, Islamabad. Pakistan Institute of Ophthalmology, Al-Shifa Trust Eye Hospital, Rawalpindi. 79. Peoples University of Medical & Health Sciences, Nawab Shah. 80. Peshawar Medical College, Peshawar. 81. Postgraduate Medical Institute/HMC, Peshawar. 82. Punjab Institute of Cardiology, Lahore. 83. Punjab Medical College, Faisalabad. 84. Quaid-e-Azam Medical College, Bahawalpur. 85. Quaid-e-Azam Postgraduate Medical College/ Pakistan Institute of Medical Sciences, Islamabad. 215 86. Quetta Institute of Medical Sciences, Quetta. 87. Rashid Latif Medical College, Lahore. 88. Rawal Institute of Health Sciences, Islamabad. 89. Rawalpindi Medical College, Rawalpindi. 90. Rehman Medical College, Peshawar. 91. Sahiwal Medical College, Sahiwal. 92. Saidu Medical College, Swat. 93. Sargodha Medical College, Sargodha. 94. Services Institute of Medical Sciences, Lahore. 95. Shaheed Benazir Bhutto Medical College, Lyari, Karachi. 96. Shaheed Mohtarma Benazir Bhutto Medical University, Larkana. 97. Shaikh Zayed Medical College, Rahim Yar Khan. 98. Shaikh Zayed Postgraduate Medical Institute, Lahore. 99. Shalamar Medical and Dental College, Lahore. 100. Sharif Medical & Dental College, Lahore. 101. Sheikh Khalifa Bin Zayed Al-Nahyan Medical College, Lahore. 102. Shifa College of Medicine, Islamabad. 103. Sindh Institute of Urology & Transplantation, Karachi. 104. Sindh Medical University/Sindh Medical College, Karachi. 105. Sir Syed College of Medical Sciences for Girls, Karachi. 106. The Aga Khan University Medical College, Karachi. 107. United Medical & Dental College, Karachi. 108. University College of Medicine & Dentistry, Lahore. 109. University Medical and Dental College, Faisalabad. 110. University of Health Sciences, Lahore. 111. Wah Medical College, Wah Cantt. 112. Women Medical College, Abbottabad. 113. Yusra Medical & Dental College, Islamabad. 114. Ziauddin Medical University/Ziauddin Medical College, Karachi. 216 Appendix H COVERING LETTER SENT WITH THE DRAFT INTERVIEW SCHEDULE Department of Library and Information Science University of the Punjab, Lahore Dear Sir / Madam, Subject: The Status of information literacy instruction in medical libraries of Pakistan: An appraisal I am currently studying for my PhD degree at the Department of Library and Information Science, University of the Punjab, Lahore. I am conducting research under the supervision of Professor Dr Kanwal Ameen for my thesis to assess the status and practices of information literacy instruction in medical libraries of Pakistan. It is hoped that the findings will help to introduce and improve the IL instruction programmes in medical libraries of Pakistan in particular and in other academic libraries in general. I have collected (through questionnaire survey) and analyzed the quantitative data in the first phase of this study. One of the requirements of this study is to conduct interviews with purposively selected head librarians of medical libraries in Pakistan. The purpose of interviews is to gain detailed comments on the most significant results of the questionnaire survey. In this regard, an interview schedule consisting of the questions to be asked from interviewees has to be prepared before the interviews of head librarians are actually conducted. These interview questions are based on the findings from a questionnaire survey carried out in phase-1 of my doctoral study during August-October 2013. A panel of experts is needed to review the initial interview schedule. You have been selected as one of the members of the expert panel considering your qualification and experience in this area. The main part of the initial interview schedule listing the seven areas: perceptions of medical librarians towards the importance of IL skills; current practices of IL Instruction in medical libraries, the barriers when advocating or providing IL instruction programmes, IL training needs of medical librarians, and strategies to be adopted for the effective implementation of 217 IL instruction programmes in medical libraries of Pakistan. You are requested to kindly judge the quality of the construct, its language, logical sequence and appropriateness for the study. Kindly return the enclosed interview schedule reviewed as soon as possible. I will be grateful for your valuable feedback/comments. Regards, Midrar Ullah (PhD scholar at University of the Punjab) Librarian & LSO Army Medical College (NUST) Abid Majeed Road, Rawalpindi Cell: 03325584132 Email: midrarullah2007@yahoo.com Dated: January 6, 2014 218 Appendix I LIST OF PILOT INTERVIEW PARTICIPANTS 1. Mr. Ikram-ul-Haq, Librarian, Armed Forces Postgraduate Medical Institute (AFPGMI), Rawalpindi. 2. Mr. Waseem Riaz, Ex-Librarian, Islamic International Medical College (IIMC), Rawalpindi. 3. Mr. Zahid Iqbal, Assistant Manager (Information Services Department), Islamic International Medical College (IIMC), Rawalpindi. 4. Ms. Safina Kausar, Librarian, Rehman Medical Institute (RMI), Peshawar 219 Appendix J INTERVIEW SCHEDULE These interview questions are based on the findings from a questionnaire survey carried out in phase-1 of my doctoral study during August-October 2013. Perceptions of Medical Librarians towards the Importance of Information Literacy Skills 1. The questionnaire survey has revealed that most of the medical librarians did not consider the following IL skills "very important" for their library users (got mean scores less than four): “Evaluating the information critically” (by public sector medical librarians) and “using the selected information effectively to accomplish a specific task” and “organizing information collected or generated in a logical way” (by private sector medical librarians). How do you see the importance of these IL skills for library users? And in your opinion, what could be the possible reasons that most of the respondents did not consider these skills very important? Current Practices of Information Literacy Instruction 2. Most of the medical librarians offered basic level of IL instruction (library orientation and introductory information skills) for their users while 41% (mostly in medical universities and postgraduate medical institutes) offered research-level skills in IL instruction. What are your comments about this? 3. Topics like Plagiarism awareness, copyright, citation of information, and OPAC/library catalogue were covered by less than 40% of the respondents in IL instruction programmes. In your opinion, what could be the possible reasons for this? 4. Most of the medical librarians (86.3 %) used face-to-face method for delivery of IL instruction while online or web based-tutorials were mentioned by only two respondents. In your opinion, what could be the possible reasons for this? 5. The questionnaire survey has revealed that 66.7 % of the respondents evaluated/assessed their IL instruction outcomes. Most of them used oral or written feedback and very few 220 respondents used formal assessment methods for this. In your opinion, what could be the possible reasons for this? 6. Most of the medical institutions (74 %) did not integrate IL instruction into the curriculum. And none of the institutions integrated it as a credit-course. What are your views and comments on this issue? 7. The questionnaire survey has revealed that IL instruction was delivered by the librarians in isolation and they lacked collaboration with the faculty. What are your comments on this? Barriers When Advocating or Providing IL Instruction 8. Lack of training opportunities for IL instruction for librarians and lack of policy regarding IL instruction in the medical institutions have been mentioned by medical librarians as the most significant barriers that affect development of IL instruction programme. To what extent these two barriers affect IL in your library? And what could be the other significant barriers besides these two barriers? Information Literacy Instruction Training Needs of Medical Librarians 9. The study has revealed that IL instruction knowledge of head librarians was not very good while their knowledge of IL standards and models was weak. In your view what could be the possible reasons for this and how IL instruction competencies of medical librarians could be improved? 10. Earlier results have revealed that medical librarians were not very much interested in the development of their assessment and evaluation skills to measure learning outcomes of the participants. In your view what could be the possible reasons for this? Strategies for the Effective Implementation of IL Instruction Programmes in Medical Libraries 11. The results of the questionnaire survey have revealed that IL skills of library users were inadequate as perceived by medical librarians. In your view, what could be the possible reasons for this and how their IL skills could be improved? 221 12. Workshops/seminars and formal in-class teaching as part of the main curriculum have been considered by the medical librarians as the most effective IL delivery methods. What are your comments on this issue? 13. Majority of the respondents were of the opinion that IL might be integrated in the curriculum and might be taught as an independent and a credit-based course. What are your comments on this issue? 14. An overwhelming majority (92.5 %) of the respondents was of the opinion that both librarians and faculty should design IL instruction curriculum. What are your comments on this issue? 15. Medical librarians were divided and undecided regarding the role of the faculty in imparting IL instruction. Because 35 (52.2 %) of the respondents felt that IL instruction should be delivered by both the faculty and librarians, while 32 (47.8%) of them were of the opinion that librarians should be solely responsible for this. What are your views on this issue? 16. Any other comments and suggestions in this regard. Thank you very much for granting me your time to conduct this interview. 222 Appendix K LIST OF INTERVIEW PARTICIPANTS 1. Dr Ijaz Miraj, Librarian, Punjab Institute of Cardiology, Lahore 2. Mr. Atta Ullah Shah, Chief Librarian, Ziauddin Medical College, Karachi 3. Mr. Azhar Iqbal Deputy Chief Librarian, King Edward Medical College, Lahore 4. Mr. Azhar Mahmood Qazi, Librarian, Foundation Medical College, Rawalpindi 5. Mr. Ghulam Farid Malik, Librarian, Rashid Latif Medical College, Lahore 6. Mr. Ghulam Murtaza Rafique, Librarian, University College of Medicine, Lahore. 7. Mr. Khwaja Mustafa, Librarian, Agha Khan University Medical College, Karachi. 8. Mr. Mian Muhammad Ramzan, Library Manager, Islamic International Medical College, Rawalpindi 9. Mr. Muhammad Ansar, Senior Librarian, Fatima Memorial Hospital (FMH) College of Medicine & Dentistry, Lahore 10. Mr. Muhammad Haroon, Library Manager, Rehman Medical Institute, Peshawar. 11. Mr. Muhammad Javed, Chief Librarian, Shifa College of Medicine, Islamabad 12. Mr. Mushahid Hussain, Librarian, Qaid-e-Azam Postgraduate Medical College/PIMS, Islamabad 13. Mr. Noor Hussain, Librarian, Shalamar Medical & Dental College, Lahore 14. Mr. Shams-ud-Din, Librarian, Ayub Medical college, Abbottabad 15. Mr. Suhail Nasir, Senior Librarian, Armed Forces Postgraduate Medical Institute, Rawalpindi. 16. Ms. Ayesha Gul, Librarian, Hafeez Institute of Medical Sciences, Peshawar. 17. Ms. Riasat Ali Asghar, Librarian, Khyber Medical University, Peshawar 18. Ms. Sadaf Rafique, Librarian, CMH Medical college, Lahore 19. Ms. Shagufta Naseem, Librarian, University of Health sciences, Lahore 20. Ms. Shahana Bano, Senior Librarian, Dow Medical College, Karachi 223 Appendix L COVERING LETTER SENT WITH THE INTERVIEW SCHEDULE Department of Library and Information Science University of the Punjab, Lahore Dear Sir / Madam, Subject: The Status of information literacy Instruction in medical libraries of Pakistan: An appraisal I am currently studying for my Ph.D. degree at the Department of Library and Information Science, University of the Punjab, Lahore. I am conducting research under the supervision of Professor Dr Kanwal Ameen for my thesis to assess the status and practices of information literacy instruction in medical libraries of Pakistan. It is hoped that the findings will help to introduce and improve the IL instruction programmes in medical libraries of Pakistan in particular and in other academic libraries in general. I have collected (through questionnaire survey) and analyzed the quantitative data in the first phase of this study. One of the requirements of this study is to conduct interviews with selected head librarians of medical libraries in Pakistan. The purpose of interviews is to gain a deeper understanding and detailed comments on the most significant results of the questionnaire survey. You are selected as one of the potential interview participants. I appreciate your willingness to participate in this study. Your participation in the interview for this study is entirely voluntary. You have the right to refuse to answer any question and with draw from interview, any time. The interviews will be audio taped and transcribed and the material will be kept confidential and the information provided will be used for the purposes of this research project only. Under no circumstances you and your institution name or personal identifying characteristics will be included in this report; any tape recording, field notes of the interview and observation will be erased after awarding of the degree. 224 Interview schedule is attached herewith. Kindly give your consent and time for face-to-face or telephone interview as soon as possible. I will be grateful for your help. Regards, Midrar Ullah (PhD scholar at University of the Punjab) Librarian & LSO Army Medical College (NUST) Abid Majeed Road, Rawalpindi Cell: 03325584132 Email: midrarullah2007@yahoo.com Dated: March 26, 2014 225

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The Status of Information Literacy Instruction in Medical Libraries of Pakistan: An Appraisal

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