Introduction

This chapter pursues the theme of equity in more depth and asks the question: ‘should public libraries focus on social exclusion, social inclusion or community cohesion?’ This question is considered through the lens of the ground-breaking report Open to All? The Public Library and Social Exclusion (Muddiman et al., 2000). This research suggested that although public libraries were currently modernising their services, this modernisation was unlikely to refocus the public library on excluded communities and social groups. The report concluded that, to do this, and to become more than superficially ‘open to all’, the public library would need to transform itself into a far more proactive, educative and interventionist public institution, with a concern for social justice at its core. If libraries are to make a difference on the ground, they must first of all identify the needs of everyone in their communities, particularly those at risk of exclusion, through unemployment, disability, age or language barriers. Public libraries have the potential to play a key role in tackling social exclusion, but in order to make a real difference they need to undergo rapid transformation and change. It is interesting to revisit these recommendations now that the New Labour concept of social exclusion (a proxy for social class) has been superseded by the Tory notion of ‘levelling up’.

New Labour

The latter part of the 20th century saw deteriorating trends in social exclusion and inequality. Some of the main causes of social exclusion, such as unemployment (particularly long-term unemployment) and the proportion of children growing up in workless and low-income households, got significantly worse.

Introduction

This chapter describes the biggest international debate that has taken place within the UK library profession since the turn of the century and asks the question: ‘who are the real “friends” of Cuban libraries?’ Much can be learned from the development of public libraries in the socialist systems of Cuba, North Korea, Vietnam and China (Pateman, 2004d). These needs-based libraries are openly political and ideological in favour of the working class. The example they set is seen as a threat by capitalist countries like the USA who use public libraries in Cuba as a soft entry point for spreading reactionary and revisionist ideas, going about this through funding organisations such as the ‘Friends of Cuban Libraries’ (sic) which organise and support ‘independent’ libraries in Cuba. These are, in fact, neither ‘independent’ nor ‘libraries’, but are run by Cuban political dissidents who are in the pay of the Central Intelligence Agency and its cultural front organisations such as Freedom House, which is funded by the US State Department and other government grants. In the early 2000s the debate about Cuban libraries raged within the international library community – particularly in the US – and the International Federation of Library Associations. The UK Library Association tried to take a balanced approach and recognised the Cuban government's right to develop a socialist library system (Pateman, 2000c).

Cuban libraries

Historical circumstances, political upheaval and professional resourcefulness have shaped the development of Cuban libraries. Since 1959, the objectives and policies of the Cuban government and its revolutionary mandate have also been of paramount importance in aiming to place libraries in all schools and in all provinces, and in promoting literacy and free education throughout the country.

Introduction

As with any technology in use in healthcare – and many other settings – there are a number of ethical and moral considerations that need to be observed for the safety, privacy and security of all users: those who create the content and those who consume it. Wolfe et al. (2021) have highlighted some of the issues around ethical considerations of social media in healthcare, including maintaining patient privacy, ensuring any conflicts of interest are proclaimed and exercising due care when using social media to engage patients, educate the public and marketing.

As well as national and international legislation and guidelines, we are all bound – as are our users – by organisational policies and guidelines. It would be a rare hospital Trust or university that would not have guidelines and policies in place around the use of social media in the 2020s, although there are vast variations between organisations.

According to Coburn (2021), librarians are one of the most trusted professions (right after nurses). We can use that reputation in our efforts to ensure that social media in healthcare is used as ethically, morally and responsibly as possible.

Confidentiality, privacy and security

Ensuring the privacy, security and confidentiality of patients or service users – and that of ourselves and colleagues too – should be at the very top of the list of ethical considerations. As healthcare information professionals, we are similarly bound by both the relevant legislation of our own territories or jurisdictions and by the guidance of our professional membership organisations.

Introduction

One area of healthcare information where social media shows tremendous potential is that of research.

This may involve reaching out to potential subjects or research partners in the first place, ‘horizon scanning’ for emerging – or re-emerging – topics or, once the research or phase is complete, disseminating the results. It may also be a fruitful way of connecting researchers with further potential research partners and funding streams. According to Elliott (2014), social media can facilitate all of these. Other identified uses included the possibility of using social media to advance research careers and promote the reputation of a healthcare organisation as a leading research institute.

Using social media for healthcare research can however, be fraught with difficulties and controversies. These may include the difficulty of applying relatively formulaic medical research techniques and approaches to a system that is intrinsically informal.

Popularity of social media platforms for health research recruitment

Historically, Facebook was the most popular platform for recruitment of research participants, followed by Twitter, although the latter was some way behind. Despite some concern that Facebook has been losing market share and/or social reach, Bour et al. (2021) found that Facebook remained one of, if not the, leading social media platforms for health research. Although other platforms including YouTube, Instagram and LinkedIn were also mentioned, they appeared to be relatively infrequently used compared to the two market leaders. One of the key findings related to the ability of social media to recruit participants from populations which have traditionally been difficult to recruit.

In a world where so many of our daily transactions and tasks depend on it, it can be difficult to remember what life was like before the arrival of the internet. It's not surprising that it can sometimes feel as if the internet has always been with us. That perception is, however, misleading.

Social media is a relatively recent internet development, although the principles of the network as a platform for social interactivity can be seen right from the start. While there were huge steps forward in the 1960s that set the scene for our modern internet, it wasn't until around the mid-to-late 1990s that this ‘network of computer networks’ showed signs of becoming the powerhouse and essential life tool it is today. It's generally agreed that the World Wide Web was created by Tim Berners-Lee in 1989 during his time at the Conseil Europeen pour la Recherche Nucleaire (better known as CERN).

The internet as we know it is, therefore, about as old as one human generation. From its origins, when it was mostly the preserve of defence and research, the ‘information superhighway’ or simply the internet has become an essential and almost unavoidable feature of our everyday lives. At the time of writing, in the mid-2020s, it has become an integral part of banking, education, travel, our working lives and almost every aspect of daily life.

In the early days of the internet's development, users were often happy to share content, frequently for little or no financial reward.

Introduction

In 1994, there were an estimated 20 million internet users around the world. By 2008, this number was more than 1.5 billion (World Bank, 2011) and at the time of writing, there are an estimated 5.35 billion people online (around 66.2% of the global population (Liu, Amin and Stemmler, 2024).) In 2023 alone there were approximately 97 million new users. Alongside the UK and the USA, the countries which dominate this picture of internet usage include European countries Norway, Denmark, Sweden and Finland, and Middle East locations Bahrain, Kuwait, Qatar, Saudi Arabia and the United Arab Emirates. Despite their large populations, India and China still have a high proportion of citizens who are not connected. At the bottom of the table is North Korea, where access to the internet is estimated to be below 10% of the country's population (Kemp, 2024).

The internet rapidly became an information tool of choice for many in its early days, before evolving into the interactive virtual social environment that we know today.

The mid-1990s were a pivotal time for internet development, when the mainly text-based information environment transformed and new interactive sites appeared at a rapid pace. In 1994, the first sale on Echo Bay's Auction Bay took place. This online marketplace was a forerunner of eBay (eBay, 2023). Not only could users trade items, it was also possible to exchange e-mails and an important feature was the ability to rate transactions, thereby enabling buyers and sellers to achieve approval scores.

The evolution of the internet

Whenever we want to understand where we are and how we got here, taking a brief look at history can be invaluable, especially in a world where the internet is now so ubiquitous that its origins have almost faded into myth. There are now generations of individuals who have never known a world without the internet. Effectively, that means the majority of those born post- 1994.

As with all life-changing inventions, the internet as we know it at present owes a great deal of its development to previous inventions and discoveries. These include the telephone, radio and television.

Developments in the progress of the internet can often be ‘grouped’ by years or decades. Long before the internet was even a twinkle of an idea, there were many real-world analogue proposals to create a physical representation of all the knowledge in the world. The concept of the internet, or at least of an immense repository of human knowledge, has been predicted in literature and the arts for centuries.

Imagining the internet

In 1728, when Ephraim Chambers published his Cyclopaedia, articles were linked through cross-references, an early real-world forerunner of the hyperlink. For Paul Otlet and Henri La Fontaine, the Universal Decimal Classification was central to their Mundaneum proposal (Hanlon, 2008). This central repository of global knowledge was followed, in 1934, by Otlet's vision for the ‘Radiated Library’, where phones retrieved information before transmitting it as television signals.

In the 50-plus years since the concept became a reality, the internet has changed the world we live in beyond recognition and continues to do so. It was designed for co-operation and instantaneous information dissemination, at a time when idealism was far higher and cynicism far lower than today.

In the same time frame, healthcare has also made immense strides forward. Clinicians and scientists have worked out how to transplant organs to extend life, how to cure some forms of cancer and how to diagnose some health conditions in the very earliest stages at which they pose a potential threat to the carrier.

When a global pandemic threatened the world – and tragically, killed and incapacitated far too many – the power of social media was apparent as an information force for both the benefit and detriment of humanity. Scientists were able to track the disease in ‘real time’, combining this with behavioural science insights into behavioural psychology that, in some cases, encouraged responsible actions to help limit the spread. Social media offered a way to communicate evidence-based news instantaneously. It was both a balm to assuage fears and a vessel for misinformation and conspiracy theories.

During the pandemic, education, working life and healthcare were transformed as online meetings software like Zoom and Microsoft Teams became accessible to the many, not just the fortunate few in highly academic settings. Universities and other seats of learning saw the potential of this new mode of working and used the channels to deliver lectures, discussions and even webinars during lockdowns.

Introduction

Although a small number of healthcare libraries had already experimented with using a social media platform or delivery method for educational opportunities and information, it was during COVID-19 in particular that social media came into its own in this respect. Social media lends itself well to synchronous remote learning as well as video sessions, flipped classrooms, virtual classrooms and e-learning (Fouasson-Chailloux et al., 2022).

Healthcare information professionals may often find themselves able to use social media to contribute in the realm of medical education, from delivery to analysis of feedback. In addition to suggesting appropriate social media tools for a given task, there are also specific areas where social media can support the creation of educational resources and where healthcare librarians can assist. Benchmarking searches to uncover innovative uses of social media in other organisations are another potentially beneficial way in which librarians can contribute.

Social media in its current form is not, however, suitable as an acquisition method for all skills. Gheshlagh et al. (2022) were amongst those who highlighted the current inadequacy of online methods as an option to acquire practical skills. Other factors highlighted in this study included lack of responses or answers from educators. A further finding which is particularly interesting in a healthcare context where interpersonal relationships are the lifeblood of many interactions is that the use of social media occasioned, for some, a perception of ‘coldness’ in the educator/trainee relationship. When it comes to e-learning in particular, although Web 2.0 technologies have shown great promise since the early years (Blaum et al., 2013), a decade later the barriers to accessing these relatively advanced technologies remain significant in some healthcare settings and will be considered in more detail in Chapter 7 on barriers (Mahdavi et al., 2023).

Introduction

While there is no foolproof way of predicting the future, we can find hints about probable future trajectories by both looking at past developments and by understanding likely trends. They can act as an early warning, as it were, for skills that healthcare information professionals may need to acquire or to help their colleagues to acquire.

Social media is affected by technological advancements and societal shifts, as well as user preferences. As artificial intelligence (AI) becomes more integrated with social media, it's likely that content will become more tailored and feeds far more personalised. Augmented reality filters like those used in the Pokemon Go craze of 2016 may also be of use in both encouraging increased physical activity (Piqueras-Sola et al., 2024; Baronowski and Lyons, 2020) and medical and healthcare education applications (Wan, 2017). Not only that, but the filters and effects will become more sophisticated. There may also be a move towards more decentralised social networks, as users gain more control over their data. This may allay some of the current fears around privacy and security of personal data.

The bulk of this book has been concerned with where we are now and to some extent how we got here with regard to social media. It's therefore timely to consider where we’ve been; and where we might go next.

User education

While promotion of a library and its offer has always been a major focus for social media pages for both academic and public libraries, there are no rules around combining these with content that also has an element of learning or education.

Introduction

In recent years there have been many acknowledgements of the importance of the online world if we are to advance our knowledge of healthcare information and help patients access robust evidence-based resources, but this brave new world is riddled with barriers. Some of these barriers are technological; others related to skills mix; while still others relate to finances. Although there are often basic free versions of social media apps available, one issue with these is that they may often come with advertising and sponsorship which may not always be appropriate to healthcare settings. Where sites make heavy use of modern technology or popups these are often blocked, leading to a suboptimal experience for users.

Other barriers to the use of technology in general and social media in particular, include low network speeds; copyright and intellectual property; commercial in confidence data; data protection; lack of training for librarians and others who put social media sites together; and, in some cases, technophobia.

Unfortunately, despite several published strategies outlining the importance of technology, including the NHS Long Term Workforce Plan (NHS England, 2023b), many NHS and public sector institutions in particular remain suspicious of and even hostile to the whole idea of social media. The situation has not been helped by some recent high-profile security lapses and cyberattacks which often either target patient data directly, as in the 2017 WannaCry attack, or bring systems crashing to a halt, as in the 2024 CrowdStrike incident.

In addition, most healthcare libraries or units are constantly having to justify their budgets while still finding a way to fulfil their contract with their host and overarching organisations.

What is healthcare information?

Before we move on to look at the uses of social media in healthcare information, it's appropriate to consider the nature of healthcare information. Although it's a somewhat broad classification, those who use health information can be divided into two main groups. One group delivers the care, or supports the delivery of care, while the second group encompasses those who receive care. Healthcare professionals and healthcare information professionals usually fall into the first group, while patients, residents, service users and the general public fall into the second – although of course users may fall into both groups at once.

The first group can be further subdivided into more defined professional groups, with each group requiring slightly different types of information. Registered medics, nurses and allied health professionals may need information to assist in patient treatment, enhance continuing professional development, or to gather evidence to support presentations, unit meetings, training or papers to present to organisational executives or board members. Students, on the other hand, may require simply a brief overview of conditions or interventions to support an assignment. And members of the public might require in-depth information about their condition or that of a loved one or dependant, or reassurance from others in a community with the same condition.

Whenever any new technology makes an appearance, there is often, understandably, scepticism over what is not yet tried and tested. In a world where being able to demonstrate the impact of everything we do is increasingly important to ensure our survival, it was apparent right from the start that an evidence base was required if the success of Library 2.0 or Web 2.0 initiatives were to be measured.