Where there is no doctor by Dr. David Werner (497 pages, Hesperian rev. 2017) is considered to be the most widely-used health care manual in the world. This classic title is for health workers, clinicians, health educators, midwives, community leaders, and others involved in primary health care delivery and health promotion around the world.
It’s popularity illustrates the global demand for health related information without downplaying the need for experienced health workers who, by the way, also need access to timely information, both evidence based and of practical value.
But a serious shortage of health workers is one of the major constraints to tackling global access to essential health care services is. One of the proposed solutions is task shifting, the process of delegation whereby tasks are moved, where appropriate, to less specialized health workers [WHO 2008]. Specifically health workers should be trained and encouraged to execute certain tasks normally performed by medical professionals, particularly in situations of emergency or when no doctor can be reached.
Enabling health workers to assume higher level tasks and facilitating easy access to know-how may be one of the most promising endeavours to achieve the UN sustainable health goal.
Encouraging health workers to acquire new skills and instilling a sense of purpose is a first step, but the provision of training (professional skills, information literacy, communication technology) as well as tools and support are ongoing responsibilities.
The delivery of actionable knowledge to both experienced and less experienced health workers is an integral part of support, but information overload being a grim reality makes it increasingly difficult for individuals to filter out useful know-how from all available information.
A large body of practical knowledge exists already, but it is often hard to find, deeply buried in a much larger mass of academic content and submerged in advertising, distracting animations and unrelated links.
Health workers depend on rapidly accessing life-saving knowledge (user-friendly textbooks, tutorial videos, course material etc.) in a language they can understand and don’t have the time to wade through hundreds of web pages and guessing where to click to find and download practical advice for off-line use.
This project looks at the three components of the knowledge exchange process (content, exposure/discovery and adoption) and proposes a universally applicable know-how delivery system that is provider neutral, facilitates discovery and comparison before downloading and helps end users to organize their personal knowledge base so that they can rapidly re-find the information they may need in an emergency situation.
Components of knowledge exchange
Useful content in this context is any digital asset available online or offline that a) contains useful learning support or readily implemental practical know-how and b) can classify itself automatically in the user’s knowledge base.
Typical examples are precisely targeted documents and textbooks (usually in PDF format) and tutorial videos (*.mp4 or *.mov), but also course material and telemedicine apps etc.
Content providers offering articles of practical knowledge are encouraged to present their contributions in way to facilitate exposure + discovery and adoption to help closing the health care knowledge gap.
Core to this system are search friendly documents containing catalogue data (aka metadata) that travels with each digital asset, either embedded, in an accompanying data manifest or in a data + metadata bundle zip file - useful in cases where metadata cannot directly be embedded in the digital resource.
It is recommended that keywords are always be listed in English (in addition to the document language) to facilitate searching at the user’s end (assuming their reading software can handle translation).
Since Textbooks with several hundred pages are never read from cover to cover but consulted only in specific situations, it is equally important that such documents are user friendly, i.e. easy to navigate and to peruse. They must absolutely contain bookmarks and an interactive table of contents.
2. Exposure + discovery
Ideally all items that fall under the category of practical knowledge or know-how are exposed or presented by all content providers in a distinctive way so that they can be instantly located and discovered by health workers on any web site, compared with other offerings and ambiguities eliminated.
This latter point requires that the items include embedded, attached or bundled metadata for indexing and searching purposes at the recipient’s end (at least a meaningful title, description and keywords).
Whether preloaded (boxed) or offered online, free or against payment, as a single contribution or as part of a bulk offering, metadata must accompany every resource offered.
In PDF files these can easily be embedded and viewed in a reader. In office documents and some multimedia files thy can also be embedded, but may require special software to extract.
Where embedding is not possible such metadata can be packaged together with the object in a data+metadata container file for individual items or for bulk submission in a manifest using an electronic library exchange format (see proof of concept below).
Adoption follows successful discovery, downloading of an article and integrating it in one’s personal knowledge base for future use. This may require specially enabled software tools (see proof of concept below).
Software developers of knowledge organization tools are encouraged to produce apps for end users that
- Can Import digital assets of any type and display them in a searchable list by title, topic or other attributes
- Reads embedded metadata in PDF files as well as in data + metadata bundles and in manifests published for the bulk exchange of library items.
- Allows the user to add local and downloaded content from any source and adjust its metadata to suit his needs and facilitate searching
Proof of concept
For the purpose of demonstrating the viability of the proposed project and reaching the objective, we have developed
- dMeta: for bundling data + metadata in a single package
- elxf: a universally applicable electronic library exchange format
- digi-libris mobile: a free software tool for end users that understands the above formats, can extract metadata and use them to automatically classify incoming material in a user’s knowledge base for easy re-finding when needed in a hurry.
Where embedding is not possible such metadata can be packaged together with the object in a dMeta container file (see http://digi-libris.com/dmeta--share-data-metadata.html) for individual items or for bulk submission in a manifest using the electronic library exchange format (see elxf.info).
dMeta stands for Data plus Metadata bundled together in a zip file with the ending *.dMeta.
They are simply assemblies of electronic files of any kind tied together with their corresponding metadata. Such a package may contain multiple pairs of data and metadata sets and even single metadata files containing virtual items or links to an external resource.
dMeta uses the XMP file format for the metadata part, a proven technology developed by Adobe©, same as used inside PDF. XMP files use the XML structure and they can even be built “by hand” with any text processing tool and saved as plain UTF-8 text file.
The format is designed for
- content providers to distribute any type of digital asset together with its relevant metadata to facilitate discovery and automatic classification in the user’s knowledge base,
- libraries to distribute the descriptive metadata, which they hold anyhow in their repositories, together with documents which they are not allowed to modify due to checksum verification of the original item,
- connecting researchers with research in that any file can be coupled and transmitted together with its descriptive metadata. This can include research-relevant data from an instrument and support notes that are not normally included in a paper but that Open Access requires to be made available to the scientific universe. Scientists can more easily share resources and knowledge and it facilitates collaboration,
- increasing an author’s exposure by making sure that metadata survives peer review and page setup as the publisher can easily import this metadata in the final PDF prior to publishing