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Facilitating Rural Access to Quality Health Information through Little Free Libraries

Posted by on November 5th, 2020 Posted in: Funding, Public Libraries

Guest post by NNLM SEA Subawardee. Full information provided below the article.

Project Background

At a fortuitous meeting at the ‘graduation’ of Florida’s Sunshine State Library Leadership Institute 2019 cohort in December, librarians from the Okeechobee County Public Library (OCL) and the University of Florida Health Science Center Libraries (UF HSCL) realized that they had much to offer each other. OCL had been interested in developing more health information outreach services, and UF HSCL had been looking for ways to support rural health in Florida. After a few brainstorming conversations via email and Zoom, the groups decided to collaborate on an NNLM/SEA All of Us Community Engagement Project Award proposal to improve access to quality health information in rural county communities through the innovative Little Free Libraries (LFLs) system. Little Free Library is an international nonprofit fostering neighborhood book exchanges through outdoor book-sharing boxes, which, while originally independent of public library systems, are now sometimes incorporated into library outreach programs.

OCL is building 30 LFLs to hold 30-50 books each, located on county properties near low-income neighborhoods, such as parks, sport centers, and civic centers. When in-person events become possible, OCL will collaborate with their local health department to conduct weekly mobile health reference hours at the LFLs.

Little Free Library in Okeechobee County, FL

Little Free Library in Okeechobee County, FL

Little Free Library in Okeechobee County, FL

Little Free Library in Okeechobee County, FL

Project Activities

Grant funding was used to purchase 424 consumer health and health literacy books for the LFLs in English and Spanish. Book selection criteria were based on local health concerns, ascertained through OCL circulation data, county health educators’ feedback, census data, and the County’s Community Health Improvement Plan. The same criteria informed the selection of 40 online consumer health resources that were printed and shipped to OCL in preparation for the mobile health reference hours, such as NLM’s MedlinePlus bookmarks and NIH brochures for the All of Us Research Program. Laptops, Wi-Fi hotspots, and a printer were also purchased, to enable access to online health resources during LFL reference sessions. Additionally, 30 charter signs were ordered through the Little Free Library organization, meaning that each LFL is now registered with the National Network of Little Free Libraries.

Grant-purchased Technology

Grant-purchased Technology

 LFL Charter Signs and Promotional Materials

LFL Charter Signs and Promotional Materials

In order to prepare OCL and Okeechobee County health educators for these exciting new health reference services and outreach events, the UF HSCL librarians developed a one-day online training. The June workshop covered topics such as health reference techniques, evaluating and using online health resources, health literacy, strategies for successful health tabling, and conveying the benefits of All of Us to patrons. Attendees took the eHEALS eHealth Literacy Scale before and after the training; the self-assessment revealed that the training day increased participants’ ability to navigate health information online. Slides for the workshop are available here.


Due to COVID-19, no in-person health reference sessions have taken place yet. In the meantime, temporary live virtual health reference sessions and scheduled reader’s advisory services for health materials are now being offered as services for OCL patrons to accommodate CDC guidelines; this provides an unexpected positive alternative use for grant-funded technology and materials.

Flier for Virtual Health Reference Services

Flier for Virtual Health Reference Services


Although project completion has been delayed by COVID-19, the health books purchased have already been an important resource for lower-income rural families in Okeechobee. So far, the most popular LFL location is the Okeechobee County Sports Complex, with over 600 items circulated since its installation in April. The most frequently restocked health resources are those about teaching children healthy habits and children’s books about emotions, indicating that the resources needed by these lower-income families are those that promote and identify healthy behaviors and provide health information for kids.

This project has highlighted the importance of health literacy and the need for free access to health resources, particularly in rural areas; as such the existing Little Free Library project has been well received in the community and has been featured in local print news coverage. Plans to expand the program are already in development for the future, once it becomes safe to do so.


University of Florida Health Science Center Libraries (Gainesville and Jacksonville)

PI: Jane Morgan-Daniel, Community Engagement and Health Literacy Liaison Librarian, MLIS, MA, AHIP
Co-PI: Lauren Adkins, College of Pharmacy Liaison Librarian, MLIS, AHIP
Investigator: Margaret Ansell, Nursing & Consumer Health Liaison Librarian, MLIS, AHIP
Investigator: Susan Harnett, Medical Information Services Librarian, MLS, AHIP
Investigator: Melissa Rethlefsen, MSLS, AHIP; Associate Dean, George A. Smathers Libraries & Fackler Director, Health Science Center Libraries

Okeechobee County Public Library, Florida

Co-PI: Sonya Chapa, Assistant Coordinator, Heartland Library Cooperative; Librarian, Okeechobee County Public Library, MLIS
Investigator: Kresta King, Director, Okeechobee County Public Library, MLIS

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Funded under cooperative agreement number UG4LM012340 with the University of Maryland, Health Sciences and Human Services Library, and awarded by the DHHS, NIH, National Library of Medicine.

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