1. Using Print and Online Content: The Information Seeking and Reading Habits of Physicians: A Case Study of Pediatricians Michael Clarke Executive Editor, Pediatrics Online Information & Education Conference 2005

2. Development of Electronic Journals Mainframe Computing WWW Search Engines HTML PubMed SGML UNIX Electronic Databases PC Windows Internet Algorithmic Search XML CrossRef DOIs 1960s1980s1990s1970s2000s The Launch of E-Journals

3. Development of Electronic Journals Launching online journals and getting 100% of journal content online and searchable 200320052004 1 st Phase of Electronic Journals Critical mass of legacy archives online Development of a truly integrated search of all scholarly literature (i.e. Google Scholar) 200620072008 2009 Incremental improvements for searching and filtering vast amounts of information 2 nd Phase of Electronic Journals 2006 2007 20082009

4. Methods Used to Analyze Readership Reader Surveys Focus Groups/ User Studies Usage & Citation Analysis Readers?

5. Methods: Reader Survey Survey design and analysis conducted in collaboration with Professors Carol Tenopir & Donald King 4,000 surveys sent out by snail mail Spring 2004 2 versions, each sent to 2,000 readers Surveys sent to AAP members $1 incentive Return postage paid 1 follow-up letter

6. Methods: Reader Survey Version 1: PEDIATRICS Journal Survey  685 returned questionnaires (34.25%) Version 2: Critical Incident Survey  666 returned questionnaires 33.3%

7. Methods: Questionnaires 2 brief questionnaires (sent to different sample groups of 1000 at different times) 34% & 31% response rates Conducted by Research USA Blinded data collection Sample of Table of Contents Purpose was to determine whether specific articles were read in print or online

8. Methods: Focus Groups 2 focus groups were held in May 2004: Focus Group 1: Researchers  PAS, May 2, 2004, San Francisco Focus Group 2: Clinicians  AAP Practical Pediatrics Course, May 14, 2004, Sante Fe

9. PEDIATRICS: Vital Signs Published monthly “Early Release” articles published on 1 st and 15 th of every month Impact factor: 3.781 (1 st in field) Total citations: 25,691 (1 st in field) Original science articles: ~700 annually 62,000 subscribers (English edition)

10. Pediatrics Print and Online

11. Journal Subscription Profile Total Subscriptions = 62,000 Represent a much greater percent of total readers

12. Demographics: Practice Setting of Individual Subscribers Spring Reader Survey

13. PEDIATRICS Electronic Pages Began in 1997 (first online-only section of a medical journal) Articles freely accessible (“open access”) from day of publication Same peer review process as printed articles Final, edited, redacted version only 30-40 percent of research articles published in e-pages

14. Pediatrics Electronic

15. Electronic Pages

16. Electronic Abstracts

17. Why do you read PEDIATRICS? (print) 78.8% Keep current 36.7% Find specific information 20.2% Know what my colleagues are up to 12.0% Learn about other subspecialties Spring Reader Survey

18. What Sections of PEDIATRICS Do You Read Regularly? Abstracts71% Policy Statements56% TOC on Cover39% Articles32% Commentaries29% TOC Inside Journal18% Green Pages18% Spring Reader Survey

19. What Sections of PEDIATRICS Do You Read Regularly? Abstracts71% Policy Statements56% TOC on Cover39% Articles32% Commentaries29% TOC Inside Journal18% Green Pages18% “The abstracts in the Green Pages are difficult to read. The green paper makes it harder to read and the abstracts are formatted poorly. I often read on the exercise bike, and I just give up when I get to the green section.” —Focus Group Participant Spring Reader Survey “The abstracts in the Green Pages are difficult to read. The green paper makes it harder to read and the abstracts are formatted poorly. I often read on the exercise bike, and I just give up when I get to the green section.” —Focus Group Participant

20. What Sections of PEDIATRICS Do You Read Regularly? Abstracts71% Policy Statements56% TOC on Cover39% Articles32% Commentaries29% TOC Inside Journal18% Green Pages18% “I get the journal in the mail. I look at the cover, circle the articles I am interested in, and then set it aside for when I have time to come back to it.” —Focus Group Participant Spring Reader Survey

21. Indicate your agreement with the following statements (print) (Strongly agree = 5/Strongly disagree= 1) It is easy for me to read4.08 It is easy for me to use4.07 I like it because it is portable4.06 It is convenient for me3.88 It is easy for me to find things2.95 Using it is time consuming2.88 Spring Reader Survey

22. Indicate your agreement with the following statements (electronic) (Strongly agree = 5/Strongly disagree= 1) Can search comprehensively3.42 Online features are valuable3.29 It is easy for me to find things3.16 The navigation makes sense3.14 It is convenient for me3.08 The interface is cumbersome2.94 Using it is time consuming2.94 Spring Reader Survey

23. Which features of the electronic edition do you use? Advanced searching14.2% Links to Medline12.1% Most-Read Articles8.9% Topic Collections5.4% E-mail Alerts4.7% E-Letters4.7% Free Reference Links4.5% Spring Reader Survey

24. What electronic features would you be likely to use if added? CME56% Download Figures to PowerPoint56% Publish Ahead of Print41% Full-text & Search on PDA32% Citation Reporting by Article27% Usage Reporting by Article15% Spring Reader Survey

25. What format do you prefer to receive PEDIATRICS in? 59.3% Print only 8.2% Electronic only 33.6% Both print & electronic 92% Wish to continue to receive print Spring Reader Survey

26. And Yet… PEDIATRICS electronic usage… *projected based on year-to-date statistics

27. Indicate your agreement with the following statements (e-only articles) (Strongly agree = 5/Strongly disagree= 1) e-articles are reviewed as strictly as print3.21 e-articles are as useful as print2.84 e-articles are second class2.71 Spring Reader Survey

28. e-Articles vs Articles, 1999 – 2005 *projected based on year-to-date statistics

29. Most-Read Articles, July 2004 Reported via SurveyReported via Usage Statistics 1. Hyperbilirubinemia & Kernicterus…1. Hyperbilirubinemia in the Newborn… 2. Assessment of Sleep Apnea…2. Neonatal Hyperbilirubinemia (e) 3. Violent Television Viewing…3. Nocturnal Cough & Sleep Quality (e) 4. Gastrointestinal Disorders…4. Hymenal Measurements 5. Hyperbilirubinemia in the Newborn…5. Multivitamin Supplementation 6. SIDS: Definitional Approach…6. Imperforate Hymen (e) 7. Trial of Multivitamins…7. Predicting Obesity (e) 8. Neonatal infections…8. Attention-Deficit Disorder (e) 9. Food Allergy and Asthma…9. Reduced Unnecessary Antibiotic… 10. Habitual Snoring in Children…10. Use of Practice Guidelines (e) July Questionnaire

30. Most-Read Articles, July 2004 Reported via SurveyRead in PrintRead Online 1. Hyperbilirubinemia & Kernicterus…46.2%1.3% 2. Assessment of Sleep Apnea…44.6%1.3% 3. Violent Television Viewing…44.6%0.6% 4. Gastrointestinal Disorders…43.0%0.6% 5. Hyperbilirubinemia in the Newborn…42.4%0.6% 6. SIDS: Definitional Approach…41.1%0.3% 7. Trial of Multivitamins…37.9%.06% 8. Neonatal infections…36.0%1.3% 9. Food Allergy and Asthma…35.6%1.0% 10. Habitual Snoring in Children…35.6%1.0% July Questionnaire

31. Top e-Articles, July 2004 Reported via SurveyRead Abstract in Print Read Article Online 1. Azithromycin for Petussis20.4%3.2% 2. Once-a-Day Aminoglycosides…9.2%2.5% 3. Beordetella Pertussis Infections and …16.6%2.2% 4. Conscious Sedation of Children with…14.6%2.2% 5. Neonatal Hyperbilirubinemia…18.2%1.9% 6. Vaccine Safety Concerns16.2%1.9% 7. Levels After Otitis Media…12.4%1.9% 8. Children with ADHD…18.5%1.6% 9. Atomoxetine in Childhood ADHD…16.9%1.6% 10. Predictors of Asthma Care Quality…9.2%1.6% July Questionnaire

32. Comparisons: PEDIATRICS Readers to Other Scientists King and Tenopir have surveyed ~25,000 respondents since 1977 Medical, physical, and social scientists in all settings Data from 2001-2004 reported today

33. Number of Articles Reader per Year Article Read Univ. medical Univ Scientists All Scientists Soc Sci/Psych Engineers Pediatricians ~322 articles/year ~216 articles/year ~130 articles/year ~191 articles/year ~111 articles/year ~180 articles/year Spring Reader Survey Compared with Data from King & Tenopir

34. Form of Reading Astronomers 80% 20% Medical Faculty 75 % 25% University Faculty 63 % 37 % Pediatricians 16% 84% Spring Reader Survey Compared with Data from King & Tenopir

35. 92.6% 7.5% Form of Final Reading: PEDIATRICS Readers Spring Reader Survey Compared with Data from King & Tenopir

36. Sources of Readings Astronomers Medical Faculty University Faculty 44 % 21.4 % 36 % 22% 62% 72 % 12 % Pediatricians 21 % 16% 49%36% Spring Reader Survey Compared with Data from King & Tenopir

37. Pediatricians ScientistsAstronomers 81% 17 % 2 % 64 % 13 % Age of Last Article Read 17 % 21 % 69 % 10 % 23 % Spring Reader Survey Compared with Data from King & Tenopir

38. Principal Purpose of Reading ReasonsPediatricians Univ. Medical Current Awareness50.022.1 Treatment18.2- Diagnosis10.7- Teaching5.316.9 Research5.136.4 Consulting3.43.9 Other5.89.0 Writing1.611.7 Spring Reader Survey Compared with Data from King & Tenopir

39. LocationPercentage Home50.5 Office36.8 Hospital/Clinic6.2 In transit3.1 Other2.5 Library1.1 Location when reading Spring Reader Survey Compared with Data from King & Tenopir

40. Conclusions – e-articles E-articles are read more online because that is the only place they can be found Perception of e-articles as second-class articles has diminished, but still lingers  “I sometimes wonder, why wasn’t this one printed?”

41. Conclusions – e-articles Due to rising tide of manuscripts and costs of print/postage, e-only articles are necessary ~50% in 2005 and as high as 80% in near future Necessity of reader education on benefits of and reasons for e-only articles

42. Conclusions—PEDIATRICS Readers Pediatrics has a bifurcated readership:  AAP members who receive print & read primarily print  Non-members who read the online edition largely via institutional subscriptions Those who receive print, go online for specific reasons: searching, looking up a specific article, reading e-articles, etc.

43. Conclusions—PEDIATRICS Readers Those members who do use the online edition seem to like it, but it is still not as convenient for most as print due to:  Portability  Paper is easier to read  It shows up in their mailbox Members indicate they may use electronic journals more in the future, particular for online-only features such as CME, obtaining figures for PowerPoint lectures, publish ahead of print, etc…

44. Thoughts for Libraries Serving Physicians: Physicians may not be entirely comfortable yet with electronic journals (they are migrating slower than other scientists) The role of the librarian is critical in educating physicians in using electronic journals  Tutorials  Instructional material  Web sites designed with physicians in mind