title: Do language fluency and other socioeconomic factors influence the use of PubMed and MedlinePlus?
abstract: BACKGROUND
  Increased usage of MedlinePlus by Spanish-speakers was observed after introduction of MedlinePlus in Spanish. This probably reflects increased usage of MEDLINE and PubMed by those with greater fluency in the language in which it is presented; but this has never been demonstrated in English speakers. Evidence that lack of English fluency deters international healthcare personnel from using PubMed could support the use of multi-language search tools like Babel-MeSH.
  
  
  OBJECTIVE
  This study aims to measure the effects of language fluency and other socioeconomic factors on PubMed MEDLINE and MedlinePlus access by international users.
  
  
  METHODS
  We retrospectively reviewed server pageviews of PubMed and MedlinePlus from various periods of time, and analyzed them against country statistics on language fluency, GDP, literacy rate, Internet usage, medical schools, and physicians per capita, to determine whether they were associated.
  
  
  RESULTS
  We found fluency in English to be positively associated with pageviews of PubMed and MedlinePlus in countries with high literacy rates. Spanish was generally found to be positively associated with pageviews of MedlinePlus en Español. The other parameters also showed varying degrees of association with pageviews.
  
  
  CONCLUSIONS
  After adjusting for the other factors investigated in this study, language fluency was a consistently significant predictor of the use of PubMed, MedlinePlus English and MedlinePlus en Español. This study may support the need for multi-language search tools and may increase access of health information resources from non-English speaking countries.
authors.affiliation: University of Missouri Informatics Institute, Columbia, Missouri 65211, USA. lincolnsheets@gmail.com
authors.forename: L
authors.initials: L
authors.lastname: Sheets
authors.forename: A
authors.initials: A
authors.lastname: Gavino
authors.forename: F
authors.initials: F
authors.lastname: Callaghan
authors.forename: P
authors.initials: P
authors.lastname: Fontelo
mesh_terms: D003144:Communication Barriers; D059066:Gross Domestic Product / Q000706:statistics & numerical data; D006801:Humans; D038622:Internationality; D020407:Internet / Q000706:statistics & numerical data; D007802:Language; D049293:MedlinePlus / Q000706:statistics & numerical data*; D010820:Physicians / Q000600:supply & distribution; D039781:PubMed / Q000706:statistics & numerical data*; D012577:Schools, Medical / Q000600:supply & distribution; D012959:Socioeconomic Factors
keywords: Library information systems; access to information; communication barriers; diffusion of innovation; economic barriers