Research Article
“Wellbeing Through
Reading”: The Impact of a Public Library and Healthcare Library Partnership
Initiative in England
Anita Phul
Librarian
Birmingham and Solihull Mental Health NHS Foundation Trust
Birmingham, West Midlands, United Kingdom
Email: a.phul@nhs.net
Hélène Gorring
Knowledge & Library Services Development Manager
NHS England
London, United Kingdom
Email: h.gorring@nhs.net
David Stokes
Library Service Manager: Reader Services
Birmingham Library Services
Children and Families Directorate
Birmingham City Council
Birmingham, West Midlands, United Kingdom
Email: david.stokes@birmingham.gov.uk
Received: 1 Nov. 2023 Accepted: 19 Apr. 2024
2024 Phul, Gorring,
and Stokes. This is an Open Access article distributed under the
terms of the Creative Commons‐Attribution‐Noncommercial‐Share Alike License 4.0
International (http://creativecommons.org/licenses/by-nc-sa/4.0/),
which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly attributed, not used for commercial
purposes, and, if transformed, the resulting work is redistributed under the
same or similar license to this one.
DOI: 10.18438/eblip30475
Abstract
Objective
– This project sought to build upon a reader development tool, Many
Roads to Wellbeing, developed by a health librarian in a mental health NHS
Trust in Birmingham, England, by piloting reading group sessions in the
main public library in the city using wellbeing-themed stories and poems. The aim was to establish
whether a “wellbeing through reading” program can help reading group
participants to experience key facets of wellbeing as defined by the Five Ways
to Wellbeing.
Methods – The program developers ran 15 monthly sessions at the Library of Birmingham. These were advertised
using the Meetup social media tool to reach a wider client base than existing
library users; members of the public who had self-prescribed to the group and
were actively seeking wellbeing. A health librarian selected
wellbeing-themed short stories and poems and facilitated read aloud sessions.
The Library of Birmingham provided facilities and a member of staff to help
support each session.
Results
– A total of 131 participants attended the 15 sessions that were hosted.
There was a 95% response rate to the questionnaire survey. Of the
respondents, 91% felt that sessions had helped them to engage with all of the Five Ways to Wellbeing. The three elements
of Five Ways to Wellbeing that participants particularly engaged with were
Connect (n=125), Take Notice (n=123), and Keep Learning (n=124).
Conclusion – The reading program proved
to be successful in helping participants to experience multiple dimensions of
wellbeing. This project presents a new way of evaluating a bibliotherapy scheme
for impact on wellbeing, as well as being an example of effective partnership
working between the healthcare sector and a public library.
Introduction
Events in recent years have threatened to erode
healthy environments that promote wellbeing. The COVID-19 pandemic has led to
increases in chronic loneliness that have continued to manifest beyond the
lockdown periods (Campaign to End Loneliness, 2023). The visibility of an
increased sense of community spirit at the start of the pandemic has given way
to old fractures and tensions between different societal groups, resulting in a
sense of decreased social cohesion (Abrams et al., 2021). The cost-of-living crisis
in the UK has forced some people to reduce activities that are protective of
mental health (Mental Health Foundation, 2023), and 44% of public libraries
have experienced an increase in usage of services that aim to help people
through this crisis (Libraries Connected, 2022). In the World Health
Organization constitution, the definition for health includes physical, mental,
and social wellbeing rather than it being defined as solely a state without
disease or disability. Good mental health means having the capacity to connect,
cope, and thrive (World Health Organization, 2022). The World Health
Organization recommends a multi-sectorial approach to mental health and
wellbeing in recognition that services and support in addition to clinical
treatment are usually required (Ibid.). Health libraries are actively looking
for opportunities to work in partnership with public libraries in order to address the objectives of the ‘Knowledge for
Healthcare’ national strategy for NHS funded libraries in England. Resources
are being increasingly stretched across both the healthcare service and public
library sectors (CIPFA, 2022; The King’s Fund, 2022), and partnerships allow
both to achieve the common goal of community wellbeing with a wider pool of
resources from both sectors. The project described in this study is one example
of such a partnership. The reading program described in this paper was planned
and took place in pre-COVID times but the literature
review synthesizes evidence up to 2023.
The primary author and a psychiatrist at Birmingham
and Solihull Mental Health NHS Foundation Trust initiated the Many Roads to Wellbeing collection of reading
suggestions comprising stories and poems. This work was in response to a need
for those in clinical practice to easily find helpful stories to direct users,
patients, or the public to that encourage self-reflection about improving
wellbeing. Once the collection launched, feedback from clinical colleagues in
the organization suggested that using these types of materials in reading
groups would likely be more beneficial to the wellbeing of participants than
reading alone.
Loneliness is
known to be a problematic issue in the UK with recent data showing that over a
quarter of adults feel lonely always, often, or some of the time (Office for
National Statistics, 2023). Therefore, providing opportunities for participants
to connect with each other was central to this project. Public library spaces
can help to support community wellbeing with their wide range of reading
resources and community events for social engagement. Therefore, in partnership
with the Library of Birmingham, the authors decided to facilitate monthly
reading group sessions in a public library setting,. The mental health librarian selected wellbeing-themed short stories and
poems from stock available in local public libraries and volunteered to
facilitate read aloud sessions that used the Five Ways to Wellbeing as a
framework.
The Five Ways to Wellbeing is a set of evidence-based
actions to improve people's wellbeing (Aked et al., 2008), which has been
adopted by a number of mental health charities and
health services in the United Kingdom. The five elements comprise Connect, Be
Active, Take Notice. Keep Learning and Give.
The aim of the reading group sessions was to enable
members of the general public to experience the Five
Ways to Wellbeing through engagement with the sessions in a public library
setting. Bibliotherapy initiatives in the Library of Birmingham have traditionally been based around
consumer health information and cognitive behavioural
therapy-based self-help books for mental health, so this provided an
opportunity to explore a new method for supporting reading for wellbeing by
making use of poetry and short stories.
The Library of Birmingham provided a room and a member
of staff to support each session. Sessions were
facilitated during 2018-2019. Fifteen “short story and poetry reading group”
sessions were advertised using the Meetup social media tool (Appendix A). The aim
was to draw a broader client base to the library; members of the public who had
self-prescribed to the group and were actively seeking wellbeing.
The sessions were two hours long, including a break in
the middle, and structured in two parts with a short story and a poem. The
material was selected on the basis that it addressed themes around human coping
skills or suggested potential ideas about how to manage emotions and
circumstances to enhance mental wellbeing. The short stories were a mixture of
real-life accounts and fiction. The facilitator started each session by
offering an introduction that aimed to create a safe space for expressing
differing thoughts and opinions in the discussions. The facilitator then read
the short story aloud, pausing at pre-planned points where discussion questions
were offered to participants, several of which were designed to help
attendees reflect upon wellbeing themes in the story. The decision to have the
facilitator do most of the reading aloud was intended to help make the group
more inclusive for those with limited literacy skills (Frude, 2005; Naylor et
al., 2010; Simpson et al., 2020). Following a short break, the poem was read aloud two
or three times by the facilitator and volunteer participants and then discussed
in the group. The group then learned about the Five Ways to Wellbeing with the
facilitator talking through an associated handout. The handout also included
signposting information about The Samaritans charity, which provides a 24-hour
confidential helpline to those struggling with mental health issues, and local
talking therapies services provided by the mental health service.
Literature Review
The concept of bibliotherapy or using reading to heal the mind is not a
new one. A library in Alexandria has above its entrance an inscription from
about 300 B.C.E. claiming “The healing place of the soul” (McCulliss, 2012). Bibliotherapy can be divided broadly into
two types of reading content: self-help books and fiction or poetry. This
second type of bibliotherapy is often referred to as creative
bibliotherapy.
Self-Help Schemes
One of the most widely known self-help bibliotherapy schemes in the UK
is the national Reading Well Books on Prescription scheme, which was
founded by a clinical psychologist in response to the demand for psychological
therapies exceeding provider capacity (Frude, 2005). The scheme proved popular
and in high demand. The self-help books were made available through the public
library service and promoted by general practitioners. The national initiative
is now managed by the Reading Agency, a UK charity dedicated to promoting
reading. Indeed, the Reading Well website states that 99% of English library
authorities now operate one of these schemes as part of their Universal Public
Library Offer. Self-reported effectiveness of the scheme is high from those
using the service (Ingham, 2014; Trier et al., 2019).
High-level evidence also reports the benefits of self-help
bibliotherapy, especially for depression. One systematic review of randomized
clinical trials concluded that bibliotherapy is cost-effective,
resource-efficient, and non-stigmatizing compared to other treatments and that
it seems to be effective in alleviating depression symptoms in the adult
population in the long-term period (Gualano et al., 2017). A randomized trial
that evaluated the impact of family physicians prescribing a self-help book
for depression compared to treatment as usual found that the self-help book
performed just as well as treatment as usual as an intervention for depression
(Naylor et al., 2010). Both treatment groups experienced a significant
reduction in depression symptoms, but the self-help book intervention was more
cost effective. The authors hypothesized that the bibliotherapy intervention
may also lead to fewer side effects compared to antidepressants.
Another randomized clinical trial found that a self-help book improved
mild depressive symptomatology and that this outcome was maintained at follow
up compared to placebo (Moldovan et al., 2013).
Another two studies that identified important recovery outcomes
demonstrated how partnerships between healthcare services and public libraries
can be utilized to deliver effective bibliotherapy schemes. Participants in one
of the schemes were prescribed self-help reading materials by healthcare
workers. Those who benefitted from the scheme reported feeling empowered by the
active involvement in their own recovery provided by engaging with the
bibliotherapy activity (McKenna et al., 2010). The other study reported that
the bibliotherapy intervention was successful in helping to alleviate mild to
moderate mental health issues when delivered in the community through a public
library service (Macdonald et al., 2013). Public libraries are trusted
institutions (Audunson et al., 2011; Ingham, 2014;
Varheim, 2017) that are accessible to all as a space for contemplation and
wellbeing (Philbin et al., 2019; Pyati, 2019). Research has shown that reading
groups that aim to enhance mental health are seen as non-stigmatizing when they
are based in the neutral environment of a library (Shipman & McGrath,
2016). In their systematic review about bibliotherapy practices in public
libraries, Zanal Abidin et al. (2021) make a call for
greater collaboration between the public library and healthcare sectors as a way to achieve the common goal of improved public
wellbeing, utilizing the unique skillsets of professionals in both sectors to
set up bibliotherapy programs.
Creative Bibliotherapy
There has also been interest in the literature in the benefits of
creative bibliotherapy groups where fiction or poetry is discussed with
others. Connecting with fiction and poetry in reading groups can result in a more
personalized experience in meeting individual needs due to the open approach of
any reading-related discussions as compared to talking therapies, which may
more narrowly focus only on targeting negative thought patterns (Fearnley &
Farrington, 2019). Instead of restricting the notion of bibliotherapy to only
self-help materials designed to cure a disease, a broader interpretation allows
that any book helping a reader to feel less alone or calmed and soothed by way
of escapism is valuable to mental wellbeing (McCaffrey, 2016). A recent
systematic review of bibliotherapy interventions found that the value of
autonomy is a common theme as individuals experience a feeling of empowerment
by engaging in the bibliotherapy process to enhance their own mental health
(Monroy-Fraustro et al., 2021). However, the simple
act of reading fiction alone may not be enough to be considered a therapeutic activity but reflection and discussion of the work may
enable it to aid wellbeing (Carney & Robertson, 2022). Bibliotherapy is not
without risks as selected reading materials could be triggering to participants
and disagreement in discussion could occur, but the facilitator can help to
mitigate these issues by creating a nurturing environment where a diversity of
opinions is welcomed (Blundell & Poole, 2022).
Considering good mental wellbeing as involving healthy interactions with
others and living a purposeful life also enables bibliotherapy to enter the
realm of public health so that broader societal concerns such as loneliness can
be addressed (Corcoran & Oatley, 2019). Loneliness is increasingly
identified as a public health issue. Systematic review data shows strong
associations between loneliness and all-cause mortality, cardiovascular
disease, and poorer mental health outcomes (Leigh-Hunt et al., 2017). Public
libraries have already been involved in providing extensive activities to help
to alleviate loneliness (Gielgud, 2018; Leathem et al., 2019; Shared
Intelligence, 2017; Peachey, 2020; Vincent, 2014). Over 80% of respondents in a
recent report indicated that use of the library helped them to reduce feelings
of isolation and loneliness (Chartered Institute of Public Finance and
Accountancy, 2020).
The Reader Organisation is a
national UK charity that has developed a Shared Reading model where fiction and
poetry is read aloud in a group and then discussed. The Shared Reading model
has demonstrated benefits for several groups of people with varying sociodemographic
characteristics and healthcare needs. Reading groups for participants with
dementia resulted in a positive impact on quality of life that was maintained
at follow up (Longden et al., 2016). People with dementia who were involved in
other reading groups using the model showed evidence of lower symptom scores
after the intervention, as well as gaining an opportunity for meaningful
interaction with others beyond routine care (Billington et al., 2013). A more
recent study further added to the evidence base for dementia by showing how
these reading groups can improve communication, mood, and behaviour, offer
opportunities for self-expression and help create a
sense of identity for people with dementia (DeVries et al., 2019).
Studies have also reported favourable outcomes for people with other
types of mental health issues. Participants in one study provided feedback that
the use of fiction in these groups allowed them to escape to a less distressed
moment in time and that the groups were experienced as a safe space to discuss
difficult emotions indirectly through the reading material (Shipman &
McGrath, 2016). Participants in another study reported feeling that the quality
of social interaction was better in the reading circle they attended as it
brought individuals together compared to opportunities they had to socialize
with others in an open room (Pettersson, 2018). Outcomes
included increased self-confidence, an increase in social connections, a
beneficial effect on psychological wellbeing, and a greater desire to
continue with reading as an activity as a consequence of
participating in the reading circle. Another bibliotherapy program facilitated
in an acute inpatient psychiatric setting made use of autobiographies with the theme
of a lived experience of mental health issues (Eisen et al., 2018). Evaluation
data indicated that the program helped participants to increase their
sense of hope and self understanding. A
study of a reading group in Denmark with mentally vulnerable young people as
participants found that the group provided attendees with a regular source of
social connection with peers without being focussed on their illness
(Christiansen & Dalsgard, 2022). This allowed the expression of identities
that were unrelated to their diagnosis.
Evidence from Shared Reading groups that were facilitated in a doctor’s
surgery and mental health drop-in centre showed that participants experienced a
reduction in depressive symptoms after the intervention as measured by a
validated tool for depression (Dowrick et al., 2012). One study compared the
impact of a Shared Reading group with a tour group type activity to pinpoint
whether the bibliotherapy group had any unique benefits (Longden et al.,
2015). The participants in this study were experiencing or were at risk of
mental health issues, social isolation, or unemployment. The results showed
that, in comparison to the tour group activity, the Shared Reading group
participants were able to express and share a broader range of emotions and also had more opportunities to value both similar and
different experiences in response to the texts read, contributing to a richer
emotional experience.
In another study, residents in an Australian care home appreciated the
opportunity to think for themselves in the reading group and to divert their
minds away from their healthcare conditions (Bolitho, 2011). Other studies
evaluating creative bibliotherapy groups for older adults found that
they led to greater opportunities for social interaction provoked by the
reading material (Seymour & Murray, 2016), encouraged self-expression
and led to feelings of empowerment through creating a safe space in the group
(Chamberlain, 2019) and helped to elevate feelings of confidence and
self-esteem in participants (Malyn et al., 2020).
Research Gaps
Many of the existing
research studies on arts and wellbeing tend to focus on visual arts, rather
than literary interventions (Malyn et al., 2020). Existing research studies of
this type also tend to have very small sample sizes. There is a research gap with
regards to partnership working between public libraries and health services
(Macdonald et al., 2013). The extent of the role public libraries could play in
helping to promote community wellbeing has not been adequately acknowledged by
policy or decision makers (Hudson, 2019; Shipman & McGrath, 2016; Philbin
et al., 2019) despite the fact that public libraries
already receive high volumes of health-related enquiries and would appear to be
natural partners for the healthcare sector (Whiteman et al., 2018). There
is also a need to evaluate how public libraries are supporting health, as
impact data is frequently not being gathered, leading to public library
contributions to community health being underappreciated (Lenstra &
Roberts, 2023).
The current study aims to address some of these research gaps, including
a larger sample size than previous studies. It presents a new way of evaluating
a bibliotherapy scheme for impact on wellbeing as well as being an example of
effective partnership working between the healthcare sector and a public
library.
Aim
To determine the extent to which a wellbeing through reading program can
help reading group participants to experience the Five Ways to Wellbeing
elements.
Methods
The researchers designed a feedback survey containing a mixture of open-
and closed-ended questions (Appendix B), and facilitators used it at the end of
each session. The survey primarily aimed to measure whether reading group
sessions had an impact on the wellbeing of participants. Therefore, the
researchers decided to base the key questions around the Five Ways to Wellbeing
and ascertain whether respondents felt that they had experienced any of them
during their reading group activity attendance. To encourage confidence that
their individual responses were anonymous, respondents were prompted to place
their completed evaluation forms into an evaluation bag left in the corner of
the room.
Statistics were calculated
for all closed-ended survey responses. Free text responses were picked through
and deductive coding using the Five Ways to Wellbeing was used for these, as it
was a subject area with previous knowledge or theory (Bowling, 2023). Inductive
coding was used to conduct a thematic analysis for the remaining comments to
find any additional themes emerging from free text survey responses. The
benefit of using this approach for the remaining data was to allow for the
construction of new categories (ibid.) that did not fit with the Five Ways to
Wellbeing.
Results
There were 131 participants
attending in total across the 15 sessions facilitated. Of these, 125
participants completed feedback forms for a response rate of 95%.
Figure 1
Engagement in all the Five Ways to Wellbeing elements.
Evaluation Feedback About Each of the Five Ways to Wellbeing
Figure 2 shows that participants engaged with all elements of Five Ways
to Wellbeing. Connect, Take Notice and Keep Learning received the most
additional comments in the free text responses.
Figure 2
Engagement with each of the Five Ways to Wellbeing by 125 total
respondents.
1. Connect
All 125 respondents felt that the session helped them to connect with
others and Connect was the strongest theme from the
analysis of free text responses with 71 references to this aspect. Several
respondents expressed pleasure that the session provided them with an easy way
to meet new people and engage in meaningful discussions with them. Some
commented that the discussions reminded them of their common humanity with
others through the sharing of similar memories or experiences. A few
respondents as demonstrated by the following quotations were able to use the
sessions to help build their social confidence:
“I enjoy how the story brings together a group of
people who don’t know each other together. They become aware of things,
instances past that may connect them. We realise that we are all people making
our way in the world.”
“It was good to share experiences with others in the
group. It brought back memories I’d forgotten and we
could recall similar experiences. There was a lot of laughter
and this did a lot for my wellbeing!”
Those who already enjoyed literary activities when alone reported even
greater enjoyment of consuming stories and poems in the company of others in a
group. Attempts to create a safe space for discussion were successful as
respondents commented on experiencing a non-judgemental atmosphere where they
could contribute to discussions freely, without fearing criticism of their
interpretations of the literature. Participants also reported benefiting from
general social conversation before and after the sessions as well as during
breaks. As one respondent in the current study commented:
“These types of sessions are ideal to someone like me
who is mostly stuck indoors in isolation from the outside world.”
2. Keep Learning
Keep Learning was the second most commented upon element with 43
respondents remarking on it. Participants commented upon how their learning
came from others, particularly through the varying interpretations that
different group members made of the stories and poems during the discussion
activities. Some reported feeling validated when their views matched those of
other participants, but they also experienced a greater breadth of perspective
in hearing differing opinions. Learning also came from new words or phrases and
the discovery of a new author.
A few
participants commented on their intention to look up an author or poet newly
discovered during a reading group session. More than half of all participants
stated that they felt encouraged to access more stories (84 respondents), more
poems (86 respondents), and make more use of public libraries (69 respondents).
Some participants admitted that they usually find poetry to be difficult or
dense but discovered that they enjoyed exploring the meaning of a poem in a
group setting where group members could support each other in their learning
and understanding. The following quotations provide representative comments:
“It was a kind of learning to find out that other people have different
interpretations of a poem, and that my viewpoint isn’t the only one.”
“I do not usually interact with people I do not know
about life struggles; or poems … learning others’ contributions were often
enlightening.”
3. Take Notice or Be Mindful
A total of 34 respondents
commented upon the Take Notice (or Be Mindful) element ,
the third most important element in the results. Some respondents commented on
how the session itself encouraged concentration through having to listen
carefully to the story and poem in order to engage
with group discussions. This helped to divert the minds of participants from
difficult life experiences, ranging from everyday stress to a bereavement, as
indicated by these participant comments:
“Mindful – allowed me to relax and set aside stressors for a little
while.”
“I was able to be mindful while others were talking and notice any
judgements I was making.”
“Thank you for telling us to turn off our phones – it helped to stay
mindful.”
The setting meant that some
respondents had the opportunity to use the physical space at the Library of
Birmingham to engage in mindfulness, taking in the herb garden on the roof
terrace during break times or focusing on the views.
4. Give and 5. Be Active
The two remaining ways to wellbeing were Give and Be Active, and they
received 18 and 13 comments respectively, so they were the two least commented
upon elements. Regarding opportunities to give during the session, respondents
commented upon contributing in a number of ways: by
offering their viewpoints during discussions, by becoming a spokesperson to
summarize and report back discussions for their small groups, and by
volunteering to read the poem aloud. Some participants also mentioned actively
listening and giving each other time and attention as forms of giving:
“We gave our time to each other and listened.”
“I helped to include someone else in the
discussion.”
Some respondents felt they had been active whilst travelling to the
location of the reading group sessions. For most of the sessions, the room was
located on the seventh floor of the library so some respondents, as the
following comment shows, chose to go up the stairs instead of taking the lift:
“Because library is in a pedestrianized area we are active in getting here!”
Themes From the Free Text Comments
Reflections on Wellbeing Themes in the Reading Material
Some respondents chose to use the evaluation form to express their
personal reflections on the wellbeing themes in the stories and poems and the
meaning that they took away from these. For example, one of the respondents
expressed gratitude for some of the experiences they had had in childhood in
response to a short story, while another participant gained a deeper
perspective of their own values and what helps and hinders in their life.
Personal reflections such as the following on self-care, contentment, and life
goals were also made:
"I thought the poem was really interesting and
thought provoking. It reminded me how important it is to re-connect with
yourself, to treat yourself with love and care."
"I thought both the short stories were really
good as it makes you think about going after your dreams, what happiness means,
being contented, moving on in life."
Respondents described stories and poems as meaningful,
thought-provoking, and inspiring, with one respondent commenting:
"I also appreciate the wellbeing theme – too many
thrillers and horrors in other book clubs – nice to have more mellow, enhancing
reads."
Format of the Sessions
There were several positive comments about the format of the sessions,
including comments expressing appreciation that no prior reading was required
to fully engage with the session. In addition to this, respondents appreciated
that intervals of space were purpose-built into the session to consider
reflections about the readings, especially focusing on wellbeing themes
regarding the human condition. Respondents thought that the format of the
sessions was successful in encouraging active thinking through the question and
discussion activities.
"The sessions easily covered the five ways to
wellbeing. I loved the format in that you are able to turn up without any prior
work."
"Thought it was very enjoyable: good to have to
think and great to talk to others. Easier because of the fact we were
discussing a story and poem rather than talking about ourselves. The latter
would set an unwelcome context for some."
Improvement to the Sessions
One of the main feedback recommendations that was taken on board after
the first couple of sessions was to lengthen the break time between the story
and poem. This helped to create a more relaxed atmosphere, in keeping with the
spirit of the sessions. Evaluation forms revealed that some participants were
experiencing grief or mental health issues, so signposting to available support
was introduced in a session handout. Participants expressed finding connecting
to different members of the group particularly beneficial, so the organizers
decided to swap some participants around on discussion tables after the breaks,
allowing for a wider diversity of connections in the group.
Characteristics of Attendees
A large proportion (74%) of
respondents had had some experience of depression or anxiety. Of these, 93%
respondents reported that the session they attended had helped them to engage
with all the Five Ways to Wellbeing. Of the respondents, 23% reported that they
had experienced loneliness in the past few months. Only 6% identified as carers
in this study.
In addition to this, 67% of attendees were female and 33% were male.
Representation spanned the adult age groups with the least represented group
being the youngest with only 4% of participants being aged 18-30 years. For the
other groups, 39% of participants were aged 30-49 years, 29% of participants
were aged 50-64 years, and 28% of participants were aged over 65 years.
Discussion
Similar to other studies highlighted in the literature review,
this study also showed that participants particularly valued the interactivity
of the reading group where they were able to share similar and differing
opinions about the selected texts with each other in a safe space and learn
from one another. Again, as suggested in the literature, the current study also
found that use of short stories and poetry meant that participants were able to
discuss wellbeing themes more broadly and flexibly based on the emerging themes
in the texts, rather than only narrowly tackling negative thought patterns as
groups based on cognitive behavioural therapy would do. The indirect method of
encouraging these discussions through a poem and a story allowed participants to
be more open in their conversations. Some respondents were surprised at the
levels of meaningful conversation they had in the group, with people they had
never met before. This was also expressed in the wider research with studies
indicating that reading groups can lead to a broader sharing of emotions
and thoughts compared to other types of group activities.
This current study adds to
the evidence base with regards to a reading group activity that has been very
successful in helping participants to feel connected to each other through
their engagement in a group. Public libraries are ideal settings for such
groups as it has been found that reading groups that meet in a library report a
greater likelihood of encountering other groups meeting in the same location
(Reading Agency, 2015), which could further enhance social connections. This
was certainly the case in this study as what became evident as the sessions
progressed was that some attendees were planning other library activities
adjacent to their reading group session. The Connect element of the Five Ways
to Wellbeing manifested very broadly with reading group participants not only
connecting with each other in the group but also engaging with wider community
activities available around them. This could have a particularly beneficial
effect on people feeling socially isolated. Research shows a correlation
between loneliness and both physical and mental disease, so reading groups
could be an important public health intervention.
Integration of learning about the Five Ways to Wellbeing into the reading group
acted as a mental wellbeing promotional initiative as to simple but
evidence-based actions participants could engage in to improve their personal
wellbeing.
As a result of
this study, a number of easy-to-use session plans
have been created that are Creative Commons licensed so that others can easily replicate sessions and corresponding book sets
have been purchased by the Library of Birmingham. The Many Roads to Wellbeing support materials have also been
adopted in two different settings within Birmingham and Solihull Mental Health
NHS Foundation Trust, with good engagement from a range of multidisciplinary
staff including nursing, medical, and peer support workers. These colleagues
helped to test and adapt existing session plans to make them suitable for use
with service users in a healthcare setting. During the COVID-19 pandemic
lockdowns, the materials were also used to facilitate Stories to Connect
sessions online with NHS staff who were working remotely to reduce the workers’
feelings of isolation (Gardner, 2022).
From the
viewpoint of the public library, the partnership has resulted in a positive
impact on staff development with the service. Public library staff from the
Reader Services team were primarily on hand to assist with safety, comfort and
to help with matters such as membership and lending opportunities. The staff
also expressed a desire to observe and shadow the session, so they could
develop a similar program. Public library staff did embark on facilitating
their own book club with encouragement and support from the health librarian.
This was the first time that the mostly reference team had attempted to
facilitate a book club for adults.
Limitations of this study include that the results relied upon a
self-reporting tool for wellbeing in which some participants may have been
reluctant to report not engaging with some of the Five Ways to Wellbeing. The
facilitator attempted to encourage honest answers under the cover of individual
anonymity within the group, but the aforementioned limitation
of self-report measures may have had some impact on results. This study had a
high response rate, but future studies may wish to use online and postal evaluation
to mitigate the limitations of this method. The evaluation tool could also be
improved by quantifying some of the Five Ways to Wellbeing better. For example,
it was difficult to quantify when respondents had said they had been
(physically) active as a result of attending the
session. This was due to the feedback form only allowing participants to select
from a binary YES/NO response. A Likert-type scale would have allowed
participants to specify how much they felt they had engaged with the various
elements of the Five Ways to Wellbeing. The phraseology of the question
relating to the subsequent public library use also needed refining to include
those who were already heavy users of the service.
Whilst the
reading program took place before the global pandemic, the findings are
arguably even more relevant in the post-COVID population, given the evidence
they present about enhancing mental wellbeing and loneliness. These are now key
concerns being discussed by more recent reports due to the impact of the
pandemic and cost-of-living crisis on population health.
Conclusion
Reading group
attendees engaged with all of the Five Ways to
Wellbeing to different degrees with the most significant outcome the
benefit of connecting. Research shows that loneliness has negative health
impacts, and this initiative can be used to help isolated individuals
connect with other people by actively encouraging conversations. Attendees felt
a sense of community in sessions through interacting with different people, so
this initiative could be useful as a tool to help build a sense of social
cohesion. Findings suggest that this project has the potential to support wider
social prescribing initiatives, and session plans are available so other
facilitators can easily replicate the reading group sessions.
The Five Ways to
Wellbeing evaluation tool proved effective in capturing a range of impacts, and in itself raised awareness of how to improve wellbeing. Mental health
has traditionally been neglected in public health initiatives but introducing
the Five Ways to Wellbeing to the group was an easy way to provide some
evidence-based self care techniques to participants.
Studies show a research gap in the
area of partnership working between public libraries, and health or
third sector services and this study provides encouraging evidence of what can
be achieved together. This project has demonstrated the power of partnership
where capacity, resources, and expertise are pooled together to benefit the
health and wellbeing of the local population.
Author Contributions
Anita Phul:
Conceptualization, Methodology, Writing – original draft Hélène Gorring:
Supervision, Writing – review & editing; David Stokes: Resources,
Writing – original draft.
Acknowledgements
Thank you to the
following people for their ideas, encouragement, inspiration, or practical help
during this project: Sarah Carmichael (Nurse), Eugene Egan (Peer Support
Transition Worker), Pravir Sharma (Psychiatrist), John Travers (Staff
Experience and Engagement Lead), Pamela Turner (Chaplain), and The Reader
Services team at the Library of Birmingham.
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Appendix A
Themes of Stories and Poems Used to Promote Short Story and Poetry
Group Sessions
Session one:
choices
Session two:
breaking barriers
Session three:
decisions
Session four:
outside in
Session five: reacting
Session six:
letting go
Session seven:
strong tides
Session eight: being
Session nine:
small moments of sunshine
Session ten:
being yourself
Session eleven:
the everyday classroom
Session twelve: connecting
Session
thirteen: eye of the storm
Session
fourteen: finding meaning
Session fifteen:
journeys and dreams
Appendix B
The Evaluation Survey
Evaluation Form
I am trying to evaluate whether these sorts of short
story and poetry reading groups have any impact on the wellbeing of attendees.
I am using the ‘Five steps to wellbeing’ model to base my main questions
on.
1. Did this session help you to do any of the following
today?
a. Connect – talk to or interact with other people in the
group?
Yes [ ]
No [ ]
b. Take notice/be mindful – were you able
to do this while focusing on the activity today?
Yes [ ]
No [ ]
c. Keep learning – did you learn anything from the story, the poem or
any of the
discussions?
Yes
[ ]
No [ ]
d. Give – do you feel you have given others something in this
session today? For
example, this could have been by contributing to the discussions.
Yes [ ]
No [ ]
e. Be active – Consider how you travelled to the session.
Yes [ ]
No [ ]
2. If this session did help with any of these wellbeing
factors, please write a bit more about this, perhaps choosing the one/s that
had most importance for you and giving a bit more detail.
3. Has this session encouraged you to do any of the
following more?
(Please
tick all that apply, if any)
a. Read/listen to more stories [
]
b. Read/listen to more poems [ ]
c. Make more use of public libraries [
]
4. Please tell us a bit about yourself so we can measure
if these sessions might be
helpful to any particular groups of people: -
a. I am a carer [ ]
b. I have had experience of anxiety or depression [ ]
c. I have experienced loneliness in the past three months
[ ]
5. Any other comments about the session today?
Thank you very
much for your feedback! Your responses and comments are much appreciated.