NHS Education for Scotland Knowledge Services
Report of Bibliotherapy Pilot Projects 2013-14
Contents
Introduction
Background
Methods
Summary of findings
Detailed results
1.Resource
2.Activities
3.Outputs
4.Reach
5.Reactions
6.Knowledge, Skills and Attitudes
7.Practice/ behaviour change
8.More effective practice
NES KSG Lessons Learned
Conclusion
Appendices
Appendix 1 Bibliotherapy Evaluation Framework and Forms
Appendix 2 Breakdown of reactions by programme
Introduction
During 2013-14 NHS Education for Scotland, Knowledge Services Group (NES,KSG)coordinated a number of bibliotherapy activities including the commissioning of bibliotherapists to deliver sessions to patients and the public. The programmes aimed to help participants gain personal meaning from information for health and wellbeing. The programmes included creative writing, Living Life to the Full (LLTTF), reading and health literacy. The Knowledge into Action Evaluation Framework1 was used to measure the impact of the activities from the perspective of the participants and the bibliotherapists. The Framework provided mechanism to capture initial reactions, increased knowledge and sustained behaviour change. During the year 9 programmes with a total of 67 participants were evaluated. An additional programme was planned but only one participant attended the first session so the programme had to be cancelled, the lessons learned from this are reported in section 8. The report is organized under the evaluation framework headings.
This report focuses on the 9 programmes completed but lessons were learned, see section 8.
Background
NES,KSG has an ongoing interest in the role of bibliotherapy to improve the quality of life of patients and carers. Bibliotherapy covers a broad spectrum of approaches which help people to gain personal meaning from information to take more control of their health and wellbeing. To date the evidence has shown results most consistently in mental health, particularly mild to moderate depression and anxiety.
Methods
A series of bibliotherapy events and training during 2012-2013 increased interest among the NHS Scotland librarians and others.During 2012 NES funded 10 people to be trained as Living Life to the Full (LLTTF) ( facilitators and purchasedtheir licenses to practice. These individuals were then encouraged to contribute to this project by hosting and evaluating a programme. Of the 9 facilitators of the programmes included in the project 5 were trained by the NES initiative.
Letters were sent to GPs in NHS Scotland asking for expressions of interest to host a programme in their practice. From this letter 14 total responses were received and following discussions 3 practices were identified and matched with facilitators. The other hosts for programmes were identified in a variety of ways through contacts via NES KSG and the facilitators themselves.
To evaluate the impact of the interventions each facilitator was provided with a series of evaluation forms, see Appendix 1. Each form was mapped to the evaluation framework to indicate the level of impact measured.
Summary of the types of interventionsincluded in the research
Supported self-help
Supported self-help provision using the ‘Living Life to the Full’ life skills course.
This course takes place over 8 weeks, each session lasting one hour and a half. The group of participants work through topics led by the facilitator using discussion and reflection to learn new life skills. These are directed to mood, behaviour and lifestyle changes. The system uses small booklets and homework exercises and is a form of cognitive behavioural therapy. 6 settings employed this course, from third sector and a GP surgery.
Reading
The librarian at a Scottish hospital was developing a service for one-to-one fiction reading with long-term patients with mental health issues. The long term aim for this intervention was a stepped approach to exploring fiction with patients. This was a supportive activity for existing readers. By reading fiction novels with patients, she could then discuss other titles for them to read.
Creative Writing
A block of 8 creative writing and journaling sessions, each of 2 hours duration, was delivered at The Centre for Integrative Care. The aim was to use creative writing exercises and journaling to enable participants to see progress in their work and gain a sense of developing potential writing. For the creative writing programme, exercises were designed or adapted to facilitate experience of a range of potential therapeutic benefits.
Health literacy
An information afternoon was delivered at the Motherwell Well- Informed Information service. This event offered help with mental health information to encourage and support self-management. Four short information sessions/presentations were given by each speaker /service. This activity aimed to enable people to use information effectively to understand issues relating to their health and care, participate effectively in their care, and live well on their own terms with any health conditions they may have.
Summary of findings
- Resource
Demand for the programmes and facilitators to deliver them.
9 programmes successfully delivered by 7 facilitators
- Activities
A range of types of bibliotherapy programmes delivered and evaluated
Living Life to the Full (LLTTF) – 6
Reading – 1
Creative writing - 1
Health literacy sessions -1
- Outputs
Facilitated sessions delivered and participants attended all sessions.
9 programmes delivered, 1 programme cancelled after one week
54 forms returned to NES KSG and interviews conducted with 6 of the bibliotherapists/facilitators.
- Reach
Number of bibliotherapists and participants in a range of settings.
Total number of participants was 67 in 9 programmes facilitated by 7 bibliotherapists/facilitators.
Range of settings and audiences reached from health, social care and third sector.
NHS Settings –5 Voluntary sector – 4
The Health Literacy workshop in Motherwell was the only programme to involve practitioners as participants, the others were all service users and/or patients.
.
- Reactions
Initial reactions to the sessions from the perspective of the participants and the facilitators from evaluation form 1.
Evaluation forms received from 81% of the participants and 84% are satisfied with the sessions.
Interviews conducted with 6 facilitators. The facilitatorsof Living Life to the Full (LLTTF) programmes reported a high level of satisfaction with the training materials, format of sessions and relevance to participants.
- Knowledge, skills, attitudes, aspirations
Participants improve their understanding of self-help techniques and how to improve personal wellbeing.
Participants reporting
- increased awareness of own health and well-being – 31 yes; 3 no
- improved attitudes to health and well-being – 29 yes; 2 no
- changes in behaviour or decisions about their own health and well-being - 29 Yes; No 3; Don’t know 3
Facilitators reported informally that they were enjoying delivering the sessions and that the confidence of those recently trained had increased.
- Practice, behaviour change
Participants use techniques in own setting.
Participants spent time completing forms providing many positive examples of how the programme had affected them and changes they had made to their lives.See examples on page 14-16.
Bibliotherapist confident in delivering sessions.
The facilitators provided a number of examples of how they had altered their practice and what they had learned from the experience of delivering the programme. The courses on Living Life to the Full (LLTTF) demanded skills that were new to some facilitators and 5 out of 6 reported increased skills.
- More effective practice
Participants develop increased confidence and personal wellbeing.
The facilitators provided a number of examples of sustained changes in behaviour reported by participants at the reunions 6 weeks or so after the programme was completed.
Bibliotherapists improve service delivery.
Increased uptake for Living Life to the Full (LLTTF) course for the future in Glasgow Women's Aid and the Workers Educational Association in Inverness wishes to extend for young people.
A number of lessons learned were reported by the organizations and by NHS Education for Scotland, Knowledge Services Group.
Detailed results
This section reports on the findings for each of the elements in the outcomes framework in detail. Where appropriate these are reported from the perspective of the participants followed by the feedback from the facilitators.
1.Resource
NES coordinated and in some cases commissioned, 7 facilitators to deliver a total of 9 programmes to67 participants.
2.Activities
The format of the 8 programmes
6 -Living Life to the Full (LLTTF) coursesover 8 sessionseach
1-health literacy single event
1-creative writingcourse over 6 sessions
1 –readingactivity over 1 session
Location/Group / What activity was delivered / Date / Number of participants / Were they the intended peopleASD Group (People with Autism Spectrum Disorders) / Living Life to the Full (LLTTF) course. / May-July 2013 / 6 / Yes
Carers Organisation / Living Life to the Full (LLTTF) course / 2 days- April 2014 / 5 / Yes
Centre for Integrative Care / Creative writing / November 2013 - January 2014 / 6 / Yes
Glasgow Women’s Aid / Living Life to the Full (LLTTF) course / March-May 2014 / 10 / Yes
GP Practice Lanarkshire / Living Life to the Full (LLTTF) course / February 2014 / 6 / Yes
GP Practice Lothian / Living Life to the Full (LLTTF) course / February 2014 / 8 / See note *
The State Hospital / Reading fiction / October 2013 / 1 / Yes
Well-Informed Service / Information Afternoon- Self-help and Mental Health Information. Four short information sessions/presentations by each speaker. / July 2013 / 12 / See Note **
Workers Educational Association / Living Life to the Full (LLTTF) course. / January – February 2014 / 13 / Yes
The numbers and audience for each programmes met expectations with the exception of two situationsNHS Lothian* and Well Informed, Motherwell**.
*The host GPs had anticipated higher numbers for these sessions and did promote them widely but as the facilitator requested each participant completed a depression questionnaire and post it to the facilitating organization then The GP observed for 3 sessions but as participants were not happy she was asked to leave.
**Well Informed- Out of the 20 people who had registered/booked, 10 people plus 2 additional turned up. The 12 attendees were 10 service providers and 2 service users. The hope had been for a more equal balance of service providers and service users.
3.Outputs
The impact on the participants and the facilitators was recordedusing evaluation forms supplied by NES, see Appendix 1, ensuring these were returned to NES and through interviews with each of facilitators.
Total number of participants is 67
Total number of users’ feedback forms received 54, that is equal to 81%
One programme commissioned by NES did not use the forms supplied.
4.Reach
Overall reach of the programmes met the expectations of the project with a total of 9 programmes with 67 participants in range of NHS and third sector settings. NES planned for more programmes to be linked with GP practices but circumstances prevented this and lessons learned, see Section 8.There was an expectation of more participants at the GP programme in NHS Lothian but due to the recruitment process the numbers were low and again lessons were learned, see Section 8. Due to the cancellation of one programme anopportunity was identified to include a programme for carers whichprovided additional insight into the benefits to participants.
NHS Settings – 4
Voluntary sector – 5
Seven facilitators delivered the programmes including two librarians, one from the NHS. With one exception, all had attended one or more of NES Bibliotherapy events.
The initial reactions of the participants to the first session can be used as an indicator that the programmes reached the appropriate audience.
Total scores for participant feedback from Form 1 after first session:
42 Smiley faces = 63%
14 neutral = 21%
5 Unhappy = 7%
3 Anxious but not unhappy = 4%
5.Reactions
The participant’sreactions to the programme were measured through responses to the first session and through Form 2 completed by each participant at the end of the programme.
After the 1st session 42 simley faces were reported, see Reach section above.
Summary of the total scores for participant feedback from Form 2 at the end of the whole programme:
Question 1 How did the activity make you feel?
46 smiley faces; 2 neutral; 1 unhappy
Question 2. Please tell us your overall reaction to the activities you did in sessions
23 Very Satisfactory; 6Satisfactory; 2 neutral; 1 Unsatisfactory
Question 3 Did attending these sessions have any positive effects?
33 Yes; 1 Don’t know; 1 No
Question 4 Did you have any negative effects?
30 No; 2 Yes; 1 don’t know
Any other comments or notes?
All comments are themed below including at least 31 very positive comments
NES, KSG comment
The negative reactionsrelate to LLTTF participants but as there were more participants in these activities we do not think too many conclusions can be drawn.
6.Knowledge, Skills and Attitudes
Participants – increase in knowledge, skills, attitudes
To measure any changes in behaviour or attitude of participants to their health and wellbeing question 5 on Form 2 at the end of the programme asked –
After the activity have you noticed any change in the following?
A)Awareness of your health and well-being?
31 Yes; No 3
B) Attitudes to your health and well-being?
29 Yes; No 1
C) Behaviour or decisions about your health or well-being?
29 Yes; No 3; Don’t know 3
To gaugeparticipants understanding of the use of bibliotherapy techniques for self help Form 2 Question 6 asked if they would recommend the course to others. The result was -
Question 6 Would You recommend activity or do it again?
41 Yes;1 No; 2don’t know
See Appendix 2 for breakdown by programme.
Theresponses were supported by comments gathered at the end of each programme. Thesehave been themed and presented below.
Confidence / It has helped me with confidence and self-esteem and dealing with problems. Thank you. Keep this course going.Group dynamics / Enjoyed how everyone joined in and felt like good company.
Interesting to hear others experiences and thoughts.
Working with the group and listen about things that have been said are helpful.
the comment that a useful aspect was “conferring with others”
I would recommend this course to everybody: it is very positive to life. Enjoyed very very much; enjoyed how it was put across and it was easy to understand. Enjoyed how everyone joined in and felt like good company. Enjoyed the social side of it. like being in a group context
Health-related Issues / Keen to try but hard to build on any small step as still such a vacuum each day. Feel lacking in a ‘core’ on which to build.
In a health context, especially when awakening and waiting about health issues, it would be good to build some way of acknowledging and talking about these when they arise
Very good course, with clear explanations and not many embarrassing moments. It has helped me reduce my antidepressant.
The course was relaxed and informal which added to its benefits. Will help to identify negative thoughts and awareness of ways of dealing with them.
Life skills / Understanding more about how things can make you feel bad, both physically and mentally, and how to avoid doing them and instead do things that help …feel better afterwards and know more about techniques to help feel better.
It has been great and helped me so much. I have made changes to my life skills,
Will help to identify negative thoughts and awareness of ways of dealing with them
Good course for anyone especially carers, care workers. Provided the tools required to live life to the full. Deal with the daily challenges we all face throughout our lives. Help you deal with loss and caring for those left behind (Dad) after the loss of life partner of 55 years (LLTTF)
Motivation / “helping me find out how to motivate myself into doing things”.
(course had )quite a big impact in getting me to be a bit more positive
it is very positive to life.
Peer support / Enjoyed how everyone joined in and felt like good company
Like being in a group context.
Enjoyed the social side of it.
…made friends and have enjoyed the course.
Self-esteem / …rebuilding my routine… talking about things that mess you up and dealing with them.
Course has helped me get out of bed in the morning and go for a walks, generallyfeeling better.
Very good course, with clear explanations and not many embarrassing moments. It has helped me reduce my antidepressant medication.
Support for work/
signposting to others / Very useful information. Will pass on and use.
Having just recently started working in the North, I have found this very helpful and will be informing my -workers. I use the self-help information from the Elamentwebsite every day for patients.
Good work! Will be useful for signposting parents and carers I work with.
Comments on theprogrammes including facilitator and atmosphere created / I would say please have an advanced course, so that our brain is alive and we stay positive. Would like to say to our class teacher thank you very very much. …She is a wonderful teacher. I would like to be in her class again. Thank you very very much.(LIVING LIFE TO THE FULL (LLTTF))
This was helpful, technically and encouragingly relaxing atmosphere. Would certainly take the course again and would recommend it.(Writing)
Good course, good selection of skills to know about. I had some one- to-one support throughout the course to make this relevant to my specific situation. This was necessary, not sure if I had got as much out of the course otherwise.
Excellent today and techniques for awakening and waiting…it is fine balance between writing and health issues-writing side is secretly done; perhaps, just wee bit more thought into therapeutic side.(Writing)
I would like this course to become permanent fixture healthcare options for patients/subjects in NHSS. (Writing)
I would recommend this course to everybody: it is very positive to life. Enjoyed very very much; enjoyed how it was put across and it was easy to understand (LLTTF)
I would recommend this course to everybody. (LLTTF)
Enjoyed very very much; enjoyed how it was put across and it was easy to understand. (LLTTF)
The course was relaxed and informal which added to its benefits.
I thoroughly enjoyed this course and the teacher was amazing, everything was explained in plain English. I would recommend this course to any friend wanted to improve their life.( LLTTF)
Very Insightful well structured and well presented. ( LLTTF)
I would like to be notified know when the next class like this is, my daughter to attend please.(LLTTF)
A most enjoyable and informative course and a wonderful teacher.( LLTTF)
The facilitator was very professional and came over that she knows her subject.(LLTTF)
Facilitators- reportedincrease in knowledge and skills