Bibliotherapy by medical librarians for the blind females

Abstract

This quasi-experimental study aimed to investigate the effect of group bibliotherapy on the self-esteem of blind females. Thirty blind females agreed to participate in the study. They were randomly divided into experimental and control groups. Data were collected through the Coopersmith Self-Esteem Inventory. A medical librarian performed an eight-session bibliotherapy intervention in collaboration with a psychological counsellor for the experimental group. After the intervention, the experimental group’s self-esteem scores were higher than the control group’s (p < 0.05). The mean self-esteem scores in the experimental group after the intervention increased significantly (p < 0.05). The highest percentage increase is related to the family and educational/professional self-esteem subscales. Using bibliotherapy by a team of medical librarians and psychologists to improve the psychological problems of the blind and other people with disabilities is recommended.

Keywords

Bibliotherapy self-esteem the blind medical librarians

Introduction

Vision loss is one of the critical sensory impairments and many people have blindness and related disorders globally. This number has risen from 216.6 million in 2015 (Flaxman et al., 2017) to 338 million in 2020 and is expected to reach 535 million by 2050 (Bourne et al., 2021). The prevalence of visual impairment in developed countries increases due to increasing population age. Accordingly, these countries need eye and psychiatric care programmes for visually impaired individuals (World Health Organization, 2012; Van Der Aa et al., 2015). In Iran in 2011, approximately 22,000 people had complete blindness, about 0.03% of this country’s population that needs special services (Siamian et al., 2012). Blindness causes many psychological, emotional and social problems, such as depression or permanent isolation, and reduces the quality of life (Van Der Aa et al., 2015). Isolation, seclusion and lack of adequate social support for blind and visually impaired people reduce their self-esteem (Salehi et al., 2015). Self-esteem is one of individuals’ essential personality and behavioural characteristics, which according to psychologists, is the basis of mental health. Self-esteem makes a person feel valued and respected. People with self-esteem believe in their ability to overcome problems and feel self-satisfied (Tuttle and Tuttle, 2004; Salehi et al., 2015). Lack of self-esteem causes mental disorders and social issues such as depression, anxiety, loneliness, hopelessness, isolation, seclusion and aggression ( Tuttle and Tuttle, 2004; Salimi et al., 2014; Salehi et al., 2015).

Various methods can be used, such as referring to a psychologist or using the bibliotherapy technique to increase self-esteem. Bibliotherapy is defined as “The use of books selected based on content in a planned reading program designed to facilitate the recovery of patients suffering from mental illness or emotional disturbance” (Reitz, 2013). In addition, it is a practical, low-cost intervention and global strategy to increase mental health. Besides, it is used as a complementary method to help treatment by medical librarians in collaboration with psychologists, counsellors, or physicians (Salimi et al., 2014; Gualano et al., 2017). The bibliotherapy technique has been scientifically and professionally studied for over a hundred years. Most researchers and psychologists believe that bibliotherapy can be used as a supporting device in treating mental disorders and helping people improve mental health resilience and sedatives of human pains (Stip et al., 2020; Bankar and Patil, 2021). In some sources, bibliotherapy has been introduced as one of the activities offered by the hospital and organizational librarians (Beatty, 1962; Salimi et al., 2014; Bankar and Patil, 2021). Librarians and information professionals committed to their profession and expertise, familiarity with various information sources and continuous interaction with different people in educational, research and library environments can play essential roles in bibliotherapy (Gualano et al., 2017; Czernianin et al., 2019).

Roberts (1984) pointed out the importance of bibliotherapy for the blind and Hardiansyah et al. (2022) indicated that bibliotherapy is effective in the environmental mastery of blind students. Nevertheless, no study has been done on the effect of bibliotherapy on the self-esteem of the blind. Considering that blind people are also a part of society, and their mental health affects the health of their families and society, it is necessary to pay enough attention to this critical issue. Therefore, the present study aims to investigate the effect of bibliotherapy on the total self-esteem of the blind and its dimensions at the Fatemeh Zahra Center in Isfahan, Iran.

Literature review

Since bibliotherapy was introduced as a complementary tool in treating mental disorders, many studies have been conducted in this field, only one of which has been done on the blind. In this study, Hardiansyah et al. (2022) indicated that bibliotherapy is effective in the environmental mastery of blind students. They developed an educational tool to aid teachers in increasing students’ environmental awareness.

In other studies, Radtke et al. (2022) studied the impact of bibliotherapy on reducing the fear of dogs in a sample of seven children, four to seven-years-old. They observed a significant reduction in phobia diagnostic severity and parent and child fear ratings. Parents reported being highly satisfied with the children’s improvement. In a randomized pilot trial, Kim et al. (2022) investigated the efficacy of eight-week forgiveness bibliotherapy with a few undergraduate nursing students. The results revealed that bibliotherapy effectively improves the forgiveness feeling, anxiety, depression and fatigue in nursing students. Vetri et al. (2022) tested the impact of bibliotherapy on the acceptability of elementary school-aged children of parents with a mental illness. The participants were eight children, eight parents, and six psychologists. They found that parents, children and psychologists believe bibliotherapy is a valuable and appropriate tool for supporting children. In a quasi-experimental study, Hamdan et al. (2021) showed that bibliotherapy helped to reduce the stress of female college students before their examination. Zandian et al. (2019), in a study on 30 prisoners of the Rey Women’s Penitentiary, concluded that bibliotherapy could improve the mental health of women prisoners. In a meta-analysis study, Yuan et al. (2018) examined bibliotherapy’s relative and acceptable efficacy for treating depression and anxiety disorders in children and adolescents. They concluded that bibliotherapy is a valuable intervention to reduce depression and anxiety and is more effective for adolescents. Loveimy and Safarzadeh (2017) concluded that narrative therapy positively reduces shyness and depression and increases children’s self-esteem. Salimi et al. (2014) showed that bibliotherapy could increase female students’ self-esteem.

In general, the findings of previous studies indicated a positive effect of bibliotherapy on some mental disorders such as stress, anxiety, depression, self-esteem and life satisfaction in children and adolescents. Nevertheless, little study has been done in this regard due to the problems of implementing bibliotherapy for the blind and the present research is designed to fill this gap.

Methods

The research method was quasi-experimental, with two experimental and control groups as pre-test–post-test. The study population included blind females from Fatemeh Zahra Centre affiliated with the Welfare of Isfahan province. It is worth noting that this centre only cares for blind women. The number of blind people in Fatemeh Zahra Centre at the time of the research was 35 and their age range was between 16 and 40 years. Of these, only 30 people willing to cooperate were numbered from 1 to 30, and alternately (even–odd number) were divided into two experimental and control groups. Then, the second author of this article (medical librarian) obtained consent from the participants to enter the study and distributed a pre-test questionnaire among the study population (experimental and control groups). Given the participants’ disabilities, she read all the questions and recorded the responses from the participants. In the next stage, eight-sessions of 60 minutes of direct therapeutic intervention was considered in 15 samples (experimental group). In these eight sessions, the blind were taught how to raise self-esteem through group reading. Bibliotherapy sessions were held using the book Seven Day Self-Esteem Super Booster (Alexander, 2019). The book was selected based on the opinions of psychologists, librarians and information professionals, because, in addition to numerous reprints in Iran, it had already been used in another study (Salimi et al., 2014) in addition to its numerous reprints in Iran. Additionally, this book uses practical examples and exercises for sample engagement. It should be noted that no intervention was performed for the control group. After eight weeks, at the end of the sessions, both groups completed a post-test and data were collected.

The data collection tool is the Persian version of the Coopersmith Self-Esteem Inventory (SEI), one of the most popular and widely used tools for measuring self-esteem. This questionnaire consists of 58 items describing the person’s attitudes, feelings, ideas, or reactions toward oneself. This tool has four subscales: general self-esteem; family self-esteem; social self-esteem; and educational or professional self-esteem. General self-esteem is about the attitudes toward himself in general situations. Family self-esteem is related to home/parents’ situations. Social self-esteem is associated with social self-peers’ situations, and the professional situation is related to the school or academic or professional situations. Some of the questions asked in the subscales are as follows:

General self-esteem: (I’m never happy; Things are all mixed up in my life; Things usually don’t bother me).

Family self-esteem (My family and I have much fun together; There are many times when I would like to leave home; I get easily upset at home)

Social self-esteem: (I’m popular with people my age; I find it very hard to talk in front of a group)

Educational self-esteem: (I’m not doing as well at work as I’d like to; I’m proud of my work; I often get discouraged in school/work)

The SEI is scored at zero and one. Eight questions are not included in the total score because they are lie detector tests. If the respondent scores more than four points on the lie detector questions, the test’s validity is low, and the subject has tried to show herself better than she is. The score range is between zero and 50. The general self-esteem subscale has 26 questions and ranges from zero to 26. Each family, social and educational/professional subscale has eight questions with a score ranging from zero to eight. This questionnaire has also been used as a standard questionnaire in various studies in Iran and the validity and reliability of the questionnaire have been reported as acceptable (Salimi et al., 2014; Loveimy and Safarzadeh, 2017; Potard, 2017).

Data analysis was performed using the paired t-test, independent t-test, Chi-square and Mann–Whitney covariance analysis. The statistical software used for data analysis was SPSS version 22.

Results

Comparison of demographic variables in the experimental and control groups

In the experimental group, the mean age was 28.6, with a standard deviation of 7.7. The control group’s mean age was 28.1, with a standard deviation of 6.2. The independent t-test showed that the mean age was not significantly different between the experimental and control groups (p-value = 0.86). Besides, most samples in both experimental and control groups were unmarried (60% and 53.3%) and completely blind (86.7% and 80%). The Chi-square test revealed that the frequency distribution of marital status did not differ significantly between the two groups (p > 0.05). The Mann–Whitney test also showed no significant difference in the severity of vision loss between the two groups (p > 0.05). The leading causes of absolute blindness and severe low vision in both experimental and control groups (73.3% and 60%) were congenital. The Chi-square test showed that the frequency distribution of the cause of blindness was not significantly different between the two groups (p > 0.05). Most degrees in the experimental group were middle school and diploma (33.3%) and in the control group were diploma (33.3%). The Mann–Whitney test showed that the level of education of the subjects was not significantly different between the two groups (p > 0.05) (Table 1).

Table 1.

Comparison of marital status, blindness severity, blindness cause, and participants’ education level in the experimental and control groups.

Variables		Experimental group		Control group		p-value
Variables		n	%	n	%	p-value
Marital status	Married	9	60	8	53.3	0.71
Marital status	Unmarried	6	40	7	46.7	0.71
Blindness severity	Severe low vision	2	13.3	3	20	0.77
Blindness severity	Absolute blindness	13	86.7	12	80	0.77
Blindness cause	Congenital	11	73.3	9	60	0.45
	Seizure	0	0	2	13.3
	Diabetes	2	13.3	1	6.7
	Problem at birth	1	6.7	1	6.7
	Accident	1	6.7	2	13.3
Education level	Elementary	4	26.7	4	26.7	0.51
	Middle school	5	33.3	3	20
	Diploma	5	33.3	5	33.3
	Bachelor’s degree	1	6.7	3	20

Comparison of test and control groups in terms of self-esteem score before bibliotherapy (pre-test)

Table 2 indicates that the experimental and control groups scored 22.1 and 23.8 out of 50 self-esteem scores before the intervention. Also, among all subscales, only the subscale educational/professional self-esteem score was higher than the average in both experimental and control groups. The other subscales scored lower than the average. The independent t-test showed no significant difference between the mean score of total self-esteem and its subscales before the intervention between the experimental and control groups (p > 0.05).

Table 2.

Comparison of self-esteem scores in the experimental and control groups before the intervention (pre-test).

Self-esteem	Score range	Experimental group		Control group		p-value
Self-esteem	Score range	Mean score	Standard deviation	Mean score	Standard deviation	p-value
General	0–26	10.9	2.5	11.3	3.4	0.72
Family	0–8	3.2	1.6	3.9	1.1	0.11
Social	0–8	3.8	1.7	4.5	1.4	0.21
Educational/professional	0–8	4.2	1.5	4.06	1.5	0.81
Total	0–50	22.1	4.9	23.8	4.9	0.32

Comparison of experimental and control groups in terms of self-esteem score after bibliotherapy (post-test)

Table 3 illustrates that after the intervention, out of 50 total self-esteem scores, the experimental and the control groups scored 26.7 and 24.4, respectively. Analysis of covariance shows that after the intervention, the mean total score of self-esteem and its subscales in the experimental group is significantly higher than the control group (p < 0.05).

Table 3.

Comparison of self-esteem scores in the experimental and control groups after the intervention (post-test).

Self-esteem	Score range	Experimental group		Control group		p-value
Self-esteem	Score range	Mean score	Standard deviation	Mean score	Standard deviation	p-value
General	0–26	12.7	2.7	11.8	3.7	0.01
Family	0–8	4.1	1.7	3.8	1.5	0.02
Social	0–8	4.9	1.2	4.7	1.3	0.003
Educational/professional	0–8	5	1.6	4.1	1.8	0.03
Total	0–50	26.7	4.4	24.4	6.03	<0.001

Comparison of pre-test and post-test scores in the experimental and control groups

The paired t-test revealed that the mean score of total self-esteem and all its subscales in the experimental group increased significantly after the intervention (p < 0.05). The highest percentage increase is related to the family self-esteem and educational/professional self-esteem subscales and the lowest is related to the general self-esteem subscale. However, the mean score of total self-esteem and its subscales in the control group were not significantly different before and after the intervention (p > 0.05) (Table 4).

Table 4.

Comparison of self-esteem score and its subscales before and after bibliotherapy intervention in the experimental and control groups.

Self-esteem	Groups	Pre-test		Post-test		Increase %	p-value
Self-esteem	Groups	Mean score	Standard deviation	Mean score	Standard deviation	Increase %	p-value
General	Experimental	10.9	2.5	12.7	2.7	16.5	<0.001^*
General	Control	11.3	3.4	11.8	3.7	4	0.19
Family	Experimental	3.2	1.6	4.1	1.7	28	0.006*
Family	Control	3.9	1.1	3.8	1.5	-2.5	0.72
Social	Experimental	3.8	1.7	4.9	1.2	29	0.001*
Social	Control	4.5	1.4	4.7	1.3	4	0.16
Educational/professional	Experimental	4.2	1.5	5	1.6	19	0.02*
Educational/professional	Control	4.06	1.5	4.1	1.8	1	0.77
Total	Experimental	22.1	4.9	26.7	4.4	21	<0.001*
Total	Control	23.8	4.9	24.4	6.03	2.5	0.16

Note: *significant

Figure 1 also shows that the mean self-esteem score of the blind before and after bibliotherapy differs in the experimental group but not much in the control group.

Figure 1.

The mean of total self-esteem score in the experimental and control groups before and after the intervention.

Discussion

The results revealed no significant differences between the mean score of self-esteem in the two experimental and control groups before bibliotherapy. However, a significant difference between the two groups was observed after bibliotherapy. In addition, this study showed that the experimental group that received the bibliotherapy intervention, compared to the control group, had a significant difference in increasing self-esteem. In other words, bibliotherapy sessions have effectively increased the experimental group’s self-esteem. These findings are in line with most previous studies that examined the effect of bibliotherapy on the mental health of different groups (Salimi et al., 2014; Lewis et al., 2015; Riahinia et al., 2015; Gerlach and Subramanian, 2016; Jacob and De Guzman, 2016; Betzalel and Shechtman, 2017; Block et al., 2017; Hazlett-Stevens and Oren, 2017; Loveimy and Safarzadeh, 2017; Böttcher et al., 2018; Yuan et al., 2018; Zandian et al., 2019; Hardiansyah et al., 2022).

The present study indicated that bibliotherapy intervention positively affects and increases all subscales of self-esteem, which is consistent with in Loveimy and Safarzadeh’s (2017) research on the effectiveness of narrative therapy on self-esteem in preschool children. However, in some previous studies, the positive effect of bibliotherapy on increasing self-esteem has not been observed in some of its subscales, such as social (Salimi et al., 2014), family and educational/professional subscales (Riahinia et al., 2015).

According to the findings, total self-esteem and its subscales are lower than the average in most blind people before bibliotherapy intervention. Notably, self-esteem is an indicator of mental health and is an essential and fundamental factor in human growth and prosperity. Therefore, low self-esteem is the cause of many psychological problems that are harmful to both the individual and society. The blind and legally blind are part of society, so the mental health of these people is also vital and must be promoted. Regarding the present and Hardiansyah et al. (2022) studies, bibliotherapy can help the blind improve their ability to solve or minimize some problems, such as low self-esteem or environmental mastery skills.

All bibliotherapy sessions emphasized increasing the sense of value, respect and interest that the person receives from others. As a result, total self-esteem and all its subscales were affected after the intervention. In addition, the highest percentage increase is related to the two subscales of social self-esteem and family self-esteem (29% and 28% increase, respectively). In conclusion, the bibliotherapy method has influenced the individual’s beliefs about himself as a member of society or the so-called subscale of social self-esteem after the intervention. In addition, it impacts a person’s beliefs about himself/herself as a member of the family or the so-called family self-esteem scale. Accordingly, the sense of self-worth was strengthened in blind people and they better judged themselves. However, no significant increase was observed in the control group that received no intervention. Low self-esteem is a risk factor for aggression, depression, delinquency, substance abuse and the like (Mahmoodi, 2013). Therefore, using bibliotherapy in welfare and rehabilitation organizations to increase the self-esteem of the blind is suggested.

For decades, librarians have been involved in some bibliotherapy programmes and evidence strongly supports bibliotherapy in libraries (Fanner and Urqhuart, 2008). Furthermore, Fanner and Urqhuart (2009) found that libraries need more facilities for service users and psychiatric librarians are uncertain about the benefits of bibliotherapy for mental health patients. Nevertheless, in Hamdan et al. (2021) and in the present study, in which bibliotherapy intervention was done by librarians and considering the positive impact of bibliotherapy, it is suggested that librarians participate in holding this type of intervention. Seemingly, if the collaboration between clinical librarians and psychologists expands, bibliotherapy can be used as an accessible way to improve mental health. Furthermore, in line with Fanner and Urquhart (2008) and Hamdan et al. (2021), this study can conclude that bibliotherapy can be used to expand the traditional services to libraries. However, no training is available in bibliotherapy in the Medical Library and Information Science courses in Iran (Eshaghi et al., 2022). Hence, proposedly bibliotherapy should be considered in the courses of this field or workshops so that students and librarians can get to know this technique scientifically and apply it in libraries.

Limitations

One of the limitations of this study was the samples. The samples of this study were blind females in a centre for the blind in Isfahan. We needed permission from the Isfahan Welfare Organization to conduct the research. Considering that the second and third authors of the study, who were responsible for holding bibliotherapy sessions, were female, the organization mentioned above issued the license for this study to the Fatemeh Zahra Centre for the Blind, which is only for females. If the study had been conducted by males or on blind males, the results would have been different. Another limitation relates to the number of participants, which was limited to 15 blind people in each experimental and control group. Although it is adequate to test the hypotheses, conducting studies in larger groups may provide opportunities to test other hypotheses. The other limitation is related to the completion of the questionnaire. As the samples were blind, the second author of the article read the questions for them and completed the questionnaire based on their answers. She tried to be neutral while completing the questionnaire and recorded responses from the blind participants with no bias.

Conclusion

This study investigated the impact of bibliotherapy on the self-esteem of the blind. According to the research findings, bibliotherapy positively impacts the total self-esteem of the blind and the general, social, family and educational subscales. Bibliotherapy can be used to expand the traditional services to libraries in rehabilitation centres. Some of these centres may have no library, such as the centre in which the present study was conducted. Therefore, it is recommended to establish libraries in these centres and employ medical librarians. Identifying the other mental health problems of the blind and holding regular bibliotherapy and book reading sessions is also recommended.

Footnotes

Acknowledgement

The authors thank all participants in this study.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and publication of this article: This work was supported by the School of Allied Medical Sciences of Shahid Beheshti University of Medical Sciences, Tehran, Iran, which has been approved by the ethics committee with the ethics code IR.SBMU.RETECH.REC.1400.1158 (grant number: 31708).

ORCID iDs

Maryam Shekofteh

Maryam Kazerani

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