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Using Diverse Methodologies to Assess the Outcomes of Reading for Mental Health and Wellbeing Within Community and High Secure Settings

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Using Diverse Methodologies to Assess the Outcomes of Reading for Mental Health and Wellbeing Within Community and High Secure Settings Turn the Page: Using Diverse Methodologies to Assess the Outcomes of Reading for Mental Health and Wellbeing within Community and High Secure Settings Thesis submitted in accordance with the requirements of the University of Liverpool for the degree of Doctor in Philosophy by Megan Watkins September 2019 i Acknowledgments My sincere thanks to: The participants whose time, effort and willingness to share their experiences made this research possible; Professor Rhiannon Corcoran, for mentorship; Professor Philip Davis and Dr. Josie Billington, for insight and encouragement; Dr. Kathryn Naylor, for going above and beyond; Dr. Christophe de Bezenac, for sentiment analysis software expertise; Dr. David Fearnley, Dr. Cecil Kullu, Dr. Grace Frame and colleagues at The Reader, Dr. Celia Bell, referring clinicians, Mersey Care NHS Foundation Trust R&D, University of Liverpool Clinical Research Governance and the team at Ashworth Hospital, for supporting research initiatives and implementation; Sarah and Meg, for being there throughout; Mum and Dad, for everything. ii “Turn the Page: Using Diverse Methodologies to Assess the Outcomes of Reading for Mental Health and Wellbeing within Community and High Secure Settings” by Megan Watkins Abstract This research aimed to investigate the effects of the therapeutic use of literature on mental health and wellbeing for individuals in community and high secure settings. Evidence gaps are addressed by exploring the value of Shared Reading within populations experiencing enduring and complex mental health needs and, in so doing, this research informs future work and practice. The thesis comprises a general introduction, two systematic reviews, a methodology chapter, a cross sectional survey, two longitudinal analyses of Shared Reading groups, a qualitative analysis of post reading group interviews and a general discussion and conclusions section. The existing literature was systematically reviewed using an integrative narrative synthesis approach to determine the effects of creative bibliotherapeutic interventions and to inform subsequent studies. For children, reading interventions were related to socioemotional development, enhanced communication, understanding of complex matters, the development of coping strategies and reduced isolation. For adults, the evidence indicates that reading fosters a sense of identity, adds value to life, promotes social support and reduces symptom intensity. A cross sectional survey with 286 respondents further investigated the relationship between wellbeing and reading behaviour. High frequency of reading for pleasure was associated with significantly greater subjective wellbeing scores and there was a significant positive correlation between recollection of being read to as a child and psychological wellbeing for current users of mental health services. A longitudinal study of six weekly Shared Reading sessions took place with a small group of participants referred from Community Mental Health Teams. A Sentiment Analysis on participant discussion demonstrated reduced negative affect and enhanced descriptive language use over the duration of intervention. Furthermore, four patients with experience of psychosis and a history of self-harm took part in a 12-month longitudinal case series design investigating the efficacy of Shared Reading within a high secure hospital. Psychological Discourse Analysis identified participants’ broadened capacity to consider, increased assertiveness, engagement and reduced avoidance of expression over time. Semi-structured interviews were conducted post-Shared Reading interventions with six participants, using Framework Analysis to extract themes. Shared Reading was reported to provide participants with a relief from emptiness through bringing contrast to their everyday lives, enhancing hedonic feeling and life satisfaction. Shared Reading created a space that supported capacity to reach others in which participants described a sense of being alone together. Effective facilitation, use of appealing reading material and lack of disruption within the group were considered crucial to support these outcomes. The diverse range of methodologies used in this research, to examine the multidimensional outcomes of reading, has enabled a holistic representation of Shared Reading outcomes and experience. As many of these methods have not previously been used to explore the value of Shared Reading, they are described and reviewed within a dedicated methodology chapter. The findings reported in this thesis should be interpreted with consideration to the strengths and limitations of the studies reported. Overall, there is evidence for Shared Reading promoting interactional accomplishment for individuals ready to engage with recovery-related activity within high secure settings. Additionally, Shared Reading may increase readiness and responsiveness to psychological therapy for individuals within community settings. Therapeutic reading can have beneficial outcomes for the child-self, adult-self and future-self. iii Contents 1. Chapter 1. Introduction to Turn the Page ........................................................ 1 1.1. Historical bibliotherapy ................................................................................. 2 1.2. Models of bibliotherapy ................................................................................ 3 1.3. Research Aims ............................................................................................... 6 1.4. Structure of thesis .......................................................................................... 7 2. Chapter 2. The effects of Reading Interventions on Mental Health and Wellbeing for Children: A Systematic Review ........................................................ 9 2.1. Abstract ....................................................................................................... 10 2.2. Introduction ................................................................................................. 11 2.2.1. Interventions for children in a clinical context .................................... 12 2.2.2. Interventions for children in a non-clinical context ............................. 12 2.2.3. Rationale .............................................................................................. 13 2.2.4. Objectives and Structure ...................................................................... 14 2.3. Method ......................................................................................................... 14 2.3.1. Types of studies ................................................................................... 14 2.3.2. Types of data ........................................................................................ 15 2.3.3. Types of methods ................................................................................. 15 2.3.4. Types of outcome measures ................................................................. 15 2.3.5. Search Strategy..................................................................................... 16 2.3.6. Data Collection..................................................................................... 18 2.3.7. Critical Appraisal ................................................................................. 18 2.3.8. Data Extraction..................................................................................... 18 2.3.9. Independent Review ............................................................................. 18 2.3.10. Data Synthesis ..................................................................................... 19 2.4. Results ......................................................................................................... 19 2.4.1. Methodological Issues .......................................................................... 21 2.4.2. Quantitative study findings .................................................................. 21 2.4.3. Qualitative study findings .................................................................... 23 2.4.3.1. Communication ............................................................................. 24 2.4.3.2. Understanding ............................................................................... 25 2.4.3.3. Reducing isolation ........................................................................ 25 2.4.3.4. Forming coping strategies ............................................................. 26 2.5. Discussion ................................................................................................... 26 iv 3. Chapter 3. The effects of Reading Interventions on Mental Health and Wellbeing for Adults: A Systematic Review .......................................................... 30 3.1. Abstract ........................................................................................................ 31 3.2. Introduction ................................................................................................. 32 3.2.1. Existing reading interventions and their development ......................... 32 3.2.2. Interventions for adults in a clinical context ........................................ 33 3.2.3. Interventions for adults in a forensic context ....................................... 34 3.2.4. Interventions for adults in a non-clinical context ................................. 34 3.2.5. Rationale ............................................................................................... 35 3.3. Method
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