Reading groups at vauxhall health care centre

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READING AND TALKING: EXPLORING THE EXPERIENCE OF TAKING PART IN READING GROUPS AT VAUXHALL HEALTH CARE CENTRE

Dr Jude Robinson

Research Report 116/08

2008

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CONTENTS Introduction to this report ........................................................................................................................ 1 Background to the Vauxhall Health Care Centre (VHCC) Reading Group ............................................ 1 Aims ......................................................................................................................................................... 1 Research questions ................................................................................................................................... 2 Methodology ............................................................................................................................................ 2 Analysis.................................................................................................................................................... 4 Ethical Considerations ............................................................................................................................. 4 Results ...................................................................................................................................................... 5 Future work: ........................................................................................................................................... 11 Outputs ................................................................................................................................................... 11 References .............................................................................................................................................. 12

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Introduction to this report This project is a continuation of the Reading and Talking research undertaken by the Health and Community Care Research Unit at the University of Liverpool, and this report is designed to act as a supplementary report to the report, Reading and talking: Exploring the experience of taking part in reading groups at the Walton Neuro-Rehabilitation Unit (NRU), (Robinson, 2008). The Vauxhall Reading Group, like the Walton NRU Reading Group, is an innovative, exploratory community based reading initiative in the UK run by a facilitator from the Reader (www.thereader.co.uk) based at the University of Liverpool.

Background to the Vauxhall Health Care Centre (VHCC) Reading Group Vauxhall Primary Health Care Centre was established in one of the most disadvantaged areas of Liverpool in 1993 and with the Vauxhall Health Forum, works to address the health concerns of local residents. In 2006, through discussions with Dr David Lewis, a GP at the VHCC, The Reader successfully applied for funding to enable a ‘Reader in Residence’, to set up reading groups for one year with patients from the practice and with people from the local community to improve access to literature and to promote positive self esteem and participation. It is worth noting that although the GPs may make some patients aware of the scheme unlike other reading schemes this is not a GP referral scheme, and their participation in the groups is entirely voluntary.

Unlike other reading groups, where group members may agree to read a book (privately) outside the group, and then come to the group to discuss it, at Get into Reading projects, all of the reading activity takes place in the group, using shared copies of texts to encourage group members to either follow, or contribute to, the reading of the texts. This method is participative and all group members are encouraged to read, listen, discuss, and reflect on the readings in an informal and supportive environment.

Aims This research aims to capture: (i) What happens when people got together in a group to read a text aloud, and to talk about the text; (ii) How participation in the group relates to aspects of physical and emotional health and wellbeing (iii) How situating the group within the VHCC affects access to, and participation in, the reading group?

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Research questions How do people find out about the group and what motivates them to take part?

Who participates in the group and how much and how often?

How do people participate, i.e. do they actively discuss issues, volunteer to read, read when asked, decline to participate, support the participation of others?

To what extent are any discussions prompted by the facilitators and to what extent are issues raised by the text itself, or through further discussions?

What is talked about, and does this relate to the participants’ past and/ or present lives?

How does this relate to aspects of participants’ physical and/ or emotional health?

How does the reading group as an entity relate to the wider setting of the Vauxhall HCC, and how is it viewed by other people who work there?

Methodology Research design Observations of five reading group sessions, which were digitally recorded Mini-questionnaire completed by all participants A 30 minute focus group discussion with reading group participants from each of the two groups.

Unstructured interviews with the reading group facilitator and two of the practice GPs

Recruitment a. Reading groups Everyone who was taking part in each of the reading groups over the research period of five weeks was invited to take part in the research. As the groups remained open to new members and attendance varied from week to week, the NHS Research Ethical Committee required consent to be sought from everyone present at each session, including the Reader in Residence. Additional consent was sought for participation in the focus group discussions. In total 6 people took part in the study, with 6 participating in the focus group discussion, which lasted about 45 minutes. No-one refused to take part in the study. b. Unstructured interviews The reading group facilitator agreed to take part in an interview, which took place at the University of Liverpool and lasted about an hour. Three GPs, who were aware of the reading group project and had

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3 had the opportunity to tell patients about the reading group sessions, were invited by letter to take part in the study. Two GPs elected to take part and their interviews lasted between 30 - 45 minutes.

NB. The following account of the methodology mirrors the approach of that undertaken in the Walton Centre Neuro-Rehabilitation Unit (NRU).

Observing and recording four reading group sessions.

The reading group was scheduled to meet once a week, for over 2 hours for each group session. The observer (JR) attended a total of 5 group sessions over a period of four months, and observed a number of dimensions to group participation, which included: (i)

action (reading, active listening and other forms of non-verbal communication) which will be captured by the researcher (JR) as a non-participant observer at each of the four sessions.

(ii)

discourse (reading, talking, questioning, discussing etc.) which will be partly captured by observation (i.e who is talking) but principally by digitally recording and then transcribing all of the sessions. This will also capture periods of silence within the discussions.

(iii)

context (where the group is taking place, the wider physical and social environmental context) will form part of the observation.

Mini-questionnaires Each of the group participants was asked to complete a mini-questionnaire, designed to elicit some basic demographic data, namely their sex, age and ethnicity, and what they consider to be their first language. Participants who had difficulty reading or completing the form were assisted to complete the questionnaire in a secure, confidential environment, either by the researcher (JR), or the Readerin-Residence. All six participants described their ethnicity as ‘White British’ with English as their first language, and four were females and two were males. One person was aged 18-24 years, one aged 55– 64 years, one aged 65– 74, and three people were aged over 75 years.

Focus group for the reading group participants During the final reading group session (Week 5 of data collection), the six people taking part in the reading group agreed to participate in a short focus group discussion moderated by JR. This discussion did not include the Reader in Residence, who left the room in order to enable participants to freely reflect on the organisation and delivery of the reading group sessions. With permission, the discussion was audio recorded and later transcribed. Participants were asked to reflect on their

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4 motivation for taking part, their experiences of taking part, and also whether they had any views, comments or insights to make about being involved in the research?

Analysis The ethnography of speaking The audio recordings of the reading group sessions were transcribed verbatim, using appropriate annotation to prepare the text for an ethnographic approach to conversation analysis, in which the reading groups were presented as examples of speech situations. This level of the analysis was informed by the observations of the group and the immediate setting, and the wider social context within which the groups took place. Further analysis of the text involved the identification of patterns and structures of the different speech events, such as turn-taking, interruptions, participation, and silences. The notes from the observed sessions enabled the researcher to identify the speakers, and also their familiarity with the reading group over the five weeks. Specific speech acts such as the use of anecdote, questioning and reflection were also identified as part of the analysis. This approach enables researchers not only to explore what was talked about, but the ways in which particular issues were talked about, based on the premise that talk can communicate other things about people and their lives. Particular attention was paid to the ways in which prose and poetry may prompt and stimulate participants to express their emotions, and reflect on aspects of their lives.

The focus group discussion was analysed thematically, and the demographic data from the miniquestionnaire was used to describe the participants. These data was also used to further contextualise what happens in the reading groups discussions, and what taking part means to the participants.

Ethical Considerations This research was conducted within an ethical framework that respected the autonomy and right to privacy and confidentiality of all of the research participants. All data are stored securely within the University of Liverpool, according to University guidelines. Pseudonyms will be used to refer to respondents in any written material, and the data will be seen only by members of the research team.

This research project was submitted for ethical approval to Salford & Trafford NHS REC and for site approval by Liverpool Research Governance Committee.

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Results The following presentation of findings represents a summary of the preliminary findings from the project. A more detailed analysis of the findings will be published in peer-reviewed papers.

Points derived from the Focus Group Discussion and from personal communications with the reading group participants The group was valued by all the participants, who intended to continue coming every week for the foreseeable future The role of the facilitator was considered crucial to the success of the group by all of the respondents, and they agreed that the group would be unable to meet without their presence and support. The contribution of the facilitator was variously described as someone who was: o knowledgeable about books and poetry o able to introduce them to new literature that they either would not have known about, or would have felt was too difficult/ academic/ even culturally elevated(?) for them to read o able to help them work through any more complicated or obscure passages o encouraging, by asking them to reflect and look more deeply at the text o able to move them on if they got bogged down in a discussion or went off on a tangent o willing to give everyone space to talk and read and reflect o skilled in giving them to confidence to read aloud to the group o able to make them feel that their contributions to any discussions was valuable and interesting to others in the group The participants were adamant that they would not otherwise be reading books that stimulated their imagination and critical faculties. There was a feeling that the books they were reading were ‘real’ books, works of literature, rather than popular ‘trashy’ novels.

Three people stated that they certainly would not be reading poetry if it wasn’t for the group.

Yet all of these three people found themselves enjoying the weekly poem, with one person taking a copy of the poem away to read and reflect on over the next week, and who shared them occasionally shared them with their friends and family People said that taking part in the groups, either listening, or reading, or discussing the text felt that it ‘took them out of themselves’ in some way, and made them feel stimulated and positive.

One person described taking part in the group as taking time away from any worries or cares,

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6 as the story was the focus and it was sufficiently stimulating and engrossing to make the time pass very quickly. In this way, they described how taking part in the reading session made them ‘feel better’ after the group and more positive about things. All participants said that in different ways, they felt ‘good’ or ‘better’ after taking part in the group Most of the participants were aware how hearing the story either evoked memories or emotions, which they were happy to share with the rest of the group. The opportunity to consider aspects of their past lives and to share their reflections in a supportive and convivial environment was one of the most important aspects of taking part for many people, and people found that this helped them get to know other people in the group quickly and easily.

Participants reflected on how important the social contact had become to them, the weekly contact with one another and discussions, the chance to talk People liked to listen, and others liked to take turns to read aloud, although no-one experienced any pressure to read, and one member of the group (who had limited hearing) was content to listen and did not want to read. One person had suffered a stroke and talked about how reading aloud in the group had given her confidence in her ability to speak. Another person, who had some reading difficulties, talked about how the support of the other group members had given her the confidence to read loud, something she would never before have considered doing.

Observations Members of the group welcomed each other by name, and used the time waiting for the room to become free, and before the session formally started to ‘catch up’ with each other’s lives.

Topics included: visits to hospital, doctors, progress of any health issues, visits to and from friends and neighbours, courses attended, trips past and planned, holidays, and always any absent members of the group were asked after.

I was unaware of how long people had been in the group as everyone treated one another in the same friendly, jocular way with additional kindness to anyone who they felt needed sensitivity.

Two members of the group were related, but they made any shared memories inclusive rather than exclusive, and this did not seem to disrupt the ‘balance’ of the group in a particular way.

Everyone in the group were able to hold their books, and turn the pages, sometimes slightly ahead of the reader as if they were following the story at a slightly accelerated rate, suggesting that they were partly following the story, and at other times reading slightly ahead.

The apparent concentration of the group members was extraordinary, as although there was often considerable noise either from the adjoining kitchen or the waiting room of the GP surgery outside, inside the room there was a real sense of purpose, and the readers never JR/TQ/Vauxhallfinalreport.doc/July08

7 faltered, and the attention of the readers and the listeners never seemed to wander from the text.

The facilitator seemed to be able to sense the mood of the group and often invited a specific person to comment on the developing story – inviting them to reflect, to speculate, and share their views with others. In this way participants appeared to become enmeshed in the plot, as they developed their own theories around characters actions and motivations, and the author’s intent in using particular words, or including descriptions of particular contexts. Part of the fun of the group from week to week was seeing if a particular prediction had come to pass, or if they had been surprised by the way the plot had developed. In this sense, the group seemed to be a ‘journey’ they had taken together, as they brought in comments from past discussions, and reflected how their emotional response to events of characters had changed, or was changing as they read on.

The initial questions used by the facilitator were generally quite open, inviting personal reflection and diverse views, but by fixing on particular responses by the participants, or words in the text, the facilitator enabled the participants to move deeper and deeper in to the text, raising issues and probing responses until the participants seemed to surprise themselves with how much they could get from looking at a particular word, phrase or passage.

Despite only reading short passages, the thread of the story was held together within the group, and they seemed happy and willing to break off, speculate as to what would happen next, reflect on what they might have done in the same position, and introduce memories of their own lives that more or less related to the topic of discussion. These contributions were often elicited from participants by the facilitator who sought to bring people in as much as possible into the general discussion.

Although the facilitator often instigated a break in the reading, occasionally it was the reader or their ‘audience’, typically if something they had read was particularly obscure and required further explanation, or so thrilling or notable it required some remark or discussion. Any such break was handled well by the facilitator who was willing to engage in the ensuing discussion, and the participants often asked and answered questions among themselves, rather than referring everything to the facilitator, suggesting that they were confident and relaxed and willing to share their views.

A number of participants volunteered to read aloud, and some were invited to read by the facilitator. The reading aloud, whether fluent or otherwise, was received by the other group members with words of encouragement and praise, and although some people stumbled over words, and occasionally mispronounced them, this was largely overlooked by the rest of the

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8 group, or any help that was given was tactful and supportive rather than corrective. At times, the group members rather than the facilitators were familiar with a word, or phrase, or word in a foreign language and this gave them a chance to share their knowledge with the rest of the group. This appeared to be possible by the approach of the facilitator who presented herself as a fellow reader who was willing to learn from the others.

One person brought their own poems to read to the group, and time and space was made for their reading without compromising the core activities of the group. This was clearly important for the person writing the poems and this appeared to be tacitly understood by the other group members.

Sometimes the group members talked about other books they were reading/ had read, as some people had been stimulated to read more as a result of taking part in the group. At the end of the discussion one week just before people were preparing to leave, I noted that three people were still holding their books, picking them up and turning them over in their hands, as if they didn’t actually want to ‘let go’ of the story.

The Reader in Residence perspectives The balance between spending some time talking informally at the start of the group and then moving on to the book itself is an important part of ‘managing’ the reading session, as inevitably people bring aspects of their outside lives into the group that they may want or need to discuss, before settling down to read. Once this has been done however, the act of reading the story seems to take people ‘out of their lives’, giving participants a new, more positive experience, to take away with them.

Balance also needs to be achieved between the desire to read through passages of the book, and to stop for discussion. Some people within groups seem to feel the need to pause frequently, occasionally at the expense of the ‘action’ in the book. However this can be managed as part of the process of responding to some people’s need to be actively involved, and so responding to individuals, while still recognising the needs of the group, is an essential skill for the leader of the group.

The Reader in Residence described how they believed that the act of group reading transformed the experience both for the reader and for the co-readers in their audience. An important aspect was the ‘immediacy’ of the shared experience, which is very different to people reading a book alone, and then coming together to discuss their (remembered) experiences.

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9 From listening to peoples’ response to particular passages and from observing the group members, the Reader in Residence was aware of the powerful emotional response that many people have to some passages in the books, and how these intense experiences can lead people to reflect on their own lives, past and present. They were also aware of the growing relationships between the different participants, and were sensitive to their body language, as to whether or not they were comfortable with their role as either reader, or listener.

In their experience, new groups may need to be introduced gradually to works of literature, perhaps starting with a more accessible book, and then after they have mastered that, move on to another more challenging work of literature. However it was important that the groups enjoy what they are reading, or at least want to continue with the book, as the aim is to encourage an exploration of literature and foster a love of books, rather than ‘make people read’.

The location of the reading group in proximity to the health care centre has not necessarily meant that people have come to the groups on the recommendations of the GPs working there.

However there is potential to develop the initiative based on what has been learned so far, perhaps by encouraging other surgeries in the city to set up comparable initiatives and so make taking part in a reading group more a more mainstream activity for people living in disadvantaged communities.

The GP’s perspective Both GPs felt that the proximity of the reading group to the waiting room and consulting rooms of the health centre did not necessarily mean that this was a ‘health’ reading group, pointing out that the rooms used were part of the community centre and were frequently used for community initiatives unrelated with the surgery. Therefore the use of an established community venue and the proximity to the surgery was seen as a positive advantage, as potential participants did not have to travel far, may be familiar with the venue, and the proximity for the surgery means that when the GPs may mention it to patients, they can associate one with the other.

The GPs were very supportive of the idea of having books in the waiting room, and they themselves had donated books to the scheme. The fact that some books were taken away was also regarded as a very positive measure, and they mentioned how they were aware that many households in the area were unlikely to have many books.

Characterising the wider community in Vauxhall as having poor health, associated with high levels of material and social disadvantage, the GPs discussed that in their opinion, for a

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10 number of patients who experienced poor health and who frequently consulted, one of root problems was social isolation linked to possibly poor mental health. For these patients, GPs often felt unable to offer conventional medicine, and instead preferred to discuss with them whether they had considered joining an activity, club, association, or community initiative. It was intended that GPs should mention the reading group as one of a number of community initiatives that may meet these patients’ needs.

However the GPs mentioned that it was hard for them to remember the reading group once they were involved in the intricacies of a consultation with patients, and were sometimes aware that patients may not be readily be able to understand what the reading group involved.

The fact that the Reader in Residence gave a telephone number where they could be contacted to discuss, or meet up with potential participants, was therefore an important link between the surgery and the group.

However the GPs did reflect that some patients did not appear to understand what the reading group was about, and were reluctant to go along and see, or contact the facilitator, and so possibly referral alone was not necessarily a successful way of directing patients towards the reading group.

One of the GPs commented that the people who come to the practice are not just poor in the sense of material deprivation, but that they are also ‘word poor’ and may lack the resources to be able to communicate their day to day (health) concerns to their GPs. The GP went on the reflect that projects such as the reader which aim to introduce people to reading, may also introduce people to verbal forms of expression, new or less familiar vocabulary, and so improve the potential of people to communicate with others.

Some preliminary conclusions From observing the groups, there was a sense that the group were taking a ‘journey together’ rather than undertaking a course or programme of instruction and this lead to regular attendance as the people looked forward to the weekly sessions and made a special effort to be there.

The apparent informality, the coming and going of people over the weeks, with some people needing to leave early, or arriving slightly late, was a strength of the group, as the group was well organised, planned and delivered, people could catch up very quickly, as space was made, literally and metaphorically, for anyone who was able to attend that week.

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11 The sense of quiet concentration and purpose during the sessions, as the readers read the text remains for me one of the most extraordinary effects of the group, and needs to be explored further.

From discussions with the participants, there is an overwhelming sense of pride in taking part in the group and in the achievement of reading and following the story. Yet this appears to be more than an individual sense of achievement, but is shared by, and is a product of being part of, the rest of the group.

Future work: To critically compare and contrast the experiences of people taking part in the Vauxhall Reading Group with findings from the research set up to explore the experiences of people taking part in Walton Neurological Rehabilitation Unit at the Walton Centre, Liverpool to gain an understand of how the Get into Reading initiative operates in health care settings, and whether the people taking part report any additional health benefits.

Outputs A brief (two page) summary of the findings will be prepared to feedback the findings to the participants and to anyone interested in the research. This summary will include a web link and further details of how to access this brief report of the findings that will be made available to key stakeholders (people working at the practice, patients, members of the local community). As these research findings indicate that taking part in reading groups can benefit people, it is hoped that the summary and report will be used by staff at the Vauxhall Health Care Centre, Get into Reading and Liverpool Reads to secure further funding and to promote the reading groups. This research will also be written up as an article for submission to a peer-reviewed publication, and so contribute to the evidence base around reading and health.

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References Robinson, J. (2008). Reading and Talking: Exploring the experience of taking part in reading groups at the Walton Neuro-Rehabilitation Unit (NRU). , HaCCRU, 114/08, University of Liverpool.

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