International Journal of Research in Engineering, Science and Management 153

Volume 4, Issue 3, March 2021

Effectiveness of Bibliotherapy in Reducing the

Abstract: Illness and hospitalization are fearful experiences for between the pre test and post test level of anxiety scores of children
children and their families. Recent research has identified a range regarding Bibliotherapy. Findings revealing the presence of
of variables that can influence the extent of negative reactions of significant difference between pre-test and post-test level of
children to hospitalization and medical interventions. These anxiety scores, hence the Bibliotherapy is proved to be effective in
include the family's previous medical experience, the child's reducing the hospitalized anxiety among hospitalized children.
developmental status, the parent-child interaction, the seriousness Conclusion: This study inference revealed that regular practice
of the illness, the severity of the medical procedure, and the coping of bibliotherapy during hospitalization could bring about desired
style adopted by a child. Hospitalized children identified a range reduction of anxiety among children.
of fears and concerns which include separation from family and
parents, unfamiliar environment, investigations, treatments and Keywords: Hospitalization, Anxiety, Children, Bibliotherapy,
loss of self-determination. Numerous research studies have found Hamilton anxiety rating score.
that the children have fears and concerns regarding illness and
hospitalization. 1. Introduction
Aim: The aims of this study are as follows: (l) To assess the level
of anxiety among hospitalized children. (2) To evaluate the Children of today tomorrow’s citizen, thus it is extremely
effectiveness of Bibliotherapy in reducing the level of anxiety important to ensure good health for children. Child health plays
among hospitalized children. (3) To find out the association a vital role in the development of a country. The first six years
between the post test level of anxiety scores among hospitalized of life constitutes the most crucial span in life. At this stage if
children with their selected socio demographic variables. life, the foundation are laid for mental, physical and social
Materials and Methods: Study approach- An evaluative research development. Children health was once a subset of adult
approach and follows the study design as pre- experimental with
one group pre test post test without control group. The population medicine. In the 19th and early 20th century, people recognized
involved in this study was hospitalized children in selected pediatrics as a medical specialty because of the gradual
hospitals at Bagalkot. Samples are hospitalized children admitted awareness that the health problems of children are different
in pediatric general ward. Sample size is 50 (Total Hospitalized from those of adults. It was also recognized that a child's
children were included in the study. Further, data were collected response to illness, medications, and the environment depends
by semi structure and Hamilton Anxiety rating scale. upon the age of the child [1].
Result: After collection, an a data are organized and analyzed
with the help of mean median and percentage, and the socio-
demographic characteristics of hospitalized children were as 2. Need for Study
follows: 36% of hospitalized children are in the age group of 12-13 Illness and hospitalization are the first crisis children must
years, Majority of subjects 62% were male children, 36% of face. Especially during the early years, children are particularly
hospitalized children belongs to 6th standard, 74% of hospitalized
vulnerable to the crisis of illness and hospitalization because
children are Hindu , 16% of hospitalized children are Muslim,
28% of children had stayed in hospital about more than four days, stress represents a change from the usual state of health and
Majority of subjects (58) were belongs to a nuclear family and environmental routine and children have a limited number of
32% of children were family income was 10,00 I to I 5,000. coping mechanisms to resolve stressors [2], [3].
Assessment of levels of anxiety scores among children during pre World Health Organization estimates that common pediatric
test revealed that, the majority of children 23 (46%) had extremely hospital stays are 4,279,000 and 2.2 million non-newborn
severe anxiety, 22 (44%) percent of them had moderate to severe
pediatric stays. In the hospital stays 23% of children had
anxiety; And 05 (10%) had mild to moderate severity. None of the
children were having Mild severity anxiety level. Assessment of respiratory condition, 12% of children had digestive condition,
levels of anxiety among children during post test reveals that, the 8% of children had disorder of nervous system, 6% of children
majority of children 41 (82%) had mild severity anxiety, 09 (18%) had endocrine and musculoskeletal disorder, 4% of had skin
percent of them had mild to moderate severe anxiety; None of the disorder, Kidney disorder, infectious and parasite disease, 3%
children were having extremely severe anxiety, moderate to of children had blood and circulatory disorder, 2% of children
severe, no any level of anxiety. So there is a significant difference

*Corresponding author: [email protected]

had injuries and neoplasm [3], [4]. Bagalkot. Accessible population is Hospitalized children from
According to CDC report in India 2015: Data collected from HSK hospital of Bagalkot. Hospitalized children were selected
a variety of data sources. Shows, Children aged 7- 1 2 years by purposive sampling technique and 50 hospitalized children
currently had, ADHD (6.8%), Behavioral or conduct problems were selected, and data were collected by semi structure
(3.5%), Anxiety (3.0%), Depression (2.1%), Autism spectrum questionnaire and Hamilton anxiety rating scale. Data analysis
disorders (1.1%). According to child mental health statistics and interpretation were performed description such as
2014 3.3°/c or about 290,000 children and young people have frequency distribution, mean, median, percentage, and
an anxiety disorder, 2.2% or about 96,000 children 8 have an inferential statistics such as Chi-square test.
anxiety disorder, 4.4°/c or about 195,000 young people have an
anxiety disorder [5]. Tools for data collection: Hamilton anxiety rating scale
Blondi Ming Chaukwok (2010) conducted a study to find out Scoring:
the effectiveness of bibliotherapy on reduction of anxiety and Each item is scored on a scale of 0 (not present) to 4 (severe),
fear of hospitalized children and they found that Allegorical with a total score range of 0-56, where <l7 indicates mild
stories can be used to help children cope with the worries and severity, 15-24 mild to moderate severity and 25-30 moderate
fears precipitated by illness, medical procedures, and to severe.
hospitalizations. They supplement explicit discussions of O = Not present.
illness and preparation for procedures and hospitalization. 1 = Mild.
Stories with appropriate symbolic themes are readily available 2 = Moderate.
in children's literature. Individuals without special training in 3 = Severe.
counseling or emotional support of children can quickly learn 4 = Very severe.
to use these stories effectively. These results are consistent with
the idea that bibliotherapy can be an affective accessible 4. Results of the Study
intervention for reducing the anxiety of the hospitalized PART-I: Description of sample with their socio demographic
children [6]. variables.
The Percentage wise distribution of samples according their
3. Materials and Methods age wise depicts that, majority of children 36 % were belonging
The present study was conducted on an evaluative approach to 12-13 years of age, 25% of them were belonging to 10-11
and pre- experimental with one group pre test post test without years of age, and 36% of them were belonging to 14-15 years
control group design. The target is Hospitalized children in of age. The percentage wise distribution of samples according
Table 1
Hamilton anxiety rating scale
S. No. Assessment Questions 0 1 2 3 4
1 Anxious mood.
Worries, anticipation of the worst, fearful anticipation, irritability.
2 Tension.
Feeling of tension, fatigability, startle response, moved to tears easily, trembling, feeling of restlessness, inability to relax.
3 Fear.
Of dark, of strangers, of being left alone, of animals, of traffic, of crowds.
4 Difficulty in falling asleep, broken sleep, unsatisfying sleep and fatigue on waking, dreams, nightmares, night terrors.
5 Intellectual.
Difficulty in concentration, poor memory.
Depressed.
6 Loss of interest, loss of pleasure in hobbies, depression,
Early waking, diurnal swing.
7 Somatic (muscular).
Pains and aches, twitching, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscle tone.
8 Somatic (sensory).
Tinnitus, blurring of vision, hot and cold flushes, feelings of weakness, pricking sensation.
9 Cardiovascular symptoms.
Tachycardia, palpitations, pain in chest, throbbing of vessels, fainting feelings, missing beat.
10 Respiratory symptoms.
Pressure or constrictions in chest, choking feelings, sighing, dyspnoea.
11 Gastrointestinal symptoms.
Difficulty in swallowing, wind abdominal pain, burning sensations, abdominal fullness, nausea, vomiting, borborygrni,
looseness of bowels, loss of weight,
Constipation.
12 Genitourinary symptoms.
Frequency of rnicturition, urgency of micturition, amenorrhea, menorrhagia, development of frigidity, premature ejaculation,
loss of libido, impotence.
13 Autonomic symptoms.
Dry mouth, flushing, pallor, tendency to sweating, giddiness, tension, headache, raising of hair.
14 Behavior at interview.
Fidgeting, restlessness or pacing, tremors of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor,
swallowing, etc.
T. R. Lamani et al. International Journal of Research in Engineering, Science and Management, VOL. 4, NO. 3, MARCH 2021 155

to their gender reveals that out of 50 children, highest Comparison of levels of anxiety among children in pre test
percentage (62%) Children were male and lowest percentage and post test reveals the following results. In pre-test, out of 50
(38%) of the children was female. lt reveals that majority y of hospitalized children during pre test reveals that, the majority
children under the study were male. The percentage wise of children 23 (46%) had extremely severe anxiety, 22 (44%)
distribution of samples according to their studying in class percent of them had moderate to severe anxiety and 5(10*/c)
shows that the 5th class children were 14 (28%), 6th class percent of children were having Mild to moderate anxiety; none
children were 18 (36%), 7th class children were 13 (26%) and of children were having Mild severity anxiety level. Post test
8th class children were 5 (10%). The percentage wise data reveals that, the majority of children 41(82%) had mild
distribution of samples according to their duration of stay in severity anxiety, 9 (I 8%) percent of them had mild to moderate
hospital. The 10 (20%) children were stayed one day, 12 (24%) anxiety; none of the children were having very severe anxiety,
children stayed two days, 9 (18%) children stayed Three days, moderate to severe anxiety.
5 (10%) children stayed Four days, and 14 (28%) children However, after administration of Bibliotherapy there was
stayed more than four days. The percentage wise distribution of reduction in the level of anxiety scores in posttest among
samples according to their Religion illustrates that, majority of hospitalized children. Study proved that Bibliotherapy is
children were Hindu that is 37 (74%), Muslims children were effective in reducing the level of anxiety.
8(I 6%), Christian children were 5 (10%) and none of the Part-VI: Association of the level of anxiety scores among
children belongs to other religion. The percentage wise hospitalized children with their selected socio-demographic
distribution of samples according to t heir type of family variables
illustrates that, highest number of children were belongs to Chi-square test is used to find the association between post
Nuclear family (58%) and from joint family children were 42% test level of anxiety scores of children and selected socio-
had none of the hospitalized children belongs to extended demographic variables. The finding regarding association of the
family. The percentage wise distribution of samples according post test level of anxiety scores of children with their selected
to their monthly family income shows that major it y of samples socio-demographic variables shows that, there was no
were having monthly family income (20%) below 5000, (18%) significant association found between level of anxiety scores of
of samples were having family income between 5,001 to children with their other demographic variables like age,
10,000, (32°/c) of samples were having 10,001 to 15,000 and gender, Religion, studying in class, Duration of stay in hospital,
samples are family income i.e. (30%) were having income Type of family and family income (Table 2).
above 150001. Chi-square value 3.84 is less than the table value Hence
PART-II: Assessment of level of anxiety among hospitalized research hypothesis was rejected and null hypothesis was
children. accepted.
Assessment of levels of anxiety among children during pre
test reveals that, the majority of children 23 (46%) had Table 3
Association of the level of anxiety scores among hospitalized children with
extremely severe anxiety, 22 (44%) percent of them had
their selected socio-demographic variables (N=50)
moderate to severe anxiety; And 05 (10%) had mild to moderate S. Socio- Df Chi- Table Level of
severity. None of the children were having Mild severity No. demographic square Value significance
anxiety level. variables value
1 Age 1 0.0003 3.84 NS
Assessment of levels of anxiety among children during post 2 Sex 1 0.67 3.84 NS
test reveals that, the majority of children 41 (82%) had mild 3 Religion 1 0.13 3.84 NS
severity anxiety, 09 (18%) percent of hospitalized children had 4 Studying in class 1 0. 049 3.84 NS
mild to moderate severe anxiety: None of the children were 5 Duration of stay 1 0.076 3.84 NS
in hospital
having extremely severe anxiety, moderate to severe, no any 6 Type of family 1 0.28 3.84 NS
anxiety level. 7 Monthly income 1 0.41 3.84 NS
PART-III: Assessment of effectiveness of Bibliotherapy by of family
comparing pretest and posttest NS=Not significant
Level of anxiety scores among hospitalized children:
Table 2 5. Discussion
Assessment of effectiveness of Bibliotherapy by com paring pretest and
After reviewing many studies related to hospitalized anxiety
post test level of anxiety scores among hospitalized children (N=50)
Level of Pre-test (O1) Post-test (Or) among children in India and Abroad it has immensely
anxiety No. of Percentage No. of Percentage influenced rue to take up the present stud y, the research studies
scores respondents respondents influenced me to conduct this present study are as follows.
Extremely 23 46 % 00 00%
An experimental study was conducted in Pune city to assess
Severe
anxiety and compare the level of anxiety before and after story narration
Moderate to 22 44% 00 00 % and to associate the level of anxiety with selected demographic
severe variables. This study based on pre-experimental one group
Mild to 5 10% 09 18%
moderate pretest, posttest research design.100 samples were selected by
Mild severity 00 00% 41 82% non-probability purposive sampling technique. Modified
Not present 00 00% 00% 00% Spence children anxiety scale was used. In this the study results
T. R. Lamani et al. International Journal of Research in Engineering, Science and Management, VOL. 4, NO. 3, MARCH 2021 156

revealed the average anxiety score 69.6 with standard deviation 6. Conclusion
of 17.2 before story narration and average score 37.9 with From the result of the study, it was concluded that
standard deviation of 8.3 were found after story narration. T- bibliotherapy was effective in reducing the level of anxiety
value corresponding to this comparison were 14.5 at 99 degree among hospitalized children. The bibliotherapy was cost
of freedom. Corresponding table valued were 2.05, the null effective it can be done at any time. The hospitalized children
hypothesis was rejected. Average anxiety level before story also feel comfort while providing bibliotherapy.
narration was 69.6 which decreased to 37.9 after the story
narration therapy. This study concludes that the story narration 7. Recommendations
therapy was effective in reducing the level of anxiety among
A bibliotherapy is necessary for these children to reduce the
hospitalized children [6].
hospitalized anxiety y among hospitalized children.
A quasi-experimental study was conducted in Mangalore to
assess the effectiveness of bibliotherapy for stress reduction
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