Effectiveness of Bibliotherapy on Self-Esteem among Young Adults in a Selected Nursing College, Kanniyakumari District.

Effectiveness of Bibliotherapy on Self-Esteem among Young Adults in a Selected Nursing College, Kanniyakumari District.

Dr. Sheeja S, Mrs. Medonna Shajini P.S, Miss. Brijet Malar M

Nursing, Bethlahem college of Nursing, Marthandam, Tamil Nadu, India

DOI: https://doi.org/10.51244/IJRSI.2025.120500100

Received: 21 May 2025; Accepted: 26 May 2025; Published: 12 June 2025

ABSTRACT

This study investigated the effectiveness of bibliotherapy in enhancing self-esteem among young adults in a selected nursing college, Kanniyakumari district. The study was conducted at Bethlehem College of Nursing, Karungal. A pre-experimental one-group pre-test and post-test design was adopted with a sample of 50 young adults selected via a non-probability consecutive sampling technique. The pre-test was conducted using Coopersmith’s self-esteem inventory. The participants were provided with the self-help guide of Ten Days to Self-Esteem for 10 days, and the post-test was performed using the same scale. Results showed an increase in mean self-esteem scores from 33.9 to 38.98, with a statistically significant paired t-value of 20.9 (p<0.05). The findings suggest that bibliotherapy is a promising intervention for improving self-esteem in young adults

Keywords: effectiveness, bibliotherapy, self-esteem, young adults.

INTRODUCTION

The World Health Organisation (WHO) defined the term ‘young adult’ as people between 18 and 22. Among 1.8 billion young adults worldwide, 235 million live in India and 225 million in China. India has more than 50% of its population below the age of 25 and more than 65% below the age of 35. ¹ As per the 2011 census, the young adult population of Kerala is 33,406,061, of which males and females are 16,027,412 and 17,378,649, respectively. ²

Young adulthood is a period of adjustment to new patterns of life and new social expectations. A young adult is expected to play new roles such as spouse and parent, and to develop new attitudes, interests, and values in keeping with these roles. These adjustments make young adulthood a distinctive period in the life of a person while also being a difficult one.³ Thus, self-esteem, which is high during childhood, drops in young adulthood

Researchers agree that due to some significant biological, social, psychological, and academic changes that make young adulthood is stressful.⁵

Background of the Study

According to Dr Joe Rubio, 85% of the world’s population is affected by low self-esteem.⁴ UNFPA (The United Nations Population Fund) reported that the young adults of 20% of the population suffer from low self-esteem. Statistics show that 70% of young adults are refraining from participating in day-to-day activities due to a lack of self-esteem.⁶

WHO (2011) reported that 42 out of 1 lakh young adults suffer from low self-esteem. Purposeful prevention and intervention strategies should be developed, researched, and implemented during this time to improve the health and well-being of young adults.⁷ Self-esteem enrichment program is a planned and systematic teaching using cooperative learning activities to enhance an individual’s self-worth and confidence. These Self-esteem enrichment programs can be combined with bibliotherapy in educational settings.⁸

Bibliotherapy is a therapeutic activity of reading literature as a healing tool to deal with a problem faced by a person.⁹ It is useful for building self-concept, knowing human attitudes and motivations, and alleviating emotional stress by identifying the problems and discussing them openly to find other alternatives in problem-solving. This therapy shows the benefit of positive influence on the self-esteem of students. ¹⁰

Need and Significance of the Study

A quasi-experimental study was conducted in Pudukkottai (Tamil Nadu, October 2015) to evaluate the effect of bibliotherapy on self-esteem among adolescents in selected schools. The sample includes adolescent boys and girls between the age group of 12-19 years. The nonprobability purposive sampling technique was used to select 60 samples, 30 samples each were in the experimental and control groups. Results showed that the pre-test mean value of self-esteem was 28.06 ± 5.05, and the post-test mean value of self-esteem was 67.06 ± 6.88. The calculated paired ‘t’ value of t=27.802 was found to be statistically significant at p<0.001 level. This shows that the administration of bibliotherapy had a significant improvement in the post-test level of self-esteem in the experimental group.¹¹

An experimental study was conducted in the USA to assess the Effect of self-esteem enrichment bibliocounseling program on the self-esteem level of sixth-grade students. The subjects of the study were 24 students. The students were divided into an experimental group and a control group. The Coopersmith Self-esteem Scale was used to assess self-esteem in the pre-test and post-test of both groups. The result shows that the pre-test mean value of self-esteem in the experimental group was 25 ± 7.45, and the post-test mean value of self-esteem was 33 ± 10.62. The pre-test mean value of self-esteem in the control group was 28 ± 8.75, and the post-test mean value of self-esteem was 29 ± 10.14. This suggests that the self-esteem enrichment bibliocounseling program attended by the treatment group subjects was effective in increasing their self-esteem scores.¹²

This study contributes to the growing body of evidence supporting non-pharmacological interventions for mental health improvement among young adults.

Purpose of the Study

To assess the effectiveness of bibliotherapy on self-esteem among young adults by providing a bibliotherapy self-help guide

Statement of the Problem

A study to assess the effectiveness of bibliotherapy on self-esteem among young adults in a selected nursing college, Kanniyakumari District

Objectives

• Assess the baseline score of self-esteem among young adults
• Evaluate the effectiveness of bibliotherapy on self-esteem among young adults.
• Find the association between self-esteem among young adults and selected socio-personal variables

Operational Definitions

Effectiveness:            

Effectiveness refers to the change in the level of self-esteem among young adults by providing bibliotherapy.

Bibliotherapy:

Bibliotherapy is an innovative therapy in which the students are given a self-help guide named “10 Days to Self-esteem” and are assisted in reading, learning, and practicing the guide with the help of a researcher. The “10 Days to Self-Esteem” self-help guide consists of 10 self-help chapters and 10 sessions.

Self-esteem:

Self-esteem is an essential component of psychological survival, including the feeling of confidence in one’s own abilities, behavior, and personal values, which will be assessed by using Coopersmith’s Self-esteem Inventory.

Young Adults of a selected nursing college

Third-year BSc nursing students within the age group 18-22 years studying at Bethlahem College of Nursing, Kanniyakumari

Hypotheses

• H1: There is a significant difference in self-esteem among young adults after bibliotherapy.
• H2: There is a significant association between self-esteem among young adults and selected socio-personal variables such as age, gender, religion, family type, place of residence, education of parents, monthly income of parents, birth order, and medium of school education

Assumptions

• Young adults may experience low self-esteem
• Bibliotherapy may help young adults to enhance self-esteem and promote their psychological well-being

Conceptual Framework

The conceptual framework of the present study is based on Kenny’s Open System Model

RESEARCH METHODOLOGY

• Research Approach : Quantitative approach
• Research Design : Pre-experimental one-group pre-test and post-test design
• Variables : Independent variable: Bibliotherapy Dependent variable: Self-esteem                            
• Setting : Bethlahem College of Nursing, Kanniyakumari District Tamilnadu
• Population

The target population of this study was young adults between the ages of 18-22 years

The accessible population of this study was third-year BSc Nursing students who were in the age group of 18-22 years

• Sample: The third-year BSc Nursing students studying at Bethlahem College of Nursing, who fulfilled the inclusion criteria
• Sampling Technique: A non-probability consecutive sampling technique was used.
• Sample size: 50

Criteria For Sample Selection

Inclusion Criteria

• Students who are available at the time of data collection
• Both male and female students of third-year BSc Nursing students between the age group of 18-22 years

Exclusion criteria

• Students who are not willing to participate in the study

TOOLS FOR DATA COLLECTION

TOOL-1 Socio-personal variables

Socio-personal variables include age, gender, religion, family type, place of residence, occupation of parents, education of parents, monthly income of parents, number of siblings, and medium of school education.

TOOL-2 Coopersmith self-esteem inventory

Coopersmith Self-esteem Inventory is a standard self-esteem inventory. It is designed to measure self-esteem in a variety of areas among young people and adults. The questionnaire includes all aspects of self-esteem. It consists of 58 questions, and the questions were on a rating scale form.  Each question had 2 responses, like me, and unlike me.

Pilot Study

The purpose of the pilot study was to determine the feasibility and practicability of the study and to finalize the tool.  After getting informed consent, a pre-test was conducted using the Coopersmith self-esteem inventory. The participants were provided with each chapter of Ten Days to Self-Esteem for 10 days, and the post-test was conducted using the same scale. Pilot study findings revealed that Bibliotherapy was effective in increasing self-esteem among young adults. The pilot study also revealed that it was feasible, relevant, and practicable to conduct the main study.

Data Analysis and Interpretation

After obtaining ethical clearance from the Institutional Review Board (IRB) and permission from the Principal of Bethlahem College of Nursing, Kanniyakumari District, the purpose of the study was explained using a participant information sheet, and informed consent was obtained from the study participants. Samples were selected based on the inclusion criteria by a non-probability consecutive sampling technique. Coopersmith’s self-esteem inventory was distributed among students to assess the baseline self-esteem level. After conducting the pre-test, each chapter of the self-help guide named “10 Days to Self-Esteem” was issued to all the participants for 10 days. The researcher assists in reading, learning, and practicing the chapters within the given time. The duration of the 10 sessions will be one hour on all days.

The main chapters covered during each session were noted following:

Session	Chapter
Session 1	The Price of Happiness
Session2	You FEEL the Way You THINK
Session 3	You Can CHANGE the Way You FEEL
Session 4	How to Break Out of a Bad Mood
Session 5	The Acceptance Paradox
Session 6	Getting Down to Root Causes
Session 7	Self-Esteem-What Is It? How Do I Get it?
Session 8	The perfectionist’s Script for self-defeat
Session 9	A Prescription for Procrastinators
Session 10	Practice, practice, practice!

Post-test was conducted one week after the completion of 10 sessions by using the Coopersmith Self-esteem inventory.

Data Analysis and Interpretation

Data was analyzed using descriptive and inferential statistics.

Descriptive statistics

Frequency, mean, and standard deviation were used to describe socio-personal variables and the level of self-esteem

Inferential statistics

• A paired t-test was done to evaluate the effect of bibliotherapy on self-esteem among young adults
• The Chi-square test was used to find the association between self-esteem and socio-personal variables

Findings of the Study

Section -A

Table 1: Frequency and percentage distribution of demographic variables among young adults.

S.NO	Demographic variable	N=50
		f	%
1	Age: a) 18-20 Years b) 21-23years	32 18	64 36
2	Gender a) Male b) female	0 50	0 100
3	Religion a) Hindu b) Christian c) Muslim	18 27 5	36 54 10
4	Family type a) Nuclear family b) Joint family c) Broken family d) Single parent e) Extended	40 9 0 1 0	80 18 0 2 0
5	Place of residence a) Rural b) Urban	40 10	80 20
6	Monthly income a) Below 10000 b) 10000-20000 c) 20000-30000 d) Above 30000	7 27 12 4	14 54 24 8
7	Birth order a) 1st child b) 2nd child c) Third and above	28 21 1	56 42 2
8	Medium of schooler a) English b) Tamil c) Malayalam	45 2 3	90 4 6

Table 1 shows that, age-wise, 32 (64%) young adults belong to the age group of 18-20 years, and 18 (36%) students belong to the age group of 21-23 years.

Regarding gender, all the students were female.

Regarding religion, 18(36%) were Hindu, 27 (54%) were Christian, and 5 (10%) were Muslim.

With the type of family, 40 (80%) were from the nuclear family, 9 (18%) were from the joint family, 1 (2%) from a single-parent family, and none from broken and extended family.

Concerning place of residence, 40 (80%) resided rural areas and 10(20%) in urban areas.

Considering the family monthly income, 7(14%) had up to ₹.10000 as family income, 27(54%) had ₹.10000-20,000 as family income, 12(24%) had ₹.20,000-30,000 as family income, 4(8%) had ₹.30,000 and above as family income.

Regarding birth order, 28 (56%) were first children, 21(42%) were second children, and 1 (2%) were third and above.

Regarding the medium of schooling, most students (90%) studied in English medium, 2 (4%) in Tamil medium, and 3(6%) in Malayalam medium.

Section-B

Percentage distribution of Pre-test and post-test scores on self-esteem among young adults

Figure 1 depicts that among the young adults, 40% in the pre-test and 12% in the post-test were significantly below average, 14% in the pre-test and 18% in the post-test were somewhat below average, 20% in the pre-test and 16% in the post-test were average, 14% in the pre-test and 32% in the post-test were somewhat above average, 12% in the pre-test and 22% in the post-test were significantly above average.

Section –C

Table 2: Comparison of the pre-test and post-test mean, mean difference, standard deviation and paired ‘t’ value on self-esteem among young adults

S.No	Test	Mean	Standard deviation	Mean difference	df (n-1)	Paired ‘t” test
1.	Pre-test	33.9	6.90	5.08	49	20.9 ** P<0.05
	Post-test	38.98	7.03

Table 2 shows that the mean in the pre-test was 33.9 and in the post-test was 38.98, the standard deviation in the pre-test was 6.90 and in the post-test was 7.03, the mean difference was 5.08, and the paired ‘t’ value of 20.9, which was significant at p<0.05.

DISCUSSION

From the above findings, according to age 32 (64%) young adults belong to the age group of 18-20 years, and 18 (36%) students belong to the age group of 21-23 years. Regarding gender, all the students were female. Regarding religion, 18(36%) were Hindu, 27 (54%) were Christian, and 5 (10%) were Muslim. With the type of family, 40 (80%) were from the nuclear family, 9 (18%) were from the joint family, 1 (2%) from a single-parent family, and none from broken and extended family. Concerning place of residence, 40 (80%) were from rural areas and 10(20%) were from urban areas. Considering the family monthly income, 7(14%) had up to ₹.10000 as family income, 27(54%) had ₹.10000-20,000 as family income, 12(24%) had ₹.20,000-30,000 as family income, 4(8%) had ₹.30,000 and above as family income. Regarding birth order, 28 (56%) were first children, 21(42%) were second children, and 1 (2%) were third and above. Regarding the medium of schooling, 45 (90%) were from English medium, 2(4%) were from Tamil medium, and 3 (6%) were from Malayalam medium.

Among the young adults, 40% in the pre-test and 12% in the post-test were significantly below average, 14% in the pre-test and 18% in the post-test were somewhat below average, 20% in the pre-test and 16% in the post-test were average, 14% in the pre-test and 32% in the post-test were somewhat above average, 12% in the pre-test and 22% in the post-test were significantly above average.

Also, the mean in the pre-test was 33.9, and in the post-test was 38.98, the standard deviation in the pre-test was 6.90, and in the post-test was 7.03, the mean difference was 5.08, and the paired ‘t’ value of 20.9, which was significant at p<0.05. Hence the research hypothesis H1 was accepted.

In this study, a statistically significant association was found between the pretest score on self-esteem and the medium of schooling. Other demographic variables were not significantly associated at p<0.05 by using the chi-square test.

CONCLUSION

The findings of the study conclude that there was a significant difference between the pre-test and the post-test scores on self-esteem, proving that bibliotherapy was effective in improving self-esteem among young adults. There was a significant association between the pre-test score on self-esteem and the medium of schooling.

NURSING IMPLICATIONS

Nursing practice

• Nurses shall develop their knowledge regarding the benefits of bibliotherapy intervention.
• Nurses shall develop skills in implementing bibliotherapy interventions.
• Nurses shall create awareness of the benefits of bibliotherapy intervention and encourage nursing students to increase their self-esteem.

Nursing education

• Nursing students shall receive adequate training regarding bibliotherapy
• Nurse educators can conduct in-service educational programs on the benefits of bibliotherapy intervention to their nursing students.

Nursing administration

• Nurse administrator shall assist in implementing bibliotherapy intervention in the hospital, community, and educational settings.
• A request shall be made by the nurse administrator to the institutions to implement a bibliotherapy intervention.

Nursing research

• Nurses shall conduct research for further clarification on the benefits of bibliotherapy intervention on nursing students.
• A large-scale study shall be conducted on the benefits of bibliotherapy intervention among students.

RECOMMENDATIONS

• A similar study can be conducted on a large sample.
• A study can be conducted to correlate self-esteem and academic performance among nursing students.
• A similar study can be conducted by using a bibliotherapy intervention to improve self-esteem among school students

Acknowledgement: We express our gratitude and thanks to all who have directly or indirectly helped to complete this study, and for their support in each major step of the study.

Conflict of interest: Nil

Source of funding: The study was self-funded.

Ethical clearance: Obtained permission from the institutional ethical clearance committee. Confidentiality of subjects was ensured.

REFERENCES

1. Demographics of India (Internet), Cited on: 2020, Available from: https://en.m.wikipedia.org
2. Kerala population Sex ratio in Kerala and Literacy rate, (Internet) Cited on 2011 Available from: https://www.census 2011-co.in
3. Srivastava N, Agarwal S. Self-esteem among young adults: A comparative study. International Journal of Humanities and Social Science Invention. 2013;2(3):59-61.
4. Demographics of India (Internet). Cited on: 2020, Available from: https://en.m.wikipedia.org
5. Karacan N, Güneri OY. The effect of self-esteem enrichment bibliocounseling program on the self-esteem of sixth-grade students. Procedia-Social and Behavioural Sciences. 2010 Jan 1; 5:318-22.
6. Demographics of India (Internet). Cited on: 2020, Available from: https://en.m.wikipedia.org
7. Lenkowsky LK. The behavioural and psychological adjustment, family functioning, and adoption dynamics of adopted adolescents growing up in biological-adoptive families, compared with adopted adolescents growing up in all-adoptive families. Columbia University; 1998.
8. Karacan N, Güneri OY. The effect of self-esteem enrichment bibliocounseling program on the self-esteem of sixth-grade students. Procedia-Social and Behavioural Sciences. 2010 Jan 1; 5:318-22.
9. Eliasa EI. Bibliotherapy as a method of meaningful treatment. Yogyakarta: Universities Negeri Yogyakarta. 2011:1-1.
10. Salimi S, Zare-Farashbandi F, Papi A, Samouei R, Hassanzadeh A. The effect of group bibliotherapy on the self-esteem of female students living in a dormitory. Journal of education and health promotion. 2014;3.
11. Unaisy Vinolin G. A quasi-experimental study to evaluate the effectiveness of bibliotherapy on self-esteem among adolescents in selected schools at Pudukkottai (Doctoral dissertation, Karpaga Vinayaga College of Nursing, Pudukkottai).
12. Karacan N, Güneri OY. The effect of self-esteem enrichment bibliocounseling program on the self-esteem of sixth-grade students. Procedia-Social and Behavioural Sciences. 2010 Jan 1; 5:318-22.