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Abstract

Introduction/Objectives:

Social prescribing aims to improve health and well-being by connecting individuals with mental health, housing, and loneliness issues to informal services and support. This approach connects individuals to activities and services in their community to fulfill their practical, social, and emotional needs. However, no reports of community libraries being prescribed as a place to be referred through social prescribing were observed in the literature and the impact of community libraries on community residents and communities in social prescribing. The aim of this study was to identify the functions of a community library operated by medical and social professionals in the social prescribing initiative, its functions, and its impact on community residents and communities.

Methods:

Semi-structured interviews were conducted with the users of the Daikai Bunko Library, a community library in Toyooka City, Japan. The library was established by a primary care physician and community residents as a place where visitors can stay and use it as a library, a bookstore, a café, and a consultation place. Interviews were recorded, and the verbatim transcript was analyzed using the Steps for Coding and Theorization.

Results:

Ten individuals participated. The theoretical description of the interview texts revealed 11 categories as the function of the library and its effect on the individuals and the community: a place to stay, attractive space design, diverse accessibility, choosability of various roles, consultation function, social support, empowerment, mutual trust, formation of connections across generations/attributes, co-creation, and social impact.

Conclusions:

We found that a community library run by medical and social professionals was a useful social prescribing site and had various effects on the community residents who used it. Various functions of the community library, such as consultation functions and attractive space design, may lead to effects on local individuals providing social support and empowerment, with social impacts such as co-creation and formation of connections to the local community.

Keywords

social prescribing community library primary care physician qualitative study

Introduction

Addressing Health Disparities and Social Challenges

Due to the aging population and changing social conditions, more individuals face multiple diseases, disabilities, and complex challenges. Because of social determinants of health like social isolation, poverty, and discrimination, health disparities significantly affect health status.¹ The World Health Organization has identified measures to assess health disparities, promote collaboration, improve living environments, and reduce health risks.² The COVID-19 pandemic further exacerbated health disparities, and support remains inadequate.³ A comprehensive response, including improving living environments and continuous support, is necessary.

Social Prescribing: A Potential Solution

Social prescribing aims to improve health and well-being by connecting individuals with mental health, housing, and loneliness issues to informal services and support.^4
-8 At the societal level, it encourages integrated care and collaboration among health, social, and community sectors.⁹ Originating in the United Kingdom, social prescribing has gained global interest over the past decade.⁴ According to the website of the NHS of England,¹⁰ social prescribing is “an approach that connects people to activities, groups, and services in their community to meet the practical, social and emotional needs that affect their health and well-being.” It involves local agencies referring individuals to a social prescribing link worker, who co-designs personalized care and support plans with clients.^4,9

Japan has introduced a government initiative to create a community-based symbiotic society (Chiiki kyosei shakai), aiming to restructure local support networks and reduce social isolation.¹¹ Social prescribing, as a countermeasure against isolation and loneliness, is included in Japan’s basic policy and promoted nationwide.¹² Improvements in mental health, reduced hospital admissions, and decreased medical costs have been observed after social prescribing.^13,14 Additional benefits include better health behaviors, well-being, increased self-esteem, self-worth, and hope.¹⁴ Social prescribing also assists service users in finding or returning to work after illness or accidents.¹⁵

Community Libraries and Their Impact

Activities recommended in social prescribing include volunteer organizations, self-help groups, art and physical activity groups, adult education, luncheon clubs, and social services.¹³ Public libraries, as vital community resources, can play a significant role in promoting social prescribing.¹⁶ Although no research on social prescribing has focused exclusively on public libraries, several examples of initiatives have been reported.^16,17 Another type of library is a community library. Community libraries are established based on local needs, funded by community donations, managed by community members, and served by community volunteers.¹⁸ Because community libraries are established by community members, they can contribute to local welfare and social inclusion and strengthen connections.¹⁸ Notably, community libraries in Uganda have reported that women living in poverty under gender discrimination where access to education is low feel safe to gather in community libraries, which has led to empowerment, including the acquisition of local resources and job skills.¹⁹

However, according to a review of the literature, neither community libraries prescribed by social prescribing as a source of activities nor the impact of community libraries on residents and communities in the context of social prescribing have been investigated. Therefore, this study aimed to clarify the role of the community library operated by medical and social professionals in social prescribing, its functions, and its impact on residents and communities.

Methods

A Place With Books and Life: Outline of Daikai Bunko Library (DBL)

DBL is a community library in the central area of Toyooka City, Hyogo Prefecture, Japan. Toyooka City is a regional city with a high aging rate of 35.2% and a declining population, with a current population of approximately 72 000, an area of approximately 700 km² and a population density of 107 persons/km². The city is also famous for producing the largest amount of bags in Japan. The founder of DBL is the first author (YM), a primary care physician residing in Toyooka City. DBL was established in November 2020 with the cooperation of an architect and other community residents. The community members who operate DBL and contribute books and funds are called One-box Bookshelf Owners. The One-box Bookshelf Owners pay a monthly membership fee of 2400 yen to have a personal bookshelf, on which they can place approximately 1 dozen books that they own and recommend to others. Some owners use the bookshelves for self-expression, for example, decorating them with flowers or placing Kokeshi dolls on them. Except for a few new books for sale, anyone can borrow books for free from DBL.

The store staff also serves as link workers in social prescribing at wages ranging from 1000 yen to 1450 yen per hour, referring individuals with social issues to relevant social services and local communities. In addition to the DBL staff who are medical and social professionals and link workers, the store is staffed by volunteers from One-box Bookshelf Owners and Store Keeper Interns, who are various community residents, including administrators, artists, teachers, unemployed persons, and students. Store Keeper Interns do not own bookshelves. They are volunteers who want to be involved in DBL and serve as storekeepers approximately twice per month. Coffee and other beverages are provided, and customers can freely spend time in the store browsing, reading, borrowing, and buying books, as well as tending to the store, talking with other customers, and working on their PCs while using Wi-Fi. DBL also provides counseling on problems related to daily life, and their staffs, who are link workers, provide health counseling, loneliness, and living-related help. Community residents visit DBL for consultations of their own volition or at the urging of local medical institutions, welfare centers for handicapped individuals, and the general public. Visitors to the DBL are, for example, mentally disabled, unemployed, in need of grief care, anxious caregivers, and isolated parents with preschool children. The counseling staff recommends DBL as a place to stay where they can easily visit and feel at ease, and, if necessary, refers them to further welfare services and the local community.

Participants and Data Collection

Semi-structured interviews were conducted by the first author (YM) and the second author (YK) with DBL users who agreed to participate in the study, as well as One-box Bookshelf Owners and Store Keeper Interns. The interviews were conducted during the month of September 2022, either at DBL or at the Professional College of Arts and Tourism to which the second author belongs. The interview guide is presented in Table 1. The inclusion criteria were volunteering to participate and being continuously involved in DBL as a user, a One-box Bookshelf Owner who does not act as a storekeeper, a One-box Bookshelf Owner who acts as a storekeeper, or a Store Keeper Intern. Exclusion criteria were being aged under 15 years and having a verbal communication disorder (e.g., Alzheimer’s disease). Eleven individuals were asked to participate in this study, and 10 agreed. After consent was obtained, conversations were recorded with digital recording equipment. The interview was conducted in a private room with a relaxed atmosphere. While asking questions according to the interview guide, we encouraged the participants to speak freely. Transcriptions were made from the recorded conversations. As the interviews were conducted in Japanese, all verbatim transcripts and textual analysis were conducted in Japanese. Translation into English was done after the analysis was completed by the researcher using the translation software DeepL (https://www.deepl.com/ja/translator). The English text was proofread by an English proofreading service with native speakers.

Table 1.

Interview Guide.

Categories	Time axis	Questions
Living conditions	Present	Basic attributes, e.g., age, school or work, and hobbies
	Present	About your daily life (How do you spend your day?)
	Present	Where do you usually go?
	Present	Who are the individuals you are usually involved with?
	Past	What was your daily schedule before joining DBL?
	Past	What places did you go to and whom did you meet before you got involved with DBL?
Living place	Present	How do you feel about this town?
	Present	What do you think are the challenges of this town?
	Present	What are the good points of this town?
DBL	Past	How and when did you come across DBL? (e.g., time of year, why did you come to the store)
	Past	What feelings did you have when you first came to DBL? (Emotions)
	Present	When and how often do you visit the DBL? (Frequency of use)
	Present	How do you spend your time at DBL? (How to spend time)
	Present	What do you expect from DBL? (Expectations)
	Present	When you come to DBL, how do you feel, and how do you change? (Impact)
	Present	What do you think is particularly good about the functions that DBL has (e.g., consultation, exchange, a place to stay)? Why do you think so? (Evaluation)
	Present	Why did you get involved with DBL? (One-box Bookshelf Owner/Store Keeper Intern/customer/staff)
	Present	Why did you decide to get involved in this way?
	Past-present	Is there anything about you that has changed since you first got involved with DBL? (e.g., changes in emotions, relationships with individuals)
	Past-present	How has the town changed since the establishment of DBL?
	Present-future	How do you think you will change by continuing to be involved with DBL?
	Present-future	How do you think the town will change if you continue to be involved with DBL?
	Present-future	Do you have any ideas about how you would like DBL to change?

Data Analysis

This study was conducted using the Steps for Coding and Theorization (SCAT) method (hereafter, SCAT), a qualitative analysis.²⁰ SCAT is relatively easy to implement, even for beginners in qualitative research, and the analytical process is explicit; thus, the validity of the analysis can be continuously checked. It comprises a four-step coding process: 1) highlighted words from within the interview text; 2) words outside the text that are replaceable with the words from 1; 3) words that explain the words in 1 and 2; 4) themes and constructs, including the process of writing a storyline and offering theoretical descriptions that weave together the themes and constructs. In this study, to conduct SCAT, YM primarily conducted the analysis, namely, the initial coding and writing storylines, and the co-author (DS), who has extensive SCAT experience, supervised the theoretical description. The validity of the results and the structure of each theme were finalized through discussions among all authors.

Ethical Considerations

A research protocol was submitted to the Ethics Committee of Hyogo Prefectural Tamba Medical Center, and it was determined that an ethical review was not required for this study. Subjects were notified in advance that cooperation in the study was voluntary, and written consent was obtained from all participants.

Results

Ten individuals involved with DBL participated in this study. Table 2 shows the demographics of the study participants. Table 3 shows the categories and theoretical descriptions of the SCAT analysis. The attributes and storylines of each interviewee are also presented in Supplemental Table 1.

Table 2.

Demographics of Study Participants.

ID	Age	Gender	Occupation	Involvement with DBL
1	50s	Male	Unemployed	User
2	60s	Male	Unemployed	User
3	60s	Male	Unemployed	Store Keeper Intern
4	30s	Female	Part-time job	Store Keeper Intern
5	20s	Female	Part-time job	One-box Bookshelf Owner (not a storekeeper)
6	50s	Female	Teacher	One-box Bookshelf Owner (not a storekeeper)
7	20s	Female	Part-time job	One-box Bookshelf Owner (storekeeper)
8	20s	Male	Caregiver	One-box Bookshelf Owner (storekeeper)
9	30s	Female	Cinema staff	One-box Bookshelf Owner (storekeeper)
10	60s	Female	Organization administration	One-box Bookshelf Owner (storekeeper)

Table 3.

Theoretical Description of SCAT and Corresponding Categories.

Categories	Theoretical descriptions
A place to stay	- A place where individuals can feel free to discuss their health and illness. - In a town where there are few places for individuals with difficulties in life, DBL exists as a place where individuals can feel safe and comfortable. - DBL is a place open for long hours, a reading space, and a shelter and is used daily. - Nighttime hours are available; thus, individuals can spend time with others without spending money. - The community feels a sense of security by having a place open at night. - In this place, individuals with mental illness and those caring for their parents can refresh themselves. - They expect DBL to remain the same and continue to be a place to stay. - DBL is a unique place in the community that functions as a place to stay, a place to consult, and a place to visit.
Attractive space design	- Individuals recognize DBL through books and social networking sites and start using it because of its stylish space design and their interest in people and themes commonly related to the books on sale. - The stylish space design and the staff’s good impressions lead to the use of the store. - The spatial design and the presence of the storekeeper and staff make individuals with mental health problems want to use the store. - The spatial design, staff, coffee aroma, books, and so forth appeal to various senses.
Diverse accessibility	- The participants discovered DBL by chance while taking a walk and started to use it. - DBL is one of the available daily outings they discovered through social networking sites while they were restricted from going out due to the COVID-19 pandemic. - The local social welfare council introduced them to DBL, and they started using it. - They became aware of DBL through social networking sites, and from the beginning, they have been involved in DBL as storekeepers for themselves and for society. - They found DBL by passing by and started using it as a consultation center.
Choosability of various roles	- The interest in books is a gateway to the roles of the One-box Bookshelf Owners and Store Keeper Interns. - The owner system of the bookshelf is a good way to contribute to the place. - DBL is a good place to contribute to the community, and the Bookshelf Owner system is a good way to contribute to the community. - At DBL, individuals are allowed to behave freely, and it is not limited to a place for consultations. - At DBL, individuals can play a role in a reasonable way, even if they have financial problems. - The role of the Bookshelf Owner has expanded from being a customer to being a storekeeper, helping with problems, and conducting environmental maintenance. - That a storekeeper has a title and a role, despite having dropped out of college and being out of work, was appealing to them. - The participants expect DBL to continue as it is, and by ordering a drink as a customer, they have a sense of contribution to the community.
Consultation function	- The storekeeper functions as a consultant for residents who have psychological obstacles to government consultation services and medical institutions. - DBL is a comfortable place for consultation as a second opinion, which is different from a hospital. - The staffs are always willing to listen regardless of the subject of the consultation, and they are used as a consultation service because of their sense of security and trust. - The staff is reliable and trustworthy; thus, they use DBL as a place where they can consult about caregiving and medical problems without feeling any psychological obstacles. - They use DBL because they feel secure in knowing that there is someone here who is always willing to listen to them and because it is less intimidating than a workplace or a public institution. - DBL is a place to consult with medical and social professionals as an alternative to medical care in rural areas. - Users are able to talk about their problems because the other party is a stranger.
Social support	- At DBL, individuals can consult with others in a casual manner, which is not the case with the government’s formal counseling services, and the advice received can help solve problems related to caregiving (informational support). - The staff encourages users to take a proactive role, and they have become owners of a bookshelf, which is good for them and the community (emotional support). - Participation in management meetings and the sense of security provided by the accompanying support of the staff promote self-disclosure (emotional support). - The social connections made at DBL helped them find a job that suited them. They have obtained several places to stay in the community, starting with DBL (instrumental support). - The staff’s words helped the users affirm his/her self (evaluative support). - It is a multifunctional rehabilitation center with medical professionals who drop by daily.
Empowerment	- Through the experience of working as a storekeeper, the participants gained an awareness of the importance of daily care and conversation while considering the background of others. - Having been saved by the nosiness, the participants developed a sense of wanting to be nosy by providing a place for individuals to stay. - The staff’s involvement helped them change from being withdrawn from and concerned about conversations owing to their illness to being able to converse with others. - They experienced the gratitude of users as storekeepers and gained the ability to be aware of the condition of others. - Through interacting with individuals of different generations, which were mediated by books, they were able to change and reexamine themselves. - The experience of being ill was transformed into a positive experience because they had the opportunity to reaffirm the value of individuals and the community. - Through their continued involvement with DBL, they gained the skills to self-provide health counseling and to take on the role of connecting individuals to counseling institutions. - Through the experience of storekeeping, they gained an alternative value that they can live their lives even if they never went to or dropped out of school. - The experience of storekeeping led to the acquisition of digital device skills. - Through the experience of storekeeping, the participants acquired an attitude of listening without forcing answers and conversational skills with consideration for others, which they can use in their daily lives. - Through interaction with individuals from different social backgrounds, they became empowered to understand and appreciate others’ backgrounds, not their titles or appearances. - The desire to be involved with DBL and to contribute to others is fostered. - As a One-box Bookshelf Owner, the participants feel the joy of having their expressions appreciated by others. - They felt proud to be involved in DBL. - Communication through roles and themes has changed positively. - They feel proud to be involved in a meaningful place of social prescribing. - They feel that they can do what they are interested in and want to do with DBL. - DBL is a place where self-expression through books is accepted.
Mutual trust	- The presence of staff that is comfortable with small talk and health counseling leads to increased use. - There is a sense of trust not only in the staff but also in the users of DBL. - Positive messages from the staff form a sense of trust in the individuals involved in the altruistic nature of the place.
Formation of connections across generations/attributes	- Users who borrow books can interact through the bookshelves and multiple tools to express their individuality, which leads to a sense of satisfaction and a desire for approval. - Seeming lonely after a leave of absence due to mental illness, users begin to use the service as an opportunity to reintegrate into society, building social relational capital beyond geographical ties and motivating them to reintegrate into society. - In this place, minorities, such as individuals who are handicapped, homemakers, and retirees, can interact easily. - As users, they feel a sense of security that they do not have to speak, and they have a sense of expectation for community building and encounters mediated by books. - They look forward to meeting individuals at DBL who are interested in the same themes and books. - The easy use as a customer and book-mediated communication allows individuals to participate even if they are not good at conforming to others’ needs. - The experience of self-disclosure has increased their interaction with others. - DBL is an attractive place for nosy individuals to gather. - Unlike users of public libraries, the users enjoy learning about books recommended by others and interacting with individuals of different generations whom they do not encounter in their daily lives. - Individuals who have felt lonely since they lost their jobs and have a desire to interact with others have used the library, and those who are not good at socializing have made connections with others based on topics that interest them.
Co-creation	- At DBL, individuals can take the initiative and create for themselves. - The number of options for places to stay increases and the number of resident-led activities that do not rely on the government increases.
Social impact	- The impact of DBL will lead to a change in the town because of the projected increase in the related population and immigrants. - The change that community residents begin to engage with DBL can be a catalyst for change in the community. - Government support for places such as the DBL is necessary. - Positive impact on the community through recognition of DBL as an interesting place and a place where individuals with disabilities can stop by.

The analysis of the theoretical descriptions revealed 11 categories: a place to stay, attractive space design, diverse accessibility, choosability of various roles, consultation function, social support, empowerment, mutual trust, formation of connections across generations/attributes, co-creation, and social impact. The 11 categories were divided into effects on individuals, effects on the community, and the functions of DBL that affected the effects on individuals and the community (Figure 1).

Figure 1.

Diagram of functions of DBL and its effect on individuals and the community.

A Place to Stay

DBL is recognized as a place where individuals can feel safe to discuss their illnesses, care issues, and other difficulties in life, which can lead to a reduction in loneliness. Also considered important is having a place open at night that is free of charge.

For those who come here often, it is a place of peace of mind, or an asylum, or even a bit of a refuge, where they can feel a little relieved when they come here, or see someone they know, like seeing the usual Ms. A, or seeing the bookshelf owner. (ID 8, male in his 20s)

Attractive Space Design

The attractive design of the interior, architecture, and other hardware designs, as well as the design of the software that connects users with each other, attracts individuals.

When I first arrived, I thought I was in a mysterious space. It was like I had never been in a place before, a museum, art museum, and library all rolled into one, but I liked the atmosphere. It was a bit like a bookstore in a book world. I remember I was excited when I first entered the store because I thought it was a little romantic or fantastic. (ID 4, female in her 30s)

Diverse Accessibility

Individuals access DBL in various manners, such as through social networking sites, discovering it while walking, or being introduced to it by friends or the local social welfare council. The purposes of using DBL are also diverse, including as a library, for consultation, as a place to stay, and as a place to drop in.

My wife invited me to go for a walk. We usually just go around our house, but we decided to go to a different place, so we came to this side of the shopping street. I was wandering around here and happened to find this place. (ID 3, male in his 60s)

Choosability of Various Roles

Similar to other community libraries, DBL has roles for community residents, inviting their participation. Multiple roles have been established, including users of the library and consultation functions, One-box Bookshelf Owners, and Store Keeper Interns. At DBL, individuals who are unemployed or disabled can volunteer for the role of storekeeper. Residents who participate may also help with problems that arise at DBL. They can deepen their roles by participating in ways that suit them. In some cases, the support from the staff affects the change in roles.

The reason I went from being a user to an intern was because at the time when Mr. B asked me if I was interested in applying for an internship, I was not even working part-time at the time and really had no title. I thought that one day I would have to work part-time or do something like that, so I thought it was a very attractive offer for the first phase of my career. (ID 7, female in her 20s)

Consultation Function

The DBL functions as an accessible consultation center for residents and others who are psychologically reluctant to seek medical care at existing medical and social consultation services or medical institutions. Regardless of the content of the consultation, a sense of security and trust in the staff who listen to them leads to continued use and support. Individuals might more readily discuss difficult topics with strangers than with their neighbors.

I thought the staff at DBL would listen to me. To discuss my work. I have thought about going to DBL to get energy. Yes, Ms. C., or Ms. D., or the counselors. I had different things I wanted to talk to each person, but there were so many things I wanted to talk to them. (ID 9, female in her 30s)

Social Support

Social support can be divided into informational support, emotional support, instrumental support, and evaluative support. Each of these types of support was found to be provided by DBL.

At that time, I was glad that they listened to me anyway, and I think the only concrete advice they gave me was that I should get certified for long-term care insurance as soon as possible, which I am glad I did. It was just the 3rd of January, and I went to City Hall on the 6th anyway. I knew I had to do it sooner or later, but being told objectively made me feel better about going. (ID 10, female in her 60s)

Empowerment

Through the continued involvement at DBL, members who are not medical and social professionals have learned the roles of link workers, such as listening, considering the psychosocial background of others, providing counseling, and referring users to specialized institutions. The experience of being supported promoted the desire to become a supporter. In addition, some of the participants were able to have conversations with others, which had been a complex experience for them. Individuals also acquired digital device skills through their experience as storekeepers. For socially marginalized individuals, gaining skills and alternative values led to their empowerment. There is a sense of being able to do what they want to do at DBL, and an environment where self-expression through books is accepted is provided.

Yes, I think so. I am starting to be able to speak a little bit. I have a complex about it . . . I have a complex because I wonder if my speech is not right. I don’t talk much outside of this place . . . I guess I trust the doctors and the staff. It’s like they are protecting me. I’m hoping that I can talk a little. (ID 1, male in his 50s)

Mutual Trust

Many respondents cite trust in the staff and users. This difference may lead to continued use of the center.

I have come to think that there are a lot of good people who can be trusted, and I think that DBL is a place where there are a lot of such people. It is easy to go to a place like that, and I feel safe in the knowledge that there are not many mean-spirited people or people who try to kick people down. (ID 4, female in her 30s)

Formation of Connections Across Generations/Attributes

Connections are formed through books among multiple generations, including socially vulnerable groups such as those comprising individuals who are unemployed, disabled, or raising children. Unlike the users of public libraries, these users enjoy learning about the books recommended by community members and conversing and interacting with each other in the context of reading and books. These characteristics allow even those who are not good communicators to participate. These interactions are recognized as an attraction of DBL and provide an opportunity for socially vulnerable individuals to participate in society.

I think it is great that there are more places where people of different generations are thinking about going. One of those places is DBL. I see a lot of people come here. There are older people, people of my generation, and I’ve even seen college students come here. (ID 5, female in her 20s)

Co-Creation

As a community library, DBL is recognized as a place where community members collectively donate money and time, collectively operate, and collectively create. There, resident-led activities are conducted collaboratively.

As an owner of a bookshelf, I can enjoy the feeling of building my own community with my own hands, or rather, I can learn from the experience of deciding the rules together with others and watching them take the initiative. It is also a chance to connect with other people, and I feel that I belong here, and that I feel at ease with the people in this community. (ID 8, male in his 20s)

Social Impact

Regarding the social impact of DBL, the results suggest that the activities of residents involved in DBL are a catalyst for change in the city and that the existence of socially inclusive third places could lead to a positive change in the community.

People who know DBL think it’s a good base for something, or that something will change, or that the station street will change. This street is also getting desolate, so I hope that something will change in various ways. There are many people who come here on a whim as tourists. I have a feeling that something is going to change. (ID 1, male in his 50s)

Discussion

Key Functions and Benefits of Community Libraries

This study identified 11 categories as functions of community libraries that exist as part of a social prescription and their impact on the community: a place to stay, attractive space design, diverse accessibility, choosability of various roles, consultation function, social support, empowerment, mutual trust, formation of connections across generations/attributes, co-creation, and social impact. The results suggest that a community library run by a primary care physician and medical staff effectively links the community and local public health services.

Studies have shown that social prescriptive initiatives have led to self-affirmation, well-being, employment support, connection formation, and social support.^13,15 Similarly, in this study, the participants involved in the community library were residents, and they created new activities together, which led to the formation of connections and social support. Furthermore, we found new roles of community libraries, such as the empowerment of residents who acquired listening, social care, and linkage work skills. The importance of person-centeredness, co-production of solutions, and empowerment in social prescribing efforts has been noted.²¹ This study demonstrated that residents were empowered and new activities were co-created by the residents, suggesting the potential of community libraries in social prescribing. One of the results also shows the possibility of a social impact on the community. This result may be related to the nature of community libraries in which community residents participate. That is, the nature of attractive space design and supporting participation by diverse accessibility. In addition, the nature of such multiple functionality of DBL may have contributed to the formation of connections, mutual aid, and new activities among individuals who had gathered for different purposes.

Involvement of Medical and Social Professionals

One novelty of this study is that the medical and social professionals hosted and were involved in the community library. This may have led to a consultation function because the psychological barrier was reduced for community residents to obtain a second opinion for medical problems which is different from a hospital, and social support. This finding is similar to the role of social support and complementary outpatient functions for community residents that the site played in the literature, in which primary care physicians implemented health café initiatives.^22,23 The National Academy of Sciences of the United States defines primary care as “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.”²⁴ The social support and consultation functions provided by the community library operated by primary care physicians, as demonstrated in this study, have the potential to improve the primary care function in the community. Possible reasons for this result include accessibility owing to the many staff who are link workers and that the local primary care physician operates the community library, which may lead to trust in the place.

Role of Community Libraries in Future Social Prescribing

Community library initiatives involving community residents are spreading throughout Japan and other countries.^25,26 These places could become coordination points for social prescribing by linking them with primary care physicians, social workers, public health nurses, and other professionals, with social support expected to be provided through the assignment of link workers. Different from the function of public libraries, which is mainly to lend books, the function of community libraries is to support various citizen-oriented activities and play a role in empowering the community.²⁶ This study is the first to position libraries in the context of social prescribing, and our expectation is that they will play an important role in social prescribing in the future.

Limitations of the Study

There are several limitations to this study. First, the relatively small sample size of 10 study participants may have prevented sufficient exploration of the current study’s research question. Therefore, thick descriptions including writing detailed storylines and typical case sampling were conducted to enhance the transferability of this study. Second, because the study population was members continuously involved in community libraries, the opinions of other categories of individuals, such as transient users, were not captured. Third, the primary researcher, the first author, is a physician and the manager of DBL, so his relationship with the interviewee may have affected the quality of the interview. In particular, participants working as staff such as storekeepers may have been reluctant to say anything negative for fear of jeopardizing the relationship. Finally, the findings of this study relate to 1 community library in 1 local area in Japan and have limited generalizability to many other community libraries.

Conclusions

We found that a community library run by medical and social professionals was a useful social prescribing site and affected the community residents who used it. Various functions of the community library, such as consultation functions and attractive space design, may lead to effects on local individuals providing social support and empowerment, with social impacts such as co-creation and formation of connections to the local community.

Supplemental Material

sj-docx-1-jpc-10.1177_21501319231181877 – Supplemental material for Social Prescribing Initiative at Community Library and Its Impact on Residents and the Community: A Qualitative Study

Supplemental material, sj-docx-1-jpc-10.1177_21501319231181877 for Social Prescribing Initiative at Community Library and Its Impact on Residents and the Community: A Qualitative Study by Yoichi Morimoto, Yayoi Koga, Tsuneaki Kenzaka and Daisuke Son in Journal of Primary Care & Community Health

Footnotes

Acknowledgements

The authors would like to thank all the study participants for their willingness to cooperate with them in this study.

Declaration of Conflicting Interests

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

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Daisuke Son

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