Using Evidence in Practice

Modernization of the Care Library by the Belgian Red Cross: Leveraging Digitalization and Volunteers to Reduce Loneliness with Library Services

Gaelle Huysentruyt
Manager Social Activities & Youth
Belgian Red Cross
Mechelen, Belgium
Email: gaelle.huysentruyt@rodekruis.be

Mathilde Krols
Project Manager Humanitarian Services
Belgian Red Cross
Mechelen, Belgium
Email: mathilde.krols@rodekruis.be

Liesbeth Vercammen
Coordinator Volunteering
Belgian Red Cross
Mechelen, Belgium
Email: liesbeth.vercammen@rodekruis.be

Fritz Schiltz
Chief of Staff
Belgian Red Cross
Mechelen, Belgium
Email: fritz.schiltz@rodekruis.be

Philippe Vandekerckhove
Managing Director, Belgian Red Cross
Mechelen, Belgium

Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven

Leuven, Belgium

Centre for Evidence-Based Health Care, Stellenbosch University

Cape Town, South Africa
Email: philippe.vandekerckhove@rodekruis.be

Received: 28 Dec. 2021 Accepted: 25 Jan. 2022

2022 Huysentruyt, Krols, Vercammen, Schiltz, and Vandekerckhove. This is an Open Access article distributed under the terms of the Creative Commons‐Attribution‐Noncommercial‐Share Alike License 4.0 International (http://creativecommons.org/licenses/by-nc-sa/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly attributed, not used for commercial purposes, and, if transformed, the resulting work is redistributed under the same or similar license to this one.

DOI: 10.18438/eblip30091

Setting

In 1937, the Belgian Red Cross launched the Care Library, a library service tailored to the needs of people who are unable to visit a regular library. Although originally targeted towards in-hospital patients, this service now mainly concerns people who are staying in residential care centres. The Care Library is essentially a social activity, aiming to prevent and/or break through loneliness, hence our slogan: more than a book. This is what distinguishes the Care Library from both web shops and regular libraries: it brings the library to people unable to visit in person and allows volunteers to spend time with them.

The central warehouse contains more than 200,000 materials adapted to the specific target group of the Care Library. There are also 40,000 books with large print, books for young people, picture books, and books in other languages for shelters for asylum seekers operated by the Red Cross. There is also guidance material to trigger memories. For example, scent boxes are used to play the game bingo. Every player gets a game board and tries to complete it by correctly guessing the scent flasks. Other examples include audio bingo games, pictures of everyday objects, memory games, and puzzles with pictures of the past.

Lending points become a mini library with a tailored service, thanks to the materials from the central warehouse and the book tour by more than 700 volunteers. Lending points have a small adapted part of the library collection they can use to lend out materials. Seventy-seven percent (77%) of lending points are residential care centres, 15% are hospitals, and 6% psychiatric centres or others (2%). Volunteers act as the point of contact between the care location and the library. As lending point coordinators, they ensure that materials are requested according to the wishes of the residents, and they make time to speak to residents. In this way, bonds of trust are created for people in vulnerable and sometimes lonely situations.

The Belgian Red Cross team manages the collection, delivers tailor-made packages to the lending points, and trains the volunteers before they go on a book tour. The volunteers use a book cart with different materials to go on their book tour. If possible, they go from room to room and speak with the residents of the care centres. The training of volunteers hence guarantees both the quality of the collection and the service provided.

Problem

In contrast to traditional libraries in Belgium, which experienced a 30% drop in number of operating points between 2008 and 2015 (Statistics Flanders, 2016), there has been a strong increase in demand for the Care Library. In the past five years, the number of lending points has increased by almost 40%. A possible explanation is the shift in the target group. For example, 77% of the people reached by the lending points are residents of a residential care home. Social contact therefore plays an even more important role, which distinguishes the Care Library from traditional libraries. Demographic trends in Belgium point to a growth of 22% in the number of people over 65 between 2017 and 2027, indicating a continued shift in the coming years.

The ever-growing demand poses challenges for the Belgian Red Cross. In addition to the purchase of materials and the use of the warehouse, Baumol’s law characterizes a library, like other services, as follows (Baumol & Bowen, 1966): slower growth of labour productivity compared to general productivity results in relatively high service costs. The Care Library is a free service, only possible thanks to the daily efforts of volunteers and support from government funding. A decrease in the number of volunteers in Belgium (20% in the past five years) was compensated by the deployment of employees, which further increased the cost. In order to meet this challenge the Belgian Red Cross invested heavily in the modernization of its central operations.

Evidence

In the case study of the Care Library, there are two main levels of evidence. First, our internal research team conducted two systematic reviews of the literature on the impact of in-person visits and book reading on the well-being and health of senior citizens. Second, we used a data-driven approach to tailor book deliveries to residents’ demands. Both systematic reviews are currently under review. The protocols for these systematic reviews are published and available online (Laermans et al., 2020a, 2020b).

The literature review provides a scientific base for the activities of the Care Library. It includes research on (1) the effect of friendly visiting by a volunteer on loneliness of residents of an assisted living facility (e.g. Arthur, Donnan, & Lair, 1973; Reinke & Holmes, 1988), and (2) on the impact of book reading on the physical and mental health of older adults (e.g. Bavishi, Slade, & Levy, 2016; Krell-Roesch et al., 2017). The former concludes that friendly visits benefit the life satisfaction and self-assessed health of residents of an assisted living facility, although it should be noted that further research is needed due to a lack of recent evidence and rather low quality of available evidence. The latter concludes that reading a book enhances both the mental health (reduced risk of developing dementia, and improved social connectedness), and physical health (lower mortality rates) of older adults. However, caution should be exercised regarding this latter set of results due to the relatively low quality of available evidence.

A data-driven approach enables deliveries and new purchases that are better attuned to the wishes of residents. This is possible through real-time insights into the collection, but also the size of the lending points (number of beds), participation (% readers), and areas of interest. Volunteers who are paying friendly visits can submit data through an online portal, helping the central team to continuously improve its offerings. By equipping the lending points with specific materials, personal conversations are facilitated (e.g. reminiscence books with pictures of the past are used for residents with dementia).

Implementation

The project “Optimization Central Library” was launched, with the objective of modernizing the Care Library, in order to increase its capacity without increasing costs. The components of this project are shown in the Figure 1.

Figure 1

Modernization of the Care Library in five steps.

The entire book collection was inventoried in a data warehouse by the Belgian Red Cross team. Each item in the collection was given a unique code and was linked to specific characteristics of the material such as its genre. Reporting using Cognos software allows insight into the stock. To interact with this new source of information, an application was developed: Zorgbib.be. This application is publicly available and allows users to consult the collection directly. The application was developed because the purchase and disposal was previously based on the perception of the staff, volunteers, and institutions instead of standardized records. In addition, our customers have changed over the last years to a specific profile: seniors in care centres. To follow the growth in lending points for this target group, we needed an optimized stock system and maximal rotation of the existing collection.

Lending points can use this application to request a change directly, but they can also enter their own data (e.g. number of readers). In addition, volunteers can follow an e-learning training for free before going on a book tour. When a new lending point is launched or a change is requested, a tailor-made package with materials is put together by employees and volunteers of the Belgian Red Cross. When the package is delivered, the used materials are returned and added to the collection again.

Outcome

The modernization as described above has improved the quality of the functioning of the Care Library, increased its reach, and reduced costs. Between 2016 and 2021, the number of conversations, as logged by volunteers in the web-based application, increased by almost 60% to 158,000 per year. At the same time, financial resources are made available that can be used elsewhere by the Belgian Red Cross. By offering training online and automating certain processes (e.g. requesting a change via an application instead of via email), staffing could be reduced by almost 40%. Targeted purchases and better stock management mean that more lending points can be reached with the same materials. At the same time, the shorter shelf life of books means that less space is needed in the warehouse. Figure 2 summarizes the increased reach of the care library (+145% since 2006), while government funding has remained constant during the same period (+1% after correcting for inflation in the same period).

Figure 2

Evolution of lending points and funding over time.

Reflection

Throughout the process of modernizing the Care Library, two challenges emerged. First, the ability to shift to a data-driven approach crucially hinges on the quality of the data. As volunteers provide data, a complementary training needed to be developed. Volunteers can now follow online classes to get to know the application, making sure that data quality is maintained. In addition, volunteers (and employees) with lower levels of digital literacy are receiving in-person training, provided by staff of the Belgian Red Cross. Modernizing our process without supporting our volunteers along the way would limit – or nullify – the impact of the renewed Care Library.

Second, cooperation with experienced partners helps to overcome technical difficulties. Our team working in the Care Library has deep expertise in materials for our specific target groups, and in training volunteers to prepare for their visits. However, the team has limited expertise in digital transformations, requiring an experienced partner to support this transformation process. Because of the organizational structure of the Belgian Red Cross, support services such as IT, facilities, and learning and development can be leveraged to successfully complete this project. For organizations that do not have this scale or organizational structure, our key recommendation is to find a partner that has experience in digital transformations such that the library team can fully focus on its core expertise.

Author Contributions

Gaelle Huysentruyt: Project administration, Supervision, Writing – review & editing Mathilde Krols: Project administration, Writing– review & editing Liesbeth Vercammen: Project administration Fritz Schiltz: Writing – original draft, Writing – review & editing Philippe Vandekerckhove: Funding acquisition, Supervision, Writing – review & editing

References

Arthur, G. L., Donnan, H. H., & Lair, C. V. (1973). Companionship therapy with nursing home aged. The Gerontologist, 13(2), 167-170. https://doi.org/10.1093/geront/13.2.167

Baumol, W. J., Bowen, W. G. (1966). Performing arts, the economic dilemma: A study of problems common to theater, opera, music, and dance. Twentieth Century Fund.

Bavishi, A., Slade, M. D., & Levy, B. R. (2016). A chapter a day: Association of book reading with longevity. Social Science & Medicine, 164, 44-48. https://doi.org/10.1016/j.socscimed.2016.07.014

Krell-Roesch, J., Vemuri, P., Pink, A., Roberts, R. O., Stokin, G. B., Mielke, M. M., Christianson, T. J., Knopman, D. S., Petersen, R. C., Kremers, W. K., & Geda, Y. E. (2017). Association between mentally stimulating activities in late life and the outcome of incident mild cognitive impairment, with an analysis of the APOE ε4 genotype. JAMA neurology, 74(3), 332-338. https://doi.org/10.1001/jamaneurol.2016.3822

Laermans, J., Scheers, H., Vandekerckhove, P., & De Buck, E. (2020a). PROTOCOL: Recreational book reading for promoting cognitive functioning and emotional well-being in older adults: A systematic review. Campbell Systematic Reviews, 16(4). https://doi.org/10.1002/cl2.1117

Laermans, J., Scheers, H., Vandekerckhove, P., & De Buck, E. (2020b). PROTOCOL: Friendly visiting by a volunteer for reducing loneliness and social isolation in older adults. Campbell Systematic Reviews, 16(2), e1084. https://doi.org/10.1002/cl2.1084

Reinke, B., & Holmes, D. S. (1988). The “friendly visitor” program data: A reply to Denney. American Journal of Community Psychology, 16(3), 427-433. https://doi.org/10.1007/BF00919380

Statistics Flanders. (2016). BIOS Library Statistics. Interactief Platform Bibliotheken. https://statistieken.vlaanderen.be/QvAJAXZfc/opendoc.htm?document=cjsm%5Ccjm%20-%20bib2.qvw&lang=nl-NL&host=QVS%40cwv100154&anonymous=true