title: Equity and service innovation: the implementation of a bibliotherapy scheme in Wales.
abstract: OBJECTIVE
  Book Prescription Wales (BPW) is a pilot bibiliotherapy scheme launched in July 2005 as a primary care treatment option for people with mild to moderate mental health problems. In an innovative model, patients are prescribed self-help books from a list, to borrow from local libraries. Our objective was to evaluate its implementation, focusing on the issue of equity of service delivery.
  
  
  METHODS
  Data were gathered from Welsh Assembly Government concerning project set-up and borrowing rates. Mailed questionnaires were completed by 21/22 (95.4%) Local Health Boards and 44/64 (68.8%) Community Mental Health Teams. In addition, 327 out of 497 (66%) primary care practices were surveyed by telephone, 20 prescribers took part in in-depth telephone interviews and three focus groups were conducted with library staff.
  
  
  RESULTS
  From July 2005-March 2006, books were borrowed 15,236 times. There was a 10-fold variation in borrowing rates across local authorities (1.07 to 10.18 loans/1000 people). The priority which Local Health Board staff reported giving to the scheme varied. Uptake among prescribers was mixed: in 35% of general practices (n = 116) no-one participated. Prescribers reported different ways of using the bibliotherapy scheme. Library staff reported issues of patchy uptake.
  
  
  CONCLUSIONS
  Variation in usage of bibliotherapy raises questions about equity; it is unlikely to reflect the distribution of people who could potentially benefit. Factors influencing variation existed all along the implementation chain. It is not always possibly to separate demand-side and supply-side factors when considering equity and service innovation in health care.
authors.affiliation: CHIRAL, School of Medicine, Swansea University, Singleton Park, Swansea, UK. a.m.porter@swansea.ac.uk
authors.forename: Alison
authors.initials: A
authors.lastname: Porter
authors.forename: Julie
authors.initials: J
authors.lastname: Peconi
authors.forename: Angela
authors.initials: A
authors.lastname: Evans
authors.forename: Helen
authors.initials: H
authors.lastname: Snooks
authors.forename: Keith
authors.initials: K
authors.lastname: Lloyd
authors.forename: Ian
authors.initials: I
authors.lastname: Russell
mesh_terms: D001638:Bibliotherapy; D004059:Diffusion of Innovation; D017144:Focus Groups; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D001523:Mental Disorders / Q000628:therapy*; D012648:Self Care; D011795:Surveys and Questionnaires; D014852:Wales