The idea of a relationship between literature and reading and human health dates back to ancient times. In ancient Greece, Apollo was the god of both medicine and poetry. Similarly, Aristotle developed the concept of emotional catharsis among the drama audience of his time, thereby strengthened the connection between literature and personal and psychological growth (Sheppard, 1987). For a long time, books have been used as a treatment for various mental health problems and lifestyle issues, a practice often recognized under the umbrella term bibliotherapy. Bibliotherapy can take many forms, and it can include the use of self-help literature or fiction and poetry, and bibliotherapy can be conducted individually or in group (Canty, 2017). Bibliotherapy using self-help books has shown to be effective to reduce depressive symptoms up to three years after the intervention in adults (Gualano et al., 2017). However, reading books is not equally accessible to all, as it among other things requires reading comprehension and perseverance.

Just after the turn of the millennium the British national charity The Reader in Liverpool developed the group reading concept Shared reading (SR) as an initiative to promote literature and reading (The Reader, 2024). In a SR group meeting, led by a trained facilitator, short stories, novels, and poetry are read out aloud and discussed. No previous preparation is required by the participants – the facilitator hands out the different texts during the session. The participants are thus offered a dialogical interaction in a social context, where they interact with texts written by different authors as well as with their co-participants and the facilitator leading the group sessions. Normally, a SR group consists of 8–12 participants and meets weekly for 1 or 2 h. Although the basic concept is quite clear, there is room for variation and adaptation of the length of the sessions, the session intervals, and number of participants depending on the context.

In a perspectives article published in The Lancet 2009, Jane Davis, the founder of The Reader, highlights the uniqueness of participating in an SR group: “The reading-aloud group model offers something live: the sharing of the experience itself, the reading together, and also the immediate discussion of that complex experience in a social community” (Davis, 2009).

The SR concept has, thus, been suggested to facilitate the recognition of thoughts and feelings. This could in turn positively affect participants’ well-being without directly trying to address a specific problem. As a result, SR has in recent years been tried out as an intervention to promote health and well-being in different populations and settings, and beneficial outcomes such as improved quality of life, less pain and better sleep have been reported (Billington et al., 2013; Longden et al., 2016; Billington et al., 2017). In contrast to several other reading interventions directed toward vulnerable groups, the literature is chosen on its value to the human existence in a broad sense for all groups and is not specifically targeting the illness or problem the participants are facing.

Today, many societies are burdened by high prevalence of mental disorders as well as loneliness (GBD 2019 Mental Disorders Collaborators, 2022). The health care systems are keen to find cost-effective interventions beyond pharmacological and psychotherapeutic treatments. SR has several advantages, as SR is scalable, comes with a low cost, and meets several different needs: social, cognitive, cultural, and existential. There is a low threshold to participate in an SR group as it requires no preparation or prior knowledge. Participants are invited and encouraged to reflect on the literature, but there is no pressure to perform or say anything. SR could also serve as a way for people with cognitive impairments or fatigue to get access to literary experiences (Billington et al., 2013; Longden et al., 2016; Andersen, 2022). Libraries constitute an existing infrastructure for conducting SR in terms of facilities, personnel, and material (books).

Other reading interventions aiming to improve mental health and well-being have been studied for a longer time and enough data have been reported to conduct systematic reviews and meta-analysis (Gualano et al., 2017; Wang et al., 2020; Zanal Abidin et al., 2021). However, since the specific SR-concept is a relatively new intervention, the number of publications is limited, and the existing studies have been conducted in various scientific disciplines (psychology, anthropology, literary studies etc.) making it difficult to synthesize the data in a systematic review. Scoping review is a form of review suitable to map the evidence in relatively new areas, where there is a diversity of methods, and an overview is needed to identify research gaps. Therefore, we undertook this scoping review to map the existing SR evidence and identify areas appropriate for further research by addressing the following questions: For whom and in what settings has SR been used? How have the interventions been carried out? What are the outcomes reported? How have outcomes been conceptualized and assessed? What further research is needed to better capture the effects of SR?

We followed the PRISMA guidelines for Scoping reviews (Tricco et al., 2018). However, there was no preregistered review protocol for this scoping review.

For this scoping review, we found 15 papers – published between 2007 and 2024 – reporting data from SR interventions to improve health and well-being in adults. The use of SR in various settings with different groups indicates a willingness to explore culture-based health interventions and is in line with the general upswing of arts in health over the past decades (Fancourt, 2017). In line with other forms of reading interventions to improve mental health and well-being (Canty, 2017; Gualano et al., 2017; Wang et al., 2020), a majority of the SR studies showed promising results, sparking the interest in further exploring SR as an intervention for various groups.

A strength of the reviewed studies is that all were conducted in naturalistic settings and had few exclusion criteria. This indicates a high ecological validity and feasibility. Targeted groups in the reviewed studies were predominantly vulnerable populations of different kinds, showing that SR is feasible for a range of different groups.

Overall, the analyzed studies showed high fidelity to the SR concept, such as having a reading group with a facilitator, reading aloud, and discussing poetry and short stories for 1 or 2 h. However, a great variation in the number of sessions, number of participants, and length of the interventions makes it difficult to assess more precisely the frequency of SR necessary to be effective. It is not known if a single, deeply profound SR session could elicit significant change. However, in the study by Watkins et al. (2022), analyzing the effect of SR on the participants’ discourse, the changes were discernible from around 6 months. As a result, it is difficult to estimate the resources necessary to deliver an effective SR intervention. Still, SR and other reading interventions (Gualano et al., 2017), in comparison with many other types of health interventions (nature-based interventions, art therapy, animal assisted therapy, virtual reality therapy etc.) may be a potentially cost-effective and scalable intervention.

The analyzed SR interventions were carried out in the UK and the Scandinavian countries. This may be due to the selection criteria. Only studies published in English, Danish, Norwegian, and Swedish could be included in this review, although only studies in English were found. There may be papers trying out SR as an intervention to improve health and well-being in adults published in other languages that were not included in this scoping review. The fact that a majority of the studies were conducted in the UK is, however, in line with SR being created and developed at the University of Liverpool. Several of the reviewed studies with data from the UK have been conducted by researchers connected to the founding SR organization (Hodge et al., 2007; Billington et al., 2013; Longden et al., 2015). Likewise, most Scandinavian studies have been carried out by researchers who have introduced SR – or are collaborating with the introducers – in the respective countries (Ohlsson et al., 2018; Christiansen and Dalsgård, 2021; Tangerås, 2022). Researchers trying out interventions they have developed or interventions they are highly invested in can be expected to be more dedicated, adherent, and enthusiastic than other practitioners, which may influence the outcomes. Such a dedication effect is something else than the intrinsic effect of the intervention per se, and in the future, SR needs to be evaluated by researchers less invested in the concept (Durlak and DuPre, 2008). In relation to funding, the studies included in this review were funded by health care authorities, research councils, and universities. We have not found any specific commercial interests that would benefit from the SR concept being implemented or promoted.

The existing studies have laid the ground for upcoming studies, by showing feasibility for different groups in different settings and promising effects on mental health and well-being (Dowrick et al., 2012; Billington et al., 2016a; Longden et al., 2016; Billington et al., 2017) as well as more fundamental mental effects such as a renewed sense of personal identity and improved capacity for mentalization (Billington et al., 2013; Billington et al., 2016b; Ohlsson et al., 2018). However, future studies need more scientific rigorousness, and the findings need to be replicated, and other forms of reading interventions have more solid evidence at the moment (Gualano et al., 2017). Most studies included in this review were limited by small sample sizes and lacked a control group. Attrition was high in some studies (e. g. 56% in Dowrick et al., 2012 and 60% in Watkins et al., 2022) or not reported. Post-intervention assessments were mostly done in connection to the end of intervention, and little is known about the long-term effects of participating in an SR group. However, Longden et al. (2016) reported sustained effects in people with dementia 3 months after the end of intervention. The effectiveness of different intensities and length of SR should also be compared. Further, SR interventions also need to be compared with other types of social interventions where people meet and interact around a common task, which so far has only been done by Longden et al. (2015). Effective therapeutic interventions potentially have side effects such as deterioration of symptoms, or onset of new symptoms (Rozental et al., 2016), and future studies also need to address potential adverse outcomes.

Other reading interventions have successfully been conducted online (Hoover et al., 2023). In the reviewed studies only one used SR digitally (Andersen, 2022), and it is not known whether SR has the same effect on mental health and well-being when delivered online compared to in-person. In a Swedish study on an online SR group during the COVID pandemic, the participants did not perceive the online format as negatively affecting the group cohesion, instead highlighting that it allowed for more focused attention on the text and the discussion (Gustafsson et al., 2023). However, this group was not aiming at improving the participants’ health and well-being. Some groups could especially benefit from participating digitally, e.g., if participants in a targeted group are geographically spread or if showing up in real life is experienced as too exhausting. Future studies could compare the outcomes between SR delivered in-person versus digitally, potentially in a randomized controlled trial.

So far, there is a lack of common terminology and a methodological consensus within the SR studies. This makes comparison between studies difficult. Consistency in qualitative and quantitative methods over several studies to compare results would be preferable. As an example, the same questionnaires could be used between studies to assess mental health and well-being before and after the SR group. Longden et al. (2015) have suggested that it is necessary to use specific and sensitive questionnaires, since SR may affect specific aspects of well-being such as purpose in life. There is also a need for replicated studies on specific target groups. Only one of the reviewed studies had used a biological marker to study the effect on the participants (Steenberg et al., 2014), and future studies could potentially study SR’s effect on brain connectivity (Berns et al., 2013). The qualitative studies on SR have been conducted in different academic disciplines and on different levels, using different methods for collecting and analyzing the data. A strength is that different perspectives have been explored, but different research practices and traditions make it difficult to evaluate the studies against the same quality criteria and perform a qualitative synthesis of the results.

The specific literary components of the SR intervention were addressed in some studies, but not on a content level so much as regarding the format: in a study with patients diagnosed with cancer the chosen stories were short due to fatigue being a common symptom among the patients (Andersen, 2022). In a similar manner, poetry has been the preferred choice in interventions for elderly people with mild to moderate dementia (Billington et al., 2013; Longden et al., 2016). However, most studies lack a thorough discussion of the literary texts and the specific way they challenge and affect the participants. In some studies, all literature used is listed, e.g., Billington et al. (2017), whereas other studies do not mention the titles of the texts used. In such studies, the literature is an unknown ‘stimulus’ the participants are responding to rather than a central agent.

As acknowledged above, using literature to improve mental health and well-being is not just a recent phenomenon (Canty, 2017), and SR has not been evaluated against other reading interventions. So far, other forms of bibliotherapy have more scientific evidence, with data from several randomized controlled trials and published systematic reviews (Gualano et al., 2017; Zanal Abidin et al., 2021) and also meta-analysis (Wang et al., 2020). In more traditional bibliotherapy the literary content is often specifically chosen for the participants as a therapeutic tool and self-help books can be used (Canty, 2017; Jack and Ronan, 2008). Participants with different health issues or in certain circumstances may find targeted SR groups especially valuable, even if the literature read and discussed during SR is not focusing on the specific illness or life circumstances. It may be valuable to be able to meet with people in the same situation, without having to interact by talking about the common problem (Andersen, 2022). Sharing and discussing poetry and fiction with others can be an appreciated mental challenge and improve self-esteem beyond what a support group can accomplish (Billington et al., 2016a).

It is not only the chosen and read aloud fictional texts that may affect the result of the intervention, but also the facilitator. A few studies explored the importance of the facilitator in the SR concept, and it is not known if a skilled reader leader gets a significantly better result than a less skilled one, and what qualities of the facilitator that are most important. Thus, the facilitator’s role needs to be addressed in future studies, analyzing the actions taken by the facilitator in relation to the group and the texts. Both the literature chosen and the role of the facilitator can be described as mechanisms within the SR group which produce the potential effects. Another such mechanism to explore in future studies is the interaction between the participants necessary to create an effect, as SR may offer unique opportunities to practice perspective taking and mentalization (Gustafsson et al., 2023).

This scoping review gives an updated overview of where the SR research focusing on health and well-being stands today and can serve as a foundation when future studies are designed. SR so far appears to be feasible and appreciated by participants and facilitators, and is potentially an effective and cost-effective intervention, filling an important societal need. However, this scoping review shows that more research is necessary before implementation in clinical care. At present, there is a lack of large, controlled studies comparing SR to other potential interventions to the targeted groups. Also, long-term studies showing lasting benefits from SR are lacking. A key future research question, beyond the scope of this review, is also if SR could be used to prevent mental illness.