In modern society, university students are constantly competing academically from elementary school to university before going out into society, and through competition, they are required to prove their outstanding ability and self-existence. In this process, excessive tension and pressure are felt, and anxiety is inevitably accompanied. Anxiety is a basic reaction that occurs when humans are placed in an unfamiliar environment, and it can be said that it is a representative symptom of psychological maladaptation along with depression [1]. Unlike the previous school life, college students have to adapt to the new environment and solve various problems on their own. In this process, they experience various types of worries and conflicts. At this time, the perceived appropriate level of stress has a positive effect on their mental health and college life adjustment, but sometimes also negatively affects their mental health [2]. Korean adolescents have no choice but to spend their middle and high school years receiving education centered on entrance exams, so they have difficulties in developing the values or norms necessary for establishing personal identity at that time. You are at a time in your life when you have to perform an important developmental task. College students who have entered the Department of Dental Hygiene also have expectations for a new life for new relationships, academic research, and career decisions when values are not established, but they are experiencing embarrassment and confusion about the vague and unprepared university life, having a hard time studying for the national exam need to take. Erirson viewed self-esteem formation as a core developmental task to be accomplished in adolescence [3]. Lim said that adolescence is a very important period for an individual’s socio- psychological developmental stage, and it is a time that must be accompanied by various social demands and role changes necessary for adulthood [4]. According to Erirson, self-esteem is another self-image that is contrary to the self-consciousness formed during adolescence due to rapid physical changes, cognitive and psychological changes and subsequent adaptation, and adaptation to changes in social needs during adolescence. is sought to form and pursue the integrated general self that one will have as an adult in the future [3]. This integrated self-formation process is conceptualized as a crisis between self-esteem and identity chaos, and self-esteem can be said to be a sense of trust in one’s self-worth. Therefore, if college students have a healthy self-esteem, they will be able to overcome wandering and confusion well, have inner stability, and will be able to respond appropriately to the many challenges and opportunities they will face in the future. In a study by Watson et al., the lower the self-esteem level, the higher the aggression, and when the narcissistic tendencies of college students were controlled, the lower the self-esteem, the more anger, hostility, and physical aggression were shown [5]. Reading therapy is one of the best ways to help young college students form self-esteem, which is the most important period in the formation of self-esteem. According to Woo’s research results, reading expands the breadth of experience, deepens and broadens the interest that was lightly overlooked through reading, and makes one think about how to live by relating the results of reading to one’s life [6]. In Son’s study, reading therapy generally meant treating diseases using books or changing attitudes or personality in a healthy direction [7]. Seong’s it is defined as an activity for the purpose of forming a sound personality and establishing values [8]. Reading therapy or bibliotherapy refers to a treatment method used for mental health using books. The etymology is a compound word combining two Greek words, biblion (book, literature) and therapeia (help, medical help, cure), and started from the basic assumption that literature has therapeutic properties. It is known for biblio counceling, biblioe ducation, biblio psychology, tutorial group therapy, library therapeutics, and literatherapy [9-11]. In other words, books are used for overall development, and books are used to measure the character of the reader, and are also used for adaptation, growth, and mental health. The interaction between the book and the reader is called reading therapy. And it is the concept that the thought inherent in the selected book material can have a therapeutic effect on the reader’s systemic or psychological disease [12-14].

Reading therapy includes the use of books to influence overall development, interaction between the reader and the literature used for personal evaluation, adjustment, growth, and clinical and mental health purposes; It is defined as the concept that the ideas inherent in the selected reading material can have a therapeutic effect on the reader’s mental or physical illness [13]. Through reading therapy, dental hygiene and students’ values have been established, and recently, the level of medical service recipients in the dental field and their needs such as interest in health have diversified [15-17], it is thought to be necessary for coping with interpersonal relationships that can bring emotional stability. The purpose of this study is to find out how reading is related to the establishment of self-esteem by administering reading therapy to students in the dental hygiene department, the college student period, when self-esteem develops the most, and by identifying academic self-efficacy and mental health status. Reading therapy is intended to be used when developing a student counseling program.

1. Study subject

Among 74 second-year students who participated in reading therapy among students from the dental hygiene department in city A, those who understood the purpose of this study and agreed to participate in writing were selected. was used for the final analysis. The data collection period was from June to December 2021. As a control group, students from department A of the same university who participated in the program were compared and analyzed before and after the program was implemented.

2. Research tool

The self-esteem scale test produced by Kim [16] was used. Identity is a ‘developmental stage-type self-esteem scale’, based on the ‘self-esteem scale’ produced by Rasmussen and the ‘Ericsson psychosocial development stage scale’ made by Rosenthal et al. [17]. As a measure of self-awareness with the ‘component-type self-esteem’ scale, it is a scale to measure self-esteem by subdividing it more specifically, defining it as sub-component domains, and then measuring each of them. A total of 60 items readjusted by Kim Hyung-tae were used. The scoring method is 40 items, 10 items in each area. The possible scores ranged from 10 to 40 in each domain, and the reliability Cronbach’s α=0.80 in this study.

3. Analysis method

For statistical analysis of the collected data, SPSS 21.0 program (IBM SPSS Statistics, New York, USA) was used, and the significance level of the statistical test was set to α=0.05. The frequency and percentage were calculated for the general characteristics of the study subjects, and the t of the pre- and post-tests to examine the difference between the experimental group and the control group’s developmental stage-type self- esteem scale, the component-type self-esteem scale, and the experimental group and control group the test was carried out.

1. General characteristics of subjects

For demographic characteristics by subject, age distribution was 38 people (52.8%) over 20 years old, gender 68 people (94.4%), religion 25 people without religion (69.4%), 13 people living in Seoul, Gyeonggi (36.1%), one month The amount of reading was ‘not reading’ 16 people (44.4%) and ‘reading one book’ 14 people (38.9%). In the control group, 33 people over 20 (96.9%), 34 women (94.4%), 47 people without education (65.2%), 23 people in Gyeongsang-do (31.9%) living in Gyeongsang-do, 31 people (43.0%) ‘do not read’, and 28 people (38.9%) ‘reading one book’ in monthly reading (Table 1).

Table 1 . Demographic characteristics of the subjects

Category		N (%)
Age	<20	34 (47.2)
	≥20	38 (52.8)
Sex	M	4 (5.6)
	F	68 (94.4)
Religion	Christian	6 (8.3)
	Catholic	9 (12.5)
	Buddhism	5 (7.0)
	No	47 (65.2)
	Etc	5 (7.0)
Region	Seoul, Gyeonggi	21 (29.2)
	Chungcheong-do	9 (12.5)
	Gyeongsang-do	23 (31.9)
	Jeolla-do	5 (7.0)
	Etc	14 (19.4)
Monthly reading books	One	28 (38.9)
	Two	11 (15.3)
	More than three	2 (2.8)
	Unread	31 (43.0)

2. Testing the difference between the experimental group and the control group according to demographic characteristics

Looking at the difference between the experimental group and the control group, the age of the experimental group was 1.14±0.351 and the control group was 1.97±1077, showing a significant difference (p<0.001), and there was no significant difference in other demographic characteristics became (Table 2).

Table 2 . Difference test between experimental group and control group

Category	Experimental group		Control group	F (t)	p-value
	M±SD		M±SD
Age	1.14±0.351		1.97±0.177	11.522 (−12.083)	0.001
Sex	1.94±0.232		1.97±0.176	0.940 (−0.481)	0.336
Grade	1.03±0.167		1.97±0.177	0.028 (−22.585)	0.868
Religion	3,47±0.998		3.66±1.00	0.037 (−0.724)	0.847
Region	2.61±1.54		2.88±1.34	1.773 (−0.751)	0.188
Monthly reading books	2.53±1.40		2.47±1.41	0.003 (0.172)	0.957

3. Developmental stage-type self-esteem scale between the experimental group and the control group

Looking at the developmental stage-type self-esteem scale, the pre-test in the experimental group was 203.91±21.55 and the post-test was 203.44±24.41, showing no statistically significant difference. In the control group, the pre-test was 218.76±30.32 and the post-test was 222.09±35.06, showing a statistically significant difference (p<0.001) (Table 3).

Table 3 . Developmental stage-type self-esteem scale of experimental group and control group (N=34)

Category	Variable	Before		After	t	p-value
		M±SD		M±SD
Experimental group	Total	203.91±21.55		203.44±24.41	0.278	0.779
	Reliability	43.39±4.43		43.51±4.14	0.000	1.000
	Autonomy	40.11±4.07		40.23±5.03	−0.126	0.863
	Initiative	39.79±4.28		39.41±4.87	0.667	0.506
	Diligence	40.44±4.63		39.28±6.11	1.560	0.141
	Sense of identity	40.18±4.14		40.94±4.26	−1.131	0.257
Control group	Total	208.76±30.32		222.09±35.06	−3.194	0.004
	Reliability	44.67±6.85		47.03±5.56	−2.475	0.020
	Autonomy	40.75±5.63		44.65±6.48	−3.813	0.001
	Initiative	38.64±6.87		41.31±7.28	−2.609	0.015
	Diligence	41.63±5.74		43.38±8.95	−1.843	0.077
	Sense of identity	43.07±5.23		45.72±7.09	−3.045	0.005

4. Component-type self-esteem scale of experimental and control groups

Looking at the component-type self-esteem scale, the pre-test in the experimental group was 168.98±18.09 and the post-test was 161.41±20.69, showing no statistically significant difference. In the control group, the pre-test of the component-type self-esteem was 169.59±23.9 and the post-test was 180.44±29.86, showing a statistically significant difference (p<0.001) (Table 4).

Table 4 . The composition of the experimental and control groups and the doll self-esteem scale (N=34)

Category	Variable	Before		After	t	p-value
		M±SD		M±SD
Experimental group	Total	168.98±18.09		161.41±20.69	−0.693	0.493
	Stability	26.24±1.64		26.71±2.73	−1.215	0.233
	Goal orientation	27.04±3.05		27.24±3.63	−0.272	0.787
	Self-existence uniqueness	26.56±2.89		26.93±2.69	−0.274	0.785
	Recognizing Interpersonal Roles	28.44±3.40		28.31±3.82	0.356	0.724
	Self-acceptance	25.26±3.63		24.83±4.09	0.306	0.761
	Self-assertiveness	26.63±3.48		27.39±3.73	−1.224	0.230
Control group	Total	169.59±23.9		180.44±29.86	−3.370	0.003
	Stability	28.44±3.21		29.42±3.82	−1.841	0.078
	Goal orientation	31.37±4.72		32.65±4.97	−2.887	0.008
	Self-existence uniqueness	27.52±3.81		29.77±3.77	−3.356	0.002
	Recognizing Interpersonal Roles	28.29±4.47		30.04±6.34	−2.074	0.047
	Self-acceptance	27.08±4.68		28.61±5.43	−2.120	0.034
	Self-assertiveness	26.89±3.01		29.95±5.53	−3.386	0.003

5. Test the difference between the pre-test and post-test between the experimental group and the control group

Looking at the difference between the pretest between the experimental group and the control group, the developmental stage-type self-esteem scale in the experimental group was 201.82±16.96 in the experimental group and 210.73±27.41 in the control group, showing no statistically significant difference. The esteem scale also showed 188.48±12.85 in the experi-mental group and 189.48±12.85 in the control group, showing no statistically significant difference. And looking at the difference in the posttest between the experimental group and the control group, the developmental stage-type self-esteem scale was 201.11±18.47 for the experimental group and 223.42± 31.47 for the control group, showing a statistically significant difference (p<0.001), and the composition The factor-type self-esteem scale was 172.18±13.62 in the experimental group and 184.42±34.81 in the control group, showing a significant difference (p<0.001) (Table 5).

Table 5 . T-test for differences in pre-post tests between experimental and control groups (N=34)

Category	Variable	Before		After	t	p-value
		M±SD		M±SD
Experimental group	Developmental stage self-identity scale	201.82±16.96		210.73±27.41	1.348	0.159
	Constituent self-identity scale	188.48±12.85		189.88±19.30	1.421	0.187
Control group	Developmental stage-type self-esteem scale	201.11±18.47		223.42±31.47	3.462	0.001
	Factor-type self-esteem scale	172.18±13.62		184.64±34.81	3.253	0.003

This study is a study on the effect of reading therapy on dental hygiene and students’ self-esteem. An attempt was made to identify reading therapy as one of the methods to increase self-esteem by understanding the difference between the self- esteem scale for each developmental stage and the self-esteem scale for each component before and after reading therapy experience. The pretest of the developmental stage-type self-esteem scale of the experimental group showed 203.91±21.55, and the posttest showed 203.44±24.41, showing no statistically significant difference. The pretest of the component-type self-esteem scale of the experimental group was 168.98±18.09, and the posttest showed 161.41±20.69, showing no statistically significant difference. It is considered that there was no change in self-esteem after reading therapy in the experimental group. The pretest of the developmental stage-type self-esteem scale of the control group showed 218.76±30.32, and the posttest showed 222.09±35.06, showing a statistically significant difference. The pre-test of the component-type self- esteem scale of the control group was 169.59±23.9, and the post-test showed a statistically significant difference of 180.44±29.86. After reading therapy, the control group showed a high change in self-esteem. There is a significant difference between the experimental group and the experimental group. Looking at the difference in the posttest between the experimental group and the control group, the developmental stage-type self-esteem scale was 201.11±18.47 in the experimental group and 223.42±31.47 in the control group, showing a significant difference. The component-type self-esteem scale was 172.18±13.62 in the experimental group and 184.64±34.81 in the control group, which was higher in the control group than in the experimental group. Looking at most of the preceding studies, the control group shows a lot of change after reading therapy. According to Lee and Park’s study [18], when the subjects individually compared the pre- test and the post-test, reliability, initiative, and Stability and self-acceptance were increased, and there was no difference in the mean in the control group. Lee [19] found that the results of the reading therapy program showed that the increase in satisfaction with personal and relational aspects of life and satisfaction with the group to which they belong was statistically significant.

If we look at the cause of the lack of change in self-esteem after reading therapy in the experimental group, we can see the attitude of reading discussion. In the experimental group, it was observed that they did not read a book or had a discussion without revealing their inner side during discussion. On the other hand, there is a difference in that the control group read books well, showed their inner side during discussions, and took an active stance [13]. In addition, the lack of time to read books due to the schoolwork with a lot of homework. There-fore, it is necessary to create time for students to establish their values and self-esteem. In addition, reading therapy started at the same time as admission, and there is a lack of motivation. The purpose of this study was to use it as a basic data for a personality education program that can help students establish values and self-esteem in dental hygiene, but it did not have a great effect. However, it was an opportunity to reset the direction of teaching for dental hygiene and students, and I would like to refer to the guidance for the national examination in consideration of the motivation and satisfaction of the students. As this study was measured by extracting students from some universities, there is a limitation in expanding and interpreting the research results as a whole, but it is thought that it can be used as basic data for judging students’ values in dental hygiene. In addition, in order to examine the effects of reading therapy on the establishment of self-esteem for students in the dental hygiene department, it is reflected in the student guidance to positively develop the mental health of students in the dental hygiene department and to identify academic self-efficacy and mental health status. By doing so, we aim to provide a stable device for relieving the stress of college life and help design a student counseling program for a more satisfying college life. From the above results, one study on dental hygiene and reading therapy for students was found to be a factor influencing self-esteem. In the future, repeated studies targeting various fields and classes and follow-up studies to verify their effectiveness are suggested.

This study was conducted to investigate the effect of establishing self-esteem after reading therapy by dental hygiene students. From June 1 to December 17, 2021, a self-report questionnaire was conducted with students in the dental hygiene department of a university located in A city. As a result of analyzing the final 72 people of the survey, the following conclusions were obtained.

1. Age distribution was 38 people over 20 (52.8%), gender 68 people (94.4%), religious affiliation 25 people (69.4%), Seoul Gyeonggi residents 13 people (36.1%), the amount of reading per month was ‘not reading’ There were 16 people (44.4%) of ‘don’t read’, 14 people (38.9%) of ‘reading one book’, and in the control group, 33 people (96.9%) over 20 years old, 34 women (94.4%), and 47 people without education ( 65.2%), Gyeongsang-do was 23 people (31.9%), and the monthly reading amount was ‘do not read’ 31 people (43.0%), and ‘read one book’ 28 people (38.9%).

2. The developmental stage-type self-esteem scale of the control group was 218.76±30.32 in the pretest and 222.09± 35.06 in the posttest, showing a statistically significant difference (p<0.001).

3. The component-type self-esteem scale of the control group was 169.59±23.9 in the pre-test and 180.44±29.86 in the post-test, showing a statistically significant difference (p<0.001).

4. In the posttest difference between the experimental group and the control group, the developmental stage-type self-esteem scale of the experimental group was 201.11±18.47 and that of the control group was 223.42±31.47, showing a statistically significant difference (p<0.001), and the component type The self-esteem scale was 172.18±13.62 in the experimental group and 184.42±34.81 in the control group, showing a significant difference (p<0.001).

From the above results, one study on dental hygiene and reading therapy for students was found to be a factor influencing self-esteem. In the future, repeated studies targeting various fields and classes and follow-up studies to verify their effectiveness are suggested.

No potential conflict of interest relevant to this article was reported.