Nature Based Interventions for Human Health and Wellbeing

Background. Nature exposure is beneficial to human health and wellbeing, but the evidence base for nature-based interventions (NBI) is still developing. Heterogeneous naming conventions, study designs, and intervention contexts create difficulty in accessing and assessing the evidence for such programming. While NBI have been utilized in a wide array of human populations, no interventions have been reported among clinical health professions students. Aims. The objectives of this dissertation project were to review the existing body of NBI literature exploring health and wellbeing outcomes, and to conduct a feasibility trial of forest bathing, a type of NBI, among clinical students. Specifically, this study aimed to: (Aim 1) conduct a scoping review to (1) identify the different nomenclature used to define NBI, (2) describe the NBI utilized and the contexts in which they occurred, and (3) describe the methodologies used in studies of NBI; (Aim 2) assess the feasibility of implementing a pilot forest bathing intervention for stress management among clinical health professions students; and (Aim 3) assess the preliminary effectiveness of a pilot forest bathing intervention for stress management among clinical health professions students. Methods. (Aim 1) A scoping review was conducted following a prospectively published protocol and adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. We searched PubMed, Web of Science, Scopus, and ProQuest Dissertations and Theses Global for studies on NBI in humans. Dual independent screening and single-author data abstraction were conducted. (Aims 2 and 3) A single-arm feasibility trial of a six-week forest bathing intervention was conducted. Proctored, self-guided sessions were held on weekday afternoons in a local arboretum. The protocol was prospectively registered and CONSORT reporting guidelines were followed. Participants were clinical students enrolled in a public university in the United States. Aim 2 used qualitative (surveys, focus group, and researcher observation) and quantitative (surveys) methods to assess the feasibility of implementing the program. Aim 3 used quantitative survey data to explore preliminary effectiveness measures: perceived stress, attitudes toward spending time in nature (TSN), self-efficacy TSN, and intentions TSN. Results. (Aim 1) A total of 406 papers comprising 416 reported studies were included. Multi-day programs, repeated short-session programs, and single short-session programs comprised the sample. NBI were reported in 36 countries and published as dissertations and peer-reviewed papers in 160 journals. 155 unique NBI names were reported. (Aim 2) 413 students were invited to participate in the program, and 13 students enrolled. Seven individuals participated in at least one session; of those attending at least once, five (71.4%) attended at least five of the six sessions. Measures and data collection methods were well-received and reliably reported. Interpersonal commitment was a primary facilitator to participation, and time constraints were a key barrier. (Aim 3) Participants reported positive affective impacts during 63.6% (n=21) of sessions, and present stress declined significantly over a single 40-minute session (p=0.0007). Over the course of the study and into follow-up, stress decreased by half of a point on the Perceived Stress-10 scale per week (p=0.0308). Participating enrollees and non-participating enrollees may have differed on baseline perceived stress, baseline positive attitudes TSN, and time spent in nature in the week prior to enrollment. Conclusion. (Aim 1) Taken on the whole, NBI are highly diverse in design and reporting. The field of research would be strengthened by the development of (1) consistent naming conventions and (2) NBI-specific reporting guidelines (i.e., a checklist). (Aims 2 and 3) While recruitment proved challenging in this population, preliminary evidence suggests that forest bathing or other NBI may be acceptable and beneficial for clinical students experiencing stress. Further feasibility work should explore weekend-based NBI programming offering guided activities

Factors Associated with Physical Activity Increases and Decreases Among a Sample of Appalachian Residents During the COVID-19 Pandemic: A Cross-Sectional Study

Introduction: Physical activity (PA) can prevent and reduce the deleterious physical and mental health effects of COVID-19 and associated lockdowns. Research conducted early in the pandemic demonstrates that a greater proportion of adults in the U.S. have decreased than increased PA, and the effects vary by sociodemographic factors. Ongoing evidence is important to identify patterns in PA changes during the pandemic. Purpose: This study aims to identify factors associated with increases and decreases in PA during the COVID-19 pandemic in a convenience sample of adults residing in Appalachia. Methods: Surveys were collected from a convenience sample of adults from eight counties in West Virginia from January to March 2021. Logistic regression analysis was used to identify sociodemographic, health, and rurality factors associated with (1) increased PA and (2) decreased PA during the pandemic, assessed retrospectively via self-report. Results: Analysis of 1,401 survey responses revealed that better self-rated health, lower body mass index, and higher income and education were associated with a greater likelihood of more time spent doing PA during the pandemic (p ≤ .05). Respondents with lower self-rated health, higher body mass index, lower income, and lower levels of education—plus females and those living in a more urban county—were more likely to spend less time doing PA during the pandemic (p ≤ .05). Implications: Analyses suggest that pre-pandemic disparities in PA by health, wealth, and education were exacerbated during the pandemic. These must be addressed before physical inactivity and ill health become endemic to the Appalachian Region

Context, classification and study methodologies in research into nature-based therapies: protocol for a scoping review

Introduction Nature provides an array of health benefits, and recent decades have seen a resurgence in nature-based interventions (NBI). While NBI have shown promise in addressing health needs, the wide variety of intervention approaches create difficulty in understanding the efficacy of NBI as a whole. This scoping review will (1) identify the different nomenclature used to define NBI, (2) describe the interventions used and the contexts in which they occurred and (3) describe the methodologies and measurement tools used in NBI studies. Methods and analysis Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols Extension for Scoping Reviews, four databases will be searched (PubMed, Web of Science, Scopus, ProQuest Dissertations and Theses Global) as well as cross-referencing for published and unpublished (masters theses and dissertations) studies on NBI in humans. Eligible studies must employ intervention or observational designs, and an English-language abstract will be required. Database searches will occur from inception up to the date of the search. Animal-based therapies and virtual-reality therapies involving simulated nature will be excluded. Independent dual screening and data abstraction will be conducted. Results will be analysed qualitatively as well as with simple descriptive statistics (frequencies and percentages). Ethics and dissemination Since this is a scoping review of previously published summary data, ethical approval for this study is not needed. Findings will be published in a peer-reviewed journal. This protocol has been registered with Open Science Framework (https://osf.io/mtzc8)