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Nature-based interventions to promote health in people with stress-related illness
Luleå University of Technology, Department of Health, Education and Technology, Nursing and Medical Technology.ORCID iD: 0000-0003-1367-2247
2024 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Naturbaserade interventioner för att främja hälsa hos personer med stressrelaterad ohälsa (Swedish)
Abstract [en]

Stress-related illness is increasing and is a common cause of sick leave in Sweden. Spending time in nature reduces stress and promotes health and well-being. Consequently, nature-based interventions (NBI) for people with stress-related illness have been developed, implemented and studied in southern Scandinavia. However, such interventions are uncommon in the Circumpolar North with a different climate which affect conditions for outdoor activities. 

The overall aim of this doctoral thesis was to explore NBIs to promote health in people with stress-related illness from the perspectives of previous research, people with stress-related illness, healthcare professionals and entrepreneurs offering NBIs with a specific focus on northern natural conditions.

The thesis includes four studies. An integrative literature review (I) identified and summarised scientific studies of NBIs for people with stress-related illness. Studies using both qualitative and quantitative designs were included. Study II explored key stakeholders’ perceptions of the value of NBIs in promoting health in people with stress-related illness. Semi-structured interviews were conducted with people with stress-related illness experience, healthcare professionals, and entrepreneurs offering NBI and data were analysed through qualitative content analysis. In study III people with stress-related illness experiences of participating in an NBI program in a northern natural setting were explored. A longitudinal case study design was used, and data were collected through repeated semi-structured interviews, diary entries and self-assessment questionnaires. Qualitative content analysis was used to analyse interviews and reflections from diaries and data from self-assessing questionnaires were presented descriptively. Study IV explored people with stress-related illness experiences of nature prescription. Data were collected through interviews with open-ended questions and analysed with a phenomenological-hermeneutic method.

Findings show that natural environments offer unique qualities for individualised, meaningful activities and interactions with others in a non-demanding atmosphere. In NBI people with stress-related illness find a source for recovery, joy, and well-being. Spending time in nature is perceived as calming and facilitates being in the present. NBIs improve health and strengthen self-efficacy and work ability. Time in nature provides new perspectives, supports existential reflections, and empowers people with stress-related illness to find opportunities for change to achieve balance in everyday life. NBIs can be helpful for people with stress-related illness to overcome barriers to going out in nature or to find their way back to nature. 

In conclusion, NBIs seem to be beneficial in promoting health in people with stress-related illness. Different stakeholders have similar perceptions of the value of NBIs, indicating that it could be a valuable complement to health care. NBIs in a northern natural setting seems to have similar health promoting qualities as those seen in studies of NBIs in other natural settings.

Place, publisher, year, edition, pages
Luleå: Luleå University of Technology, 2024.
Series
Doctoral thesis / Luleå University of Technology 1 jan 1997 → …, ISSN 1402-1544
Keywords [en]
case study, experience, health promotion, literature review, nature-based intervention, nature prescription, nursing, qualitative research, stress-related illness
National Category
Nursing
Research subject
Nursing
Identifiers
URN: urn:nbn:se:ltu:diva-105465ISBN: 978-91-8048-581-4 (print)ISBN: 978-91-8048-582-1 (electronic)OAI: oai:DiVA.org:ltu-105465DiVA, id: diva2:1857791
Public defence
2024-09-20, E632, Luleå University of Technology, Luleå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2024-05-14 Created: 2024-05-14 Last updated: 2024-05-14Bibliographically approved
List of papers
1. Nature-based interventions to promote health for people with stress-related illness: An integrative review
Open this publication in new window or tab >>Nature-based interventions to promote health for people with stress-related illness: An integrative review
2022 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 36, no 4, p. 910-925Article, review/survey (Refereed) Published
Abstract [en]

Background

Stress-related illness is increasing and is a common cause of sick leave. Spending time in nature have a positive effect on health and well-being for instance by reducing stress. Specific programmes with nature-based interventions (NBI) with the intention to involve people in activities in a supportive natural environment have been developed for people with stress-related illness.AimTo identify and summarise scientific studies of NBIs to promote health for people with stress-related illness.

Method

The design used in this study is integrative literature review. Scientific studies focusing on any type of NBI for people with stress-related illness were sought in Cinahl, PubMed, PsycInfo, AMED and Scopus. In total, 25 studies using both qualitative and quantitative designs were included in the review.ResultThe reviewed studies focused on garden or forest interventions. In the majority of the studies, NBIs were performed in groups, including individual activities, and the length of programmes varied. Interventions in natural environments have unique qualities for individualised, meaningful activities and interactions with others in a non-demanding atmosphere. NBIs offer restoration that reduces stress, improves health and well-being and strengthen self-efficacy and work ability. Connectedness with nature support existential reflections and people with stress-related illness can achieve balance in everyday life.

Conclusion

In conclusion, NBIs may have advantages to promote health for people with stress-related illness and should therefore be considered as an alternative to those affected. Further research from different perspectives, including nursing, is needed to understand the possibilities of NBIs and how they can be integrated into practice.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
Keywords
health promotion, literature review, natural environment, nature- based intervention, stress- related illness
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-90867 (URN)10.1111/scs.13089 (DOI)000798817100001 ()35604072 (PubMedID)2-s2.0-85130322184 (Scopus ID)
Funder
Norrbotten County CouncilInterreg NordLuleå University of Technology
Note

Validerad;2022;Nivå 2;2022-11-11 (joosat);

Available from: 2022-06-02 Created: 2022-06-02 Last updated: 2024-05-14Bibliographically approved
2. Stakeholders’ perceptions of value of nature-based interventions in promoting health in people with stress-related illness: a qualitative study
Open this publication in new window or tab >>Stakeholders’ perceptions of value of nature-based interventions in promoting health in people with stress-related illness: a qualitative study
2024 (English)In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 83, no 1, article id 2349330Article in journal (Refereed) Published
Abstract [en]

Stress-related illness is a common and increasing cause for sick leave in Sweden. Spending time in nature reduces stress and promotes health and well-being. Accordingly, nature-based interventions (NBI) for people with stress-related illness have been developed and implemented in southern Scandinavia; however, such interventions are uncommon in the Circumpolar North. Previous studies have examined the effects and experiences of participating in NBI, but research about different stakeholders’ perspectives on NBI is lacking. The aim of this study was to explore different key stakeholders’ perceptions of the value of NBI in promoting health in people with stress-related illness. Data were collected through semi-structured interviews with 11 persons with stress-related illness experience, 14 healthcare professionals, and 11 entrepreneurs offering NBI. Qualitative content analysis resulted in four categories: Providing opportunity for recovery, Offering new perspectives and opportunity for reflection, Empowering balance and control in life, and Enabling one to overcome barriers. Although the study was conducted in a region where NBI is not widely implemented, the different stakeholders expressed similar perceptions of the value of NBI, indicating that NBI may be a valuable complement to health care which reaches people with stress-related illness needs and promotes their health. 

Place, publisher, year, edition, pages
Taylor & Francis, 2024
Keywords
Health promotion, nature-based intervention, nursing, qualitative study, stakeholder, stress-related illness, value
National Category
Nursing
Research subject
Nursing; Entrepreneurship and Innovation
Identifiers
urn:nbn:se:ltu:diva-105466 (URN)10.1080/22423982.2024.2349330 (DOI)
Funder
Interreg NordNorrbotten County CouncilLuleå University of Technology
Note

Validerad;2024;Nivå 2;2024-05-14 (joosat);

Funder: EU;

Full text: CC BY-NC License

Available from: 2024-05-14 Created: 2024-05-14 Last updated: 2024-05-14Bibliographically approved
3. Experiences of a nature-based intervention program in a northern natural setting: A longitudinal case study of two women with stress-related illness
Open this publication in new window or tab >>Experiences of a nature-based intervention program in a northern natural setting: A longitudinal case study of two women with stress-related illness
2023 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 18, no 1, article id 2146857Article in journal (Refereed) Published
Abstract [en]

Purpose

This study explored the experiences of people with stress-related illness participating in a nature-based intervention programme in a northern natural setting.

Methods

A longitudinal case study was conducted with two women participating in a nature-based intervention programme on a farm. Data were collected by semi-structured interviews, diaries, rating scales, and self-assessment. Qualitative data were analysed by qualitative content analysis and quantitative data are presented descriptively.

Results

The theme of finding a source for recovery and well-being permeates all categories. The participants perceived the farm and nature to be a calming refuge; they learned to be in the present and could manage the tasks. In togetherness with each other and the facilitator on the farm they felt understood and confident, experienced joy, and found opportunities for change. They gained knowledge and positive memories and found new approaches in life. Self-assessment questionnaires indicated improvements of functioning in everyday life and reduced stress-related exhaustion at the end of the NBI programme.

Conclusions

Nature-based interventions lasting for a relatively short period seem to promote health and may be a complement to other treatments of stress-related illness. Further research is needed with a larger number of participants and in various natural settings.PurposeThis study explored the experiences of people with stress-related illness participating in a nature-based intervention programme in a northern natural setting.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Case study, nature-based interventio, nnatural setting, recovery, stress-related illness, well-being
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-94333 (URN)10.1080/17482631.2022.2146857 (DOI)000890913300001 ()36433841 (PubMedID)2-s2.0-85142856418 (Scopus ID)
Projects
New Nordic Nature Based Service Models
Funder
Interreg NordNorrbotten County CouncilLuleå University of Technology
Note

Validerad;2022;Nivå 2;2022-11-29 (sofila);

Funder: European Union

Available from: 2022-11-29 Created: 2022-11-29 Last updated: 2024-05-14Bibliographically approved
4. The meaning of nature prescription for people with stress-related illness
Open this publication in new window or tab >>The meaning of nature prescription for people with stress-related illness
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-105464 (URN)
Available from: 2024-05-14 Created: 2024-05-14 Last updated: 2024-05-14

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