Cultivating our humanity: A systematic review of care farming & traumatic grief

Co-producing Human and Animal Experimental Subjects: Exploring the Views of UK COVID-19 Vaccine Trial Participants on Animal Testing

Preclinical (animal) testing and human testing of drugs and vaccines are rarely considered by social scientists side by side. Where this is done, it is typically for theoretically exploring the ethics of the two situations to compare relative treatment. In contrast, we empirically explore how human clinical trial participants understand the role of animal test subjects in vaccine development. Furthermore, social science research has only concentrated on broad public opinion and the views of patients about animal research, whereas we explore the views of a public group particularly implicated in pharmaceutical development: experimental subjects. We surveyed and interviewed COVID-19 vaccine trial participants in Oxford, UK, on their views about taking part in a vaccine trial and the role of animals in trials. We found that trial participants mirrored assumptions about legitimate reasons for animal testing embedded in regulation and provided insight into (i) the nuances of public opinion on animal research; (ii) the co-production of human and animal experimental subjects; (iii) how vaccine and medicine testing, and the motivations and demographics of clinical trial participants, change in an outbreak; and (iv) what public involvement can offer to science.

Characteristics of natural environment use by occupational therapists working in mental health: a scoping review protocol

OBJECTIVE

The objective of this review is to identify and characterize the use of the natural environment/outdoor space by occupational therapists working in mental health care.

INTRODUCTION

Research has shown that the natural environment is beneficial for our health and can be used to help people who are experiencing mental health problems. Occupational therapists are well placed to assess and utilize the environment when treating people with mental health problems; however, the use of the natural environment/outdoor space by occupational therapists working in mental health is unclear.

INCLUSION CRITERIA

This scoping review will include both primary research and gray literature relating to the use of the natural environment/outdoor space in mental health occupational therapy practice. The review will be limited to studies published in English. There will be no geographical or age restrictions.

METHODS

Embase (Ovid), MEDLINE (Ovid), CINAHL (EBSCO), PsycINFO (ProQuest), AMED (EBSCO), Trip Database, Emcare (Ovid), and OTSeeker will be searched for studies. Unpublished studies and gray literature will be searched using GreyNet and National Grey Literature Collection, alongside professional magazines and websites. Titles and abstracts will be screened by 2 independent reviewers for assessment against the inclusion criteria, followed by a full-text review and data extraction. Any disagreements will be discussed with a third reviewer. Data will be extracted using a data extraction tool developed by the reviewers, and presented in tabular format, accompanied by a narrative summary describing how the results relate to the review objective and question.

Exploring how greenspace programmes might be effective in supporting people with problem substance use: a realist interview study

BACKGROUND

Greenspace programmes are health projects run outside in nature, typically with the aim of improving mental health. Research suggests that programmes may also be effective in supporting people with problem substance use (PSU), but there is limited understanding of the key components that make them successful for this client group. Previous work has claimed that a realist-informed intervention framework for greenspace programmes for mental health could be transferable to programmes that support people with PSU, and that this could provide insight into the causal processes within programmes. However, this claim is yet to be explored in depth. The aim of this study was to further test, refine, and consolidate the proposed framework to show how greenspace programmes could support people with PSU.

METHODS

Using a realist approach, 17 participants (8 programme staff; 9 wider stakeholders) were interviewed about contexts, mechanisms, and outcomes (CMOs) relative to greenspace programmes for mental health and PSU. Semi-structured interviews were used since they facilitated exploration of the proposed framework but were flexible enough to allow identification of new CMOs for framework refinement. Interviews were audio-recorded, fully transcribed, and analysed inductively and deductively against the proposed framework.

RESULTS

Findings supported the proposed framework and indicated that greenspace programmes support people with poor mental health and PSU due to: feelings of escape; space to reflect; physical activity; self-efficacy; feelings of purpose; relationships; and shared experiences. However, data showed that programmes must also consider: explicit intervention focus to ensure adequate support for clients; existing challenges with funding and stakeholder buy-in; and the impact of COVID-19. Findings allowed development of a refined framework that shows how greenspace programmes can support people with PSU.

CONCLUSION

The findings of this project are theoretically novel and have practical relevance for those designing greenspace programmes by providing recommendations on how to optimise, tailor, and implement future interventions. Findings could be particularly relevant for academic researchers, multidisciplinary health professionals, and for those working in the third sector, developing and delivering greenspace programmes for people to improve their mental health and to support them with PSU.

Nature-based interventions for bereavement care: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to understand the types of nature-based interventions currently used in bereavement care and to map the theories of change explaining how such interventions may support bereavement care.

INTRODUCTION

Bereavement can be associated with adverse psychosocial health outcomes. Nature-based interventions have been shown to have positive health and well-being outcomes, and offer diverse and flexible design and delivery options. However, this is an emerging field, and there is a need to explore the literature on the different types of nature-based interventions used in bereavement care and to identify the underpinning theories of change.

INCLUSION CRITERIA

This review will include studies or reviews of participants who have experienced bereavement following the death of a loved one, and who have taken part in a nature-based intervention (eg, animal-assisted therapy, care farming, therapeutic horticulture, community gardens). Considering all nature contexts and geographic locations, this review will include studies that explore the role of nature-based interventions in bereavement care.

METHODS

Searches will be conducted in eight databases: Web of Science, Scopus, PubMed, PsycINFO, CINAHL, Social Science Database (ProQuest), PTSDpubs (ProQuest), and Research Library: Health and Medicine (ProQuest). Manual searches of reference lists of included full-text articles and keyword searches of prominent journals will be conducted. Data on the type of nature-based intervention, target sample, health outcomes, measures and methods used, and theory of change will be extracted from selected articles. The data extraction results will be presented in tabular format along with a narrative summary.

Greenspace programmes for mental health: A survey study to test what works, for whom, and in what circumstances

The health benefits of greenspace are widely acknowledged. Greenspace programmes, defined as health programmes undertaken in outside green areas such as parks, gardens, hills, and forests, are becoming more commonplace. However, there is still limited understanding of the mechanisms by which greenspace programmes are effective. This makes future development and implementation very difficult. We recently developed and published a novel framework for greenspace programmes for mental health showing what works, for whom, and in what circumstances (Masterton et al., 2020). In this current study, the accuracy of the proposed framework was tested for the first time using primary data from greenspace organisations in Scotland. Given the link between mental health and substance use, the applicability of the framework to programmes that support people with problem substance use was also tested. A survey was designed to test the contexts, mechanisms, and outcomes identified within the previously proposed framework. The survey was completed by 64 participants to provide a general overview of the framework's applicability for programmes that support mental health, as well as for programmes that support people with problem substance use. Overall, respondents agreed with all survey statements. This suggests that the framework does effectively represent the underlying context, mechanism, outcome configurations of greenspace programmes for mental health. Furthermore, there were no differences between responses from organisations that support people with problem substance use, and organisations that do not support this client group. This shows that the framework has the potential to be applicable to both greenspace programmes for mental health and greenspace programmes for people with problem substance use. This is a novel finding as, to our knowledge, there is currently no framework looking to explain the contexts, mechanisms, and outcomes necessary for greenspace programmes to be successful for people with problem substance use.

"Perhaps something of beauty can grow:" experiences of care farming for grief

Care farming has been used to alleviate distress and increase wellbeing in various populations. This study provides an overview of how bereaved adults (N = 115) experienced a grief-specific care farm through a content analysis of open-ended survey questions. The care farm's nature spaces and interactions with animals emerged as important components of the experience, interacting with grief-related activities and experiences. Together, the spaces and species of the care farm provided a supportive context for integrating grief, processing emotions, and receiving compassionate support. Some participants also experienced changes in how they viewed their grief and improvements in interpersonal relationships.

A nature-based health intervention at a military healthcare center: a randomized, controlled, cross-over study

We describe a mixed qualitative and quantitative research study in a military facility regarding the role of nature in well-being. Study intervention included two 20-minute walks. One walk was in an intentionally designed woodland environment (Green Road) and the other was on a busy campus road in a medical treatment facility (Urban Road). Twelve volunteers from a military facility participated in both walks in a cross-over experimental design. The two walking sessions were randomly ordered and preceded by pre-walk instructions appropriate to each road’s characteristics and incorporated focused attention and present moment orientation. A semi-structured post-walk interview, the primary outcome, was conducted after the conclusion of each walk. Qualitative data analyses consisted of sentiments and themes by using NVivo 12 software. The Green Road was unanimously rated as positive (100%). Responses to Urban Road were evenly distributed among positive (33.3%), negative (33.3%), and neutral/mixed (33.3%) sentiments. The Green Road yielded predominantly positive themes such as enjoyment of nature, relaxation, and feelings of privacy and safety. Urban Road produced significantly more negative themes such as concerns for safety, dislike of noise and other noxious experiences. Quantitative assessment of distress and mindfulness with Distress Thermometer (DT) and Mindful Attention Awareness Scale-state version (MAAS) demonstrated that a walk on the Green Road significantly decreased distress and increased mindfulness compared to a walk on the Urban Road. We also observed that pre-walk instructions could direct attention to both obvious and subtle elements of experience and enhance awareness. Results support the notion that an intentional nature-based environment may produce significantly more positive experiences and result in health-promoting benefits in a military health-care setting compared to an urban environment. Future studies with clinical populations could advance our understanding of the healing value of nature-based interventions. The impact of intentional green environments may be enhanced by well-designed instructions for both recreational and therapeutic use.

Evaluating care farming as a means to care for those in trauma and grief

The interrelationships between nature, health, and wellbeing are increasingly recognized and incorporated into therapeutic interventions. Care farming, the concept of utilizing agricultural places and practices for providing care, therapy, and rehabilitation, is a paradigmatic example of this shift. This mixed method study empirically evaluates the efficacy of care farming as an intervention for individuals affected by traumatic grief, a complex experiential condition. Both quantitative and qualitative results suggest this care farm intervention was beneficial, yielding significant reductions in subjective distress to grief intensity. The study's findings add to the growing body of evidence on care farming and support green care as a therapeutic potential for individuals affected by traumatic grief.

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Few interventions have been successfully tested with those suffering traumatic grief. Care farming is a potential alternative means toward provision of care for the traumatically grieving population.

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After a two-day, 10 h intervention, participants experienced significantly less subjective trauma and distress in pre/post tests using the TGI psychometric measures.

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Rich qualitative data reveal that participants felt supported, connected, and yielded therapeutic benefit.

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Given the lack of consensus on the use psychotropic medications for grief, green models, such as care farming, provide to care that is not limited to a medical model.

An ambivalent atmosphere: Employment training programs and mental health recovery

This article critically examines the role of employment training programs in the personal recovery of adults living with mental illness in community settings. Using Cameron Duff's (2014) notion of 'assemblages of recovery,' we explore how, and to what extent, employment training programs provide the supportive resources linked to personal recovery. Using an ethnographic case study, we describe the ambivalent atmospheres associated with one program. This ambivalence expresses the fundamental tension between the genuine aspirations of personal recovery and the realities of the capitalist labor process.

[What is the scientific evidence with regard to the effects of forests, trees on human health and well-being?]

In today's modern society, lifestyle-related diseases play an increasingly important role as the cause of bad health. Staying in and access to environments that contain natural elements such as forests, parks and gardens has been featured because of its potential to stimulating people's health and well-being. An independent research area has developed, which addresses issues that try to explain and document the health effects of access to and activities in nature. To bring together European researchers working with different aspects of the relation between nature and health, COST Action E39 "Forests, Trees, and Human Health and Wellbeing" was established in 2004 and terminated in November 2009. The main results of COST E39 was presented in the book "Forests, Trees and Human Health" published in 2011. This article focuses on three central research questions regarding the relationship between nature and health: (1) Nature's restorative and salutogenic effects on human beings, (2) Health effects of outdoor physical activities, and (3) Therapeutic interventions such as therapy gardens and forest bathing. Based on a systematic review of research carried out in the aftermath of the COST Action the following conclusions are made: (1) There is a remarkable amount of research publications showing a statistical correlation between access to nature and green areas and human physical activity and health. However, there are few studies that really prove a causal relationship, i.e. that access to green areas leads to increased physical activity and better health. (2) The existing research on outdoor activities in natural environments describes a number of positive associations and effects on health, and the evidence for some of these are convincing, albeit there must be reservations for the immediate applicability of the conclusions. (3) A lot of studies also show that nature-based therapeutic interventions work and provide clear positive effects, but there is serious criticism about the quality of the studies. Finally, the authors suggest more emphasis on research regarding the economic benefits of nature's health effects, more research on the effects of nature-based therapeutic interventions, and of broadening the theoretical basis. Furthermore, we foresee a better integration with health policies and practical implementation within urban planning and forest management.

Using the natural environment to address the psychosocial impact of neurological disability: A systematic review

Engaging with the natural environment contributes to favourable psychosocial health outcomes. A systematic review of research published before June 2017 was conducted to establish how engaging with natural environments impact the psychosocial health of people with a neurological disability. Identified studies included populations with dementia (n=14), brain injury (n=2), and stroke (n=2). Evidence suggests that engaging with gardens, and gardening, can favourably impact the emotional and social health of people with dementia and, an explanatory theoretical model is proposed. Considerable research gaps exist and further research investigating the psychosocial impact of engaging with natural environments for people with different neurological conditions (for example spinal cord injury or stroke) is warranted.