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Jong MC, Fernee CR, Stenling A, Lown EA, Berntsen S, Victorson DE, Jong M. Protocol of a randomised controlled multicentre trial investigating the effectiveness and safety of a wilderness programme on the mental and physical well-being of adolescents and young adults affected by cancer: the WAYA-2 study. BMJ Open 2024; 14:e087626. [PMID: 38772886 PMCID: PMC11110565 DOI: 10.1136/bmjopen-2024-087626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/09/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION Adolescents and young adults (AYAs) affected by cancer are an understudied group. Effective interventions are needed to support coping with the late effects of cancer, its treatment and to promote quality of life. Nature-based interventions may be promising in support of the self-management and health of AYAs affected by cancer. However, randomised controlled studies (RCTs) on the effectiveness of such interventions are lacking. We performed a first pilot RCT (n=42) that showed that it is feasible and safe to conduct such a study. Here, we propose a full-scale RCT to investigate the effectiveness and safety of a wilderness programme on the mental and physical health of AYAs affected by cancer. METHODS AND ANALYSIS Participants are 150 AYAs affected by cancer, aged 16-39 years, who will be randomised to a wilderness (n=75) or a hotel stay (n=75). The wilderness programme is an 8-day intervention including a 6-day wilderness expedition. This is followed 3 months later by a 4-day intervention including a 2-day basecamp. Activities include hiking, backpacking, kayaking, rock climbing, mindfulness and bush-crafting. The comparison group is an 8-day hotel stay followed by a 4-day hotel stay (interventions include two travel days) at the same hotel after 3 months. Primary outcomes are psychological well-being and nature connectedness up to 1 year after the study start. Secondary outcomes are quality of life, physical activity and safety parameters. ETHICS AND DISSEMINATION The Swedish Ethical Review Authority approved the study protocol on 27 September 2023 (reference: 2023-05247-01). The recruitment started on 19 February 2024 and the first part is planned to end on 31 December 2027. Study results will be disseminated by means of scientific publications, presentations at conferences, popular articles, interviews, chronicles and books. News items will be spread via social media, websites and newsletters. TRIAL REGISTRATION NUMBER ISRCTN93856392.
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Affiliation(s)
- Miek C Jong
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
- Department of Community Medicine, National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway Faculty of Health Sciences, Tromso, Norway
| | - Carina Ribe Fernee
- Department of Child and Adolescent Mental Health, Sorlandet Hospital Kristiansand, Kristiansand, Norway
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Andreas Stenling
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Department of Psychology, Umeå University, Umea, Sweden
| | - E Anne Lown
- Department of Social & Behavioral Sciences, University of California, San Francisco, California, USA
| | - Sveinung Berntsen
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - David E Victorson
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Mats Jong
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
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Jong M, Stub T, Jong MC. Supporting Personal Growth in Childhood, Adolescent and Young-Adult Cancer Survivors Through Challenges in Nature - A Qualitative Study of WAYA Wilderness Programme Participation. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241238150. [PMID: 38464957 PMCID: PMC10924559 DOI: 10.1177/27536130241238150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/31/2024] [Accepted: 02/22/2024] [Indexed: 03/12/2024]
Abstract
Background Childhood, adolescent and young-adult (AYA) cancer survivors often experience health problems due to late or long-term effects of their cancer or the treatment thereof. The general population gains health benefits from immersion in nature, and nature-based programmes seem to be an intervention that can promote health among childhood and AYA cancer survivors. Objective To explore the impact of the WAYA wilderness programme on the health of childhood and AYA cancer survivors. Methods The study had a qualitative approach, with data from individual interviews (n = 18) 3 months after completion of the WAYA programme. In addition, case report data was collected during follow-up talks (1, 2 and 12 months after the programme) (n = 19). The WAYA programme consisted of an 8-day expedition, followed 3 months later by a 4-day base camp. The programme included activities such as hiking, backpacking, kayaking, rock climbing, bushcraft and mindfulness. Data was analysed according to a qualitative content analysis. The consolidated criteria for reporting qualitative research (COREQ) were followed. Results An overarching theme was identified: "Personal growth from challenges in nature supported by deep connections with others". In 4 additional themes, participants' experiences describe how deep personal connections arose, as they developed a feeling of being able and competent in nature. Nature provided a space that supported relaxation and respite from everyday challenges and stimuli, which also led to an experience of being more connected to nature. Conclusion The WAYA programme was experienced as being of support to childhood and AYA cancer survivors. The programme provided them with skills and tools to be safe in nature. When connected to nature, the participants developed trust and self-confidence, personal growth, relaxation and recovery from stress. Their engagement in outdoor activities continued after completion of the programme, when they returned to everyday life at home.
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Affiliation(s)
- Mats Jong
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Trine Stub
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, UiT, Tromsø, Norway
| | - Miek C Jong
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, UiT, Tromsø, Norway
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Jong MC, Dahlqvist H, Lown EA, Schats W, Beckman L, Jong M. A randomized controlled pilot study assessing feasibility and safety of a wilderness program for childhood, adolescent, and young adult cancer survivors: the WAYA study. BMC Public Health 2023; 23:1504. [PMID: 37553637 PMCID: PMC10410899 DOI: 10.1186/s12889-023-16408-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 07/27/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The majority of childhood, Adolescent and Young Adult (AYA) cancer survivors suffers from long-lasting health issues following cancer treatment. It is therefore critical to explore effective health promotion strategies to address their needs. Exposure to nature is a promising approach to support the needs of young cancer survivors. This study investigated whether it is feasible to conduct a randomized controlled trial (RCT) of a wilderness program for childhood and AYA cancer survivors. METHODS Eligible participants were aged 16-39 years, had a cancer diagnosis, and met minimal criteria. Seventy-one individuals expressed interest and 59 were randomized to either a wilderness or a holiday program. The wilderness program involved an 8-day expedition including backpacking, sea kayaking, gorge climbing, camping, bush-craft skills, and mindfulness-practices. It was followed by a 4-day basecamp after 3 months. The comparison was an 8-day holiday program at a Spa-hotel followed by a 4-day holiday program at the same hotel after 3 months. Primary outcome was study feasibility and safety. RESULTS Ultimately, 19 AYAs participated in the wilderness and 23 in the holiday program. All completed the study at one-year follow-up. Participants were mostly female (70%) and represented diverse cancers. Clinical characteristics were similar between study arms excepting greater age at cancer diagnosis in the wilderness program (age 19.1 vs. 12.5; p = 0.024). Program adherence and data completeness was high (> 90%) in both arms. Adverse Effects (AEs) in the wilderness vs. the holiday program were similar (Relative Risk: 1.0, 95% Confidence Interval 0.8-1.3). The most frequent AE was tiredness, all were mild to moderate in severity, and serious AEs were not reported. Nature connectedness significantly increased over time in the wilderness program participants, but not in the holiday program (p < 0.001). No differences were found between the two study arms regarding quality of life, self-esteem, or self-efficacy. CONCLUSION It is feasible to conduct a RCT and a supervised wilderness adventure is equally safe for childhood and AYA cancer survivors as a holiday program. This pilot study lays the foundation for a larger RCT to investigate the effectiveness of wilderness programs on the health of young cancer survivors. TRIAL REGISTRATION DATE AND NUMBER 18/02/2021, NCT04761042 (clinicaltrials.gov).
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Affiliation(s)
- Miek C Jong
- Department of Health Sciences, Mid Sweden University, Holmgatan 10, 851 70, Sundsvall, Sweden.
- The Arctic University of Norway, National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, UiT, Hansine Hansens Veg 18, 9019, Tromsø, Norway.
| | - Heléne Dahlqvist
- Department of Health Sciences, Mid Sweden University, Holmgatan 10, 851 70, Sundsvall, Sweden
| | - E Anne Lown
- Department of Social & Behavioral Sciences, University of California San Francisco, 490 Illinois Street, SBS, Box 0612, San Francisco, CA, 94143, USA
| | - Winnie Schats
- Scientific Information Service, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Lars Beckman
- Department of Oncology, Sundsvall Hospital, 85186, Sundsvall, Sweden
| | - Mats Jong
- Department of Health Sciences, Mid Sweden University, Holmgatan 10, 851 70, Sundsvall, Sweden
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Lindgren Westlund K, Jong M. Quality of Life of People with Mobility-Related Disabilities in Sweden: A Comparative Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15109. [PMID: 36429826 PMCID: PMC9690284 DOI: 10.3390/ijerph192215109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
Little is known about the Quality of Life (QoL) and how QoL is related to the social and economic situation of people with mobility-related disabilities in Sweden. QoL and well-being do not only relate to the absence of impairments but also to the level of social inclusion and the economic situation. The objective of this study was to explore if there were differences in QoL between a group with and a group without mobility-related disabilities in Sweden. Cross-sectional data were collected through self-reported questionnaires. WHOQOL-BREF was used to assess QoL. Recruitment was conducted through social media platforms. Comparisons were made between and within groups using the Welch t-test. Generalized linear models were used to predict score change for the WHOQOL-BREF items and domains accounting for sex, age, education, social inclusion, economic situation, and presence of additional or other disability. Included in the analysis was data from 381 participants, 143 with mobility-related disabilities and 238 without. Participants in the mobility-related disability group scored significantly lower than those without on General Health, General QoL, Health Satisfaction, and the four WHOQOL-BREF domains. The group with mobility-related disabilities also reported a lower Social Inclusion Score (SIS) and a higher proportion of people without a cash margin. An increased SIS indicated higher QoL in the generalized linear model, whereas the absence of cash margin and mobility-related disability negatively influenced the QoL scores. This study indicated that a person with mobility-related disabilities has lower QoL than those without mobility-related disabilities. A lower QoL was also related to a lack of cash margin, a lower social inclusion score, and whether there were additional or other disabilities present.
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Affiliation(s)
| | - Mats Jong
- Correspondence: ; Tel.: +46-10-142-89-66
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Jong MC, Stub T, Mulder E, Jong M. The Development and Acceptability of a Wilderness Programme to Support the Health and Well-Being of Adolescent and Young Adult Cancer Survivors: The WAYA Programme. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12012. [PMID: 36231313 PMCID: PMC9566286 DOI: 10.3390/ijerph191912012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Detailed descriptions of theory, structure, and activities with causal links to specified outcomes of wilderness programs are lacking. Addressing this gap, the present qualitative study gives a thorough description of the development of the Wilderness programme for Adolescent and Young Adult (AYA) cancer survivors (WAYA). WAYA is adapted to the individual needs of AYA cancer survivors. It was conceived around Næss's ecosophy and the Positive Health Model, and refined based on findings from a scoping review and patient/public involvement. Programme aims were to increase physical activity, self-confidence, personal growth, joy, safety within nature, meaningful relationships, and self-efficacy. The programme was an eight-day expedition followed three months later by a four-day base-camp. Activities included hiking, backpacking, kayaking, rock climbing, mindfulness and bushcrafting. Evaluation of the programme through focus group and individual interviews with 15 facilitators and 17 participants demonstrated that a diverse group of participants, challenging activities, and mindfulness-based practices were found to positively influence group bonding and the learning process. Furthermore, including an expedition and base-camp component was found to be beneficial in supporting the development of participants' own personal outdoor practices. In conclusion, this study demonstrated that the WAYA programme is safe and well accepted by AYA cancer survivors.
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Affiliation(s)
- Miek C. Jong
- National Research Centre in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, UiT, Hansine Hansens veg 18, 9019 Tromsø, Norway
- Department of Health Sciences, Mid Sweden University, Holmgatan 10, 851 70 Sundsvall, Sweden
| | - Trine Stub
- National Research Centre in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, UiT, Hansine Hansens veg 18, 9019 Tromsø, Norway
| | - Eric Mulder
- Department of Health Sciences, Mid Sweden University, Holmgatan 10, 851 70 Sundsvall, Sweden
| | - Mats Jong
- Department of Health Sciences, Mid Sweden University, Holmgatan 10, 851 70 Sundsvall, Sweden
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