ABSTRACT
Objective: In the US, most attendees of forest bathing (Shinrin-yoku) are older women. During perimenopause and menopause, women often deal with anxiety or depression, or seek new meaning in life. Forest bathing research from Japan and Korea identifies both physiologic and psychological benefits. However, little research has investigated holistic wellbeing outcomes, including spiritual wellbeing, and few studies have focused on women or have been located within the US culture. Methods: In this protocol paper we delineate a mixedmethods feasibility study to: (1) investigate forest bathing experiences while preserving fidelity to the intervention;and (2) explore relevant holistic outcomes. Forest bathing, as practiced in the US by certified Association of Nature and Forest Therapy (ANFT) guides, consists of a forestbased sensory experience lasting 120 - 180 minutes. Forty women over 40 years old will be recruited to participate in one of four forest bathing experiences. Validated self-report measures will be collected before and after the experience, as well as, 1 and 2 weeks later. Results: Holistic wellbeing will be quantified using the Self- Assessment of Change (SAC), a rigorously created measure for integrative medicine whole systems research (Ritenbaugh, 2011). Spiritual wellbeing, as previously defined (Fisher, 2011), will be measured as the quality of the relationship one has with self, community, nature, and transcendent other(s). Other validated scales will assess perceived stress, depression, anxiety, and both positive and negative affect states. Qualitative data will derive from participant drawings and interviews designed to illicit the women's experiences in forest bathing. We will also report adaptations in implementation that are necessitated by COVID times. Conclusion: This protocol focuses on exploring older women's experiences during and after a manualized forest bathing intervention led by certified forest therapists. The completed feasibility study will set the stage for a large randomized controlled trial of forest bathing in older women in the US.
ABSTRACT
Objective: In these times of COVID, social isolation is a problem especially affecting older adults. Outdoor social gathering, with appropriate physical distancing, is often recommended. Group outdoor health walks (GOHW) are nature-based interventions that promote physical activity, positive emotions, and mental wellbeing. However, results of quantitative social health scales often do not match qualitative reports of enhanced social wellbeing. In this qualitative study, we explore older adults' experiences of a GOHW to learn how the walks might mitigate social isolation and promote social wellbeing. Methods: Eight individual or paired interviews were recorded among nine walkers six months after a 12-week GOHW. Analysis was conducted by a multi-disciplinary team. The coding frame included both a priori and emergent codes. An iterative process identified key themes. Results: Three themes illustrated the social dimensions of GOHW. First, individuals' social relatedness changed loneliness, social confidence and the quality of friendships, through mixing during and after the walks. Second, social support was experienced through emerging group cohesion and the supportive environment for inexperienced or physically challenged individuals. Tensions were also identified. Third, the social component of GOHW was related to walker wellbeing, by providing an opportunity to safely exercise outdoors, while the socializing helped them overcome their physical ailments and offered something to look forward to each week. Together these themes provide insight into the social elements of nature-based interventions, the mediating effects of group cohesion and social support, and the contribution to wellbeing. Conclusion: GOHWs mitigate social isolation by providing a low-risk social activity that develops and strengthens relationships among members of the walking group. Socializing, group cohesion and social support contribute to both physical and social wellbeing. With attention to physical distancing, GOHW may be beneficial in COVID times. Findings also can inform selection and development of social health measures for use in studies of nature-based interventions.