Walking groups for women with breast cancer: Mobilising therapeutic assemblages of walk, talk and place

Urban novel ecosystems as affective landscapes

Intertwined within a patchwork of different types of land use and land cover, novel ecosystems are urban ecosystems that have no historical analogues and contain novel species assemblages. Some researchers and practitioners in the field of conservation and restoration regard urban novel ecosystems unworthy of concern, while other groups call for their preservation due to the rate of biodiversity loss in cities and limited access to nature among some social groups. However, very little is known about how people perceive novel ecosystems (such as informal green spaces, post-industrial or derelict land sites awaiting redevelopment, brownfield sites, vacant lots, interstitial or gap spaces) which are often characterised by assemblages of wild, spontaneous, and overgrown vegetation, but also remanent or derelict urban infrastructure in cities. This paper addresses this gap by firstly asking how people percieve assemblages of wild-looking vegetation and urban infrastructure often found in novel ecosystems and how our affective and aesthetic responses to these ecosystems affects our attitudes towards wildness in cities. To begin to unpack this question, we obtain data from a series of exploratory workshops held in four cities in the global north where we asked people 'what is urban nature?' Our findings suggest that value judgements that people ascribe to novel ecosystems are often deeply polarised, but they are influenced by different ecological and urban conditions that people encounter within them. However, some negative perceptions about novel ecosystems may be mediated by situational cues; these situational cues could have important implications for rewilding and restoration programmes that aim to reconnect urban communities with nature through socio-ecological stewardship. To conclude, areas for further research that could improve our understanding of the social values of novel ecosystems in cities and the influence that these ecosystems may have on affective encounters with urban nature are proposed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11625-024-01539-w.

Speed as an expression and texture of space: theory at play in a movement activity

In recent years, following new materialist, posthumanist and non-representational turns, human geography has increasingly understood the worlds it studies as vital, immediate and emergent. As part of this vision, studies have empirically animated and theoretically articulated various expressions/textures in the movement of space, including its rhythms, shapes, timings, repetitions, sensuousness, and infections. Speed is one such expression/texture that has received some empirical attention but, in comparison to most others, has not been so thoroughly theorized. In response, this paper conducts a reconnaissance into speed, its intentions being to convey some foundational theoretical understandings of speed and, through empirical research, show these at play in social contexts. Specifically, naturalistic participant observations of forms of the movement activity of cycling are used to animate how; (i) speed can be represented and affective as a scalar quantity; (ii) all objects possess speeds and affect other speeds; (iii) speeds and objects are known through relative positions and speeds; (iv) speeds create rates of happening; (v) speeds occur in all expressions/textures of space; (vi) the accelerating world is engaged at relational speeds. From this reconnaissance, to assist future research on speed, the paper closes with some suggested avenues for further inquiry.

Psychosocial interventions that target adult cancer survivors' reintegration into daily life after active cancer treatment: a scoping review

OBJECTIVE

This review explored psychosocial interventions targeting adult cancer survivors' reintegration following active cancer treatment. This included the types of interventions tested and the tools used to measure reintegration.

INTRODUCTION

Cancer survivors face lingering health issues following the completion of cancer treatment. Many cancer survivors still experience unmet psychosocial care needs despite receiving follow-up care. Further, many survivorship interventions do not specifically address outcomes important to survivors. A number of primary studies have identified reintegration as an outcome important to cancer survivors. Reintegration is a concept that focuses on returning to normal activities, routines, and social roles after cancer treatment; however, it is emerging and abstract.

INCLUSION CRITERIA

Studies involving adult cancer survivors (18 years or older at diagnosis) of any cancer type or stage were included in this review. Studies with psychosocial interventions targeted at reintegrating the person into daily life after cancer treatment were included. Interventions addressing clinical depression or anxiety, and interventions treating solely physical needs that were largely medically focused were excluded.

METHODS

A literature search was conducted in MEDLINE (Ovid), CINAHL (EBSCOhost), and Embase. Gray literature was searched using ProQuest Dissertations and Theses (ProQuest). Reference lists of included studies were searched. Studies were screened at the title/abstract and full-text levels, and 2 independent reviewers extracted data. Manuscripts in languages other than English were excluded due to feasibility (eg, cost, time of translations). Findings were summarized narratively and reported in tabular and diagrammatic format.

RESULTS

The 3-step search strategy yielded 5617 citations. After duplicates were removed, the remaining 4378 citations were screened at the title and abstract level, then the remaining 306 citations were evaluated at the full-text level by 2 independent reviewers. Forty studies were included that evaluated psychosocial interventions among adult cancer survivors trying to reintegrate after active cancer treatment (qualitative n=23, mixed methods n=8, quantitative n=8, systematic review n=1). Included articles spanned 10 different countries/regions. Over half of all included articles (n=25) focused primarily on breast cancer survivors. Many studies (n=17) were conducted in primary care or community-based settings. The most common types of interventions were peer-support groups (n=14), follow-up education and support (n=14), exercise programs (n=6), and multidisciplinary/multicomponent programs (n=6). While the majority of included studies characterized the outcome qualitatively, 9 quantitative tools were also employed.

CONCLUSIONS

This review identified 6 types of interventions to reintegrate survivors back into their daily lives following cancer treatment. An important thread across intervention types was a focus on personalization in the form of problem/goal identification. Given the number of qualitative studies, future research could include a qualitative systematic review and meta-aggregation. Quantitative tools may not be as effective for evaluating reintegration. More primary studies, including mixed methods studies, utilizing consistent measurement tools are required. Furthermore, this work provides a basis for future research to continue examining the complexity of implementing such interventions to successfully achieve reintegration. To do so, primary studies evaluating interventions from an implementation science and complex systems perspective would be useful.

REVIEW REGISTRATION

Open Science Framework https://osf.io/r6bmx.

Benefits of nature-based walking for breast cancer survivors

INTRODUCTION

Physical activity (PA) promotes significant physical and psychosocial benefits for breast cancer survivors. While evidence exists regarding recommendations for the frequency, duration and intensity of exercise that optimise PA benefits for cancer survivors, the role of the environment in achieving optimal outcomes has yet to be determined. This paper presents a protocol for a clinical trial to evaluate the feasibility of a 3-month nature-based walking programme for breast cancer survivors. Secondary outcomes assessed include the impact of the intervention on fitness, quality of life outcomes, and biomarkers of ageing and inflammation.

METHODS AND ANALYSIS

The trial is a 12-week single-arm pilot study. Twenty female breast cancer survivors will engage in a supervised moderate intensity walking intervention in small groups in a nature reserve for 50 minutes three times per week. Data will be collected at baseline and end of study, and include assessment of inflammatory cytokines and anti-inflammatory myokines (TNF-α, IL-1ß, IL-6, CRP, TGF-ß, IL-10, IL-13), as well as ageing (DNA methylation, ageing genes) biomarkers; surveys (Patient-Reported Outcomes Measurement Information System-29, Functional Assessment of Cancer Therapy-General, Post-Traumatic Growth Inventory); and fitness assessments (6 min Walk Test, Grip-Strength, One Repetition-Maximum Leg Press). Participants will also complete weekly surveys assessing social support and participate in an exit interview. This is an important first step for future research on the influence of exercise environment on cancer survivor PA outcomes.

ETHICS AND DISSEMINATION

This study was approved by the Cedars Sinai Medical Center Institutional Review Board (IIT2020-20). Findings will be disseminated through academic manuscripts, conferences, and community presentations.

TRIAL REGISTRATION NUMBER

NCT04896580.

Therapeutic landscapes, networks, and health and wellbeing during the COVID-19 pandemic: A mixed-methods study among female domestic workers

The COVID-19 pandemic has had profound impacts on access to and use of therapeutic landscapes and networks, especially for people who are vulnerable due to economic, social, and work-related disadvantage. For one such vulnerable population, Indonesian female domestic workers (FDWs) in Hong Kong, this study employed a mixed methods approach to examine the associations between perceptions of therapeutic landscapes (TLs), therapeutic networks (TNs), subjective wellbeing, and self-rated health during the COVID-19 pandemic. Data from an online survey were analyzed via structural equation modeling (SEM) and confirmatory factor analysis (CFA) to investigate the direct and indirect associations between TLs, TNs, and health and wellbeing. The findings demonstrate little or no association among FDWs' perceptions of TLs and TNs and FDWs' self-rated health and subjective wellbeing, except for a negative total association between TL and subjective wellbeing. Using insights gleaned from thematic analysis of in-depth interviews with FDWs, we suggest that these unexpected findings are mainly due to restricted access to public places, reduced social gatherings, and the fact that employers rarely granted days off during the lockdown. Although processes at the employer and municipal scales limited FDWs' access to therapeutic places, increased use of digital communications and spaces provided an important source of social and emotional support during the pandemic.

The ends of an assemblage of health

This paper identifies and responds to three key challenges that have emerged in discussions of the assemblage across health geography. These challenges concern the problem of identifying the borders or limits of an assemblage of health; the problem of clarifying how such assemblages change over time; and the more general problem of identifying the affective and material character of the assemblage such that one may distinguish 'therapeutic' from 'oppressive' arrangements. The paper argues that each challenge calls for a novel analytics of power grounded in assessments of the generative forces of stratification and selection expressed within an assemblage. Assemblages of health are composed in relations of power, affect and desire that stratify the assemblage in ongoing processes of selection, acting upon heterogeneous entities (material and immaterial, intensive and extensive, human and nonhuman), bringing them into contact, causing them to affect one another, transforming their activity. Analysis of these processes provides potent tools for rethinking how relations, events, spaces and encounters mediate experiences of health and illness, and novel grounds for intervening in the formation of an assemblage of health.

Hopeful adaptation after acquired brain injury: The case of late referrals in the Netherlands

A substantial number of people with 'mild' acquired brain injury (ABI) suffer from cognitive impairments that are not immediately acknowledged as such. Some are eventually referred to multidisciplinary rehabilitation care after months or years of suffering, which is why we have labelled them 'late referrals'. The aim of this paper is to add to the discussion on hopeful adaptation by focussing on the diverse adaptive strategies of late referrals. Hope is typically discussed as a positive emotion that can contribute to transformative processes, but that is also mirrored by despair. We conducted in-depth interviews with ten late referrals in the Netherlands. Our findings demonstrate that the trajectories of late referrals are characterised by wandering and navigating. Wandering is predominantly associated with feeling lost, and not knowing where one is going. While navigating is more purposeful, we found that our participants sometimes navigated in directions that turned out to be dead-end streets. We conclude that hopeful adaptation encompasses a circuitous way of trying and adapting and trying again. As a key recommendation for practice, we suggest that people with cognitive problems due to mild ABI should be supported in reducing the complexities of their everyday lives by taking up challenges one place at a time.

Physical activity domains are differently related with quality of life in breast cancer survivors: a cross-sectional study

OBJECTIVES

Treatments for breast cancer (BC) can lead to physical and mental impairments which may affect quality of life (QoL). Physical activity (PA) is highly recommended for this population due to its protective effect against BC relapse and its ability to reduce the health impact of treatment. However, it is not clear whether the different domains of PA are associated with better QoL of BC survivors. The current study aimed to verify the relationship between different PA domains with QoL of BC survivors.

METHODS

The sample consisted of 128 women BC survivors, with a mean age of 58.2 ± 9.7 years. QoL was assessed using the Short-Form Health Survey questionnaire (SF-36) and PA was verified through the Baecke questionnaire, in domains of occupation, sports practice, and leisure time/commuting. The relationship between QoL and different PA domains was verified by linear regression, adjusted by age, marital status, and socioeconomic condition.

RESULTS

Occupational PA was negatively related to physical limitations [β= -15.36 (-29.04 to -1.68] and body pain [β=-6.61 (-14.53 to 1.31) marginal association]. Sports practice was positively related to functional capacity [β= 4.24 (0.60 to 7.88)]. Leisure time/commuting PA was positively related to functional capacity [β = 7.17 (3.09 to 11.26)], vitality [β = 4.30 (0.39 to 8.22)], social aspects [β= 5.47 (0.80 to 10.15)], and mental health [β = 4.08 (0.40 to 7.75)].

CONCLUSIONS

Sports practice and leisure time/commuting PA were positively related to QoL in BC survivors, while occupational PA was negatively related to QoL, independently of age, marital status, and socioeconomic condition.

Therapeutic landscape experiences of everyday geographies within the wider community: A scoping review

As community dwelling populations of older people and those living with chronic and life limiting conditions continue to grow, the role of everyday geographies, particularly of community based settings and activities, in supporting health and wellbeing has become a focus in both research and policy development. The therapeutic landscape scholarship provides a holistic view of how place promotes health and wellbeing, and has in recent years expanded its focus from reputable places of healing to everyday geographies. Based on a scoping review of 45 studies on everyday community based therapeutic landscapes, this paper identifies and critically examines the settings, populations and mechanisms of therapeutic experiences. It presents critical summaries of the scales and boundaries of landscapes; the diverse and dichotomous characteristics of places; the therapeutic benefits of proximal and distal socio-spatial interactions; the role of everyday settings and activities as sources of refuge, anchor and resonance and finally the broader social, cultural, political and economic contexts in which everyday therapeutic landscapes are embedded. In so doing the paper highlights the complex nature of everyday therapeutic landscape experiences and how this research can further inform the development of community based settings and activities that promote health and wellbeing. It also identifies areas for future research on everyday therapeutic landscapes.

Multi-sited therapeutic assemblages: Virtual and real-life emplacement of youth mental health support

This paper draws together work on therapeutic assemblages, geographic assemblages, and therapeutic landscapes to develop the concept of "multi-sited therapeutic assemblages." Assemblage theory has been productively used in health research since it achieved prominence in the social sciences two decades ago. One facet that, however, remains as yet under-developed in the literature on "therapeutic assemblages" (as well as their close kin, "health assemblages," "ill-health assemblages," "care assemblages," etc.) is that of the multi-sited therapeutic assemblage. This paper demonstrates the significance of the multi-locality of therapeutic assemblages by mapping the mental health support activities of young New Zealanders. Grounded theory analysis of interviews with 150 New Zealand youth (which took place from 2015 to 2020) about their online and offline engagements in mental health support highlights the importance of the emplacement of therapeutic practices whilst also foregrounding their multi-sitedness. It enables opportunities to examine how therapeutically-meaningful places can be constituted both as independent sites and simultaneously re-made through their fluid, dynamic and temporal relations with one another. Through this analytic perspective, care and other elements of the therapeutic come to be understood as neither anchored to a single site nor constituted through the inter-relation of home and clinic, but defined via a shifting, dynamic, and multi-directional assemblage of multiple places, people, and resources. This has noteworthy implications for how we envisage relationships between a wide variety of therapeutic digital and real-life sites, as well as for examining scholarly and practical understandings of the emplacement of care.

Evaluating the literature of therapeutic landscapes with an emphasis on the search for the dimensions of health: A systematic review

Health geography emphasizes landscape capacity as a perspective for examining health dimensions. Much of this emphasis is on the concept of therapeutic landscapes. In the last two decades, changes in the therapeutic landscapes concerning health, as well as why and how the development of the emphasis on the dimensions of the health in the landscape in proportion to the temporal-spatial course of literature in this field can be considered. The framework of the present study is based on a systematic review of therapeutic landscapes in the geography of health in the last two decades. This systematic literature review followed the PRISMA guidelines. Searching for "Therapeutic Landscapes" term at Science Direct and PubMed, screening, 56 eligible articles were selected in the journal Social Science and Medicine, and Health and Place. The results of the systematic review, aiming to search for the health dimensions of the therapeutic landscape, and recognize main gaps, identified three main issues: scale and range of users of therapeutic landscapes, the position importance of experiences in therapeutic landscapes, therapeutic landscapes as the holistic paradigm. The results of the research show that in recent years, attention to multiple dimensions of health, especially non-physical relationships of therapeutic landscapes and multiple dimensions of health, has been considered more and more by researchers. Personal-social perceptions and experiences are also continually evolving, so the concept of therapeutic landscapes and its relationship to health is considered living and dynamic.

Communal therapeutic mobility in group walking: A meta-ethnography

Increased attention to links between walking, health and wellbeing have contributed to a growth in the number of walking groups meeting on a regular basis to offer short, social walks. Walking group interventions are known to increase physical activity and to have wide-ranging health benefits, and there is evidence that drop out is generally low. The aim of this paper is to synthesise qualitative research on experiences and perceptions of group walking in order to develop a new conceptual understanding of the group walking experience. We conducted a systematic search of the literature and identified 22 such studies which we synthesised using meta-ethnography. Included studies were conducted in the UK, USA, Australia and Ireland. Most reported research was undertaken with outdoor walking groups, some of which catered specifically for people who shared a disease experience or a disability. A smaller number of studies examined indoor mall walking groups, while two looked at perceptions of non-participants of group walking as a potential activity. From the original constructs identified in the papers we derived five higher order constructs: seeking and enjoying health and fitness, attachment to walking, providing purpose and confidence, mobile companionship and a peaceful and contemplative shared respite from everyday life. We argue that participating in a walking group provides a set of experiences that together constitute a specific form of shared or communal therapeutic mobility that is not simply the accumulation of the constructs we have outlined. Rather, we suggest that an initial instrumental and disciplinary focus on health and fitness is transformed through the experience of group walking into a shared meaningful and enjoyable practice; an emergent communal therapeutic mobility, which recruits and retains large numbers of group walkers. However, this communal therapeutic mobility is not equally accessible to all.

Doing more with movement: constituting healthy publics in movement volunteering programmes

The recent phenomenon of movement volunteering programmes is a form of 'fitness philanthropy' that combines exercise with volunteering in order for physical activity to generate a more widely shared set of benefits. These newest practices of fitness philanthropy radically rework both exercise and volunteering through the ways in which these come together and take place outdoors and in the everyday spaces of the street or community. The paper explores these new practices through the movement volunteering programme 'GoodGym', in relation to the concept of 'healthy publics'. Fieldwork comprised ethnography, including participant observation, interviews, go-along interviews, conversations, photography and an end of fieldwork discussion workshop. We focus on the experiences of three different constituencies in GoodGym: the volunteers; the participants and passers-by; the space and atmosphere. The formation of these dynamic, multiple and shifting healthy publics emerge through the complex intersections of several processes. We draw particular attention to the centrality in the new fitness philanthropy practices of visibility and spectacle, sociality and merging mobilities in constituting healthy publics.

Therapeutic or detrimental mobilities? Walking groups for older adults

The health benefits of walking through greenspace have earned widespread academic attention in recent years and have been termed 'therapeutic mobilities'. As a result, walking groups are actively encouraged by health professionals as a way to promote 'healthy ageing'. This paper examines whether the promotion of community-led walking groups relies upon overly optimistic understandings that portray walking in greenspace as an inherently therapeutic practice. Accordingly, this paper introduces the concept of 'detrimental mobilities' to explore how the shared movement promoted via walking groups may not always be inherently therapeutic and may have some detrimental impacts on the individuals who take part in these activities. Drawing on findings from in-depth walking interviews with older members of the 'Walking for Health' scheme in Southampton, England, this paper examines how mobilities have the potential to disable, as much as they enable, health and wellbeing.

Exercise: A positive feature on functioning in daily life during cancer treatment - Experiences from the Phys-Can study

PURPOSE

Impaired functioning due to cancer treatment is a challenge for daily life. Exercise during treatment can improve functioning. However, research describing experiences of how exercise affects activities of daily life is limited. We aimed to explore how individuals with cancer receiving curative treatment and participating in an exercise intervention experienced their functioning in daily life.

METHODS

Twenty-one participants were recruited from Phys-Can, an exercise intervention study. Semi-structured interviews were conducted after the intervention had finished, and data was analysed using thematic analysis.

RESULTS

Two main themes evolved: "Striving to maintain a normal life in a new context" and "Struggling with impairments from side effects of cancer treatment". The supervised group exercise proved popular, and participants reported positive effects on physical and psychological functioning, as well as social and informative support from other participants. Participants struggled with impaired cognitive and physical functioning and exhaustion. They strove to maintain a normal life by adjusting their activities.

CONCLUSIONS

Perceived physical and psychological benefits from exercise during cancer treatment suggest that exercise should be a part of cancer rehabilitation to facilitate activities and participation in daily life. Striving to maintain a normal life during cancer treatment is vital, and adjustments are needed to maintain activities and participation in daily life. Cancer nurses should motivate patients to engage in physical activity and encourage the introduction of exercise as part of their rehabilitation. They could also support patients in making adjustments to maintain functioning in daily life.

Women's stories of living with breast cancer: A systematic review and meta-synthesis of qualitative evidence

RATIONALE

Globally, breast cancer is by far the most frequently occurring cancer amongst women. Whilst the physical consequences of the disease and associated treatments are well documented, a comprehensive picture of how breast cancer is experienced at all stages of disease progression is lacking.

OBJECTIVE

This systematic review aimed to synthesize qualitative studies documenting women's breast cancer narratives into an empirically based explanatory framework.

METHODS

Two investigators independently searched Academic Search Premiere, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE, PsycARTICLES, PubMed, Science Direct, SCOPUS, Web of Science and three international dissertation repositories using a pre-specified search strategy to identify qualitative studies on women's breast cancer narratives across all geographic and income-level settings. Of the 7840 studies that were screened for eligibility, included in the review were 180 studies, which were assessed using the Critical Appraisal Skills Programme. Using a 'meta-study' approach, an explanatory model of the breast cancer experience was formulated. Finally, we assessed the confidence in the review findings using the 'Confidence in the Evidence from Reviews of Qualitative Research' (CERQual) guidelines.

RESULTS

Eight core themes were identified: the burden of breast cancer, existential ordeal, illness appraisal, sources of support, being in the healthcare system, the self in relation to others, changes in self-image, and survivor identity. Together, these form the proposed Trajectory of Breast Cancer (TBC) framework.

CONCLUSION

The Trajectory of Breast Cancer explanatory framework offers a theoretically defensible synthesis of women's experiences of breast cancer. This framework provides an empirical basis for future reviewers conducting qualitative and narrative breast cancer research.