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Barclay R, Webber SC, Hahn F, Jones CA, Mayo NE, Sivakumaran S, Liu Y, Chilibeck PD, Salbach NM. A park-based group mobility program for older adults with difficulty walking outdoors: a quantitative process evaluation of the Getting Older Adults Outdoors (GO-OUT) randomized controlled trial. BMC Geriatr 2023; 23:833. [PMID: 38082248 PMCID: PMC10712059 DOI: 10.1186/s12877-023-04524-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Process evaluations of randomized controlled trials (RCTs) of community exercise programs are important to help explain the results of a trial and provide evidence of the feasibility for community implementation. The objectives of this process evaluation for a multi-centre RCT of outdoor walking interventions for older adults with difficulty walking outdoors, were to determine: 1) implementation fidelity (the extent to which elements of the intervention were delivered as specified in the original protocol) and 2) participant engagement (the receipt of intervention components by the participants) in the Getting Older Adults Outdoors (GO-OUT) trial. METHODS GO-OUT participants attended an active 1-day workshop designed to foster safe, outdoor walking skills. After the workshop, 190 people at 4 sites were randomized to an outdoor walk group (OWG) (n = 98) which met 2x/week for 10 weeks, or the weekly reminders (WR) group (n = 92) which received a phone reminder 1x/week for 10 weeks. The OWG had 5 components - warm-up, continuous distance walk, task-oriented walking activities, 2nd continuous distance walk, and cool-down. Data on implementation fidelity and participant engagement were gathered during the study through site communications, use of standardized forms, reflective notes of the OWG leaders, and accelerometry and GPS assessment of participants during 2 weeks of the OWG. RESULTS All sites implemented the workshop according to the protocol. Participants were engaged in all 8 activity stations of the workshop. WR were provided to 96% of the participants in the WR intervention group. The 5 components of the OWG sessions were implemented in over 95% of the sessions, as outlined in the protocol. Average attendance in the OWG was not high - 15% of participants did not attend any sessions and 64% of participants in the OWG attended > 50% of the sessions. Evaluations with accelerometry and GPS during week 3 and 9 OWG sessions suggest that participants who attended were engaged and active during the OWG. CONCLUSIONS This process evaluation helps explain the main study findings and demonstrates the flexibility required in the protocol for safe and feasible community implementation. Future research could explore the use of additional behaviour change strategies to optimize attendance for community implementation. TRIAL REGISTRATION ClinicalTrials.gov NCT03292510 Date of registration: September 25, 2017.
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Affiliation(s)
- Ruth Barclay
- Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada
| | - Sandra C Webber
- Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada
| | - Francine Hahn
- Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada
| | - C Allyson Jones
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Nancy E Mayo
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Shajicaa Sivakumaran
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Yixiu Liu
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Philip D Chilibeck
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
- The KITE Research Institute, University Health Network, Toronto, ON, Canada.
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Irvine KN, Fisher D, Marselle MR, Currie M, Colley K, Warber SL. Social Isolation in Older Adults: A Qualitative Study on the Social Dimensions of Group Outdoor Health Walks. Int J Environ Res Public Health 2022; 19:5353. [PMID: 35564752 DOI: 10.3390/ijerph19095353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 12/05/2022]
Abstract
Physical distancing practices during the COVID-19 global pandemic contributed to a high degree of social isolation among older adults. To reduce loneliness and other ill effects of social isolation, public health experts recommended outdoor social gathering, with physical distancing. Adopting a case study approach, we explored how social aspects of group outdoor health walks (GOHWs) mitigate social isolation for older adults and improve individual social wellbeing. We used semi-structured interviews to understand the experiences of social isolation and social relationships in nine older (50–80 s) adults participating in a GOHW in Scotland, United Kingdom (UK). Verbatim transcripts were analysed through an iterative process of thematic analysis carried out by an interdisciplinary team of qualitative researchers from environmental psychology, medicine, and geography. Themes provide insight into the social dimensions of GOHWs, the mediating effects of social experiences, and the contribution these make to individual social wellbeing. GOHWs provide opportunities to be part of a group and attend to the needs of inexperienced or physically challenged individuals. Being part of the group walk fosters casual interpersonal interactions through spontaneous mixing during and after the walk. This programmatic structure counters loneliness, engenders pleasurable anticipation of regular contact with others, supports physical activity, and fosters group cohesion. These in turn contribute to individual social wellbeing, including expanding social networks, meaningful relationships, a sense of belonging, and acting on empathy for others. GOWHs may be beneficial for mitigation of social isolation as we emerge from the COVID-19 pandemic. Findings were used to propose a conceptual model to parse social constructs and inform selection or development of quantitative social measures for future studies of nature-based interventions such as GOHWs.
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Abstract
OBJECTIVE The evidence base for social prescribing is inconclusive, and evaluations have been criticised for lacking rigour. This realist review sought to understand how and why social prescribing evaluations work or do not work. Findings from this review will contribute to the development of an evidence-based evaluation framework and reporting standards for social prescribing. DESIGN A realist review. DATA SOURCES ASSIA, CINAHL, Embase, Medline, PsycINFO, PubMed, Scopus Online, Social Care Online, Web of Science and grey literature. ELIGIBILITY CRITERIA Documents reporting on social prescribing evaluations using any methods, published between 1998 and 2020 were included. Documents not reporting findings or lacking detail on methods for data collection and outcomes were excluded. ANALYSIS Included documents were segregated into subcases based on methodology. Data relating to context, mechanisms and outcomes and the programme theory were extracted and context-mechanism-outcome configurations were developed. Meta-inferences were drawn from all subcases to refine the programme theory. RESULTS 83 documents contributed to analysis. Generally, studies lacked in-depth descriptions of the methods and evaluation processes employed. A cyclical process of social prescribing evaluation was identified, involving preparation, conducting the study and interpretation. The analysis found that coproduction, alignment, research agency, sequential mixed-methods design and integration of findings all contributed to the development of an acceptable, high-quality social prescribing evaluation design. Context-mechanism-outcome configurations relating to these themes are reported. CONCLUSIONS To develop the social prescribing evidence base and address gaps in our knowledge about the impact of social prescribing and how it works, evaluations must be high quality and acceptable to stakeholders. Development of an evaluation framework and reporting standards drawing on the findings of this realist review will support this aim. PROSPERO REGISTRATION NUMBER CRD42020183065.
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Affiliation(s)
- Megan Elliott
- Wales School for Social Prescribing Research, PRIME Centre Wales, Faculty of Life Sciences & Education, University of South Wales, Pontypridd, UK
| | - Mark Davies
- Wales School for Social Prescribing Research, PRIME Centre Wales, Faculty of Life Sciences & Education, University of South Wales, Pontypridd, UK
| | - Julie Davies
- Valleys Regional Park, Bridgend County Borough Council, Bridgend, UK
| | - Carolyn Wallace
- Wales School for Social Prescribing Research, PRIME Centre Wales, Faculty of Life Sciences & Education, University of South Wales, Pontypridd, UK
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Marselle MR, Hartig T, Cox DTC, de Bell S, Knapp S, Lindley S, Triguero-Mas M, Böhning-Gaese K, Braubach M, Cook PA, de Vries S, Heintz-Buschart A, Hofmann M, Irvine KN, Kabisch N, Kolek F, Kraemer R, Markevych I, Martens D, Müller R, Nieuwenhuijsen M, Potts JM, Stadler J, Walton S, Warber SL, Bonn A. Pathways linking biodiversity to human health: A conceptual framework. Environ Int 2021; 150:106420. [PMID: 33556912 DOI: 10.1016/j.envint.2021.106420] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/10/2021] [Accepted: 01/22/2021] [Indexed: 05/05/2023]
Abstract
Biodiversity is a cornerstone of human health and well-being. However, while evidence of the contributions of nature to human health is rapidly building, research into how biodiversity relates to human health remains limited in important respects. In particular, a better mechanistic understanding of the range of pathways through which biodiversity can influence human health is needed. These pathways relate to both psychological and social processes as well as biophysical processes. Building on evidence from across the natural, social and health sciences, we present a conceptual framework organizing the pathways linking biodiversity to human health. Four domains of pathways-both beneficial as well as harmful-link biodiversity with human health: (i) reducing harm (e.g. provision of medicines, decreasing exposure to air and noise pollution); (ii) restoring capacities (e.g. attention restoration, stress reduction); (iii) building capacities (e.g. promoting physical activity, transcendent experiences); and (iv) causing harm (e.g. dangerous wildlife, zoonotic diseases, allergens). We discuss how to test components of the biodiversity-health framework with available analytical approaches and existing datasets. In a world with accelerating declines in biodiversity, profound land-use change, and an increase in non-communicable and zoonotic diseases globally, greater understanding of these pathways can reinforce biodiversity conservation as a strategy for the promotion of health for both people and nature. We conclude by identifying research avenues and recommendations for policy and practice to foster biodiversity-focused public health actions.
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Affiliation(s)
- Melissa R Marselle
- Helmholtz Centre for Environmental Research - UFZ, Department of Ecosystem Services, Permoserstraße 15, 04318 Leipzig, Germany; German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Puschstraße 4, 04103 Leipzig, Germany; Institute of Biodiversity, Friedrich Schiller University Jena, Dornburger Straße 159, 07743 Jena, Germany; Institute of Psychological Sciences, De Montfort University, Leicester, United Kingdom.
| | - Terry Hartig
- Institute for Housing and Urban Research, Uppsala University, Box 514, SE-75120 Uppsala, Sweden; Department of Psychology, Uppsala University, Box 1225, SE-75142 Uppsala, Sweden
| | - Daniel T C Cox
- Environment and Sustainability Institute, University of Exeter, Penryn, Cornwall TR10 9FE, United Kingdom
| | - Siân de Bell
- European Centre for Environment and Human Health, University of Exeter, Truro, Cornwall TR1 3HD, United Kingdom
| | - Sonja Knapp
- Helmholtz Centre for Environmental Research - UFZ, Department of Community Ecology, Theodor-Lieser-Str. 4, 06120 Halle, Germany
| | - Sarah Lindley
- Department of Geography, School of Environment, Education and Development, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
| | - Margarita Triguero-Mas
- Universitat Autònoma de Barcelona, Barcelona, Spain; Institute for Environmental Science and Technology, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Barcelona Lab for Urban Environmental Justice and Sustainability, Barcelona, Spain
| | - Katrin Böhning-Gaese
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Puschstraße 4, 04103 Leipzig, Germany; Senckenberg Biodiversity and Climate Research Centre (SBiK-F), Senckenberganlage 25, 60325 Frankfurt (Main), Germany; Goethe University Frankfurt am Main, Institute for Ecology, Evolution & Diversity, Max-von-Laue-Str. 13, 60439 Frankfurt (Main), Germany
| | - Matthias Braubach
- WHO Regional Office for Europe, European Centre for Environment and Health, Platz der Vereinten Nationen 1, 53113 Bonn, Germany
| | - Penny A Cook
- School of Health and Society, University of Salford, Salford M6 6PU, United Kingdom
| | - Sjerp de Vries
- Cultural Geography, Wageningen Environmental Research, Wageningen University & Research, P.O. Box 47, 6700 AA Wageningen, the Netherlands
| | - Anna Heintz-Buschart
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Puschstraße 4, 04103 Leipzig, Germany; Helmholtz Centre for Environmental Research - UFZ, Department of Soil Ecology, Theodor-Lieser-Str. 4, 06120 Halle, Germany
| | - Max Hofmann
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Puschstraße 4, 04103 Leipzig, Germany; Institute of Biology, Martin Luther University Halle-Wittenberg, Am Kirchtor 1, 06108 Halle (Saale), Germany; Leibniz Institute of Agricultural Development in Transition Economies (IAMO), Theodor-Lieser- Strasse 2, 06120 Halle (Saale), Germany
| | - Katherine N Irvine
- Social, Economic and Geographical Sciences Department, The James Hutton Institute, Aberdeen AB15 8QH, United Kingdom
| | - Nadja Kabisch
- Humboldt-Universität zu Berlin, Geography Department, Unter den Linden 6, 10099 Berlin, Germany; Helmholtz Centre for Environmental Research-UFZ, Department of Urban and Environmental Sociology, Leipzig, Germany
| | - Franziska Kolek
- Chair and Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum München, Germany - German Research Centre for Environmental Health, Augsburg, Germany
| | - Roland Kraemer
- Humboldt-Universität zu Berlin, Geography Department, Unter den Linden 6, 10099 Berlin, Germany; Helmholtz Centre for Environmental Research - UFZ, Department of Monitoring and Exploration Technologies, Permoserstraße 15, 04318 Leipzig, Germany
| | - Iana Markevych
- Institute of Psychology, Jagiellonian University, Ingardena 6, 33-332 Krakow, Poland
| | - Dörte Martens
- Eberswalde University for Sustainable Development, Faculty of Landscape Management and Nature Conservation, Eberswalde, Germany
| | - Ruth Müller
- Unit Entomology, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium; Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt (Main), Germany
| | - Mark Nieuwenhuijsen
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Mary MacKillop Institute for Health Research, Melbourne, Australia
| | - Jacqueline M Potts
- Biomathematics and Statistics Scotland, Craigiebuckler, Aberdeen AB15 8QH, United Kingdom
| | - Jutta Stadler
- German Federal Agency for Nature Conservation (BfN), Germany
| | - Samantha Walton
- Department of English Literature, Bath Spa University, Bath, United Kingdom
| | - Sara L Warber
- European Centre for Environment and Human Health, University of Exeter, Truro, Cornwall TR1 3HD, United Kingdom; Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Aletta Bonn
- Helmholtz Centre for Environmental Research - UFZ, Department of Ecosystem Services, Permoserstraße 15, 04318 Leipzig, Germany; German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Puschstraße 4, 04103 Leipzig, Germany; Institute of Biodiversity, Friedrich Schiller University Jena, Dornburger Straße 159, 07743 Jena, Germany
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Naor L, Mayseless O. The Wilderness Solo Experience: A Unique Practice of Silence and Solitude for Personal Growth. Front Psychol 2020; 11:547067. [PMID: 33071862 PMCID: PMC7533647 DOI: 10.3389/fpsyg.2020.547067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/14/2020] [Indexed: 11/26/2022] Open
Abstract
Silence is now acknowledged by science as a significant construct of healthy human development and well-being, linked to humans’ neurobiology, psychology, physiology, and spirituality. This paper focuses on a particular form of silence experienced through the solo experience in the wilderness. The solo experience, involving varying periods of time spent in solitude and silence in the wilderness is a common method of intervention implemented among therapeutic and educational nature-based approaches. Numerous studies and personal accounts in the field underscore the solo experience as one of the most significant nature based interventions linked to various beneficial outcomes. These studies emphasize the significance of the wilderness, far from daily demands, and devoid of technological stimuli allowing the silence, time and space for self-reflection and contemplation on the sacredness and meaning of life. Although new to modern culture, solitude in nature is an ancient form of initiation used ceremonially by indigenous cultures worldwide. These practices challenge the individual who alone in the wilderness battles fear and loneliness only to discover inner strengths and true identity. The solo experience, viewed as enacting these ancient rituals in modern form may serve as an antidote to the loneliness, stress, and depression on the rise in the current era, which have been linked to our overly stimulated urban environments and lifestyles. This paper sheds light on how the wilderness solo is experienced and understood, specifically as contributing to therapeutic outcome and personal growth. The empirical and theoretical literature is reviewed pointing to the significance of solitude and silence as basic components of the wilderness solo. These are linked to profound personal outcomes including the discovery of new and expansive ways of knowing the self and the world, specifically as interconnected in the larger web of life, enhancing a sense of personal belonging and purpose.
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Affiliation(s)
- Lia Naor
- Department of Counseling and Human Development, University of Haifa, Haifa, Israel
| | - Ofra Mayseless
- Department of Counseling and Human Development, University of Haifa, Haifa, Israel
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