Stepped-Wedge Cluster Randomised Trial of Social Prescribing of Forest Therapy for Quality of Life and Biopsychosocial Wellbeing in Community-Living Australian Adults with Mental Illness: Protocol
Abstract
:1. Introduction
1.1. Aims
1.2. Hypotheses
2. Methods
2.1. Design
2.2. Participants
2.2.1. Inclusion Criteria
- Adult (aged 18+ years);
- Any sex i.e., male, female, or non-specified;
- Referred to PCCS by GP for SP program;
- Diagnosed with a mental illness (mood or psychotic disorder) *;
- Able to complete study questionnaires in English;
- Capable of providing informed consent.
2.2.2. Exclusion Criteria
- Receiving inpatient care in the past 6 months;
- Current thoughts of harm to self or others;
- Cognitive deficit which prevents capacity to provide informed consent or to complete study questionnaires.
3. Recruitment and Informed Consent
4. Intervention
4.1. Intervention Objectives
- Promote nature as a place of relaxation;
- Demonstrate mindfulness techniques;
- Develop a gratitude-based focus to enhance positive mood;
- Enhance wellbeing using a range of creative and sensory activities;
- Experience relaxing activities with others, increasing social connectedness through shared experiences;
- Develop an understanding of the importance of nature and local culture in a specific area.
4.2. Forest Therapy Sessions
- Introduction to FT;
- Sensory tuning activity—designed to ground participants using a combination of breathing exercises and gentle physical movement;
- Introduction to the local environment—overview of ecological, historical, and cultural information;
- Creative and sensory activities designed to facilitate mindfulness, including:
- a.
- Focusing on a specific nature point in the distance;
- b.
- Collecting fallen objects such as leaves and creating a collective artwork *;
- c.
- Creating a sound map of the area using paper/pens;
- d.
- Exploring textures in the natural environment by safely touching trees, grass, etc.
- ‘Sit spot’—sit quietly and observe nature in a safe and calm environment;
- Tea ceremony—drink tea and discuss favourite part of the experience *.
5. Data Collection
5.1. Data Matching and Confidentiality
- First letter of participant’s mother’s first name;
- Number of participant’s older brothers (living and deceased);
- Month participant was born;
- First letter of participant’s middle name (if none, use X).
5.2. Materials
5.2.1. Demographics
5.2.2. Quality of Life
5.2.3. Social Adjustment and ADLs
5.2.4. Loneliness
5.2.5. Depression
5.2.6. Anxiety
5.2.7. Health Self-Efficacy
5.2.8. Health Service Utilisation
5.2.9. Mood
5.2.10. Pulse Rate and Blood Pressure
6. Outcomes of interest
6.1. Primary Outcomes
6.2. Secondary Outcomes
6.2.1. Mental Health
6.2.2. Health Self-efficacy
- The Health Confidence Score [63]
6.2.3. Physical Health
- Physical Health Subscale of WHO-QoL-Bref [56]
6.2.4. Health Service Utilisation
7. Statistical Analysis
7.1. Sample Size Estimation
Analysis
8. Ethical Considerations
9. Compensation for Potential Bias
9.1. Lack of Blinding and Randomisation
9.2. Heterogeneity of Participant Clusters
9.3. Concurrent Treatments
10. Discussion
11. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Thomas, T.; Baker, J.; Massey, D.; D’Appio, D.; Aggar, C. Stepped-Wedge Cluster Randomised Trial of Social Prescribing of Forest Therapy for Quality of Life and Biopsychosocial Wellbeing in Community-Living Australian Adults with Mental Illness: Protocol. Int. J. Environ. Res. Public Health 2020, 17, 9076. https://doi.org/10.3390/ijerph17239076
Thomas T, Baker J, Massey D, D’Appio D, Aggar C. Stepped-Wedge Cluster Randomised Trial of Social Prescribing of Forest Therapy for Quality of Life and Biopsychosocial Wellbeing in Community-Living Australian Adults with Mental Illness: Protocol. International Journal of Environmental Research and Public Health. 2020; 17(23):9076. https://doi.org/10.3390/ijerph17239076
Chicago/Turabian StyleThomas, Tamsin, James Baker, Debbie Massey, Daniel D’Appio, and Christina Aggar. 2020. "Stepped-Wedge Cluster Randomised Trial of Social Prescribing of Forest Therapy for Quality of Life and Biopsychosocial Wellbeing in Community-Living Australian Adults with Mental Illness: Protocol" International Journal of Environmental Research and Public Health 17, no. 23: 9076. https://doi.org/10.3390/ijerph17239076