Learning Module | Connecting with Nature
Chapter Three
3. Practical Strategies
Introduction
The goal of this section is to introduce how to apply your knowledge behind the benefits of connecting to nature into practical strategies for your patients and your community.
As healthcare professionals, we have the opportunity to play an integral role in educating our patients and others about the evidence-based health promotion strategy of connecting to nature.
Research shows that to encourage behaviour to connect to nature, one needs both opportunity and orientation, one alone is not sufficient. [1]
In our role as a health advocate, we have the incredibly unique and important opportunity to increase one’s level of orientation, inclination or motivation of why they should connect to nature.
Key Strategies for encouraging others to connect with nature
Lead by example. Disclose personal healthy behaviours of connecting to nature.
It has been shown that physicians can enhance their level of credibility and motivate patients to adopt healthy behaviours by modelling these behaviours themselves. [4]
Communicate the evidence-based health promotion strategy of connecting to nature.
As nurses and physicians are among the most trusted and well-respected professions, we have the opportunity to utilize our voice. [2,3]
The following sections will focus on key messages that can help effectively communicate the need for a nature connection to our patients.
Forms of connecting with nature
With over 80% of Canadians living in urban areas, opportunities to connect with nature may be more difficult to find. Geographically, there are more accessible forms of nature in rural areas, and with increased urbanization, we are seeing a loss of many forms for experiencing nature on a regular basis.
Beginning with connecting to nature as an evidence-based health promotion strategy, we must first orient ourselves to find and create more unique and accessible means of connecting to nature within urban contexts.
Many people think that to connect to nature they have to go into the wilderness, go for a hike, or completely unplug on a camping trip. Although those are some great examples of getting outside, connecting with nature can take place in many forms.
The following examples are evidence-based forms of connecting with nature.
BEING IN NATURE
Why should you spend time in nature?
Whether it is going to a place in nature that brings you feelings of meaning, spending time in the forest atmosphere or gardening - all of these forms are associated with the health benefits that were discussed in section 3. Gardening has found to reduce greater levels of stress (measured through salivary cortisol levels) than a restful indoor task, and cancer survivors reported better strength and endurance after participating in a gardening program. [8, 9] Those who have the closest proximity and quantity of parks in their community have reported higher mental health scores and overall subjective well- being. [10 11] Forest bathing (shinrin- yoku) is the practice of taking in the atmosphere of the forest with all of one’s senses. It has been found to increase positive feelings and decrease stress, blood pressure measurements and sympathetic nervous system activity. [12, 13]
Examples of being in nature: Visiting parks, forest bathing (Shinrin-Yoku), meaningful natural setting, gardening, working in nature.
MOVing IN NATURE
Why should you move in nature?
There is a synergistic benefit between the psychological benefits of physical activity and nature. The self-reported psychological well-being benefits of physical activity in nature have been found to be higher in natural settings as opposed to other environments. [5] Studies have shown that this may be associated with a reduction in risk of poor mental from exercising in nature due to the restorative effects of a natural environment. [6] Even exercising and viewing nature has been found to reduce BP, increase self-esteem and mood. [7]
Examples of moving in nature: Walking, hiking, any physical activity outdoors.
OBSERVING NATURE
Can observing nature itself be beneficial? Yes!
Research has shown that even the indirect effects of viewing nature such as through plants in an area within the hospital, or outside one’s window at work can have a positive effect. [X, 15]. Moving or physically being within a nature environment may not be accessible for everyone due to limitations such as mobility or financial challenges. Thus, we have to foster opportunities to bring nature to ourselves to connect with.
Examples of observing nature: indoor plants, listening to nature sounds.
Movement to urban areas does not mean we cannot connect to nature, but rather, it means that we must move ourselves to create, find, and foster new ways to do so.
Frequency & “DOSAGE” of Nature
What is the right “nature dose?”
There is a growing body of evidence indicating that greater opportunities to connect with nature are associated with better health and well- being. However, there is less research that measures what amount of recreational or ‘purposeful’ time individuals need to spend to promote the associated health factors. To be introduced to this emerging concept, look below at two seminal studies that have focused on defining this relationship.
Recommendations:
Spend at least 2 hours in nature/week [16]
Set aside intervals of at least 20- 30 minutes [17]
Case study: “Spending at least 120 minutes a week in nature is associated with good health and wellbeing” [16]
One of the first studies focused on defining optimal exposure-response dose that measured individual’s nature contact directly rather than focusing on the usual measurement of proximity to green space found that reporting good health and well-being was significantly greater when spending 2+ hours in nature/week.
Aim of Study: To improve our understanding of any exposure-response relationship between contact with natural environments and health, well- being.
Methods: Used data from large nationally representative sample in England. Direct nature exposure was defined in terms of self-reported minutes spent in natural environment in the last seven days.
Results:
Likelihood of reporting good health or high well-being became significantly greater with contact >120 mins.
This positive association peaked at 200-300 minutes with no increased gain
Intervals of how this time was achieved did not matter in this study
Read this study: White, M. P., Alcock, I., Grellier, J., Wheeler, B. W., Hartig, T., Warber, S. L., Bone, A., Depledge, M. H., & Fleming, L. E. (2019). Spending at least 120 minutes a week in nature is associated with good health and wellbeing. Scientific Reports, 9(1), 7730..
Case study: “Urban Nature Experiences Reduce Stress in the Context of Daily Life Based on Salivary Biomarkers” [17]
A seminal study, focused on describing the relationship between mental restoration from nature experiences (measured through physiological biomarkers) and the effective “nature dose” of time spent outdoors that brings a sense of connection to nature.
Aim of the Study: To improve our understanding of optimal “nature dose” that is applicable within the context of the unpredictability of daily life.
Methods: Over 8 weeks, 36 individuals living in urban areas were asked to have a nature experience in an outdoor place that brings a sense of connection for at least 3 times/week for 10 minutes or more.
It is unique in that participants were able to choose the time of day, duration and place for their nature experience, to make it applicable to daily life.
Results: Stress levels and cortisol levels were measured. Salivary cortisol was found to drop 21.3%/hr or greater after a nature experience in comparison to the hormone’s 11.7% diurnal drop. The most efficient nature dose was found to be greatest between 20-30 minutes.
Read this study: Hunter, M. R., Gillespie, B. W., & Chen, S. Y.-P. (2019). Urban Nature Experiences Reduce Stress in the Context of Daily Life Based on Salivary Biomarkers. Frontiers in Psychology, 10, 722.
Canada’s Parks Prescription Program
Introducing Canada’s first-ever evidence-based Parks Rx Program, an initiative of the BC Parks Foundation.
This initiative is driven by health professionals with the goal of improving their patient’s health by connecting them to nature. Research shows that a written goal-oriented prescription is better at motivating patients’ behaviour than verbal advice alone. [18]
Highlights:
PaRx is a simple, practical intervention that is free for physicians and patients to use
You can begin prescribing nature today, no matter where your practice or patients are located
Accessible handouts are available for patients regarding nature benefits for specific diseases (e.g., anxiety, CVD)
You can learn WHY and HOW you can begin prescribing time in nature to your patients today on the Parks Rx Program website linked below.
“We wanted to formalize [connecting to nature] because in part, the evidence shows that writing something down increases the chances that the patient will be motivated to make that change.”
— Dr. Melissa Lem
Introducing Dr. Melissa Lem
Founder of Canada’s PaRx Program, president-elect of the Canadian Association of Physicians for the Environment (CAPE), a recipient of the 2020 Joule Innovation Grant, and a Vancouver family physician and mother.
We had the opportunity to chat with her, and this is what she had to say:
“I regularly counsel patients, especially those with mental health concerns, to spend time in nature. Usually, this counselling takes place along with our discussion about other lifestyle interventions. I am currently working to determine best prescribing natures for nature, and which sorts of nature experiences are best suited to different populations, to allow us to pin more specific recommendations on how to counsel patients. Part of the reason why I'm working on a ParkRx is because I want to formalize the process more and provide tracking and incentives for patients that will increase their likelihood of adherence.”
— Dr. Melissa Lem, April 2020