Chapter 17

a well‐known measure used to study the effectiveness of youth therapy.

 Outcomes evaluation is a particular kind of

research methodology used to objectively
validate the effectiveness of specific programs
(Cone, 2001).

 They include problems resulting from single

method bias and working with small sample
sizes, balancing differing views about the goals of
the research, and dealing with varying levels of
buy‐in from stakeholders regarding the research
process itself.
In this chapter ….
Three research programs that provide excellent role models:
Forestry Scotland’s “Branching Out”
program
The Outdoor Behavioral Healthcare
Industry Research Council (OBHIRC)
University of Illinois Landscape and
Human Health Laboratory (LHHL)
But, before proceeding to details about
research programs, it is worth
addressing the linkages between
environmental psychology and human
health and well‐being. This reveals the
basis for ecotherapy and environmental
health approaches and alerts us to
factors involved in our research
designs, including how to operationalize
“nature” as a therapeutic mechanism.
Environmental Psychology and
Human Health

 Natural settings, outdoor activities, and

contacts with other species have been
utilized in therapeutic ways, with a variety of
client groups, in the fields of ecotherapy,
environmental social work, wilderness and
adventure therapy, horticultural therapy, and
in animal‐assisted therapies
 In addition, these findings parallel initiatives in
the fields of medicine and environmental health
on the influence of nature‐based methods and
nature views on physical health outcomes,
including the use of healing gardens in
hospitals and creation of community‐wide
greening programs

 Further, once these benefits are documented

they provide valid reasons for preserving and
creating green space and for the support of
environmental conservation
initiatives.
The study of ecotherapy and environmental health
can be approached in a number of ways, ranging
from
 positivist/biomedical approaches (e.g., quantitative
symptom reduction and physiological measures)
 To post‐positivist/biopsychosocial approaches (i.e.,
these include the personal meaning of treatment and
roles of interpersonal support systems),
 To interpretive/humanistic approaches (e.g., in‐depth
qualitative interviews), and
 constructivist/critical approaches (i.e., these recognize
the roles of cultural discourses, power, and equity in
the research process) (Marks & Yardley, 2004)
 In terms of the restorative effects of
nature contacts, qualitative methods are
generally most suitable for inquiring into
the personal meanings of these
experiences (e.g., through focus groups,
journals, or using a video diary).

 These case studies can provide a solid

foundation for developing satisfying and
effective therapeutic techniques.
Reflection about Your
Personal Beliefs and
Motivations
about research
methods can help identify which
approaches you are best suited for
and increase your awareness of
blind spots and biases that may
impact your findings.
Researchers (e.g., Clayton & Myers, 2009)
may characterize nature and natural settings
as:
 Domestic nature: examples include living
plants in homes or offices, indoor gardens,
aquariums, pets.
 Nearby nature: parks, gardens, urban
greenery, waterways, beaches.
 Managed nature: forests, zoos, farmlands,
fisheries, wildlife refuges.
 Wild nature: places, beings, or processes
that are objectively, or perceived to be,
beyond human control, including remote
 These studies highlight the importance of
a clear and compelling research agenda
that answers questions of significance to
stakeholders (Kuo, 2002).
 They also illustrate the effective use of
quantitative and qualitative methods to
study treatment outcomes and evaluate
new programs.
Quantitative outcome measures.
 Pre‐ and post‐measures of general health,
mental well‐being, and physical activity were
assessed by standardized questionnaires
completed by clients. General health was
measured using the 12‐item SF‐12v2 Health
Survey (Ware, Kosinski,Turner‐Bower, & Gandeck, 2007).

 Mental well‐being was measured by the

Warwick‐Edinburgh Mental Well‐Being Scale
(WEMWBS; Parkinson, 2007).

 Physical activity was measured by the Scottish

Physical Activity Questionnaire (SPAQ; Lowther, Mutrie,
Loughlan, & McFarlane, 1999).
Qualitative interviews
A qualitative approach was adopted to assess
clients’ perceptions of program elements that
facilitated change.

Focus groups with clinicians.

A facilitator led the discussion and ensured all
respondents had equal opportunity to respond.
 Verbatim transcription of interview data was
analyzed thematically by interpretive
phenomenological analysis (IPA; Smith, Harre, &
Langenhove, 1995).

Meaning, rather than frequency, was central in

the process and the transcript was read several
times to document emergent themes.
Future directions. The second phase of
program evaluation will involve probing the
costs and potential health benefits to the
participants. The evaluation process will
involve three stages of data collection:

1. 2. 3.
baseline before Measures used and the Stage of
starting on for the Change
Branching Out; evaluation will Questionnaire
at the end of include the for Physical
SF‐12 Health Activity. This
the 12‐week
Survey, the project is
project‐ and a
International currently in the
3‐month
Physical Activity data‐collection
follow‐up. Questionnaire, process
 Wilderness and adventure therapy: the outdoor
behavioral healthcare industry research council

 Assessing treatment outcomes of

wilderness programs. Longitudinal
outcome studies completed by the
Outdoor Behavioral Healthcare Industry
Research Council (OBHIRC)
Public health approaches:The Landscape and
Human Health Laboratory
 Attention restoration theory (Kaplan,
1995), which predicts that natural
environments, drawing predominately on
involuntary attention, ameliorate
attention fatigue and restore children’s’
ability to concentrate
 Correlational studies.
Research in Environmental Psychology and
Health: Reflection on Practical and Ethical
Issues

Make it personal.Think about your life

and experience and observe things that
interest you; this will make you more
reflective.”
 Consult the ethics code in your discipline

 Most healthcare disciplines have a

well‐articulated ethics code and it is
important to consult these for guidance on
ethical issues that arise throughout the
research process.
In all therapeutic endeavors, and in research that
addresses people and their wellbeing,
it is crucial to identify possible iatrogenic
effects, commonly known as “side effects” (e.g.,
injury or discomfort).

in environmental
health related research can be promoted and
ensured in several ways. They all begin with
being mindful of the cultural differences
between you as an investigator and the people
in your potential research setting
 In these cases, the use of participatory research
design and holistic/indigenous methods may be
most appropriate.
Therapeutic mechanisms, satisfaction
and the placebo effect
 Gass, Gillis, and Russell (2012, p. 286) note, it
is important for researchers in innovative
areas such as adventure therapy to ask the
“hard questions” about their programs if
they are aspiring to evidence‐based practice.

 It is also important to recognize and attempt

to control for placebo effects – therapeutic
effects associated with contextual factors
including a person’s expectations about a
treatment’s effectiveness.
Summary and Conclusions
In reviewing the programs for this chapter, it was
necessary to move across a number of disciplines
and dig into the separate “silos” where the needed
information could be found on:
 (1) theories of well‐being vis‐à‐vis humans and
nature;
 (2) basic findings on therapeutic mechanisms;
 (3) applied studies with specific groups;
 (4) fully fledged intervention programs; and
 (5) appropriate research methods and examples.
As our research examples show, it is important
to integrate qualitative, quantitative, and culture
sensitive approaches to maximize the validity
and usefulness of your investigations.This
includes looking across academic and
healthcare specialties and recognizing their
associated organizational and cultural contexts.
Knowledge of how individuals can utilize
experience in nearby and wild nature to
promote health and well‐being can be seen as
a component of mental health literacy – both
in terms of self‐help strategies and as potential
psychological treatments. From both a human
and an environmental ethics perspective, our
research methods do matter.