Abstract
We describe a mixed qualitative and quantitative research study in a military facility regarding the role of nature in well-being. Study intervention included two 20-minute walks. One walk was in an intentionally designed woodland environment (Green Road) and the other was on a busy campus road in a medical treatment facility (Urban Road). Twelve volunteers from a military facility participated in both walks in a cross-over experimental design. The two walking sessions were randomly ordered and preceded by pre-walk instructions appropriate to each road’s characteristics and incorporated focused attention and present moment orientation. A semi-structured post-walk interview, the primary outcome, was conducted after the conclusion of each walk. Qualitative data analyses consisted of sentiments and themes by using NVivo 12 software. The Green Road was unanimously rated as positive (100%). Responses to Urban Road were evenly distributed among positive (33.3%), negative (33.3%), and neutral/mixed (33.3%) sentiments. The Green Road yielded predominantly positive themes such as enjoyment of nature, relaxation, and feelings of privacy and safety. Urban Road produced significantly more negative themes such as concerns for safety, dislike of noise and other noxious experiences. Quantitative assessment of distress and mindfulness with Distress Thermometer (DT) and Mindful Attention Awareness Scale-state version (MAAS) demonstrated that a walk on the Green Road significantly decreased distress and increased mindfulness compared to a walk on the Urban Road. We also observed that pre-walk instructions could direct attention to both obvious and subtle elements of experience and enhance awareness. Results support the notion that an intentional nature-based environment may produce significantly more positive experiences and result in health-promoting benefits in a military health-care setting compared to an urban environment. Future studies with clinical populations could advance our understanding of the healing value of nature-based interventions. The impact of intentional green environments may be enhanced by well-designed instructions for both recreational and therapeutic use.
Highlights
Military service members spend an inordinate amount of their lives on military installations
qualitative data analysis (QDA) was continued through 12 participants to ensure new themes did not emerge
Sentiments relating to the participants’ general experience on the Green Road (Question 1) indicated that all 12 participants (100%) had a positive experience when walking this road, whereas responses to the Urban Road experiences were varied and were evenly distributed among positive (33.3%), negative (33.3%), and neutral/mixed (33.3%) sentiments
Summary
Military service members spend an inordinate amount of their lives on military installations. Domestic military treatment facilities are a special instance of this, as they provide primary and specialized inpatient care to service members from all around the country. Naval Support Activity, Bethesda, home of Walter Reed National Military Medical Center (NSA/B/ Walter Reed), is the largest joint military treatment facility (WRNMMC, 2020). It includes a number of specialty treatment programs for wounded and transitioning service members, who often have complicated physical and mental ailments that require prolonged inpatient care. Efforts have been underway to leverage evidence-based design principles (Casscells, Kurmel & Ponatoski, 2009) to make NSA/B a patient-centered environment that fosters holistic healing and welcomes patients and their families (Foote, 2012; Foote et al, 2012). One relevant approach for this is to create intentional green spaces with implicit and explicit invitations to relax, reflect, and enjoy
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