Razani Nooshin, Kohn Michael A, Wells Nancy M, Thompson Doug, Hamilton Flores Hanna, Rutherford George W
Center for Nature and Health, UCSF Benioff Children's, Hospital Oakland, 747 52nd St, Oakland, CA 94609, USA.
Department of Epidemiology and Biostatistics, School of Medicine, University of California, 550 16th St, San Francisco, CA 94158, USA.
Contemp Clin Trials. 2016 Nov;51:8-14. doi: 10.1016/j.cct.2016.09.007. Epub 2016 Sep 29.
Contact with nature improves human health; stress reduction is a mediating pathway. Stay Healthy in Nature Everyday (SHINE) is a stress reduction and health promotion intervention for low-income families at an urban Federally Qualified Health Center. We plan to evaluate two service-delivery models for SHINE and present here the intervention design and evaluation protocol.
Behavioral change theory and environmental education literature informed the intervention. Outcomes were selected after review of the literature and field tested procedures to determine what was feasible and ethical in a busy clinic serving vulnerable populations.
We designed a randomized controlled trial to examine two levels of intensity in behavioral counseling about the health benefits of nature. Dyads consisting of a caregiver and a child aged 4 to 18 who access our pediatric primary care center are eligible. All dyads receive a pediatrician's recommendation to visit parks to experience nature and written resources (a "park prescription"). The intervention group receives added case management and an invitation to three group outings into nature with transportation, meals and activities provided. Primary outcomes measured at baseline, one month and three months post-enrollment are caregiver stress measured by PSS-10 score and salivary α-amylase; secondary outcomes are park prescriptions adherence, physical activity recorded by pedometer and journaling, loneliness, family cohesion and affinity to nature as measured by a validated scales. Both groups receive incentives to participation.
Our intervention represents a feasible integration of recent research findings on the health benefits of nature and primary care practice.
与自然接触可改善人类健康；减轻压力是其中介途径。“每日在自然中保持健康”（SHINE）是一项针对城市联邦合格健康中心低收入家庭的减压与健康促进干预措施。我们计划评估SHINE的两种服务提供模式，并在此介绍干预设计和评估方案。
行为改变理论和环境教育文献为干预提供了依据。在查阅文献和进行实地测试程序后选择了结果指标，以确定在为弱势群体服务的繁忙诊所中哪些是可行且符合伦理的。
我们设计了一项随机对照试验，以研究关于自然对健康益处的行为咨询的两个强度级别。由一名照顾者和一名4至18岁儿童组成的二元组，若他们使用我们的儿科初级保健中心，则符合条件。所有二元组都会收到儿科医生关于参观公园体验自然的建议以及书面资料（“公园处方”）。干预组会额外接受病例管理，并受邀参加三次户外自然出行活动，活动提供交通、餐饮和活动。在基线、入组后1个月和3个月测量的主要结果指标是用PSS - 10评分和唾液α -淀粉酶测量的照顾者压力；次要结果指标是公园处方的依从性、用计步器记录的身体活动和写日记情况、孤独感、家庭凝聚力以及用经过验证的量表测量的对自然的亲近感。两组都有参与激励措施。
我们的干预措施代表了近期关于自然对健康益处的研究结果与初级保健实践的可行整合。
