School of Nursing, University of Wollongong, Wollongong, Australia.
Centre for Evidence Based Initiatives in Health Care: A JBI Centre of Excellence.
JBI Evid Synth. 2020 Sep;18(9):1820-1869. doi: 10.11124/JBISRIR-D-19-00263.
The objective of this review was to identify, appraise, and synthesize the best available evidence related to participation in outdoor nature-based therapeutic recreation programs for adults with a mental illness living in the community.
Therapeutic recreation is posited to be beneficial for persons living with a mental illness. Research evidence indicates that therapeutic recreation programs can foster mental health recovery. It is important to understand the effectiveness of this from the perspective of persons living with mental illness how outdoor nature-based therapeutic recreation programs are meaningful and helpful for recovery.
This review considered studies that collected qualitative data on the experiences and perspectives of adults with a mental illness regarding their participation in outdoor nature-based therapeutic recreation programs.
The databases PsycINFO, CINAHL, MEDLINE, Scopus, and Informit, as well as unpublished sources in gray literature (Google Scholar, OpenGrey), were searched and reference lists were checked to locate any additional studies. Studies published in English were considered, with a date range from inception to 2019. Three reviewers independently assessed the methodological quality of the studies that met the inclusion criteria using the JBI critical appraisal approach for qualitative research. Data were extracted by one reviewer using the standardized qualitative extraction tool and checked for accuracy by three other reviewers. The qualitative research findings were pooled using JBI methodology. The JBI process of meta-aggregation was used to identify categories and synthesized findings, and a level of confidence was assigned to both synthesized findings.
Eighteen papers met the inclusion criteria and were included in the data extraction phase. A total of 84 findings were extracted and aggregated into six categories based on similarity of meaning and two synthesized findings. The methodological quality of the studies varied, and the overall level of confidence of the synthesized findings was determined to be moderate.
This review identified that persons living with mental illness perceive outdoor nature-based therapeutic recreation as enjoyable and that therapeutic recreation makes a positive contribution to mental health. Congruent with the literature, therapeutic recreation offers a socially inclusive and psychologically safe environment. The intentionally structured social milieu enhances the formation of social relationships and meaningful connections for persons with mental illness. Elements linked with psychological well-being, such as intrinsic motivation, overcoming perceived challenges, and finding purpose and meaning, are enhanced through participation in therapeutic recreation in outdoor nature-based settings. Increased levels of physical activity, greater self-esteem, and enhanced sense of identity were some of the perceived positive changes. This review provides important insights into the subjective needs of persons with mental illness who undertake therapeutic recreation in outdoor nature-based settings. The qualitative findings can inform health care providers, or those interested in therapeutic recreation programming, to use alongside quantitative evidence of effectiveness to design nature-based therapeutic recreation activities that are meaningful for persons with mental illness. Limitations of the research were that papers published in languages other than English were not searched, and papers not located may have influenced the findings of this review.
本综述旨在确定、评价和综合与社区中患有精神疾病的成年人参与户外自然为基础的治疗性娱乐项目相关的最佳现有证据。
治疗性娱乐被认为对患有精神疾病的人有益。研究证据表明，治疗性娱乐项目可以促进心理健康康复。了解这一点很重要，从患有精神疾病的人的角度来看，户外自然为基础的治疗性娱乐项目对康复意味着什么，有什么帮助。
本综述考虑了收集有关成年人参与户外自然为基础的治疗性娱乐项目的经验和观点的定性数据的研究。
使用 PsycINFO、CINAHL、MEDLINE、Scopus 和 Informit 数据库，以及 Google Scholar、OpenGrey 等未发表的灰色文献来源进行搜索，并查阅参考文献以查找任何其他研究。考虑了发表在英语中的研究，时间范围从开始到 2019 年。三位评审员使用 JBI 定性研究评估方法独立评估符合纳入标准的研究的方法学质量。一位评审员使用标准化定性提取工具提取数据，并由另外三位评审员检查准确性。使用 JBI 方法对定性研究结果进行汇总。使用 JBI 元聚合过程确定类别并综合研究结果，并为综合研究结果分配置信度级别。
18 篇论文符合纳入标准并进入数据提取阶段。共提取了 84 个发现，并根据相似的含义将其分为六个类别，同时形成了两个综合发现。研究的方法学质量各不相同，综合研究结果的整体置信度水平被确定为中等。
本综述发现，患有精神疾病的人认为户外自然为基础的治疗性娱乐活动令人愉快，并且治疗性娱乐活动对心理健康有积极的贡献。与文献一致，治疗性娱乐活动提供了一个社会包容和心理安全的环境。有意设计的社交环境增强了精神病患者之间社会关系和有意义联系的形成。与心理幸福感相关的元素，如内在动机、克服感知到的挑战以及寻找目标和意义，通过在户外自然环境中进行治疗性娱乐活动得到了增强。一些感知到的积极变化包括更高水平的身体活动、更高的自尊心和增强的身份认同感。本综述为在户外自然环境中进行治疗性娱乐活动的精神病患者的主观需求提供了重要见解。定性研究结果可以为卫生保健提供者或对治疗性娱乐项目感兴趣的人员提供信息，以便与治疗性娱乐活动的有效性的定量证据一起使用，为精神病患者设计有意义的自然为基础的治疗性娱乐活动。研究的局限性在于，没有搜索以英语以外的语言发表的论文，并且未找到的论文可能会影响本综述的结果。
