Yeon Hee Choi; Young Sun Ha

doi:10.12799/jkachn.2014.25.2.109

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Original Article
The Effectiveness of a Forest-experience-integration Intervention for Community Dwelling Cancer Patients' Depression and Resilience: Yeon Hee Choi¹, Young Sun Ha²; Journal of Korean Academy of Community Health Nursing 2014;25(2):109-118.
DOI: https://doi.org/10.12799/jkachn.2014.25.2.109
Published online: June 14, 2014

¹College of Nursing, Kyungpook National University, Daegu

²Institute of Nursing Science, Kyungpook National University, Daegu, Korea

Corresponding author: Ha, Young Sun, Institute of Nursing Science, Kyungpook National University, 680 Gukchabosangro, Jung-gu, Daegu 700-422, Korea. Tel: +82-2-53-420-4925, Fax: +82-2-53-421-2758, E-mail: hajin24@hanmail.net

• Received: March 17, 2014 • Revised: May 29, 2014 • Accepted: June 5, 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
References

Abstract

Purpose:
This study examined the effectiveness of a forest-experience-integration intervention in community dwelling cancer patients.
Methods:
The study was done with a nonequivalent control group pretest-posttest design. The subjects of the present study were 53 community dwelling cancer patients who were registered in a community health center in Gyeongsangbuk-do. The subjects were divided into an experimental group (n=26) who participated in the forest-experience-integration intervention and a control group (n=27) who did not participate. Data were collected from May to June in 2011. Collected data were analyzed using SPSS PC+ 19.0 through x² test, and independent t-test.
Results:
There were significant differences between the groups in depression (t=-4.51, p<.001), self-regulation resilience (t=6.95, p<.001), interpersonal resilience (t=10.10, p<.001), positivity resilience (t=9.67, p<.001), and total resilience (t=13.93, p<.001) measurements.
Conclusion:
The forest-experience-integration intervention delivered to community dwelling cancer patients was an effective method for relieving depression and enhancing self-regulation resilience, interpersonal resilience, positivity resilience, and total resilience, and can be utilized as an effective nursing intervention for community dwelling cancer patients.
Key Words: Neoplasms; Community health centers; Depression; Resilience

Table 1.

The Forest-experience-integration Intervention

Title	Session		Contents	Time (minutes)
Preparation phase	All Session		Introduction, friendship, abdominal breathing, stretching, safety training, respiratory and heart rate measurements, checking the necessary	30
Execution phase	Physical intervention	All session	Walking and abdominal breathing	20
	Psychological intervention	1st session	Learn to forest activities: Description of trees and landscape	20
		2nd session	Activities to get close to the forest: Touching wood, touching natural objects and expressing the feeling of body
		3rd session	Accompany with forest: Lying in the woods, viewing the sky, expressing the feeling
		4th session	Utilizing forest: Create self-image by leaves
		5th session	Promotion activities in sensitive: Meditation
		6th session	Promote self-esteem activities: Write a letter to me
		7th session	Promote cooperativity activities: Treasure hunt
		8th session	Promote empathy activities: Talk about lifestyle
	Physical intervention	All session	Walking and abdominal breathing	20
Completion phase	All Session		Friendship, abdominal breathing, stretching, respiratory and heart rate measurements Next session guide	30
Total				2 hour (120)

Table 2.

Homogeneity Test for General Characteristics between Groups

Variables	Categories	Total (n=53)	Exp. (n=26)	Cont. (n=27)	x²	p
Variables	Categories	n (%)	n (%)	n (%)	x²	p
Age (year)	50~59	20 (37.7)	10 (38.5)	10 (37.0)	0.02	.915
Age (year)	≥60	33 (62.3)	16 (48.5)	17 (51.5)
Gender	Male	15 (28.3)	6 (23.1)	7 (25.9)	0.69	.407
Gender	Female	38 (76.9)	20 (66.7)	20 (74.1)
Diagnosis	Digestive system cancer	18 (34.6)	9 (34.6)	9 (33.3)	0.06	.971
	Female cancer	22 (41.5)	11 (42.3)	11 (40.7)
	Others	13 (24.5)	6 (23.1)	7 (25.9)
Periods of struggle against disease (year)	1~2	24 (45.3)	10 (38.5)	14 (51.9)	0.96	.618
	3~4	11 (20.8)	6 (23.1)	5 (18.5)
	≥5	18 (34.0)	10 (38.5)	8 (29.6)
Type of medical insurance	Insurance payment	36 (67.9)	18 (69.2)	18 (66.7)	0.04	.842
Type of medical insurance	Health insurance	17 (32.1)	8 (30.8)	9 (33.3)
Education	＜Elementary	40 (75.5)	20 (76.9)	20 (74.1)	0.06	.810
Education	≥Middle school	13 (24.5)	6 (23.1)	7 (25.9)
Living together	Spouse	31 (58.5)	15 (57.7)	16 (59.3)	0.01	.908
Living together	Offspring	22 (41.5)	11 (42.3)	11 (40.7)

Exp.=experimental group; Cont.=control group.

Table 3.

Homogeneity Test for Dependent Variables between Groups

(N=53)

Variables	Categories	Exp. (n=26)	Cont. (n=27)	t	p
Variables	Categories	M±SD	M±SD	t	p
Depression		45.8±7.06	46.7±6.66	−0.48	.637
Resilience	Self-regulation	60.4±8.12	60.2±7.84	0.09	.928
	Interpersonal	60.6±5.15	60.1±5.94	0.33	.742
	Positivity	52.0±3.71	51.7±3.75	0.29	.774
	Total	173.0±11.37	172.0±10.97	0.33	.746

Exp.=experimental group; Cont.=control group.

Table 4.

Comparison of Scores between Pretest and Posttest in Two Groups

(N=53)

Variables		Groups	Pretest (n=26)	Posttest (n=27)	t	p
Variables		Groups	M±SD	M±SD	t	p
Depression		Exp.	45.8±7.06	41.4±5.66	−4.51	＜.001
Depression		Cont.	46.7±6.66	48.3±5.45
Resilience	Self-regulation	Exp.	60.4±8.12	68.5±5.15	6.95	＜.001
		Cont.	60.2±7.84	57.3±6.53
	Interpersonal	Exp.	60.6±5.15	68.3±2.81	10.10	＜.001
		Cont.	60.1±5.94	57.7±4.55
	Positivity	Exp.	52.0±3.71	58.7±2.67	9.67	＜.001
		Cont.	51.7±3.75	50.5±3.42
	Total	Exp.	173.0±11.37	195.4±7.10	13.93	＜.001
		Cont.	172.0±10.97	165.5±8.46

Exp.=experimental group; Cont.=control group.

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The Effectiveness of a Forest-experience-integration Intervention for Community Dwelling Cancer Patients' Depression and Resilience

Title	Session		Contents	Time (minutes)
Preparation phase	All Session		Introduction, friendship, abdominal breathing, stretching, safety training, respiratory and heart rate measurements, checking the necessary	30
Execution phase	Physical intervention	All session	Walking and abdominal breathing	20
	Psychological intervention	1st session	Learn to forest activities: Description of trees and landscape	20
		2nd session	Activities to get close to the forest: Touching wood, touching natural objects and expressing the feeling of body
		3rd session	Accompany with forest: Lying in the woods, viewing the sky, expressing the feeling
		4th session	Utilizing forest: Create self-image by leaves
		5th session	Promotion activities in sensitive: Meditation
		6th session	Promote self-esteem activities: Write a letter to me
		7th session	Promote cooperativity activities: Treasure hunt
		8th session	Promote empathy activities: Talk about lifestyle
	Physical intervention	All session	Walking and abdominal breathing	20
Completion phase	All Session		Friendship, abdominal breathing, stretching, respiratory and heart rate measurements Next session guide	30
Total				2 hour (120)

Variables	Categories	Total (n=53)	Exp. (n=26)	Cont. (n=27)	x²	p
Variables	Categories	n (%)	n (%)	n (%)	x²	p
Age (year)	50~59	20 (37.7)	10 (38.5)	10 (37.0)	0.02	.915
Age (year)	≥60	33 (62.3)	16 (48.5)	17 (51.5)
Gender	Male	15 (28.3)	6 (23.1)	7 (25.9)	0.69	.407
Gender	Female	38 (76.9)	20 (66.7)	20 (74.1)
Diagnosis	Digestive system cancer	18 (34.6)	9 (34.6)	9 (33.3)	0.06	.971
	Female cancer	22 (41.5)	11 (42.3)	11 (40.7)
	Others	13 (24.5)	6 (23.1)	7 (25.9)
Periods of struggle against disease (year)	1~2	24 (45.3)	10 (38.5)	14 (51.9)	0.96	.618
	3~4	11 (20.8)	6 (23.1)	5 (18.5)
	≥5	18 (34.0)	10 (38.5)	8 (29.6)
Type of medical insurance	Insurance payment	36 (67.9)	18 (69.2)	18 (66.7)	0.04	.842
Type of medical insurance	Health insurance	17 (32.1)	8 (30.8)	9 (33.3)
Education	＜Elementary	40 (75.5)	20 (76.9)	20 (74.1)	0.06	.810
Education	≥Middle school	13 (24.5)	6 (23.1)	7 (25.9)
Living together	Spouse	31 (58.5)	15 (57.7)	16 (59.3)	0.01	.908
Living together	Offspring	22 (41.5)	11 (42.3)	11 (40.7)

Variables	Categories	Exp. (n=26)	Cont. (n=27)	t	p
Variables	Categories	M±SD	M±SD	t	p
Depression		45.8±7.06	46.7±6.66	−0.48	.637
Resilience	Self-regulation	60.4±8.12	60.2±7.84	0.09	.928
	Interpersonal	60.6±5.15	60.1±5.94	0.33	.742
	Positivity	52.0±3.71	51.7±3.75	0.29	.774
	Total	173.0±11.37	172.0±10.97	0.33	.746

Variables		Groups	Pretest (n=26)	Posttest (n=27)	t	p
Variables		Groups	M±SD	M±SD	t	p
Depression		Exp.	45.8±7.06	41.4±5.66	−4.51	＜.001
Depression		Cont.	46.7±6.66	48.3±5.45
Resilience	Self-regulation	Exp.	60.4±8.12	68.5±5.15	6.95	＜.001
		Cont.	60.2±7.84	57.3±6.53
	Interpersonal	Exp.	60.6±5.15	68.3±2.81	10.10	＜.001
		Cont.	60.1±5.94	57.7±4.55
	Positivity	Exp.	52.0±3.71	58.7±2.67	9.67	＜.001
		Cont.	51.7±3.75	50.5±3.42
	Total	Exp.	173.0±11.37	195.4±7.10	13.93	＜.001
		Cont.	172.0±10.97	165.5±8.46

Table 1. The Forest-experience-integration Intervention

Table 2. Homogeneity Test for General Characteristics between Groups

Exp.=experimental group; Cont.=control group.

Table 3. Homogeneity Test for Dependent Variables between Groups (N=53)

Exp.=experimental group; Cont.=control group.

Table 4. Comparison of Scores between Pretest and Posttest in Two Groups (N=53)