Research in Green Care in Europe. How can we collaborate to speed up high quality research

Jan Hassink Wageningen University and ResearchThe NetherlandsJan.Hassink@wur.nl

Typology of green care.

H Elsey et al. BMJ Open 2014;4:e006536

©2014 by British Medical Journal Publishing Group

Qualities and effects nature and care farm

Quality Effects

• Tranquillity / rest

• Space

• Life processes

• Appeal to senses

• Recovery of stress

• Exercise

•Social contacts

• Personal development

• Status/ identity

• Self esteem

• Social Skills

• Responsibility

• Physical health

• Involvement

• Inclusion

• Useful work

• Diverse work

• Working together

• Caring for

• Physical work

Publications “green care” Year Number Country2017 212016 12 Port, Can, SP,

2015 8 Pol, Australia, Bulgaria2014 21 Switserland, Romania,

Czech Republic2013 4 Belgium, Greece, US2012 19 Germany2011 5 Austria, Sweden2010 5 Italy2009 52008 7 Norway2007 52006 1 Neth. UK<1996 5 US Horticultural

therapy

Subject areas of the publications

Medicine 63Agriculture/biological sciences 40Social Sciences 40Nursing 22Psychology 10Business, management, accounting

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Humanities 6Environmental Sciences 6Economics 3

Types of “Green care”

HT AAT Nature-based

Farm program

Toppublishing countries

US (38) , Japan, South Korea

US (129) Denmark (3), Sweden, Norway, Switzerland

Netherlands (22), UK, Norway

Second group

UK, Germany, Norway, Sweden

Italy, France, Norway, Spain, Germany

Italy, US

Since Start 1979 Start 1991 Start 2007 Start 2007

Significance green care in agriculture

Benefits for ‘users’; empowerment, inclusion, education, employment, therapy, wellbeing…..Benefits for farmers Innovation in agriculture, health care, education,

social sectorNew sustainable links between agriculture, health,

social sector, education and society Strengthening urban-rural relationships; healthy

cities Economics of farms and rural areas: jobs, income Preserving landscapes

COST 866: Green Care a conceptual framework

Defining concept of and approaches in green care Describe the benefits for different types of participants Explore the mechanisms and health promoting elements Link with existing theories, frameworks and models Link with other approaches or interventions

Challenges in research

Diversity in participants Diversity in settings Diversity in programs Diversity in objectives Diversity in methods Diversity in outcomes (not one topic) Different networks “healing nature” and “care farms”

Often no fixed intervention

Types of “interventions”

Fixed intervention: HT, AAT● RCT● Quantitative research ● Validated instruments (depression, self esteem)● Brain images

“Context” with multiple factors; “green care in agriculture”● Diversity; each case is different● Interviews - experiences● Validated instruments● Questionnaires

Green care in Agriculture (care/socialfarms): European support

COST action Sofar project Interreg projects Erasmus projects December 2012 European Economic and Social

Committee. Document on social farming: “innovative approach connecting multipurpose farming and social/health care services. It can make a contribution in the ambit of agricultural production to the well being and social integration of people with particular needs”

Diversity in green care in agriculture: Types of social/care farms in different countries

Netherlands, Norway, Belgium, Switzerland: Mainly private family farms; diversity of client groups

Italy: Mainly social cooperatives: ‘users’ of social sector are employed

Germany, Ireland: Institutional farms; mentally disabled

Orientation in different countries

Society and social sector

Health Agriculture

Italy, France

Germany, Ireland, Slovenia

BelgiumNetherlands

Qualities care farms

Green environ-

ment

Attitude farmer

Social community

Useful work

Less protocols Informal

Research: Comparing user groups

Mental illness: personal development

● Flexibility to adjust work to daily conditions

● Social community

Intellectual disabilities: learning a job

● Real work

● Learning opportunities

Problem youth: building new life

● Farmer and family as role model

● Reflection on previous life and future

Elderly dementia: staying active and unburden partner

● Involvement in normal household processes

● Activities that match interests and history

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Research: Differences between user groups

Mental illness

Intellectual disabilities

Youth Dementia

Guidance Reflection, time for feelings, bad days

Real farmerWorking

Farmer as role modelStrictResponsi-bility

Stimulating rest capacitySensible

Activities Flexibility in demands and stress

Real workLearning a job

Real workResponsible work

Normal dailyactivities

Environment ReflectionQuiet

Functional Family as role model

Stimulating, rest, senses

Research combining user groups

Combination of mental illness and intellectual disabilities● Less rigidity● Helping each other● Different atmosphere

Combination elderly and children or elderly and intellectual disabilities● Creating rest, atmosphere, intimicay

Research specific value Farm Animals

Meaningful day occupation

Valued relationship

Mastery of tasks

Reciprocity

Distraction from problems or difficulties

Relaxation

Tailored care/support

Relationship with other human beings

Stimulating health behavior

Familiar environment

Research: Specific qualities plants

Rhythm of seasons Life processes: sowing, treating, harvesting, dying Metaphors for own life Less direct impulse than animals Silence, rest, tranquillity

Connecting plants and nature: care farm and landscape

Combining qualities of plant production and healing qualities of plants and nature● Nature and garden as co-therapist● Reflection● Appealing all senses● Creating spaces for different moods● Smells, sounds

Cerwen ea 2016. The role of soundscape in Nature-based rehabilitation;

Gorman 2017: Smelling therapeutic landscapes: embodied encounters within spaces

of care farming

Effects of green care farms

In collaboration with researchers Health Care Collaboration with practitioners Make it relevant for practitioners In line with objectives of users/clients Find instruments that are relevant Longitudinal studies Involve “critical outsiders” Multiple methods, multiple studies, multiple sources

Discussion with care farmers

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Effects on residents’ daily life MEDLO-Tool (De Boer et al., submitted)

Domains of daily life:● Activity

● Activity performed by or occurring near the resident● Engagement is the activity● Degree of physical effort during (in)activity

● Physical environment● Location of resident● Interaction with physical environment

● Social environment● Level of social interaction● Type of social interaction● With whom the social interaction takes place

● Psychological well-being● Mood● Agitation

Observation of daily life

Topics for joint researchChallenges: collaborative action

Describing and understanding developments in diverse contexts● Diversity in orientation; regulations; legitimacy;

entrepreneurship Health promoting qualities/mechanisms Impact on participants

● Methodologies, empirical data Impact on society

● Methodologies, empirical data

Types of papers

Focused on specific type of participants (Secondary) analysis of specific elements Essay papers: integrating mechanisms, settings Understanding mechanisms Using green care as example to enrich theories like:

● Self-determination theory● Assets approach● Salutogenesis● Transition theory

Connecting research and practitionersResearch articulation

Consortium of organisations green care in agriculture● Federation Care Farms Netherlands● Care farming UK● Italy: National Forum

Consortium of Nature organisations (city farms – UK) Connecting researchers “green care in agriculture” and

“green therapies” / “healing nature” Monitoring/collecting data by practitioners

Connection with topics European programs and other disciplines

Sustainable agriculture and rural development (EIP Focus Groups): sociologist, economists Healthy cities (JPI Urban Europe): health promotion Social Innovation Ecosystem services Social entrepreneurship

Citizen initiatives● Strategic coalitions● Pressing issues

Research issues

Identification of “health promoting” qualities and mechanisms Incorporation of these qualities in diversity of settings

(being active, social participation, stress reduction)

● Health care● Living environment● Working environment

Combine analysis of process and impact Economic, policy and implementation studies Different types of beneficiaries, outcomes and impact:

neighbourhood, specific client, health, well-being, re-integration, healthy food, climate, rural economy, urban economy....

Future research Green care

Holistic approach and combination of methods Design projects in which multiple factors can be seen in

relation to each other Longitudinal studies in close collaboration with

practitioners Studies that contribute to and test theories Integration disciplines; process, mechanisms and impact See also: Steigen et al. 2016

Proposal

European platform for exchange and collaboration of practitionars, researchers and supporting organizations and “critical/constructive outsiders” Euromed Agrosocial forum: hearing at ESSC, newsletter,

website Green care for health promotion, care, cure,

prevention.... Integrating different types of green care

● Discuss developments, insights● Joint and comparison methodologies● Monitoring schemes● Combining data