Finding With Nature: A Study Testing Nature-Based Support for Family Caregivers Aged 65 and Over

An intervention study in randomised control trial design will be conducted with a target sample of 350 participants living in Central Finland. After receiving information about the research and providing a written consent, participants answer a question of caregiver burden and indicate whether they would prefer to participate in the Finding with Nature (FWN) programme in face-to-face group meetings or individually via an interactive online platform. After that, the participants are randomly allocated to intervention and control groups which are balanced according to the caregiver burden. The participants in the intervention group will be offered a 6-week FWN programme either in a face-to-face group or individually online, according to their own preference. In the face-to-face group implementation, the FWN programme will be carried out by a trained facilitator with meetings once a week. In the online implementation, the FWN programme will be completed individually at their own pace via an interactive online platform. In both implementation formats, participants will complete independent tasks and have the opportunity to share their experiences with peers.

At the core of the FWN programme are facilitated nature-based, low-threshold exercises in six theme areas of the FWN programme (one theme for each week): 1) Introduction, personal situation, and starting points for change; 2) personally meaningful matters and values; 3) acceptance of emotions and confronting barriers; 4) listening to the body, meaningful movement, and natural settings; 5) mindfulness skills and everyday choices; and (6) self-concept, self-compassion, and self-awareness.

Participants respond to surveys at three measurement points: a pre-measurement at the start of the programme, a post-measurement at the end of the programme, and a follow-up measurement three months after the end of the programme. The participants in the intervention group are compared to the participants in the control group who continue life as usual and only respond to online surveys at three measurement points (pre-, post- and follow-up measurements). The control group participants are offered a opportunity to participate in face-to-face group meetings or the online implementation of the FWN programme after the follow-up measurement.

This research is funded by the Health Promotion Grant (Ministry of Social Affairs and Health, STM, va-thl-2025-1-80).

• Finding with Nature Programme (Behavioral): A 6-week nature-based program integrating physical activity in nature and Acceptance and Commitment Therapy (ACT) methods to promote well-being, functioning, and nature connectedness. Delivered either in face-to-face groups or via an online platform, including guided sessions, independent exercises, informational content, and opportunities for peer support.

Primary outcomes

• Psychological well-being: the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) [Pre-intervention, immediately post-intervention, and 3-month follow-up.]: 7-item scale, range 7-35; higher scores indicate better mental well-being.

Secondary outcomes

• Caregivers' perceived coping as caregivers: COPE Index [Pre-intervention, immediately post-intervention, and 3-month follow-up.]: COPE Index evaluates the caregiver's subjective experience of strain, support, and quality of the caregiving relationship. 15-item scale, range 15-75; higher scores indicate greater caregiving burden.
• Functioning: the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) [Pre-intervention, immediately post-intervention, and 3-month follow-up.]: A standardized assessment of functioning across multiple life domains. 12-item scale, range 0-48; higher scores indicate greater disability (worse functioning).
• Adult Social Care Outcomes Toolkit (ASCOT) SCT4 [Pre-intervention, immediately post-intervention, and 3-month follow-up.]: Measure designed specifically for informal caregivers, focusing on social care-related quality of life. 8-item scale; higher scores indicate better social care-related quality of life.
• Self-rated health: a single validated item [Pre-intervention, immediately post-intervention, and 3-month follow-up.]
• Connectedness to nature: short version of Connectedness to Nature Scale (CNS) [Pre-intervention, immediately post-intervention, and 3-month follow-up.]: Short version of the Connectedness to Nature Scale (CNS), 7-item scale, range 7-35; higher scores indicate greater connectedness to nature.
• Connectedness to nature and nature-related experiences: the Holistic Nature Experience measure [Pre-intervention, immediately post-intervention, and 3-month follow-up.]: 16-item scale, range 16-96; higher scores indicate more positive nature-related experiences.
• Psychological flexibility: Comprehensive Assessment of ACT Processes (CompACT-10) [Pre-intervention, immediately post-intervention, and 3-month follow-up.]: 10-item scale, range 0-60; higher scores indicate greater psychological flexibility
• Anxiety: Generalized Anxiety Disorder 7-item Scale (GAD-7) [Pre-intervention, immediately post-intervention, and 3-month follow-up.]: 7-item scale, range 0-21; higher scores indicate greater anxiety symptoms
• Physical activity: International physical activity questionnaire -short form (IPAQ-SF) [Pre-intervention, immediately post-intervention, and 3-month follow-up.]: International Physical Activity Questionnaire - Short Form (IPAQ-SF), 7-item questionnaire. Total physical activity is expressed as MET-minutes per week. The minimum value is 0 MET-minutes/week, with no fixed maximum value. Higher scores indicate higher levels of physical activity.
• Restorative experiences: the Restoration Outcome Scale (ROS) [Immediately before and after each of the six weekly intervention sessions during the 6-week intervention period.]: 6-item scale, range 6-42; higher scores indicate greater restorative experiences
• Life-space mobility: the Life-Space Assessment (LSA) [Pre-intervention, immediately post-intervention, and 3-month follow-up.]: Capture the spatial extent and frequency of participants' mobility in daily life, assessing mobility over the previous 4 weeks, range 0-120; higher scores indicate greater life-space mobility
• Engagement with natural and green environments [Pre-intervention, immediately post-intervention, and 3-month follow-up.]: Assessed through questions on frequency, purpose, and patterns of nature visits.

Other outcomes

• Caregiver characteristics [Pre-intervention, immediately post-intervention, and 3-month follow-up.]: Information is collected on the care recipient, duration of caregiving, formal caregiver status, and use of support services.

Sex: All, ages: 65 Years to any

Inclusion Criteria:

* Age 65 years and older
* Providing care for a close one, formally or informally
* Able to communicate adequately in Finnish
* Willingness to commit to a 6-week intervention programme

Exclusion Criteria:

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• Julija Chichaeva, MHS, Principal investigator, JAMK University Of Applied Sciences