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Engaging with nature: a participatory study in the promotion of health Open Access


Other title
health promotion
restorative places
environmental health
Type of item
Degree grantor
University of Alberta
Author or creator
Hansen-Ketchum, Patricia Anne
Supervisor and department
Dr. Patricia Marck, Faculty of Nursing
Examining committee member and department
Dr. Kaysi Kushner, Faculty of Nursing, University of Alberta
Dr. Elizabeth Halpenny, Faculty of Physical Education and Recreation, University of Alberta
Dr. Linda Reutter, Faculty of Nursing, University of Alberta
Dr. Renee Lyons, Bridgepoint Chair in Complex Chronic Disease Research TD Financial Group Scientific Director, Bridgepoint Collaboratory for Research and Innovation Professor Dalla Lana School of Public Health University of Toronto
Faculty of Nursing

Date accepted
Graduation date
Doctor of Philosophy
Degree level
Research evidence suggests that engaging with nature can promote health by reducing stress, improving cognition, fostering social connectivity, and supporting healthy behaviours such as physical activity, healthy eating, and pro-environmental practices. Yet there are empirical data gaps about how community members engage with nature in their local context, what facilitates or inhibits access to outdoor places , and how health practitioners and decision-makers use evidence on the linkages between health and nature to inform their work. Using a participatory, community-based research design and adapting photographic methods from the fields of ecological restoration and health care, this dissertation study addressed these critical gaps. The study was conducted in rural Nova Scotia, a site that offered considerable access to natural environments. In phase one, an aggregate group of parents with young children (n=8) participated in photo narration and photo elicitation interviews and focus groups to explore how they engage with nature to promote their individual and family health. In phase two, local practitioners and decision-makers (n=16) engaged in photo elicitation focus groups to discuss and expand the analytic themes from phase one and to examine how they use evidence on the health benefits of engaging with nature to design community-based health promotion interventions. Critical analytic themes emerged from the dialectical analysis of data from both phases and offered insight into the value of restorative places and experiences in nature, the barriers and facilitators to connecting with the natural world, the ties between engaging with nature and ecological citizenship, and the proposed shifts in practice and policy norms and governance processes needed across sectors and citizen groups to simultaneously promote and protect the health of people and the natural world. The findings provided a unique view of ecologically-sound everyday access to restorative outdoor places as critical to the promotion of health. This paper-based dissertation details study findings and implications for research, practice, and policy through five manuscripts that together confer conceptual, evidence-informed, and analytic views of nature-based health promotion and provide insight into rigorous participatory photographic research methods for community engagement in mutual generation and exchange of knowledge.
License granted by Patricia Hansen-Ketchum ( on 2010-09-23T17:33:44Z (GMT): Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of the above terms. The author reserves all other publication and other rights in association with the copyright in the thesis, and except as herein provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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