Nature-based therapy in blue (water) settings has the potential to improve mental health for diverse groupsThe term “nature-based therapy” refers to any intervention that uses nature to improve health or manage illness. Related research usually focuses on green space or green environments versus blue space or water settings. This paper represents the first systematic review of the literature on therapeutic blue space interventions (BSIs). Blue space is defined as “all visible, outdoor, natural surface waters with potential for the promotion of human health and wellbeing.” Examples of blue space include streams, coastal areas, and rivers, but excludes swimming pools, garden ponds, and fountains. Only studies with a nature-based therapy or health-related treatment intervention conducted in an outdoor natural blue space were included in this review.
Thirty-three studies met the inclusion criteria and were analyzed. While included studies were published between 2004 and 2017, the majority were published in the last 5 years. Sample sizes varied widely – from a single participant in one study to over 300 participants in another study. The combined number of participants for all the studies was 2031. The majority of studies involved adults, but not the elderly population. A few studies involved preteens and teens. Treatment interventions ranged from a single day activity to several months and took place primarily in marine or coastal settings. The interventions – which included surfing, Dragon Boat Racing, sailing, fly-fishing, and kayaking -- emphasized active (rather than passive) activities. Most of the studies assessed mental health and/or psycho-social wellbeing. One study focused exclusively on physical health.
Many of the studies reported “significant positive effects for health, especially psycho-social wellbeing benefits.” These reports were generally referencing short-term benefits versus long-term effects. While there was some evidence of greater social connectedness during and after interventions, the results were inconsistent. Very few findings related to physical health. Barriers to blue care identified through this review include various access issues, lack of resources and equipment, and fears and stigma associated with such concerns as level of fitness, social and cultural norms, and diagnosis of illness. The level and appropriateness of training for those delivering blue care interventions was also identified as a barrier in some cases. Some evidence suggests that the activities in blue space – rather than the particular qualities of blue space -- promote rehabilitation and health.
This review illustrates that blue care has the potential to improve mental health for diverse groups. More research is required, however, to better understand the complex nature-based interventions for health and well-being. Especially needed are more rigorous pilot interventions co-designed in collaboration with population groups, professionals, policymakers, and researchers to evaluate outcomes of different blue care interventions.
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