The Development and Acceptability of a Wilderness Programme to Support the Health and Well-Being of Adolescent and Young Adult Cancer Survivors: The WAYA Programme
Abstract
:1. Introduction
“The smaller we come to feel ourselves compared to the mountain, the nearer we come to participating in its greatness”.Arne Næss
- To systematically develop a Wilderness programme for AYA cancer survivors (WAYA programme) in the Scandinavian countries, including theory, concept, and content building.
- To investigate the acceptability of the wilderness programme among facilitators and AYA cancer survivors.
2. Material and Methods
2.1. Study Subjects
2.1.1. Facilitators
2.1.2. Participants
2.2. Programme Development
2.2.1. Theoretical Foundation, Concept Building and Aims of the Programme
- To increase physical activity in the context of the natural environment
- To increase self-confidence and provide an increased perception of internal control
- To support personal growth
- To foster togetherness, a sense of community, and support the building of meaningful relationships
- To provide joy, balance, and safety within the grandness of nature
- To increase self-efficacy and self-care in the context of personal health and well-being.
2.2.2. Content Building
2.2.3. The Role of Nature in the WAYA Programme
2.2.4. Structure of the Programme
2.2.5. Setting
2.3. Risk and Safety Plan
2.4. Programme Evaluation
2.4.1. By Facilitators
2.4.2. By Participants
2.5. Ethical Considerations
3. Results
3.1. Type of Wilderness Programme
“…first and foremost, it was that we were a group hiking together, it’s a lot easier when you are a team… one day we hiked about ten kilometres or similar, it was far and took a whole day but since we were a team supporting and encouraging each other and having fun, we could really have hiked 40 kilometres.”(Participant 10)
“I understand that I am not on a spiritual camp, but on a camp to hike along with other people touched by cancer. So in case I would want more relaxation, it would have been more appropriate with a retreat for ten days or so…”(Participant 18)
“I believe that one of the advantages to the expedition is kind of getting through the challenges of it together, so that participants have an opportunity to help one another and, build their relationships…. therefore, when they get to base-camp follow up, they can….—I love the idea that there was both actually -…. kind of solidify the relationships started with the expedition …. and have the space to talk and hang out.”(Facilitator 8)
3.2. Activities in the Programme
“Since I don’t have any distance vision it affects me in a way that I need a guide, and I need to fully concentrate. On our first hike we hiked on a narrow inclining path with lots of tree roots and stones, then I needed double concentration which was exhausting. At the same time, the rest of the group moved ahead, and I was left behind with the guide which was a bit sad, since I felt outside the group… and the second hike was too long, it was ten kilometres, so I could not make it, it would take too long.”(Participant 11)
“I also think that it is one of the beauties that people have so different needs and learn from each other and learn to take care of each other, so I think it was a good mix, because if you only had chosen the most fit participants, we would have lost a good teaching opportunity for the whole group.”(Facilitator 4)
“but if you have an expedition, and you have a goal to reach the top of, whatever you want to reach, in my experience there’s not much free time. Free time is when you are there, and if you are there earlier, well you have more free time, and then your free time is cooking and chatting, and maybe checking your environment and then going to bed.”(Facilitator 1)
“she came up to me and said: “I just want to take a stroll, going towards the waterfall”, and I was thinking…. what I have always been taught… like OK, is that safe? Is it safe for her to wander off? I do not know her.”(Facilitator 10)
“there was a time when I went off for meditation on my own, I let them know before I left as I knew I should do so …., but then I stayed a bit longer than I had said and one of the facilitators checked on me to see whether I was ok… I understand it was out of concern for me, and I know that I am in general terrible at keeping time, and then especially while being in nature without a clock!”(Participant 16)
“(camping) went really well but was something out of the ordinary. Still you learned what was a good place to be and what was a less good place to be. I mean in what way the ground was. A couple of times I started out high up in tent when going to sleep and woke up in the foot end. During the night I slid down (smiling).”(Participant 5)
“We became a group very fast. People opened up and talked about, well it was also very emotional, and at the same time when you come there and meet people who have been ill and talk about their illness there are lots of emotions, and you are allowed to just be yourself instead of trying to be someone else. That was nice… and emotional.”(Participant 10)
“it was hard for me to sit in the ring and share after the mindfulness exercises, even though what is shared is true, it is hard. People got deeper and deeper and were more and more affected. Finally, I said that if this is how it is going to be, I am not going to join in on the sharing unless it becomes sharing of something that is more positive.”(Participant 12)
3.3. Safety of the Programme
“I think, having facilitators with medical backgrounds or nurses is wonderful, and that you cannot be in the back wilderness, and be in the ocean, and be on the mountain and not have some challenges, that’s part of the… risk that they all agree to take on. So I felt, even though I tried to always write down the near misses, I felt it to be very safe.”(Facilitator 8)
“I had never kayaked before, and it was really frightening in the beginning. I also capsized (unintentionally) and that was scary, but directly as soon as I came up from under the water, they (facilitator 3 and 7) were there. You feel safe when someone is there to support you.”(Participant 10)
3.4. Facilitators in the Programme
3.5. Equipment in the Programme
“there was just some really cold night, so sleeping… and I do not know if they were, but I did trade sleeping bags with several people, and they were mentioning that they were warmer, so… I think that would be the only thing, I think everyone was getting a little wet and stuff.”(Facilitator 8)
“I learned, because I did not know that the cold comes from the ground, so I had some extra insulation under my sleeping mat, and additionally I learned that it is good to run a bit to get warm before you go to bed in the sleeping bag.”(Participant 16)
4. Discussion
5. Strenghts and Limitations
6. Recommendation for Practice and Further Research
7. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Value |
---|---|
Age, mean ± SD | 46.3 ± 8.4 |
Gender, n/% | |
Male | 7/46.7 |
Female | 8/53.3 |
Nationality, n/% | |
Sweden | 7/46.7 |
Netherlands | 3/20.0 |
USA | 3/20.0 |
Finland | 1/6.7 |
Norway | 1/6.7 |
Competence/skills, n/% | |
Outdoor/nature guide | 8/47.1 |
Research data collection/physical measurements | 5/33.3 |
Counselling/supervision (youth) groups | 5/33.3 |
Survival training/instructor | 4/26.7 |
Mindfulness-based practices | 3/20.0 |
Kayak instructor | 2/13.3 |
Nursing | 2/13.3 |
Climbing instructor | 1/13.3 |
Characteristics | Value |
---|---|
Age, mean ± SD | 29.1 ± 3.8 |
Gender, n/% | |
Male | 6/35.3 |
Female | 11/64.7 |
Ethnicity, n/% | |
One or both parents from Sweden | 16/94.1 |
Both parents from outside Sweden | 1/5.9 |
Marital status, n/% | |
Married-partner | 8/47.1 |
Single | 9/52.9 |
Family situation, n/% | |
No children | 16/94.1 |
Children | 1/5.9 |
Education, n/% | |
Comprehensive | 1/5.9 |
High school | 5/29.4 |
College/university | 9/52.9 |
Other | 2/11.8 |
Employment status, n/% | |
Full time work | 7/41.2 |
Part time work | 4/23.5 |
Full time education | 2/11.8 |
Unable to work | 4/23.5 |
Economic situation, n/% | |
(how often do you have good finances to be able to do the same things as your friends) | |
Always | 7/41.2 |
Often | 8/47.1 |
Sometimes | 1/5.9 |
Seldom | 1/5.9 |
Primary cancer type, n/% | |
Haematological | 6/35.3 |
Brain | 5/29.4 |
Testicular | 2/11.8 |
Thyroid | 2/11.8 |
Osteosarcoma | 1/5.9 |
Breast | 1/5.9 |
Age at cancer diagnosis, mean ± SD (min-max) | 18.9 ± 8.5 (1.5–29) |
Time since last treatment, n/% | |
<3 months | 4/23.5 |
4–11 months | 1/5.9 |
1–5 years | 4/23.5 |
>5 years | 7/41.2 |
On active treatment | 1/5.9 |
Health Issue | n/% |
---|---|
Pain (all pain) | 12/70.6 |
Mental health problems (all combined) | 10/58.8 |
Allergies/asthma | 6/35.3 |
Cognitive dysfunction | 6/35.3 |
Depression | 5/29.4 |
Gastro-intestinal problems | 4/23.5 |
Anxiety | 4/23.5 |
Visual impairment | 2/11.8 |
Hearing compromised | 2/11.8 |
Sleeping problems | 2/11.8 |
Balance problems | 2/11.8 |
Hormonal dysfunction | 2/11.8 |
Tiredness (general) | 1/5.9 |
Concentration problems | 1/5.9 |
Memory problems | 1/5.9 |
Skin sensitivity | 1/5.9 |
Restricted joint movement | 1/5.9 |
Paresis (partial) | 1/5.9 |
Gout | 1/5.9 |
Osteoporosis | 1/5.9 |
Anaemia | 1/5.9 |
Characteristics | Programme Model | ||
---|---|---|---|
Expedition | Online Coaching | Base-Camp | |
Duration (days) | 8 | 90 | 4 |
Group size | 10 | NA ** | 10 |
Group structure | closed | NA | closed |
Amount of time in group activities * (h) | 4–8 | NA | 4–6 |
Amount of time in structured activities * (h) | 6–8 | NA | 4–6 |
Amount of free time * (h) | 3 | NA | 6 |
Facilitator-participant ratio | 1:2 | 1:1 | 1:3 |
Programme Activity | Disability of Participant (n) | Adaptation/Alternative |
---|---|---|
Hiking trails | Peripheral neuropathy (n = 1) | Kayaking, shorter hiking trails, extra breaks, warm water bottles for pain relief |
Restricted joint movement (n = 1) | Shorter hiking trails, hiking with Nordic hiking poles, extra breaks, canoeing | |
Visual impairments (n = 2) | Assistance by facilitators, boat transport, canoeing, swimming to shore with guidance of facilitator | |
Obsessive-compulsive disorder symptoms (n = 1) | Guidance by facilitator to assure that nothing is left behind on the trail | |
Cognitive dysfunction (n = 1) | Shorter hiking trails, canoeing | |
Paresis (n = 1) Balance problems (n = 2) | Hiking with Nordic hiking poles | |
Backpacking | Peripheral neuropathy (n = 1) Restricted joint movement (n = 1) Visual impairments (n = 2) | Backpack carried by facilitators |
Balance problems (n = 4) Pain (n = 4) Skin sensitivity (n = 1) | Bigger items such as tent carried by facilitators | |
Setting up/breaking down camp | Visual impairments (n = 1) | Long rope from the tent to trees in forest for guidance relating to going to the “bathroom” in the woods |
Cognitive dysfunction (n = 6) Concentration problems (n = 1) | Allowing extra time to sleep in the morning and for breaking down camp and packing up, full-time assistance by facilitator throughout all camping activities | |
Obsessive-compulsive disorder symptoms (n = 1) | Allowing extra time for breaking down camp and packing up. Check by facilitators that all outdoor equipment is in order and in place in the tent | |
Anxiety/depression (n = 9) | Supportive talks, individually guided meditation exercises, allowing extra time by themselves to process and recover, journaling | |
Kayaking | Visual impairments (n = 2) | Double kayak with facilitator |
Rock climbing | Visual impairments (n = 2) Peripheral neuropathy (n = 1) | Alternative activities such as learning bushcraft skills |
Eating/Cooking | Allergies/intolerance (n = 6) | Home-made freeze-dried food |
Gastro-intestinal problems (n = 4) | Medication |
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Jong, M.C.; Stub, T.; Mulder, E.; Jong, M. The Development and Acceptability of a Wilderness Programme to Support the Health and Well-Being of Adolescent and Young Adult Cancer Survivors: The WAYA Programme. Int. J. Environ. Res. Public Health 2022, 19, 12012. https://doi.org/10.3390/ijerph191912012
Jong MC, Stub T, Mulder E, Jong M. The Development and Acceptability of a Wilderness Programme to Support the Health and Well-Being of Adolescent and Young Adult Cancer Survivors: The WAYA Programme. International Journal of Environmental Research and Public Health. 2022; 19(19):12012. https://doi.org/10.3390/ijerph191912012
Chicago/Turabian StyleJong, Miek C., Trine Stub, Eric Mulder, and Mats Jong. 2022. "The Development and Acceptability of a Wilderness Programme to Support the Health and Well-Being of Adolescent and Young Adult Cancer Survivors: The WAYA Programme" International Journal of Environmental Research and Public Health 19, no. 19: 12012. https://doi.org/10.3390/ijerph191912012