Journal List > J Korean Acad Community Health Nurs > v.25(2) > 1058340

Choi and Ha: The Effectiveness of a Forest-experience-integration Intervention for Community Dwelling Cancer Patients’ Depression and Resilience



This study examined the effectiveness of a forest-experience-integration intervention in community dwelling cancer patients.


The study was done with a nonequivalent control group pretest-posttest design. The subjects of the present study were 53 community dwelling cancer patients who were registered in a community health center in Gyeongsangbuk-do. The subjects were divided into an experimental group (n=26) who participated in the forest-experience-integration intervention and a control group (n=27) who did not participate. Data were collected from May to June in 2011. Collected data were analyzed using SPSS PC+ 19.0 through x2 test, and independent t-test.


There were significant differences between the groups in depression (t=-4.51, p<.001), self-regulation resilience (t=6.95, p<.001), interpersonal resilience (t=10.10, p<.001), positivity resilience (t=9.67, p<.001), and total resilience (t=13.93, p<.001) measurements.


The forest-experience-integration intervention delivered to community dwelling cancer patients was an effective method for relieving depression and enhancing self-regulation resilience, interpersonal resilience, positivity resilience, and total resilience, and can be utilized as an effective nursing intervention for community dwelling cancer patients.


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Table 1.
The Forest-experience-integration Intervention
Title Session   Contents Time (minutes)
Preparation phase All Session   Introduction, friendship, abdominal breathing, stretching, safety training, respiratory and heart rate measurements, checking the necessary 30
Execution phase Physical intervention All session Walking and abdominal breathing 20
Psychological intervention 1st session Learn to forest activities: Description of trees and landscape 20
  2nd session Activities to get close to the forest: Touching wood, touching natural objects and expressing the feeling of body  
  3rd session Accompany with forest: Lying in the woods, viewing the sky, expressing the feeling  
  4th session Utilizing forest: Create self-image by leaves  
  5th session Promotion activities in sensitive: Meditation  
  6th session Promote self-esteem activities: Write a letter to me  
  7th session Promote cooperativity activities: Treasure hunt  
  8th session Promote empathy activities: Talk about lifestyle  
Physical intervention All session Walking and abdominal breathing 20
Completion phase All Session   Friendship, abdominal breathing, stretching, respiratory and heart rate measurements Next session guide 30
Total       2 hour (120)
Table 2.
Homogeneity Test for General Characteristics between Groups
Variables Categories Total (n=53)
Exp. (n=26)
Cont. (n=27)
x2 p
n (%) n (%) n (%)
Age (year) 50~59 20 (37.7) 10 (38.5) 10 (37.0) 0.02 .915
≥60 33 (62.3) 16 (48.5) 17 (51.5)    
Gender Male 15 (28.3) 6 (23.1) 7 (25.9) 0.69 .407
Female 38 (76.9) 20 (66.7) 20 (74.1)    
Diagnosis Digestive system cancer 18 (34.6) 9 (34.6) 9 (33.3) 0.06 .971
Female cancer 22 (41.5) 11 (42.3) 11 (40.7)    
Others 13 (24.5) 6 (23.1) 7 (25.9)    
Periods of struggle against disease (year) 1~2 24 (45.3) 10 (38.5) 14 (51.9) 0.96 .618
3~4 11 (20.8) 6 (23.1) 5 (18.5)    
≥5 18 (34.0) 10 (38.5) 8 (29.6)    
Type of medical insurance Insurance payment 36 (67.9) 18 (69.2) 18 (66.7) 0.04 .842
Health insurance 17 (32.1) 8 (30.8) 9 (33.3)    
Education <Elementary 40 (75.5) 20 (76.9) 20 (74.1) 0.06 .810
≥Middle school 13 (24.5) 6 (23.1) 7 (25.9)    
Living together Spouse 31 (58.5) 15 (57.7) 16 (59.3) 0.01 .908
Offspring 22 (41.5) 11 (42.3) 11 (40.7)    

Exp.=experimental group; Cont.=control group.

Table 3.
Homogeneity Test for Dependent Variables between Groups
Variables Categories Exp. (n=26)
Cont. (n=27)
t p
Depression   45.8±7.06 46.7±6.66 −0.48 .637
Resilience Self-regulation 60.4±8.12 60.2±7.84 0.09 .928
Interpersonal 60.6±5.15 60.1±5.94 0.33 .742
Positivity 52.0±3.71 51.7±3.75 0.29 .774
Total 173.0±11.37 172.0±10.97 0.33 .746

Exp.=experimental group; Cont.=control group.

Table 4.
Comparison of Scores between Pretest and Posttest in Two Groups
Variables   Groups Pretest (n=26)
Posttest (n=27)
t p
Depression   Exp. 45.8±7.06 41.4±5.66 −4.51 <.001
  Cont. 46.7±6.66 48.3±5.45    
Resilience Self-regulation Exp. 60.4±8.12 68.5±5.15 6.95 <.001
  Cont. 60.2±7.84 57.3±6.53    
Interpersonal Exp. 60.6±5.15 68.3±2.81 10.10 <.001
Cont. 60.1±5.94 57.7±4.55    
Positivity Exp. 52.0±3.71 58.7±2.67 9.67 <.001
Cont. 51.7±3.75 50.5±3.42    
Total Exp. 173.0±11.37 195.4±7.10 13.93 <.001
Cont. 172.0±10.97 165.5±8.46    

Exp.=experimental group; Cont.=control group.

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