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| A Manual for Developing a Public Program |
Many people find public gardens to be relaxing places that provide them with inner peace.
Visitors to the Morikami Museum and Japanese Gardens in Delray Beach, Fla., have made such comments for years, saying the gardens helped them overcome grief and loss. Museum officials were aware of this anecdotal evidence and wanted to back it up with some data.
So the Morikami worked with the nearby Christine E. Lynn College of Nursing at Florida Atlantic University to figure out how to measure the gardens’ health effects. The large and growing geriatric population in South Florida, combined with a high incidence of depression in people over 65, led the two organizations to develop the grant project, "The Effect of Public Garden Visitation on Mild Depression in the Elderly."
An estimated 40 percent of the Morikami’s visitors are age 65 or older, thanks to the museum’s location in Palm Beach County, where seniors comprise half of the population.
"What we looked at the study to do was to kind of guide us in a way to design a program that we could use at our facility," said Tom Gregersen, cultural director of the Morikami.
The project also dovetailed nicely with part of the college’s mission.
"One of our goals is to help people remain healthy and take charge of their health, without the use of medications or more expensive treatments if possible.… Sometimes there are other things that can be used—like walking in the garden," said Ruth McCaffrey, DNP, ARNP, an associate professor at the college.
In 2005, the Morikami won a $110,283 National Leadership Grant for Museums from IMLS for this project. The Lynn College of Nursing was listed as a collaborator.
A Scientific Study
The partners set out to determine whether museums and public gardens can deliberately provide programs designed for seniors that improve their mental health and overall well-being.
There were two parts to the project. First, researchers from the college set up a traditional study to try to determine which of three "interventions" was most effective in alleviating symptoms of depression among seniors: 1) Walking a garden with a trained therapist who provided "guided imagery," 2) walking in a garden on one’s own, and 3) receiving art therapy outside of a garden environment.
Art therapy has been shown to decrease depression in the elderly. The researchers hypothesized that walking in a garden would have similar health effects.
The Morikami Japanese Gardens encompass 16 acres and contain a series of six unique gardens. They incorporate vegetation, water, islands, and boulders, as well as built features such as gates, bridges, and stone lanterns.
The process of recruiting study participants began in December 2005. To be included, participants had to be more than 65 years old, able to walk one mile, have their cognition intact, and have a medical diagnosis of depression.
The researchers planned two six-week sequences, working with 30 people per sequence, for a total of 60 participants. During each sequence, participants were randomly assigned to one of the three intervention types, resulting in 10 people per intervention.
Before beginning the sequence, each participant met with a research assistant who was trained in story collection techniques. Participants completed the Geriatric Depression Scale survey and spent 20 minutes telling stories that described what brought sadness and/or joy into their lives in the past and present, and what their hopes were for the future.
Tape recordings of the stories were transcribed and analyzed with Linguistic Inquiry and Word Count software.
Starting in February 2006, the groups met for walks twice weekly for a six-week period. During the guided imagery walks, a trained therapist made suggestions for visualizing garden elements in the context of one’s life experience, in order to stimulate thoughtful contemplation.
After the sequence ended, all participants met again with a research assistant, completed the Geriatric Depression Scale, and told their stories.
A second sequence began in May 2006, although with fewer participants. The researchers set up a third sequence in October 2006 with 10 people in one type of intervention only (walking in the garden on one’s own), in order to balance the number of participants in the study overall. A total of 58 people completed the study.
Results Lead to a Museum Program
All three groups had a significant reduction in their depression. None of the three interventions was significantly more successful than the other two, but the walking interventions were just as effective as art therapy. The story analysis showed that the guided imagery group had a greater increase in positive emotion word-use in comparison to the walk alone group.
"There wasn’t any statistically significant difference; however, I believe that there was a practically significant difference in that people really enjoyed working in the guided imagery group," said McCaffrey, who was the project director and principal researcher.
The study results led to the second part of the project, in which the partners developed a "Stroll for Well-Being: Garden Walks at The Morikami" booklet and program. The museum received an extension of the project until June 2008 and permission to reallocate funds to develop "Stroll for Well-Being."
McCaffrey wrote the booklet along with a colleague at the college. It contains 12 themed guided imagery walks, plus blank pages for journaling. The themes are Awareness, Possibility, Transition, Connection, Journey, Trust, Joy, Freedom, Forgiveness, Reflection, Gratitude, and Fulfillment.
The booklet section for each walk contains a number of places to stop and contemplate the surrounding beauty. "It gives the participants ways of thinking about their own lives using the features in the garden," said Gregersen.
The partners recruited 40 people to test the booklet from December 2007 to April 2008.
"The response was overwhelming," said McCaffrey. "They really enjoyed the book; many people said it changed their lives."
Now, the Morikami offers the "Stroll for Well-Being" program twice a year. McCaffrey meets with each class on the first day of the program, about a month later, and then at the end. She discusses the walks and how the participants felt.
Challenges Along the Way
It wasn’t always easy to round up enough study participants. Holidays and the seasonal exodus of southern Florida’s winter residents caused delays that pushed the project beyond its original two-year time frame.
Attending the walks at the same days and times twice a week also was problematic for some people.
"That’s why our sample size was even a little smaller than we had hoped, because some people had to drop out," said McCaffrey.
She would like to do a larger study, with twice as many participants, possibly at multiple sites. "If we could do a bigger study, then perhaps we could really determine which of the groups was more significant," she said.
Spreading the Word, Continuing the Work
Both Gregersen and McCaffrey have shared their findings at various conferences. In addition, McCaffrey has published the results in the Journal for Holistic Nursing Practice and the Journal of Clinical Nursing. The partners also created a manual—available on the Morikami’s Web site—to provide other organizations with information about offering similar programs.
The project has inspired another initiative McCaffrey is working on at Jupiter Hospital’s oncology center, where a donor gave money to develop a healing garden.
There are dozens of healing gardens around the country; this study has provided a bit more evidence of their efficacy.