Supporting Personal Growth in Childhood, Adolescent and Young-Adult Cancer Survivors Through Challenges in Nature — A Qualitative Study of WAYA Wilderness Programme Participation

Abstract

Background Childhood, adolescent and young-adult (AYA) cancer survivors often experience health problems due to late or long-term effects of their cancer or the treatment thereof. The general population gains health benefits from immersion in nature, and nature-based programmes seem to be an intervention that can promote health among childhood and AYA cancer survivors. Objective To explore the impact of the WAYA wilderness programme on the health of childhood and AYA cancer survivors. Methods The study had a qualitative approach, with data from individual interviews (n = 18) 3 months after completion of the WAYA programme. In addition, case report data was collected during follow-up talks (1, 2 and 12 months after the programme) (n = 19). The WAYA programme consisted of an 8-day expedition, followed 3 months later by a 4-day base camp. The programme included activities such as hiking, backpacking, kayaking, rock climbing, bushcraft and mindfulness. Data was analysed according to a qualitative content analysis. The consolidated criteria for reporting qualitative research (COREQ) were followed. Results An overarching theme was identified: “Personal growth from challenges in nature supported by deep connections with others”. In 4 additional themes, participants’ experiences describe how deep personal connections arose, as they developed a feeling of being able and competent in nature. Nature provided a space that supported relaxation and respite from everyday challenges and stimuli, which also led to an experience of being more connected to nature. Conclusion The WAYA programme was experienced as being of support to childhood and AYA cancer survivors. The programme provided them with skills and tools to be safe in nature. When connected to nature, the participants developed trust and self-confidence, personal growth, relaxation and recovery from stress. Their engagement in outdoor activities continued after completion of the programme, when they returned to everyday life at home.

Protocol of a randomised controlled multicentre trial investigating the effectiveness and safety of a wilderness programme on the mental and physical well-being of adolescents and young adults affected by cancer: the WAYA-2 study

“…The selection of outcomes is driven by the aims of the WAYA programme and recently published qualitative study results of the WAYA programme. 26 The aims of the WAYA programme and underlying process to support self-realisation via nature connectedness are hypothesised to contribute to a chain of actions that impacts the six domains of Positive Health. 25 The WAYA programme is a complex intervention and may potentially impact multiple factors.…”

“… 32 The PWS was not included as an outcome measure in our previous pilot study, 1 but based on the findings from the qualitative study of the WAYA programme, we have selected PWS as a primary outcome measure. 26 For the qualitative analysis of the pilot study, participants in the wilderness programme were interviewed at 3 months after start of the programme to explore the impact of the programme on their health and well-being. The themes that arose through the inductive content analysis related to self-confidence, self-acceptance, meaningful relationships and personal growth.…”

“…24 25 Based on these observations, we recommended for a future larger RCT to (1) apply additional recruitment strategies for participants, (2) to stratify for the inclusion of cancer survivorship (childhood cancer vs AYA cancer), (3) to optimise the content of the WAYA programme and (4) to select health-related outcomes based on the lived experiences of participants in the WAYA programme. 26 The aim of this study is to perform a full-scale multicentre RCT (WAYA-2 study) that investigates the effectiveness and safety of a wilderness programme on the mental and physical well-being of AYAs affected by cancer. The WAYA programme and WAYA-2 study protocol have been optimised according to the findings and recommendations from the pilot study as described above.…”

“… 24 25 Based on these observations, we recommended for a future larger RCT to (1) apply additional recruitment strategies for participants, (2) to stratify for the inclusion of cancer survivorship (childhood cancer vs AYA cancer), (3) to optimise the content of the WAYA programme and (4) to select health-related outcomes based on the lived experiences of participants in the WAYA programme. 26 …”