Action Research: Refining a Therapeutic Walking Intervention and Identifying Outcomes

Problem/Purpose: The therapeutic walking intervention is an innovative evidence-based program that has shown wellness effects for people who have suffered loss. Participants engage in a guided Japanese garden walking program twice a week for six weeks. Due to distance and disability it is sometimes difficult for participants to visit the garden at the prescribed frequency. The purpose of this study is to describe cross-sectional data from the first and second (look and think, respectively) phase of action research to evaluate an enhanced therapeutic walking intervention (ETWI) that incorporated six Japanese culture-relevant motions in preparation for an experimental study to examine the effects of the ETWI on participant well-being.

Significance: Like other behavioral interventions, therapeutic walking can only benefit an individual if the intervention is integrated into everyday patterns. The intention of the Japanese culture-relevant motion addition (Circle of Life, Mindful Walking, Spiral Rotation, Opening and Lengthening, Resting Breath, Washing Meditation) to the therapeutic walking program was to enable home practice when unable to come to the garden thereby contributing to potential for integration that would enable achievement of wellness effects.

Method: In the “look” and “think” phases of action research, community guidance is sought to clarify the problem being addressed and refine study plans. Specifically, the “look” phase may include dialogue, record review and meeting attendance. The “think” phase includes group discussions with community participants to optimize plans for action. This study included three sessions each having two components. First, participants completed self-report measures [Personal Growth Initiative Scale (PGIS), the PROMIS Emotional Distress short form (PED), Quality of Life (SF-36), Perceived Stress Scale (PSS)] to capture wellness effects. Second, an outside psychologist conducted audio-recorded focus groups. Self-report measures were analyzed with descriptive statistics. Focus group data were content analyzed independently by two researchers and findings were discussed to reach consensus. Trustworthiness criteria were applied.

Results: Internal consistency reliability for the measures ranged from .80 (PSS) to .97 (PED). Participants (N=15) identified measures that queried pre-post distress/stress as most relevant. They mainly appreciated the “Circle of Life” and “Spiral Rotation” motions, two of six contributing to the ETWI, but they also note the value of “Resting Breath”.

Discussion: In the “act” phase of this research, the refined ETWI will include three Japanese culture-relevant motions and pre-post distress/stress assessment. The “look” and “think” phases of action research have enabled grass roots guidance to enhance relevance of an experimental study designed to take the effects of a therapeutic Japanese garden walking program out of the garden to participants’ home environments.