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BACKGROUND: Naturally occurring retirement communities (NORCs) are geographic areas (generally high-rise buildings or neighborhoods) that have a high concentration of individuals 65 years and older. Supportive service programs in NORCs can address resident needs and delay nursing home (NH) admission but understanding what factors are associated with NORC residents requiring NH admission is needed to tailor such programs. Our aim was to examine individual- and neighborhood-level factors associated with NH wait-list status in NORC residents in Ontario. METHODS: We conducted a population-based, cross-sectional study of Ontario adults 65 years of age or older living in a NORC building as of January 1, 2020, by linking a provincial registry of NORC high-rise buildings with health administrative data. Older adults were classified as being on the NH wait-list if they had an open application for a NH on the index date. We conducted a multilevel logistic regression analysis using generalized estimating equations to determine individual- and neighborhood-level factors associated with NH wait-list status, including sociodemographic, clinical, healthcare use, and building factors. We explored the role of sex and age through stratification by sex (male, female) and age (65-80 and 80+ years). RESULTS: Among 220,864 NORC residents, 4710 individuals (2.1%) were on the NH wait-list. Female sex, older age, immigrant status, dementia diagnosis, receiving homecare, multimorbidity, and polypharmacy (five or more unique drug names) were associated with an increased odds of wait-list status. Several neighborhood-level variables were associated with a significantly increased likelihood of wait-list status, including low income, high dependency, high ethnic diversity, and living in a building with supports. CONCLUSION: NORC supportive service programs can be tailored to account for the factors associated with NH wait-list status, allowing NORC residents who are living in the community to age in their desired place and achieve optimal health outcomes.

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Critical health literacy enables individuals to use cognitive and social resources for informed action on the wider determinants of health. Promoting critical health literacy early in the life-course may contribute to improved health outcomes in the long term, but children's opportunities to develop critical health literacy are limited and tend to be school-based. This study applies a settings-based approach to analyse the potential of public libraries in England to be supportive environments for children's development of critical health literacy. The study adopted institutional ethnography as a framework to explore the public library as an everyday setting for children. A children's advisory group informed the study design. Thirteen children and 19 public library staff and community stakeholders were interviewed. The study results indicated that the public library was not seen by children, staff, or community stakeholders as a setting for health. Its policies and structure purport to develop health literacy, but the political nature of critical health literacy was seen as outside its remit. A supersetting approach in which children's everyday settings work together is proposed and a conceptual model of the public library role is presented.

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Social inequities in childhood affect children's health and development. Active In-Betweens is a weekly, healthy lifestyle and outdoor activity after-school programme, tailor-made for preadolescent children (9-12 year olds), incorporating a strengths-based, trauma-informed, co-designed and place-based approach. This study evaluated the extent to which the programme strategies and activities met the anticipated short- to medium-term programme outcomes during its first year of operation in two socio-economically disadvantaged housing communities in New South Wales, Australia. A qualitative case study used data from semi-structured interviews with child participants (n = 11) and key stakeholders (n = 10). A broad range of positive outcomes were described. Children's feedback indicated they had experienced opportunities which facilitated the development of new physical activity skills; new healthy eating experiences and knowledge; positive relationships with peers and facilitators and new connections with neighbourhood programmes and outdoor environments. Stakeholders valued the programme for the positive outcomes they observed among the children and the strong organizational partnerships which resulted. The importance of skilled facilitators to deliver the programme, the engagement of local stakeholders and a long-term commitment to programme delivery, with secure funding to ensure continuity, were clearly identified as integral for effective, sustainable outcomes.

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Men with health problems refuse to participate in rehabilitation programmes and drop out of healthcare offerings more often than women. Therefore, a nature-based rehabilitation programme was tailored specific to men with mental health problems, and long-term illnesses. The rehabilitation programme combines the use of nature, body, mind, and community spirit (NBMC) and is called the 'Wildman Programme'. The presented study was designed as a matched-control study with an intervention group participating in the Wildman Programme (N = 114) compared to a control group receiving treatment as usual (N = 39). Outcomes were measured at baseline (T1), post-intervention (T2), and 6 months post-intervention (T3). The primary outcome was the participants' quality of life measured by WHOQOL-BREF, which consists of four domains: physical health, psychological health, social relationships, and environment. The secondary outcomes were the level of stress measured by the Perceived Stress Scale (PSS), and the participants' emotional experience in relation to nature, measured by the Perceived Restorativeness Scale (PRS). The intervention group improved significantly in the physical and psychological WHOQOL-BREF domains and in PSS at both follow-ups. The participants' interest in using nature for restoration increased significantly as well. The only detectable difference between the control group and the intervention group was in the WHOQOL-BREF physical domain at the 6-month follow-up. For further studies, we recommend testing the effect of the Wildman Programme in an RCT study.

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PURPOSE: Restaurants have the potential to improve nutrition and positively shape social norms. We describe lessons learned and recommended strategies from Eat Well El Paso! (EWEP), a local restaurant initiative. DESIGN: Descriptive case study. SETTING: EWEP partnered with local restaurants from 2012-2017 in El Paso, Texas, along the US/Mexico border. SAMPLE: Our sampling frame included EWEP staff and managers/owners at participating restaurants, of which the majority participated (80% and 85%, respectively). INTERVENTION: EWEP was a local restaurant initiative led by the city public health department. EWEP contracted registered dietitians to assist locally-owned restaurants to increase availability of healthy menu options. MEASURES: Observation, key informant interviews, and document review assessed participation, barriers, and facilitators to restaurant participation and program sustainability. ANALYSIS: Thematic and descriptive analyses. RESULTS: 57% of restaurants completed the full on-boarding process, but long-term retention was low (24% of completers). Restaurant managers/owners perceived value in marketing, nutritional analysis, and menu design. Barriers included scheduling, complexity of restaurant culture, fear of food inspections, restaurant turnover, competing responsibilities, and lack of dedicated funding. CONCLUSION: Although local context and sample size may limit generalizability, lessons learned and recommended strategies are relevant and informative for communities working to increase restaurants' healthy menu options.

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Our collective experience with COVID-19 and Black Lives Matter has heightened awareness of deeply embedded racial and socioeconomic disparities in American businesses. This time, perhaps, sustained change is within reach. As organizations advance diversity, equity and inclusion (DEI) initiatives, an often overlooked focus of is the health status of employees and their families, where equitable access to high-value health benefits offerings should be available to all. This commentary provides guidance for employers to expand their DEI initiatives to include employee and family health and well-being as a central outcome measure. Employers should ensure that DEI efforts incorporate equitable benefits design, and objectively assess benefit design impact on healthcare utilization and cost. Additionally, employers must appreciate the workplace as a significant determinant of health-for lower income workers, in particular-with review of policies and practices to mitigate any discriminatory negative health or well-being impact. Further, race and ethnicity data should be incorporated in health benefits data analysis to understand more clearly the differential outcomes of health management offerings on these different sub-populations. Finally, social needs data should be incorporated into strategic benefits planning to better understand gaps and opportunities to foster greater benefits equity. The provided recommendations can support employer goals of achieving greater equity and value in workforce health, measurably contributing to business success.

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PURPOSE: African Americans experience a high burden of chronic diseases and cancers that are prevented and ameliorated with physical activity (PA) and fruit and vegetable (FV) intake. The purpose of this study is to identify individual, social, and neighborhood variables associated with African Americans attaining high levels of both behaviors. DESIGN: This study is a cross-sectional analysis. SETTINGS AND PARTICIPANTS: Cohort of African Americans adults recruited from black churches in the Greater Houston area. MEASURES: Self-administered questionnaires collected in 2012 assessed correlates and behavioral outcome variables (PA and FV consumption). A combined 4-category behavioral outcome was created: high PA/high FV, low PA/high FV, high PA/low FV, and low PA/low FV. ANALYSIS: Standard and stepwise multinomial logistic regression examined the association between the various variables and the behavioral outcome. RESULTS: This sample (n = 1009) had a mean age of 49 years, was mostly female, and obese. Compared to the low PA/low FV intake group, the high PA/high FV intake group had significantly lower odds of individual-level variables (worrying about getting cancer, perceived stress, loneliness, and financial strain) and higher odds of social-level variables (social status, social cohesion, social organization involvement, and social norms). Only social-level variables remained significantly associated with higher odds of high PA/high FV intake in stepwise regression. CONCLUSION: These findings indicate that social influences may be most critical for high PA and FV intake in African Americans adults.

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PURPOSE: To explore the selection, use, and reporting of theories, models, and frameworks (TMFs) in implementation studies that promoted healthy eating in center-based childcare. DATA SOURCE: We searched 11 databases for articles published between January 1990 and October 2018. We also conducted a hand search of studies and consulted subject matter experts. STUDY INCLUSION AND EXCLUSION CRITERIA: We included studies in center-based settings for preschoolers that addressed the development, delivery, or evaluation of interventions or implementation strategies related to healthy eating and related subjects and that explicitly used TMF. Exclusion criteria include not peer reviewed or abstracts and not in English, French, German, and Korean. DATA EXTRACTION: The first author extracted the data using extraction forms. A second reviewer verified data extraction. DATA SYNTHESIS: Direct content analysis and narrative synthesis. RESULTS: We identified 8222 references. We retained 38 studies. Study designs included quasi-experimental, randomized controlled trials, surveys, case studies, and others. The criteria used most often for selecting TMFs were description of a change process (n = 12; 23%) or process guidance (n = 8; 15%). Theories, models, and frameworks used targeted different socioecological levels and purposes. The application of TMF constructs (e.g., factors, steps, outcomes) was reported 69% (n = 34) of times. CONCLUSION: Reliance on TMFs focused on individual-level, poor TMF selection, and application and reporting for the development of implementation strategies could limit TMF utility.

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PURPOSE: To examine changes in organizations' workplace health promotion (WHP) initiatives over time associated with repeated self-assessment using the Well Workplace Checklist (WWC). DESIGN: Well Workplace Checklist data include a convenience sample of US organizations that selected to assess their performance against quality WHP benchmarks. SETTING: Workplaces. SUBJECTS: In total, 577 US organizations completed the WWC in 2 or more years from 2008 to 2015. MEASURES: The WWC is a 100-item organizational assessment that measures performance against the original set of quality benchmarks that were established by the Wellness Council of America (WELCOA). ANALYSIS: This study examined changes in overall WWC scores as well as 7 separate benchmark scores. Multilevel modeling was used to examine changes in scores associated with repeated assessments, controlling for the year of assessment and organizational characteristics. RESULTS: There were significant increases in overall WWC scores (ß = 2.93, P < .001) associated with the repeated WWC assessments, after controlling for organizational characteristics. All 7 benchmark scores had significant increases associated with reassessment. Compared to other benchmarks, operating plan (ß = 6.18, P < .001) and evaluation (ß = 4.91, P < .001) scores increased more with each reassessment. CONCLUSION: Continued reassessment may represent more commitment to and investment in WHP initiatives which could lead to improved quality. Other factors that may positively influence changes in performance against benchmarks include company size, access to outside resources for WHP, and a history with implementing WHP.

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BACKGROUND: An inner-city neighbourhood of Regina, Saskatchewan continues to have recurring issues of drug and alcohol use affecting parents' caregiving opportunity. In relation to this, many children, mostly of First Nations descent, are raised in out-of-home care away from their families. With the promotion of breastfeeding, in a neighbourhood prenatal/postnatal support program, breastfeeding rates have doubled and mothers' participation in their children's care has increased. Recognition and promotion of cultural beliefs about breastfeeding is integral to raise community awareness of the practice. To bring additional support for breastfeeding, the empowerment effects observed were measured. METHODS: Using a longitudinal study design, indicators of empowerment were assessed prenatally and again at two months postpartum. Indicators included self-esteem, caregiving activities, and drug and alcohol use. Outcomes of assessments were correlated to infant feeding practices and findings compared. RESULTS: Findings supported a statistically significant improvement for empowerment scores when mothers breastfed. Mean scores for self-esteem increased from 2.87 to 3.57 (r = .90, p = <.001); for caregiving, scores increased from 2.60 to 3.16 (r = .91, p = <.001); and for drug and alcohol use, scores decreased from 59 to 9% (p = <.001). CONCLUSIONS: The study brings attention to the value of breastfeeding for caregiving in situations of addiction and limited resources. Practitioner reflexivity in regards to their support for breastfeeding is critical and includes openness to alternate breastfeeding situations and beliefs. The study found that a positive outlook on breastfeeding is the first step for a practitioner-client relationship that fosters confidence for marginalized populations. SIGNIFICANCE STATEMENT: According to research, less breastfeeding occurs when mothers are marginalized. In turn, as marginalization increases, a mother's self-esteem regarding her ability to adequately care for her child decreases. Healthcare professionals tend to be less likely to support a decision to breastfeed if there is concern about the mother's resources and lifestyles. This research brings new attention to the importance of breastfeeding in disadvantaged situations related to an empowerment effect of breastfeeding for caregiving which includes cessation of drug and alcohol use. This effect has not previously been measured.

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PURPOSE: Social support has been identified as a determinant of physical activity (PA), but research has been primarily cross-sectional, with mixed findings for different Hispanic subgroups and limited longitudinal research with Hispanics. The purpose of this study is to assess the longitudinal associations of social support with PA in Hispanics on the Texas-Mexico Border. DESIGN AND SAMPLE: We used 2 time points of data collected from Hispanic adults in the Cameron County Hispanic Cohort (N = 588). MEASURES: We collected social support for PA and self-reported leisure-time PA. ANALYSIS: We used cross-lagged panel models to assess the association between friend support, family support, family punishment (criticizing or complaining) and PA over time. RESULTS: Although social support overall was low for PA, fully adjusted cross-lagged panel models indicated that time 1 friend support was associated with time 2 PA (adjusted rate ratio = 1.02, 95% confidence interval = 1.00 -1.04), though family support was not associated with time 2 PA. In males, time 1 friend support was inversely associated with time 2 family punishment. CONCLUSION: As expected, the directionality of the relation appears to be from social support to PA. Friend support appears to be predictive of PA in Hispanics, whereas family support is not. This should be considered in intervention development, particularly because familismo (commitment and mutual obligation to family) is considered to be a strong value in these communities.

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BACKGROUND: Voorstad on the Move (VoM) is a community health promotion program implemented in a socioeconomically deprived city district in the Netherlands. Based on exploration of the health situation, concurrent views on health promotion, and insights from literature, VoM is grounded in a social-ecological perspective and puts three action principles center core: citizens' participation, intersectoral collaboration, and a health supportive environment. VoM aims to improve the health of inhabitants, mostly low socioeconomic status (SES) families, and to realize changes in the social and physical environment. This current research, as part of the wider VoM project, aims to study the impacts and action principles of VoM. The main research questions concern the inhabitants' perceptions on health and health supportive environments, the perceived benefits of citizen participation in terms of health literacy and empowerment, and the factors and mechanisms that contribute to citizen participation and intersectoral collaboration. METHODS: The study has a mixed methods design, including process evaluation and monitoring, and combines qualitative and quantitative data. Research activities include literature study, in-depth interviews, focus group discussions, concept and capacity mapping, document analysis, and health survey data. A prominent strategy is action research, which aims to involve all stakeholders, capturing the different perspectives of citizens and professionals, and engaging low SES groups. The principle of triangulation is continuously applied to optimize the reliability of this study, using multiple methods and multiple sources. Internal validity is enhanced by triangulation of methods and resources. Other verification techniques will also be used, such as expert consultation. DISCUSSION: The design of the study, with a strong focus on action research, facilitates the involvement of all stakeholders and contributes to the development of capacities, learning, and empowerment, and thus contributes to health. The VoM program is innovative because it adopts an open approach in which activities evolve from citizens' needs, with a focus on action elements. This study will unravel the mechanisms of the action elements at community level, thereby helping to find ways to reduce health inequities. The findings will further elucidate what works and why it works for low SES groups.

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PURPOSE: To examine the trends in total and segmented sedentary and physical activity behaviors during a Sports, Play, and Recreation for Kids (SPARK) program in incarcerated adolescent boys. DESIGN: Longitudinal trend analysis. SETTING: Two juvenile justice facilities. SUBJECTS: Eighty-six adolescent boys (mean age = 17.1 ± 1.0 years). INTERVENTION: Sports, Play, and Recreation for Kids implemented over 36 weeks. MEASURES: Sedentary times and physical activity were examined at baseline and at 3 follow-up time points at 12, 24, and 36 weeks after SPARK implementation. Physical activity was assessed using the percentage of accelerometer wear time within each segment for sedentary (%SED) and moderate-to-vigorous physical activity (%MVPA). ANALYSIS: Trends in %SED and %MVPA were assessed using 2 × 4 doubly multivariate analysis of variance tests. RESULTS: For the total week, there was a significantly lower %SED (mean difference = -10.6%, P < .001) and significantly higher %MVPA (mean difference = +3.0%, P < .001) at the 24-week follow-up compared to baseline. There were also significantly lower %SED and higher %MVPA before school, after school, and during the weekends at 24-week follow-up compared to baseline ( P < .01). CONCLUSION: There were significantly lower sedentary times and higher levels of physical activity during the middle portions of the SPARK intervention in incarcerated adolescent boys, highlighting the potential of this intervention to affect sedentary and physical activity behaviors in the population.

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PURPOSE: To explore the availability and utilization of workplace health supports by employees of small and large-sized employers. DESIGN: Cross-sectional, telephone-based interviews collected on 16 workplace health supports for physical activity and diet. SETTING: Participants selected by random-digit-dialing from 4 metropolitan areas of Missouri employees from 2012 to 2013. PARTICIPANTS: Two thousand fifteen working adults. METHODS: We explored the availability and use of supports by employer size (<100 employees vs ≥100 employees), accounting for industry and personal factors. ANALYSIS: We examined distributions and Poisson regression models of availability for supports by employer size and by industry and use of supports by employer size and personal factors. RESULTS: One-fifth of the 1796 employees were employed by small-sized employers. Large employers offered more supports than small (mean: 6 vs 3), but a higher proportion of employees of small-sized employers used supports when available (59% vs 47%). The differences in offered supports between industries were not due to size alone. In regard to the determinants of participation, the personal factors of gender, age, weight, and income were associated with participation in 10 of the supports. Employer size was also associated with participation in 10 supports. No associations were found between personal factors or workplace size and participation for 3 supports. CONCLUSION: A higher proportion of employees working for smaller businesses use available supports than employees of larger businesses. Supports offered by employers should target the needs and interests of the workforce, particularly for the higher risk low-income employees.

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PURPOSE: Evaluate the effect of a policy-based, multicomponent workplace diet intervention on young adult employees' diet and health. DESIGN: A 6-month, single-armed pilot study with before and after assessments. SETTING: Insurance company in Belfast, Northern Ireland. PARTICIPANTS: Employees who worked at the company throughout the intervention period were included. Employees were excluded if pregnant, breast-feeding, or following a strict diet. INTERVENTION: Multicomponent diet intervention: ban of unhealthy foods brought into the premises, free fruit, education, individual advice, and further support. MEASURES: Mixed-methods approach: Diet-, health-, and work-related measures were assessed quantitatively. The campaign was evaluated quantitatively (via questionnaire) and qualitatively (via semistructured interviews). ANALYSIS: Changes in measures were analyzed using paired samples t tests. Interviews were analyzed using thematic analysis. RESULTS: Sixty (75.9%) staff completed all assessments. Males reduced their sugar intake on working days (-8.7% of total energy standard deviation [SD]: 20.1; P value <.01). Systolic blood pressure reduced in males and females (-3.3 SD: 9.9; P value <.05 and -8.0 SD: 7.7; P value <.001, respectively); 85.2% of staff strongly agreed/agreed that they appreciated the healthy eating ethos. This was supported by the qualitative analysis which furthermore suggested that the education, team support, individual advice, and free fruit were beneficial. CONCLUSION: Influencing workplace policies and offering additional dietary support could lead to meaningful changes in employees' diet and health and may change workplace culture.

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PURPOSE: The purpose of this study was to explore the relationship between ecological factors and occupational sedentary behavior (SB). DESIGN: Cross-sectional online survey. SETTING: Participants were employees recruited from a large, public university in the Southeastern United States from August to November 2016. PARTICIPANTS: The final sample included 527 (56% response rate) employees. MEASURES: Data were collected through an 87-item survey using previously validated scales that assessed occupational SB, perceived behavioral control, barrier self-efficacy, self-regulation strategies, organizational social norms, office environment, and worksite climate. ANALYSIS: One-way analysis of variance analyses were used to determine differences in occupational SB by demographic factors. A multivariate regression model was used to determine significant ecological determinants of occupational SB. RESULTS: Mean SB was 342.45 (standard deviation = 133.25) minutes. Significant differences in SB were found by gender, education, and employment classification. Barrier self-efficacy and workplace connectivity, which evaluates the spatial layout of the office setting that may impact mobility within the workplace, were significant predictors of SB in the multivariate model. CONCLUSION: Results from this study provide new information regarding the potential impact of workplace barriers and connectivity on occupational SB. The findings from this study support the inclusion of intervention modalities to minimize workplace barriers and increase workplace connectivity to increase workplace mobility and decrease SB.

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PURPOSE: The purpose of this study was to quantify the performance of organizations' worksite health promotion (WHP) activities against the benchmarking criteria included in the Well Workplace Checklist (WWC). DESIGN: The Wellness Council of America (WELCOA) developed a tool to assess WHP with its 100-item WWC, which represents WELCOA's 7 performance benchmarks. SETTING: Workplaces. PARTICIPANTS: This study includes a convenience sample of organizations who completed the checklist from 2008 to 2015. The sample size was 4643 entries from US organizations. MEASURES: The WWC includes demographic questions, general questions about WHP programs, and scales to measure the performance against the WELCOA 7 benchmarks. ANALYSIS: Descriptive analyses of WWC items were completed separately for each year of the study period. RESULTS: The majority of the organizations represented each year were multisite, multishift, medium- to large-sized companies mostly in the services industry. Despite yearly changes in participating organizations, results across the WELCOA 7 benchmark scores were consistent year to year. Across all years, benchmarks that organizations performed the lowest were senior-level support, data collection, and programming; wellness teams and supportive environments were the highest scoring benchmarks. CONCLUSION: In an era marked with economic swings and health-care reform, it appears that organizations are staying consistent in their performance across these benchmarks. The WWC could be useful for organizations, practitioners, and researchers in assessing the quality of WHP programs.

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PURPOSE: To examine whether perceived safety modified the effectiveness of the Walk Your Heart to Health (WYHH) intervention in promoting physical activity and reducing central adiposity in predominantly non-Latino black (henceforth black) and Latino communities. DESIGN: Generalized estimation equations were used to assess modifying effects of perceived safety on the route and perceived neighborhood safety on (1) WYHH participation at 8 weeks and 32 weeks, (2) associations between participation and physical activity, and (3) associations between physical activity and central adiposity. SETTING: Community-based and faith-based organizations in black and Latino communities. PARTICIPANTS: There were 603 adults, aged 18 years and older, who were predominantly black, Latino, and female. MEASURES: Participation and physical activity (piezoelectric pedometer) were measured at each walking session. Perceived safety on the route (questionnaire), perceived neighborhood safety (questionnaire), and waist circumference were measured at baseline, 8 weeks, and 32 weeks. ANALYSIS: Secondary analysis of repeated measures using generalized estimation equations. RESULTS: Retention was 90% at 8 weeks and 64% at 32 weeks. Perceived safety on the route, but not perceived neighborhood safety, dampened participation at 8 weeks but not 32 weeks. Consistent participation in the intervention increased physical activity and reduced central adiposity irrespective of perceived safety on the walking route or perceived neighborhood safety. CONCLUSION: Efforts to improve safety in conjunction with interventions focused on increasing physical activity can work toward improving physical activity for blacks and Latinos, leading to a myriad of improved health outcomes including reduced central adiposity.

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BACKGROUND: Although research has shown that numerous perceived environmental factors are supportive of physical activity, little is known about their associations with sedentary transport in motorcycle-oriented countries. This study examined the association between perceptions of Taiwan's environmental factors and urban adults' motorcycle use. METHODS: Cross-sectional data from 1003 Taiwanese adults aged 20-64 years from three urban cities were collected through telephonic surveys in 2015. Data on motorcycle use, sociodemographic variables, and perceived environmental attributes were obtained. Logistic regression analyses were performed. RESULTS: In Model 1, adults who perceived favorable access to public transport and destinations, presence of sidewalks, and safety from crimes at night were less likely to use motorcycles. In Model 2, in which potential covariates were additionally adjusted for, the same four environmental attributes (perceived favorable access to public transport and destinations, presence of sidewalks, and safety from crimes at night; odds ratio [OR] = 0.46, 0.65, 0.63, 0.64, respectively) were significantly associated with motorcycle use. CONCLUSION: The investigated perceived environmental factors, which have previously been associated with facilitating active transportation, discourage sedentary modes of transport, such as motorized vehicles.

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Evidence confirms that nature-based therapy (NBT) has a positive effect on people with mental illnesses. However, there is a lack of evidence on the meaning of NBT for specific patient groups. The Nacadia® Therapy Garden was designed according to an evidence-based design process, and an NBT programme was developed. The aim of the study was to illuminate the phenomenon of participants' lived experience of the NBT in Nacadia. Fourteen participants took part in semi-structured interviews (SSIs), and by way of reflective lifeworld research, the SSIs were analysed to identify and describe the meanings of the phenomenon. The essence of the phenomenon was found to be a process of adopting a searching approach to NBT and Nacadia to become familiar with the conditions. This familiarity stimulated the development of confidentiality and attachment to Nacadia. Feeling protected, safe, cared for, and not exposed was important, and motivated feelings of freedom, reduced demands, and increased the ability to access and try a spectrum of NBT activities. It encouraged participants to develop personal approaches and coping strategies to implement in their everyday lives for moving on.

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