Validierung eines Fragebogeninstrumentes zur Erfassung des Erlebens von Natur: Die Experience of Nature Scale.

Hintergrund: In den letzten Jahren ist insbesondere die Natur als Ressource in das Interesse der gesundheitspsychologischen Forschung gerückt. In Ergänzung zum etablierten Konzept der Naturzuwendung als Haltung wurde ein Forschungsinstrument zum Naturerleben entwickelt, welches das subjektive, teilweise intentionale Erleben von Natur unter unterschiedlichen Aspekten beleuchtet. Dazu gehören insbesondere Natur als Erlebensraum, um sich von der Alltagsbelastung distanzieren zu können, um Auszeit durch Ruhe und Stille finden zu können, um emotionale Ausgeglichenheit zu erlangen, Natur als Ort der Faszination und des Staunens, Naturerleben als Basis für einen verantwortlichen Umgang mit der Natur. Das Manuskript zeigt die Ergebnisse der Validierung des neu entwickelte Fragebogeninstrument zum Naturerleben. Methoden: Anonyme Online-Querschnittsstudie unter 441 Teilnehmenden mit standardisierten Fragebogeninstrumenten zur Validierung der Experience of Nature Scale (ENS) mittels explorativer Faktoren- (Hauptkomponentenanalyse mit Varimax-Rotation) und Reliabilitätsanalysen (Cronbachs alpha). Ergebnisse: Die explorative Faktorenanalyse der Naturerlebens-Skala mit 11 Items ergab drei Hauptfaktoren mit guter interner Kongruenz, die 71% der Varianz erklären: 1) Alltagsdistanzierung/Entspannung (Cronbachs α = 0,87), 2) Faszination Natur/Staunen (Cronbachs α = 0,82) und 3) Verantwortungsempfinden für Natur (Cronbachs α = 0,85) Diese Faktoren korrelierten stark mit der Naturverbundenheit (NR-6) und moderat bis stark mit Ehrfurcht/Dankbarkeit (GrAw-7) im Sinne der Konvergenzvalidität, aber nur marginal bis schwach mit psychologischem Wohlbefinden (WHO-5). Schlussfolgerungen: Die Experience of Nature Scale zur Erfassung des affektiven Erlebens von Natur hat gute psychometrische Qualitätsindizes und kann in künftigen Studien zur Bedeutung dieses Erlebens von Natur zum Beispiel als Prädiktor- oder Prozessvariable eingesetzt werden.

Experience of nature and times of silence as a resource to cope with the COVID-19 pandemic and their effects on psychological wellbeing-Findings from a continuous cross-sectional survey in Germany.

Background: The COVID-19 pandemic with its lockdowns affected social relations and mental health conditions of people worldwide. We aimed to analyze the relevance of nature and times of silence as resources to cope with the pandemic. Of interest were how experiences of nature and times of silence are related to the perception of wondering awe and gratitude and psychological wellbeing and how these have changed during the different phases of the pandemic. Finally, we asked whether Nature/Silence would mediate the link between Awe/Gratitude and wellbeing. Methods: A cross-sectional survey with standardized questionnaires (i.e., PCQ, GrAw-7, BMLSS-10, WHO-5) enrolling participants during the different phases of the COVID-19 pandemic was conducted. The total sample of 5,155 participants from Germany consisted of 65% women and 34% men, with a mean age of 45.0 ± 14.0 years. Results: Directly after the first lockdown, Nature/Silence and Awe/Gratitude scores were high and decreased along with wellbeing with the onset of the second lockdown in winter 2020, while perceived burden constantly increased. Nature/Silence was rated lowest by people with reduced wellbeing (eta2 = 0.058) and feeling lonely or socially isolated (eta2 = 0.042). Predictor analyses revealed that wellbeing as a dependent variable was predicted best by corona-related perception of burden, Awe/Gratitude, reflection of life, and Nature/Silence and further by perceived changes in terms of relationships and spirituality (R2 = 0.55). In mediation analyses, Awe/Gratitude proved to be a significant predictor for Nature/Silence (ß = 0.55, p< 0.0001) and wellbeing (ß = 0.05, p < 0.0001). The mediation analysis explained 37% of the variability in the data. The direct influence of Awe/Gratitude on wellbeing was estimated as ß = 0.09 (p < 0.0001), and the mediation effect of Nature/Silence on the link between Awe/Gratitude and wellbeing was significant, too (ß = 0.03, p < 0.0001), explaining 25% of the total effect. Conclusion: Nature/Silence and Awe/Gratitude were used as relevant resources during the pandemic, although they cannot fully buffer the negative effects of the social restrictions that resulted in decreases in wellbeing and increases in perceived burden. Perception of nature as a sensitizer of positive experiences particularly during difficult phases of life could be trained to stabilize wellbeing and thus to contribute to public health.

Perceived Changes of Attitudes and Behaviors of Seventh-Day Adventists During the COVID-19 Pandemic: Findings from a Cross-Sectional Survey in Germany.

To analyze which pandemic related changes of attitudes and behaviors were perceived by Seventh-day Adventists (SDA) and how these relate to wellbeing, a cross-sectional survey with standardized questionnaires was performed. Participants (n = 1,494) stated changes for Relationships, Digital media usage and Nature/Silence/Contemplation, but not for Spirituality or Reflection of life. Best predictors of psychological wellbeing (WHO-5) were Spiritual wellbeing, perceived Restrictions and Awe/Gratitude (R2 = .32). Mediation analyses (R2 = 0.51) revealed a mediation effect of Awe/Gratitude between spiritual to psychological wellbeing (ß = 0.11, p < 0.0001). Perceived changes were less relevant to buffer the negative effects of the pandemic; instead, they were related to fears of future. More relevant to stabilize SDAs´ wellbeing was their spirituality.

Profiles and predictors of healthcare utilization: using a cluster-analytic approach to identify typical users across conventional, allied and complementary medicine, and self-care.

INTRODUCTION: The identification of typologies of health care users and their specific characteristics can be performed using cluster analysis. This statistical approach aggregates similar users based on their common health-related behavior. This study aims to examine health care utilization patterns using cluster analysis; and the associations of health care user types with sociodemographic, health-related and health-system related factors. METHODS: Cross-sectional data from the 2012 National Health Interview Survey were used. Health care utilization was measured by consultations with a variety of medical, allied and complementary health practitioners or the use of several interventions (exercise, diet, supplementation etc.) within the past 12 months (used vs. not used). A model-based clustering approach based on finite normal mixture modelling, and several indices of cluster fit were determined. Health care utilization within the cluster was analyzed descriptively, and independent predictors of belonging to the respective clusters were analyzed using logistic regression models including sociodemographic, health- and health insurance-related factors. RESULTS: Nine distinct health care user types were identified, ranging from nearly non-use of health care modalities to over-utilization of medical, allied and complementary health care. Several sociodemographic and health-related characteristics were predictive of belonging to the respective health care user types, including age, gender, health status, education, income, ethnicity, and health care coverage. CONCLUSIONS: Cluster analysis can be used to identify typical health care utilization patterns based on empirical data; and those typologies are related to a variety of sociodemographic and health-related characteristics. These findings on individual differences regarding health care access and utilization can inform future health care research and policy regarding how to improve accessibility of different medical approaches.

Tumor patients' fears and worries and perceived changes of specific attitudes, perceptions and behaviors due to the COVID-19 pandemic are still relevant.

OBJECTIVE: During the COVID-19 pandemic, tumor patients not only perceived fears and worries but were experiencing also positive changes as the perception of nature and silence, moments of wondering awe, and more intense relationships. We intended to analyze whether these perceptions may differ between patients from waves 1 and 2 of the pandemic. METHODS: Cross-sectional study at two time periods (May to June, sample 1) and September to November 2020 (sample 2) with standardized questionnaires (i.e. WHO-5, MLQ, PCQ-12). RESULTS: Patients from sample 1 (n = 292) and sample 2 (n = 221) did not differ with respect to gender, age, partner or tumor status. Most are still "irritated by statements about danger and course of the infection" (58%) and are "worrying to be infected and to have complicated course of disease" (55%). Neither their well-being nor meaning in life nor fears and worries were significantly different. In sample 2 patients, Worrying reflections and loneliness scored significantly lower, while their Perception of nature and silence was lower in trend only; more intense relationships are still relevant. Moments of wondering awe and religious trust were perceived less often during wave 2. Particularly religious patients scored stronger for Perception of nature and silence and Worrying reflections and loneliness. CONCLUSION: Oncologists/psychologist have to know that patients' situation has not changed within the time of pandemic and that they still require information, close support and encouragement to rely on their resources to cope. Perceived changes are reflecting coping strategies that could be trained to increase patients' resilience during further pandemic waves.

Development of a documentation instrument for movement-orientated Mind-Body-Therapies taking the example of Eurythmy-Therapy.

INTRODUCTION: Movement orientated Mind-Body-Interventions become more popular. But there are no standardized documentation tools to show if an improvement in movement could correlate with an improvement in health. Yet systematic documentation is a vital requirement to their efficacy. METHOD: We developed a 5-module documentation structure including patients' perspective. Over a period of five months 11 therapists used the modules to document their treatments on 41 patients and evaluated their feasibility at hand a questionnaire. RESULTS: 10 therapists and 37 patients met the inclusion criteria. In a documented variety of treatment concepts moderate to large effect size in observed movement qualities was found. Furthermore large correlation of observed movement qualities and patients' self-reported Quality of Life indicators could be shown. CONCLUSION: The modules were regarded feasible. Moreover, the outcomes showed initial sensitivity to change. They should therefore be tested in various movement orientated Mind-Body-Therapies.

German Soldiers' Needs to Clarify Open Aspects in Their Life, to Talk About Fears and Worries, and to Forgive and to Be Forgiven as a Matter of Life Reflection.

Background: In missions, soldiers are confronted with difficult situations which may impair their physical and mental health. As the resulting problems are commonly regarded as stigmata, soldiers may obviate talking about their experiences and try to oppress them. It was aim of this study to clarify whether soldiers do perceive needs to reflect back on life, to seek release from "open aspects" of their life, and to talk with others about fears and worries, to forgive others or to be forgiven. Further we intended to clarify whether these needs were related to stress perception, post-traumatic stress disorders (PTSD) symptoms and reduced life satisfaction on the one hand, and religious trust as a resource to cope on the other hand. Methods: Cross-sectional survey of 1,097 German soldiers (92% men). Existential/spiritual needs and mental health indicators, including stress perception, PTSD symptoms, life satisfaction, were assessed using standardized questionnaires. Results: For 30% of soldiers it was important to reflect on life, 23% had a strong need to clarify open aspects of life, 30% had a strong need to talk with others about their fears and worries, 13% had strong needs to forgive, and 13% had a strong need to be forgiven. Soldiers' needs to clarify open (and probably conflicting) aspects of life were moderately related to their intention to forgive others and to be forgiven (rs > 0.35). Soldiers treated in the hospital for psycho-mental trauma had significantly higher needs scores than soldiers still serving on active duty, particularly for the need to talk with others (F = 39.1; p < 0.0001) and to be forgiven (F = 26.0; p < 0.0001). Across all soldiers the best predictors of these needs were PTSD symptoms and stress perception, albeit with relatively weak predictive power (ßs < 0.25; R 2s < 0.24). Conclusions: The process of life reflection and subsequent intention to solve conflicting situations and experiences can be considered a process of coping with one's own failures, guilt, and mistakes. It should be noted that these needs were significantly stronger in soldiers with trauma. Addressing unmet needs may help them to communicate and to reject the stigma of "weakness."

Work stress associated cool down reactions among nurses and hospital physicians and their relation to burnout symptoms.

BACKGROUND: Hospital staff experience high level of work stress and they have to find strategies to adapt and react to it. When they perceive emotional exhaustion and job dissatisfaction in response to constant work stress, one reaction might be emotional withdrawal. This emotional distancing can be seen as an adaptive strategy to keep 'functionality' in the job. Both, perception of emotional exhaustion and emotional distancing as a strategy, can be operationalized as 'Cool Down'. We assume that work stress associated variables are positively associated with Cool Down reactions, while internal and external resources are negatively associated and might function as a buffer against emotional distancing. Moreover, we assume that the perception of stress and work burden might be different between nurses and physicians and women and men, but not their cool down reactions as a strategy. METHODS: Anonymous cross-sectional survey with standardized instruments among 1384 health care professionals (66% nurses, 34% hospital physicians). Analyses of variance, correlation and also stepwise regression analyses were performed to analyze the influence of demands and resources on Cool Down reactions. RESULTS: As measured with the Cool Down Index (CDI), frequency and strength of Cool Down reactions did not significantly differ between women and men, while women and men differ significantly for their burnout symptoms, stress perception and perceived work burden. With respect to profession, Cool Down and stress perception were not significantly different, but burnout and work burden. For nurses, "Emotional Exhaustion" was the best CDI predictor (51% explained variance), while in physicians it was "Depersonalization" (44% explained variance). Among putative resources which might buffer against Cool Down reactions, only team satisfaction and situational awareness had some influence, but not self-efficacy expectation. CONCLUSION: The perceptions of emotional exhaustion and distancing of nurses and physicians (and women and men) seems to be different, but not their adaptive Cool Down reactions. Data would support the notion that a structural approach of support would require first to control and eliminate work stressors, and second a multifaceted approach to strengthen and support hospital staff's resources and resilience.