THE DEVELOPMENT AND EVALUATION OF NATURE MATTERS: AN

EVIDENCE-INFORMED PROGRAM FOR INCREASING NATURE-FOCUSED

BEHAVIOURS AND NATURE CONNECTION IN UNDERGRADUATE
STUDENTS

by

Yasmeen A. Ibrahim

Submitted in partial fulfilment of the requirements for

the degree of Doctor of Philosophy

at

Dalhousie University
Halifax, Nova Scotia
May, 2025

Dalhousie University is located in Mi’kma’ki,

the ancestral and unceded territory of the
Mi’kmaq. We are all Treaty people.

© Copyright by Yasmeen A. Ibrahim, 2025

 DEDICATION PAGE

To my parents, Amira and Ashraf, and my husband, Abdelrahman, with immense love
and my deepest appreciation, I dedicate this thesis to you. No words can express my
gratitude for your unconditional love, unwavering support, and the sacrifices you have
made for me to get to where I am today and complete this journey. Thank you for
standing by me through every challenge, setback, and late night — and for celebrating
each little victory along the way. Your constant presence made all the difference. Thank
you for believing in me. I truly could not have made it without the three of you. This
accomplishment is as much yours as it is mine.

With all my heart, thank you today, tomorrow, and for the rest of my life. I love you.

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 TABLE OF CONTENTS

LIST OF TABLES .......................................................................................................... vii

LIST OF FIGURES ....................................................................................................... viii
ABSTRACT ...................................................................................................................... ix
LIST OF ABBREVIATIONS AND SYMBOLS USED ................................................ x
ACKNOWLEDGEMENTS ........................................................................................... xii
CHAPTER 1: INTRODUCTION.................................................................................... 1
1.1 Summary of Problem and Brief Overview ............................................................... 1
1.2 Main Theories Behind the Benefits of Nature ................................................ 3
1.2.1 Biophilia Hypothesis .......................................................................................... 3
1.2.2 Attention Restoration Theory ............................................................................. 5
1.2.3 Stress Reduction Theory .................................................................................... 8
1.2.4 Interrelatedness of Theories .............................................................................. 9
1.3 Benefits of Interacting and Connecting with Nature ................................... 10
1.3.1 Urbanization and Associated Risk Factors...................................................... 10
1.3.1 Health Benefits of Stress Reduction ................................................................. 11
1.3.2 Mental and Affective Health Benefits .............................................................. 12
1.3.3 Cognitive Benefits ............................................................................................ 14
1.3.4 Benefits of Biophilic Design and Indoor Nature.............................................. 17
1.3.5 Prescribing Exposure to Nature ...................................................................... 19
1.3.6 COVID-19 and Nature Exposure ..................................................................... 20
Rationale and Overview of Dissertation Studies ...................................................... 21
CHAPTER 2: PROGRAM DEVELOPMENT: EVIDENCE-BASED
IMPLEMENTATION .................................................................................................... 23
2.1 The Behaviour Change Wheel Framework ........................................................ 23
2.1.2 Strengths of the BCW Framework ................................................................... 24
2.1.3 The BCW framework and Nature-related Interventions .................................. 25
2.2 Rationale Behind Program Features ................................................................... 27
2.2.1 BCW and Program Development..................................................................... 27
2.2.2 Rationale for E-learning .................................................................................. 28
2.2.3 Video Portion – Overview and Rationale ........................................................ 29

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 2.2.4 Video Portion – Content and Development ..................................................... 32
2.2.5 Written Portion – Overview and Rationale ..................................................... 34
2.2.6 Written Portion – Content and Development................................................... 38
2.2.7 Summary of Program Development ................................................................. 39
CHAPTER 3: AN ONLINE WELLNESS PROGRAM TO INCREASE NATURE
EXPOSURE, NOTICING NATURE, AND NATURE CONNECTION IN
UNDERGRADUATE STUDENTS: RESULTS OF A USABILITY STUDY ........... 42
3.1 Abstract .................................................................................................................. 43
3.2 Introduction ........................................................................................................... 44
3.2.1 Exposure to Nature and Well-Being ................................................................ 45
3.2.2 Nature Relatedness and the Importance of Connecting with Nature .............. 46
3.2.3 Human-Nature Disconnect .............................................................................. 47
3.2.4 Current Study ................................................................................................... 48
3.3 Methods .................................................................................................................. 49
3.3.1 Participants ...................................................................................................... 49
3.3.2 Materials .......................................................................................................... 49
3.3.3 Procedure ......................................................................................................... 52
3.3.4 Thematic Analysis ............................................................................................ 52
3.4 Results .................................................................................................................... 54
3.4.1 Quantitative Results ......................................................................................... 54
3.4.2 Item-Specific Quantitative Data ...................................................................... 55
3.4.3 Qualitative Data/ Thematic Analysis ............................................................... 57
3.5 Discussion ............................................................................................................... 63
3.5.1 Strengths and Limitations ................................................................................ 67
3.5.2 Implications and Future Directions ................................................................. 67
CHAPTER 4: EXAMINING A NOVEL ONLINE PROGRAM AIMED AT
INCREASING NATURE CONNECTEDNESS, NATURE EXPOSURE, AND
NOTICING NATURE IN UNDERGRADUATE STUDENTS .................................. 80
4.1 Abstract .................................................................................................................. 81
4.2 Introduction ........................................................................................................... 82
4.2.1 Human Relationship with Nature..................................................................... 84
4.2.2 Mental Health and Wellness Benefits of Nature Exposure .............................. 85

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 4.2.3 Mental Health and Wellness Benefits of Noticing Nature ............................... 87
4.2.4 Mental Health and Wellness Benefits of Nature Connectedness ..................... 88
4.2.5 Disconnect from Nature ................................................................................... 89
4.2.6 Current Study ................................................................................................... 89
4.3 Methods .................................................................................................................. 90
4.3.1 Power Analysis................................................................................................. 90
4.3.2 Participants ...................................................................................................... 91
4.3.3 Materials .......................................................................................................... 93
4.3.4 Measures .......................................................................................................... 94
4.3.5 Procedure ......................................................................................................... 95
4.4 Results .................................................................................................................... 97
4.4.1 Primary Results ................................................................................................ 98
4.4.2 Post-Hoc Regressions ...................................................................................... 99
4.5 Discussion ............................................................................................................... 99
4.5.1 Exploratory Findings ..................................................................................... 104
4.5.2 Limitations and Future Directions................................................................. 105
4.5.3 Conclusion ..................................................................................................... 108
CHAPTER 5: DISCUSSION ....................................................................................... 118
5.1 Strengths and Limitations .................................................................................. 121
5.1.1 Strengths ........................................................................................................ 121
5.1.2 Limitations ..................................................................................................... 124
5.2 Future Directions................................................................................................. 127
5.2.1 Program Modifications .................................................................................. 127
5.2.2 Nature Matters for Other Populations ........................................................... 129
5.3 Clinical Implications ........................................................................................... 130
5.3.1 Integration with Stepped Care Approach ...................................................... 131
5.4 Planetary Health Implications ........................................................................... 134
5.5 Conclusions .......................................................................................................... 136
REFERENCES.............................................................................................................. 138
APPENDIX A ................................................................................................................ 178
APPENDIX B ................................................................................................................ 194

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APPENDIX C ................................................................................................................ 198

vi
 LIST OF TABLES

Table 3.1. Means, Standard Deviations, and One Sample t-test Results for the
Video Portion’s UEQ+ Scales (N = 99)............................................................................ 70

Table 3.2. Means, Standard deviations, and One Sample t-test Results for the Written
Portion’s UEQ+ Scales (N = 72) ...................................................................................... 71

Table 3.3. Wilcoxon Signed-rank Test Results for Comparison of Skill Building
Opportunities..................................................................................................................... 72

Table 4.1. Bayesian Information Criterion Values for the Normal Identity Model,
Poisson Log-link Model, Negative Binomial Log-link Model, and Gamma Log-link
Model .............................................................................................................................. 110

Table 4.2. Post-Hoc Regression Results using Pre-program Scores as the Predictor..... 111

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 LIST OF FIGURES

Figure 2.1. The Behaviour Change Wheel (BCW) and the Capability, Opportunity,
and Motivation model of Behaviour (the COM-B Model) ............................................... 41

Figure 3.1. UEQ+ Mean Scores for the Video Portion of the Nature Matters
Program ............................................................................................................................. 73

Figure 3.2. UEQ+ Mean Scores for the Written Portion of the Nature Matters
Program….……………………………………………………………………….……....74

Figure 3.3. Number of Participants Ranking each SBO as the SBO Most Likely to
Increase their Nature Exposure ........................................................................................ 75

Figure 3.4. Themes and Underlying Codes for the Liked Features Reported for the
Video Portion of the Program ........................................................................................... 76

Figure 3.5. Themes and Underlying Codes for the Disliked Features/Areas for
Improvement Reported for the Video Portion of the Program ......................................... 77

Figure 3.6. Themes and Underlying Codes for the Liked Features Reported for the
Written Portion of the Program......................................................................................... 78

Figure 3.7. Themes and Underlying Codes for the Disliked Features/ Areas for
Improvement Reported for the Written Portion of the Program ....................................... 79

Figure 4.1. Estimated Marginal Means of Nature Relatedness Scale Scores at Time 2 . 112

Figure 4.2. Estimated Marginal Means of Noticing Nature Scores at Time 2................ 113

Figure 4.3. Mean Nature Contact Questionnaire Scores at Time 2 ................................ 114

Figure 4.4. Change in Nature Relatedness Scores by Baseline Nature Relatedness

Scores for Active Group ................................................................................................. 115

Figure 4.5. Change in Nature Contact Scores by Baseline Nature Contact Scores
for Active Group ............................................................................................................. 116

Figure 4.6. Change in Noticing Nature Scores by Baseline Noticing Nature Scores
for Active Group ............................................................................................................. 117

viii
 ABSTRACT

Mental health difficulties and stressors are prevalent amongst undergraduate students,
whereas resources to support students’ mental health are limited. The well-documented
benefits of exposure to, and connection with, nature include various aspects of mental,
physical, and cognitive health, yet many people are unaware of these benefits and do not
engage with nature as a health behaviour. This dissertation describes the development
and evaluation of Nature Matters, an online evidence-informed wellness program that
integrates the behavior change wheel framework with evidence-based learning strategies
to raise undergraduate students’ awareness of the benefits of exposure to nature and
encourage behavior change. In Study 1 (N = 108), I assessed the usability and
acceptability of Nature Matters using a mixed-methods design. Both quantitative and
qualitative results indicated that the program was well-received by undergraduate
students, with positive ratings attained for all user-experience domains (1. Perspicuity or
clarity/ ease of understanding, 2. Stimulation, 3. Usefulness, 4. Attractiveness, 5. Visual
Aesthetics, 6. Trustworthiness of Content, and 7. Quality of Content). In Study 2, I
examined if completing Nature Matters 1) enhanced connectedness to nature, 2)
increased frequency of exposure to nature; and 3) increased frequency of noticing nature.
As hypothesized, participants who completed the program (n = 45) reported greater
connectedness to nature and a higher frequency of exposure to nature compared to
control participants (n = 46), after accounting for baseline scores. Results for noticing
nature were not significant. Exploratory regression analyses revealed that lower baseline
levels of nature connectedness, noticing nature, and exposure to nature were all
associated with a larger change in post-program outcome scores. Overall, the findings
demonstrate the acceptability and effectiveness of Nature Matters for an undergraduate
population, suggesting that this program has potential as an intervention for increasing
exposure to and connection with nature. Building upon this evidence will advance the
utilization of the human-nature connection for improving well-being and pave the way
for the development of similar wellness programs.

ix
 LIST OF ABBREVIATIONS AND SYMBOLS USED

% Percentage
ANCOVA Analysis Of Covariance
ANOVA Analysis Of Variance
ART Attention Restoration Theory
B Unstandardized Beta Coefficient
b Standardized Beta Coefficient
BCW Behaviour Change Wheel
BIC Bayesian Information Criterion
CI Confidence Interval
COM-B Capability Opportunity Motivation - Behaviour
d Cohen’s d
df Degrees of Freedom
E-learning Electronic Learning
EEA Environment of Evolutionary Adaptedness
EMM Estimated Marginal Mean
EWB Engagement with Beauty Scale
F ANOVA/ ANCOVA F-Value
GliM Generalized Linear Models
HEQCO Higher Education Quality Council of Ontario
ICR Intercoder Reliability
INE Indoor Nature Exposure
K Cohen’s Kappa
KT Knowledge Translation
M Mean
N Total Sample Size
n Subsample of Total Sample Size
NHS National Health Service
np2 Partial Eta Squared
p P-Value for Significance Testing
PaRx A Prescription for Nature
PEB Pro-Environmental Behaviors
PFA Processing Fluency Account
r Correlation Coefficient
R2 Coefficient of Determination
SBO Skill Building Opportunity
SD Standard Deviation
SE Standard Error
SES Socioeconomic status

x
sic Odd/ incorrect quoted word(s) pasted as provided by participant
SMART Specific Measurable Attainable Realistic Timely
SONA Dalhousie University’s Experimental Sign-Up System
SPSS Statistical Package for Social Sciences
SRT Stress Reduction Theory
t Regression t-Value
UEQ+ User Experience Questionnaire - Plus
Z Wilcoxon Signed-Rank Test Z-Value
χ2 Wald’s Chi-squared Value

xi
 ACKNOWLEDGEMENTS

I would like to express my deepest gratitude to my supervisor, Dr. Shannon Johnson,

whose kindness, support, generosity, and wisdom have been exceptional. Your insightful
feedback, encouragement, thoughtful approach, and steady presence helped shape this
thesis and guide me through the inevitable challenges of the process. You’ve always
made time to listen and to guide and advise with clarity and patience. I am incredibly
lucky to have had a mentor who not only nurtured my academic development but also
reminded me of the importance of work-life balance, self-care, and kindness. Your
balanced approach has been both inspiring and grounding, fostering in me the values that
truly sustain a long and fulfilling journey. I am very thankful for the opportunity to work
under your guidance and to learn from you. This work is better — and I am better —
because of you.

To my outstanding committee members, Dr. Leanne Stevens, Dr. Sean Barrett, and
Dr. Alissa Pencer, it was an absolute pleasure having you there through this special part
of my journey. I want to express my utmost appreciation for your guidance and support.
It has been invaluable.

To the amazing lab members I have been honoured to work with, George Fazaa, Maggie
Baxter, and Blythe MacDougall—thank you for all your hard work, commitment, and
enthusiasm. It was integral to the success of this research project.

To my incredible friends, Teba Hamodat, Karen Tang, Momina Raja, and Madison
MacLachlan, this degree may mark a milestone, but the real highlight has been sharing
it with you. From our deep conversations and jokes to the venting sessions, spontaneous
hangouts, and bursts of laughter, I do not know how I would have done it without you.
Thank you for being my safe space. I am so grateful for having amazing sincere friends
like you. You have listened without judgment, supported without hesitation, and managed
to brighten even the toughest of days. You have been the heart of this journey, and I will
always treasure our memories and beautiful friendships.

To the best sister and partner in crime one could ask for, Mariam. There are no words
that can fully capture how much you mean to me. I have shared more memories with you
than I have shared with anybody. You get me in a way no one else does. Thank you for
your continuous support, encouragement, and pride in me ever since we were little.
Thank you for believing in me. You have always had my back, and that means the world
to me. Thank you for cheering me on and lifting me up when I needed it. I hope I made
you proud.

Last but not least, a very special thank you to my uncle, Ahmed. Thank you for being a
continuous source of encouragement and support ever since I was a child. Your kind
uplifting words meant a lot to me. You have been, and continue to be, my rock. Words
cannot do justice the amount of love, care and support you have given me over the years.
Thank you.

xii
 CHAPTER 1: INTRODUCTION

1.1 Summary of Problem and Brief Overview

There has been a considerable increase in distress and mental health difficulties

experienced by university students in the past decade, which was amplified by the

COVID-19 pandemic (Frazier et al., 2023; King et al., 2023; Salimi et al., 2023; Sutton,

2019; Wood et al., 2024). This has led to an influx in the number of students seeking

mental health supports and services from healthcare systems that are already strained,

further widening the gap between demand and available supports and increasing the

prevalence of mental health difficulties in post-secondary campuses and worldwide

(Abrams, 2022; World Health Organization, 2022). The need for accessible supports and

strategies to help students manage stressors and reduce symptoms of mental health

problems is pressing. There is extensive and robust evidence demonstrating that

interacting and connecting with the natural environment has positive impacts on humans’

mental and physical health (Jimenez et al., 2021; Richardson, 2019; Ríos-Rodríguez et al.,

2024). As such, programs that target connection with nature could equip individuals with

low-cost and accessible strategies for protecting and improving their health and well-

being.

A few prominent theories seek to explain why and how nature improves human

health and well-being. A key theory, the biophilia hypothesis, proposes that humans have

an inherent connection to the natural environment due to evolution and our dependence

on nature for survival (Kellert & Wilson, 1995; Wilson, 1984). It also highlights the need

to nourish this bond so that humans can preserve and enhance their well-being (Kellert &

Wilson, 1995; Wilson, 2007). Notably, the core tenets of the biophilia hypothesis have
long been central to many Indigenous cultures and ways of knowing (Hart, 2010).

Theories such as the attention restoration theory (ART) and the stress reduction theory

(SRT) provide compelling arguments for how nature exposure can enhance our mental

and physical health through replenishing our attentional resources, reducing our stress

levels, and improving several aspects of our wellbeing. Importantly, there has been

numerous research over the decades providing support for these theories. For instance,

connecting with nature in its many forms (e.g., spending time in parks, viewing images of

nature, adding potted plants in indoor settings), was found to reduce stress levels,

negative affect, and symptoms of depression and anxiety as well as increase happiness,

positive affect, quality of life, and enhance sleep quality and immune system functioning

(Bratman et al., 2021; Chow & Lau, 2015; Jimenez et al., 2021; Richardson, 2019; Ríos-

Rodríguez et al., 2024). Viewing and interacting with nature has also been found to

improve cognitive and executive functions, including attention, cognitive performance,

and creativity (Bourrier et al., 2018; Dadvand et al., 2017; Ferraro, 2015; Lee et al., 2015;

Mason et al., 2022; Palanica et al., 2019; Yeh et al., 2022).

Unfortunately, increasing urbanization has contributed to disconnection from

nature (Aschenbrand, 2024; Clements, 2004; Cox, Hudson, et al., 2017). In 2023, 57% of

individuals worldwide were living in urban areas, a large shift from the 1960’s when only

33% of the world’s population lived in urban areas (UN Population Division via World

Bank, 2025). This number is expected to increase to 70% by 2050 and is already much

higher in North America, at over 80% in both Canada and the United States (UN

Population Division via World Bank, 2025; United Nations, 2023).This increasing

disconnection from nature is hypothesized to contribute to the rise in mental and physical

2
health ailments (Chavaly & Naachimuthu, 2020). Notably, public awareness of the

importance and benefits of nature connection is limited, and many people remain

uninformed, necessitating initiatives that promote this free and effective health resource.

As such, the overarching goal of my dissertation was to develop and evaluate an

evidence-based program, Nature Matters, aimed at translating the benefits of nature-

focused behaviour and connection with nature, and equipping individuals with practical,

accessible strategies for incorporating nature into their daily lives to strengthen the

human-nature bond and improve peoples’ well-being.

In this introductory section, I outline the major theories proposed to explain the

numerous well-being benefits that accompany nature-based interactions, and provide a

review of the evidenced physical, mental, and cognitive benefits. I also describe the

impact of urbanization on the human-nature disconnect and review the impact of

biophilic design on our well-being. Further, I highlight the move towards prescribing

nature and the protective impact of exposure to nature during the COVID-19 pandemic.

This chapter concludes with a summary of the rationale and overview of my dissertation

studies.

1.2 Main Theories Behind the Benefits of Nature

1.2.1 Biophilia Hypothesis

The term “Environment of Evolutionary Adaptedness (EEA)” provides the

foundational evolutionary framework for the biophilia hypothesis. EEA refers to the

environment, more specifically a group of selection pressures present in the environment,

that lead to the production of an adaptation (Barkow et al., 1992; Bennett, 2018;

Crawford & Krebs, 1997). The EEA provides an explanation for the psychological and

3
behavioural adaptations that humans have attained and retained over the centuries. The

following is a potent summary shared by Irons (1998) for the assumptions of EEA noted

in the book “The Adapted Mind”: ‘‘. . . the evolved structure of the human mind is

adapted to the way of life of Pleistocene hunter-gatherers, and not necessarily to our

modern circumstances. . . . The few thousand years since the scattered appearance of

agriculture is only a small stretch in evolutionary terms, less than 1% of the two million

years our ancestors spent as Pleistocene hunter-gatherers.’’

In line with EEA, the biophilia hypothesis postulates that humans have an

inherent affection towards nature and are instinctively inclined to be around and engage

with natural environments as a result of evolution (Kellert & Wilson, 1995). Humans

lived in natural settings for around two million years, and had frequent positive

interactions with elements of nature, both blue (e.g., lakes, rivers) and green (e.g., forests,

parks) spaces. Bodies of water were linked to drinking, a vital biological human need,

and animals congregated around blue spaces, making them ideal for hunting and

obtaining food. In a similar vein, green spaces (trees and plants) provided shelter as well

as sustenance (Gullone, 2000). Based on the biophilia hypothesis, humans relied heavily

on nature and its many resources to survive, which fostered a strong emotional bond with

nature (Kellert & Wilson, 1995). In many cultures and across generations, humans

demonstrate fondness for natural scenery and elements of nature (e.g., trees, flowers),

which is thought to be a result of our innate biophilic tendencies (Grinde & Patil, 2009).

Notably, the biophilia hypothesis aligns closely with Indigenous worldviews. Hart (2010)

highlighted that many Indigenous cultures believe that all things are alive and equal, that

the land is sacred, and, most importantly, that all beings are interconnected and

4
interdependent. Further, all beings are believed to have a role in maintaining balance and

harmony and, thus, many Indigenous cultures consider themselves to have an obligation

to nurture and protect the wellbeing of life, land, and the environment (Hart, 2010).

Proponents of the biophilia hypothesis believe that biophilic rules and preferences

that have been ingrained in our species and strengthened for thousands of years cannot be

easily replaced or erased by the relatively recent technological advancements, manmade

objects, and industrialization (Wilson, 2007). As such, Wilson (2007) and proponents of

the biophilia hypothesis argue that humans will continue to aspire to be in close

proximity to nature, yearning for the well-being and fulfilment that only nature can

bestow. Notably, if humans are strongly driven to be connected with nature, yet

increasingly disconnected from it, this might have serious consequences for our health

and well-being (Wilson, 2007). In extension, it is argued that the ability to enhance our

well-being through nature exposure is a universal human feature embedded in our genes

(Wilson, 2007).

While the Biophilia hypothesis provides an explanation for why humans are

inherently connected to nature and have an affinity for it, theories such as the attention

restoration theory (ART) and the stress reduction theory (SRT) offer potential

mechanisms underlying the beneficial impacts of connecting and interacting with nature.

1.2.2 Attention Restoration Theory

Whether at work, school, or home, many individuals put extensive efforts into

focusing on the task at hand and ignoring distractions throughout the day, which often

results in mental fatigue and exhaustion. Mental fatigue is known to reduce the ability to

regulate emotions, increase impulsiveness, reduce cognitive performance and decision-

5
making ability, and lead to more errors (Aniţei et al., 2013; Grillon et al., 2015; Ishii et

al., 2014; Pignatiello et al., 2020; Van Der Linden et al., 2003). Nature exposure can

provide a respite from attentional demands and replenish our ability to maintain directed

attention. One of the most prominent theories in this area of research is the attention

restoration theory (ART; R. Kaplan & S. Kaplan, 1989; S. Kaplan, 1995). The theory

discusses two types of attention: endogenous attention, or voluntary, top-down attention

that is effortful and controlled, and exogenous attention, or involuntary, bottom-up

attention that is effortless and automatic. Endogenous attention is employed during most

daily activities such as attending to someone talking, reading, driving, and cooking. On

the contrary, exogenous attention is engaged when attention is automatically pulled to a

stimulus, such as viewing something startling, hearing a loud noise, or when viewing

stimuli that are inherently fascinating, such as elements of the natural environment.

Importantly, endogenous attention is a limited resource and fatigues with overuse

(Dragone, 2006). Engaging exogenous attention can provide a break for endogenous

attention, which allows for recovery and replenishment of endogenous attention. ART is

based on the assumption that nature primarily calls upon an individual’s exogenous

attention, which allows for the restoration of endogenous attention and therefore

increases one’s ability to focus (S. Kaplan, 1995; S. Kaplan & Berman, 2010).

According to ART, for an environment to restore attention, it should entail four

key features: 1. soft fascination, 2. being away, 3. extent and 4. compatibility. To

elaborate, the environment should be able to elicit soft fascination, which, as described in

the previous paragraph, involves exogenous attention and is effortless. Soft fascination

involves being absorbed in the surrounding stimuli without trying to direct one’s

6
attention. The environment should also be able to evoke a sense of “being away” (i.e.,

feelings of being separated from daily hassles and worries) as well as feelings of “extent”

(i.e., feelings of being immersed and that there is a lot out there to discover).

Compatibility is achieved when a person is in nature out of intrinsic motivation, is

inclined to be there, and appreciates the surrounding environment. As such, if one passes

by elements of nature or walks in a park while rushing to work or school, they will not

attain the same benefits that would be achieved if intentionally walking in the park to

enjoy the scenery. Therefore, how one interacts with or is exposed to nature is thought to

play a significant role in how their attention is affected.

S. Kaplan and R. Kaplan (1989) suggested that the process of attention restoration

is made up of four progressive levels. First, the individual slowly forgets about the

worries, thoughts, and cognitive ‘leftovers’ that were lingering in their minds from prior

tasks and occupying their attention. Subsequently, in the second level, the person’s direct

attentional capacity begins to be restored. In the third level, which is set in motion by soft

fascination and is dependent on the level of “cognitive quiet” that has been reached, the

individual gently drifts away and is immersed in the environment which in turn makes

more cognitive space for attending to and reflecting on important matters that the person

needed to attend to. According to ART and the research it was based on, this includes

matters from past days, months, or years that are of significance to the individual. The

final level of restoration entails the deepest level of restoration, and it is often

characterized by individuals reflecting on their life goals, priorities, and the possibilities

available to them (Han, 2003; S. Kaplan & R. Kaplan, 1989). This level is the most

difficult to achieve and often requires spending an extended amount of time in

7
environments that are high on the aforementioned criteria for restorative environments.

This highest level of restoration was reportedly achieved by individuals who spent over a

week in the wilderness (S. Kaplan & R. Kaplan, 1989).

1.2.3 Stress Reduction Theory

Another fundamental theory explaining the benefits of nature exposure is the

stress reduction theory (SRT; Ulrich et al., 1991). As described by Ulrich et al. (1991),

stress induced by a perceived threat or challenge puts into motion a series of

physiological, psychological, and behavioural responses in an attempt to cope with the

threat. The whole body is deployed to respond, including the endocrine system releasing

hormones and activating chain reactions leading to the cardiovascular system working

intensively and muscles tensing up. Further, unhelpful appraisal of physiological stress

reactions often cause stress to be accompanied by anger, anxiety, and/or sadness. As

such, prolonged stress results in the depletion of resources and energy and induces

negative affect (Ulrich, 1981, 1983; Ulrich et al., 1991).

The stress reduction theory (SRT) posits that exposure to nature allows

individuals to recover, physiologically and affectively, from a stressful state, which frees

cognitive resources and elicits positive emotions, leading to many beneficial outcomes

such as enhanced mood, reduced biological markers of stress as well as increased

attention and improved cognitive functioning (Ulrich, 1983; Ulrich et al., 1991).

Therefore, SRT proposes that improved attention attained as a result of time in nature is

primarily a function of nature’s ability to reduce stress and enhance positive emotions,

rather than activation of exogenous attention as outlined in ART. The cornerstones of

SRT are a reduction in stress and negative affect, and it is built on the notion that

8
individuals are experiencing heightened stress levels before nature contact. Notably, SRT

is grounded in Ulrich’s psycho-evolutionary framework and, as such, SRT assumes that

evolution has led humans to be biologically prepared to attain restoration through nature

exposure and predisposed to prefer unthreatening natural environments over urban

environments (Ulrich, 1983; Ulrich, 1991; Joye & van den Berg, 2011).

1.2.4 Interrelatedness of Theories

Gaekwad and colleagues (2022) reviewed the current theories and evidence

regarding the impact of nature on functioning and emotional responses, and described the

biophilia hypothesis as “necessarily broad” due to the intricacies and complex nature of

the human-nature relationship and the broad range of potential associated mechanisms.

They interpreted the mechanisms suggested within SRT and ART as potential routes

through which the biophilia hypothesis can manifest. Joye and van den Berg (2011)

argued that the evidence for an evolutionary predisposition underlying the benefits of

nature is still lacking and claim that the benefits are due to the characteristics of

unthreatening natural environments, namely processing fluency, rather than innate

predispositions. In their account, processing fluency can be construed as the personal

perception of the ease by which stimuli are perceived and interpreted. Processing fluency

is often associated with positive affect, which is thought to be a manifestation of efficient

stimulus processing that is well within the available cognitive resources. They argue that

elements of nature are easily processed by our visual system and this processing fluency

allows for the replenishment of cognitive resources and stress recovery.

Joye and van den Berg (2011) explained that the processing fluency account

(PFA) does not pose a “paradigm shift” but rather is in congruence with ART and SRT in

9
some ways while bringing the potential underlying impact of processing fluency to the

forefront. For example, the effortless processing of nature scenery at the core of PFA is in

line with nature’s ability to evoke soft fascination as described by ART. In a similar vein,

SRT and PFA both consider restoration to be a result of nature’s ability to induce positive

emotions which in turn can ameliorate the impact of stress.

In conclusion, several explanations have been proposed in an attempt to shed light

on the factors and mechanisms underlying the positive impacts of nature on our well-

being, with common themes emerging across theories and accounts. At present, ART and

SRT continue to garner the most attention and empirical support, while the biophilia

hypothesis and PFA offer broader explanations that may encompass both ART and SRT.

1.3 Benefits of Interacting and Connecting with Nature

1.3.1 Urbanization and Associated Risk Factors

Although urbanization comes with many benefits, urban cities are also the source

of several risk factors for mental illnesses. Individuals living in cities often experience

heightened levels of stress due to the fast-paced lifestyle, pressure to succeed coupled

with limited competitive job opportunities, noise pollution from traffic and construction,

as well as overcrowded public spaces and long daily commutes which contribute to

increased levels of tension, alertness, sleep difficulties, and fewer opportunities to unwind

(Mckenzie, 2008; Prakash et al., 2023; Ventriglio et al., 2021). Further, while rural areas

are known for their close-knit communities, a fast-paced urban lifestyle along with urban

dwellers’ heavy reliance on technology and social media for communication and

socialization renders them more socially isolated, lonely, and with less supportive

networks (Jeste et al., 2020; Meshi & Ellithorpe, 2021). Social isolation and loneliness

10
have been linked to poor mental health outcomes (Brandt et al., 2022; Richardson et al.,

2017; J. Wang et al., 2018). Given increasing levels of urbanization, it is important to

consider how nature-related behaviours and connection may help to reduce the stress

associated with urban living.

1.3.1 Health Benefits of Stress Reduction

A high level of stress is a key contributor to many physical and mental health

ailments. High stress levels have been found to negatively impact the nervous system and

the structure of the brain, resulting in a host of undesirable acute and chronic symptoms

such as memory impairment, sleep disturbances, inattention, and irritability (McEwen et

al., 2016; Musić & Rossell, 2016; Ovsiannikova et al., 2024; Timotius & Octavius, 2022;

Van Reeth et al., 2000). Prior studies have also shown that uncontrolled or high levels of

stress can have detrimental effects on students’ ability to process, recall, and apply

information, impacting their ability to effectively complete their coursework (Marsch et

al., 2024; Palmer, 2013; Sandi, 2013; Vogel & Schwabe, 2016). In addition, there is

strong evidence for links between stress and disturbed functioning of the immune system,

cardiovascular system, and gastrointestinal system (Yaribeygi et al., 2017). A strong

connection between mental health disorders, including mood disorders, and stress has

also been demonstrated (Baumeister et al., 2014; Calcia et al., 2016).

Recent reviews have summarized literature on the physiological health benefits of

nature, and there is extensive evidence in favour of the stress reduction theory, suggesting

stress reduction is one of the primary mechanisms by which nature improves health

outcomes. Exposure to greenspaces has consistently been found to reduce biological

markers of stress including blood pressure, heart rate, skin conductance levels, heart rate

11
variability and salivary cortisol, as well as self-reported stress levels (Shuda et al., 2020;

Twohig-Bennett & Jones, 2018; Yao, Zhang, et al., 2021). Exposure to nature was also

linked to improved immune system functioning, including a reduction in pro-

inflammatory molecules and enhanced anti-allergenic and anti-asthmatic effects

(Andersen et al., 2021). Moreover, living in greener environments was associated with

reduced mortality risk, especially cardiovascular diseases (Gascon et al., 2016; van den

Berg et al., 2015).

1.3.2 Mental and Affective Health Benefits

The benefits of human-nature interactions extend beyond reducing stress and

associated symptomology, with evidence of improvements in affect, self-regulation, and

mental health symptoms. Mounting evidence supports the impact of exposure to nature,

whether through pictures, videos, or immersion in actual natural environments on

reducing a host of negative emotions, enhancing positive emotions, and improving

overall affect and mood (Bratman et al., 2021; Jimenez et al., 2021; McMahan & Estes,

2015; Yao, Chen, et al., 2021). Exposure to nature has also been found to augment the

ability to self-regulate emotions, leading to shorter recovery periods from distressing

emotions as well as better impulse control (Beute & de Kort, 2014; Chow & Lau, 2015;

Richardson, 2019; Ríos-Rodríguez et al., 2024; Tost et al., 2019; Y. Wang et al., 2018;

Weeland et al., 2019). The ability to manage mood and regulate emotions and impulses is

deeply intertwined with and critical for our mental health.

Several meta-analyses and systematic reviews have found promising effects of

nature-based interventions, particularly forest-based interventions, on a range of mental

health outcomes including symptoms of depression and anxiety (Kotera et al., 2022;

12
Rajoo et al., 2020; Stier-Jarmer et al., 2021; Wen et al., 2023). Further, a recent meta-

analysis of the impacts of nature exposure on adults with symptoms of mental health

disorders revealed a significant and moderate effect size for improvements in mental

health symptoms including affect, mood, negative emotions, anxiety, and depression,

across all studies, as well as a subset of studies with control groups (Bettmann et al.,

2024). In a similar vein, a systematic review of randomized and non-randomized control

studies concluded that nature prescriptions yielded significant improvements in

depression scores (moderate effect size) and anxiety scores (moderate to large effect size)

compared to control conditions (Nguyen et al., 2023).

Given the increase in urbanization, it is not always possible for people to spend

time in natural environments. Notably, a growing area of research examines the impact of

brief daily exposure to nature via virtual reality (i.e., three dimensions simulations of

natural environments) on clinical levels of mental health symptoms, and early findings

are promising. For instance, for a sample of individuals with anxiety, depression, and

bipolar disorders, being immersed in an interactive natural setting using virtual reality

headsets for at least ten minutes daily for ten days at home led to immediate

improvements in positive affect and reductions in negative affect as well as significant

post-intervention reductions in symptoms of depression and anxiety (Veling et al., 2021).

There are also studies examining the impact of virtual reality nature experiences on the

mental health outcomes of patients with physical ailments. For example, Chin and

colleagues (2022) reported that, in women with metastatic cancer, participants that

viewed natural environments through virtual reality headsets daily for two weeks

reported significantly less fatigue and depression symptoms and better quality of life

13
compared to their counterparts in the control group. Notably, a moderating effect of

nature connectedness was present, where depression symptoms only improved for

women who had low baseline nature connectedness. This intervention did not reduce

anxiety symptoms (Chin et al., 2022). Similarly, individuals with spinal cord injury who

received rehabilitation and engaged with virtual reality nature up to three times over the

duration of a week had lower depressive symptoms by the end of the intervention week

compared to their counterparts who only received rehabilitation during that week

(Lakhani et al., 2020). While promising, the generalizability of the findings is limited by

the study’s small sample size and unmatched groups with regard to gender distribution

(Lakhani et al., 2020).

Although there is emerging evidence of the benefits of nature for those with

mental health challenges, there is still much to learn. Prior studies in this area have

employed a range of study designs, doses (i.e., duration, frequency) and types (e.g.,

virtual) of nature exposure, and participant groups (Wendelboe-Nelson et al., 2019). This

lack of consistency and replication in the literature in addition to the notable variability in

the samples (e.g., presence—or lack thereof—of physical ailments and diagnosed mental

health disorders) has yielded mixed results and thus, it is difficult to draw firm

conclusions at present regarding the required “dosage” and duration of nature-based

interventions and their efficacy for different clinical populations.

1.3.3 Cognitive Benefits

Immersion in natural environments and viewing nature scenes also has a positive

effect on many cognitive and executive functioning skills. The strongest evidence and

most notable improvements have been demonstrated for working memory, which is the

14
ability to store, manipulate, and retain information in the short-term, and cognitive

flexibility, which is the ability to alter behaviour and swiftly switch between tasks or

learned rules depending on the need (Cowan, 2014; Dajani & Uddin, 2015). Various

experimental designs employing a broad range of exposure types including actual nature,

images, videos, and virtual reality depictions of nature have all yielded similar results

(Ohly et al., 2016; Stevenson et al., 2018). To a lesser extent, there is also evidence in

support of nature’s ability to strengthen attention control (i.e., the capacity to discern

stimuli in one’s environment and choose what to disregard and what to focus on;

Draheim et al., 2022; Stevenson et al., 2018). All three aforementioned cognitive

processes are strongly implicated in learning, completing daily tasks, and work demands,

and strengthening them can undoubtedly enhance performance and productivity

(Burgoyne & Engle, 2020; Dajani & Uddin, 2015; Draheim et al., 2022).

With regards to education, exposure to nature over extended periods of time has

been found to promote learning, with better cognitive and academic outcomes attained

from nature-based learning (i.e., receiving education while surrounded by elements of

nature) in comparison to traditional learning (Kuo et al., 2019). Relatedly, a review by

Mason and colleagues (2022) indicates that exposures to nature breaks, varying between

10 to 90 minutes during study days or school time, enhanced the cognitive performance

of students across age groups, ranging from elementary school to university students.

More specifically, nature exposures facilitated recovery from mental fatigue, increased

accuracy and reduced response times on measures of attention and working memory,

enhanced the ability to detect errors in proofreading tasks, and improved capacity to

maintain concertation (Mason et al., 2022). In keeping with both the attention restoration

15
theory and the stress reduction theory, nature’s ability to stimulate learning and

information retention is thought to be due to several factors including its ability to

enhance attention, reduce stress, and improve affect, all of which are thought to

contribute to the replenishment of the cognitive and mental resources necessary for

effective learning (Kuo et al., 2019; Mason et al., 2022).

The effects of exposure to nature on creativity, a higher-order cognitive function

that enables individuals to be innovative and generate a range of novel, beneficial ideas

and solutions (Hennessey & Amabile, 2010), has been understudied in comparison to

other cognitive processes such as working memory and attention control. Nevertheless,

the body of literature examining the impact of nature on creativity has been growing in

recent years. Findings suggest that immersing oneself in the wilderness, taking part in

forest therapy or briefly viewing nature through 2D and 3D mediums, such as images and

virtual reality, can lead to significant improvements in creativity (Atchley et al., 2012;

Ferraro, 2015; Palanica et al., 2019; Williams et al., 2018; Yeh et al., 2022; Yu & Hsieh,

2020). It is thought that natural environments invoke curiosity and imagination as well as

attention restoration, which when paired together can stimulate novel ideas (Yeh et al.,

2022).

Interestingly, viewing urban images that depicted high and medium amounts of

natural environments was also found to enhance components of creative expression,

namely the generation of more innovative responses (originality), the accuracy and detail

in the expression of ideas (elaboration), and flexible thinking (flexibility), compared to

viewing images with little nature present (Yeh et al., 2022). Furthermore, there is

evidence indicating that the addition of natural elements in and around workplaces and

16
classrooms can enhance aspects of creativity. For instance, individuals who work in

places surrounded by natural settings were found to be more likely to spend time

outdoors compared to individuals in workplaces lacking outdoor natural features, which

in turn was associated with more creative output and work engagement (Brossoit et al.,

2024). Relatedly, engineering students were able to generate more ideas and produce a

larger variety of design concepts when working in natural settings compared to traditional

classrooms (Chulvi et al., 2020), and students in university classrooms with window

views of nature and plants in the room performed better on tasks of visual creativity

compared to their counterparts in the same classroom but without these natural elements

(Studente et al., 2016).

1.3.4 Benefits of Biophilic Design and Indoor Nature

As stated above, urbanization rates worldwide are climbing rapidly, reshaping

landscapes and societies. Importantly, as urbanization increases, access to nature

becomes more limited and people become more disconnected from nature (Aschenbrand,

2024; Clements, 2004; Cox et al., 2017, 2018). The biophilia hypothesis indicates that

humans have an innate connection and longing for nature and underscores our species

dependence on nature for survival and the importance of maintaining this connection for

our well-being (Kellert & Wilson, 1995; Wilson, 1984, 2007). As referenced earlier,

there is an extensive body of literature in support of nature’s ability to enhance numerous

aspects of well-being and reduce stress levels and physiological arousal. Therefore,

increasing connection with nature can act as a buffer against the determinantal effects of

urbanization on mental health.

17
 Since the majority of individuals now spend most of their time indoors, the

architecture and design of buildings can shape our experiences and influence our health

and wellness. In the 21st century, the field of architecture began to embrace the biophilia

hypothesis and use it to guide the design of buildings and indoor settings, with the goal of

increasing people’s exposure to nature and enabling them to reap the wellness benefits

(Zhong et al., 2022). This is referred to as biophilic design or architecture, and it takes

many forms including the provision of waterscapes such as fountains, water walls and

constructed ponds, built landscapes (e.g., grasslands) around sites, indoor green roofs or

walls, more daylight via glass walls, natural ventilation through windows and balconies,

the addition of potted plants, images and paintings of natural scenes and landscapes, and

the use of natural materials such as wood, bamboo, rocks, and clay to nourish the human-

nature connection (Kellert, 2018).

Biophilic design has been shown to improve well-being. For instance, individuals

working for 90 minutes in offices with natural wood features (e.g., wood walls, wooden

desk) were found to experience less tension and fatigue, less perspiration, and lower

blood pressure compared to those in non-wooden offices (Zhang et al., 2017). Offices

with natural wood features also enhanced emotion regulation and reduced experiences of

stress (Zhang et al., 2016). Further, when in a biophilic office space (i.e., an office with

plants, bamboo floor, and a window view of nature), participants’ short term-memory

improved by 14% and they reported a reduction in negative emotions and an increase in

positive emotions following their visit compared to their counterparts in the non-biophilic

setting; similar benefits were obtained from virtual exposure to the biophilic environment

(J. Yin et al., 2018).

18
 A scoping review by Mcsweeney and colleagues (2015) of indoor nature

exposure (INE; i.e., exposure to real or artificial nature such as potted plants, photos of

landscapes, window views of nature in indoor settings) presented evidence for INE for

enhancing pain tolerance, mood, attention, and feelings of restoration as well as reducing

perceived stress and blood pressure. The review also found that the level of attained

benefits can be impacted by individual preferences as well characteristics of the natural

elements such as the amount of natural elements present and how realistic they appear

(Mcsweeney et al., 2015). In another review paper describing the benefits of indoor

plants, Yeo (2020) highlighted their ability to improve pain tolerance and enhance

positive affect, and likewise underscored the importance of selecting the right plants and

placement to match the individual’s preferences.

There are broad applications for this research across urban settings. The ability of

indoor plants to enhance cognition, emotional well-being, and general health has been

well documented, and researchers are advocating for their use in health facilities (Sal

Moslehian et al., 2023). In a similar vein, exposure to nature within office spaces and

work environments using biophilic design and the presence of natural elements (e.g.,

indoor plants, window views of nature) was found to enhance employees’ motivation,

well-being, ability to cope with stress, and cognitive functioning, and as such has been

recommended as a strategy to preserve employees’ mental health and enhance their

performance (Gritzka et al., 2020; Sadick & Kamardeen, 2020).

1.3.5 Prescribing Exposure to Nature

Forest bathing, a term coined in Japan, refers to immersing oneself in the forest

and experiencing the natural environment using all five senses as a form of healing (Li,

19
2009). Forest bathing has been found to enhance immunity and improve symptoms of

chronic illnesses, with proponents arguing that it should be used to supplement medical

practices to enhance health (Wen et al., 2019). Although forest bathing is less well known

in North America, using nature to prevent and improve health symptoms has been

garnering increased attention. Through PaRx, Canada’s national nature prescription

program, all health professionals in Canada are now encouraged to prescribe nature-based

activities to their patients. The program was established in British Colombia in 2020 and

subsequently implemented across Canada (see parkprescriptions.ca). Notably, engaging

with nature is now viewed by many Canadian healthcare providers as one of the four

pillars of health, alongside nutrition, sleep, and exercise (Elassar, 2022). In his speech

about collaborating with PaRx, the honourable Steven Guilbeault, Minister of

Environment and Climate Change of Canada, remarked: “This exciting collaboration

with PaRx is a breakthrough for how we treat mental and physical health challenges, and

couldn’t come at a better time as we continue to grapple with the impacts of the COVID-

19 pandemic on our daily lives” (PaRx, 2022). Not only can nature prescribing improve

health, but it can potentially also increase people’s propensity to protect natural

environments since exposure to nature has been linked to more pro-environmental

behaviours (Alcock et al., 2020; DeVille et al., 2021).

1.3.6 COVID-19 and Nature Exposure

Exposure to nature during the pandemic was in fact linked to better mental health,

less stress, and more happiness and life satisfaction (Labib et al., 2022). For instance,

when outdoor nature exposure was not accessible, more exposure to window views of

greenery during isolation was associated with lower anxiety and depression symptoms

20
and the presence of indoor plants were associated with less depressive symptoms

(Dzhambov et al., 2021). Feelings of “being away” and the fascination that is inherent to

viewing and or being surrounded by elements representative of the natural environment

were found to be mediators (Dzhambov et al., 2021). Relatedly, perceptions of nature

deprivation during the COVID-19 lockdown predicted overall well-being/ flourishment—

which encompassed factors such as happiness and life satisfaction, mental and physical

health, meaning and purpose, character and virtue, and close social relationships; more

specifically, individuals who had higher perceptions of nature deprivation during the

COVID-19 lockdown experienced reduced flourishment compared to those who were

able to experience nature and did not feel deprived of nature during the lockdown

(Tomasso et al., 2021). These effects held after controlling for sociodemographic factors,

employment status, household composition, and lockdown mandates. Although the

studies currently available are still limited and more research in this area is warranted, the

trends across studies completed during COVID-19 suggest that exposure to nature can

potentially promote psychological resilience and provide a buffer during difficult

situations that are likely to negatively impact mental health (Patwary et al., 2024).

Rationale and Overview of Dissertation Studies

Given that exposure to nature is associated with numerous benefits that many

people are not aware of and thus may not experience, the overall objective of the current

dissertation was to develop and assess the usability and effectiveness of a novel program

designed to increase awareness of the benefits of exposure to nature and promote

behaviour change (e.g., increase exposure to nature). Undergraduate students were

chosen as the target population for this project because they experience higher rates of

21
stress and mental health difficulties compared to the general population, making them a

vulnerable population that would benefit from additional wellness resources (Robinson et

al., 2016; Durand-Bush et al., 2015). Nature-based behaviours, such as viewing nature

and spending time in parks, can provide low-cost, accessible interventions that can

improve undergraduate students’ mental health and provide a buffer against the countless

frequent stressors that they experience.

Following the review of the benefits of nature (Chapter 1), the next step in

developing the program was a review of relevant literature on behaviour change and

effective teaching and learning strategies. I utilized the information on behaviour change

and teaching and learning approaches to guide the translation of research findings about

the benefits of nature into an online evidence-informed program entitled Nature Matters

(Chapter 2). Next, I conducted a usability study for the program where I obtained

quantitative and qualitative feedback from undergraduate students to assess the program’s

acceptability and potential as well as inform any necessary modifications and changes

(Chapter 3). After making modifications to the program to better meet the needs and

preferences of the target population, I conducted a second research study to examine the

program’s effectiveness; specifically, if the program increased undergraduate students’

self-reported 1) nature connectedness 2) exposure to nature and 3) noticing nature

(Chapter 4). The dissertation concludes with an overall discussion summarizing the key

findings and highlighting the contributions of this work to the field of research focused

on the benefits of nature for human and planetary health (Chapter 5). Limitations of the

studies completed for this dissertation and future directions are also described in Chapter

5.

22
 CHAPTER 2: PROGRAM DEVELOPMENT: EVIDENCE-BASED

IMPLEMENTATION

2.1 The Behaviour Change Wheel Framework

Behaviour-change interventions refer to a set of coordinated activities that

collectively aim to alter a behaviour (Michie et al., 2011). After evaluating frameworks of

behaviour change, identifying gaps, and consulting with experts in the field, Michie et al.

(2011) created the behaviour change wheel (BCW) framework to guide the development

and evaluation of behaviour-change interventions. This framework combines and builds

on elements from 19 behaviour-change frameworks to develop a single framework that

can be applied to any targeted behaviour. The BCW is thought to be a comprehensive,

congruent framework that is built around the analysis of and solid understanding of the

domains that can impact behaviour; it captures many factors that could be targets of

behaviour change, including both internal (i.e., psychological and physical) and external

targets (i.e., changes to the environment; Michie et al., 2011, 2014).

More specifically, the core of the BCW entails three main sources of behavior:

capability, opportunity, and motivation (the “COM-B system”; Michie et al., 2011). In

this model, both opportunity and capability influence the individual’s motivation, and all

three categories interact to generate and influence behaviour. These three components of

behaviour can also be impacted and altered by performing the behaviour (Michie et al.,

2011). Each component in the COM-B system is sub-divided into two domains, resulting

in six sub-domains in total: capability is categorized into (1) physical capability (i.e.,

having the necessary skillsets to engage in the behaviour) and (2) psychological

capability (i.e., having the required knowledge and thought processes, such as reasoning

23
and comprehension). Motivation refers to the brain processes that propel you to behave in

a certain way, including (3) reflective motivation (i.e., brain processes such as conscious

intentions and plans) and (4) automatic motivation (i.e., brain processes that are driven by

emotions, habits, and impulses). In contrast to capability and motivation, opportunity

includes factors that are external to the person but can still facilitate or impede the

behaviour. Opportunity is split into (5) physical opportunity (e.g., accessibility, having

sufficient time) and (6) social opportunity (e.g., peer influences, social support).

In addition to the COM-B system, there are two more layers in the BCW

framework—intervention functions (i.e., goals that are to be achieved through

interventions) and policy categories (e.g., guidelines, legislation). Intervention functions

were placed in between the COM-B system and policy categories as it is argued that

policy can only influence behaviour through facilitating interventions. None of the

components encapsulated in the different layers act in isolation; it is believed that, within

each layer, the components interact with each other to influence behaviour (Michie et al.,

2011; See Figure 2.1).

2.1.2 Strengths of the BCW Framework

The COM-B system allows developers of intervention to consider how they will

target each source (i.e., capability, opportunity, motivation) of behaviour in their

intervention, and how these will interact and affect each other. Importantly, this

framework requires developers to take into account the physical and social context that

the person is embedded in through the “opportunity” condition. The next layer of the

wheel presents nine potential intervention functions (e.g., modelling, persuasion) that

could elicit behaviour change (Michie et al., 2014). By providing a comprehensive list of

24
possible intervention functions, the framework facilitates choosing the appropriate

interventions for the targeted behaviour and reducing the likelihood of failing to

incorporate important behaviour-change techniques in the program. Unlike many other

frameworks that focus solely on goal setting and reflective practices, the BCW

framework also accounts for the impact of autonomic processes such as habits and

emotional reactions. Lastly, Michie et al. (2011, 2014) provide concrete definitions and

examples for the provided intervention functions and policies to facilitate application of

the framework to any given intervention.

The BCW framework has been commonly used to understand the predictors of

behaviours and to design interventions to modify health behaviours, such as reducing

sitting time at work, increasing Canadian’s physical activity using a mobile app,

improving hearing aid use, and enhancing self-care adherence in patients with heart

failure (Michie et al., 2011). The BCW has also been utilized in research focused on

nature-related behaviours and potential interventions (T. Beery et al., 2021; S. Yin et al.,

2022). A recent scoping review on nature-based interventions (NBIs) recommended

using the COM-B model when designing NBIs and indicated that most of NBIs

behaviour change techniques could be mapped on to a subdomain of the BCW (Wilkie &

Davinson, 2021).

2.1.3 The BCW framework and Nature-related Interventions

Based on recommendations by Michie et al. (2014), to create an intervention with

the purpose of changing behaviour, it is important to (1) understand the target behaviour

and the factors impacting it, (2) identify the applicable intervention functions that can

foster change in the target behaviour and their feasibility, and lastly, (3) identify

25
behaviour change techniques that would serve those functions as well as an appropriate

mode of intervention delivery (Michie et al., 2011, 2014). As such, by categorizing

facilitators and barriers of a behaviour using the COM-B model, researchers can identify

target areas of behaviour change and accordingly tailor specific behaviour-change

strategies.

Leckey et al. (2021) used the COM-B model to identify the barriers and

facilitators among children and their families to spending time in nature. The main

facilitators identified were physical capability (e.g., physical health and access to nature),

psychological capability (e.g., knowledge of where to find natural environments), social

opportunity (social support), and reflective motivation (i.e., motivation stemming from

positive evaluations of nature including the associated mental and physical health

benefits). Notably, planning and prior goal setting was identified by several families as an

effective means of facilitating nature exposure. Key barriers reported by participants were

physical opportunity (lack of time, inclement weather, finances), automatic motivation

(e.g., it is not a habit), and reflective motivation (e.g., “not being a priority”/ is not

planned for). Based on their findings and following the proposed links between the

COM-B model domains and intervention functions, Leckey et al. (2021) suggested some

intervention approaches to increase families’ engagement with nature. For instance, to

address reflective motivation barriers, they proposed educating children about the

benefits of nature.

Similarly, Cochrane and colleagues (2019) used the COM-B model to assess

undergraduate students’ attitudes and beliefs towards spending time in nature. The same

subdomains were identified with regards to barriers, including physical opportunity,

26
reflective motivation, and autonomic motivation – underscoring the importance of

addressing them in our intervention. Moreover, the reported level of connectedness to

nature appeared to be a distinguishing factor with regards to reflective motivation, with

only individuals high on nature connectedness remarking on plans and intentions to spend

time in nature because of the health benefits it can afford. In terms of autonomic

motivation, unlike the group low on nature connectedness, those with higher reported

connection to nature were more readily able to describe the mental and physical health

benefits of exposure to nature (Cochrane & Johnson, 2019). As such, higher awareness of

the benefits of exposure to nature appears to be linked to higher nature connectedness and

wanting to spend more time in nature.

2.2 Rationale Behind Program Features

2.2.1 BCW and Program Development

The BCW framework, in addition to the pertinent findings of Cochrane et al.

(2019) and Leckey et al., (2021) guided the development of the Nature Matters program.

To elicit change in the targeted behaviours and attitudes (i.e., exposure to nature, noticing

nature), and connectedness to nature, we sought to address the three main barrier

subdomains identified. For example, we aimed to enhance automatic motivation by

providing opportunities to develop positive associations with the target behaviour (i.e.,

exposure to nature) by filming the videos in captivating nature scenery and including an

experiential activity with a nature video to enable participants to experience and reflect

on changes in mood and cognition first-hand. Moreover, benefits shared by interviewees

were delivered in relatable terms that we anticipated would be viewed favourably. To

assist with reflective motivation and planning, we developed content geared towards

27
increasing awareness and understanding of the benefits of exposure to nature and guided

individuals through the development of SMART (specific, measurable, attainable,

realistic, timely) goals specific to increasing nature exposure. Further, to help individuals

overcome the physical opportunity barriers, we provided a wide range of cost-free

practical ways to increase exposure to nature and emphasized that small amounts of

nature exposure are beneficial.

The BCW intervention functions that were used in Nature Matters and that guided

the creation of the activities were: 1. Education (increasing awareness of benefits), 2.

Persuasion (instilling belief in the benefits by allowing them to experience it firsthand), 3.

Environmental Restructuring (encouraging modifications to their environment to increase

exposure to nature), 4. Modeling (including relatable speakers and trusted professionals

to share the benefits they have experienced), and 5. Enablement (enabling them to

overcome barriers such as time constraints and weather as well as equipping them with

practical strategies to increase their nature exposure).

2.2.2 Rationale for E-learning

The Nature Matters program also involves e-learning. E-learning (i.e., electronic

or online learning) refers to learning and acquisition of information that takes place

online via electronics and often through the internet. It is believed that e-learning is an

effective method of reaching the general public and disseminating information

effectively, as videos and electronic content can be compelling, easily available and

shareable, and have a larger geographical reach (Song et al., 2021; Vandormael et al.,

2021). E-learning also allows for greater flexibility as learners can often access materials

anytime, anywhere, and as many times as they please (Anggraini et al., 2018; Giannakos

28
et al., 2014). Given the benefits of e-learning, the Nature Matters program was developed

as an online program.

2.2.3 Video Portion – Overview and Rationale

Overview

The video portion of the Nature Matters program includes a series of seven short

videos. The goal of the videos is to translate empirically derived knowledge on the

benefits of exposure to nature in an interesting and clear manner, and to share simple

cost-effective strategies for incorporating nature into daily life.

Rationale for Using Videos

Videos have long been used in educational settings and have shown promise in

raising awareness on several topics, including mental health first aid (Jorm et al., 2010),

COVID-19 prevention methods (Vandormael et al., 2021), as well as approaches for

protecting the environment (Ahmad et al., 2015). They have been found to be more

effective than traditional teaching methods at reaching a large audience and enhancing

learning and content retention (Cucu, 2021). Factors associated with their efficacy

include allowing students to re-watch the content and to take notes at their own pace,

keeping them more engaged and attentive (Abbas & Arslanyilmaz, 2010; Guo et al.,

2014; Kullberg et al., 2020).

Rationale for Video Duration

Guo and colleagues (2014) conducted one of the largest studies assessing

engagement with educational videos, where they examined 6.9 million video watching

sessions with varying video durations, ranging from less than a minute to 40 minutes.

They found that the median engagement time for students watching online educational

29
videos was 6 minutes regardless of the video’s duration, with videos three minutes or less

receiving the most engagement. As such, Guo et al. (2014) recommended using

educational videos that are 6 minutes or shorter in duration to maximize viewer

engagement and concentration. In line with those findings, Afify (2020) found that

students who learned material through educational videos less than 6 minutes long

outperformed those who were taught content using medium (i.e., 6-12 minutes) and long

(>12) educational videos on both immediate knowledge tests and long-term retention

measures. Ahmad et al. (2015) conducted a study to compare the use of a 14-minute

video and a pamphlet in educating their participants on environmental issues. They found

that although students generally preferred learning about the environment in the video

format, many stated that they would rather reread the pamphlet than rewatch the video

due to its duration. Therefore, I ensured that all six videos included in Nature Matters

were less than six minutes, with half of them being less than 3 minutes in duration.

Rationale for Using Narratives/ Interviews

Storytelling is a common way of communication that we use on a daily basis. It

is therefore familiar, appealing, and well-received (Hinyard & Kreuter, 2007). Sharing of

lived experiences and narratives has been found to supplement evidence-based health

interventions and increase the likelihood of behaviour change and implementation of

recommendations, and it has also been reported to be more persuasive compared to facts

and statistics only, particularly in the presence of pre-conceived notions (Larkey &

Gonzalez, 2007; Meisel & Karlawish, 2011). Narratives are thought to evoke a sense of

identification and relatability and elicit inspiration, which in turn can reduce resistance

towards behaviour change (Brooks et al., 2022; Petraglia, 2007; Rose et al., 2015).

30
Researchers are increasingly leveraging narratives and incorporating them into their

interventions and knowledge translation (KT) programs to achieve better results (e.g.

Houston et al., 2011; Katz et al., 2023; Lee et al., 2017). We opted to include evidence-

driven narratives shared by individuals from the target population (i.e., post-secondary

and graduate students) to capitalize on their unique motivational qualities and ability to

solicit behavioural change. In addition, since the general public tends to trust information

shared by scientists, researchers, and experts that are perceived to have good intentions,

integrity, and competence (Besley et al., 2021; Hendriks et al., 2016), we also

interviewed a neuropsychologist and environmental researcher that we believe embodies

these qualities to share some of the key research findings.

Rationale for Nature Background

The videos were filmed in a park with beautiful nature scenery to allow

participants to experience the benefits of nature firsthand, accentuating knowledge

translation through experiential learning. It was also meant to provide a relaxing

atmosphere that would facilitate learning and retention of the material. A recent review

indicates that nature-based instruction (i.e., teaching in natural environments) surpasses

traditional teaching in many aspects including the garnered attention of the students, their

enjoyment levels, and test scores (Kuo et al., 2019). In a similar vein, another recent

systematic review highlighted the ample evidence supporting sustained attention and

working memory in outdoor educational settings (Vella-Brodrick & Gilowska, 2022).

Although these studies focused on spending time outdoors in nature, indirect nature

exposure through electronic means such as videos and pictures has been shown to

produce similar benefits (Jimenez et al., 2021; Jo et al., 2019; Mostajeran et al., 2021).

31
Thus, we expected that utilizing natural settings as a background to the videos would be

beneficial.

2.2.4 Video Portion – Content and Development

Content Creation

I conducted a broad literature review on the benefits of exposure to nature,

including real, virtual, and artificial nature, on different aspects of well-being and

summarized the most relevant findings with the target audience, undergraduate students,

in mind. I then selected content that was considered most relevant and interesting to this

audience. I developed a preliminary structure of the video portion (i.e., number of videos

and a distinct topic for each) as well as scripts for each of the videos. The scripts included

bullet points to allow each speaker’s personality and presentation style to shine through.

The scripts were reviewed by my supervisor, the guest speakers, and several members of

the research team at JackHabbit (an e-health company we partnered with which

specializes in developing and providing access to wellness programs) to ensure high-

quality content. After several rounds of modifications and revisions based on their input,

the video content was finalized.

Below I provide a summary of the content for each video:

Video #1: Our Innate Connection with Nature (1 minute 51 seconds). In this

introductory video, I describe the Biophilia Hypothesis and the evidence supporting it

and provide a brief overview of the evidence-based benefits of exposure to nature.

Video #2: Nature as a Need (2 minutes 17 seconds). In this video, I present the

argument that exposure to nature is a need, and that fulfilling this need allows people to

thrive and maintain their well-being.

32
 Video #3: Clinician Discusses the Benefits of Exposure to Nature (4 minutes

48 seconds). In this video, I interview a Clinical Neuropsychologist, and we discuss the

clinical benefits of exposure to nature. This video focuses on the physiological benefits of

exposure to nature (e.g., reduction in cortisol level) and raises awareness of PaRx,

highlighting that doctors are currently prescribing exposure to nature to their patients to

improve health and well-being.

Video #4: Interviewing an Undergraduate Student (4 minutes 21 seconds). In

this video, I interview an undergraduate student who shared the benefits he has

experienced from exposure to nature and the ways he incorporates nature in his everyday

life. The benefits shared by this student include improved mood, reduced stress, and

enhanced attention. The strategies he shared include listening to nature sounds, sitting on

the porch, and viewing nature from a window.

Video #5: Interviewing a Graduate Student (3 minutes 42 seconds). In this

video, I interview a graduate student. She shared different set of benefits of engaging

with nature including enhanced creativity, problem-solving, and self-regulation.

Watching nature videos in the winter and jogging outdoors were some of the strategies

she shared.

Video #6: Practical Tips to Getting Nature Exposure (4 minutes 51 seconds).

In this video, I describe practical and feasible strategies that can enable the audience to

engage with nature on a daily basis. Most of the strategies provided in this video are free

and accessible. I also share tips for integrating exposure to nature with other activities

that we often engage in, such as walking or exercising in a park instead of indoors. To aid

in the recall of the content, I developed an acronym that I share in the video.

33
 Video #7: Recap/ Summary (2 minutes 40 seconds). In this video, I briefly

summarize the key takeaways and discuss the importance of being proactive rather than

reactive regarding exposure to nature.

Videography

Following the development of the content, we collaborated with a professional

videographer to film and edit the videos. All videos were filmed in a natural setting,

Shubie Park. This largely forested municipal park in Dartmouth, Nova Scotia contains

several bodies of water and many kilometers of hiking trails. The videos were filmed in

the afternoon of a sunny day in the Fall of 2021 with backdrops of trees and water. Each

video was filmed with a different background within the park to enhance novelty and

maintain interest. The videos were subsequently edited by the videographer to

incorporate the general introduction (i.e., the title of the program, Nature Matters, along

with compelling nature visuals) at the beginning of each video and a carefully selected

written quote at the end of each video. Other visuals, key words, and images were added

to the videos when relevant for an enhanced viewing and learning experience.

2.2.5 Written Portion – Overview and Rationale

Overview

The written portion of the Nature Matters program features a series of short

readings each accompanied by one or two relevant activities, referred to as skill building

opportunities (SBOs). The goal of the readings is to re-iterate the key information shared

in the video portion and prepare students to complete the SBOs. Each SBO concludes

with a short summary highlighting the purpose of the SBO and how it can further their

ability to attain more nature exposure.

34
Rationale for Active Learning

Active learning is an umbrella term that refers to instructional activities that

prompt students to perform an act and engage in higher order reasoning and critical

thinking (Bonwell & Eison, 1991; Freeman et al., 2014; Roehl et al., 2013). It entails a

wide range of strategies, such as reflections, discussions, and problem solving, that

enable students to actively engage with the learned material (Dolan & Collins, 2015). It

can also involve the exploration of attitudes and values and promote the application of the

content outside of the classroom (Brame, 2016). When paired with traditional lecture-

based delivery, active learning leads to a deeper understanding of the material, greater

knowledge retention, and higher marks (Barile et al., 2022; Biwer et al., 2020;

Hacisalihoglu et al., 2018; Singer & Smith, 2013). Further, students reported higher

satisfaction levels when active learning strategies were incorporated in their courses

(Hacisalihoglu et al., 2018). Kas-Osoka et al. (2017) introduced online learning modules

on health and wellness to a course that was originally only delivered in-person. Active

learning was incorporated in the modules by encouraging students to reflect on the

educational content through developing learning goals and provide feedback about the

content. Students reported that they were most engaged with the content when it was

applicable to them, that they appreciated opportunities for critical thinking and self-

reflection, and that providing feedback prompted them to self-reflect and apply the

content to their own lives. This study further supports the use of active learning strategies

in health interventions.

35
Rationale for Experiential Learning and Reflections

The increase of reliance on technology is one of the many reasons that humans

have grown more detached from nature (Pergams & Zaradic, 2006; Richardson et al.,

2018). Despite this, recent evidence has shown that using virtual methods to connect

people with nature has been successful in increasing nature connectedness. For instance,

Breves and Heber (2020) found that participants who underwent an immersive 360º

nature video experience reported increased psychological attachment to nature as well as

increased interest in improving their connectedness to nature in the future. This was

supported by a recent meta-analysis which found that connectedness to nature can be

strengthened through exposure to nature, regardless of whether it was actual nature (e.g.,

physically going to a park) or depictions of nature (e.g., watching a nature video;

Sheffield et al., 2022).

Reflections are often paired with experiential activities to augment learning

(Harvey et al., 2016; Helyer, 2015). The Higher Education Quality Council of Ontario

summarizes common definitions of reflection proposed by scholars; reflection is

described as a learning process that often entails analyzing or engaging in retrospection

about prior practices or experiences which aids in the development of more self-

awareness and new understanding that can in turn inform future action (HEQCO, 2016).

Reflective practices build a deeper association between an experience and the purpose

and meaning behind it, allowing for deeper processing and knowledge retention (Denton,

2011; Whalen, 2020). Asking individuals who completed Nature Matters to experience

and reflect on their thoughts and feelings pre-and post-nature exposure was therefore

36
expected to help them build new insights and attitudes toward exposure to nature and

support behaviour change.

Rationale for Identifying Barriers and Setting SMART Goals

Setting goals is a well-known strategy for the facilitation of health behaviour

change. Despite originally being developed to help businesses and organizations achieve

their goals, it is now commonly used in the health field (Bailey, 2017; Epton et al., 2017).

Leading health organizations such as the American College of Sports Medicine and

National Health Service (NHS) recommend that practitioners set SMART goals, given

the feasibility and effectiveness of this method (Swann et al., 2023). The SMART

acronym stands for specific, measurable, achievable, realistic, and timebound, and it is

used to guide these specific aspects of the goal-setting process. Setting SMART goals

increases the likelihood of goal attainment and is therefore an important part of the

Nature Matters written portion.

Even when SMART goals are employed, many factors can impede achievement

of goals and derail the plan. To counteract this when planning for health behaviour

changes, coping planning is recommended (Bailey, 2017). Coping planning is the process

of foreseeing possible barriers and preparing for how to transcend them (Sniehotta et al.,

2005; Sniehotta, 2009). As such, Nature Matters pairs coping planning—through the

identification of personal barriers that can hinder exposure to nature practices—with goal

setting, increasing the chances of successfully meeting goals.

37
2.2.6 Written Portion – Content and Development

Content Creation

I reviewed the literature to identify effective teaching and learning strategies as

well as behaviour change theories to tailor the activities in the written portion in a way

that would maximize retention of information and facilitate the application of the material

in participants’ daily lives. The written portion was designed to be concise and

interactive. The SBOs, the most important components of the written portion, were

developed to promote active and experiential learning as well as individualized

application of the knowledge to facilitate and encourage behaviour change.

SBO #1: How Can Exposure to Nature Help You? For this activity,

participants are prompted to identify areas in their lives they wish to improve through

increased exposure to nature. The list of options includes categories that have empirical

evidence supporting their enhancement through nature exposure (e.g., attention, mood).

To foster deeper engagement, participants are then invited to write a few sentences on

how nature can help them achieve these improvements, drawing on what they have

learned in the program. Examples are provided to guide this activity.

SBO #2: Identifying Barriers to Nature Exposure. In this activity, participants

are encouraged to identify the barriers to nature exposure that they have experienced or

anticipate experiencing. Common barriers were provided for participants to choose from

as well as the opportunity to include additional personal barriers.

SBO #3: Increasing Exposure to Nature in Your Everyday Life. After

identifying the barriers, participants are asked to select practical nature exposure

strategies that will help them overcome or work around the barriers. As such, SBO #3

38
provides a list of a broad range of feasible, free or low cost, and accessible nature

exposure strategies for them to select from.

SBO #4: Experiencing Exposure to Nature. In this activity, participants

experience some of the benefits of exposure to nature firsthand by watching a short 2-

minute video of nature and imagining themselves in the setting they are viewing. They

are asked to reflect on their physical sensations, emotions, and thoughts prior to watching

the video and immediately afterwards, commenting on any changes they noticed.

SBO #5: Preparing to Be Proactive. To be proactive with regard to health

behaviours, it is important to plan ahead. As such, for the final activity, participants were

asked to set SMART goals for more nature exposure. Several practical examples are

provided, and participants are prompted to review the strategies they identified in SBO #3

to guide their goal setting.

2.2.7 Summary of Program Development

In sum, the development of the Nature Matters program was guided by the BCW

framework which allowed us to obtain a comprehensive understanding of the targeted

outcomes (i.e., exposure to nature, noticing nature, and nature connectedness) and the

intervention functions that should be addressed by Nature Matters. Nature Matters was

also designed to address the barriers to exposure to nature and build on the facilitators

that were reported by the target population in prior research studies. Evidence-based

effective educational techniques including the usage of short videos, narratives, and

active learning strategies were implemented to maximize knowledge retention and

facilitate the application of the material in participants’ daily lives. Nature Matters

currently consists of a video portion (i.e., a series of short videos that translate the

39
benefits of exposure to nature) and a written portion (i.e., summary readings and

corresponding personalized activities geared towards fostering behaviour change).

40
Figure 2.1

The Behaviour Change Wheel (BCW) and the Capability, Opportunity, and Motivation

model of Behaviour (the COM-B Model)

Note: Adapted from “The behaviour change wheel: A new method for characterizing and

designing behaviour change interventions”, by S. Michie, M. M. van Stralen, and R.

West, 2011, Implementation Science, 6(42), p. 8. Copyright 2011 by Michie et al.

Adapted under CC-BY L2.0 License: https://creativecommons.org/licenses/by/2.0/

41
 CHAPTER 3: AN ONLINE WELLNESS PROGRAM TO INCREASE NATURE

EXPOSURE, NOTICING NATURE, AND NATURE CONNECTION IN

UNDERGRADUATE STUDENTS: RESULTS OF A USABILITY STUDY

The manuscript prepared for this study is presented below. Readers are advised that

Yasmeen A. Ibrahim, under the supervision of Dr. Shannon Johnson, was the lead

developer of the Nature Matters program, developed and implemented the methodology,

led data collection, performed data analyses, interpreted study findings, and is the first

author on the manuscript.

Yasmeen A. Ibrahim, George R. Fazaa, and Shannon A. Johnson. An Online Wellness

Program to Increase Nature Exposure, Noticing Nature, and Nature Connection in

Undergraduate Students: Results of a Usability Study [Manuscript in Submission

Process]. Department of Psychology and Neuroscience, Dalhousie University.

42
 3.1 Abstract

Mental health difficulties and stressors are prevalent amongst undergraduate students and

have increased following COVID-19. Given the many mental and physical health

benefits associated with exposure to and connection with nature, the Nature Matters

program was developed to promote wellness in undergraduate students. The program

disseminates evidence-informed knowledge about the benefits of exposure to nature and

utilizes behaviour-change principles to increase nature-focused behaviours. We examined

the usability and acceptability of the program. One-hundred and eight undergraduates

completed the program’s video portion in session 1, of which 83 also completed the

written portion in session 2. Results from quantitative and qualitative feedback for both

portions were positive overall, and valuable insights regarding potential modifications to

the program were identified. The Nature Matters program was well-received by the

intended audience and should be examined as a potentially cost-effective approach to

increasing well-being and decreasing mental health difficulties in the broader population.

Keywords: nature, mental health, knowledge dissemination, behaviour change, usability

43
 3.2 Introduction

Over the past several years, there have been significant increases in psychological

distress and mental health difficulties, which were exacerbated by the COVID-19

pandemic (Frazier et al., 2023; King et al., 2023; Salimi et al., 2023; Sutton, 2019; C. I.

Wood et al., 2024). For instance, Sutton (2019) indicated that self-reported diagnosed

anxiety in university students aged 18 to 26 doubled between 2008 and 2016, rising from

10% to 20%, and Frazier et al. (2023) found that depression symptoms and stress

experienced by undergraduates were significantly higher in 2020 (i.e., during the initial

phase of the COVID-9 pandemic) compared to 2017. Not surprisingly, there has also

been a reported increase in help-seeking for mental health problems on post-secondary

campuses, which is often met with limited services and long wait times (Abrams,

2022).The World Health Organization is encouraging all countries to increase their

mental health support services in response to a 25% increase in mental health disorders

such as anxiety and depression during the first year of the COVID-19 pandemic (World

Health Organization, 2022).

While there is an evident increase in the number of individuals seeking help for

mental health problems, many individuals with mental health concerns do not seek

services. Robinson et al. (2016) examined the mental health needs and barriers to seeking

mental health supports facing university students. Forty-two percent of the total sample

were above the clinical threshold for psychological distress. Within this distressed group,

55.8% reported that they were unlikely to seek mental health services. Across all

students, reported barriers to seeking services included not being distressed (this reason

was counterintuitively also provided by 32.5% of the students in the distressed group),

44
lack of time, feeling uncomfortable accessing services, perceived cost, and worrying

about what others may think. Furthermore, university students from underrepresented

backgrounds reported additional barriers to accessing mental health resources, such as

greater concern about stigma from within their communities (Kook et al., 2023; Masuda

et al., 2012). First-generation students from lower income households who represent

ethnic/racial minorities were less likely to access mental health services despite

experiencing higher psychological distress than their non-underrepresented colleagues

(Kook et al., 2023). Taken together, this research highlights the increased need for

supports and strategies to help students manage the distress associated with university

life. To address perceived barriers, services should be low-cost, consider students’ time

constraints, and address concerns about stigma and discomfort in accessing services.

3.2.1 Exposure to Nature and Well-Being

The biophilia hypothesis suggests that based on our evolution as a species, we

have an innate desire to associate and connect with nature (Wilson, 1984). In support of

this theory, research has demonstrated that people consistently prefer nature to urban

settings (Hartig & Staats, 2006; Ibarra et al., 2017). There is mounting evidence that

exposure to nature (i.e., viewing/spending time in nature) improves various aspects of

well-being (Capaldi et al., 2015; Franco et al., 2017, Lackey et al., 2021), including mood

(Neill et al., 2019), restorativeness (i.e., feelings of calmness and vitality; Schutte et al.,

2017), and work performance (Lee et al., 2017). Nature exposure has been reported to

reduce symptoms of depression, worrying, and rumination (Beute & de Kort, 2018), and

to reduce stress, as measured both by self-reports and objective measures of stress, such

as lower blood pressure levels (Jimenez et al., 2021). Research also supports relationships

45
between nature exposure and enhanced sleep quality and immune system functioning

(Jimenez et al., 2021). In addition, some studies have demonstrated that exposure to

nature improves cognitive functions including creativity (Ferraro, 2015), attention

(Dadvand et al., 2017; Lee et al., 2015), executive functioning (Bourrier et al., 2018), and

self-regulation (i.e., controlling impulses; Beute & de Kort, 2014). Importantly, a recent

meta-analysis has found that spending time in gardens was associated with lower rates of

depression and anxiety during the COVID-19 pandemic (Patwary et al., 2022). In recent

years, healthcare providers have been prescribing exposure to nature to their patients as a

broader health care approach for improving mood, stress, cardiac health, and longevity

(“nature prescribing”; see parkprescriptions.ca). Many healthcare professionals now

consider nature to be the fourth pillar of health (Elassar, 2022), alongside nutrition, sleep,

and exercise.

3.2.2 Nature Relatedness and the Importance of Connecting with Nature

Nature relatedness (also known as nature connectedness) refers to the subjective

feeling or experience of being part of nature, as well as the behavioural, cognitive, and

affective elements that result from this feeling (T. H. Beery & Wolf-Watz, 2014; Schultz,

2002; Tam, 2013). A higher level of self-reported nature relatedness is associated with

more positive affect, vitality, autonomy, personal growth, purpose in life, life satisfaction,

and better mental and physical health . In addition, higher nature relatedness is associated

with higher environmental awareness and more pro-environmental behaviours (Frantz &

Mayer, 2014; Nisbet et al., 2011).

Many previous interventions that promote nature connectedness have focused on

connecting children with nature (Braun & Dierkes, 2017; Kruger et al., 2010; Mullenbach

46
et al., 2019; Shanahan et al., 2009; Staempfli, 2009), as young age plays an important

role in the development of long-lasting pro-environmental behaviours such as recycling

and conserving water and electricity (Collado et al., 2013; J. Wang et al., 2019). Those

who engage with nature at early stages of childhood are more likely to develop positive

attitudes towards outdoor activities, such as gardening and hiking, and demonstrate

higher environmental awareness as adults (Greenleaf et al., 2014; Kruger et al., 2010).

Although childhood is an important window for developing connectedness to nature, this

does not mean that aiming to improve nature connectedness in young adults is less

important. Despite interventions showing more promise in children (Braun & Dierkes,

2017), adolescents’ and young adults’ connectedness to nature has been shown to

improve after undergoing interventions aimed at promoting contact with nature (Braun &

Dierkes, 2017; Breves & Heber, 2020; Razani et al., 2020; Sheffield et al., 2022).

3.2.3 Human-Nature Disconnect

Despite strong evidence underscoring the numerous health and well-being

benefits of exposure to and connectedness to nature, humans have never been so

disconnected from nature (Clements, 2004; Kesebir & Kesebir, 2017). Most people are

not cognizant of these relationships and thus, do not reap the benefits. It has become

apparent that promoting nature connectedness and the benefits of exposure to nature is

not a simple task. As noted above, nature prescribing has been employed as a method for

increasing people’s time in nature; this approach enlists physicians and other health

professionals to prescribe spending time in nature to their patients and educate them

about the benefits (Robinson & Breed, 2019). Robinson and Breed (2019) discussed how

nature prescribing could solve multiple issues simultaneously, as connecting people with

47
nature not only provides benefits for overall health and well-being but is also likely to

increase awareness of and vigilance about conserving nature and biodiversity. However,

Razani et al. (2020) found that within a group of individuals prescribed nature visits,

there was notable variability in their frequency of visiting parks, even after accounting for

age, gender, race, and poverty. Those who were higher in nature affinity and knew where

to go were more likely to visit parks. As such, Razani et al. (2020) highlighted the

importance of addressing knowledge gaps, attitudes, and perceived barriers to facilitate

nature contact.

3.2.4 Current Study

Despite considerable evidence indicating mental health and well-being benefits of

nature, there have been no reports of e-health interventions geared towards increasing

awareness of the benefits of nature and propelling individuals towards spending time in

and connecting with nature. We developed a novel evidence-informed program entitled

Nature Matters. The development of Nature Matters was guided by Michie et al.'s (2014)

recommendations and the Behaviour Change Wheel’s COM-B model (Michie et al.,

2014; Michie, Van Stralen, et al., 2011). The three domains of the COM-B model –

capability, opportunity, and motivation – capture various factors that could be effective

targets for changing behaviours related to nature exposure and connection. As such, we

used the COM-B model to identify relevant target areas and develop educational content

and activities that have the potential to increase individuals’ capability and motivation to

engage with nature, as well as enhance their knowledge of cost-effective opportunities

available for them to do so. A key advantage of the online format of the program is that it

can be widely accessible. The goal of the current study was to assess the usability of the

48
beta-version of Nature Matters and obtain feedback from the target population, i.e., post-

secondary students, to inform any necessary modifications.

3.3 Methods

3.3.1 Participants

We recruited 108 undergraduate university students from Dalhousie University in

Nova Scotia, Canada, online through SONA—a credit-point attainment system that

manages study participation. The total sample comprised 85 women, 18 men, and 5 non-

binary/gender-fluid individuals. The participants’ ages ranged from 18 to 41 years (M =

20.4, SD = 2.9). Most of the participants were White (66.7%), followed by Middle

Eastern (11.1%), and South Asian (10.2%), and more than half majored in psychology

(38.7%) or neuroscience (19.8%). Eighty-three (76.9%) of the participants who began the

study fully completed all aspects of the study.

Of note, we did not exclude participants if they did not complete the full program.

This ensured representation of feedback from all participants, not only those that

completed the full program. Thus, all feedback provided was included in the reported

quantitative and qualitative analyses. The number of feedback questionnaires obtained for

session 1 ranged from 108 (first video) to 100 (last video), and for session 2 was 83 for

all components.

3.3.2 Materials

Background Questionnaire

The background questionnaire was used to obtain demographic information to

characterize our sample. See Appendix A.

49
Nature Matters Program

The Nature Matters program is made up of two parts— a video portion and a

written and activity portion (referred to as written portion hereafter). The video portion

includes a series of seven short videos that translate the benefits of exposure to nature in

an interesting and clear manner. The written portion summarizes key points from the

videos and some new information in short sections. Following each section is an activity

or “Skill Building Opportunity (SBO)” (five in total), that enable participants to actively

engage with the material in a personalized way—e.g., identify the barriers to exposure to

nature they encounter; develop SMART (specific, measurable, attainable, realistic,

timely) goals for increasing their daily exposure to nature based on the learned material.

Video Feedback Questionnaire

Participants were asked to provide feedback for each of the seven videos by

rating them on the following three statements using a 5-point Likert scale: 1. The video is

clear and understandable.; 2. The content provided in this video is valuable.; and 3. I feel

motivated to incorporate nature into my life. See Appendix A. By obtaining feedback on

each video separately, we were able to compare them on three dimensions

(understandability, value of content, and ability to encourage nature exposure) and

determine which videos were most the impactful, and which could possibly be

eliminated.

Activity/ SBO Feedback Questionnaire

Consistent with the video feedback questionnaire, this questionnaire was

developed to assess each of the five activities and allow for comparisons between

activities. The three statements in this questionnaire were: 1. This skill building

50
opportunity was useful/beneficial for me.; 2. I liked this skill building activity.; and 3.

This skill building opportunity increased my motivation to engage with nature. Each

statement was rated on a 5-point Likert scale. See Appendix A.

User Experience Questionnaire - Plus

The User Experience Questionnaire - Plus (UEQ+; Schrepp & Thomaschewski,

2019) is a standardized questionnaire that is used to obtain quantitative feedback

regarding the user experience. It is an upgraded and customizable version of the User

Experience Questionnaire (UEQ), one of the most utilized usability questionnaires (Díaz-

Oreiro et al., 2019). The UEQ+ has been shown to have strong validity with several

distinct platforms, including video platforms (Schrepp & Thomaschewski, 2019). The

customized UEQ+ developed for the current study includes the following seven scales,

which were most pertinent to the assessment of the Nature Matters program: 1.

Perspicuity (i.e., clarity/ ease of understanding), 2. Stimulation, 3. Usefulness, 4.

Attractiveness, 5. Visual Aesthetics, 6. Trustworthiness of Content, and 7. Quality of

Content. The UEQ+ was completed twice: once following the video portion and once

following the written portion in order to assess each portion separately. See Appendix A

for UEQ+ scale descriptions and questionnaires.

Video Portion: Qualitative Feedback Form

This feedback form was completed at the end of the video portion. The purpose

was to obtain qualitative responses regarding aspects of the program’s video portion that

participants liked and disliked, and areas that could be improved. See Appendix A.

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Written Portion: Qualitative Feedback Form

This feedback form was placed at the end of the written portion to obtain

qualitative responses regarding aspects of the program’s written portion that participants

liked and disliked, and areas that could be improved. See Appendix A.

3.3.3 Procedure

Interested participants completed the consent form online and were given the

opportunity to ask questions via phone or email prior to providing consent. In accordance

with the university’s ethics board requirements, undergraduate students were given the

option to participate as “observers”; thus, denying permission for including their data in

any analyses. Only those who provided full consent are included in the sample sizes

described above. Upon consenting, participants were automatically directed to the study’s

webpage. During session 1, they completed the background questionnaire, watched the

video components of Nature Matters and completed a brief feedback questionnaire after

every video. They then filled out the UEQ+ and the qualitative feedback form to evaluate

the video portion. One to four days later, participants completed the second session,

which entailed completing the written portion of the program. Likewise, participants

completed a brief feedback questionnaire after each activity in the written portion as well

as the UEQ+ and qualitative feedback form upon finishing the written portion. At the end

of each session, participants received their compensation in the form of SONA credit

points.

3.3.4 Thematic Analysis

The qualitative data was analyzed through an inductive thematic analysis. The

analysis was based on guidelines offered by Roberts and colleagues (2019), with the

52
exclusion of the deductive component. Given that the program is novel, and the research

questions were generic (i.e., liked features and features that can be improved), developing

categories primarily based on what was encountered in the data was most appropriate.

Codebook Development

The two raters first familiarized themselves with the raw data and developed

initial codes for a subset of the data. They then compared and discussed the initial codes,

solved any discrepancies, and combined duplicate codes. Each code was labelled,

defined, and included examples. Similar codes were grouped into themes. When certain

ideas emerged only once, the coders collaboratively decided whether or not to code those

segments. This preliminary codebook was then applied iteratively to other subsets and

refined by adjusting code names and definitions, adding new codes to pre-existing

themes, and creating new themes. Once saturation was achieved/no new codes were

emerging in the subset, the codebook was assumed to be a valid representation of the

data.

Codebook Application

Subsequently, split coding was conducted for the entire dataset by the two raters;

the data was coded at the sentence level since most responses consisted of one or two

sentences only. The raters discussed any ambiguous responses that occasionally arose

during split coding and collaboratively decided on the most appropriate code.

Assessing Intercoder Reliability

Once the full dataset was coded, a randomly chosen subset was used to assess

intercoder reliability (ICR). There is little agreement on what proportion of the data is

needed to adequately assess ICR; however, most researchers tend to assess between 10-

53
25% of their dataset. Following recommendations suggested by Campbell et al., (2013),

20% of entries were randomly chosen from the video likes, video dislikes/improvements,

written likes, and written portion dislikes/improvement datasets, respectively, to ensure a

representative selection. Guidelines offered by Kolbe and Burnett (1991) as well as

O’Connor and Joffe (2020) suggest using an external reviewer for enhanced objectivity

and bias reduction when assessing ICR. As such, a lab member not involved in the

development of the codebook coded the selected subset of responses using the codebook,

and the ICR was calculated against one of the primary coders. The intercoder reliability

results were interpreted according to NVivo's (i.e., software that facilitates qualitative

analysis for researchers) descriptors of Cohen’s Kappa.

3.4 Results

3.4.1 Quantitative Results

UEQ+ Scores

The mean value for each of the seven UEQ+ scales was calculated. Based on

recommendations from Schrepp and Thomaschewski (2019), for ease of interpretation,

the 1 – 7 Likert scale was changed to a range of -3 to 3, with mean scores in the negative

range suggesting unfavourable feedback, 0 indicating neutral responses, and scores in the

positive range indicating positive feedback. The mean scores for all scales were in the

positive range. For the video portion, the mean score for the Perspicuity scale was the

highest (M = 2.53) and the Stimulation scale was the lowest (M = 1.75). See Figure 3.1.

The mean scores obtained for the written portion were also all in the positive range, with

the Quality of Content scale having the highest mean value (M = 2.19) and Visual

Aesthetics having the lowest mean value (M = 1.51). See Figure 3.2. One-sample t-tests

54
were conducted to test whether the obtained means were significantly higher than 0

(neutral). The means for all scales used to assess both the video (Table 3.1) and written

(Table 3.2) portions were significantly greater than 0 (p < 0.001 for all analyses).

Findings from the question assessing the importance of each scale for the product

indicate that Quality of Content and Trustworthiness of Content were perceived as the

most important qualities for both the video and written portions.

3.4.2 Item-Specific Quantitative Data

Ratings for Individual Videos

The means and medians for each of the three questionnaire items were calculated

for each of the seven videos. The means and medians for all questions for each video

were above 4 (out of 5), as shown in Appendix B, Figure B1. Given the similar means

and medians, to be able to compare the video ratings, we categorized the three responses

for each video for every participant into one of three categories (Negative Feedback,

Neutral Feedback, and Positive Feedback) and calculated the percentage for each

category. With regards to “Understandability”, 99-100% of the feedback was in the

positive category for all videos. There was more variability with regards to “Valuable

Content”, with the percentages in the positive category ranging from 80.4% (video 5:

interviewing graduate student) to 98.1% (video 3: clinician discusses the benefits of

exposure to nature) and “Motivation to Incorporate Nature” ranging from 79.6% (video

4: interviewing undergraduate student) to 90.5% (video 3: clinician discusses benefits of

exposure to nature). See Appendix B, Figure B2.

55
Ratings for Individual SBOs

Likewise, the means and medians for each feedback item were calculated for

each of the five SBOs. The means ranged between 3 and 4 (out of 5), and the medians

were all 4 except for two ratings that were 3 (out of 5), namely SBO 1: “identifying

benefits” and SBO 2: “identifying barriers”. This indicates that these two were relatively

the least likely SBOs to encourage more nature exposure compared to the other SBOs—

see Appendix B, Figure B3. As reported for the video ratings, we include the percentage

of participants who endorsed each Likert scale rating for each of the three questionnaire

items. See Appendix B, Figure B4.

SBO Rankings

A chi-square goodness of fit test was conducted to assess whether the attained

number of votes for each SBO (i.e., number of participants ranking it as Number 1/ the

most likely activity to increase their nature exposure) significantly differed between the

SBOs. The expected and observed frequencies for all SBOs are shown in Appendix B,

Table B. The results indicate that one or more of the SBOs was ranked higher than the

others more often than would be expected by chance χ2(4) = 26.22, p < .001. See Figure

3.3. A series of post-hoc Wilcoxon signed-rank tests indicated that SBO 4: “watching

nature video and engaging in reflection” was ranked significantly higher than SBO 1:

“identifying benefits,” Z = - 2.05, p = .04, and SBO 2: “identifying barriers”, Z = -3.02, p

= .003. SBO 3: “increasing exposure to nature strategies” and SBO 5: “developing

SMART nature exposure goals” both ranked higher than SBO 2: “identifying barriers,”

respectively, Z = -2.78, p = .005; Z = -2.76, p = .006. There were no other differences in

rankings. See Table 3.3 for the complete post-hoc results.

56
3.4.3 Qualitative Data/ Thematic Analysis

In line with the quantitative feedback, most of the qualitative feedback was

positive for both the video and the written portions. Presented below is a summary of the

results of the thematic analysis. The number of times each theme/code was provided is

included in parentheses in the sections below. If a remark was mentioned less than 4

times (i.e., by less than 5% of the sample), it was deemed insignificant and was not

reported. Moreover, it was found that many participants reported the same points in their

responses for “disliked areas” and “suggested improvements”; as such, we merged these

two sets of answers for each participant. See Figures 3.4 and 3.5 for a comprehensive list

of the video portion themes and Figures 3.6 and 3.7 for a list of the written portion

themes, as well as the codes under each and their frequencies.

Intercoder Reliability

Following the NVivo interpretation of Cohen’s Kappa, the intercoder reliability

for video portion likes (K = .88), video portion dislikes/ areas of improvement (K = .88),

and written portion dislikes/areas of improvement (K = .79) was excellent, and the inter-

coder agreement achieved for written portion likes was good (K = .71).

Video Portion Likes

Each theme is described in the next section; the number of times the theme

occurred is presented in parentheses.

Theme 1 – High-Quality Well-Structured Videos (97). Participants commented

on the aesthetically appealing nature background and that it reinforces the presented

information. They also stated that they enjoyed the high-quality videography, video

57
editing, and organization of the program. For example, one participant wrote, “the film

quality of the videos is very high and the videos appear very cinematic.”

Theme 2 – Well-Presented/ Engaging Content (83). Many participants

indicated the content of the videos was captivating and well-presented and commented on

the content’s clarity, conciseness, and engaging visuals. One participant noted: “I stayed

engaged as a viewer and recall the information presented very well, I would definitely

say better than I do for the average video.”

Theme 3 – Valuable Content (70). Participants commented on the usefulness,

applicability, and motivational value of the content presented in the videos. For example,

“I feel confident that I have the power to add nature into my life and am already thinking

of ways that are applicable and possible for me.” Some expressed appreciating that the

information provided was based on evidence and/or credible sources.

Theme 4 – Interviews with Diverse Guest Speakers (36). Participants

commented positively about the diversity of guest speakers and the relatability of their

personal stories. One participant stated, “[the interviews] made me feel represented. They

also reported that the interview format was enjoyable and helpful. For example, one

participant noted, “I really enjoyed ... that the content was presented through

conversations, it made learning much easier.”

Theme 5 – Presenter’s Friendliness and Appeal (22). Positive feedback was

provided regarding the video’s primary presenter, including that she was genuine,

friendly, and well-spoken, e.g., “the narrator appears very genuine in facial expressions

and tone of voice and body language and this is very appealing and puts the viewer at

ease.”

58
 Theme 6 – Eye-Opening (19). This theme is well-represented by the following

quote, which speaks to the program’s ability to change people’s perspective around

nature: “Sometimes it is easy to disregard nature and consider it as something that is not

directly necessary to being successful, but these videos really drove the idea home that a

huge factor of personal, spiritual, and mental well-being is one's experience and

relationship with nature.”

Video Portion Dislikes/Improvements

Theme 1 – Enhance Videography/Video Editing (44). The largest area for

improvement was related to further enhancing the video editing, particularly through

adding more visuals, portraying more natural elements, and using a broader range of

scenes and camera angles. A few comments also suggested adding captions to the videos

to make them more accessible.

Theme 2 – Interviews with Guest Speakers (35). Participants requested the

addition of more guest speakers, and some participants provided feedback on the format

of the interviews, with one participant stating, “the people speaking should be speaking at

the camera, not to each other.” Some found the interviews to appear scripted or

rehearsed.

Theme 3 – No Dislikes (34). A notable proportion of the feedback stated that the

videos did not require any improvements, e.g., “there was nothing I disliked, I thought it

was great!”

Theme 4 – Reduce Length and Repetition (34). Some participants suggested

making the videos more concise, which included reducing repetition. For instance, one

59
participant remarked, “try not to say the same thing too much of [sic] people will get

bored quicker.”

Theme 5 – Increase Research Content (29). Some of the feedback was related

to adding more scientific elements to the videos, with most comments suggesting the

inclusion of references. A few suggestions were about adding more information from

research studies rather than anecdotal data, more “research” visuals (such as graphs), and

more statistics. For instance, one participant commented, “The only things I would say

could elevate the videos is to reference some of the facts mentioned and to include a bit

more statistics to really drive the message home.”

Theme 6 – Cover More Content (16). Some participants suggested including

more complex content in the videos and/or discussing topics in more depth. One

participant noted, “I think there could have been more in-depth/complex information that

could have been incorporated.” Two individuals requested including more tips for

enhancing nature exposure.

Written Portion Likes

Theme 1 – Interactive Personalized Activities (63). Most of the positive

feedback received on the written portion was related to the engaging and individualized

quality of the activities included in the program. Examples of statements include, “I felt

that it met participants where they currently are in terms of nature engagement and

illustrated ways that they could start small” and “Since it was interactive it helped you to

actually think of what the text was saying.”

Theme 2 – Clear/User-Friendly (19). We also received feedback on the user-

friendliness and understandability of the written portion. For example, one participant

60
noted, “I liked that all of the material was provided in lay-person terms and was easy to

understand from an ordinary persons [sic] perspective.”

Theme 3 – Appealing, Well-Structured Companion (17). Participants

commented positively on the organization and visual appeal of the written portion. Some

of the comments received were: “I liked how it was split up, meaning that you could

think about each section fully before moving on the the [sic] next on [sic]” and “I enjoyed

the thorough organization.”

Theme 4 – Brevity/Simplicity (14). Some participants indicated that they liked

the conciseness of the written portion and the ease of completing the included activities.

For instance, one participant said, “I liked how brief everything was ... there was no

excessive info.” Another stated, “I enjoyed the quickness of the activities.”

Theme 5 – Valuable Content (13). Positive feedback regarding the usefulness

and practicality of the information provided in the written portion was noted. One

participant wrote, “I ... liked that it provided both tips and facts about the benefits of

nature” and another student noted, “In the end, I was able to create real and achievable

goals that will benefit me greatly.”

Theme 6 – Motivating/Persuasive (9). Some participants reported that the

written portion was persuasive, thought-provoking, and motivating with regard to

increasing one’s exposure to nature. One of the participants remarked: “Very beneficial

in encouraging me to take the steps to increase my exposure to nature.”

Theme 7 – Nature Video and Immediate Benefits (9). The last theme for liked

features was positive feedback about the nature video, which was part of SBO #4. Several

participants commented on the immediate positive impact it had on their mood and stress

61
levels as illustrated by this comment: “I particularly liked watching the nature video and

experiencing the benefits of exposure to nature firsthand.”

Written Portion Dislikes/Improvements

Theme 1 – Length/Repetition (34). The largest theme for areas of improvement

for the written portion was related to length and repetitiveness. For example, one

participant shared, “The amount of readings in some sections were [sic] lengthy.”

Theme 2 – Design/Formatting (27). Participants also suggested enhancements to

the visuals and layout of the written portion. One participant noted, “I thought that more

pictures should be included.” Some participants also felt that the design of the written

portion should reflect the content it describes. For instance, “I was expecting there to be

background images of nature.”

Theme 3 – No Dislikes (18). Some participants expressed that there was nothing

they disliked about the written portion/ it did not require any improvements. One

participant remarked, “There wasn't anything I didn't like about this module. The ideas

and activities were all very well done and it wasn't just a long boring couple pages to read

like I had assumed”

Theme 4 – Content Modifications (15). Some participants suggested

adjustments to the content of the written portion, which were mainly related to providing

more information based on empirical research, including references and citations, and

including more complex information. For instance, one suggestion was “I think the

written portion of the module could include more statistics to support the claims it is

making, but this might not be something that would appeal more to a general audience.”

62
 Theme 5 – Accessibility (8). There were some suggestions pertaining to making

the written portion more accessible to the general public as well as to individuals with

reading disabilities. One participant suggested adding “text to speech for people who

have trouble staring at words on a screen.”

3.5 Discussion

The purpose of the current study was to assess the usability and acceptability of

Nature Matters for undergraduate students and identify any modifications that are needed

to improve the program. A mixed methods design was used to obtain feedback from

Canadian post-secondary students who were provided an opportunity to complete the

program. A quantitative assessment of the program was based on seven standardized user

experience scales (i.e., trustworthiness of content, quality of content, usefulness, ease of

use, stimulation, visual aesthetics, and overall impression). Open-ended questions

regarding the liked features and disliked features/areas of improvement were incorporated

to supplement the quantitative data and provide richer content.

Participants’ feedback on the program was generally positive, which was

observed in both quantitative and qualitative feedback. All UEQ+ scales were rated at the

higher end of the positive range of the scale, with the majority of participants rating the

program most favourably in the UEQ+ domains of perspicuity, trustworthiness of

content, and quality of content. The high rating on the domain of perspicuity could be

attributed to the user-friendliness of the program, as navigating through it, watching the

videos, and completing the skill building opportunities was straightforward. In addition,

incorporating scientific information and interviewing an expert in the field of mental

health and wellness may have contributed to the favourable ratings in the UEQ+ domains

63
of trustworthiness and quality of content. This is not surprising, as the public generally

tends to trust the opinions of scientists and scientific news (Besley et al., 2021; Bromme

et al., 2022; Hendriks et al., 2016). Participants’ ratings on the UEQ+ also indicated a

positive experience of the video portion’s visual aesthetics. Qualitative responses

indicated that participants liked that the videos were filmed in a natural setting, as well as

the high-quality videography and added visuals (e.g., pop-up words, short demonstrative

video clips).

Participants were also asked to note what they disliked in the program and to

provide suggestions for improvements. One of the main disliked features for the written

portion was the white/bland background—participants requested the addition of more

colors and images of nature. A suggested change was the inclusion of references for the

scientific studies that support the information provided in the videos and readings.

Improving accessibility by adding closed captioning was also recommended. Listed

below are the modifications made to the program based on the feedback and suggestions

provided:

(1) added a reference list of the studies used to develop the content presented in

the videos and readings,

(2) included the option for closed captioning to the videos to improve

accessibility,

(3) incorporated a brief statement about the goals/objectives of the program (i.e.,

educational) at the beginning of the program so that individuals know what to expect,

(4) presented each skill building opportunity on one webpage rather than across

multiple pages,

64
 (5) removed minimum word count requirements for open-ended questions

included in SBOs,

(6) changed the white background of the written portion to a colorful background

depicting nature to make it more visually appealing, and

(7) modified the colors that were reported to make some headings potentially

difficult to read by individuals with color blindness.

Of note, some of the qualitative data on likes and dislikes yielded conflicting

feedback, which is not uncommon when receiving feedback about a product (Mijumbi-

Deve et al., 2017; Xian et al., 2024). When selecting which feedback to implement, we

followed recommendations based on the literature and feasibility for the Nature Matters

program. For instance, although many participants reported enjoying the conciseness of

the videos, some provided feedback that one or more videos were too long. To address

this conflicting feedback, we reviewed the recommendations of Guo et al. (2014) based

on the assessment of 6.9 million videos on educational platforms. These authors

suggested using videos that are six minutes or shorter in length to maximize viewer

engagement and concentration. Since all seven videos in the program were under six

minutes long, and the information provided in each video was unique from the other

videos, we decided not to change the length of the videos. Another conflicting theme was

the diversity of guest speakers interviewed in the videos. Although the majority of

participants provided positive feedback regarding the inclusion of interviews with guest

speakers from different backgrounds and experiences, some participants preferred the

more experienced guest speaker (i.e., the mental health expert). We decided to include all

interview videos, as having diverse testimonies increases the relatability and inclusivity

65
of the program (Botticello, 2020). In sum, we made modifications that were feasible,

were deemed likely to improve the program, and that were not based on conflicting

feedback. These modifications are expected to improve the quality and reachability of the

program to wider and more diverse audiences without altering any of the factors that led

to the favorable ratings and feedback.

With regards to the specific activities/SBOs, the feedback was positive for all five

SBOs, but some appeared to be more impactful than others. SBO 4 (i.e., watching a

nature video and reflecting on it) and SBO 5 (i.e., creating SMART goals on how to

increase one’s engagement with nature) were ranked highest on ability to increase the

likelihood of spending more time in nature. This is not surprising, as SBO 4 allowed

participants to experience the benefits of nature exposure, and research has demonstrated

the effectiveness of experiential learning (Breves & Heber, 2020; Sheffield et al., 2022).

Further, the SBO 4 activity required participants to reflect on their emotions and feelings

by writing them down, which has been found to be beneficial in understanding and

processing them better (Baikie & Wilhelm, 2005; Lara, 2020; Tartakovsky, 2022). On the

other hand, SBO 5 involved creating SMART goals—an approach that has been reported

to increase motivation, engagement with the material, and likelihood of behaviour change

(Robins, 2014; Weintraub et al., 2021). We decided not to make changes to the content of

the SBOs at this time, given that most feedback was positive, and the content and purpose

of each activity is distinct. Results for individual videos indicated that all were well-

received. Nevertheless, some videos yielded somewhat higher ratings. Video 3 (i.e.,

clinician discussing benefits of exposure to nature) received the greatest proportion of

positive reviews regarding the value of the content and ability to motivate individuals to

66
spend more time in nature. Video 6 (i.e., practical tips to getting nature exposure) came

close, with the second highest ratings. Video 6 included the highest number of pop-up

words and supplementary images and clips, which were specifically reported as appealing

features in the open-ended questions. The data on the most and least effective videos and

SBOs may be helpful in the development of shorter versions of future programs by

allowing researchers to discern which components are most impactful.

3.5.1 Strengths and Limitations

The primary strengths of the current study include the relatively large sample size,

the breadth of feedback (i.e., both quantitative and qualitative), and the utilization of a

standardized usability questionnaire. Moreover, to ensure objectivity, the qualitative data

analysis was rigorous, including the development of a codebook, use of an external coder,

and calculation of ICR.

A notable limitation of this study is the use of a convenient sample of post-

secondary students from a single university and largely from a single department, which

impacts the generalizability of the results. Future researchers are encouraged to recruit

from multiple post-secondary institutions, as well as recruit from subsamples of students

who may have unique perspectives on the program, such as individuals on waitlists for

mental health supports or those who identify as experiencing mental health difficulties.

3.5.2 Implications and Future Directions

Nature Matters is a novel evidence-informed online program developed to

increase nature exposure, noticing nature, and nature connectedness. The practical tips

and strategies offered in the program were specifically tailored to benefit individuals

from a range of SES and varied cultural backgrounds. The quantitative and qualitative

67
feedback obtained in this usability study indicates that the program has many strengths

and, thus, holds considerable promise for increasing the targeted outcomes. Nature

Matters is intended to enhance knowledge about the role of nature in supporting mental

health and resilience and to increase motivation and opportunities to spend time in nature

based on the strategies provided. Consistent with previous research (e.g., Barton &

Pretty, 2010; Meredith et al., 2020), even small changes in this health behaviour are

expected to be associated with improved well-being and mental health. Delivery of

Nature Matters to post-secondary students has the potential to equip this at-risk

population with cost-effective, accessible, and evidence-informed strategies for managing

stress and improving their performance and well-being, which, in turn, may play an

important role in curtailing symptoms of mental health problems.

Given that the results of this usability study were generally positive and that

suggested improvements were implemented, the next step is to examine the effectiveness

of Nature Matters for increasing exposure to nature, noticing nature, and nature

connectedness. We are currently conducting studies to test the current version of the

program with post-secondary students from across Canada. Additional research is needed

to examine the generalizability of this program for students in various countries and

cities. Future research should also assess the utility of specific components of the

program (e.g., chosen videos, SBOs, or the program as a whole) to determine which

elements are most effective. As noted earlier, the obtained data revealed that some videos

and SBOs had relatively higher ratings than others. As such, a shorter version of the

program could be developed using the most highly rated components and subsequently

evaluated for usability and effectiveness.

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 The results also revealed that the students in this study were generally curious to

learn about the benefits of nature, enjoyed the methods used to disseminate the

information, and engaged with the material. The Nature Matters program and the

feedback from this study can serve as a template for other researchers to develop

educational programs about the benefits of nature and other related wellness topics (e.g.,

benefits of exercise, benefits of healthy eating) and consider using standardized

customizable questionnaires such as the UEQ+ to reliably assess participants’

experiences. Researchers could also use this program as a template for creating similar

programs suitable for other audiences. For instance, marginalized communities are more

likely to experience stress, anxiety, and depression compared to the general population

(Cyrus, 2017; Kim & Kim, 2013; Matheson et al., 2019). Many marginalized

communities experience unique barriers to accessing necessary mental health services

(Lu et al., 2021; Maura & Weisman de Mamani, 2017) and may be less likely to engage

with and have connections to nature. Similar programs that share the benefits of nature

and ways to engage and connect with nature are more likely to be successful when

tailored to specific communities, such as incorporating cultural beliefs and practices. The

benefits of nature exposure and connection are vast, and Nature Matters offers an

important step in building a unique set of resources to harness these benefits for those

that need them most, while also reducing the strain and long wait times to accessing

mental health services.

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Table 3.1
Means, Standard Deviations, and One Sample t-test Results for the Video Portion’s

UEQ+ Scales (N = 99)

UEQ+ Scale Mean Mean 95% CI SD t df p d

Perspicuity 2.53 [2.33, 2.73] 1.02 24.68 98 <.0001 2.48

Stimulation 1.75 [1.48, 2.03] 1.39 12.53 98 <.0001 1.26
Usefulness 1.95 [1.72, 2.18] 1.19 16.30 98 <.0001 1.64
Trustworthiness of 2.11 [1.89, 2.34] 1.14 18.42 98 <.0001 1.85
Content
Attractiveness 2.21 [1.99, 2.42] 1.10 19.99 98 <.0001 2.01
Visual Aesthetics 2.30 [2.08, 2.51] 1.10 20.80 98 <.0001 2.09
Quality of Content 2.40 [2.21, 2.58] 0.93 25.68 98 <.0001 2.58
Note. SD = Standard Deviation; d = Cohen’s d; CI = Confidence Intervals

70
Table 3.2

Means, Standard Deviations, and One Sample t-test Results for the Written Portion’s

UEQ+ Scales (N = 72)

UEQ+ Scale Mean Mean 95% CI SD t df p d

Perspicuity 2.49 [2.29, 2.68] 0.85 24.86 71 <.0001 2.93

Stimulation 1.76 [1.49, 2.02] 1.14 13.10 71 <.0001 1.54
Usefulness 1.97 [1.64, 2.29] 1.41 11.86 71 <.0001 1.40
Trustworthiness of 2.23 [2.01, 2.45] 0.95 19.92 71 <.0001 2.35
Content
Attractiveness 1.96 [1.67, 2.24] 1.23 13.52 71 <.0001 1.59
Visual Aesthetics 1.36 [1.05, 1.67] 1.34 8.61 71 <.0001 1.01
Quality of Content 2.37 [2.15, 2.59] 0.94 21.39 71 <.0001 2.52
Note. SD = Standard Deviation; d = Cohen’s d; CI = Confidence Intervals

71
Table 3.3

Wilcoxon Signed-rank Test Results for Comparison of Skill Building Opportunities

SBO Pairs Ranks N p

SBO 1 vs. SBO 2 Positive Ranks 38 .317

Negative Ranks 45
SBO 1 vs. SBO 3 Positive Ranks 39 .217
Negative Ranks 44
SBO 1 vs. SBO 4 Positive Ranks 34 .040*
Negative Ranks 49
SBO 1 vs. SBO 5 Positive Ranks 37 .098
Negative Ranks 46
SBO 2 vs. SBO 3 Positive Ranks 28 .005**
Negative Ranks 55
SBO 2 vs. SBO 4 Positive Ranks 29 .003**
Negative Ranks 54
SBO 2 vs. SBO 5 Positive Ranks 27 .006**
Negative Ranks 56
SBO 3 vs. SBO 4 Positive Ranks 40 .326
Negative Ranks 43
SBO 3 vs. SBO 5 Positive Ranks 35 .606
Negative Ranks 48
SBO 4 vs. SBO 5 Positive Ranks 47 .738
Negative Ranks 36
Note. The “N” column shows the number of participants who favoured the 1 st SBO in the

pair (positive ranks) and the number of participants who favoured the 2nd SBO in the pair

(negative ranks). For instance, results outlined for the 1st pair indicate that 38 participants

ranked SBO 1 higher than SBO2 (positive rank), and 45 participants ranked SBO 2

higher than SBO 1 (negative rank). * indicates p < .05. ** indicates p < .01.

72
Figure 3.1

UEQ+ Mean Scores for the Video Portion of the Nature Matters Program

Note. The figure illustrates the mean scores for each of the seven UEQ+ feedback scales

for the video portion of the Nature Matters program. The x-axis represents the UEQ+

feedback scales, and the y-axis represents the mean scores. Within the graph, the upper

green area/ diagonal lines delineate the positive range that would suggest a well-received

product while the lower red area/ horizontal lines delineate the negative range that would

suggest that users were unhappy with the product. The bars in this figure show that the

scaled mean scores for all 7 UEQ+ scales were in the higher end of the positive range,

with perspicuity and quality of content having the highest scores, followed by visual

aesthetics, attractiveness, trustworthiness of content, usefulness, and stimulation,

respectively.

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Figure 3.2

UEQ+ Mean Scores for the Written Portion of the Nature Matters Program

Note. The figure illustrates the mean scores for each of the seven UEQ+ feedback scales

for the written portion of the Nature Matters program. The x-axis represents the UEQ+

feedback scales, and the y-axis represents the mean scores. Within the graph, the upper

green area/ diagonal lines delineate the positive range that would suggest a well-received

product while the lower red area/ horizontal lines delineate the negative range that would

suggest that users were unhappy with the product. The bars in this figure show that the

scaled mean scores for all 7 UEQ+ scales were in the higher end of the positive range,

with perspicuity and quality of content having the highest scores, followed by

trustworthiness of content, usefulness, attractiveness, stimulation, and visual aesthetics,

respectively.

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Figure 3.3

Number of Participants Ranking each SBO as the SBO Most Likely to Increase their

Nature Exposure

25

Experiencing
Nature
Exposure

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Figure 3.4

Themes and Underlying Codes for the Liked Features Reported for the Video Portion of

the Program

Note. Themes are presented in the blue boxes and the codes within each theme is listed

below them. The numbers represent the number of times each theme/code was reported

by participants in the feedback.

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Figure 3.5

Themes and Underlying Codes for the Disliked Features/Areas for Improvement

Reported for the Video Portion of the Program

Note. Themes are presented in the blue boxes and the codes within each theme is listed

below them. The numbers represent the number of times each theme/code was reported

by participants in the feedback. When “more” is included in the code, it indicates that

participants requested more of this aspect.

77
Figure 3.6

Themes and Underlying Codes for the Liked Features Reported for the Written Portion of

the Program

Note. Themes are presented in the green boxes and the codes within each theme is listed

below them. The numbers represent the number of times each theme/code was reported

by participants in the feedback.

78
Figure 3.7

Themes and Underlying Codes for the Disliked Features/ Areas for Improvement

Reported for the Written Portion of the Program

Note. Themes are presented in the green boxes and the codes within each theme is listed

below them. The numbers represent the number of times each theme/code was reported

by participants in the feedback.

79
 CHAPTER 4: EXAMINING A NOVEL ONLINE PROGRAM AIMED AT

INCREASING NATURE CONNECTEDNESS, NATURE EXPOSURE, AND

NOTICING NATURE IN UNDERGRADUATE STUDENTS

The manuscript prepared for this study is presented below. Readers are advised that

Yasmeen A. Ibrahim, under the supervision of Dr. Shannon Johnson, was responsible for

the study conceptualization and design, developed the research questions and hypotheses,

implemented the methodology, led data collection, performed data analyses, interpreted

study findings, and is the first author on the manuscript.

Yasmeen A. Ibrahim, Maggie R. Baxter, George R. Fazaa, and Shannon A. Johnson.

Examining a Novel Online Program Aimed at Increasing Nature Connectedness, Nature

Exposure, and Noticing Nature in Undergraduate Students. [Manuscript in Submission

Process]. Department of Psychology and Neuroscience, Dalhousie University.

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 4.1 Abstract

Nature Matters, a novel online wellness program, was developed to improve

undergraduate students’ awareness of the benefits of nature and encourage nature

connection. This study examined if completing the program 1) enhanced connectedness

to nature, 2) increased frequency of exposure to nature; and 3) increased frequency of

noticing nature. Undergraduate students were recruited from universities across Canada.

As hypothesized, participants who completed the program (N = 45) reported greater

connectedness to nature and a higher frequency of exposure to nature compared to

control participants (N = 46), after controlling for baseline scores. Results for noticing

nature approached significance. Findings demonstrate the effectiveness of Nature Matters

in an undergraduate population, and this program’s promise as an intervention for

increasing exposure to and connection with nature, which are related to better mental,

physical, and cognitive health. Building upon this evidence will advance the utilization of

the human-nature connection for improving well-being.

Keywords: nature, environmental psychology, behaviour change, online, undergraduate,

mental health

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 4.2 Introduction

For decades, research has shown that undergraduate students experience

significantly higher rates of stress and mental health difficulties than the general

population (Adlaf et al., 2005; Durand-Bush et al., 2015; A. M. Robinson et al., 2016).

These students face a variety of stressors that often contribute to mental health problems.

For most undergraduate students, it is their first experience with university, first time

moving away from home, and first time being independent (Kang et al., 2021). Many

students grapple with challenges related to peer group pressure, relationships, and

personal identity (Arnett, 2000). They are confronted with various decisions that will

shape the trajectory of their education and future careers (Arnett, 2000). Additional

stressors include academic pressures, financial stress and debt, and changes in substance

use (Arnett, 2000; Sheldon et al., 2021).

For a population already at high risk of developing mental health problems, the

COVID-19 pandemic had negative implications (Chen & Lucock, 2022; Elmer et al.,

2020; Lipson et al., 2022; Sivertsen et al., 2022). A comparison of university students’

mental health in April 2020 to longitudinal data since 2018 found that students spent

significantly more time alone in 2020, and had higher levels of stress, anxiety, loneliness,

and depressive symptoms (Elmer et al., 2020). COVID-19-specific worries, isolation, and

lack of emotional and social support were found to contribute to the observed decline in

mental health (Backhaus et al., 2023; Elmer et al., 2020). Sivertsen and colleagues (2022)

found that fewer days spent on campus was associated with mental health problems and

higher suicide risk indicators, highlighting the role of campus closures and isolation.

Throughout the pandemic, over 60% of students from 363 U.S. campuses met criteria for

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one or more mental health problems and over 50% experienced levels of anxiety and

depression above clinical cutoffs (Chen & Lucock, 2022; Lipson et al., 2022). The

negative impact of the pandemic on the mental health of this population cannot be

denied.

Although the pandemic began several years ago, mental health difficulties

amongst university students continue to be a significant concern in the current “post-

pandemic” phase (Elmer et al., 2020; Horita et al., 2022; Macalli et al., 2025; Wirkner &

Brakemeier, 2024). This may be due, in part, to the significant lifestyle changes and

habits developed during the pandemic, including increased sedentary behaviour, a greater

reliance on work from home and virtual communication, and a reduction in support

networks, increased social disconnection, and loneliness (Elmer et al., 2020; Hamza et

al., 2021; Pandya & Lodha, 2021; Tison et al., 2020). In addition, continued increasing

global issues, including climate change, increased cost of living, financial stress, political

and socioeconomic uncertainties, racial injustice, and cyberbullying continue to adversely

impact undergraduate students’ mental health (Khan et al., 2025; Kirkbride et al., 2024;

Lawrance et al., 2022; Martínez-Monteagudo et al., 2020; Russell et al., 2025; Slimmen

et al., 2022; Stantcheva, 2024; Tyagi, 2025).

Unfortunately, access to mental health services for these students is limited, and

undergraduate students’ mental health needs remain unmet (King et al., 2024; Moghimi

et al., 2023; Zhao et al., 2025). Given high rates of mental health difficulties in this

population, there is a strong need for accessible and effective interventions to support

resilience and coping, and to help reduce stress and mental health symptoms. We propose

83
that increased exposure to and connection with nature has potential to improve mental

health and well-being in undergraduates.

4.2.1 Human Relationship with Nature

It has long been believed that humans possess an innate connection to the natural

world, a concept Edward O. Wilson described as ‘The Biophilia Hypothesis’ (1984).

Wilson defined biophilia as, “the urge to affiliate with other forms of life” (p. 85; Wilson,

1984). While Wilson gave a name to this concept, his idea was by no means new. Many

Indigenous peoples hold a worldview which includes a principle of connectivity within

the natural, spiritual, and mortal worlds; they believe humans and nature to be equal

members of the same kin (Hart, 2010). In contrast, a widespread worldview that human

life and the natural world are separate arose from European colonialism and the values

settlers aimed to promote (T. Beery et al., 2023). A growing body of evidence indicates

that humans and the natural world are connected, and this connection plays an important

role in humans’ health and well-being (Garza-Terán et al., 2022; Hartig et al., 2014;

Nisbet et al., 2020; Richardson, Passmore, et al., 2021).

The extent to which humans interact with nature varies across people, situations,

and settings. At a basic level, there is exposure. For the current study, exposure to nature

is defined as sensory contact with nature (Kamitsis & Francis, 2013). This involves

passively or actively exposing one or more of the senses to nature, including both real

and artificial elements representative of natural elements. The next level of interacting

with nature is noticing. This involves actively attending to, or being mindful of, the

elements of nature that one is exposed to. For example, one might expose oneself to

nature by walking in a park, while actively noticing nature by attending to the colour of

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leaves and the smell of flowers. Exposure to nature is often naturally accompanied by

noticing nature, but not always. For example, people may live near trees and other

elements of nature and passively receive this sensory input without actively noticing

these elements of nature (Richardson, Passmore, et al., 2021).

The third way of relating to nature is connectedness. Nature connectedness refers

to one’s subjective sense of their relationship with nature and how one conceptualizes

themself within the natural world (Martin et al., 2020). A strong connection to nature

includes feelings such as being part of nature, experiencing happiness when in nature,

and having a strong respect for and need to protect nature. Understanding the different

ways humans relate to nature and their effects on well-being is essential for identifying

behaviours and strategies that allow one to experience nature’s benefits.

4.2.2 Mental Health and Wellness Benefits of Nature Exposure

Many studies have demonstrated positive benefits of nature exposure for mental

health and well-being. Thus, increasing exposure to nature offers the potential to improve

the current state of undergraduates’ mental health. Previous studies have reported both

associations and causal relationships between exposure to nature and positive mental

health outcomes.

Xie and colleagues (2022) found a causal positive effect of the addition of a

greenway (i.e., a long linear path for cyclists and pedestrians with surrounding parks and

forests) on the general mental health and quality of life of the people living within a 2 km

radius from the greenway. Similarly, levels of neighborhood greenspace, such as parks

and forests, are associated with better mental health outcomes when controlling for

confounding variables (Beyer et al., 2014). Others have found similar correlations

85
between nature exposure and overall mood, including a study of undergraduates that

found those who frequently engaged in physical activity in green spaces reported higher

quality of life, better overall mood, and lower perceived stress (Holt et al., 2019; Mayer

et al., 2009).

Many researchers have specifically investigated relationships between symptoms

of anxiety and depression and nature exposure and have found similarly promising results

(Cox, Shanahan, et al., 2017; Maund et al., 2019; Mayer et al., 2009; Sarkar et al., 2018;

P. Wang et al., 2019). In undergraduate students, Mayer and colleagues (2009) found that

depression and anxiety symptomology were inversely associated with exposure to natural

environments as well as videos of nature. In people diagnosed with anxiety and

depressive disorders, weekly activities in nature such as walks and bird watching have

been shown to reduce symptoms and serve as a protective factor against lifetime

depression (Maund et al., 2019; Sarkar et al., 2018).

One of the most significant benefits of nature, especially for undergraduates, is

stress reduction. Many studies have shown that exposure to nature can reduce both

perceived and physiological stress (Ewert & Chang, 2018; Haluza et al., 2014; Shuda et

al., 2020). Beyond the reduction of one’s experience of stress, nature’s benefits extend to

the many ways stress increases the risk of poor mental health, such as symptoms of

depression and anxiety (Schönfeld et al., 2016). The impact of nature exposure on these

symptoms has been examined in conjunction with stress, and findings have shown that

nature reduces stress as well as its associated mental health risks (Choe et al., 2020a,

2020b; Cox, Shanahan, et al., 2017; Haluza et al., 2014; Holt et al., 2019; McSweeney,

2015; Perrins et al., 2021; Shuda et al., 2020; Ulrich et al., 1991). For comprehensive

86
reviews of the mental health benefits associated with exposure to nature, please see

Corazon et al. (2019), James et al. (2015), Jimenez et al. (2021), and Thomsen et al.

(2018).

4.2.3 Mental Health and Wellness Benefits of Noticing Nature

Noticing nature requires a more dynamic approach than mere exposure, involving

elements of attention, awareness, and use of the senses (Lumber et al., 2017; Richardson,

Passmore, et al., 2021). Nevertheless, noticing nature is reliant on exposure to and contact

with nature, which in turn paves the pathway to nature connectedness (Hamlin &

Richardson, 2022; Richardson, Hamlin, et al., 2021), with previous research documenting

a causal relationship between noticing nature and nature connectedness (Passmore,

Yargeau, et al., 2022; Pocock et al., 2023). Noticing nature (e.g., observing the scenery;

listening to the sounds) was found to predict nature connectedness, above and beyond

what is explained by spending time in nature (Richardson, 2022).

The connections between noticing nature and improved well-being and reduced

ill-being are also well documented. Previous research has found that actively paying

attention to and noticing nature enhanced participants’ transcendent connectedness (i.e., a

eudaimonic, existential feeling of unity with one’s environment and/or a higher power)

and positive affect, and reduced their levels of stress (Passmore, 2019; Passmore &

Holder, 2017; Passmore, Yang, et al., 2022), regardless of the amount of time they spent

in nature (Passmore & Holder, 2017; Passmore, Yang, et al., 2022). Noticing nature has

also been shown to lead to enhancements in feelings of elevation (i.e., feeling inspired

and appreciative; Passmore & Holder, 2017, Passmore, Yargeau, al., 2022), satisfaction

with life (Passmore, Yargeau, et al., 2022; Pocock et al., 2023), and reductions in

87
symptoms of anxiety and depression (Passmore, Yang, et al., 2022). In addition,

qualitative data have shown that individuals report positive emotions including

happiness, awe, peace, safety, comfort, reassurance, clarity, and rejuvenation when

increasing their efforts to notice nature (Passmore, 2019; Passmore & Holder, 2017),

highlighting the impactful role of noticing nature on overall well-being.

4.2.4 Mental Health and Wellness Benefits of Nature Connectedness

Nature connectedness is a deeper way of relating to nature than exposure or

noticing, as it relates to an individual’s worldview and sense of self. It has been proposed

that this depth of connection may influence the effects of nature on health and well-being,

as well as pro-environmental behaviours (Martin et al., 2020). In fact, experimental

studies indicate that nature connectedness mediates the benefits of interacting with

nature. For example, Mayer and colleagues (2009) found that increases in positive affect

and ability to reflect on a life problem due to nature exposure were amplified by stronger

nature connectedness. This mediation effect was observed regardless of the modality of

exposure to nature (i.e., walking in a natural setting, watching a video of nature). Nature

connectedness was also found to explain 19.3% of the variance in psychological health

(Richardson & Sheffield, 2017). Further, nature connectedness has been shown to be

strongly associated with a sense of purpose and psychological well-being and is a

stronger predictor of mental well-being than nature exposure (Cervinka et al., 2012; Liu

et al., 2022; Richardson & Sheffield, 2017). Thus, enhancing nature connectedness will

likely yield the most benefits.

Fortunately, although innate, connectedness to nature is not fixed (Mayer et al.,

2009; Ray et al., 2021; Unsworth et al., 2016). Intentionally noticing nature and writing

88
three good things about nature for five days resulted in significant increases in nature

connectedness, which were still present in a 2-month follow-up (Richardson & Sheffield,

2017). Exposure to nature also increased connectedness to nature, suggesting that nature

connectedness and its benefits can be accessed by spending more time in nature (Mayer

et al., 2009). These findings indicate that improving nature connectedness, and thereby

improving well-being, is not only possible but widely attainable.

4.2.5 Disconnect from Nature

Despite a growing evidence base for the importance of human connection to the

natural world, humans are increasingly alienated from it. Studies have shown that youth

are now spending less time playing in nature and more time playing indoors compared to

previous generations (Kellert et al., 2017; Larson et al., 2019; Natural England, 2009).

Beery et al. (2023) proposed a so-called ‘wheel of disconnection’, which illustrates how

disconnection can occur at both the individual level, including material, experiential,

cognitive, emotional, and philosophical dimensions, and the societal level, including

sociocultural, institutional, and political dimensions. This model demonstrates how a

wide variety of factors can contribute to an individuals’ reduced connection to nature, and

how these factors can influence one another. As is evident in this model, the factors

contributing to a general human disconnection from nature do not influence one age

group alone; these issues are widespread and multigenerational.

4.2.6 Current Study

Since there is a large gap between undergraduate students’ mental health and

wellness needs and the services being provided by universities, it is important to explore

new ways to meet these needs. Given the high prevalence of depression and anxiety and

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heightened stress levels in undergraduate populations, along with increasing

disconnection from nature, increasing exposure to and connection with nature is an

important intervention option for students who are struggling. We developed an online

wellness program, entitled Nature Matters, to disseminate the evidence-based benefits of

nature to undergraduate students with the goals of increasing awareness of the benefits of

nature and providing practical strategies for changing their behaviours to obtain these

benefits. To evaluate this wellness program, prior to assessing its impact on mental

health, it was important to test whether it can increase nature-related behaviours and

nature connection (i.e., the key outcomes/mediators targeted by Nature Matters that are

linked to and expected to lead to enhanced mental health). To this end, in the current

study we examined if the completion of Nature Matters 1) enhanced feelings of

connectedness to nature; 2) increased the frequency of participants’ exposure to natural

settings; and/or 3) increased the frequency at which they noticed nature. It was

hypothesized that students who complete Nature Matters will report enhanced

connectedness to nature, increased frequency of exposure to nature, and more instances

of noticing nature. The findings of this study will help to inform stakeholders, such as

universities and healthcare services, about potential strategies to better support

undergraduate students and provide strategies for students to better support themselves.

4.3 Methods

4.3.1 Power Analysis

A sample size estimate was determined by completing an a priori power analysis

using G*Power 3.1(Faul et al., 2009) for a between-subjects repeated measures analysis

of covariance (ANCOVA). The power analysis revealed that a total of 106 participants,

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53 per group, were needed to achieve a power of 0.95, and 88 participants, 44 per group,

were needed to achieve a power of 0.9. Given that three ANCOVAs were planned for the

analyses (i.e., one for each outcome measure), the Holm-Bonferroni correction method

was used to account for Type 1 error and alpha was set at 0.0167. As there were no prior

studies on which to base effect size due to the novelty of the program, a conservative

effect size of 0.2 was used.

4.3.2 Participants

Undergraduate students were recruited from Canadian universities via social

media, recruitment posters across Dalhousie University’s campus, and Dalhousie

University’s Experimental Participation System (SONA). Ethics approval was obtained

before beginning recruitment, and participants were self-selected. To be eligible to

participate, individuals were required to be currently registered undergraduate students at

a Canadian University and to have not completed the prior usability study for Nature

Matters. Eligible participants were randomly assigned to either the active or control

group. As per Dalhousie University’s Research Ethics Board (REB) requirements,

undergraduate students were allowed to complete the study as observers (i.e., data not

used) or participants (i.e., data included in analyses).

During data cleaning, it became clear that many participants had rushed through

the sessions and skipped a considerable amount of content. As such, prior to completing

planned analyses, we established criteria for the minimum duration required to complete

each of the sessions if one is interacting with the content; the established criteria ensured

that participants were only excluded if there was a high probability that they did not have

sufficient time to interact with or comprehend the content (i.e., minimum duration was

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based on watching the videos at 1.5 times the original speed). For the active group,

participants who did not meet the criteria for session 1 (pre-questionnaires and video

component) or session 3 (post-questionnaires) were excluded. We did not exclude

participants that completed session 2 (written component) quickly because all participants

had to complete each activity in this component to progress to the next activity; as such,

they had to at least review and complete all activities. Completing the activities within

the written component in conjunction with meeting the minimum duration for the

completion of the video component may be sufficient to yield the desirable behaviour

changes. Similarly, control group participants who did not meet the duration criteria for

session 1 and session 3 were excluded as this would suggest random responding to the

outcome questionnaires.

One-hundred-ninety-seven participants completed the study’s required sessions

(active: 95; control: 102). Out of the 95 participants in the active group, nine opted to be

observers and 41 did not meet the sessions’ minimum duration; for the control group,

eight out of the 102 participants opted to be observers, 48 did not meet duration criteria,

and one completed the post questionnaires outside the allowed 1-3 weeks window (i.e.,

after 58 days). The final sample included 90 participants (active: 45; control: 45). This

sample included 73 women (81.1%), 14 men (15.6%), one gender fluid (1.1%), and two

transgender participants (2.2%), and their ages ranged from 17 to 31 (M = 20.37, SD =

2.49). The majority of participants (53.3%) identified as White, 25.6% as Asian, 5.6% as

Hispanic, 5.6% as Middle Eastern/Arab, 4.4% as Black, 4.4% as Aboriginal/Indigenous,

and 1.1% (i.e., one participant) identified as Other - Caucasian/Middle Eastern. The

largest proportion was in their second year of study (29.7%), followed by third, first, and

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fourth year (23.3%, 20.9%, and 18.7%, respectively). They majored predominantly in

psychology (37.8%) and medical or health sciences (18.9%). Most participants reported

currently living in suburban areas (46.7%), followed by urban (34.4%) and rural areas

(15.6%), with 96.7% within walking distance to features of nature. See Appendix C for a

more detailed breakdown of the sample demographics.

4.3.3 Materials

Nature Matters

This study is part of a larger project and examined the effectiveness of the Nature

Matters program that was developed at an earlier phase. Nature Matters was designed to

educate participants about the benefits of exposure to nature, the barriers to accessing

these benefits, and easy cost-effective ways of incorporating nature into their daily lives.

The program is composed of two parts: a video component and a written component. The

video component includes seven short videos, each of which is approximately two to five

minutes in duration. The videos were filmed in an outdoor natural environment and

feature either one person speaking to the camera or conversations between two people

about nature and its benefits. For example, one video includes an interview with an

undergraduate student, while another involves an expert explaining practical tips for

getting nature exposure. The written component promotes active learning through written

summaries of the information provided in the videos, paired with activities for the

participant to complete, such as identifying specific benefits of nature that the participant

would personally enjoy, identifying barriers that apply to them, and developing

S.M.A.R.T. goals that will help increase their nature exposure. S.M.A.R.T. goals are

specific, measurable, achievable, relevant, and time-bound and are considered by some to

93
be gold standard of goal setting as they are clear and actionable (Bowman et al., 2015;

CDC, 2024).

4.3.4 Measures

Demographic Characteristics

Participants completed a background questionnaire at the beginning of the first

study session. This questionnaire was used to gather information such as age, gender, and

year of study as well as nature-related information such as location of residence and

proximity to nature.

Outcome Measures

Nature Relatedness Scale. The 21-item Nature Relatedness Scale (Nisbet et al.,

2009) measures nature connectedness and comprises three sub-scales. The NR-Self scale

measures the extent to which individuals identify with nature, the NR-Perspective scale

assesses the behaviors and attitudes toward nature, and the NR-Experience measures

level of attraction to and familiarity with the natural environment. Respondents rate each

item on a 5-point scale ranging from 1 (strongly disagree) to 5 (strongly agree). The

average score across items is then calculated, with higher scores indicative of greater

nature connectedness. The scale has been shown to be valid and reliable (Cronbach’s

alpha of .87 for the full scale) when assessed with a sample of undergraduate students

(Nisbet et al., 2009).

Nature Contact Questionnaire. The Nature Contact Questionnaire (Largo-Wight

et al., 2011) is a 16-item measure of nature exposure in three forms (i.e., outdoor, indoor,

and indirect exposure to nature). Respondents report how often over the previous week

they experienced different types of nature exposure and the number of natural elements in

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their primary indoor space (i.e., the room/ space they spend most of their day) on a 6-

point scale (0 – 5+). The total score for this measure can range between 16 and 96, with

higher total scores suggesting higher nature contact. The questionnaire has been shown to

have acceptable construct validity (Kaiser-Meyer-Olkin = 0.68) and internal consistency

(alpha = 0.63), and very good test-retest reliability (r = 0.84; Largo-Wright et al., 2011).

The Nature Contact Questionnaire was originally designed to be used with the

general adult population; therefore, some items were modified slightly in this study to be

more applicable to undergraduate students. For example, Part 1 of the original

questionnaire states, “The following questions are about your contact with the outside

environment near your office,” (Largo-Wight et al., 2011). This was altered to read, “The

following questions are about your contact with the outside environment near you.”

Noticing Nature Items. Two items of the Nature Exposure Scale were used to

measure noticing nature. The Nature Exposure Scale is a 4-item scale that is made up of

two items (i.e., questions 2 and 4) that assess the frequency of noticing nature and two

that measure nature exposure (Francis, 2011; Kamitsis & Francis, 2013). For the noticing

nature items, respondents rate the frequency at which they notice nature, both within and

outside their everyday environments. These frequencies are scored from 1 (low) to 5

(high). To our knowledge, at the time of choosing measures for this study, there were no

questionnaires that solely measure noticing nature and the aforementioned two items

from this questionnaire appeared to be the most suitable way to measure this outcome.

4.3.5 Procedure

Recruitment for this study took place from January to December of 2023. Once

the eligibility of the interested individual was established (either automatically through

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SONA or by reviewing the completed screening form), the participant was randomly

assigned to the active or control group. Subsequently, they received the link to the online

consent form and were given the opportunity to ask questions via email or phone prior to

consenting and beginning the study. Following completion of the consent form, they

shared whether they wanted to be a “participant” or “observer”. The study included three

sessions in total. For session 1, all participants that enrolled through the experimental

participation system (i.e., SONA) received course credit and all those who enrolled via

email were entered in a draw for a CA$50 Amazon gift card. For session 2, participants

chose to receive course credit or be entered in a draw for a CA$50 Amazon gift card and,

for session 3, they chose course credit or a guaranteed CA$10 Amazon gift card upon

completion.

In the first session, all participants in both groups completed the background

questionnaire, Nature Relatedness scale, Nature Contact questionnaire, and the noticing

nature questions. The control group only completed the questionnaires, whereas the

active group also completed the video component of Nature Matters in the first session.

One to three days later, the active group completed the written component of the program

(session 2 for the active group). The control group did not attend this session. Between 1-

3 weeks after session 2, to allow participants in the active group enough time to

implement some of what they learned in sessions 1 and 2, the active group completed the

three outcome measures again to assess whether there was a change. The control group

repeated the questionnaires at this time as well (session 2 for the control group) but

without having completed the Nature Matters program.

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 The control group was given the opportunity to complete Nature Matters for their

own benefit (session 3 for the control group), following the completion of the study. To

ensure reliable results, a mild form of deception was used; that is, study participants were

informed that the two groups would be completing the program at different times,

without explaining that one of the groups was a control group.

4.4 Results

Correlational and regression analyses revealed that the duration between

completing pre- and post-program questionnaires was not associated with change in

scores for any of the outcome measures in either group. As such, all participants were

included in their respective groups (i.e., control or active group) regardless of the time

frame between sessions. To assess the hypotheses that there would be increased exposure

to nature, higher frequency of noticing nature, and enhanced connectedness to nature in

the active group only, a between-subjects repeated measures analysis of covariance

(ANCOVA) was completed for each of the three outcome measures. Time 1 (T1)

outcome was used as the covariate and Time 2 (T2) as the dependent variable. By

controlling for baseline scores for each outcome measure, ANCOVAs allowed for more

statistical power compared to repeated-measures ANOVAs (Van Breukelen, 2006).

Analyses were conducted using the Statistical Package for Social Sciences (SPSS)

version 28. Outliers were defined as scores more than three standard deviations away

from the mean, and no outliers were identified for any of the three outcomes. Evaluations

of the one-way ANCOVA assumptions of normality, homogeneity of variance, linearity,

and homogeneity of regression slopes were performed. None of the assumptions were

violated except for the homogeneity of variance assumption for the nature contact

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measure, as evidenced by a significant Levene’s test. As such, this dependent variable

was analyzed using Generalized Linear Models (GliM), a method robust to this violation.

4.4.1 Primary Results

The first ANCOVA examined the Nature Relatedness Scale scores and revealed a

statistically significant effect of experimental condition, with the active group

demonstrating higher nature connectedness scores than the control group, after

controlling for baseline scores on this measure, F(1, 87) = 7.97, p = .006, np2 = .084 (p-

value adjusted using Holm-Bonferroni correction). The estimated marginal mean (EMM)

for the active group was 3.69, 95% CI [3.60, 3.77] and 3.51, 95% CI [3.43, 3.60] for the

control group. See Figure 4.1. The covariate results were significant, indicating that the

baseline scores explained a significant proportion of the variance in post-program scores

for this measure, F(1, 87) = 263.77, p < .001, np2 = .75.

Results of the second one-way ANCOVA revealed a similar but weaker pattern.

After controlling for baseline scores of the Noticing Nature items, the EMM for

participants in the active group (8.38, 95% CI [7.98, 8.77]) was higher than that of the

control group (EMM = 7.85, 95% CI [7.45, 8.24]). See Figure 4.2. However, the results

for noticing nature were not significant, F(1, 87) = 3.53, p = .064, np2 = .039 (p-value

adjusted using Holm-Bonferroni correction). The covariate results were significant,

indicating that the baseline scores explained a significant proportion of the variance in

post-program scores for this measure, F(1, 87) = 47.76, p < .001, np2 = .354.

Given that data for the Nature Contact Questionnaire, the nature exposure

outcome measure, were slightly positively skewed, we ran the following four GLiMs: 1)

assuming a normal distribution, with an identity link, 2) assuming a Poisson distribution,

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with a log link, 3) assuming a negative binomial distribution, with a log link, and 4)

assuming a gamma distribution, with a log link. Next, models were compared using the

Bayesian Information Criterion (BIC) values. The negative binomial log-link model was

selected as it had the lowest BIC value (see Table 4.1), and its residuals were close to

normal. The subsequent Wald’s Chi-Square test was significant, χ2(1) = 13.35, p < .001,

while controlling for baseline Nature Contact Questionnaire scores, suggesting that

participants in the active group had higher nature exposure after completing the program,

compared to those in the control group. The EMM for the control group was 39.1, 95%

CI [37.1, 41.4] and 44.8, 95% CI [42.2, 47.6] for the active group. See Figure 4.3.

Further, the covariate results were significant, indicating that the baseline scores

explained a significant proportion of the variance in post-program scores for this

measure, χ2(1) = 65.87, p < .001.

4.4.2 Post-Hoc Regressions

Given that the planned analyses revealed that the covariate (baseline scores) was

significant for all three outcome measures, post-hoc regressions were conducted to shed

light on the nature of this relationship. The results indicated that lower baseline scores

predicted higher post-program scores for all three outcome measures, with effect sizes in

the moderate range. See Figures 4.4-4.6. The Unstandardized (B) and standardized (b)

beta coefficients, SEs, 95% CIs, t-values, p-values, and R squared values (R2) are

reported in Table 4.2.

4.5 Discussion

It is widely acknowledged that undergraduates are experiencing high rates of

mental health challenges (Adlaf et al., 2001; Chen & Lucock, 2022; Durand-Bush et al.,

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2015). Research has consistently demonstrated the beneficial effects of nature exposure

in mitigating such difficulties (Adlaf et al., 2005; Chen & Lucock, 2022; Durand-Bush et

al., 2015; Elmer et al., 2020; Linden & Jurdi-Hage, 2017; Lipson et al., 2022; A. M.

Robinson et al., 2016; Sivertsen et al., 2022; E. Yu et al., 2022); yet, many people are not

cognizant of the benefits nature can provide. Nature Matters, a novel online wellness

program, was developed to increase undergraduates’ awareness of the benefits of

exposure to nature for improving well-being and mental health, and to motivate them to

implement strategies provided to increase their nature focused-behaviours and

connection. The purpose of this study was to evaluate if Nature Matters 1) enhances

feelings of connectedness to nature; 2) increases the frequency of exposure to natural

settings; and 3) increases the frequency of noticing nature. It was hypothesized that

students who completed the program (i.e., active group) would report: 1) enhanced

connectedness to nature, 2) increased frequency of exposure to nature, and 3) increased

frequency of noticing nature. Whereas the first two hypotheses were clearly supported by

the findings, the third hypothesis was not supported in this study.

The results suggest that the program motivated behaviour change, namely

increased exposure to nature. Although the specific mechanisms for this change were not

examined in this study, there are several possible reasons why this program led to the

observed change in nature exposure. One possibility is consistent with evidence showing

that when people think of a health behaviour (e.g., exercise) that has a positive

association for them, it increases the likelihood that they will engage in that behaviour

(Kiviniemi et al., 2007; Kiviniemi & Duangdao, 2009; Lawton et al., 2009). Results from

the usability study of Nature Matters suggests several potential positive associations that

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may have contributed to changes in behaviour (Redacted for anonymity). For instance,

we found that, directly after completing the program’s experiential activity where

participants watched a short nature video, many participants reported enjoying the

activity, improved mood, and reductions in stress levels in their post-activity reflections.

Similarly, many students commented on the aesthetically appealing nature background

depicted in the program’s educational videos, with some explicitly highlighting its

calming effect and reinforcement of the presented content. As such, it is possible that the

nature scenery participants viewed in the seven educational videos also resulted in

positive changes in mood and wellness. Proximal improvements may have resulted in a

positive association with exposure to nature, which in turn may have led to increased

motivation to seek exposure to nature. Notably, perceiving a behaviour as enjoyable has

been shown to influence behaviour more strongly than knowing it is beneficial (Lawton

et al., 2009). Moreover, a systematic review of 24 studies focusing on physical activity as

a health behaviour concluded that experiencing positive affect during the activity, as

opposed to after the activity, predicted future engagement in that activity 2025-07-02

6:35:00 PM, underscoring that positive experiences during the completion of Nature

Matters may have played an important role in the change in nature exposure for the

active group.

The biophilia hypothesis, which postulates that humans have an innate need to

affiliate with nature (Wilson, 1984), may also play a role in explaining the

aforementioned findings. Decades of research in this area have strongly supported this

hypothesis. For instance, an unconscious urge to approach nature and experience

automatic positive affective responses to nature has been consistently demonstrated in

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systematic and critical reviews (Gaekwad et al., 2022; M. Lee et al., 2022; Seymour,

2016). Further, the results are in line with Indigenous views that involve a principle of

connectivity within the natural, spiritual, and mortal worlds (Hart, 2010). There is an

abundance of evidence that humans inherently like to associate with nature; thus, Nature

Matters guides people toward a change in behaviour to which they are already inclined.

Therefore, we argue that programs targeting increased nature-based behaviours may have

a higher likelihood of success than other behaviour change programs.

Our findings also suggest that Nature Matters was effective in educating

undergraduate students about the benefits of exposure to nature and the practical ways

they can incorporate nature exposure in their day-to-day lives, which aligns with

established research in support of the efficacy of online learning (George et al., 2014;

Petrarca et al., 2018). Notably, Nature Matters employed retrieval practice by requiring

participants to reflect on what was taught in the program and complete related activities.

Distributed practice was also used in that participants were required to wait several days

between watching the video component and completing the written component (i.e.,

summary readings and activities). The success of the program in increasing nature

exposure and nature connectedness may therefore be explained, in part, by the previously

demonstrated efficacy of active learning techniques, including retrieval practice and

distributed practice, and their application in knowledge translation and implementation

programs (Biwer et al., 2020; Bjork et al., 2014; Cepeda et al., 2006; Donoghue & Hattie,

2021; Dunlosky et al., 2013). Numerous studies have also found that combining active

learning techniques with the provision of information is highly effective for gaining

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knowledge and understanding (Barile et al., 2022; Biwer et al., 2020; Hacisalihoglu et al.,

2018; Singer & Smith, 2013).

Although completing Nature Matters did not lead to a significant increase in the

frequency of noticing nature, the data indicates a trend in the direction hypothesized.

Therefore, further work will need to be completed to better understand how the program

impacts noticing nature. One potential explanation for the insignificant change in scores

obtained could be the relatively small sample size in our study, which may have masked

the positive effect of completing the program on improvements in noticing nature.

Therefore, we recommend that future studies attempt to recruit larger sample sizes and

employ methods to enhance their participants’ engagement while completing the study,

as we had to exclude many participants who did not spend adequate time engaging with

the program and/or responding to outcome measures. Further, using only two items to

assess noticing nature may have been insufficient to accurately measure this construct,

and as such may have yielded inaccurate results. Although the chosen items appear to

have face validity, other important forms of validity and reliability are not available for

those items, making it difficult to judge their psychometric properties and utility.

According to our knowledge, prior studies that quantitatively assessed noticing

nature either used one item that directly asked participants whether they spent time

noticing and engaging with nature (Hamlin & Richardson, 2022; Reddington, 2021) or

used specific sub-scales that assess noticing nature from larger scales, such as the

Engagement with Beauty Scale (EWB; Diessner, 2008). For instance, Passmore and

Holder (2017) used the Natural and Artistic Beauty sub-scales of the EWB to assess

noticing nature even though the larger scale assesses engagement with beauty more

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generally. We opted to use two items from the Nature Exposure Scale (Francis, 2011;

Kamitsis & Francis, 2013) because the items assess noticing nature more directly than the

items in the EWB sub-scales. Notably, subsequent to developing our study, the Noticing

Nature Activities measure was developed by Richardson and colleagues (2022). This

self-report scale consists of 13 items that assess noticing nature, and a one-factor solution

was found to represent the data well, with factor loading ranging from .55 to .76. As

such, the Noticing Nature Activities measure might be a promising new measure for

assessing noticing nature.

4.5.1 Exploratory Findings

The results of the exploratory regressions indicate that individuals with lower

levels of nature contact, nature relatedness, and noticing nature experiences benefitted

most from the program. This makes intuitive sense, as individuals with lower levels of

nature contact, nature relatedness, and noticing nature experiences had more room to

increase in these areas and were less likely to reach a ceiling effect compared to

individuals who already spent a lot of time in and had a strong connection to nature prior

to completing the program. This pattern is not uncommon in the intervention literature.

For instance, Conn and colleagues (2011) conducted a meta-analysis on the benefits of

physical activity interventions among healthy adults and found that the effect size of

behaviour change in physical activity was larger among chronically ill participants than

healthy participants, most likely because the ill participants had a higher potential for

improvement than the already-healthy adults. Similarly, a study examining the benefits of

gratitude interventions on youth found that participants lower in positive affect reported

greater gains from the intervention than those higher in positive affect (Froh et al., 2009).

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The researchers explained that individuals higher in positive affect reached an “emotional

ceiling” which prevented them from experiencing additional gains in well-being, while

those lower in positive affect had a larger window for improvement (Froh et al., 2009). In

a similar vein, Goedendorp and Steverink (2017) found that individuals with lower levels

of well-being were more likely to benefit from a self-management well-being

intervention than individuals with higher levels of well-being. It was suggested that

excluding participants with higher levels of well-being could allow them to better

examine the effectiveness of their intervention (Goedendorp & Steverink, 2017).

Future studies that identify how individual characteristics and prior experiences

impact the outcomes of the Nature Matters program will be useful for understanding for

whom this program could be most beneficial. Excluding participants with high baseline

levels of nature exposure, noticing nature experiences, and nature connectedness could

also allow us to better understand the effects of the Nature Matters program. At present,

however, it is difficult to determine clear cut-off points on these experimental measures.

4.5.2 Limitations and Future Directions

While our study contributes valuable insights to the field, it is important to

acknowledge the limitations that may affect the interpretation and generalizability of our

findings.

Extrinsic Motivation

The final sample of the study included participants who did not meet the time

requirement established for full engagement with the written component of the program.

We lacked a concrete way to ensure students were engaged in a thoughtful manner with

this component, which may have dampened the benefits attained. The incentive of course

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credit for completion of this study, along with a chance to win a gift card, likely drew

some participants who were motivated to complete the study quickly, rather than engage

with it as intended. As such, the current findings indicate that benefits were gained even

when participants were not fully engaged with all aspects of the program.

Future researchers who intend to build upon these results could account for

participants with low motivation by embedding comprehension questions or attention

checks before transitioning from a reading to an activity section of the program, or within

the activities, and excluding those who fail one or more checks. Numerous studies have

demonstrated the efficacy of adjunct, or text-related, questions (Cerdán et al., 2009;

Dornisch, 2012; Hamaker, 1986) and attention checks (Berinsky et al., 2014; Silber et al.,

2022) in facilitating reading comprehension. This would ensure that participants are

attentive as they complete the program, regardless of motivating factors. Additionally, an

audio recording of the written passages could be played aloud such that participants

cannot proceed without each section being played in full. This would not guarantee

attention, but it would deter participants from skipping the readings and increase the

likelihood of content retention through two methods of delivery; written and auditory

(Low & Sweller, 2005).

An important next step will be to conduct this study with individuals who choose

to complete the Nature Matters program for their well-being or mental health and have

agreed to try it as an intervention. These participants would be expected to bring a higher

level of intrinsic motivation rather than the extrinsic motivation that may have been a

factor for our participants. A meta-analysis by Cerasoli and colleagues (2014) concluded

that intrinsic motivation is more important for performance quality, whereas extrinsic

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motivation is predictive of performance quantity. The findings of this meta-analysis in

the context of the current study would mean that intrinsically motivated individuals will

be more likely to take the time to comprehend and process the content presented in

Nature Matters, thoroughly engaging with the activities, and thus, maximizing their

benefits from the program.

Follow-Up Sessions

Our study did not include follow-up sessions. Future research and

implementations of this program would benefit from incorporating a longer follow-up

timeline to determine whether the observed changes in exposure to nature, noticing

nature, and connectedness to nature persist beyond the two-to-three-week study period.

Additional sessions would also be a good opportunity to “boost” the utility of the

program by reminding people of the benefits of nature. This would be expected to further

increase connection to nature and contribute to maintaining the observed behavioural

changes through distributed practice and active learning techniques such as retrieval

practice (Biwer et al., 2020; Bjork et al., 2014; Cepeda et al., 2006; Donoghue & Hattie,

2021; Dunlosky et al., 2013).

A study by Richardson and Sheffield (2017) found that noting three good things

in nature each day over five days, compared to a control group that noted 3 factual things

each day, led to profound changes in nature connectedness that were sustained over two

months. Incorporating a similar practice in the follow-up sessions could enhance positive

associations with nature and increase the long-term efficacy of the Nature Matters

program. For example, participants could be encouraged to review the goals they set

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during the goal-setting activity of the written component of the program and asked to

identify positive experiences or emotions related to working toward their goals.

Future Directions: Mental Health

The aim of the current study was to examine the efficacy of Nature Matters for

influencing the way individuals interact with and relate to nature. This is the first step in a

series of studies that will be used to investigate if the program will benefit mental health

and well-being in undergraduates and other populations. The next step of this

investigation will be to determine whether the effects observed in this study translate into

beneficial effects on factors that influence mental health and well-being, such as mood,

stress, and quality of life. Given the limitations and subjective nature of self-report

measures, it’s recommended that future studies also assess well-being objectively. Some

of the ways this could be achieved include monitoring participants’ heart rate, cortisol

levels, and/or sleep patterns through wearable devices (e.g., smart watches). This would

enable us to determine whether the physiological data is consistent with self-reports and

would allow for a more comprehensive understanding of the impact of Nature Matters on

different aspects of well-being and mental health. Ultimately, we hope to establish

evidence for the use of Nature Matters as an intervention to address the mental health

crisis facing undergraduates, and to subsequently adapt it for other populations.

4.5.3 Conclusion

In conclusion, this study demonstrated the effectiveness of Nature Matters for

increasing undergraduates' exposure to natural settings and connectedness to nature.

Although changes in noticing nature were not supported, data from this study suggest that

future studies should continue to examine this behaviour. The findings support the use of

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the program as a possible intervention to address the mental health crisis among

undergraduates. Findings also support the use of innovative educational approaches, such

as online learning and active learning techniques for knowledge translation and

promoting engagement with educational materials among undergraduate students.

Moreover, the results align with Indigenous perspectives and the biophilia hypothesis,

highlighting humans' innate affinity for nature and the potential of interventions that aim

to provide knowledge, strategies, and motivation to facilitate behavior change that

increases human-nature interaction and connection. Future studies should build upon the

insights gained from the current study to address the limitations of this study and

contribute to a better understanding of evidence-informed interventions that harness the

inherent human connection to nature for improved well-being.

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Table 4.1
Bayesian Information Criterion Values for the Normal Identity Model, Poisson Log-link

Model, Negative Binomial Log-link Model, and Gamma Log-link Model

Model BIC Value

Normal Identity Model 629.96
Poisson log-link model 669.19
Negative Binomial log-link model 624.27
Gamma log-link model 634.56

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Table 4.2

Post-Hoc Regression Results using Pre-program Scores as the Predictor

Outcome B SE 95% CI t p R2/ b

Measures Adjusted R2
Nature -.205 .077 [-.360 – -.049] -2.648 .011* .140/ .120 -.374
Relatedness Scale
(n=45)
Nature Contact -.259 .111 [-.484 – -.035] -2.328 .025* .112/ .091 -.335
Questionnaire
(n=45)
Noticing Nature -.419 .086 [.590– -.249] -4.884 <.001** .211/.202 -.460
(n=44)
* indicates p < .05. ** indicates p < .01.

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Figure 4.1

Estimated Marginal Means of Nature Relatedness Scale Scores at Time 2

Note. Covariates appearing in the model are evaluated at the following values: Baseline

(Time 1) nature relatedness = 3.48. Error bars display 95% confidence intervals. The

Nature Relatedness Scale was used as a measure of nature relatedness.

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Figure 4.2

Estimated Marginal Means of Noticing Nature Scores at Time 2

Note. Covariates appearing in the model are evaluated at the following values: Baseline

(Time 1) nature exposure = 7.68. Error bars display 95% confidence intervals. The two

noticing nature items of the Nature Exposure Scale (i.e., questions 2 and 4) were used as

a measure of noticing nature.

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Figure 4.3

Mean Nature Contact Questionnaire Scores at Time 2

Note. Covariates appearing in the model are evaluated at the following values: Baseline

(Time 1) nature contact score = 14.39. Error bars display 95% confidence intervals. The

Nature Contact Questionnaire was used as a measure of nature exposure.

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Figure 4.4

Change in Nature Relatedness Scores by Baseline Nature Relatedness Scores for Active

Group

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Figure 4.5

Change in Nature Contact Scores by Baseline Nature Contact Scores for Active Group

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Figure 4.6

Change in Noticing Nature Scores by Baseline Noticing Nature Scores for Active Group

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 CHAPTER 5: DISCUSSION

Although numerous and well-evidenced in the literature, the physical, mental, and

cognitive benefits of exposure to, noticing, and connecting with nature remain unknown

to many. I collaborated with an interdisciplinary team to develop Nature Matters, a novel

evidence-informed program that translates the research on the benefits of exposure to

nature and provides cost-effective, accessible strategies to facilitate nature-focused

behaviour and connection. This dissertation documents the development of Nature

Matters and the testing of the program’s usability and effectiveness. This final chapter

includes a summary of the key research activities that were undertaken, the main findings

of the studies, and the overall strengths and limitations of this research project.

Implications and future research directions are also discussed.

The first project of this dissertation (as described in Chapter 2) was the

development of the program. Importantly, there is strong integration of the BCW

framework and evidence-based teaching strategies. The program’s content targets

relevant BCW intervention functions (e.g., persuasion, modeling) using effective

knowledge translation and educational strategies, such as active learning, experiential

learning and the inclusion of short videos and narratives, to increase knowledge retention

and engagement with the content. The resulting program, Nature Matters, comprises two

portions – a video portion and a written portion, that complement each other and provide

distinct modalities and experiences for those who engage with the program. The written

portion is designed to be completed a few days after finishing the video portion. It

contains brief summaries of the important information shared in the video portion; each

summary is then followed by a personalized activity/ skill building opportunity (SBO)

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that allows participants to engage in active learning and apply the learned knowledge to

their own lives. The overarching goals were to increase knowledge and motivation and

prepare individuals to easily increase nature-focused activities in their everyday lives.

Study 1 (as described in Chapter 3) examined the usability of Nature Matters

using a mixed methods design. The scores attained for all 7 UEQ+ scales (i.e.,

trustworthiness of content, quality of content, visual aesthetics, attractiveness, usefulness,

stimulation, perspicuity) for both the video and written portions of the module indicate

that Nature Matters performed well across all assessed domains and was well-received by

the target audience. The qualitative results were largely consistent with the quantitative

results, with thematic analyses indicating that Nature Matters was perceived to be well-

structured and engaging, with valuable, clearly presented content. Notably, around 25%

of the sample reported no dislikes for either portion, and the combined frequency of

qualitative positive feedback outweighed the constructive feedback for both portions. The

qualitative results also provided some important feedback for improving Nature Matters,

and these data led to some minor modifications to the program. For example, the

background of the written portion was changed to make it more appealing, closed

captioning was enabled for the videos to make them more accessible, and a reference list

was added at the end for participants that are interested in reading the scientific literature.

The individual ratings allowed us to capture important information about the comparative

value of the main components of the program—highlighting the most and least influential

components; this information may be useful in guiding the development of shortened

versions of the program. In summary, the findings from both quantitative and qualitative

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feedback indicates that Nature Matters was viewed positively overall and that

undergraduate students were interested in and engaged with the content.

Study 2 (as described in Chapter 4) employed a pre-post intervention design to

examine the impact of completing Nature Matters on undergraduate students’ level of

nature connectedness, the frequency at which they spend time in nature, and how often

they notice surrounding nature. Consistent with two of the three hypotheses, participants

who completed Nature Matters (active group) demonstrated greater increases from

baseline for nature connectedness and nature exposure scores compared to their

counterparts in the control group. Our third hypothesis was not supported as the results

for noticing nature only approached significance; thus, it is unclear if Nature Matters is

able to increase the frequency of noticing nature. Exploratory analyses revealed

relationships between baseline scores and post-intervention scores for all three outcomes.

More specifically, regression analyses indicated that lower baseline scores predicted

more gains post-intervention, suggesting that individuals with lower nature

connectedness and those who spend less time in nature and notice nature less are more

likely to benefit from this program. The effectiveness of Nature Matters supports the

future use of this and similar evidence-informed programs to modify people’s

interactions and relationships with nature as well as future research that evaluates how

the program benefits humans (e.g., mental health outcomes) and planetary health (e.g.,

sustainability attitudes and behaviours). Findings also provide important information

regarding which individuals are most likely to benefit from completing Nature Matters.

More broadly, this research contributes to our understanding of the impact of knowledge

translation and behaviour change interventions on health-related behaviours.

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 5.1 Strengths and Limitations

Several areas of strength and some important limitations were noted earlier in

Chapter 3 (Usability Testing) and Chapter 4 (Assessing Effectiveness). Below I

summarize and expand on the strengths and limitations of this dissertation.

5.1.1 Strengths

The development of Nature Matters addressed an important knowledge

translation gap. The general public’s awareness of the numerous mental and physical

health benefits of exposure to, noticing, and connecting with nature is limited, and

initiatives to educate individuals about their positive impact remains scarce. As such,

Nature Matters plays an important role in bridging this gap by informing individuals

about this free and effective health behaviour. In addition to dissemination of important

information, Nature Matters also serves as a behaviour change intervention that utilizes a

range of evidence-based behaviour change strategies that are tailored to meet the needs,

opportunities, and capabilities of a broad range of individuals. This is crucial because

knowledge alone is often not enough to elicit behaviour change due to the presence of

barriers or limited opportunities, among other things (Arlinghaus & Johnston, 2017;

Corace & Garber, 2014; Kelly & Barker, 2016; Toral & Slater, 2012). Nature Matters

integrates the BCW framework with past literature on the barriers and facilitators to

nature exposure allowing individuals to identify their barriers and choose from an array

of concrete, accessible, and easy to implement strategies created to facilitate nature-

focused behaviours in daily life.

A key strength of this program is the integration of a comprehensive behaviour

change framework with evidence-based teaching strategies from the education/learning

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literature. The success of the program in increasing nature exposure and nature

connectedness is likely due, in part, to the employment of active learning techniques,

including retrieval practice and distributed practice, as these are known to be efficacious

in knowledge translation and implementation programs (Biwer et al., 2020; Bjork et al.,

2014; Cepeda et al., 2006; Donoghue & Hattie, 2021; Dunlosky et al., 2013). Numerous

studies have found that combining active learning techniques with the provision of

information is highly effective for gaining knowledge and understanding, which suggests

that Nature Matters has the potential to be an effective knowledge translation tool (Barile

et al., 2022; Biwer et al., 2020; Hacisalihoglu et al., 2018; Singer & Smith, 2013).

Of note, the varied roles of individuals interviewed for the Nature Matters video

portion allows the material and narratives to resonate with a wide range of students and

promote inclusivity. This was corroborated by qualitative feedback of participants who

shared that they felt represented by and identified with certain interviewees and/or their

lived experiences. This is important given that increased relatability can reduce resistance

towards behaviour change and increase the likelihood of applying recommendations

(Brooks et al., 2022; Larkey & Gonzalez, 2007; Meisel & Karlawish, 2011; Petraglia,

2007; Rose et al., 2015). This project provides a model for integrating the BCW

framework and effective learning strategies in the development of behavioural health

interventions. This integrated approach may help to pave the way for future clinicians and

researchers who aim to develop similar programs and interventions.

Another notable strength of this dissertation was the application of the data

gathered from the usability study to improve the program prior to testing its effectiveness.

The mixed-methods research design provided a comprehensive understanding of the user

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experience by harnessing the advantages of both quantitative and qualitative methods.

Quantitative data from the UEQ+ provided objective reliable data on several important

aspects of the program including how valuable, clear, and trustworthy the content was

perceived to be, and the feedback questionnaires embedded after each video and SBO

shed light on each component’s potential to motivate individuals to increase their

exposure to nature. Overall, these quantitative findings indicated that the program was

well-received and ready for implementation and testing. The qualitative data enhanced

the feedback by providing invaluable information on the specific aspects of the program

that participants valued as well as features that could be added or modified to better meet

end-users’ needs and preferences. These data facilitated minor revisions and

enhancement of the beta version of Nature Matters.

Moreover, the sample recruited for usability testing was relatively large compared

to other user-experience studies. Based on 548 studies conducted between 2006-2018, the

average sample size for the most commonly used standardized usability questionnaires,

including the one employed in this study (i.e., UEQ+) was 20 participants (Díaz-Oreiro et

al., 2019). Including a relatively large sample size and open-ended questions allowed for

the calculation of the frequencies of each theme, which indicated when there were high

agreement rates on certain favoured or unfavoured features. This facilitated an objective

decision-making process when determining which changes to implement to improve the

program without compromising the frequently liked features.

With regards to the effectiveness study, a key strength is the high quality of

Nature Matters, as expressed by participants in the usability study. Participants’

perceptions of the program, such as high ratings of trustworthiness, quality of content,

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and usefulness, are foundational to its effectiveness. Additional strengths of the

effectiveness study included the use of a quasi-randomized control design and the

utilization of questionnaires that have strong psychometric properties such as the Nature-

Relatedness Scale and the Nature Contact Scale. Conducting a power analysis with a

conservative effect size estimate and meeting the sample size required for 90% power

lends further confidence to the findings of this study. Notably, we decided to oversample

and continue recruitment for the full duration of the academic semesters to provide a

buffer for individuals who opted to be “observers/ choosing for their data to not be

analyzed” as well as potential exclusions. This decision proved vital as it enabled the

necessary data cleaning to ensure the validity of findings without compromising power.

Moreover, by recruiting undergraduate students from across Canada, the findings are

likely more generalizable than if our sample was obtained from a single university or

course.

Lastly, the program is housed in an online platform, is asynchronous, and is self-

administered making it widely accessible and easily scalable. Participants can download

the written portion including content summaries and their responses to the SBOs,

allowing them to revisit the content, their responses, and personalized nature exposure

strategies for a long-lasting impact.

5.1.2 Limitations

There are also some noteworthy limitations. With regard to the development of

the program, the content was developed by a group of researchers based on experience

and the current literature. Although feedback and suggestions were gathered from a few

undergraduate students involved in our research lab, input from the target population

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(e.g., undergraduates without prior knowledge of this area of research) was relatively

minimal. This may have resulted in a lack of inclusion of content that would be desired

by and/or valuable to undergraduate students. Conducting focus groups prior to the

development of Nature Matters may have provided important information regarding the

preferences and needs of undergraduate students and led to the inclusion of information

or strategies that are currently missing from Nature Matters. Beyond focus groups,

inclusion of youth/student partners throughout the research process is recommended for

continuous input.

With regard to sample characteristics, both research study samples consisted

entirely of undergraduate students, and the majority self-identified as female, restricting

the generalizability of the findings to other populations, including individuals from

different age groups and clinical samples. A considerable number of participants were

likely motivated to take part in the effectiveness study for monetary reward or course

credit, and therefore potentially only extrinsically motivated to complete the program.

Given the fast completion times for nearly half of the participants, it appears that many

participants did not sufficiently engage with the material to reap the full benefits, and this

may have attenuated the findings. An important next step will be to examine the

effectiveness of Nature Matters with an intrinsically motivated population (e.g.,

individuals who express interest and willingness to learn about ways to improve their

well-being) to better understand its potential for changing nature-focused behaviours and

connection.

Some research design and measurement limitations are also important to consider.

Participants had only 1-3 weeks between completing the pre- and post-intervention

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questionnaires. This decision was pragmatic and informed by time constraints such as

when SONA is open to students for course credit and concerns about participant dropout.

In addition, the timing of program completion within seasonal and academic calendars

varied widely across participants; as such, some students were likely preparing for exams

and midterms and may not have had adequate time to apply the learned skills and

strategies in the short timeframe between completing Nature Matters and the post-

intervention questionnaires. Seasonal differences, including inclement winter weather and

short days in comparison to the lively spring atmosphere and longer days, may have

impacted participants’ nature exposure motivation and activities. It is also important to

acknowledge that most research participants resided in Halifax, which has a high level of

green and blue spaces, both in and near the city. Thus, outdoor nature may have been

more available for participants in this study compared to students in other cities. As

such, the level of surrounding nature may be a potentially relevant variable for

researchers to consider in future studies. It may also be beneficial to explore the

effectiveness of Nature Matters in places that are more densely populated and/or that

offer less accessible natural areas.

The measures used introduce some concerns as well. Subjective questionnaires

rely on participants’ memory, which may have resulted in some over- or under-reporting.

Unique issues arose with assessing the frequency of noticing nature since there were no

established questionnaires for this construct at the initiation of the effectiveness study,

which led to the selection of two questions to assess noticing nature. It is therefore not

possible to determine if the insignificant results obtained for noticing nature are a true

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representation of the impact of Nature Matters or if the construct was insufficiently

captured by these questions.

5.2 Future Directions

Several pertinent avenues for future research directions were discussed in their respective

manuscripts; below I present broader suggestions that could be used to build upon and

utilize the findings of this dissertation. The usability testing of the Nature Matters

program and the initial examination of the effectiveness of the beta version are

promising. As such, the next steps could entail using the findings of this dissertation to

inform modifications to Nature Matters as well as examine its effectiveness with

different populations and age groups to enhance its utility, efficacy, and reach. The

suggested next steps can also serve to address accessibility, generalizability, and

replicability.

5.2.1 Program Modifications

With regard to specific modifications to future versions of the program, two

elements appear to be particularly promising. First, according to the results of the

usability study, the majority of participants rated the experiential skill building

opportunity (i.e., completing a reflection before and after watching a nature video) as the

most likely activity to motivate them to increase their nature exposure. Similarly, many

provided feedback regarding the positive impact of viewing nature and experiencing the

benefits firsthand whilst viewing the videos presented in Nature Matters. The

augmentative impact of experiential activities on retaining the key message (in this case,

the positive impacts of exposure to nature) is validated by prior literature (Breves &

Heber, 2020; Sheffield et al., 2022). Further, the evidence underscores the impact of

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exposure to, and noticing of, nature on increasing nature connectedness (Choe et al.,

2020a, 2020b; Mayer et al., 2009), with higher levels of nature connectedness amplifying

the attained benefits of nature exposures (Mayer et al., 2009; Richardson & Sheffield,

2017). As such, adding more experiential activities to the program (or replacing the least

liked components with experiential components) could result in more favourable

outcomes.

Second, in contrast to the first two assessed outcomes (i.e., nature connectedness

and exposure to nature), the impact of Nature Matters on noticing nature did not reach

significance, underscoring the value of adding components to the program that

specifically target noticing nature. Although the benefits of exposure to nature and the

research findings in this area were highlighted throughout the program, research

regarding the importance of noticing nature, which entails using your senses to receive

and appreciate nature, in comparison to just being exposed to nature was not explicitly

explained. Some strategies specific to noticing nature were shared; however, it will be

important for future iterations to explain why noticing nature is important and its links to

better well-being. Relatedly, it would be prudent to include an experiential activity that

guides participants to use their senses to notice the different elements of nature and be

fully immersed in it.

As noted previously, an important next step following modifications would be to

assess whether increases in exposure to nature and nature connectedness following

completion of Nature Matters are accompanied by enhancements in mental health and

well-being, as would be expected. Following additional studies that examine Nature

Matters’ impacts on mental health and well-being, one productive way forward that

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would facilitate the translation and adaptation of Nature Matters is the development of

animated versions of the program. Using animation would make it less labour-intensive

to translate and deliver Nature Matters in different languages as it would only require the

audio to be translated rather than having to recruit individuals that speak other languages

and filming multiple versions. Although subtitles could be used with the current version,

we expect this would alter users’ experience of the program considerably. A more

flexible animated approach would allow for a broader delivery of Nature Matters to reach

and support a more diverse and larger group of end-users. Given feedback received from

participants in the usability study, future animated versions should include realistic and

dynamic natural settings as the background to confer similar benefits as the current

version. Studies that examine the acceptability and efficacy of animated versions relative

to the original program will be needed to determine its utility and potential.

5.2.2 Nature Matters for Other Populations

Since the results of the effectiveness study indicate that Nature Matters can be a

promising intervention for increasing nature connectedness and exposure to nature in

undergraduate students, the information and strategies included in the program could be

adapted to target other vulnerable groups. Notably, much of the content and the strategies

provided by Nature Matters apply to a broad range of populations and age groups,

making the program amenable to the development of alternate versions. For instance,

suggested ways to benefit from nature, such as having indoor plants, viewing nature from

a window, and viewing images and videos of nature on a phone/ laptop screen, can be

made available to and accessed by vulnerable populations such as seniors, individuals

with physical disabilities, hospitalized individuals, and those who have difficulty

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accessing natural spaces. It will be important to involve end-users in the development and

evaluation of alternate versions of the program and assess its efficacy.

Notably, Nature Matters reminds individuals that “prevention is better than cure”.

As evident in the literature, childhood years are a prime time for the development of

preventative health habits, and parents can be role models that strongly influence their

children’s choices and behaviours (Fruh et al., 2021; Matos et al., 2021; Wakschlag et al.,

2019; Yee et al., 2017). As such, adopting Nature Matters for parents to equip them with

the knowledge to support themselves and their children to increase their nature

connectedness and time in nature could be another fruitful next step. Relatedly, educating

children about the benefits and ways of engaging with nature could be achieved by

adopting Nature Matters for children and/or teachers and incorporating components of it

in school programming. Educating children and youth about the many benefits of

interacting with nature and scaffolding the application of the suggested strategies can aid

in fostering stronger connections and more frequent interactions with nature at a sensitive

developmental period. In extension, this can shape long-lasting relationships with nature

that could serve as a protective mechanism from mental and physical health ailments.

This is supported by evidence linking childhood exposure to nature and engagement in

nature-based play and activities to higher nature exposure and better health and well-

being during adulthood (Asah et al., 2012; Hosaka et al., 2018; D. Li et al., 2022; Vitale

et al., 2022; C. J. Wood & Smyth, 2020).

5.3 Clinical Implications

The biophilia hypothesis has been supported by a substantial body of research,

and there is considerable evidence that humans inherently want to associate with nature

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and prefer it over non-natural stimuli. Thus, Nature Matters encourages the adoption of

behaviours that individuals are already inclined towards. Although our research studies

did not include mental health and well-being outcome measures, there is a wealth of clear

evidence affirming the positive impacts of exposure to nature and higher levels of nature

connectedness on several well-being constructs, such as attention, mood, and stress

levels, with stress being one major culprit underlying physical and mental health ailments

(Capaldi et al., 2015; Franco et al., 2017; Jimenez et al., 2021; Lackey et al., 2021).

Therefore, wellness programs targeting increased nature-based behaviours may have a

higher likelihood of implementation and broader impacts than other health behaviour

change programs (e.g., exercise, nutrition), and should be incorporated in clinical practice

and stepped care when appropriate.

5.3.1 Integration with Stepped Care Approach

The stepped care approach provides a framework for offering and delivering a

range of mental health services that vary in terms of intensity and input from health care

workers depending on the needs of the individual. Stepped care models have garnered

increased attention and implementation in recent years given their patient-centred

approach, cost savings, and effectiveness (Cornish, 2020; Hopkins et al., 2021; Mareya et

al., 2024). A key tenant of the framework is that the mental health service provided

begins with the least intensive option that meets the needs and preferences of the

individual. By having more readily available resources that are less labour-intensive at

the initial steps of the stepped care approach, this framework maximizes the number of

people that can be supported at any given time and allows for better allocation and

utilization of the limited mental health resources available (Cornish, 2020).

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 In the first two steps of the framework, individuals receive support through self-

help and computerized programs. To our knowledge, few if any resources at this level are

related to helping individuals utilize nature’s healing potential to improve their mental

health symptoms. The addition of Nature Matters to the list of available resources in

schools, university campuses, primary care, workplaces and libraries, and promoting the

benefits of engaging with nature, may help a wide range of people increase nature

interaction and connection. This can, in turn, a This may contribute to reducing pressures

on health care systems by providing individuals with easily accessible resources and

simple strategies to protect and enhance their well-being.

Nature Matters can also be incorporated in the higher, more intensive steps of the

stepped care models, where input from clinicians is required. An increasing number of

physicians and other healthcare providers are currently prescribing nature-based activities

to their patients, such as through the PaRx program, to encourage them to harness the

benefits of exposure to nature to improve physical and mental health symptoms (Elassar,

2022). However, healthcare providers may not have sufficient time to provide patients

with a thorough explanation of the rationale for increasing this behaviour, the potential

benefits of exposure to nature, and/or a comprehensive list of the different options for

increasing nature-focused behaviours. Since the content in Nature Matters is presented in

lay language and requires around an hour to thoroughly complete, patients can complete

it on their own time, with healthcare provider involvement when needed to troubleshoot,

offer guidance, or help them remain consistent with their nature exposures—making it a

good fit for supporting higher levels of a stepped care approach.

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 Nature Matters can also be particularly beneficial to mental health professionals,

including psychologists, counsellors, and social workers. More specifically, mental health

professionals, in collaboration with their clients, can choose from the nature-based

activities outlined in Nature Matters to facilitate or augment therapeutic activities such as

mindfulness or behavioural activation. For instance, clients who choose to engage in

walking for behavioural activation could be encouraged by clinicians to walk in nature

versus urban environments to further enhance the benefits. A recent systematic review

underscores the superiority of walking in natural environments in terms of improving

mental health outcomes, such as mood enhancement, increased sense of optimism, and

reductions in stress, anxiety, and negative rumination, relative to walking in urban

environments (Ma et al., 2024). Likewise, a systematic review and meta-analysis of

nature-based mindfulness reveals that context (i.e., green versus non-green settings)

matters and contributes substantially to the effectiveness of mindfulness practice on

improving psychological and physiological health measures, with mindfulness practice

completed in green spaces leading to more improvements in health outcomes compared

to the same practice in non-green spaces (Djernis et al., 2019). Practicing mindfulness in

simulated natural settings (e.g., in front of a large projected image of a woodland) was

also found to lead to more pronounced and sustained mental health benefits as well as

increased nature connectedness in comparison to urban settings (Choe et al., 2020b).

Notably, the stepped care framework includes an initial assessment of the

symptoms to inform the supports that should be in place to meet the individual’s specific

needs. Insights from the exploratory regression analyses indicate that individuals who are

low on connectedness with, exposure to, and/or noticing nature are significantly more

133
likely to benefit from completing Nature Matters. Hence, using brief measures, such as

the six-item Nature Relatedness Scale (NR-6; Nisbet & Zelenski, 2013), and/or brief

questioning regarding nature exposure experiences and frequency can be used to help

clinicians and potential users determine whether a particular individual is likely to benefit

from completing Nature Matters.

In summary, there is a growing movement towards incorporating nature in health

interventions to increase their efficacy while also strengthening the human-nature bond.

Nature Matters and future iterations of this program can help pave the way and simplify

the process for a wide range of healthcare providers and their patients/clients by

providing the necessary psychoeducation and accessible cost-effective strategies for a

smooth integration of nature-based activities as a stand-alone intervention or combined

with other interventions within a stepped care approach.

5.4 Planetary Health Implications

Findings from the effectiveness study indicate that Nature Matters is a promising

approach for increasing individuals’ nature connectedness. These increased feelings of

nature connection could contribute to planetary health by propelling individuals towards

engaging in more pro-environmental behaviors (PEB). Below I discuss the link between

planetary health and the constructs enhanced by completing Nature Matters and

summarize pertinent key findings in the literature.

Planetary health is a term denoting the interdependence between the health of

humans and the natural environment that it depends on (Whitmee et al., 2015). Human

behaviour has altered nature in unprecedented ways, leading to climate change and

environmental degradation (i.e., a reduction of biodiversity and overall health of the

134
environment), which has led to the development of ecological anxiety (typically referred

to as eco-anxiety, and interchangeable with climate anxiety and climate change anxiety),

defined as worry and fear of environmental doom (Coffey et al., 2021; Díaz et al., 2019).

Environmental degradation is a major threat to humans and is having detrimental impacts

on human health (Díaz et al., 2019). We need nature, yet behave in ways that destroy it,

and subsequently fear the present and future losses because we are inextricably linked to

nature. Calls to action highlight the urgent need to strengthen people’s connection with

nature as a pathway to protect our environment given the strong links between exposure

to and nature connectedness and PEB (Ives et al., 2018; Zylstra et al., 2014). A meta-

analysis evaluating the evidence presented by correlational and experimental studies on

the links between nature connectedness and PEB concluded the presence of a large

association between nature connectedness and PEB that remained robust regardless of

age, gender, ethnic diversity or nationality, as well as a significant albeit small causal

effect of nature connectedness on PEB (Mackay & Schmitt, 2019). In a similar vein,

there is a growing body of correlational and experimental studies linking exposure to

nature to more PEB and promoting nature exposure as a pathway towards improving the

sustainability of the natural environment (Alcock et al., 2020; Collado et al., 2013;

DeVille et al., 2021).

Another arguably effective way of increasing PEB is through increasing

awareness of environmental issues (Hwang et al., 2024; Masud et al., 2015).

Unfortunately, knowledge about threats to the environment and their potential

consequences have also been linked to increased eco-anxiety (Comtesse et al., 2021;

Klassen, 2022), which in turn is thought to present a challenge to safely delivering

135
sustainability and environmental education (Pihkala, 2020). Although there is strong

evidence indicating that eco-anxiety predicts PEB, with higher levels of eco-anxiety

linked to more PEB, the findings also highlight that eco-anxiety is associated with poorer

health outcomes including functional impairment, insomnia, depression, and anxiety

(Boluda-Verdú et al., 2022; Hogg et al., 2024; Pavani et al., 2023). Nisbet and Zelenski

(2011) and Nisbet et al. (2014) proposed an alternative “happy path to sustainability” by

means of increasing nature exposure and nature connectedness, since this approach has

the potential to elicit happiness in individuals and promote PEB without contributing to

eco-anxiety. Notably, educators in the United Kingdom and Canada reportedly fear

invoking eco-anxiety in their students and as such choose to enhance students’

connection to nature over increasing their awareness of environmental degradation

(Edwards et al., 2024).

Collectively, an increasing body of literature is calling and advocating for the

development of interventions aimed at reviving and strengthening the human-nature bond

in response to its strong link with PEB. As outlined, the research findings suggest that

Nature Matters could result in increased PEB in those who complete the program and

experience an increase in nature connectedness and nature exposure, and thus, contribute

to buffering some of the planetary health challenges through individual PEB.

5.5 Conclusions

This dissertation describes the development and evaluation of a novel evidence-

informed program, entitled Nature Matters, aimed at encouraging and facilitating nature-

focused behaviours and connection. This initial version of the program targeted

undergraduate students and findings indicate that Nature Matters was well-received by

136
these students and effectively increased their nature connectedness and exposure to

nature. Nature Matters is the first program, to our knowledge, to integrate the behavior

change wheel framework with evidence-based educational strategies to increase nature-

focused behaviours and nature connection. Thus, the outlined key components informing

its development could be used as a foundation for devising similar e-health programs for

different populations, settings, and health behaviours. With a paucity of programs

addressing the need to raise awareness of the importance of nourishing the human-nature

bond, this dissertation highlights several considerations for future research and

implications for clinical practice, particularly in relation to the stepped care approach.

Nature Matters also has the potential to promote pro-environmental behaviors through

increased nature exposure and connectedness. Further evaluation of the program is

warranted to obtain more information about its effectiveness, educational and clinical

utility, and the generalizability of the findings to inform modifications, adaptations, and

broader implementation.

137
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 APPENDIX A

Usability Study Measures

Background Questionnaire

Please note that the numbering of the questions was not visible to participants.

178
179
180
Video Feedback Questionnaire

Please provide feedback about the video you just watched by responding to the following
questions. Use the scale below to answer each question.

3 4
1 2 5
Neither Agree
Disagree Disagree Agree
Agree or A
Strongly A Little Strongly
Disagree Little

The video is clear and

□ □ □ □ □
understandable.

The content provided in this □ □ □ □ □

video is valuable.

I feel motivated to incorporate

□ □ □ □ □
nature into my life.

181
Activity/ SBO Feedback Questionnaire

Please provide feedback on the activity you just completed by responding to the
following questions. Use the scale below to answer each question.

1
2 4
Very 3 5
A Quite
Slightly or Moderately Extremely
Little a Bit
Not at All

This skill building

opportunity was
□ □ □ □ □
useful/beneficial for
me.

I liked this skill □ □ □ □ □

building activity.

This skill building

opportunity
increased my □ □ □ □ □
motivation to engage
with nature.

182
UEQ+ Scale Descriptions

Scale Short Description

Perspicuity Subjective impression that it is easy to get familiar

with the product. It is easy to learn how to use the product.

Stimulation Feeling that it is exciting and motivating to use the

product.

Usefulness Subjective impression that using the product brings

advantages, saves time or improves personal productivity.

Attractiveness Overall impression from the product. Do users like or dislike

the product?

Visual Aesthetics Impression that the product looks nice and appealing.

Trustworthiness Subjective impression that the information provided by the

of Content product is reliable and accurate.

Quality of Subjective impression if the information provided by the

Content product is up to date, well-prepared and interesting.

183
UEQ+ for Video Portion of the Nature Matters Program

Please complete the following questionnaire to assess the video portion of the nature
module. The questionnaire contains opposing pairs of properties to describe the videos.
The ratings in between the opposites are indicated by circles. Select one of the circles to
indicate your rating for each of the individual terms.

Example:

unattractive □ □ □ □ □ □ □ attractive

This response would indicate that you consider the nature module more unattractive than
attractive.

Try to make a spontaneous decision! It is important not to think too long about the terms
to make your response. Please always check only one answer, even if you are unsure
about your rating of one pair of terms or if you think that it does not fit for the video
portion.

The opposing pairs are presented in groups relating to a similar aspect of the videos.
Under each group, after you have rated the individual items, you will rate the importance
of the aspect (i.e., group of items) for your overall impression of the video portion of the
nature module. There are no "right" or "wrong" answers. Your personal opinion is all that
counts!

184
 In my opinion, the video portion of the nature module is
1 2 3 4 5 6 7
not understandable □ □ □ □ □ □ □ understandable
difficult to learn □ □ □ □ □ □ □ easy to learn
complicated □ □ □ □ □ □ □ easy
confusing □ □ □ □ □ □ □ clear

For the video portion of the nature module, I consider the property described by
these terms as
1 2 3 4 5 6 7
Completely irrelevant □ □ □ □ □ □ □ Very important

In my opinion, the content of the video portion of the nature module is

1 2 3 4 5 6 7
not interesting □ □ □ □ □ □ □ interesting
boring □ □ □ □ □ □ □ exciting
inferior □ □ □ □ □ □ □ valuable
demotivating □ □ □ □ □ □ □ motivating

For the video portion of the nature module, I consider the property described by
these terms as
1 2 3 4 5 6 7
Completely irrelevant □ □ □ □ □ □ □ Very important

I consider the video portion of the nature module as

1 2 3 4 5 6 7
useless □ □ □ □ □ □ □ useful
not helpful □ □ □ □ □ □ □ helpful
not beneficial □ □ □ □ □ □ □ beneficial
not rewarding □ □ □ □ □ □ □ rewarding

For the video portion of the nature module, I consider the property described by
these terms as
1 2 3 4 5 6 7
Completely irrelevant □ □ □ □ □ □ □ Very important

185
 In my opinion, the information and data provided by the video portion of the
nature module are
1 2 3 4 5 6 7
useless □ □ □ □ □ □ □ useful
implausible □ □ □ □ □ □ □ plausible
untrustworthy □ □ □ □ □ □ □ trustworthy
inaccurate □ □ □ □ □ □ □ accurate

For the written portion of the nature module, I consider the property described by these
terms as
Completely irrelevant Very important
1 2 3 4 5 6 7

In my opinion, the video portion of the nature module is generally

annoying □ □ □ □ □ □ □ enjoyable
bad □ □ □ □ □ □ □ good
unpleasant □ □ □ □ □ □ □ pleasant
unfriendly □ □ □ □ □ □ □ friendly

For the video portion of the nature module, I consider the property described by these
terms as
1 2 3 4 5 6 7
Completely irrelevant □ □ □ □ □ □ □ Very important

In my opinion, the visual design of the video portion of the nature module is
1 2 3 4 5 6 7
ugly □ □ □ □ □ □ □ beautiful
lacking style □ □ □ □ □ □ □ stylish
unappealing □ □ □ □ □ □ □ appealing
unpleasant □ □ □ □ □ □ □ pleasant

For the video portion of the nature module, I consider the property described by these
terms as
1 2 3 4 5 6 7
Completely irrelevant □ □ □ □ □ □ □ Very important

186
 In my opinion, the information and data provided by the video portion of the
nature module are
1 2 3 4 5 6 7
obsolete □ □ □ □ □ □ □ up-to-date
not interesting □ □ □ □ □ □ □ interesting
poorly prepared □ □ □ □ □ □ □ well prepared
incomprehensible □ □ □ □ □ □ □ comprehensible

For the video portion of the nature module, I consider the property described by
these terms as
1 2 3 4 5 6 7
Completely irrelevant □ □ □ □ □ □ □ Very important

187
UEQ+ for Written Portion of the Nature Matters Program

Please complete the following questionnaire to assess the written portion of the nature
module. The questionnaire contains opposing pairs of properties to describe the written
portion. The ratings in between the opposites are indicated by circles. Select one of the
circles to indicate your rating for each of the individual terms.

Example:

unattractive □ □ □ □ □ □ □ attractive

This response would indicate that you consider the written portion more unattractive than
attractive.

Try to make a spontaneous decision! It is important not to think too long about the terms
to make your response. Please always check only one answer, even if you are unsure
about your rating of one pair of terms or if you think that it does not fit for the written
portion.

The opposing pairs are presented in groups relating to a similar aspect of the videos.
Under each group, after you have rated the individual items, you will rate the importance
of the aspect (i.e., group of items) for your overall impression of the written portion of
the nature module. There are no "right" or "wrong" answers. Your personal opinion is all
that counts!

188
 In my opinion, the written portion of the nature module is
1 2 3 4 5 6 7
not understandable □ □ □ □ □ □ □ understandable
difficult to learn □ □ □ □ □ □ □ easy to learn
complicated □ □ □ □ □ □ □ easy
confusing □ □ □ □ □ □ □ clear

For the written portion of the nature module, I consider the property described by
these terms as
1 2 3 4 5 6 7
Completely irrelevant □ □ □ □ □ □ □ Very important

In my opinion, the content of the written portion of the nature module is

1 2 3 4 5 6 7
not interesting □ □ □ □ □ □ □ interesting
boring □ □ □ □ □ □ □ exciting
inferior □ □ □ □ □ □ □ valuable
demotivating □ □ □ □ □ □ □ motivating

For the written portion of the nature module, I consider the property described by
these terms as
1 2 3 4 5 6 7
Completely irrelevant □ □ □ □ □ □ □ Very important

I consider the written portion of the nature module as

1 2 3 4 5 6 7
useless □ □ □ □ □ □ □ useful
not helpful □ □ □ □ □ □ □ helpful
not beneficial □ □ □ □ □ □ □ beneficial
not rewarding □ □ □ □ □ □ □ rewarding

For the written portion of the nature module, I consider the property described by
these terms as
1 2 3 4 5 6 7
Completely irrelevant □ □ □ □ □ □ □ Very important

189
 In my opinion, the information and data provided by the written portion of the
nature module are
1 2 3 4 5 6 7
useless □ □ □ □ □ □ □ useful
implausible □ □ □ □ □ □ □ plausible
untrustworthy □ □ □ □ □ □ □ trustworthy
inaccurate □ □ □ □ □ □ □ accurate

For the written portion of the nature module, I consider the property described by
these terms as
1 2 3 4 5 6 7
Completely irrelevant □ □ □ □ □ □ □ Very important
In my opinion, the written portion of the nature module is generally
1 2 3 4 5 6 7
annoying □ □ □ □ □ □ □ enjoyable
bad □ □ □ □ □ □ □ good
unpleasant □ □ □ □ □ □ □ pleasant
unfriendly □ □ □ □ □ □ □ friendly

For the written portion of the nature module, I consider the property described by
these terms as
1 2 3 4 5 6 7
Completely irrelevant □ □ □ □ □ □ □ Very important

In my opinion, the visual design of the written portion of the nature module is
1 2 3 4 5 6 7
ugly □ □ □ □ □ □ □ beautiful
lacking style □ □ □ □ □ □ □ stylish
unappealing □ □ □ □ □ □ □ appealing
unpleasant □ □ □ □ □ □ □ pleasant

For the written portion of the nature module, I consider the property described by
these terms as
1 2 3 4 5 6 7
Completely irrelevant □ □ □ □ □ □ □ Very important

190
In my opinion, the information and data provided by the written portion of the
nature module are
1 2 3 4 5 6 7
obsolete □ □ □ □ □ □ □ up-to-date
not interesting □ □ □ □ □ □ □ interesting
poorly prepared □ □ □ □ □ □ □ well prepared
incomprehensible □ □ □ □ □ □ □ comprehensible

For the written portion of the nature module, I consider the property described by
these terms as
1 2 3 4 5 6 7
Completely irrelevant □ □ □ □ □ □ □ Very important

191
Video Portion: Qualitative Feedback Form

Thanks for reviewing the video portion of the nature module! We really value your input
and would like to hear from you about the specific things you liked and disliked about the
video portion and how we can improve this part of the nature module.

Q1. What are the things you liked about the video portion of the nature module?

Q2. What are the things you did not like about the video portion of the nature module?

Q3. How can the video portion of the nature module be improved?

192
Written Portion: Qualitative Feedback Form

Thanks for reviewing the written portion of the nature module! We really value your
input and would like to hear from you about the specific things you liked and disliked
about the written material and how we can improve this part of the nature module.

Q1. What are the things you liked about the written portion of the nature module?

Q2. What are the things you did not like about the written portion of the nature module?

Q3. How can the written portion of the nature module be improved?

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 APPENDIX B

Table B

Chi-Square Distribution of Goodness of Fit for the SBOs with observed and expected

counts and percentages for each SBO

─────────────────────────────────────────

SBO Distribution Count Percentage (%)

─────────────────────────────────────────

1 Observed 16.00 19.28

Expected 16.60 20.00

2 Observed 4.00 4.81

Expected 16.60 20.00

3 Observed 9.00 10.84

Expected 16.60 20.00

4 Observed 28.00 33.73

Expected 16.60 20.00

5 Observed 26.00 31.33

Expected 16.60 20.00

─────────────────────────────────────────

Note. The “Count” column includes the number of participants who ranked the SBO as

Number 1/the most likely SBO to increase their nature exposure. The “Percentage”

column reflects the percentage for each count. χ2(4) = 26.22, p < .001.

194
 Figure B1
Means and Medians of Video Feedback Questionnaire items for Individual Videos

Mean Median

Item 1: Clear and Understandable

4.93 4.83 4.90 4.80 4.86 4.87 4.88 5 5 5 5 5 5 5

5

Item 2: Valuable Content

Likert Scale Responses

5 4.77 4.76 4.59 5 5 5 5 5 5 5

4.51 4.56 4.41 4.310
4

Item 3: Motivation to Incorporate Nature

5 5 5 5 5
4.47 4.28 4.49 4.41
4.23 4.26 4.20
4 4 4
4

1
Video Video Video Video Video Video Video Video Video Video Video Video Video Video
1 2 3 4 5 6 7 1 2 3 4 5 6 7

Nature Module Videos

Note. Likert Scale Responses: 1 = Disagree Strongly; 2 = Disagree A Little; 3 = Neither

Agree or Disagree; 4 = Agree A Little; 5 = Agree Strongly

195
Figure B2

Percentage of Participants Endorsing each Rating (i.e., Positive, Neutral, Negative) on

each of the Three Feedback Items Used to Assess each Video.

Feedback Items

Note. Positive Feedback = Agree A Little + Agree Strongly; Neutral Feedback = Neither

Agree or Disagree; Critical Feedback = Disagree A Little + Disagree Strongly

196
 Figure B3

Means and Medians of SBO Feedback Questionnaire items for Individual SBOs

Mean Median

Item 1: Useful/ Beneficial

5
3.98 3.92 4.08 4 4 4 4 4
4 3.57 3.41
3

Item 2: Liked
Likert Scale Responses

5
3.87 3.89 3.90 4 4 4 4
4 3.45 3.42
3
3

Item 3: Increased Motivation

5
4.01 4.02 4.07 4 4 4 4
3.82
4
3.36
3
3

1
SBO 1 SBO 2 SBO 3 SBO 4 SBO 5 SBO 1 SBO 2 SBO 3 SBO 4 SBO 5

Skill Building Opportunities

Note. Likert Scale Responses: 1 = Very Slightly or Not at All; 2 = A Little; 3 =

Moderately; 4 = Quite a Bit; 5 = Extremely; SBO = Skill Building Opportunity

197
Figure B4
Percentage of Participants Endorsing each Rating for the Three Feedback Items Used to

Assess each Skill Building Opportunity

Note. Useful/Beneficial = This skill building opportunity was useful/beneficial for me;
Liked = I liked this skill building opportunity; Increased Motivation = This skill building
opportunity increased my motivation to engage with nature.
APPENDIX C

Effectiveness Study Demographics

Full Sample Active Control
Variable
(N = 90) (n = 45) (n = 45)

198
 Mean SD Mean SD Mean SD
Age 20.37 2.49 20.24 2.72 20.49 2.27
n % n % n %
Gender
Woman 73 81.10 36 80.00 37 82.20
Man 14 15.60 9 20.00 5 11.10
Fluid 1 1.10 0 0.00 1 2.20
Transgender 2 2.20 0 0.00 2 4.40
Race/Ethnicity
Caucasian 48 53.30 27 60.0 21 46.70
Black/African 4 4.40 2 4.40 2 4.40
Aboriginal/Indigenous 4 4.40 2 4.40 2 4.40
Asian 23 25.60 10 22.20 13 28.90
Hispanic 5 5.60 1 2.20 4 8.90
Middle Eastern/Arab 5 5.60 2 4.40 3 6.70
Caucasian/Middle Eastern 1 1.10 1 2.20 0 0.00
Year of Study
1 19 20.88 15 33.33 4 8.90
2 27 29.67 10 22.22 17 37.80
3 21 23.30 11 24.44 10 22.20
4 17 18.68 5 11.11 12 26.70
5 5 5.49 4 8.89 1 2.20
6 1 1.10 0 0.00 1 2.20

Program of Study
Psychology or Psychology with another
34 37.8 18 40.00 16 35.60
major/minor
Neuroscience or Neuroscience with
7 7.80 2 4.40 5 11.10
another major/minor
Medical/Health Sciences or Medical
17 18.9 9 20.0 8 17.80
Sciences with another major/minor
Biology or Biology with another
10 11.1 4 8.90 6 13.30
major/minor
Kinesiology or Kinesiology with another
3 3.30 3 6.70 0 0.00
major/minor
Bachelor of Science (Undeclared) 5 6.7 5 11.1 1 2.20
Bachelor of Science (Other Major) 5 5.60 1 2.20 4 8.90
English or English with another
2 2.20 2 4.40 0 0.00
major/minor
Other 6 6.70 1 2.20 5 11.10

199