‘Looking for flowering trees to walk past’: A qualitative analy- sis of US older adults’ therapeutic landscapes during the COVID-19 pandemic †

Therapeutic engagement with nature can support health and wellbeing among older adults. This may be particularly important to cope with adversities of the COVID-19 pandemic when public health measures have been particularly stringent for individuals in this age group. Utilizing therapeutic landscapes as a conceptual framework, we conducted a secondary thematic analysis of qualitative data to explore older adults’ everyday experiences (N=769) with parks and nature during the early months of the COVID-19 pandemic in the US. The data analyzed is part of the COVID-19 Coping Study baseline survey collected online between April to May 2020. Preliminary findings indicate that participants purposefully engaged with nature and outdoor spaces in diverse ways. This engagement provided opportunities for exercising and maintaining a routine at a safe physical distance from others, which promoted physical and mental health and well-being.


Introduction
Exposure to nature and residential green and blue spaces have been associated with better physical and mental well-being in later life (1,2). However, there is limited evidence of the role of such settings during the COVID-19 pandemic when public health efforts to contain the virus have included shelter-in-place orders and restrictions of movement. Although evidence is emerging about the relevance of contact with nature during the COVID-19 pandemic (3), to our knowledge no previous study has conducted an in-depth qualitative analysis to understand how older adults interpret and use nature during this time of collective trauma. The aim of this study is to explore the experiences and perceptions of older adults regarding the role of nature and the outdoors to support health and well-being during the first months of the COVID-19 pandemic in the US. We utilize the therapeutic landscapes as a conceptual framework to examine how physical and social characteristics of natural spaces contribute to health and well-being (4,5).

Methods
Data for analysis was collected as part of the COVID-19 Coping Study, a longitudinal mixed-methods study of US adults aged over 55. Participants were recruited between April and May 2020 using online multi-frame non-probability sampling (n= 6938). A list  of keywords screened open-ended questions and created a qualitative database for the present study, including all responses that relate to participants' experiences, attitudes and behaviors about engaging with parks, green/blue spaces, and nature during the pandemic (n=769). Analysis is ongoing utilizing NVivo12 software following Braun and Clarke's (2006) six steps for thematic analysis: (1) familiarization; (2) generation of initial codes; (3) search for themes; (4) review themes; (5) define and name themes; and (6) write up the analysis (6).

Results
Preliminary results suggest that during the implementation of public health restrictions, participants purposefully engaged with nature in diverse ways. Multi-scalar engagement ranged from the home (e.g., garden views from a household window, tending to potted flowers on a balcony) to neighborhood and broader community (e.g., taking long walks in a nearby park or taking photographs in a wildlife area). Older adults appreciated that outdoor spaces provided opportunities for exercising, social interaction and maintaining a routine at a safe physical distance from others, which boosted their social, mental and physical wellbeing.

Discussion
Preliminary findings indicate that for older adults, diverse settings in the natural and built environment act as well-being enablers and play an influential role in coping with the negative effects of the COVID-19 restrictions. A deeper understanding of the interactions with therapeutic landscapes will provide opportunities to develop or adapt community and environmental interventions that promote the health and wellbeing of older people during pandemics and their aftermath.
Supplementary Materials: The following are available online at https://ecerph-3.sciforum.net/, Video S1: 'Looking for flowering trees to walk past': Qualitative study of therapeutic landscapes during COVID-19, Presentation S1: 'Looking for flowering trees to walk past': Qualitative study of therapeutic landscapes during the COVID-19 pandemic.
Funding: V.G. contributed to this project as a PhD scholar funded by the Health Research Board under SPHeRE-2019-1.