Green Care: A Conceptual Framework - Frisk i naturen

way to ‘measure’ the outcomes is to listen to the experiences and views
of participants. Much good work has been carried out exploring the
perceptions of green care participants, looking at how green care benefits
the individual. Some of these studies have been described throughout this
document.
Hence, qualitative research shows that green care is valued, enjoyed and
considered to be personally beneficial. Therefore, is there a need for any
other type of evidence or research?
There is often an assumption or perhaps an expectation that such benefits
are founded on changes in psychological functioning or changes in clinical
condition that are directly attributable to green care. Whilst it may be true
that if a client reports that he or she feels happier then there has been some
psychological change, this does not mean that any underlying condition
has necessarily been altered by participation in green care. It may have –
but if we wish to claim that green care directly changes a client’s clinical
condition or affects any disease process then we need to test it in the same
way as any medicinal product might be tested.
Whilst those in the green care movement and many of those in health care
may consider the experiences of participants to be the best evidence of
effectiveness, many of those responsible for formulating health policy and
providing funding are firmly rooted in the world of quantitative data and
randomised controlled trials (RCTs). This is the currency of the regulatory
authorities that give approval for new medicines.
Complex interventions are difficult to study and as a result, controlled trials
are the ‘gold standard’ of some green care researchers and the antithesis
of others. That is certainly the experience of those in the Therapeutic
Community movement where there have been few such trials and where
also the issue is hotly debated. For example, Manning (2004), explored
the potential of RCTs in researching the effectiveness of the therapeutic
community approach to mental ill health and concluded:
“The RCT is for many observers of medical and social practice
a powerful method of developing a strongly legitimate means
for gathering evidence which carries extensive social power.
However, the RCT as practised is not an appropriate gold
standard solution for all problems. It certainly cannot be
the required standard for an assessment of the therapeutic
114 Green Care: A Conceptual Framework