Use of Measurement Tools to Validate the Health Effects of Forest Healing Programs: A Qualitative Analysis

Abstract

Research is increasingly focusing on the health-promoting effects of forest healing programs. A number of different health indicators are in use, necessitating the establishment of standardized health measurement tools and protocols for forest healing. Also, it is necessary to improve the indicators and protocols by incorporating the opinions of program participants and instructors, so we conducted a qualitative analysis based on focus group interviews (FGIs) and in-depth interviews (IDIs). We collected opinions through interviews conducted for about 1 h with 32 participants in the pilot study and three instructors of the forest healing program. We utilized the MAXQDA program, commonly employed for qualitative research, such as coding and analyzing interview transcripts and literature reviews, as part of the qualitative research process. Three researchers coded and categorized the data, and the first author and corresponding author performed the final coding and categorization. Opinions on the five mental health questionnaires, three physical health measures, and exercise behavior measures used in the forest healing program were solicited. Opinions on the measurement protocol were also solicited. Participants faced challenges in completing the mental health questionnaire due to inappropriate terminology, difficulty in providing truthful responses due to repetitive questions, and the complexity of answering exercise-type questions due to the length of the survey and the absence of clear examples. It was identified that improvements are needed in the future. Some participants commented on the need to measure blood circulation and short-term health changes, and others noted that performing measurements in large groups was difficult, such that there was a need to introduce a measurement protocol for groups. This study is the first to qualitatively evaluate the validity of health measurement tools associated with forest therapy programs. It can contribute to the establishment of standardized health indicators and protocols, as well as serve as a valuable reference for selecting measurement tools to evaluate the effectiveness of forest healing interventions.