Growing Together: completed research
A feasibility study of the use of a randomised controlled trial of therapeutic horticulture for people with mental health problems in the UK
The Mental Health Foundation and Thrive
Following on from the original “Growing Together” research project completed in 2005, we recently completed a study with
funding from Thrive and the Mental Health Foundation on the feasibility of conducting a randomised controlled trial of social and therapeutic horticulture (STH) for people with mental health problems in the UK.
 The original Growing Together study was a qualitative exploration of the experiences and perceptions of clients and staff of garden projects, however, there is also a need to provide quantitative, statistically robust, evidence of the effectiveness of STH.
This project examined the methodological and practical issues associated with quantitative studies of the effectiveness of STH and explored whether methods such as randomised controlled trials (RCTs), commonly used in ‘mainstream’
biomedical research, could be applied to STH.
Randomised controlled trials (RCTs) involve the comparison of two (or more)
treatments or interventions under conditions that remove any bias, either in selection of participants or in the measurement of the outcomes of intervention, so that a fair test or comparison is performed. In medical research they are regarded by many as a ‘gold standard’, however, such an approach has not been used successfully in the field of STH or similar interventions.
The purpose of this project has been to prepare the way for major research into social and therapeutic horticulture that will provide quantitative, statistically robust evidence of its effectiveness.
The study attempted to assess the feasibility of using a randomised control trial design for studying social and therapeutic horticulture and to explore alternative approaches and methods.
- Explore and assess all of the issues surrounding the use of a randomised controlled trial design to evaluate the benefits of social and therapeutic horticulture (STH).
- Identify health trusts (and individuals) who will refer potential participants for a RCT of STH, and garden projects able to participate in such a trial and to obtain a commitment from these parties.
- Identify suitable outcome measures and methods for use in a RCT and evaluate them in a pilot study.
- Use data from the pilot of outcome measures to inform the sample size calculation for a RCT.
- Formulate criteria for the STH interventions to be used within a RCT and to identify and formulate criteria for control activities.
- Identify inclusion and exclusion criteria for participants.
- Bring together all interested parties, including service users of STH, in a ‘Community of Interested Parties’ that will inform and facilitate the development of a strategy for a RCT in this area.
- Examine any logistical or procedural issues that may be pertinent to a full scale study.
- Explore alternatives to a RCT design.
The study has shown that there is a need for a rigorous trial of STH and that most of the conditions for an RCT could be fulfilled. The final project report proposes a protocol for a study, the main points of which are outlined below. We are currently seeking funding to carry out this work.
- Research participants will be new starters at STH garden projects and have mental health problems. They will have either self referred or been referred by other agencies, e.g. GPs.
- Participants will be allocated at random to one of two groups: the first group will start immediately at the
garden (or after any waiting period normally used at the garden); the second group will start three months later (this will be the waiting control group). Randomisation is therefore carried out after the point of entry into an STH garden project.
- Study participants will attend a project for at least two days per week and will take part in the standard range of activities of the project. A record of attendance will be kept by project staff.
- A series of outcome measures assessments will be conducted, e.g. Clinical Outcomes in Routine Evaluation (CORE) Outcome Measure, The Hospital Anxiety and Depression Scale (HADS), and The World Health Organisation Quality of Life Questionnaire (WHOQOL – BREF).
- Participants in the intervention group will be followed for 12 months and those in the control group for 15 months (12 month intervention period plus three months waiting control).
- A sample of 30 participants will be interviewed at the time of each assessment in order to explore their
perceptions of their health and wellbeing and of the
effects of attending the project or of being on the waiting list. These interviews will be recorded and subsequently analysed thematically.
Sempik, J. (2007) Researching Social and Therapeutic Horticulture: A study of methodology. Reading: Thrive and Loughborough: CCFR.
Although STH is considered to be effective by many medical and social care practitioners, including psychiatrists, nurses, occupational therapists and social workers, ‘lack of hard evidence’ is an inhibiting factor in the provision of funds for this intervention.
Additional, high quality research in this field will therefore improve funding and provision of services and will promote the professionalisation of practitioners of STH.
Dr Joe Sempik
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