HSH 703 - Analyzing Health Promotion Intervention Efficacy Report

This report assesses the efficacy of the WILD bush therapy, a health promotion intervention aimed at improving the mental health and well-being of young adults, by employing a socio-ecological approach. It identifies socio-ecological determinants affecting mental health in young adults, emphasizing factors such as early life events, education, social environment, and physical environment. The report utilizes various health promotion frameworks, including the Ottawa Charter and Kickbusch’s determinants of health, to analyze the intervention's alignment with established health promotion principles. The WILD bush therapy is evaluated for its ability to create supportive environments, strengthen community actions, and develop personal skills, with a focus on improving daily living conditions and addressing inequitable distribution of resources. The analysis highlights the intervention's congruency with environmental and behavioral determinants of health, concluding that the WILD bush therapy is an effective approach to promoting mental health among young adults by integrating systems thinking and ecological perspectives.

Running head: HEALTH CARE
Health care
Name of the student:
Name of the University:
Author’s note

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Table of Contents
1. Introduction:................................................................................................................................2
2. Socio-ecological determinants influencing the health issue:.......................................................3
3. Assessment of efficacy of the intervention:.................................................................................4
3.1 Evaluation of the intervention against heath promotion framework:....................................5
3.2 Suitability of the intervention according to the 3 principles areas of action:........................6
3.3 Congruency with two of the five determinants of health:.....................................................7
3.4 Evaluation of system thinking approach................................................................................8
3.5 Suitability of the intervention in promoting health equity or environmental sustainability:.8
4. Conclusion:..................................................................................................................................9

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1. Introduction:
Health promotion in the 21st century is dependent on adapting systematic approaches and
networking response at all levels. As disease outbreak is a long term process influences by socio-
ecological changes like demographic transitions, food insecurity and climate change, taking
effective steps to take response at all level is critical. This report is concerned with maintaining
mental health and well-being in young adults. In current, time paying attention to identify
effective health promotion intervention that fulfils socio-ecological approaches to health
promotion for mental well-being is importance because recent evidence shows high prevalence
of mental illness for young people aged 12-25 years and socio-ecological approach helps to
address important determinants influencing mental health outcome of the group (Mojtabai,
Olfson and Han, 2016). Young adults are most vulnerable to mental illness because of high risk
taking behaviours and disparities between lived reality and expected outcomes for children. The
World Health Organization (2018) report shows that 16% of the global burden of mental health
conditions is shared by people aged 10-19 years. The national statistics regarding the prevalence
of mental illness among youths in Australia shows that 14% of young people experience mental
illness disorders according to survey done between June 2013 and April 2014 (Parliament of
Australia 2019). Hence, as mental illness in youths would lead to loss of productivity and
increased health cost, the main purpose of this report is to identify socio-ecological determinants
affecting mental health for young adults and utilize different health promotion framework to
assess and analyse the efficacy of chosen health promotion intervention for the target population
group.
2. Socio-ecological determinants influencing the health issue:
Various ecological processes and natural resources play a role in influencing health and
well-being of humans. For human development, there is a need for abundant energy, resources to
constructs shelters and reasonable climate conductive to human health (Williams 2016). Hence,
it can be said that health is sensitive to social and economic factors. These factors affect the
likelihood of developing mental illness in youths. Engagement in mental health is influenced by

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factors like social, physical and policy environments. According to the ecological model,
individual comes at the centre of the model. The individual factors that may contribute to mental
illness in youths include age, gender, money and personal factors. Early life events like parental
separation and child abuse and violence create risk of exposure to prolonged to stress for people
and increased duration of stress is strongly linked with the increase in risk of developing
psychiatric disorders (Schiavone, Colaianna & Curtis, 2015). Hence, review of early life events
in youth can be important predictors of factors influencing mental illness. In addition, low
education, unemployment and poor housing contributed to mental disorders. Education
profoundly influences adult socioeconomic status and access to resource for good life. Hence,
educational attainment is a strong predictor of employment, access to quality life and the
likelihood of experiencing mental health problems (Brännlund, Strandh and Nilsson 2017).
The social environment of an individual is strongly linked with development of mental
health problems. Social environment includes exposure to appropriate relationship, culture and
society. Mental health of youth is influenced by factors like peer group, overcrowding and social
support. Peers and family have a significant role in promoting health of young children.
Relationship with peers plays a role in children’s development and getting opportunities for
being acquainted with social norms and self-control. However, negative peer influence such as
peer rejection and peer harassment contribute to later life maladjustment and risk of mental
illness. In addition, social support has been determined as a determinant for mental illness by
WHO and different types of access to social networks and social support predicts development of
mental illness and psychiatric symptoms (Smyth et al. 2015). In addition, physical environments
like access to health care facilities, cultural aspects and community environments are the
determinants influencing rate and type of mental health problems. Satcher, Okafor and Dill
(2012) defines that build environment of people such as access to mental health service, public
transportation, availability of recreational source and peaceful or violent environment are some
determinants of health. Unequal distribution of these resources in youth contributes to hardship,
deprivation and risk factors of mental illness. Furthermore, policy related action such as
implementation of appropriate urban planning policies, active transport policies, health policies,
workplace policies has indirect effect on mental health problems. Therefore, this discussion
shows how chain of social and ecological factors interconnects with each other to influence
mental health.

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Events: Early life events like parental separation, exposure to violence and abuse
Patterns or trends: Level of educational attainment, quality of housing, overcrowding, peer influence,
social support, employment, personal skills and sense of belonging
Underlying structures: Negative life events, poor socioeconomic status, unemployment, peer rejection,
social discrimination, neglect, lack of policies on employment and housing and availability of health
services.
Mental models: Access to appropriate physical and social environment plays a role in influencing child
development, positive life opportunities for youth and engagement in employment and meaningful
activities for living.
Table 1: Representation of ecological determinants of mental illness through the concept of ice-
berg model
3. Assessment of efficacy of the intervention:
Based on the review of mental health disorders in youth, the WILD bush therapy is one
of the health promotion interventions to promote mental health and well-being of young adults. It
is a program that has been implemented by Bush Adventure Therapy service. The WILD
program focuses on providing a safe space to client for personal development and gives them the
opportunity to connect with the surrounding environment. The intervention supports people to
develop happy relationship with others and environment through adventure based learning (Liz
& Francis, 2018). The chosen intervention is effective for health promotion in the 21st century as
utilized systems thinking approach and ecological approach to promote mental health of youths.
3.1 Evaluation of the intervention against heath promotion framework:
The efficacy of the WILD bush therapy can be understood from the alignment of the
intervention with current health promotion framework. The five key actions areas of the Ottawa
Charter is a useful health promotion framework that provides guidance regarding the ways to
implement a health promotion intervention. The five action areas of the Ottawa Charter includes
building healthy public policy, creating supportive environment, strengthening community
actions, developing personal skills and reorienting health services (World Health Organization
2019). The first action areas relates to building appropriate public policies to help target group

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make healthier choices. On reviewing the core features of the WILD bush therapy, it has been
found that wilderness therapy is not focussed on developing healthy public policy. However, the
activities of the WILD busy therapy take relevant actions to create supporting environments.
This can be said because by planning adventure activities, the intervention supports young
people to appropriately use the natural environment for health and well-being. Adventure based
activities provided them with the scope to learn protective behaviours instead of focusing on risk
taking behaviour. It supports people to increase resilience and adapt positive coping style to deal
with mental illness (McIver, Senior and Francis 2018).
On comparison of the WILD bush therapy with the five action areas of the Ottawa Charter, it
has also been found that intervention fulfils the criteria of strengthening community actions and
developing personal skills too. The Ottawa Charter prioritizes health promotion through
community action and encouraging community members to extend help and social support to
vulnerable group (Fry and Zask 2016). The WILD bush therapy is efficacious in adapting this
framework by implementing group based adventure activities and encouraging clients to work
together in groups. The WILD program recruits group of young people who are disengaged from
the community and arrange outdoor activities for them based on personal and group goals. Group
members get the opportunity to engage in outdoor activities and adventures like indoor rock
climbing, canoeing and beach visits. The program is coordinated by wilderness leaders (McIver,
Senior and Francis 2018). Hence, this reflects how the program is effective in bringing
community members together and learning opportunities through group based adventure
program. In addition, the intervention is found relevant to develop personal skills for the young
adults too. This can be said because the program focus on delivering individual recovery goals
and implementing activities that supports youth to develop their capacity to manage daily living
skills and get new world of adventure to develop resilience. Resilience is an important skill to
promote mental health as it enables an individual to successfully adapt to severe adversities in
life (Rutten et al. 2013). However, the therapy does not address the action areas of reorienting
health services.

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Figure: OTTAWA CHARTER
Source: (Fry and Zask 2016)
3.2 Suitability of the intervention according to the 3 principles areas of action:
According to the Commission on Social Determinants of Health, three principles areas of
action necessary in a health promotion intervention includes improving daily living conditions,
dealing with inequitable distribution of money and resource and raising public awareness. Out of
the three principles, the WILD bush therapy is found to be effective in addressing the first two
principle areas. The intervention has played a role in improving conditions of life of youth
through the implementation of appropriate adventure activities for the group. By giving youths
the activity to engage in adventure based activities like wild based therapy, the therapy supports
client to develop capacity for daily life skills and demonstrate methods by which high quality of
life can be created with or without mental health symptoms. Hence, with a focus on skill-
building, the intervention is found effective in improving conditions and quality of life of youth.
Gabrielsen and Harper (2018) supports that quality of life of mentally ill youths are
compromised because of poor participation in daily life activities and therapeutic outdoor
OTTAWACHARTER

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programs supports youth to spend more quality time in natural environments to reduce
maladaptive behaviours.
The WILD bush therapy is favoured according to the socio-ecological principle as it
promotes equity and addresses inequitable distribution of money and resources. For example, the
main reason behind deteriorating health outcome for young adults with mental illness includes
cost barrier and poor access to appropriate mental health service. However, the WILD program
delivered by EACH, a national community organization address health equity by providing
different types of service for recovery and healing. The advantage of the intervention compared
to traditional mental health services is that it s a low cost intervention and it may favour
participation of people with poverty and poor socioeconomic status (Gabrielsen and Harper
2018). However, it takes no step to raise public awareness regarding mental health in youths.
3.3 Congruency with two of the five determinants of health:
Kickbusch’s determinants of health:
As outlined by Kickbusch (2012), five determinants of health include political, commercial,
social, environmental and behavioural determinants of health. The political determinants include
distribution of money, power and resources. The commercial determinants of health includes
economic context of people’s life. Social determinants are conditions where people live and
work and its impact on health. In addition, environmental determinants includes physical
environment surrounding the patients. Individual characteristics and behaviours that has an
impact on health outcomes are example of behavioural determinants of health.
Congruence of the intervention with Kickbusch’s determinants of health:
The WILD BUSH therapy is found congruent with addressing the environmental and
behavioural determinants of health contributing to mental illness. The environmental
determinants that contribute to poor mental health include poor access to services and exposure
to stress. The significance of the WILD bush therapy is that it recognized the need to provide a
new environment to young people with mental illness and the intervention specially emphasizes
on changing the environment to support development of new skills and managing mental illness.
It had addressed the unique needs of the youth and creates a youth focused therapeutic

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environment where youths get unique environment to self-health and recover from mental
illness. The social aspects of the program also worked to create an environment of social support
and encourage healthy behaviour in youths (McIver, Senior and Francis 2018).
The behavioural determinants of mental health include resilience and coping skills.
Resilience supports individuals to adapt positive mechanism to deal with stress and mental
illness. The WILD therapy is congruent with addressing the behavioural determinant of mental
illness as it focuses on increasing resilience and increasing emotional expression in mentally ill
youths. The evidence by Kelly (2019) demonstrates that when wilderness therapy is provided to
youth at risk of mental illness, it is associated with build up of resilience skills and developing
the capacity to effective counter negative events in life. This outcome is achieved because the
therapy strengthens the protective factors for youth and provides them the opportunity to learn
ways to deal with stress. For example, the participants in the study by McIver, Senior and
Francis (2018) reported that while controlling the canoe in the river, he learnt to go with the
current and let things take its natural course slowly. The adventure activity reduces present
moment awareness and negativity and increased resilience and level of support.
3.4 Evaluation of system thinking approach
As different socio-ecological factors interact with each other to develop risk of mental
illness, the quality of a health promotion intervention is understood if it adapts systems thinking
approach to resolve the problem. According to Fisher’s system thinking approach, it means
engaging in health promotion through changing the micro, meso and macro environment of
client. The micro environment includes individual and family factors. The WILD bush therapy
addresses the micro factors by giving youths the opportunity to engage in group based adventure
programs. They get the opportunity to develop social bonding and social support during the
process. The program also focused on involvement of participants in program related activities
thus supporting social inclusion (Archer 2017). The meso environment includes regional
structures like health services and community. The WILD therapy modifies the build
environment of youths by delivering a health service to promote mental health. The adventure
therapy is a unique intervention that increases access to accurate mental health and support
service for youths. The macro environment includes changes at the government policy levels.
This may involve community engagement and stakeholder involvement. This value is exhibited

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by the WILD bush program as it focus on involvement of community members and build a sense
of community by involve of members from the community with different level of expertise.
3.5 Suitability of the intervention in promoting health equity or environmental sustainability:
The Wild bush therapy is congruent with environmental sustainability principles as it took all
approach to ensure that natural resources surrounding an individual are appropriately utilized to
promote health and well-being. Through participating in outdoor activities like canoeing and
rock climbing, the intervention taught clients to learn from the activity regarding ways to counter
struggle in life and achieve self-control. The focus on providing therapeutic environment to
youths by exposure to outdoor environment is a strength of the intervention as it promoted
interaction of the individual with their environment (McIver, Senior and Francis 2018). .
Health equity was also promoted by reducing experiences of biases and discrimination. As
the WILD interventions arrange group activities to treat mental illness, it provided opportunities
for creating friendly environment. This increases the scope of all youths to get equal treatment
and increased attention despite poor socioeconomic background. This form of healthy and
friendly environment can alleviate stress and motivate youths to develop trust with health care
system. The intervention minimizes risk of discrimination by increasing community and social
support. When children are ill-treated, it has effect on self-esteem and confidence. It also
increases risk of mental illness. However, focusing on addressing maladjustment, the
intervention is effective in promoting optimal growth and personal development (Gabrielsen and
Harper 2018).
4. Conclusion:
From the evaluation of the WILD bush intervention for mental health and well-being of
young adults using the socio-ecological framework and systems thinking approach, it can be
concluded that the chosen intervention is appropriate as per the demands of health promotion in
the 21st century. The strength of the wild bush therapy is that emphasized on providing new
environment for coping and learning personal skills to counter life stress. The interventions
helped to increase daily living skills of youths and increase opportunity to develop personal
skills, self-confidence and positivity while working with youths at risk of mental illness. The

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intervention can be recommended to the WHO as its core features and activities are congruent
with the three of the five action areas of the Ottawa Charter, principle areas of action, key
determinants of health, promotion of environmental sustainability and engagement in health
promotion interventions. As it works to address both social, environmental, physical and
behavioural aspects of mental illness, the program is congruent with systems approach and
networked response. This intervention can be implemented for high risk youths experiencing
mental problems.

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References:
Archer, R.J., 2017. Wilderness Programs. The Encyclopedia of Juvenile Delinquency and
Justice, pp.1-5.
Brännlund, A., Strandh, M., and Nilsson, K. 2017. Mental-health and educational achievement:
the link between poor mental-health and upper secondary school completion and grades. Journal
of Mental Health, 26(4), 318-325.
Fry, D., and Zask, A. 2016. Applying the Ottawa Charter to inform health promotion programme
design. Health promotion international, 32(5), 901-912.
Gabrielsen, L.E. and Harper, N.J., 2018. The role of wilderness therapy for adolescents in the
face of global trends of urbanization and technification. International Journal of Adolescence
and Youth, 23(4), pp.409-421.
Gabrielsen, L.E. and Harper, N.J., 2018. The role of wilderness therapy for adolescents in the
face of global trends of urbanization and technification. International Journal of Adolescence
and Youth, 23(4), pp.409-421.
Kelly, J., 2019. Influence of Outdoor and Adventure Activities on Subjective Measures of
Resilience in University Students. Journal of Experiential Education, p.1053825919831724.
Liz and Francis Z. 2018, Evaluating WILD: A Bush Adventure Therapy Program 2018, retrieved
15 May 2019, <http://www.each.com.au/wp-content/uploads/2018/06/EACH_WildReport-4-
June-2018.pdf>