Forest-Based Health Practices: Social Representations of Nature and Favorable Environmental Characteristics

Abstract

Forest frequentation is associated with benefits for human health, warranting the importance of forest-based health practices. These practices can be classified into four categories: connection with nature (e.g., Shinrin-Yoku, yoga, and meditation); sports, outdoor, and adventure activities; Indigenous health practices on the land; and professional consultations in a natural environment. The aim of this research was to better understand the social representations of the forest supporting these practices and the environmental characteristics that are favorable to them, as well as to examine the effects of these practices on the forests. We interviewed 28 forest-based health practitioners in Quebec and conducted four participant observation activities. Data analysis led us to five forest representations: an entity in its own self, an unfamiliar area, a place of attachment, a land at the heart of Indigenous cultures, and a tool to improve health. The results showed that favorable environmental characteristics varied according to the type of health practice. The presence of water (e.g., drinking water, lakes, and rivers) is favorable to all forest-based health practices and access to nature seems to be an issue for many practitioners. We also found that forest-based health practices were leaving traces in the forest and attempting to redefine the place of humans in nature.

1. Introduction

Easy access to green spaces (such as forests) close to living environments is linked to higher longevity [1,2,3,4,5,6]. In recent years, the growing body of research on the benefits of forest use for human health has prompted forestry professionals to position themselves in their role as land-use planners in both urban and rural areas. Knowledge of nature’s health benefits has led to the emergence of so-called “forest-based health practices”, which are influenced by the cultures in which they take place [7]. Within these practices, health is considered holistically and includes well-being [8]. Forest-based health practices are situated on a continuum from preventive to curative and can be classified into four categories: (a) practices of connection with nature (e.g., Shinrin-Yoku, yoga, meditation, etc.); (b) sports, outdoor, and adventure activities; (c) Indigenous health and well-being practices on the land; and (d) professional consultations in a natural environment [7]. However, knowledge is lacking regarding which environmental characteristics are favorable to each category of forest-based health practices. Biomedical research on the link between health and forest use [9,10,11] has paid little attention to forest ecosystems themselves, and mostly focused on comparing the reactions of the human body in nonthreatening natural environments and in stressful built environments [12].

Which environmental characteristics are sought by forest-based health practitioners? Do these practices require any specific forest management? What do forest-based health practices tell us about society’s relationships with forest areas, and how do these practices affect these relationships? The primary objective of this research was to determine the environmental characteristics that are considered favorable to forest-based health practices. We interviewed 28 forest-based health practitioners in Quebec (Canada) to document their social representations of the forest. The results allowed us to identify environmental characteristics considered to be favorable, as well as certain challenges related to access to nature. Additionally, the practitioners shared their reflections on the effects of their practices on the forest. We found that the practitioners’ social representations of the forest consider humans as an integral part of nature. To develop and maintain a relationship with nature, practitioners need access to various forest types managed differently.

2. Social Representations of Forests

According to Durkheim, social representations constitute “a vast class of mental forms (sciences, religions, myths, space, time), opinions and knowledge without distinction” [13] (our translation p. 82). In this sense, social representations correspond to collective shared knowledge based on cognitive and affective mechanisms [13,14,15,16,17]. In other words, they are “a form of knowledge, socially elaborated and shared, with a practical aim and contributing to the construction of a reality common to a social whole” [18] (our translation p. 53). Through forest-based health practices, social representations of the forest will be mobilized in this study to better grasp the place of humans in nature, conceived in various ways depending on the discipline. Nature is considered here as a social construct [19], i.e., a reality elaborated through the various interpretations and representations that can be made of it [20,21]. Science contributes to social constructions, notably by proposing representations of the subject/object of research [18,22,23].

Our goal is not to present an in-depth review of the social representations of the forest, but rather to point out that their study requires a dialog between the environmental sciences and the social sciences. There are myriad ways of representing the forest [24]. From a technical perspective, in Quebec, the Dictionary of forestry defines a forest as “a relatively large vegetation assemblage of tree-dominated stands” [25] (p. 448). In an urban context, it includes “trees, forests, and associated organisms that grow near buildings and in gardens, green spaces, parks and golf courses, located in a village, town, suburban, and urban areas” [25] (p. 634). From this perspective, forests can be considered “green spaces”, usually associated with the concept of “nature” [26]. The Western social representations of forest conservation and management generally exclude humans from nature [27,28].

In natural sciences, nature is frequently represented as an ecosystem. The concept of ecosystem services focuses on the benefits that humans can obtain from ecosystems, including forests: provisioning (e.g., food and water), regulation (e.g., floods and droughts), and culture (e.g., recreation, spirituality, and aesthetics) [29,30]. The concept of services to ecosystems [31] has been proposed to counterbalance the discomfort sometimes caused by this utilitarian perspective of ecosystems that maintains the separation of humans from nature [32,33] and the idea that humans benefit unilaterally from ecosystems. Thus, in a reciprocal loop, nature serves humans, and humans in turn can serve nature to maintain balance [32,33].

Social science research has shown how forests can be conceived in a variety of ways: as an object useful to humans; as an antidote to urban life; as a space full of symbols; as somewhere to work; as a place of wilderness or perdition; or as an object of knowledge to be measured, calculated, mapped, segmented, categorized, and monetized [27,28,34,35,36,37,38]. These representations of the forest are not mutually exclusive, and a single person may simultaneously adhere to several of them [32]. The concept of therapeutic landscape, rooted in geography, proposes a conception of nature as a healing place with which people maintain social, physical, and symbolic relationships [39,40,41,42]. This conception is close to Indigenous perspectives, in which humans are an integral part of nature [43]. Nevertheless, within Indigenous peoples, there are multiple representations of forests, and different cultural or age groups do not necessarily share the same visions [44,45]. Indeed, within the same community, the forest may represent a living environment, a medicine, a heritage, and a spirit world [46]. For young Indigenous people living in urban areas, nature can mean a place of calmness, a metaphor ofresilience, and a place of hope [47]. In the Indigenous context, the land can include environments transformed by humans, and the health perspectives linked to the land can be as much transmitted in urban as in remote environments. Land is intimately linked to culture and language [48,49,50]. Although this link has been profoundly affected by colonial history [51,52], it is still very much alive [50,53,54,55].

3. Environmental Characteristics Conducive to Health and Well-Being

The environmental characteristics considered favorable to human health and well-being are difficult to identify. For example, the volatile organic compounds present in forests have positive effects on health [56,57,58], and studies have investigated the beneficial effects of the presence of birds [59,60,61]. The richness of biodiversity in an urban forest ecosystem may have psychological benefits [62,63,64], but a “wild” forest ecosystem would be more beneficial to health than would a managed urban forest [65]. Although health benefits may vary according to the type of environment [66,67,68], not all forest ecosystems are conducive to resourcing [12]. For example, a very dense forest is likely to increase brain activity, stress, and fatigue [12,69,70,71]. For some people, forests evoke fear and disgust [12,41,72]. Nature-related fears can have a negative effect on well-being [41], as well as on forest frequentation. However, it is possible to develop a positive connection with nature at any stage of life [73]. The quantity and quality of natural environments also influence health effects [74]. Thus, ensuring access to a variety of forest ecosystems, ranging from a few trees to a large forest, is important to meet diverse needs [75].

Environmental preferences are an interesting avenue to identify the properties of forests that contribute to human health [41,76,77,78,79]. Nevertheless, studies have produced variable results [80]. For example, environmental preferences may change according to the psychological state and emotions experienced [77,81,82,83,84] or during therapy [83,84]. Conversely, mood can be influenced by the environment [85]. Environmental preferences stem from the social representations of nature and can be influenced by several elements, including connections with nature during childhood, family values, and social norms [41,86,87,88]. They may also differ according to parents’ level of education, the field in which a person has studied, or living in an urban environment [89]. However, cultural differences and individual preferences related to the relationship with nature have thus far received little attention in research on forest health [90]. From the perspectives of public health and land-use planning, it is important to understand the social representations of nature and environmental preferences [91].

4. Methods

To study the interactions between the social representations of the forest and forest-based health practices in Quebec (a province in eastern Canada), we opted for a qualitative approach [92]. In 2022, after obtaining a certificate from the Université Laval’s Research Ethics Board (Approval No. 2022-024/01-03-2022), we conducted semi-directed walking interviews [93,94,95] with forest-based health practitioners, each lasting between 90 and 120 min. The practitioners’ perspective is relevant, as their experiences and links with a diversity of participants make them apt to identify the environmental characteristics ideal for forest-based health practices. To be recruited, practitioners had to operate in Quebec and propose outdoor activities whose main objective is to improve health or well-being. The first participants to be recruited were selected through purposeful sampling among the practitioners who were promoting their practice (e.g., conferences, advertising, etc.) and through a public invitation posted on social media. Snowball sampling allowed us to add further participants. Recruiting lasted until the saturation of information was reached.

Before starting data collection, the interviewer (lead author, Théberge) had experience in sports, outdoor, and adventure activities, in addition to having worked in Indigenous contexts, but these experiences were not specifically related to health practices. Furthermore, one of the co-authors (Bradette) is an emergency doctor and provides training to physicians on interventions in natural and adventure settings. All the interviews were conducted in French and covered a range of topics, including the practitioners’ backgrounds, their representations of health and the forest, and their needs and challenges. Among the 28 interviews conducted, 22 took place outdoors, either in a location close to the practitioner’s home or workplace, or in a place where they usually practice. In addition to enabling us to identify the characteristics of these places, being physically in the forest enabled us to develop a more detailed understanding of their social representations. Through the practitioners’ lens, we also had access to the perspective of the participants on their practices.

Four participant observation activities were also conducted during forest-based health practices or during training sessions for forest-based health practitioners. The lead author (Théberge) participated in two group activities: a Shinrin-Yoku session and a mindful walk. Furthermore, she joined two training activities: one for mental health professionals who wanted to work in closer relation to nature, and the other one in a sports, outdoor, and adventure context for physicians. These observations provided a better understanding of the foundations of forest-based health practices, how they are conducted, and the different forest environments in which they take place. The observations of the dynamics among participants also helped contextualize the testimonies of the practitioners gathered from individual interviews. A partnership was also established with a provincial association of Native Friendship Centres—the Regroupement des centres d’amitié autochtones du Québec (RCAAQ)—whose mission is to act for the recognition of the rights and collective interests of Indigenous people in cities and to ensure that research projects are consistent with the realities and collective principles of urban Indigenous people (https://www.rcaaq.info; accessed on 25 October 2024) [96,97]. Social representations and environmental characteristics conducive to forest health practices were highlighted through a thematic analysis of practitioners’ discourses [98,99,100]. The NVivo software (version 11) was used to codify the interview transcripts. Continuous thematization was conducted inductively through “an uninterrupted process of assigning themes and, simultaneously, constructing a thematic tree” [98] (p. 241, our translation). Themes were first identified, then grouped, merged, and prioritized. The thematic tree was constructed throughout the process, and was fully completed at the very end of the analysis [98]. Notes taken during the participant observation activities were used to triangulate the analysis [101].

5. Results

Table 1. Characteristics of the interwied forest-based health practitioners.

Gender
Women	19
Men	9
Education
University	25
College	1
Main field of study
Health and care	14
Outdoors, physical education, and teaching	6
Environment	2
Other	4
Years of experience in forest-based health practices
<2 y	6
2–4 y	8
5–10 y	6
11–20 y	7
>20 y	1

summarizes the characteristics of the 28 forest-based health practitioners we interviewed. Among them, 19 were women, 8 had more than 10 years of experience working in the forest, and 25 had a university diploma. Only two had environmental degrees. To preserve confidentiality, the practitioners are identified by a randomly assigned number at the end of each quotation.

5.1. Social Representations of the Forest

The forest-based health practitioners’ representations of the forest were divided into five categories which are not mutually exclusive. The first category represents the forest as an entity in its own self, whereby nature is conceived as having its own autonomy. The second category refers to the negative characteristics associated with nature: scary, dirty, and a source of danger. This category contrasts with the last three, which indicate harmonious links between humans and nature: a place of attachment, a land at the heart of Indigenous cultures, and a tool to improve health. Although the perspectives of practitioners working in Indigenous contexts can be found in all the categories of social representations, the uniqueness of their links with the forest warranted a distinct category.

5.1.1. The Forest as an Entity in Its Own Self

The views expressed by the forest-based health practitioners we met show that nature can be considered to have its own autonomy. According to many practitioners, the forest possesses wisdom, consciousness, and intelligence. Some see nature as a “therapeutic ally” (9893) or “a teacher in its own self” (3090) and feel that this entity participates in the activity or is even a caregiver in its own right:

I truly use nature as a coach or therapist who helps you to move forward, to question yourself, to look for answers, to unblock things, to stop being afraid. (…) I don’t see what I should do? OK, I’ll go out and ask nature for my answer.

(1288)

[During] an encounter in a marsh, it was obvious to me that nature was inviting us. Like “your heavy things and your wastes, you leave them there”. (…) I work a lot with metaphors and images. But the fun thing about the forest is that it has (…) its own language and its own symbols. Each place has something different to offer.

(9893)

From this perspective, nature communicates; it can perceive humans and make contact with them:

Because animals know when you’re in another state. I’ve experienced it so often myself, being in harmony (…). Having animals come to see you. I’ve had deer come to see me, birds often.

(4776)

According to the practitioners, nature has a capacity to act. It is not just a decorative backdrop for therapeutic activities but also a part of the interactions. Nature can be represented as an ally, with its own rhythms and intensity, which positions the practitioners in a humble posture. Nature is constantly changing: “It’s a dynamic environment (…) There are lots of things we can’t control”. (0283) This uncontrollable aspect of nature encourages the practitioners to be cautious about risks to physical health. In this sense, it is important to be attentive to nature’s rhythms and to know, for example, how weather systems work:

Being able to foresee what’s coming, even just by looking at the sky, the clouds, a change in wind direction, a change in pressure. It’s all about getting [participants in forest-based health practices] to have better knowledge and understanding, an open mind to all that. Also, to be able to appreciate its power.

(6703)

Appreciating the power of nature was mostly mentioned by the practitioners involved in sports, outdoor, and adventure activities. The forces of nature lead them to perceive the real risks it can generate. A taste for adrenaline can also create a particular relationship with nature:

I was always out in nature, all the time, with expeditions, all the risks there are (…) at some point, it was like too much. It took up too much place. What I finally realized was that my relationship with nature was dysfunctional. It was too intense. It was too much about taking risks.

(5815)

The practitioners mentioned that the various rhythms of nature allow participants to find the intensity that suits them, from contemplation to canoeing down rapids. There is something for everyone. The fact that nature is an uncontrollable entity suggests that frequenting it involves risks, which can also lead to fear and insecurity.

5.1.2. The Forest as an Unfamiliar, Scary, Dirty, and Dangerous Place

The practitioners explained that the forest, particularly in adventurous contexts, is likely to provoke fear in some participants. This fear seems to be linked to primary human needs, such as feeding, sheltering, or feeling safe. “All the fears are there: fear of the dark, fear of animals, fear of lacking food”. (3946) Moreover, the presence of mosquitoes and animals and the idea of becoming dirty can discourage some participants from returning to the forest on their own after a session with a practitioner. The representation of nature as a dirty place annoys some practitioners:

When someone says that wood is dirty… There’s nothing dirty about it! It’s organic matter, and plants grow in it. What’s dirty about it?

(4620)

Wilder environments are more destabilizing. Being far from civilization or alone in the forest can be frightening. For practitioners, some of these fears are caused by a lack of knowledge about nature and by the fact that it is an unfamiliar place: “People are less and less used to being outdoors; in a natural environment. It’s as if it’s become a hostile environment”. (7743)

For example, when we ask [participants in forest-based health practices] to smell humus, it’s like a revelation, whereas… It seems to me that everyone should have put their hands in the soil at some point somewhere. How many times have people gone for a walk in the forest… But in all their lives… they’re 70 years old now, they’ve never stopped to [take the time to] dig under the leaves.

(6390)

Most forest-based health practices encourage people to familiarize themselves with nature. However, fear is not necessarily negative and can encourage caution:

I think it’s quite normal to be afraid in the forest (…). The forest and nature require a bit of vigilance, and I think that’s fine. And for me, fear is part of the nature experience. Not the big scare! Just a little fear of what might happen.

(1154)

In a curative context, some practitioners use fear and exposure to an unfamiliar environment as intervention tools to encourage people to go beyond their limits. Taming one’s fears allows for a different relationship with the forest.

5.1.3. The Forest as a Place of Attachment

Most forest-based health practitioners try to encourage participants to develop a relationship with nature. All the practitioners we met had a certain level of comfort with the natural environment. Some also spoke about a sense of home or a special relationship they have with a place. This relationship can be developed by observing, for example, the transformations over the seasons or meteorological disturbances:

As much as I like this relationship I’ve developed [with this place], it’s because I’ve been here so many times, all winter long. “Oh dear, the river, it went up. It went down. Ah! It’s growing. Oh, the tree has fallen”. It’s becoming my home.

(3761)

They also spoke of the memory of a place, of the links developed with plants or animals. For some practitioners, doing interventions in a place to which they have an attachment allows them to remain in a comfort zone.

I even have an emotional attachment to the places I go (…). It’s places where I felt good. [In my practice], I have to feel good in this environment. It shouldn’t be an unfamiliar place. I have to be completely in my comfort zone. In a way, I’m exaggerating, but I recognize the trees on the campsites.

(7743)

Most practitioners have a childhood attachment to nature. They attended summer camps (as campers or instructors), went into nature on vacation with their parents, or lived near wooded areas. In fact, some of them have now made forests their living place. Therefore, the relationship with nature is not new to them and is not limited to the professional sphere.

5.1.4. The Forest at the Heart of Indigenous Cultures

The practitioners working in an Indigenous context have noted that many young people want to reconnect with the land to have a better understanding of their ancestors’ life.

There are young people who say, “I want to find myself, [to know] how my ancestors lived. I want to find peace. I don’t know how to find peace in nature. I want to find that. I want to experience that feeling”. (…) These young people were discovering themselves and wanted to discover the forest to see where their ancestors walked.

(2613)

Therefore, following the paths of their ancestors in the forest provides an opportunity for self-discovery. The memory of their ancestors also brings strength and inspiration to overcome the difficulties encountered on the land.

When we did the rabaska [big canoe] rides, I thought I wasn’t going to be able to do it. Then, suddenly, I thought of my ancestors who had been there… They were even living with me. Then, I looked at the trees, and I thought: “surely those trees have seen my ancestors pass here too”.

(1023)

Ancestors show the way, not only symbolically but also concretely through the knowledge of the Elders (e.g., about portage trails, departure times, and routes to take according to prevailing winds). Based on their experiences, in-depth observations, and lessons learned from the land, the Elders also teach a way of being in the forest, such as wondering, being open to the senses, being attentive to what is going on all around you, and having an attentive presence. From this perspective, the forest heals, nourishes, and provides food. Furthermore, many Indigenous people have a special bond with animals, and this relationship, sometimes symbolic, can be a part of a healing process. As a place of cultural transmission, the land is a place to heal from the consequences of colonialism, particularly those resulting from residential schools.

There was a great desire to get to know this land among the ex-residents [people having experience residential schools] (…). There was a need to see where the parents had come from, where the grandparents had come from.

(2613)

For some Indigenous practitioners (or those working in an Indigenous context), spending time on the land allows them to be grounded in gratitude and aware of its benefits.

5.1.5. The Forest as a Tool to Improve Health

Most practitioners work in the forest because of their attachment to nature. Many of them began this type of practice after experiencing a difficult time in their lives (burnout, separation, depression, bereavement, etc.). After realizing that the time spent in nature was good for them, many began to take an interest in research on the subject, consolidating their conception of the forest as a place good for health.

In fact, [it is about] going to a forest and being aware that it’s not just a place for recreation and that it has an impact on a lot of things in the body (…) It’s to stop thinking that nature is something completely separate from humans, and that there are humans on one side and nature on the other. And showing that nature is a tool for health.

(1154)

Some places, however, seem more appropriate for certain types of intervention or certain emotions “because every little corner of the forest has its own medicine”. (4776) The representation of the forest as a tool to improve health does not make it an object or a simple background.

Our relationship with nature is often a museum relationship. I’m going to see nature, I’m going to pass along nature, I’m going to look, I’m not going to touch anything, and I’m going to leave as if I were visiting an environment foreign to my natural environment. For me, this dissociation from nature is part of a social problem.

(4776)

Certain practitioners find it difficult to use a vocabulary that moves away from the utilitarian vision of nature, for example, when writing a grant application for forest-based health projects. “I try to get out of this position of saying ‘I use nature for intervention purposes’. It’s a bit oversimplistic”. (7743) To avoid this utilitarian representation of nature, some propose anchoring themselves in gratitude and awareness of their relationship with nature:

If you truly thank [the forest] every time after [a health practice], that’s something else. (…) If [you become aware that] we’re all interrelated, if nature nourishes us, keeps us alive… Well, that immediately puts you in a position of equality.

(6822)

Therefore, even from a perspective where nature is a tool that may seem utilitarian, there is a desire to escape from the pattern of the human–nature division. Symbols, metaphors, comparisons, and analogies are used in forest-based health practices:

[I ask participants] “What do you see in this tree?”. Usually, all the qualifiers they’ll come up with… They’re talking about themselves, but they’re pointing to the tree. It’s less difficult for them. Then, I ask, “Could these words also illustrate how you feel? And what you’re going through?”. That helps them project themselves into something else.

(4776)

Some forest-based health practices, particularly connections, forbid naming the elements of nature (e.g., names of plants or birds). The purpose is to devote the moment to wonder and awareness of the sensory experience. Some practitioners are critical of taxonomy, which can objectify nature and contribute to the division between it and humans. This is “because of the scientific approach, which has been solely cognitive and has treated nature as an object, which has objectified nature”. (1154)

If you put a name to it, if I say: this plant, an ostrich fern (…), I’ve labeled it, so I have given it a name. That means that somehow (…), it’s an object.

(8650)

Very few of the practitioners we met had a university degree in environmental studies, but some had been part of the scouting movement or had taken part in activities that provided “naturalist” knowledge. This kind of knowledge is sometimes used in environmental education activities.

5.2. Environmental Characteristics Conducive to Health Practices in the Forest

As mentioned in Section 2, social representations are articulated to practice and influence the use and development of woodland areas. As such, they are linked to practical needs in terms of places that support these practices. The environmental characteristics favorable to forest-based health practices are summarized in Figure 1. Favorable environmental characteristics were the least ambivalent (fewest yellow circles) for professional consultation practices, whereas Indigenous practices were the most accommodating for a wide range of characteristics. Two table cells are empty because the environmental characteristics have not been addressed by the practitioners we met who work in Indigenous contexts. The presence of two circles in the same cell indicates that this characteristic is preferable most of the time, but this need can change under certain circumstances.

Several practitioners have expressed the need for a variety of ambiences: “What’s important is to have several kinds of ambiences in the forest (…): darkness, light, rock, water, tree”. (1288) Different elements can be used in practice, such as the presence of fields, gardens, mountains, marshes, certain plants or flowers, fauna, rocks, colors, insects, wind, or soil types. Ambience can be characterized not only by the components found in a place, but also by how people feel about it. Sites are generally chosen based on multiple criteria: the number of people present, the objectives of intervention, the health problems of participants, and the type of activity that will be carried out. In Indigenous contexts, a place linked to the home community or territory of the participants can also be a criterion. The ideal location does not seem to exist, and practitioners have no choice but to find compromises: “You have to make compromises between distance, noise, view, visibility, how you can get off the trails, and all that”. (3761)

For sports, outdoor, and adventure practices, approaches to place can differ according to needs:

Sometimes, we’ll have more of a “base camp” approach, settling comfortably and doing activities around it. Sometimes, it’s more an expedition approach.

(0283)

Some practices require a remote location, whereas others can take place in an urban setting. The practitioners are generally flexible regarding choosing locations: “I adapt myself according to the environment I’m invited to”. (2935) However, depending on the type of practice, some prefer a pleasant environment without rain or too many biting insects. These practices take place all year long, no matter the season. A few prefer to wait for pleasant weather, postponing their activity in the case of rain or cold. Others go outside no matter what the weather is: “If you want to do something in nature in Quebec, you shouldn’t wait for good weather (…), maybe if I wait for the perfect day, I’ll never do it”. (2306) More difficult elements of nature can be used in interventions, such as the cold, to nourish reflections. “Our relationship to the cold, our relationship to winter. What can the cold bring to our health? (…) Even if we’re Quebecers, we’re disconnected from the cold. We’re constantly running away from it”. (3761)

5.2.1. Water, Aesthetics, and Tree Characteristics

A virtually unanimous preference among the practitioners is the presence of water. It can be for drinking (particularly useful for long periods in forest-based health practices), it can be used for sports (e.g., canoeing), and it can be mobilized in an exercise:

There’s a Chi-Gong movement that is truly about going to the source of water and the energy of nature, the energy of the sky. So, in the water, with both feet in the water, it’s amazing to do it like that.

(8407)

Water bodies can also be contemplated. The beauty of landscapes is a valued characteristic, especially in sports, outdoor, and adventure activities: “There has to be a little ‘wow’ factor. It can’t just be a quiet little river across the plain with no spectacular visual effects”. (6703) Landscape aesthetics are often associated with an open view: the top of a hill, a view of a lake, etc. In addition to its aesthetic character, an open view can provide a feeling of calmness and openness, which may be appropriate for certain types of intervention:

I know that the person I’m meeting is a bit hopeless (…) we’re climbing a mountain and often, the feeling when we look around [at the top], ah! it’s as if we’re growing from inside.

(2613)

Some practitioners were relatively uncomfortable with the idea of looking absolutely for aesthetic places because it evoked nature as a background:

We’re still in the 17th century in our heads; we’re still in landscape painting. To go and see the landscape unobstructed, profound and the feeling of vastness it brings.

(5815)

Preferences for tree species can change depending on the season. Conifers seem to be more appreciated in winter. Practitioners also mentioned a preference for mature trees: “When you get to a place where you have majestic pines, wow!”. (2306) Trees with special attributes, such as twisted or intertwined trunks, are also perceived as more interesting:

I’m going to ask people: “I’d like you to walk until you find a tree that makes you truly enthusiastic”. The chances of them choosing a straight tree are zero. Generally, they’ll be attracted by weird, crooked trees, and they’ll have an explanation like: “Ah I like it, it looks like it’s twisting or dancing. It’s fully resilient”.

(4776)

Trees are not just looked at, they can also be used for activities such as chopping wood or building shelters. The presence of dead trees can also be useful in forest-based health practices, but not all locations leave them in place:

The [name of park and town], it’s cleaned up (…) because it’s dangerous, it’s not beautiful, it’s not clean (…), but fir trees that are standing, dead standing dried, they start campfires well. But if you don’t have that, because the forest has been cleaned, it’s less interesting. But we certainly use the trails. Otherwise, you work hard to convince people to keep walking.

(3946)

In this sense, the presence of dead wood is associated with a dirty forest, a representation that many practitioners are trying to deconstruct.

5.2.2. Need for Specific Management, Naturalness, and Freedom

It is not only the aesthetics of the landscape that matter, but also the stimulation of other senses, such as smell and sound. However, it is difficult to find areas free of noise pollution. “You asked me about the ideal place. We’re very sensitive to the senses. (…) I can hear the highway here. That bothers me a lot”. (3761) Few accessible locations are free from anthropogenic noise, which worries practitioners because forest-based health practices require a degree of intimacy and quietude. Nonetheless, most practitioners need a relatively managed location, where there are trails and where it is easy to walk, especially for practices that do not involve physical performance. In some more difficult-to-access zones, walkways, ramps, or stairs may be useful, especially for elderly individuals or those with reduced mobility.

We want something comfortable. But I couldn’t see myself doing that on an asphalt trail with lampposts. (…) I love natural types of installations (…) something that’s well thought out in terms of safety, ease and durability (…) Look at the wooden bridge, it’s beautiful, it’s the same color as the trees (…). [Installations] are there to support us, but nature is most important.

(9893)

Facilities must respect the natural character of the site. Shelters, benches, picnic tables, toilets, parking spaces, and clear signage are also helpful. Trail maintenance seems to be a challenge in many places, hindering forest-based health practices. In addition, overregulated areas restrict some activities. For example, there are places where people cannot pick things up from the ground, put their feet in the water, or go off the trails:

I need freedom (…),as many permissions as possible. It means having an area where I can get off the trail, where I can cut a tree, where I can work with nature.

(5815)

There is also a need for more rustic sites, with low levels of infrastructure, where a variety of activities can be carried out, such as camping, fires, or gathering. Some activities, such as orienteering, take place where there are no trails or installations.

Although for some participants in forest-based health activities, urban forests may feel like they are not “real” forests because they are not “wild” or “natural” enough, urban nature is, nonetheless, important to forest-based health practitioners, both for their practice and for the health of the general population.

What I’d like to do is try to estimate the health costs saved by having access to nearby natural spaces. (…) If governments and municipalities were aware of just how much they could reduce [health] costs, social problems, and improve quality of life by having green spaces everywhere (…) Protecting our green spaces. (…) If we were truly aware of the value of a mature tree we’d truly benefit socially.

(4620)

It is not just a question of finding a place that is favorable for practices; participants also need to be able to return autonomously, to go in nature daily, close to where they live. Easily accessible on foot or by bus, the ideal urban park needs to be nearby while simultaneously giving the impression of remoteness.

5.2.3. The Challenges of Access to Nature

Although a few practitioners said that they had no difficulty finding places to carry out their activities, the majority spent a considerable amount of time working on this issue. For example, access to water (e.g., lake or river) is a frequently cited challenge: “When you don’t own a cottage by a lake, it’s difficult”. (9117) Because forest-based health practices are not well known, it is sometimes difficult to obtain authorizations. For example, many cities, municipalities, and protected areas prohibit paid activities in parks, and insurance issues can make things complicated. In addition, it is often difficult to find sites that adequately meet the practitioners’ needs, which can be multiple, as outlined above. To guarantee the privacy of participants, organize group activities, or get off the trails, some practitioners make agreements with private forest owners. However, many private lands have no sanitary facilities. Moreover, many landowners are reluctant to let groups onto their land for fear of being sued in case of injury. On public land, the rules are not well known, and cohabitation with other users can be an issue.

Some professionals are obligated to offer confidentiality to clients, which can be difficult in busier areas. To meet this obligation, different options have been explored by the practitioners, such as having a private closed trail or going to lesser-known places. The feeling of being far from society can bring a particular dimension to forest-based health practices, where the gaze of others becomes less important. Sharing the land with tourists and vacationers seems laborious because it is more difficult for a group to have privacy and confidentiality, especially during sharing sessions when outsiders come to say hello: “You lose the confidential and precious aspect”. (4620)

It can be difficult for participants to go out into nature on their own after a session with a practitioner. Even without returning to the exact place where the practice took place, barriers can be numerous, especially for people with socioeconomic constraints.

Unfortunately, the outdoors is still an environment accessible to the financially well-off. Because they have transportation to get there, because they have money for equipment. I often say that you don’t necessarily need that much specialized equipment to go outside. But there are many socioeconomic obstacles.

(6202)

Furthermore, forest areas are often not accessible to people with reduced mobility. Many would like to see the development of public transport systems to access forests, equipment loans at no cost, and free access to the land: “[Access to nature is] a fundamental right that should never have to be paid for!”. (3090) For Indigenous people living in urban settings, access to nature and to the land is also an issue: “Most [people who attend the Native Friendship Centre] don’t have access to nature, except for those who go to [name of community]”. (2669)

5.3. Effect of Health Practices on the Forest

A more accessible and more frequented territory inevitably raises questions about the consequences of human activities on nature, particularly in relation to waste: “I think that if we make the territories more and more accessible, there needs to be an education that goes with that”. (2935) Notions of environmental protection are integrated into some forest-based health practices. Without always teaching how to protect nature, they encourage the development of a relationship with it that can eventually lead to reciprocity-based behaviors. “If we relearn to be connected to it, to see that it feels good, to find it beautiful… maybe we’ll feel even more like protecting it”. (8099)

For some practitioners, the health of nature and the health of humans are interrelated. “So you can’t have a sustainable development approach if you don’t have a personal development approach”. (1288) Some people do parallel activities to “help” nature, for example, by trying to control invasive species:

We too continue to be janitors of the forest, in other words, to give back to the forest (…), there’s a buckthorn infestation here. (…) It’s choking the soil. [Buckthorn] will [block] all the light. (…) You have to pull them out in spring, when the soil is still soft. We’d like to come with our friends and families [to pull it out] and give back to the forest.

(3761)

This quote shows the importance of reciprocity with nature and developing a relationship with it. Various activities are integrated into forest-based health practices: a moment of silence for nature, writing a message for nature, and becoming aware of the traces left behind. In practices ending with a tea ceremony, there is usually one cup more than the number of people present, which is offered to nature.

The vast majority of the practitioners we interviewed do not tolerate waste being left in nature. Forest-based health practices are usually planned to minimize their consequences on the environment. The most common effects are related to picking up material from the ground, going off the trail, and starting fires. Some practices involve camping, gathering, hunting, or fishing. When the practitioners are asked if their activities have any negative effect on nature, many reply that they apply the Leave No Trace principles (https://leavenotrace.ca/; accessed on 25 october 2024). In addition to the idea of leaving no waste, these principles of environmental ethics suggest, among other things, opting for a portable stove for cooking (instead of starting a fire) or staying on durable and resistant surfaces (trail, bare soil, rock, sand, snow, etc.). However, the Leave No Trace principles are often difficult to apply, for example, in activities where fire plays an important role.

Some activities involve exploring the forest, going off the trail, particularly to create different experiences and feel nature in a different way: “When you arrive [in a place] with ferns up to your waist, people experience something else”. (3761) Moreover, several practitioners feel that the Leave No Trace principles lead to a disconnection with nature. They suggest that if natural environments had not been destroyed so much and if there was more land to frequent, strict Leave No Trace principles might not be necessary. Nevertheless, this virtuous movement seems difficult to criticize openly.

In Indigenous health practices on land, which often involve activities such as hunting, fishing, trapping, and gathering, the Leave No Trace principles are impossible to apply: “Since human beings are part of nature, how can we … leave no trace? This is a major clash between Indigenous people and environmentalists”. (3090) Moreover, this practitioner questions the legitimacy of “teaching leave no trace to Indigenous people who have been excluded from their land for over 400 years”. (3090) Therefore, the issue of protecting the health of the forest highlights two types of representations of humans in nature: one in which human beings should leave no trace and one in which we must address and even assume the traces that humans leave in nature.

6. Discussion

Forest-based health practices embody multiple social representations. Although thinking of the forest as a tool for health may reflect a utilitarian vision, most practices are driven by reflections that attempt to redefine the place of humans in nature. The representation of the forest as an entity in its own self suggests that nature is autonomous and acts on its own. This representation can be associated with agency. Generally attributed to humans, agency corresponds to the ability to act through systemic constraints [102,103]. Agency can also be associated with conscious intention and the ability to imagine [102,103]. Some disciplines (such as ethology [104,105]) and approaches (such as multispecies ethnography [106,107] or anthropology beyond humans [108]) consider a form of agency in the multiple elements of nature, which helps to avoid discrimination between humans and nature [102].

Moreover, in many Indigenous conceptualizations of nature, nonhumans are also endowed with intention and agency [109,110,111,112]. A number of Indigenous groups refer to the notion of Mother Earth in a variety of ways [113,114,115,116]. She can be thought of as an entity that feeds us, teaches us, and takes care of us, which implies reciprocity with the land and a responsibility to protect it (in both urban and “wild” environments). In Nelueun (Innu language of Mashteuiatsh), the word Kanuelitam represents the sacred relationship with the land, as well as the responsibility to take care of it for future generations [117]. In Indigenous contexts, naming elements of nature does not necessarily suggest a detachment from it. On the contrary, it can provide a spiritual connection to the land, encourage a proud sense of identity, highlight knowledge, and contribute to the preservation of Indigenous language and culture [118]. This way of conceiving forests, and more broadly nature, might be conflicting for the natural sciences, whose purpose is the objective study of the elements of nature [109,119]. Thus, the blurring boundaries between humans and nature raise epistemological questions that precede pragmatic issues related to management and access. Without denying the biophysical reality of nature, it remains a social construct that reveals much about how different social groups, including scientists, define themselves in the world [120].

The representations of the forest as a scary place are present in various cultures [37]. The concepts of biophobia (fear of nature) [121,122,123] and ecosystem disservice [124] illustrate how the relationship between humans and nature is not always positive. There are many examples of nature’s seeming disservice to humans: allergies to pollen, diseases, epidemics, natural disasters, animal attacks, etc. [124,125,126]. Practically absent from the international reports of the Millenium Ecosystem Assessment [124], many argue that we should talk more about ecosystem disservices because “Nature sometimes kills us” [127]. However, the dichotomous representation of nature between service and disservice is criticized for its lack of nuance [128]. It would also be appropriate to add to the equation the notion of service to ecosystems [31]. Indeed, some forest-based health practitioners engage in activities that encourage greater reciprocity toward nature, for example, by organizing events to remove invasive plants or by engaging in activities to express gratitude to nature.

Although forest-based health practitioners are aware that nature carries risks and can be frightening, they encourage attachment to natural places. Attachment to a place can be linked to well-being. This theme has been explored in various studies via the notions of sense of place, place attachment, and therapeutic landscape [129,130,131]. Attachment to a place is complex because it involves the symbolic meanings that people attribute to it [132]. Models such as the Recreation Opportunity Spectrum could be used to further integrate the notions of place attachment into land-use planning [131]. In this sense, the environmental characteristics favorable for forest-based health practices may share similarities to those favorable for a spectrum of recreational activities. However, it is difficult for forest-based health practices to share the land simultaneously with other visitors, as these practices require intimacy.

The various environmental characteristics favorable to forest-based health practices (Figure 1) do not seem difficult to find (e.g., water bodies, panoramic views, a variety of ambiences, facilities, and installations that combine well with the natural aspect of the site). Some organizations, such as Shinrin Yoku Québec, identify ideal environmental characteristics to meet their needs: areas at least 10,000 m² in size and trees of various species—at least 5 m high and at least 50 years old [133]. Ambience is also an important characteristic for connection practices. The notion of ambience can be complex to capture because it is not just a list of biophysical characteristics. It is also about what a place feels like. Indeed, a study carried out in an Indigenous context associated the ambience of the land not only with its forest components, but also with its socio-cultural elements [134].

To gain an in-depth understanding of ambiences, we may need to consider the representations associated with the multiple components of a place. For example, in many Indigenous contexts, water can be represented as the blood of Mother Earth and a living force with medicinal properties [113]. Thus, the presence of water creates an atmosphere not only for its biophysical characteristics, but also because of the meaning that the people who frequent the place attribute to it. Ambience can also be created by the absence of certain elements, such as motor noise. Nevertheless, several challenges remain. Finding silent places remains a challenge because it is difficult to control everything that goes on around a natural environment. Practitioners also encourage participants to return to nature on their own. At this point, it is assumed that the environmental characteristics to be preferred will not be exactly the same, probably because the need for space for large groups and the need for confidentiality will be less important. However, accessibility might be a more important aspect to consider.

Some practitioners have insisted that access to nature is unequal and that this environmental injustice has a negative effect on the health of populations [135,136]. Often considered a luxury, access to nature should rather be seen as a right or a necessity [137]. In the case of urban Indigenous populations, research has highlighted the need to create culturally safe environments [47,138]. Access to land can be seen as a determinant of health for Indigenous people [139,140,141,142]. Despite this, throughout colonial history, Indigenous peoples have been uprooted from their land. Their knowledge, values, and relationships with other living beings have been described as superstitions and chimeras, associating them with a savage, rudimentary, unsophisticated way of life [53]. According to Viola Cordova, an Indigenous philosopher from the Jicarilla Apache nation, these peoples would not have survived for millennia on the land if their myths, legends, and traditions did not contain a pragmatic core based on empirical observations of nature [116]. In this way, a closer adequacy between Indigenous knowledge (including their systems of values and representations) and scientific knowledge would perhaps resolve the epistemological challenge posed by nature’s agency.

7. Conclusions

The objective of this research was to determine the environmental characteristics that are considered favorable to forest-based health practices. These characteristics vary according to both activities and participants. Nevertheless, the presence of water seems to be a characteristic appreciated by all. Aesthetic landscapes, tranquility, accessibility, proximity, the presence of facilities, and well-maintained trails are also sought after by many practitioners. Moreover, the freedom of action and the possibility to go off trails are appreciated by a large number of the practitioners interviewed in this research. Their impact on the environment appears to be minimal, and many apply the Leave No Trace principles, although to varying degrees. Still, from a perspective where humans are a part of nature, some practitioners assume the traces they leave behind in an effort to move away from the dichotomy between exploited environments (with human presence) and protected environments (without human presence).

With its focus on forest characteristics, this research contributes to the international literature on forest-based health practices which so far insisted on showing what are the physical and psychological benefits to participants’ health as a part of clinical research protocols. Our research shows how these practices take place and adapt to the assets and constraints of the forest environment. By providing a better understanding of the variety of forest representations held by forest-based health practitioners and the environmental characteristics they rely on, our results provide useful information for forest management.

Because of its qualitative nature, this research was limited to a small number of participants (only a third of which were men) and ecosystems (all in the temperate and boreal forests of Quebec). Nevertheless, several environmental characteristics were highlighted, related to five different representations of the forest and four different types of forest-based health practices. The results also identify a range of needs in terms of forest use and management to ensure relevant and safe practices. Further studies will be needed to assess the transferability of these results to other ecosystems or cultural contexts. Future research could also compare the perspectives of people engaging in forest-based health practices to those of practitioners as described here.

To better understand the effects of various environmental characteristics on the health outcomes of people engaging in forest-based health practices, fine-scale data could be obtained from forest maps and ecological inventories across a large number of sites where forest-based health practices take place, and combined with participants’ profile (e.g., forest experiences, environmental preferences, and therapeutic needs) and biomedical data such as cortisol level or blood pressure. An improved understanding of the link between health outcomes and environmental characteristics would be useful both to health practitioners and forest managers.