Nature-based interventions have been shown to benefit physical, mental, and social health, yet this promising therapeutic area has not yet been explored within pediatric rheumatology. Such interventions, which range from individual “nature prescriptions” to group gardening programs to viewing images of nature, have been effective among adolescents with mental health illnesses, youth experiencing adverse childhood experiences, and adults with chronic diseases, but limited data exists in youth with chronic illness. Nature-based interventions have not yet been studied as a potential therapeutic tool for youth with rheumatic diseases. We postulate that nature-based interventions can support the health and wellbeing of adolescents with juvenile idiopathic arthritis (JIA) as an innovative therapeutic tool for this patient population.

This proposed study builds on a local pilot project to explore how adolescents with JIA experience nature and how nature engagement could be used in therapeutic intervention. To investigate these questions, in the first part of our study we will conduct in-depth interviews with adolescents with JIA to hear their perspectives on experiences in nature. These interviews will enable identifying barriers and facilitators to nature engagement. In the second part of our study, we will build a multidisciplinary study team that includes JIA patients, with the goal of designing a nature-based intervention likely to be effective among youth with JIA. We will test intervention ideas with additional patient and family partners, who will provide feedback on intervention ideas and help with the design process. At the end of the study, we will have created a patient-centered, nature-based intervention design ready to be tested in a clinical trial. This study will open doors to studying nature-based interventions in other pediatric rheumatic diseases. By prioritizing patient perspectives at every step, this study will also help guide future patient-centered environmental health studies within pediatric rheumatology.