Health regions in Canada are primarily associated with the rationalization of conventional, historically expensive provincial health care systems. At the same time, it is unclear what contribution health regions make to advancing health system reform, particularly health-promoting activities. This work sets out to understand the relationships between regionalization and health-promoting activity by studying two health regions in Canadian provinces that have different approaches to regionalization (British Columbia and Ontario). I use a constructivist grounded theory methodology (Charmaz, 2006) to analyse data from nineteen key informant interviews with senior management working in the two regional health authorities and in provincial health organizations. The iterative analysis of the empirical data and the review of corporate documents from both regional organizations result in the identification of three core themes grounded in the data. The dominant theme emerging from the analysis is identified as place-making referring to a region’s ability to facilitate health-promoting activity by making the region a place with special meaning and resonance for the populations served. The other two themes are creating space within organizations for health-promoting activity and developing networks. The former refers to a region’s willingness and ability to operationally support health-promoting activity and the latter refers to efforts undertaken to establish relationships with other organizations in the health-promotion and healthcare networks. I conclude that these three themes characterize critical components of a therapeutic region. A therapeutic region suggests a conceptualization of regional health authorities (RHAs) in which priority is given to health-promoting activities, alongside an entrenched curative healthcare agenda (the medical model). A therapeutic region is conceived of as a region that implements policies and develops structures aimed at achieving improvements in the overall health status of the population it serves. In this research I develop a four-cell matrix to frame the theory of therapeutic regions. One axis represents a continuum of place-making, while the second axis reflects a continuum depicting how regions develop the two other themes -- one extreme represents a piecemeal or patchwork approach, and the other an integrated strategic approach. The implications of this research relate to practice and policy. The practice of improving the health of the population served requires regions to open pathways, and remove longstanding barriers by making place-making core to all community engagement and develop health-promoting activity within their organizations and their networks. Policy-makers need to bring clarity to the regions’ role in health-promoting activity. This research indicates that health-promoting activity, innovation and progress occur when a region has the ability to manage both conventional, curative health care and health-promoting activities. Whether that is through direct governance or new ways to bring together decision-making, service co-ordination and evaluation is a subject for future work. / Graduate

Therapeutic landscapes are places that contribute positively to a healing experience or to the maintenance of an individual's health and wellbeing. The literature on therapeutic landscapes has been growing steadily since the early 1990s, but researchers have yet to sufficiently explore both non-Western and gendered perspectives. The research presented in this thesis addresses these two gaps by examining how Kaqchikel men and women in the municipality of San Lucas Tolimán, Guatemala, differ in their construction and use of the therapeutic landscapes that surround them in their daily lives. <br /><br /> This research is broadly informed by feminist thought and methodologies, and the specific strategy of reflexivity was employed throughout the research process. In terms of gathering data, the two specific methods used were photovoice and structured interviews. Photovoice, it is argued, is an ideal method for studying therapeutic landscapes (particularly in a cross-cultural setting) because it gives participants the opportunity to reflect on their therapeutic landscapes before explaining them. The photographs also act as a visual cue that enhances interviews and can also bridge different experiences of reality. In total, 28 key informants were recruited through snowball sampling, with an equal number of male and female participants. Issues of foreign language research and translation are also addressed and some strategies for dealing with working in a foreign language are suggested. <br /><br /> Four main themes emerged from the data, and these themes revealed that Kaqchikel therapeutic landscapes are heavily driven by the poverty and violence experienced by the majority of participants. These four themes were: daily survival, community development, 'escape', and negative landscapes. Through these themes it was shown that the therapeutic landscapes of the Kaqchikel differ greatly between men and women due to traditional gender roles and relationships as well as the disproportional effect of violence on women, which restricts their mobility and ability to access their therapeutic landscapes. Finally, these themes reveal that Kaqchikel therapeutic landscapes span multiple generations and are multilayered, highly dynamic, and contingent on the social, political, and economic climates of the day.

Therapeutic landscapes are places that contribute positively to a healing experience or to the maintenance of an individual's health and wellbeing. The literature on therapeutic landscapes has been growing steadily since the early 1990s, but researchers have yet to sufficiently explore both non-Western and gendered perspectives. The research presented in this thesis addresses these two gaps by examining how Kaqchikel men and women in the municipality of San Lucas Tolimán, Guatemala, differ in their construction and use of the therapeutic landscapes that surround them in their daily lives. <br /><br /> This research is broadly informed by feminist thought and methodologies, and the specific strategy of reflexivity was employed throughout the research process. In terms of gathering data, the two specific methods used were photovoice and structured interviews. Photovoice, it is argued, is an ideal method for studying therapeutic landscapes (particularly in a cross-cultural setting) because it gives participants the opportunity to reflect on their therapeutic landscapes before explaining them. The photographs also act as a visual cue that enhances interviews and can also bridge different experiences of reality. In total, 28 key informants were recruited through snowball sampling, with an equal number of male and female participants. Issues of foreign language research and translation are also addressed and some strategies for dealing with working in a foreign language are suggested. <br /><br /> Four main themes emerged from the data, and these themes revealed that Kaqchikel therapeutic landscapes are heavily driven by the poverty and violence experienced by the majority of participants. These four themes were: daily survival, community development, 'escape', and negative landscapes. Through these themes it was shown that the therapeutic landscapes of the Kaqchikel differ greatly between men and women due to traditional gender roles and relationships as well as the disproportional effect of violence on women, which restricts their mobility and ability to access their therapeutic landscapes. Finally, these themes reveal that Kaqchikel therapeutic landscapes span multiple generations and are multilayered, highly dynamic, and contingent on the social, political, and economic climates of the day.

Master of Landscape Architecture / Department of Landscape Architecture/Regional and Community Planning / Mary Catherine (Katie) Kingery-Page / It is estimated by the Center for Disease Control and Prevention that approximately 1 in every 88 children are diagnosed with some level of autism or various degrees of Pervasive Developmental Disorders (2012). Pervasive Developmental Disorders are commonly referred to as Autism Spectrum Disorders (and hereafter referred to as autism). Many children with autism have difficulty communicating, must cope with their disorder, and may need special considerations in the classroom. Needs of children with autism vary from child to child, but they all can benefit from environments that are designed with awareness of challenges and characteristics associated with autism. Schoolyards commonly contain asphalt, turf, and traditional play structures that do not take into consideration the needs of children with mental or physical disabilities. However, schoolyards can be designed to provide therapeutic benefits on these children without segregating them from the larger school community. In order to understand how a schoolyard might be designed as a therapeutic environment for children with autism the challenges, needs, and common therapies for children with autism must be understood. The characteristics of therapeutic landscapes for children must be considered in addition. After examining both therapeutic landscapes and the many facets of autism, the researcher applied lessons learned to the design of a schoolyard master plan for Amanda Arnold Elementary School in Manhattan, Kansas.

The search for better quality of life is in our human nature. Health and wellness tourism is therefore not a new phenomenon, but the business is growing in modern day society. Our stressful lives and the need to get away from it is one reason for this change. Traveling to a health destination is one way to increase our wellness state. The purpose of this study is to explore what aspects that effects the well-being of visitors of health destinations in the north. Using the theory of therapeutic landscapes as the theoretical framework, this was done by a case study of Källans spa, which is a spa facility in Västerbotten northern Sweden. People come here to get away from everyday life, relax and recharge in a natural environment.   Data collection was collected through interviews with overnight guests at Källans spa. The material has later been analysed using thematic analysis to find connections with therapeutic landscapes. Results show important aspects for well-being in the physical and social environment while well-being aspects from the spiritual environment appear weak.

Research demonstrates that perspectives of health and illness vary by social and cultural context. This has implications for the ways in which people experience and respond to health and illness and becomes particularly important when people face major social and cultural change through migration. This is explored in this study through the relationship between health and place. The location for the study is a Chinese community centre, in which the centre members are first generation migrants from Hong Kong, China and Vietnam, aged 50 and over, who have spent the larger part of their lives living in the UK. The study uses the concept of therapeutic landscapes as an analytical lens through which to explore understandings of health and illness, issues of identity and belonging, and practices of wellbeing as they are enacted outside of formal healthcare settings. As an ethnographic study, the primary means of data collection has been through participant observation. This included regular attendance at the community centre to participate in activities and events over a period of ten months from August 2013 to May 2014. Twenty one formal interviews were also conducted with members of the community centre, the majority in English, and several in Cantonese. The migration stories of the participants in the study are explored as gendered experiences; that is, that the men and women experienced, and spoke about, migration differently. For the women in particular, their experiences of migration were recalled as a time of profound loneliness and isolation. Understandings of health and illness among the centre members are also explored. A shared understanding of health as a holistic and collective concept was expressed. In particular, they spoke about maintaining a positive attitude in the face of difficulties, about their own health in terms of family and social relationships, and the importance of being together and being active. The choices that they make around the use of Chinese and/or biomedicine are also explored within the context of this understanding. The experiences of migration and the understandings of health and illness are further explored through a consideration of the everyday practices, and associated materialities, that constitute the day-to-day life of the centre. These are explored as ways of re-connecting with the past and maintaining a sense of identity, but also as ways of negotiating both continuity and change at the same time. The role of the community centre in the lives of its members, and the ways in which they interact with one another in this particular place, is approached through the concept of therapeutic landscapes. The day-to-day activities, and the ways in which the centre members participate in these are presented as everyday practices of care; as the enactment of a particular understanding of health and wellbeing that helps to create a sense of identity and belonging at the community centre, which in turn contributes to the health and wellbeing of the centre members.

Therapeutic landscapes involve the collaboration of landscape architecture, architecture, planning, and behavioral psychology. By incorporating research from each field and tailoring the design to a generalized special education elementary school, this project aims to create a multisensory experience that incorporates opportunities for play, education, community, and relaxation. Preliminary research explored the history of therapeutic landscapes and architectural design in historical psychiatric facilities, which then led to the current literature on therapeutic design for educational campuses. Findings show that the use of these therapeutic design principles are becoming more common, but there is still room for improvement. The proposed school site is based on the Bedford School in Fairburn, Georgia, but does incorporate the current academic program. The theoretical program for grades 1-6 focuses on cognitive ability, and relies on the outdoor space as an important part of the educational program. The proposed site design includes aromatherapy, tactile therapy, audial therapy, visual therapy, and levels of enclosure. The design will incorporate an open lawn area, a traditional playground, a music area with equipment and instruments, several outdoor classrooms, a produce garden, small, enclosed quiet rooms, a path with seasonal plants and seating areas, and a relocated soccer field. Given the constraints placed on this project, such as time, inability to visit the site, and inability to have discussions with the client, it is as complete as possible. That being said, future advancements in the field may build on it and create a fuller set of guidelines for multisensory therapeutic design. / Master of Landscape Architecture / Therapeutic landscapes involve the collaboration of landscape architecture, architecture, planning, and behavioral psychology. By incorporating research from each field and tailoring the design to a generalized special education elementary school, this project aims to create a multisensory experience that incorporates opportunities for play, education, community, and relaxation. Preliminary research explored the history of therapeutic landscapes and architectural design in historical psychiatric facilities, which then led to the current literature on therapeutic design for educational campuses. Findings show that the use of these therapeutic design principles are becoming more common, but there is still room for improvement. The proposed school site is based on the Bedford School in Fairburn, Georgia, but does incorporate the current academic program. The theoretical program for grades 1-6 focuses on cognitive ability, and relies on the outdoor space as an important part of the educational program. The proposed site design includes aromatherapy, tactile therapy, audial therapy, visual therapy, and levels of enclosure. The design will incorporate an open lawn area, a traditional playground, a music area with equipment and instruments, several outdoor classrooms, a produce garden, small, enclosed quiet rooms, a path with seasonal plants and seating areas, and a relocated soccer field. Given the constraints placed on this project, such as time, inability to visit the site, and inability to have discussions with the client, it is as complete as possible. That being said, future advancements in the field may build on it and create a fuller set of guidelines for multisensory therapeutic design.

Master of Landscape Architecture / Department of Landscape Architecture / Laurence A. Clement, Jr. / Restorative landscapes are a growing trend within health care environments and can have a lasting impact on people if applied within other settings, particularly higher education campuses. Their design captures the many healing qualities of nature that humans are instinctively attracted to (Heerwagen, 2011). Within restorative landscapes, people have been historically found to experience relief of stress, improved morale, and improved overall well-being (Barnes et al., 1999). While campus planning standards do consider the outdoor environment as an extension of the classroom, higher education campuses can do more to utilize the cognitive benefits of nature for students, faculty and staff. This project explores principles and theories of restorative landscape design, empirical psychological research, and campus design to develop a framework that facilitates the creation of restorative campus spaces on higher education campuses. In partnership with the Office of Design and Construction Management at the University of Kansas, the framework was subsequently applied through the design of the landscape for the Center for Design Research on the KU campus. In the context of current campus planning challenges, restorative landscape design is a potentially valuable strategy in strengthening the beneficial roles and efficacy of the campus landscape. This design project explores its application to envision places within a higher education campus that, along with other benefits, relieve stress for students, faculty and staff.

The first paper is a two-phase mixed methods study that explored the relationship among nature connectedness, mental health, and childhood nature experiences in a sample of McMaster undergraduates. Study objectives were twofold: (1) to determine associations between measures of nature connectedness, positive childhood nature experiences, and mental health via an online survey (Phase One); and, (2) to compare, qualitatively, the self-reported childhood nature experiences of students who are more nature connected to those who are less nature connected via in-depth interviews (Phase Two). Quantitative findings from the Phase One survey (N=308) showed that nature connectedness is associated with higher levels of emotional and psychological well-being and also correlates positively with students’ self-recalled positive childhood nature experiences. Thematic analysis of qualitative findings from in-depth interviews held with students (n=12) in Phase Two showed that students who measured relatively higher in nature connectedness recall growing up in the vicinity of accessible, expansive, natural places, and being raised in families that modeled a love for nature and valued shared nature experiences. Overall, findings suggest that positive experiences in natural places growing up may have long-term mental health benefits through fostering a more ecological self. The second paper, an exploratory qualitative study, investigated the types of natural places that McMaster undergraduates consider beneficial to their mental health, and why. Twelve students were invited to photographically document a natural place that they consider mental health promoting. Thematic analysis of photographs and follow-up in-depth interviews revealed that students prefer familiar natural places that contain a variety of natural elements (especially mature trees and some form of water) and are separate from the context of everyday campus life (distanced from both the built and social campus environment). Overall, findings demonstrate the importance of acknowledging symbolic and social factors when assessing the potential mental health benefits of natural places for different groups and individuals. In the third paper, an argumentative essay, we argued that colleges and universities should take nature’s mental health benefits seriously by finding ways to foster student-nature relationships both on their campuses, and in their surrounding communities. We present and describe four geographically informed ways that this might be accomplished: (1) raising awareness; (2) planning for the availability and accessibility of natural spaces; (3) bringing nature indoors, and; (4) using nature-based therapies. While many students may be “bleeding at the roots”, it is not too late to graft them back onto the earth. / Thesis / Master of Arts (MA) / The first paper explored associations among childhood nature experiences, nature connectedness (a measure of the degree to which an individual includes nature in her or his identity), and mental health in McMaster undergrads. Quantitative results showed that positive childhood nature experiences, nature connectedness, and mental health are all significantly related. Qualitative findings showed that students who are more nature connected remember growing up in nature loving families and in the vicinity of expansive natural areas (e.g., a conservation area). The second paper explored the types of natural places that McMaster undergrads consider beneficial to their mental health, and why. Twelve students were invited to visit a favourite natural place and take photographs of it. Qualitative findings showed that students’ prefer familiar natural places that contain a variety of natural elements and are separate from the context of campus life. In the third paper, four strategies that post-secondary institutions can use to connect students with nature are presented: (1) raising awareness; (2) planning for the availability and accessibility of natural spaces; (3) bringing nature indoors, and; (4) using nature-based therapies. While many students may be “bleeding at the roots”, it is not too late to graft them back onto the earth.

This dissertation explores entanglements of body, national identity and nature in contemporary Mongolia. The project is situated within the rising popularity of natural remedies and alternative medicine during a time described as disorganized (zambaraagui) and disorderly. Data was collected from 33 months of fieldwork in Ulaanbaatar and elsewhere, focused on non-biomedical practices and therapeutic landscapes, especially medicinal springs (arshaan) and their sanatoria. This work contributes to studies of post-socialist Mongolia in a few ways. The methodological decision to engage in interview and participant observation of fortunetellers (üzmerch), practitioners of Buddhist and traditional medicine (otoch, ardiin emch), astrologists (zurhaich), energy healers (bio energich), shamans (böö, zairan, udgan), enlightened lamas (huvilgaan) and massage therapists (bariach) was driven by the fluid approach with which patients approach fulfilling the needs of their health and wellbeing. Such fluidity was also echoed in healing practice; as opposed to bounded by strict conceptual distinctions, healers re-purposed personally and culturally-familiar techniques, ranging from biomedical to those of Buddhist medicine (sowa rigpa) to occult practices. Many of the same techniques were practiced by a range of practitioners. The term orthopraxy, commonality of practice across conceptual difference, is used to address this phenomena. Such pairing together of different kinds of therapies – biomedical or otherwise – calls into question a “traditional” vs. modern or neo-spiritual framework within which such practices are often cast. I employ Robbin’s anthropology of discontinuity (2003), suggesting that Soviet influences represented “hard” cultural forms that provided a partial rupture in cultural knowledge between pre-revolutionary society and 1990. Nature (baigal) and natural surroundings (baigal orchin) were concepts often raised when discussing health and wellbeing. “Spiritual” earth and mountain masters (gazariin/uuliin ezed) of estranged homelands (nutag) that cause illness in families relocated to Ulaanbaatar; the water, flora, and mutton from one’s homeland as especially medicinally-suited to the body; shamans empowered to heal by appropriating into their practices the worship of nationally-significant mountains: territorialized national identity represented a prominent trend in healing practices. The revering of a nation through natural landmarks I call national nature, and suggest it be seen both with respect to romantic and utilitarian conceptions of a therapeutic nature that underpinned Soviet medicine, and Soviet indigenization campaigns and the ethnonationalism that was encouraged to flourish in borderland republics. Affective rooting to natural landmarks to maintain or restore wellbeing was also a way to enact Mongol-ness, rendering healing the body at once a practice of national subject-making.