Building up bit by bit, parent’s experiences of equine–assisted intervention among children and adolescents with mental illness: a grounded theory study

ABSTRACT

Background

Mental ill health among children and adolescents has increased worldwide. Mental health difficulties from a young age are associated with school absence and educational underachievement. A holistic perspective of treatments besides medical treatment is essential Thus, there is a need for research regarding equine-assisted intervention (EAI).

Purpose

The present study aimed to understand the outcomes of an equine-assisted intervention for children and adolescents with mental ill health from the perspectives of parents and close relatives.

Methods

This study used a qualitative research design informed by Charmaz’s Grounded Theory, with a purposive sample including six in-depth interviews.

Results

The theory “building up bit by bit” was constructed, explaining the recognition that their children/adolescents were built up bit by bit and created a stronger self-identity. The participants referred to changes in the child’s or adolescent’s way of being and emotional regulation, which constituted building blocks leading to the child’s or adolescent’s ^1. increased Harmony. ^2. enhanced Self-identity, and ^3. improved Capability.

Conclusion

Parents and close relatives experienced that their child or adolescent was built up bit by bit and gained a stronger foundation to stand on. This led to increased harmony in everyday life with stronger self-worth, better performance, and reduced school absenteeism.

KEYWORDS:

• Children and adolescents
• equine-assisted intervention
• grounded theory
• mental health
• parents

Acknowledgments

We are grateful to the families who participated in the research and the owner who ran the farm where the intervention occurred.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contributions

Carlsson, IM, and Jormfeldt, H contributed to the conception and design of the study and acquisition of data. Carlsson, IM, and Bräutigam Ewe contributed to the analysis and interpretation of data. All authors wrote the manuscript, were involved in critically revising the article for important intellectual content and gave final approval of the version to be published.

Additional information

Notes on contributors

Ing-Marie Carlsson

Ing-Marie Carlsson is a nurse and a midwife and gained a PhD at Karolinska Institutet, Department of Women´s and Children´s Health, Stockholm, Sweden with the thesis “The movement towards birth: a study of childbirth self-efficacy and early labour”. Since then, Ing-Marie Carlsson has conducted several health science projects focusing on lifestyle interventions and implementation research. Further, she has expertise in the methodology of grounded theory and has also an interest in the research field of health geography. Ing-Marie Carlsson is the head of the Department of Health and Nursing. She also teaches health and healthcare in nursing education at basic and advanced levels.

Marie Bräutigam Ewe

Marie Ewe is an occupational nurse who works part-time in occupational health care. She has previous experience of cardiac care and health promotion projects in primary care with practicing motivational interviewing. She defended her dissertation in 2020 with the thesis, A Prevention and Health Promotion Program for Persons overweight in Primary Health Care- Patients outcomes and Nurses experiences in Terms of weight, lifestyle, health, and Risk Factors at Sahlgrenska Academy, Department of Community Medicine, and Public Health. Since then, Marie has worked as a senior lecturer at Halmstad University as an examiner in the scientific course, health, and lifestyle course at a basic level in the nursing program and at an advanced level in a health and lifestyle program with a focus on health-promoting interventions. Marie has a special interest in qualitative research.

Peter Nymberg

Peter Nymberg is a district nurse and gained a PhD in 2021 at Lund University, Department of Clinical Sciences, Malmö, Sweden, with the thesis “Promoting physical activity and lifestyle changes in primary health care. Interviews, randomized controlled trial and cohort studies examining lifestyle factors and venous thromboembolism.” Since then, Peter Nymberg has had ongoing health science projects with interventions focusing on improving lifestyle habits and mental health among individuals with mental illness, as well as epidemiological studies in the field of cardiovascular disease prevention. Further, he has ongoing research projects in the field of complementary medicine. Peter Nymberg is a senior lecturer at the Department in Health and Nursing and teaches health and healthcare in nursing education at basic and advanced levels.

Henrika Jormfeldt

Henrika Jormfeldt is a registered nurse specializing in mental health care and a professor of nursing at the School of Health and Welfare at Halmstad University, where she is responsible for the master level mental health nursing education and teaches health and healthcare in nursing education at bachelor-, master- and PhD level. Henrika Jormfeldt is the Editor-in-chief of the International Journal of Qualitative Studies on Health and Well-being (QHW), her research area includes the development of outpatient health education and coordinated nursing interventions to promote holistic health among patients with mental illness. Furthermore, the research area includes animal-, nature- and equine-assisted health-promoting mental health nursing interventions. Henrika Jormfeldt is a board member of the HETI (Horses in Education and Therapy International) Executive Committee; she is a member of the research network of the Swedish Organization of Equine-assisted Interventions and holds a certification to perform equine-assisted interventions in mental health nursing.