| Older women with osteoarthritis (OA) need effective pain management strategies. Distraction, a strategy known to be effective, may be facilitated through environmental stimuli (specifically, multi-sensory stimuli from nature). The study aims were to explore outdoor symptom experiences of women with OA, compare pain symptom experiences in outdoor spaces with a higher versus lower level of multi-sensory nature (M-SN), describe amount of time spent in higher/lower M-SN spaces by women (based on OA, bodily pain, and functional status), and develop a situation-specific model for future research.;This cross-sectional descriptive study, using Symptom Management Theory as the conceptual framework, involved four retirement community study sites with two outdoor spaces (e.g., a courtyard) measured objectively as having higher/lower M-SN levels. Qualitative (directed content analysis of interview texts) and quantitative (statistical analysis of self-administered survey items) methods were then used. Integration of qualitative and quantitative findings enabled development of a situation-specific model.;Analysis of qualitative data (N=16 women with OA) provided descriptive themes regarding outdoor experiences of older women with OA and uncovered two concepts: Sense of Well-being Outdoors and Person-Environment Relation. However, these data were insufficient to compare OA pain experiences in higher/lower M-SN spaces. Quantitative data (N=276 women with/without OA), analyzed with two-way fixed-effects ANOVA, showed no difference in the amount of time spent in higher/lower M-SN spaces by person factors (OA, bodily pain or functional status) analyzed separately. Exploratory analyses showed that women spent significantly less overall time outdoors if they had OA (p=.03), greater bodily pain (p=.001), or lower functional status (p<.001). Additionally, t-tests demonstrated that women with OA reported spending significantly fewer days outdoors per week ( p=.005), but a similar amount of time outdoors on days when they went outside (p=.27). A situation-specific model of an environment-based pain management strategy for older women with OA, derived from Symptom Management Theory, was developed.;The negative impact of OA on women's overall time spent outdoors and the use of multi-sensory stimuli to distract from OA pain merit further study. Ultimately, this work may lead to strategies for pain self-management involving outdoor environments and evidenced-based design recommendations for senior-living communities. |
