An Awareness and Demand Survey on Agro-Healing Among Adults with Symptoms of Stress

Study respondents and survey methods

We conducted an awareness and demand survey on agrohealing to establish the basic data to develop agro-healing programs and improve service quality for the healing of mental health among people with symptoms of stress. A survey was conducted through an online survey platform for a total of 58 days from May 27, 2021 to July 23, 2021, targeting adults in their 20s and 30s showing symptoms of stress. Subjects were recruited by simple random sampling, and the Perceived Stress Scale (PSS) was used to select the people with symptoms of stress. Total 225 copies of the questionnaire were collected, and 42 with omissions or normal PSS results (13 or below) were excluded, leaving total 183 copies to be used in analysis. This study was approved by the Institutional Review Board (IRB) of Konkuk University (7001355-202104-HR-432).

Assessments

To conduct the awareness and demand survey on agrohealing among adults in their 20–30s showing symptoms of stress, we developed a questionnaire with total 23 survey items. The questionnaire is comprised of 3 items on the awareness of agro-healing and the need for policies, 6 items on analysis of agro-healing service demand, 7 items on agrohealing policy service design, and 7 items on demographic data (Park et al., 2017; Lee et al., 2018; Hassink et al., 2017; Bae et al., 2019a).

Detailed items are as follows. The awareness of agro-healing and the need for policies is comprised of ‘awareness’, ‘participation experience’, and ‘need for policy (providing agro-healing program)’. Agro-healing service demand analysis is comprised of ‘intent to participate’, ‘person I want to participate with’, ‘number of times participated (1 year)’, ‘length of stay (each time), ‘number of regular visits (1 month)’, and ‘preference for each type of agro-healing’. Agro-healing policy service design is comprised of ‘evaluation of service use environment’, ‘inconveniences’, ‘shortcomings’, ‘desired effect in service participation’, ‘need to adopt and institutionalize policies’, ‘service charging type’, and ‘priorities in national or local government support’. Demographic data is comprised of ‘gender’, ‘age’, ‘place of residence’, ‘education’, ‘marital status’, ‘occupation’, and ‘PSS’.

Analysis method

We analyzed the descriptive statistics on frequency, percentage, and standard deviation using Excel (Microsoft Office 2020; Microsoft Corp., Redmond, WA) for demographic information of the respondents and data from the awareness and demand survey on agro-healing data collected in this study.

The PSS is a test that measures the level of stress by evaluating the perceived stress experience of the subject in the past month (Cohen et al., 1983; Lee et al., 2012). This test consists of 10 items rated on a 5-point Likert scale. Items 1, 2, 3, 6, 9, and 10 are positive items rated as ‘0 = never, 1 = rarely, 2 = sometimes, 3 = often, 4 = very often’, and Items 4, 5, 7, and 8 are negative items that are reverse coded. The total scores range from 0–40, with higher scores indicating higher levels of perceived stress. Scores of 13 and below indicate normal, 14–16 indicate mild stress, 17–18 indicate moderate stress, and 19 and above indicate severe stress. The Cronbach’s α of the variables used in this study was 0.82, showing a high confidence level.

Perceived Stress Scale (PSS) screening results

This study used the PSS to conduct an awareness and demand survey on agro-healing among adults in their 20–30s showing symptoms of stress (Table 1). As a result of the perceived PSS of total 225 copies of the questionnaire collected, it was found that 18.7% were below 13 points, which is the normal range (N = 225). 20.0% were 14–16, which is the mild stress range. 12.4% were 17–18, which is the moderate stress range. 48.9% were 19 and above, which is the severe stress range. Therefore, 183 copies of the questionnaire were used in the final analysis, with the subjects showing mild stress, moderate stress, and severe stress, excluding the normal range.

Table 1

Perceived Stress Scale (PSS) result (N = 225)

Respondents’ demographic information

This study was conducted on adults in their 20–30s showing symptoms of stress (Table 2). As for gender, 67.8% were women and 32.2% were men. Most (30.1%) lived in Seoul, followed by Chungcheongbuk-do (27.9%), Gyeonggi-do (16.9%), Daejeon (6.0%), Incheon (4.4%), Jeollabuk-do (3.8%), Chungcheongnam-do (including Sejong) (3.3%), Daegu/Gyeongsangnam-do (1.6%), Gyeongsangbuk-do (1.1%), and Busan/Ulsan/Jeju-do (0.5%). For education, 54.6% were high school graduates, 38.8% were college graduates, and 6.6% were graduate school graduates. Most of the subjects were single (95.6%), followed by married/living together (3.8%) and others (0.5%). By occupation, most were students (59.0%), followed by education/professional work (11.0%), general office work (7.7%), production/technical work (5.5%), and sales/business/service work (2.7%).

Table 2

Demographic information (N = 183)

Awareness and whether a policy is necessary of agro-healing

As for awareness of agro-healing, 66.1% responded that they are ‘not aware at all’, and 33.9% responded that they are ‘aware’ (Table 3). Among those who responded that they are ‘aware’, most encountered agro-healing by ‘mass media’ (51.6%), followed by ‘institutions related to agriculture/rural areas’ (19.4%), and ‘agriculture-related events’ (11.3%).

Table 3

Awareness and whether a policy is necessary of agro-healing (N = 183)

According to a previous study, as a result of an awareness survey on agro-healing among agro-healing experts, care farm operators, social welfare experts, and social welfare facility operators, 54.9% responded they are ‘not aware at all’ of agro-healing, and 45.1% responded they are ‘aware’ (Bae et al., 2019a). As a result of surveying whether one has experience participating in agro-healing, 68.7% responded they had ‘no experience’, and 31.3% responded they had ‘experience’ (Bae et al., 2019a). This indicates that the general public awareness of agro-healing is lower than that of experts related to agro-healing. In addition, as a result of an agro-healing awareness survey conducted on 1,302 general citizens in 2015, 46% responded that they are aware of agro-healing, indicating that the awareness of agro-healing is still low even after 6 years of conducting the survey (Park et al., 2017). Therefore, to promote agro-healing in Korea, it is necessary to establish national-level policies or support measures as well as systematic strategies and publicize agro-healing through all kinds of media.

68.3% of the subjects had no experience participating in agro-healing, and 31.7% had experience. Among those who said they have experience, the goals of participating in agro-healing were ‘experience’ (31.0%), ‘education’ (27.6%), ‘leisure’ (20.7%), ‘healing’ (10.3%), and ‘recreation’ (5.1%). Moreover, among those who had experience, 93.1% said they had intention to participate again, and 3.4% said they had no intention. Among those who did not have experience, 82.4% said they had intention to participate in agrohealing, and 17.6% said they had no intention.

In a previous study that examined the purpose of operating agro-healing programs among program operators (Gim et al., 2013), education was the first priority, followed by healing. As a result of examining the purpose of operating agro-healing facility among facility operators, experience was first priority, healing was second, and education was third (Kim et al., 2021). Agro-healing services in Korea are mostly offered for purposes such as experience, education, and healing, whereas Europe provides services for healing and education with different types of agro-healing (① focused on healing to provide healing services for those in need, ② focused on employment aligned with the labor market to offer jobs and specialized training for the socially disadvantaged, and ③ focused on education to meet the educational needs of students). In addition, care farming in Europe is aligned with the labor market to induce employment. As such, each country has a different purpose of agro-healing or care farming, which is why Korea must also discuss the adoption of employment policies in agor-healing (Choi et al, 2021; Gim, 2013; Lee, 2016).

Whether policies are needed to provide agro-healing programs was rated on a 10-point Likert scale, with higher scores indicating that the subject feels a greater policy demand. The survey results showed that the policy demand for providing agro-healing programs was 7.6 points. More specifically, agricultural work healing was 7.1, horticultural therapy was 8.0, forest healing was 8.2, and animal-assisted therapy was 7.6, showing that the policy demand for overall agro-healing intervention was high, especially the policy demand for forest healing and horticultural therapy intervention.

Recently, with regard to agro-healing, advanced countries are actively operating education programs such as R&D, technical support, and expert training focused on agro-healing at the national level. Korea also needs to establish policies to promote agro-healing that creates technological, social, and economic values using various agricultural and rural resources based on the 6^th industries. Accordingly, the Act on Research, Development, and Promotion of Healing Agriculture was established in March 4, 2020 (No. 17100) and has been enforced since March 25, 2021. The purpose of this Act is to contribute to the promotion of people’s health, the improvement of the quality of life, and sustainable growth of agriculture and agricultural communities by promoting agro-healing. The Act specifies policy matters necessary for R&D and promotion of agro-healing such as R&D of agro-healing, diffusion of programs, commercialization, and training of experts.

To train and secure experts in each field based on the type of agro-healing provided in the survey, Article 2, paragraph 4 of the Act on Research, Development, and Promotion of Healing Agriculture specifies the qualifications of a healing agriculture specialist. It is necessary to develop common agro-healing programs as well as specialized programs in each field to actively promote the qualification course for healing agriculture specialists, which will contribute to the growth and development of agro-healing such as development and R&D of agro-healing programs and increase of jobs.

Agro-healing service demand analysis

The intent to participate by type of agro-healing was rated on a 5-point Likert scale, and detailed items were agricultural work healing, horticultural therapy, forest healing, and animal-assisted therapy (Kim, 2019) (Table 4). The survey results showed that agricultural work healing was 3.2, horticultural therapy was 3.8, forest healing was 4.0, and animal-assisted therapy was 3.8.

Table 4

Agro-healing service demand analysis (N = 183)

The person who the subjects wanted to participate in agro-healing activities with were ‘friend or lover’ (47.5%), ‘family’ (27.9%), ‘alone’ (18.6%), and ‘others participating in agro-healing activities’ (6.0%). This is similar to the survey conducted on adults in 2015, showing results such as ‘family’ (63.1%), “friend or lover’ (13.7%), ‘alone’ (10.9%), ‘an ill family member I am taking care of’ (7.5%), and ‘others participating in agro-healing’ (3.6%) (Park et al., 2017).

The number of times the subjects want to participate in agro-healing a year was as follows. For agricultural work healing, 35.5% responded that they wanted to participate once, and 20.8% responded that they wanted to participate twice. For horticultural therapy, 25.1% said they wanted to participate twice, and 18.0% said once. For forest healing, 25.1% said they wanted to participate twice, and 18.0% said once. For animal-assisted therapy, 24.6% said they wanted to participate once, and 17.5% said twice. Therefore, they responded that once a year is most adequate for agricultural work healing and animal-assisted therapy and twice a year for horticultural therapy and forest healing. According to Park et al. (2017) that surveyed the demand for care farms, most of the subjects responded that they wanted to use twice a year, which is consistent with the results of this study. However, the difference is that this study investigated the desired frequency of participation by classifying the type of agro-healing into detailed item. Based on these results, it is necessary to organize various types of agro-healing programs in care farms.

The desired length of stay for agro-healing each time was as follows. For agricultural work healing, 41.5% wanted to spend less than half a day, and 31.7% wanted to spend a day. For horticultural therapy, 48.1% wanted to spend a day, and 35.5% less than half a day. For forest healing, 40.4% wanted to spend 2–4 days, and 29.5% a day. For animal-assisted therapy, 40.4% wanted to spend a day, and 34.4% less than half a day. Therefore, the most desired length of stay by type of agro-healing was less than half a day each time for agricultural work healing, a day for horticultural therapy and animal-assisted therapy, and 2–4 days for forest healing. In the UK, most users of agro-healing want to spend 5 days (Hine et al., 2008). This difference may be due to the fact that, while there are many short-term programs for education and healing targeting the general public in Korea, Europe implements many long-term programs for the socially disadvantaged.

We surveyed the preference for each intervention activity as the basic data for development of agro-healing programs. Main activities for agricultural work healing, horticultural therapy, forest healing, and animal-assisted therapy were selected, and the preference for each was rated on a 5-point Likert scale (Table 5).

Table 5

Preference by type of agro-healing (N = 183)

Agricultural work healing activities were classified into creating an animal breeding environment, carpentry, cleaning around the farm, using and managing mechanical equipment and tools, managing firewood, making processed food, and other creative activities. The preference for each detailed activity was 3.8 points for making processed food and other creative activities, 3.5 points for carpentry, 2.6 points for creating an animal breeding environment and managing firewood, 2.5 points for using and managing mechanical equipment and tools, and 2.0 points for cleaning around the farm.

Horticultural therapy activities were classified into designing vegetable gardens, creating vegetable gardens, cultivating plants, managing vegetable gardens, managing harvested crops, making crafts using plants, and farm party. The preference for each detailed activity was 3.9 points for farm party, 3.7 points for managing harvested crops and making crafts using plants, 3.4 points for cultivating plants, 3.3 points for managing vegetable gardens, 3.2 points for creating vegetable gardens, and 3.1 points for designing vegetable gardens.

Forest healing activities were classified into walking in the forest, meditation in the forest, crafts in the forest, playing in the forest, and yoga in the forest. The preference for each detailed activity was 4.2 points for walking in the forest, 3.9 points for meditation in the forest, crafts in the forest, and playing in the forest, and 3.6 points for yoga in the forest.

Animal-assisted therapy activities were classified into activities with dogs, activities with horses, activities with rabbits, activities with cows/pigs, activities with sheep/goats, catching fish, and insect experience. The preference for each detailed activity was 3.9 points for activities with dogs, 3.4 points for activities with horses, 3.3 points for activities with rabbits, 3.1 points for activities with sheep/goats, 3.0 points for catching fish, 2.8 points for activities with cows/pigs, and 2.1 points for insect experience.

A similar study before had surveyed the preference for virtual care farm programs among general adults and discovered that the preference was highest for making processed food in agricultural work healing, for managing harvested crops in horticultural therapy, for walking in the forest in forest healing, and for activities with dogs in animal-assisted therapy (Koo et al., 2022). This is similar to the results of this study, and the preference for each agrohealing intervention will be used as the basic data in developing agro-healing programs for people with symptoms of stress in the future.

Agro-healing policy service design

Most of the respondents considered that the environment for using agro-healing services was moderate (63.4%), followed by inconvenient (25.7%), convenient (7.7%), and very inconvenient (3.3%) (Table 6). The disadvantages of using agro-healing services were lack of publicity and content (51.4%), lack of accessibility (29.5%), lack of expertise and financial reasons (3.8%), and lack of time (2.2%). What must be improved when using agro-healing services was lack of various promotional contents (73.8%), lack of education and training programs (13.7%), lack of partnership with the government (7.1%), and lack of consideration for the underprivileged (5.5%).

Table 6

Evaluation about agro-healing services use environment (N = 183)

The agricultural powers of Europe have already captured their national situations and needs and are establishing concepts, purposes, and public support policies for agro-healing, which takes up a major part of their agricultural industry (Hine et al., 2008; Di lacovo and O’Connor, 2009; Lee, 2016). Moreover, in the Netherlands, there are regional-level care farm organizations such as the Association of Green Care Farms in most regions, which not only share information or hold workshops but also invite outside experts for advice (Lee, 2016). Most users of agro-healing services in Korea are living in urban areas. However, most care farms have switched from production farms or experience farms to agro-healing (Kim et al, 2021). Agro-healing services are mostly provided in rural areas since they are agricultural activities, making user access difficult (Roesta et al, 2010). Meanwhile, the Netherlands adopted agro-healing in rural areas adjacent to the cities, which led to rapid development (Lee, 2016). Therefore, for agro-healing services in Korea, it is necessary to focus on providing publicity and contents and improving accessibility to care farms.

The expected outcomes of participating in agro-healing services are promoting mental health (71.0%), increasing and leisure and hobbies (15.3%), promoting physical health and social activities (4.9%), and promoting vocational skills and employment opportunities (3.8%). According to Lee (2013), 76.5% (208) of all respondents said they are willing to participate in agro-healing programs to reduce job stress, and most of them seemed to be participating with expectations related to promoting and recovering mental health.

74.3% of the respondents said it is necessary to implement and systemize agro-healing policies, showing that a majority of people felt the need to implement agro-healing policies (Table 7). Agro-healing service charges are covered by individual users or paid by the national and local governments (59.6%), provided by local communities (24.6%), covered by the government (13.7%), and covered entirely by individual users (2.2%).

Table 7

Awareness about haling agricultural policy (N = 183)

Advanced countries in Europe have already clearly set the concept and purpose of agro-healing, establishing public support policies at the national level (Hine et al., 2008; Di lacovo and O’Connor, 2009; Dessein and Bock, 2010). The Netherlands improved accessibility to agro-healing services by implementing a system that includes agro-healing in public medical services and paying the medical fees based on the Exceptional Medical Expenses Act (AWBZ) and Persoonsgebonden Budget (PGB) (Hassink et al., 2014). The service charges for care farms in the Netherlands are covered 60% by subsidies and 20% by the national health insurance, leaving users to pay only about 20% of total charges (Hassink et al., 2007). Belgium is offering 40 euros (€) a day for up to 3 users of care farms at the national level (Goris and Weckhuysen, 2007). The service charges for care farms in the UK were covered mostly by charity (49%) and local governments (33%) (Hine et al., 2008). Therefore, to promote agro-healing in Korea, it is necessary to implement a social security system for agro-healing services as a welfare category and consider expanding the scope of policies so that national health insurance can be applied.

The priorities for national or local government support to promote agro-healing policy services are as follows (Table 8). The first priority (first + second priority) regarding agro-healing policy services was program and content development 29.0% (45.4%), followed by service charge support (including national health insurance) 16.4% (45.9%), establishment of facilities 11.5% (37.7%), and training of agro-healing experts 8.7% (33.7%).

Table 8

Preferred policy priority for revitalizing agro-healing service (N = 183)

As a result of the survey by Bae et al. (2019b) on the priorities of agro-healing policy services, the first priority (first + second priority) was agro-healing program and content development 39.0% (71.6%), establishment of agro-healing facilities 32.3% (63.1%), agro-healing service charge support 16.6% (35.6%), and training of agro-healing experts 11.7% (28.9%) (Bae et al., 2019b). Therefore, the results of this study show that compared to agro-healing experts, the general public tend to feel a greater need for agro-healing service charge support.

The current Act on Research, Development, and Promotion of Healing Agriculture specifies that agro-healing services can be provided by 1. Developing and implementing agrohealing programs, 2. planning and managing agro-healing services, 3. operating and managing agro-healing services, 4. training and managing human resources in agro-healing, and 5. operating and managing agro-healing resources and facilities by nurturing healing agriculture specialists. In this regard, the local agricultural community development promotion agency must actively promote training for capacity improvement targeting the operators of agro-healing facilities so as to enhance the competencies of healing agriculture specialists and align agro-healing with social services for related workers in medical care institutions and special education.

It is necessary to link agro-healing with social services for workers. Moreover, by stably establishing the Act on Research, Development, and Promotion of Healing Agriculture by actively discovering and applying various policies for job creation using experts and making assignment and employment of healing agriculture specialists mandatory for agricultural community development promotion agencies, agro-healing may generate more demands and show higher growth potential when there are social grounds to meet the improved national awareness and social values.