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Case study 3 (CS3) is being conducted in the city of Plovdiv, Bulgaria. It aims to assess the capacity of nature exposure and contact to help build biopsychosocial resilience. Focus is on restorative and capacity building activities and experiences in nature, as well as through healthier metabolic and immune function. This is measured both objectively with remote sensing technology and though a detailed questionnaire.. CS3 is collecting information for a variety of settings, including exposure to nature at home, in the neighbourhood, and in more distal natural areas. The research team in Bulgaria is also considering different forms of exposure, such as passive or active engagement with nature, as shaped by perceived qualities of those settings. Unlike most other case studies in RESONATE, CS3 is looking into habitual nature exposure in people’s daily lives and how this may be supporting their health and pro-environmental behaviours year-round. The study also tests the hypothesis that nature contact could buffer the effects of daily hassles and stress on psychological health.

High interest to participate in the study

The study combines a longitudinal panel survey where we are following about 1500 people from the general population over the course of one year, with a clinical assessment of biochemical, immunological and inflammatory biomarkers measured in blood samples in a smaller sample of about 250 people. An incentive for the participants is that they receive feedback from clinical specialists on their laboratory test results and recommendations in case the results are suggestive of some potentially underlying physiological dysfunction or disease. For instance, we have so far identified several people with subtle or more obvious imbalances in their immune cells, something which they were unaware of. Those participants have been consulted by an immunologist and received expert advice on follow-up examinations and modifications to lifestyle. Interestingly, while initially we were struggling with identifying volunteers for this clinical arm of CS3, once the word got out about the interesting and important data collected, the Bulgarian case study team quickly reached the target sample size and were forced to turn down further volunteers.

Added value for both research and practice

The RESONATE project offers the CS3 team a rare opportunity to overcome many of the limitations of earlier research on this subject conducted in Bulgaria, scarce as it is. This is the first longitudinal study with several follow-ups over time, which will allow researchers to study the causality between observed associations between nature and health. It also brings in objective clinically-relevant health outcomes together with first-person accounts of experiences and perceptions. The hope is that the study will demonstrate the potential of nature to boost resilience and health and will encourage prevention specialists and clinicians in Bulgaria to consider integrating nature-based therapies in the management of health and disease.


Photo of a recent visit of the RESONATE coordinators to CS3. From left to right: RESONATE project manager Julia Egger, CS3 principal investigator Angel Dzhambov, RESONATE project leader Mathew White and CS3 senior social scientist, with case study city Plovdiv in the background. Photo by Sabine Pahl.