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Peer-reviewedCC BY 4.0Frontiers in Public Health

A multilevel evaluation of the development and implementation of a promotora-led nature-based intervention

  • Shreya S. Aragula1,2,3
  • Anne Saw1
  • Jessica Rodriguez4
  • Yenny Avila Vazquez5
  • Viridiana Gonzalez5
  • Monica Zohar5,6
  • Catherine Game4
  • Dani Abboud4
6 affiliations
  1. 1Chicago Asian American Psychology (CAAP) Lab, Department of Psychology, College of Science and Health, DePaul University
  2. 2Academic Medical Center Department of Psychiatry, Mass General Brigham
  3. 3Department of Psychiatry, Harvard Medical School
  4. 4Health Equity and Nature (HEN) Accelerator, Brushwood Center Ryersonwoods
  5. 5Highwood Library and Community Center (HLCC)
  6. 6Lotus Wellness Center
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Abstract

Background: Latine communities in the U. S. face persistent barriers to mental health care, exacerbated by inequities and trauma, requiring accessible and culturally congruent care. Simultaneously, these communities also possess profound strengths. To address these needs, Transforming Internal Experiences for Resilience and Restoration through Acceptance (TIERRA), an intervention led by Community Health Workers (CHWs, promotoras in Spanish) that combines third-wave cognitive behavioral therapy with Forest Bathing, was co-developed. The purpose of this paper is to detail the collaborative processes of TIERRA’s intervention development and implementation, and to report initial contextual evaluation outcomes.

Methods: The subsequent pilot development and implementation was evaluated using the Practical Robust Implementation and Sustainability Model (PRISM) and the embedded Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to assess capacity building, implementation, and preliminary outcomes.

Results: TIERRA was developed utilizing Community-Based Participatory Research (CBPR) to center local community needs and assets. Its pilot demonstrated high feasibility and engagement (86% completion rate; n = 43). Evaluation of the implementation process revealed strong adoption and sustainability. Contextual evaluation with qualitative insights on effectiveness revealed the cultivation of radical hope, and that healing occurred through individual, interpersonal, community, and environmental pathways. Quantitative effectiveness outcomes showed significant reductions in stress ( p = 0.026) and depression ( p = 0.031), and significant increases in sense of community ( p < 0.001) and sense of belongingness ( p = 0.009).

Discussion: TIERRA is a promising culturally relevant, CHW-led mental health intervention that promotes healing among Latine Americans. This study also shows that intervention development and implementation that centers community participation and attends to cultural contextual factors can build community capacity and is sustainable.

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Cite

BibTeXRIS
BibTeX
@article{aragula2026multilevel,
  title = {{A multilevel evaluation of the development and implementation of a promotora-led nature-based intervention}},
  author = {Shreya S. Aragula and Anne Saw and Jessica Rodriguez and Yenny Avila Vazquez and Viridiana Gonzalez and Monica Zohar and Catherine Game and Dani Abboud},
  journal = {Frontiers in Public Health},
  year = {2026},
  month = oct,
  doi = {10.3389/fpubh.2026.1854138},
  url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1854138/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - A multilevel evaluation of the development and implementation of a promotora-led nature-based intervention
AU  - Shreya S. Aragula
AU  - Anne Saw
AU  - Jessica Rodriguez
AU  - Yenny Avila Vazquez
AU  - Viridiana Gonzalez
AU  - Monica Zohar
AU  - Catherine Game
AU  - Dani Abboud
PY  - 2026
DA  - 2026/10/27
JO  - Frontiers in Public Health
DO  - 10.3389/fpubh.2026.1854138
UR  - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1854138/full
AB  - Background: Latine communities in the U. S. face persistent barriers to mental health care, exacerbated by inequities and trauma, requiring accessible and culturally congruent care. Simultaneously, these communities also possess profound strengths. To address these needs, Transforming Internal Experiences for Resilience and Restoration through Acceptance (TIERRA), an intervention led by Community Health Workers (CHWs, promotoras in Spanish) that combines third-wave cognitive behavioral therapy with Forest Bathing, was co-developed. The purpose of this paper is to detail the collaborative processes of TIERRA’s intervention development and implementation, and to report initial contextual evaluation outcomes.  Methods: The subsequent pilot development and implementation was evaluated using the Practical Robust Implementation and Sustainability Model (PRISM) and the embedded Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to assess capacity building, implementation, and preliminary outcomes.  Results: TIERRA was developed utilizing Community-Based Participatory Research (CBPR) to center local community needs and assets. Its pilot demonstrated high feasibility and engagement (86% completion rate; n = 43). Evaluation of the implementation process revealed strong adoption and sustainability. Contextual evaluation with qualitative insights on effectiveness revealed the cultivation of radical hope, and that healing occurred through individual, interpersonal, community, and environmental pathways. Quantitative effectiveness outcomes showed significant reductions in stress ( p = 0.026) and depression ( p = 0.031), and significant increases in sense of community ( p < 0.001) and sense of belongingness ( p = 0.009).  Discussion: TIERRA is a promising culturally relevant, CHW-led mental health intervention that promotes healing among Latine Americans. This study also shows that intervention development and implementation that centers community participation and attends to cultural contextual factors can build community capacity and is sustainable.
SN  - 2296-2565
ER  -