What is the evidence for the impact of gardens and gardening on health and well-being: a scoping review and evidence-based logic model to guide healthcare strategy decision making on the use of gardening approaches as a social prescription

Developing a research agenda on NATure-based and Animal-assisted Intervention Strategies (NATAIS) in people with neurodegenerative diseases with a specific focus on social isolation and loneliness: a group concept mapping procedure

BACKGROUND

Social isolation and feelings of loneliness are very prevalent in people with neurodegenerative diseases and are associated with a lower quality of life and other negative outcomes. These problems were increased during the COVID-19 pandemic resulting in initiatives to address social isolation. Given the potential benefits of nature-based and animal-assisted intervention strategies (NATAIS), it is crucial to further investigate if and how these strategies might minimize negative effects of social isolation and feelings of loneliness in this population. Therefore, the aim of this project was to develop a research agenda for NATAIS in people with neurodegenerative diseases, especially during challenging times, such as pandemics.

METHODS

This article outlines the process and results of a group concept mapping procedure aimed at developing a research agenda based on a logic model. In total, 19 work group members participated through a combination of in-person and online group meetings. Additionally, face-to-face group sessions were held at two international scientific conferences, during which feedback was solicited from 12 experts in the field of NATAIS and psychogeriatrics.

RESULTS

The group concept mapping procedure resulted in 14 clusters describing various future research topics, which were further refined and detailed during group discussions. The remaining eleven clusters, encompassing important research themes within the field of NATAIS, were organized into a logic model and summarized into the research agenda. The overarching cluster 'ethical issues, possible risk factors, and their solutions' was considered the most relevant during times of increased social isolation, such as during a pandemic, along with the necessity for more accessible NATAIS.

CONCLUSIONS

This project resulted in a research agenda, directing future research and fostering collaboration between practitioners and researchers in the field of NATAIS. Such an enhanced partnership between science and practice has the potential to significantly contribute to the well-being of people with neurodegenerative diseases, in their daily lives and also during pandemics.

Exposure to green spaces and schizophrenia: a systematic review

The mental health benefits of exposure to green spaces are well known. This systematic review summarizes the evidence of green space exposure for people with schizophrenia spectrum disorders (SSDs), focusing on incidence and mental health outcomes, including mental health symptoms and health service use. The study was pre-registered (PROSPERO ID: CRD42023431954), and conducted according to PRISMA guidelines. Seven databases, reference lists, and gray literature sources were searched. Methodological quality was assessed using The Quality Assessment Tool for Quantitative Studies. 126 studies were screened, and 12 studies were eligible for inclusion. Seven studies found that exposure to green space was associated with a reduced risk of schizophrenia (lowest to highest green space exposure: HRs = 0.62-0.37; IRRs = 1.52-1.18), with five studies reporting a dose-response relationship. Of these studies, four examined childhood exposure and the remainder examined adult exposure. Regarding health service use, proximity to green space was not significantly associated with length of hospital admission, though greater green space exposure was associated with reduced hospital admission rates. Three studies found reduced symptoms of anxiety (d = -0.70-2.42), depression (d = -0.97-1.70) and psychosis (d = -0.94) with greater green space exposure. Exposure to green space reduces the risk of schizophrenia, and there is emerging evidence of the potential benefits of green space for reducing symptoms and health service use among people with SSDs. Future research using experimental and longitudinal designs will provide more robust evidence of the benefits of green space for people with SSDs.

A process evaluation of a randomized-controlled trial of community gardening to improve health behaviors and reduce stress and anxiety

As part of the Community Activation for Prevention (CAPS) randomized controlled trial (RCT) of community gardening, we conducted a process evaluation to assess the implementation of a community gardening intervention over nine months, as measured by reach, fidelity (delivery, receipt, enactment), and acceptability. Evaluation instruments included repeated semi-structured interviews with study participants, direct observation of community garden sites, and an exit survey of participants. Primary outcomes were diet, physical activity, and anthropometry; secondary outcomes were stress and anxiety. The CAPS trial included 291 participants (19% non-white; 34% Hispanic/Latino; 35% without a college degree; 58% with income < $50,000 per year). Intervention delivery and receipt were high for environmental supports. Garden social events were offered by 73% of gardens, although only 48% of intervention participants reported attending these events. Of the 145 participants assigned to the gardening intervention, 97 (67%) reported gardening the entire season and reported visiting the community garden a median of 90 min per week (range: 0-840). Of the participants who completed the exit survey (48%), 89% were highly satisfied with the overall garden experience. The CAPS trial was favorably received and implemented with high fidelity, supporting the validity of the trial outcomes. These findings suggest that community gardens are a viable health promotion strategy that can be successfully implemented among new gardeners from diverse backgrounds. Strategies that engage new gardeners in the social aspects of the garden environment and connect gardeners with garden "mentors" or "buddies" to ensure new gardeners achieve success in their first years of gardening are recommended.Trial registration: NCT03089177. Registered 24 March 2017, https://clinicaltrials.gov/study/NCT03089177 .

The Impact of Urban Allotment Gardens on Physical and Mental Health in Norway

In Norway, many communities offer low-rent plots of land on which city dwellers can build summer cottages and grow crops. These allotment gardens serve as recreational escapes from urban life. However, little is known about the impact these gardens have on their members. This study attempts to shed light on today's impact of allotment gardens in a public health setting in Norway. The study was based on 17 semi-structured interviews and 2 in-depth interviews with allotment house owners. Informants were mainly recruited by "snowball sampling". Our data show that maintaining an allotment promotes exercise and provides a positive impact on self-perceived well-being and physical health through outdoor activities. Spending time in the garden contributes to new knowledge and experiences. Owning an allotment garden has provided new knowledge, new skills, new hobbies, and thereby an improvement in lifestyle. The allotment garden has a strong impact on perceived health, well-being, and sense of coherence (SOC) for the individuals. It promotes outdoor activities along with social interaction and can prevent feelings of loneliness and isolation.

Development of the Prevention of Suicide Behaviour in Prisons: Enhancing Access to Therapy (PROSPECT) logic model and implementation strategies

AIMS AND METHOD

This study aimed to develop and articulate a logic model and programme theories for implementing a new cognitive-behavioural suicide prevention intervention for men in prison who are perceived to be at risk of death by suicide. Semi-structured one-to-one interviews with key stakeholders and a combination of qualitative analysis techniques were used to develop programme theories.

RESULTS

Interviews with 28 stakeholders resulted in five programme theories, focusing on: trust, willingness and engagement; readiness and ability; assessment and formulation; practitioner delivering the 'change work' stage of the intervention face-to-face in a prison environment; and practitioner training, integrating the intervention and onward care. Each theory provides details of what contextual factors need to be considered at each stage, and what activities can facilitate achieving the intended outcomes of the intervention, both intermediate and long term.

CLINICAL IMPLICATIONS

The PROSPECT implementation strategy developed from the five theories can be adapted to different situations and environments.

Implementation and Impact of Health Care Gardens: A Systematic Scoping Review

Background: In community and school settings, gardens and garden interventions have been shown to confer several psychosocial, physiological, and nutritional benefits. However, little is known about the implementation and impact of health care gardens on patients, visitors, and staff health and well-being. The primary aim of this review is to identify and describe the types of gardens and common design elements implemented in health care settings and the impact these gardens have on the health and well-being of patients, visitors, and staff. A secondary aim is to assess the quality of available evidence. Methods: PubMed, CINAHL, EMBASE, and PsycINFO were systematically searched on October 28, 2022. Primary qualitative and quantitative studies (excluding case reports and studies) were eligible for inclusion if they described the types of gardens and common design elements implemented in health care settings (hospitals, aged care, rehabilitation facilities, and medical centers) and/or assessed the impact of garden interventions on the health and well-being of patients, visitors, and staff. Review, selection, and data extraction were conducted by two independent researchers, with findings synthesized and presented in narrative form. Articles were critically appraised using the mixed methods appraisal tool (MMAT). Results: Eighteen articles were included. Eight studies provided detailed descriptions of the types of gardens implemented in health care settings (healing [n = 3], therapeutic [n = 2], sensory [n = 2], children's fairy gardens [n = 1], and enriched [n = 1] gardens). Studies examining the psychosocial impacts of gardens were most frequently reported (n = 16), followed by physical (n = 4) and nutritional (n = 2). A wide range of positive outcomes, predominantly relating to patients (n = 12), were reported, including improvements in stress, quality of life (QOL), cognitive function, physical activity, and fruit and vegetable intake. The evidence was heterogeneous and low-medium quality. Conclusions: The findings suggest that implementing gardens and garden interventions in health care settings may positively impact the health and well-being of patients, visitors, and staff. Most studies related to the impact of gardens on patients' mental health and QOL, indicating the need for further research to explore physical and nutritional outcomes, as well as health outcomes of staff and visitors. Findings also suggest the need for high-quality study designs (e.g., cluster control trials) and standardized measurement tools.

Effect of Therapeutic Gardening Program in Urban Gardens on the Mental Health of Children and Their Caregivers with Atopic Dermatitis

This study was conducted to identify the physical and psychological difficulties of children with atopic dermatitis and their caregivers, and to investigate the effects of participation in a novel therapeutic gardening program based on psychological intervention on their physical and mental health. The program, consisting of 15 sessions, was conducted for approximately 4 months in urban gardens in Seoul and involved 30 children with atopic dermatitis and their caregivers. Additionally, a control group of 30 non-participating caregivers was recruited for comparative analysis. The psychological and emotional changes in caregivers were assessed using six self-report scales (depression, anxiety, stress, vitality, life satisfaction, parenting efficacy) before and after participation in the program. Additionally, the depression index (CDI) and atopic dermatitis index (SCORAD, TEWL) were measured for the children with atopic dermatitis. The research results indicate that the therapeutic gardening program utilizing psychological intervention had a positive impact on the physiological and psychological health of participants. These results are significant as they demonstrate the clinical application of the professionally developed therapeutic gardening program through active intervention and operation. This study suggests that this program can serve as an effective intervention in improving the mental health of both children with atopic dermatitis and their caregivers.

A qualitative study of the barriers to commissioning social and therapeutic horticulture in mental health care

BACKGROUND

Social and Therapeutic Horticulture (STH) is a process where trained practitioners work with plants and people to improve an individual's physical and psychological health, communication and thinking skills. Evidence suggests that STH can support individuals with mental ill-health, however, current commissioning of STH within mental health care is limited. This study aimed to understand the barriers to commissioning STH in mental health care and to identify potential solutions to barriers, to support more widespread availability of services.  METHODS: Individuals with a role in mental health care commissioning from across the UK were invited to take part in semi-structured interviews via zoom. Interviews explored factors influencing the mental health services they commission or refer to, their perception of the role of STH in mental health care and the barriers to commissioning STH, together with potential solutions to any barriers identified.

RESULTS

Commissioners identified a lack of knowledge of STH and evidence of its effectiveness, and a culture which prioritises traditional medical models, as barriers to commissioning. Challenges for STH providers in responding to large-scale commissioning requirements were also highlighted as a barrier.

CONCLUSIONS

To upscale commissioning of STH in mental health care, STH interventions need to be embedded within NHS priorities and information on STH services and their effectiveness needs to be easily accessible to practitioners. The sector should also be supported in working collaboratively to enable commissioning of services at scale.

Does urban agriculture contribute to food security, and how might this be achieved?

OBJECTIVE

Food system challenges exacerbate inequalities in access to fresh healthy food and threaten food security. Lack of food security, referred to as food insecurity, is associated with poorer physical and mental health outcomes and has been identified as a key challenge to address by calls for food system transformation. Increasing food production through urban agriculture, the production of fruit and vegetables in urban areas, has been identified as a potentially effective contributor to food system transformation, but the effect of this on household or UK-level food security is unclear. This paper reviews international evidence of urban agriculture's impact on food security.

DESIGN

Narrative review.

SETTING

This paper reviews international evidence of urban agriculture's impact on food security.

PARTICIPANTS

Previously published international research.

RESULTS

Whilst findings are mixed, available evidence suggests that urban agriculture makes a modest, yet positive, contribution to food security by facilitating the availability of and access to fresh fruit and vegetables to food insecure households.

CONCLUSIONS

Capitalising on the potential for urban agriculture to benefit food security requires government investment and support at both the national and local levels; therefore, increasing access to land for food growing, reducing costs of related resources and collaboration with existing community groups to enhance sharing of skills and expertise are identified as avenues for exploration that may help to achieve this. This review also highlights opportunities for future research in this field that may strengthen the quality of the evidence supporting urban agriculture's impact on food security.

The impact of gardening on well-being, mental health, and quality of life: an umbrella review and meta-analysis

BACKGROUND

Gardening and horticultural therapy (HT) has been widely recognised as a multicomponent approach that has affected a broad range of health and well-being outcomes. The aim of this umbrella review and meta-analysis was to compare the findings of previous reviews on the impact of multiple gardening interventions and gardening attributes on different well-being constructs.

METHODS

Electronic databases including PubMed, Web of Science, Science Direct, the Cochrane Library, and Google Scholar were searched from inception to December 2022. Interventional and observational reviews were eligible for inclusion in this umbrella review. Outcome measures included mental well-being, health status and quality of life. The key exposure variables were gardening and horticultural therapy. Narrative synthesis was used to evaluate the overall impact of gardening and HT on study outcomes. For a subsample of studies with available quantitative data, a random effect meta-analysis was conducted.

RESULTS

This umbrella review included 40 studies (10 interventional studies, 2 observational studies, and 28 mixed interventional and observational studies). The reviewed studies reported an overall positive impact of gardening activities on several measures of mental well-being, quality of life, and health status. Meta-analysis showed a significant and positive effect of gardening and HT activities on well-being (effect size (ES) 0.55, 95% confidence interval (CI) 0.23, 0.87, p < 0.001).

CONCLUSIONS

Evidence from observational and interventional studies supports a positive role for gardening and HT activities on well-being and general health. Interventional studies with horticultural-based therapies were effective in improving well-being and quality of life both in the general population and vulnerable subgroups. The high degree of heterogeneity in the included studies cautions against any direct clinical implications of the study findings.

Green spaces and the impact on cognitive frailty: a scoping review

Some literature indicates that contact with green spaces can benefit health and wellbeing, but it is unclear whether this is protective of cognitive health in older people. Using Arskey and O'Malley's framework the aim was to investigate ageing, cognitive frailty and the effects of green access including any causality. The evidence was somewhat inconsistent but suggestive for a beneficial role of green space exposure on cognitive functions. Results suggested that globally, the poorer urban environments are high risk for older people's mental health and these places often lack parks and green spaces. There is evidence that the level of activity and social participation may be greater with access to green spaces and therefore reduces health risks. Green spaces seem to have a role in preventing cognitive frailty, especially for more vulnerable older populations living in poorer urban environments.

Impact of information technology supported serious leisure gardening on the wellbeing of older adults: The Turntable project

OBJECTIVE

The study presented in this paper aimed to assess the effect of an Information Technology enabled community gardening program for older adults, developed by an international consortium.

METHODS

We have executed a quantitative, pre- and post-test field trial with older adult volunteers to test the proposed programme in two European countries, Italy and Belgium (n=98). We used standardized and ad hoc questionnaires to measure changes in the volunteers' mental and psychological state during the trial. The statistical data analysis sought for differences in the pre- and post-test values of the key scores related to the perceived quality of life and benefits of gardening via paired-samples t-tests, and also tried to identify the important factors of significant changes via logistic regression.

RESULTS

We found significant improvements in the perceived benefits of gardening and also in the scores computed from the WHO Quality of Life instruments, especially in the social sub-domains. The improvements were associated with the country, age, marital state and education of the volunteers. Higher age or being widow, divorced or single increased the odds of a significant improvement in the scores in more than one sub-domains.

CONCLUSION

Though the two trial settings were different in some aspects, the observed significant improvements generally confirmed the positive effects of gardening concerning the perceived quality of life and benefits of gardening.

Community Activities in Primary Care: A Literature Review

Community health promotion activities are a useful tool for a proactive approach to healthy lifestyles. However, the implementation of these types of activities at health centers is not standardized. The aim of this review was to analyse the characteristics of community activities undertaken in the primary care setting and substantiate available evidence on their health impact. We conducted a bibliographic review until November 15th, 2023 in the TRIPDATABASE, MEDLINE, EMBASE, and DIALNET databases. We included original papers on interventions, community activities, and actions and/or social prescriptions which had been implemented in a Primary Care setting, included a group approach in at least one session, and described some type of evaluation of the intervention applied. Studies targeted at professionals and those without involvement of the primary care team were excluded. The search identified 1912 potential studies. We included a total of 30 studies, comprising 11 randomized clinical trials, 14 quasi-experimental studies, 1 cohort study, and 4 qualitative studies. The issues most frequently addressed in community activities were healthy habits, physical activity, cardiovascular diseases and diabetes. Community activities can improve the physical and psychological environment of their participants, as well as their level of knowledge about the issues addressed. That said, however, implementation of these types of interventions is not uniform. The existence of a professional community-activity liaison officer at health centers, who would help integrate the health system with the community sector, could serve to standardize implementation and maximize the health impact of these types of interventions.

Current Trends and Future Directions in Urban Social Prescribing

PURPOSE OF REVIEW

Social prescribing (SP) is defined as a non-medical community referral program to support well-being and health. This review explores the current evidence about the effectiveness of SP.

RECENT FINDINGS

This review examined existing SP models that have been or are being tested to connect people to these opportunities through direct and indirect referral schemes. The review identified a fifth model that facilitates a group-based approach used to mental well-being and resilience. While the development of SP largely originates from the UK, the global interest in SP has increased, with over 31 nations reporting elements of SP. The main goal of SP is to better integrate care between the traditional medical setting and resources available in the community and voluntary sectors. Although this review found widespread optimism around SP, there remain concerns about its effectiveness and demands for high-quality evaluations to strengthen the evidence base for SP.

A critical exploration of the diets of UK disadvantaged communities to inform food systems transformation: a scoping review of qualitative literature using a social practice theory lens

The UK food system affects social, economic and natural environments and features escalating risk of food insecurity. Yet it should provide access to safe, nutritious, affordable food for all citizens. Disadvantaged UK communities [individuals and families at risk of food and housing insecurity, often culturally diverse] have often been conceptualised in terms of individual behaviour which may lead to findings and conclusions based on the need for individual change. Such communities face public health challenges and are often treated as powerless recipients of dietary and health initiatives or as 'choiceless' consumers within food supply chains. As transforming the UK food system has become a national priority, it is important a diverse range of evidence is used to support understanding of the diets of disadvantaged communities to inform food systems transformation research.A scoping review of UK peer reviewed qualitative literature published in MEDLINE, CINAHL Plus with Full Text, EMBASE, PsycINFO and Web of Science between January 2010 and May 2021 in English. Eligibility criteria were applied, a data extraction table summarised data from included studies, and synthesis using social practice theory was undertaken.Forty-five qualitative studies were reviewed, which included the views of 2,434 community members aged between 5 and 83. Studies used different measures to define disadvantage. Synthesis using social practice theory identified themes of food and dietary practices shaped by interactions between 'material factors' (e.g. transport, housing and money), 'meanings' (e.g. autonomy and independence), and 'competencies' (e.g. strategies to maximise food intake). These concepts are analysed and critiqued in the context of the wider literature to inform food systems transformation research.This review suggests to date, qualitative research into diets of UK disadvantaged communities provides diverse findings that mainly conceptualise disadvantage at an individual level. Whilst several studies provide excellent characterisations of individual experience, links to 'macro' processes such as supply chains are largely missing. Recommendations are made for future research to embrace transdisciplinary perspectives and utilise new tools (e.g., creative methods and good practice guides), and theories (e.g., assemblage) to better facilitate food systems transformation for disadvantaged communities.

The effects of COVID-19 on Central Florida's community gardens: lessons for promoting food security and overall community wellbeing

For quite some time, food systems scholars, public health workers, and food justice activists have recognized structural problems in the global food system that can cause food insecurity and inequitable access to nutritious foods. The COVID-19 pandemic and the accompanying disruption in food supply chains (FSCs) exposed these problems and raised questions about how community gardening and urban agriculture might offer some solutions. In this article, we examine the effects of the pandemic on the operations of community gardens in Central Florida and the attempts of these gardens to address the disruption in food supplies in their local communities. We do so by using data drawn from two research strategies employed by the members of University of South Florida's Urban Food Sovereignty Group: (1) a survey conducted in 2021 of 45 leaders of community gardens throughout the Central Florida region; and (2) participation in the meetings and activities of a coalition of community gardens based in Tampa, Florida, from 2019 to 2022. Results reveal that although most community gardens in Central Florida were forced to change their routines in various ways (e.g., limiting the number of workers or volunteers who could work at the garden at the same time, or delivering workshops and education programs online instead of in-person), some gardens were able to maintain their regular operations and even reported increases in their membership or participation during the pandemic. Many community garden leaders also recognized the positive effect that community gardening seemed to have on their gardeners' mental health, noting that their gardens became places of refuge for gardeners who sought safe, outdoor spaces, to relieve stress and interact with their neighbors. These same leaders also observed the effect of the pandemic on residents' access to quality food, and intensified their efforts to provide more fresh food to pantries and traditional emergency food outlets. Survey respondents also shared important lessons they learned from the pandemic by suggesting that community gardens establish clear emergency protocols, use existing resources more efficiently, continue their educational programs, and strengthen their communications and cooperation with other gardens and actors in local food supply chains in order to ensure food security. We conclude by suggesting that one of the best ways that local communities can avert future food crises and strengthen their resilience is to root themselves more firmly in the principles of food sovereignty so they can sustain themselves when commercial FSCs are disrupted.

Inspired to Garden: A Qualitative Study of Participants' Experiences in an Academic Medical Center Garden

Introduction Gardening is a healthy activity that promotes nutrition and satisfaction, with positive impacts on patients with chronic diseases, including patients with obesity, diabetes, and cardiovascular disease. Hospital-based gardening programs may provide opportunities to introduce patients to gardening. However, few studies have included participant experience as a metric of evaluation. The objective of this study was to explore participant experience in a hospital-based gardening intervention designed for individuals with metabolic syndrome. Methods This study was a qualitative evaluation of free text responses from four questions included in post-participation questionnaires from 59 community-dwelling adults who participated in a hospital-based garden program located at the University of Vermont Medical Center in 2020 and 2021. Eligible participants included a convenience sample of novice gardeners with self-reported hypertension, diabetes, pre-diabetes, or overweight/obesity. We used an interpretative phenomenological approach to analyze the questionnaire data. The phenomenological cycle for each of the questions included: 1) reading and re-reading participant responses, 2) exploratory noting, 3) constructing experimental statements, 4) searching for connections across statements, and 5) naming the themes. This process also involved working with individual question-level themes to develop group themes across questions. Results This dataset was one of positivity about gardening, new information gleaned, and the quality of instruction. Several themes and codes emerged: program implementation (new knowledge, new skills, new connections, instructor ability, climate), self-efficacy (confidence, vicarious experience, mastery experience, verbal persuasion), and future change (behavior change, future issues/problem-solving, passing it on). Conclusion This study supports analyzing participant experience as part of hospital-based gardening interventions. We found positivity around program implementation, increased self-efficacy, and intentions to change behavior in ways that support healthy lifestyles.

Natural environments, psychosocial health, and health behaviors in a crisis - A scoping review of the literature in the COVID-19 context

The COVID-19 outbreak led to major restrictions globally, affecting people's psychosocial health and their health behaviors. Thus, the purpose of this scoping review was to summarize the available research regarding nature and health in the COVID-19 context. Keywords relating to natural environments and COVID-19 were combined to conduct a systematic online search in six major databases. Eligibility criteria were a) published since 2020 with data collected in the COVID-19 context b) peer-reviewed, c) original empirical data collected on human participants, d) investigated the association between natural environments and psychosocial health or health behaviors, and e) English, German, or Scandinavian languages. Out of 9126 articles being screened, we identified 188 relevant articles, representing 187 distinct studies. Most research focused on adults in the general population and was predominantly conducted in the USA, Europe, and China. Overall, the findings indicate that nature may mitigate the impact of COVID-19 on psychological health and physical activity. Through a systematic thematic analysis of the extracted data, three primary themes were identified: 1) type of nature assessed, 2) psychosocial health and health behaviors investigated, and 3) heterogeneity in the nature-health relationship. Research gaps in the COVID-19 context were identified regarding I) nature characteristics that promote psychosocial health and health behaviors, II) investigations of digital and virtual nature, III) psychological constructs relating to mental health promotion, IV) health-promoting behaviors other than physical activity, V) underlying mechanisms regarding heterogeneity in the nature-health relationship based on human, nature, and geographic characteristics, and VI) research focusing on vulnerable groups. Overall, natural environments demonstrate considerable potential in buffering the impact of stressful events on a population level on mental health. However, future research is warranted to fill the mentioned research gaps and to examine the long-term effects of nature exposure during COVID-19.

Joint associations and pathways from greenspace, traffic-related air pollution, and noise to poor self-rated general health: A population-based study in Sofia, Bulgaria

BACKGROUND

Little is still known of how multiple urban exposures interact as health determinants. This study investigated various ways in which greenspace, traffic-related air pollution, and noise could operate together, influencing general health status.

METHODS

In 2022, a cross-sectional population-based survey was conducted in Sofia, Bulgaria. Included were 917 long-term adult residents who completed questionnaires on poor self-rated health (PSRH), total time spent in physical activity (PA), home garden presence, time spent in urban greenspace and nature, and sociodemographics. Residential greenspace was operationalized using the normalized difference vegetation index (NDVI), tree cover density, number of trees, and access to local greenspace and parks. Nitrogen dioxide (NO₂) was modeled for the study area. Road traffic, railway, and aircraft day-evening-night sound levels (L_den) were extracted from EU noise maps. Area-level income and urbanicity were considered. Analyses included multivariate ordinal regressions, interactions, and structural equation modeling (SEM).

RESULTS

Associations with PSRH were per 0.10 NDVI _300 m: OR = 0.65 (0.42-1.01), home garden: OR = 0.72 (0.49-1.07), per 5 μg/m³ NO₂: OR = 1.57 (1.00-2.48), per 5 dB(A) L_den road traffic: OR = 1.06 (0.91-1.23), railway: OR = 1.11 (1.03-1.20), and aircraft: OR = 1.22 (1.11-1.34). Spending >30 min/week in nature related to better health. In multi-exposure models, only associations with aircraft and railway L_den persisted. People with lower education and financial difficulties or living in poorer districts experienced some exposures stronger. In SEM, time spent in nature and PA mediated the effect of greenspace.

CONCLUSIONS

Greenspace was associated with better general health, with time spent in nature and PA emerging as intermediate pathways. NO₂, railway, and aircraft noise were associated with poorer general health. These results could inform decision-makers, urban planners, and civil society organizations facing urban development problems. Mitigation and abatement policies and measures should target socioeconomically disadvantaged citizens.

Gardening Is Associated With Better Cardiovascular Health Status Among Older Adults in the United States: Analysis of the 2019 Behavioral Risk Factor Surveillance System Survey

BACKGROUND

Gardening benefits health in older adults, but previous studies have limited generalizability or do not adequately adjust for sociodemographic factors or physical activity (PA).

OBJECTIVE

We examined health outcomes, fruits and vegetables (F&V) intake, and 10-year mortality risk among gardeners and exercisers compared with nonexercisers.

DESIGN

Cross-sectional data of noninstitutionalized US adults in the 2019 Behavioral Risk Factor Surveillance System was collected via landline and cellular phone survey.

PARTICIPANTS/SETTING

Adults 65 years and older reporting any PA (n = 146,047) were grouped as gardeners, exercisers, or nonexercisers.

MAIN OUTCOME MEASURES

Outcomes included cardiovascular disease (CVD) risk factors, mental and physical health, F&V intake, and 10-year mortality risk.

STATISTICAL ANALYSES

Summary statistics were calculated and adjusted logistic regression models were conducted to calculate adjusted odds ratios (aORs) and 95% CIs, accounting for the complex survey design.

RESULTS

The sample included gardeners (10.2%), exercisers (60.0%), and nonexercisers (30.8%). Gardeners, compared with nonexercisers, had significantly lower odds of reporting all studied health outcomes and higher odds of consuming 5 or more F&V per day (CVD: aOR 0.60, 95% CI 0.53 to 0.68; stroke: aOR 0.55, 95% CI 0.47 to 0.64; heart attack: aOR 0.63, 95% CI 0.55 to 0.73, high cholesterol: aOR 0.86, 95% CI 0.79 to 0.93; high blood pressure: aOR 0.74, 95% CI 0.68 to 0.81; diabetes: aOR 0.51, 95% CI 0.46 to 0.56; body mass index ≥25: aOR 0.74, 95% CI 0.68 to 0.80; poor mental health status: aOR 0.50, 95% CI 0.43 to 0.59; poor physical health status: aOR 0.35, 95% CI 0.31 to 0.39; 5 or more F&V per day: aOR 1.56, 95% CI 1.40 to 1.57; high 10-year mortality risk: aOR 0.39, 95% CI 0.36 to 0.42). Male and female gardeners had significantly lower odds of reporting diabetes even when compared with exercisers.

CONCLUSIONS

Among adults 65 years and older, gardening is associated with better CVD health status, including lower odds of diabetes. Future longitudinal or interventional studies are warranted to determine whether promoting gardening activities can be a CVD risk reduction strategy.

Enablers and Barriers of Community Garden Use in New Orleans, Louisiana: An Environmental Assessment and Qualitative Analysis

PURPOSE

To explore factors associated with community garden use.

APPROACH

Environmental assessment of community gardens and semi-structured interviews.

SETTING

New Orleans, Louisiana.

PARTICIPANTS

10 community gardens (environmental assessment), 20 community members (including garden users and non-users) and garden administrators (qualitative interviews).

METHOD

Gardens were assessed based on (1) accessibility, (2) information, (3) design, (4) cleanliness, (5) walkability, (6) parking, and (7) noise. Semi-structured interviews took place over Zoom; transcribed interviews were analyzed using thematic analysis.

RESULTS

Gardens assessed in the environmental assessment ranked high in design and cleanliness but low on accessibility and information availability. Salient themes from the qualitative interviews include skill-building, access to fresh foods, and increased social engagement as enablers of community garden participation, with availability of information and time as both potential enablers of, or barriers to, participation. Community members perceived that gardens could increase fresh food access, while administrators believed that it is not possible for community gardens to produce enough food to create community-wide impact, highlighting instead the importance of the social aspects of the garden as beneficial for health.

CONCLUSION

Community gardens should improve garden physical accessibility and information availability to incentivize use. Community gardens are valued as means for skill-building and social engagement. Future research should prioritize investigating the association between the social aspects of participating in community gardens and health outcomes.

Acceptability and Feasibility of Community Gardening Interventions for the Prevention of Non-Communicable Diseases among Indigenous Populations: A Scoping Review

Compared with non-Indigenous populations, Indigenous populations experience worse health across many outcomes, including non-communicable diseases, and they are three times more likely to live in extreme poverty. The objectives were to identify (1) the content, implementation, and duration of the intervention; (2) the evaluation designs used; (3) the outcomes reported; and (4) the enablers and the challenges. Using the PRISMA-ScR guidelines, a search of research databases and grey literature was conducted. Seven studies met the inclusion criteria. Papers reported on acceptability, nutrition knowledge, fruit and vegetable intake, self-efficacy, motivation, and preference concerning fruit and vegetable, diet, and gardening. No study measured all outcomes. All papers reported on acceptability, whether implicitly or explicitly. The evaluation used mostly pre- and post-intervention assessments. The effect of gardening on nutrition and gardening knowledge and fruit and vegetable intake was inconclusive, and was related to a general lack of robust evaluations. Applying the He Pikinga Waiora Framework, however, revealed strong evidence for community engagement, cultural centeredness, integrated knowledge translation and systems thinking in increasing the acceptability and feasibility of gardening in Indigenous communities. Despite environmental challenges, the evidence signaled that gardening was an acceptable intervention for the Indigenous communities.

Therapeutic Community Gardening as a Green Social Prescription for Mental Ill-Health: Impact, Barriers, and Facilitators from the Perspective of Multiple Stakeholders

The UK government has invested £5.77 million in green social prescribing to prevent and tackle mental ill-health. Therapeutic community gardening, one type of green social prescription, provides a range of health outcomes. However, for increased accessibility, a greater understanding of how it impacts mental health and the facilitators and barriers to referral, uptake, and attendance by individuals with mental health problems is required. We conducted and thematically analysed interviews with thirteen stakeholders including social prescribing link workers and garden staff; and focus groups with twenty garden members. The mechanisms by which therapeutic community gardening were suggested to impact mental health were by engaging members with nature and the outdoors, providing hope for the future and facilitating social support and relationships. Factors facilitating referral, uptake, and attendance included a holistic and person-centred approach, which is flexible around health needs. Barriers included awareness of the full offering of therapeutic community gardens and accessibility, in terms of physical location and waiting lists. Given that nature-based interventions have the potential to protect and enhance population health and offer cost savings through reduced reliance on other health services; overcoming these barriers is key to ensuring that therapeutic community gardening is more widely available as an additional mental health treatment.

The Impact of Therapeutic Community Gardening on the Wellbeing, Loneliness, and Life Satisfaction of Individuals with Mental Illness

BACKGROUND

literature on the mental health benefits of therapeutic community gardening is not specific to individuals with mental illness and reports short-term outcomes. The impact of the coronavirus pandemic on intervention effectiveness is also unknown. This study examined the impact of therapeutic community gardening prior to and across the pandemic on the wellbeing of individuals referred for support with their mental illness.

METHODS

garden members (n = 53; male = 36, female = 17) aged 47.38 ± 13.09 years reported their wellbeing at baseline and four follow-up points (FU1-FU4) across the pandemic.

RESULTS

there was significant quadratic growth in wellbeing (-1.248; p < 0.001) that varied between genders (p = 0.021). At baseline, male wellbeing scores were significantly lower (p = 0.020) than the UK population norm, but there were no significant differences at any other follow-up point. Female wellbeing was significantly lower than the UK population norm at baseline (p < 0.001), FU1 (p = 0.012) and FU2 (p < 0.001), but not FU3 and FU4.

CONCLUSION

therapeutic community gardening can improve and maintain the wellbeing of individuals with mental illness, even when wellbeing is deteriorating nationally. Future research should further demonstrate the long-term and cost-effectiveness of interventions.

Holistic approach to assess the association between the synergistic effect of physical activity, exposure to greenspace, and fruits and vegetable intake on health and wellbeing: Cross-sectional analysis of UK Biobank

Background

Urban agriculture has been shown to contribute to healthy lifestyle behaviors, such as increased fruit and vegetable intake and greater exposure to greenspaces and there is plenty of evidence linking these lifestyle behaviors to better health and wellbeing. However, most evidence relates to assessing one behavior at a time despite available epidemiological research showing how the combined effects of multiple behaviors are associated with health and wellbeing. This research aims to examine the association of the interactions between various lifestyle behaviors and exposures related to urban agriculture and health and wellbeing.

Methods

We used data from the UK Biobank baseline questionnaire (N~500, 000) to assess the association of two lifestyle behaviors (fruit and vegetable intake and physical activity) and greenspace exposure, with four health and wellbeing markers (blood pressure, BMI, self-health assessment, and self-reported loneliness) independently, and in combination. Associations between lifestyle behaviors, greenspace exposure, and the possible interactions with health and wellbeing were explored using general linear models (GLMs), adjusted for socio-demographic confounders including age, sex, educational qualifications, index of multiple deprivation, and ethnicity, and a lifestyle confounder: smoking status.

Results

After removing missing data, as well as participants who did not meet the inclusion criteria, the final study sample was n = 204,478. The results indicate that meeting recommended levels of the World Health Organization (WHO) for fruits and vegetable intake, and the advice from the UK Chief Medical Officer for physical activity, is linked to better health and wellbeing markers. We found that UK Biobank participants who lived in greener areas and were physically active were more likely to feel alone and think their health was poor. Participants who were physically active and met the recommended intake of fruits and vegetables were more likely to have healthy blood pressure, feel less lonely, and rate their health as good. Evidence of three-way interactions was weak, and mostly was not associated with the health and wellbeing markers assessed here.

Conclusion

Taken in combination, healthy diets, physical activity and exposure to greenspaces are associated with health and wellbeing. In some cases, these effects are synergistic, indicating associations above and beyond the mere additive effect of the behaviors considered independently. Promoting such behaviors together, for example, through urban agriculture, is therefore more likely to generate greater public health changes than if they are promoted through independent policies and programs. Inter-relationships between these pathways and different health and wellbeing markers, however, are complex, and require further investigation to understand optimal environments and conditions for urban health promotion.

An international qualitative feasibility study to explore the process of using social innovation (co-production) strategies with older people: the SAIL project

Purpose

This paper aims to present the feasibility study findings from a four-year project funded by the European Union Commission (the SAIL project, Staying Active and Independent for Longer). The funding stream was Interreg 2Seas which offers opportunities for coastal areas on both sides of the English Channel to work together on complex practical issues. The project focused on enabling older people to stay active and independent for longer using social innovation (co-production) approaches.

Design/methodology/approach

Ten pilot projects were developed, and each of the pilots worked with an academic partner to undertake a feasibility study that included 10 pilots across the four countries involved, France, Belgium, Holland and England.

Findings

This paper presents barriers and facilitators (using logic models) to the social innovation process with older people, which has wider relevance in terms of social innovation and its application.

Research limitations/implications

The findings which inform this paper are extensive, and this is a longitudinal qualitative study with much of the data collection being done using an online wiki (complemented by interviews and documentary analysis) which is a relatively new method for data collection. However, the consistency of the findings when analysed by three researchers was clear and pragmatically this complex method was required to examine complexity in the process of implementing social innovation in practice.

Practical implications

This project has enabled greater understanding of how social innovation can be applied and has highlighted contextual issues that can undermine or enable attempts to adopt the approach.

Social implications

For the 10 pilot projects generated, there were obviously important cultural and geographical differences in terms of engagement and practical implementation of social innovation. Some of which, as mentioned in this paper, are very important for the successful implementation of social innovation in a particular setting and indeed may be a strength or a barrier in terms of engaging with local people and agencies.

Originality/value

The development of logic models is a useful approach when the topic under study is complex and likely to produce a diverse set of process outcomes. The logic model focuses upon the relationships between the resources that are used to create the intervention and what is produced in terms of outcomes. Ultimately, this enables the identification of the factors that contribute to a successful intervention. Thus, in relation to this study, logic models have helped to provide an evidence-based framework that can support decision-making regarding the most effective use of limited resources to support successful social innovation processes in the future. The logic model for each area of the findings presented here can in the future be used to help implement social innovation; also, to consider how it can be improved in future research.

The effectiveness of group-based gardening interventions for improving wellbeing and reducing symptoms of mental ill-health in adults: a systematic review and meta-analysis

BACKGROUND

There is increasing interest in the association between nature, health and wellbeing. Gardening is a popular way in which interaction with nature occurs and numerous gardening projects aim to facilitate wellbeing among participants. More research is needed to determine their effectiveness.

AIM

To systematically evaluate the effectiveness of group-based gardening interventions for increasing wellbeing and reducing symptoms of mental ill-health in adults.

METHODS

A systematic review of Randomised Controlled Trials was conducted following the protocol submitted to PROSPERO (CRD42020162187). Studies reporting quantitative validated health and wellbeing outcomes of the community residing, adult populations (18+) were eligible for inclusion.

RESULTS

24 studies met inclusion criteria: 20 completed and four ongoing trials. Meta-analyses suggest these interventions may increase wellbeing and may reduce symptoms of depression, however, there was uncertainty in the pooled effects due to heterogeneity and unclear risk of bias for many studies. There were mixed results for other outcomes.

RESEARCH LIMITATIONS/IMPLICATIONS

Heterogeneity and small sample sizes limited the results. Poor reporting precluded meta-analysis for some studies. Initial findings for wellbeing and depression are promising and should be corroborated in further studies. The research area is active, and the results of the ongoing trials identified will add to the evidence base.

Experiences of Health-Promoting Activities among Individuals with Knee Pain: The Halland Osteoarthritis Cohort

Knee pain is an early sign of knee osteoarthritis (KOA) and a risk factor for chronic widespread pain (CWP). Early prevention is vital, and more research is needed to understand health-promoting activities for individuals with knee pain from a patient perspective. This study aimed to explore how individuals with knee pain experienced health-promoting activities. Explorative qualitative design with inductive approach was applied to explore the experiences of 22 individuals (13 women, 9 men; median age: 52). Semi-structured interviews were conducted and analysed using latent qualitative content analysis. The results revealed health-promoting activities in individuals with knee pain and were interpreted in the overall theme, striving for balance in everyday life. Two categories explored the content in health-promoting activities: (1) Caring for the body-being physically active, having a healthy diet, and utilising support; and (2) Managing life stressors-allowing for recovery, promoting vitality, and safeguarding healthy relationships. In conclusion, individuals with knee pain described various health-promoting activities. They strived for balance in everyday life by caring for the body and managing life stressors. We suggest that a broader approach to everyday life can be helpful in treatment plans and health promotion to manage and prevent KOA and CWP, while striving for a healthy lifestyle.

A present from the forest: Focus group interviews on cancer survivors’ forest experiences

Objective

To explore cancer survivors' forest experiences and to understand the relevance of these experiences from their perspectives in the context of the growing interest in nature's impact on health and quality of life.

Methods

From July 29 to August 12, 2021, four focus group interviews were conducted with cancer survivors who visited forests in South Korea. The data were analyzed using qualitative content and thematic analysis.

Results

The participants were 21 female cancer survivors with a mean age of 58.4 (age range 44–69) years. The focus group interviews revealed three themes and 10 sub-themes regarding subjective perceptions and experiences related to forests. The overarching themes were as follows: (1) awakened bodily senses and fascination with the forest; (2) remedial effect; and (3) a source of inspiration. These three themes capture the impact of forest experiences on participants’ lives and the value they derived from these experiences. The participants considered these experiences a gift from forests. In particular, they experienced aesthetic enrichment and restorative effects such as boosted energy levels, reduced fatigue, and a buffer against mood swings. Finally, forests were a source of inspiration that led the participants toward personal growth.

Conclusions

By gaining a better understanding of survivors' forest experiences, we identified that forest-based interventions for supportive cancer care can align with patients’ values and preferences and serve as a secure space where they can feel cared for. This study can contribute to the development of forest-based interventions for cancer survivorship care.

•

Cancer survivors experienced awakened bodily senses and fascination with the forest.

•

Cancer survivors realized the remedial effects of forests.

•

Forests also became sources of inspiration for cancer survivors.

•

These results can contribute to the development of forest-based interventions.

Experiences of gardening during the early stages of the COVID-19 pandemic

Gardening has the potential to improve health and wellbeing, especially during crises. Using an international survey of gardeners (n = 3743), this study aimed to understand everyday gardening experiences, perspectives and attitudes during early stages of the COVID-19 pandemic in 2020. Our qualitative reflexive thematic and sentiment analyses show that during the first months of the COVID-19 pandemic, gardening seemed to create a safe and positive space where people could socially connect, learn and be creative. Participants had more time to garden during the pandemic, which led to enhanced connections with family members and neighbours, and the ability to spend time in a safe outdoor environment. More time gardening allowed for innovative and new gardening practices that provided enjoyment for many participants. However, our research also highlighted barriers to gardening (e.g. lack of access to garden spaces and materials). Our results illustrate the multiple benefits of gardening apparent during COVID-19 through a lens of the social-ecological model of health.

Mental health clinicians' perceptions of nature-based interventions within community mental health services: evidence from Australia

BACKGROUND

Mental health conditions are one of the largest burdens of disease in Australia and globally. There is a need to seek innovative and alternative interventions that can prevent and alleviate mental health symptoms. Nature-based interventions (NBIs), namely programs and activities where individuals engage with natural environments with the aim of improving their health and wellbeing (e.g., nature walking groups), may be such an alternative. This study aimed to explore the perceptions of mental health clinicians on the potential benefits of, and barriers to, implementing NBIs within a community mental health setting.

METHODS

This study used a qualitative, exploratory research design. Fifteen mental health clinicians were recruited from the Illawarra Shoalhaven Local Health District, Australia, and interviewed (September-October 2021) about their perceptions of NBIs within mental health settings. The semi-structured interviews were analysed using an inductive thematic approach and managed with NVivo.

RESULTS

Mental health clinicians viewed spending time in nature as relaxing, refreshing, and therapeutic. Many described it as part of their lifestyle and encouraged consumers to engage in nature-based activities on their own time. If NBIs were to be introduced as part of mental health services, clinicians expressed willingness to promote them to their consumers. Clinicians listed many potential benefits of NBIs for mental health consumers including improved mood, calmness and relaxation, a sense of empowerment, and social connections. Despite these benefits, clinicians were concerned about a variety of barriers to NBIs including consumers' mental health symptoms such as anxiety or lack of motivation, scepticism, and geographic accessibility, as well as organisational barriers such as policies around safety risk.

CONCLUSION

Responding to the individual and organisational factors that could hinder the implementation of NBIs while building on the existing evidence of the positive impact of nature on health and wellbeing and, as demonstrated in this study, mental health clinicians' interest and supportiveness of NBIs, mental health services should consider the implementation of NBIs as part of routine practice.

Increased Wellbeing following Engagement in a Group Nature-Based Programme: The Green Gym Programme Delivered by the Conservation Volunteers

The wellbeing benefits of engaging in a nature-based programme, delivered by the Voluntary, Community and Social Enterprise sector, were examined in this study. Prior to attending The Conservation Volunteers' Green Gym™, attendees (n = 892) completed demographics, health characteristics and the Warwick Edinburgh Mental Wellbeing Short-Form Scale. Attendees (n = 253, 28.4%) provided a measure on average 4.5 months later. There were significant increases in wellbeing after engaging in Green Gym, with the greatest increases in those who had the lowest starting levels of wellbeing. Wellbeing increases were sustained on average 8.5 months and 13 months later in those providing a follow up measure (n = 92, n = 40, respectively). Attendees who continued to engage in Green Gym but not provide follow up data (n = 318, 35.7%) tended to be more deprived, female and self-report a health condition. Attendees who did not continue to engage in Green Gym (n = 321, 36.0%) tended to be less deprived and younger. These findings provide evidence of the wellbeing benefits of community nature-based activities and social ('green') prescribing initiatives and indicate that Green Gym targets some groups most in need.

The Socio-Cultural Benefits of Urban Agriculture: A Review of the Literature

Despite extensive literature on the socio-cultural services of urban open spaces, the role of food-producing spaces has not received sufficient attention. This hampers advocacy for preserving and growing urban agricultural activities, often dismissed on justifications that their contributions to overall food supply are negligible. To understand how the social benefits of urban agriculture have been measured, we conducted a systematic review of 272 peer-reviewed publications, which drew on insights from urban agriculture sites in 57 different countries. Through content analysis, we investigated socio-cultural benefits in four spheres: engaged and cohesive communities, health and well-being, economic opportunities, and education. The analysis revealed growth in research on the social impacts of gardens and farms, with most studies measuring the effects on community cohesion and engagement, followed by increased availability and consumption of fruits and vegetables associated with reduced food insecurity and better health. Fewer studies assessed the impact of urban farming on educational and economic outcomes. Quantifying the multiple ways in which urban agriculture provides benefits to people will empower planners and the private sector to justify future investments. These findings are also informative for research theorizing cities as socio-ecological systems and broader efforts to measure the benefits of urban agriculture, in its many forms.

Gardening can relieve human stress and boost nature connection during the COVID-19 pandemic

The COVID-19 pandemic has severely disrupted social life. Gardens and yards have seemingly risen as a lifeline during the pandemic. Here, we investigated the relationship between people and gardening during the COVID-19 pandemic and what factors influenced the ability of people to garden. We examined survey responses (n = 3,743) from gardeners who reported how the pandemic had affected personal motivations to garden and their use of their gardens, alongside pandemic-related challenges, such as food access during the first wave of COVID-19 (May-Aug 2020). The results show that for the respondents, gardening was overwhelmingly important for nature connection, individual stress release, outdoor physical activity and food provision. The importance of food provision and economic security were also important for those facing greater hardships from the pandemic. While the literature on gardening has long shown the multiple benefits of gardening, we report on these benefits during a global pandemic. More research is needed to capture variations in public sentiment and practice - including those who do little gardening, have less access to land, and reside in low-income communities particularly in the global south. Nevertheless, we argue that gardening can be a public health strategy, readily accessible to boost societal resilience to disturbances.

Effectiveness and Benefits of Exercise on Older People Living With Mental Illness’ Physical and Psychological Outcomes in Regional Australia: A Mixed-Methods Study

Regular exercise is reported to improve depressive symptoms and quality of life for people experiencing mental illness. For older adults, including strength and balance can also decrease falls. Mental health services seldom include funding for Accredited Exercise Physiologist programs. A 9-week Accredited Exercise Physiologist-led program for older adults receiving mental health treatment with a community Older People’s Mental Health Service was trialed in regional Australia. This clinician-conceived small-scale feasibility study utilized a two-phase concurrent triangulation mixed-method design to evaluate physical and psychological program outcomes and identify factors related to engaging in physical activity. This tailored exercise program led to improvements in measures of psychological distress and physical and psychological function. These changes corresponded with participants identifying benefits of exercising as a group of adults living with mental illness. Such findings suggest a supervised, individualized program for older mental health consumers confers physical and psychological benefits; however, further research evaluating exercise interventions with this population is required.

Nature-based outdoor activities for mental and physical health: Systematic review and meta-analysis

Mental health problems are associated with lower quality of life, increased unscheduled care, high economic and social cost, and increased mortality. Nature-based interventions (NBIs) that support people to engage with nature in a structured way are asset-based solutions to improve mental health for community based adults. However, it is unclear which NBIs are most effective, or what format and dose is most efficacious. We systematically reviewed the controlled and uncontrolled evidence for outdoor NBIs. The protocol was registered at PROSPERO (CRD42020163103). Studies that included adults (aged ≥18 years) in community-based settings with or without mental and/or physical health problems were eligible for inclusion. Eligible interventions were structured outdoor activities in green and/or blue space for health and wellbeing. We searched ASSIA, CENTRAL, Embase, Greenfile, MEDLINE, PsycINFO, and Web of Science in October 2019; the search was updated in September 2020. We screened 14,321 records and included 50 studies. Sixteen studies were randomised controlled trials (RCTs); 18 were controlled studies; and 16 were uncontrolled before and after studies. Risk of bias for RCTs was low to moderate; and moderate to high for controlled and uncontrolled studies. Random effects meta-analysis of RCTs showed that NBIs were effective for improving depressive mood -0.64 (95% CI: 1.05 to -0.23), reducing anxiety -0.94 (95% CI: 0.94 to -0.01), improving positive affect 0.95 (95% CI: 0.59 to 1.31), and reducing negative affect -0.52 (95% CI: 0.77 to -0.26). Results from controlled and uncontrolled studies largely reflected findings from RCTs. There was less evidence that NBIs improved physical health. The most effective interventions were offered for between 8 and 12 weeks, and the optimal dose ranged from 20 to 90 min. NBIs, specifically gardening, green exercise and nature-based therapy, are effective for improving mental health outcomes in adults, including those with pre-existing mental health problems.

Evaluating the effects of a Therapeutic Day Rehabilitation program and inclusion of gardening in an Australian Rural Community Health Service

Therapeutic day rehabilitation (TDR) is a non-residential intensive structured program designed for individuals recovering from substance misuse. A weekly afternoon of therapeutic gardening was a new incentive initiated in a TDR program at one Australian community health service, designed to give participants the opportunity to spend time outdoors connecting with nature and each other. The aim of this study was to explore perceptions of participants enrolled in this program by employing a convergent parallel mixed-method design using qualitative individual, semi-structured interviews (n = 14) and longitudinal quantitative quality of life (QOL) data at three different intervals (n = 17). The analysis of the quantitative data showed that there was a statistically significant increase in the participants' QOL scores in three of four domains (physical health, psychological, social relationships) when comparing baseline and post completion of the TDR. These observed changes were maintained at the 4-week follow up. The key findings from the semi-structured interviews include positive effects for participants on social connectivity, structure and achievement, understanding of recovery and relaxation from contact with nature. This study shows that a combination of TDR and therapeutic gardening can improve participants' physical health, psychological health and social relationships.

Associations of Vigorous Gardening With Cardiometabolic Risk Markers for Middle-Aged and Older Adults

This study investigates the associations of vigorous-intensity gardening time with cardiometabolic health risk markers. This cross-sectional study (AusDiab) analyzed 2011-2012 data of 3,664 adults (55% women, mean [range], age = 59.3 [34-94] years) in Australia. Multiple linear regression models examined associations of time spent participating in vigorous gardening (0, <150 min/week, ≥150 min/week) with a clustered cardiometabolic risk (CMR) score and its components, for the whole sample and stratified by age and gender. Of participants, 61% did no vigorous gardening, 23% reported <150 min/week, and 16% reported ≥150 min/week. In the whole sample, spending ≥150 min/week in vigorous gardening was associated with lower CMR (lower CMR score, waist circumference, diastolic blood pressure, and triglycerides) compared with no vigorous gardening. Stratified analyses suggested that these associations were almost exclusively observed for older adults and women. These findings suggest the public health potential of vigorous-intensity gardening in reducing CMR.

Household Physical Activity and Risk for Future Falls in Community-Dwelling Older Adults

Household physical activity is associated with decreased risk for future falls; however, it is not known what components of household physical activity are associated with this decreased risk. In the current study, the frequency of seven household physical activities performed in the previous 12 months was assessed: child or older adult care, meal preparation, major cleaning, routine cleaning, gardening/yardwork, heavy outdoor work, and major home decoration or repair. Berg Balance Scale scores were dichotomized at ≤50, indicating less risk for future falls. Only gardening/yardwork was associated with less risk for future falls (odds ratio = 1.41, p = 0.007) while controlling for age, gender, race, body mass index, and number of medications (χ² = 18.33 [6], p = 0.005), explaining 17% to 23% of the variance in risk of future falls in community-dwelling older adults aged 65 to 90 years (N = 99). Clinical nursing implications include considering gardening/yardwork as an intervention to decrease risk of future falls. [Journal of Gerontological Nursing, 47(6), 13-18.].

Urban agriculture in times of crisis: the role of home food growing in perceived food insecurity and well-being during the early COVID-19 lockdown

Household food insecurity and poor well-being have increased during the coronavirus disease 2019 (COVID-19) pandemic and resulting lockdown measures. Home food growing has been associated with improved food access and well-being, but it is unknown what role it plays during food supply crises and lockdown. It is also unclear how home food growing and social restrictions may affect opinions about growing food in urban areas (i.e., urban agriculture [UA]).

A cross-sectional online survey was conducted during the UK national lockdown in March-April 2020 to measure home food growing, perceived food insecurity, well-being, and opinions of UA.  The participants were 477 UK-based adults (369 female, mean age 39.57 years ± 13.36); 152 participants were engaged in home food growing prior to the pandemic. Responses were compared to data collected from a separate sample of participants before the pandemic ( N = 583) to explore potential shifts in opinions about UA.

Participants who engaged in home food growing had lower levels of food insecurity ( U _­= 19894.50, z = -3.649, p<.001, r = -.167) and higher well-being ( U = 19566.50, z = -3.666, p<.001, r = -.168) than those not engaged in home food growing. Perceived food insecurity partially mediated the relationship between home food growing and well-being; home food growing was associated with less food insecurity, which in turn was associated with better well-being. There were no differences in opinions of UA compared to the sample of participants from before the pandemic.

Home food growing may have had a protective effect over perceived food security and well-being in the early stages the pandemic. Opinions of UA were positive and unchanged compared to data collected pre-pandemic. Policies that support home food growing and access to suitable growing spaces and resources may be beneficial for food system resilience and well-being.

Does greenery experienced indoors and outdoors provide an escape and support mental health during the COVID-19 quarantine?

BACKGROUND

The COVID-19 pandemic has profoundly changed people's ability to recreate in public green spaces, which is likely to exacerbate the psychological impacts of the pandemic. In the current study, we seek to understand whether greenery can support mental health even with insufficient outdoor exposure in times of physical isolation from the outdoor environment.

METHODS

Between 17 May and 10 June, 2020, we conducted an online survey among 323 students (21.99 ± 3.10 years; 31% male) in health-related programs from two universities in the city of Plovdiv, Bulgaria. Severities of depressive and anxiety symptoms over the past two weeks were measured with the Patient Health Questionnaire 9-item and the Generalized Anxiety Disorder 7-item scale. We employed two self-reported measures of greenery experienced indoors (number of houseplants in the home and proportion of exterior greenery visible from inside the home) and two measures of greenery experienced outdoors (presence/absence of a domestic garden and availability of neighborhood greenery). Restorative quality of the home (the "being away" dimension of the Perceived Restorativeness Scale; PRS) and the neighborhood (the "being away" and "fascination" dimensions of the PRS), engagement with outdoor greenery (frequency of different types of interaction) and perceived social support were treated as mediators. Associations between greenery and mental health were tested using generalized linear regression and logistic regression. Structural equation modelling (SEM) techniques were used to test the theoretically-indicated relations among the variables.

RESULTS

Clinically-meaningful symptoms of moderate depression and anxiety were reported by approximately 33% and 20% of the students, respectively. The relative abundance of greenery visible from the home or in the neighborhood was associated with reduced depressive/anxiety symptoms and lower depression/anxiety rates. Having more houseplants or a garden was also associated with some of these markers of mental health. As hypothesized, the mental health-supportive effects of indoor greenery were largely explained by increased feelings of being away while at home. Neighborhood greenery contributed to neighborhood restorative quality, which in turn facilitated social support and more frequent engagement with greenery, and that led to better mental health.

CONCLUSIONS

Students who spent most of their time at home during the COVID-19 epidemic experienced better mental health when exposed to more greenery. Our findings support the idea that exposure to greenery may be a valuable resource during social isolation in the home. However, causal interpretation of these associations is not straightforward.

Mental Health, Greenness, and Nature Related Behaviors in the Adult Population of Stockholm County during COVID-19-Related Restrictions

International data suggest that exposure to nature is beneficial for mental health and well-being. The restrictions related to the COVID-19 pandemic have created a setting that allows us to investigate the importance of greenness exposure on mental health during a period of increased isolation and worry. Based on 2060 responses from an online survey in Stockholm County, Sweden, we investigated: (1) whether the COVID-19 pandemic changed peoples’ lifestyle and nature-related habits, and (2) if peoples’ mental health differed depending on their exposure to greenness. Neighborhood greenness levels were quantified by using the average normalized difference vegetation index (NDVI) within 50 m, 100 m, 300 m, and 500 m buffers surrounding the participant’s place of residence. We found that the number of individuals that reported that they visited natural areas “often” was significantly higher during the pandemic than before the pandemic. Higher levels of greenness surrounding one’s location of residence were in general associated with higher mental health/well-being and vitality scores, and less symptoms of depression, anxiety, and perceived and cognitive stress, after adjustments for demographic variables and walkability. In conclusion, the results from the present study provided support to the suggestion that contact with nature may be important for mental health in extreme circumstances.

[Using endurance training in nature as a resource in inpatient psychotherapy]

Using endurance training in nature as a resource in inpatient psychotherapy Objectives: Although positive effects of nature on mental health are generally well-documented, clinical studies into the deliberate use of nature as a resource in in-patient psychotherapy are missing. The following study examined whether an endurance training intervention in psychosomatic rehabilitation showed differential effects on patients depending on its implementation in an indoor or outdoor nature setting. Methods: Endurance training indoors (ergometer) was compared to training outdoors in the nature (walking) in N = 88 in-patients of a psychosomatic rehabilitation clinic using a linear mixed effects model. Health effects were examined using a standardized questionnaire on somatic symptoms (Giessener Beschwerdebogen GBB-24) and a mood questionnaire (Aktuelle Stimmungsskala ASTS). Seasonal effects were assessed by testing half of the sample in summer and half in winter. Secondary analyses of the linear mixed effects model were run for depression as primary diagnosis which accounted for half of the sample. Results: A nature setting positively predicted improvements on the ASTS positive mood scale (B = 0.34; t(245) = 3.25; p = .001; p_Bonferroni = .052). No significant interaction was found between the effect of the training setting and depression as primary diagnosis (B = -0.05; t(245) = -0.30; p = .76) in secondary analyses. Conclusions: The results primarily point to an improvement in mood following endurance training in a nature setting. Improvements are independent of depression as the primary diagnosis.

Where birds felt louder: The garden as a refuge during COVID-19

During the COVID-19 pandemic, many countries experienced something of a boom in interest in gardening. Gardens have long been considered as refuges into which we retreat to escape various struggles and challenges. In this study we examine the characteristics and functions of the garden as a refuge during the period of increased garden interest associated with the COVID-19 pandemic. Analysis of qualitative results about garden experiences from 3,743 survey respondents revealed intertwining garden and emotional geographies. Utilising non-representational and therapeutic landscape theories, we found multifarious and heightened experiences of non-material aspects of gardens; that is, the sensory and emotional aspects. People experienced, for example, a sense of joy, beauty, and reassurance, a greater attunement to the natural world and an increased sense of nature connection than they had at other times: birds felt louder. These heightened sensory and emotional experiences had therapeutic benefits, across age and geographical spectrums, during these difficult times. This research improves our understandings of the positive potential of non-material aspects of gardens in the creation of therapeutic landscapes in and beyond COVID-19.