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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Public Health 1/2015

Understanding how environmental enhancement and conservation activities may benefit health and wellbeing: a systematic review

BMC Public Health > Ausgabe 1/2015
Rebecca Lovell, Kerryn Husk, Chris Cooper, Will Stahl-Timmins, Ruth Garside
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12889-015-2214-3) contains supplementary material, which is available to authorized users.

Competing interests

RL has worked with authors of individual studies included in the review but not on the studies themselves. All other authors declare they have no competing interests.

Authors’ contributions

RG conceived, obtained funding for and led the review. RL and KH screened, quality appraised, extracted data and conducted the synthesis (including initial iterations of the model). CC developed the search strategy and conducted database searches. WS-T provided graphic support and produced the final version of the conceptual framework. The manuscript was written through contributions of all authors. All authors have given approval to the final version of the manuscript.



Action taken to enhance or conserve outdoor environments may benefit health and wellbeing through the process of participation but also through improving the environment. There is interest, amongst both health and environmental organisations, in using such activities as health promotion interventions.
The objective of this systematic review was to investigate the health and wellbeing impacts of participation in environmental enhancement and conservation activities and to understand how these activities may be beneficial, to whom and in what circumstances or contexts.


A theory-led mixed-method systematic review was used to assess evidence of effect and to identify pathways to change (protocol:​1002/​14651858.​CD010351/​full). Due to the multi-disciplinary, dispersed and disparate body of evidence an extensive multi-stage search strategy was devised and undertaken. Twenty-seven databases and multiple sources of grey literature were searched and over 200 relevant organisations were contacted. The heterogenous evidence was synthesised using a narrative approach and a conceptual model was developed to illustrate the mechanisms of effect. Due to the limited nature of the evidence additional higher order evidence was sought to assess the plausibility of the proposed mechanisms of effect through which health and wellbeing may accrue.


The majority of the quantitative evidence (13 studies; all poor quality and lower-order study designs) was inconclusive, though a small number of positive and negative associations were observed. The qualitative evidence (13 studies; 10 poor quality, 3 good) indicated that the activities were perceived to have value to health and wellbeing through a number of key mechanisms; including exposure to natural environments, achievement, enjoyment and social contact. Additional high level evidence indicated that these pathways were plausible.


Despite interest in the use of environmental enhancement activities as a health intervention there is currently little direct evidence of effect, this is primarily due to a lack of robust study designs. Further rigorous research is needed to understand the potential of the activities to benefit health and environment.
Additional file 1: Table S1. List of organisations and websites searched. An exhaustive list of organisations contacted by the team, as well as websites hand-searched, for relevant studies. Table S2. Sample search strategy (MEDLINE) and databases searched. Search strategy submitted to the MEDLINE database is indicative of all database searches, with minor alterations for other databases. Table S3. Data extraction forms. Tables showing the variables extracted from both the qualitative and qualitative studies. Figure S1. Results flow diagram. PRISMA diagram showing included/excluded number of items at each stage of the review. Table S5. Quality/risk of bias assessments. Quality/risk of bias assessments of each study included in the review, as assessed by two team members independently. Table S6. Supplementary evidence details. Details of each study included in the supplementary searches. (DOCX 2294 kb)
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