Background
Methods
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any population of participants (whether voluntary or compelled) of any age (the review reported here includes children and young people, populations which were excluded from the Cochrane review [14]);
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outdoor, physically active environmental enhancement or conservation activities;
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activities that occurred in any urban or rural context whether built or natural;
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any relevant health and wellbeing outcomes whether physiological, physical, mental (including emotional and quality of life), or social (see [14] for example measures of each outcome). Mechanisms known to be determinants of health (i.e. physical activity behaviours) were also considered; and
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(for controlled or comparative designs) any suitable comparator.
Results
The evidence
Primary ref | Ref | Additional paper refs | Study type and report type | Country | Design | N | % women | Mean age | Participants | Activity descriptors and environment | Intensity | Comparator | Quality grading |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Barton et al. 2009 | [46] | Quantitative, thesis and peer reviewed articles | UK | uBA | 19 | 26 | ~60 | Volunteers | Conservation. Rural natural environment. | NR | Active recreation | Weak | |
Brooker and Brooker 2008a | [42]a | Quantitative, unpublished case study | UK | N of 1 uBA | 1 | 100 | 49 | Volunteers | Green Gym. Rural natural environment. | “Regular” | Other physical activity | Weak | |
Brooker and Brooker 2008aa | [43]a | Quantitative, unpublished case study | UK | N of 1 uBA | 1 | 100 | 49 | Volunteers | Green Gym. Rural natural environment. | “Regular” | Other physical activity | Weak | |
BTCV 2009 | [36] | Quantitative, unpublished evaluation report | UK | uBA | 122 | 47 | 9 | School pupils | Green Gym. Mixed natural environments. | 1 – 1.5 hours per week | N/A | Weak | |
Eastaugh et al. 2010 | [33] | Quantitative, unpublished evaluation report | UK | uBA | 8 | NR | NR | Referred and voluntary | Conservation. Woodlands. | NR | N/A | Weak | |
Moore et al. 2006 | [44] | Quantitative, peer reviewed article | Australia | Case control | 102 | 37 | 55 | Volunteers | Conservation. Rural natural environment. | NR | Community members not involved in conservation | Weak | |
Pillemer et al. 2010 | [45] | Quantitative, peer reviewed article | Canada | Cohort | 2630 | 57 | 45 | NR | Conservation. No detail on environment. | NR | Alternative volunteering | Weak | |
Reynolds 1999a | [47] | [93] | Quantitative, peer reviewed article and unpublished evaluation report | UK | uBA | 16 | 49 | 60 | Volunteers | Green Gym. Rural natural environment. | 3 hours twice a week | N/A | Weak |
Small Woods 2011 | [40] | [94] | Quantitative, unpublished evaluation reports | UK | uBA | 7 | 100 | NR | Referred | Woodland management. Woodlands. | NR | N/A | Weak |
Yerrell 2008 | [41] | Quantitative, unpublished evaluation report | UK | uBA | 194 | 40 | 45 | Volunteers and referred | Green Gym. Mixed natural environments. | 1-4 hours once a week | N/A | Weak | |
Birch 2005 | [48] | Qualitative, peer reviewed article | UK | Interviews, ethnographic | 3 | 67 | 42 | Volunteers | Green Gym. Rural natural environment. | 3 hrs twice weekly | N/A | Poor | |
Burls 2007 | [34] | Qualitative, peer reviewed article | UK | Focus groups, ethnographic | 11 | NR | NR | Volunteers | Conservation gardening. Urban natural environments. | NR | N/A | Poor | |
Carter and O'Brien 2008 | [39] | [95] | Qualitative, unpublished evaluation report | UK | “qualitative evaluation” | NR | NR | NR | Referred | Habitat Restoration. Rural natural environments, woodlands | 1-2 days per week for 6 months | N/A | Poor |
Christie 2004 | [49] | Qualitative, unpublished report | Australia | Interviews | 18 | NR | 30 | Volunteers | Bush Regeneration. Rural natural environment. | NR | N/A | Poor | |
Gooch 2005 | [35] | Qualitative, peer reviewed article | Australia | Interviews | 85 | NR | NR | Volunteers | Conservation activities. Natural environments, water catchments. | NR | N/A | Poor | |
Halpenny and Caissie 2003 | [50] | [96] | Qualitative, peer reviewed articles | Canada | Interviews | 10 | 50 | 40 | Volunteers | Restoring habitats. Rural natural environments. | 3-17 day vacations | N/A | Good |
Miller et al. 2002 | [37] | Qualitative, peer reviewed article | USA | Focus groups, ethnographic | 30 | NR | 19 | Students | Trail creation. Urban natural environments. | 1 day per week for 10 weeks | N/A | Poor | |
O'Brien et al. 2011 | [53] | Qualitative, peer reviewed article | UK | Ethnographic | 10 | 40 | 40 | Volunteers | Wildlife gardening. Urban natural environment. | 2-3 days per week | N/A | Good | |
Townsend and Marsh 2004 | [52] | Qualitative, unpublished evaluation report | Australia | Interviews, focus groups | NR 18+ | 33 | 65 | Volunteers | Restoration of reserve. Rural natural environment. | NR | N/A | Poor | |
Townsend 2006 | [51] | [97] | Qualitative, peer reviewed article and unpublished evaluation report | Australia | Interviews | 35 | NR | NR | Volunteers | Maintenance of creek and reserves. Rural natural environment. | NR | N/A | Poor |
BTCV 2010 | [38] | Mixed, unpublished evaluation report | UK | uBA | 136 | NR | NR | Volunteers and referred | Green Gym. Rural natural environment. | NR | N/A | Weak | |
Interviews | 19 | 16 | NR | Poor | |||||||||
O'Brien et al. 2010 | [54] | [98] | Mixed, peer reviewed article and unpublished evaluation report | UK | uBA | 88 | 28 | 43 | Volunteers | Vegetation Clearing. Rural natural environment. | 0 - 33 hrs per month | N/A | Weak |
Interviews, ethnographic | Good | ||||||||||||
Wilson 2009 | [32] | Mixed, unpublished evaluation report | UK | uBA | 77 | 26 | 41 | Referred | Conservation. Rural natural environment, woodlands. | 3 hours per week for 12 weeks | N/A | Weak | |
Interviews | Poor |
The environmental enhancement and conservation activities
Study participants
Study designs and methodologies
Assessments of study quality
Quantitative outcome measures
Qualitative themes
Ref | Ref | N. | Method | Quality | Personal achievement | Personal/ social identify | Developing knowledge | Benefits of place | Social contact | Physical benefits | Physical activity | Spirituality | Psychological restoration | Risks/ negatives |
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Birch 2005 | [48] | 3 | Interviews | Poor | X | X | X | X | X | |||||
BTCV 2010 | [38] | 19 | Interviews | Poor | X | X | X | X | X | X | X | X | ||
X | X | X | X | X | X | |||||||||
Burls 2007 | [34] | 11 | Focus Groups | Poor | X | X | X | X | X | X | X | X | X | |
Carter and O'Brien 2008 | [39] | NR | "Qualitative evaluation" | Poor | X | X | X | X | X | X | X | |||
Christie 2004 | [49] | 18 | Interviews | Poor | X | X | X | X | X | X | X | X | ||
Gooch 2005 | [35] | 85 | Interviews | Poor | X | X | X | X | X | X | X | |||
Halpenny and Caissie 2003 | [50] | 10 | Interviews | Good | X | X | X | X | ||||||
Miller et al. 2002 | [37] | 30 | Focus Groups, ethnographic | Poor | X | X | X | X | X | X | ||||
O'Brien et al. 2010 | [54] | 88 | Interviews | Good | X | X | X | X | X | X | X | |||
O'Brien et al. 2011 | [53] | 10 | Ethnographic | Good | X | X | X | X | X | X | X | X | X | |
Townsend and Marsh 2004 | [52] | 18 | Interviews | Poor | X | X | X | X | X | X | ||||
X | X | X | X | X | X | X | ||||||||
Townsend 2006 | [51] | 35 | Interviews | Poor | X | X | X | X | X | |||||
Wilson 2009 | [32] | 29 | Interviews | Poor | X | X | X | X | X | X | X |
Quantified impacts of environmental enhancement and conservation activities to health and wellbeing outcomes
Ref | Ref | N. | Method | Quality | Physiological | Physical | Mental and emotional | Quality of life | Social/other |
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BTCV 2009 | [36] | 122 | uBA | Weak | ↑ | ↑ (↑ →) | |||
BTCV 2010b | [38] | 136 | uBA | Weak | (→→) | ||||
Eastaugh et al. 2010 | [33] | 8 | uBA | Weak | →(→→→) | ||||
Moore et al. 2006 | [44]a | 102 | Case–control | Weak | ↑↓→→ | ↑↑↑→→→→ | ↑↑↑↑↑→→→→→→→→→→→→→→ | ||
O'Brien et al. 2010 | [54] | 88 | uBA | Weak | ↑ | ||||
Pillemer et al. 2010 | [45]a | 2630 | Cohort | Weak | ↑↑ | ↑ → | ↑ | ||
Barton et al. 2009 | [46] | 19 | uBA | Weak | →→ | ||||
Reynolds 1999a | [47] | 16 | uBA | Weak | ↑→→→→→→→→ | (↑↑→→→→→→) | |||
Small Woods 2011 | [40] | 7 | uBA | Weak | →→(→→→→→→) | ||||
Wilson 2009 | [32] | 77 | uBA | Weak | ↑ | → | → → (→→ →→→→→→) | ||
Yerrell 2008 | [41] | 194 | uBA | Weak | ↑↓ |
Subgroup variation
Qualitative findings
Direct impacts to physiological and mental health and wellbeing
“I feel it’s actually benefited my health, because I do suffer from asthma. It seems as if I’m getting more fresh air and I feel a wee bit healthier and plus some of the work that they dae, I feel that, in a way it is making me lose a wee bit of weight. I used to be twenty stone now I’m only eighteen” [Participant. 32]
“Just even, like peace of mind as well. There’s something about being outdoors that I think just gives you calmness” [Participant. 50]
Achievement and sense of reward from activities
“I am part of a group, a city, a country and a society which can take care of its vulnerable members, of which I was one, and this has benefited me greatly and I feel I want to give something back to this culture and to nature in general by coming here and making an effort” [53].
“…I wasn’t too good at it [willow weaving] but at the end I done it. At least I tried …I feel in myself I’ve achieved something …Like see when I gae home after leaving here I’m puffed oot and I feel as if I’ve achieved something. I’m knackered and I’m quite proud of myself cause I’ve done it.” [Participant. 32]
“One participant brought the other group of home residents and staff out to the trail to show off what he had accomplished… "It's their trail, you can see the pride and ownership; it's theirs. It's something they worked on, something that they value”.” [Author and programme leader. 37]
“There’s a need here, I don’t enjoy this [volunteering] at the moment, I must admit it, it’s… it’s killing me, but I’ve got to keep going, there’s just too much at stake” [35].
Skills and learning
Benefits of the environment/context
Social contact
“We all get on very well it’s quite a close band of people. There’s no hidden agenda; you don’t need to know who the people are or what they do. You just come [and] enjoy the day that’s the beauty of it.” [Participant. 54].
Benefits of a structured programme
Conceptual model and supplementary evidence
Mechanisms of change and pathways to impact
Pathway 1. Physical activity
Pathway 2. Achievement and contribution
Pathway 3. Social contact
Pathway 3. Contact with the natural environment
Linearity of pathways and impacts
“Respondents felt that volunteers had benefitted over the course of their involvement, with examples including: increased confidence and sociability, becoming less stressed, more relaxed, developing confidence, taking on leading roles. Improved confidence was felt to be linked to enhanced knowledge about how to use tools properly" [Author].
“You’ve got to weigh up your family life on the one hand, and your work and then your… this is just supposedly a recreation, your life is split into thirds, well I don’t have recreation, I have our catchment group. Which is my work, my real work” [Participant. 35]
Discussion
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The study designs of the included research were insufficient to show any causal relationships between the activities and outcomes. This was particularly problematic for the studies which focused on marginalised groups, where the activities tended to be part of multi-faceted programmes and were likely to be delivered in conjunction to other interventions (e.g. mental health support). Additionally, and more generally, the outcome measures used in the studies, the majority of which relied on self-report, were not necessarily appropriate to detect what was likely to be relatively small and potentially transient changes in health status. These factors may partially account for the inconclusive findings in many of the quantitative studies. Finally the qualitative and quantitative data is drawn from what appears to be a predominantly self-selected group, there is the potential that these participants elected to take part because they enjoy such activities and expected to benefit.
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Further uncertainty was related to the generally poor level of reporting and description within the studies, this was true for both the academic studies as well as those identified from the grey literature. This lack of information renders a fair assessment of potential sources of bias (particularly selection bias) impossible, resulting in the grading of many studies as ‘poor’ quality.
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Meta- and sub-group analyses of the quantitative findings were not carried out because of a lack of comparability between studies. Even when the same assessment tool had been used (for instance the SF36) the method of application and inconsistency in reporting results meant that pooling data was not possible.