Perceived Health Benefits and Willingness to Pay for Parks by Park Users: Quantitative and Qualitative Research

Should Commercial Diagnostic Testing Be Stimulated or Discouraged? Analyzing Willingness-to-Pay and Market Externalities of Three Commercial Diagnostic Tests in The Netherlands

INTRODUCTION

Consumers may purchase commercial diagnostic tests (CDT) without prior doctor consultation. This paper analyzes three CDT markets-commercial cholesterol tests (CCT), direct-to-consumer genetic health tests (DGT) and total body scans (TBS)-in the context of the universal, collectively financed health care system of the Netherlands.

METHODS

An online willingness-to-pay (WTP) questionnaire was sent to a representative sample of 1500 Dutch consumers. Using contingent valuation (CV) methodology, an array of bids for three self-tests were presented to the respondents. The results were extrapolated to the Dutch population and compared to current prices and follow-up medical utilization, allowing analysis from a societal perspective.

RESULTS

Overall, 880 of 1500 respondents completed the questionnaire (response rate 59%). Of the respondents, 26-44% were willing to pay a positive amount for the CDT. Willingness-to-pay was correlated to age and household income, but not to health status or prior experience with these tests. At mean current prices of €29 for CCT, €229 for DGT and €1,650 for TBS, 3.3%, 2.5%, and 1.1%, were willing to purchase a CCT, DGT, and TBS, respectively. All three CDT resulted in net costs to the health system, estimated at €5, €16, and €44 per test, respectively. Reducing volumes by 90,000 CCTs (19%), 19,000 DGTs (5%) and 4,000 TBSs (2.5%) in 2019 would optimize welfare.

CONCLUSION

Most respondents were unwilling to consume CDT at any price or only if the CDT were provided for free. However, for a small group of consumers, societal costs exceed private benefits. Therefore, CDT regulation could provide small welfare gains.

Residential open space and the perception of health benefits: How much is the public willing to pay?

Emerging evidence suggests that residential open space (ROS) is beneficial for multiple health outcomes for urban residents. However, the general public's understanding of and demand for the health benefits related to ROS have not been widely explored. This study aims to examine the impact of residents' socioeconomic status and perceptions of landscape health benefits on their willingness to pay (WTP) for ROS and to evaluate the perceived monetary value of different residential landscape elements. An online survey with 1348 respondents was conducted between August 2020 and October 2021 in China using a contingent valuation (CV) method. Respondents perceived the landscape benefits related to mental health to be higher than those related to physical and social health. The perception of landscape health benefits positively affected WTP and the WTP value of ROS. Residents' monthly income was a significant influencing factor for WTP and the latter's value. For individuals with positive WTP, the average annual WTP for ROS was CNY 68.98 (USD 10.81), while for all the respondents, the estimated mean annual WTP for ROS was CNY 91.75 (USD 14.38). Moreover, the estimated WTP for plants was the highest, whereas the WTP for activity spaces was estimated as the lowest. These findings may improve city planners' and community managers' understanding of the perceived value of residential landscapes among the public and help them make effective decisions to build healthy communities.

Perceived Benefits and Forest Tourists Consumption Intention: Environmental Protection Attitude and Resource Utilization Attitude as Mediators

Establishing a relationship model between environmental protection and resource utilization attitude and consumption intention is the key to promoting the sustainable development of forest tourism. From the standpoint of the Stimulus–Organism–Response (SOR) framework, the purpose of this study is to explore the complex causal relationships between perceived benefits, attitudes toward environmental protection, resource utilization attitudes, and consumption intentions in the context of forest tourism. The research data have been collected using a questionnaire survey of 436 tourists at Siming Mountain in the suburbs of Ningbo city, China. Furthermore, it is analyzed by structural equation modeling. The results indicate a positive correlation between the perceived benefits and tourists’ consumption intention that is mediated by the tourists’ attitude toward resource utilization. Although the independent mediating effect of environmental protection attitude is not supported in this study, both attitudes have played a chain-mediating role between perceived benefit and consumption intention. This study contributes to the existing knowledge by measuring the impact of perceived benefits and environmental attitudes of forest tourists on consumption intentions.

Addressing Inequity: Evaluation of an Intervention to Improve Accessibility and Quality of a Green Space

Green space areas offer several benefits that support our physical, psychological, and social health. However, the level of engagement with green space areas may not be the same across population groups. Using a mixed-method research design, we investigated the use of a green space area and whether and how the area was beneficial for health, social inclusion, and physical activity for all socioeconomic groups in a suburban area in Norway. The study showed significantly increased use of the area from 2015-2018 and that users belonged to different socioeconomic groups. The motivation for using the area was the opportunity to experience nature and to interact socially. While no significant changes in self-rated health, life satisfaction, or levels of physical activity were found, the study indicates that factors such as location, availability, and designated places for social interaction are important motivating factors for use. Users from the lower socioeconomic groups were among the frequent users but were also the least satisfied with the quality and availability of the path. Our findings call for closer consideration of the location and availability of green spaces and that including places for social interaction and relaxation can contribute to increased use of green spaces.

A Scoping Review Mapping Research on Green Space and Associated Mental Health Benefits

BACKGROUND

There is a growing interest in research investigating the association between green space (GS) and mental health and wellbeing (HWB), in order to understand the underlying mechanisms. Accordingly, there is a need to map the literature and create an overview of the research.

METHODS

A scoping review approach was used to map literature on GS, including context and co-exposures (the GS exposome), and their associations with mental HWB. The review considers mental HWB definitions and measurements and how GS is characterized. Furthermore, the review aims to identify knowledge gaps and make recommendations for future research.

RESULTS

We identified a great diversity in study designs, definitions, outcome measures, consideration of the totality of the GS exposome, and reporting of results. Around 70% of the 263 reviewed studies reported a positive association between some aspect of GS and HWB. However, there is a limited amount of research using randomized controlled crossover trails (RCTs) and mixed methods and an abundance of qualitative subjective research.

CONCLUSIONS

The discords between study designs, definitions, and the reporting of results makes it difficult to aggregate the evidence and identify any potential causal mechanisms. We propose key points to consider when defining and quantifying GS and make recommendations for reporting on research investigating GS and mental HWB. This review highlights a need for large well-designed RCTs that reliably measure the GS exposome in relation to mental HWB.

Social Determinants of Health-Related Quality of Life: A Recreation Setting Analysis

Objective. To determine if significant differences between park users and non-park users are associated with scores on a composite health-related quality of life (HRQoL) index. Methods. Data for this study were collected based on random intercept of a cross section of eligible Monroe County, Indiana, residents at four selected public recreational parks, as well as nonpark locations from July to December 2017. Based on data collected using validated survey items, we created a composite HRQoL index. Statistical analysis included independent-samples t test, chi-square cross-tabulation, bivariate regression, and multivariate regression. Results. Frequent park users were significantly different from nonfrequent park users in various respects. The most leisure-time physical activity (LTPA) experiences of frequent park users occurred at a park location. Body mass index and park-based LTPA were significantly positively associated with HRQoL scores in a linear regression model. Conclusion. Frequent park use was shown to be positively associated with increased park-based LTPA and HRQoL. It is therefore possible that increasing park visitation will result in more members of a community who report experiencing their LTPA at a park location. Study outcomes lend support to the validity of a composite HRQoL index for population health assessments.

Visitors' Perceived Place Value and the Willingness to Pay in an Urban Lake Park

As highly developed nature, an urban lake park will be a place required to integrate various functions such as health promotion, recreation, and cultural exchange by focusing on ecological aspects. We applied latent profile analysis (LPA) to identify latent classes based on visitors’ perceived place value, and to estimate the willingness to pay (WTP) by these classifications. Park visitors were classified according to place value into three groups: Local Seekers (LS), Ecology Seekers (ES), and Recreation Seekers (RS). To compare the WTP of the three groups and examine differences in attributes between the groups, we used a choice experiment (CE). The results from the CE revealed that the WTP for attributes was ranked in the order of basic infrastructure, advanced services, and ecological activities. These differences in the WTP of visitors in an urban lake park may be useful for park management, such as providing strategies for zoning and ecotourism, which is specialized by visitor type.

How Urban Parks Offer Opportunities for Physical Activity in Dublin, Ireland

Parks are an important part of the urban fabric of cities. They offer people the opportunity to connect with nature, engage in physical activity, find a haven away from the city noise, or spend time alone or with family and friends. This study examines the relative importance of park and park visit characteristics for 865 survey participants in Dublin, Ireland. The data is analyzed using a multinomial logistic regression model which can distinguish the relative importance of attributes. The model results demonstrate an improvement over proportional by chance accuracy, indicating that the model is useful. The results suggest that when and why individuals go to the park along with the proximity of their residence to the park influence visit frequency more than their age and gender and more than their impression of the sound levels in the park. The contribution of the results, in terms of their potential usefulness to planners, suggest that the priority should be on the provision of park space close to residential areas, so that individuals can engage in activities such as walking and relaxation, and that the quality of that space, in the context of noise levels at least, is less important.

The Development of Three Questionnaires to Assess Beliefs about Green Exercise

Green exercise is physical activity that takes place in the presence of natural environments. Despite the promising evidence of the benefits, little is known about how individuals’ thoughts and feelings influence participation in green exercise and subsequent outcomes. The aim of the current research was to develop questionnaires using the Theory of Planned Behaviour as a framework that could both directly and indirectly assess attitudes, subjective norms and perceived behaviour control, along with intention toward green exercise. Confirmatory factor analyses confirmed that the indirect, direct, and intention measures all had good overall model fits when tested on a refinement (n = 253) and validation (n = 230) sample. The questionnaires will contribute towards helping to better understanding individuals’ beliefs about green exercise, how these influence behaviour, and ultimately to enable the development of effective interventions promoting green exercise.