What is the impact of nature on human health? A scoping review of the literature

How are nature-based interventions defined in mild cognitive impairment and dementia studies? A conceptual systematic review and novel taxonomy

ObjectivesTo systematically review research testing nature-based interventions for people living with mild cognitive impairment or dementia, and to report how authors have defined their interventions by presenting a taxonomy of the nature-based interventions.MethodsA conceptual systematic review of research published between 2008 and 2024 investigating nature-based interventions for people living with mild cognitive impairment or dementia was conducted. Three reviewers contributed independently. Exclusion criteria: not specifying if participants had mild cognitive impairment or dementia, only recruiting caregivers, no primary data, study protocols, abstracts, reviews, not peer-reviewed journal articles and any other grey literature. Intervention descriptions within the papers were thematically analysed.ResultsFifty-two articles reporting fifty-one studies were included. The most common interventions were nature virtual reality (VR technology) and gardening. From the definition data, we produced a taxonomy with overarching domains of: (a) Other terms used; (b) Characteristics; (c) Activities. Subdomains included: development or approach, modes of action, location, physical features, and activities. Some interventions could be grouped. Structure and standardisation of the interventions varied, with a lack of clear reporting.ConclusionThis taxonomy provides conceptualisations of nature-based interventions that can be used by future researchers to guide the development, evaluation and reporting of robust interventions in this area.

Measuring Adult Health and Well-Being Outcomes Associated With Nature Contact in Parks and Other Forms of Protected Areas: Protocol for a Scoping Review

BACKGROUND

Growing evidence shows various health and well-being benefits from nature contact in parks and other forms of protected areas. However, the methods to measure these outcomes lack systematic identification, critical appraisal, and synthesis. Researchers working in this area would benefit from a clear framework highlighting key considerations when selecting measurement tools, along with a summary of the measures used, and insights into the limitations of generalizing existing research findings.

OBJECTIVE

The objectives of this scoping review are 2-fold. First, we aim to identify the instruments used to measure mental health and well-being outcomes of adults associated with direct nature contact in parks and other forms of protected areas. Second, we aim to evaluate the psychometric properties associated with the validity of these instruments to better understand the strengths and weaknesses of current measurement approaches.

METHODS

Following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, 8 scholarly databases were searched (PubMed, Web of Science, PsycINFO [via ProQuest], ERIC [via EBSCOhost], CINAHL [via EBSCOhost], GreenFILE [via EBSCOhost], OVID, and GEOBASE) on January 4, 2023, for literature measuring the mental health and well-being outcomes associated with nature contact in protected areas. Sources were screened by reviewers based on clear inclusion or exclusion criteria relevant to the research questions: peer-reviewed English language studies measuring mental health and well-being focused on adults (aged 18+ years) with direct, in-person nature contact in parks and protected areas. Data will be extracted, analyzed, and represented according to 3 domains. This includes study details, characteristics of the measurement instruments, and their validity.

RESULTS

The results of the study and submission of a manuscript for peer review are expected in April 2025. The results of the scoping review are expected to contribute to an understanding of the diverse methods used to measure mental health and well-being related to nature contact in protected areas. Expected findings will include an organized summary of existing quantitative and qualitative instruments for measuring mental health and well-being outcomes, including appraisal of the instrument's psychometric properties.

CONCLUSIONS

To the authors' knowledge, this will be the first scoping review undertaken on measures used to assess mental health and well-being outcomes related to nature contact in parks and protected areas context, offering a starting point from which to critically examine the validity and consistency of such methods. Findings will aid in identifying the strengths and weaknesses of current measurement approaches to mental health and well-being outcomes of nature contact and may be used to guide future research on this topic, helping researchers choose the best tool to assess outcomes.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/63338.

Nature's impact on human health and wellbeing: the scale matters

Contact with nature can have a significant influence on human physical and mental health and wellbeing. As such, various concepts and theories as well as therapeutic approaches have been developed. The term "nature," however, covers a broad range of size and scales, ranging from individuals or small groups of animals or plants, certain ecosystems toward landscapes. The purpose of this paper is to differentiate concepts, theories, and therapy forms according to the scales of nature. We base our conceptional approach on the biological/ecological scales of species/individuals, ecosystems/land-use types, and landscapes. Based on a review, we differentiate the current state of the utilization of greenspace exposure measurements and measures assessing mental health according to these scales. We argue that a clear differentiation of biological and ecological scales provides a better understanding of the impact of nature with its components, characteristics, and dynamics on human health and wellbeing. Our paper also supports further inter- and transdisciplinary research as well as methodological approaches with regard to environment and health, such as environmental public health.

Nature-based approaches: a mixed methods study of facilitators and barriers to implementation in CAMHS

BACKGROUND

There is growing evidence that spending time with or in nature can be beneficial for health and wellbeing. Emerging evidence suggests potential benefits for staff and service users in healthcare settings, yet little is known about how to put Nature-based approaches (NBAs) into practice within the Child and Adolescent Mental Health Services (CAMHS) setting. The CAMHS Goes Wild project in Southwest England aimed to explore the implementation of NBAs within CAMHS, examining staff attitudes and understanding to identify potential benefits and challenges through a mixed methods study.

METHODS

The study involved three phases of data collection: an online survey with two waves, the first wave prior to the training, and the second four months post-training, and semi-structured interviews. Data collection was designed to fit around NatureWell training, attended by sixty-four CAMHS staff, which took place alongside the study. All participants were sampled from one NHS Trust and the study was open to both those who had attended the NatureWell training and those who had not. Data were synthesised to produce an understanding of staff attitudes towards NBAs and perceived barriers and facilitators to the implementation of this approach.

RESULTS

Ninety-seven staff responded to the wave 1 survey and 57 responded to the wave 2 survey. Fourteen staff members were interviewed. Data synthesis generated three themes: Tension between the culture of CAMHS and NBAs (Theme 1) and the need for buy-in and governance support (Theme 2). Theme three described the potential benefits of NBAs for staff and service users in CAMHS and is presented in a separate paper. The first two themes are presented in this paper.

CONCLUSIONS

The implementation of NBAs in mental health service settings for CYP presents both significant challenges and opportunities. Our findings suggest multiple barriers to implementation, often in the form of organisational or cultural factors, such as the risk averse nature of the service. Our work also elucidates several potential facilitators which may address or mitigate some of these barriers. These potential enablers, such as harnessing the role of firsthand experience, warrant further exploration in the implementation of NBAs in CAMHS.

Salutogenic Environmental Health Model-proposing an integrative and interdisciplinary lens on the genesis of health

Introduction

The maintenance of health is a central objective of public health initiatives. Within the salutogenic paradigm, health promotion is focused on understanding the mechanisms of health development. Models serve as indispensable tools. One of the leading paradigms in the health sciences is the Salutogenic Model developed by Aaron Antonovsky. However, it lacks sufficient specification to reflect the complexity of the environmental dimensions that have emerged from research in environmental health science. The interactions and impact pathways between these dimensions on health status are not adequately distinguished. The objective of this study is to address this gap by extending Antonovsky's model to encompass environmental dimensions, that is, the interactions between humans and their environment. Furthermore, the study will integrate examples of models and theories from various disciplines to illustrate how a more comprehensive and holistic explanation of health development can be provided from an interdisciplinary environmental public health perspective.

Methodology

As part of a three-step approach, a Basic Model was first developed that integrates the five environmental dimensions-Natural, Built-Material, Socio-Cultural, Psycho-Social, and Individual-into the Salutogenic Model. Subsequently, narrative non-exhaustive literature research was used to identify interdisciplinary example models. The models were used to identify gaps in the Basic Model through a critical lens and to synthesize them into a more holistic model.

Results

The synthesis of fifteen interdisciplinary models resulted in the development of an integrative Salutogenic Environmental Health Model (SEHM), which comprises twelve principal components of health development and their interactions and pathways. Links to the original models permit the user to refer back to them.

Discussion

This integrative approach offers a comprehensive understanding of the development of health by synthesizing disparate explanatory models and theories from various disciplines through theoretical analysis. The various environmental dimensions and the determinants of health contained therein, as well as their mental and physical processing and the associated components of health development and their interactions, are summarized in this new model. The SEHM thus enables a differentiated analysis of health determinants and serves as an operational framework for health promotion and pathways to well-being in contemporary research contexts.

Pathways linking greenspace to behavioural problems in Polish children

Background

Previous cross-sectional studies have found a beneficial relationship between greenspace and children's behaviour. Nevertheless, evidence on the mechanisms underlying this association remains scant. We examined whether the availability of greenspace was related to fewer behavioural problems in Polish children and investigated potential mechanisms.

Methods

Data were obtained from the case-control NeuroSmog study, in which children with and without attention deficit hyperactivity disorder (ADHD) were tested from October 2020 to September 2022. The analytic sample comprised 679 children aged 10-13 years. Parents reported internalizing, externalizing, and total behavioural problems using the Child Behaviour Check List (CBCL), as well as information about the presence of a domestic garden and potential mediators: greenspace perception, neighbourhood social cohesion, and physical activity. Tree and grass covers were extracted in 500 m and 1 km buffers around lifelong residences. Structural equation modelling (SEM) was used to examine the psychosocial pathways linking the greenspace metrics to behavioural problems.

Results

Greenspace was only indirectly related to fewer behavioural problems. Specifically, tree cover was related to greater levels of physical activity which, in turn, was related to fewer internalizing and total behavioural problems. Tree cover and presence of garden were related to greenspace perception which, in turn, was associated with higher neighbourhood social cohesion which, in turn, was linked to fewer behavioural problems. The patterns of associations in children without ADHD were very similar to those in the full sample except that the associations from garden to greenspace perception and from physical activity to total behavioural problems were no longer significant. The only association persisted among girls was from neighbourhood social cohesion to behavioural problems and among boys were from tree cover to physical activity and tree cover and garden to greenspace perception.

Conclusion

Trees and garden, but not grass, are linked to fewer behavioural problems through greenspace perception, neighbourhood social cohesion, and physical activity in Polish children.

Impact of "blue-green diet" on human health and wellbeing: A systematic review of potential determinants in shaping the effectiveness of blue-green infrastructure (BGI) in urban settings

Discourses concerning the potential health benefits of blue-green infrastructure (BGI) have gained momentum, highlighting its positive influence on human health and wellbeing. While studies have explored the concept of "Nature Pyramid" and the role of exposure to natural environments in promoting health, the role of water elements remains underexplored. Rooted in this concept, this study proposed a notion of "blue-green diet" as a framework to understand the intricate mechanisms and determinants of optimal blue-green exposure. Understanding the relationship between these determinants and their health-related impacts can facilitate the enhancement of BGI design, leading to greater effectiveness in promoting health and wellbeing and supporting sustainable urban development strategies. To enhance the comprehension of the "blue-green diet", this study conducted a systematic literature review to grasp the underlying mechanisms behind its beneficial effects, focusing on two key determinants of "blue-green diet", which are also derived from the concept of the "Nature Pyramid": (1) the type of BGI and (2) the mode of interaction with and within BGIs. Under the search of BGI's overall health impacts, this study selected 54 journal publications concerning BGI's type and interaction mode from Web of Science and Scopus since 2010. The review revealed significant disparities in the health benefits provided by different types of BGI (in terms of artificial extent and scale) and between active and passive interaction modes. It examines how to balance natural and artificial elements for enhancing the benefits of BGI and discusses the attributes of BGI that encourage diverse and meaningful interaction patterns. These efforts collectively aim to optimize BGI design and planning, increase its capacity to promote health, and extend its benefits to a wider range of individuals. Future research should encompass a broader spectrum of determinants, such as diverse BGI settings, visit frequency and duration, and user's social-cultural backgrounds.

Promoting stress and anxiety recovery in older adults: assessing the therapeutic influence of biophilic green walls and outdoor view

Previous research has already provided evidence regarding the favorable impact of green walls and outdoor views on stress reduction and anxiety alleviation. However, there has been limited exploration into the combined effects of green walls and outdoor views on older adults. In this study, a between-subjects experiment was conducted using virtual reality (VR) technology with 23 participants. Following exposure to stressors, each participant underwent four randomized sessions, each lasting 5 min, in various virtual reality (VR) environments, encompassing non-biophilic and biophilic environments (including green walls, outdoor views, and their combination). Throughout the process, we measured physiological indicators of stress responses, including heart rate, heart rate variability, skin conductance levels, and blood pressure, using biometric sensors. Psychological changes in participants, including anxiety levels, were evaluated through the State-Trait Anxiety Inventory, recovery scales, and self-reported emotional assessments. In conclusion, in comparison to non-biophilic environments, older adults consistently exhibited lower stress levels, experienced superior anxiety relief, and demonstrated improved recovery in nature connectedness environments, with a notably faster recovery rate. These findings suggest that the incorporation of nature connectedness principles into the indoor environments of public activity spaces within older adults care facilities can significantly contribute to stress reduction and anxiety alleviation among older adults. Furthermore, these effects appear to be contingent on the specific types of nature connectedness environments. These results can provide substantial evidence to support the design of indoor common activity spaces within older adults care facilities.

A scoping review of human health co-benefits of forest-based climate change mitigation in Europe

Climate change is a pressing global challenge with profound implications for human health. Forest-based climate change mitigation strategies, such as afforestation, reforestation, and sustainable forest management, offer promising solutions to mitigate climate change and simultaneously yield substantial co-benefits for human health. The objective of this scoping review was to examine research trends related to the interdisciplinary nexus between forests as carbon sinks and human health co-benefits. We developed a conceptual framework model, supporting the inclusion of exposure pathways, such as recreational opportunities or aesthetic experiences, in the co-benefit context. We used a scoping review methodology to identify the proportion of European research on forest-based mitigation strategies that acknowledge the interconnection between mitigation strategies and human impacts. We also aimed to assess whether synergies and trade-offs between forest-based carbon sink capacity and human co-benefits has been analysed and quantified. From the initial 4,062 records retrieved, 349 reports analysed European forest management principles and factors related to climate change mitigation capacity. Of those, 97 studies acknowledged human co-benefits and 13 studies quantified the impacts on exposure pathways or health co-benefits and were included for full review. Our analysis demonstrates that there is potential for synergies related to optimising carbon sink capacity together with human co-benefits, but there is currently a lack of holistic research approaches assessing these interrelationships. We suggest enhanced interdisciplinary efforts, using for example multideterminant modelling approaches, to advance evidence and understanding of the forest and health nexus in the context of climate change mitigation.

Quality criteria of nature-based interventions in healthcare facilities: a scoping review

Introduction

Implementing integrated nature-based interventions that simultaneously serve human health and the restoration of biodiversity in healthcare facilities is considered a promising strategy. As an emerging field of research and practice in healthcare, identification of quality criteria is necessary to support desired outcomes related to biodiversity, human health and intervention processes. This study is part of a larger research project in collaboration with the Flemish Agency of Nature and Forest in Belgium.

Methods

A scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews, in PubMed, Medline, Web of Science and Scopus. A step-by-step tabular screening process was conducted to identify relevant studies and reviews of nature-based interventions, published in English between January 2005 and April 2023. A qualitative content analysis was conducted and the results were then presented to the project steering group and a panel of stakeholders for refinement.

Results

After filtering on the eligibility criteria, and with focus on healthcare facilities, 14 articles were included in this study. A preliminary nature-based interventions quality framework with a set of quality indicators has been developed.

Discussion

When designing integrated nature-based interventions, a needs analysis of users and the outdoor environment should be conducted. Next, the integration of a One Health and biodiversity perspective and the application of a complex intervention framework, could support the quality of the design and implementation of nature-based interventions in healthcare facilities and facilitate their assessment. In future work, more rigorous research into the design and implementation of integrated nature-based interventions is needed to test and refine the quality criteria in practice.

The outdoor office: a pilot study of environmental qualities, experiences of office workers, and work-related well-being

Outdoor office work is an emerging aspect of the concept of 'new ways of working', but only sparse data are available about the environmental qualities of the outdoor office space, experiences of office workers, and work-related well-being of outdoor office work. Here, we present an exploratory pilot study on well-being and outdoor office work in a public urban space. An outdoor office was set up in the courtyard of a university campus, and the participants (n = 16) conducted office work outdoors for 30 min and thereafter participated in an eye-tracking session for 11-15 min (n = 8) and subsequently filled out surveys (n = 16). The eye tracker allowed the discovery of natural and built elements in the outdoor environment that caught the participants' visual attention, whereas the surveys assessed aspects of their subjective experiences of the outdoor office space (its visual and spatial qualities) and the work there. The results are presented as network graphs where correlations are shown regarding different aspects of office work outdoors. The results indicate that outdoor office work in a public urban space may promote work-related well-being in terms of positive outdoor office space experiences. Based on the findings, a preliminary set of outdoor office qualities is proposed. Those qualities relate to the legibility and imageability of the outdoor office space, its focal points, and depth/spaciousness, in addition to attributes of usability and environmental richness, including if the outdoor office space affords natural contact and supports activities, in addition to social and individual interactions and relations.