Participation in environmental enhancement and conservation activities for health and well‐being in adults: a review of quantitative and qualitative evidence

摘要: Background There is growing research and policy interest in the potential for using natural environment to enhance human health well-being. This resource may be underused as a promotion tool address increasing burden of common problems such increased chronic diseases mental concerns. Outdoor environmental enhancement conservation activities (EECA) (for instance unpaid litter picking, tree planting or path maintenance) offer opportunities physical activity alongside greater connectedness with local environments, enhanced social connections within communities improved self-esteem through that improve locality which may, turn, further well-being. Objectives To assess well-being impacts on adults following participation activities. Search methods We contacted searched websites more than 250 EECA organisations identify grey literature. Resource limitations meant majority were from UK, USA, Canada Australia. We databases (initially October 2012, updated 2014, except CAB Direct, OpenGrey, SPORTDiscus, TRIP Database), search strategy developed our project advisory groups (predominantly leaders EECA-type methodological experts): ASSIA; BIOSIS; British Education Index; Nursing Abstracts; Campbell Collaboration; Cochrane Public Health Specialized Register; DOPHER; EMBASE; ERIC; Global Health; GreenFILE; HMIC; MEDLINE-in-Process; MEDLINE; OpenGrey; PsychINFO; Social Policy Practice; SPORTDiscus; TRoPHI; Services Sociological The Library; database; Web Science. Citation related article chasing was used. Searches limited studies English published after 1990. Selection criteria Two review authors independently screened studies. Included examined impact adult Eligible interventions needed include each following: intended outdoor built at either wider level; took place urban rural locations any country; involved active participation; NOT experienced paid employment. We included quantitative qualitative research. Includable study designs were: randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs, before-and-after studies, interrupted-time-series, cohort (prospective retrospective), case-control uncontrolled (uBA). if it used recognised methods data collection analysis. Data analysis One reviewer extracted data, another checked data. Two appraised quality Effective Practice Project studies) Wallace criteria studies). Heterogeneity outcome measures poor reporting intervention specifics prevented meta-analysis so we synthesised results narratively. findings thematic analysis. Main results Database searches identified 21,420 records, 21,304 excluded title/abstract. Grey literature 211 records. 327 full-text articles 21 (reported 28 publications): two case-studies (which not synthesis due inadequate robustness), one case-control, retrospective cohort, five uBA, three mixed-method (uBA, qualitative), nine 19 detailed total 3,603 participants: 647 2630 study; 326 (one sample size). Included shared key elements defined above, but range varied considerably. Quantitative evaluation heterogeneous. both, rated ‘weak’ high risk bias design, detail, participant selection, blinding. Participants’ characteristics poorly reported; eight did report gender age none reported socio-economic status. Three participants referred services, ill (five studies), however participants' engagement routes often clear. Whilst (n = 8) no effect outcomes, positive effects six relating short-term physiological, mental/emotional health, quality-of-life outcomes. Negative studies; higher levels anxiety amongst participants, stress. The design reporting, good nine; mainly missing detail about interventions. evidence provided rich experience participation. Thematic analysis themes supported by least study, regarding experiences personal/social identity, activity, developing knowledge, spirituality, benefits place, personal achievement, psychological contact. There negative experiences. Authors' conclusions There little participating EECA. However, showed perceived benefit among participants. resulted bias, lacked detail. programme evaluations, conducted internally funded provider. The conceptual framework illustrates interlinked mechanisms people believe they potentially achieve benefits, It also considers moderators mediators effect. One main finding inherent difficulty associated generating robust effectiveness complex illustrate how believed benefited. Investigating subsequent theory-led might way examining these activities. The needs refinement linked reviews reliable evidence. Future should use