Abstract
BackgroundCreating or improving urban green space has the potential to be an effective, sustainable and far-reaching way to increase physical activity and improve other aspects of wellbeing in the population. However, there is a dearth of well-conducted natural experimental studies examining the causal effect of changing urban green space on physical activity and wellbeing. This is especially true in older adults and in the United Kingdom. This paper describes a natural experimental study to evaluate the effect of four small-scale urban street greening interventions on older adults’ physical activity and wellbeing over a 1-year period, relative to eight matched comparison sites. All sites are located in deprived urban neighbourhoods in Greater Manchester, United Kingdom.MethodsComponents of the interventions include tree and flower planting, and artificial tree decorations. Eight unimproved comparison sites were selected based on a systematic process of matching using several known objective and subjective environmental correlates of physical activity in older adults. The outcome measures are physical activity and two other behavioural indicators of wellbeing (Connect: connecting with other people; and Take Notice: taking notice of the environment), collected using a newly developed observation tool. The primary outcome is Take Notice behaviour due to largest effects on this behaviour being anticipated from improvements in the aesthetic quality of green space at the intervention sites. Baseline data collection occurred in September 2017 before the interventions were installed in November 2017. Follow-up data collection will be repeated in February/ March 2018 (6 months) and September 2018 (12 months).DiscussionThe present study permits a rare opportunity to evaluate the causal effects of small-scale changes in urban green space in an understudied population and setting. Although the interventions are expected to have small effects on the outcomes, the present study contributes to developing natural experiment methodology in this field by addressing key methodological weaknesses causing high risk of bias in previous natural experimental studies. Key improvements to reduce risk of bias in the present study are rigorous matching of multiple comparison sites and appropriate statistical control of key confounders.Trial registrationRetrospectively registered with study ID NCT03575923. Date of registration: 3 July 2018.
Highlights
Creating or improving urban green space has the potential to be an effective, sustainable and farreaching way to increase physical activity and improve other aspects of wellbeing in the population
Interventions targeted at the individual level to increase physical activity in adults yield modest improvements and often lack long-term effectiveness, and are not cost-effective [6] and this lack of long-term effectiveness is evident in older adults [7]
intraclass correlation coefficients (ICC) were used to estimate the average reliability of hourly counts of older adults for the following abbreviated schedules: combinations of 2, 3, or 4 h per day compared to the full 10 h per day
Summary
Creating or improving urban green space has the potential to be an effective, sustainable and farreaching way to increase physical activity and improve other aspects of wellbeing in the population. There is a dearth of well-conducted natural experimental studies examining the causal effect of changing urban green space on physical activity and wellbeing. This is especially true in older adults and in the United Kingdom. This paper describes a natural experimental study to evaluate the effect of four small-scale urban street greening interventions on older adults’ physical activity and wellbeing over a 1-year period, relative to eight matched comparison sites. Creating a supportive environment at the population level may be a more effective, sustainable and far-reaching approach to increase older adults’ physical activity levels by targeting the wider determinants of health [8]. The specific objectives of the feasibility study were to determine: (1) how many days of observation per week and hours per day are needed to provide a valid estimate of older adults’ activity in a UK urban setting; (2) what times of the day should observations be carried out to capture variation in older adults’ activity across the course of a day; and (3) any key differences in older adults’ activity patterns on weekdays compared to weekends.
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