Nature and Well-Being Project

Not Applicable

Completed

• Conditions: Environmental Exposure; Health Behavior; Health, Subjective
• Interventions: Other: Nature Nook; Behavioral: Nature Coach; Other: Nature Nook + Nature Coach

• Registration Number: NCT04642235
• Lead Sponsor: University of Pennsylvania

Brief Summary

The investigators pilot test two intervention strategies to increase green space use- place-based and person-based, as well as evaluate the dose-response relationship between green space use and health.

Detailed Description

Neighborhood conditions can positively impact mental health and wellbeing. Green space has been cited as a potential buffer between inequitable neighborhood conditions and poor health. However, there is limited evidence how to increase exposure to green space and how much exposure is needed to produce benefit. Place-based and person-based interventions offer contrasting approaches to improving the impact of the environment on health. The environment influences people as they traverse the spaces between home, work, and recreation, in ways that can be healthy or harmful. Place-based approaches directly change the environment to encourage healthy behaviors, and potentially have broad population impact. Alternatively, person-based approaches directly target individuals' behavior and may be more feasible. To our knowledge, no studies combine both approaches into a single intervention, which may be more effective over either alone.

The broad objectives of this proposal are to pilot test two intervention strategies to increase green space use- place-based and person-based, as well as evaluate the dose-response relationship between green space use and health. Our place-based intervention, Nature Nooks, builds on our prior greening treatment by adding new features to encourage use - a path and benches to invite people into the space and instillation on large corner lots to maximize visibility. The investigators develop our person-based intervention, Nature Coach, as a novel adoption of an analogous, established patient navigator concept in healthcare.

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Study First Submitted: 2020-11-13
• Study First Submitted QC: 2020-11-23
• Study First Posted: 2020-11-24
• Study Start: 2021-04-12
• Status Verified: 2022-08
• Primary Completion: 2022-08-23
• Study Completion: 2022-08-23
• Last Update Submitted: 2022-08-31
• Last Update Posted: 2022-09-01

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 74

Inclusion Criteria

• 18 years or older
• Live in one of the 8 target neighborhoods identified
• Have a smartphone
• Able to understand and respond to an oral interview in English.

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Exclusion Criteria

• Unwilling to go outside
• Not ambulatory

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: FACTORIAL

Arm && Interventions

Group	Intervention	Description
Nature Nook	Nature Nook	Nature Nook builds on our prior work with a standard vacant lot greening intervention involving: removing trash, grading the land, planting new grass and trees, installing a low wooden perimeter fence, and regular maintenance. This greening intervention was designed as a blight removal strategy. People in this arm receive no intervention.
Nature Coach	Nature Coach	The Nature Coach intervention, developed in a prior study (NCT04146025), will be delivered to people in their homes. Participants will live in the blocks immediately surrounding the study vacant lots randomized to this arm. The lots in this arm receive no intervention.
Nature Nook + Nature Coach	Nature Nook + Nature Coach	This is a combined arm: a place-based intervention (Nature Nook) and a person-based intervention (Nature Coach).

Primary Outcome Measures

Name	Time	Method
Green Space Use	12 months	This will measured using GPS data to see the amount of time spent in green space.

Secondary Outcome Measures

Name	Time	Method
Mental health and well-being: CES-D	12 months	This will be measured using the Center for Epidemiologic Studies - Depression Scale (CES-D). The CES-D scale is a brief 20-item self-report scale designed to measure self-reported symptoms associated with depression experienced in the past week. Response options range from 0 to 3 for each item (0 = Rarely or None of the Time, 1 = Some or Little of the Time, 2 = Moderately or Much of the time, 3 = Most or Almost All the Time). Scores range from 0 to 60, with high scores indicating greater depressive symptoms. A score of 16 points or more is considered depressed.
Mental health and well-being: PSS-10	12 months	The Perceived Stress Scale-10(PSS-10) is a self-report instrument consisting of 10 items to assess stress perception, with the time frame being during the last month. Each of the items on the PSS-10 are rated on a 5-point Likert scale (0 = never, 1 = almost never, 2 = sometimes, 3 = fairly often, 4 = very often). Four positively stated items (item 4, 5, 7, and 8) are reversely scored (0 = very often, 1 = fairy often, 2 = sometimes, 3 = almost never, 4 = never). The sum of the 10 items represents the total score, with higher scores representing higher levels of perceived stress.
Mental health and well-being: WHO-5	12 months	The WHO-5 Well-Being Index is a questionnaire that measures current mental well-being, with the time frame being the previous two weeks. This is five items rated on 6-point Likert scale (All of the time, Most of the time, More than half the time, Less than half the time, Some of the time, At no time). The raw score is calculated by totaling the figures of the five answers. The raw score ranges from 0 to 25, 0 representing worst possible and 25 representing best possible quality of life.

Trial Locations

Locations (1)

University of Pennsylvania, Department of Emergency Medicine; 🇺🇸 Philadelphia, Pennsylvania, United States