Activity in nature mediates a park prescription intervention’s effects on physical activity, park use and quality of life: a mixed-methods process evaluation
Abstract Background This process evaluation explored the implementation and mechanisms of impact of a Park Prescription Intervention trial (PPI), including the effects of hypothesised mediators (motivation, social support, recreational physical activity [PA], park use and park PA) on trial outcomes....
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2021-01-01
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Online Access: | https://doi.org/10.1186/s12889-021-10177-1 |
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doaj-f7d9e1e412e84a7b9ac7b5229f9201a8 |
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Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Nicholas Petrunoff Jiali Yao Angelia Sia Alwyn Ng Anbumalar Ramiah Michael Wong Jane Han Bee Choo Tai Léonie Uijtdewilligen Falk Müller-Riemenschneider |
spellingShingle |
Nicholas Petrunoff Jiali Yao Angelia Sia Alwyn Ng Anbumalar Ramiah Michael Wong Jane Han Bee Choo Tai Léonie Uijtdewilligen Falk Müller-Riemenschneider Activity in nature mediates a park prescription intervention’s effects on physical activity, park use and quality of life: a mixed-methods process evaluation BMC Public Health Parks Urban green space Physical activity Process evaluation Mediation analysis |
author_facet |
Nicholas Petrunoff Jiali Yao Angelia Sia Alwyn Ng Anbumalar Ramiah Michael Wong Jane Han Bee Choo Tai Léonie Uijtdewilligen Falk Müller-Riemenschneider |
author_sort |
Nicholas Petrunoff |
title |
Activity in nature mediates a park prescription intervention’s effects on physical activity, park use and quality of life: a mixed-methods process evaluation |
title_short |
Activity in nature mediates a park prescription intervention’s effects on physical activity, park use and quality of life: a mixed-methods process evaluation |
title_full |
Activity in nature mediates a park prescription intervention’s effects on physical activity, park use and quality of life: a mixed-methods process evaluation |
title_fullStr |
Activity in nature mediates a park prescription intervention’s effects on physical activity, park use and quality of life: a mixed-methods process evaluation |
title_full_unstemmed |
Activity in nature mediates a park prescription intervention’s effects on physical activity, park use and quality of life: a mixed-methods process evaluation |
title_sort |
activity in nature mediates a park prescription intervention’s effects on physical activity, park use and quality of life: a mixed-methods process evaluation |
publisher |
BMC |
series |
BMC Public Health |
issn |
1471-2458 |
publishDate |
2021-01-01 |
description |
Abstract Background This process evaluation explored the implementation and mechanisms of impact of a Park Prescription Intervention trial (PPI), including the effects of hypothesised mediators (motivation, social support, recreational physical activity [PA], park use and park PA) on trial outcomes. Methods Participants from the community were randomly allocated to intervention (n = 80) or control (n = 80) group. The intervention included baseline counselling, a prescription of exercise in parks, materials, three-month follow-up counselling and 26 weekly group exercise sessions in parks. Process evaluation indicators were assessed at three- and six-months. Implementation indicators included participation rates in intervention components and survey questions plus focus group discussions (FGDs) to understand which components participants valued. FGDs further assessed barriers and facilitators to intervention participation. To explore mechanisms of impact, linear regression was used to compare objectively measured PA between quantiles of group exercise participation. Structural equation modelling (SEM) explored hypothesised mediation of the significant intervention effects. Framework analysis was conducted for FGDs. Results Participants were middle-aged (mean 51, SD ± 6.3 years), predominantly female (79%) and of Chinese ethnicity (81%). All intervention participants received baseline counselling, the park prescription and materials, whilst 94% received the follow-up counselling. Mean minutes of moderate-to-vigorous PA/week (95% CI) differed by group exercise participation (p = 0.018): 0% participation (n = 18) 128.3 (69.3, 187.2) minutes, > 0–35.9% participation (n = 18) 100.3 (36.9, 163.6) minutes, > 35.9–67.9% participation (n = 17) 50.5 (− 4.9, 105.9) minutes and > 67.9% participation (n = 18) 177.4 (122.0, 232.8) minutes. Park PA at three-months had significant mediating effects (95% CI) on recreational PA 26.50 (6.65, 49.37) minutes/week, park use 185.38 (45.40, 353.74) minutes/month, park PA/month 165.48 (33.14, 334.16) minutes and psychological quality of life score 1.25 (0.19, 2.69) at six-months. Prioritising time with family and preferences for unstructured activities were barriers to intervention participation. Human interaction via follow-up or group exercise were facilitators. Conclusion This process evaluation showed park PA consistently mediated effects of the PPI, suggesting activity in parks was a mechanism of its effects. To optimise effectiveness, participants’ preference for prioritising time with family through family involvement and tailoring the intervention to participants’ preferences for structured or unstructured PA could be considered in future studies. Trial registration ClinicalTrials.gov NCT02615392 , 26 November 2015. |
topic |
Parks Urban green space Physical activity Process evaluation Mediation analysis |
url |
https://doi.org/10.1186/s12889-021-10177-1 |
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doaj-f7d9e1e412e84a7b9ac7b5229f9201a82021-01-24T12:03:46ZengBMCBMC Public Health1471-24582021-01-0121111410.1186/s12889-021-10177-1Activity in nature mediates a park prescription intervention’s effects on physical activity, park use and quality of life: a mixed-methods process evaluationNicholas Petrunoff0Jiali Yao1Angelia Sia2Alwyn Ng3Anbumalar Ramiah4Michael Wong5Jane Han6Bee Choo Tai7Léonie Uijtdewilligen8Falk Müller-Riemenschneider9Saw Swee Hock School of Public Health, National University of SingaporeSaw Swee Hock School of Public Health, National University of SingaporeCentre for Urban Greenery & Ecology, National Parks Board SingaporeSaw Swee Hock School of Public Health, National University of SingaporeHealth for Life Centre, Khoo Teck Puat Hospital, Alexandra Health Pte Ltd. 90 Yishun CentralHealth for Life Centre, Khoo Teck Puat Hospital, Alexandra Health Pte Ltd. 90 Yishun CentralHealth for Life Centre, Khoo Teck Puat Hospital, Alexandra Health Pte Ltd. 90 Yishun CentralSaw Swee Hock School of Public Health, National University of SingaporeSaw Swee Hock School of Public Health, National University of SingaporeSaw Swee Hock School of Public Health, National University of SingaporeAbstract Background This process evaluation explored the implementation and mechanisms of impact of a Park Prescription Intervention trial (PPI), including the effects of hypothesised mediators (motivation, social support, recreational physical activity [PA], park use and park PA) on trial outcomes. Methods Participants from the community were randomly allocated to intervention (n = 80) or control (n = 80) group. The intervention included baseline counselling, a prescription of exercise in parks, materials, three-month follow-up counselling and 26 weekly group exercise sessions in parks. Process evaluation indicators were assessed at three- and six-months. Implementation indicators included participation rates in intervention components and survey questions plus focus group discussions (FGDs) to understand which components participants valued. FGDs further assessed barriers and facilitators to intervention participation. To explore mechanisms of impact, linear regression was used to compare objectively measured PA between quantiles of group exercise participation. Structural equation modelling (SEM) explored hypothesised mediation of the significant intervention effects. Framework analysis was conducted for FGDs. Results Participants were middle-aged (mean 51, SD ± 6.3 years), predominantly female (79%) and of Chinese ethnicity (81%). All intervention participants received baseline counselling, the park prescription and materials, whilst 94% received the follow-up counselling. Mean minutes of moderate-to-vigorous PA/week (95% CI) differed by group exercise participation (p = 0.018): 0% participation (n = 18) 128.3 (69.3, 187.2) minutes, > 0–35.9% participation (n = 18) 100.3 (36.9, 163.6) minutes, > 35.9–67.9% participation (n = 17) 50.5 (− 4.9, 105.9) minutes and > 67.9% participation (n = 18) 177.4 (122.0, 232.8) minutes. Park PA at three-months had significant mediating effects (95% CI) on recreational PA 26.50 (6.65, 49.37) minutes/week, park use 185.38 (45.40, 353.74) minutes/month, park PA/month 165.48 (33.14, 334.16) minutes and psychological quality of life score 1.25 (0.19, 2.69) at six-months. Prioritising time with family and preferences for unstructured activities were barriers to intervention participation. Human interaction via follow-up or group exercise were facilitators. Conclusion This process evaluation showed park PA consistently mediated effects of the PPI, suggesting activity in parks was a mechanism of its effects. To optimise effectiveness, participants’ preference for prioritising time with family through family involvement and tailoring the intervention to participants’ preferences for structured or unstructured PA could be considered in future studies. Trial registration ClinicalTrials.gov NCT02615392 , 26 November 2015.https://doi.org/10.1186/s12889-021-10177-1ParksUrban green spacePhysical activityProcess evaluationMediation analysis |