Clinic and park partnerships for childhood resilience: A prospective study of park prescriptions

Razani, Nooshin; Niknam, Kian; Wells, Nancy M.; Thompson, Doug; Hills, Nancy K.; Kennedy, Gail; Gilgoff, Rachel; Rutherford, George W.

doi:10.1016/j.healthplace.2019.04.008

Cited by 34 publications

(25 citation statements)

References 39 publications

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“…This is a secondary data analysis of pooled data from a clinical trial that prescribed park visits to children and their caregivers in a low-income, urban setting and has been described in detail elsewhere, including power and sample size calculations [7,11,12]. Patients (children ages 4-17) and one caregiver at a Federally Qualified Health Center in Oakland, California, were eligible for enrollment if they were not enrolled in a weight loss or exercise program, were able to walk and be physically active, and were available for the park outings and two follow-up visits over three months.…”

Section: Methodsmentioning

confidence: 99%

“…The body of experimental studies evaluating this practice has also started to build. The few experimental studies on park prescription programs to date have shown moderate adherence [9], increased physical activity [5], improved quality of life [10], and improved resilience in children who received park prescriptions [11]. A park prescription for the family demonstrated increased weekly park visits and lowered stress in parents [12].…”

Section: Ofmentioning

confidence: 99%

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The Association of Knowledge, Attitudes and Access with Park Use before and after a Park-Prescription Intervention for Low-Income Families in the U.S.

Razani

Hills

Thompson

et al. 2020

IJERPH

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We conducted secondary data analyses of pooled data from a clinical trial that prescribed park visits to children and their caregivers in a low-income, urban setting. Data were collected at the prescribing visit (baseline) and at one and three months of follow up from 78 families. Family characteristics were identified at baseline; regression models were used to explore changes during follow up in associations of park use with knowledge, attitudes and perceived access to parks. At baseline, park users differed from non-users in demographics, knowledge of park locations, attitudes about the value of park visits, but not affinity for nature. Park users were also more likely than non-users to feel that their neighborhood was safe for children to play in. Changes in knowledge of park locations, nature affinity, and perceived access to parks were each significantly associated with increased park use by families at one and three months after the park prescription. Adjusting for age, gender, race, poverty, and US birth, increases in knowing the location of parks were associated with an increase of 0.27 weekly park visits (95% CI 0.05, 0.49; p = 0.016); increases in feeling a caregiver had money to visit parks were associated with 0.48 more weekly park visits (95% CI 0.28, 0.69; p < 0.001); increases in perceived money for park outings were associated with 0.24 increased park visits per week (95% CI 0.05, 0.42; p = 0.01); each unit increase in nature affinity was associated with 0.34 more weekly park visits (95% CI 0.09, 0.59; p = 0.007). In other words, knowing where to go, valuing nature, and having time, and money contributed to increased likelihood of visiting a park. We discuss in terms of health behavior theory how demographics, knowledge, attitudes and perceived barriers to park use can inform park prescription interventions.

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Section: Methodsmentioning

confidence: 99%

Section: Ofmentioning

confidence: 99%

The Association of Knowledge, Attitudes and Access with Park Use before and after a Park-Prescription Intervention for Low-Income Families in the U.S.

Razani

Hills

Thompson

et al. 2020

IJERPH

Self Cite

View full text Add to dashboard Cite

show abstract

“…Experimental studies evaluating this practice also are on the rise. To date, the few experimental studies on park prescription programs have shown moderate adherence [17], increased physical activity [18], improved quality of life [19], and improved resilience in children who received park prescriptions [20]. Park prescriptions for families demonstrated increased weekly park visits and lowered stress in parents [21].…”

Section: Introductionmentioning

confidence: 99%

“…Because research shows that nature exposure may be most beneficial to low-income communities and may decrease health inequities [4], park prescription programs have been started in low-income communities [20]. We currently lack information on how poverty may be associated with park access in clinic patients that may be candidates for a park prescription and on how those patients may prioritize park access.…”

Section: Introductionmentioning

confidence: 99%

Screening for Park Access during a Primary Care Social Determinants Screen

Razani

Long

Hessler

et al. 2020

IJERPH

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While there is evidence that access to nature and parks benefits pediatric health, it is unclear how low-income families living in an urban center acknowledge or prioritize access to parks. Methods: We conducted a study about access to parks by pediatric patients in a health system serving low-income families. Adult caregivers of pediatric patients completed a survey to identify and prioritize unmet social and economic needs, including access to parks. Univariate and multivariate analyses were conducted to explore associations between lack of access to parks and sociodemographic variables. We also explored the extent to which access to parks competed with other needs. Results: The survey was completed by 890 caregivers; 151 (17%) identified “access to green spaces/parks/playgrounds” as an unmet need, compared to 397 (45%) who endorsed “running out of food before you had money or food stamps to buy more”. Being at or below the poverty line doubled the odds (Odds ratio 1.96, 95% CI 1.16–3.31) of lacking access to a park (reference group: above the poverty line), and lacking a high school degree nearly doubled the odds. Thirty-three of the 151 (22%) caregivers who identified access to parks as an unmet need prioritized it as one of three top unmet needs. Families who faced competing needs of housing, food, and employment insecurity were less likely to prioritize park access (p < 0.001). Conclusion: Clinical interventions to increase park access would benefit from an understanding of the social and economic adversity faced by patients.

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“…Intervention process evaluations can help to understand which components worked, which didn't and why by exploring the mechanisms of impact of the intervention on outcomes (21). Although studies prescribing park PA have been published (11,(22)(23)(24)(25), to our knowledge no process evaluations to understand the mechanisms of impact of such interventions exist in peer-reviewed scientific journals.…”

Section: Introductionmentioning

confidence: 99%

Activity in Nature Mediates a Park Prescription Intervention’s Effects on Physical Activity, Park Use and Quality of Life: A Mixed-Methods Process Evaluation

Petrunoff¹,

Yao²,

Sia³

et al. 2019

Preprint

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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.

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Clinic and park partnerships for childhood resilience: A prospective study of park prescriptions

Cited by 34 publications

References 39 publications

The Association of Knowledge, Attitudes and Access with Park Use before and after a Park-Prescription Intervention for Low-Income Families in the U.S.

The Association of Knowledge, Attitudes and Access with Park Use before and after a Park-Prescription Intervention for Low-Income Families in the U.S.

Screening for Park Access during a Primary Care Social Determinants Screen

Activity in Nature Mediates a Park Prescription Intervention’s Effects on Physical Activity, Park Use and Quality of Life: A Mixed-Methods Process Evaluation

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