Identifying Effective Behavior Change Techniques in Built Environment Interventions to Increase Use of Green Space: A Systematic Review

Abstract

Green space has beneficial impacts on health, and there is increasing interest in how to modify green space in order to promote use. We identified effective behavior change techniques in environmental interventions that aimed to encourage use of green space. Fifteen studies met the inclusion criteria. Interventions were coded by reviewers using the Behavior Change Technique taxonomy (BCTTv1). Eleven studies reported an increase in green space use post-intervention. Techniques involving physical environment changes ('adding objects to the environment' or 'restructuring the physical environment') were commonly delivered alongside additional techniques such as 'restructuring the social environment', introducing 'prompts or cues' and 'demonstration of the behavior'. Risk of bias was high or unclear for all, and the quality of evidence was very low. Intervention content was poorly described according to current reporting guidelines. More rigorous evaluations of green space interventions are needed, coupled with full descriptions of intervention content to allow replication. 2 IntroductionNumerous health benefits have been linked to contact with green space, including improved self-perceived health (Maas, Verheig, Groenewegen, de Vries, & Spreeuwenberg, 2006), reduced risk of low birth weight (Dadvand et al., 2014), reduced cardiovascular mortality (Gascon et al., 2016), improved general mental health (de Vries, van Dillen, Groenewegen, & Spreeuwenberg, 2013), and reduced likelihood of depressive symptoms (McEachan et al., 2015). Four main mechanisms for this relationship have been identified: improved air quality, opportunity for physical activity, facilitation of social contact, and stress reduction and attention restoration (Hartig, Mitchell, de Vries, & Frumkin, 2014).The health benefits of green space may be moderated by socioeconomic status, with lower socioeconomic groups seeing greater benefit (Dadvand et al., 2012;McEachan et al., 2015). As a result green spaces are increasingly recognized as a valuable resource for health promotion at a population level (Lee & Maheswaran, 2011), which may be useful as a tool to reduce health inequalities (Mitchell & Popham, 2008). Lee, Jordan, and Horsley (2015) argue the green space associated health benefits are more likely a result of the activities undertaken in green space rather than simply provision per se. In other words, the health benefits of green space are brought about by its functionality and its use rather than presence alone. Moreover, White et al. (2016) calculated that over 8 million adults in England undertake physical activity in natural environments each week, demonstrating how green spaces might be actively used to improve health. It is therefore important to understand how a green space might be optimized in order to encourage use.Environmental interventions on green space offer clear potential to target a large population. Understanding how a green space might be designed or adapted to maximize the potential health benefits is useful for many...

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