The impact of a park refurbishment in a low socioeconomic area on physical activity: a cost-effectiveness study

Abstract

Background Physical inactivity is the fourth highest cause of death globally and is a major contributor to increases in healthcare expenditure. Improving public open spaces such as parks in areas of low socio-economic position (SEP) may increase recreational physical activity in disadvantaged populations. We assessed the cost-effectiveness of the installation of a play-space in a large metropolitan park in a low socioeconomic area based on changes in physical activity. Methods Observational data of visitor counts and activities undertaken in the park before the installation of the new play-scape (T1), at two months (T2) and 14 months post-installation (T3) were obtained for the intervention and a control park (with no refurbishment) located in a high SEP metropolitan area. Observed sitting, standing, and moderate and vigorous-intensity physical activity were converted to yearly MET-h according to age. Costs of the play-scape and ongoing maintenance were obtained from the organisation managing the refurbishment. The incremental cost-effectiveness ratio (ICER) (ratio of incremental cost to incremental effect) was calculated based on the incremental increase in MET-h from T1 to T3 assuming a 20-year lifetime of the play-scape. Observation counts combining moderate and vigorous activity were used in the sensitivity analysis. Results When compared with T1, at T3 the new play-scape resulted in an overall incremental net gain of 114,114 MET-h (95% UI: 80,476 − 146,096) compared with the control park and an incremental cost effectiveness ratio (or cost per MET-h gained per park visitor) of AUD $0.58 (95% UI: $0.44–$0.80). The sensitivity analysis combining moderate and vigorous activity into one category showed an increase in estimated incremental MET-h of 118,190 (95% CI: 83,528 − 149,583) and a lower incremental cost per MET-h gained of AUD $0.56 (95% UI: $0.43–$0.77). Conclusions Using a benchmark of cost-effectiveness for physical activity interventions of AUD $0.60–$1.30, this study suggests that the installation of a play-scape located in a low SEP area is cost-effective based on its potential to facilitate increases in MET-h. It provides much needed preliminary evidence and requires replication elsewhere. Electronic supplementary material The online version of this article (10.1186/s12966-019-0786-5) contains supplementary material, which is available to authorized users.

Determining Factors in the Use of Urban Parks That Influence the Practice of Physical Activity in Children: A Systematic Review

“…Of the sample object of this study ( n = 31), 48.38% ( n = 15) of the papers established a direct relationship between the design, characteristics and equipment of the park with an increase in visits, a greater and more effective use of the park, and a greater intensity of PA, with 32.25% ( n = 10) being remodelled, innovative, contemporary and sustainable parks with special characteristics [ 4 , 53 , 62 , 64 , 69 , 72 , 75 , 77 , 80 ]. If the needs of users are also taken into account in the remodelling or design of new parks, 16.12% ( n = 5) of the studies analysed concluded that it can create a positive effect on the number of visitors and, therefore, an increase in PA performed [ 49 , 66 , 71 , 83 ].…”

“…Focusing efforts on the remodelling and/or design of parks in areas of low socioeconomic status is essential from the perspective of health and PA. This is because improving public spaces in disadvantaged areas can increase recreational PA [ 4 , 62 , 64 ]. This is not only beneficial for children from disadvantaged backgrounds, but it also applies to other contexts where, as current data indicate, park use is higher among boys than girls [ 49 , 64 , 79 ].…”

Time-trends and correlates of obesity in Czech adolescents in relation to family socioeconomic status over a 16-year study period (2002–2018)

“…Therefore, in addition to sport, it is necessary to support and create the conditions for daily implementation of MVPA in all children and adolescents, regardless of the SES category. Improving public open spaces in low-SES areas by installing play spaces for recreational PA [77] or expanding school-related PA (including active recess, physical education lessons [78,79] and after-school nursery [80]) has an impact on increasing day-to-day PA [80] and reducing children's obesity [80,81].…”

Examining Health-Related Effects of Refurbishment to Parks in a Lower Socioeconomic Area: The ShadePlus Natural Experiment

“…These findings suggest that further research to identify how to sustainably increase park-based physical activity for different communities is worth pursuing. Moreover, studies have found park refurbishments a cost-effective way to increase physical activity [ 40 ]. Innovative amenities may be required.…”