Investigating the physical activity, health, wellbeing, social and environmental effects of a new urban greenway: a natural experiment (the PARC study)

Ruth Hunter, Deepti Adlakha, Christopher Cardwell, Margaret Cupples, Michael Donnelly, Geraint Ellis, Aisling Gough, W George Hutchinson, Therese Kearney, Alberto Longo, Lindsay Prior, Helen McAneney, Sara Ferguson, Brian Johnston, Michael Stevenson, Frank Kee, Mark Tully

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Abstract

Background
Evidence for the health benefits of urban green space tends to stem from small, short-term quasi-experimental or cross-sectional observational research, whilst evidence from intervention studies is sparse. The development of an urban greenway (9 km running along 3 rivers) in Northern Ireland provided the opportunity to conduct a natural experiment. This study investigated the public health impact of the urban greenway on a range of physical activity, health, wellbeing, social, and perceptions of the environment outcomes.

Methods
A repeated cross-sectional household survey of adult residents (aged ≥16 years) who lived ≤1-mile radius of the greenway (intervention sample) and > 1-mile radius of the greenway (control sample) was conducted pre (2010/2011) and 6-months post implementation (2016/2017). We assessed changes in outcomes pre- and post-intervention follow-up including physical activity behaviour (primary outcome measure: Global Physical Activity Questionnaire), quality of life, mental wellbeing, social capital and perceptions of the built environment. Linear regression was used to calculate the mean difference between post-intervention and baseline measures adjusting for age, season, education, car ownership and deprivation. Multi-level models were fitted using a random intercept at the super output area (smallest geographical unit) to account for clustering within areas. The analyses were stratified by distance from the greenway and deprivation. We assessed change in the social patterning of outcomes over time using an ordered logit to make model-based outcome predictions across strata.

Results
The mean ages of intervention samples were 50.3 (SD 18.9) years at baseline (n = 1037) and 51.7 (SD 19.1) years at follow-up (n = 968). Post-intervention, 65% (adjusted OR 0.60, 95% CI 0.35 to 1.00) of residents who lived closest to the greenway (i.e., ≤400 m) and 60% (adjusted OR, 0.64 95% CI 0.41 to 0.99) who lived furthest from the greenway (i.e.,≥1200 m) met the physical activity guidelines - 68% of the intervention sample met the physical activity guidelines before the intervention. Residents in the most deprived quintiles had a similar reduction in physical activity behaviour as residents in less deprived quintiles. Quality of life at follow-up compared to baseline declined and this decline was significantly less than in the control area (adjusted differences in mean EQ5D: -11.0 (95% CI − 14.5 to − 7.4); − 30.5 (95% CI − 37.9 to − 23.2). Significant change in mental wellbeing was not observed despite improvements in some indicators of social capital. Positive perceptions of the local environment in relation to its attractiveness, traffic and safety increased.

Conclusions
Our findings illustrate the major challenge of evaluating complex urban interventions and the difficulty of capturing and measuring the network of potential variables that influence or hinder meaningful outcomes. The results indicate at this stage no intervention effect for improvements in population-level physical activity behaviour or mental wellbeing. However, they show some modest improvements for secondary outcomes including positive perceptions of the environment and social capital constructs. The public health impact of urban greenways may take a longer period of time to be realised and there is a need to improve evaluation methodology that captures the complex systems nature of urban regeneration.
Original languageEnglish
Article number142
JournalInternational Journal of Behavioral Nutrition and Physical Activity
Volume18
Issue number1
Early online date30 Oct 2021
DOIs
Publication statusPublished - Dec 2021

Bibliographical note

Funding Information:
The Physical Activity and Rejuvenation of Connswater (PARC) Study is a before-and-after evaluation of the public health effects of the CCG on physical activity, health, mental wellbeing, social and perceptions of the environment outcomes in Belfast []. The study was developed in partnership with statutory, voluntary and community organisations, and comprised four main elements: 1) a quasi-experimental before-and-after survey of the local CCG population (repeated cross-sectional design); 2) assessment of change in the local built environment and walkability using data from geographic information systems (GIS); 3) semi-structured interviews with local residents, and a range of community stakeholders before and after the regeneration project; 4) an economic evaluation. The current study focuses on the results from the before and after household survey. Economic evaluations have been published elsewhere [, ]. The study was funded by the National Prevention Research Initiative (Medical Research Council) and approved by the Office for Research Ethics Committees, Northern Ireland (09/NIR02/66).

Funding Information:
The authors would like to acknowledge the partners and stakeholders involved in the PARC Study including the Eastside Partnership; Belfast City Council; Department of Health, Social Services and Public Safety; Department for Communities; Department of the Environment; Department for Infrastructure; Belfast Health and Social Care trust; East Belfast Community Development Agency; Sport Northern Ireland; Belfast Healthy Cities; Sustrans; Public Health Agency; Ordnance Survey NI and local residents of the Connswater Community Greenway population.

Funding Information:
The PARC study is supported by a grant from the National Prevention Research Initiative (NPRI) (grant number: G0802045/1). The funding partners are (in alphabetical order): Alzheimer’s Research Trust; Alzheimer’s Society; Biotechnology and Biological Sciences Research Council; British Heart Foundation; Cancer Research UK; Chief Scientist Office; Scottish Government Health Directorate; Department of Health; Diabetes UK; Economic and Social Research Council; Engineering and Physical Sciences Research Council; Health and Social Care Research and Development Division of the Public Health Agency (HSC R&D Division); Medical Research Council; The Stroke Association; Welsh Assembly Government and World Cancer Research Fund. We wish to also acknowledge funding from the UKCRC Centre of Excellence for Public Health Northern Ireland. The authors declare that the funders had no role in any aspect of the PARC study, including the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

Publisher Copyright:
© 2021, The Author(s).

Keywords

  • Health
  • Intervention
  • Mental wellbeing
  • Natural experiment
  • Physical activity
  • Urban green space

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Nutrition and Dietetics

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