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  1. Green spaces/outdoor leisure in mental health



    Discuss the Evidence-Based Practice Health Report: Green Space/ Outdoor Leisure in Mental Health


Subject Nursing Pages 9 Style APA


Mental health is vital at every stage of human life because it determines how individuals handle stress and make healthy choices. Mental health patients need to adopt the most effective evidence-based care towards ensuring their wellbeing. Evidence-based strategies can be established via an evaluation of the different studies conducted on a topic and the determination of the most appropriate approach to use in ensuring better mental health. One of the methods used in mental health is exposure to green space and outdoor leisure activities (Wendelboe-Nelson et al., 2019). A majority of those studies have established that urban green spaces have various benefits to mental health. However, there have been inconsistencies in the findings of the studies reported (Van den Berg et al., 2016). Whereas some studies report significant health benefits arising from exposure to green space, others show marginal benefits and in some studies, there is an absence of any positive health outcomes. As such, a need arises for further studies to be done to get evidence-based results about the potential of green spaces and outdoor leisure in ensuring better mental health. The present study seeks to explore different studies to establish the correct position in terms of how green spaces coupled with outdoor leisure affect the mental health of individuals.


            The search for the different qualitative and quantitative studies started with an exploration of various search engines such as Google and Google Scholar. The literature review question that was used during the search is: What is the impact of exposure to green spaces/outdoor leisure on mental health? The inclusion criteria for articles were that they had to be published within the last five years and scholarly. Some of the keywords used in the search are green space, mental health, stress, and empirical research. Non-scholarly articles were excluded and those found to be outside the topic area were excluded. A PICO format was used to help in narrowing down the research area from a general one to a specific topic. After the use of keywords and phrases, six articles were found which all touched on the impact of exposure to green space on mental health. The various scholarly sources obtained from the search were reviewed to ensure that they met all the inclusion criteria such as year of publication, quality of information contained therein, the relevance of the findings, and their overall contribution to the topic of interest. An exanimation of the articles resulted in various findings.



            Barton and Rogerson’s (2017) article is a descriptive study that focuses on discussing the importance of green space for mental health. After a review of the literature, the authors established that there exists modern research evidence that green space is important in ensuring population-level mental health.

Coppel and Wüstemann (2017) sought to investigate the impact of access to urban green space and self-reported mental health. Their quantitative study; which relied on a cross-sectional survey of the European urban area, found out that access to urban free space contributed to improved mental health outcomes.

Ekkel and de Vries’s (2017) study reviewed various quantitative and qualitative studies to identify the accessibility metrics related to green space indicators of better mental health. The findings of the studies were that some of the metrics, which affect the effectiveness of urban green spaces in ensuring better mental health include the quality of the green spaces, sizes of the green spaces, and distance from the users.

Kondo et al. (2018) sought to establish any causal relationships between green spaces and urban settings. The authors used a systematic review of the literature to determine whether there is an interconnectedness between urban green spaces and human health. Their findings were mixed in that in some instances a positive correlation was found whereas in others there was no association at all.

The aim of Wood et al.’s (2017) article was to investigate any association between the presence, amount, and attributes of public green space and the mental health of residents in a new greenfield neighborhood developments. Using a quantitative study, the authors found out that the overall number, as well as the total area of the public green spaces, was significantly associated with improved and greater mental health and wellbeing.

Zhang and Tan (2019) set out to establish the dependence on urban green spaces’ health association on some of the parameters for quantifying the urban green spaces. The metrics studied include park area, canopy cover, and vegetation cover. After using a population-based household survey in different areas of Singapore, the authors’ results were that all three metrics have a positive correlation with mental health.


            After an examination of the different studies, it has been established that urban green space has a positive correlation to mental health. A majority of the studies explored have illustrated that exposure to urban green spaces results in better mental health. For example, Barton and Rogerson’s (2017) study established urban green spaces are important in ensuring population-level mental health. Similarly, Coppel and Wüstemann (2017) found out that exposing mental health patients to urban green spaces results in improved health. However, Kondo et al. (2018) study obtained mixed results where in some instances a positive correlation was found to exist between urban green spaces and mental health whereas, in other instances, no correlation existed at all. However, overall, a positive correlation was found to exist between exposure to urban green spaces and improved mental health.

            The nature of improvement to mental health for individuals exposed to green spaces is affected by metrics such as the size of the green space, the quality of the green spaces, and the distance of the urban green spaces from the users. Ekkel and de Vries’s (2017) study reported that although the urban greenspace had a positive impact on mental health, more improvements to mental health outcomes were found in areas where the green spaces were of high quality, large sizes, and a short distance to the users’ residences. Similarly, Zhang and Tan (2019) found out that some of the metrics, which make urban green spaces have a significant impact on mental health are park area, canopy cover, and vegetation cover. Based on these findings a gap can be identified.


            Although many studies have found out that urban green spaces are vital in ensuring the mental health of the users, a majority of the studies have only focused on green spaces in urban areas and not those in rural areas. Additionally, none of the studies have explored the impact of combining the urban green spaces with different types of leisure activities. As such, a need arises for a study to establish how exposure to both green spaces and leisure activities affects mental health in rural areas. Thus, the proposed research question is:-

What is the impact of exposure to green spaces and leisure activities on mental health?     

Quality of Evidence

Qualitative Study

Ekkel and de Vries (2017) is the qualitative study chosen from the search yields for evaluation of its quality of evidence. The qualitative research approach is appropriate for the study because it ensures that the authors can review both quantitative and qualitative studies to gauge the impact of accessibility to nearby green space and human health. A qualitative study was appropriate in responding to the research question, which was on the specific metrics of green space which can affect mental health. The research question for the study was: what is the impact of the accessibility metrics of residential proximity and cumulative opportunity aspects of urban green spaces on mental health? The study was needed because of the little attention paid in the past to the differences between different metrics of nature and how they impact mental health. Ekkel and de Vries (2017) do not mention any ethical clearance sought, which is a key weakness. Also, the authors make no mention of any conflict of interest nor ways used to address such conflicts. Nevertheless, the random sampling used in the selection of the articles to review is appropriate for the qualitative study design because it allows the authors to come with a wide array of scholarly sources. A thematic analysis used was appropriate for the study design because it allows the authors to group the information obtained into different themes.

A qualitative approach was appropriate because the research question that Ekkel and de Vries (2017) sought to answer could be best addressed via such an approach. Specifically, a determination of the factors that affect the effectiveness of green spaces in addressing mental through a review of different articles could be best done through a qualitative design. The setting for the study was selected to be an online search and review of articles, which makes it possible to have a wide range of scholarly studies. Additionally, the articles selected for review, which in this case are the participants, were selected randomly; thus, eliminating any likelihood of bias. The authors’ perspective was that nature would most likely affect mental health. However, such a perspective was eliminated by ensuring that they had an objective evaluation of different articles to establish whether they align or reject their perspective. The methods used were inclusion criteria for the articles to be reviewed. The method of ensuring that the articles were relevant and current was appropriate because Ekkel and de Vries (2017) could get current information about their topic of interest. A thematic data analysis technique was appropriate for the study design because it allowed for the information to be placed into different themes for easy analysis. Ekkel and de Vries (2017) did not use any quality control measures, which affects their research rigor. However, the findings contribute to practice because they provide the different metrics for access to urban green spaces, which should be considered by healthcare professionals to ensure optimal mental health outcomes.

Quantitative Study

The quantitative study to be evaluated for quality of evidence is Coppel and Wüstemann’s (2017) study, which sought to investigate the impact of green spaces on mental health in the Berlin area of Germany. The quantitative research design used in the study was appropriate because it ensured that the authors could get empirical results. The primary research question that Coppel and Wüstemann’s (2017) sought to answer is: What is the impact of various metrics of urban green spaces such as vicinity, spatial coverage, and distance on mental health outcomes? The study was needed because the existing research was incomplete in addressing the effects of spatial coverages of urban green spaces on mental health. However, despite the study using human subjects, there was no mention of ethical clearance. Additionally, Coppel and Wüstemann (2017) do not state the existence of any conflict of interests and how they addressed it. Nevertheless, the non-random sampling technique used was undesirable because it could lead to bias, which could affect the validity and reliability of the findings (Wu et al., 2016). The statistical analyses approach used such as regression statistics were appropriate in determining any relationships between the dependent and independent variables.

Coppel and Wüstemann (2017) presented their results adequately because they used not only various analyses but also tables, which helped in providing the readers with a better representation of the findings. The setting of study which is Berlin was selected based on the population of the city and the knowledge about the number of green spaces available. Additionally, the statistics were selected appropriately because a regression statistical analysis could show any correlation (Johnson, 2015). The statistics were majorly descriptive because the data analysis technique was used to summarize the data such that any patterns could be established. The researchers relied on their own judgment to non-randomly selected the participants. Specifically, Coppel and Wüstemann (2017) selected the participants based on web panels of two independent survey companies. As such, they were able to select the participants who they deemed to have met their inclusion criteria. Correlations were addressed because Coppel and Wüstemann (2017) determined how factors such as the quality of green spaces and the spatial coverage of the space were correlated with better mental health. The authors mentioned the possibility of bias arising from measurement error. The authors claim that the findings are useful for the Berlin residents who will use them to ensure that they have larger green spaces for ensuring improved mental health.



Barton, J., & Rogerson, M. (2017). The importance of greenspace for mental health. BJPsych International, 14(4), 79-81.

Coppel, G., & Wüstemann, H. (2017). The impact of urban green space on health in Berlin, Germany: Empirical findings and implications for urban planning. Landscape and Urban Planning, 167, 410-418.

Ekkel, E. D., & de Vries, S. (2017). Nearby green space and human health: Evaluating accessibility metrics. Landscape and urban planning, 157, 214-220.

Johnson, P. (2015). Evaluating qualitative research: Past, present, and future. Qualitative Research in Organizations and Management: An International Journal.

Kondo, M. C., Fluehr, J. M., McKeon, T., & Branas, C. C. (2018). Urban green space and its impact on human health. International journal of environmental research and public health, 15(3), 445

Van den Berg, M., van Poppel, M., van Kamp, I., Andrusaityte, S., Balseviciene, B., Cirach, M., … & Maas, J. (2016). Visiting green space is associated with mental health and vitality: A cross-sectional study in four European cities. Health & place38, 8-15.

Wendelboe-Nelson, C., Kelly, S., Kennedy, M., & Cherrie, J. W. (2019). A scoping review mapping research on green space and associated mental health benefits. International journal of environmental research and public health16(12), 2081.

Wood, L., Hooper, P., Foster, S., & Bull, F. (2017). Public green spaces and positive mental health–investigating the relationship between access, quantity, and types of parks and mental wellbeing. Health & place, 48, 63-71.

Wu, Y. P., Thompson, D., Aroian, K. J., McQuaid, E. L., & Deatrick, J. A. (2016). Commentary: Writing and evaluating qualitative research reports. Journal of pediatric psychology41(5), 493-505.

Zhang, L., & Tan, P. Y. (2019). Associations between urban green spaces and health are dependent on the analytical scale and how urban green spaces are measured. International journal of environmental research and public health, 16(4), 578.


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