Health and wellbeing under COVID-19: the GreenCOVID survey

Royal College of Surgeons in Ireland [email protected] Health and wellbeing under COVID-19: the GreenCOVID surveyHealth and wellbeing under COVID-19: the GreenCOVID survey AUTHOR(S) Viveka Guzman, Marco Garrido-Cumbrera, Olta Braçe, Denise Hewlett, Ronan Foley CITATION Guzman, Viveka; Garrido-Cumbrera, Marco; Braçe, Olta; Hewlett, Denise; Foley, Ronan (2023): Health and wellbeing under COVID-19: the GreenCOVID survey. Royal College of Surgeons in Ireland. Journal contribution. https://hdl.handle.net/10779/rcsi.13625960.v1 HANDLE 10779/rcsi.13625960.v1 LICENCE CC BY 3.0 This work is made available under the above open licence by RCSI and has been printed from https://repository.rcsi.com. For more information please contact [email protected] URL https://repository.rcsi.com/articles/journal_contribution/Health_and_wellbeing_under_COVID- 19_the_GreenCOVID_survey/13625960/1 * [email protected] (corresponding author) Irish Geography Vol. 53, No. 2 November 2020 DOI: 10.2014/igj.v53i2.1420 Health and Wellbeing under COVID-19: The GreenCOVID Survey Viveka Guzman1, Marco Garrido-Cumbrera2, Olta Braçe2, Denise Hewlett3 and Ronan Foley*4 1. Division of Population Health, Royal College of Surgeons in Ireland, 123 St Stephen’s Green, Dublin, D02 YN77, Ireland. 2. Health and Territory Research (HTR), Department of Physical Geography and Regional Geographic Analysis, Universidad de Sevilla, Doña María de Padilla s/n, 41004 Seville, Spain. 3. Faculty of Business, Law and Digital Technologies, University of Winchester, Sparkford Road, Winchester, Hampshire, SO22 4NR, United Kingdom. 4. Department of Geography, Maynooth University, Maynooth, Co. Kildare, WE23 HW31, Ireland. First received: 18 September 2020 Accepted for publication: 17 December 2020 Context Given the impact of COVID-19 on populations, especially under lockdown conditions, there has been more attention than ever focused on the role of nature, including green and blue spaces, to act as a form of health-enabler across societies (Morrow-Howell et al., 2020; Shanahan et al., 2016). Access to green space, with its potential for physical activity and mental health support has been specifically identified within the literature as an important asset for neighbourhood and citizen health and wellbeing (Astell-Burt and Feng, 2019; Honey-Roses et al., 2020; Brace et al., 2020). The established positive relationships between access to and benefits from green and blue space are variable over space, both in terms of the kinds of built environments in which people live, but also the availability nearby of natural assets like parks, coasts, rivers, etc.; as well as ease of access to those spaces for all citizens (Bambra et al., 2020; Honey-Roses et al., 2020). With the advent of the COVID-19 pandemic, most countries have developed as part of their public health strategies, a series of lockdown measures in which citizens have either been confined to home, or at best, a small catchment area immediately surrounding their homes (World Heath Organization et al., 2020). As part of a flurry of recent research on such relationships, the GreenCOVID study was carried out by a group of researchers in Spain, the UK and Ireland, all broadly operating to a similar framework and collecting information from the general adult population in each of the three countries. This 158 Health and Wellbeing under COVID-19: The GreenCOVID Survey short commentary introduces the survey alongside preliminary Irish results specifically focused on household characteristics, access to nearby green space as well as a measure of psychological wellbeing. The GreenCOVID Survey The original survey was designed by the lead author (Garrido-Cumbrera) from the University of Seville and disseminated online across Spain in March/April, 2020. Researchers in the UK and Ireland joined the initiative and disseminated translated versions of the questionnaire survey in June/July, 2020. For the English language version, some small adjustments to the cultural and geographic characteristics were needed but the set of questions posed allows comparisons across all three countries. The survey was designed to collect contextual information on respondents including personal and household characteristics alongside several health measures including physical health, wellbeing and mental health, as well as information on pre- and post-lockdown perceptions and use of green and blue spaces. For the Irish component, ethical approval was granted by Maynooth University and it was disseminated using an approved online survey tool which generated 261 responses. This compared with approximately 500 respondents in England and 2,500 in Spain; the latter running for the longest period. In this short paper, participant’s socio-demographic and health characteristics are described by means and standard deviations (SDs) for continuous variables, and proportions for categorical variables. Chi-square tests were used to analyse household characteristics against the distribution of psychological wellbeing and mental health, using the 5-item World Health Organization Well-Being Index [WHO-5] (WHO, 1998) and the Kessler Psychological Distress Scale [K10] (Kessler et al., 2003). The former measure is briefly summarised below. The level of statistical significance was set at <0.05. Analyses were performed using SPSS v26.0. Preliminary Results Socio-demographic and health characteristics of participants From the total of 261 entries received in June/July 2020, 243 eligible participants from the Republic of Ireland are included in this study. Participant socio-demographic and health characteristics are presented in Table 1. The mean age of respondents was 43+16, with a higher participation rate among females. The majority of participants were either married or in a relationship, with a high level of education, currently employed, with normal weight, non-smokers, alcohol consumers, perceived themselves in good health status, likely to be well according to Kessler Psychosocial Distress Scale and had not presented symptoms of COVID-19 or been tested. The wellbeing mean score of the WHO- 5 index was 52+23 (min 0- max 100), slightly above the cut-off score of ≤50 commonly used for screening depression (Topp et al., 2015). 159 Irish Geography Table 1. Socio-demographic and health characteristics of GreenCOVID participants in Ireland Socio-demographic characteristics Health characteristics Variables Mean +SD n (%) Variables Mean +SD n (%) Age (n=242) 43 + 16 Self-rated health (n=242) 19-29 62 (26%) Very good / Good 204 (84%) 30-39 49 (20%) Fair / Bad / Very bad 38 (16%) 40-49 47 (19%) BMI category (km/m2) (n=216) 50-59 45 (19%) Underweight (<18.5) 7 (3%) 60-69 26 (11%) Normal weight (18.5–24.9) 104 (48%) >70 13 (5%) Overweight (25-29.9) 65 (30%) Gender (n=243) Obese (>30) 40 (19%) Female 174 (71.6%) Smoking (n=242) Male 68 (28%) No 202 (84%) Other 1 (.4%) Yes 40 (16%) Marital status (n=243) Alcohol consumption (n=242) In a relationship / married 161 (66%) No 39 (16%) Separated / Divorced 6 (3%) Yes 203 (84%) Single 73 (30%) Kessler Psychological Distress Scale (n=231) Widow / widower 3 (1%) Likely to be well 106 (46%) Level of education (n=243) Likely to have a mild disorder 50 (22%) Primary- Secondary 26 (11%) Likely to have a moderate disorder 29 (13%) Third level 217 (89%) Likely to have a severe disorder 46 (20%) Employment status (n=243) WHO-5 Wellbeing index (n=239) 52 + 23 Employed, temporary sick leave 141 (58%) Negative screening for depression (>50) 132 (55%) Employed, temporary sick leave 141 (58%) Positive screening for depression (<50) 107 (45%) Student 53 (22%) COVID-19 status (n=242) Housework, other 11 (4.5%) No test + no symptoms 217 (90%) Early retirement, retirement, permanent sick leave 27 (11%) No test + symptoms +/- waiting for test 6 (2%) Tested negative 15 (6%) Test positive +/- recovered 4 (2%) BMI= body mass index; SD= standard deviation. Relevance of household characteristics and environmental factors for psychosocial well-being 160 Health and Wellbeing under COVID-19: The GreenCOVID Survey The majority of participants lived in shared households (91%), located in cities (65%), with 3-4 bedrooms (69%). Most households had at least one element enabling contact with the outdoors (93%), views of green spaces (85%) and no structural issues (64%). Household elements enabling contact with the outdoors included having a terrace, yard, garden, rooftop or balcony. Respondents mean score of quality of available views from their residence was 7.3 ±2.3. None of our respondents had direct views on to blue space. When asked about the extent to which being, seeing and/or hearing the outdoors was helping them cope with lockdown (in a scale of 0-10, where higher numbers indicated higher contribution), the mean score was 8.54±1.79, with 43% of respondents providing the maximum score (10). Views of blue and green spaces were considered relevant contributors to wellbeing prior to the lockdown, with means of 7±2.4, and 7.68±2.13 respectively. Their perceived importance as contributors to coping during lockdown increased to 7.82±2.45 for views to blue spaces, and 8.84±1.76 for views of green spaces. Initial results from the bivariate analysis of household characteristics and wellbeing are shown in Table 2. The variables associated with wellbeing were type of household (p=0.005), household spaces enabling outdoor access (p=0.015), issues in the household (p<0.001), and quality of views (p=0.006). Issues in the household that more negatively affected wellbeing included: bad odours, moisture, poor natural lighting, insulation problems, safety issues, neighbours’ noise, smoke and poor accessibility for people with physical disabilities. Discussion Our preliminary findings indicate that adults in Ireland perceived that contact with the outdoors and views to green and blue spaces positively impacted their psychological wellbeing, and that this was enhanced during the COVID-19 lockdown. Those living in a household with problems had higher likelihood of lower wellbeing scores, according to the WHO-5 scale. Further analysis, both for the Irish data as well as comparative international data from UK and Spain will allow us to assess attitudes and perceptions of the value of green space that will emerge alongside data on health, physical activity and access to health-enabling resources in people’s lives. The GreenCOVID survey will also provide additional insights into how public health policy, together with built environmental characteristics related to green and blue space exposure, affected people’s wellbeing during the initial COVID-19 lockdown. Acknowledgements VG contributed to this project as a PhD scholar funded by the Health Research Board under SPHeRE-2019-1. 161 Irish Geography Table 2. Association of household characteristics and wellbeing (WHO-5)* WHO-5 Wellbeing Index Screening for Depression* Variables Positive wellbeing (≤50) n (%) Negative wellbeing (≤50) n (%) Total n (%) p-Value Household location 236 0.232 City based 88 (58%) 65 (42%) 153 Non-city based 41 (49%) 42 (51%) 83 Type of household 239 0.016 House 71 (63%) 41 (37%) 112 Townhouse / Semidetached / Terraced 50 (52%) 46 (48%) 96 Flat / Apartment 11 (36%) 20 (65%) 31 Number of bedrooms 236 0.544 1-2 21 (48%) 23 (52%) 44 3-4 93 (57%) 70 (43%) 163 >5 16 (55%) 13 (45%) 29 Number of people in household 231 0.208 1 10 (46%) 12 (54%) 22 2-3 64 (62%) 40 (38%) 104 >4 54 (51%) 51 (49%) 105 Household spaces enabling outdoors access 239 0.015 Yes 127 (58%) 94 (42%) 221 No 5 (28%) 13 (72%) 18 Issues in household 234 <0.001 Yes 100 (66%) 52 (34%) 152 No 27 (33%) 55 (67%) 82 Green views from household 239 0.217 Yes 115 (57%) 87 (43%) 202 No 17 (46%) 20 (54%) 37 Quality of views from home 239 0.017 Low 36 (46%) 42 (54%) 78 Middle 43 (52%) 40 (48%) 83 High 53 (68%) 25 (32%) 78 162 Health and Wellbeing under COVID-19: The GreenCOVID Survey References Astell-Burt, T. and Feng, X. 2019. 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