Investigating health-related barriers to green space use, chronic health conditions and sociodemographic characteristics: a structural equation modelling approach

Introduction: Using green space improves health and well-being. However, there are many barriers to green space use, including poor health. Evidence is lacking on how health-related barriers to green space differ by chronic health condition. This study investigates health-related barriers to green space use, chronic health conditions and sociodemographic characteristics. Methods: We assessed health-related barriers to green space use using Natural England's People and Nature Survey. Data from 5 months of the nationally representative survey of English adults (aged 16+) were used (n=10 415), collected during November 2020-March 2021. To assess relationships between reporting of health-related barriers to using green space, an individual's chronic health conditions and sociodemographic characteristics, structural equation modelling was used (n=201). Results: Respondents with progressive illnesses or physical disabilities had a higher likelihood of reporting multiple (four) health-related barriers as important compared with respondents with arthritis or diabetes (both had no barriers that they were more likely to report). For example, respondents with physical disabilities (32%) and progressive illnesses (31%) had an increased likelihood of reporting lack of disabled facilities as an important barrier to using green space compared with those with other conditions. Those with progressive illnesses (34%) had a particularly higher likelihood of reporting having no one to go with/help as an important barrier to using green space (p=0.001). Both physical health-related (eg, fatigue) and place-based (eg, poorly maintained sites) factors are barriers to green space use for individuals reporting a chronic condition. Conclusions: The results suggest that those with physical disabilities and progressive illnesses would benefit most from reducing place-based and support barriers, such as a lack of disabled facilities and no one to go with/help. By improving the suitability of green spaces using this evidence, barriers to green space would be reduced for all users, which may improve the quality of the space.