What are the health and well-being impacts of community gardening for adults and children: a mixed method systematic review protocol

Community gardens

A community garden is defined and described by the American Community Garden Association (the ACGA) as a place

that can be urban, suburban, or rural. It can grow flowers, vegetables or community. It can be one community plot, or can be many individual plots. It can be at a school, hospital, or in a neighborhood. It can also be a series of plots dedicated to “urban agriculture” where the produce is grown for a market [1].

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The UK focused Federation of City farms and Community Gardens notes that community gardens are diverse in size and focus; they range from tiny wildlife gardens to fruit and vegetable plots on housing estates, to large community polytunnels [2]. The activity is described using many different terms, including community-agriculture, -farms or -market gardens, however for the remainder of this protocol the term ‘community garden’ will be used to refer to this family of related activities.

Communal gardening activity has a long history, with evidence of 2000 year old communally managed plots in Cornwall, in the south-west of the UK, to the re-emergence of the idea during both World Wars where small plots, called ‘Victory Gardens’, were given over to the co-production of food [3]. In the 1960’s and 70’s concerns about urban decay, community breakdown and issues of food quality prompted a re-emergence of the concept [4]. More recently ‘community gardening’ has become a globally popular activity; networks and coordinating groups have been identified in the USA, UK, southern Africa, and Australia, and evidence of community gardening can be found elsewhere including Asia and South America.

Community gardening is generally a non-profit making endeavour, though in some case profits are made through the sale of surplus products (often the explicit aim of projects in the developing world) or where members run courses in gardening and other related skills. While some gardens are developed and used as settings for health or wellbeing focused interventions – for instance as therapeutic setting for people suffering from dementia, mental health issues and social isolation [5-12] – it is likely the majority do not have this as a stated objective.

Communities and the gardens

For the purposes of this review, ‘communities’ are defined as groups of individuals, either by geographical proximity or brought together as interest groups, who work together to develop and maintain a garden as a shared resource.

A fundamental aspect of community gardening is that it is a shared endeavour, often from the very conception of the project to the management and maintenance of the garden. The gardens can be located on public or private land and may be managed (possibly by a paid coordinator) by an external organisation (such as a charity or land trust) or by the gardeners themselves. Participants range from those keen to improve the aesthetic of their neighbourhoods to those who perceive community gardens to be a more sustainable source of fruit and vegetables. Some participants are involved for social or health reasons. Participants will on the whole be volunteers; this is one of the factors which differentiates community gardening from similar endeavours such as (some forms of) market gardening where gardeners may receive a salary. The size of the ‘community’ involved in the project also varies hugely, from the garden sharing projects common in the UK (where, for example, elderly people unable to manage their large gardens share the spaces with local families, who in turn share their produce with the landowner) to the much larger scale market-garden projects aiming to achieve a consistent supply of fruit and vegetable to their members and beyond.

The aims of the garden typically focus on providing opportunities for local residents, improving local environments and/or on producing fruit and vegetables for food. Community gardening is defined as distinct, at least for the purposes of this review protocol, from individual or family based residential or allotment gardening, and from city farms (where they only manage livestock) and other collective livestock management. Urban agriculture has been the subject of a separate review; however the authors focused solely on low and middle income countries [13].

Community gardening and health and wellbeing outcomes

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Populations around the world face a range of threats to health and wellbeing which could potentially be addressed by initiatives such as community gardening [14, 15]. These threats include the non-communicable diseases and their contributory risk factors such as low levels of physical activity and poor diet. Poor mental health is projected to be one of the most extensive population health issues and current trends, such as the increase in factors such as loneliness and poor social contact, will further exacerbate this situation [16, 17]. Poverty and food insecurity also contribute to the burden of poor health [18]. More broadly environmental degradation (both social and physical) has also been shown to impact on health and wellbeing [19].

Community gardening is a complex multi-factorial activity, likely to have multiple impacts (direct and indirect) on the health and wellbeing of those taking part [14, 15]. These impacts may be positive but also, potentially, negative. The specific ways in which community gardening may impact on health and wellbeing are numerous and operate on a variety of scales and through several mechanisms (see Figure 1). Community gardening has been argued to have potential to improve the nutritional status of those involved. For example, where community gardeners focus on fruit and vegetable production there is the potential that participants could improve their diets through more positive perceptions towards, awareness of, and access to these foodstuffs [20-22]. Community gardening may also be effective in mitigating the effects of food insecurity and poverty both for those undertaking the gardening activities but also for the wider community where the produce may be distributed or sold [21, 23]. Regular involvement in gardening may contribute to achieving recommended levels of physical activity, a well-established feature of healthy life styles [5, 24]. Furthermore the communal, collective nature of the activities within these projects may promote adherence and greater motivations to continuing higher levels of physical activity [5]. Some have argued that community gardening may have a role in reducing stress and promoting better mental health [25-27]. This is thought to come about through various mechanisms but includes time spent in neutral spaces (i.e. those not associated with specific institutions) and the therapeutic nature of the activities [28]. Positive engagement in worthwhile activities, such as volunteering for community benefit, may promote a sense of value and achievement, both are factors which contribute to enhanced sense of quality of life (QOL) [29, 30].

Developing and strengthening community and social ties through, for example, providing opportunities for positive social contact between community members who share common interests may be a further way in which community gardening promotes better health and wellbeing [31]. Community gardening may also promote good health and wellbeing by strengthening social resilience and motivating the implementation of other neighbourhood improvements, especially in deprived areas [32, 33]. Evidence from South America suggests that involvement in community gardening leads to increased civic engagement, thereby promoting social wellbeing and QOL [26, 34, 35]. For example, through community gardening members may need to engage with the planning and legal processes associated with land ownership and management [36]. More widely, features of community gardening such as environmental education, skills acquisition and access to shared resources may contribute to QOL and aspects of personal and social capital [37]. Wellbeing is also strongly linked with employment and income, and community gardening may lead to the development of skills suitable to enhance employability [38]. Finally contact with the natural world has been argued to be of benefit to health and wellbeing by providing opportunities for mental restoration and stress recovery [39].

It should also be noted that there may be potential for community gardening to negatively impact on health and wellbeing. For instance the programme may be exclusionary, with specific members of the community being unable (through, for example, lack of resources whether financial, material or in terms of social capital) or desiring to take part. There is the potential that community gardening may exacerbate or increase local health inequalities and individual or group level social exclusion [40]. Furthermore there are physical risks of the gardening activities such as injury or over exertion. Disturbance and inadvertent consumption of metals and other contaminants in the ground may cause serious health damage [41]. The stress associated with managing the project and people involved may also result in negative health and wellbeing outcomes [42].

There are several theoretical understandings as to how community gardening, in common with several other forms of community engagement activity, might promote better health and wellbeing. Examples include the development of the concept of ‘social or community capital’, community development, and sustainability (in terms of food and nutrition and in reference to community structures) [43-45]. Furthermore the suite of theories, such as Biophilia and Attention Restoration, which seek to explain the apparent benefit from contact with the natural environment [46, 47], may also be of value in understanding if and how community gardening might impact on wellbeing.

An initial exploratory theory of change model has been developed by the authors using evidence derived from the scoping reviews for this protocol and from previous research [30]. The model illustrates the processes though which community gardening activities could lead to the kinds of outcomes (both positive and negative (red boxes)), such as contact with the natural environment, mitigation of poverty, or improved nutrition, which may have direct or indirect impacts to the health and wellbeing of those taking part (Figure 1) [48].

Reviewing the evidence relating to community gardening

Whilst there appears to be a considerable body of literature which has sought to understand the impacts of community gardening, no previous comprehensive systematic review which has reliably addressed the potential health and wellbeing benefits of community gardening was identified. Several linked reviews, some of which were not carried out using systematic review methodologies, were identified but these were limited in scope (e.g. focusing on one geographical area, such as the UK [15]), considered just one of the potential outcomes (e.g. nutrition [49]) or a specific population (e.g. amongst youth [50]). The results of previous reviews are indicative that there is a sizable body of research and that community gardening may have beneficial impacts to health and wellbeing [15]. Furthermore, there is evidence that policy makers and those interested in cost-effective health improvement programmes around the world are increasingly considering supporting this type of activity [51]. It is therefore timely that the evidence of effectiveness is reviewed in a systematic and rigorous manner. The findings of the scoping further justify the necessity of a more comprehensive review.

A related review of the impacts of school based gardening is being undertaken in conjunction with this review and with input from the authors. This review is titled “A systematic review of the health and well-being impacts of school gardening” and focuses solely on the impacts of communal gardening activities in the school setting to school children, school staff, family and community members (all ages) [52]. Therefore the present review will exclude all studies relating to the impacts of community gardens in school settings.

Objectives of the review

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The objectives of this mixed method (including both quantitative and qualitative evidence) review are to assess the health and well-being impacts.

The objectives of this mixed method (including both quantitative and qualitative evidence) review are to assess the health and well-being impacts experienced by adults and/or children following active participation in community gardening in any context (other than school gardening). The aims are to provide further understanding by answering the following research questions:

1. 1.

   Does active involvement in community gardening lead to improved health and/or wellbeing (e.g. physical, mental, social or QOL)?

2. 2.

   If so, how does active involvement in community gardening affect health and/or wellbeing?

3. 3.

   Are there different impacts for different population groups (for instance according to age, socio-economic status or sex)?

4. 4.

   Do different types of community gardening (for example producing vegetables or a flower garden) or in different contexts (e.g. urban/rural, developed/low-middle income country, community/therapeutic setting) have different types of impacts?

The empirical evidence relating to the above questions, both quantitative and qualitative, will be identified, appraised and synthesized. Evidence drawn from quantitative studies will be used to appraise the strength and direction of effect of community gardening on health and wellbeing outcomes. The qualitative evidence will be used to understand the experience and meaning of participation in community gardening, the various pathways to engagement, process of involvement and factors which may mediate experiences. A theoretical framework, informed by our initial theory of change model, will be produced which will aim to illustrate the outcomes of participation and any mechanisms of action [30, 48]. The synthesis will be sensitive to factors which may affect the impacts, such as the context of the activities, the demographics of participants, and the implementation and specifics of the community gardening interventions. This review will consider potential mechanisms of action primarily through research q2 but also by addressing formal academic theories (where available) and through the lay or practitioner theories used in existing evaluations.

Stakeholders

A project advisory group will be convened to guide the process and focus of the review. Individuals who have experience of community gardening, associated funding, relevant research and of effective dissemination of environment-health evidence to policy makers and practitioners will be invited to take part. It is anticipated that the advisory group will be drawn from experts based in the UK, while it is appreciated this may introduce a bias this is for pragmatic reasons relating to resources. If potential advisory group members are identified in other parts of the world, they will be invited to participate and contribute their ideas and suggestions via email or teleconferencing.

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