Allotment gardening, health and well-being: a systematic reviewChris Genter M.Phil./Ph.D. Student, Faculty of Health, Plymouth University

Email: christopher.genter@plymouth.ac.uk

1. Introduction

BackgroundAllotment gardening is a popular pastime in the UK (Campbell and Campbell, 2011).

Occupational therapists (OTs) hold a core belief of a connection between engagement in meaningful occupation, health and well-being. A review of this relationship has been conducted, although this did not focus on the occupation of allotment gardening (Law et al, 1998).

Conducting a systematic review of allotment gardening, occupation and well-being will highlight the relationship and identify areas for further research.

The systematic review process includes: setting a question, establishing inclusion criteria, evidence searching, assessing evidence quality and reviewing evidence. Guidelines provide a framework for this process (CRD, 2009).

2. Methods

Search strategy: search conducted with following terms “allotment”, “garden”, “gardening”, “horticulture”, “well-being”, “wellbeing”, “well being” and “health”.

Inclusion Criteria (Table 1):

Data Sources: •Search of databases (AMED, ASSIA, CINAHL, PsycINFO, MEDLINE, SocINDEX and Web of Science).•Search of „grey literature‟ (gardening organisations‟ websites, internet search engines, hand search of specific journals).•Citation snowballing - review the reference lists of selected articles for further evidence (Booth, 2001).

Quality Appraisal: •Used as method for developing familiarity with evidence.•Methodological limitations of selected studies recorded in Tables 2 and 3.•A sample of selected articles was appraised by another researcher for comparison.•Quantitative appraisal method: Downs and Black (1998).•Qualitative appraisal method: Walsh and Downe (2006).

Data Extraction:Conducted simultaneously with quality appraisal. The same standardised form was used for all articles (Rutter et al, 2010).

Data Analysis:• Quantitative and qualitative articles were analysed separately. • Thematic analysis applied to all the qualitative articles together, which produced a list of themes.• Quantitative articles were analysed individually.

Review:The analysis of qualitative and quantitative evidence was compared to produce a response to the research question.

3. Results (Cont.)

Table 3. Overview of selected qualitative articles

Population •Adults (aged 18+)•Active engagement in allotment gardening

Requirements of Evidence •Qualitative or Quantitative research methods•Written/translated in English•Time frame ≥ 1998

Outcome •Subjective or objective measures of health or well-being

3. Results

Search Results: Initial screening removed duplicate articles. Abstracts of remaining articles were compared with the inclusion criteria (Table 1). Where selection was unclear the full article was reviewed with the inclusion criteria. The final selection was also compared with the inclusion criteria by another researcher. From an initial selection of 637 articles, 13 articles were identified; Figure 1 illustrates the selection process. 7 articles were analysed for the review. The remaining 6 articles reported on different aspects of the 7 selected articles. These were used for further methodological detail and are identified in the reference list (#).

Figure 1: Overview of selection process

Review of selected articlesOf the 7 selected articles in the review, 2 used quantitative research methods. An overview of these is presented in Table 2. The remaining 5 used qualitative research methods and an overview of them is presented in Table 3.

Table 2: Overview of selected quantitative articles

Initia

l Sele

ctio

n:

637 articles identified

Initia

l Scr

eenin

g: Duplicates and

out of date articles excluded.

438 articles left.

Abst

ract

Revie

w: Comparison of

article abstracts with inclusion criteria.

24 articles left.

Art

icle

Revie

w: Comparison of

article with inclusion criteria.

13 articles left.

Fin

al Sele

ctio

n: 7 articles

included in the review.

5 qualitative research

2 quantitative research

4. Discussion

The following themes were identified through thematic analysis of the qualitative articles.

5. Conclusion:

This review indicates through the qualitative themes, that allotment gardening contributes to an individual‟s experience of well-being. The experience of health is also indicated in both the qualitative themes and the quantitative evidence. This supports the claim that occupation promotes and maintains well-being and health (Law et al, 1998). For clinical practice it demonstrates how allotment gardening can be used to enhance the experience of well-being and health. There is scope for further research, for example to understand the impact of allotment gardening on health, with improved use of a control group and physiological measures.

Author/

Location

Description Limitations

Fieldhouse

(2003)

UK

Aim: Explore the subjective experience of regular attendance of an

allotment group for people with mental health problems. Sample: Nine

out of the thirteen group members. Data collection: Individual semi-

structured interviews and focus group. Findings: Benefits of allotment

group were felt through the interaction of environment, individual‟s

subjective experience and their occupational performance.

•Very specific subject group.

•Dual role of researcher/group

facilitator and impact of this was not

explored.

Kingsley et al

(2009)

Australia

Aim: To understand the health and well-being benefits of an Australian

community garden. Sample: Ten participants from one allotment site

recruited using snowball sampling, starting with President of allotment

committee. Data collection: Individual semi-structured interviews.

Findings: Allotment beneficial to health and well-being through

providing: “sanctuary”, social opportunities, support, a sense of

achievement, improved fitness, connection with nature/spiritual

aspects and healthy food.

•Sampling method could recruit a

biased sample as six participants

served on the site committee. These

were likely to be active members

who were likely to focus on the

positive perspective of allotment.

•Participants were known to one

another, which may have influenced

how they responded.

Milligan et al

(2004)

UK

Aim: Examine the role of allotment gardening activity in improving the

health and well-being of older people living in Northern England.

Sample: Older adults (over 65, not mentally confused, some physical

mobility). Initially thirty participants, reduced to sixteen over the nine

month study period. Data collection: Individual interview and focus

groups at start and end of study. Weekly diaries using SF-36

questions. Findings: Development of social network was a buffer to

stress; participants reported experience of pleasure, enjoyment and

satisfaction from working on the allotment.

•Allotment activity was a facilitated

intervention.

•Individuals chose to work together

as a group.

• Diaries could be challenging for

those with literacy difficulties.

• Diaries were written with the

knowledge they would be read,

which could lead to bias.

Teig et al

(2009)

North

America

Aim: Examine the “intervening mechanisms” that explain how

community gardens impact the health and well-being of

neighbourhood residents. Sample: Forty seven participants from

twenty eight different allotment sites. Data collection: Individual

interviews and focus groups. Findings: Identified mechanisms that

promote health and well-being through allotment gardening. These

include: social connections, reciprocity, trust, collective decision

making, social norms, civic engagement and community building.

•Limited explanation of how the

sample was identified and

developed.

•No reflection on the role and impact

of the researcher.

Wakefield et

al (2007)

Canada

Aim: To investigate the health impacts of allotment gardening.

Sample: Sixty eight participants from ten allotment sites across a

region of Canada. Data collection: Participant observation, focus

groups and individual interviews. Findings: Two sets of health benefits

noted. Health of participants (access to fresh food, improved nutrition,

increased physical activity, improved mental health), Community

health (improved relations, increased community pride). Some

challenges (insecure tenure, personal safety, urban pollution affecting

produce).

•Limited description of how the

sample was recruited from the sites

that were visited.

•No discussion of ethical concerns

despite intrusive research process

Author/

Location

Description Limitations

Van den Berg

et al (2010)

Netherlands

Aim: Comparing health, well-being and physical activity of

allotment gardeners to neighbours without allotments. Sample:

Allotment gardeners (129 out of 1625, 8% response rate),

Neighbours (68 out of 200, 34% response rate). Data

collection: Health measure (parts of Short Form Health Survey,

SF-36), Well-being measures (stress, Life Satisfaction Index,

loneliness and social contacts). Findings: Older gardeners

(≥ 62yrs) reported significantly better scores on health and

well-being than neighbours in same age group. This effect was

not noted in the younger age group (<62yrs).

•Allotment gardener sample was self

selecting (unlike neighbour sample),

which could be biased towards those who

had most benefited.

• Evidence based on self-report, no

objective measures used.

•Control group of neighbours was not well

matched with the allotment group, which

could introduce bias.

Van den Berg &

Custers (2011)

Netherlands

Aim: Test hypothesis that gardening would be more effective at

reducing stress than a control activity of indoor reading.

Sample: 30 participants from same allotment site (14

gardening, 16 indoor reading). Data collection: Stress measure

(salivary cortisol levels taken before and after stress induction,

and before, during and after assigned activity), Mood measure

(Positive and Negative Affect Schedule, PANAS). Findings:

Cortisol levels decreased from post-stress induction to post

activity in both groups, although to greater extent in the

gardening group. Positive mood increased from post-stress

induction to post activity in gardening group, but decreased in

reading group. Negative mood results not significant.

•Control activity may have induced stress

as it prevented participants from engaging

in valued occupation.

• Control activity was passive and non-

natural, limiting understanding of how

active gardening and natural environment

contribute to stress.

• Both groups were active allotment

gardeners, so they may already be

sensitive to the benefits of gardening.

Research Question: How does allotment gardening contribute to an individual’s experience of health and well-being?

• The allotment gives people an opportunity to withdraw from the busy urban environment (Fieldhouse, 2003, Wakefield et al, 2007, Kingsley et al, 2009). This provides a relaxing environment which reduces stress (Fieldhouse, 2003, Milligan et al, 2004, Wakefield et al, 2007, Kingsley et al, 2009). This is reflected in improved mental health (Wakefield et al, 2007, Teig et al, 2009).

A stress-relieving refuge

• This is contributed to by actively gardening on the allotment and other associated activities and products, such as improved nutrition from the fresh produce and increased exercise on and around the allotment site (Wakefield et al, 2007, Kingsley et al, 2009).

A healthier lifestyle

• The allotment environment encourages social connections to develop (Fieldhouse, 2003, Milligan et al, 2004, Kingsley et al, 2009, Teig et al, 2009). This is achieved through sharing thoughts, skills, produce and time (Fieldhouse, 2003, Milligan et al, 2004, Wakefield et al, 2007). People experience it through feeling included and supported (Milligan et al, 2004, Teig et al, 2009, Kingsley et al, 2009).

A social network

• Allotment encounters with nature (i.e. flora and fauna) provoke a spiritual/emotional response (Fieldhouse, 2003, Milligan et al, 2004, Kingsley et al, 2009, Teig et al, 2009).

A spiritual/emotional response

• Allotment gardening provides an outlet for creative skills to be expressed (Milligan et al, 2004, Wakefield et al, 2007). Observing and reflecting on the personal development and success that result causes people to experience achievement and satisfaction (Fieldhouse, 2003, Milligan et al, 2004, Kingsley et al, 2009).

A sense of achievement

• Allotment gardening provides an opportunity for people to assert some control over their circumstances and experience empowerment (Fieldhouse, 2003, Wakefield et al, 2007, Teig et al, 2009).

A sense of control

• Access to the allotment experience is threatened for some people by personal or societal influences (Wakefield et al, 2007, Kingsley et al, 2009, Teig et al, 2009).

A threatened experience

4. Discussion (cont.)

Some of the qualitative analysis is supported by the quantitative evidence. For example, in Van den Berg et al (2010) older allotment gardeners (≥62 yrs) reported better scores in health and well-being than the non-allotment gardening neighbours. This reflects the qualitative theme „a healthier lifestyle‟ as described above. The findings of Van den Berg & Custers (2011) identified the stress reducing, mood enhancing qualities of allotment gardening, which is reflected in the qualitative theme „a stress-relieving refuge‟.

Limitations of the review• Guidelines suggest evidence selection, data extraction and appraisal should be conducted by a minimum of two researchers working independently (CRD, 2009). Due to resource limitations for this review these tasks were conducted by one researcher, although the final selection and some appraisals were confirmed by other researchers.•The limited experience of the researcher may have caused interpretative aspects of the review to be neglected (Pope et al, 2007).

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