A systematic review of the relationship between the built environment and children’s quality of life | BMC Public Health

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Figure 1 shows the PRISMA flowchart for this study. More detailed exclusion criteria are provided in Supplementary Materials S1 and S2.

Figure 1
Figure 1

Table 1 provides an overview of the 17 included studies and their characteristics. [29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45].

Table 1 Research overview

The scope of the research design was cross-sectional (n= 13), [29,30,31,32,33,34,35, 39,40,41,42, 44, 45] Vertical design (n= 2), [36, 38] one mixed methods study (with a cross-sectional quantitative part); [37] and one intervention design. [43]. His seventy-five percent (75%) of the research was published within the past five years. Most studies focused on Europe and North America, while four studies focused on South America, Asia, Africa, and Australia. [38, 39, 41, 42]. Participants’ ages ranged from her 3 years to 18 years, with most studies including middle childhood and early adolescence (7–13 years). [29,30,31,32, 35, 36, 38,39,40,41,42, 44, 45].The sample size ranges are: n= 63 to 21,019 participants. More than 80% of the studies were of good methodological quality according to the Joanna Briggs Institute Critical Appraisal Checklist (see Supplementary Material S3) [29,30,31,32,33,34,35,36,37, 40, 42,43,44,45].

Independent variable: built environment

The study includes a variety of objective and subjective measures of the built environment. Four studies assessed the built environment only through objectively measured means, such as the spatial pattern of the landscape and amount of green space, street connectivity, density of facilities and play areas, and traffic volume using geographic information systems (GIS). I rated it. [29, 32, 33, 40]. Eleven studies included subjective surveys of the built environment, including neighborhood perceptions and satisfaction, housing, traffic, environmental safety, public transport, accessibility and quality of green spaces, playgrounds, open spaces, and play spaces. measurement was used. [31, 34,35,36,37,38,39, 41, 42, 44, 45]. One study combined objective and subjective measurements of the built environment. [30] And another single study utilized an intervention design that exposed participants to green spaces in the form of small urban parks, large urban parks, and forest environments. [43].

Dependent variable: child’s QoL

There was wide variation in QoL measurements. Pediatric Quality of Life Inventory (PedsQL); [5] Kindle, [6] and children’s screens, [57] It was the most commonly used measure in 7 of 17 studies. Additional measures specific to each study can be found in Table 1.

More than 75% of studies included child-reported QoL measures. [29, 31,32,33, 35, 36, 39,40,41,42,43,44,45] On the other hand, three studies used parent-reported results; [34, 37, 38] One study utilized both self-report and parent-report QoL. [30].

Review the findings

Figure 2 shows the distribution of studies by three categories.

Figure 2
Figure 2

Distribution of studies based on three broad categories of built environment exposure

Note. This review includes 17 of his studies. Ten included exposure to green and blue spaces, seven included exposure to other neighborhood infrastructure, and six included perceptions of general neighborhood quality. Six studies included exposure measurements across two different categories and are shown in overlapping spaces in the figure.

Neighborhood green and blue spaces and QoL

Ten studies focused on green and blue space, using objective measures including number of tree areas, amount of green space, proportion of green and blue space (i.e. water bodies) in the neighborhood, and whether green, blue, or We use subjective measures that include the presence of open space. and the accessibility of these spaces.

On the other hand, most studies showed a positive relationship between objectively measured green space aspects and children’s QoL. [30, 33, 35,36,37,38, 40, 42, 43]. Increased tree area or increased proportion of green space within the neighborhood landscape was associated with higher QoL. [30, 33, 38, 40].These findings were supported by studies utilizing self-report measures [35,36,37]. On the other hand, two studies found a negative association between long distances from one tree area to another and self-reported access to green spaces and QoL. [30, 40].Two other studies found no significant results regarding the proportion of green space and children’s QoL. [29, 32].

The evidence regarding blue space is mixed. One study found a negative association between the proportion of blue spaces in a neighborhood and children’s QoL; [33] another reported a positive relationship [37].

The only intervention study in this systematic review used school lunch breaks to expose children to forest environments or large and small urban parks. [43]. The authors found a positive relationship between exposure to different types (and sizes) of green space and children’s well-being. [43]. The authors also found that compared to indoor lunch breaks and large forest environments, small urban parks had the smallest (but still significant) effect on well-being and the largest increase in self-reported well-being. We found a dose-response relationship. [43].

Neighborhood infrastructure and QoL

Seven studies included measures such as road connectivity, walkability, and density of athletic and recreational facilities. [29, 34, 36, 40,41,42, 44]. The evidence is mixed and inconclusive. Two studies found non-significant results [29, 32].Children’s access to and use of public transport without adult supervision had a negative impact on children’s QoL. [41]. Self-reported places to play outside the home have also shown mixed results, with one study showing a positive relationship with children’s QoL, while two other studies showed a positive association with children’s QoL. These results are not confirmed due to the lack of statistical significance. [34, 35, 44].

Neighborhood awareness and QoL

Six studies included self-reported neighborhood perceptions [26, 27, 31, 35, 38, 41]. One study found that perceived walking impairment was negatively correlated with children’s QoL. [30].Broad concepts such as overall neighborhood quality and satisfaction were positively correlated with children’s QoL. [31, 41]. Perceived environmental safety concepts have shown a positive relationship with children’s QoL in three studies; [31, 39, 42] Two other studies found the association to be non-significant [31, 35].

Study-level risk of bias and overall certainty of evidence

Of the 14 cross-sectional studies examined, 9 met all 11 criteria of the cross-sectional study JBI assessment tool. [29, 31, 32, 35, 37, 40, 42, 44, 45]. There were exceptions, such as Kim et al. Although we did not specify the data collection or analysis period, [30] Tillman et al. using a predictive model to make confounder control items inapplicable; [33] and Weigl et al. and de Macedo et al.There was a lack of clear exclusion criteria for the study population. [34, 41]. Furthermore, de Macêdo et al. and Gonzalez-Carrasco et al.Confounders were not explicitly addressed and unadjusted estimates were presented. [39, 41].

For the two longitudinal studies included, no control groups were included, nor were strategies in place to address incomplete follow-up. [36, 38]. By creating additional categories, Feng et al. identified and managed missing data on exposure variables and confounders and avoided participant deletion to prevent further sample loss. [38].

According to the JBI checklist for specific study designs, the quality of evidence may be good at the study level, but the risk of bias across studies may be high. Overall, the lack of longitudinal and intervention studies and the absence of appropriate comparison groups makes it difficult to determine causality and increases the risk of bias. Most studies were conducted in Europe and North America. Therefore, generalizability to other populations may be limited. Furthermore, publication bias is likely to be high, especially as most of the previous studies are observational in nature. Finally, outcome measures vary across studies and the precision of the estimates is likely to be low due to limited research on the built environment and children’s QoL. We therefore judge the overall certainty of the evidence to be very low or low in most cases and moderate according to GRADE in the case of the role of green spaces in children’s QoL.

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