TOP 74 - Project IMAGINE: IMproving Access to Greenspace IN the Estate

Publication Number: 2827.TOP 74

Samantha Neumann, NemoursAlfred I. duPont Hospital for Children, Wilmington, DE, United States; Abby Nerlinger, NemoursAlfred I. duPont Hospital for Children, Wilmington, DE, United States

Background: Spending time in nature has positive impacts on child mental health, health outcomes, and chronic disease control. However, access to safe greenspaces vary by neighborhood. Even in under-resourced neighborhoods, parks that are easily accessible tend to have fewer amenities, lower maintenance, and higher crime rates. Such disparities mean that children living in underserved neighborhoods have limitations to experiencing the positive benefits of nature contact.
Most of the medical literature on greenspace access initiatives have been focused on the outpatient setting, with limited evaluation of interventions within the inpatient setting. Pediatricians in the hospital setting have an opportunity to address these disparities, as evidenced by studies showing the positive effect of inpatient screening. Additionally, stress and burnout can uniquely and significantly affect caregivers of hospitalized children.

Objective: Funded by an American Academy of Pediatrics Community Access to Child Health (CATCH) Grant, our project aims to measure changes in acute distress levels and disparities in urban greenspace access for patients and families receiving care at a tertiary stand-alone children’s hospital in Wilmington, Delaware. In collaboration with community partners, results will be used to generate a roadmap for safe and equitable nature access in surrounding communities.

Design/Methods: The Nemours Estate, housing 300-acres of greenspace, is located adjacent to Nemours Children’s Hospital, Delaware. Patients and caregivers can visit the Estate for free using a unique Estate Rx pass distributed by clinical care teams. Caregivers who visit will be offered to complete matched pre-Estate visit and post-Estate visit surveys, with a gift card incentive provided upon completion. Surveys will use the National Comprehensive Cancer Network Distress Thermometer, which measures acute distress on a scale of 0 to 10. We hypothesize that Estate visitation will significantly decrease caregiver acute distress levels, as shown through paired t-tests. Families will additionally be asked a series of questions regarding sociodemographic factors (e.g., zip code to generate Child Opportunity Index, insurance type, race, and ethnicity), in addition to frequency of greenspace access at home, and perceived community-level barriers to greenspace access. Statistical associations will be analyzed using ANOVA and chi-square tests. This project is exempt by the Nemours Institutional Review Board. We expect collection of goal pilot sample size of 50-100 survey completions and statistical analysis by early 2026.