Background The positive health impacts of contact with green spaces are well studied. However, there is a lack of research exploring the impact that health, and particularly poor health, can have on green space use. With poor health being one of the most commonly reported barriers to green space use, and increasing interest in green social prescriptions, this is a key research gap. Therefore, we explore how barriers to green space use differ by chronic health conditions and socio-demographic characteristics.

Methods Natural England’s People and Nature Survey (PANS) was used to explore barriers to green space use. A question collecting data on types of chronic health condition (including arthritis, respiratory conditions, circulatory conditions, diabetes, physical disabilities, progressive illnesses, and mental health conditions) was added to PANS between November 2020-March 2021. Data were collected over the five months, with a total sample of 10,415 English adults (aged 16+). With weightings applied, this was a nationally representative sample of England’s population. Data were collected on frequency of green space use and 14 barriers to green space use, including ‘bad weather’ and ‘poor physical health’. Demographic information was collected on health status, health conditions, sex, age, income, and ethnicity. Associations between the outcome variables and predictors were assessed using multiple binary logistic regression models (reported as odds ratios), with sensitivity analyses undertaken using R.

Results Overall, 30% of respondents reported using green spaces less than once a week, and 40% of respondents reported having a chronic health condition. The most commonly reported barrier to green space use for those with chronic health conditions was ‘poor physical health’, which was reported by all health conditions except for respondents with diabetes and mental health conditions. Respondents with physical disabilities (p<0.001; OR 2.46, 95%CI:1.89–3.2) and progressive illnesses (p<0.001; OR 2.17, 95%CI:1.6–2.96) had the highest odds of reporting this barrier. There were higher odds of reporting neighbourhood barriers, such as ‘fear about crime’ and ‘nowhere near me is nice enough to spend free time in’, for individuals with physical disabilities, females, and Black, Asian and Minority Ethnic respondents.

Conclusion We found that there were differences by type of health condition and socio-demographic characteristics when reporting barriers to green space use. The findings outlined in this study emphasise that a ‘one size fits all’ approach to increasing green space use will not work, with a more targeted approach required for ensuring that green spaces are accessible for all.