Urban Care Farming on Living Well and Productive Engagement of Older Adults

Effects of Urban Care Farming on Promoting Wellbeing and Productive Engagement for Older Adults: A Randomised Controlled Trial

The goal of the randomized controlled trials is to learn about the effects of urban farming interventions on older adults' physical, mental, and social well-being of older adults aged 50 and above. The main questions the study aims to answer are Q1. Would participants who have undergone the urban care farming intervention have lower stress levels compared to those who did not undergo the intervention? Q2. Would the quality of life and biopsychosocial factors of older adults who participate in the urban farming interventions be better before the intervention and compared to those who did not participate? Q3. Would running intervention programs as such demonstrate cost-effectiveness? Participants will be enrolled in 24 weekly lessons providing hands-on urban farming techniques, including physical activity, planting, and social interactions. Researchers will compare older participants with similar demographic profile to determine if the biological, psychological, and social factors are better for the intervention group.

Study Overview

• Status: Recruiting
• Conditions: Stress, Psychological
• Intervention / Treatment: Behavioral: Urban care farming

Detailed Description

The data collection consists of three sessions, before and after the 24-week intervention program, and 6 months post-intervention. Prior to the data collection, participants will be assessed for eligibility criteria and explained the detailed study procedures by trained research staff for informed consent. After completing the written informed consent, participants will be interviewed using detailed questionnaires relating to their health, nutrition, and dietary status, psychosocial measures, and undergo a series of physical examinations. These examinations include physical performance tests of mobility and gait, balance and strength, body measurements of weight, height, body mass index (BMI), waist-hip circumference, mid-upper-arm and calf circumference, blood pressure, and blood tests that will examine participants' clinical profile, biomarkers, and immunoassays. Participants will also be given Fitbit trackers to determine if they have improved their physical activity. Last, data collected will also include Functional near-infrared spectroscopy (fNIRS), a non-invasive procedure to determine the oxygenation levels of participants at rest and while doing some thinking activities. This data collection procedure will be conducted at baseline before the intervention and after the completion of the intervention.

The intervention will include a weekly, 24-week urban farming program. Each weekly session is where participants will engage in outdoor and indoor horticultural activities ranging from fertilization, sowing, and watering, to transplanting, maintaining, and harvesting vegetables and herbs.

• Study Type: Interventional
• Enrollment (Estimated): 200
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Cynthia Chen, PhD; Phone Number: 66015526; Email: cynchen@nus.edu.sg
• Study Contact Backup: Name: Jocelin Lam; Phone Number: 66013343; Email: jocelinl@nus.edu.sg

Study Locations

• Singapore
  • Singapore, Singapore, 117549
    • Recruiting
    • NUS
    • Contact: Ezra Chiam; Phone Number: +6566016036; Email: ezra.chiam@nus.edu.sg
    • Principal Investigator: Cynthia Chen, PhD
    • Sub-Investigator: Choon Nam Ong, MD, PhD
    • Sub-Investigator: Schwarz Herbert, PhD
    • Sub-Investigator: Mary Chong, PhD
    • Sub-Investigator: Roger Ho, PhD
    • Sub-Investigator: Leng Leng Theng, PhD
  • Singapore, Singapore, 618661
    • Recruiting
    • Jurong Lake Garden
    • Contact: Joan Hung; Email: Joan_HUNG@nparks.gov.sg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Aged between 50 and 80
• Reside in Singapore
• Willing to take part in the intervention
• Agree for their data to be used for research purposes
• Ambulant and able to carry out some tasks independently

Exclusion Criteria:

• Not willing to participate in the data collection (participants can opt not to answer some questions in the questionnaire but have to consent to the other data collection methods, e.g., Blood taking/test)
• Refusal to give informed consent
• Unable to give consent independently
• Have a disability of the upper or lower body that limits their mobility
• Have medical conditions which in the opinion of the research/investigative team that would compromise (or interfere with) their ability to participate in the study
• Had a recent severe medical episode (e.g., heart attack)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Urban Care farming Intervention; This intervention group of participants will receive the experimental urban care farming treatment.	Behavioral: Urban care farming; An intervention curriculum has been designed using horticulture therapy combined with urban farming techniques. The sessions will use plants and interaction with nature to engage and rehabilitate participants. Both the intervention and control group participants will undergo the intervention. But the intervention group will start with the urban care farming intervention first, and the control group will follow once the intervention group completes the program.
Other: Waitlist control; Waitlist control group consists of participants who do not receive the experimental treatment, but who are put on a waiting list to receive the intervention after the active treatment group does.	Behavioral: Urban care farming; An intervention curriculum has been designed using horticulture therapy combined with urban farming techniques. The sessions will use plants and interaction with nature to engage and rehabilitate participants. Both the intervention and control group participants will undergo the intervention. But the intervention group will start with the urban care farming intervention first, and the control group will follow once the intervention group completes the program.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
WHO Quality of Life Scale (WHOQOL-BREF)	Brief version consisting of 26 QOL related questions developed by World Health Organisation. There are four domains, Physical, Psychological, Social relationships, and Environment. The minimum and maximum for each domain is 0 and 100 respectively, with higher scores being better outcome for each domain.	Baseline, 6 months, 12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Immuno-biomarkers: IL-1RA, IL-6, IL-8 (CXCL8), IL-10, IL-13, IL-17A (CTLA-8), MIP-3 beta (CCL19), SDF-1 alpha, MMP-3, MMP-9, MCP-1 (CCL2), and TNF alpha	changes in concentration of cytokines, chemokines and selected ageing and inflammatory markers in measured in pg/mL	Baseline, 6 months
Brief sense of community scale (BSCS)	8-items measuring the dimensions of needs fulfillment, group membership, influence, and emotional connection. Composite scores with the average of the 8 items is computed, min 1 and max. 8, with higher scores showing greater sense of community.	Baseline, 6 months, 12 months
Fried phenotype of frailty	Fried frailty phenotype (FP) assesses physical frailty through five criteria: unintentional weight loss; weakness or poor handgrip strength; self-reported exhaustion; slow walking speed; and low physical activity. Total scores are classified into 3 categories: non-frail, pre-frail, and frail.	Baseline, 6 months, 12 months
Lubben social network scale (LSNS-6)	This scale measure of social engagement including family and friends, min score of 6 and max. score of 30. A higher score indicating more social engagement and a cutoff of 12 points indicate risk of social isolation.	Baseline, 6 months, 12 months
Functional near-infrared spectroscopy	Brain oxygenation levels measured in cerebral metabolic rate of oxygen (CMRO^2).	Baseline, 6 months
EQ5D	EQ5D-5L, a measure that consists five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. An utility score can be attached to the total score to determine the cost utility of the participants' quality of life. An utility score between 0 to 1 on the Singapore population will be derived.	Baseline, 6 months, 12 months
Geriatric anxiety scale (GAS-10)	Geriatric anxiety scale that measures older adults' self-reported anxiety. Minimum score is 0 and maximum of 30. The higher the score, the more anxious.	Baseline, 6 months, 12 months
MOCA	Participants are scored following MOCA scoring criteria. Max. 30 points. Scores lower than 26 showed signs of cognitive impairment.	Baseline, 6 months, 12 months
Brief resilience scale	Resilience scale on a 5 points scale, strongly disagree to strongly agree, the higher the score, the greater resilience.	Baseline, 6 months, 12 months
De jong Gierveld loneliness scale	Measures emotional and/or social loneliness situation of respondents and adds up to a total loneliness score. the total loneliness score can be categorized into four levels: not lonely (score 0, 1 or 2), moderate lonely (score 3 through 8), severe lonely (score 9 or 10), and very severe lonely (score 11).	Baseline, 6 months, 12 months
Fitbit	Steps count	Continuous for 12 months
Body weight and height	Measured in kilograms and metres respectively. Weight and height will be combined to report BMI in kg/m^2	Baseline, 6 months, 12 months
Fasting plasma glucose, HbA1c	measures average blood sugar levels over the past 3 months	Baseline, 6 months
Serum Creatinine	measures the level of creatinine in the blood	Baseline, 6 months
Attitude towards eating healthy food	Attitude of healthy eating (11-items) adapted from Saba et al 2019 (DOI: 10.1016/j.foodqual.2018.11.017). Composite score computed from the averaged measures will have a min of 1 and max of 5.	Baseline, 6 months, 12 months
Waist and hip circumference	Measured in centimetres	Baseline, 6 months, 12 months
Blood pressure	Measured in systolic and diastolic	Baseline, 6 months, 12 months
Lipid panel	A lipid panel measures levels of various types of lipids (fats) in the blood. Measures HDL cholesterol (High-Density Lipoprotein) and LDL cholesterol (Low-Density Lipoprotein) and Triglycerides	Baseline, 6 months
Eating fruits and vegetables behavior	Behavior (8-items) towards eating fruits and vegetables developed for this study. Max. score of 10 and minimum score of 2 will be derived from this measurement.	Baseline, 6 months, 12 months

Collaborators and Investigators

• Sponsor: National University of Singapore
• Collaborators: National Medical Research Council (NMRC), Singapore
• Investigators: Principal Investigator: Cynthia Chen, PhD, National University of Singapore

Study record dates

Study Major Dates

• Study Start (Actual): November 28, 2023
• Primary Completion (Estimated): December 31, 2024
• Study Completion (Estimated): December 31, 2025

Study Registration Dates

• First Submitted: December 1, 2023
• First Submitted That Met QC Criteria: February 18, 2024
• First Posted (Estimated): February 26, 2024

Study Record Updates

• Last Update Posted (Estimated): February 26, 2024
• Last Update Submitted That Met QC Criteria: February 18, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Keywords: quality of life; anxiety; stress
• Additional Relevant MeSH Terms: Behavioral Symptoms; Stress, Psychological
• Other Study ID Numbers: NUS-IRB-2023-191

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: There is plan to share data dictionaries and unidentified IPD will be shared.
• IPD Sharing Time Frame: June 2024
• IPD Sharing Access Criteria: Study protocol will be published as a journal article.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No