Cultivating Health: Therapeutic Landscapes and Older People

1. Cultivating
Health
Cultivating Health
A study of health and
The Cultivating Health Project was a joint study with the Institute for Health
Research (IHR), Lancaster University, NHS Carlisle & District PCT (formerly
mental well-being
NHS North Cumbria Health Authority), Age Concern, Carlisle and Carlisle City
amongst older people in
Council. The following people were involved:
Northern England
Professor Tony Gatrell IHR, Lancaster University
Dr Christine Milligan, IHR, Lancaster University
Dr Amanda Bingley, IHR, Lancaster University
Dr Rebecca Wagstaff, Director, Eden Valley PCT
Mrs Jessica Riddle, End of Project
Director, Age Concern, Carlisle
Mrs Elizabeth Allnutt, Allotments Officer, Carlisle City Council
Mrs Jane Barker Research Report
Gardener/Club Organiser, IHR, Lancaster
University
The project was funded by the former NHS Executive-Northern and Yorkshire
as part of the Government ‘Healthy Ageing’ initiative.
Institute for Health Research
§ Lancaster University
O t b 2003
This Research Report is co-authored by
Christine Milligan, Amanda Bingley, and Tony Gatrell.

2. Cultivating Health
The Cultivating Health Project was a joint study between the Institute for
Health Research (IHR) at Lancaster University; Carlisle and district PCT
(formerly North Cumbria Health Authority); Age Concern, Carlisle; and Carlisle
City Council.
The project was funded by the former NHS Executive – Northern and Yorkshire
Region as part of its Healthy Aging R&D Programme.
The following people were involved in the project:
Prof. A. Gatrell IHR Lancaster University
Dr C.Milligan IHR Lancaster University
Dr A. Bingley IHR Lancaster University
Dr R. Wagstaff Director of Public Health, Eden Valley PCT
Ms J. Riddle Age Concern, Carlisle
Ms E. Allnutt Allotments Officer, Carlisle City Council
Ms J. Barker Gardener/Club Organiser, IHR Lancaster University
This research report is co-authored by
Christine Milligan, Amanda Bingley and Anthony Gatrell.
Details and downloadable versions of reports can also be found on the IHR website:
http://www.lancs.ac.uk/depts/ihr/research/mental/cultivatinghealth.htm
For further details about the study please contact:
Dr Christine Milligan, Institute for Health Research, Lancaster University, Bailrigg, Lancaster,
LA1 4YT. Tel: 01524 592127 e-mail: c.milligan@lancaster,ac,uk
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3. Acknowledgements
We would like to thank the following organisations and people who supported the
project:
The NHS Executive (Northern and Yorkshire Region) for their generous
funding
NHS staff who supported us from Carlisle & District PCT (formerly North
Cumbria Health Authority)
Carlisle City Council Department of Leisure and Community Development who
offered free use of Longsowerby and Lingmoor Way allotment sites during
the study for the project gardening club
Age Concern, Carlisle who provided support for the project social club
The many people who offered their time as part of project club activities
giving talks, demonstrations and hosting visits and outings.
We would, particularly, like to thank all the people who volunteered to
participate in this study and without whom the project would have been
impossible. Their willingness and commitment has demonstrated that older
people in Carlisle have a great deal to offer each other and the community.
With adequate support they can create new opportunities for social and
gardening activities that positively promote health and mental well-being. We
hope that the ideas and experiences of those older people participating in
this project will provide inspiration for continuing improvements in community
health for older people both within Carlisle and beyond.
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4. Content
Acknowledgements 3
Introduction 6
Summary of key points 7
Ideas and recommendations 8
Section 1: Aims of the study 9
Section2: Methods of collecting information 11
Section 3: Setting up and running the groups 17
Section 4: Dilemmas of recruitment and research
design 19
Section 5: Analysis of quantitative data 22
Data analysis and results 24
Concluding comments 27
Section 6: Analysis of qualitative data 29
Gardening activity 30
Gardening in a Club 37
Social Clubs 41
Section 7: Discussion 46
Section 8: Conclusion 55
Section 9: Dissemination 57
Bibliography 60
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5. Tables and Figures
Table 1: Summary of Research Design 12
Table 2: Distribution of respondents - 1st SF-36 22
Table 3: Living circumstances by group 22
Table 4: Housing tenure by group 23
Table 5: Age distribution by group 23
Table 6: Survey responses by group 23
Table 7: Number of diary participants by group 24
Table 8: Health comparison: 1st and 2nd survey responses 24
Table 9: Change in health score at 5th week 26
Table 10: Change in health score at final week 26
Figure 1: Age range (%) – Carlisle over 65s population
compared with CHP over 65s 13
Figure 2: Age range in groups (%) 14
Figure 3: Gender balance in groups compared with
Carlisle over 65s population 14
Figure 4: Numbers active in Clubs at start (blue)
and finish of study (red) 21
Figure 5: Comparison of family and adult history/
experience in gardening in three groups 31
Figure 6: Comparison of age-related restriction to
garden, expertise and interest in gardens
in three groups 34
Figure 7: Comparison of activities with members of
the Social Club 42
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6. Introduction
In early 2002 ninety-three older people in Carlisle volunteered to take part in
the Cultivating Health Project (CHP), which ran from January to November
2002. The project, funded by the NHS Executive (former Northern and
Yorkshire Region), was set up as part of the ‘Healthy Ageing’ R & D programme.
The aim was to study the effects of different activities on the health and
mental well-being of people over 65 years of age. In particular, the study was
designed to compare the relative health benefits of gardening versus social
activity. We set up three groups, a gardening club, a social club and a reference
group. People were invited to join one of these groups over the nine months of
the study where they could take part in regular activities, or, for those in the
reference group, continue to go about their everyday lives. Participants’ health
and well-being was assessed throughout by a combination of self-assessment and
researcher-led observation. The gardening and social clubs proved successful
interventions and both have continued to run following the end of the study.
In this report we present the main findings and key recommendations arising
from the study. In the first section we outline the aims of the project and the
methodology used. We discuss recruitment issues, the setting up and everyday
running of the project interventions. We also discuss, in detail, ideas and
recommendations for future initiatives that, we suggest, may help to promote
health and well-being amongst older people in the community. In the second
section we explore the quantitative and qualitative findings in relation to each of
the two clubs set up as part of the project, referring also to the reference
group. We conclude with a detailed discussion of several key issues that
emerged from the study.
The Cultivating Health Project proved to be an enriching process for many of
the people who took part as well as for us, as researchers. The study has
deepened our understanding of the needs of older people and points to a number
of ways, very often simple and people-led, in which health and well-being can be
more effectively promoted and maintained in older age.
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7. Summary of Key Points
Evidence from this study suggests that gardening and
social activities have profound and positive effects on a
person’s sense of worth and mental well-being. These
effects support older people to cope better with chronic
or debilitating physical ill health.
Social contact is a vital factor in enhancing the health and
well-being of older people, whatever activity they are
involved in.
There are positive benefits for the health and mental well-being of older
people if they garden ‘communally’ in a club with regular support.
Gardening as an activity has a number of important qualities that help to
sustain older people, not just by encouraging physical fitness, but also by
mental stimulation.
Social club activities were can be highly beneficial and sustaining to the
health and mental well-being of older people.
It is important that the organisation and
choice of activities in clubs is entirely
guided by the participants. This was key
to the success of both the gardening and
social clubs set up by this project,
The ongoing support of a project
gardener/club organiser is essential in setting up and sustaining a successful,
functioning club.
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8. Ideas and Recommendations
Both the garden club and social club demonstrated that older people-led
groups have definite benefits for the health and mental well-being of their
members. However, to be successful they require appropriate and adequate
support and resources.
The health benefits associated with sociable activities when meeting in clubs
and societies, whether gardening or with otherwise, are far reaching. Even a
single weekly social meeting can add a new dimension to an older person’s
everyday routine. Developing older people-led activity groups is an important
way of reducing social isolation and improving mental well-being.
There is potential for local clubs to run schemes, which aim to support people
to continue to garden and thereby enjoy the benefits of their own gardens
for longer than is currently possible. People-led schemes of this kind could
advise each other over designing appropriate adaptations, locating regular
help, and offer sociable opportunities to exchange ideas and skills.
To be successful, older people-led groups require the support of a community
officer(s) to give initial guidance and ongoing support. This will provide the
structure around which a group can be recruited and developed. Our research
indicates that groups can become largely self-sustaining, requiring only
limited (but regular) support, after the first year.
Limited, ongoing support can help to maintain membership and recruitment of
a people-led group through outreach and other referrals, as well as acting as
an independent group ‘mentor’ for supporting the organisation of the group’s
activities.
Clubs of this kind can also accommodate disabled older people, but would
require additional financial resources and support.
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9. Section 1: Aims of the Study
The Cultivating Health Project was developed in response to a call from the
‘Healthy Ageing’ R & D programme to look at more holistic ways of improving and
maintaining health in older people by appropriate support of their everyday
activities.
The project was a two-year in-depth study, which included an intervention over
nine months. The aim was to explore the extent to which different kinds of
gardening and social activities might help to promote the health and mental well-
being of people over 65 years of age. In particular we focused on the benefits
of communal gardening on allotment sites, and social activity as part of a club.
We were especially keen to study the benefits of gardening in comparison to
other activities. Largely, this was because a number of previous studies
suggested that there were tangible and long-term positive effects to physical
health and well-being for people that garden regularly (see Galgali et al, 1998;
Lemaitre et al, 1999; Galloway et al, 2000).
However, very few of these studies looked, specifically, at an older age group in
terms of general health and mental well-being. There are virtually no other
studies that we are aware of, which compare gardening with social activities. Yet
older people, with or without age-related and/or other health problems, are
often seen to rely on a great deal of social activity for their enjoyment and well-
being, as well as very often being keen gardeners in their own and (less often),
allotment gardens (Jerrome, 1990; Milligan et al, 2003). We, therefore, felt
that there was a need to better understand the ways in which these different
activities promoted (or on occasion did not promote) health and mental well-
being.
It is essential that older people have an opportunity to voice their own ideas,
opinions and thoughts about their experience of different activities. We,
therefore, set out to offer as many openings as possible for this process during
the nine months in which the intervention was conducted. We did this through
discussion in the groups, meeting with members of the research team in weekly
clubs, individual interviews, focus groups and asking our older participants to
complete weekly diaries. Our aim was to discover more about how, when and
where gardening, socialising and other activities fitted into the lives of older
people, as described by themselves.
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10. We present this report in the hope that we may inspire future innovative
community-based initiatives with older people-led leisure and other activities for
those aged over 65.
The study was based in Carlisle, north Cumbria, and targeted those electoral
wards in the south of the city, that firstly, had been recognised as being
deprived by the Health Action Zone (HAZ), and secondly, were located in areas
where the population as a whole experienced a comparatively high level of social
and economic need.
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11. Section 2: Methods of Data Collection
In the course of the project we gathered a vast amount of information with
which to gain a better understanding of the relationship between health and
mental well-being and the different kinds of gardening and social activities
undertaken by older people. In this section we describe the methods used and
the kinds of data collected.
After gaining approval from the Local Research Ethics Committee, we collected
two sorts of information. The first was quantifiable in the form of a Health
Survey Questionnaire and the incorporation of standardised questions in the
weekly diaries that gave longitudinal health data that related back to the
questionnaire.
Here, we chose to use a well-known health profile, the Short Form 36 Health
Survey (abbreviated to SF-36), as the instrument with which to collect
quantifiable data from our three groups, both before and after the intervention.
This was chosen because it is considered relatively straightforward, and not
time-consuming (no more than ten minutes) to complete (Jenkinson, 1996). The
SF-36 comprises a series of eight ‘domains’, covering: physical functioning; social
functioning; role limitations due to physical health; role limitations due to
emotional health; mental health; energy/vitality; bodily pain; and general health
perceptions (Jenkinson et al, 1996). Within each of these domains a number of
specific questions are asked, and then ‘scored’ for analysis.
The results from these data were analysed numerically. Due to the numbers of
participants involved, however, the data were used largely to generate
descriptive statistics, although some statistical tests were performed on the
longitudinal data (see section 6).
There is a wealth of applications using the SF-36 among older adults, typically in
assessing the effects of clinical interventions (such as hip replacement) but also
in needs assessment. Some authors (Mallinson, 1998; Hill et al, 1996) have
criticised the usefulness of the instrument among groups who are disabled or
who are hospital-based or who have serious illness, arguing in particular that it
masks patients’ views and proposing instead a more qualitative perspective.
However, in a study of nearly 10,000 adults in Sheffield, Walters and colleagues
(2001: 342) found that it is useful ‘as a self-completed instrument in community-
based surveys of older people’. Their large sample permits them to report
means and medians, and standard deviations, for all domains, by age group and
sex. Given that our population was also community-based we were confident that
11

12. the SF-36 would be a useful instrument, particularly, when complement by a rich
body of qualitative material that we report on separately.
The second source of information was qualitative and involved asking people to
talk and write about their everyday lives. Here, we conducted focus groups and
semi-structured interviews with participants from each of the three groups. In
addition, each participant was asked to complete a [standardised] diary giving
details each week about a) their general health and well-being; b) events that
may have affected their health and well-being; c) activities undertaken during
the course of the week. The researcher also undertook regular observations of
the club activities, recording the data both visually and in a research diary.
Analysis of the qualitative data is reported in section 7.
Table 1: Summary of Research Design:
Method of Data Gardening Club Social Club Reference Group
Collection
Health Survey Completed at beginning & Completed at beginning & Completed at beginning
Questionnaire end of project end of project & end of project
Discussion Convened: beginning & Convened: beginning & Convened: beginning &
(Focus) end of project end of project end of project
Groups
Semi- 10 participants: 10 participants: 10 participants:
structured beginning & end of project beginning & end of project beginning & end of
Interviews project
Weekly All willing participants All willing participants All willing participants
Diaries over 30 weeks over 30 weeks over 30 weeks
Observation Regular visits over 30 Regular visits over 30 No
weeks weeks
Visual data Yes – photographic Yes – photographic No
records of the sites and records of outings and
gardening activities
The main themes and the complex of meanings and ideas that emerged from
these qualitative data were then analysed using qualitative software (Atlas/ti)
and interpreted thematically. In order to ensure the reliability of the data, the
emergent themes were returned to the participants in the form of a project
summary, and participants were encouraged to feed back their views on these
themes.
All participants gave informed (written) consent to the gathering and use of
both the visual and spoken data and pseudonyms have been used throughout to
preserve confidentiality.
The Sample
Ninety-three people, over the age of 65, were recruited to the project with the
help of General Practitioners. This was mainly by invitation to 1,800 people in
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13. south Carlisle, but also through the distribution of general publicity about the
study in health centres, libraries and community organisations. The recruitment
was conducted with the help of GPs to ensure that people were reasonably fit
and able to take part. The only exclusion criteria were that potential
participants were aged over 65 not mentally confused and had some physical
mobility (to the extent that they were able to walk at least one hundred yards
without support). The decision to exclude on the basis of lack of physical
mobility was purely a financial one; in that the project did not have sufficient
resources to put in place the hardcore pathways and raised beds that would have
been necessary to facilitate disabled access.
We invited our recruits to join one of three groups set up as part of the
project, either the gardening group, the social group or the reference group.
Each person had the option to join the group of their preference. We aimed to
have roughly equal numbers in each group, though seven recruits withdrew
before the start of the club meetings and a further seven withdrew during the
first three months of the project. By the end of June 2002 the numbers of
active members in each of the three groups had stabilised. All those who
subsequently withdrew or stopped attending club meetings and activities did so
because they were unable to take any active part in the study (due either to
their own, or partner’s ill-health).
In general, the age distribution of participants follows the trend evident in
Carlisle as a whole. However, as Figure 1 (below) illustrates, the project did
recruit a rather higher proportion of 65-74 year olds and a slightly lower
proportion of those aged 85 and over than the Carlisle average. This was not
unexpected given the tendency for increased age-related health problems and
the pattern in the general population.
Figure 1: Age range (%) - Carlisle over 65s
population compared with CHP over 65s
40
% in Age Group
30 Carlisle
20 CHP
10
0
65-69 70-74 75-79 80-84 85-89 >90
Age Group (years)
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14. The age range between the three groups varied significantly (see Figure 2,
below). These variations appeared to be directly related to the amount and kind
of activities people anticipated would be involved in joining a particular group and
whether they felt physically able to take part. Gardening was perceived as the
most physically strenuous and appealed to few people over 80 years of age
(although, interestingly, gardening appealed to a higher percentage of people in
the 75-79 age group). There was a more even balance in age range within groups
where less active input was required (as in the case of the reference group) and
which did not appear to intervene in an individual’s everyday, regular pursuits.
For instance, more people over 80 years of age felt able to take part in what
they perceived to be the two less physically demanding groups.
Figure 2: Age range in groups (%)
60
50
40 Gardeners
30 Social
%
20 Reference
10
0
65-69 70-74 75-79 >80
Age (yrs)
There were, however, some marked differences in the gender balance between
the three groups (see Figure 3) and against that of the population aged over 65
in Carlisle as a whole. Very few men elected to either join or were prepared to
attend the social club.
Figure 3: Gender balance in Groups compared with over
65s population in Carlisle (%)
100 86
80
58
55 52 % Men
60 48
45 42
% Women
%
40
17
20
0
Garden Social Ref Grp Carlisle
Group / over 65 population
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15. Conversely more women were prepared to join and regularly attended the
gardening club than had been anticipated. The balance of men and women in the
reference group was roughly in accordance with the general population, possibly
because, unlike the other two groups, this did not require any change in their
everyday activities. Clearly, the reference group presented the least challenge
to each individual’s gender perception and consequent choice of activity. There
appeared to be a number of other reasons for the gender differences between
the three that emerged as the project progressed. These are considered in
more detail in the Discussion section.
Method
At the start of the project all ninety-three volunteers completed a Health
Survey Questionnaire; this was repeated again at the end of the project. The
aim, here, was to enable us to numerically assess and compare participants’
general health and well-being at the start and end of the nine month study.
Over the course of the project a total of sixty-six people from the group also
took part in in-depth discussions. Following an initial pilot discussion (focus)
group we convened three separate focus groups, each with around eight to nine
people from each of the three groups. The focus groups were repeated at the
end of the intervention. We also conducted semi-structured interviews with
thirty people selected equally from each of the three groups at both the
beginning and end of the intervention.
In the first round of interviews and focus group discussions we asked people
about their general pattern of health and well-being and the kinds of activities
they participated in over the course of an average week as well as things that
affected their everyday lives and health. People spoke about how their health
and well-being was affected by their living situations, their neighbourhood,
family situations and events and also the effects of local and national events.
In the second assessment we were concerned to examine the extent to which
participants’ general pattern of health and well-being had (or had not) changed
over the period of the study. We were also interested in people’s experience of
being involved in activities, whether in the reference group or as part of the
garden or social club. People spoke about the extent to which the club and other
similar activities affected their own sense of their health and mental well-being.
We also explored, in more depth, the kinds of everyday activities people liked to
participate in and how different activities and events in the average week
appeared to affect their lives.
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16. Throughout the nine months of the data collection all participants were asked to
complete and return a weekly diary. The first section of the diary involved a
numerical score of self-assessed general health and mental well-being that
related directly to questions on the SF-36. The second section was an
opportunity for people about each week’s activities both outside the project (for
those in the reference group) and within the project if they were part of the
garden or social club. Participants could write as much or a little as they wished.
Participants from all groups also wrote about events in their everyday lives and
could include ideas, thoughts and feelings in connection to anything they wrote
about in the diary. This gave us (and the diarists) a rich and detailed picture of
people’s everyday lives and events over a sustained period of time.
In addition to the above methods of data collection, we also undertook regular
observations of both the social and gardening club activities. Over the course of
the project, the researcher spent one day per fortnight observing and recording
gardening activities on the allotments and one day per fortnight observing and
recording the social club activities. These observations were supplemented by
regular visual photographic data and written and oral reports gathered from the
project gardener/club organiser.
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17. Section 3: Setting up and running the groups.
The Gardening Club
The gardening club started out with twenty-nine participants. The club was given
two City Council allotment sites in Carlisle to use throughout the course of the
project, one site in Longsowerby and the other in Harraby. People were given a
choice about which site to garden, though most chose the site nearest to their
home. The sites were prepared for use by the City Council under the supervision
of the allotments officer. The club was organised and supported by a
gardener/club organiser, who was employed by the project, and who brought
invaluable experience to the project of working with groups and gardens over
many years. The gardener/club organiser was ‘on duty’ on both sites at specified
times during the week in order to offer advice and encouragement to people
within the group and to help arbitrate in minor disputes until it began to cohere.
Project funds provided for all the gardening equipment including seeds, tools,
specialist tools for the less able-bodied, bedding plants, compost, a garden shed
and most importantly a polytunnel for each of the two sites along with some
chairs and tables. We believed (accurately, as it turned out) that the northern
climate would be erratic, generally wet and often cold. In order to encourage
people to leave their homes to attend the site, we would have to provide shelter
and somewhere to sit, rest and socialise. We also had to ensure that the site
was accessible and manageable for the less able-bodied participants. With this
in mind, the polytunnels proved essential for sheltering both the club members
as well as nurturing the seedlings, growing tomatoes and the more delicate
flowers in hanging baskets.
The gardeners could meet on their allotment site either on a weekly basis or as
often or as little as they wanted (or were able) to. The gardener/club organiser
also arranged a monthly meeting in Carlisle Old Town Hall Assembly Rooms for
talks and discussions. On two occasions an outing to a local open garden was
arranged in place of the indoor session.
The Social Club
Twenty-nine people initially joined the social club. A regular weekly venue was
arranged in the Old Town Hall Assembly Room. This site is conveniently located
in the centre of Carlisle and has good disabled access, both of which acted to
facilitate and greatly encourage attendance. The club was organised by the
project gardener/club organiser, who set up an initial programme of events,
talks and activities suggested by club members and with which everyone in the
club agreed.
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18. Project funds covered all costs incurred in running the club and Age Concern’s
involvement in the project enabled the venue to be booked at a reduced cost.
The project also covered the costs of: all equipment and materials required for
arts and crafts; engaging speakers; and arranging outings to local (and more
distant) places of interest. From the outset, club members were encouraged to
take ownership of the club – to have a say in the kinds of activities that they
wanted to take part in; to make suggestions; and to become involved in the
weekly running of the club. This was welcomed by participants who insisted that
they wanted to avoid the ‘games’ style of activities commonly offered in many
other local clubs around the city.
The Reference Group
The reference group, with twenty-seven members, was designed to provide a
baseline for the study in terms of understanding the kinds of activities that
older people engaged in, generally, on a weekly basis. We were interested in
understanding the level of participation in activities as well as the ways in which
ill health or disability impinged upon an individual’s ability to become involved in
different activities. We were keen to ascertain how much and what kinds of
everyday activities seemed to generally promote health and mental well-being in
a group of older people in the city. This information, we hoped would enable us to
compare the ways that the project clubs affected people’s everyday health and
mental well-being in comparison to that of people who may or may not be involved
in similar activities in the area.
Though reference group participants completed the Health Survey
Questionnaire (HSQ), and participated in the focus group and interview process,
the main means of data collection was via the weekly diaries. A core of twenty-
one reference group members became regular (and mostly) very keen diarists.
§
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19. Section 4: Dilemmas of recruitment and research design
We learned a number of significant lessons in undertaking this research that we
suggest could support others involved in designing future projects of this kind.
With this in mind, we have attempted to be frank about the dilemmas that we
faced and how we resolved them.
The original research design was based on a mixed methodology with an emphasis
on quantitative data collection using a well-known quality of life questionnaire,
the SF-36 (Walters et al, 2001), together with interviews and focus groups. In
order to ensure the study was sufficiently powerful, it required the recruitment
of up to 300 participants. Recruitment was intended to be via a random
stratified sample drawn from GP lists. Within a few weeks of initiating
recruitment, however, it became clear that the take up rate would be
substantially lower than we had anticipated. We can point to three contributory
reasons for this low take up rate:
1) Unforeseen delays occurred in gaining access to the sample. GPs are busy
people and giving up time to identify exclusions for a research project is
necessarily low on their agenda. Consequently, the turnaround time for the
return of these lists was considerably longer than anticipated. As a result,
the main recruitment drive fell around the Christmas period. Recruitment
in winter time is likely to be more difficult especially as the project
involved (amongst other activities) outdoor gardening;
2) Despite clear assurances that we were setting up accessible gardening
that did not require any heavy digging, the perceived strenuous nature of
the allotment gardening activity appeared to be putting some people off
joining the study;
3) The initial publicity was not as effective as we had anticipated.
In a bid to increase recruitment, we made conscious efforts to improve
publicity. This was achieved through the wider dissemination of leaflets locally
through GP surgeries, community groups and other community facilities. We also
liased with two of the main Community Nurse teams in the area; and raised the
project profile by ensuring appeals and articles were published in local
newspapers. A short slot was also broadcast on both the local radio and
television. Border TV also interviewed some of the project team on the
allotment sites. We also increased the extent to which we emphasised the
support that would be offered in the two clubs, especially that gardening
activities would be tailored for people of all abilities and skills and extended the
recruitment deadlines later into the spring.
19

20. Even with this change in strategy it became clear that recruitment would not
reach those levels anticipated in the original research design. Following
discussion amongst the research team we took the decision to modify the
research strategy to one that would give us greater depth of data using a
smaller number of participants. The focus on the use of quantitative methods
was thus reduced, with a concomitant increase in the qualitative element of the
study. This shift allowed us to work with smaller numbers of participants, using a
variety of ‘in-depth’ methods (semi-structured interviews, discussion groups,
written weekly diaries, regular participant observation, visual data and regular
participant feedback), as outlined above.
The shift from a quantitative to a qualitative approach also meant that it was no
longer necessary to use a stratified random sampling technique. Given the
significantly different sampling strategies used in qualitative research design,
we were able to employ snowballing techniques to increase our sample size.
Clearly, a theoretical or a purposive approach would have strengthened the
sampling strategy, but despite this, as Figures 1 to 3 have illustrated, our sample
of ninety three older people represented a good range of men and women
between the ages of 65 years to 91 years.
The, largely, ethnographic study that emerged as a result of the change in
research design proved to be a highly effective way of covering the issues
explored. The changes also meant that, once identified, we could also address
some of the limitations found in using the SF-36 Health Survey Questionnaire
(Mallinson, 2002). It became clear that participants frequently found the ticking
of boxes to answer questions to be a difficult exercise. At times they found
questions and possible responses either irrelevant, inaccurate, or lacking in
meaning. In addition, it became clear that participants’ responses were either
highly subjective or relative (for example, one elderly participant consistently
marked his health down as being ‘excellent’ despite evidence from the qualitative
data that revealed he had serious heart problems).
Because the researcher and the gardener/club organiser were in regular contact
with participants, the project team was able to explore quite accurately what
was actually happening in the lives of people within the groups. Participants,
themselves, had far greater opportunity to share their thoughts and ideas with
the research team and to talk about their feelings and reasons for enjoying or
avoiding different activities. In contrast to the questionnaire, the ethnographic
approach appeared to be a mutually enjoyable and instructive experience for
those who remained actively involved in the project.
§
20

21. Dilemmas of drop out
Any longitudinal study of older people is likely to suffer high rates of attrition
given that there are inevitably increased age-related health and mobility
problems in any group over 65 years of age. Relatively high rates of attrition
were not, therefore, unexpected in this study. Over a nine months period, nearly
one third of our original participants dropped out (see Figure 4 below).
Figure 4: Numbers active in Club at start (blue)
and finish of study (red)
40
29 29 27
Participants
30 22 21
16
20
10
0
Gardeners Social Reference
Club/Group
If someone left the group the remaining active members, understandably, often
felt disappointed. However, there were always clear reasons, ranging from
unexpected commitments, serious or incapacitating health problems (unrelated
to the project activities), to illness or bereavement in the family. By July 2002,
midway through the project, the numbers stabilised and remained at the levels
illustrated above. There were sixteen active members of the gardening club,
around twenty-two members regularly attending the social club and twenty-one
regular diarists in the reference group. However, there were several club
members who, though ‘non-active’, were still considered part of the project.
These participants were unable, for a variety of reasons, to either attend any,
or only occasional, social club meetings or gardening club site activities. For
example, two or three of this ‘non-active’ group were occasionally able to attend
a club outing, or in the case of the gardening club, one of the monthly talks or
events. This group continued to complete diaries and their contribution was
invaluable.
§
21

22. In the following sections we discuss the main research findings
Section 5: Analysis of quantitative data
In this section we report on the collection and analysis of the quantitative
survey data collected from our respondents. This took two forms; first, data
collected using the SF-36 and, second, data from the weekly diaries.
Diaries
Each group was asked to fill in a weekly diary between 15th March and 2nd
November (31 weeks) responding to four general health and well-being questions,
together with a comment whether any particular event had affected their lives
in each week. The response to this last question is to help interpretation of the
scores for the general health and well-being questions.
Sample characteristics
We recruited 93 participants to the study, although 8 withdrew before the
study commenced. For the first SF-36 survey the distribution of respondents
was as follows:
Table 2: Distribution of respondents –1st SF-36
Group Number
(%)
Gardeners 29 (33.7)
Social 29 (33.7)
Reference 27 (31.4)
Slightly more men (n=16) than women (n=13) were in the gardening group and the
reverse was true for the reference group (12 men, 15 women). However, very
few men were in the social group (n=4), compared with women (n=25). Not
surprisingly, as table 3 indicates, the living circumstances of the three groups
reflected this, with those in the social group tending to live alone compared with
the two other groups (percentages in parenthesis):
Table 3: Living circumstances by group
Group Living alone Living with spouse Living with other
family member
Gardeners 10 (35) 16 (55) 3 (10)
Social 15 (54) 10 (36) 3 (11)
Reference 11 (41) 14 (52) 2 (7)
22

23. In terms of housing tenure (see table 4), again the gardening and reference
groups were broadly similar, but the social group had more participants living in
private rented or sheltered accommodation:
Table 4: Housing tenure by group
Group Own home Local Private Sheltered
Authority/Housing rented housing
Association
Gardeners 22 (82) 3 (11) 0 2 (7)
Social 19 (66) 5 (17) 3 (10) 2 (7)
Reference 23 (85) 3 (11) 1 (4) 0
The age distribution was broadly similar across the social and reference group;
however, the gardening group tended to have a greater proportion of younger
people. While five members of the social and reference groups were in their 80s
only one of the gardeners was:
Table 5: Age distribution by group
Group 65-69 70-74 75-79 Over 80
years years years years
Gardeners 15 (52) 7 (24) 6 (210 1 (3)
Social 10 (35) 10 (35) 4 (14) 5 (17)
Reference 10 (37) 8 (30) 4 (15) 5 (19)
While there were data for 85 study participants at the time of the first SF-36
survey, as table 6 indicates, this dropped to only 68 at the time of the second
survey. Moreover, while there was little drop-out among the social group the
responses from gardeners had dropped by a third and the reference group
responses were also fewer, as the table below indicates:
Table 6: Survey responses by group
Group Number in first Number in second
survey (%) survey (%)
Gardeners 29 (33.7) 20 (29.4)
Social 29 (33.7) 27 (39.7)
Reference 27 (31.4) 21 (30.9)
We obtained diary data from a total of 62 individuals. The gardening club
attendance records show that seven participants never worked on the
allotments, while a further four were there a maximum of four times. We
focused on the remaining 18 individuals who worked on the allotments at least 5
23

24. times, but note that while many attended on five consecutive weeks, others
came sporadically and, therefore, any health benefits may not be comparable.
Two people in the social club never attended club meetings, but wrote diaries
(for 26 and 18 weeks respectively); a further four attended the club on no more
than four occasions. We focused on the remaining 23 individuals who attended
the club at least 5 times. The reference group (apart from two individuals who
dropped out from the study) have fairly complete diary records with some
missing data. The diary data is therefore summarised in table 7 below:
Table 7: Number of diary participants by group
Group Number completing diaries
(%)
Gardeners 18 (29.0)
Social 23 (37.1)
Reference 21 (33.9)
Diary entries were not completed for some weeks because of holidays. There
were a maximum of 28 weeks of diary entries for the reference group (29/3,
3/5,20/7 missing), and a maximum of 30 weeks of diary entries for the social
and gardening clubs (20/7 and 29/3 missing respectively). There is considerable
missing diary data. In addition to the diary entries information is available about
club attendance. Many people completed diaries without attending their clubs;
the diary data for these weeks therefore does not relate to club participation.
Data analysis and results
SF-36
A preliminary comparison of responses to the question that asked about health
now, compared with a year ago, suggested evidence that the gardening group felt
better about their health, compared with other groups (see table 8). For
example, while in the first survey 14 per cent of the gardeners felt that their
health was better than 12 months ago, this proportion had increased to 25 per
cent by the time of the second survey; of course, this suggestion is subject to
the caveat of the samples being very small.
Table 8: Health comparison: 1st and 2nd survey responses.
First survey Second survey
Group worse same better worse same better
Gardeners 6 (21) 18 4 (14) 3 (15) 12 (60) 5 (25)
(65)
Social 7 (25) 17 (61) 4 (14) 4 (15) 19 (70) 4 (15)
Reference 5 (19) 17 5 (18) 6 (29) 11 (52) 4 (19)
(63)
24

25. However, we also conducted some more rigorous statistical analysis of the data
in order to determine what influence, if any, group membership (gardening,
social, reference) had on changes in health status during the study period. The
method used was analysis of covariance (ANCOVA: see Field, 2000). This is a
form of linear modelling in which variation in a response variable (here, one of
the changes in the nine ‘domains’ of the SF-36) is ‘explained’ in terms of group
membership, while controlling for the possible confounding effects of other
variables. For example, if we detect between-group differences in changed
health status, this could be because the groups differ in terms of age
distribution, or living arrangements. We therefore entered into the model the
following four variables, before entering group type: age (65-69 years; 70-74
years; over 75 years); sex (female; male); living arrangement (alone; not alone);
tenure (owning home; not owning home). We then conducted nine separate
ANCOVA analyses, where the dependent variables were, in turn, changes in
health status on the SF-36 domains.
In six of the domains changes in health status could not be accounted for by any
explanatory variables. These domains were: physical function; role limitation due
to physical problems; role limitation due to emotional problems; social
functioning; energy/vitality; and change in health. There were no significant
differences between the three groups, nor were age, sex, tenure or living
arrangements associated with changed health status.
For the pain domain there was evidence that those aged 65-69 years were
significantly more likely to have had improved health (p = .020). For mental
health there was weak evidence that those aged 70-74 years had significantly
improved health (p = .074) and also that the social group had also registered
improved health status (p = .061). Last, considering general health perception
there is a suggestion that membership of the social group brought significant
improvements along this dimension (p = .015), while adjusting for other factors
(owning one’s own home was weakly significant: p = .060).
Diary data
As explained above, the diary entries must be used together with allotment or
social club attendance records. As each individual enters the study with a
different level of health and well-being, we looked for changes in health and
well-being scores (sum of scores for the four questions) between the beginning
of the study for each person (some people entered the study late) and later
weeks.
25

26. Each individual’s entry score was taken to be the score for the first week of
their diary entry. This is to be compared with the scores a few weeks later (see
table 7):
a) on the fifth week of diary entry (at least four weeks later) for the reference
group, the fifth week of allotment attendance (at least four weeks – in one case
19 weeks later) for the gardening group and the fifth week of club attendance
for the social club group (at least four weeks later) and
b) on the last week of diary entry for the reference group, the last week of
allotment attendance (or as soon as possible after) for the gardening group and
last week of club attendance for the social club group (or as soon as possible
after) (see table 8).
Rarely, there was a missing value for a question. Then the average of the
previous and next week’s score for that question was used, or for the first and
last week, a score was imputed from the pattern of scores for that question, e.g.
consistent value over several weeks.
Of the 62 individuals included (with data at week 5), there were 20 in the social
club and 14 in the gardening club who continued with both club activities and
with diary entries so as to produce useful data beyond the fifth week. The
quantity of useful data was therefore limited.
Table 9: Change in health score at fifth week
change in Q2 score week 5
Standard
Mean Error of Mean Minimum Maximum Valid N
1 reference .38 .62 -4.00 11.00 N=21
2 social .48 .63 -7.00 5.00 N=23
3 gardening -.67 .61 -5.00 4.00 N=18
Table 10: Change in health score at the final week
change in Q2 score final week
Standard
Mean Error of Mean Minimum Maximum Valid N
1 reference .33 .64 -4.00 11.00 N=21
2 social .70 .62 -6.00 6.00 N=20
3 gardening -.36 .71 -5.00 5.00 N=14
The mean change in health score for each of the social club and gardening club
was compared with that of the reference group, using t-tests for the equality of
means and analysis of variance. There is no evidence of a difference in the mean
26

27. change in health scores between groups either after five club attendances
(p≥0.24) or at the end of the study (p>0.48). However, as in the analysis of SF-
36 data this does not control for other explanatory variables. We, therefore,
tested the group effect using normal regression analysis, with change in health
score as the response variable and controlling for change in Q3 score (health
qualifier coded as 0 for serious illness or grief to 5 for a very happy event) and
for measures of involvement in the project.
Analysing data after the fifth week of club attendance suggests that after
control for the change in the health qualifier (entered either as a continuous or
categorical explanatory variable) there was no evidence for a group effect
(p≥0.3). Analysing data after the last week of club attendance was as follows. In
addition to the change in health qualifier, two measures of involvement in the
project were used:
a) the number of social club or allotment attendances, or the number of
diary entries for the reference group, expressed as a percentage of the
maximum possible for each group
b) the number of social club attendances plus diary entries for the social
group, the number of allotment and club meeting attendances plus diary
entries for the garden group and the number of diary entries for the
reference group, expressed as a percentage of the maximum possible for
each group.
After control for the change in the health qualifier (entered either as a
continuous or categorical explanatory variable) and a measure of involvement,
there was no evidence for a group effect (p≥0.4). Last, as an exercise, four non-
attendants from the social and gardening clubs were added to the reference
group. The mean change in health score for the reference group was then
negative, showing the effect of just a few more observations on this small
sample. The overall conclusions are unchanged.
Concluding comments
From the analyses we have conducted we draw the following main conclusion.
There is no quantitative evidence that belonging to the gardening group brought
significant health improvements across a range of health ‘domains’. There was
weak evidence that membership of the social group conferred benefits in terms
of improved mental health, and stronger evidence that it led to improved general
health. From the diary data there was no evidence of a ‘group membership’
effect on health and well-being.
27

28. We need to interpret these findings with some caution, for several reasons.
First, the sample sizes are modest, certainly in comparison with other published
studies using the SF-36 (Jenkinson et al, 1996). Second, our study has suffered
from considerable drop-out, not least among the very group (gardeners) in which
we were interested. We were restricted to only 20 gardening respondents in the
second survey and in analysing change from the baseline could never increase our
sample size beyond that number. A consequence of this is that random
modifications in how the questionnaire was filled in (or how the diaries were
completed) could affect the results quite markedly.
There is very little quantitative evidence of a ‘group’ effect and nothing to
indicate that our small sample of gardeners were statistically more likely than
the other groups to register an improvement to their health.
§
28

29. Section 7: Cultivating health: analysis of qualitative data
The previous sections have illustrated some of the difficulties we encountered
in attempting to analyse the quantitative data and the limited utility of these
findings given our small sample size. While we were unable to demonstrate from
these quantitative data that participating in social or gardening activity
produced any statistically significant changes in the health and well-being of
older people, the qualitative data gave us some rich and detailed insights into
their experiences during the course of the nine month intervention. We have
summarized these findings for both of the two main activity groups, before
drawing together the implications of these findings in Section 8.
As indicated previously, the qualitative data was analysed thematically, we have
therefore chosen to present the main findings under heading that represent the
key themes emerging from the data.
§
29

30. Gardening activity
“I love my garden, like. I come away/I stand back
and look as I close the gate and say ‘I achieved
something today’, you know? I love it, aye.”
(Archie, 70 yrs)
Gardening is a very popular leisure activity amongst
the older people in Carlisle. The Carlisle City Forum
survey, undertaken in 2003, found that three quarters
of the respondents aged over 65 to 75 gardened regularly and over half the
respondents aged over 75 were regular gardeners (Wilde, 2003). The vast
majority of them gardened in their own homes, and almost all had gardened
throughout their adult life. However, very few of those in the 65-75 age group
gardened on allotments. Those older people who responded to the survey noted
that their main reasons for gardening were enjoyment, exercise and general
interest.
Inevitably the nature of the Cultivating Health Project appealed to those people
with a particular interest in gardening and in common with the older population
as a whole in Carlisle, the majority of those who took part in the project
(whichever club/group they were in) had a garden. Garden sizes varied, but
almost all well-tended.
The past history of gardening and garden ownership between members of the
three groups was varied (see Figure 5). About a quarter of all participants (in
the gardening and social clubs) to a third (in the reference group) had been
brought up with gardening, either in the family garden or on an allotment plot: a
history described by one of the gardening club members as ‘gardening in the
blood’. Where gardening had been a prominent activity for members of their
family or themselves as children, participants were more likely to have been
garden owners in adult life, and vice versa.
Of those people who were able and willing to join the gardening club, and thus
take part in allotment gardening, more had experience with their own allotments
as adults. In contrast no-one with gardens in either the social club or reference
group had been involved with allotment gardening as adults and only some people
30

31. Figure 5: Comparison of family and adult history/experience of gardening in
three groups
Garden/Allotment History - Garden Club participants
30
25
Number of participants
20
15
10
5
0
Own garden No garden Allotment now Allotment in Family
past gardened
Garden History - Social Club
20
18
Number of participants
16
14
12
10
8
6
4
2
0
Own garden No garden Allotment Garden in past Family
gardened
Garden history - Reference Group
25
Number of participants
20
15
10
5
0
Own garden No garden Allotment Allotment in Family
now past gardened
31

32. had childhood memories of fathers, uncles, or in one or two cases mothers, who
had gardened allotments.
This pattern would suggest that childhood experience in gardens tends to
encourage more confidence and interest in later life.
However, we found that not everyone enjoyed gardening in spite of his or her
childhood experiences and that a love of gardening appeared to be more of an
innate enjoyment. One participant noted that despite having two sisters (with
exactly the same upbringing), she was the only one who had developed a lifelong
love of gardening. Very often people described either themselves, or others, as
having a ‘natural gift’ for gardening.
Most of those participating in the project had enough garden space in which
they could at least keep some tubs and hanging baskets. There were a surprising
number of very enterprising gardeners who, despite only having a tiny backyard,
grew carrots, potatoes, fruit bushes and, in one case, even a cherry tree using
old buckets and variety of containers.
Although many participants described enjoying their garden, for others, keeping
the garden tidy and looking good had become a burden as their age-related
health problems many gardening tasks exhausting or impossible.
People had found various ways of overcoming these problems. About a quarter of
our participants, for example, had paved or grassed over existing garden areas.
This was viewed as a positive action in the face of increasing limitations as it
eased the chore of tidying. Other
adaptations ranged from gardening almost
entirely in easily managed pots and tubs or
putting down ‘shillies’ (shingle or gravel) with
pots or tubs set within the areas. Planting
that did not require annual replacement (such
as small trees, shrubs etc.) was also popular.
Only two of those participating in the project had paved or grassed over areas
because they actively disliked or had absolutely no interest in gardening.
Some participants had found help in maintaining their own gardens, but only two
were able to pay for this service. More often relatives or neighbours helped to
keep the grass cut and the garden weeded and tidy.
32

33. Several people had been keen gardeners in the past, but age-related disabilities
and changing circumstances had forced them to move to apartments or
sheltered housing which had either no garden or small, communal gardens which
were managed by the city council or housing association. One or two people in
this situation noted that, if they wanted, they could still have a hanging basket
or share some small area that was gardened for residents.
Those without gardens often had a long-held interest in gardening generally, and
most enjoyed visiting garden centres or open gardens, an activity that was also
popular with garden owners (see Figure 6). Many people without gardens felt,
that to some extent, this made up for the loss of their garden or the fact they
only had a small yard or shared resident garden.
Gardening, for those who do enjoy it, has certain particular qualities that
are distinct from other activities.
There is a strong sensory pleasure associated with being in a garden. Many
people said that they enjoyed just sitting or gardening amongst the colours,
scents and different types of flowers. Others described a sense of wonder in
the process of nature: the ‘magic’ of seeds germinating, plants growing and
ripening.
“the magic of planting something and seeing that it grows, you
know, is still a source of wonder.” (Hugh, 70 yrs)
Some gained particular enjoyment from the task of nurturing young seedlings
and plants, which they likened to the kind of tending involved in caring for a
child. While tending young plants always has an edge of uncertainty, those
participants who gardened, especially the more experienced, were very
philosophical about the likelihood of certain plants failing in some years, and saw
such events as a challenge to be overcome. As one man said: ‘there’s a challenge
every day - you learn summat every day’ (Archie, 70 yrs).
For many people the challenge was to successfully grow fresh
vegetables that could then be eaten. This added to the overall
sense of ‘achievement’, ‘satisfaction’ and ‘wonder’ reported by the
majority of those that gardened.
33

34. Figure 6: Comparison of age-related restriction to garden, expertise
and interest in gardens in three groups
Ability and interest in garden - Gardening Club
10
9
Number of participants
8
7
6
5
4
3
2
1
0
Does minimum Has help Garden Unable to do Keen/able Like it/less
adapted able
Ability and interest in garden -- Social Club
6
Number of participants
5
4
3
2
1
0
Does Has help Garden Unable to do Keen/able Like it/less
minimum adapted able
Ability and interest in garden - Reference Group
12
10
8
6
4
2
0
Does Has help Garden Unable to do Keen/able Like it/less
minimum adapted able
34

35. People described gardening as ‘creative’: it provided mental as well as
physical stimulation.
Gardening is often assumed to be largely about physical activity. This view was
re-iterated, mostly, by those who were either unable to garden due to physical
disability or who had little gardening experience. However, the more
experienced gardeners in our study noted that gardening is creative in many
ways, both physically and mentally, in that people have to plan and think about
the design, learn about the needs of different plants and glean new ideas from
other gardeners.
Others had very little gardening knowledge, but as one woman commented, this
had made the gardening club more interesting for her as ‘you are learning all the
time’ (Amy, 72 yrs).
This mental stimulation was an aspect of gardening that some participants felt
was often overlooked; yet it is an important feature of the activity. One
individual noted that gardening encouraged him to go and look up information and
gather gardening books, where previously he had very little call to acquire
knowledge through books.
“It’s a bit of a challenge the garden like, in any sense, and as I say
I’m still learning. I’ve got a lot of books on gardening.” (Stuart, 66
yrs)
Another described how he enjoyed lying in bed at night thinking out his
gardening plans and designs for the season and attempting to work out how to
solve problems in the garden.
Gardening is perceived to provide a ‘therapeutic' space, which enhances or
improves mental well-being.
Gardening and gardens can offer many opportunities for engendering positive
feelings of well-being, for example through the sense of achievement in
successfully nurturing and tending plants, to the pleasure of being surrounded
by the colours, scents and variety of flowers and shrubs (Milligan et al,
forthcoming). Gardening activity differs from many other popular activities in
that it can also provide solitary space and time, which is beneficial to the
individual rather than leaving them feeling lonely or isolated.
35

36. As described by ‘Barbara’, below, not only can gardening be less stressful than
forcing oneself to socialise and do things that perhaps may not be enjoyed, but
the garden, itself, can also provide a setting in which it is possible for an
individual to sort out difficult feelings on their own:
“I was a bit of wary wondering what the Social Club was going to
involve you in, if you were sitting, you know, ’four walls to a group
of people’ that you maybe didn’t gel with and doing things that you
weren’t very happy with. Where in the garden you can just dig your
way out of your misery.’ (Barbara, 67 yrs)
While the positive and therapeutic aspect of gardening is well-documented in
studies, largely arising from research in ‘horticultural therapy’ (see Wells, 1997;
Sempik et al., 2003), there is also a negative aspect to gardening that has, to
our knowledge, not been addressed in other studies to date, and which we found
to be especially prevalent in this older age group.
Participants noted, that at some point, due to reduced physical health and
energy, a garden or allotment plot can become too difficult to manage and
consequently becomes uncared for and overgrown. Its presence, then, can be a
source of worry, anxiety and depression - a constant reminder of the individual’s
increasing disability and loss of strength. This aspect of gardening activity may
be particularly relevant to those older people who are not associated with any
particular ‘therapeutic’ or ‘community’ gardening project and who thus remain
unsupported in their gardening activities.
As we discuss in the following section ‘communal gardening’ can go some way to
mitigating this perceived burden. These findings are examined in more detail in
the Discussion Section.
§
36

37. Gardening in a Club
Sharing tasks is a vital and very supportive
way of gardening.
Communal gardening activity on an allotment
site offers the opportunity to share the
responsibility for the upkeep and maintenance
of the garden plot with others. This can reduce
the burden of a garden site, which has become
too large for one individual to manage, and increase the enjoyment gained from
the gardening activity.
In our project, gardening in a club appeared to counteract this problem very
well, particularly for those participants who had been forced to abandon their
gardening activity after a period of illness, or because they felt generally less
energetic and able to manage an allotment site or their own garden. Even those
gardening club participants who were still able to manage their own plots or
gardens found ‘communal gardening’ on allotment sites to be better than
gardening alone.
For six participants who had never before considered an allotment, being in the
club opened up a ‘new dimension’ to gardening:
“.. because there was quite a bit of enthusiasm, people were
quite keen to learn and, you know, put effort into it. And it
did, it went well, and when they saw things growing of course/
I mean some of them hadn’t gardened before, you know. And
when they saw things growing/ took more interest in it. It was
good.” (Ben, 65 yrs)
A key reason for the success of the club approach to gardening was the
opportunity it offered to share tasks in a sociable environment and, as ‘Barbara’
says below, as part of a ‘communal effort’:
“[It’s] ..a communal effort. So when you’re digging out or
weeding and that, instead of having a tired/well you know it’s
weary when you’re doing a section on your own, you don’t seem to
get anywhere. We do it in little groups and you have a bit [of a]
laugh and talk and stop and get a chair out..” (Barbara, 67 yrs)
37

38. Group support offered people an opportunity to garden as much or as little as
they were able to without feeling guilty or pressured. Those who were frail or
unwell were particularly appreciative of this. Despite feeling unwell, some group
members would come to the allotment site simply to sit down, watch the
activities and enjoy the company. Though the gardening activity still continued,
other members of the group would express their concern and care for the
individual, facilitating their ability to still feel included as part of the group.
This was viewed as an extremely supportive function of the club, combining the
therapeutic benefits of both social contact and gardening. As ‘Ben’ commented:
“There was a lot of people who weren’t really physically fit
enough to do the work. So then it was just a matter of helping
them, so everybody just ended up piling into the plot, and that
seemed to work. It was communal, everyone helped each other.”
(Ben, 65 yrs)
Group support offered the potential for everyone could go away from a
gardening session with a sense of achievement. Communal gardening can, thus,
fulfil several different functions: from the therapeutic effects of gardening
activity; to the beneficial effects of social contact between the members of the
group. The social space and opportunity for social contact provided by the
gardening club was an aspect of the activity that was seen to be of equal
importance to the gardening, itself:
“.. when I come home, and I’m thankful I’ve been and happy
I’ve been, you know. ‘Cos like you say, you’ve got that feel good,
you’ve been in the fresh air, you’ve been talking to people and
discussing the gardening and this, that and other. .. It’s gave
you that pleasure to know that you’ve been and enjoyed it.. You
feel so different.” (Alice, 66 yrs)
As ‘Alma’ explains below, whether able to do the heavy
digging or only able to be involved in less strenuous
activities such as potting up or planting seeds,
participants could still enjoy the social interaction.
38

39. “I don’t know what else I can do except set seeds in the
polytunnel and do little jobs, sit around or maybe have a chat
with them. ..We are all a lively group, you know, we are/really,
have some fun, you know laugh and that. So I quite enjoy that.”
(Alma, 80 yrs)
In addition to the weekly gardening on the allotment sites, all the club members
from both the Lingmoor Way and Longsowerby allotment sites met every month
in a central indoor venue. The meeting would involve both a talk on gardening
given by an invited ‘expert’ speaker and a general get together. On two occasions
members went on visits to local ‘open gardens’. On one further occasion there
was a demonstration of the use of coppice products in the garden.
These outings and talks were very successful and universally enjoyed, mainly
because the events encouraged discussion and ideas on gardening. The events
also provided an opportunity for those who were unable do the gardening as a
result of ill health to participate in some club activities, so gaining a degree of
social benefit from sharing their enjoyment of gardens and gardening.
The sharing of gardening knowledge and ideas is an important element of
‘communal gardening’.
People noted that they found the club a safe, sociable place in which to learn
new techniques or to pass on their skills to others. As noted above, this was
found to been an especially compelling aspect of gardening:
“the thing I like about it is we all seem to have gelled you know,
the people that go there.. There’s different characters, we’ve
all sort of gelled, and talk to each other a lot, and ask, you know,
not be frightened to ask anybody something, you know.
Shouldn’t be ashamed to ask anybody anything if you are not
sure.” (Ben, 65 yrs)
For some, the opportunity to grow vegetables was an aspect of gardening
activity that they had not experienced before. Participants not only gained
knowledge and a sense of achievement, but also benefited from harvesting fresh
produce to eat.
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40. Oh I’ve done a bit of digging .. and a bit of weeding and a little
bit of planting. I did potatoes and lettuce and things like that. I
put potatoes in early on. Well I’d never done that before. Aye
it’s very rewarding I think like. .. it’s nice when you’ve grown
them and you’ve eaten them. You know it’s lovely. (Amy, 72 yrs)
For many participants, sharing and gaining knowledge promoted a sense of worth,
re-affirming their place as a valued and experienced member of the community.
Our observations indicated this was not only an important element in the
‘communal approach’ to gardening, but also in the running and dynamics of the
social club and in other group activities undertaken by members of the
reference group. We discuss this in more detail in the following section.
Towards the end of the active fieldwork, participants were encouraged to
discuss how they might go about continuing the club by themselves. The aim was
to demonstrate how a gardening club, of this kind, might become self-sustaining
or at least manage with limited support. At the time of writing (October 2003) a
small group are still successfully maintaining allotment plots at Longsowerby.
This was the larger of the two sites with a greater core of able-bodied
members. However, our findings indicate that for a club to work, successfully,
for its less able members, older people need to be offered regular and sustained
support. This need not be the intensive levels of support offered during the
first year of the project, but should be offered on a regular weekly basis. The
recommendation is discussed in more detail in the later section.
§
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41. Social Clubs
The Social Club added a new dimension to the lives of many of those who
regularly took part.
Although the club was only convened once a week, many participants reported
that attending it had made a significant change in their weekly life. It was an
event to look forward to, one which was especially enjoyable for those who lived
alone, felt isolated or restricted in their activities.
“Makes another afternoon out, if you’re
on your own, you know, you enjoy an
afternoon out.” (Connie, 71 yrs)
For others the club provided an opportunity to
meet with other people, where previously they
had felt increasingly anxious about going out as a
result of age-related disabilities or frail health.
“..as somebody who’s sort of housebound because of physical
disability, getting out, at first I couldn’t stop talking. Now I just
talk as much as everybody else does, and I thoroughly enjoyed
it, and the company [and] the speakers because it’s something
different to think about. I’ve thoroughly enjoyed it.” (Angela, 68
yrs)
For some, the contact and opportunity to share each other’s stories and
experiences was particularly valued as it helped them to see their own lives in a
different perspective:
“Well, I find that’s the best bit about it. It does get you out. You
meet other people and you make friends. Instead of sitting at
home feeling sorry for yourself or depressed it gets you out and
about. And you realise that other people have illnesses and things,
you know and that.” (Esther, 68 yrs)
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42. The social club opened up the opportunity to make new social contacts.
Participants particularly appreciated being able to start afresh in a club where
everyone was on an equal footing in a new venture. This aspect of the club was
interesting given the findings of Jerrome’s (1989) earlier study, in which the
‘ritual’ of attending an established club with regular, well-practised activities
was found to be of prime importance. In contrast, in our study, although
eighteen (out of the total of twenty-nine) participants in our social group were
regular attendees of other clubs or activities, many had previously (and in some
cases studiously) avoided some of the more traditional clubs.
Participants maintained that they often found people in well-established clubs to
be ‘set in their ways’ and that the activities on offer were often ‘boring’ and
routine. Some, further, noted that when they had attempted to join a well-
established club they had experienced unfriendliness, even hostility, from the
long-term members, who appeared to find a newcomer rather threatening to the
status quo.
Figure 7 illustrates the extent of social club participants’ involvement in
additional activities such as clubs, societies, or adult education.
Fig.7 Comparison of Social Club members outside activities
13
14
12 10
Numbers involved
10
8
6 4 4
3
4
1 1
2
0
Social Class Society Sport Games Church MU/WI
Club Club
Club/Society etc
We found sporting activities to be the most common additional activity that
people participated in on a regular basis. Indoor (and outdoor) bowling, keep fit
and gym, swimming and golf were particularly popular. Only one third of our
social club members attended other clubs. In the main, (with the exception of
sporting activities) this group was involved in far fewer outside clubs or
societies than those who participated in the gardening club or reference group.
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43. This finding reflects the more isolated nature of the lives of the majority of
social club members.
The social club was, therefore, felt by some participants to have provided an
unusual and welcome opportunity to join a club where previously they might
never have considered such a move.
For those put off by what they perceived to be the negative aspects of existing
social clubs, the project offered an opportunity to create a club with a
different agenda. Club members had a wide choice and say in the kinds of
activities they would like to participate in. Some also felt that this provided an
opportunity to develop a different and more inclusive ethos within the club.
Without exception, participants asked for arts and crafts, talks, and
outings rather than games.
These activities, particularly the local outings, proved very popular. Only four
members already attended clubs where they could take part in arts, music, adult
education, or cookery (two of which were organised by Age Concern). The other
members had either been unaware of possible educational activities or societies,
or felt unable to get out to a music or art class or club.
Within the social club, several arts and crafts sessions were organised ranging
from silk painting, card making to pot decoration. The arts and crafts sessions
were greatly enjoyed. Some participants noted that they would never have
imagined being able to do any arts and crafts before, and were surprised how
much fun and pleasure they gained from taking part. As ‘Meryl’ commented:
“I’ve thoroughly enjoyed it. Oh, it’s really tickled me pink. Like last
week sitting painting plant pots. I thought if anybody, any of my
colleagues, knew and they could see me now they wouldn’t believe it.
And yet you get something out of things you never think of doing,
you know the painting and that sort of thing. It never entered my
head I would paint, ‘cos I’m not a person for my hands. But I’ve
enjoyed doing different things.” (Meryl, 71 yrs)
Some participants noted that they had consciously avoided the traditional
‘games style’ of club. They had no interest in playing Scrabble, board games or
cards. Within the project social club, everyone, it seemed, was looking for some
different or new ideas.
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44. Organised outings were felt by social club participants to be very important. In
many cases it was an opportunity to get out and about, with company, in a way
that was otherwise no longer possible:
“I like getting out to Tullie House very much, I enjoy that. You see
any change of scene is a joy to me now, and going somewhere
different. Going to the llama farm, we had a bit of a laugh on the
bus going. I enjoyed seeing the animals. I haven’t seen them
before. I’ve enjoyed the activities and the lectures.”
While local activities in the immediate vicinity, or the city centre, were popular
the outings further afield were less well-attended in spite of significant
interest, initially, in the suggestion. The longer trips were, mostly, attended by
the more able members of the group. This suggests that, for less-able members,
the reality of longer excursions may be too arduous, hence they opted to stay
home.
At the regular venue people enjoyed the way the sessions were structured, with
the planned activity at the start of the session followed by some social time
with refreshments. This facilitated the opportunity for participants to chat
together, encouraging a ‘social atmosphere’:
“this club’s different from the other Clubs that I go to because
the other Clubs are more competitive and this is you know a social
atmosphere.” (Monica, 73 yrs)
Participants felt the emphasis placed on developing the ‘social atmosphere’
meant that the club was very relaxed. As one person said: “There’s no stress
attached to this club.” (Esther, 68 yrs). This highlights the general feeling amongst
participants that because the club was a new venture, they had a sense of
empowerment and common ownership.
It is worth noting that the preferred activities of this group were markedly
secular with only three people professing to be strong churchgoers involved in
their local church activities. This, contrasts sharply with the findings of
Jerrome’s study (see above) in which she had found that older people’s clubs
often retained a strongly religious ethos that determined the structure and
running of a club.
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45. An important function of the social club was to provide a focus of
conversation for people to share with family or friends.
“It’s a shared experience, you know. You chat about it the next
week and I’ve been able to share it with friends and family, that
sort of thing.” (‘Meryl’, 72 yrs)
Being involved in activities outside the home was seen by participants as
empowering, enabling them to renew their sense of selves as valued, valid and
active member of the community as well as gaining a sense of well-being from
taking part in their chosen activities.
The key to the success of the social club proved to be the way members
chose to organise it.
As a people-led venture decisions about the organisation and activities within
the club were made by consensus (supported by the organiser). The club
organiser ensured all participants had an opportunity to discuss their choice of
activities with both her and each other. As a consequence, all participants were
able to have an equal say in the running of the club.
Towards the end of the Project members were encouraged to discuss continuing
the Club by themselves. At the time of writing the Club’s success has been
maintained by a continuing, strong group commitment and limited but ongoing
support from Age Concern.
§
45

46. Section 7: Discussion
Health: physical fitness and mental stimulation
The health benefits of different activities for older people often tends to focus
around promoting or improving physical health and fitness. In terms of
gardening, for instance, this is reflected in previous studies that emphasise
physical activity as the major health factor in gardening (see for example
Caspersen et al., 1991; Cowper et al., 1991; Crespo et al., 1996; Galgali et al.,
1998). Mental health and well-being in relation to gardening activity for older
people has been less well-documented (for exceptions see Houseman, 1986;
Armstrong, 2000). Importantly, as noted in the gardening section of this report,
mental stimulation was considered by many of our participants to be a key
element of gardening activity.
In this study we were primarily concerned to explore the benefits to mental
health and well-being of different activities, although we did note those changes
in physical health and fitness that participants observed in their self-
assessment both during and at the end of the project. It is interesting to note
that, for those older people participating in the project, the physical benefits
arising from an activity were of less concern than whether or not they ‘felt
better in themselves’. The exception to this general view focused around those
activities specifically designed to improve physical fitness, such as yoga, keep-
fit classes, ‘prescription fitness’ gym sessions, walking, cycling and so on.
Whilst a varying degree of age-related illness and disability is inevitable with
increasing age, participants demonstrated a variety of strategies that they
employed to maintain their physical and mental abilities for as long as possible.
These included keeping themselves ‘disciplined’ by making a positive effort to go
out to do things whenever and wherever possible and keeping their minds active
with topics that interested them. This might include either joining a club,
society, or an adult education class, keeping physically active, gardening, and
making a positive effort to ignore their chronological age. As Ted (69) and
Natalie (69) commented respectively, ‘my age is no excuse’ ; ‘I don’t want to be
saying ooh I’m seventy and I can’t do this.’
Most significantly, participants noted that they made a positive choice to avoid
watching much television. This activity was considered by most of the
participants as a ‘death knell’, particularly daytime television. As Archie (70) put
it, ‘In fact you get worse as you/sitting watching television is/you’re
deteriorating all the time’. Conversely, crossword puzzles were seen as a
particularly useful means of keeping the mind active. For some participants this
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47. kind of mental activity was viewed as a preventative measure against illnesses
such as Alzheimer’s or other memory loss problems.
The intensity with which some people engaged in activities suggested they were
distracting themselves from concerns about possible, and in some cases
increasingly real, age-related disability. Mental impairment was by far the most
troubling aspect of ageing for our participants and finding sufficient mental
stimulation in their activities was a priority for many. These strategies could
(and some felt should) be used to minimise age-related physical restrictions to
getting out of the home, thus maximising older people’s enjoyment of everyday
life.
Several participants noted that the highly creative and mentally stimulating
qualities of gardening are also to found in other skilled activities. This was
particularly true of those activities that require manual dexterity and
creativity, such as upholstery, flower arranging, art, DIY or woodwork. In part,
as suggested by the quote below, there is great value in any activity that is
mentally stimulating and which provides a sense of achievement:
“I get the same feeling with the DIY work I do as well. Yeah, I
agree entirely with everything said there, maybe, about the
gardening. Brilliant. You know the achievement. Ah, I just think
being active is mentally stimulating really.”(Ronald, 67 yrs)
Health and gardening
Participants noted that although, on occasion, they found that gardening helped
their fitness and stamina, its key benefit was in improving their sense of mental
well-being. These positive aspects to gardening activity occurred despite, in
some cases considerable, age-related health problems and disabilities that
placed limits on their ability to bend or kneel, or to undertake any gardening
that demanded physical exertion. In particular, people gained pleasure in being
able to get out and feel occupied, even if this was limited to a little ‘pottering
about’:
You get out in the garden and it keeps you going, summat to
occupy. Whether you can bodily or physically do it or not it’s ‘get
out there and get summat done’. That’s what I say!
(Archie, 70yrs)
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