Household-level surrounding greenspace as a nature-based intervention for health recovery after occupational injury

Urban greening has been increasingly discussed as a component of health-supportive environments. While greenspace exposure has been associated with psychological restoration, limited evidence exists regarding household-level responses among families affected by occupational injury. This study examined whether a structured forest-based intervention was associated with short-term changes in psychological burden, resilience, and perceived family relationship quality across household roles.

A single-group pre-post design was applied to injured workers and their cohabiting family members participating in a forest-based rehabilitation program in South Korea. Paired analyses included 1,194 participants. Role-stratified linear mixed-effects models (N = 918) adjusted for age and sex. Exploratory heterogeneity analyses focused on resilience (N = 789). Outcomes included occupational injury distress, resilience (KRQ-27), and family relationship quality. Mean changes, 95% confidence intervals, Holm-adjusted p-values, and paired Hedges' g were reported. Psychometric outcomes were assessed immediately before program initiation and immediately after completion of the final scheduled session.

Occupational injury distress decreased (Δ = -7.81, g = -0.397, p < 0.001), resilience increased (Δ = +8.51, g = 0.517, p < 0.001), and family relationship quality improved over the immediate post-program period (Δ = +4.38, g = 0.391, p < 0.001). Reductions in distress were numerically larger among injured workers, whereas gains in resilience appeared numerically larger among children and spouses. Pre-post changes were observed across income and age strata, although some subgroup contrasts did not remain statistically significant after multiplicity adjustment.

Forest-based programming within an urban greenspace context was associated with short-term favorable changes in psychological and relational outcomes. Because the design lacked a control group, outcomes were assessed only within an immediate post-program window, and long-term follow-up was not available, the observed changes should be interpreted as short-term associations rather than confirmed causal effects.