Objective and perceived service accessibility and mental health in older adults

Abstract

Objectives

Service accessibility plays a pivotal role in older adults’ mental health. However, accessibility measures used in previous studies are either objective or perceived. This study aimed to integrate both objective and perceived measures of service accessibility to explore the relationship between environmental cognition on service accessibility and mental health in older adults and the pathways.

Methods

We used both questionnaire data collected from 2,317 older adults in Hong Kong and geographical data to explore the direct and indirect effect of environmental cognition (i.e. positive, negative, and matching evaluation) relating to service accessibility on mental health and two pathways (i.e. physical activity and sense of belonging) based on a structural equation model.

Results

Physical activity mediated the positive relationship between non-negative perceptions toward access to convenience stores, leisure facilities, clinics, community centers, places of worship and mental health. Sense of community can significantly mediate the positive relationships between non-negative perceptions toward all 10 types of services and mental health.

Conclusion

This study provides an empirical contribution to environmental cognition theory and person-environment fit theory; its findings have implications for urban planning policy.

Translational Significance

The findings from this study provide significant evidence that environmental cognition distortion, especially negative perception, can be significantly associated with lower mental health through physical activity and a sense of community. This suggests that policies focused on changing environmental cognitions could be a promising public health strategy. Environmental cognition theory suggests that improving awareness of setting could help improve the precision of cognitive mapping of environmental reality. This can be very important where it is difficult to change the objective environment due to the deep-rooted and long-standing urban structure.

Keywords:

• Service accessibility
• mental health
• physical activity
• sense of belonging
• older adults

Acknowledgements

The research was supported by The Hong Kong Jockey Club Charities Trust and approved by the Human Research Ethics Committee of the University of Hong Kong [ethical approval number: EA1510033]. The funder had no role in the study design, analysis, interpretation of data, writing this article or deciding to submit the article. We thank all community partners in the five Districts for their support in collecting the data. We also thank the Census and Statistics Department, Lands Department and Planning Department, Common Spatial Data Infrastructure (CSDI), the Government of the Hong Kong Special Administrative Region for their support in accessing the data.

Disclosure statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.