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A Review of the Literature

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Subject Guide

1. Introduction

Not to be confused with a book review, a  literature review  surveys scholarly articles, books and other sources (e.g. dissertations, conference proceedings, reports) relevant to a particular issue, area of research, or theory, providing a description, summary, and critical evaluation of each work. The purpose is to offer an overview of and background on significant literature published on a topic.

2. Components

Similar to primary research, development of the literature review requires four stages:

• Literature search—finding materials relevant to the subject being explored
• Data evaluation—determining which literature makes a significant contribution to the understanding of the topic
• Analysis and interpretation—discussing the findings and conclusions of pertinent literature

Literature reviews should comprise the following elements:

• An overview of the subject, issue or theory under consideration, along with the objectives of the literature review
• Division of works under review into categories (e.g. those in support of a particular position, those against, and those offering alternative theses entirely)
• Explanation of how each work is similar to and how it varies from the others
• Conclusions as to which pieces are best considered in their argument, and make the greatest contribution to the understanding and development of their area of research

3. Definition and Use/Purpose

A literature review may constitute an essential chapter of a thesis or dissertation, or may be a self-contained review of writings on a subject. In either case, its purpose is to:

• Place each work in the context of its contribution to the understanding of the subject under review
• Describe the relationship of each work to the others under consideration
• Identify new ways to interpret, and shed light on any gaps in, previous research
• Resolve conflicts amongst seemingly contradictory previous studies
• Identify areas of prior scholarship to prevent duplication of effort
• Point the way forward for further research
• Place one's original work (in the case of theses or dissertations) in the context of existing literature

The literature review itself, however, does not present new  primary  scholarship. 

Information adapted from UC Santa Cruz University Library .

• Master's Theses Database of master's theses written by CSU, Chico students, from 2009 on. Many of these will contain published examples of literature reviews.
• Proquest Dissertations and Theses: The Humanities and Social Sciences Collection Containes over 2 million dissertations and theses with abstracts, 24 page free previews, and full-text PDF, if available, for dissertations and theses dating back to 1637.
• Sample APA Paper (lit. review begins page 3) Purdue University Online Writing Lab (OWL)
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Farming for Life Quality and Sustainability: A Literature Review of Green Care Research Trends in Europe

Marina garcía-llorente.

1 Department of Applied Research and Agricultural Extension, Madrid Institute for Rural, Agricultural and Food Research and Development (IMIDRA), Finca Experimental ‘‘El Encín’’Ctra N-II, Km 38, Madrid 28800, Spain

Radha Rubio-Olivar

2 Social-Ecological Systems Laboratory, Department of Ecology, Edificio de Biología, Universidad Autónoma de Madrid, C/Darwin 2, Madrid 28049, Spain; [email protected] (R.R.O.); [email protected] (I.G.B.)

Inés Gutierrez-Briceño

Associated data.

Green care is an innovative approach that combines simultaneously caring for people and caring for land through three elements that have not been previously connected: (1) multifunctional agriculture and recognition of the plurality of agricultural system values; (2) social services and health care; and (3) the possibility of strengthening the farming sector and local communities. The current research provides a comprehensive overview of green care in Europe as a scientific discipline through a literature review ( n = 98 studies). According to our results, the Netherlands, the UK, Norway and Sweden followed by Italy have led the scientific studies published in English. Green care research comprises a wide range of perspectives and frameworks (social farming, care farming, nature-based solutions, etc.) with differences in their specificities. Green care studies have mainly focused on measuring the effectiveness of therapeutic interventions. Studies that evaluate its relevance in socio-economic and environmental terms are still limited. According to our results, the most common users studied were people suffering from psychological and mental ill health, while the most common activities were horticulture, animal husbandry and gardening. Finally, we discuss the potential of green care to reconnect people with nature and to diversify the farming sector providing new public services associated with the relational values society obtains from the contact with agricultural systems.

1. Introduction

Agriculture has been performed by our species for approximately 10,000 years [ 1 ], and practices have been altered according to human needs and preferences. The agricultural industrialization of the 20th century dramatically changed agricultural activities and relations between agriculture and our culture; for example, agriculture now focuses largely on the maximization of both production and profit [ 2 ]. This change has become even more severe over the last 50 years, during the green revolution, with the intensification of large-scale agricultural production and the abandonment of the countryside in traditionally agricultural rural areas [ 3 , 4 ].

The consequences of this transition not only has environmental impacts (i.e., loss of agricultural landscapes, water pollution, loss of genetic heritage related to local varieties and breeds), economic impacts (i.e., loss in profitability) and cultural impacts (i.e., loss of local knowledge and identity linked to agricultural management) but also affects our general nutrition, relationships, health and quality of life. The value and importance of the relation between humans and nature has been overlooked during recent decades. However, currently, it is known that contact with nature has a positive influence on quality of life in terms of both physical and psychological health [ 5 , 6 , 7 ]. Nevertheless, this disconnection (in terms of access and appreciation) with agroecosystems and the ecosystem services that agroecosystems provide is increasing in western and urbanized societies. It is argued by Pretty [ 8 ] that as urbanized societies we have become disconnected from the land that sustains us and we cultivate; thus, we are losing part of our culture and identity.

Human beings, as part of nature, have always coexisted with it; thus, the association between people and nature has always existed. This concept has been formalized in the academic world through the study of social-ecological systems [ 9 ]. Following the biophilia theory [ 10 ], this connection should be more important and integrated into our lives, but the ability to connect with and understand nature often depends on our experiences as children, and such experiences should be reinforced in our society [ 11 ]. In addition to the biophilia theory, Kaplan’s attention restoration theory [ 12 ] and Ulrich’s psycho-evolutionary theory [ 13 ] should be highlighted, as these theories defend and explain why and how our surrounding natural environment influences our lives and is important for us. In socio-cultural terms, the current individualist lifestyle in western societies has resulted in a disregard for social well-being, deriving in a disconnection from other people and lack of community [ 14 ]. According to Spain’s Millennium Ecosystem Assessment, in recent decades in urbanized societies’ good social relations have deteriorated, with a specific tendency toward the loss of social cohesion and an increase in individualistic, sedentary and isolated lifestyles [ 15 ]. These trends are reflected by various indicators such the number of people living alone and the amount of television consumption [ 3 ]. This situation affects the most vulnerable people in the system more dramatically, placing them at risk of social exclusion.

Green care is an approach that aims to combine, simultaneously, caring for people and caring for land. It promotes health and well-being for people at risk of social exclusion through the use of natural environments as the central element [ 14 , 16 ]. In green care, a series of activities are carried out in the context of agricultural and natural environments where activities and interactions with nature take place (i.e., activities performed on farms, orchards and gardens, forests, etc.) to produce physical, psychological, emotional, social, cognitive-educational, social and labor-integration benefits for people at risk of social exclusion [ 7 , 14 , 16 , 17 , 18 ]. At those interventions, diverse social groups could be involved, including elderly people, people with mental disabilities, people with various mental disorders or mental health problems (i.e., dementia, stress, anxiety, depression and schizophrenia), refugees, teenagers with problems, ex-prisoners, people with addiction or abuse problems, women suffering from male violence, people with various physical disorders (cancer, obesity, hearing impairment and other disabilities), migrants with difficulties, long-term unemployed people, persons belonging to ethnic minorities, etc.

Green care is an inclusive and umbrella term that includes a broad variety of interventions such as nature-based rehabilitation, care farming, social farming, therapeutic horticulture, animal-assisted intervention, etc. While these concepts are sometimes used as synonyms, all of them are sustained by different backgrounds and theories and have different representations in each country. In this study we will refer to the term green care in order to cover a broad area of research. Over recent decades, in many European countries, the use of agriculture as a tool of public health and social integration has been developed in different forms. Many projects and initiatives have arisen, with the existence of more than 170 care farms in the UK as of 2011 [ 19 ], nearly 600 care farms in the Netherlands as of 2005 [ 20 ], and nearly 700 social farms in Italy [ 17 ]. In this way, in many European countries, green care is a practice with a long history; however, numerous research projects and studies have been developed to formalize the concept only in the last decade. In fact, in 2007, a cost action called “COST Action 866 Green Care in Agriculture” was created as one of the first attempts to increase scientific knowledge of green care, as one of the main limitations of green care has been the lack of evidence about the effectiveness of its various practices [ 16 ].

Since the end of the 20th century and the beginning of the 21st century, there has been an increase in the number of scientific studies focused on green care throughout Europe. Therefore, the current paper uses Europe as a case study with the intention of better understanding the main research trends and pathways that have been taken in terms of green care development to obtain a comprehensive understanding of the progress and dimensions of this new discipline in Europe. The proposed specific objectives of this systematic review have focused on analyzing: (1) which countries have published more, within which approach and which research areas have been emphasized by studies related to green care; (2) the temporal evolution of these studies and the research objectives investigated; (3) the targeted populations of green care studies as well as the activities carried out with each population; and (4) the methods used for assessing green care interventions. Finally, we discuss how our analysis can contribute to future research and green care practices.

2. Materials and Methods

2.1. search procedure.

The methodology of this study consists of a systematic review of the existing scientific literature on green care in Europe. Specifically, we gathered and selected all studies published in peer-reviewed journals via the search engine Web of Science. To encompass the spectrum of terminology used to refer to green care, we considered this term as well as all related terms that have been used. The complete list of English keywords included “care farm”, “ecotherapy”, “farm animal-assisted”, “gardening-based intervention”, “green care”, “horticultural therapy”, “nature-based rehabilitation”, “nature-assisted therapy”, “social farm”, “therapeutic garden”, “therapeutic horticulture”, “working in nature”.

The search was restricted according to the following criteria: (1) all studies published until 2017 were included to avoid incomplete years (i.e., 2018); (2) original articles were from scientific journals to avoid double counting (and excluded short communications, letters to the editor or editorials, communications in congresses and reviews); (3) scientific articles were restricted to those published in English; and (4) scientific articles were published in European countries.

Initially, 128 scientific articles were gathered in the search. Following the application of the above selection criteria and an inspection of the abstracts, 98 valid articles were selected ( Supplementary material, Table S1 ). The remaining articles were excluded from the study because they did not meet any of the above criteria or because a read through of the publication indicated that they did not correspond to the topic in question ( Figure 1 ).

Flow diagram with the different phases of a systematic review (adapted from PRISMA, [ 21 ]).

2.2. Database Generation and Analysis

We extracted the following information from these publications: (1) publication identification (title, authors, year and journal); (2) discipline (level of disciplinary integration, i.e., uni-disciplinary or interdisciplinary, discipline area and research labels); (3) study characteristics (country studied, study type—theoretical or empirical); (4) study approach (following the terminology used in the study) and purpose; (5) target population; (6) type of activities conducted; and (7) methodological approach used to assess the intervention (when an intervention was implemented) ( Table 1 ).

List of variables extracted from the database.

Regarding the purpose of publications, the published studies were classified into three main categories: (1) therapeutic assessments, including all the studies from the health sector that analyzed the effectiveness of different interventions; (2) concept, development and relevance of green care, including all the studies that practically or theoretically addressed the emergence of this new approach or aimed to define concepts, hypothesize potential benefits, or consider the impacts of its implementation; and (3) publications where the professionals were the cornerstone of the article and defined their preferences, views, needs to provide this health and social service as well as their networks (i.e., how are they organized).

First, we explored the current state of knowledge of green care through a general descriptive analysis of all included studies. To do so, we analyzed the countries that have published more studies, the theoretical framework used (care farming, nature-based rehabilitation, etc.), the field-specific disciplines related to the subject, the temporal evolution of the studies that included green care as their main research goal, the activities conducted, the main stakeholders and the methods used. Then, chi-square tests were performed to detect significant associations between specific variables. Specifically, chi-square tests were used to assess the relationship between countries and theoretical frameworks used, countries and discipline areas, countries and user types, countries and activities conducted, and finally, between activities and user types.

3.1. Overview of the Scientific Studies on Green Care Carried out in Europe

A comparison of the studies published in different European countries showed that four countries led the scientific research on green care: the Netherlands (24%), the UK (22%), Norway (17%) and Sweden (16%). These top four countries were followed by Italy, which accounted for 7% of the publications, and other countries, such as Denmark, Spain, Germany, Switzerland, Belgium, Finland and France, which had low representation (approximately 1–4% each) (see Figure 2 ). The differences in the percentages of studies published in different countries may be due to the language restrictions used during the search process, as we analyzed only papers published in English.

Number of publications per country, including the approach used.

Green care research comprises a wide range of perspectives and frameworks with differences in their specificities. In this regard, we identified seven different terminologies associated with those frameworks: care farming (used at 31% of the publications), nature-based rehabilitation (which includes forest interventions and ecotherapy, used at 16% of the publications), green care (15%), therapeutic horticulture (13%), therapeutic gardening (11%), social farming (8%) and farm animal-assisted interventions (5%). We detected significant differences performing chi-squared contingency-table test showing that some countries follow specific approaches. In this regard, the Netherlands used green care concept in its broadest sense more than other terms in their research studies (χ 2 = 27.46; p < 0.05). In the UK most of the studies came from the therapeutic horticulture approach (χ 2 = 21.64; p < 0.05). In Norway we found a significantly higher number of studies using the farm animal-assisted intervention approach (χ 2 = 30.06; p < 0.05). Publications conducted in Sweden used the term nature-based rehabilitation significantly more than other terms (χ 2 = 52.87; p < 0.05). Finally, studies from Italy used mainly the term social farming (χ 2 = 35.46; p < 0.05) ( Figure 2 ).

Most of the articles (63% of the studies analyzed) were interdisciplinary in nature, which allowed for a holistic approach to assessing the field of green care. Concerning the disciplines that assessed the subject of green care, health sciences and environmental sciences were the dominant areas (45% each of them), followed by social sciences (10%). In Europe, green care has been frequently framed in the field of health sciences (including areas such as rehabilitation, geriatrics and gerontology, occupational health, public health, psychiatry, dietetic and nutrition and oncology) and has included research on the therapeutic effects of green care and its impact on indicators of health and well-being. Such research includes publications on the impacts of therapeutic landscapes for older people [ 22 ], horticulture for clinical depression [ 23 ], and farm animal-assisted interventions for people with clinical depression [ 24 ]. From the environmental perspective (including researchers from the fields of vegetal science, agriculture, ecology and forest science), examples of published studies have focused on the values of landscapes and their management [ 25 ] or on the conceptualization of terms and the capacity of green care farms to promote social-ecological sustainability and ecosystem services [ 26 ]. A lower number of authors came from social sciences backgrounds emphasizing socioeconomic aspects; such as analyzing the economic impacts of green care, including indicators of expenditure and employment [ 27 ]; or investigating the evolution of rural social cooperatives engaged in green care farm practices [ 28 ]. When we performed the chi-squared contingency table test we detected significant differences, showing that the Netherlands and the UK were specialized in specific research areas. Such specialization was specifically seen in the Netherlands, where there was a predominance of studies coming from the environmental sciences (χ 2 = 9.21; p < 0.05). In the UK most of the studies came from the health sector (χ 2 = 11.88; p < 0.05), which is consistent with the therapeutic horticulture approach used with clear health goals defined ( Figure 2 ).

3.2. Temporal Evolution of Green Care Studies and Their Research Objectives

The first study was published in the UK in 1979, and it focused on the requirements of horticultural training programs for people with mental health disabilities [ 29 ]. During the 1990s, two studies were published in relation to the concept, development and relevance of green care. These two theoretical studies were conducted in the health sector and explored the role of horticultural therapy [ 30 ] and gardens [ 31 ] in supporting people with disabilities, and they emphasized the elderly population. These types of studies had the purpose of providing confidence to caregivers regarding the use of green tools in human well-being interventions. Since 2004, a progressive increase in the number of studies has been observed, and this increase has been exponential since 2010 ( Figure 3 ). In 2004, a network was created to promote knowledge sharing in European countries; it was the community of practice (Cop) “farming for health”. Later, in 2007, a project called “COST Action 866 Green Care in Agriculture” was launched, and it aimed to further investigate the concept of green care and its development in different European countries. The COST Action 866 Green Care Initiative was born in 2007 as a network in which researchers, engineers and scientists cooperated and whose main objective was to increase knowledge within the framework of green care. This project involved researchers from 22 countries, and it aimed to promote scientific knowledge in relation to green care, develop and deepen the concept, and highlight the potential of this new discipline in different European countries [ 16 ]). Thus, COST 866 was one of the first initiatives to formalize green care as a scientific discipline. Subsequently, at the scientific level, the European SoFar (Social Farming in Multifunctional Farms) project was financed by the Sixth Framework Programme during the 2006–2009 period. More recently, the SoFab Project (Social Farming across Borders) has been approved and implemented (2014–2017) in Ireland and Northern Ireland through INTERREG IVA Cross-border Programme funding. All these academic initiatives may explain the increase in the number of published studies.

Temporal trends in published research by the study purpose.

Considering the general purposes of these publications, articles assessing health interventions have a long tradition, while studies exploring the concept, development and implementation of this discipline have been present but to a much lesser extent. During recent years, articles from the perspective of green care providers and how they are organized have become more visible ( Figure 3 ). In our sample, we found that 58% of the studies were assessments on therapeutic intervention. Specifically, these studies from the health sector analyze the effectiveness of different treatments with different user types. Währborg et al. conducted a study comparing the effects of therapeutic gardening with the effects of conventional therapy on the rehabilitation of people suffering from depression or stress [ 32 ]. The results obtained after therapy concluded that people who had been treated in nature required less medical help than the other group. The study carried out by [ 33 ] aimed to evaluate whether the results of therapy that used activities in boreal forests could be utilized for the rehabilitation of patients suffering from exhaustion disorder. One of the results obtained suggested that the effect of this therapy is transitory, indicating that activities in nature should not be temporary in our lives; rather, these activities should be incorporated into our daily lives. The influence of contact with nature on children with attention deficit hyperactivity disorder was examined by [ 34 ]. The way in which women with stress-related illnesses experienced rehabilitation in a therapeutic garden was described by [ 35 ].

Then, 27% of the studies emphasized the concept, development and relevance of green care and included practical or theoretical publications that addressed the emergence of this novel approach; these studies aimed to identify the concepts and potential benefits, implementation possibilities and legislative frames that supported its implementation. These aspects differed by country, and many of these studies analyzed the evolution of green care in different countries that had their own particularities and trends, as seen by the evolution in the Netherlands [ 36 , 37 ], Flanders [ 36 ], Italy [ 28 ], and Switzerland [ 38 ]. Finally, in 15% of the publications, professionals were the cornerstone of the research, and they defined their preferences, views, need to provide this social service and health care, as well as their networks and organizational strategies and the benefits that they could obtain by including green care (mainly care and social farms) in their enterprises [ 39 , 40 , 41 ].

3.3. Target Population and Greem Care Activities

Green care research covers a wide range of users who benefit from the interventions in which they participate. Following our sample, 10 categories of users have been identified, and two of these categories stand out ( Figure 4 ): people suffering from psychological health illnesses such as depression, burnout and/or stress (e.g., [ 35 , 42 ]; in 30% of the studies), and people suffering from mental health illnesses, such as cases of dementia, schizophrenia, personality and behavioral disorders and other mental health problems (e.g., [ 43 , 44 ]; in 21% of the studies). Other publications focused on children and young people at risk of exclusion (e.g., those with behavioral problems or with dysfunctional family backgrounds; such as [ 11 ]; in 8% of the studies), on people with learning disabilities (e.g., [ 45 ]; in 7% of the studies), on elderly populations (e.g., [ 22 ]; in 7% of the studies), and on people suffering from physical disabilities or physical health illnesses (e.g., people with chronic muscle pain, coronary and pulmonary diseases or cancer; [ 46 ]; in 6% of the studies). Finally, a more limited number of studies focused on people suffering from addictions (4%), offenders (e.g., [ 47 ]; in 3% of the studies), people experiencing long-term unemployment (e.g., [ 48 ]; in 1% of the studies), and refugees and displaced people (e.g., [ 49 ]; in 1% of the studies).

Type of users involved in green care programs.

Most of the studies were concentrated on a particular type of user (in 90% of the studies). We found a higher number of studies on people suffering from mental health illnesses in the Netherlands than in other countries (χ 2 = 4.71; p < 0.05). We found a significantly higher number of studies focused on people suffering from psychological health illnesses in Sweden than in other countries (χ 2 = 23.67; p < 0.001). Finally, we found a significantly higher number of studies focused on people with learning disabilities in the UK than in other countries (χ 2 = 7.74; p < 0.05).

A wide variety of activities and tasks have been analyzed in the literature review conducted. Horticulture stands out as the most widely performed activity (32%), followed by animal husbandry by feeding and taking care of farm animals and working in stables (27%), gardening (26%), and outdoor activities, such as forest walks and other physical activities in green spaces (24%; Figure 5 ). Other types of activities that were carried out included being in contact with nature (e.g., passive exposure to vegetated environments) and contemplation (12%); food processing, cooking and preparing meals from farm products for sale (9%); agriculture production, including viticulture and olive orchards (9%); relaxation (6%); conversation with the farmers, other staff and the farm community (7%); firewood collection (2%) and equine-assisted therapy (2%). There were also mentions of training and educational activities through combined workshops (e.g., textile, carpentry, ceramics and art) focused on agricultural education and user training for labor market integration.

Green care activities carried out during interventions.

In 60% of the publications analyzed, a unique principal activity was studied, with 27% of the studies having two or three activities and 13% of the publications describing more than four activities. The typology of activities also differed from country to country in some cases, and we found a higher number of studies on engaging in outdoor activities (χ 2 = 6.73; p < 0.05), relaxation activities in nature (χ 2 = 18.38; p < 0.001) and gardening (χ 2 = 6.03; p < 0.001) in Sweden than in other countries. Gardening was significantly more studied in the UK than in other countries (χ 2 = 5.11; p < 0.05). In addition, Norway and the Netherlands produced more studies related to animal-assisted interventions, including activities such as animal husbandry (χ 2 = 7.36 and χ 2 = 5.25, respectively; p < 0.05). Finally, we tested associations between activities and user types. Following chi-square tests, we found that research publications studied the impact of relaxation activities on people suffering from psychological health illness (χ 2 = 7.00; p < 0.05).

3.4. Methodological Tools for Assessing Green Care Interventions

The most common methods used to evaluate green care interventions were interviews (43%) and surveys (41%; Figure 6 ). Interviews involved semi-structured guides and open-ended questions to explore users’ experiences with green care practices. This was the case in the work conducted by [ 50 ], who analyzed forest-based rehabilitation through semi-structured interviews and analyzed the results from the perspective of the grounded theory. Interviews were carried out by [ 51 ] with care farmer professionals to explore the characteristics of diverse types of care farms in the Netherlands. Interviews were conducted by [ 52 ] with therapeutic garden users who had stress-related disorders to explore how they experienced the rehabilitation process.

Methodological tools to assess intervention effectiveness.

Other studies have used quantitative data collected from questionnaires using experimental or quasi-experimental designs at clinical assesments. How a woodland program improved the psychological well-being of members of deprived urban communities was assessed by [ 53 ] using the perceived stress scale. Horticultural therapy as a physical health, mental health and social interaction with patients with chronic musculoskeletal pain was used by [ 54 ]. They used an experimental design and assessed indicators measured by the West Haven-Yale multidimensional pain inventory or the hospital anxiety and depression scale. A lower number of other studies gathered information from participant observations (8%), official statistics (7%), focal groups (7%), participatory methods (2%) and recordings (2%).

4. Discussion

4.1. overview of green care discipline across europe.

This study builds on previous literature reviews of green care interventions. A literature review was completed by [ 55 ] ( n = 38 studies) on nature-assisted therapy that used controlled and observational studies to evaluate the scientific evidence, while five other publications were dedicated to specific user groups. The impacts on military veterans of sport and physical activity, including nature-based physical activities, were analyzed by [ 56 ] , ( n = 11 studies). In the same way, [ 57 ] focused their literature review ( n = 20 studies) on military veterans suffering traumatic experiences after active service and their participation in nature-assisted therapies. The evidence on the effectiveness of farm-based interventions for people with mental health disorders was reviewed by [ 58 ] ( n = 11 studies). The benefits of gardening-based mental health interventions was evaluated by [ 59 ] ( n = 10). Regarding dementia care, Whear et al. used qualitative and qualitative studies to examine the impacts of gardens and outdoor spaces on people with dementia ([ 60 ]; n = 17 studies), while González et al. evaluated the benefits of sensory gardens and horticultural activities ([ 61 ]; n = 16). Those reviews aimed to evaluate evidence that supported the effectiveness of green care interventions to significantly improve public health, mainly the health of specific users. Finally, a descriptive review was conducted by [ 62 ] of research on care farms for adults with mental health problems in Norway.

This research provides the first attempt to complete a comprehensive review of green care as a scientific discipline and includes studies assessing not only the effectiveness of interventions from the perspective of health but also other key aspects that require scientific attention, such as the concept, development and relevance of green care, as well as publications where professionals’ preferences, views, needs and networks were explored. Here, we analyzed trends in green care research using 98 publications that were conducted in different European countries. Although this study covered all Europe, we specifically reviewed scientific articles published in English. This limit provided a systematic method of searching for publications and avoided duplication; simultaneously, there was a limitation imposed by not collecting works published in other languages. For instance, there is evidence concerning the situation of green care under the approach of social farming in Catalonia in studies written in Spanish [ 63 ] or Catalan [ 64 ]. Much research conducted in Italy, mainly within the framework of social farming, has been published in Italian [ 17 ]; thus, such research has been underrepresented in the current study. In addition, Pawelczyk et al. attributed the lack of knowledge and research in Poland to the lack of knowledge about the usefulness of farming activities as a tool for tackling socio-health problems [ 65 ].

In this study we decided to use the broadest framework (green care) in order to cover the larger number of studies developed in Europe. However, as presented in our findings and also pointed out by other authors, there is a diversity of terms associated with different interpretations of the synergy between being in contact with natural and agricultural landscapes and the promotion of health together with other quality of life dimensions (e.g., employment, good social relationships, equity, education) [ 14 , 48 , 66 ]. Here, we identified seven terms used in research publications, the most popular being care farming. Nevertheless there were differences among countries, for example the green care term was used more in the Netherlands research, therapeutic horticulture approach in UK, farm animal-assisted intervention in Norway, the concept of nature-based rehabilitation in Sweden, and studies from Italy mainly used the term social farming. Some of the differences between those approaches are in the level of care and therapy provided [ 16 ]. Those interventions done within structured rehabilitation or health programs with clearly defined patient-orientated goals are commonly defined with the terms therapy or care such as therapeutic horticulture, therapeutic gardening or care farming [ 67 ]. In care farming and social farming the objectives are more related to conducting meaningful occupational activities and achieving employment goals at real production and commercial farms [ 40 ] and especially within social farming the therapeutic intent is not so explicit, with the aim being to promote innovation and collaboration pathways between sectors in local communities following social and employment inclusion and integration principles [ 68 ]. Other studies differ by the key element or tool used during the intervention, such as being in contact with nature at outdoor surroundings (at nature-based rehabilitation, [ 50 ]) or farm animal-assisted therapy being essential to the interactions established with animals (such as empathy, expression emotions or not being judged; [ 69 ]). In this way, green care is an umbrella term that represents a complex interaction between nature–people with different goals and specificities that determines the formalization of the approach. Green care is a dynamic concept, that has developed rapidly during the last 10 years and that will continue in progress as it represents a mirror of the different European countries and societies in terms of its culture, path dependence, needs and future expectations. This study reflects the green care research trends, giving the opportunity to offer an overview of the recent years and present time and to draw conclusions for the future. As presented by Di Iacovo et al., in Europe there are two models derived from two welfare systems: the northern European specialized model and the Mediterranean communitarian one. While in the first (followed by countries such as Sweden and the Netherlands), green care farms provide a health service (delivered by specialized facilities and skills) in private farms they receive direct payments (from the state or from the market being directly paid by users) for those services [ 70 ]. In the Mediterranean model (e.g., Italy or Spain) usually farmers do not receive a direct payment but receive other benefits more related with enhancing their reputation and expanding their networks. In this model, the goals pursued are more linked to social inclusion and justice than therapy. This situation may also explain the larger number of studies found in northern countries compared with those in the Mediterranean area; the number of studies being higher when the green care activities are more explicitly defined and where it is essential to measure the therapeutic effectiveness of the interventions conducted. In fact, there are small cooperatives or enterprises operating at the agrifood sector sustained by social economy and following agroecological principles (e.g., community supported agriculture) which are closely connected with social farming (e.g., justice, inclusion, solidarity, promotion of rural economies) but this is not explicitly stated, and it would be interesting to study the association between both approaches.

4.2. Target Population and Green Care Activities

It has increasingly been seen that green care responds to the needs of diverse groups, such as the training and working skills required by people who have experienced long-term unemployment or low employability, and the social integration of marginalized communities or spaces for community dialogue and interaction [ 71 ]. It improves not only their health but also their physical, psychological and emotional well-being (e.g., [ 55 ]). Green care provides opportunities to allow people to actively participate in society and agricultural landscape conservation. Green care has the potential to stress the relationships established between people and nature, uncovering the relational values obtained from agricultural landscapes. In an increasingly urban society, spending time in more natural, greener and more rural environments can help to meet new food, labor and social needs [ 72 ]. It has been proposed that to go beyond the classical duality to sustain landscape conservation based on intrinsic vs. instrumental values, policies should take into consideration relational values derived from the relationships establish between people and nature (e.g., cultural identity, stewardship principles), including relationships that are between people but involve natural surroundings (e.g., social cohesion) [ 73 ]. Active exposure to nature can promote a healthier lifestyle in the long term, which can help people cope with the effects of rapid lifestyles experienced in cities (e.g., stress, depression, fatigue) and address problems (quality food or lack of physical activity) facing people with increasingly sedentary futures [ 74 ].

Regarding green care activities, according to our findings, the most researched activities are horticulture, feeding and taking care of farm animals, gardening activities and outdoor activities, such as forest walks and green exercise. We found some significant associations between users and activities. In this regard, [ 75 ] analyzed different green care farming activities in terms of their suitability for different type of users taking into account aspects such as previous knowledge needed, need of support, risk due to the use of tools, etc. It would be a step forward to carry out further research to connect practices and specific well-being objectives to reach different users.

5. Conclusions

Some of the difficulties that a new science, movement and practice such as green care can face include gaining scientific, political and social credibility. Despite the advances in research publications, the potential of green care is still poorly understood [ 19 , 38 ]. As shown, in the last decade, researchers have started to study the effectiveness of green care compared to other therapeutic processes. However, since green care (mainly its orientation through social farming) contributes to rural revitalization—and the conservation of the agricultural landscape—it requires more scientific research that evaluates its relevance in socio-economic and environmental terms. It has been stressed that there is a need to recognize the complexity of views required to evaluate green care and to go beyond health indicators, since the mainstream measures of those indicators could mask and underestimate key components necessary to assess the development of green care practices (e.g., management procedures, networks of actors involved, certifications, consumer knowledge and acceptance of green care farms products, private or public policies to support them, etc.) [ 76 ]. Further research that proposes indicators and measures to analyses it as an innovative practice to diversify the farming sector, conserve agricultural landscapes and improve human well-being is required to ensure its establishment. In this regard, green care farming can be a major source of income for farmers [ 19 , 20 ] and a way to increase their visibility and reputation [ 26 ], which can stimulate the economy of the sector. It is necessary to determine which strategies farmers use, whether they are sufficiently innovative and whether they favor economic development [ 77 ]. It is also important to analyze the key factors that contribute to the success of green care projects by focusing on the point of view of producers and their willingness to innovate [ 40 ]. According to our findings, during recent years, the number of publications from the perspective of green care providers has been increasing ( Figure 3 ). A shift in production models on farms can attract new types of workers by offering diversified activities through other approaches, skills, interests, benefits and resources that break with traditional farming and livestock activities. The diversification of agricultural activities can offer farm owners opportunities to provide new services. Green care, together with agro-tourism, has also been seen as motivation for women to diversify farming activities and promote female succession in farm properties in Norway, helping to counterbalance the masculinization of rural areas [ 78 ]. This can provide an incentive to significantly halt population declines in rural areas and could stimulate an increase in the number of women owners at the head of green care activities that occur on farms.

Green care activities can play a key role in enhancing life quality and sustainability in rural areas by providing economic and social benefits, as seen by recent cases of rural social cooperatives that have emerged in Italy [ 28 ]. Such cooperatives create a new relationship between urban and rural areas, as urban people are attracted to local markets in which they can find organic and ethical products with added social value. As was shown by [ 79 ], people were willing to support a green care initiative in the UK and were willing to contribute their money and voluntary time. Similarly, Carbone, A. et al. found that consumers’ buying groups in short food supply chains in Italy hold a strong concern for ethical issues when purchasing products and had an interest in supporting social farming products [ 80 ]. Unlike other economic sectors, agricultural activity can be understood as a transversal field with the capacity to influence a diversity of well-being components, not only in terms of production but also in terms of nutritional, educational, social and relational components as well as a new way of understanding the food system and our relationship with natural environments. This viewpoint aims to intensify social capital over intensive technological capital. From this perspective, farmers are essential actors since they can provide new services to society.

Acknowledgments

We would like to thank the two anonymous referees for providing thoughtful and valuable comments and suggestions.

Supplementary Materials

The following are available online at http://www.mdpi.com/1660-4601/15/6/1282/s1 , Table S1: Publications included in the systematic review.

Author Contributions

M.G.L. conceived and designed the study; R.R.O. and I.G.B. conducted the literature review and data extraction; M.G.L. provided conceptual and analytical advice; R.R.O., I.G.B. and M.G.L. conducted the data analysis, M.G.L. wrote most of the paper.

This research was funded by a grant from the Spanish National Institute for Agriculture and Food Research and Technology, co-funded by the Social European Fund (Doc-INIA CCAA); and the IMIDRA research projects: Social Farming viability at the Madrid Region (FP16 VAS) and Assessment of Ecosystem Services provided by Agroecosystems (FP16 ECO).

Conflicts of Interest

The authors declare no conflict of interest.

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What is a literature review

The term "literature review" can mean different things in different contexts.  All share in common the idea of examining the scholarly literature on a topic.  It is the end result that differs:

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A literature review can be free-standing article. "A review article or review of the literature article considers the state and progress of current literature on a given topic or problem by organizing, integrating, and evaluating previously published books and articles. In short, a review article is a critical evaluation of material that has already been published." ( Writing Literature Reviews )  "The purpose is to offer an overview of significant literature published on a topic." (Write a Literature Review )

A literature review is a vital part of research papers including theses and dissertations.  "Surveying the literature is necessary because scholarship is cumulative -- no matter what you write, you are standing on someone else's shoulders. Scholars must say something new while connecting what they say to what has already been said." ( Writing Literature Reviews );

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Agricultural Literature and Rural Life

Photograph of a man plowing a field in Colorado using a mass-produced plow pulled by a team of horses.

University Historic Photograph Collection, Colorado State University, Archives and Special Collections.

“Agriculture . . . is our wisest pursuit, because it will in the end contribute most to real wealth, good morals and happiness” —Thomas Jefferson, letter to George Washington from Paris, 14 August 1787

We may not need a quote from a founding father to know the importance of agriculture, but a full understanding of the history of the United States requires an appreciation of our rural heritage. From the arrival of the first Native Americans to the many subsequent waves of settlers and immigrants, agricultural work has transformed the American countryside. Not only has the sowing of crops shaped our landscape and environment, it has also influenced many aspects of American society. It is easy to forget in our urban culture that as recently as 1870, more than 70 percent of Americans worked the land. For most of U.S. history, the farm has been the foundation for family life in America.  Most rural communities and many cities depended on agricultural production for their livelihood. Throughout American history agricultural activity has been the engine that spurred land ownership, maintained state and local economies, motivated pioneers and family farmers, and produced our “amber waves of grain.”

Design proposed by Thomas Nutt for a bee hive (London, 1832).

Core Historical Literature of Agriculture, Cornell University.

“The vineyard apiary,” illustration from The A B C of bee culture: a cyclopædia of everything pertaining to the care of the honey bee, bees, honey, hives, implements, honey plants, &c., &c.: compiled from facts gleaned from the experience of thousands of bee-keepers, all over our land, and afterward verified by practical work in our own apiary (Medina, OH, 1879).

Preserving the Legacy

A significant record of the history of agriculture in America can be found in documentary and literary collections of research libraries at land-grant universities across the country. These materials included resources ranging from the memoirs and transactions of early agriculture societies to newspapers and almanacs; family, community, and corporate archives; and state and county extension service publications. A complementary body of published materials included agricultural periodicals that chronicled farm life and economy, as well as the many local, regional, and national farm journals that exhorted, informed, and shaped the opinions, values, and concerns of early farm families. Unfortunately, most printed materials created after 1840 were on acidic paper that rapidly broke down. By the 1980s, much of this literature was in danger of crumbling to dust on library shelves, which would have meant the loss of records on many aspects of rural history.

To preserve this literature and to increase future access to it, the Mann Library at Cornell, in collaboration with the United States Agriculture Information Network (USAIN), coordinated the work of librarians, preservationists, and researchers concerned with the survival of these collections. Beginning in 1993, USAIN began the systematic review and planning for the preservation microfilming of agricultural materials held in the research collections of major land-grant universities. In 1996, Cornell University applied to the National Endowment for the Humanities for support to undertake the project. Over the period from 1996 to 2008, the consortium received six grants totaling nearly $4.5 million.

The effort was based in part on the bibliographic work of librarian Wallace Olsen at Cornell who formulated selection criteria for materials to be preserved and who coordinated teams of scholars to review the massive bibliographies of agricultural literature produced in each state. Olsen’s own bibliographic work was published in the seven-volume Literature of the Agricultural Sciences (1991–1996), which provided a basis for the selection of materials digitized through the Core Historical Literature of Agriculture (CHLA) , a project begun at Cornell in 1994. CHLA has digitized agricultural materials of national significance and currently provides public access to over 1 million pages scanned from more than 2,000 books and 26 journals. Olsen’s bibliographic work and CHLA proved to be one step in the larger effort, subsequently funded by NEH, to preserve the large body of state and local agricultural articles, journals, and outreach publications produced or held by land-grant universities across the country. Following planning efforts to create a nationwide strategy to preserve historical agricultural literature in the early 1990s, the USAIN advisory panel on preservation produced the National Preservation Program for Agricultural Literature in 1993, which served as a guiding document for coordinating preservation efforts across agricultural collections. Together USAIN and Cornell, with coordination by Olsen who served as the first project director, applied to NEH for support to put the preservation plan into action.

The project first sought to produce bibliographies of agricultural literature in each state. General ranking schemes based on key topic areas and preservation need were used by every collection, and individual state universities participating in the project also developed local priorities, based on the agricultural history of each state, for selecting materials related to agriculture and rural life that would be microfilmed or digitized. In all, agricultural bibliographies were completed for twenty-nine states. The amount of available literature on the history of agriculture is enormous. Colorado for example, identified 4,000 print items and 12,000 additional archival materials (numbering nearly 75,000 individual pages preserved); the University of Kentucky’s bibliography contained 12,498 items, with 6,455 prioritized for further preservation attention; South Dakota State University submitted a bibliography of nearly 2,000 items, excluding a large portion of materials published by the university’s Experiment Station and Cooperative Extension. In the final analysis, NEH funding supported bibliographic analysis, selection, and preservation microfilming of nearly 34,000 volumes, as well as the digitization of over 141,000 pages, of agricultural literature published between 1820 and 1945.

The NEH project sowed the seeds for further development of these collections. Although many of the items remain accessible only in their microfilm versions, which are held at the original libraries and at the U.S. Department of Agriculture’s National Agricultural Library, many of the individual libraries (for example, in Colorado and Arizona) have created digital collections of these materials.

“Playmates,” photograph from a column introducing children to natural history and farm life, “For Chautauqua Junior Naturalists,” in Boys and Girls: A Nature Study Magazine, vol. 4, no. 5 (1905), 112.

Design for a Cow Barn from Radford's combined house and barn plan book, being a complete collection of practical, economical and common sense plans of houses, barns, outbuildings, stock sheds, etc, illustrated with over twelve hundred copper half tone plates and zinc etchings, and containing over three hundred house and barn designs by William A. Radford (Chicago, 1865).

Historical Agricultural Literature

The stories of American agriculture are told through a broad swath of primary sources, both published and unpublished, many of which are now preserved on microfilm or available on the Web. Many of these materials date to the nineteenth century, a period when agriculture experienced an unprecedented growth in productivity. Farming and agricultural communities also changed greatly during this time. In 1820, farming was a self-sufficient enterprise largely unchanged since colonial times; by the beginning of the twentieth century, farming was no longer oriented to local communities and families but was directed instead to larger markets and expanding urban populations. These changes were furthered in part by the proliferation of agricultural literature produced by individual horticulturalists and farmers, researchers and engineers at land-grant universities, and agricultural manufacturers, all of which served as a means of sharing and expanding agricultural knowledge. One might say that these publications were as important to the agricultural economy of the nineteenth century as social media and the Internet are to the information economy today.

Manuals and advertisements discussing new types of crops, farm management techniques, and other vehicles for improvement formed a large part of this literature. Trade journals and agricultural publications supported the introduction of new crops and livestock. Notable activity was devoted, for example, to beekeeping, as evidenced by Englishman Thomas Nutt’s 1832 monograph, Humanity to honey bees, or, Practical directions for the management of honey bees upon an improved and humane plan, by which the lives of bees may be preserved, and abundance of honey of a superior quality may be obtained . Nutt proposed his own designs for bee houses, which he promised would lead to higher amounts of honey production, so long as readers followed his advice to the letter. In his words, “I do flatter myself that the principle of managing Bees after my plan is right.” That Nutt’s publication was available in the United States suggests a close relationship between American and European agriculture in the early nineteenth century. By 1879, an American publication rivaled Nutt’s both in the length of its title and advice for beekeepers: A. I. Root’s The A B C of bee culture: a cyclopædia of everything pertaining to the care of the honey bee, bees, honey, hives, implements, honey plants, &c., &c.: compiled from facts gleaned from the experience of thousands of bee-keepers, all over our land, and afterward verified by practical work in our own apiary ( Medina, OH, 1879 ).

Illustration of “The Senator” variety of sweet pea from All about Sweet Peas by W. T. Hutchins (Philadelphia, 1892).

Title page, James John Howard Gregory, Cabbages and cauliflowers: how to grow them, a practical treatise, giving full details on every point, including keeping and marketing the crop (Boston, 1889).

The expansion of agricultural literature mirrored the advances in applied science that helped to foster more specialization and greater productivity in farming. Beginning in the 1840s, many journals featured columns with titles like “Cattle Husbandry,” “Horticulture,” and “Poultry.” Educational and engineering advances led to the proliferation of new production and distribution techniques. In particular, the foundation of the land-grant university system through the Morrill Act of 1862 paved the way for rapid growth in applied agricultural research and led to the creation of a body of specialized scientific literature on farming that was circulated among rural communities throughout the United States. Although most activities of these institutions went toward agricultural research and engineering, many efforts also supported general education about agricultural work, whether for lifelong learners at extension campuses or to primary-school learners through organizations like 4H. For example, Alice McCloskey’s “Poultry” entry for the May 1905 issue of Boys and Girls magazine (“official organ of the Chautauqua junior naturalist clubs”), gives pointers on identification, care, and feeding. McCloskey advises youthful readers to observe differences between various breeds, noting, “I am sure you will not see two hens alike any more than I should expect to find in your schoolroom two boys or girls exactly alike.”

The “America” grape, as illustrated in The Grapes of New York (Albany, 1908), 168.

The “Black Eagle” grape variety, as illustrated in The Grapes of New York (Albany, 1908), 184.

Other examples of agricultural literature preserved through this project deal with the many concerns of running a farm, such as how to store produce before it is brought to market. For those unfamiliar with the latest trends in barn construction, William A. Radford composed Radford’s combined house and barn plan book, being a complete collection of practical, economical and common sense plans of houses, barns, outbuildings, stock sheds, etc, illustrated with over twelve hundred copper half tone plates and zinc etchings, and containing over three hundred house and barn designs ( Chicago, 1865 ). The development of new cultivars in farms and gardens increased the variety of produce available in markets. For example, the manual All about Peas by W. T. Hutchins ( Philadelphia, 1892 ) notifies gardeners of new varieties of sweet peas available for purchase and advises on their successful cultivation. Accompanying illustrations, such as that for “The Senator” variety, entice readers with the prospect of lush summer harvests. Similarly, James J. H. Gregory introduces readers to the finer points of cabbage cultivation and marketing in his Cabbages and Cauliflowers: How to Grow Them, a practical treatise, giving full details on every point, including keeping and marketing the crop ( Boston, 1889 ). Particularly notable for its beautiful color-plate illustrations is The Grapes of New York ( Albany, 1908 ), which lists hundreds of varieties of grapes, many created in the United States such as the “America,” which would be of interest or suitable for cultivation in the soils and climate of New York. Another attractive variety that had nearly disappeared by the early twentieth century, is the “Black Eagle,” which according to the authors, “has wholly failed as a commercial variety and its several weaknesses will prevent amateurs from growing it largely, yet it is far too good a grape to give up altogether and lovers of grapes should keep it in cultivation.”

Funding information

Cornell University received grants from the Division of Preservation and Access to support the multi-phase project, “Preserving the History of United State Agriculture and Rural Life: State and Local Literature, 1820–1945” ( PA-22859-96 , PA-23108-98 , PA-23445-00 , PA-24058-02 , PA-50733-04 , PA-52021-06 ).

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Political-economic dynamics and mechanisms underpinning the food-system’s inequality-unsustainability nexus

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The expected articles may address these socio-economic challenges by considering public policies, collective actions, power relations and conflicts at the various scales of the farming systems (farm, landscape, region). Proposals are expected to fill up knowledge gaps in the comprehensive understanding of these both dynamics of vulnerability and inequality. Approaches providing insights for an integrated understanding of land and water resources at a landscape scale will be particularly welcome.

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