Biophilic Infrastructure as Stress Recovery Strategy in Urban Environments

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University of Edinburgh Edinburgh College of Art Edinburgh School of Architecture and Landscape Architecture

Biophilic Infrastructure as Stress Recovery Strategy in Urban Environments Research Question: How does the presence of biophilic infrastructure in a city affect resident’s perceived stress level in Hong Kong and Singapore?

Word Count: 10615

MSc Landscape Architecture 2019 Lok Chi Audrey Chan (s1433555)


Abstract Mental health problems in urban environments are growing proportionately to the continuous expansion of cities. Interested in biophilic designs – designs that promotes a inner hereditary connection between human and nature, this research aims to investigate how the presence of biophilic infrastructure affect resident’s perceived stress level in Hong Kong and Singapore through measuring perceived stress level, connection with nature, accessibility and exposure to biophilic infrastructure. This research also recorded pilot reference figures of perceived stress level and connection with nature for two cities from the South East Asian region. A self administrative questionnaire was carried out and sampled 82 participants from Hong Kong and 35 from Singapore, recording their demographic profile, perceived stress level, accessibility and exposure to biophilic infrastructure, connection with nature and living environment through a mix of existing scales, piloted questionnaires and other questions. Results reflected from the questionnaire shows consistent results with Kellert and Ulrich’s research, which natural environment offers passive mental recovery from highly stressful environment and improve cognitive performance. Research findings also show that Singapore participants have lower perceived stress level and a higher exposure to biophilic infrastructure than Hong Kong participants. More importantly, there is a decrease in perceived stress level and higher capability to cope with stress when there is a higher exposure and higher active engagement with biophilic infrastructure. With a direct correlation established between presence of biophilic infrastructure and perceived stress level in urban environments in Hong Kong and Singapore, this research findings suggest biophilic infrastructure can potentially become an useful preventative measure for highly individual to recover from stress before developing any mental health problem, on top of improving greening in a densely built environment for sustainability.

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Table of Contents Abstract Acknowledgements Introduction Biophilia Biophilia and Landscape Architecture Biophilia and Current State of Art Biophilic Infrastructure Stress How is it Triggered Landscape Architecture, Biophilia, Stress How is urban environment worsening or causing more of stress factors? What is the role of landscape architecture in remediating stress? How does Biophilic Infrastructure be adapted by landscape architecture, in the aim of providing a well-being environment? Methodology Site Study and Condition Hong Kong Singapore Study Setting Data Collection Results Approach to Data Analysis Demographics Living Environment Perceived Stress Level Presence of Biophilic Infrastructure Connection with Nature Environmental Identity Scale Self-rated Statements Correlation Testing Demographic profile, perceived stress level, connection to nature and biophilic infrastructure Association between biophilic infrastructure, perceived stress level or connection to nature Perceived Stress Level and Connection to Nature Engagement with biophilic infrastructure, connection with nature, perceived stress levels and accessibility to biophilic infrastructure Summary Discussion Overall Trends Regional Differences Correlation Demographics Connection to Nature and Perceived Stress Level

2 4 5 6 6 6 6 8 8 9 9 9 10 11 11 12 12 12 13 15 15 15 16 16 17 19 19 19 20 20

Perceived Stress level and Accessibility, Exposure to biophilic infrastructure Support Research Findings Biophilic Infrastructure and Perceived Stress Level Accessibility to Biophilic Infrastructure and Residing Floor Engagement with biophilic infrastructure, connection to nature and perceived stress level Perceived Stress, accessibility and engagement to biophilic infrastructure Summary Limitation Methodological Weakness Questionnaire Composition Demography profile of participants Implication Conclusion Reference Appendices Appendices A - Glossary Appendices B - Questionnaire for Research Data Collection Appendices C - Perceived Stress Scale Survey Appendices D - Survey of refined Environmental Identity Scale Appendices E - Singpore’s Biophilic Design Guidelines Appendices F - Identifying notable results in data analysis

27 27 27 28 28 28 28 29 29 29 31 31 32 33 36 36 37 49 51 52 52

21 22 22

24 25 25 26 27 27 27

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Acknowledgements Inspired from my working experience in Singapore and Australia last year, I believe biophilia is an important movement for landscape architecture to construct a liveable, sustainable city. To seek more substantial evidence in the benefits of biophilic design within 5 months, this research focused on the relationship of biophilic city and inhabitant’s wellbeing in Hong Kong and Singapore. As a pilot research of similar topics in the South East Asian region, I envision an increasing awareness and more accessible professional resources to analyse the socioeconomical benefits of a biophilic city.

Figure 1 - Cheonggyecheon river, South Korea (Citywallpapers, 2019)

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Introduction A city is only operational when there are sufficient infrastructure for inhabitants to live and work in (Unknown, 2019, A. Lynch, 2008). Cities are mostly classified as densely populated, highly built urban environment with little presence of natural elements (Fromm, 1965, Beatley, 2011). Today, only 3% of global land surface are registered as parks and protected areas, whereas more than 95% have been influenced by civilization (Gullone, 2000). While cities are continuously is thriving, there is also a noticeable increase in mental health problems especially those who dwell in urban environments(Degenhardt et al., 2018). Studies have shown social capital, mental health and built environment are constantly affecting one another (Figure 2) (Araya et al., 2006), suggesting an improvement on the quality of urban environment can promote better mental health resilience and socio-economical performance. (Mind, 2013, Araya et al., 2006) Specifically focusing in stress and stress recovery, this research aims to explore two aims. Firstly, how environments affect stress level and mental health for individuals, focusing for the first time on biophilic designs as a solution (Kurt and Douglas, 2013). Secondly, to record reference figures and pilot relevant studies in the Asia region. This research shall answer the question: How effective is exposure to biophilic infrastructure as a stress recovery strategy in Hong Kong and Singapore? Figure 2 (Araya et al., 2006) This research is guided by the following supporting questions, with the corresponding hypotheses as below: 1. How does demographic and other individual characteristics relate to perceived stress level, age and connection to nature and between age and presence of biophilic infrastructure? • There is a negative correlation between age and perceived stress level, connection to nature, presence to biophilic infrastructure 2. How does biophilic infrastructure help participants to connect with nature and relieve stress? • A positive correlation between presence of biophilic infrastructure and connection of nature. • A negative correlation between accessibility to biophilic infrastructure and perceived stress level • A positive correlation between accessibility to biophilic infrastructure and residing floors • A positive correlation between capability to cope with stress and exposure to biophilic infrastructure 3. How is participant’s connection to nature associated to perceived stress level? • Connection to nature and perceived stress level holds a negative correlation 4. How does frequency of active engagement with biophilic infrastructure associated to connection to nature, or perceived stress level. • A positive correlation between engagement with biophilic infrastructure and connection with nature • A positive correlation between engagement with biophilic infrastructure and accessibility to biophilic infrastructure • A negative correlation between perceived stress level and engagement with biophilic infrastructure

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Biophilia Biophilia and Landscape Architecture The term ‘Biophilia’ was first used by Erich Fromm, a psychoanalyst and social philosopher (Britannica, 2018) in his book named ‘The Heart of Man’ (Figure 3 right). He discussed the nature of human’s state of mind revolving a balance between the love of life or death, known as Biophilia and Necrophilia respectively in the book. Biophilia underlies multiple humanistic philosophy. It is an inherent quality and tendency of all living organism to live and preserve its existence. It underlies multiple humanistic philosophy. A biophilic person expresses biophilic qualities through more than just ideas. (Fromm, 1965) ‘Biophilia’ was subsequently popularised by Edward Osborne Wilson in his book ‘Biophilia’ (Figure 3 left). As an advocate in social biology, Wilson defined Biophilia Figure 3 - Origin of Biophilia(Fromm, 2010, as the innate tendency to focus on life and lifelike processes. Although it is a Wilson, 2011) complicated process to fully explore the deeper connection with life in mental development, Wilson emphasizes the natural environment is as central to human history as social behaviour itself due to human’s inherent dependency of natural resources, such as access to clean water and soil to maximise survivability (Wilson, 1984, Kellert, 2015).

Biophilia and Current State of Art Both definitions from Wilson and Fromm demonstrated humanistic principles, proposing a hereditary cognitive connection with all living beings in an environment. Besides from a philosophical standpoint, multiple researches have shown common environmental preferences stems from conditions to maximising survivability before civilisation. Biophilia is more than just a philosophical concept, its principles can be applied into multiple disciplinaries, as seen from the rising trend of, nature based therapies in medicine and mindfulness practices(Arvay, 2018, Williams, 2018, Li, 2018), and most importantly biophilic design in both architecture and landscape architecture (Beatley, 2011, Beatley, 2016, Heerwagen and Hase, 2001, Browning et al., 2014)

Biophilic Infrastructure Biophilic infrastructure are physical structures and facilities that both serve the city’s fundamental system, while promoting a reconnection and positive experience with natural elements (Dictionary.com, 2019). As dense urban environment gradually replaces natural prominent spaces, biophilic infrastructure provides an effective alternative to preserve and retain natural elements in a built environment, and reintroduce ecology and greater biodiversity into the city whilst maintaining most of urban lifestyle. It promotes recovery to human’s wellbeing through sustained, repetitive encounters with localised nature (Figure 4)(Beatley, 2011, Beatley, 2016). Through encouraging responsive interaction between the inhabitants and spatial context, it encourages a sense of emotional attachment and stewardship over the inhabitant’s surround environment.(Browning et al., 2014, Kellert et al., 2008, Kellert, 2015) Browning have proposed 14 principles of biophilic design: Figure 4 - C (BOSA properties,2007)

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Visual connection with nature Non-visual connection with Non-rhythmic sensory stimuli Thermal and airflow nature variability Figure 5 - Natural view from F i g u r e 6 - Ta c t i l e , a u r a l Figure 7 - Hong Kong wetland F i g u r e 8 - B u i l d i n g w i t h Marina Bay Sands, Singapore. experience of nature (Pixabay, park provides different stimuli in permeable facade and open Photo taken by me 2019) different zones (Hayati, 2018) shelter (Choe, 2012)

Presence of water

Dynamic and diffuse light

Connection with natural B i o m o r p h i c f o r m s a n d systems patterns

Figure 9 - Kallang promenade, Figure 10 - Tree canopies provide Figure 11 - Park connector Figure 12 - An university building SIngapore. Photo taken by me soft shadings in broad daylight. network in Singapore (Ngo, designed like a stacked beehive. Photo taken by me 2017) Photo taken by me.

Material connection with Complexity and order nature

Prospect

Refuge

Figure 13 - Constructed elements Figure 14 - Stormwater channel Figure 15 - Highly visible view Figure 16 - Pagoda as a refuge blending with existing natural mimicking the dynamic form of from Hama Rikyu gardens, To- from storm and strong sunlight. material. (PicPortugal,2017) natural river. Photo taken by me. kyo. Photo taken by me Photo taken by me

(All principles above refers to Browning et al., 2014)

Mystery

Risk and peril

Figure 17 - Using enclosure to create a mysterious mood and obscure views to provoke curiosity. Photo taken by me.

Figure 18 - Closely paved stepping stones that is impossible to fall through but creates an illusion of risk. Photo taken by me

Based on these principles, biophilic infrastructure provides both venue for social and cultural exchange, as well as restorative benefits physically and to individual’s wellbeing, especially common urban problems like heat island effect and provide filtration for air pollutants. Research have also shown an increase in property value in proximity to natural elements, not limiting to biophilic infrastructure. (Beatley, 2011, Chow, 2018, Beatley, 2016)

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Stress Stress is generally conceived as a negative element as it is related to events that threatens an individual’s life. It is perceived as a cause that hinders recovery and make individuals more vulnerable to other illnesses (Pitts and Phillips, 1998). Stress is still an ambiguous term in the medical field. It can be considered as a precursor to physical or mental diseases, or a disability to cope with external stimuli (Gunderson and Rahe, 1974).

Stress

Figure 19 - How stress is triggered (Pitts and Philips,1998)

How is it triggered Contrary to popular beliefs, stress can be caused by both negative and positive stimuli, as long it causes distress, and requires individual’s capacity to adapt and provokes physiological reactions involving neuro-systems (Gunderson and Rahe, 1974, Pitts and Phillips, 1998). Multiple models have been developed to determine the role of stress in affecting an individual’s health and welling, where some models consider stress as an outcome of the cognitive process in which a challenge/ threat is first perceived (Pitts and Phillips, 1998); Levi’s model provides substantial evidence that environmental stimuli is more likely to cause physical diseases over psychosocial stimuli (Gunderson and Rahe, 1974), which is also reflected in the Stress-diathesis model, where stress is determined by both environmental and Figure 20 - Stress forming from understimulation or overstimulation psychological vulnerability of an individual. (Pitts and Phillips, 1998) (Gunderson and Rahe, 1974)

Figure 21 - Stress forming psychosocial and psychological program (Gunderson and Rahe, 1974)

Dysfunction on physical systems is triggered when an individual cannot cope with the level of stress one perceives, in forms of physical and mental responses such as anxiety, depression (Gunderson and Rahe, 1974). If stress persists, biological vulnerability shall give rise to disease(Pitts and Phillips, 1998)

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Landscape Architecture, Biophilia, Stress How is urban environment worsening or causing more of stress factors? Extensive landscapes and delicately arranged gardens have been a part of human civilisation worldwide, for individuals to maintain contact with nature (Figure 22). People travelling to national parks, strolling along seaside and expresses enjoyment to when they make contact with other species for leisure demonstrated an inherited desire to reconnect with nature, despite adapting to new mechanising living conditions (Fromm, 1965, Gullone, 2000). Research show there are more children and adult visiting zoos than attend major professional sporting event combined. (Gullone, 2000) To create a stress-free and beneficial environment, Hosey suggests it should be Figure 22 - Hidcote Manor Garden built in responsive to interact with, and provide a comfortable and meaningful variation 1905, Photo taken by me in light, air, temperature. (Figure 23) It should provide places of refuge with views towards outdoors, which is constantly offered in the natural environment. In contrast, the urbanizing environment does not fulfill such conditions in the lacking of natural elements. (Hosey, 2016). Such observation is further supported by Kurt and Douglas’s study, where a reduction of subjective stress after exposure to a natural environment with absence of urban elements, with overwhelmingly positive feedbacks. (Kurt and Douglas, 2013)

What is the role of landscape architecture in remediating stress? A series of researches throughout 20th century have indicated better stress Figure 23 - Singapore National Botanic restoration when people are exposed to certain natural settings. Unthreatening, Garden. Photo taken by me prospective natural landscapes with presence of waterbodies like parks promote better stress restoration than built environment (Figure 24), and has higher levels of positive feelings and lower aggression(Kellert and Wilson, 1993, Gullone, 2000, Kurt and Douglas, 2013, 1991, Ulrich et al., 1991). Researches worldwide have shown consistent results of lower stress and anxiety levels if individuals live in proximity to natural environments (Chow, 2018, Kellert and Wilson, 1993, Kurt and Douglas, 2013). Moreover, recent medical research indicates natural based therapy shows significant long term effect in treating stress-related illnesses (Stigsdotter et al., 2018). Figure 24 - Singapore National Botanic

Whether one might argue that it is difficult to differentiate natural environment’s Garden. Photo taken by me role in stress recovery from other mechanisms such as physical activity (Kellert and Wilson, 1993), natural elements still sits as one crucial element of stress recovery.

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How can biophilic infrastructure be adapted by landscape architecture to improve stress recovery? Adapting biophilic design principles into landscape projects can increase the efficacy of the restorative quality of built environment, without compromising a large piece of land to create quality natural spaces with the assistance of modern technology. (Figure 25, 26) Certain principles can be prioritized from the 14 principles in the aims to recreate a stress relieving environment (Browning, 2016). A visual exposure to nature encourages the brain to shift from explicit, conscious processing to implicit, unconscious processing in as short as 40 seconds, which creates less tension to the brain (Browning, 2016, Lizardo et al., 2016). The higher cortical functions becomes rested as the user experiences a ‘soft fascination’ to Figure 25 - Lee Kong Chian Natural History nature, they perform better on recovery tasks (Browning, 2016); visual presence of Museum. Photo taken by me water reactivates a feeling of tranquillity, which reduces stress, lowers heart rate and blood pressure (Figure 27). Otherwise, a non-visual, multi-sensual stimulus from natural elements reduces blood pressure, sympathetic nervous system activity and release of stress hormones. Thermal, airflow and light variability provides comfort, recovers wellbeing and boosts productivity. Although the sound of water does not mitigate urban noises, human users focuses towards the sound of water, which acts as a filter to other noises (Browning, 2016, Browning et al., 2014). In terms of spatial composition, A prospective, complex spatial layout is preferred Figure 26 - Vertical greenwall on a private condominium. (Sweet, 2014) hereditarily due to higher survivability (Kellert and Wilson, 1993, Browning, 2016)

Figure 27 - Photo taken by me

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Methodology Site study and conditions Category Population

Sub-category

Population Density

Human Development Index Gross Domestic Product, (Purchasing power parity, international $) Land Area

Green space indicator

Hong Kong 7.482 million (Department, 2019)

Singapore 5.638 million (Singapore, 2019)

6777 people/km2 (overall)

7831 people/km2

32100 people/km2 (developed land)(Chow, 2018) 0.933 (#7 in the world) 0.932 (#9 in the world) (Programme, 2017) (Programme, 2017) 455 Billion (Bank, 2019b)

527 Billion (Bank, 2019b)

1104 km2 (Overall) (Leung, 2019)

720 km2 (Leinbach et al., 2019)

264 km2 (Developed land) (Chow, 2018) Percentage of 40.0% (London and public greenspace Consulting, 2018) Green city index Above Average (Sumner, 2012)

Urban-Rural Population Ratio Economic Structure (% of GDP) (Bank, 2019a) Stress and Happiness

100%/0% (2010) – The greatest urban population density in East Asia (Chow, 2018)

47.0% (London and Consulting, 2018)

Figure 28 - Location of Hong Kong in Asia

Figure 29 - Location of Singapore in Asia

Well above average/ Best city in Asia region (Sumner, 2012) 100%/0%

Primary

0.1

0

Secondary Tertiary World Happiness Report 2018

7.2 188 5.43 (#76 in the World) (Helliwell et al., 2018)

23.2 173.3 6.343 (#34 in the World) (Helliwell et al., 2018)

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Hong Kong Known as ‘the Eastern Pearl’, Hong Kong has overcome land scarcity and became an iconic city in Asia. However, the shortage of space has contributed substantially to a rising of mental unwellness in the city (McCay and Yip, 2018). A local survey conducted in 2014 revealed that 50 percent of respondents perceived poor mental health, where 25% reported stress and anxiety level that is 250 times the global average. 10 percent of students surveyed also reported having suicidal thought at least once. (Heifetz, 2016, McCay and Yip, 2018) In relation to the living environment, research has found that the further individuals Figure 30 - Urban areas of Hong Kong live from parks, higher levels of worry are reported. (Chow, 2018) The average (Wpcpey, 2008) amount of open space per capita is 2.7-2.8m2 at maximum, which lags far behind both international and Asia average (Chow, 2018). Meanwhile 93% of the Hong Kong population lives within 400m of at least one public open space, there is an awakening awareness to improve the quality of public space, with higher greening ratio and better accessibility(Chow, 2018), as seen from the recently proposed landscape spatial framework published by Hong Kong government. (HKSARG, 2016)

Singapore Branded as ‘A city in a garden’, Singapore’s vision to decorate the city with lush greenery started after gaining independence in 1967(Singapore, 2014). Housing more than 5 million people within 720 square kilometres, 24% of Singapore workers Figure 31 - Rural areas of Hong Kong. reported high stress levels and 52% feels an increase in stress. However, 94% of Photo taken by me respondents also feel they can cope with the current stress level well. (Dewan, 2014, Li Sen, 2016) In 50 years, Singapore has transformed from being a polluter’s paradise to the greenest city in South East Asia, with 1100% increase in green spaces and 25 times more parks. Government departments such as National Parks Board, Public Utilities Board are constantly working with the Singapore community to evaluate greening masterplan (Department of Environment, 2018).

Study Setting Due to the lack of relevant reference figures from Asia, the selection of cities for Figure 32 - Urban areas of Singapore. Photo this study are limited to Asian regions to record pilot and reference figures of taken by me stress levels, connection to nature and presence of biophilic infrastructure of Asian regions by sampling two similar cities, which can be used for further comparison on comparing figures between European and American cities. Besides, this can be used to test a set of criteria for assessing the accessibility and exposure to biophilic infrastructure. Hong Kong and Singapore were selected for comparison based on sharing similarities in terms of economic structure and development index figures, while both are considered as part the Four Asian Tigers, providing a similar background to compare the causes behind the contrasting ranking from World Happiness Report. (Helliwell et al., 2018, Programme, 2017, Leung, 2019, Leinbach et al., 2019) As a further matter, Singapore is famously known to be one of the most leading, Figure 33 - Rural areas of Singapore. Photo taken by me innovative biophilic city in Asia (Tang, 2018), which provides a contrast to Hong Kong, where there is less awareness.

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Data Collection A cross-sectional self-administered online questionnaire was developed by me, using Google forms. Convenience sampling was used to maximise the number of submissions. Recruitment was done through advertisement across social media platforms and private messaging. Anybody who have resided in Singapore or/and Hong Kong for more than 3 consecutive months are eligible to participate. A cash voucher lucky draw was used to incentivise to maximise number of inputs. The questionnaire is composed of 5 sections, which approximately takes 30 minutes to complete, measuring the following variables and outcome: Category Demographic profile

Living environment

Sub-category Age Ethnicity Gender Education Level Occupation Income Level (Optional) Current city of residence Housing typology Floor level of accommodation Exposure to nature

Description

Participants must rate between the accommodation’s exposure to nature by choosing one of four below, with pictorial reference: • Very built: Entirety of viewable landscape is due to human influence, with minimal presence of natural elements • Mostly built: Majority of viewable landscape is due to human influence, with some presence of natural elements • Mostly Natural - Presence of significant amounts of vegetation and some human influence such as walkways and buildings. • Very Natural: Trees, shrubs, and other natural elements with minimal evidence of human influence (Kurt and Douglas, 2013) Perceived stress How much perceived This section of the questionnaire measures the participant’s perceived stress level distress participant is level in the past 8 weeks through asking how much distress an individual is experiencing? in, and how are they coping from 10 questions(Denovan et al., 2017). It is (Item 1-3,6,9-10) a measure of the degree to which situations in one’s life are appraised as (Denovan et al., 2017) stressful (Cohen, 1994) Participants rate themselves on how often they feel How well participant is as the statements described from never to always. For items that measures coping with perceived perceived distress, ‘Never’ gives 0 points and ‘Always’ scores 4 points. stress? (Item 4,5,7,8) For items 4,5,7,8 which measures the capability to cope with stress, scoring are (Denovan et al., 2017) Overall perceived stress inverted during the quantification of the data, where ‘Never’ is scored 4 points and ‘Always’ is 0 points. level

Presence of biophilic infrastructure

It is adapted from Sheldon Cohen’s Perceived Stress Scale without any adjustment (Cohen, 1994). Scored out of 40 points, the higher the participants’ score, the higher level of stress they are perceiving. A c c e s s i b i l i t y t o A brief definition of Biophilia and list of examples are provided for the architectural biophilic participant’s reference to complete this section. This section is divided in infrastructure two parts: The first part investigates the participant’s awareness and physical Accessibility to outdoor exposure to biophilic building complexes and public spaces through a set biophilic infrastructure of criteria adapted from Terrapin Green’s ’14 patterns of Biophilic designs’. Participants have to rate choose one of four options, ranging from there is none in the city to my knowledge, and present in daily surroundings. Overall accessibility to This figure is derived from adding up the quantified figures from accessibility to biophilic infrastructure architectural and outdoor biophilic infrastructure. 13


Engagement with biophilic infrastructure

Frequency of actively using biophilic infrastructure around daily routine, supported with reason Frequency of actively visiting biophilic infrastructure, supported with reason. Average frequency of using biophilic infrastructures

Exposure to biophilic infrastructure

Connection to Nature

The second part discusses how often and on what basis do participants use and visit biophilic infrastructure actively. ‘Actively engages’ means voluntary interactions that participants pay attention and experience to any biophilic infrastructure elements more than just visually appreciating it. Participants must rate between never, to everyday. Reasons of using biophilic infrastructures are also requested. Figures are measured in ‘…days per year’

This figure is derived from averaging the figures from frequencies of actively using and visiting biophilic infrastructure. Figures are measured in ‘…days per year’ This figure is derived from the following formula: where: stands for the average accessibility of architectural biophilic infrastructure; stands for how often participants engage with architectural biophilic infrastructure; stands for the average accessibility of outdoor biophilic infrastructure; stands for how often participants engage with outdoor biophilic infrastructure.

Environmental Identity Scale

Biophilic infrastructure can help me reconnect with nature Nature and urban city can co-exist within the same environment Biophilic design can help preserve nature

The higher value, the more exposed the participant is to biophilic infrastructure. The first section consist of Clayton’s Environmental Identity Scale. It is a 22 item survey, which measures the importance of environment as part of an individual’s identity, recognition as a part of nature’s collective environment, agreement with environmental ideology, enjoyment and positive experiences associated as a result of experience with nature (Clayton, 2003). The second section consist of 3 self-report statements for participants to rate on likert scale of 1 to 5, partially adapted from the survey of Green skins project in Fremantle, Australia (CUSP, 2011)

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Results Approach to Data Analysis All data collected from the questionnaire are automatically imported onto a excel sheet, where quantification of ratings and measurement for prospective regression analysis are done on multiple section of data. Secondary calculations such as exposure to biophilic infrastructure are also done before importing into SPSS Statistics for further analysis. Frequencies and descriptive statistics are analysed and inspected on every items, both for overall results and individual city of residence. This led to a decision where income level and ethnicity collected from the questionnaire is disregarded due to dramatic difference on average, and the overwhelming participation from Chinese and lack of other ethnicities. After that, correlation are analysed based on Pearson’s correlation, and tested against null hypothesis with a two-way analysis of variance (ANOVA).

Demographics A total of 200 invitations were formally sent out, with 100 sent to Hong Kong and 100 sent to Singapore. A total of 117 responses was received, where 82 (70.1% of all responses) are from who have resided in Hong Kong, and 35 (29.9% of all responses) from whom have resided in Singapore for more than 3 months. Regardless of city of residence, the average age reported from all participant is 31.6 years old (ranging from 0-65+) and over 90% participants are of Chinese ethnicity. There is a balanced gender ratio in participants, and all except 1 participant has obtained a diploma or above certification. Participants are mainly employed in architecture & engineering (32.5%), administrative & management (14.5%) or finance (11.1%) sector, composing over half of the participant’s profile. Category

Overall

Description

Hong Kong

Singapore

Percentage Mean Standard Percentage Mean Standard Percentage Mean Standard Deviation Deviation Deviation

Age

Gender Ethnicity

Education (Diploma or above)

Occupation

Mean Age

31.6 13.1

32.9 14.4

28.4 8.75

0-19 20-29 30-39 40-49 50-59 60-64 65+ M F Chinese Malay European Others High School

1.7% 69.2% 6.8% 3.4% 17.1% 0.9% 0.9% 45.3% 54.7% 94.9% 0.9% 1.7% 2.6% 0.9%

1.2% 69.5% 1.2% 3.7% 22.0% 1.2% 1.2% 43.9% 56.1% 97.6% 0.00% 1.2% 1.2% 4.9%

2.9% 68.6% 20.0% 2.9% 5.7% 0.0% 0.0% 48.6% 51.4% 88.6% 2.9% 2.9% 5.7% 2.9%

Diploma Degree Postgraduate

11.1% 62.4% 25.6%

64.6% 30.5% 100.0%

25.7% 57.1% 14.3%

% of Diploma or above Administrative & Management Architecture, Engineering and Construction Art Education Finance Human Science

99.1%

97.1%

14.5%

14.6%

14.3%

32.5%

24.4%

51.4%

5.1% 6.8% 11.1% 6.0%

6.1% 8.5% 14.6% 7.3%

2.9% 2.9% 2.9% 2.9% 15


Information Technology

4.3%

3.7%

5.7%

Law and Politics Medical Service Retired/ Unemployed

2.6% 9.4% 7.7%

3.7% 7.3% 9.8%

0.0% 14.3% 2.9%

Table 1 - Demographic profile of questionnaire participants

Living Environment 94% of participants grew up in a city, with more than 70% of participants residing in private housing, living on average 16.8 floors from ground. Most participants (68.4%) reported currently living in a mostly built environment but prefers a mostly natural environment. All Hong Kong participants except 2 grew up in the city, residing in private housing (86.6%). Living on 20.3 floors above ground, 67.1% of all participants are currently living in a mostly built environment and prefers to live near mostly natural locations. All except 5 Singapore participants grew up in the city and mainly resides in public housing (62.9%). Singapore participants live way lower than the average residing floors at 8.59 floor. 71.4% of all participants currently lives in a mostly built environment and the same percentage prefers to live near mostly natural locations. Description

Overall Mode

Grow up in a city? Types of Housing

Mean Standard Deviation

Yes

Hong Kong

Singapore

Percentage Mean Standard Deviation

Percentage Mean Standard Deviation

97.6% 86.6%

85.7% 62.9%

Yes Private

Yes Public

Flat Floors Current living environment

20.3 14.3 Mostly Built

8.59 5.62 Mostly Built

Preferred living environment

Mostly Natural

Mostly Natural

Relax Companion

Relax Companion

Reason of Interacting with biophilic infrastructure

Relax Companion

Table 2 - Living environment of questionnaire participants

Perceived Stress Level Overall, the perceived stress level is surveyed at 18.3, with both cities higher than the reported national average from United States at 15.83(Cohen and Janicki‐Deverts, 2012). Statistics also detected a higher perceived distress per item than capability to cope per item. Hong Kong participants have reported a higher perceived stress level than the overall average by 0.2. Participants reported high perceived distress while maintaining same capability of coping. Standard deviation of the figures shows that data presented by Hong Kong participants are more consistent than Singapore participants. Singapore participants have reported a lower perceived stress level at 18.0, 0.3 lower than the overall average. Reported with lower perceived distress and coping capability, data indicates a higher fluctuation of data range.

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Description

Overall

Hong Kong

Singapore

Percentage Mean Standard Percentage Mean Standard Percentage Mean Standard Deviation Deviation Deviation

How much perceived distress participant is experiencing? (Item 1-3,6,9-10) (Denovan et al., 2017) How well participant is coping with perceived stress? (Item 4,5,7,8) (Denovan et al., 2017) Average Perceived Stress Level

Table 3 - Perceived stress level of questionnaire participants

11.5 3.93

11.6 3.77

11.3 4.31

6.82 2.51

6.85 2.37

6.74 2.83

18.3 5.28

18.5 5.00

18

5.97

Presence of Biophilic Infrastructure Survey reported a mean score of 15.4 in accessibility to architectural biophilic infrastructure, and 16.7 in accessibility to outdoor biophilic infrastructure. Participants show strong awareness and moderate engagement to most of the architectural elements except item 10, which describes education panels and active educational programs, where over 75% of all participants reported no such element in their area or limited engagement. Out of all architectural elements, participants reported strongest presence of physical access to greening where more than 75% reports visiting such elements occasionally to surrounded by it daily, followed by multi-sensory experience with nature such as views to natural scenery and sounds, where over 60% strong engagement to it, with an additional 40% of all participants reporting occasionally visiting it. There is a mixed presence of soothing natural circulation in architectural elements, with approximately 25% of all participants reporting all choices between none in the city, to present in daily surroundings. In terms of outdoor biophilic infrastructures, there is a strong presence of roadside plantation, with more than 50% of participants reporting presence in their daily surroundings, followed by multi-sensory experience with nature, with almost 50% of participants visit it occasionally. Other elements with more than 40% participants reporting paying occasional visits include physical access to greening, greenspace tied to a wider ecological network or physical access to waterfront. There is a consistent absence or lack of awareness to education panels and tours promoting biophilia, with more than 60% participants reporting none in the city or does not visit it. Participants reported actively engaging with biophilic infrastructure around their daily surroundings 83.7 days per year, equivalent to once every 4.36 days and visits biophilic infrastructures 61.9 days per year, equivalent to once every 5.90 days. Reasons of engagement with biophilic infrastructure are consistent across both cities, where participants visit it to relax and spend time with friends and family. Average exposure to biophilic infrastructure is 2.90. Participants from Hong Kong reported 15.1 in accessibility to architectural biophilic infrastructure and 16.4 in outdoor biophilic infrastructure, both lower than the overall average of the survey and higher variance. Physical access to greening has the strongest presence out of all rated architectural elements, with more than 70% local participants reporting strong presence. In contrast, over half of local participants reported lack of educational programs promoting biophilia in the city, composing almost 80% of all local participants when combined with participants reporting awareness but no interaction to it. Consistent with the overall results, Hong Kong participants reported strong presence of roadside plantation, with more than half reported present in their daily surroundings, composing more than 80% of participants combined with those who occasionally visits it. It is followed by physical access to greening and multi-sensory experience with nature, each with more than 40% visiting occasionally, and more than 70% of participants combined with those who reported present around their daily scenery. Over 70% of participants reports none to limited awareness to biophilic educational programs, consistent with overall results. Hong Kong participants actively engage with biophilic infrastructure around their daily surroundings every 81.8 days annually, equivalent to once every 4.47 days and visits biophilic infrastructures voluntarily 62.7 days annually, equivalent to visiting biophilic infrastructures every 5.82 days. Average exposure to biophilic infrastructure remains lower than overall average at 2.86.

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Singapore participants reported a higher accessibility to biophilic infrastructure with the score of 15.9 for architectural infrastructure and 17.5 at outdoor biophilic infrastructure, both scoring higher than the overall average with a narrower distribution of data. For architectural elements, overall results indicate a lack of presence of architectural biophilic elements around their daily surroundings except providing natural circulation, but participants visits these elements occasionally. 60% of Singapore participants reporting visiting architectural spaces where multi-sensory experience with nature is provided. More than 40% participants occasionally visiting architectural spaces that provides physical access to natural elements, with additional 40% reporting these spaces are present around their daily surroundings. Similarly, more than 40% participants reports occasionally visiting architectural structures with vertical greening, with additional 40% of participants reporting awareness to it, but does not visit it. Consistent with overall results, there is a mixed response in presence of natural circulation within enclosed space. There is a consistent presence of planting strips in public space as reported by more than 60% of local participants in their living surroundings, composing more than 85% of local participants to those who pays occasional visits. It is followed by physical access to greening, with more than 80% of participants reporting either visiting or present around living surroundings. Other strong presence of outdoor elements includes physical access to waterfront and multisensorial experience with water, with more than 50% of participants visiting occasionally, and composing more than 80% of Singapore participants when combined with those reporting awareness to it but does not visit. Singapore participants actively engages with biophilic infrastructure around their daily surroundings every 88.0 days annually, equivalent to once every 4.15 days and visits biophilic infrastructures voluntarily 60.1 days every year, equivalent to visiting biophilic infrastructures every 6.07 days. Average exposure to biophilic infrastructure remains higher than overall average at 3.01. Description

Overall

Hong Kong

Singapore

Percentage Mean Standard Percentage Mean Standard Percentage Mean Standard Deviation Deviation Deviation

Accessibility to architectural biophilic infrastructure Accessibility to outdoor biophilic infrastructure Overall accessibility to biophilic infrastructure Frequency of actively using biophilic infrastructure around daily routine, supported with reason Frequency of actively visiting biophilic infrastructure, supported with reason. Average frequency of using biophilic infrastructures Exposure to biophilic infrastructure

15.4 6.58

15.1 6.84

15.9 5.96

16.7 6.01

16.4 6.19

17.5 5.59

32.1 11.7

31.5 12.2

33.4 10.6

83.7 134

81.8 131

88

61.9 114

62.7 115.2

60.1 113.1

72.8 112.8

72.3 113.8

74

2.9

2.86 5.34

3.01 4.71

5.14

Table 4 - Questionnaire participants’ perceived presence and engagement biophilic infrastructure, and active engagement

141.9

112

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Connection with Nature Environmental Identity Scale Scored out of 154 points, the average score of all results are 103, equivalent to 4.68 per item rated between 1 to 7 in the survey. Participants reported the lowest score at ‘I spend a lot of time in natural setting’ at 3.64, indicating participants disagreeing to the statement. Such trend is consistent from both cities, reporting at 3.52 and 3.97 respectively. Participants reported the highest score at rating ‘Learning about the natural world should be an important part of every child’s upbringing.’, with an average score of 5.74 and standard deviation of 1.42, which is the lowest of all items. Consistent with Hong Kong and Singapore participants at the average score of 5.74 and 5.97, the standard deviation across both cities are also the lowest.

Self-rated Statements All participants reported a moderate to strong agreement to All three statements, where Singapore mostly scores higher than Hong Kong. Out of all the statements, ‘biophilic design can help preserve nature’ scored the weakest at 3.91, the only one that scored below 4 on average. This is consistent with results from both cities, and this is also the only statement that Singapore scored lower than Hong Kong, at 3.89 compared to 3.93 out of all three statements. Description Overall Hong Kong Singapore Percentage Mean Standard Percentage Mean Standard Percentage Mean Standard Deviation Deviation Deviation

Environmental Identity Scale Biophilic infrastructure can help me reconnect with nature Nature and urban city can co-exist within the same environment Biophilic design can help preserve nature

Table 5 - Questionnaire participants’ connection with nature

103 25.2 4.01 0.749

101 25.491 3.98 0.72

108 24.2 4.09 0.818

4.11 0.859

4.09 0.849

4.17 0.891

3.91 0.915

3.93 0.913

3.89 0.932

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Correlation Testing All correlations are tested according to the supporting question of this research. The strength of correlation are determined by the correlation coefficient, in the following range regardless of positive and negative: 0-0.199 is a very weak correlation which is not accepted in this research; 0.2-0.399 is a weak correlation; 0.4-0.599 is a moderate correlation; 0.6-0.799 is a strong correlation and 0.8-1.00 is a very strong correlation. For p-value, value <0.05 indicates a sufficient significance of data to support the correlation, which is the minimum value to support a minimum weak correlation; p-value <0.01 is moderately significant to support a correlation, and p-value <0.001 is strongly significant dataset to support a proposed correlation.

Demographic profile, perceived stress level, connection to nature and biophilic infrastructure There is a correlation coefficient at -0.254 and p-value at 0.006 between age and perceived stress level, indicating a weak negative correlation with moderate significant results. With coefficients less than 0.2 and p-value higher than 0.05, data collected from this survey is unable to determine a correlation between age and connection to nature, age and exposure to biophilic infrastructure as well as age and accessibility to biophilic infrastructure. Singapore Age Perceived stress level Pearson Correlation p-value

28.4 18

Standard Deviation 8.75 5.97

Hong Kong 32.9 18.5

Standard Deviation 14.4 5

Overall

Standard Deviation 14.4 25.5

Overall

Standard Deviation 14.4 12.2

Overall

31.6 18.32

Table 6 - Correlation between age and perceived stress level

Singapore Age Connection to nature Pearson Correlation p-value

28.4 108

Standard Deviation 8.75 24.2

Hong Kong 32.9 101.11

31.6 103.21

Table 7 - Correlation between age and connection with nature

Singapore Age 28.4 Accessibility to biophilic 33.4 infrastructure Pearson Correlation p-value

Standard Deviation 8.75 10.6

Hong Kong 32.9 31.54

31.6 32.1

Age

28.4

Standard Deviation 8.75

Exposure to biophilic infrastructure Pearson Correlation

3.01

4.71

p-value

Hong Kong

Standard Deviation 13.1 25.2 0.073 0.433 Standard Deviation 13.1 11.7 0.108 0.248

Table 8 - Correlation between age and accessibility to biophilic infrastructure

Singapore

Standard Deviation 13.1 5.28 -0.254 0.006

Overall

32.9

Standard Deviation 14.4

31.6

Standard Deviation 13.1

2.86

5.34

2.9

5.14

Table 9 - Correlation between age and exposure to biophilic infrastructure

0.179 0.054

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Association between biophilic infrastructure, perceived stress level or connection to nature While the presence of biophilic infrastructure is measured by a combination of accessibility and exposure to biophilic infrastructure, and perceived stress level is measured by perceived distress and capability to cope. 4 correlations were test to fully examine the correlation between the presence of biophilic infrastructure and perceived stress level. Except for a very weak negative correlation and insufficient significant data to justify a correlation between accessibility to biophilic infrastructure and perceived stress level, the other three tests have all shown consistent weak negative correlation, supported by sufficiently significant data from the questionnaire. Singapore Accessibility to biophilic 33.4 infrastructure Perceived stress level 18

Standard Deviation 10.6

Hong Kong

Overall

31.54

Standard Deviation 12.2

32.1

Standard Deviation 11.7

5.97

18.5

5

18.32

5.28

Pearson Correlation

-0.148

p-value

0.11

Table 10 - Correlation between accessibility to biophilic infrastructure and perceived stress level

For accessibility to biophilic infrastructure and capability to cope with stress, a correlation coefficient of -0.229 and p-value at 0.013 is detected, indicating a weak negative correlation and moderate significant results. Singapore Coping with stress

6.74

Accessibility to biophilic 33.4 infrastructure Pearson Correlation

Standard Deviation 2.83

Hong Kong

Overall

6.85

Standard Deviation 2.37

6.82

Standard Deviation 2.51

10.6

31.54

12.2

32.1

11.7 -0.229

p-value

Table 11 - Correlation between capability to cope with stress and accessibility to biophilic infrastructure

0.013

For exposure to biophilic infrastructure and perceived stress level, a correlation coefficient at -0.230 and p-value at 0.012 is detected, indicating a weak negative correlation and moderate significant results. Singapore Exposure to biophilic infrastructure Perceived stress level

Hong Kong

3.01

Standard Deviation 4.71

Overall

2.86

Standard Deviation 5.34

2.9

Standard Deviation 5.14

18

5.97

18.5

5

18.32

5.28

Pearson Correlation

-0.23

p-value

0.012

Table 12 - Correlation between perceived stress level and exposure to biophilic infrastructure

For exposure to biophilic infrastructure and capability to cope with stress, a correlation coefficient of -0.2 and p-value at 0.03 is detected, indicating a weak negative correlation supported by sufficient significant results. Singapore Coping with Stress Exposure to biophilic infrastructure Pearson Correlation p-value

6.74 3.01

Standard Deviation 2.83 4.71

Hong Kong 6.85 2.86

Standard Deviation 2.37 5.34

Table 13 - Correlation between capability to cope with stress and exposure to biophilic infrastructure

Overall 6.82 2.9

Standard Deviation 2.51 5.14 -0.200 0.03

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Secondly, for exposure to biophilic infrastructure and connection to nature, a correlation coefficient of 0.275 and p-value of 0.003 can be detected, indicating a moderately strong dataset to support weak positive correlation. Singapore Exposure to biophilic infrastructure Connection to nature Pearson Correlation p-value

Hong Kong

3.01

Standard Deviation 4.71

Overall

2.86

Standard Deviation 5.34

108

24.2

101.11

25.5

103.21

2.9

Table 14 - Correlation between connection to nature and exposure to biophilic infrastructure

Standard Deviation 5.14 25.2 0.275 0.003

Data collected from the questionnaire is not significant and strong enough to form a correlation between accessibility to biophilic infrastructure and participant’s residing floors, with a correlation coefficient at 0.088 and p-value at 0.343. Singapore Accessibility to biophilic 33.4 infrastructure Residing floors 8.59 Pearson Correlation p-value

Standard Deviation 10.6

Hong Kong

Overall

31.54

Standard Deviation 12.2

5.62

20.3

14.3

16.8

32.1

Table 15 - Correlation between residing floors and accessibility to biophilic infrastructure

Standard Deviation 11.7 13.4 0.088 0.343

Perceived Stress Level and Connection to Nature For correlation between perceived stress level and connection to nature, a correlation coefficient of 0.048 and p-value of 0.608 indicates limited to none correlation between perceived stress level and connection with nature, and the data is unable to present a correlation. Singapore Perceived stress level

18

Standard Devia- Hong Kong tion 5.97 18.5

Connection to nature Pearson Correlation p-value

108

24.2

101.11

Standard Devia- Overall tion 5 18.32

Standard Deviation 5.28

25.5

25.2 0.048 0.608

103.21

Table 16 - Correlation between perceived stress level and connection to nature

Engagement with biophilic infrastructure, connection with nature, perceived stress levels and accessibility to biophilic infrastructure A weak positive correlation coefficient of 0.228 can be detected between average frequency of engaging with biophilic infrastructure and connection of nature, as supported by moderately sufficient significant results with a p-value of 0.013. Singapore Connection with nature Frequency of engaging with daily occuring biophilic infrastructure (…days annually) Frequency of occasionally visiting biophilic infrastructure (…days annually) Average frequency of engaging with biophilic infrastructure (…days annually) Pearson Correlation p-value

Hong Kong

108 88

Standard Deviation 24.2 141.9

Overall

101.11 81.8

Standard Deviation 25.5 131

103.21 83.7

Standard Deviation 25.2 133.7

60.1

113.1

62.7

115.2

61.9

114.1

74

112

72.3

113.8

72.79

112.8

Table 17 - Correlation between connection with nature and active engagement with biophilic infrastructure

0.228 0.013 22


A weak negative correlation coefficient of -0.205 is analysed between perceived stress level and the average frequency of engaging with biophilic infrastructure, as supported by moderately sufficient significant results with a p-value of 0.027. Singapore Perceived stress level Frequency of engaging with daily occuring biophilic infrastructure (once every … days) Frequency of occasionally visiting biophilic infrastructure (…days annually) Average frequency of engaging with biophilic infrastructure Pearson Correlation p-value

18 88

Standard Devia- Hong Kong tion 5.97 18.5 141.9 81.8

Standard Devia- Overall tion 5 18.32 131 83.7

Standard Deviation 5.28 133.7

60.1

113.1

62.7

115.2

61.9

114.1

74

112

72.3

113.8

72.79

112.8

Table 18 - Correlation between perceived stress level and active engagement with biophilic infrastructure

-0.205 0.027

The correlation between accessibility to biophilic infrastructure and average frequency of engaging with biophilic infrastructure is the only one test that achieves a moderate positive correlation of 0.443, supported by most significant results at a p-value of 0.00. Singapore Accessibility to biophilic infrastructure Frequency of engaging with daily occuring biophilic infrastructure (once every … days) Frequency of visiting occasional biophilic infrastructure (once every … days) Average frequency of engaging with biophilic infrastructure (once every … days) Pearson Correlation p-value

33.4

Standard Devia- Hong Kong tion 10.6 31.54

Standard Devia- Overall tion 12.2 32.1

Standard Deviation 11.7

88

141.9

81.8

131

83.7

133.7

60.1

113.1

62.7

115.2

61.9

114.1

74

112

72.3

113.8

72.79

112.8

0.443 0.000

Table 19 - Correlation between accessibility to biophilic infrastructure and active engagement with biophilic infrastructure

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For correlation between accessibility to biophilic infrastructure and connection to nature, a correlation coefficient of 0.324 and p-value of 0.000 can be detected between, indicating a most significant dataset that supports a weak positive correlation between the two variables. Singapore Accessbility to architec- 15.9 tural biophilic infrastructure Accessbility to public 17.5 outdoor biophilic infrastructure Accessibility to biophilic 33.4 infrastructure Connection to nature 108 Pearson Correlation p-value

Standard Devia- Hong Kong tion 5.96 15.1

Standard Devia- Overall tion 6.84 15.4

Standard Deviation 6.58

5.59

16.4

6.19

16.7

6.01

10.6

31.54

12.2

32.1

11.7

24.2

101.11

25.5

103.21

25.2 0.324 0.000

Table 20 - Correlation between connection with nature and accessibility with biophilic infrastructure

Summary Summing up the overall results, majority of the survey participants are working in the Architecture and engineering, administrative and management and finance industry. All except 1 acquired diploma education or above, and lives in a mostly built setting while preferring a mostly natural living environment. The overall average of perceived stress level reported from the survey is higher than the United States national average from 2009. There is a higher level of perceived distress than the capability to cope with stress. Breaking down the presence of different biophilic infrastructural elements, participants report most presence for physical access to greening in architectural spaces, and most presence of roadside plantation outdoors. There is least presence of educational panels or active programs around both architectural and outdoor spaces. Correlation testing mostly shows weak correlation supported by at least sufficiently significant results for most of the research hypotheses, Comparing the two cities surveyed, Singapore generally has a lower perceived stress level but higher variance than Hong Kong. It also has a higher exposure to biophilic infrastructure and has a higher connection to nature. Although Singapore participants visit biophilic infrastructure more often, Hong Kong participants report more intentional visits to biophilic infrastructure for relax and companion purposes.

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Discussion Overall Trends Data reflected living environments providing a mix natural and built elements are preferable than purely natural or built environments, which can be justified based on the pictorial reference provided in the questionnaire (Figure 32). According to Kellert, human have a hereditary preference to highly prospective, undulating landscape with physical access to water and food to avoid enemies and maximise survivability (Gullone, 2000, Kellert and Wilson, 1993). The picture from very natural setting situates inside a flat, dense woodland with limited prospect and no Figure 32 - Pictorial reference provided in visible water and food, causing a sense of insecurity due to the lack of visibility. In the questionnaire for living environment (Kurt and Douglas, 2013) contrast, pictures for ‘mostly natural’ and ‘mostly built’ situates participants with high visibility and source of food, presenting a sense of safety and refuge. 20 18 16

It is interesting that perceived stress level reported from both cities are classified as high stress (Roe et al., 2017) and both higher than the 2009 United States national average (Cohen and Janicki-Deverts, 2012). This is driven by lifestyle changes and land scarcity from both cities, since an increasing indoor lifestyle with lack of perceived space can cause anxiety. Alternatively, the figure might not as credible Figure 33 - Prediction of perceived stress to be a comparison in the context of small cities, since Cohen’s research compiled level made based on data from 1993-2009 a national average, which includes all states and cities that are very developed (Cohen and Janicki-Deverts, 2012) like New York city, or underdeveloped. It is possible that developed cities such as Las Vegas and New York city might have a higher perceived stress level than the rest of the state. Moreover, the lack of updated reference figures can also cause a misconception of high perceived stress level. Based on the data reported from Cohen’s research, it is forecasted the perceived stress level national average of United States in 2019 is 18.1, which is extremely close to surveyed level (Figure 33). 14 12 10

8 6 4 2 0

01/01/1993 Values

01/01/2009

Forecast

Lower Confidence Bound

01/01/2025

Upper Confidence Bound

Results consistently shows a higher accessibility of outdoor biophilic infrastructure than architectural biophilic infrastructure, which can be justified that multiple biophilic design principles are already embodied in traditional public space, but not necessarily architectural structures in the city, due to lack of innovation Figure 34 - Traditional design of greenspaces and investment (Figure 34). Since it requires technological innovation and more embodies some biophilic design principles. investment. Moreover, architectural biophilic structures may be private and Photo taken by me. inaccessible by public due to management and ownership reasons. Looking into details of the presence of multiple biophilic design elements, there is a lack of presence of education tours and panels. A huge part of urban environments are not designated to be educational, therefore developers would avoid implementing such educational facilities to minimise cost of maintenance and maximise profit (Figure 35). In contrast, there is a strong presence of physical access of greening and multi-sensorial experience with nature in architectural structures, which is contributed by the access to ornamental podium gardens, atrium decoration planted with fragrant plants and artificial water features in order to fulfil F i g u r e 3 5 - Pa n e l r e q u i r e s r e g u l a r public space guidelines and attraction to increase property value. The prominent maintenance. Photo taken by me. physical access to greening can be caused by the lack of specifying distance from greening as described in the statement. Also, ‘greening’ is a vague term that can mean any greenery such as unusable lawn strips next to traffic, potentially causing miscommunication when the questionnaire asks for usable green spaces. Main reasons reported from participants showed a consistent pattern from Kellert and Ulrich’s research. Interacting with biophilic infrastructure once every week provides opportunity for human to reconnect with nature and foster social interaction, recovering from highly stressed environments(Kellert and Wilson, 1993, Ulrich et al., 1991).

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Regional Differences Hong Kong has a lower accessibility of biophilic infrastructure than Singapore, which can be contributed to the lack of incentives and design guidelines to innovate green building construction, which is crucial for promoting biophilia. Due to housing demands, developments prioritize high capacity building over liveable sustainable green buildings in urban areas. Moreover, there is a lack of permeable public transport and accessible network hindering accessibility to natural areas caused by the natural topography. Compared to Singapore, Singapore have stronger incentives, design guidelines and recognition for smart construction strategies such as LUSH, BCA and ABC certification scheme (Appendices E), promoting vertical greening, high energy efficiency and water-harvesting facilities in developments, attracting investments to innovate in recent projects (Figure 36). The natural Figure 36 - Kampung Admiralty, an awardtopography of Singapore is relatively flat to Hong Kong, enabling a more permeable winning project in Singapore.(Hall, 2017) transport network to access natural areas especially different water edges, both situated within city centre or isolated areas. Both Hong Kong and Singapore have a strong presence of roadside plantation, however the quality of roadside planting can contrast quite drastically (Figure 37,38). Many plantation strips in Hong Kong public areas are not properly maintained, often causing safety risk during major storms, whereas Singapore planting strip remains in good condition due to their stable climate condition. As Singapore has better accessibility to biophilic infrastructure and higher amount Figure 37 - Roadside planting in Singapore. of green cover in urban areas, it contributes to a higher rating in Environmental Photo taken by me. Identity Scale, indicating a closer connection to nature. Looking into details, Singapore participants scores lower at the statement ‘I believe that some of today’s social problems could be cured by returning to a more rural lifestyle in which people live in harmony with the land.’, since the current socio-political problem cannot be resolved by rural lifestyle including ageing population and ISIS threats (2017, TODAYonline, 2017). All participants also score low at ‘I spend a lot of time in natural setting’, which can be explained by the lack of accessible fully unaltered natural habitat, or difficulty to access these areas on top of potential risk of bug bites, heatstroke and getting lost. Figure 38 - Roadside planting in Hong Kong

Nonetheless, all participants scores ‘Learning about the natural world should be (Google, 2017) an important part of every child’s upbringing.’ the highest, meaning participants agreeing to the statement. This indicate a similar outcome to Wilson and Kellert’s research, where human have an innate, hereditary connection and shows an urge to reconnect with nature throughout generations(Wilson, 1984, Kellert and Wilson, 1993)

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Correlation Demographics Results from the questionnaire indicates participant’s perceived stress level decreases as their age increases, which can be explained by less source of stressor such as change in lifestyle since they do not have to work anymore especially for those already retired, or now living on a stable pension system where source of income is no longer an issue. After retirement, participants have more free time to socialize and relax, as seen from retirees practicing Taichi (Figure 39) and mass dancing in public spaces (Figure 40)(McCay and Yip, 2018). Such outcome corresponds to Catharine’s research in Scotland and Cohen’s research conducted in the United States, implying this pattern is universal regardless of geographical area (Cohen and Janicki‐Deverts, 2012, Roe et al., 2017). Due to a lack of responses from Figure 39 - Elderly practicing Taichi in Hong participants older than 60 years of age, further exploration of correlation between Kong (Vesely, 2016) retirement and changes in perceived stress level cannot be done in this research. Contrasting to expectation, there is not enough results to indicate correlation between age and connection to nature, or between age and accessibility or exposure of biophilic infrastructure. This is potentially caused by decreasing mobility, stamina and health issues as participant’s age increases, hindering participants to access biophilic infrastructure frequently.

Connection to Nature and Perceived Stress Level Results from the questionnaire is not consistent and significant enough to indicate Figure 40 - Line dancing in Singapore (ULive, a correlation between connection with nature and perceived stress level, failing 2012) the hypothesis. Participants highly connected to nature does not equate they have a high accessibility to biophilic infrastructure or high capability to cope with stress. On the other hand, a lack of natural setting in urban environment might in turn enhance participant’s perceived stress level due to a lack of natural setting around them.

Perceived Stress level and Accessibility, Exposure to biophilic infrastructure To answer the research question, although the correlation between accessibility to biophilic infrastructure and perceived stress level was not strong enough to support the hypothesis, multiple other findings from the research were able to support the main hypotheses. Firstly, there is a negative correlation between perceived stress level and accessibility to biophilic infrastructure, and the correlation between perceived stress level and exposure to biophilic infrastructure are both strong and significant to conclude participant’s perceived stress level decreases as their exposure to biophilic infrastructure increases. It supports Ulrich’s recovery theory, and previous researches (Stigsdotter et al., 2018, Sus Sola et al., 2018).

Support Research Findings Biophilic Infrastructure and Perceived Stress Level Although data indicated a negative correlation between presence of biophilic infrastructure and participant’s capability to cope with stress, this correlation in fact implies the higher exposure or accessibility to biophilic infrastructure, the higher capability a participant can cope with stress. Such correlation is caused by the inverted scoring system in the perceived stress level in the process of obtaining the overall level (Figure 41). This finding reflects multiple reports from Hong Kong, reporting how public space, especially with quality greenspace fosters stress recovery(McCay and Yip, 2018, Chow, 2018)

Item Never Rarely O c c a - Often Always No. sionally 1 0 1 2 3 4 2 0 1 2 3 4 3 0 1 2 3 4 4 4 3 2 1 0 5 4 3 2 1 0 6 0 1 2 3 4 7 4 3 2 1 0 8 4 3 2 1 0 9 0 1 2 3 4 10 0 1 2 3 4 Figure 41 - Scoring Scheme of Perceived Stress Level (Cohen, 1994)

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Accessibility to Biophilic Infrastructure and Residing Floor This is tested if higher residing floor results in better accessibility to biophilic infrastructure since there are potentially more access to natural views on a daily basis. However, data analysis concludes accessibility to biophilic infrastructure and residing floors are not correlated. This can be explained since most residential buildings are located adjacent to other residential estates and situates within urban environments, therefore views to natural scenery are actually scarce, where most residential buildings look towards other buildings and skyscrapers (Figure 42).

Engagement with biophilic infrastructure, connection to nature and per- Figure 42 - Cramped residential building estates (Ko, 2018) ceived stress level The weak positive correlation between frequency of active engagement with biophilic infrastructure and connection with nature,implying the more participants engage with biophilic infrastructure, the more closely connected with nature participants feel. Consistent with hypothesis, it shows a similar underlying reason and pattern with the correlation between exposure to biophilic infrastructure and connection with nature, where the more participants are exposed to biophilic infrastructure, the closer participants feel connected to nature. Biophilic infrastructure here acts as a replacement of natural elements and provides a physical foundation for individuals to reconnect with nature while encircled by urban environments. This experience rewards pleasant natural stimulation, causing individuals to associate pleasure while interacting from nature.

Perceived Stress, accessibility and engagement to biophilic infrastructure There is a weak negative correlation between perceived stress and frequency of engagement with biophilic infrastructure, indicating the more individuals engage with biophilic infrastructure, the less individuals perceive stress. This result corresponds to McCay’s mental health resiliency and Ulrich’s theory, where frequent engagement with nature fosters better stress recovery (McCay and Yip, 2018, Ulrich et al., 1991). Furthermore, research suggests active engagement with biophilic infrastructure also enhances cognitive performance and productivity in working environments (Browning et al., 2014, Browning, 2016, Ulrich et al., 1991), as supported by how Singapore also have a higher productivity figure than Hong Kong while having a higher average exposure to biophilic infrastructure (CEIC, 2018b, CEIC, 2018a). This result implies individuals should engage with biophilic infrastructure more often to foster better stress management without medical help. To promote higher engagement to biophilic infrastructure, research suggests improving accessibility to biophilic infrastructure can be one crucial solution to encourage engagement with biophilic infrastructure.

Summary From the above findings, this research supports a increase of accessible biophilic infrastructure can be a solution to prevent mental health issues. Biophilic infrastructure can become a widely accessible self-guided stress relief facility for stressed individuals or patients diagnosed with stress-induced diseases, as well as a normal public space that fosters subjective stress recovery and intervention to foster better mental health through facilitating the space for physical activity, positive social interaction and nature exposure.(McCay and Yip, 2018)

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Limitation Methodological weakness Overall, there are multiple weaknesses in the research methodology which potentially affects the certainty of the research. Similar to most social science researches, this questionnaire is a retrospective study, which request participants to look backward in time and recall memories and impressions related to the research objectives (Statsdirect Limited, 2018). Such study method is unreliable as participants might have overlooked or forgotten certain details that might be Figure 43 - participant feedback present in either cities but did not include in the response. Besides,they may be recalling far memories that might not exist in the city anymore. If resources allowed, a prospective study with smaller sample size should be carried out, where a residency program should be carried out to track the changes in stress level when exposed to the two cities, with different level of accessibility to biophilic infrastructure. Secondly, all questionnaires are carried out in a self-administered format, meaning participants have to speculate and interpret ambiguous terms without access to clarification, hindering participants from responding accurately. Some participants, especially layman of architectural terms gave feedbacks that the questionnaire is hard to understand, which further enhances the uncertainty and potential inaccuracy to their responses (Figure 42, 43). One way to improve the quality of the questionnaire can be piloting the questionnaire, which has been carried out once Figure 44 - participant feedback before opening for responses. However, with more piloting trials, it allows more refinement in the clarity and well-rounded questionnaire. Thirdly, participants only have to reside in Hong Kong or Singapore for more than 3 consecutive months to be eligible to take part of the survey, unlimited to when that residency took place. Some participants might have already left the cities for substantial amount of time, which means their impression towards the city might not be accurate as to today’s environment. According to participants’ feedback, they did not get to know and explore the city enough within 3 months, therefore their responses might not be accounted to how much biophilic infrastructure the city actually have. One way to improve this is to change the eligibility of participants from ‘have resided in Hong Kong or Singapore for more than 3 months’ to ‘resided in Hong Kong or Singapore for more than 1 year in the past 5 years’ to collect more accurate data. Lastly, the questionnaire samples participant through convenience sampling in order to acquire the maximum number of responses. By such non-probability sampling method, demographic profiles of all participants are unlikely to be able to represent both city’s demographic profile, therefore generalization from this research cannot be considered as credible for further research (Saunders, 2012).

Questionnaire Composition Specifically looking into the design of the questionnaire, multiple adjustments can be made to improve the accuracy of responses. First and most important of all, a more refined layout can be applied to explain biophilia and biophilic infrastructure, while the definitions provided for terms should be more detailed and specific while supported with visual references. Due to the software constraints, the written definition of the technical terms are very small, and hard to understand for some of the participants, while the pictorial examples of biophilic infrastructure are very bulky in proportion to the other elements in the page. To improve, the layout can be designed through other graphic design software, exporting the overall layout as one or more image file and upload them onto the software, instead of constrained to the default layout provided.

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In terms of adapted assessment scales, there are also several weaknesses in hindering the accuracy of the data collected. Cohen’s Perceived Stress Scale is only valid for the performance from past 8 weeks, which indicates the results are not permanent and only shows short term stressor’s impact to individuals (Cohen, 1994). However, reference data from this scale is most accessible and most commonly used for similar researches, providing a good foundation for comparison. For Environmental Identity Scale, item 10 – ‘Being a part of the ecosystem is an important part of who I am’ should be removed from the survey since it is the only element most inconsistent to the rest of the survey while the other 21 items shows a stable pattern, as seen from Olivo’s study of the scale (Olivos and Aragonés, 2011). During data processing, multiple flaws are found within the formula for calculating the exposure to biophilic infrastructure, however due to time constraint, the formula was not refined at the end of this research. The current formula takes the accessibility to biophilic infrastructure and multiply by to corresponding frequency of engagement with, where there is no weighting between biophilic infrastructure existing in daily surroundings and ones that requires visits. A new equation with such weighing is proposed if this research is carried out again:

where: stands for the average accessibility of outdoor, biophilic public spaces; stands for the average accessibility of architectural biophilic infrastructure; stands for the frequency of engagement with biophilic infrastructure embodied in daily surroundings; stands for stands for the biophilic infrastructure that requires visiting. The weighing of 5/7 and 2/7 from the equation is based on the assumption that most full time working class only have time to visit biophilic infrastructures on the weekends and the remaining 5 days are mainly engaging with biophilic infrastructure with daily surroundings. A quick correlation test against the main three outcome variables to test the credibility of the formula, results displayed as below: Current exposure

Perceived stress level Accessibility to biophilic infrastructure Connection to nature

Correlation Coefficient -0.230 0.567 0.275

P-value 0.012 .000 0.003

New exposure using new formula Correlation P-value Coefficient -0.246 0.007 0.561 0.000 0.287 0.002

Table 21 - Comparison of the current exposure and new exposure formula

Testing results shows a similar correlation coefficient between the variables, however the p-value that supports the significance of the dataset has improved all to moderately significant or above. Besides, the questionnaire neglected passive interaction with biophilic infrastructure that also offers passive stress recovery on individuals, but the specific method of measuring it remains unclear throughout the research. Once quantifiable, passive interaction should also be taken into account in the exposure formula. In addition, the increment between the options for frequency of interacting with biophilic infrastructure is too large that hinders an accurate result to be collected. Instead of jumping from ‘once every 6 months’ directly onto ‘once every month’, a ‘once every 3 months’ option should be added to the list of options available.

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Demography profile of participants The data collected from the questionnaire shows a contrasting number of participants between Hong Kong and Singapore, causing a methodological difference in analysing the data from two cities, as seen in identifying notable results and the different uncertainty by default caused from the number of participants (Appendices F). Such results from data collection is caused by the chosen sampling method. Despite the effort to promote on multiple organizational webpages to attract more participant from different backgrounds, most of the participants of the survey are family members, friends, previous work colleagues from my social circle, which are predominantly residing in Hong Kong. Secondly, over 30% of all participants are working in the architecture, engineering and construction industry, which is especially significant for data from Singapore, where half of the participants are working in this industry, which potentially made them more aware and has a higher preliminary understanding to biophilic infrastructure. Besides caused by sampling method, it potentially can be caused by how different occupations are classified into clusters. Moreover, over 99% of participants have acquired diploma or above certification, which firstly does not account demographic profile and they are more aware to current news and technical knowledge. Less educated participants are more likely to forfeit or unable to complete the questionnaire due to the difficult terms, otherwise completely unreachable with the advertising method which is almost entirely online. To improve the accuracy of results and eliminate as much uncertainty from the above limitations, research sampling method should be replaced by random sampling. Although unable to do so in this research due to resource and time constraints, random sampling participant allows a more accurate demographic profile to be constructed for this research, achieving a more accountable and reliable data and figures for perceived stress level, connection with nature and presence of biophilic infrastructure.

Implication As a prospective landscape architect, this study is particularly useful to understand how important my industry is, since the quality of environment and the tiniest multi-sensorial prompt in a space can change how individuals react and feel. This study has inspired me to understand the underlying reasons of why different biophilic design element foster recovery, and how can one implement these elements creatively to create urban hideaway for individuals to recover and reconnect with nature, while surrounded by a highly built environment. For further research, there are other variables that are not tested within the data that has been collected. Firstly, more tests can be carried out on discovering hidden correlation between different demographic indicators such as occupation and gender, and how their perceived stress level, connection with nature and presence of biophilic infrastructure differs. If resources allows, this study should be conducted under more control such as evaluating the effectiveness of stress recovery on different level of engagement with biophilic infrastructure, or even a residency program. Noting the triangle of city, a further study should also take account of social capital. Relating to landscape architecture, one can evaluate different biophilic-branded projects worldwide and consult the psychological impact it has on the surrounding community, setup a hard set of specific, quantifiable criteria to evaluate how biophilic in a development. In terms of designing the biophilic infrastructural elements, interesting topics are not limited the preference of types of public facilities to develop with biophilic considerations to maximise efficacy and usage by public, the efficiency and efficacy of biophilic infrastructure as a stress recovery solution by comparing with nature based therapy and other clinical therapies.

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Conclusion A liveable and productive city is built upon three elements: Social capital, good mental health and planned built environment (Araya et al., 2006). As cities continue to thrive, there is also a noticeable increase in mental health problems (Degenhardt et al., 2018). Inspired from Ulrich, Kellert and Wilson’s research, a biophilic city – a city that fosters co-existence and reconnection with nature can be a crucial solution to improve living quality and mental wellbeing in urban environments. With limited to none scientific research certifying the benefits of biophilic infrastructure Figure 44 - Singapore, photo taken by me specifically in mental health recovery, this research aimed to record pilot figures of perceived stress levels and connection with nature at two cities in South East Asia region, as well as to examine the relationship between the presence of biophilic infrastructure in a city and resident’s perceived stress level. As seen from multiple established correlation from this research, The more individuals are exposed and actually engages with biophilic infrastructure, they have a higher capability to cope with stress and a lower overall perceived stress level. Biophilic infrastructure can provide a middle ground to fulfil the need of urbanizing environments while staying closely connected with nature, most importantly serving as a widely accessible passive stress recovery strategy for highly stressed individual and fosters mental health resilience. Figure 45 - Hong Kong, photo taken by me

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Appendices Appendices A - Glossary • Biophilia - an inherent quality and tendency of all living organism to live and preserve its existence • Biophilic infrastructure - physical structures and facilities that both serve the city’s fundamental system, while promoting a reconnection and positive experience with natural elements • Perceived stress level - Measure of the degree to which situations in one’s life are appraised as stressful • Presence of biophilic infrastructure - The existence and popularity of biophilic infrastructures in the city. Due to technical constraints of the study, this term refers to how aware is the participant of biophilic infrastructure around their surroundings since there is no objective way to measure it in this research. • Accessibility to biophilic infrastructure - The quantifiable score of how many biophilic design elements are present and accessible to a participant • Exposure to biophilic infrastructure - A derived figure based on the accessibility to biophilic infrastructure and engagement with biophilic infrastructure to calculate how exposed is a participant to biophilic infrastructure • Engagement with biophilic infrastructure - How often particpants activaly appraise and interact with biophilic infrastructure.

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Appendices B - Questionnaire for research data collection

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Appendices C - Perceived Stress Scale Survey

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Appendices D - Survey of refined Environmental Identity Scale Environmental Identity (EID) scale Appears in Clayton,S., (2003).Environmental identity: A conceptual and an operational definition. In S. Clayton & S. Opotow, (Eds.). Identity and the natural environment (pp. 45-­‐65). Cambridge, MA: MIT Press. Indicate your sex: Female/Male (circle one) Please indicate the extent to which each of the following statements describes you by using the appropriate number from the scale below. 1 2 3 4 5 Not at all neither true true of me nor untrue

6

7 completely true of me

_____ 1. I spend a lot of time in natural settings (woods, mountains, desert, lakes, ocean). _____ 2. Engaging in environmental behaviors is important to me. _____ 3. I think of myself as a part of nature, not separate from it. _____ 4. If I had enough time or money, I would certainly devote some of it to working for environmental causes. _____ 5. When I am upset or stressed, I can feel better by spending some time outdoors "communing with nature". _____ 6. Living near wildlife is important to me; I would not want to live in a city all the time. _____ 7. I have a lot in common with environmentalists as a group. _____ 8. I believe that some of today’s social problems could be cured by returning to a more rural lifestyle in which people live in harmony with the land. _____ 9. I feel that I have a lot in common with other species. _____ 10. Being a part of the ecosystem is an important part of who I am. _____ 11. I feel that I have roots to a particular geographical location that had a significant impact on my development. _____ 12. Behaving responsibly toward the earth -- living a sustainable lifestyle -- is part of my moral code. _____ 13. Learning about the natural world should be an important part of every child's upbringing. _____ 14. In general, being part of the natural world is an important part of my selfimage. _____ 15. I would rather live in a small room or house with a nice view than a bigger room or house with a view of other buildings. _____ 16. I really enjoy camping and hiking outdoors. _____ 17. Sometimes I feel like parts of nature -- certain trees, or storms, or mountains have a personality of their own. _____ 18. I would feel that an important part of my life was missing if I was not able to get out and enjoy nature from time to time. _____ 19. I take pride in the fact that I could survive outdoors on my own for a few days. _____ 20. I have never seen a work of art that is as beautiful as a work of nature, like a sunset or a mountain range. 51


_____ 21. My own interests usually seem to coincide with the position advocated by environmentalists. _____ 22. I feel that I receive spiritual sustenance from experiences with nature. _____ 23. I keep mementos from the outdoors in my room, like shells or rocks or feathers.

Appendices E - Singpore’s Biophilic Design Guidelines Singapore’s city planning revolves around 4 planning departments. Firstly, Public Utilities Board (PUB) manages water and energy supplies. In 2012, Ramboll Studio Dreiseitl of Singapore collaborated with PUB and curated the Active, Beautiful and Clean Water Feature Framework. It is a certification scheme which encourages rainwater harvesting and on-site water treatment to reduce imported water consumption and higher recycling rate of water. Secondly, Housing Development Board is the department in charge of developing public housing estates to accomodate the increasing population of Singapore. They have a research team which published a framework called HDB Sustainable Development Framework that breaks sustainable into three main components of social, environmental and economical, which also then breaks down into many more indicators. In collboration with other governmental department and National University of Singapore, they have published a research called ‘Nature, Place, People: Foraging Connections through Neighborhood Landscape Design’ which ddescribes the biophilic town framework. Thirdly, National Parks Board is a environment oriented department which monitors, preserve, maintain all national parks of Singapore including the iconic Botanic garden. In relation to biophilic design, they have published and developed a park connector network (PCN), consisting designated pedestrian and cycling path for public to access from one park to the other across Singapore. Lastly, Urban Redevelopment Authority (URA) focuses on the central, built areas of Singapore, and the larger urban planning aspect of all departments. URA monitors greening ratio and eco-friendly building standards in the nation. They have developed several design guidelines for developers to earn certifications if their development fulfills their design standards. This includes a vertical greening framework called LUSH, which stands for Landscaping for Urban Spaces and High-Rises Programme which encourages developers to implement urban rooftop farms, productive gardens and other plantations above ground level.

Appendices F - Identifying notable results in data analysis Due to the difference in sample size between Singapore and Hong Kong, notable results from each cities have to be determined at a different criteria. This is directly related what is mentioned in the results section and the focus of discussion. For Hong Kong, a notable result is defined by 40% or above of all Hong Kong participants picking the same option out of the 4-5 options available. If more than 80% of participants chose two of the options combined, it is the most notable and shall be mentioned in the results section. For Singapore, a notable result is defined by 60% or above of all Singapore participants picking the same option out of all options available. If more than 80% of participants chose two of the options combined, it is the most notable and shall be mentioned in the results section.

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