IDEAS home Printed from https://ideas.repec.org/a/gam/jsusta/v17y2025i13p5779-d1685641.html
   My bibliography  Save this article

An Exploratory Estimation of the Willingness to Pay for and Perceptions of Nature-Based Therapy for Cardiovascular Diseases

Author

Listed:
  • Aisling Sealy Phelan

    (Department of Land, Environment, Agriculture and Forestry (TESAF), University of Padova, Viale dell’Università 16, 35020 Legnaro, Italy)

  • Elena Pisani

    (Department of Land, Environment, Agriculture and Forestry (TESAF), University of Padova, Viale dell’Università 16, 35020 Legnaro, Italy)

  • Chiara Tessari

    (Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy)

  • Laura Secco

    (Department of Land, Environment, Agriculture and Forestry (TESAF), University of Padova, Viale dell’Università 16, 35020 Legnaro, Italy)

Abstract

There is increasing evidence of the benefits of natural environments for human health. Interest is growing in nature-based therapy (NBT), organised initiatives that promote human–nature interactions with the aim of achieving positive health outcomes. Although the benefits of spending time in nature are now widely recognised, the public’s perspective of NBTs is still not well understood nor quantified. At the same time, chronic non-communicable diseases such as cardiovascular disease are on the rise, increasing costs and pressure for public health services. Using a sample of 96 respondents in Italy, this exploratory study investigates the economic value and perceptions of an NBT for cardiovascular disease. We employed the contingent valuation method to estimate marginal willingness to pay (WTP) for a nature-based rehabilitation programme compared to a standard indoor clinic-based programme. Logistic regression was used to estimate median WTP and influencing factors. We investigated the preferences of patients for the features and potential benefits of nature-based rehabilitation. We show that patients with cardiovascular disease in Italy have a positive WTP between EUR 14.01 to EUR 42.69 per day (median value EUR 27.26). Our findings indicate that NBTs could offer a promising alternative to standard indoor programmes. We provide recommendations for designing NBTs based on the preferences of our sample, aiming to contribute to sustainable health and land management policies.

Suggested Citation

  • Aisling Sealy Phelan & Elena Pisani & Chiara Tessari & Laura Secco, 2025. "An Exploratory Estimation of the Willingness to Pay for and Perceptions of Nature-Based Therapy for Cardiovascular Diseases," Sustainability, MDPI, vol. 17(13), pages 1-25, June.
  • Handle: RePEc:gam:jsusta:v:17:y:2025:i:13:p:5779-:d:1685641
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/2071-1050/17/13/5779/pdf
    Download Restriction: no

    File URL: https://www.mdpi.com/2071-1050/17/13/5779/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Shogren, Jason F. & Seung Y. Shin & Dermot J. Hayes & James B. Kliebenstein, 1994. "Resolving Differences in Willingness to Pay and Willingness to Accept," American Economic Review, American Economic Association, vol. 84(1), pages 255-270, March.
    2. Kanninen Barbara J., 1995. "Bias in Discrete Response Contingent Valuation," Journal of Environmental Economics and Management, Elsevier, vol. 28(1), pages 114-125, January.
    3. Elizabeth W. Holt & Quinn K. Lombard & Noelle Best & Sara Smiley-Smith & John E. Quinn, 2019. "Active and Passive Use of Green Space, Health, and Well-Being amongst University Students," IJERPH, MDPI, vol. 16(3), pages 1-13, February.
    4. Sebastian Hinde & Laura Bojke & Peter Coventry, 2021. "The Cost Effectiveness of Ecotherapy as a Healthcare Intervention, Separating the Wood from the Trees," IJERPH, MDPI, vol. 18(21), pages 1-13, November.
    5. Richard D. Smith, 2008. "Contingent valuation in health care: does it matter how the ‘good’ is described?," Health Economics, John Wiley & Sons, Ltd., vol. 17(5), pages 607-617, May.
    6. Jules Pretty & Jo Barton, 2020. "Nature-Based Interventions and Mind–Body Interventions: Saving Public Health Costs Whilst Increasing Life Satisfaction and Happiness," IJERPH, MDPI, vol. 17(21), pages 1-23, October.
    7. Peter A. Diamond & Jerry A. Hausman, 1994. "Contingent Valuation: Is Some Number Better than No Number?," Journal of Economic Perspectives, American Economic Association, vol. 8(4), pages 45-64, Fall.
    8. W. Michael Hanemann, 1994. "Valuing the Environment through Contingent Valuation," Journal of Economic Perspectives, American Economic Association, vol. 8(4), pages 19-43, Fall.
    9. Henriette Busk & Ulrik Sidenius & Line Planck Kongstad & Sus Sola Corazon & Christina Bjørk Petersen & Dorthe Varning Poulsen & Patrik Karlsson Nyed & Ulrika Karlsson Stigsdotter, 2022. "Economic Evaluation of Nature-Based Therapy Interventions—A Scoping Review," Challenges, MDPI, vol. 13(1), pages 1-19, May.
    10. Yonko Dodev & Miglena Zhiyanski & Maria Glushkova & Bilyana Borisova & Lidiya Semerdzhieva & Ivo Ihtimanski & Stelian Dimitrov & Stoyan Nedkov & Mariyana Nikolova & Won-Sop Shin, 2021. "An Integrated Approach to Assess the Potential of Forest Areas for Therapy Services," Land, MDPI, vol. 10(12), pages 1-30, December.
    11. Bateman, Ian J. & Burgess, Diane & Hutchinson, W. George & Matthews, David I., 2008. "Learning design contingent valuation (LDCV): NOAA guidelines, preference learning and coherent arbitrariness," Journal of Environmental Economics and Management, Elsevier, vol. 55(2), pages 127-141, March.
    12. J. Pretty & J. Peacock & R. Hine & M. Sellens & N. South & M. Griffin, 2007. "Green exercise in the UK countryside: Effects on health and psychological well-being, and implications for policy and planning," Journal of Environmental Planning and Management, Taylor & Francis Journals, vol. 50(2), pages 211-231.
    13. Michael Hanemann & John Loomis & Barbara Kanninen, 1991. "Statistical Efficiency of Double-Bounded Dichotomous Choice Contingent Valuation," American Journal of Agricultural Economics, Agricultural and Applied Economics Association, vol. 73(4), pages 1255-1263.
    14. Alberini Anna, 1995. "Optimal Designs for Discrete Choice Contingent Valuation Surveys: Single-Bound, Double-Bound, and Bivariate Models," Journal of Environmental Economics and Management, Elsevier, vol. 28(3), pages 287-306, May.
    15. Richard Cookson, 2003. "Willingness to pay methods in health care: a sceptical view," Health Economics, John Wiley & Sons, Ltd., vol. 12(11), pages 891-894, November.
    16. Ned Hartfiel & Heli Gittins & Val Morrison & Sophie Wynne-Jones & Norman Dandy & Rhiannon Tudor Edwards, 2023. "Social Return on Investment of Nature-Based Activities for Adults with Mental Wellbeing Challenges," IJERPH, MDPI, vol. 20(15), pages 1-13, August.
    17. Mandy Ryan & Emmanouil Mentzakis & Catriona Matheson & Christine Bond, 2020. "Survey modes comparison in contingent valuation: Internet panels and mail surveys," Health Economics, John Wiley & Sons, Ltd., vol. 29(2), pages 234-242, February.
    18. Sujin Park & Soojin Kim & Geonwoo Kim & Yeji Choi & Eunsoo Kim & Domyung Paek, 2021. "Evidence-Based Status of Forest Healing Program in South Korea," IJERPH, MDPI, vol. 18(19), pages 1-16, October.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Tsu‐Tan Fu & Jin‐Tan Liu & James K. Hammitt, 1999. "Consumer Willingness to Pay for Low‐Pesticide Fresh Produce in Taiwan," Journal of Agricultural Economics, Wiley Blackwell, vol. 50(2), pages 220-233, May.
    2. John K. Horowitz & Kenneth E. McConnell & James J. Murphy, 2013. "Behavioral foundations of environmental economics and valuation," Chapters, in: John A. List & Michael K. Price (ed.), Handbook on Experimental Economics and the Environment, chapter 4, pages 115-156, Edward Elgar Publishing.
    3. Ryan, Mandy & Scott, David A. & Donaldson, Cam, 2004. "Valuing health care using willingness to pay: a comparison of the payment card and dichotomous choice methods," Journal of Health Economics, Elsevier, vol. 23(2), pages 237-258, March.
    4. Mvangeli Dlamini, Nqobizwe, 2015. "Households' Water Use Demand and Willingness to Pay for Improved Water Services: A Case Study of Semi-Urban Areas in the Lubombo and Lowveld Regions of Swaziland," Research Theses 243464, Collaborative Masters Program in Agricultural and Applied Economics.
    5. Robert J. Johnston & Kevin J. Boyle & Wiktor (Vic) Adamowicz & Jeff Bennett & Roy Brouwer & Trudy Ann Cameron & W. Michael Hanemann & Nick Hanley & Mandy Ryan & Riccardo Scarpa & Roger Tourangeau & Ch, 2017. "Contemporary Guidance for Stated Preference Studies," Journal of the Association of Environmental and Resource Economists, University of Chicago Press, vol. 4(2), pages 319-405.
    6. Akoko, Peter Obuon & Gathungu, Edith & De Groote, Hugo, 2024. "Evaluating Smallholder Farmers’ Willingness to Pay for Improved Maize Dryers in Njoro Sub-County, Nakuru, Kenya," IAAE 2024 Conference, August 2-7, 2024, New Delhi, India 344279, International Association of Agricultural Economists (IAAE).
    7. Smith, V. Kerry & Mansfield, Carol, 1998. "Buying Time: Real and Hypothetical Offers," Journal of Environmental Economics and Management, Elsevier, vol. 36(3), pages 209-224, November.
    8. Ebers Broughel, Anna, 2019. "On the ground in sunny Mexico: A case study of consumer perceptions and willingness to pay for solar-powered devices," World Development Perspectives, Elsevier, vol. 15(C), pages 1-1.
    9. John C. Whitehead & Timothy C. Haab & Ju‐Chin Huang, 1998. "Part‐Whole Bias in Contingent Valuation: Will Scope Effects Be Detected with Inexpensive Survey Methods?," Southern Economic Journal, John Wiley & Sons, vol. 65(1), pages 160-168, July.
    10. Catherine L. Kling & Daniel J. Phaneuf & Jinhua Zhao, 2012. "From Exxon to BP: Has Some Number Become Better Than No Number?," Journal of Economic Perspectives, American Economic Association, vol. 26(4), pages 3-26, Fall.
    11. Powe, N. A. & Bateman, I. J., 2003. "Ordering effects in nested 'top-down' and 'bottom-up' contingent valuation designs," Ecological Economics, Elsevier, vol. 45(2), pages 255-270, June.
    12. Schwarzinger, Michaël & Carrat, Fabrice & Luchini, Stéphane, 2009. ""If you have the flu symptoms, your asymptomatic spouse may better answer the willingness-to-pay question": Evidence from a double-bounded dichotomous choice model with heterogeneous anchori," Journal of Health Economics, Elsevier, vol. 28(4), pages 873-884, July.
    13. Diane Dupont, 2003. "CVM Embedding Effects When There Are Active, Potentially Active and Passive Users of Environmental Goods," Environmental & Resource Economics, Springer;European Association of Environmental and Resource Economists, vol. 25(3), pages 319-341, July.
    14. Henrik Andersson & James Hammitt & Gunnar Lindberg & Kristian Sundström, 2013. "Erratum to: Willingness to Pay and Sensitivity to Time Framing: A Theoretical Analysis and an Application on Car Safety," Environmental & Resource Economics, Springer;European Association of Environmental and Resource Economists, vol. 56(3), pages 457-457, November.
    15. Kees Vringer & Eline van der Heijden & Daan van Soest & Herman Vollebergh & Frank Dietz, 2017. "Sustainable Consumption Dilemmas," Sustainability, MDPI, vol. 9(6), pages 1-21, June.
    16. Veisten, Knut, 2007. "Contingent valuation controversies: Philosophic debates about economic theory," Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Elsevier, vol. 36(2), pages 204-232, April.
    17. Bodo Sturm & Joachim Weimann, 2006. "Experiments in Environmental Economics and Some Close Relatives," Journal of Economic Surveys, Wiley Blackwell, vol. 20(3), pages 419-457, July.
    18. Ndebele, Tom & Forgie, Vicky, 2017. "Estimating the economic benefits of a wetland restoration programme in New Zealand: A contingent valuation approach," Economic Analysis and Policy, Elsevier, vol. 55(C), pages 75-89.
    19. Richard T. Carson, 2011. "Contingent Valuation," Books, Edward Elgar Publishing, number 2489, December.
    20. Cook, David & Davíðsdóttir, Brynhildur & Kristófersson, Daði Már, 2016. "Energy projects in Iceland – Advancing the case for the use of economic valuation techniques to evaluate environmental impacts," Energy Policy, Elsevier, vol. 94(C), pages 104-113.

    More about this item

    Keywords

    ;
    ;
    ;
    ;
    ;
    ;
    ;

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jsusta:v:17:y:2025:i:13:p:5779-:d:1685641. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.