The COVID-19 pandemic has had a profound impact on human society (1). Although control measures have calmed the outbreak, they have also exacerbated mental health problems (2, 3). A growing body of literature underlines the importance of extended psychological and physical health distress during the COVID-19 epidemic (4, 5), which is considered a public health concern. Although people may suffer from many adverse effects on their health during an epidemic, such as fear of viral infection, prolonged isolation, and other complex factors, people with optimistic dispositions tend to ease stress and anxiety caused by the epidemic because of their positive psychological cues, improve their physical health, seek social interactions to fulfill their social roles, and maintain their intrinsic mental and emotional health (6, 7).

Natural areas can provide an escape from mundane urban life (8). Many studies have suggested that natural connectivity in a therapeutic landscape provides a comfortable and healing environment for tourism and recreation (8–10). This reduction in mental and physical resources can be offset by access to a therapeutic environment (11, 12). Thus, visits to wetland parks, which are special parks with therapeutic landscapes in urban areas, may effectively prevent anxiety and depression caused by short- and long-term quarantines and lockdowns in natural environments (13–15). Wetland parks in urban areas improve water and air quality, support biodiversity, and promote human comfort (16, 17). However, less attention has been paid to the important role of therapeutic landscapes in urban wetland parks in healing, restoring, and maintaining human health (18–20). Therefore, it is paramount to understand how the experience of wetland parks benefits visitors’ perceived health. This study attempts to broaden the knowledge of how the experience of wetland parks’ therapeutic environment affects people’s health perceptions.

In addition, evidence shows differences in individuals’ perceptions of their health status based on gender, age, personality traits, and cultural background. These heterogeneities can directly influence visitors’ attitudes and behaviors toward health issues. Highly preferable and stimulating landscapes in wetland parks can improve people’s mental state and promote physical wellbeing. However, factors such as social background and personal preferences differ between individuals, leading to differences in their subjective perceptions of health. Therefore, understanding the heterogeneity of visitors’ health perceptions during their visit to wetland parks is important for improving their health status. Heterogeneity in health perceptions has become an important issue in several fields, including social psychology and behavioral medicine. However, academic research on health perception in wetland parks is lacking. Therefore, further research is needed to understand the heterogeneity in the health perceptions of wetland park visitors and guide the planning and management of wetland park landscapes.

The following section proposes a comprehensive framework through which we explore the nature and strength of the relationships between people’s perceived health and their experiences with the therapeutic landscape in terms of landscape perception, restorative experiences, and dispositional optimism tendencies in wetland parks. This is followed by a description of the methods used for data collection and modeling approaches, including latent class analysis (LCA) and structural equation modeling (SEM). Based on these results, the key findings and discussion are presented in Section 4. Finally, conclusions and implications are presented in the last section.

The landscape comprises physical, social, and symbolic aspects (21). People perceive the physical landscape as the interaction between individuals and the natural and built environments (22). The park, which is characterized by highly visible mowed areas, open water, and flourishing planting mixtures, provides a diverse and picturesque landscape for visitors to enjoy (23–27). It is attractive to walkers, dog walkers, and cyclists and provides space and opportunities for physical activity (28, 29). The social aspect of the landscape is perceived by individuals when they interact socially, and it includes a wide range of themes related to public attitudes, values, behaviors, and activities (30). The social aspect of the landscape benefits social integration by providing public spaces for activities that generate broad social connections and overcome people’s feelings of social isolation and exclusion (31, 32). The symbolic landscape, as a psychological cue, is associated with the public’s belief in the healing characteristics of the therapeutic environment (33–36). For example, national parks in the United States function prominently in American culture and religion, with symbolic meanings of ‘inspiration’, ‘stability’, and ‘healing’ (37).

By visiting urban wetland parks, people can access the therapeutic landscape of nature with water, diverse vegetation, open lawns, and bright flowers, resulting in substantial improvements in mood, cognitive function, and mental health (38–40). A temporary escape from the dreary pressures of work and life and immersion in nature can satisfy the need for fresh air, sunlight, water, and food, thus facilitating a restorative experience (41). Moreover, comfortable public spaces in wetland parks allow visitors to interact socially, independent of their socio-economic status (31, 32). Wetland parks provide uncrowded and undisturbed spaces for visitors seeking solitary experiences, such as meditation and independent thinking, in natural environments. In addition, visitors can achieve psychological benefits through horticultural activities that ultimately improve their perception of restoration (40).

According to the literature, an individual’s health is influenced by environmental factors, sociodemographic characteristics, and psychological traits (18, 39, 42, 43). Dispositional optimism is a positive psychological trait often associated with good health and relief from stress and anxiety (44). Therefore, experiences in wetland parks may have an impact on health perception, which may vary among individuals with various sociodemographic backgrounds and behavioral activities.

Previous studies have indicated a diversity in individuals’ health perceptions (45, 46). However, it cannot be simply determined a priori from the relevant observed variables because the unobserved heterogeneity in an individual’s perception is not necessarily captured by the variables preconceived and specified by existing theoretical and conceptual models, but it can exist outside of the previously identified variables (47). For example, the results of various studies on gender differences in health perceptions in wetland parks are mixed: Some studies have found no significant differences in health perceptions between men and women who visited wetland parks before and after the outbreak (39), while others have shown that women who visited nature reserves felt healthier than men (48). It is imperative to classify heterogeneous visitors into multiple homogeneous groups and identify appropriate treatments for wetland park planning and design. A new modeling framework (Figure 1) was developed to accurately capture the health behavior patterns and core characteristics of different populations.

We investigated the impact of restorative landscapes in wetland parks on the health perceptions of respondents during the COVID-19 pandemic. By classifying respondents’ health perceptions into latent classes, we found that visitors could be classified into three groups with significant group heterogeneity in the population. Sociodemographic characteristics and behavioral factors showed different associations with each group.

Compared with the ‘medium self-perception of health’ class, respondents in the ‘good self-perception of health’ group were more likely to be freelancers and have a higher education level. Consistent with previous studies, freelancers have more time at their disposal and fewer stressors than other professionals, and participating in leisure and recreational activities can reduce psychological stress and improve their physical and mental wellbeing. With the improvement in education level, highly educated people have a relatively high preference for wild nature and a strong restorative experience in wetland parks (23). Our results also showed that residents of unsealed neighborhoods had a higher probability of belonging to the ‘good self-perception of health’ category during the peak of the epidemic. Lockdown measures have been a panacea for pandemic control. However, home restrictions and the overall disruption of personal daily life have made people exercise less; the workspace in a home office environment has increased the chances of physical pain and other physical health conditions, and blurred work–life boundaries can make it difficult to detach mentally from work, which can increase stress and anxiety. Therefore, when dealing with major safety and health events such as the epidemic, the community and the wetland park should adopt a ‘closed’ and ‘open’ relationship (12, 60–64). The frequency and intensity of park cleaning and disinfection can be increased within the park, and infrastructure to stimulate exercise can be incorporated. The maximum number of visitors to a park during an outbreak can also be predicted, and spaces with a large distribution of visitors can be monitored for flow and effective evacuation guidance. Outside the parks, it is necessary to increase connections with residents in neighboring communities and improve residents’ accessibility to parks (65).

Compared to the ‘medium self-perception of health’ group, the ‘poor self-perception of health’ group was more likely to include women. Consistent with previous studies, gender strongly shapes the experience of visitors to urban parks, with men being more likely than women to rate health benefits when visiting urban blue-green spaces at peak times. In addition, the more frequently residents visit parks, the better their perceived health status, which indicates that park users develop place attachment and increased affinity with nature, which contribute to health benefits. The more residents lived in a wetland park, the worse their perceived health. This is because, at the peak of the epidemic, many non-essential commercial and public spaces were off-limits. People’s need to visit outdoor spaces was higher than ever. Thus, the closer the urban wetland park was to the neighbourhood, the more people had access to the park, and the more likely they felt healthy. Therefore, it is possible to extend the opening hours of wetland park services during epidemics and improve accessibility to parks while observing more accurate infection prevention methods to ensure wetland park use (65, 66).

The SEM results of the three categories showed that landscape perception, optimistic personality tendencies, and restorative experiences had different strengths and associations with health perception. It is worth noting that in the first category, the symbolic landscape has no positive effect on health perception and restorative experience, possibly because the environmental elements and cultural cues associated with symbolic restorative health in China’s wetland parks have not yet established positive images for people. Fewer psychological hints about health are available to visitors compared to those available at famous sites known for longevity and healing. Therefore, in future construction of wetland parks, planning designers can try to add cultural clues and symbols with symbolic significance for health and create environmental factors conducive to the healthy restoration of wetland parks. Additionally, the results showed that optimism had an impact on health perceptions regardless of group, and optimists’ positive expectations are not limited to specific areas of behavior or types of circumstances.

This study examined the impact of wetland park landscapes on different health-perceiving populations during the COVID-19 pandemic. The study identified various factors affecting the potential categories of health perception of visitors, such as gender, marital status, education, work status, housing, community management, distance from home, purpose, form of companionship, and frequency of pre-pandemic park visits. The existence of different pathways and correspondence coefficients among the three potential categories of visitor groups was also investigated. In the event of a future major safety and health event, wetland park managers should pre-emptively address the need for ‘closed’ and ‘open’ relationships between communities and wetland parks and try to increase cultural cues and symbols with health symbolism. However, this study had several limitations. First, the findings were limited to Chinese participants. Future studies should explore cross-cultural comparisons among visitors from different countries. Second, this study did not examine the dynamics of health perceptions over time. Future research could examine longitudinal changes in the health perceptions of wetland parks. These insights can inform the decision-making process and contribute to better planning and management of wetland parks.

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding authors.

Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent from the participants was not required to participate in this study in accordance with the national legislation and the institutional requirements.

JL: Conceptualization, Funding acquisition, Resources, Supervision, Writing – original draft. YC: Writing – original draft, Data curation, Formal analysis, Investigation, Methodology. XC: Conceptualization, Funding acquisition, Resources, Writing – review & editing. SL: Funding acquisition, Resources, Supervision, Writing – review & editing. YP: Conceptualization, Methodology, Writing – review & editing. TF: Writing – review & editing. JQ: Formal analysis, Investigation, Writing – original draft. YJ: Formal analysis, Investigation, Writing – original draft. YX: Formal analysis, Investigation, Writing – original draft. WL: Resources, Writing – review & editing.