Post-pandemic one health: Unpacking the role of greenspaces and human-dog interactions in long-term health and well-being

Abstract

The social isolation measures implemented during the outbreak of COVID-19 in 2020 have had lasting effects on public health and well-being. In response, a growing body of discourse has emerged to examine the long-term impacts of the pandemic on human health and welfare. Addressing these complex challenges requires innovative, interdisciplinary approaches grounded in a conceptual framework that integrates perspectives from both the social and natural sciences.

At the intersection of human-animal-green space interactions, the One Health framework has become a prominent driver of holistic health research. However, there is still a lack of comprehensive reviews on how this framework has been applied to investigate the interconnected health and well-being outcomes associated with these dynamics. To fill this gap, the present study conducted a systematic scoping review to identify patterns, gaps, and key themes in the literature, while outlining priorities and considerations for future research.

Following standardized PRISMA guidelines, the review employed clearly defined inclusion and exclusion criteria, along with dual-reviewer screening and data extraction procedures. A total of 29 studies were included, all of which directly or indirectly utilized the One Health framework. These studies were categorized into two primary thematic areas: (1) the role of green spaces in promoting human health in the post-pandemic context, and (2) emotional interactions between humans and animals during the pandemic. A notable trend in the literature is the incorporation of the Sense of Coherence as a key dimension of health and well-being within the One Health framework, highlighting the potential of human-dog-green space interactions to contribute meaningfully to salutogenic health processes.

The limited number of studies identified also reflects the current underrepresentation of well-being as a core pillar within established One Health research. Based on existing evidence, this review provides a foundational reference for researchers seeking to explore health and well-being through a One Health perspective. It offers guidance for future investigations into the synergistic effects of human-dog-green space interactions on well-being, and proposes data-driven interventions and policy recommendations to address both general health outcomes and the prolonged effects of COVID-19.

1. Introduction

1.1. The relationship between human well-being and the natural environment

The relationship between human well-being and the natural environment is complex and multifaceted, with our understanding of it continuously evolving within interdisciplinary research. Ecosystem services provided by the natural environment are widely recognized as vital resources that enhance human quality of life and promote both physical and mental health. In particular, in the context of ongoing environmental change, resilient natural environments offer new theoretical perspectives and practical pathways for alleviating psychological stress and strengthening individuals' coping mechanisms.

One key mechanism is the individual's sense of understanding and control over themselves and the external world, known as the Sense of Coherence (SOC). SOC is a holistic belief system characterized by a person's confidence in their ability to comprehend the events occurring in life and their conviction that, regardless of the challenges faced, things will ultimately turn out in a coherent and manageable way. In high-stress contexts such as the COVID-19 pandemic, this belief undoubtedly serves as a vital psychological resource that supports individuals in navigating and enduring difficult times.

In contrast to traditional pathology-focused research, which centers on the origins and mechanisms of disease, Salutogenesis emphasizes the conditions that contribute to the formation of health, focusing on how to enhance individuals' health capital [[1], [2], [3]]. Health capital refers to the long-term accumulated and sustained reserves of physical, mental, and social health resources within an individual, which collectively influence their capacity to pursue well-being and adapt effectively to environmental and social stressors.

A growing body of research demonstrates that regular exposure to natural environments supports physical health and improves mental well-being [4]. In the post-COVID-19 social context, the positive impacts of the natural environment are increasingly recognized, with empirical studies consistently affirming its importance in promoting psychological healing and emotional recovery. These benefits include regulating physiological indicators and alleviating psychological stress and emotional disorders [3,4].

However, some scholars have questioned the therapeutic effects of the natural environment. For instance, Lymeus, Lundgren, and Hartig (2016) suggest that the healing effects of natural environments may be limited when individuals continuously deplete adaptive resources in pursuit of their daily goals [5]. Hartig and Staats (2003) further argue that individuals typically rely on social-psychological resources to restore internal balance after resource depletion, with the prerequisite being that both the social and physical environments in which they are situated must support the functioning of recovery mechanisms [6].

1.2. Characteristics of restorative environments

The effectiveness of restorative environments primarily manifests in two aspects: first, the environment's ability to reduce external demands and burdens (such as emotional pressure and task-related stress) [7]; second, the inherent qualities of the environment that provoke positive psychological and physiological responses (such as natural landscapes, tranquil atmospheres, and spatial comfort) [8]. Therefore, restorative environments should not only provide a “refuge” function that allows individuals to escape from sources of stress, but also possess “activation” characteristics that actively guide individuals into a restorative state. This dual role accelerates resource replenishment and enhances the depth and integrity of the recovery process [6].

1.3. The therapeutic impact of dog-human emotional interactions on health

In restorative environment research, the role of natural elements has been widely recognized. However, in recent years, animals—particularly pets that establish close emotional bonds with humans—have also been found to have a positive impact on mental health. Dogs, as one of the most common companion animals, have been shown in multiple studies to provide significant physical and psychological healing benefits through emotional interactions [[9], [10], [11]]. Dogs not only provide emotional support but have also been consistently shown in a growing body of research to alleviate anxiety and depression, reduce physiological stress markers (e.g., cortisol and blood pressure), improve mood, and facilitate social interaction. Early physiological studies provided foundational evidence of these effects, and more recent work has substantiated and expanded upon these findings [12]. For example, Beetz et al. (2012) reviewed multiple studies demonstrating how human–dog interactions can buffer stress responses [13]. Ein et al. (2018) conducted a meta-analysis showing that animal-assisted interventions significantly reduce anxiety symptoms [14]. Additionally, Shoesmith et al. (2025) provided further evidence linking dog companionship to improvements in mental health and emotional regulation across different populations [15]. Friedmann, Thomas, and Eddy (2000) found that the presence of dogs was more effective than supportive friends in moderating children's stress [16]. Furthermore, Kogan et al. (1999) observed significant improvements in social behavior and self-control in children with emotional disorders after animal-assisted therapy (A-AT) interventions [17]. Similarly, Katcher and Wilkins (1994) found similar positive effects in children with Attention Deficit Hyperactivity Disorder (ADHD) and Conduct Disorder (CD) [18].

1.4. The Symbiosis between companion animal welfare and human health

The research framework for restorative environments is gradually evolving, shifting from a focus on the physical dimensions of natural landscapes and spatial attributes to a growing emphasis on the emotional connections between humans, animals, and the natural environment. Studies have shown that dogs, through their social mediating role, encourage informal interpersonal communication in open spaces [9,19]. This positions dogs as a significant social factor in “third places.” Oldenburg (1989) introduced the concept of third places, referring to informal public spaces outside of home and work that play a crucial role in supporting individuals' social interactions and psychological relaxation [20].

Concurrently, the societal perception of companion animals has undergone a significant shift. Increasingly regarded as integral family members, pets now occupy affective roles comparable to those of children or close kin [21]. This redefinition has important implications not only for human psychological health and social support systems [22], but also for the conceptualization of animal welfare within the broader “One Welfare” framework. Animal welfare, defined as the physical and psychological state of an animal in relation to its living conditions and human care, is inherently interdependent with both human well-being and environmental quality [[23], [24], [25]].

Crucially, the human–animal relationship is reciprocal. Empirical evidence suggests that pet guardians who perceive their animals as family members are more likely to engage in responsible caregiving behaviors, such as adherence to veterinary recommendations, regular health monitoring, and provision of enriched environments—factors that are essential to the promotion of positive welfare states in animals [26,27]. Moreover, the quality of the human–animal bond itself serves as a key indicator of animal welfare: strong, emotionally secure relationships correlate with higher welfare standards, while neglect, weak attachment, or inadequate care may result in compromised welfare outcomes [28,29].

Poor animal welfare not only affects the animals themselves, but also poses broader societal risks. These include threats to public health (e.g., zoonotic disease transmission [25], animal aggression [26]), as well as negative environmental externalities (e.g., noise pollution [27], fecal contamination [28], and disruptions to local biodiversity through wildlife predation [29]). As such, the inclusion of animal welfare considerations is indispensable in the formulation of integrative frameworks addressing human, animal, and ecosystem health.

Accordingly, this study adopts a OH perspective to foreground the interrelated well-being of humans and animals in shared green spaces. By doing so, it seeks to establish a more comprehensive conceptual foundation for future inquiry into the therapeutic, ecological, and ethical dimensions of multispecies urban environments.

1.5. Health challenges in the post-pandemic era and human-dog interaction

The ongoing impact of the COVID-19 pandemic has posed profound challenges to global public health systems. Approximately 10–20 % of individuals who recover from the virus continue to experience symptoms such as chronic fatigue, depression, and anxiety—conditions collectively referred to as “Long COVID”—which persistently affect their physical and mental health [[29], [30], [31]]. The enduring effects of the pandemic have triggered deep societal transformations, often referred to as “Deep Transitions” [32]. This shift is manifested in daily life through persistent feelings of fatigue [33], stress [34], and anxiety [35].

During the pandemic, an increasing number of pet owners experienced emotional connections with their companion animals, such as love and companionship. These connections provided unique support in alleviating loneliness and emotional distress [[36], [37], [38]]. This phenomenon has given rise to an important research area—examining the interactive mechanisms among humans, animals, and the natural environment. Relevant literature suggests that interactions with companion animals not only have positive psychological effects but can also enhance human health and well-being when paired with natural environments [39]. Despite significant progress in current research, one key question that warrants further exploration in the post-pandemic era is whether the positive relationship between green spaces and health is further strengthened through “human-dog interaction.”

1.6. The potential of human-dog interactions in green spaces for enhancing health and well-being

Based on the above context, this paper aims to explore the potential and challenges of companion animals in green spaces in enhancing human health and well-being. The core research question is: What is the current state of empirical research examining the relationships between human–dog interactions in green spaces and human health and well-being outcomes? To address this question, this paper reviews 29 relevant studies, using a narrative synthesis method. At the same time, the review is based on a structured and replicable literature search, combining the breadth of narrative integration with the rigor of systematic identification, in order to identify and integrate empirical evidence related to health enhancement and to clarify the key factors within the mechanisms at play. Structurally, we will first provide a brief overview of the research background and objectives, then discuss the most commonly cited theoretical frameworks, emphasizing the application practices supported by experience in human public health interventions and animal-assisted therapies. Finally, we will examine the barriers faced in the practical application of green spaces and human-animal interactions and propose potential directions and recommendations for future research.

2. Methods

Given the exploratory and wide-ranging nature of the present study's objectives, a scoping review methodology was employed as the principal research approach. Scoping reviews are characterized by the implementation of systematic, comprehensive, and transparent search strategies to identify and synthesize pertinent literature [40]. Their primary aim is to delineate key concepts, define the extent of research activity, and identify existing knowledge gaps within a given field. This approach is particularly well-suited for accommodating heterogeneous study designs and diverse outcomes, thereby facilitating the establishment of a robust theoretical framework and informing directions for subsequent research endeavors [41].

This scoping review is structured according to the framework for scoping research methods proposed by Arksey and O'Malley, which includes five steps: 1) Defining the research question; 2) Systematically searching for relevant literature; 3) Establishing inclusion and exclusion criteria and selecting studies; 4) Extracting data; 5) Organizing, summarizing, and synthesizing the results.

Additionally, the review process follows the PRISMA-ScR statement and its latest explanatory literature [42], adhering to the reporting guidelines and procedures to ensure transparency and reproducibility of the review process (see Appendices 1–3) [42,43]. During the phases of literature identification, study selection, data extraction, and result synthesis, the research team utilized EndNote 21 and Microsoft Excel in collaboration for literature management and information tracking, thereby enhancing the systematization and efficiency of data processing.

2.1. Defining the research question

This study aims to systematically review empirical research literature exploring the positive associations between green spaces and human health in the post-pandemic context, with a particular focus on how these associations are enhanced through “human-dog interactions.” The review will specifically address studies that are guided directly or indirectly by the OH framework. By identifying the evidence base, research patterns, and potential gaps in the current literature, this study seeks to address the following core research questions: 1) What key components of the OH framework are included in the studies reviewed? 2) What intervention strategies or practices have been employed? 3) What types of research methods and designs have been used? 4) How are the geographic distributions of the studies implemented? 5) What social demographic characteristics of the study participants are included? 6) What specific features of green spaces (e.g., types, sizes, quality) are involved? 7) Which health outcomes have been reported to show significant positive effects? 8) What types of health outcomes (e.g., psychological, physical, social health dimensions) are specifically addressed?

2.2. Systematic literature search

In November 2024, a comprehensive literature search was conducted across three major English-language databases (e.g., Scopus, Web of Science, PubMed), covering all records from the inception of each database through February 2025. While the search was not restricted by date to ensure completeness and replicability, an inclusion criterion was subsequently applied to retain only those empirical studies that were conducted or published from January 2020 onwards, thereby aligning the evidence base with the post-pandemic context of this review. The primary objective of the search was to identify empirical research studies that explore the interactions between humans, dogs, and the natural environment. Given that “health and well-being” is a broad and complex research area, a comprehensive and systematic search strategy was developed. This strategy included keywords related to green spaces, human-dog interactions, health outcomes, and health issues directly or indirectly associated with COVID-19. A total of 108 search terms were employed, combined with Boolean logic and proximity operators to enhance the specificity and accuracy of the search (see Appendix 2).

This study included only peer-reviewed articles published in English. After importing the search results into EndNote 21, duplicate entries were initially removed (n = 6383). The primary reviewer (YP) then conducted a preliminary screening of publication types, keywords, titles, and abstracts through additional automated filtering, which eliminated clearly irrelevant items (n = 428,100).

To ensure consistency and accuracy, two senior reviewers (HS and QC) independently reviewed a 10 % random subsample of the excluded records. Any ambiguities encountered during the screening process were resolved through consensus-based discussions with the senior reviewers.

EndNote 21, as a reference management tool, effectively supported the entire process of literature screening and organization, enhancing the systematicity and transparency of the workflow.

To ensure that the included literature focused on the potential role of green spaces in promoting health-related human-dog interactions, strict exclusion criteria were applied. Excluded literature types included: studies lacking substantial relevance, those that did not explore causal or correlational relationships, review articles, news reports, conference abstracts, and studies for which full texts were not accessible (see Appendices 11–21 for detailed exclusion criteria).

2.3. Inclusion and exclusion criteria and study selection

This study included peer-reviewed academic articles published in English between January 2020 and February 2025. The starting point for the research period was set to January 2020, although the novel coronavirus (COVID-19) pandemic, first reported in December 2019 [44,45], has had profound effects on global public health [46], urban environments [47], and human behavior [48] from 2020 onward. This time frame was selected to ensure that the included studies reflect practices, policy responses, and recovery status in the post-pandemic context, thereby enhancing the contextual relevance and practical applicability of the systematic review.

The study selection process was conducted in two stages: the first stage was title and abstract screening, and the second stage was full-text review. In the first stage, the reviewers (YK and RC) assessed whether the articles met the following criteria for inclusion in the full-text review: 1) the study clearly addresses one of the following topics: green space, human-dog interaction, or health and well-being; 2) the study context explicitly indicates a connection to the COVID-19 pandemic; 3) the document is a peer-reviewed original research article, excluding editorials, opinion pieces, review articles, and book chapters.

In the second stage, during full-text screening, studies had to meet the following additional criteria to be included: 4) the study measures any form of health outcome (including both physiological and psychological dimensions); 5) the study design and/or data analysis incorporates the OH framework, or directly or indirectly reflects the core logic of OH.

To ensure consistency in the analysis of health and well-being outcomes, only studies that employed quantitative indicators (e.g., physiological, psychological measures) were included. This criterion was set to facilitate empirical comparability across studies and support the identification of measurable patterns and research gaps within the scoping framework. The inclusion and exclusion criteria were developed through collaboration between the research team members and senior reviewers to ensure scientific rigor and consistency in the screening process. In this study, “health and well-being” is defined as a broad state encompassing all positive health-related outcomes and serves as a key indicator for measuring health levels [48]. Since the aim of this study is to comprehensively review the literature, health outcomes are not restricted to primary outcome measures.

Furthermore, considering the focus on research incorporating or related to the OH theoretical framework, studies that reflect OH principles in their design or analysis were included in the review. During both the title/abstract and full-text screening stages, the reviewers YK and RC independently conducted initial screenings and cross-checked the results. In cases of disagreement, the two initial reviewers first attempted to reach a consensus through discussion. If consensus could not be reached, another research author participated in the re-evaluation and discussion. If discrepancies persisted, a third reviewer (YP) intervened to make the final decision, ensuring fairness and scientific integrity in the study inclusion process.

2.4. Data extraction

We utilized Microsoft Excel to create a structured data extraction spreadsheet for the systematic extraction of data from the final included studies. To ensure the accuracy and consistency of the data extraction process, all studies underwent a dual-extraction procedure. YP was responsible for the primary data extraction of all studies, while YK and RC each handled the secondary data extraction for half of the studies.

During the extraction process, if discrepancies arose between the primary and secondary extractors, the two extractors first engaged in a thorough discussion to reach a consensus. If consensus was not achieved after discussion, a fourth researcher (BL) acted as a third-party reviewer to make a final judgment. This process ensured the scientific rigor, transparency, and reproducibility of the data extraction, providing a solid foundation for subsequent analyses.

2.5. Organizing, summarizing, and reporting results

In this study, the research findings of the included studies were systematically organized and synthesized based on the pre-established scoping review research questions. To further enhance the scientific rigor and methodological precision of the review, we assessed the quality of the research methods used in the extracted data. The quality assessment was conducted using the Effective Public Health Practice Project (EPHPP) tool [49], which is widely applied to evaluate observational studies, cross-sectional studies, and randomized controlled trials. The EPHPP tool has demonstrated good reliability and validity [50,51].

The EPHPP tool rates each study on six key dimensions: selection bias, study design, control of confounding factors, blinding implementation, appropriateness of data collection methods, and sample attrition. Based on the evaluation results across these dimensions, studies were categorized into quality levels such as “strong,” “moderate,” or “weak.”

After completing the quality assessment, the research team compared and discussed the consistency and differences in the study results, carefully considering potential heterogeneity and its impact on the review's conclusions. Following the data extraction and quality rating, the research results were ultimately integrated and reported through a systematic data synthesis process, providing a solid foundation for subsequent theoretical analysis and practical implications.

3. Results

3.1. Summary of study characteristics

After removing 6383 duplicate records, a total of 428,393 unique articles were identified in the databases. Following a preliminary screening of titles and abstracts, 298 articles were selected for full-text review. During this phase, 130 articles were excluded due to the inability to access the full text, 93 articles did not meet the inclusion criteria, and 46 articles were excluded due to the publication type (e.g., reviews, commentaries, hypotheses, and papers) (detailed exclusion reasons are provided in Appendices 11–21). Ultimately, 29 studies met the inclusion criteria and were included in this systematic review.

All 29 studies were guided by the OH framework and directly or indirectly addressed health-related research topics, including at least OH outcome indicator (Fig.1). These studies focused on health as a central theme or primary outcome variable, with publication dates ranging from 2020 to 2025, reflecting the latest trends and advancements in this field.

Fig. 1.

PRISMA diagram of study selection process. Adopted from Page et al. (2021) [52].

During the literature selection process, keywords such as “green space,” “human-dog interaction,” and “health and well-being” were used to guide the screening and categorization. The included studies were grouped into two core themes based on their research focus: The first theme focuses on the role of urban green spaces in promoting human health during the post-COVID-19 period, exploring the multiple benefits of natural environments on physical, mental, and emotional health, particularly in the context of health challenges arising from public health events. The second theme examines the emotional interactions between humans and animals, particularly the connection between humans and companion animals (specifically dogs), and their potential therapeutic benefits in alleviating psychological stress, reducing loneliness, and addressing mental health issues resulting from social isolation during the pandemic. Table 1 lists the complete characteristics of each included article.

Table 1.

Complete characteristics of included articles.

Author(s) & Ref. No.	Title	Aims	Health outcome	Health Measurement/ Primary? Y/N	Outcomes with reported significant positive effects	Green Space Characteristics	Location/Setting	Population(s) (Human/Nonhuman)/ sample size(n)/ age group
(George et al., 2024) [53]	Associations between natural blue and green space and preschool children's movement behaviors	Understanding how neighborhood green spaces influence health-related factors in human–dog interactions, with a focus on how dog walking may help reduce sedentary behavior in the COVID-19 background.	- Physical activity - Well-being	- Physical Activity Measurement Methods - N	- Neighborhood vegetation (500 m - 1600 m range) - sedentary time (−) - Neighborhood vegetation (500 m - 1600 m range) - walking behavior (+)	Neighborhood Green Space	Australia	- Human - 1081 - children
(Ein, Reed and Vickers, 2021) [37]	The Effect of Dog Videos on Subjective and Physiological Responses to Stress	To explore the potential value of alternative dog-related media (e.g., videos) in alleviating human subjective and physiological stress responses in the COVID-19 background.	- Anxiety - Well-being	- The Depression Anxiety Stress Scale - The Social Phobia Inventory - Y	- Dog Video - Anxiety Scores (−) - Dog Video - Happiness Scores (+)	- Active nature - Tranquil nature	Canada	- Human - 103 - Adults (Ryerson University)
(Johnson, Sheetal Survase and Gray, 2023) [54]	Examining the Impact of Virtual Animal Stimuli on College Students' Affect and Perception of their Academic Advising Experience	To This study explores whether animal visual stimuli, as an alternative intervention, can effectively improve the mental health and well-being of college students in situations where traditional animal-assisted interventions (AAI) are not feasible (e.g., in public spaces or among specific populations) in the COVID-19 background.	- Mental health - Well-being	- The Positive and Negative Affect Schedule (PANAS) - The modified Differential Emotion Scale (mDES) - The University Belonging Questionnaire (UBQ)	- Dog Video - Positive Emotions (+) - Dog Video -Perceptions of Advisors (+) - Dog Video - Emotional Well-being (+)	Natural environment	USA	- Human - 152 - Adults
(Samet et al., 2022) [55]	Exploring and Developing the Questions Used to Measure the Human–Dog Bond: New and Existing Themes	Review and assess existing Human-Dog Bond (HDB) questionnaires to analyze their effectiveness in measuring the bidirectional characteristics of the human-dog relationship in the COVID-19 background.	- Physical and mental Health - Well-being	- Twelve semi-structured interviews - Human–dog interaction (HAI)	Human-Dog Relationship - Health (+)	Natural environment	UK	- Human −152 - Adults (Dog guardians)
(Scanlon et al., 2021) [56]	Homeless People and Their Dogs: Exploring the Nature and Impact of the Human–Companion Animal Bond	Explore the nature of the Human-Companion Animal Bond (H-CAB) between homeless individuals in the UK and their dogs, and document the impact of this bond on the health and welfare of both parties in the COVID-19 background.	- Physical and mental Health - Well-being	- Animal Bond (H-CAB) to document the implications of this bond for the health and welfare - Semi-structured interviews consisting of open and closed questions	Human-Dog Relationship - Health (+)	Natural environment	UK	- Human −20 - Adults (Homeless)
(Morgan et al., 2020) [38]	Human–dog relationships during the COVID-19 pandemic: booming dog adoption during social isolation	Explore the bidirectional relationship between dog owners and their pet dogs during the COVID-19 pandemic, particularly the connection between the mental health of dog owners and the health and behavioral issues of their dogs.	- Depression - Anxiety	- Yad4 website data analysis	- Dog owners' quality of life - dog's quality of life (+) - Dog Ownership - PTSD (−)	Natural environment	Israel	- Human - 3138 - Adults (Dog owners)
(Lee, Song and Lee, 2022) [11]	Influences of Dog Attachment and Dog Walking on Reducing Loneliness during the COVID-19 Pandemic in Korea	Explore the positive role of dogs as companion animals in enhancing psychological resilience amid pandemic-induced social isolation, and how dog walking not only strengthens the human-animal bond but also contributes to mental well-being.	- Mental health - Well-being	- Dogs and Walking Survey (DAWGS) - Dogs and Physical Activity (DAPA)	- Dog Walking - Health (+) - Dog Walking - Physical activity (+) - Dog Walking - Loneliness (NS)	- Green space infrastructure	Korea	-Human - 249 - Adults (Dog owners)
(Packer et al., 2023) [57]	Is UK Puppy Purchasing Suffering a Long COVID Effect? Ongoing Negative Impacts of the COVID-19 Pandemic upon Puppy Purchase Motivations and Behaviors in 2021	The aim of this study was to explore whether the changes in puppy purchasing motivations and behaviors observed during the “Pandemic Puppy” phenomenon in the UK in 2020 persisted into 2021 or returned to pre-pandemic (2019) levels.	- Mental health - Social Support	- Online questionnaire	Low Welfare Breeding - Physical and Mental Health of Dogs (−)	- Green space accessibility	UK	- Human - 2827 -Adults (Dog owners)
(Mayers, 2020) [58]	Dogs Unleashed: The Positive Role Dogs Play during COVID-19	Using the method of visual autoethnography, this study explores the significance of human-dog relationships during the COVID-19 pandemic, critiques the allocation of space for dogs and the rigid restrictions placed on them in urban public spaces, and, through the author's personal experience with their dog, reflects on the heightened regulation of public space and the broader issues of social control underlying it.	- Well-being	Visual autoethnography	- Emotional support - Anxiety(−) - Daily structure - Anxiety (−) - Outdoor activities - Physical and mental health(+) - Community relationships - Social health (+) - Public space restrictions - Mental health (−) - Public space - Psychological regulation (+)	Green space accessibility	Canada	- Human and Dog / - Adults
(Schneider et al., 2023) [59]	COVID-19 compliance among urban trail users: Behavioral insights and environmental implications	To provide insights for improving public green space management, particularly in the context of future health crises, by exploring how environmental design and visitor density can help maintain safe and active use of trails while minimizing negative impacts.	Physical health	- ‘Observation zone’ (maximize visibility and observer safety)	- Trail Width - Social Distancing Compliance (+) - Signage - Compliance Behavior (+) - Trail Width - Deviations from Trail Behavior (+) - Density - Deviations from Trail Behavior (+)	Green infrastructure	USA	- Human - 5986 - Adults (Trail users)
(Pouso et al., 2020) [60]	Contact with blue-green spaces during the COVID-19 pandemic lockdown beneficial for mental health	To explore whether contact with nature—particularly the visibility and accessibility of blue-green spaces—can help alleviate symptoms of depression and anxiety and enhance positive emotions during the COVID-19 lockdown.	- Depression - Anxiety	- The 4-item Patient Health Questionnaire (PHQ-4) screening scale - Generalized Anxiety Disorder scale (GAD-2)	Nature exposure - Depression and Anxiety Symptoms (−)	Green space accessibility	Spain	- Human - 6895 - Adults
(Mouratidis and Yiannakou, 2021) [46]	COVID-19 and urban planning: Built environment, health, and well-being in Greek cities before and during the pandemic	To investigate changes in people's health and well-being before and during the COVID-19 pandemic, and to further analyze how specific built environment characteristics in Greek cities—particularly Athens and Thessaloniki (such as accessibility to large parks, neighborhood density, and housing conditions)—relate to residents' health and well-being during the pandemic, thereby providing a basis for urban planning and policy development aimed at creating more pandemic-resilient cities.	- Physical health - Well-being	- Facebook - Snowball sampling - Project web page - Article	- Proximity to Large Parks - Health and Well-being (+=) - Number of Local Amenities - Interpersonal Relationship Satisfaction (+)	Green space infrastructure	Greece	- Human - 1201 - Adults (Residents of Greece)
(SIELAFF et al., 2024) [61]	COVID-19 pandemic and urban green spaces: Shifting usage behaviors and perceptions in Leipzig (Germany)?	To explore the impact of the COVID-19 pandemic on the perception and use of urban green spaces (UGS) in Leipzig, Germany, particularly during the later phase of the pandemic (winter 2022/2023).	Health	LimeSurvey platform	- Green Space Use - Social Interaction - Green Space Use - Physical Activity - Green Space Use - Well-being (+)	Green space visibility	Germany	- Human - 142 - Adults
(Ugolini et al., 2020) [62]	Effects of the COVID-19 pandemic on the use and perceptions of urban green space: An international exploratory study	To identify the drivers that normally attract people to urban green spaces (UGS) and to assess the effects of social isolation during the COVID-19 pandemic on the use and perception of UGS.	- Health - Well-being	Online questionnaire	Green space exposure - Physical Activity (+)	Green space accessibility	- Croatia - Israel - Italy - Lithuania - Slovenia - Spain	- Human - 2560 - Adults
(Mitra et al., 2020) [63]	Healthy movement behaviors in children and youth during the COVID-19 pandemic: Exploring the role of the neighborhood environment	To explore the patterns of changes in physical activity, sedentary behavior, and sleep among Canadian children and youth aged 5–17 during the COVID-19 pandemic, and to examine how these behavioral changes are associated with characteristics of the built environment near their residences, thereby providing insights for future urban planning and health crisis response.	- Physical health - Sleeping quality	ParticipACTION	Green Spaces Usage - Outdoor Activities (+)	Green space accessibility	Canada	- Human - 1472 - Adults
(Corley et al., 2021) [64]	Home garden use during COVID-19: Associations with physical and mental wellbeing in older adults	To examine whether the frequency of home garden use during the COVID-19 lockdown is associated with self-rated physical and mental health in older adults in Scotland, in order to evaluate the potential role of domestic gardens as a health resource during the pandemic.	- Physical health - Mental health - Well-being	Online survey	- Green Space Usage - Self-reported Physical Health (+) - Green Space Usage - Mood (+) - Green Space Usage - Mental Health (+) - Green Space Usage - Sleep Quality (+)	Green space accessibility	Scotland	- Human - 171 - Elderly
(Bustamante et al., 2022) [65]	Mental health and well-being in times of COVID-19: A mixed-methods study of the role of neighborhood parks, outdoor spaces, and nature among US older adults	Explore the role of parks and natural environments in supporting the physical and mental well-being of older adults (aged 55 and above) during the COVID-19 pandemic, assess the relationship between the number of neighborhood parks and depression, anxiety, and loneliness, and conduct qualitative analysis of participants' outdoor experiences to understand the positive impact of green spaces on well-being.	- Physical health - Mental health - well-being	Questionnaire	- Green Space Environments - Mental Health; - Green Space Environments - Stress Coping(+)	Green infrastructure	USA	- Human - 50 - Elderly (aged 55 and above)
(Geng et al., 2020) [66]	Impacts of COVID-19 pandemic on urban park visitation: a global analysis	This study analyzes the impacts of COVID-19 and government response policies on park visitation at global, regional, and national levels, and assesses the importance of parks during the global pandemic. It examines how restrictions on public activities and gatherings have influenced park visits and highlights the role of parks in supporting psychological, physical, and social well-being during the pandemic.	- Physical health - Mental health - Social well-being	Online survey	- Social Gathering Restrictions - Life Satisfaction Index (+) - Social Gathering Restrictions - Environmental Health Index (+) - Social Gathering Restrictions - Ecosystem Vitality Index (+) - Social Gathering Restrictions - Green Space Visits (+)	Green space accessibility	48 countries and regions	- Human - 4848 - Adults (from Google Community Mobility Report)
(Ugolini et al., 2021) [67]	Usage of urban green space and related feelings of deprivation during the COVID-19 lockdown: Lessons learned from an Italian case study	The study investigates how social isolation measures during the COVID-19 pandemic affected the frequency of urban green space use and people's perceptions of urban green spaces.	- Mental health - Well-being	Questionnaire	- Red zones, Non-Red zones: dog walking - lockdown restrictions (+) - Non-Red zones: lockdown restrictions - physical exercise (+)	- Green infrastructure	Italy	- Human - 2102 - Adults (Access to Urban Green Spaces During the Lockdown)
(Garrido-Cumbrera et al., 2020) [52]	Does having children or a dog influence visits to urban green spaces?	The objective of this study is to evaluate how the type of accompaniment influences the frequency of visits to urban green spaces under COVID-19, the appreciation of these spaces, and physical activity. It also explores the differences between people who visit urban green spaces alone, with an adult, with children, or with a dog, and investigates how these factors contribute to the promotion of healthy habits, particularly for individuals at risk of loneliness and the elderly.	- Mental health - Well-being	Questionnaire	Dog companion - Visiting Green Spaces (+)	Green space accessibility	Spain	- Human - 479 - Adults (Users of urban green spaces)
(Naddaf and Lavy, 2022) [68]	Character Strengths' Change During COVID-19	To explore whether the COVID-19 pandemic has promoted the development of individual character strengths, particularly among those who experienced moderate levels of difficulty and received social support. The study also aims to assess the role of varying levels of pandemic impact and social support in the changes of character strengths.	- Well-being	- The VIA Inventory of Strengths - The Multidimensional Scale of Perceived Social Support (MSPSS) - The level of COVID-19 difficulty	Green Spaces - Positive Personality Traits (+)	Green space accessibility	USA	- Human - 1700 - Adults (English-speaking)
(Peng et al., 2024) [69]	Chronic impacts of natural infrastructure on the physical and psychological health of university students during and after COVID − 19: a case study of Chengdu, China	To explore how urban natural infrastructure affected university students' physical and psychological well-being during the COVID-19 pandemic, this study specifically assessed the positive impacts of different natural elements on health, with the aim of offering recommendations for future urban design to promote outdoor activity and well-being.	- Physical health - Mental health - Well-being	- The Profile of Mood States (POMS) - Total Mood Disturbance (TMD) - The State–Trait Anxiety Inventory (STAI)	- WA and FA: NAIs - Blood Oxygen Saturation (+=) - Thermal comfort - negative emotions (−) - FA: Rich Green Spaces - Positive Mood States (+)	Green infrastructure	China	- Human - 300 - Adults (College students)
(Lee, Mai and Park, 2023) [70]	Green space accessibility helps buffer declined mental health during the COVID-19 pandemic: evidence from big data in the United Kingdom	To evaluate whether urban green space accessibility can mitigate public mental health issues during the COVID-19 pandemic and lockdown periods.	- Mental health	Big data analysis	Green space exposure - Psychological Distress Scores (−)	Green space accessibility	UK	- Human - 4998 - Adults
(Mactavish et al., 2020) [71]	Children's Mental Health in Southwestern Ontario during Summer 2020 of the COVID-19 Pandemic	Evaluate the impact of the COVID-19 pandemic on the mental health of children aged 8 to 13 during the initial phase, specifically describing the magnitude and nature of their psychological distress, and exploring whether social support acts as a buffer in the increase of children's psychological distress.	- Mental health - Well-being	Data were collected through the baseline assessment of an ongoing longitudinal study of the COVID-19 pandemic.	- Social support - Mental health (+)	Green space accessibility	UK	- Children - 4998 - Adults
(Kanelli et al., 2023) [7]	Keep Calm and Go Out: Urban Nature Exposure, Mental Health, and Perceived Value during the COVID-19 Lockdown	The study explores the mental health benefits of nature exposure during the COVID-19 pandemic, particularly the effects of nature exposure during the outbreak. It also aims to investigate changes in people's usage patterns of urban green spaces (UGS) and urban blue spaces (UBS) during the pandemic, and whether extreme conditions, such as lockdowns, increase people's appreciation of urban nature.	Mental health	online survey	Nature exposure - Mental health (+)	Green space accessibility	Greece	- Human - 927 - Adults
(Noszczyk et al., 2022) [72]	The impact of the COVID-19 pandemic on the importance of urban green spaces to the public	The study aimed to understand the impact of the COVID-19 pandemic on the importance of urban green spaces to the public in Kraków, Poland.	- Mental health - Physical health	- Survey - GIS Tools and Geoprocessing - Analysis of Visitation Trends - Health Perception Analysis	- Green space visitation - Physical and mental health (+) - Green space visitation - Perception (+)	Green space accessibility	Poland	- Human - 1250 - Adults (The residents of Kraków, Poland)
(Nicklett, Sharma and Testa, 2024) [73]	Physical Activity and Local Blue/Green Space Access During the COVID-19 Pandemic	To examine whether local blue and green space access was associated with weekly physical activity frequency during the COVID-19 pandemic.	Physical health	Self- reported survey	Proximity to blue and green spaces - physical activity (+)	Green space accessibility	USA	- Human - 1771 - Adults (age 18–94)
(Xiao et al., 2021) [74]	Social carrying capacity and emotion dynamics in urban national parks during the COVID-19 pandemic	To explore the factors influencing visitors' perceived crowding and emotions under varying levels of visitor use in urban national parks during the COVID-19 pandemic.	Physical health	Self- reported survey	- Undisturbed environment - Levels of joy, relaxation, and excitement (+) - Visitor Use Acceptability - Positive emotions (+)	Green space visibility	China	- Human - 443 - Adults (Tourists)
(Kim et al., 2023) [75]	Understanding the Impact of the COVID-19 Pandemic on the Perception and Use of Urban Green Spaces in Korea	To explore whether citizens' perceptions and usage patterns of urban green space (UGS) changed during the COVID-19 pandemic, and to collect public suggestions for improving the usability of UGS, in order to inform future planning and policymaking related to urban green spaces.	Mental health	Self- reported survey	- Increase the use of Urban green space - Physical health (+) - Outdoor activities - Anxiety (−)	Green space accessibility	Korea	- Human - 214 - Adults
(Ma, Huang and Liu, 2022) [76]	Unequal impact of the COVID-19 pandemic on mental health: Role of the neighborhood environment	To investigate whether the impact of the COVID-19 pandemic on mental health is unequal among different population groups, and the role of the neighborhood environment in alleviating this impact.	Mental health	Self- reported survey	Exposure to green space - Mental health resilience (+)	Green space accessibility	China	- Human - 2741 - Adults(Beijing metropolitan region)
(Berdejo- Espinola et al., 2021) [77]	Urban green space use during a time of stress: A case study during the COVID- 19 pandemic in Brisbane, Australia	Exploring whether people responded to stress during the COVID-19 pandemic by spending more time in natural environments, and investigating the reasons for this change.	Mental health	Self- reported survey	Green space use - Mental/Physical Health (+)	Green space accessibility	Australia	- Human - 1002 - Adults(Beijing metropolitan region)

By constructing the literature in this way, we aim to comprehensively synthesize how environmental and relational factors have contributed to human health and well-being during and after the COVID-19 crisis. This dual focus highlights the multidimensional nature of resilience, emphasizing both the positive impact of natural spaces on individual physical and mental health and the supportive role of pets in addressing post-pandemic mental health challenges. By combining environmental factors with the therapeutic effects of interpersonal relationships, we further reveal the key roles these factors play in the health recovery process.

All the included studies were research-based articles (Table 2). In the final 29 cross-sectional studies, regarding geographical distribution, there were five studies from both the UK and the USA, three studies from both China and Canada, two studies from each of Australia, South Korea, Greece, and multinational research, and one study from each of Israel, Poland, Italy, Scotland, and Germany.

Table 2.

Study characteristics of the 29 studies.

Study characteristics

Study design: 29 (100 %) cross-sectional studies Study location: 5 (17.24 %) in UK, 5 (17.24 %) in USA, 3 (10.34 %) in China, 3 (10.34 %) in Canada, 2 (6.90 %) in Korea, 2 (6.90 %) in Australia, 2 (6.90 %) in Greece, 2 (6.90 %) in multinational research, 1 (3.45 %) in Poland, 1 (3.45 %) in Israel, 1 (3.45 %) in Italy, 1 (3.45 %) in Scotland, 1 (3.45 %) in Germany. Health outcomes: 20 (68.97 %) focused on the impact of greenspace characteristics on health during the pandemic: 12 (41.38 %) for greenspace accessibility, 6 (20.69 %) for greenspace infrastructure, 2 (6.90 %) for greenspce visibility. 9 (31.03 %) focused on evaluating the health impacts of human–dog interactions: 3 (7.70 %) for interactive behaviors， 6 (20.69 %) for emotional bonding. Participant characteristics: 25 (86.20 %) with adults age 18 years and older, 2 (6.70 %) with older adults age, 2 2 (6.70 %) with children and school-aged children.

Regarding the quality assessment of the studies (detailed in the appendix 4), 21 studies were rated as moderate quality, and the remaining 8 were rated as weak quality (Fig. 2). The variation in research quality mainly stems from differences in the evaluation criteria. Most of the cross-sectional studies relied on extensive secondary data sources, which led to higher scores for blinding and data collection methods, but also resulted in selection bias. About one-third of the studies effectively controlled for confounding variables, particularly those related to sociodemographic factors and health outcomes. However, some studies only analyzed correlations between variables and did not adequately consider the effects of confounders. Additionally, due to limitations in data availability, many studies did not include known confounding factors.

Fig. 2.

Results of a quality assessment of green space and human-dog interaction for health research using the Quantitative Research Quality Assessment Tool of the Programme for Effective Public Health Practice. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Regarding the age groups of the participants, 25 studies focused on adults, 2 studies targeted older adults, and 2 studies involved school-aged children and children. In analyzing the impact of green space characteristics on health during the pandemic, 20 studies addressed this topic in the context of COVID-19, including 12 studies assessing green space accessibility, 6 studies examining green infrastructure, and 2 studies exploring visual perception features of green spaces. Furthermore, 9 studies focused on the impact of human-animal interaction on health, with 3 studies assessing human-dog interaction behaviors and 6 studies examining the emotional interactions between dogs and humans.

3.2. The role of companion animals in human health and well-being post-pandemic

In studies framed by the OH approach, there has been a noticeable research trend highlighting the well-being of both humans and animals. This trend is particularly evident in discussions about human health and well-being during the pandemic, where companion animals have been emphasized as an intervention strategy. Among the studies included in this review, dogs were the most frequently studied companion animals, often in the context of outdoor activity and nature-based interactions during the post-pandemic period. Among the 29 OH-based studies, 9 included interventions that analyzed the role of human-dog interaction in promoting health and well-being. These studies focused on companion animals, including both virtual dog media (e.g., videos) and real pet dogs.

Of the 9 studies, 6 examined the emotional connection between humans and animals [11,37,38,54,57]. One of these studies [57] utilized an online questionnaire developed by the “Pandemic Puppies” research team to investigate the motivations and behaviors of UK residents when purchasing puppies before (March 23–December 31, 2019) and during the early stages of the COVID-19 pandemic (March 23–December 31, 2020). This survey helped illustrate the changes in human-dog relationships during the pandemic, shedding light on how humans projected their emotional needs onto dogs and quantifying the potential impact of human behavior on the well-being of companion animals. Morgan et al. (2020) suggested that interaction with dogs could help alleviate and manage the onset of post-traumatic stress disorder (PTSD) [38]. One study focused on how human-dog interaction during the COVID-19 pandemic facilitated social connections and strengthened neighborhood relationships [56]. Another study emphasized that human-dog interaction could serve as a coping mechanism for stress during the pandemic, promoting the physical and mental health of both humans and their dogs [58]. Three studies evaluated the positive physiological health outcomes of human-dog interaction through increased outdoor exercise [53,55,56], noting that limited social interaction during the pandemic led to an increase in outdoor activities, which benefited both human and dog physical health.

3.3. The integrated impact of green spaces and companion animal well-being on human health

Despite substantial variation in methodology, outcome measures, and research design across the included studies, all selected works reveal the complex and profound impact of greenspace and/or animal welfare on human health. Through a variety of mechanisms, greenspace and animal well-being play critical roles in promoting and shaping population health. While causal inference lies beyond the scope of most reviewed studies, the observed patterns suggest potential interactions between factors that may influence health outcomes at the population level.

Specifically, 16 studies emphasized that during the pandemic, positive emotional interactions with greenspaces—along with the creation of more accessible and available green environments—were closely associated with improved health outcomes [7,59,60,[62], [63], [64],66,52,68,[70], [71], [72], [73],[75], [76], [77]]. Notably, Packer et al. (2023), responding to the OH framework, indicated that dog welfare not only directly affects their health but also reduces potential infectious disease risks, thereby exerting significant indirect effects on public health [57]. However, it is important to underscore that most such findings are based on cross-sectional data and should be interpreted as correlational rather than causal.

Additionally, several studies highlighted the importance of human–animal interaction in promoting health. For example, George et al. (2024) found that human-dog interaction significantly increased physical activity levels in preschool children [53], while Johnson, Shetal Survase, and Gray (2023) emphasized its positive impact on strengthening emotional bonds among adolescents [54]. While these findings are promising, few of these studies employed experimental or longitudinal designs, and many lacked rigorous control of potential confounding variables.

The study by Morgan et al. (2020) demonstrated that the quality of life of dog owners was closely linked to their dogs' quality of life, with negative interaction patterns having long-term detrimental effects on canine health [38]. Finally, research by Lee, Song, and Lee (2022) further highlighted the strong association between the quality and characteristics of greenspace and human–dog interactions, underscoring the significance of high-quality green environments in fostering such interactions and associated health benefits [11]. However, without further investigation, such findings cannot be interpreted as evidence of causal relationships.

While this scoping review primarily aims to map the current state of research at the intersection of human–dog interaction, greenspace, and health, we acknowledge that understanding causal mechanisms remains a fundamental long-term goal of the field. Determining whether and how human–animal–nature interactions influence health outcomes is central to designing effective interventions and informing policy.

Nevertheless, the body of evidence reviewed here remains limited in its capacity to support causal claims, as the vast majority of studies rely on cross-sectional, observational, or self-reported data. Few have employed robust causal identification strategies such as longitudinal tracking, natural experiments, randomized trials, or structural equation modeling. Furthermore, when statistical controls were used, they were not always grounded in theoretically justified causal models [78,79], raising concerns about potential overcontrol or omitted variable bias.

Therefore, although some studies suggest promising associations between dog companionship, green environments, and human health, these relationships should be interpreted with caution. Future research must move beyond correlational findings and engage more deeply with the growing body of literature on causal reasoning in complex systems, including the use of Directed Acyclic Graphs (DAGs) [80], counterfactual frameworks [81], and mixed-method triangulation [82]. Such efforts will help to build a more rigorous and policy-relevant evidence base, enabling stronger empirical testing of mechanisms and the formulation of causally informative conclusions.

3.4. Green spaces and well-being

The relationship between green spaces and health well-being has been widely established, with numerous studies highlighting the positive impact of green spaces, especially in the context of the COVID-19 pandemic. In 20 studies examining the relationship between green spaces and health during the pandemic, all directly or indirectly support the OH framework. Among these, 15 studies explicitly emphasize the positive effects of green space accessibility on health during the pandemic. Notably, these effects include reducing anxiety and depression [60], increasing social interactions [46], promoting physical activity [62,52], and encouraging outdoor activities [11,63].

Furthermore, the presence of green spaces significantly improved overall health ratings [64], enhanced life satisfaction [66], helped establish positive personality traits [68], and effectively alleviated psychological distress. Additionally, five studies highlighted the positive influence of green space facilities on health behaviors, such as enhancing social interaction by providing physical distancing [59], improving interpersonal relationship satisfaction through the availability of green space [46], and serving as a resource for stress management [65,69].

Two studies also evaluated the impact of the visual appeal of green spaces on health, finding that the aesthetic quality of green spaces not only promoted social activities [61] but also facilitated outdoor activities [74].

Overall, higher-quality green spaces, pleasant visual characteristics, and scientifically designed green space facilities are key components of the OH framework, playing a vital role in promoting human health and well-being.

4. Discussion

Although the OH framework emphasizes the crucial role of human, animal, and natural environments (especially green spaces) in promoting health and well-being in the context of the COVID-19 pandemic, this scoping review, based on a comprehensive search strategy, ultimately included only 29 relevant studies. The relatively small number of studies may be attributed to several factors.

Firstly, empirical research that systematically integrates human health, animal health, and the natural environment within a single analytical framework remains limited, particularly in the context of the COVID-19 pandemic. Studies explicitly adopting the OH framework for comprehensive exploration are even more scarce. While a significant body of literature has focused on the impact of green spaces on mental health or physical activity, these studies often lack a holistic analysis of the three components of OH (human, animal, and environment) and, as such, do not meet the inclusion criteria for this review.

Secondly, the limited number of studies included in this review is closely related to the high heterogeneity in study design and reporting methods. Some potentially relevant studies lacked systematic methodological support or did not use quantitative indicators to measure “health and well-being,” resulting in their exclusion based on methodological criteria.

Furthermore, research involving animal factors is notably scarce, especially studies focusing on human–companion animal emotional bonds and their impact on health and well-being. This stands in stark contrast to the number of studies examining the relationship between green spaces and mental health. In the context of the COVID-19 pandemic, research on this topic is even more restricted, further reducing the number of eligible studies.

During the COVID-19 pandemic, the behavioral patterns of dog owners regarding visits to green spaces were likely constrained by multiple factors. On one hand, the accessibility and availability of green spaces declined significantly, limiting opportunities even for dog owners to utilize such spaces regularly—particularly where safe or conveniently located green areas were lacking. In urban environments without dog-friendly infrastructure, some owners may have opted to walk their dogs in non-green public spaces such as sidewalks or parking lots. These activities are typically not classified as “green space use,” potentially leading to underestimation in related studies.

On the other hand, lockdown measures and public health restrictions during the pandemic hindered the implementation of field-based research, making it difficult for researchers to systematically collect behavioral data. Additionally, academic resources and research attention were largely redirected toward COVID-related public health issues, resulting in reduced investment in topics concerning human–animal–environment interactions. Declining participant engagement and rapidly shifting daily routines further compounded the methodological challenges and uncertainties in empirical data collection. Collectively, these factors contributed to a notable scarcity of relevant literature during the pandemic period.

In conclusion, the limited number of studies included in this review not only reflects the current stage of research integrating OH in examining the impact of green spaces and human-animal interactions on health and well-being but also highlights the need for increased interdisciplinary integration. This underscores the importance of fostering systematic research within the intersecting fields of public health, environmental health, and animal welfare in the future.

4.1. Redefining health and well-being through human - companion animal - green spaces interaction within the one health framework

Within the OH framework, researchers widely acknowledge the core principle that humans, companion animals, and natural environments—particularly urban green spaces—share interconnected and mutually beneficial interests (WHO, 2022). This recognition has led to the inclusion of positive findings from related studies in comprehensive assessments of overall health and well-being. As demonstrated by the literature reviewed in this study, health and well-being do not necessarily need to serve as primary endpoints; rather, they can also be considered secondary or ancillary outcomes within broader analytical frameworks. Some studies adopt a multidimensional approach to evaluating well-being, incorporating indicators that extend beyond individual health to encompass social and policy dimensions [74]. For instance, a study examining the relationship between social gathering restrictions and the frequency of green space visits included metrics such as per capita GDP, life satisfaction, environmental health indices, and ecosystem vitality in its assessment of well-being—highlighting the complex, multidimensional nature of health and well-being within socio-economic and ecological contexts [72].

The understanding and measurement of health and well-being are deeply influenced by social, cultural, and economic contexts. Therefore, assessment approaches must be sensitive to the potential interpretive biases and conceptual differences arising from these contextual variables. Incorporating sociodemographic characteristics—such as gender, age, income level, and educational attainment—into the analysis not only helps to reveal disparities in health status, behavioral responses, and access to resources but also enhances the explanatory power of research findings and improves the precision and equity of health intervention strategies. Moreover, the cross-cultural applicability of psychological constructs warrants careful consideration. For example, Packer et al. (2023), in their investigation of the motivations and behaviors related to puppy purchases before and after the COVID-19 pandemic, developed an online survey to capture evolving human–dog relationships under pandemic conditions [57]. Their findings underscore the potential impact of emotional bonds in human–dog interactions on individual health and well-being.

Future research within the OH framework should place greater emphasis on population heterogeneity and explore how individual characteristics may moderate health and well-being outcomes. In particular, there is a need to expand the types of health and well-being indicators by incorporating conceptual dimensions that reflect emotional connections among humans, urban green spaces, and companion animals. For example, the dog owners with higher levels of neuroticism tend to form stronger emotional bonds with their pets and exhibit more frequent caregiving behaviors [37,38,54]. Correspondingly, their dogs showed lower levels of stress-related hormones. This suggests that the style of human–animal interaction not only influences animal behavior and physiological responses but may also reflect the positive impact of emotional bonding on animal health.

At a theoretical level, the concept of Salutogenesis offers a robust analytical perspective for understanding the emotional interactions between humans, companion animals, and the natural environment. This theory focuses on how individuals maintain and generate health in the face of stress and adversity, emphasizing the activation of positive health resources rather than merely the prevention of disease [1]. During the COVID-19 lockdowns, the increased frequency of dog walking can be viewed as a typical salutogenic strategy. In a context where social and public activities were restricted, walking dogs outdoors not only fulfilled the basic needs of companion animals but also served as a crucial means for people to regulate psychological stress, regain a sense of normalcy, and restore feelings of control [62]. This behavior suggests that even in resource-constrained situations, humans can activate their health potential through emotional engagement with animals and green spaces.

Through the lens of the SOC theory, which comprises the dimensions of meaningfulness, comprehensibility, and manageability [83], we can further explore how human–dog–greenspace interactions contribute to salutogenic health processes. Meaningfulness is reflected in the sense of reconnecting with the natural world through interactions with dogs and nature, which enhances individuals' intrinsic sense of life purpose and value [52]. Comprehensibility refers to an individual's ability to understand the benefits of dog walking as a routine activity, which helps to reduce uncertainty and anxiety during crises such as the pandemic [84]. Manageability is demonstrated by the restoration of personal agency and self-efficacy through actions such as choosing walking times and routes and caring for dogs [11]. The dynamic interaction of these three dimensions provides essential psychological resources that support individuals in maintaining or regaining health under external stress.

Moreover, emphasizing the health-related interconnections between humans, companion animals, and urban green spaces has not only theoretical significance but also tangible health benefits. Human health behaviors, as shaped by daily interaction patterns, can significantly influence the quality of life and health status of companion animals [85]. For instance, healthy lifestyles and behaviors of dog owners—such as regular physical activity and proper dietary habits—can positively affect dogs' activity levels, dietary routines, and emotional stability through mechanisms of mimicry and caregiving. Conversely, the good health status of animals also contributes to owners' psychological well-being, creating a mutually reinforcing, bidirectional feedback loop [57]. This reciprocal relationship highlights the systemic and symbiotic nature of human–animal–environment interactions within the OH framework.

As an integrative and interdisciplinary model, OH extends beyond coordinated disease control to propose a multidimensional and interactive approach to health and well-being. Within this framework, health is no longer reduced to a singular representation of physical or psychological states, but rather conceptualized as a complex, systemic construct encompassing biological [69], sociostructural [70], and environmental [63] determinants. This perspective contributes to an evolving understanding of health as relational and context-dependent—where well-being can be positively influenced by individuals' embeddedness within supportive natural environments, human–animal bonds, and social networks, as emphasized in the OH framework. This does not imply that individual health is contingent upon these factors, but rather that their presence may facilitate salutogenic processes. Accordingly, future research should seek to expand conceptual and philosophical understandings of health and well-being, and to promote the development of comprehensive, inclusive, and culturally sensitive assessment standards that better reflect the multifaceted roles and interrelations of humans, companion animals, and green spaces in the co-production of well-being.

4.2. Interdisciplinary collaboration as an integrative pathway for advancing one Health Research on health-generating mechanisms

Although only a few studies explicitly adopt theoretical frameworks, several recurring conceptual orientations are evident in the literature. For example, the Biophilia Hypothesiss [86] and Attention Restoration Theory (ART) [5] are frequently cited to explain the restorative effects humans experience through contact with nature or animals. Some studies apply Attachment Theory or Social Support Theory to human-dog relationships, emphasizing the emotional and behavioral support mechanisms through which animals contribute to human well-being [87]. A small number of studies refer to Salutogenesis, particularly the SOC construct, to conceptualize how meaningful, comprehensible, and manageable interactions with dogs in green spaces promote health [1,2].

However, few studies have systematically tested these theoretical constructs or employed formal modeling to evaluate how they operate within complex socio-ecological systems [102]. This highlights a critical theoretical gap: there is an urgent need for interdisciplinary research that explicitly tests hypotheses derived from these frameworks to deepen causal understanding and support the design of theory-based interventions.

To archive this, research questions should be grounded in empirical or theoretical understandings of the health-generating relationships among humans, companion animals, and urban greenspaces, with the goal of achieving a systems-level understanding of the drivers behind health-related outcomes. Throughout this formative and iterative process, it is essential to build an interdisciplinary research team that spans both within and beyond the primary field of inquiry, particularly including individuals with expertise in mental health research and service delivery. Based on the studies reviewed in this paper, relevant practitioners may include urban planners and policy coordinators [10], veterinarians or professionals with veterinary expertise [38], members of the “Pandemic Puppies” research team [57], and non-traditional or informal practitioners with relevant health knowledge [37,53,58,69].

Moreover, the research process should avoid being dominated by any single disciplinary perspective. Stakeholders with insider knowledge of the systems in which they operate should be included at every stage. Such partnerships can broaden the scope of inquiry, foster sustained networks and collaborations, enhance the applicability of findings, and ensure that interventions remain adaptable and sustainable beyond the life of the research project.

Given the diversity of measurement dimensions related to non-human components, the selection of indicators should be aligned with the overarching objectives and intent of the study. Since uncovering the underlying mechanisms and pathways linking companion animals, greenspaces, and human health constitutes a core aim of this research agenda, health outcome measurements should be accompanied by rigorous assessments of exposure to natural elements—considering factors such as accessibility, visual contact, and environmental features. “Exposure” in this context refers to the amount and quality of contact an individual has with natural spaces. Furthermore, exposure assessment should incorporate more nuanced dimensions, including the duration of time spent in nature (i.e., “dose”) and the nature of interaction (e.g., differences between immersive experiences and virtual simulations) [54,88].

A notable limitation observed in the reviewed literature is the oversimplification of “exposure” to natural environments. Most studies relied on basic proximity measures or binary indicators (e.g., presence or absence of greenspace) without adequately capturing important exposure dimensions such as the duration of time spent in nature (“dose”), environmental quality, or the types of activities engaged in during exposure. This restricts the ability to explore dose-response relationships and to elucidate the nuanced mechanisms through which interactions with nature influence health outcomes. Future research should employ more refined and multidimensional exposure assessments to better characterize these dynamics.

4.3. Limitations and directions for future improvement

This scoping review has several limitations that warrant consideration. First, this review did not conduct a systematic appraisal of the methodological quality or rigor of the included studies. This limitation stems from the core purpose of a scoping review, which aims to comprehensively map the existing knowledge base, identify research gaps in the literature, and lay the groundwork for future research directions, rather than to assess the strength of evidence or the validity of causal inferences of individual studies. We acknowledge that the absence of a systematic quality assessment may result in some conclusions being based on methodologically weak evidence, thereby affecting the interpretation of results. Therefore, future research should incorporate systematic quality evaluations to enhance confidence in causal relationships and research findings. The exclusion of studies lacking quantitative health indicators may have limited the inclusion of rich qualitative insights. However, this decision was necessary to align with the review's aim of mapping empirically measurable outcomes and supporting future data-driven research directions.

Second, the literature search was limited to empirical studies published in English, excluding gray literature (e.g., policy reports, non–peer-reviewed publications) and studies published in other languages. These restrictions in language and publication type may have resulted in the omission of relevant findings, particularly those exploring the relationships among human–dog interactions, greenspace, and health and well-being within the OH framework. As a result, the comprehensiveness and representativeness of the review findings may have been affected.

Third, while we engaged in informal discussions with experts and researchers from various relevant disciplines throughout the research process to help refine the research questions, validate key academic terminology, and solicit feedback on interdisciplinary knowledge integration and dissemination strategies, these interactions were not conducted through standardized or systematic data collection procedures. Nor were the contents of these discussions recorded or incorporated into the formal analytical framework of this review. Although such exchanges enriched the theoretical depth and interdisciplinary dialogue of the study, they could not be included in the analytical dataset.

Building upon the preliminary findings of this review, future research should aim to expand both the empirical scope and theoretical framework in response to the OH paradigm's call for a deeper understanding of multi-agent and multi-system interactions. Specifically, future studies should move beyond the current focus on companion animals—particularly the emotional bonds between humans and dogs—and explore a broader range of human–animal–nature interactions. This broader perspective is essential to fully capture the diverse mechanisms through which human–animal relationships function within natural environments and contribute to both health and well-being.

For example, equine-assisted interventions have increasingly been recognized for their therapeutic potential in promoting mental health, supporting neurological rehabilitation, and facilitating emotional regulation. Wildlife-based encounters, such as birdwatching, have demonstrated significant benefits in enhancing environmental awareness, fostering nature connectedness, and supporting psychological restoration. Likewise, educational and therapeutic farm environments, which integrate human–animal–nature interactions within structured natural settings, provide not only opportunities for physical and emotional healing, but also serve as practical platforms for child development, social inclusion, and ecological education. These diverse interaction modalities underscore the interconnectedness of human well-being, animal welfare, and ecosystem health—an intersection at the heart of the OH framework.

To advance this research agenda more systematically, future work should emphasize structured, interdisciplinary collaboration. This entails the integration of expertise and methodologies from multiple domains, including health sciences, public health, veterinary medicine, landscape and urban planning, social work, and environmental psychology. By building a robust, theory-driven, and empirically grounded research framework through cross-sectoral knowledge exchange, researchers can foster a more comprehensive understanding of the mechanisms underpinning human–animal–nature interactions. Such efforts will ultimately strengthen the practical relevance and applicability of the OH framwork, providing integrated and forward-looking evidence for public health, environmental governance, and social welfare policy.

5. Conclusion

This review systematically examines the body of research on mental health, guided directly or indirectly by the OH framework, with the aim of identifying emerging trends and significant gaps in the existing evidence base. By doing so, it provides theoretical insights and methodological inspiration for future research, thereby fostering the development of creative, interdisciplinary research pathways that can more effectively address the ongoing health challenges related to “Long COVID” in the post-pandemic era.

The principal contribution of this scoping review is the systematic synthesis of the heterogeneous body of research at the nexus of humans, companion dogs, and natural environments. While extant studies have yielded insights into discrete facets of the human–animal–nature triad, there remains a conspicuous paucity of integrative theoretical frameworks and a limited deployment of interdisciplinary methodologies, thereby constraining a holistic elucidation of the complex and dynamic interactions inherent to this system.

Furthermore, the review highlights a substantive gap in empirical evidence addressing the role of companion animals in influencing health and well-being outcomes, particularly with respect to the affective bonds and their multifaceted cross-sectoral implications. Methodological limitations, including restricted sample representativeness, narrow variable operationalization, and impediments to data collection amid the COVID-19 pandemic, have collectively circumscribed the scope and depth of extant investigations.

In light of these findings, this review underscores the imperative for future research to adopt integrative, multidisciplinary approaches that foster theoretical and methodological innovation across health sciences, ecology, veterinary medicine, sociology, and landscape architecture. Such endeavors are critical for advancing a nuanced, systemic understanding of the human–animal–environment interface. Notably, the complexities and challenges associated with elucidating health interrelations within contemporary socio-ecological systems resonate strongly with the complex systems paradigm advanced by the OH framework. Integrating comprehensive health and welfare perspectives within this paradigm is essential to construct empirically robust and theoretically informed research trajectories, thereby furnishing rigorous scientific foundations to inform public health, environmental stewardship, and social policy. In particular, the OH framework's utility is amplified in the post-pandemic context, offering valuable insights into the mechanisms underpinning health generation and resilience in an era marked by unprecedented global health challenges.

CRediT authorship contribution statement

Yi Peng: Writing – review & editing, Writing – original draft, Resources, Methodology, Investigation. Yusong Ke: Investigation. Rui Cai: Resources. Bingyang Lv: Investigation. Shiliang Liu: Investigation. Yuzhou Liu: Resources. Xi Li: Project administration. Huixing Song: Supervision, Project administration. Qibing Chen: Supervision, Funding acquisition.

Declaration of competing interest

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

Appendix A. Supplementary data

Includes the PRISMA checklist, detailed search strategy, list of excluded full-text articles with reasons, and quality assesment of included studies using the Effective Public Health Practice Project (EPHPP) tool.

Data availability

Data will be made available on request.