Green space accessibility, barriers to use, and its association with self-rated health among adults with cerebral palsy: a nationwide cross-sectional study in South Korea

Abstract Adults with cerebral palsy experience poorer health than both the general population and other disability groups, making the identification of modifiable health-promoting factors as key research priority. Green spaces may promote their health through multiple pathways, including stress reduction, attention restoration, physical activity, and social engagement. This study examines perceived green space accessibility and use among adults with cerebral palsy in South Korea, identifies barriers to use, and investigates associations with self-rated health. We used a nationwide cross-sectional data from a 2025 survey of 689 Korean adults with cerebral palsy. Perceived accessibility was assessed by asking whether green spaces existed within walking distance, reflecting subjective proximity perception. Among those with perceived access, use in the past 30 d and reasons for non-use were assessed. Self-rated health was classified as ‘Good’ or ‘Bad.’ Logistic regression analyses examined associations between green space accessibility/use and self-rated health, adjusting for potential confounders. Among participants, 79.8% reported nearby green spaces; however, only 66.0% of those had used. The most cited barriers were difficulty traveling to green spaces (38.5%), mobility barriers within them (16.0%), and discomfort due to public attention (11.8%). Perceived accessibility was not significantly associated with self-rated health (adjusted OR: 0.78, 95% CI: 0.48, 1.26), whereas actual use was positively associated (adjusted OR: 1.57, 95% CI: 1.01, 2.43). Our findings indicate that actual use, rather than perceived accessibility, is associated with better self-rated health—consistent with stress recovery theory and attention restoration theory, which emphasize experiential engagement with nature for health benefits. Addressing physical and social barriers through universal design approaches can help ensure green spaces serve as health-promoting resources for persons with cerebral palsy.