GIS-based assessment of urban green space availability and utilization barriers among high-risk type-2 diabetic patients in Mysuru, India: a mixed method cross-sectional study

Physical inactivity exacerbates Type-2 Diabetes Mellitus (T2DM) burdens in Indian cities, yet the relationship between objective Urban Green Space (UGS) availability and actual patient utilization remains underexplored. This study investigates the “Availability-Utilization” disconnect among physically inactive T2DM patients in Mysuru, a Tier-2 Indian city undergoing rapid urbanization. A mixed-methods study was conducted in the Saraswathipuram Urban Primary Health Center (UPHC) catchment area (9.03 km²). UGS availability was quantified using Sentinel-2B Normalized Difference Vegetation Index (NDVI) mapping (Accuracy 88.3%; Kappa 0.81). Simultaneously, utilization barriers were assessed via a structured survey of 132 physically inactive T2DM patients. Per capita usable green space (66.17 m²) exceeded World Health Organization (WHO) norms (9 m²), yet a qualitative deficit was evident: 93.4% of vegetation lacked dense canopy. Despite quantitative abundance, only 29.5% of patients utilized these spaces. Males utilized UGS nearly twice as often as females (37.3% vs. 19.2%; p = 0.033). Age-stratified analysis identified distinct barriers: time constraints dominated younger cohorts (36–45 years; p = 0.022), while lack of motivation characterized middle-aged participants (46–55 years; p = 0.010). Our findings reveal a Quality-Quantity paradox: objective green space availability, though quantitatively adequate, remains substantially underutilized due to qualitative deficits in tree canopy shade and barriers shaped by gender, life stage, and psychological factors. Public health interventions must prioritize increasing tree canopy cover and addressing gender-specific safety concerns rather than solely expanding generic green cover.