Nature Interventions - 'What works' in nature based health interventions

South West PeninsulaGeneric Health Relevance
Start Date: 1 Feb 2017 End Date: 30 Apr 2017

Effective mechanisms for social prescribing


The use of non-drug, non-health-service interventions has been proposed as a cost-effective alternative to help those with long-term conditions manage their illness and improve health and well-being. The interventions typically involve accessing activities run by third sector or community agencies and may be described as non-medical referral, community referral or social prescribing. A wide range of activities and agencies have been considered, including art therapy, walking groups, reading groups, green/nature activities and volunteering. For such interventions to be effective, patients need to be “transferred” from the primary care setting into the community and maintain their participation in the activities there. It is not currently known what approaches are being used to enable people to reach community services that may benefit their health and well-being and the effectiveness of these efforts is unclear.

Work is being conducted in parallel to this review by Dan Bloomfield, Sara Warber, Lora Fleming et al. in developing a feasibility study for a nature-based social prescribing intervention, the review will inform this work.

Research question

We plan to undertake a realist review to unpack the uncertainties relating to methods of social prescription referral. Realist approaches try to understand “what works, for whom, in what circumstances, and why” and draw on evidence from a wider range of sources than traditional systematic reviews. 

This project results from a question prioritised in the 2014 round:

  • Would Green prescriptions improve patient wellbeing, quality of life and reduce GP visits by patients with complex health problems or mild to moderate depression?

Project aims/objectives

The review will have two phases in approaching the objectives listed below; (a) will identify programme theories in the literature and (b) will use targeted searches to seek suitable evidence to refine these theories.

  1. What are the main factors or mechanisms that are thought (both scientifically and experientially) to explain the success or failure of social prescribing?
  2. Are there methods of referral that are particularly useful and appropriate for different groups of people (we are particularly interested in those with mild to moderate depression)?
  3. Which approaches to referral are likely to be appropriate, or inappropriate, within NHS primary care settings?
  4. What is best practice for people with mild to moderate depression to receive nature interventions? (By this, we mean any intervention which occurs in the natural environment where, for example, greater benefits have been shown to accrue compared to similar activities indoors.)

Further information

For more information, view the protocol.

You can read Dr Kerryn Husk's piece on social prescribing in BMJ Opinion (published in July 2017) here

Dr Kerryn Husk