Nature-based Health Interventions Research Articles

The MINT Program: A Mixed-Method Approach to Identifying Nature-Based Resources to Promote Adolescent Parent Social and Psychological Well-Being.

Adolescent parents are at an increased risk for loneliness and mental health challenges compared to childless peers. Nature-based interventions are shown to promote social connectedness. To identify elements of a nature-based intervention to reduce loneliness and foster nature connection among pregnant and parenting adolescents. Sequential exploratory mixed methods. In 2020 and 2021, we piloted the 8-week MINT program at a school for pregnant and parenting teens. Our qualitative approach (n = 17) included online and in-person group meetings with nature-based educational content, discussion, park excursions, mindfulness activities, journaling and nature photography. Subsequently, we recruited 131 young mothers at a children's hospital for a cross-sectional survey based on qualitative school findings. Qualitative results from the school-based intervention showed a preference for meditative and contemplative activities and for spending time in nature with extended family. Participants typically accessed nature close to home. Our clinic-based teen parent survey illustrated that participants' access to nature were most limited by lack of time (25% of responses), company (18%) and energy (28%). While participants showed a close nature connection (mean NR-6 score = 3.9 (SD = 0.84)), they also showed moderate levels of loneliness (mean UCLA Loneliness score = 4.78 (SD = 1.60)). Walking, hiking and/or running were the most preferred nature activity. These findings provide key details to define nature-based activities to address loneliness and psychological well-being among teen mothers. Nature-based health interventions can address loneliness and nature disconnection by building community resilience, improving provider and patient well-being and motivating environmental stewardship. We identify key features of a nature-based intervention for adolescent mothers. These findings support teen mothers in the US and abroad and may serve as a foundation for using nature-based solutions for vulnerable mothers and for adolescents facing loneliness and mental health challenges. No patient or public contribution.

Perceptions of Knowledge and Experience in Nature-Based Health Interventions.

Although perceptions and uses vary, nature-based health interventions (NBHIs) help facilitate the additional health benefits of physical activity (PA) experienced in nature, thereby reducing all-cause morbidity and mortality. The purpose of this mixed-methods, cross-sectional study was to better understand perceptions, terminology, and participation in NBHIs. A questionnaire was developed by reviewing validated instruments and gauging expert experience with stakeholders. Distributed electronically, a community partner listserv promoting active living served as the population. Quantitative questionnaire measures assessed familiarity with NBHI terms, concepts, experience, how NBHI should be used, and the importance of NBHI components. Qualitative themes included the strengths and weaknesses of NBHIs. Participants (n = 53) were familiar with the terms nature play (82%), forest bathing (78%), and park and nature prescriptions (74%) and moderately familiar with NBHIs (5-point Likert scale, M = 3.27, SD = 1.17). Most thought NBHIs could be useful in treating physical (96%) and mental health conditions (100%) and would follow or write one (80%). The location was reported as the most important component, followed by access, social comfort, dosage, and ongoing support. This study suggests stakeholders are familiar with and support NBHIs conceptually; however, policies, support, and funding opportunities are needed to operationalize components to increase use of NBHIs.

Measuring nature-based health interventions – a rapid review of instrumentation and outcomes

Nature-based health interventions (NBHIs) are utilised to treat a range of physical and mental health conditions, and this rapid review sought to describe the breadth of instrumentation utilised to measure the effectiveness of NBHIs on the different domains of health and wellbeing. A total of 14,385 records were extracted from three databases, and a review of titles and abstracts and then of full text resulted in a final dataset of 167 articles that met the review criteria. NBHI settings were categorised as Garden/Horticulture, Blue Spaces, Urban Green Spaces, Wild Nature, and Camps/Residential. For each of these settings, major population groups included in the studies, health domains and outcomes addressed, as well as assessment tools used to measure NBHIs’ effectiveness were described and analysed in aggregate. A total of 336 measurement tools were utilised across the dataset, with only 29 being specifically designed to assess NBHIs. Most studies investigated mental health domains and measured the effectiveness of NBHIs to improve psychological factors and physical, behavioural, and healthy eating outcomes. Future research should interrogate how nature-based tools and outcome measurements could be used most effectively in NBHI settings.

A time with e-Natureza (e-Nature): a model of nature-based health interventions as a complex adaptive system.

Discussions surrounding the positive impacts of nature on human health and strategies to enhance our connection with the natural world have been ongoing. However, a limited number of theoretical models are available to guide research and practice in this area. Therefore, there is a pressing need for a systematic framework that outlines clear steps for conducting research implementing nature-based interventions. In this study, we investigate the relationship between health and nature through the lens of Complex Adaptive Systems. This approach involves examining the dynamic interactions between multiple interconnected elements to understand the complex emergent behaviors that arise from such relationships. Our model is designed to support nature-based interventions, considering the essential interdependence between humans and nature. This perspective aims to improve both human health and biodiversity conservation in a mutually beneficial manner. The underlying interactions that drive nature-based health interventions are thoroughly explored, leading us to propose a novel intervention model named "A time with e-Natureza" (e-Nature). This model encompasses four types of experiences, drawing from scientific literature and insights from authors engaged in an interdisciplinary research group: (1) Aesthetic and emotional experience; (2) Multisensory integration experience; (3) Knowledge experience; and (4) Engagement experience. Each experience within the model targets affective, cognitive, and behavioral aspects, with a specific focus on fostering a deeper connection with nature. Distinct activities are incorporated within each experience to promote successful outcomes. The model is grounded in existing theories that address the human-nature relationship and is informed by Nursing theories that support health promotion interventions. By presenting this new model, our aim is to contribute to the effective implementation of nature-based interventions that not only enhance human well-being but also support the conservation of nature. This integrated approach recognizes the mutual benefits of human-nature interaction and offers valuable insights for future research and practical applications in the fields of nature and health.

Towards Key Principles for the Design and Implementation of Nature Prescription Programs

The health benefits of nature are well recognised. However, nature prescriptions (nature-based health interventions) are not routine in many health systems. We interviewed health stakeholders (n = 13) who prescribe and provide nature prescriptions, to identify enablers and barriers surrounding nature prescriptions in Australia. Participants emphasised the importance of collaboration between health disciplines, community, government and industry sectors, alongside appropriate infrastructure. Patient-centred, accessible care supporting behavioural change and social wellbeing was enabling. Participants identified a need for increased awareness, accessible local resources and responsiveness regarding climate change. The findings reveal key considerations to inform effective implementation of nature prescribing for enhanced community health.

A nature-based health intervention at a military healthcare center: a randomized, controlled, cross-over study

We describe a mixed qualitative and quantitative research study in a military facility regarding the role of nature in well-being. Study intervention included two 20-minute walks. One walk was in an intentionally designed woodland environment (Green Road) and the other was on a busy campus road in a medical treatment facility (Urban Road). Twelve volunteers from a military facility participated in both walks in a cross-over experimental design. The two walking sessions were randomly ordered and preceded by pre-walk instructions appropriate to each road’s characteristics and incorporated focused attention and present moment orientation. A semi-structured post-walk interview, the primary outcome, was conducted after the conclusion of each walk. Qualitative data analyses consisted of sentiments and themes by using NVivo 12 software. The Green Road was unanimously rated as positive (100%). Responses to Urban Road were evenly distributed among positive (33.3%), negative (33.3%), and neutral/mixed (33.3%) sentiments. The Green Road yielded predominantly positive themes such as enjoyment of nature, relaxation, and feelings of privacy and safety. Urban Road produced significantly more negative themes such as concerns for safety, dislike of noise and other noxious experiences. Quantitative assessment of distress and mindfulness with Distress Thermometer (DT) and Mindful Attention Awareness Scale-state version (MAAS) demonstrated that a walk on the Green Road significantly decreased distress and increased mindfulness compared to a walk on the Urban Road. We also observed that pre-walk instructions could direct attention to both obvious and subtle elements of experience and enhance awareness. Results support the notion that an intentional nature-based environment may produce significantly more positive experiences and result in health-promoting benefits in a military health-care setting compared to an urban environment. Future studies with clinical populations could advance our understanding of the healing value of nature-based interventions. The impact of intentional green environments may be enhanced by well-designed instructions for both recreational and therapeutic use.

Urban street tree biodiversity and antidepressant prescriptions

Growing urbanisation is a threat to both mental health and biodiversity. Street trees are an important biodiversity component of urban greenspace, but little is known about their effects on mental health. Here, we analysed the association of street tree density and species richness with antidepressant prescribing for 9751 inhabitants of Leipzig, Germany. We examined spatial scale effects of street trees at different distances around participant’s homes, using Euclidean buffers of 100, 300, 500, and 1000 m. Employing generalised additive models, we found a lower rate of antidepressant prescriptions for people living within 100 m of higher density of street trees—although this relationship was marginally significant (p = 0.057) when confounding factors were considered. Density of street trees at further spatial distances, and species richness of street trees at any distance, were not associated with antidepressant prescriptions. However, for individuals with low socio-economic status, high density of street trees at 100 m around the home significantly reduced the probability of being prescribed antidepressants. The study suggests that unintentional daily contact to nature through street trees close to the home may reduce the risk of depression, especially for individuals in deprived groups. This has important implications for urban planning and nature-based health interventions in cities.

Hands-On Ecological Restoration as a Nature-Based Health Intervention: Reciprocal Restoration for People and Ecosystems

There is growing concern that lack of access to natural habitats—especially ones with diverse soil microbiota and vegetation—exacerbates individual human and community health problems. Accordingly, practitioners concerned with both human and ecological health have proposed a number of nature-based interventions to improve human health. Two of many promising advances are the Microbiome Rewilding Hypothesis (MRH) and the Psycho-Evolutionary Restoration Hypothesis (PERH). While MRH primarily evaluates whether the restoration of soil microbiota can enhance human gut microbiome health and brain function, PERH tests whether reintroduction of native plant species rich in aromatic phytoncides can reduce depression and lower cortisol levels. Such complementary approaches to the reciprocal restoration of biodiverse habitats and human health are engaging people in nature-based initiatives around the world. We offer examples of programs involving youth directly in ecological restoration activities that may also benefit human health. In particular, we explore how restoring both microbiotic soil crusts and aromatic plant guilds in the urban heat islands—especially in hot, dusty desert cities—can reduce the psychological and physical impacts of diseases such as valley fever, asthma, and other diseases exacerbated by climate change. We report on pioneering tests of indicators of soil microbiome diversity, phytoncide/biogenic volatile organic compound (BVOC) diversity, and youth responses to restoration work that can be monitored concurrently over time. We call for more collaboration among restoration ecologists and ecopsychologists to better determine the ultimate and proximate causes of nature-deficit disorders and the impacts of ecological restoration interventions on physical and mental health.

Let Nature Be Thy Medicine: A Socioecological Exploration of Green Prescribing in the UK.

Prescribing nature-based health interventions (green prescribing)—such as therapeutic horticulture or conservation activities—is an emerging transdisciplinary strategy focussed on reducing noncommunicable diseases. However, little is known about the practice of, and socioecological constraints/opportunities associated with, green prescribing in the UK. Furthermore, the distribution of green prescribing has yet to be comprehensively mapped. In this study, we conducted a socioecological exploration of green prescribing. We deployed online questionnaires to collect data from general practitioners (GPs) and nature-based organisations (NBOs) around the UK and conducted spatial analyses. Our results indicate that GPs and NBOs perceive and express some common and distinct constraints to green prescribing. This highlights the need to promote cross-disciplinary communication pathways. Greenspace presence and abundance within close proximity (100 and 250 m) to GP surgeries (but not greenness—as a proxy for vegetation cover) and NBO presence within 5 km were associated with higher levels of green prescribing provision. Lower levels of deprivation were associated with higher frequency of NBOs. This suggests that the availability of greenspaces and NBOs could be important for green prescribing provision, but there could be greater opportunities in less deprived areas. Important foci for future research should be to establish transdisciplinary collaborative pathways, efficient infrastructure management and a common vocabulary in green prescribing—with the overall aim of reducing inequalities and enhancing planetary health.

Wetlands for Wellbeing: Piloting a Nature-Based Health Intervention for the Management of Anxiety and Depression.

Nature-based health interventions (NBIs) for the treatment of poor mental health are becoming increasingly common, yet evidence to support their effectiveness is lacking. We conduct a pilot study of a six-week intervention, aiming to engage individuals with wetland nature for the treatment of anxiety and/or depression. We employed a mixed methods design, using questionnaires, focus groups and semi-structured interviews to evaluate the intervention from the perspective of participants (n = 16) and healthcare professionals (n = 2). Results demonstrate significant improvements in mental health across a range of indicators, including mental wellbeing (Warwick and Edinburgh Mental Wellbeing Scale), anxiety (Generalised Anxiety Disorder-7), stress (Perceived Stress Scale) and emotional wellbeing (Positive and Negative Affect Schedule). Participants and healthcare professionals cited additional outcomes including improved physical health and reduced social isolation. The wetland site provided a sense of escape from participants’ everyday environments, facilitating relaxation and reductions in stress. Wetland staff knowledge of the natural world, transportation and group organisation also played a considerable role in the intervention’s success. These aspects should be considered in future and existing NBIs to maximise benefits to participants. We propose NBIs based in wetlands are an effective therapy option for individuals diagnosed with anxiety and/or depression.

Nature-Based Interventions for Improving Health and Wellbeing: The Purpose, the People and the Outcomes.

Engagement with nature is an important part of many people’s lives, and the health and wellbeing benefits of nature–based activities are becoming increasingly recognised across disciplines from city planning to medicine. Despite this, urbanisation, challenges of modern life and environmental degradation are leading to a reduction in both the quantity and the quality of nature experiences. Nature–based health interventions (NBIs) can facilitate behavioural change through a somewhat structured promotion of nature–based experiences and, in doing so, promote improved physical, mental and social health and wellbeing. We conducted a Delphi expert elicitation process with 19 experts from seven countries (all named authors on this paper) to identify the different forms that such interventions take, the potential health outcomes and the target beneficiaries. In total, 27 NBIs were identified, aiming to prevent illness, promote wellbeing and treat specific physical, mental or social health and wellbeing conditions. These interventions were broadly categorized into those that change the environment in which people live, work, learn, recreate or heal (for example, the provision of gardens in hospitals or parks in cities) and those that change behaviour (for example, engaging people through organized programmes or other activities). We also noted the range of factors (such as socioeconomic variation) that will inevitably influence the extent to which these interventions succeed. We conclude with a call for research to identify the drivers influencing the effectiveness of NBIs in enhancing health and wellbeing.

Green Prescriptions and Their Co-Benefits: Integrative Strategies for Public and Environmental Health

There is a growing recognition of the links between the increasing prevalence of noncommunicable diseases, environmental concerns including biodiversity loss and ecosystem degradation, and socioecological issues such as ecological (in)justice. This has encouraged a number of recent calls for the development of integrative approaches aimed at addressing these issues—also known as nature-based solutions. An example of an emerging nature-based solution is a ‘green prescription’, broadly defined as a nature-based health intervention. Green prescriptions are typically designed for patients with a defined need and they have the potential to supplement orthodox medical treatments, particularly those aimed at addressing noncommunicable diseases. It is also thought that green prescriptions could bring about significant environmental, economic, and social co-benefits. However, researchers have recently expressed concerns over taking the ‘dose of nature’ approach, in that it may be too reductionistic for the complex social settings in which it is provided. Here we frame a holistic philosophical perspective and discuss green prescribing logic, types, mechanisms and fundamental remaining questions and challenges. We place a significant emphasis on the potential co-benefits of green prescriptions, and the importance of taking a planetary health approach. More research is needed to determine how this potential can be realised, and to further understand the complexities of the nature–human health relationship. However, with additional research and support, there is huge potential for green prescriptions to contribute to both reactive (health care) and proactive (health promoting) public health solutions whilst enhancing the natural environment.

Healthy Parks Healthy People as an Upstream Stress Reduction Strategy.

One of the primary goals of the Healthy Parks Healthy People (HPHP) program, located in the San Francisco Bay Area, is to offer group-based physical activities in natural settings. These activities arefor racially and ethnically diverse groups of individuals as an "upstream" strategy for improving health. This study investigated the health impact of selected two-hour HPHP Bay Area events that targeted low-income racial and ethnic minority groups using physiological and self-reported measures of stress and related variables. Study participants (N=52) in the selected HPHP Bay Area events donated saliva and filled out psychological measures of perceived stress (PSS-4; Cohen et al.) and mood state (I-PANAS-SF; Thompson, 2007) at the beginning and the end ofa two-hour guided walk in green spaces. Moreover, a measure of perceived restoration (SRRS; Han, 2007) was completed at the end ofthe walk. Study participants wore a physical activity self-monitoring device (Garmin Vivofit 2) to capture their step count and heart rate during the event. Stress, both measured by the analysis of salivary cortisol and self-reported perceived stress, significantly decreased over the course of the event (p<.0$) and there was a significant increase in positive mood (p<.05). The monitoring device also indicated that individuals were engaged in moderate levels of physical activity during the guided walks (<di>x</di> =8,990 steps, HR 95 bpm). The results encourage further development of nature-based health interventions to mitigate stress. Such interventions may be especially appropriate for low-income, urban, racial and ethnic minority groups that likely experience increased levels of stress due to social inequities and poor living conditions.

Landscape biodiversity correlates with respiratory health in Australia

Megatrends of urbanisation and reducing contact with natural environments may pose a largely unappreciated risk to human health, particularly in children, through declining normal (healthy) immunomodulatory environmental exposures. On the other hand, building knowledge of connections between environments, biodiversity and human health may offer new integrated ways of addressing global challenges of rising population health costs and declining biodiversity. In this study we are motivated to build insight and provide context and priority for emerging research into potential protective (e.g. immunomodulatory) environmental exposures. We use respiratory health as a test case to explore whether some types and qualities of environment may be more beneficial than others, and how such exposures may compare to known respiratory health influences, via a cross-sectional ecological epidemiology study for the continent of Australia. Using Lasso penalized regression (to interpret key predictors from many candidate variables) and 10-fold cross-validation modelling (to indicate reproducibility and uncertainty), within different socio-geographic settings, our results show surrogate measures of landscape biodiversity correlate with respiratory health, and rank amongst known predictors. A range of possible drivers for this relationship are discussed. Perhaps most novel and interesting of these is the possibility of protective immunomodulatory influence from microbial diversity (suggested by the understudied ‘biodiversity hypothesis’) and other bioactive agents associated with biodiverse environments. If beneficial influences can be demonstrated from biodiverse environments on immunomodulation and human health, there may be potential to design new cost-effective nature-based health intervention programs to reduce the risk of immune-related disease at a population level. Our approach and findings are also likely to have use in the evaluation of environment and health associations elsewhere.