Review identifies implementation strategies to support children and youth’s equitable participation in nature prescription programs Nature prescribing is a type of social prescribing in which a health provider, social provider, or educator provides a recommendation to spend time in nature. Nature prescribing often involves a prescription for nature-based activities that aim to increase physical activity and improve social connection, well-being, and mental health. While nature prescription programs may offer potential health and well-being benefits for children and youth, the approach is understudied, and little is known about the factors that hinder or support implementation. This scoping review was conducted to synthesize the existing research that has examined the barriers and facilitators to nature prescription programs for children and youth. Specifically, the study investigated the barriers and facilitators that impact: 1) the delivery of nature prescription programs to children and youth; 2) child and youth participation in nature prescription programs; and 3) provider participation in nature prescription programs.
A systematic search of the literature was conducted to identify peer-reviewed, original studies of nature prescriptions and child and youth health. Studies were eligible for inclusion in the review if they involved children or youth under the age of 24 years and were published in English. To be included, the studies had to involve a health, social, or education provider-initiated prescription to spend more time in nature or a social prescription program that involved prescribing nature. Studies that involved referrals to participate in nature-based interventions were also eligible for inclusion. Additionally, the studies had to include a discussion of the barriers and/or facilitators to program implementation and/or participation. Ten studies met these criteria and were included in the review. The studies employed a variety of research designs. Six studies were conducted in the US, and the remainder were conducted in the UK, Germany and Canada. Findings were synthesized across studies using qualitative thematic analysis.
Analysis identified three themes within the barriers and facilitators of nature prescription implementation: 1) safety considerations, 2) materials, resources, and support, and 3) program features. Safety-related barriers to child and family participation discussed by the studies revealed concerns for physical safety. Unsafe parks and neighborhood spaces, negative health outcomes, and health-related challenges for vulnerable participants (with physical or mental health conditions) were found to hinder participation in nature prescriptions. The studies reported both barriers and facilitators related to materials, resources, and support. Health care providers indicated that a lack of culturally and developmentally appropriate materials was a barrier to implementing nature prescriptions. When materials such as maps and smartphone applications were available, they helped healthcare providers discuss nature prescriptions with families. Time was a limited resource that constrained participation for both families and healthcare providers. School and caregiver work schedules negatively impacted families’ participation. Healthcare providers’ ability to discuss nature prescriptions was hindered by insufficient time allotted to patients. Inequitable access to nature emerged as a barrier across studies. Lack of access to nature and limited family financial resources hindered participation. Public transportation and healthcare providers who are aware of low or no-cost opportunities in their patients’ neighborhoods may encourage participation. The importance of support—which can help families understand the health benefits of nature and provide individualized prescriptions that address families’ specific needs and barriers—was also highlighted. Additionally, features of prescription programs were found to hinder or facilitate participation. Programs that occurred in unsafe or unmaintained neighborhoods or parks limited engagement; those offered in settings that were well maintained, safe, clean and met participants’ needs encouraged involvement. Program activities that were fun and exciting, or that were free and nearby also promoted participant engagement.
The review highlights important considerations that can guide the implementation of nature prescriptions. Barriers that limited participation in nature prescriptions were largely related to a lack of adequate time and other resources, inequitable access to nature, safety concerns, and insufficient prescribing materials and support. Importantly, facilitators that can encourage participation were also revealed, including support from healthcare providers, safe and enjoyable natural settings and activities, participant knowledge of the benefits of nature, and individualized prescriptions that account for socioeconomic status, location, and nature access. The review also calls attention to disparities that limit the participation of children and youth from marginalized communities. “Nature prescription programs should therefore integrate considerations of equity, including offering equitable opportunities in local community and utilize appropriate approaches that consider environmental and socio-ecological factors.” Future research should also address equity concerns and “explore experiences, perspectives, and implementation strategies in multiple countries and contexts to inform tailored intervention design and implementation.”
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