A nature prescription program did not influence parental perceptions of their child’s time in nature, but did encourage increased hiking trail visitationNature prescription programs aim to encourage health-promoting physical activity in nature through a “prescription” written by a physician or other health care provider. Research that has examined the effectiveness of nature prescription programs has reported mixed findings. Some studies suggest that in addition to written prescriptions, information about local outdoor activities and parks, as well as the health benefits of nature, should also be provided. This study examined a specific nature prescription program, TRACK Rx, which provides health care providers with materials to prescribe children outdoor activities in nature. The study aimed to evaluate the effectiveness of a TRACK Rx program that was implemented in an elementary school by the school nurse in conjunction with a related hiking trail network called TRACK Trails. The study investigated how the nature prescription program impacted parents’ perceptions of their children’s participation in outdoor and nature activities.
The study was conducted at two elementary schools in a rural county in North Carolina, US that were located near an extensive network of TRACK Trails. One school served as the intervention school and participated in the TRACK Rx program; the other school did not participate in the program and served as the control school. At the intervention school, the school nurse introduced the TRACK Rx program to students in the first through third grades (average age 7.7 years) at the end of the school year to encourage their participation in outdoor activities over the summer break. The nurse visited each classroom to explain the benefits of nature-based physical activity and provide students with a prescription for increased outdoor activity in nature. Information about nearby TRACK Trails was also given to students. Students selected the activities they wanted to commit to, such as playing in a park or hiking on a TRACK Trail. Information about the nature prescription program was also shared with students’ parents. Outdoor activity in nature was not prescribed to students at the control school. Parents of students at both schools were sent a baseline survey prior to the intervention and a follow-up survey three months later. The surveys assessed several aspects of parental perceptions of their child spending more time in nature or the outdoors, including: 1) attitudes; 2) subjective norms (perceived approval of others); 3) perceived behavioral control; and 4) intention to increase time in nature. The surveys also assessed awareness of nearby hiking trails and visitation to TRACK Trails. Completed baseline and follow-up surveys were obtained from 49 intervention school parents and 27 control school parents. In both groups, the majority of parent participants identified as female and White. Statistical analysis examined if parents’ attitudes, subjective norms, perceived behavioral control and intention related to having their child spend time in nature or outdoors increased from baseline to the follow-up in the intervention group as compared to the control group.
No significant changes in parental attitudes, subjective norms, perceptions of behavioral control, and intentions related to their children spending time outdoors were detected between the intervention and control groups. At the baseline assessment, analysis revealed that parental attitudes, subjective norms, and perceived behavioral control regarding having their child spend time outdoors were significantly and strongly related to parental intention to have their child spend more time outdoors. At the three-month follow-up, parental intentions for their children to spend more time outdoors declined in both groups, which is likely explained by seasonal weather changes and school schedules. Children in the intervention group demonstrated increased participation in the TRACK Trails hiking program compared to the control group. Over 50% of children in the intervention group made multiple visits to TRACK Trail sites.
Overall, the researchers concluded that “the TRACK Rx program implemented by the school nurse is a promising implementation strategy to reach children in school settings.” While the study did not influence parents’ perceptions or intentions regarding their child’s time in nature, the intervention appears to have encouraged higher rates of TRACK Trail visitation. This finding suggests that nature prescription programs may support behavioral changes that can increase children’s contact with nature. The researchers encourage larger studies of TRACK Rx to clarify the program’s impact on children’s engagement with and connection to nature.
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