School nurses can facilitate school-wide initiatives to encourage outdoor physical activity through nature prescriptionsNature prescriptions are a strategy to support children’s health through increased time outdoors and physical activity. Studies that have examined how nature prescriptions are implemented often highlight the importance of discussing the health benefits of spending time in nature with those who are receiving the “prescription.” However, studies also indicate that primary health care providers often lack sufficient time to engage families in such discussions. School nurses interact with children more frequently than other health care professionals, enabling them to help children and families understand the value of nature exposure. Consequently, they may be well-situated to effectively facilitate nature prescription programs. This study evaluated the effectiveness of the TRACK Rx nature prescription program, which was implemented by an elementary school nurse. The program aimed to increase children's time in nature and participation in nature-based physical activity (PA).
The study was conducted at two elementary schools in a rural county in North Carolina, US. The schools were selected based on their proximity to a related network of hiking trails (TRACK Trails) and other outdoor recreation opportunities. 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 end of the school year, the school nurse introduced the TRACK Rx program to students at the intervention school to encourage 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 written prescription for increased outdoor activity in nature. Students also received information about nearby TRACK Trails. Students contributed to the prescription by indicating the activities they would participate in, such as playing in a park or hiking. Information about the health benefits of outdoor activity 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, which assessed: 1) the frequency of time children spent outdoors or in nature with family, friends, or by themselves; 2) the amount of time children engaged in PA and nature-based/outdoor PA; and 3) parents’ intention to have their child spend more time in nature or outdoors. The follow-up survey also assessed parents’ trust in the school nurse as a reliable source of health information. A total of 78 parents completed both surveys, including 51 from the intervention school and 27 from the control school. In both groups, the majority of parent participants identified as female and White. Statistical analyses examined if children’s time spent in the outdoors, PA, outdoor PA, and parents’ intention to have their child spend more time outdoors increased from baseline to 3-month follow-up in the intervention school compared to the control.
From base line to follow-up, time spent engaged in outdoor PA during weekends significantly increased among children in the intervention group compared to the control group. However, there were no significant differences between the groups’ outdoor PA during weekdays. Additionally, no other significant differences were identified between the groups’ time spent outdoors or in nature, overall PA, or parent intention to have their child spend more time in nature or outdoors. At follow-up, parental intentions to have their child spend more time in nature or outdoors during the next three months decreased in both groups, which may be due to seasonal changes and the start of a new school year. The far majority of parents (85.5%) agreed or strongly agreed that the school nurse is a trusted source of health information. Even more parents (94.7%) agreed or strongly agreed that their child’s primary health care provider is a trusted source. A significant relationship was detected in which parents who reported trust in their child’s primary health care provider were likely to demonstrate trust in the school nurse as well.
Overall, the study highlights an innovative approach to school-based nature prescriptions and the potential of school nurses to “act as the champion or leader of school-wide efforts to promote nature-based PA.” Further, the study revealed that school nurses are highly trusted by parents. Although increased outdoor PA was only evident on weekends for children who received a nature prescription, the transition to fall and a new school year may explain the lack of change among other outcomes. The researchers recommend that future TRACK Rx programs in schools “utilize a student-centered approach supported by the interprofessional team that includes prescriptions written by the school nurse as well as incorporating nature-based activity programming into physical education classes, outdoor recess, and within the classroom curriculum as warranted with teacher support.”
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