Nature prescription programs are growing faster than the evidence base to support and guide such programs

Kondo, M. C., Oyekanmi, K. O., Gibson, A., South, E. C., Bocarro, J., & Hipp, J. A. (2020). Nature prescriptions for health: A review of evidence and research opportunities. International Journal Of Environmental Research And Public Health, 17.

Nature prescriptions are generally given by a physician or other healthcare provider, suggesting that patients spend a certain amount of time outside. The number of nature prescription programs is growing – especially in the U.S. -- primarily in response to concerns about chronic diseases related to increasingly sedentary and screen-based lifestyles. This review of the published literature examined the evidence base regarding such programs.

The review focused exclusively on nature prescription programs with a clinical component offered in out-patient settings. Eleven studies met the inclusion criteria. Of these, eight were empirical studies; one was a case study; the other two were research protocols. Two different types of nature prescriptions were identified: (1) prescriptions for structured programs and (2) unstructured prescriptions. Prescriptions for structured programs consisted of referrals to a formal outdoor program or activity, such as organized walks, outdoor sports or games, and group picnics. Unstructured programs usually included counseling and education about nearby outdoor resources and often referred patients to specified locations, such as local parks. In some cases, unstructured programs offered incentives such as a free pass to a state park or such supportive items as a journal and pedometer. The empirical studies evaluated a wide variety of health-related behaviors and outcomes, often focusing on at-risk children and families. Studies included in this review were “too sparse to draw patterns in health outcome responses.” Studies evaluating program structures in relation to patient follow-through showed mixed results. While a few studies focused on providers' perspectives on nature prescription programs, the challenges and opportunities of such programs for providers is an “under-explored area of research.”

Results of this review call attention to the overall lack of research and evaluation of nature prescription programs. More research is necessary to understand different facets of nature prescription programs, including how to measure and increase patient adherence, how to determine short and long-term health outcomes for patients and their families, and what determines provider participation.

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