Coventry HDRC is involved in university research to explore how nature‑based activities can better health and wellbeing.
Green health prescribing, also called green social prescribing, is when healthcare professionals like doctors and nurse practitioners recommend outdoor activities. These activities could be walking in parks, gardening, or taking part in programmes that involve nature.
But not everyone has access to these outdoor activities or green health prescribing.
New qualitative and quantitative evidence reviews were funded by National Institute for Health and Care Research (NIHR) Evidence Synthesis Programme. A team of university researchers, including a Council based HDRC research fellow, looked at the factors that affect how older adults access green health prescribing in primary care.
The qualitative review explored what helps or prevents older adults from accessing nature‑based activities in primary care. The quantitative review looked at whether these activities improve health and wellbeing outcomes.
Access to green health prescribing
The qualitative review looked at 27 studies to understand what affects access to green health prescribing. It found that while these activities can support healthy ageing, many older adults face practical barriers that stop them taking part in outdoor activities.
These include not being able to get to green spaces easily, not having local services, problems with transport, safety concerns, and wider challenges linked to deprivation, such as not having much money or poor housing. These barriers often appear before any potential benefits of green health prescriptions are felt.
The review also showed that healthcare professionals face challenges. It can be hard to recommend nature-based activities if:
- Appointment times are short
- They are not very aware of what is available locally
- It is not clear what works.
When health care professionals don't have much confidence in green health prescribing, they're less likely to refer patients.
At the same time, the qualitative evidence showed what was making things better. Older people are more likely to take part in green health prescribing when there are green spaces nearby that they feel safe in.
Group activities are important because they help people meet each other and create a routine. If people have a good time in nature, they're more likely to come back, instead of giving up after one session.
The enthusiasm and commitment of the people involved can often make the difference between an outdoor activity continuing or fading away.
Effectiveness of green health prescribing
The quantitative review looked at 21 studies measuring the effects of nature-based interventions for adults aged 50 and over. These studies looked at activities like walking in green spaces, horticultural therapy (such as gardening), group exercise outdoors, as well as indoor gardening.
Many studies reported improvements in at least one area, including quality of life, wellbeing, mental health, physical function, fatigue, loneliness, and social connection. However, it wasn’t often that the treatment was clearly and consistently better than standard care or other activities.
Most studies were small and short-term, so the overall certainty of the evidence was rated as low. This doesn't mean that green health prescriptions don't work. This means that there’s need for stronger, longer-term studies to understand what works best, for whom, and under what conditions.
What does that mean for Coventry?
“Green spaces bring communities together, reduce loneliness and mitigate the negative effects of air pollution, excessive noise, heat, and flooding.
There is opportunity to work with communities to protect and improve existing green space and create new ones in areas most in need, and to implement nature-based interventions for health, such as green walking or green social prescribing”
When we look at the evidence, both the qualitative and quantitative reviews confirm that green health prescribing can help older people feel less lonely, more confident, and more connected to their communities. But it's the access that decides who benefits.
If there are not many transport options, activities are not available locally, or green spaces do not feel safe, many older residents will not be able to benefit.
For Coventry, this means it’s important to invest in local green spaces, to support programmes that are run by the community, and to make it easier for people to access healthcare, community services, and local activities. So no-one is left behind.
Encouragingly, there is already strong local action in this space. For example, the Council’s Citywide Action work includes plans to improve nature and create fairer green futures, and programmes like Green for All are focused on making green spaces easier for everyone to use.
The papers have not yet been peer‑reviewed. Publication is expected soon. You can read the preprints on Research Square:
- Factors influencing access to green health prescribing in primary care for older adults – A qualitative systematic review on Research Square.
- Effectiveness of green health prescribing and nature-based interventions in primary care and community setting for older adults – A systematic review | Research Square
NIHR
The NIHR Health Determinants Research Collaboration (HDRC) Coventry is part of the NIHR and hosted by Coventry City Council.
Visit the NIHR website