Challenges and Approaches to Green Social Prescribing During and in the Aftermath of COVID-19: A Qualitative Study

Abstract

The last decade has seen a surge of interest and investment in green social prescribing, however, both healthcare and social enterprise has been impacted by the COVID-19 crisis, along with restricted access to public green spaces. This study examines the challenges and opportunities of delivering green social prescribing during and in the aftermath of COVID-19, in the light of goals of green social prescribing to improve mental health outcomes and reduce health inequalities. Thirty-five one-to-one interviews were conducted between March 2020 and January 2022. Interviewees included Link Workers and other social prescribers, general practitioners (GPs), managers, researchers, and volunteers working in urban and rural Scotland and North East England. Interview transcripts were analyzed in stages, with an inductive approach to coding supported by NVivo. Findings revealed a complex social prescribing landscape, with schemes funded, structured, and delivered diversely. Stakeholders were in general agreement about the benefits of nature-based interventions, and GPs and volunteers pointed out numerous benefits to participating in schemes such as parkrun. Link Workers were more circumspect about suggesting outdoor activities, pointing out both psychological and practical obstacles, including health anxieties, mobility issues, and transport deficits. Exacerbated by the pandemic, there was a way to go before older and/multi-morbidity clients (their largest cohort) would feel comfortable and safe to socialize in open air spaces. Our findings support the premise that time spent in open green spaces can alleviate some of the negative mental health effects compounded by the pandemic. However, the creation of healthy environments is complex with population health intrinsically related to socioeconomic conditions. Social disadvantage, chronic ill health and health crises all limit easy access to green and blue spaces, while those in the most socially economically deprived areas receive the lowest quality of healthcare. Such health inequities need to be borne in mind in the planning of schemes and claims around the potential of future nature-based interventions to reduce health inequalities.

Negotiating Complexity: Challenges to Implementing Community-Led Nature-Based Solutions in England Pre- and Post-COVID-19

“…This observation aligns with evidence in the literature that pandemic-related psychological effects make it more difficult to persuade some people to get outside [ 101 ].…”

“…Fixsen and Barrett (2022) found that volunteering declined due to the upheavals and health concerns caused by the pandemic [ 101 ]. Our study confirmed that after the onset of COVID-19, organisations lost skilled staff, and found it difficult to re-engage volunteers due to some being elderly, or not wishing to travel.…”

The COVID-19 pandemic has increased health inequalities by altering patterns of engagement with a mass participation event after resumption post-lockdown

“…This allows a unique opportunity to investigate what lasting impacts lockdowns have had on levels and correlates of physical activity after they have been lifted and how lockdown might have altered the demographic of parkrun participants. This is particularly important as lockdowns are likely to have increased equalities in social prescription [33]. A previous study of all parkrun events in Scotland from 2004-2019 revealed various changing correlates of participation with a narrowing gender ratio, reducing performance scores and an increasing mean age of participants [22].…”

“…This allows a unique opportunity to investigate what lasting impacts lockdowns have had on levels and correlates of physical activity after they have been lifted and how lockdown might have altered the demographic of parkrun participants. This is particularly important as lockdowns are likely to have increased equalities in social prescription [33].…”

Nature-based social prescribing programmes: opportunities, challenges, and facilitators for implementation

“…There are some examples of the use of NBSP under different names. Some of the earliest studies come from New Zealand, where the Ministry of Health developed ‘green prescriptions’ in 1997 to increase physical activity outdoors (44). Similarly in the United States, there are over 75 ‘park prescription’ programmes, in which a healthcare provider gives patients a written recommendation to do physical activity in parks (45).…”