Co-production of “nature walks for wellbeing” public health intervention for people with severe mental illness: use of theory and practical know-how

Abstract

Background: Interventions need to be developed in a timely and relatively low-cost manner in order to respond to, and quickly address, major public health concerns. We aimed to quickly develop an intervention to support people with severe mental ill-health, that is systematic, well founded both in theory and evidence, without the support of significant funding or resource. In this article we aim to open and elucidate the contents of the 'black box' of intervention development. Methods: A multidisciplinary team of seven academics and health practitioners, together with service user input, developed an intervention in 2018 by scoping the literature, face-to-face meetings, email and telephone. Researcher fieldnotes were analysed to describe how the intervention was developed in four iterative steps. Results: In step 1 and 2, scoping the literature showed that, a) people with severe mental illness have high mortality risk in part due to high levels of sedentary behaviour and low levels of exercise; b) barriers to being active include mood, stress, body weight, money, lack of programmes and facilities and stigma c) 'nature walks' has potential as an intervention to address the problem. In Step 3, the team agreed what needed to be included in the intervention so it addressed the "five ways to mental wellbeing" i.e., help people to connect, be active, take notice, keep learning and give. The intervention was mapped to key behavioural change concepts such as, personal relevance, relapse prevention, self-efficacy. In Step 4, the team worked out how best to implement the intervention. The intervention would be delivered over 12 weeks by members of the hospital team and community walk volunteers. Participants would receive a nature walks booklet and text messages. Conclusions: We developed a theoretically-informed, evidence-based nature walks programme in a timely and relatively low-cost manner relevant in an era of growing mental illness and funding austerity. Further research is required to test if the intervention is effective and if this approach to intervention development works.

Co-production practice and future research priorities in United Kingdom-funded applied health research: a scoping review

“…Many of the papers concerned with co-produced applied health research highlighted the need for future research to focus on better ways of involving more diverse groups of service users and stakeholders [ 31 , 63 , 68 – 72 , 80 , 95 , 98 ]. There were suggestions for research to focus on understanding how to involve different groups and facilitate effective involvement [ 54 , 77 ].…”

“…For example, it remains unknown whether planned activities [ 99 ] or less structure [ 72 ] allows for better involvement and more successful adoption of co-produced interventions. One questioned whether more extensive input from multiple stakeholders equates to more effective interventions [ 31 ].…”

A Systematic Review to Examine the Evidence in Developing Social Prescribing Interventions That Apply a Co-Productive, Co-Designed Approach to Improve Well-Being Outcomes in a Community Setting

“…Previous studies have stated that a co-productive and co-designed approach is necessary in the development of interventions that seek to improve community well-being outcomes. Examples of such interventions include healthy aging programs [19,20] nonmedical mental health interventions [21], community-based support for young onset dementia [19] and a mobile health programme to reduce obesity [22]. This statement is based on the perception that each community has unique socioeconomic and environmental features that influence the community's well-being [20].…”

“…This statement is based on the perception that each community has unique socioeconomic and environmental features that influence the community's well-being [20]. As a result, generic interventions will not lead to positive outcomes in every situation and engaging community members in the development of well-being interventions through co-production and co-design makes explicit the main priorities for well-being improvement, resulting in a practical and effective intervention [19,[21][22][23]. The evidence indicate that co-production and co-design can also empower communities [22,24] and enable them to have a sense of ownership of an intervention [23] consequently encouraging their participation in the delivered service [20].…”

Nature-Based Interventions and Mind–Body Interventions: Saving Public Health Costs Whilst Increasing Life Satisfaction and Happiness

“…In 2019, the UK’s 25 Year Environment Plan published by the government [ 79 ] set out six priorities, one of which was to “connect people with environments to increase health and well-being”, and substantial focus has been put on making use of green spaces and natural habitats to improve the health of whole populations. A wide range of nature-based interventions (NBIs) have been developed across conservation, wildlife and community organisations and charities [ 72 , 80 , 81 , 82 , 83 , 84 , 85 ]. These natural and social therapies have been deployed for groups under mental stress, at-risk children and young people, refugees, probationers, and dementia sufferers [ 65 ].…”