Exploring how greenspace programmes might be effective in supporting people with problem substance use: a realist interview study

Abstract

Background Greenspace programmes are health projects run outside in nature, typically with the aim of improving mental health. Research suggests that programmes may also be effective in supporting people with problem substance use (PSU), but there is limited understanding of the key components that make them successful for this client group. Previous work has claimed that a realist-informed intervention framework for greenspace programmes for mental health could be transferable to programmes that support people with PSU, and that this could provide insight into the causal processes within programmes. However, this claim is yet to be explored in depth. The aim of this study was to further test, refine, and consolidate the proposed framework to show how greenspace programmes could support people with PSU. Methods Using a realist approach, 17 participants (8 programme staff; 9 wider stakeholders) were interviewed about contexts, mechanisms, and outcomes (CMOs) relative to greenspace programmes for mental health and PSU. Semi-structured interviews were used since they facilitated exploration of the proposed framework but were flexible enough to allow identification of new CMOs for framework refinement. Interviews were audio-recorded, fully transcribed, and analysed inductively and deductively against the proposed framework. Results Findings supported the proposed framework and indicated that greenspace programmes support people with poor mental health and PSU due to: feelings of escape; space to reflect; physical activity; self-efficacy; feelings of purpose; relationships; and shared experiences. However, data showed that programmes must also consider: explicit intervention focus to ensure adequate support for clients; existing challenges with funding and stakeholder buy-in; and the impact of COVID-19. Findings allowed development of a refined framework that shows how greenspace programmes can support people with PSU. Conclusion The findings of this project are theoretically novel and have practical relevance for those designing greenspace programmes by providing recommendations on how to optimise, tailor, and implement future interventions. Findings could be particularly relevant for academic researchers, multidisciplinary health professionals, and for those working in the third sector, developing and delivering greenspace programmes for people to improve their mental health and to support them with PSU.

Nature prescribing

“…Factors affecting accessibility include infrastructural barriers (eg, transport) and cultural perceptions about nature 16. However, appropriately targeted and funded activity, with barriers addressed, can reach excluded communities such as refugees or people with substance use disorders 1718…”

Advancing Understanding on Greenspace and Mental Health in Young People

“…This association was particularly pronounced for substance use disorders, which were 40% more prevalent in small towns with poor greenspace quality, and anxiety disorders, which were 61% more prevalent in rural communities with poor greenspace quality. One of the mechanisms through which greenspace can help alleviate poor mental health is by offering avenues for mindfulness, restorative experiences, and stress reduction (Hedblom et al., 2019 ; Liu et al., 2022 ; R. Wang et al., 2021 ), which can reduce the likelihood of substance use (Berry et al., 2021 ; Masterton et al., 2022 ), and can help alleviate symptoms related to anxiety (Song & Lindquist, 2015 ; Strohmaier et al., 2021 ). More diverse greenspaces have been reported to provide more restorative experiences, as compared to less biodiverse greenspaces (Wheeler et al., 2015 ).…”

Systematic Review: Neurodevelopmental Benefits of Active/Passive School Exposure to Green and/or Blue Spaces in Children and Adolescents

“…We identified seven types of outcomes related to different aspects of neurodevelopment and/or neurobehavior, including (ordered by frequency) cognitive and/or academic performance (15), restoration of attention (8), behavior and impulsivity (8), conduct and social interaction (5), neurodevelopmental diseases and disorders (4), working memory (3), and emotional well-being (3). No articles related to motor development (gross/fine) were found.…”

“…There are various health benefits associated to contact with nature, including better control/prevention of chronic diseases, decreased mortality, improved mental health, greater social cohesion, and reduced health inequalities, among other benefits [6,7]. In childhood, living or playing in natural environments seems to help them to acquire skills, increase their self-esteem and resilience strategies, make them more independent, stimulate more cooperative and creative forms of play, and prevent the use of legal and illegal drugs [8,9]. All these positive childhood experiences in nature influence the community, which promotes pro-environmental behavior from childhood to adulthood [10].…”