Understanding the contexts and mechanisms of bluespace prescription programmes implemented in health and social care settings: a realist review

Abstract

Background: Nature-based social prescribing programmes such as "bluespace prescription" may promote public health and health improvement of individuals with long-term conditions. However, there is limited systematically synthesised evidence that investigates the contexts and mechanisms of Bluespace Prescription Programmes (BPPs) that could inform programme theories for policy and practice. Methods: We conducted a realist review by searching six databases for articles published between January 2000 and February 2020, in English, about health and social care professionals providing referral to or prescription of blue space activities with health-related outcomes. We developed themes of contextual factors by analysing the contexts of BPPs. We used these contextual factors to develop programme theories describing the mechanisms of BPP implementation. Our study was registered with PROSPERO (CRD42020170660). Results: Fifteen studies with adequate to strong quality were included from 6,736 records. Service users had improvements on their physical, mental, social health, and environmental knowledge after participating in BPPs referred to or prescribed by health and social care professionals. Patient-related contextual factors were referral information, free equipment and transportation, social support, blue space environments, and skills of service providers. Intervention-related contextual factors were communication, multi-stakeholder collaboration, financing, and adequate service providers. Programme theories on patient enrolment, engagement, adherence, communication protocols, and long-term programme sustainability described the mechanisms of BPP implementation. Conclusion: BPPs could support health and social care services if contextual factors influencing patients and intervention delivery are considered for implementation. Our findings have implications in planning, development, and implementation of similar nature-based social prescribing programmes in health and social care settings. Keywords: sustainable healthcare, social prescribing, blue spaces, bluespace prescriptions

Broadening the Perspective on Reducing Pharmaceutical Residues in the Environment

“…An evidence synthesis on EDSP programs suggests that different models have been implemented at varying scales, in which seven behavior change interventions were used in various combinations to change prescribing behaviors of prescribers (e.g., doctors, pharmacists; Alejandre et al, 2022). These behavior change interventions include training and education, enablement strategies (e.g., peer support), persuasion through new clinical guidelines, incentivization (e.g., monetary, reward, recognition), and environmental restructuring (e.g., provision of new tools to support selection of medicines).…”

“…Another targeted ecopharmacovigilance intervention, in rural China, utilized a combination of educational, enablement, incentivization, and environmental restructuring strategies to reduce ofloxacin in the water environment (Wang et al, 2019). Similar interventions were used in a pilot study to encourage the prescribing of naproxen over diclofenac in The Netherlands (Afdeling Strategie en Beleid, 2017; Alejandre et al, 2022). These examples have indicated a high level of acceptance of EDSP among patients and prescribers.…”