Nature-based social prescribing for connectedness and mental well-being: A realist evaluation of staff's experiences of the project: Interim Report

Simon Newstead, Abraham Makanjuola, Sarah Wallace, Lisa Griffiths, Llinos Spencer, Mary Lynch, Sharon Wheeler, Carolyn Wallace

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Social prescribing has been defined in Wales as 'connecting citizens to community support to better manage their health and wellbeing' (Rees et al, 2019; WG, 2022), although various models and definitions of social prescribing exist (Kimberlee, 2015; SCIE, 2020). Wales has developed a cross-sectional model of social prescribing that is integrated with existing community and statutory services (Public Health Wales, 2018; Wallace et al., 2021). It uses holistic and person centred methods (Pringle & Jesurasa, 2022) to help empower individuals to recognise their own needs and strengths, and to connect with their communities for support with their health and well-being (WG, 2022).

In 2019, a 2-year realist evaluation research project was undertaken by Wrexham Glyndwr University (WGU), in partnership with the University of South Wales, Coleg Cambria and third-sector organisations. The project primarily aimed to understand the underpinning theory of how, why, for whom and to what extent the model of social prescribing used in WGU worked (Wallace et al, 2022a,b). A secondary aim of the project was to translate what was learnt for use across the higher- and further education sectors via a replicable model of social prescribing, to enhance student well-being, build resilience, and promote new ways of working and supporting students. WGU received funding from the Higher Education Funding Council of Wales (HEFCW) to build on this previous work (Wallace et al., 2022a, b) to develop a nature-based social prescribing intervention for their students.

The use of nature-based activities and interventions (NBIs) has become increasingly prevalent within social prescribing (Brag & Leck, 2017; Howarth and Lister, 2019; Shanahan et al., 2019). The referral to such activities builds upon the earlier concepts of referral for exercise or diet-based interventions (Patel et al., 2011). NBIs is an umbrella term for interventions that use nature-based organisations to support individuals to become physically and mentally healthier through contact with nature and spending time in natural or semi-natural environments (Newstead et al., 2023). NBIs Include interventions such as green referral, blue referral, care farming, therapeutic horticulture and ecotherapy. NBIs include activities that fall under the umbrella of ‘green referral’ (Newstead et al., 2023) such as conservation activities, nature walks, gardening & therapeutic horticulture, and care farming (taking part in normal farming practices for health, socialisation and education) (Husk et al., 2018; Robinson et al., 2020). NBIS also include activities such as surfing, swimming or kayaking (Hope et al., 2022; Gibbs et al 2022; Wilkie et al., 2022) that fall under the umbrella of ‘blue referral’ (Newstead et al., 2023). Evidence suggests that NBIs provide a means to engage different populations to benefit social and community cohesion (Gonzalez et al, 2010), reduce inflammation (Van den Bosch and Bird, 2019) and can result in significant positive mental and physical health benefits (Bakolis et al, 2018; Li, 2009; McEwan et al., 2019; Sarris et al., 2019; White et al., 2019).

The link between social prescribing and green health is an important aspect which Wrexham Glyndwr University (WGU) and the University of South Wales (USW) want to develop further. The project used a co-creative approach which provided opportunities for students to find ways to feel more socially connected and be part of their university community, the wider community and the natural environment. The programme incorporated the establishment and delivery of various activities, events and physical changes to the university campuses, with the aim of evaluating:
• How nature-based social prescribing can be used as a tool to enhance student wellbeing and address students' connectedness
• How green spaces on campus can be further developed to improve or meet students' needs

Evaluation of the project utilised a mixed methods approach that includes: a scoping review, social return on investment, an exploration of ‘what matters’ to stakeholders’, Group Concept Mapping and a Realist Evaluation. This document provides an interim report on the Realist Evaluation method (Wong & Papoutsi, 2016). This Realist Evaluation also aims to inform the ‘programme theory’, developed in prior research (Wallace et al., 2022a,b), that articulates why and to what extent the nature-based social prescribing works for this group, how students access the interventions, what forms they take, and when they are accessed. The initial programme theory (Wallace et al., 2022a) informed the development of a WGU Social Prescribing model that could be scaled for implementation within other Welsh Higher Education Institutions and beyond.
Original languageEnglish
PublisherWales School for Social Prescribing Research
Commissioning bodyThe Higher Education Funding Council Wales
Number of pages22
Publication statusPublished - Jan 2024


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