Abstract

This research explores the role of nature-based interventions (NBIs) within social prescribing (SP) pathways as a means of preventing and managing non-communicable diseases (NCDs). While substantial evidence supports the physical, psychological, and social benefits of nature exposure, NBIs remain underutilised in public health strategies and SP referrals. This thesis addresses this gap by investigating the effectiveness, perceptions, barriers, and enablers associated with NBIs through SP. The primary aim is to understand how NBIs can be more systematically integrated into SP frameworks to support sustainable health behaviour change and holistic wellbeing, particularly in relation to lifestyle-driven NCDs. The thesis also seeks to inform the development of an evidence based, theory-driven intervention that aligns with the biopsychosocial model of health.
The study employed a multi-phase mixed-methods design guided by the Intervention Mapping (IM) framework. First, an umbrella review synthesised evidence from 12 systematic reviews evaluating SP interventions targeting adults with or at risk of NCDs. The review assessed biopsychosocial and behavioural outcomes across nature based and non-nature-based formats. Second, a qualitative needs assessment was conducted through semi-structured interviews and focus groups with both service users and stakeholders (e.g., social prescribers and community facilitators). Thematic analysis explored barriers to engagement, psychological readiness, and organisational constraints.
Finally, a qualitative feasibility study was conducted to assess the acceptability and perceived practicality of a co-designed intervention package, including a promotional video, a nature needs assessment, a digital green space map, and an outcome tracking tool.
The umbrella review revealed that NBIs demonstrated greater improvements compared to non-nature-based interventions in reducing physiological stress markers (e.g., blood pressure, body fat), improving psychological wellbeing (e.g., reduced fatigue and anxiety), and fostering behavioural engagement (e.g., adherence to physical activity). However, NBIs were inconsistently implemented and rarely featured in routine SP pathways. The qualitative phase identified multi-layered barriers including time constraints, lack of confidence, digital exclusion, environmental access, and organisational role ambiguity. Participants highlighted the importance of familiarity, guided choice, social connection, and perceived legitimacy in determining engagement. The feasibility study confirmed the relevance and value of the proposed intervention components but underscored the need for systemic support, streamlined referral processes, and flexible delivery formats. Personalisation and practitioner endorsement were found to be particularly influential in increasing uptake and sustained participation.
This research demonstrates that NBIs offer distinctive and meaningful contributions to health promotion within SP pathways, particularly in supporting behaviour change across physiological, psychological, and social domains. Embedding NBIs into SP systems requires systemic support, practitioner training, inclusive co-design, and greater clarity around roles and expectations. The thesis contributes a theory informed, stakeholder-driven intervention model with practical recommendations for policy and practice, including investment in green infrastructure, simplified referral mechanisms, and outcome tracking tailored to community settings. In doing so, it addresses not only what NBIs can offer but how a theoretically grounded, co-designed intervention can be developed, tested, and evaluated within SP pathways.