A scoping review of nature prescriptions offered by healthcare providers

Introduction

Time spent in nature has been linked to many health benefits for individuals, particularly those with attention-deficit/hyperactivity disorder (ADHD), anxiety, hypertension, insomnia, and myopia (1). Some of these health benefits include an increase in physical activity, social contact (2), restoration of emotional and mental health (1), and decreases in blood pressure, depression, and stress levels (3).

In the late 1990s, a study was conducted on a group of sedentary individuals in New Zealand to assess the impact of verbal versus written advice from physicians (4). Although this study was not aimed at assessing natures impact on health, one of the byproducts of the research was that those given a green, or nature, prescription tended to find the prescription itself a strong motivator (4). At approximately the same time, in New Mexico, a program called the Prescription Trails was developed with a partnership of diverse collaborators. A few of the more well-known initial partners who participated in developing the Prescription Trails program included the National Park Service’s Rivers, Trails, and Conservation Assistance Program, the New Mexico Department of Health, the Albuquerque Alliance for Active Living, and American Heart and Stroke Association (5). The Prescription Trails program aimed to utilize greenspaces and parks to promote physical activities geared toward individuals with chronic diseases (5).

Between 2000 and 2010, research on the relationship between nature and its health benefits increased (6). Several studies linked connectedness with nature to positive health outcomes such as lowered blood pressure levels and heart rates, decreases in salivary cortisol concentrations, reduction in stress levels (7), reduction in feelings of depression and hostility, increased feelings of liveliness (8), increased feelings of relaxation (9), lowered body mass indexes (BMIs), lowered cardiovascular, digestive, mental, musculoskeletal, neurological, and respiratory diseases, decreases in anxiety, increases in self-esteem and mood (10), and a reduction in ADHD symptoms (11).

Although some research had been conducted on natures’ impact on health, it was not until the 21st century that more physicians, and other healthcare providers, began to implement nature-based programs and write nature prescriptions (12). By 2013, the Institute at the Golden Gate, the National Recreation and Parks Association, and the National Park Service created Park RX as a way for healthcare practitioners first to discuss the increasing interest in prescribing nature for health-related issues (13). It quickly became resource for physicians to prescribe nature to their patients. According to Park RX, since the start of the Prescription Trails program in 1999, there are now over 80 nature prescription programs, and counting, in the United States alone (13).

These programs continue to gain significant momentum because of their ability to interact with existing nature-based facilities, programs, and organizations that assist with increasing time spent in nature across diverse populations (14). However, there has been significant variation across the world in how the prescriptions are written, who is writing them, and whether supplementary materials are provided.

For example, in European countries, a nature prescription is commonly referred to as a green prescription (15-17). It is typically prescribed by physicians and healthcare centers targeting addiction, diabetes, and obesity (15). In contrast, in the 1980s, the government of Japan sought to reduce stress in its working-class populations (18). Hence, the Japanese government invested in woodland areas that became protected and utilized as forest bathing “clinics” (18). Japanese patients could go to their primary care physicians and be prescribed forest bathing for many reasons: reducing stress and high blood pressure, enhancing innate immunity and psychological restoration (16), and more. In addition to these examples, there has been a growing popularity of park prescriptions across the United States (19).

A crucial way to ensure the consistency of identifying only reliable articles for the review was to refrain from reviewing the grey literature and understand that geographic location also impacts upon terminology (20). Since grey literature is typically not peer-reviewed, it may result in a high risk of bias (21).

This scoping review aims to identify the existing body of knowledge on nature prescriptions prescribed by a healthcare provider and produce a collection for ease of access for future research efforts. Four research questions were chosen to accomplish this objective and identify any limitations. The four questions are: (I) which type of healthcare professionals are prescribing nature; (II) who are the prescriptions written for; (III) what is being prescribed; and (IV) what is the quality of the existing studies on nature prescriptions. We present this article in accordance with the PRISMA-ScR reporting checklist (available at https://jphe.amegroups.com/article/view/10.21037/jphe-24-17/rc).

Methods

Design

For this scoping review, the five-step framework put forward by Arksey and O’Malley (22) was applied with additional modifications as recommended by Levac, Colquhoun, and O’Brien (23). The scoping review included the following steps: (I) identifying a research question; (II) identifying any relevant studies; (III) analyzing selected studies; (IV) charting the data; and (V) categorizing, summarizing, and reporting all results (22). Following this framework allows for the ease of providing a range of studies related to healthcare professionals’ prescribing nature and the various types of studies conducted to visualize what is currently available without necessarily describing the findings of each article.

Additionally, to improve the overall quality and value of this scoping review, the PRISMA-ScR checklist was also used as a guideline (24).

Research questions

This study was driven by the following questions:

• Which types of healthcare professionals are prescribing nature?
• Who the prescriptions are written for?
• What is being prescribed?
• What is the quality of the existing studies on nature prescriptions?

Identifying relevant studies and search strategy

The initial abstract search was executed on October 31, 2022, in three electronic databases, including APA PsycInfo/EBSCO Publishing (psychology and behavioral sciences; 1816–present), CINAHL Complete/EBSCO Publishing (nursing and allied health; 1995–present), and PubMed/MEDLINE (biomedical sciences; 1907–present). These databases were selected based on the disciplines found to publish in the specific journals located within these databases, which were the most likely to report on topics related to the research question for this scoping review. A title screen search for articles in Google (Google Incorporated, Mountain View, CA, USA) was also conducted.

Additionally, grey literature is not typically published within commercial publishing organizations, leading to (I) poor layout or formatting; (II) difficulty in identifying credible and quality literature (21); and (III) an increase in documents obtained during each review stage (25). All these challenges can decrease the reviewers’ confidence at each stage in determining the relevance of each article to the scoping review goals (25). For these reasons, grey literature was not searched.

Limits were not set for publication year or geographic location of the nature prescriptions in the database search. The following 26 terms were selected to refer the landscape of nature prescriptions and were entered into each of the three databases and Google: blue space prescription, blue space Rx, campus nature contact, campus nature prescription, campus nature Rx, green prescription, green Rx, green space contact, green space prescription, green space Rx, greenspace contact, greenspace prescription, greenspace Rx, nature contact, nature prescription, nature Rx, nature-based contact, nature-based prescription, nature-based Rx, natural environment contact, natural environment prescription, natural environment Rx, outdoor prescription, outdoor Rx, park prescription, and Park RX (Appendix 1).

Based on similar research done by the first author, a posteriori decision was made only to screen the first 250 results of each search query per database listed by relevance or best match and only the first 100 titles of results in Google. This decision was made after considering the following:

• The amount of time it takes to screen each article based on 26 search terms with at most 250 results per database search;
• The probability that the Google search of the terms would result in articles, not just related websites;
• Prior research conducted on a similar topic that did not yield copious results;
• The likelihood that further screening would not produce a significant amount of related articles.

For each of the three databases and Google, query results were recorded.

Citation management

Citations for all obtained articles were imported into Mendeley, a bibliographic reference manager developed by Elsevier (Mendeley Ltd., London, UK), to manage search results. Deduplication was conducted by selecting the deduplicate tool, with any potential duplicated citations removed further in the process when discovered.

Eligibility criteria

Article selection was determined by inclusion and exclusion criteria. Studies with full-text and those that broadly identified nature prescriptions were included. Articles published in any language other than English were excluded. Papers that contained research on nature or nature prescriptions but were not based on a nature prescription prescribed by healthcare professionals were also excluded.

Analyzing study selections

To ensure an effective study selection analysis, the research team (W.M., H.M., and M.S.) created and pretested a title and abstract screening form to evaluate reviewers’ agreement on screened articles (Appendix 2). The screening form was pretested using the first 20 articles queried in the PubMed database with inclusion criteria of full-text and English articles only. Search terminology was nature and health, with no limits on publication year. The pretest resulted in 299,371 articles identified from 1835 through 2023, with all three authors agreeing on all but four papers. Three of the four studies with disagreements, were based on confusion by one reviewer. This reviewer needed clarification on whether to include or exclude if health and nature was not explicitly mentioned in the abstract. After discussion, all three papers were included for full-text review to ensure that no relevant articles were excluded. One reviewer excluded the fourth article based on it not having the word “health” specifically but terminology similar to health and was ultimately included. All three authors agreed that any synonyms of “nature prescription” would be included in the abstract screening for the scoping review. Since there were no significant disagreements after the pretest, only minor changes were made to the screening form. The initial screening form included study characteristics such as article title, first author’s first initial and last name, and whether an abstract was present. The first change to the screening form included minor word changes to some of the study characteristics and an addition of three sections to the screening form. The new sections added to the screening form were for the digital object identifier (DOI) or uniform resource locator (URL) links and to identify the database in which the article was found (Appendix 3). Two reviewers independently screened each citation’s title and abstract. Authors and journal names were not concealed from the reviewers. If an abstract was not present, it was automatically included in the subsequent full-text review during data characterization. The two reviewers and a third author met throughout the abstract title review and full-text screening process to discuss any concerns or uncertainties and resolve disagreements in the study selection.

Data charting

All applicable citations after the title and abstract screening were attained for the full-text article screening (available from the first or last author). Any articles that were not readily available to the authors were attempted to be obtained by contacting the source author or article journal. Three independent reviewers (W.M., H.M., and M.S.) reviewed full-text articles in the web-based screening tool Rayyan Systems (Boston, MA, USA). A decision was made by the reviewers (W.M., H.M., and M.S.) to discuss and resolve any conflict after independent analysis on the first 20 articles queried in the PubMed database. The reviewers searched the term nature prescription and all inclusion criteria to help guarantee consistency amongst the reviewers.

Findings were recorded for full-text articles that met inclusion after the abstract screening and can be found in the screening form document (available from the first or last author). The primary differences between the full-text screening and abstract screening forms are as follows:

• Removal of whether an abstract is present;
• Revision of related terminology to exact terminology utilized in the article to describe nature prescription;
• Change in explanation to length of time of the study and any follow-up times;
• Addition of what health conditions are being addressed.

Studies that did not meet all eligibility criteria during this step of the process were excluded. Furthermore, eight terms were identified to potentially be valuable to the scoping review including hot spring contact, hot spring prescription, hot spring Rx, hot spring therapy, wilderness contact, wilderness prescription, wilderness Rx, and wilderness therapy. However, no additional relevant articles were identified for inclusion.

Categorizing, summarizing, and reporting results

Using a Google spreadsheet, the resulting data were compiled into one document and downloaded into Excel for coding via Microsoft Office 365 (Microsoft Corporation, Redmond, WA, USA). Data were transferred from Excel into the IBM SPSS version 29 software program (Chicago, IL, USA) and analyzed. Frequencies and percentages were included to explain nominal data findings.

Results

Study selection

Results of the review search across the three databases, Google, and citation references were reported following a PRISMA flow diagram (Figure 1). From the initial 7,429 articles, 3,141 studies remained for abstract screening after removing 4,288 duplicates. Through the abstract and title screening, 2,945 articles were eliminated because they were either:

• Abstracts only;
• Additional duplicates;
• Not published in the English language;
• Did not contain a nature prescription;
• Not prescribed by a healthcare professional;
• Did not contain data;
• Protocol paper;
• Review paper.

Figure 1 PRISMA flow diagram of review article selection.

The exclusion of these articles resulted in 196 studies selected for the full-text review. There were 184 studies omitted for failing to meet the inclusion criteria during the full-text screening. A total of 12 articles were eligible based on the inclusion criteria and were selected for the scoping review (Appendix 4).

Study characteristics

All 12 articles were published within the last 10 years, between 2011 and 2022, and only a max of two articles published within 1 year were identified for 2017, 2018, and 2020. The remaining six articles were published in 2011, 2015, 2016, 2019, 2021, and 2022 (Figure 2).

Figure 2 Number of articles published by year.

All 12 articles were compiled into one Excel document and coded for target outcome themes, sample sizes, type of professional prescribing, who the prescriptions were written for, the length of time the study was, follow-up time information, trial type, and type of nature prescription being prescribed. Data were transferred from Excel into the IBM SPSS version 29 software program and analyzed for frequencies. Findings on the eligible studies characteristics are reported in Table 1.

All 12 eligible studies were assigned to one of three sample size range categories, including 25 participants or less, 26 to 75 participants, or 76 participants or more. Each sample size range was represented equally across all articles, with four studies (33.3%) found within each category. Of the 12 studies included, 4 of the studies (33.3%) were randomized controlled trials (RCTs), 2 (16.7%) were observational studies, 2 (16.7%) were pilot studies, 2 (16.7%) were pre- and post-questionnaires, 1 (8.35%) was a longitudinal cohort study, and 1 (8.35%) was a qualitative evaluation.

Study outcome themes

Full-text review of the articles resulted in seven overarching target outcome themes, with five of the 12 articles indicating at least two of the target outcome themes. One study’s (27) target outcome theme was feeling better physically (8.3%). In addition, four studies (28,29,32,36) aimed to increase physical activity (33.3%), five studies (17,33-36) aimed to improve mental health (41.7%), two studies (28,30) aimed to decrease stress (16.7%), five studies (28-31,36) aimed to increase time spent outdoors (41.7%), two studies (35,36) aimed to improve emotional health (16.7%), and aimed to improve social health (16.7%). A review of the study findings indicated that 11 of the 12 articles achieved at least one of their overall target outcome themes.

Nature prescription details

For this scoping review, healthcare professionals were specified as healthcare practitioners, providers, and rehabilitation centers. The reason for not excluding rehabilitation centers as a prescriber is because rehabilitation centers consist of a multitude of professionals including, but not limited to, specialists in hearing, occupational, pathological, physical, and speech therapies, nurses, physiatrist, prosthetics, psychological services, registered dietitians, and other health-related fields (37). Other notable healthcare professionals who can prescribe nature include, but are not limited to, chiropractors, exercise physiologists, health education specialists, nurse practitioners, physicians, physician assistants, and psychiatrists (38).

Results indicated that 3 studies (25%) were prescribed by a rehabilitation center or other medical center (30), 3 (25%) were explicitly prescribed by pediatricians (28,29,31), and half, or the remaining 6 studies (50%), were prescribed by some other form of healthcare practitioner or provider, not necessarily indicating the inclusion or exclusion of a pediatrician (26,27,30,32,34,36).

Furthermore, 7 (58.3%) of the studies reported nature prescriptions primarily prescribed to adults over 18 years of age (17,26,27,32-35), with the remaining 5 studies (41.7%) written for children (28-31,36).

There were four general types of nature prescriptions being prescribed: gardening, park visits, physical activity, and water-based activities. Three of the studies (25%) solely prescribed gardening to adults (17,27,34), and 3 of the studies (25%) solely prescribed park visits to children (28,30,31). The remaining two types of nature prescriptions, physical activity (26,29,30) and water-based activities (33,35,36) were also prescribed in 3 studies each (25%). However, children were only prescribed physical activity (30) in one study and a water-based activity (36) in one study. While the remaining four studies prescribed either physical activity (n=2) (26,32) or water-based activities (n=2) (33,35) studies for adults.

The length of time the studies lasted was also assessed. Three studies (25%) were found to last 5 days or less (30,33,35). An additional three studies (25%) lasted between 1 and 2 months (17,27,36), four studies (33.3%) lasted 3 months (28,29,31,32), one study (8.3%) lasted over 3 months (26), and 1 study (8.3%) did not report how long it lasted (34).

The study, which did not report how long it lasted (34), also did not indicate if follow-ups were conducted (8.3%). However, the remaining 11 studies reported follow-ups and when they were scheduled. Nine (75%) studies indicated a baseline was taken from participants (17,25,26,28-32,36). Of those nine where a baseline was taken, 4 (33.3%) had a follow-up at 1 and 3 months (28-31). Seven studies (58.3%) from the nine where a baseline was taken, had a follow-up at 3 months (17,26,32), 2 (16.7%) of which also had a follow-up at 6 months (17,25). The remaining 5 studies (41.7%) were classified as other in frequency and percentage analysis for follow-up times, as each had varied follow-up times (27,33-36). Two of the studies were included in the nine studies with a baseline taken, with one having a follow-up time of 6 weeks (36), and the other had a follow-up time of 12 months (27). None of the remaining three studies reported a baseline (33-35). One of the studies did not report any follow-ups (34), one indicated a follow-up was conducted just 4 days after the study (33), and the last specified a follow-up was conducted at least 1 week after the conclusion of the study, but no longer than 3 months after the study’s completion (35).

Limitations across included studies

Three frequently mentioned limitations were identified within most of the eligible studies. The first limitation came from the Corazon et al. article, which stated that results could not be generalized for all stress-related illnesses (27). It is necessary to note across all 12 of the included studies because data measured only a limited set of outcomes, a change in method or content could alter the findings and thus not allow for a generalization. It was also noted as a limitation in one of the Razani and the White et al. articles, one of the parks visit studies and the sailing voyage, in a similar manner (30,35).

Comparably, in the Petrunoff et al. article, delivery of the intervention was not observed; therefore, no formal records were included for fidelity on the implementation (26). Again, this is another limitation worth noting, especially in nature prescription studies, as the delivery of the nature prescription will likely vary between healthcare professionals. Therefore, this also will likely cause mixed results from comparable studies.

As mentioned, a limitation in five of these nature prescription studies is the small sample sizes (28,29,31,35,36). Lack of statistical power may influence non-significant findings.

Summary of studies

With nature prescriptions increasing in popularity within the healthcare community, understanding what works is essential. It is especially critical to identify and analyze existing research on nature prescriptions already prescribed by healthcare professionals, like those included here. In addition, these studies can encourage other healthcare professionals, especially those whose patients would most benefit from a nature prescription, to either begin or continue more proactively writing nature prescriptions.

More research is needed on the nature of prescribing for healthcare professionals within different healthcare fields. In this scoping review, roughly half of the eligible studies prescribed nature for adults, and the other half prescribed nature for children, indicating the potential benefits for both populations.

Another significant finding from this scoping review is that even with only 12 articles meeting all eligibility requirements, almost all of the articles were based on a different type of nature prescription. Prescriptions within the scoping review range from nature-based therapy (NBT) to outdoor physical activity, park outings, even surfing lessons, and more. Although each article could be, and was, classified under a more general type of prescription, it is incredibly promising to recognize that nature prescriptions have a vast range of options.

However, the difficulty of this scoping review is proving the quality of the existing studies on nature prescriptions. It is difficult for four main reasons. The first is that there need to be more existing articles to support the studies’ quality. As seen here, even with 12 eligible articles, some topics were addressed similarly, like who was prescribing nature. In contrast, other topics, like the type of nature being prescribed, were almost entirely different for every article. There are at least 75 to 150 published articles on nature prescriptions, but only the 12 here were identified as being prescribed by a healthcare professional. That is why, as mentioned previously, this scoping review is so important to show the gap in the research of nature prescriptions prescribed by healthcare professionals. Furthermore, this leads to the limitations in generalizability because changes in methodology or content can alter the results or, in the case of the scoping review, be excluded. Additionally, the other two limitations that can also hinder the quality of the existing studies are the small sample sizes of the existing studies and the delivery method of the nature prescriptions, which may result in mixed findings of similar studies.

Discussion

Summary of evidence

The aim of this scoping review was to conduct a comprehensive scan to identify the existing body of knowledge on nature prescriptions and produce a collection for ease of access for future research efforts. This was done by identifying articles that addressed (I) what healthcare professionals are prescribing nature; (II) who the prescriptions are written for; (III) what is being prescribed in these nature prescriptions; and (IV) the quality of the existing studies on nature prescriptions.

During the initial search, a similar scoping review on health and nature prescriptions published in 2020 was found (19). Although it did not meet the eligibility criteria for inclusion here, it was reviewed because it was interested in similar studies. They included 11 articles in their final review (19). The first three articles included a field report, study design, and protocol, all of which did not yield results (19). One article was not identified in this scoping review search (19). One article was a feasibility study of parks to be employed in a specific location for park prescriptions (19). Three articles were feasibility studies of the implementation of nature prescriptions by physicians, and the last three articles included in their study met the inclusion criteria for this scoping review (19). Additionally, prior to the publication of this scoping review, a second similar systematic review on the effects of nature prescriptions on cardiometabolic, mental, and physical health was published (39). Nguyen et al. concluded that 92 studies met the inclusion criteria to be considered a nature prescription article (39). After a close review of the search strategy and included 92 articles in the systematic review, six of the 92 were found to have been included for full-text review, with only one being included here. A significant reason no additional articles are included as a nature prescription from the systematic review is that their search terms were broad and did not require being prescribed by a healthcare professional. Most articles identified were nature interventions rather than actual nature prescriptions. In addition to the differences in reported studies included within each of these scoping and systematic reviews, what makes this scoping review unique in its findings and quality is that it utilized the PRISMA-ScR checklist as a guideline to ensure a high-quality study (25).

Specific search methods were used, including a posteriori decision only to screen the first 250 results of each search query per database listed by relevance or best match and only the first 100 titles of results in Google. This decision was made after considering (I) the amount of time it would take to screen each article based on 26 search terms; (II) the probability that the Google search of the terms would result in articles; (III) prior research conducted on a similar topic that did not yield copious results, including the scoping review on health and nature prescriptions that was published in 2020 and only yielded 11 articles eligible for inclusion (19); and (IV) the likelihood that further screening would not produce a significant amount of related articles. Additionally, grey literature was excluded from the scoping review to increase the consistency of identifying only reliable articles. The PRISMA-ScR checklist was used as a guideline to ensure a high-quality scoping review (24). These specific search methods resulted in over 7,400 documents and titles initially being screened, ultimately identifying only 12 articles that met the inclusion criteria of this scoping review of being a study on nature prescriptions prescribed by any healthcare professionals.

The 12 studies examined here all reported that a healthcare professional was the prescriber in their study. These studies can encourage other healthcare professionals to begin or continue writing nature prescriptions. Furthermore, by identifying approximately half of these studies as nature prescriptions prescribed for adults and the other half as prescribed for children, these articles are laying the foundational work that nature prescriptions prescribed by healthcare professionals can be prescribed and beneficial to a multitude of diverse groups.

Almost all 12 eligible studies prescribed a unique nature prescription, which strengthens the concept that there are considerable ways healthcare professionals can prescribe nature. There are prescriptions like individual or group outings to a nearby park, participating in a river trip, or sailing voyages to cope with mental stresses, as reported by these 12 studies. While not all 12 studies concluded that their target outcomes were achieved, 10 of the 12 studies did indicate that their studies positively impacted their target outcome. The two studies which did not conclude their outcomes were achieved also indicated their findings were not negatively impacted. Instead, they indicated that their studies did not identify the relationship between a nature prescription and a positive health outcome. However, even with the omission of these two studies from accomplishing their target outcome themes, the remaining 10 still accomplished all seven overall outcomes.

Limitations

While this scoping review is one of the first to focus on healthcare professional provided nature prescriptions, it is still subjected to limitations. The apparent potential limitations of the scoping review include (I) only searching three electronic databases and Google; (II) the inclusion criteria; and (III) heterogeneity.

As noted above, this scoping review only includes studies published in English, included the full-text article, and were nature prescriptions prescribed by a healthcare professional. This inclusion criterion may have resulted in the absence of nature prescriptions prescribed in general and studies where a healthcare professional prescribed a nature prescription but was either potentially not available in the English language or, as a full-text article, was not available.

Additional studies might have been omitted during the initial search if they were unavailable in one of the three electronic databases used or in the first 100 hits provided by Google.

During this scoping review, the researchers also realized that heterogeneity would result in a limitation due to four of the studies being conducted in the United Kingdom (17,34-36), one in Denmark (27), one in Singapore (26), and six in the United States. However, all six were located within only three states, three in California (28,30,31), two in North Carolina (29,32), and one in Utah (33). Therefore, findings in each of these studies may only be generalizable to certain locations or populations.

Conclusions

Although research nature’s impact on health dates back to the 1980s, it was not until the 21st century that healthcare providers began to write nature prescriptions (12). However, there has been significant variation worldwide in what healthcare professionals prescribing nature, what they prescribe, and how prescriptions are written. One crucial way to ensure consistency was to create a scoping review consisting of studies where nature prescriptions provided by healthcare professionals have been conducted. Another key way to ensure consistency in the future is using “nature prescription” more consistently over the alternatives utilized as search terms in this article, which would lead to a refined way of identifying associated articles without misappropriating unrelated articles (20). Such as lifestyle prescriptions called green prescriptions, but which are not necessarily prescribed in nature.

Nature prescriptions offer healthcare professionals an opportunity to connect patients back with nature and provide them with a way to take advantage of nature’s health benefits. Other initiatives including Walk with a Doc and referrals to outdoor recreational professionals may be a way to supplement formal prescriptions (40). Based on the relevant studies identified by the scoping review, there are plenty of opportunities for healthcare professionals to identify a target health outcome for a specified population and tailor a nature prescription they can prescribe to them over time. Research on current nature prescriptions, specifically by healthcare professionals, must be more extensive. More studies of nature prescriptions by healthcare professionals need to be performed not only to continue to support that nature has a positive effect on human health but to optimistically show that nature prescriptions by healthcare professionals are another positive alternative, or additive, to modern-day medicine. These studies would likely result in an increase in nature prescriptions prescribed by healthcare professionals, making it a norm and building towards a more comprehensive body of knowledge on nature prescriptions. Although some healthcare professionals know of nature prescriptions, most do not and need better access to appropriate resources available for prescribing nature (38). Therefore, there is a need for nature prescription awareness and relevant resources in healthcare settings to encourage healthcare professionals to feel comfortable to take the initiative to begin or continue prescribing nature.

Acknowledgments

The authors would like to thank Dr. Tommy McDonald, Dr. Jerry Carrino, and Dr. Darren Domsky, for their input into the study design and results.

Funding: None.

Footnote

Reporting Checklist: The authors have completed the PRISMA-ScR reporting checklist. Available at https://jphe.amegroups.com/article/view/10.21037/jphe-24-17/rc

Peer Review File: Available at https://jphe.amegroups.com/article/view/10.21037/jphe-24-17/prf

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jphe.amegroups.com/article/view/10.21037/jphe-24-17/coif). J.E.M. serves as an unpaid editorial board member of Journal of Public Health and Emergency from August 2023 to July 2025. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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