Development of a realist-informed intervention framework for greenspace programmes for people with poor mental health and problem substance use

Abstract

Greenspace programmes are health projects run outside in nature, typically with the aim of improving mental health. Research suggests that greenspace programmes are also effective in supporting people with problem substance use (PSU). However, there is limited understanding of the key components that make greenspace programmes successful for this client group.

A three-phased, realist-informed study was conducted to develop a potential intervention framework. Firstly, a realist synthesis enabled initial development of a novel framework demonstrating how greenspace programmes improve mental health; secondly, the proposed framework was tested by surveying greenspace organisations across Scotland to identify if the framework was transferable to programmes that support people with PSU; finally, qualitative interviews with programme staff and stakeholders provided in-depth refinement of framework components.

The synthesis showed that greenspace programmes support mental health due to: feelings of escape; space to reflect; physical activity; self-efficacy; feelings of purpose; relationships with facilitators; and shared experiences. These findings were supported by survey data. Survey data also showed high levels of agreement from organisations that supported people with PSU suggesting that the framework was transferable to programmes that support this client group Interview data showed that, as well as the original identified factors, programmes must also consider: explicit intervention focus to ensure adequate support for people with poor mental health and PSU; existing challenges with funding and stakeholder buy-in; and the impact of COVID-19.

The findings of this project are theoretically novel, but also have practical relevance for those designing such interventions by providing recommendations on how to optimise, tailor, and implement future programmes. Findings could be particularly relevant for academic researchers, health professionals, mental health teams, 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.