Developing and pilot testing a primary care-based toolkit to improve engagement with green health prescribing of older people living in deprived areas

Most of the time, prescribing means getting medication from a doctor. Green health prescribing is becoming more popular across the UK as a new way that doctors and other healthcare staff help people of all ages improve their health and wellbeing. Instead of giving tablets for problems like depression or joint and muscle pains, green health prescribing links people to 'nature-based' outdoor activities they like that will benefit both their physical and mental health. Some activities are walking in woodlands, gardening, social community projects that link people together to help reduce loneliness, and open-air art classes to name a few. All activities are based on the preferences and appropriate fit for the individual. Thinking about more ways to get outside and enjoy fresh air is especially important as people age and find it more difficult to be active. And yet, very often people from poorer areas are not considered when creating new ways to improve health and green health prescribing is not easily accessible to all.

This project will bring many people together, including experts, GPs, patients, and others who are interested in expanding green health prescribing for older people and especially for those who live in economically challenged areas. Research in this field shows many health benefits of engaging in 'nature-based' activities yet many healthcare workers, including GPs, lack knowledge of how to refer people to such activities. Therefore, our overall aim is to develop and test an easy to use, digital toolkit to help healthcare staff working in primary care to refer more older patients living in deprived areas to 'nature-based' activities. To do this we will hold workshops and talk with people covering a wide variety of perspectives to better understand what needs to be considered to develop the toolkit. We will develop the digital toolkit together with patients and healthcare workers and monitor the use of the toolkit in primary care. We will talk to patients who are referred to 'nature-based' activities to understand their views and monitor any changes in their health before and after they are referred. The goal is to make it easier for general practice staff to use green health prescribing and in the longer term to allow more older people from deprived areas to experience the health benefits that 'nature-based' activities provide.

Background: Health inequalities continue to widen in the UK with detrimental effects. Green Health Prescribing (GHP) aims to link people to nature-based activities and results in multiple benefits for ageing. However, access to GHP is patchy across the UK and targeting older patients living in more deprived areas holds potential to advance health equity.
Aim: To develop and pilot test a primary care based digital toolkit to improve the capacity to deliver GHP.
Objectives:
1) Develop a programme theory for an intervention to enable the engagement of older patients from deprived areas with GHP.
2) Develop a digital toolkit for primary care teams to facilitate the intervention.
3) Pilot the toolkit collecting information required for a future large-scale trial.
4) Optimise the digital toolkit and revise the programme theory as required.
Methods: We will take a mixed-methods approach incorporating co-design and relevant theory to explore barriers and enablers around how the GHP digital toolkit would work in primary care. We will conduct a rapid review of the evidence and explore research questions with stakeholders through a range of participatory co-design activities in workshops and interviews with patients and stakeholders. To test the feasibility of the digital toolkit, we will invite 30 older patients living in the 15% most deprived areas to carry out assessments before and after participation in GHP. Interviews will be conducted with practice healthcare staff and patients as part of a process evaluation. We have included knowledge exchange activities with service users embedded throughout the research process to enhance our 'pathway to impact' to improve access to GHP for older people experiencing health inequalities.
The goal of this work will lead to the development of a large-scale trial with potential to provide equitable access to GHP and impact on the health and wellbeing of older patients.