A Feasibility Study Assessing a Green Prescription Version of a Novel App-based Intervention to Improve Wellbeing in Patients With Common Mental Health Problems

The proposed feasibility study is part of a larger programme of research which asks broadly how the investigators can improve health and mental wellbeing through urban nature. The feasibility study forms part of Work Package 3 delivered by the University of Derby. The main study in work package 3 will recruit over 1,000 Sheffield residents to evaluate an app-based intervention to improve wellbeing through prompting people to notice the good things about nature. For the feasibility study, the investigators will pilot a green prescription version of this intervention with 100 adults who have common mental health difficulties. The feasibility study asks the question of how feasible it is to recruit patients to the study using a green prescription method of clinician signposting (measured through referral numbers and referral source). It also asks whether there are any health and mental wellbeing benefits to adults with common mental health problems (measured through health and mental wellbeing questionnaires completed at pre, post and 3 months follow-up).

People who are exposed to nature, or feel connected with it, present higher levels of general health and subjective wellbeing. Individuals with mental health problems have been shown to particularly benefit from nature-based interventions . In a recent Natural England report, evidence from a range of nature-based interventions for mental health patients and found the following benefits: i) reduced depression and anxiety; ii) increased positive affect; iii) increased social contact; and iv) increased mental wellbeing.

At present, the knowledge about the beneficial effects of nature is insufficient to be applied in a systematic way in health promotion and urban planning. There is a need to move beyond cross-sectional evidence and natural experiments. Work package 3 aims to fill this research gap through a largescale controlled study, which will employ a robust quasi-experimental methodology to look at the health and wellbeing benefits of engaging the public with urban nature. To go beyond cross-sectional data, the study will randomise participants to an app-based intervention which will either prompt them to notice the good things about green spaces or to an active control condition which will prompt them to notice the good things about built spaces.

As part of work package 3 the investigators will conduct a feasibility study assessing a green prescription version of the app-based intervention for adults with common mental health problems. This will help estimate the wider potential for using the nature-based intervention in a clinical population. 'The natural environment has potential to offer cost-effective solutions to address health inequalities and produce positive physical and mental health outcomes'. Some of the data collected will be used to estimate QALYs and to look at cost utility of the intervention in this group of patients.

The research proposal was developed by the principal investigator (Prof. Anna Jorgensen, Sheffield University) and collaborators from Sheffield University, Derby University and Herriot-Watt University. The team is multidisciplinary encompassing public health, landscape, architecture and design, psychology and mental health, and economics. Internal peer-review was sought from experts in this field of research before submitting the research bid and the bid was reviewed and approved for funding by the Natural Environment Research Council.