Lack of awareness and structural, intrapersonal and interpersonal barriers limit Canadians' participation in nature prescriptionsInterest in nature prescriptions has expanded rapidly in both healthcare and conservation circles. Nature prescriptions are written doctor’s directives for patients to visit nature areas for health reasons. In Canada, more than 15,000 healthcare professionals have prescribed nature to patients as the Canadian Medical Association has officially endorsed nature prescriptions. However, scholarly research does not provide decision-makers with much guidance to negotiate the rapid proliferation of nature prescriptions. Therefore, this Canadian study empirically examined the public’s awareness of and interest in nature prescriptions, perceived barriers to implementing and scaling nature prescriptions, and the enablers that would increase the public’s use of nature prescription programs. These findings could provide evidence-based recommendations to help policymakers, practitioners, and other stakeholders develop and implement nature prescriptions as a complement to modern medical treatment.
The study design centered on an online survey completed by a representative sample of 3593 Canadian adults. Survey questions focused on demographic information, health and well-being status, time spent in nature, and perceptions of nature and nature prescriptions. Statistical analysis compared frequency of responses in relation to demographic variables to measure groups’ awareness of and interest in nature prescriptions, barriers to nature prescriptions, and enablers to participation in nature prescription programs. This specific article focused on the findings regarding the barriers and enablers to public participation in nature prescriptions.
The sample was mostly consistent with Canada’s demographics. The main findings were that Canadians’ interest in nature prescriptions was high. 76% of respondents were likely or highly likely to visit green spaces (land) or blue spaces (water) more often if their healthcare professionals recommended them. At the same time, awareness of nature prescriptions was low: 91.8% of respondents had not heard of nature prescriptions. Results also varied by subgroups—with people age 35-44, racial minorities, non-Canadian citizens, and parents of minors most likely to visit nature if prescribed by a healthcare professional. The survey also revealed structural, intrapersonal, and interpersonal barriers to nature prescriptions—which varied by age groups, citizenship status, gender identification, and ethnicity. From most to least frequent, the most common barriers included lack of time, bad weather, crowds, cultural barriers, fear of prejudice, and conflict with others. Cost of entry, lack of transportation, and lack of equipment figured more prominently among low-income groups. Even though cost was rarely cited as a barrier, most enablers to participation in nature prescriptions documented in the study were cost-related. Free or discounted park passes, free or discounted transportation, and insurance coverage for nature prescriptions were named the strongest incentives to participate in nature prescription programs. Analysis of sociodemographic variables revealed a whopping 54 statistically significant differences with respect to enablers. This suggests that many social, cultural, and economic differences come into play when trying to promote wider participation in nature prescriptions.
Overall, these findings suggest that many Canadians would take advantage of nature prescriptions. However, a lack of awareness of nature prescriptions and structural, intrapersonal, and impersonal barriers limit participants’ uptake of them. Results reveal an important disconnect between public awareness and interest in nature prescriptions, which points to ineffective communication about the country’s nature prescription program. In addition to building public awareness of nature prescriptions, nature prescription advocates could also leverage free and discounted park passes, free and subsidized public transportation, and health insurance coverage of nature visits to reduce barriers to participation, especially among marginalized groups. Finally, given the high status of healthcare professionals, physicians are especially well positioned to leverage their public trust to influence individuals and decision-makers to extend the reach of nature prescriptions.
The Bottom Line