A systematic review of 25 qualitative studies found that green health prescribing (nature-based interventions prescribed by clinicians) can support healthy aging in older adults, but implementation is blocked by accessibility barriers, healthcare provider hesitancy, and gaps in community infrastructure rather than lack of evidence for benefit .
Green health prescribing refers to clinician-prescribed nature-based interventions: structured activities in natural settings like park visits, gardening, or woodland walks designed to address health outcomes in older adults with chronic conditions. Researchers from the University of Exeter conducted a systematic review of qualitative evidence (25 studies from 2000-2024) to map what enables or blocks these programs from reaching the patients they're designed to help.
The barriers identified fall into two categories: individual-level obstacles and system-level problems. At the individual level, older adults reported challenges accessing green spaces due to mobility limitations, transportation barriers, and concerns about safety. Fear of falling, pain with walking, and lack of accessible routes into natural areas were consistent friction points. Healthcare providers themselves presented another barrier: many reported uncertainty about the evidence base for nature-based interventions, hesitancy about prescribing something outside traditional medical frameworks, and limited training in how to integrate these programs into clinical workflow. Socioeconomic disparities amplified access issues, with lower-income older adults less likely to have nearby green spaces or the flexibility to participate in daytime programs.
On the organizational side, the review found systematic gaps: inadequate funding for community green health programs, lack of coordination between healthcare systems and community providers, and limited capacity among primary care teams to identify eligible patients or track outcomes. Some healthcare systems lacked formal pathways to refer patients to nature-based activities. The review also noted that prescribers cited "limited evidence of effectiveness" as a reason for hesitancy, though this appears somewhat circular: programs were underfunded partly because evidence was seen as insufficient, yet evidence generation required functioning programs.
Enablers painted a different picture. Where programs succeeded, key drivers included accessible green space design (flat paths, benches for rest, clear signage), strong provider enthusiasm and commitment, positive peer experiences and group social engagement, and explicit connections made between nature contact and health benefits. Organizational enablers included embedded funding models, integration of nature prescribing into routine primary care workflows, and formal training for prescribers. The data suggest that accessibility and provider belief matter as much as program design itself.
If you're an older adult with chronic conditions, this research flags practical questions worth exploring: Does your healthcare provider know about local nature-based programs? Are there transportation or accessibility barriers preventing you from trying them? The review indicates that forest-bathing and structured nature-exposure have measurable benefits for people managing long-term health conditions, but access is unequally distributed.
For primary care clinicians, the findings suggest that prescribing nature contact doesn't require new clinical tools, but does require knowing what's available locally, having confidence in the evidence, and removing friction from referral pathways. If your practice lacks these systems, the review identifies concrete enablers: funding for community partnerships, staff training, and formal integration into standard care workflows.
Policymakers and health system administrators should note that the review found the bottleneck is not evidence or efficacy questions, but implementation infrastructure. The 25 studies analyzed indicate consistent benefits across participant groups, yet these programs remain patchy and underfunded. The review authors argue that scaling green health prescribing to support healthy aging requires investment in community green space accessibility, formal integration within primary care, and reduction of socioeconomic barriers to participation.
| Attribute | Details |
|---|---|
| Study Type | Qualitative systematic review with thematic synthesis |
| Number of Included Studies | 25 qualitative studies |
| Search Period | 2000 to October 2024 |
| Databases Searched | Medline, PsycINFO, ASSIA, GreenFILE, Web of Science, Dimensions, Overton, Google |
| Study Population | Older adults with long-term conditions; healthcare providers and service implementers |
| Primary Outcomes | Barriers and enablers to access, uptake, implementation, and delivery of green health prescribing and nature-based interventions |
| Key Barriers Identified | Accessibility challenges, service provision gaps, provider knowledge gaps, prescriber hesitancy, limited organizational capacity, socioeconomic disparities, perceived limited evidence |
| Key Enablers Identified | Accessible green space design, provider enthusiasm, positive social engagement, organizational funding and integration, formal training |
| Reporting Standards | PRISMA, ENTREQ, GRIPP2 |
| Journal | BMC Medicine |
| Registry | CRD42025603199 |
Systematic review: "Factors influencing access to green health prescribing in primary care for older adults - a qualitative systematic review." BMC Medicine. 2025.
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