Developing a Consensus-Based Nature Prescribing Framework for Australian Healthcare: A Delphi Study

Background: With growing interest in nature-based interventions for health, establishing implementation frameworks for prescribing nature in diverse settings is crucial. This study aims to develop and validate a nature prescribing framework tailored for the Australian healthcare context, employing a Delphi methodology to harness expert consensus.

Methods: The study utilised a two-round Delphi technique to gather insights from experts across various health and environmental sectors. Participants included healthcare providers, managers and policymakers engaged in or knowledgeable about nature prescribing. The initial framework, which was informed by earlier interviews with parties who prescribe or provide nature-based health interventions, was refined through the Delphi process, aiming for consensus on implementation criteria and associated practices.

Results: Sixteen experts participated in the first Delphi round, with 13 completing the second round. Participants reached consensus on five essential domains of the nature prescribing framework, which included Community: consultation and customisation, Systems: building partnerships and networks, Prescribers: cultivating awareness and capacity, Providing prescriptions: psychosocial foundations and External settings: interfacing social and natural environments. Perceived barriers and enablers to application were considered within the framework, including contextual and environmental factors, awareness and capacity among prescribers and public, and the role of infrastructure support.

Conclusion: The nature prescribing framework offers a structured approach to integrating nature-based activities into health practices, addressing both individual and community health needs. It is adaptable to various Australian settings, promoting broader implementation of nature-based prescriptions. Future research should focus on implementing and evaluating the feasibility and effectiveness of the framework in diverse demographic and geographic contexts.