Contact with nature promotes human wellbeing through diverse pathways, providing a potential way to support health especially in primary care, where patients commonly suffer from multimorbidity and poor general health. Social prescribing as a non-pharmaceutical treatment is a promising method to improve health as well as inclusion. This study explores and compares the effects of a nature based and an exercise based social prescribing scheme on mental wellbeing, physical activity and sleep, in a primary care population.

In this non-randomized, intention-to-treat, pilot study we recruited clients at the health and social service centre in Sipoo, Finland.

Participants (n=79) chose between two social prescribing programs, either taking part of guided walks in nature, including immersion in a forest with high biodiversity, or taking part in a sports group with a versatile program. Inclusion was not based on diagnosis, but an identified need of improving health. Mental wellbeing was assessed using the 14-item Warwick-Edinburgh Mental Well-Being Scale (WEMWBS), additional questions evaluated perceived health and sleep. Amount and quality of sleep and physical activity were measured using wrist-worn accelerometers.

Assessments took place before and after the 8-week intervention, as we were interested in the effect on everyday life. Even though participants lived in an area with abundant green space, taking part in the prescribed nature program improved mental wellbeing. Those who initially rated their health and mental health as good did achieve benefit from both programs, while those in poor health received better aid from the nature group.

Initial study plan aimed for 160 participants, with an equal distribution between the groups. The programs were completed in 2018-2019 (spring + autumn) The COVID-19 outbreak hindered group activities 2020, a nature-group was organized in autumn 2020.

Inclusion Criteria:

• Need of health promotion or secondary prevention of disease as identified by health care professionals or by social care professionals working in a public health care center (nurse, doctor, or social worker).
• Enrolment was not based on a diagnosis, but health care and social care professionals were instructed to identify patients/clients they felt could benefit from a targeted health intervention and involve particularly those in poor general health.
• Adults with a physical ability to slowly walk approximately 3 km in a slow tempo.
• Ability to understand and give consent to participation.
• Age 18 years or older.

Exclusion Criteria:

• Untreated medical condition hindering physical activity or symptomatic condition demanding continuous attention.
• Disability preventing ability to move in terrain.
• Inability to take part in group-based activities due to, e.g., behavioral challenges.

Although reason of referral is not reported, enrolment in intervention was part of real-life treatment.

Eligibility was assessed by professionals referring to the intervention, as well as at the introductory meeting organized by the staff at the public health care center taking place before the intervention started.

It was possible to take part in the intervention but not the study, participants in the study signed an informed consent allowing use of data and giving permission for later contact. Participants were free to withdraw from the study at any time without giving a reason, and this did not interfere with their care in any way.

According to the original research permission granted by the Finnish Institute for Health and Welfare all data is anonymized and stored at the institute, only accessible to researchers with permission from the institute.

Care provider recommended participation in either group, based on discussion with participant. All data is anonymized and stored at the Finnish Institute for Health and Welfare and outcomes assessor has access to this data, however, it includes knowledge of group participation.