Cities, states, and countries across the globe are recognizing the interconnections of human and planetary health, and are investing in greening. Nevertheless, environmental improvements may not bring adequate changes in exposure needed to reduce chronic disease and improve mental health. Nature prescription, in which a health provider refers a patient to spend time outdoors, is a potential behavioral intervention that could connect people to accessible green spaces. However, formidable patient barriers could reduce the potential to scale-up implementation in equitable and sustained ways. We surveyed 2625 adult respondents within Australia, India, Singapore, the United States, and the United States about their perceptions of a set of seven potential barriers to participation in nature prescriptions. Analyses revealed that respondents in India and Singapore, although most aware of and experienced with nature prescriptions, reported facing greater barriers than in other countries. Weather was the most commonly reported barrier, followed by the lack of time and distance. A lack of interest was a greater barrier among young, urban respondents with a college degree. The barrier of the lack of company was greater for urban residents and for those experiencing financial difficulty. In addition, contrary to many prior studies, we observed greater overall perceived barriers for respondents with higher education levels. Many of the perceived barriers covered by our survey are structurally modifiable, and programs developing in each of these locations may draw from these findings to tailor outreach strategies.

Evidence to support nature contact and nature prescriptions to reduce loneliness is scant. A total of 2100 individuals took part in a survey conducted in Australia (n = 525, mean age = 34.1), India (n = 526, mean age = 29.5), Singapore (n = 523, mean age = 36.1), the UK (n = 526, mean age = 37.3), and the US (n = 525, mean age = 43.6) in 2022 (overall age range 18–89yrs). Multilevel logistic regressions adjusted for confounding indicated mean levels of overall loneliness tended to be higher in India (Odds Ratio [OR] 1.21, 95% Confidence Interval [95%CI] 0.90–1.62), Singapore (OR = 1.54, 95%CI = 1.15–2.07), the UK (OR = 1.26, 95%CI = 0.96–1.67) and the US (OR = 1.24, 95%CI = 0.94–1.64) compared with Australia. Notable differences were observed by loneliness type, for example, with lower odds of social loneliness (OR = 0.57, 95%CI = 0.41–0.79) and higher odds of emotional loneliness (OR = 1.57, 95%CI = 1.14–2.06) in India compared with Australia. Findings with regards to loneliness and nature contact varied between country. In general, social loneliness was lower in participants who visited natural surroundings regularly (OR = 0.81, 95%CI = 0.61–0.98) and spent two hours or more per week in nature (OR = 0.65, 95%CI = 0.49–0.81). Overall loneliness (OR = 1.98, 95%CI = 1.48–2.47) and emotional loneliness (OR = 2.84, 95%CI = 2.13–3.51) were substantially higher among those who felt having no-one to go with was a barrier to spending time in nature. Emotional loneliness was higher in those who had more time in nature (OR = 1.32, 95%CI = 0.94–1.75) or more frequent visits (OR = 1.24, 95%CI = 0.94–1.49), which may be indicative of selective processes by which some people who feel emotionally lonely seek meaningful sources of connection or solace in natural environments. In sum, these findings highlight potentially important contingencies in how people feel lonely in different countries, and the potential of contact with nature as a means to address this critical issue of modern times. Randomised trials of nature prescription interventions for loneliness co-designed with respect to contrasting cultural, economic, and climatic contexts are needed to ensure programs intended to reconnect people with nature are effective, equitable, and acceptable for everyone.