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.

Objective: “Nature prescriptions” are increasingly being adopted by health sectors as an adjunct to standard care to attend to health and social needs. We investigated levels of need and interest in nature prescriptions in adults with cardiovascular diseases, psychological distress and concomitants (e.g. physical inactivity, sedentary behaviour, obesity, loneliness, burn-out). Methods: A nationally-representative survey of 3,319 adults across all states and territories of Australia was completed in February 2021 (response 84.0%). Participants were classified across 15 target groups using validated health indicators and surveyed on (1) time and frequency of visits to green and blue spaces (nature spaces), (2) interest in a nature prescription, and (3) potential confounders (e.g. age, income). Analyses were done using weighted logistic regressions. Results: The sample was 50.5% female, 52.0% were aged ≥45 years, 15.2% were living alone and 19.3% were born overseas in non-English-speaking countries. Two-thirds of the sample spent 2 hours or more a week in nature, but these levels were generally lower in target groups (e.g. 57.7% in adults with type 2 diabetes). Most participants (81.9%) were interested in a nature prescription, even among those spending fewer than 2 hours a week in nature (76.4%). For example, 2 hours a week or more in nature was lowest among sedentary adults (36.9%) yet interest in nature prescriptions in this group was still high (74.0%). Lower levels of nature contact in target groups was not explained by differences in access to or preference for local nature spaces. Conclusions: High levels of interest in nature prescriptions amid low levels of nature contact in many target health groups provides impetus for developing randomised trials of interventions that enable people to spend more time in nature. These findings can inform intervention co-design processes with a wide range of community stakeholders, end-users in target health groups, and the health professionals who support them.