An international and interdisciplinary framework for nature prescribing in healthcare: A modified Delphi study

Nature prescriptions allow healthcare providers to recommend nature connection and exposure for health and well-being benefits. However, an accepted interdisciplinary shared definition of nature prescription is currently lacking, as are frameworks to guide the use of nature prescription in healthcare. To help fill this knowledge gap, we used an international modified Delphi technique to develop a framework for nature prescribing in healthcare by interdisciplinary experts. Round 1 consisted of virtual focus groups with an expert panel to generate a preliminary framework and framework statements through a qualitative approach, followed by Round 2 to establish agreement, set a priori as ≥75%, on statements to be included in the presented framework. Eight expert panellists participated in the consensus building process, developing and agreeing on 146 statements. The framework consists of: (1) Defining nature prescriptions; (2) Human benefits and risks; (3) Environment benefits and risks; (4) Society and Culture contextual factors and perspectives, acknowledgement of Indigenous knowledges, and equity; (5) Planetary health as a positive feedback loop between the benefits for people and environments; (6) Future directions to aid moving knowledge and implementation of nature prescribing forward. We report an overview of the benefits and risks of nature prescriptions, their potential planetary health impacts, and how they can be equity-driven by incorporating social and cultural differences. This international and interdisciplinary framework for nature prescribing in healthcare offers itself as a guide for the utilization of nature prescriptions in healthcare, and proposes recommendations for research, education, and clinical practice.