The essential elements for successful implementation of nature therapy programs in mental health services: A systematic review with narrative synthesis

The essential elements for successful implementation of nature therapy programs in mental health services: A systematic review with narrative synthesis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review The essential elements for successful implementation of nature therapy programs in mental health services: A systematic review with narrative synthesis Zubair Ahmed Ratan, Óscar Gonzalo, Nicole Snowdon, Juan V. Luciano Devis, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7909468/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The potential of nature-based interventions (NBIs) for improving mental health is gaining interest worldwide. However, the elements for successful implementation of nature therapy programs by mental health service providers have not been clearly identified. The review question was, what elements are essential to successfully implement nature therapy programs in mental health services? Methods: The study was carried out as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Four electronic databases including Scopus, Web of Science, PubMed, and PsycINFO were searched to identify eligible studies. Studies were assessed for eligibility based on predefined inclusion criteria, and data were extracted in line with the review questions. Two reviewers independently used the Mixed Methods Appraisal Tool (MMAT) to assess the quality of the articles. Results: Out of 1663 articles, 38 met the inclusion criteria, with 9 found to have a high or moderate risk of bias. Sample sizes ranged from 8-781. The findings revealed that structured programs, guidance from trained multidisciplinary practitioners, and opportunities for participants to connect socially are key elements of successful implementation of nature-based therapy programs. Challenges to implementation were identified as logistical constraints, unfavourable external conditions, insufficient guidelines, and limited availability of resources. Conclusion: This systematic review highlights some components of successful implementation of nature-based therapy programs. However, implementation strategies are rarely reported. Subsequently evidence-based implementation advice for mental health services is limited. Registration: The protocol of this review was registered in the Prospective Register of Systematic Reviews (PROSPERO), under the identification number CRD42024562262. Nature-based interventions Mental health services Implementation Systematic review Multidisciplinary care Full Text Additional Declarations The authors declare no competing interests. Supplementary Files PRISMA2020checklist.docx PRISMA checkist SuppTable4.docx Supp table 4 SuppTables123.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7909468","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":532566215,"identity":"59481063-28fd-476f-97f3-a4ab11d11abf","order_by":0,"name":"Zubair Ahmed Ratan","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Zubair","middleName":"Ahmed","lastName":"Ratan","suffix":""},{"id":532566216,"identity":"589e0f1c-8888-4ba7-8251-6da925a56876","order_by":1,"name":"Óscar Gonzalo","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Óscar","middleName":"","lastName":"Gonzalo","suffix":""},{"id":532566217,"identity":"b28a0f55-4780-444a-af83-573902865e65","order_by":2,"name":"Nicole Snowdon","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Nicole","middleName":"","lastName":"Snowdon","suffix":""},{"id":532566218,"identity":"0061c8ba-7b9e-47c8-87c4-cf70e19fdab4","order_by":3,"name":"Juan V. 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systematic review with narrative synthesis\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Nature-based interventions, Mental health services, Implementation, Systematic review, Multidisciplinary care","lastPublishedDoi":"10.21203/rs.3.rs-7909468/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7909468/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground:\u003c/p\u003e\n\u003cp\u003eThe potential of nature-based interventions (NBIs) for improving mental health is gaining interest worldwide. However, the elements for successful implementation of nature therapy programs by mental health service providers have not been clearly identified. The review question was, what elements are essential to successfully implement nature therapy programs in mental health services?\u003c/p\u003e\n\u003cp\u003eMethods:\u003c/p\u003e\n\u003cp\u003eThe study was carried out as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Four electronic databases including Scopus, Web of Science, PubMed, and PsycINFO were searched to identify eligible studies. Studies were assessed for eligibility based on predefined inclusion criteria, and data were extracted in line with the review questions. Two reviewers independently used the Mixed Methods Appraisal Tool (MMAT) to assess the quality of the articles.\u003c/p\u003e\n\u003cp\u003eResults:\u003c/p\u003e\n\u003cp\u003eOut of 1663 articles, 38 met the inclusion criteria, with 9 found to have a high or moderate risk of bias. Sample sizes ranged from 8-781. The findings revealed that structured programs, guidance from trained multidisciplinary practitioners, and opportunities for participants to connect socially are key elements of successful implementation of nature-based therapy programs. Challenges to implementation were identified as logistical constraints, unfavourable external conditions, insufficient guidelines, and limited availability of resources.\u003c/p\u003e\n\u003cp\u003eConclusion:\u003c/p\u003e\n\u003cp\u003eThis systematic review highlights some components of successful implementation of nature-based therapy programs. However, implementation strategies are rarely reported. 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