The motivations, interests and concerns of prospective peer leaders of nature-based mental health interventions

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Reeves, Will Freeman, Raksha Patel-Calverley, Julia L. Newth, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4763846/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Apr, 2026 Read the published version in Wellbeing, Space and Society → Version 1 posted You are reading this latest preprint version Abstract Background There is renewed, cross-sectoral interest in nature's contributions to health and how they can be maximised for public and planetary health. Current enquiry is focused on practicalities and what strategies and collaborations are needed to operationalise the nature-health relationship for both people and the environment. Nature-based health interventions (NBIs), especially those within the framework of nature-based social prescribing (NBSP), show promise. However, in the UK, there are limitations to initiating and scaling activities due to issues like: navigating multi-stakeholder partnerships, building a work force and sustaining the provision. The short ‘course’, finite format of NBSP programmes also creates a ‘what next’ moment for participants despite willingness and interest from many participants in peer leadership type activity i.e. offering social support and leadership to help others in their community to partake in nature-based health activities. Aim: To explore peer-led community delivery options for NBIs with prospective peer leaders. Method: We recruited seventeen study participants for a daylong workshop exploring motivations, activities and perceived challenges of prospective peer leaders of NBIs. The study participants had a) been through, or supported delivery/participation of, a UK wetland-based NBSP programme for poor mental health and b) expressed an interest in peer leadership activities. The data underwent reflexive thematic analysis. Results. Motivations of prospective peer leaders to offer nature-based health activities related to the promotion of personal and community wellbeing through learning, sharing nature experiences, creating social connections, and through interests in facilitating a wide range of nature-based and salutogenic activities (e.g. arts/creative, conservation, nature appreciation, mental wellbeing activities). Concerns from peer leaders centred on the practicalities of establishing and safely delivering nature-based activity, on the personal competencies required to deliver NBIs, nervousness with the medicalised nature of social prescribing, and on resource needs for delivery; the latter highlighted the importance of local nature provision for community-led NBI delivery. Conclusions: Community-led NBIs offer potential to broaden public health options, but community concerns need to be addressed first. There is a role for allied NGO organisations, or social prescribing networks, to share resources and support communities and prospective peer leaders to overcome these concerns. nature-based health intervention nature based social prescribing social prescribing mental health ecological restoration peer leadership peer support asset-based community development Background The wide-ranging benefits to mental and physical health of spending time in natural environments are now well established ( 1 – 5 ), and the use of nature for health promotion/intervention is firmly embedded in the public and policy health discourse ( 6 – 8 ). It is also a well embedded argument in the case for nature protection/creation ( 9 – 11 ), and a regular feature in strategies of nature organisations ( 12 – 14 ). For example, nature’s role in health, and public appreciation of this benefit, is a frequent converting tactic for environmental NGOs attempting to create social movements and catalyse investment/action for the environment, and collective public health ( 15 – 17 ). Health professionals too are stressing the indivisibility of global health and environmental challenges and how they should be addressed multilaterally ( 18 ). With wider acknowledgement of the above there is now cross-sectoral interest in nature as an upstream approach to public health ( 19 – 21 ), how treatment options might be expanded via nature-based health interventions (NBI) ( 22 – 25 ), and the strategies and collaborations required to maximise the nature-health relationship for public health and the environment ( 19 , 26 ). NBIs are wide-ranging and can encompass programmes, activities and/or strategies that aim to engage people in nature experiences to improve health and wellbeing ( 23 ). They have demonstrated promise through improvements to mental health indicators such as mental and emotional wellbeing ( 27 , 28 ), anxiety ( 29 ), stress ( 28 ) and physical wellbeing ( 30 ) ( 23 , 31 , 32 ). Beyond the individual human benefits, NBIs can also offer reciprocal environmental gains through ecological improvements conducted as part of the intervention ( 26 , 33 – 35 ), potentially contributing to local environmental stewardship i.e. community actions (with various motivations and capacity) to bring about environmental and/or social benefits ( 36 ). Further co-benefits of NBIs to both people and environment can accrue through wellbeing improvements derived from increased connection to nature ( 37 – 39 ), increases in pro-environmental behaviours ( 40 – 44 ), and through reductions in the associated environmental harms of pharmaceutical production and use ( 45 – 48 ). NBIs can extend to physically manipulating environments to increase incidental nature exposure to promote population-wide health (e.g. creating pocket parks, improving urban beaches or creating greenways ( 49 , 50 )). This type of approach may also require additional promotion of the asset - through accompanying marketing/promotion ( 49 , 51 ) or long-term social programmes and activities ( 52 ) - to secure the benefits. In England the delivery of NBIs has been mainstreamed through investments in social prescribing and developed with shifts in UK health policy towards a more strengths-based personalised care approach ( 53 ). The process links people with health or social care needs to community-based, non-clinical health and social care interventions ( 54 , 55 ). It asks ‘what matters to people’, rather than ‘what is the matter with people’ ( 56 ). Nature-based social prescribing (NBSP) is social prescribing in a natural environment ( 57 ). Although there has been promising demonstration of the positive health impacts to participants ( 58 – 61 ), a range of problems have been identified that relate to: the complexity and effectiveness of NBSP interventions ( 26 , 62 , 63 ), in communication, multi-stakeholder collaboration, and adequate service provision ( 64 , 65 ). Through investment the NHS healthcare side of the system is relatively well-provisioned ( 66 ), but providers in the community report a more challenging, fragmented and precarious funding landscape ( 26 , 67 , 68 ). This has impacted the sustainability of community programmes and the ability to build and retain a dedicated workforce ( 69 – 71 ), limiting the ability to operationalise and scale NBSP. It leaves an unmet need and a requirement to innovate and develop further capacity building and delivery options ( 67 ). One solution here might be to look more closely into community-centred approaches to health. These can “mobilise the skills, knowledge and time and resources of the individuals, communities, organisations and groups to promote health and wellbeing” ( 72 ). This follows an ‘asset-based community development’ approach which looks to enhance and support the capacity of a community ( 73 ) and in the health context, can, help develop peer and volunteer roles, form collaborations and/or improve access to resources ( 72 ). They further help to shift the dynamic between communities and healthcare institutions away from a one-directional relationship in which the community only see themselves as inactive consumers of services delivered by professionals ( 74 ) to one in which they are more active, independent and capable of contributing to their own health promotion ( 75 , 76 ). NBSP maybe an area of focus for peer roles due to the unmet need outlined above, but also because NBSP providers report that the end of programmes can bring two participant responses. Firstly, disappointment at the end of the programme and a ‘what next’ moment ( 60 , 67 ). Secondly, interest in continuing, and shifting, their connection with the programme from participant to a more community-centred, peer support role to enable others to enjoy the programme and nature’s health benefits ( 67 ). Indeed, in response to findings from a UK-wide test and learn programme on green social prescribing, specially trained ‘nature buddies’ volunteers are being promoted by the National Academy of Social Prescribing to help other would-be participants to overcome barriers to taking part in nature-based activities ( 77 ). More generally, peer and volunteer roles focus on “‘enhancing individuals’ capabilities to provide advice, information and support or organise activities around health and wellbeing in their or other communities” ( 72 ). They have been adopted to support a variety of health issues like breastfeeding, healthy eating, smoking and condom use ( 72 , 78 ), but show most promise in peer-led physical activity interventions ( 79 – 82 ), and some evidence suggests they may be as effective as professionally delivered interventions ( 83 ). Peer roles are further subdivided by objectives to provide social support (peer support), encouragement on self-efficacy to find health solutions (peer coaching), one to one support from personal experience (peer mentoring), health information (peer education) and leadership or expert advice (peer leader) ( 72 , 84 ). Peer leaders are often aspirational roles, they may have received some training to be a role model or expert advisor or leader around a specific health promotion issue or activity ( 84 ). However, definitions can overlap ( 78 ) and in the UK for example this role might be called a ‘volunteer health role’ ( 72 ) or Community Health Champion ( 85 – 88 ). Here, the more ad hoc types of civic action should also be recognised (e.g. neighbour to neighbour support) as one part of the wider family of volunteerism that contributes to community building ( 75 ). In both cases volunteers require support to succeed. Central to the possibility of peer roles supporting NBI delivery is an understanding of the motivations, interests, needs and concerns of potential peer volunteers. While these factors have been researched for environmental volunteerism ( 34 , 89 – 92 ) and outdoor peer walk leading to increase physical activity ( 93 , 93 ), this area has yet to be explored for NBIs for mental health, and in the context of NBSP. Here we present a qualitative study of the perspectives of a group of prospective NBI peer leaders with an interest in peer health roles. The study explored the motivations, interests and concerns of prospective peer leaders to inform how peer health roles might potentially be developed to support NBI delivery. We discuss findings in the context of the related fields of conservation volunteering, peer-led volunteering for exercise referral, NBSP and asset-based community development (ABCD) ( 74 , 94 ). Methods Study Design A day-long workshop on the prospect of peer leadership for nature-based mental health promotion was held, at the London Wetland Centre, London. Additional in-depth interviews and questionnaires were delivered after the workshop for study participants unable to attend the workshop. The aim of the workshop (and focus groups within) was to explore study participants views on how to make NBIs more sustainable, longer-term and community-led, and what types of support and infrastructure people would need assume the role of ‘peer leader’. The study was inductively informed by the research team’s experience of delivering NBIs and NBSPs and the study participants’ lived experience of a) mental health problems b) UK mental health services, and c) nature-based health interventions ( 95 ). In our wetland context our shared definition of a peer leader was “a person with lived experience who works collaboratively to lead community groups in wetlands to improve health”, this was communicated to participants in the study information prior to the workshop. Participant recruitment Study participants were recruited through the ‘Blue Prescribing Project’ ( 96 ), a nature based social prescribing programme aimed at people who reported the greatest mental health impact of the pandemic, namely people living with long term health conditions (including mild/moderate mental health problems), single parents and people from minoritised or racialised backgrounds. The project was run by WWT and the Mental Health Foundation and delivered at WWT’s London Wetland Centre ( 60 ). An email invitation was sent to participants requesting their participation included the date, aims and proposed activities of the workshop. Seventeen participants were recruited in total, with fourteen able to attend on the day of the workshop. Two completed follow up questionnaires and one completed a follow up interview. Four of the participants engaged through the Rare Dementia Service at University College London ( 97 ). Data collection Workshop The data were collected at a workshop held in April 2023 which was facilitated by four trained facilitators with experience working with people in poor mental health. A workshop topic guide (provided in the additional information) was produced by the authors to facilitate discussion through the day, the workshop/topic guide included the following sessions: Making a landscape - As a warmup - and to stimulate thinking in an asset-based approach - the first session invited participants to ‘make a landscape’ of existing services, community groups and natural assets already known and available to participants (results provided in the additional files only). Motivations - The second session asked participants to consider their motivations and why they had taken an interest in peer leadership. Prospective activities - The third session focused on the activities study participants – i.e. prospective peer leaders - might offer. They were asked to consider what activities they would like to offer, the locations and types of activities, their time availability and what they would need. Prompts on partnerships, funding, advice/training were offered, and asking what they might offer with no help, with a little help and what they can do with only outside help. They were also asked what might prevent them from acting, their concerns, what places are nearby but inaccessible, and what places they would like nearby but do not exist. Plenary - A final session included a facilitated conversation to draw out final thoughts and concerns on the themes of the day. Prior to the workshop, participants were asked whether they had any special needs, and these were considered in the workshop design. To maximise inclusivity and participation, a mixed method approach for data collection was used to embrace differing preferences in ways of communicating. For sessions 1–3 participants wrote responses on sticky notes for collation on group white boards. For session 4, the conversation was recorded and transcribed. For all sessions, workshop facilitators took notes and recorded observations. In-depth interviews and questionnaire Both interviews and questionnaires followed the structure and questions from the workshop topic guide (provided in supplementary material 1), these were offered to study participants unable to attend on the day of the workshop. Microsoft Forms was used for distribution of the questionnaire to the two participants who expressed a preference to respond through online questionnaire. The interview was conducted through video call by one of the authors (BP, who has experience facilitating conversations with people in poor mental health). Detailed notes of responses were taken by the interviewer (BP). Data analysis The sticky notes and audio-recordings were transcribed verbatim (audio by Otter (Los, Altos, CA)), verified by JPR and collated in one master transcript document. The two questionnaire responses and the interview notes were added to the master document. Reflexive thematic analysis ( 98 , 99 ) was then conducted on the master document using Nvivo software (Release 1.7.1, QSR International). Authors JPR and BP iteratively cycled through the six phases of TA i.e. ( 1 ) The transcript was first read and re-read (JPR and BP), ( 2 ) JPR and BP produced initial codes to each participant response, ( 3 ) JPR and BP grouped the codes into tables to present early sub-themes, ( 4 ) JPR, BP and WWF convened to review and consolidate codes and sub-themes, and to ( 5 ) define overarching themes. Finally, ( 6 ) JPR produced Tables 1 – 3 and added descriptions and summaries for the themes. Results Participants In addition to lived experience of poor mental health, other long-term health conditions reported by study participants included long covid ( n = 1), cancer (in remission, n = 1), ME ( n = 1), alcoholism (in recovery, n = 2), rare dementia ( n = 2). The age range for participants was 25 to 65 + years old. Fifteen participants (88%) identified as White British. One participant identified as British Pakistani and one participant identified as Kurdish. Three indicated that they were employed (including one self-employed), eight participants were retired, two participants were carers, one participant was a student, and the remaining four participants indicated that they were unemployed (missing data for 1 person). Motivations Motivations to get involved in nature-based peer leadership were grouped into a central theme of improving wellbeing (Table 1 ). This was split into two sub-themes on a) personal and b) community wellbeing. Personal wellbeing motivations involved: doing good, building self-esteem and having meaningful activity in retirement; a desire for personal wellbeing through learning new skills and training (e.g., to be a therapist or facilitator), through self-education, discovery, and learning about nature and new places. Community wellbeing involved: creating more community connections, by enhancing existing relationship with friends and family, reaching out to more people and creating new friendships; creating new partnerships and building trust and cooperation. Another subtheme described supporting and encouraging others to get wellbeing benefit from nature by “increas[ing] access and participation for people in the community who face some barriers” . This subtheme extended beyond the immediate community to supporting workplace wellbeing and encompassed grander ideals of “ reform for all to get the benefit ”. A desire to promote community wellbeing through practices (e.g., meditation), finding inspiration for art and new (sensory) experiences was also identified. Peer leaders also wanted to share their skills, interests and knowledge to educate others and “ bring out the potential ” in other people. Finally, there were motivations to share and raise awareness of both the joy and beauty of nature, and the wellbeing benefits e.g. “ Setting the seed in others of the idea that being out in nature can really help mental health and personal resilience”. Table 1 Motivations to get involved in delivering nature-based health activity according to seventeen prospective peer leaders Theme Sub-theme Example responses Improving personal wellbeing Improving personal wellbeing Doing good, self-esteem building, going back to basics, meaningful retirement, quality of life, self-care Self-learning and education Self-education, self-discovery and a sense of achievement, training to be a therapist/leader, learning about wetlands and local places, new life skills Improving community wellbeing Creating community Connections to family and friends, new friendships, new partnerships, creating co-operation and trust Supporting others’ wellbeing Supporting/encouraging others to accrue health benefits, increasing nature participation in the community, (including the workplace) influencing political and social responsibilities and reform for societal benefit Practices, art and experience Meditation and relaxation, inspiration for art, new sensory experiences Sharing interests and knowledge Sharing: knowledge, interests, skills, joy; bringing out potential, raising awareness, educating others Sharing nature Cascading and evangelising nature’s benefits to health and resilience, sharing enjoyment of natural landscapes Prospective activities Participants were asked to consider the types of activity they would consider delivering as a nature-based peer leader (Table 2 ). Six themes captured a range of activities, from leading nature-based creative arts, e.g., community patchwork, photography, collage and storytelling; to activities that were directed at environmental and ecological improvement, i.e. from litter picking to ideas on ecological restoration and getting involved in local community action planning. Nature appreciation activities were suggested through foraging, forest bathing, pond dipping or wildlife identification activities; nature-based mental wellbeing practices, e.g., meditation or grounding exercises, through to physical wellbeing in the form of health walks, yoga or cycling. Participants also expressed interest in leading groups to increase access for less mobile people, and facilitating others to find and share nature spots the participants themselves draw benefit from. Table 2 Nature-based health activities considered for delivery by seventeen prospective peer leaders. Theme Example responses Creativity Providing art in nature teaching and guidance on e.g., cooking, community patchwork, crafts, drawing, painting, photography, poetry, printing and collage, storytelling, sculpture (e.g. willow weaving) Ecological and Conservation Action planning for local environment, ecology restoration projects e.g. restore forage diversity, environmental clean-up e.g., litter pick, simple conservation practical work Nature appreciation Foraging, forest bathing, nature connection activities (e.g. walk, pause, reflect, connect), pond dipping, scavenger hunt, plant and bird identification Mental wellbeing Meditation, grounding exercises, spirituality, emotional support (from those with training and experience) Physical wellbeing Cycling, nature and local history walk, dog walks, health walks in nature, yoga Leading and facilitating Engaging with the housebound and those unable to get outside with nature, leading a group to explore local nature for mental and physical health Needs and concerns Responses to a) participant needs to act as a peer leader and b) issues that might prevent action, were grouped into four themes: 1) set-up and management, 2) concerns about capabilities and capacity, 3) community support needs, and 4) resourcing needs (Table 3 ). Table 3 Needs and concerns in delivering nature-based activities from the perspective of seventeen prospective peer leaders Theme Sub-themes and codes Example responses Set-up and management Considerations of risk and liabilities On liabilities, risk assessments, access permissions, safeguarding, lone working and health and safety Setting objectives and scope Setting clear long- and short-term objectives, ensuring activities are nature-based, distinguishing between ‘clinical’ (e.g. social prescriptions) and ‘everyday’ group activity Engaging with healthcare Exploring both social prescribing' and self-referral routes, communication with local providers and referrers Preparing to work with participants Making facilitators feel confident through structure and sufficient support, procedures in place like signposting and communication with participants Planning activities Understanding participant needs and motivations, planning the content of the activities Publicising the activity Reaching suitable participants Capabilities and capacity Facilitator expertise Facilitators lacking skills/experience/expertise on mental health, or nature/local history; anxieties with technology Confidences affecting the ability to initiate activity Lack of credibility/qualifications deterring attendees, general self-doubts, self-doubt leading to not enough peer leaders forthcoming and participant non-attendance, lack of outdoor confidence in participants affecting attendance Working with participants Leaders bringing their own ‘baggage’, capabilities to deal with group dynamics Community support needs Community support and partnerships Finding: like-minded people, micro-providers, local community groups, local families and individuals; forming partnerships, volunteers Support for working with clients Support getting credibility/skills to deliver activities, help with client recruitment, attendance and adherence; buy in and interest from activity participants Institutional support ‘Umbrella support’ from third sector e.g. on safeguarding, risk, insurance; from local council, from local universities; support linking with site staff Resourcing needs Funding For equipment and consumables, to ensure activity is not entirely voluntary, to prevent burnout, for training Equipment Art materials, bikes, binoculars, cameras, tools, clothing and footwear Site and facilities Accessible, local, convenient sites, with access and permission, without a pay barriers; suitable spaces; sheltered from weather; some indoor space Transport Cost of transport for participants to site; and to move equipment Set-up and management This theme describes practical needs of delivering nature-based community activity. A central concern was the responsibilities and liabilities surrounding risk and safety. Normally, if you're running an activity, you're doing it under a professional umbrella and with that comes insurance, you need professional insurance. I'm wondering, are there any insurance issues? If you've just decided to run an activity? What if someone fell during your walk or have an accident? Would you be liable? Clear boundaries and a well-defined scope when planning activities was important, as was having a focus on nature; the study participants identified the need for a distinction between ‘everyday peer-led activities’ and more formal group activity which might incorporate talking therapies or other clinical approaches. That’s an interesting point about the difference between everyday activities, you know, the joy of the outside, rather than getting into the therapy, which immediately starts a bit more ‘pyschobabbly’. And really isn't it the activity that most people are interested in, like the needlework, or the walk or the cakes or the social experience? So we can get a bit muddled...let's start thinking of therapising people? I don't think that's what I would want it to be doing at all. I just want the joy of nature and to share that with other people I can see it could get a bit blurred if you weren't careful Although engaging with social prescribing systems was recognised as useful for finding potential attendees, there was scepticism of social prescribing due to its medicalised language, also due to experiences with GPs perceived as not sufficiently ‘people centred’ by referring activities that were misaligned to community need: “She [GP] was a bit miffed with me, because we're not doing that one [the activity suggested by the GP], you know. So it's like, I'm [the GP] telling you, this is what you do. And you do it... she's well briefed, but at the same time, she's becoming prescriptive” . Sub-themes identified the preparation needed to work with programme participants, e.g. ensuring the leaders feel confident, having a sufficient leader-to-participant ratio, and establishing the means to communicate with them. Also understanding why people want to attend, to plan appropriate activity and publicising and recruiting appropriately to reach target audiences, either through social prescribing routes, self-referral or word of mouth. How do you advertise?... what audience might you get? Am I gonna hit the right audience? Am I gonna hit the people that will probably get the maximum benefit? Or does it matter? There was recognition that good signposting is needed if/when leaders encounter an issue that needed more specialist support. Concerns about capabilities and capacity This theme described concerns around perceived deficits in expertise, qualifications and confidence of prospective leaders and a subsequent perception that peer leaders lack credibility. This related to both the credibility needed to be working with people in poor mental health, but also concerns regarding expertise on nature or local history. The concerns extended to worries on capabilities in working with groups, in which people in poor mental health were both the target audience but also potentially involved in leading and delivery. Issues of managing group dynamics, and that peer leaders might “ bring their own baggage ” to sessions. With these concerns there was an acceptance that accreditations/qualifications are needed to deliver activities that involved discussion of mental health issues, talking therapy or one-to-one sessions. However, as described above, convening groups around ‘everyday activity’ (see Table 3 ) was viewed as acceptable content for peer leaders. It's taking your life experience. So me talking about radiotherapy for cancer? I don't think so. But me talking about needlework or knitting. I can do that. If I can get ten people in a room who want to do Aran, I'd be fine Despite this perceived lack of capability, participants recognised that the lived experiences, interests and passions of peer leaders are community assets: “in a way everyone in this room is an expert when it comes to mental health”. Study participants with experience of leading nature-based health activities urged others to not be deterred by credibility concerns, and that prospective leaders should ask themselves “what do you want to do? what have I got to offer” and that “ you just can’t get it wrong, it's all learning ”; which highlighted the importance of defining the objective and scope of the activity. A further sub-theme identified deficits in personal confidence that would affect the ability to initiate activities. Non-specific worries on poor attendance - “ what if people don’t come ” - was a common concern, with knock-on concerns that a lack of confidence would mean not enough peer leaders coming forward. This was countered by those with experience of peer leadership who mentioned that the activity should enrich the volunteers’ life first, and participants’ lives second: “What would I like to do to enrich my life? I would like to volunteer; I'm going to go for a walk every Thursday at two o'clock. Fancy joining me?” It was also recognised that a lack of credibility within group leaders might be contributing factor to the ability to attract attendees. I if I saw a Blue Prescribing project [a wetland-based social prescribing project] and it was by, you know, somebody that wasn’t to do with the wetland centre or anything like that and it wasn't a health and wellbeing officer...I don't think I would want to want to join it. I wouldn't think it has any credibility. Yeah...safeguarding and, you know, trusting the people that are involved in it There were further concerns that a lack of experience – and fears of the unknown - of being outdoors from prospective attendees would also be a factor in whether groups would be well attended. Community support required In focusing on delivering ‘everyday activities’ the principles of keeping it simple and working through the community were expressed. Here, community networks and volunteer support were important, like starting locally with neighbours, friends and family, and forming local partnerships; and there was acknowledgment that recruitment to the activity should begin in the hyperlocal community. “I also spoke to my neighbours, a lot of my neighbours around me are rural poor kids, having troubles. And I just asked them to come out for a walk with me. And now they go on their own. And now they take their grandchildren” [participant with experience as a peer leader] Starting locally was offered as a solution to concerns on how to find appropriate, and most in-need, people for activities. Thinking about who people wanted to help, there was a recognised need for support when working with programme participants. Again, in relation to securing the credibility and confidence needed to deliver activities, but also in securing buy-in and interest from attendees and to keep the activities and groups sustained. Here – and most prominently in relation to risk and liabilities - third sector organisations were identified as a key support mechanism for peer-led activity by being a source of policy structures for e.g., risk, insurance and safeguarding, and providing a supportive ‘umbrella’ under which peer leaders could operate and gain confidence while also linking peer leaders with site staff to facilitate nature access. Yeah, presumably, you've got a code of conduct or you know, protocols, about how events are going to be run, and your own internal risk management. And we’d be expected to conform to that, you would give us support. I'm guessing “We were volunteers, so we fall under an umbrella. But then that's the setting the expectation to the facilitator, that they feel protected”. Resourcing needs Understandably, there were questions about finances and resourcing of peer-led activity, and where the money would come from to help support the peer leaders. The resourcing needed fell into sub-themes of: funding, equipment, site and facilities, and transport. Peer leaders recognised that there would need to be some financial support “ To ensure activity is not entirely voluntary ” and to purchase equipment and pay for transport to and from the activity. Peer leaders were conscious of site issues, regarding landownership permissions to use the site (associated to the risk and liabilities concerns outlined above). Finding suitable sites with appropriate facilities (e.g., toilets and shelter) and there was recognition that some local nature sites had pay barriers that would prevent community activity. Discussion Group-based activity in nature can bring broad health benefit to people with health challenges, and this approach now features alongside traditional treatment options in UK healthcare long-term plans ( 66 ). However, establishing sustainable delivery models remains a challenge ( 68 ), so developing community approaches like peer leadership may expand options ( 75 , 85 , 86 , 100 ) and contribute to environmental gains ( 33 , 35 ). Peer-led NBIs for mental health, and in the context of NBSP, have yet to be explored. This study captured the perspectives of participants and carers associated with a nature-based social prescribing programme in London ( 60 ), who, post-intervention, expressed interest in peer leadership. Motivations to be a peer leader and activities of interest Motivations to improve wellbeing We constructed two themes on peer leader motivations one, to improve personal wellbeing and two, to improve community wellbeing (i.e., promoting wellbeing in others). Personal wellbeing consisted of e.g., doing good, building self-esteem, meaningful activity, and self-learning - both new skills and about nature. Community wellbeing centred on creating community, supporting others to get into nature, practicing art, creating nature/sensory experiences, sharing interests and knowledge of nature. Work on conservation volunteers also reports learning, improving self-esteem, increasing social connections and creating appreciation for nature and place as motivational factors for involvement ( 34 , 89 – 92 ). ‘Giving back’ is a common motivation for conservation volunteers ( 34 , 91 , 92 ) and our study participants also mentioned ‘doing good’ and ‘sharing interests and knowledge’. An absence of ‘physical activity’ as a motivation We might have expected ‘increase physical activity’ to be a prominent motivation but this was largely absent in responses to the question to why they would want to be a peer leader. Seeking physical activity is common for environmental volunteering ( 89 , 101 ), for becoming a peer walk leader ( 79 ), and for visits to a variety of nature types ( 102 – 105 ). This result may reflect differences in the activity. Conservation volunteering commonly involves ‘practical action to achieve environmental gains’ ( 89 ). When we asked participants about prospective activities (Table 2 ) simple conservation practical work (e.g. litter picking) and physical wellbeing pursuits (e.g. walking and cycling) were mentioned, but to a lesser extent than nature appreciation, creative or ecological pursuits. This may also be a reflection of the NBSP programme from which the study group was formed which had a mental health focus so the activities of the intervention may have influenced participant’s conceptualisation of peer leadership. Nevertheless, the results suggest that initiatives looking to motivate nature-based peer leaders might communicate the personal and community mental wellbeing benefits rather than physical wellbeing to attract volunteers. The physical health benefits of spending time in natural environments are well established ( 4 , 30 , 106 ), and community health champions also report this as a health benefit to volunteering ( 86 ), so physical health may well accrue by stealth as a co-benefit for both participants and leaders. Sharing experiences and creating community Typically for greenspace health programmes ( 63 ), we found motivations and intentions to share experiences (i.e. lead others, improve access and share nature) and to create community by creating more social connections. These are important factors to consider for any future programme success. The creation of a ‘community feeling’ is valued highly by participants in environmental activities ( 107 ) and this sharing of experiences is one putative mechanism for how NBIs might promote such social cohesion ( 63 ); social connections and shared identities are also important factors for recruiting and sustaining peer-led and volunteer activity ( 79 , 108 ). In successful community health programmes, health champions can make significant contributions to the formation and strengthening of social networks within communities ( 85 , 86 ). The results highlight the potential for nature-based peer leadership programmes to make positive contributions to social connections and cohesion, which would positively feedback to reinforce the successful delivery of the interventions. Prospective Activities The prospective peer leaders proposed a diverse range of nature-based interests that mirror NBSP activity already delivered in the UK ( 57 , 68 ). They consisted of learning, creative, conservation, and nature appreciation activities that are known to be health promoting (e.g. forest bathing ( 109 ), birdwatching ( 110 , 111 ), nature connection activities ( 112 )). Furthermore, activities were suggested that - if conducted in natural settings – have been shown to provide greater health benefit than if conducted in non-natural settings e.g. nature-based meditation ( 113 ), walking and general exercise ( 30 , 114 – 116 ). Creative and arts activities lend themselves especially well to community activity, promoting health and wellbeing, quality of life, levels of empowerment and social inclusion when socially prescribed ( 117 , 118 ); creative activities are easily tailored in nature to create meaningful mental health programmes for all ages, interests and abilities ( 70 , 119 ). Participants also described interest in improving nature access to people with mobility problems. This can be especially beneficial public health activity through the ‘equigenic’ effects of nature reducing health inequalities ( 120 , 121 ). Needs and concerns of participants Making peer leaders feel protected and supported The potential described above was tempered by the support needs expressed by peer leaders regarding the practicalities of setting up and safely delivering nature-based activity. Fears around risks and liabilities, permissions, safeguarding, lone working and health and safety were raised. This echoes findings from other UK community health champion initiatives who report the critical role that infrastructure, training and support have to their effectiveness ( 85 , 86 ). Volunteering through a VCSE organisation was recognised by study participants as a mode for peer leaders to find this support and feel protected through built-in processes like risk assessment, public liability insurance or health and safety staff/training. This would provide reciprocal health benefit to peer leaders by making them feel more empowered ( 85 , 86 ). This aligns with ABCD approaches to health, which aim to place institutional assets at the service of the community ( 74 , 94 ), offering umbrella support to “ create a dome of protection around community inventiveness ” and by sharing personnel skills ( 75 ). Peer leaders expressed support needs in finding like-minded people, micro-providers, community groups, volunteers, families and individuals, and in forming partnerships. This is not uncommon as work on NBSP has shown small providers tend to rely on volunteers and a lack of support capacity can be a hindrance to delivery ( 69 ). Once in place, continued social support for peer leader volunteers will be needed to ensure adherence to the role, while recognising that peer-leading will not suit all volunteers ( 79 ). Support to overcome concerns with social prescribing Specific concerns were raised in relation to programme participant communication and publicity, and about recruiting through social prescribing, due to its associated medicalised and professionalised language, and on participant adherence. The issue of medicalised language is known to cause difficulties in communications with participants ( 69 , 122 , 123 ) and hinder NBSP programmes by undermining user and volunteer buy-in ( 67 , 68 ). One explanation is the diversity of public actors (healthcare, environmental, volunteer) potentially involved in any given NBI ( 33 , 124 ). To overcome this a more informal ‘health by stealth’ approach has been advocated when instigating interventions e.g. fun with families in local parks ( 69 ) and informal activities, with wellbeing as ‘by-product’ ( 125 )). Indeed health interventions in allotment settings demonstrate that a ‘real life/everyday feel’ can also be destigmatising for participants ( 126 ). This favouring of a ‘health by stealth’ approach, and aversion to medicalised/professionalised social prescribing, was exemplified by the study participants’ citing a preference for ‘everyday activities’ - this was interrelated with further concerns from the study participants in two areas. First, that social prescribing services were not sufficiently people-centred. This an issue that has also been raised by NBSP activity providers ( 67 , 68 ) and commentators in community-based health promotion. Both fields highlight the need to shift away from being ‘intervention driven’ ( 76 ). Second, study participants considered more formal therapeutic activities inappropriate for peer leaders due to perceived insufficient qualifications. Although an understandable concern, it could be argued that this may be overly circumspect because of the already high levels of variation in the skill and training among providers of UK NBSP provision ( 68 ). Expert panels - convened on the topic of NBSP – also recognise that group leaders need not be required to have a medical qualification (just appropriate training) ( 71 ). Furthermore, some of the (limited) guidance that is available on quality assurance (for social prescribing) does encourage awareness of statutory responsibilities but also guards against letting this stifle community action ( 127 ). Ultimately, there is likely to be a trade-off. While less stringent quality control would facilitate more community action, a lack of quality assurance may also deter participation through perceived lack of leader competency ( 123 , 128 ). Indeed, our study participants recognised this risk themselves. They also recognised that this boundary-setting, planning and defining scope and aim for activities was key to its mitigation, a point that has also been raised by NBSP providers as a key success factor for nature-based health programmes ( 68 ). Supporting peer leaders to plan and scope appropriate activities for participants will be important in ensuring a successful programme, as will the co-creation of activities with participants and peer leaders to ensure needs and motivations are fully addressed ( 129 , 130 ). Taken together, our study participants concerns highlight an opportunity for social prescribing systems to be more inclusive and supportive of community-led nature-based activities in ways that enhance peer leaders’ proficiency and confidence in planning and delivery, and in helping link peer-led activities and suitable participants ( 94 ). Evidence from community health championing projects suggests that support and training provided will lead to further health promotion from improvements to peer leader self-esteem, self-awareness and confidence (through increased empowerment) ( 85 , 86 ). Resourcing The sustainable funding of community-based health initiatives is a central issue limiting the development and expansion of NBSP in both the UK ( 67 , 128 , 131 , 132 ) and other countries ( 64 , 71 ). Volunteer-led nature-based health activities will be less exposed to this issue. However, as our study participants highlight many peer leaders may not be able to fully dedicate time, resources and equipment voluntarily and financial support will still be needed. The funding for NBSP are often small grants which may be sufficient to support peer-led activities, but for small NBSP providers funding applications are onerous, daunting and time-consuming ( 68 ). Here again there is a potential role for both the social prescribing system and community-facing organisations to support peer-led activity to secure funding ( 53 , 75 , 94 ). Post-pandemic, many VCSE organisations are underfunded and overstretched ( 133 ). If organisations are to support peer leaders a full-time permanent position may well be required to animate peer leadership and build expertise, especially at the outset (Russell 2022). This staff resource will come at a cost the organisation and represents an opportunity for NBSP networks to further expand their reach to develop existing local community assets and help these become more viable and sustainable ( 67 , 71 , 94 ). Study participants also recognised the critical factors for the peer-led approach of unrestricted, local, convenient, well-provisioned nature sites, and the travel resources to get participants to the sites. This is also a well-established success factor in NBSP programmes ( 67 , 71 , 128 ). Unrestricted access would allow activities to be instigated, for participants to return after group activity has ended, or for supplementary access ( 70 ). Regular and repeat visits are important for inducing and sustaining health benefit ( 70 , 134 ), so if organisations can share their natural spaces and resources this would support communities and peer leaders to locate suitable natural spaces, gain permissions and to instigate community activity ( 75 ). It would also facilitate reciprocal benefit to the organisation through demonstration of the societal value of the organisation’s natural assets (e.g. ( 59 ), and raise the prospect of more local environmental stewardship initiatives i.e. community actions to bring about environmental and/or social gains ( 36 ). The NHS too might also explore how primary and community services could make better use of their grounds to support social prescribing and community resilience ( 135 ). Finally, and fundamentally, this recognised need for unrestricted, local and well-provisioned nature sites highlights the foundational interdependence of any NBI on abundant, local and quality nature. It emphasises the importance of upholding political commitments to protect, restore and extend nature wildlife areas, especially in urban areas (e.g. the UK Government’s Environment Improvement Plan ( 136 )) for the wide-ranging health benefits provided by nature ( 2 , 137 ). Strengths and Limitations The research benefited from the study participants lived experienced of mental health problems, navigating the social prescribing system and of NBSP, the latter through which the group was formed. The group had good age representation of UK society, but was underrepresented in terms of UK ethnic diversity. It was also limited in one area of the UK, centred on Southwest London. Three of the participants responded by online questionnaire and web chat interview, meaning they were less informed on the wider discussion. Most of the group were not in full time employment so the perspective of peer-leading from those in full time employment will be underrepresented. The group discussions were facilitated to enable comments from all participants; however, we anticipate some individuals may not have felt free to express personal opinions in a group setting during open conversation. We mitigated this limitation with workshop sessions using sticky notes, to allow anonymous comment and increase inclusion, however this traded off with depth of insight from the written notes, which lacked richness in relation to the open conversation. The written part of the workshop might have biased the less literate members of the group. Conclusions and recommendations To our knowledge this study is the first exploration of health promotion through nature-based peer leadership. The findings have implications for public health practitioners, social prescribing, nature organisations, volunteers and communities. They show peer leaders are motivated to promote personal wellbeing but also, altruistically, promote wellbeing in others by leading and sharing nature experiences, creating community connections through the delivery of a wide range of health promotion activity. The absence of motivations towards physical activity suggests that initiatives looking to encourage and initiate nature-based peer leaders might focus on personal and community mental wellbeing incentives by starting hyper-locally on ‘everyday activities’ (e.g. nature walks with neighbours). We also conclude that to animate peer-led NBIs concerns need to be addressed regarding the practicalities of establishing and safely delivering nature-based activity, on the personal competencies required and nervousness with the medicalised nature of social prescribing. Here there is an opportunity for allied NGOs, and potentially social prescribing networks, to use their human and capital resources to support communities to help e.g. train and upskill, define scope, find participants and small grants. The principles of asset-based community management might also be used to help nurture this community potential. This would also bring mutual benefit to environmental ambitions to create greater social movement and action for the environment. Abbreviations ABCD: asset-based community development GP: general practitioner ME: myalgic encephalomyelitis NBSP: nature-based social prescribing NGO: non-governmental organisation NBI: nature-based intervention NHS: National Health Service VCSE: voluntary, community or social enterprise Declarations Consent for publication Not applicable Author contributions Conceptualisation: JPR, BP, WWF, RPC. Methodology: JPR, BP, WWF, RPC. Data curation: JPR, BP. Data analysis: JPR, BP, WWF. Project administration: BP, RPC. Writing: original draft: JPR. Writing: review and editing: JPR, BP, WWF, JLN, RPC. BP was working for Mental Health Foundation during conceptualisation, data curation, analysis, and the majority of the writing stages. Ethics Statement All participants gave informed consent for inclusion in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Human Research Ethics Committee of the Wildfowl and Wetlands Trust (WWT1408032023). Recruitment emails were only sent to Project participants who consented to receiving further communication from the Project delivery team. Travel costs, lunch, refreshments and a visit to the Wetland Centre were included for Study participants. To ensure anonymity, the identity of participants is not reported. All participants were aged 18 years or over. Competing interests The authors declare that they have no competing interests Funding The research was conducted as part of the ‘Blue Prescribing Project’ (96), delivered by WWT and the Mental Health Foundation and funded by Simply Health. Acknowledgments The authors would like to extend their thanks to the study participants who were so generous with their time, energy and enthusiasm for the workshop and the subject matter. Data availability Ethical approval WWT1408032023 prevents data sharing to protect participant anonymity. Additional files Title of data: Reeves et al 2024 Supplementary Material 1: Topic Guide Description of data: Workshop topic guide Title of data: Reeves et al 2024 Supplementary Material 2: Results from making a landscape session Description of data: Results from the 'making a landscape' session of the References Bratman GN, Anderson CB, Berman MG, Cochran B, de Vries S, Flanders J, et al. Nature and mental health: An ecosystem service perspective. 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Improving health and well-being through community health champions: A thematic evaluation of a programme in Yorkshire and Humber. Perspectives in Public Health. 2013 Mar;133(2):96–103. South J, White J, Branney P, Kinsella K. Public health skills for a lay workforce: Findings on skills and attributes from a qualitative study of lay health worker roles. Public Health. 2013 May;127(5):419–26. Lehmann U, Sanders D. Community health workers: what do we know about them? [Internet]. 2007 [cited 2024 Jul 12]. Available from: https://chwcentral.org/wp-content/uploads/2013/07/Community-Health-Workers-What-do-we-know-about-them.pdf O’Brien L, Research F, Townsend M, Ebden M. ‘I like to think when I’m gone I will have left this a better place’ Environmental volunteering: motivations, barriers and benefits Report to the Scottish Forestry Trust and Forestry Commission. [Internet]. 2008 [cited 2024 Jan 17]. Available from: http://www.forestresearch.gov.uk/fr/INFD-7GDHD3 Asah ST, Blahna DJ. Practical implications of understanding the influence of motivations on commitment to voluntary urban conservation stewardship. Conservation Biology. 2013 Aug;27(4):866–75. Bruyere B, Rappe S. Identifying the motivations of environmental volunteers. Journal of Environmental Planning and Management. 2007 Jul;50(4):503–16. Measham TG, Barnett GB. Environmental Volunteering: Motivations, modes and outcomes. Australian Geographer. 2008;39(4):537–52. Patterson I, Pegg S. The motivations and satisfaction levels of volunteer organisers in a community based walking program. Vol. 14, Australian Journal on Volunteering. 2009 p. 1–7. Russell C. We Don’t Have a Health Problem, We Have a Village Problem [Internet]. 2020 [cited 2024 Jan 17]. Available from: https://www.nurturedevelopment.org/wp-content/uploads/2018/09/we-dont-have-a-health-problem-we-have-a-village-problem8259.pdf Thomas DR. A general inductive approach for analyzing qualitative evaluation data. American Journal of Evaluation. 2006;27(2):237–46. Blue Prescribing | WWT [Internet]. [cited 2024 Jan 11]. Available from: https://www.wwt.org.uk/our-work/projects/blue-prescribing/ UCL. Dementia Research Centre. 2021 [cited 2024 Jan 11]. Rare Dementia Support. Available from: https://www.ucl.ac.uk/drc/rare-dementia-support Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77–101. Clarke V, Braun V. Successful qualitative research: A practical guide for beginners. London: Sage; 2013. NHS England. Peer leadership [Internet]. [cited 2024 Jan 8]. Available from: https://www.england.nhs.uk/personalisedcare/peer-leadership/ Bushway L, Dickinson J, Stedman R, Wagenet L, Weinstein D. Benefits, motivations, and barriers related to environmental volunteerism for older adults: Developing a research agenda. International Journal of Aging and Human Development. 2011 Jan 1;72(3):189–206. Reeves JP, John CHD, Wood KA, Maund PR. A Qualitative Analysis of UK Wetland Visitor Centres as a Health Resource. International Journal of Environmental Research and Public Health. 2021;18(16). Irvine KN, Warber SL, Devine-Wright P, Gaston KJ. Understanding Urban Green Space as a Health Resource: A Qualitative Comparison of Visit Motivation and Derived Effects among Park Users in Sheffield, UK. Int J Environ Res Public Health. 2013;10:417–42. Burgess J, Harrison CM, Limb M. People, parks and the urban green: a study of popular meanings and values for open spaces in the city. Urban studies. 1988;25(6):455–73. Draper C, Freedman D. Review and analysis of the benefits, purposes, and motivations associated with community gardening in the United States. Journal of Community Practice. 2010 Oct;18(4):458–92. Shanahan DF, Franco L, Lin BB, Gaston KJ, Fuller RA. The Benefits of Natural Environments for Physical Activity. Sports Medicine. 2016 Jul 1;46(7):989–95. Husk K, Lovell R, Cooper C, Stahl-Timmins W, Garside R. Participation in environmental enhancement and conservation activities for health and well-being in adults: A review of quantitative and qualitative evidence. Cochrane Database of Systematic Reviews. 2016 May 21;2016(5). Bowe M, Gray D, Stevenson C, McNamara N, Wakefield JRH, Kellezi B, et al. A social cure in the community: A mixed-method exploration of the role of social identity in the experiences and well-being of community volunteers. European Journal of Social Psychology. 2020 Dec 1;50(7):1523–39. Kotera Y, Richardson M, Sheffield D. Effects of Shinrin-Yoku (Forest Bathing) and Nature Therapy on Mental Health: a Systematic Review and Meta-analysis. International Journal of Mental Health and Addiction. 2022 Feb 1;20(1):337–61. Cox DTC, Gaston KJ. Urban bird feeding: Connecting people with nature. PLoS ONE. 2016;11(7):1–13. Hammoud R, Tognin S, Burgess L, Bergou N, Smythe M, Gibbons J, et al. Smartphone-based ecological momentary assessment reveals mental health benefits of birdlife. Scientific Reports. 2022 Dec 1;12(1). Lumber R, Richardson M, Sheffield D. Beyond knowing nature: Contact, emotion, compassion, meaning, and beauty are pathways to nature connection. PloS one. 2017;12(5):e0177186. Djernis D, Lerstrup I, Poulsen D, Stigsdotter U, Dahlgaard J, O’Toole M. A systematic review and meta-analysis of nature-based mindfulness: Effects of moving mindfulness training into an outdoor natural setting. International Journal of Environmental Research and Public Health. 2019 Sep 1;16(17). Olafsdottir G, Cloke P, Schulz A, van Dyck Z, Eysteinsson T, Thorleifsdottir B, et al. Health Benefits of Walking in Nature: A Randomized Controlled Study Under Conditions of Real-Life Stress. Environment and Behavior. 2020 Apr 1;52(3):248–74. Thompson Coon J, Boddy K, Stein K, Whear R, Barton J, Depledge MH. Does participating in physical activity in outdoor natural environments have a greater effect on physical and mental wellbeing than physical activity indoors? A systematic review. Environmental science & technology. 2011;45(5):1761–72. Barton J, Pretty J. What is the best dose of nature and green exercise for improving mental health? A multi-study analysis. Environmental science & technology. 2010;44(10):3947–55. Bungay H, Clift S. Arts on Prescription: A review of practice in the UK. Perspectives in Public Health. 2010 Nov;130(6):277–81. Thomson LJ, Morse N, Elsden E, Chatterjee HJ. Art, nature and mental health: assessing the biopsychosocial effects of a ‘creative green prescription’ museum programme involving horticulture, artmaking and collections. Perspectives in Public Health. 2020 Sep 1;140(5):277–85. Yeh CW, Hung SH, Chang CY. The influence of natural environments on creativity. Frontiers in Psychiatry. 2022;13:895213. Garrett JK, Rowney FM, White MP, Lovell R, Fry RJ, Akbari A, et al. Visiting nature is associated with lower socioeconomic inequalities in well-being in Wales. Scientific Reports. 2023;13(1):1–13. Rigolon A, Browning MHEM, McAnirlin O, Yoon H. Green space and health equity: A systematic review on the potential of green space to reduce health disparities. International Journal of Environmental Research and Public Health. 2021 Mar 1;18(5):1–29. Wood CJ, Polley M, Barton JL, Wicks CL. Therapeutic Community Gardening as a Green Social Prescription for Mental Ill-Health: Impact, Barriers, and Facilitators from the Perspective of Multiple Stakeholders. International Journal of Environmental Research and Public Health. 2022;19(20). Baxter L, Fancourt D. What are the barriers to, and enablers of, working with people with lived experience of mental illness amongst community and voluntary sector organisations? A qualitative study. Grundy Q, editor. PLoS ONE. 2020 Jul 2;15(7):e0235334. Van den Berg AE. From Green Space to Green Prescriptions: Challenges and Opportunities for Research and Practice [Internet]. Vol. 8, Frontiers in Psychology. 2017. 268 p. Available from: https://www.frontiersin.org/article/10.3389/fpsyg.2017.00268 Juster-Horsfield HH, Bell SL. Supporting ‘blue care’ through outdoor water-based activities: practitioner perspectives. Qualitative Research in Sport, Exercise and Health. 2022 Jan 2;14(1):137–50. Fieldhouse. J. The Impact of an Allotment Group on Mental Health Clients’ Health, Wellbeing and Social Networking. British Journal of Occupational Therapy. 2003;66(7). Lister C. Quality Assurance for Social Prescribing. A Guide to Support Social Prescribing Programmes in England [Internet]. 2019 [cited 2024 Jul 12]. Available from: https://docs.wixstatic.com/ugd/14f499_a5e3a40ac260401a80e01853bb7ef8b9.pdf Husk K, Blockley K, Lovell R, Bethel A, Lang I, Byng R, et al. What approaches to social prescribing work, for whom, and in what circumstances? A realist review. Health and Social Care in the Community. 2020 Mar 1;28(2):309–24. Vargas C, Whelan J, Brimblecombe J, Allender S. Co-creation, co-design and co-production for public health: a perspective on definitions and distinctions. Public Health Research and Practice. 2022 Jun 1;32(2). Villapol ME, Richter S, Petrova K. Value co-creation and opportunities in health care and wellbeing: the case of the green prescription [Internet]. 2018 [cited 2024 Jan 17]. Available from: https://aisel.aisnet.org/ecis2018_rp/73 Marx V, More KR. Developing Scotland’s First Green Health Prescription Pathway: A One-Stop Shop for Nature-Based Intervention Referrals. Frontiers in Psychology. 2022;13(April):1–14. He Y, Jorgensen A, Sun Q, Corcoran A, Alfaro-Simmonds MJ. Negotiating Complexity: Challenges to Implementing Community-Led Nature-Based Solutions in England Pre- and Post-COVID-19. International Journal of Environmental Research and Public Health. 2022 Nov 1;19(22). Thiery H, Cook J, Burchell J, Ballantyne E, Walkley F, McNeill J. ‘Never more needed’ yet never more stretched: Reflections on the role of the voluntary sector during the COVID-19 pandemic. Voluntary Sector Review. 2021 Nov 1;12(3):459–65. White MP, Alcock I, Grellier J, Wheeler BW, Hartig T, Warber SL, et al. Spending at least 120 minutes a week in nature is associated with good health and wellbeing. Scientific reports. 2019;9(1):7730. The King’s Fund. Social prescribing and NHS facilities: How could the NHS better use its facilities to support social prescribing, holistic care and community resilience? [Internet]. 2020 Nov [cited 2024 Jul 12]. Available from: https://www.property.nhs.uk/media/2889/social-prescribing-and-nhs-facilities-report-summary.pdf HM Government. Environmental Improvement Plan. 2023 [cited 2024 Jul 12]; Available from: https://www.gov.uk/government/publications/environmental-improvement-plan Shanahan DF, Lin BB, Bush R, Gaston KJ, Dean JH, Barber E, et al. Toward improved public health outcomes from urban nature. American journal of public health. 2015 Mar 9;105(3):470–7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 14 Apr, 2026 Read the published version in Wellbeing, Space and Society → 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-4763846","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":329142826,"identity":"ff6e6f03-188b-4967-a5a1-ada7fc939647","order_by":0,"name":"Jonathan P. Reeves","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABD0lEQVRIiWNgGAWjYBACxgYYAQVyCCYPHi0HkbQYMzAw49cCBshaEhsIaWFu7z34+eMOuzwG6cMHH/NU1KVvuJF/gOHjnloGgzMHsDus51yyxMEzycUMfGnJxjxnDuduuJHMwDjj2XEGg7MN2LXMyDGQONjGnNjAw2MmObPtQO6228kMzDwHjjEYnMfuMKAW4x8H2+qBWvi//5z5ry7djAgtZkBbDoNsYWP42MCcANVSg9thPWfMLM62HU9s42Ezlvhw7LDh/vuPDQ7OOHCARxKH9w3be4xvVLZVJ/bzMD/8kFBTJy/Zc/Dhgw8H6uT4ziRg1wKznA1ZFGj8YZwRKY9Log6XxCgYBaNgFIw8AAAmw2U0AHFN2gAAAABJRU5ErkJggg==","orcid":"","institution":"Wildfowl \u0026 Wetlands Trust","correspondingAuthor":true,"prefix":"","firstName":"Jonathan","middleName":"P.","lastName":"Reeves","suffix":""},{"id":329142828,"identity":"76b67ed3-73c5-45b1-aa4e-4b0250d21fd3","order_by":1,"name":"Will Freeman","email":"","orcid":"","institution":"Wildfowl \u0026 Wetlands Trust","correspondingAuthor":false,"prefix":"","firstName":"Will","middleName":"","lastName":"Freeman","suffix":""},{"id":329142829,"identity":"ccf107a4-b2b5-4698-adc2-bf0aa607af95","order_by":2,"name":"Raksha Patel-Calverley","email":"","orcid":"","institution":"Wildfowl \u0026 Wetlands Trust","correspondingAuthor":false,"prefix":"","firstName":"Raksha","middleName":"","lastName":"Patel-Calverley","suffix":""},{"id":329142830,"identity":"05e73885-20a9-4f4e-b867-f1c26b41d317","order_by":3,"name":"Julia L. Newth","email":"","orcid":"","institution":"Wildfowl \u0026 Wetlands Trust","correspondingAuthor":false,"prefix":"","firstName":"Julia","middleName":"L.","lastName":"Newth","suffix":""},{"id":329142832,"identity":"a05934f7-705c-4f77-9307-529dc8ed253a","order_by":4,"name":"Ben Plimpton","email":"","orcid":"","institution":"Independent Researcher","correspondingAuthor":false,"prefix":"","firstName":"Ben","middleName":"","lastName":"Plimpton","suffix":""}],"badges":[],"createdAt":"2024-07-18 16:03:52","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4763846/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4763846/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1016/j.wss.2026.100401","type":"published","date":"2026-04-15T00:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":107355008,"identity":"2d531def-55ad-4ffa-92dc-efc4de53dbb2","added_by":"auto","created_at":"2026-04-20 16:50:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":492952,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4763846/v1/f461aefa-8972-422b-a458-bd04ac73bc61.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The motivations, interests and concerns of prospective peer leaders of nature-based mental health interventions","fulltext":[{"header":"Background","content":"\u003cp\u003eThe wide-ranging benefits to mental and physical health of spending time in natural environments are now well established (\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e–\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), and the use of nature for health promotion/intervention is firmly embedded in the public and policy health discourse (\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e–\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). It is also a well embedded argument in the case for nature protection/creation (\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e–\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), and a regular feature in strategies of nature organisations (\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e–\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). For example, nature’s role in health, and public appreciation of this benefit, is a frequent converting tactic for environmental NGOs attempting to create social movements and catalyse investment/action for the environment, and collective public health (\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e–\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Health professionals too are stressing the indivisibility of global health and environmental challenges and how they should be addressed multilaterally (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWith wider acknowledgement of the above there is now cross-sectoral interest in nature as an upstream approach to public health (\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e–\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), how treatment options might be expanded via nature-based health interventions (NBI) (\u003cspan additionalcitationids=\"CR23 CR24\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e–\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), and the strategies and collaborations required to maximise the nature-health relationship for public health and the environment (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNBIs are wide-ranging and can encompass programmes, activities and/or strategies that aim to engage people in nature experiences to improve health and wellbeing (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). They have demonstrated promise through improvements to mental health indicators such as mental and emotional wellbeing (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), anxiety (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), stress (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) and physical wellbeing (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Beyond the individual human benefits, NBIs can also offer reciprocal environmental gains through ecological improvements conducted as part of the intervention (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e–\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), potentially contributing to local environmental stewardship i.e. community actions (with various motivations and capacity) to bring about environmental and/or social benefits (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Further co-benefits of NBIs to both people and environment can accrue through wellbeing improvements derived from increased connection to nature (\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e–\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e), increases in pro-environmental behaviours (\u003cspan additionalcitationids=\"CR41 CR42 CR43\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e–\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e), and through reductions in the associated environmental harms of pharmaceutical production and use (\u003cspan additionalcitationids=\"CR46 CR47\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e–\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). NBIs can extend to physically manipulating environments to increase incidental nature exposure to promote population-wide health (e.g. creating pocket parks, improving urban beaches or creating greenways (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e)). This type of approach may also require additional promotion of the asset - through accompanying marketing/promotion (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e) or long-term social programmes and activities (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e) - to secure the benefits.\u003c/p\u003e \u003cp\u003eIn England the delivery of NBIs has been mainstreamed through investments in social prescribing and developed with shifts in UK health policy towards a more strengths-based personalised care approach (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). The process links people with health or social care needs to community-based, non-clinical health and social care interventions (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e). It asks ‘what matters to people’, rather than ‘what is the matter with people’ (\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e). Nature-based social prescribing (NBSP) is social prescribing in a natural environment (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e). Although there has been promising demonstration of the positive health impacts to participants (\u003cspan additionalcitationids=\"CR59 CR60\" citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e–\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e), a range of problems have been identified that relate to: the complexity and effectiveness of NBSP interventions (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e), in communication, multi-stakeholder collaboration, and adequate service provision (\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e). Through investment the NHS healthcare side of the system is relatively well-provisioned (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e), but providers in the community report a more challenging, fragmented and precarious funding landscape (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e). This has impacted the sustainability of community programmes and the ability to build and retain a dedicated workforce (\u003cspan additionalcitationids=\"CR70\" citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e–\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e), limiting the ability to operationalise and scale NBSP. It leaves an unmet need and a requirement to innovate and develop further capacity building and delivery options (\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOne solution here might be to look more closely into community-centred approaches to health. These can “mobilise the skills, knowledge and time and resources of the individuals, communities, organisations and groups to promote health and wellbeing” (\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e). This follows an ‘asset-based community development’ approach which looks to enhance and support the capacity of a community (\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e) and in the health context, can, help develop peer and volunteer roles, form collaborations and/or improve access to resources (\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e). They further help to shift the dynamic between communities and healthcare institutions away from a one-directional relationship in which the community only see themselves as inactive consumers of services delivered by professionals (\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e) to one in which they are more active, independent and capable of contributing to their own health promotion (\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e). NBSP maybe an area of focus for peer roles due to the unmet need outlined above, but also because NBSP providers report that the end of programmes can bring two participant responses. Firstly, disappointment at the end of the programme and a ‘what next’ moment (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e). Secondly, interest in continuing, and shifting, their connection with the programme from participant to a more community-centred, peer support role to enable others to enjoy the programme and nature’s health benefits (\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e). Indeed, in response to findings from a UK-wide test and learn programme on green social prescribing, specially trained ‘nature buddies’ volunteers are being promoted by the National Academy of Social Prescribing to help other would-be participants to overcome barriers to taking part in nature-based activities (\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e). More generally, peer and volunteer roles focus on “‘enhancing individuals’ capabilities to provide advice, information and support or organise activities around health and wellbeing in their or other communities” (\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e). They have been adopted to support a variety of health issues like breastfeeding, healthy eating, smoking and condom use (\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e), but show most promise in peer-led physical activity interventions (\u003cspan additionalcitationids=\"CR80 CR81\" citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e–\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e), and some evidence suggests they may be as effective as professionally delivered interventions (\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePeer roles are further subdivided by objectives to provide social support (peer support), encouragement on self-efficacy to find health solutions (peer coaching), one to one support from personal experience (peer mentoring), health information (peer education) and leadership or expert advice (peer leader) (\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e). Peer leaders are often aspirational roles, they may have received some training to be a role model or expert advisor or leader around a specific health promotion issue or activity (\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e). However, definitions can overlap (\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e) and in the UK for example this role might be called a ‘volunteer health role’ (\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e) or Community Health Champion (\u003cspan additionalcitationids=\"CR86 CR87\" citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e–\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e). Here, the more ad hoc types of civic action should also be recognised (e.g. neighbour to neighbour support) as one part of the wider family of volunteerism that contributes to community building (\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e). In both cases volunteers require support to succeed.\u003c/p\u003e \u003cp\u003eCentral to the possibility of peer roles supporting NBI delivery is an understanding of the motivations, interests, needs and concerns of potential peer volunteers. While these factors have been researched for environmental volunteerism (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan additionalcitationids=\"CR90 CR91\" citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e–\u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e) and outdoor peer walk leading to increase physical activity (\u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e), this area has yet to be explored for NBIs for mental health, and in the context of NBSP. Here we present a qualitative study of the perspectives of a group of prospective NBI peer leaders with an interest in peer health roles. The study explored the motivations, interests and concerns of prospective peer leaders to inform how peer health roles might potentially be developed to support NBI delivery. We discuss findings in the context of the related fields of conservation volunteering, peer-led volunteering for exercise referral, NBSP and asset-based community development (ABCD) (\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e \u003c/div\u003e "},{"header":"Methods","content":"\u003cp\u003eStudy Design\u003c/p\u003e\u003cp\u003eA day-long workshop on the prospect of peer leadership for nature-based mental health promotion was held, at the London Wetland Centre, London. Additional in-depth interviews and questionnaires were delivered after the workshop for study participants unable to attend the workshop. The aim of the workshop (and focus groups within) was to explore study participants views on how to make NBIs more sustainable, longer-term and community-led, and what types of support and infrastructure people would need assume the role of ‘peer leader’. The study was inductively informed by the research team’s experience of delivering NBIs and NBSPs and the study participants’ lived experience of a) mental health problems b) UK mental health services, and c) nature-based health interventions (\u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e). In our wetland context our shared definition of a peer leader was “a person with lived experience who works collaboratively to lead community groups in wetlands to improve health”, this was communicated to participants in the study information prior to the workshop.\u003c/p\u003e\u003cp\u003eParticipant recruitment\u003c/p\u003e\u003cp\u003eStudy participants were recruited through the ‘Blue Prescribing Project’ (\u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e), a nature based social prescribing programme aimed at people who reported the greatest mental health impact of the pandemic, namely people living with long term health conditions (including mild/moderate mental health problems), single parents and people from minoritised or racialised backgrounds. The project was run by WWT and the Mental Health Foundation and delivered at WWT’s London Wetland Centre (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e). An email invitation was sent to participants requesting their participation included the date, aims and proposed activities of the workshop. Seventeen participants were recruited in total, with fourteen able to attend on the day of the workshop. Two completed follow up questionnaires and one completed a follow up interview. Four of the participants engaged through the Rare Dementia Service at University College London (\u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eData collection\u003c/p\u003e\u003ch2\u003eWorkshop\u003c/h2\u003e\u003cp\u003eThe data were collected at a workshop held in April 2023 which was facilitated by four trained facilitators with experience working with people in poor mental health. A workshop topic guide (provided in the additional information) was produced by the authors to facilitate discussion through the day, the workshop/topic guide included the following sessions:\u003c/p\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003eMaking a landscape\u003c/em\u003e - As a warmup - and to stimulate thinking in an asset-based approach - the first session invited participants to ‘make a landscape’ of existing services, community groups and natural assets already known and available to participants (results provided in the additional files only).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003eMotivations\u003c/em\u003e - The second session asked participants to consider their motivations and why they had taken an interest in peer leadership.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003eProspective activities\u003c/em\u003e\u003cb\u003e-\u003c/b\u003e The third session focused on the activities study participants – i.e. prospective peer leaders - might offer. They were asked to consider what activities they would like to offer, the locations and types of activities, their time availability and what they would need. Prompts on partnerships, funding, advice/training were offered, and asking what they might offer with no help, with a little help and what they can do with only outside help. They were also asked what might prevent them from acting, their concerns, what places are nearby but inaccessible, and what places they would like nearby but do not exist.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003ePlenary -\u003c/em\u003e A final session included a facilitated conversation to draw out final thoughts and concerns on the themes of the day.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003cp\u003ePrior to the workshop, participants were asked whether they had any special needs, and these were considered in the workshop design. To maximise inclusivity and participation, a mixed method approach for data collection was used to embrace differing preferences in ways of communicating. For sessions 1–3 participants wrote responses on sticky notes for collation on group white boards. For session 4, the conversation was recorded and transcribed. For all sessions, workshop facilitators took notes and recorded observations.\u003c/p\u003e\u003ch2\u003eIn-depth interviews and questionnaire\u003c/h2\u003e\u003cp\u003eBoth interviews and questionnaires followed the structure and questions from the workshop topic guide (provided in supplementary material 1), these were offered to study participants unable to attend on the day of the workshop. Microsoft Forms was used for distribution of the questionnaire to the two participants who expressed a preference to respond through online questionnaire. The interview was conducted through video call by one of the authors (BP, who has experience facilitating conversations with people in poor mental health). Detailed notes of responses were taken by the interviewer (BP).\u003c/p\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eThe sticky notes and audio-recordings were transcribed verbatim (audio by Otter (Los, Altos, CA)), verified by JPR and collated in one master transcript document. The two questionnaire responses and the interview notes were added to the master document. Reflexive thematic analysis (\u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e98\u003c/span\u003e, \u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e) was then conducted on the master document using Nvivo software (Release 1.7.1, QSR International). Authors JPR and BP iteratively cycled through the six phases of TA i.e. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) The transcript was first read and re-read (JPR and BP), (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) JPR and BP produced initial codes to each participant response, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) JPR and BP grouped the codes into tables to present early sub-themes, (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) JPR, BP and WWF convened to review and consolidate codes and sub-themes, and to (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) define overarching themes. Finally, (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) JPR produced Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e–\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and added descriptions and summaries for the themes.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eIn addition to lived experience of poor mental health, other long-term health conditions reported by study participants included long covid (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;1), cancer (in remission, \u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;1), ME (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;1), alcoholism (in recovery, \u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;2), rare dementia (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2). The age range for participants was 25 to 65\u0026thinsp;+\u0026thinsp;years old. Fifteen participants (88%) identified as White British. One participant identified as British Pakistani and one participant identified as Kurdish. Three indicated that they were employed (including one self-employed), eight participants were retired, two participants were carers, one participant was a student, and the remaining four participants indicated that they were unemployed (missing data for 1 person).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eMotivations\u003c/h2\u003e \u003cp\u003eMotivations to get involved in nature-based peer leadership were grouped into a central theme of improving wellbeing (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This was split into two sub-themes on a) personal and b) community wellbeing. Personal wellbeing motivations involved: doing good, building self-esteem and having meaningful activity in retirement; a desire for personal wellbeing through learning new skills and training (e.g., to be a therapist or facilitator), through self-education, discovery, and learning about nature and new places. Community wellbeing involved: creating more community connections, by enhancing existing relationship with friends and family, reaching out to more people and creating new friendships; creating new partnerships and building trust and cooperation. Another subtheme described supporting and encouraging others to get wellbeing benefit from nature by \u003cem\u003e\u0026ldquo;increas[ing] access and participation for people in the community who face some barriers\u0026rdquo;\u003c/em\u003e. This subtheme extended beyond the immediate community to supporting workplace wellbeing and encompassed grander ideals of \u0026ldquo;\u003cem\u003ereform for all to get the benefit\u003c/em\u003e\u0026rdquo;. A desire to promote community wellbeing through practices (e.g., meditation), finding inspiration for art and new (sensory) experiences was also identified. Peer leaders also wanted to share their skills, interests and knowledge to educate others and \u0026ldquo;\u003cem\u003ebring out the potential\u003c/em\u003e\u0026rdquo; in other people. Finally, there were motivations to share and raise awareness of both the joy and beauty of nature, and the wellbeing benefits e.g. \u0026ldquo;\u003cem\u003eSetting the seed in others of the idea that being out in nature can really help mental health and personal resilience\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMotivations to get involved in delivering nature-based health activity according to seventeen prospective peer leaders\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-theme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExample responses\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eImproving personal wellbeing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImproving personal wellbeing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDoing good, self-esteem building, going back to basics, meaningful retirement, quality of life, self-care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-learning and education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSelf-education, self-discovery and a sense of achievement, training to be a therapist/leader, learning about wetlands and local places, new life skills\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eImproving community wellbeing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCreating community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConnections to family and friends, new friendships, new partnerships, creating co-operation and trust\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupporting others\u0026rsquo; wellbeing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupporting/encouraging others to accrue health benefits, increasing nature participation in the community, (including the workplace) influencing political and social responsibilities and reform for societal benefit\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePractices, art and experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMeditation and relaxation, inspiration for art, new sensory experiences\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSharing interests and knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSharing: knowledge, interests, skills, joy; bringing out potential, raising awareness, educating others\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSharing nature\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCascading and evangelising nature\u0026rsquo;s benefits to health and resilience, sharing enjoyment of natural landscapes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eProspective activities\u003c/h2\u003e \u003cp\u003eParticipants were asked to consider the types of activity they would consider delivering as a nature-based peer leader (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Six themes captured a range of activities, from leading nature-based creative arts, e.g., community patchwork, photography, collage and storytelling; to activities that were directed at environmental and ecological improvement, i.e. from litter picking to ideas on ecological restoration and getting involved in local community action planning. Nature appreciation activities were suggested through foraging, forest bathing, pond dipping or wildlife identification activities; nature-based mental wellbeing practices, e.g., meditation or grounding exercises, through to physical wellbeing in the form of health walks, yoga or cycling. Participants also expressed interest in leading groups to increase access for less mobile people, and facilitating others to find and share nature spots the participants themselves draw benefit from.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNature-based health activities considered for delivery by seventeen prospective peer leaders.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExample responses\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreativity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProviding art in nature teaching and guidance on e.g., cooking, community patchwork, crafts, drawing, painting, photography, poetry, printing and collage, storytelling, sculpture (e.g. willow weaving)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEcological and Conservation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAction planning for local environment, ecology restoration projects e.g. restore forage diversity, environmental clean-up e.g., litter pick, simple conservation practical work\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNature appreciation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eForaging, forest bathing, nature connection activities (e.g. walk, pause, reflect, connect), pond dipping, scavenger hunt, plant and bird identification\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMental wellbeing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMeditation, grounding exercises, spirituality, emotional support (from those with training and experience)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical wellbeing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCycling, nature and local history walk, dog walks, health walks in nature, yoga\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeading and facilitating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEngaging with the housebound and those unable to get outside with nature, leading a group to explore local nature for mental and physical health\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eNeeds and concerns\u003c/h2\u003e \u003cp\u003eResponses to a) participant needs to act as a peer leader and b) issues that might prevent action, were grouped into four themes: 1) set-up and management, 2) concerns about capabilities and capacity, 3) community support needs, and 4) resourcing needs (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNeeds and concerns in delivering nature-based activities from the perspective of seventeen prospective peer leaders\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-themes and codes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExample responses\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eSet-up and management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConsiderations of risk and liabilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOn liabilities, risk assessments, access permissions, safeguarding, lone working and health and safety\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSetting objectives and scope\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSetting clear long- and short-term objectives, ensuring activities are nature-based, distinguishing between \u0026lsquo;clinical\u0026rsquo; (e.g. social prescriptions) and \u0026lsquo;everyday\u0026rsquo; group activity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEngaging with healthcare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExploring both social prescribing' and self-referral routes, communication with local providers and referrers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreparing to work with participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaking facilitators feel confident through structure and sufficient support, procedures in place like signposting and communication with participants\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePlanning activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnderstanding participant needs and motivations, planning the content of the activities\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublicising the activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReaching suitable participants\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCapabilities and capacity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFacilitator expertise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFacilitators lacking skills/experience/expertise on mental health, or nature/local history; anxieties with technology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConfidences affecting the ability to initiate activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLack of credibility/qualifications deterring attendees, general self-doubts, self-doubt leading to not enough peer leaders forthcoming and participant non-attendance, lack of outdoor confidence in participants affecting attendance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorking with participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLeaders bringing their own \u0026lsquo;baggage\u0026rsquo;, capabilities to deal with group dynamics\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCommunity support needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommunity support and partnerships\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFinding: like-minded people, micro-providers, local community groups, local families and individuals; forming partnerships, volunteers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupport for working with clients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSupport getting credibility/skills to deliver activities, help with client recruitment, attendance and adherence; buy in and interest from activity participants\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInstitutional support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lsquo;Umbrella support\u0026rsquo; from third sector e.g. on safeguarding, risk, insurance; from local council, from local universities; support linking with site staff\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eResourcing needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFunding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFor equipment and consumables, to ensure activity is not entirely voluntary, to prevent burnout, for training\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEquipment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eArt materials, bikes, binoculars, cameras, tools, clothing and footwear\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSite and facilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAccessible, local, convenient sites, with access and permission, without a pay barriers; suitable spaces; sheltered from weather; some indoor space\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTransport\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCost of transport for participants to site; and to move equipment\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eSet-up and management\u003c/h2\u003e \u003cp\u003eThis theme describes practical needs of delivering nature-based community activity. A central concern was the responsibilities and liabilities surrounding risk and safety.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eNormally, if you're running an activity, you're doing it under a professional umbrella and with that comes insurance, you need professional insurance. I'm wondering, are there any insurance issues? If you've just decided to run an activity? What if someone fell during your walk or have an accident? Would you be liable?\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eClear boundaries and a well-defined scope when planning activities was important, as was having a focus on nature; the study participants identified the need for a distinction between \u0026lsquo;everyday peer-led activities\u0026rsquo; and more formal group activity which might incorporate talking therapies or other clinical approaches.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThat\u0026rsquo;s an interesting point about the difference between everyday activities, you know, the joy of the outside, rather than getting into the therapy, which immediately starts a bit more \u0026lsquo;pyschobabbly\u0026rsquo;. And really isn't it the activity that most people are interested in, like the needlework, or the walk or the cakes or the social experience? So we can get a bit muddled...let's start thinking of therapising people? I don't think that's what I would want it to be doing at all. I just want the joy of nature and to share that with other people I can see it could get a bit blurred if you weren't careful\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAlthough engaging with social prescribing systems was recognised as useful for finding potential attendees, there was scepticism of social prescribing due to its medicalised language, also due to experiences with GPs perceived as not sufficiently \u0026lsquo;people centred\u0026rsquo; by referring activities that were misaligned to community need:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;She [GP] was a bit miffed with me, because we're not doing that one [the activity suggested by the GP], you know. So it's like, I'm [the GP] telling you, this is what you do. And you do it... she's well briefed, but at the same time, she's becoming prescriptive\u0026rdquo;\u003c/em\u003e.\u003c/p\u003e \u003cp\u003eSub-themes identified the preparation needed to work with programme participants, e.g. ensuring the leaders feel confident, having a sufficient leader-to-participant ratio, and establishing the means to communicate with them. Also understanding why people want to attend, to plan appropriate activity and publicising and recruiting appropriately to reach target audiences, either through social prescribing routes, self-referral or word of mouth.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eHow do you advertise?... what audience might you get? Am I gonna hit the right audience? Am I gonna hit the people that will probably get the maximum benefit? Or does it matter?\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThere was recognition that good signposting is needed if/when leaders encounter an issue that needed more specialist support.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eConcerns about capabilities and capacity\u003c/h2\u003e \u003cp\u003eThis theme described concerns around perceived deficits in expertise, qualifications and confidence of prospective leaders and a subsequent perception that peer leaders lack credibility. This related to both the credibility needed to be working with people in poor mental health, but also concerns regarding expertise on nature or local history.\u003c/p\u003e \u003cp\u003eThe concerns extended to worries on capabilities in working with groups, in which people in poor mental health were both the target audience but also potentially involved in leading and delivery. Issues of managing group dynamics, and that peer leaders might \u0026ldquo;\u003cem\u003ebring their own baggage\u003c/em\u003e\u0026rdquo; to sessions. With these concerns there was an acceptance that accreditations/qualifications are needed to deliver activities that involved discussion of mental health issues, talking therapy or one-to-one sessions. However, as described above, convening groups around \u0026lsquo;everyday activity\u0026rsquo; (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) was viewed as acceptable content for peer leaders.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIt's taking your life experience. So me talking about radiotherapy for cancer? I don't think so. But me talking about needlework or knitting. I can do that. If I can get ten people in a room who want to do Aran, I'd be fine\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eDespite this perceived lack of capability, participants recognised that the lived experiences, interests and passions of peer leaders are community assets: \u003cem\u003e\u0026ldquo;in a way everyone in this room is an expert when it comes to mental health\u0026rdquo;.\u003c/em\u003e Study participants with experience of leading nature-based health activities urged others to not be deterred by credibility concerns, and that prospective leaders should ask themselves \u003cem\u003e\u0026ldquo;what do you want to do? what have I got to offer\u0026rdquo;\u003c/em\u003e and that \u0026ldquo;\u003cem\u003eyou just can\u0026rsquo;t get it wrong, it's all learning\u003c/em\u003e\u0026rdquo;; which highlighted the importance of defining the objective and scope of the activity.\u003c/p\u003e \u003cp\u003eA further sub-theme identified deficits in personal confidence that would affect the ability to initiate activities. Non-specific worries on poor attendance - \u0026ldquo;\u003cem\u003ewhat if people don\u0026rsquo;t come\u003c/em\u003e\u0026rdquo; - was a common concern, with knock-on concerns that a lack of confidence would mean not enough peer leaders coming forward. This was countered by those with experience of peer leadership who mentioned that the activity should enrich the volunteers\u0026rsquo; life first, and participants\u0026rsquo; lives second: \u003cem\u003e\u0026ldquo;What would I like to do to enrich my life? I would like to volunteer; I'm going to go for a walk every Thursday at two o'clock. Fancy joining me?\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eIt was also recognised that a lack of credibility within group leaders might be contributing factor to the ability to attract attendees.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI if I saw a Blue Prescribing project [a wetland-based social prescribing project] and it was by, you know, somebody that wasn\u0026rsquo;t to do with the wetland centre or anything like that and it wasn't a health and wellbeing officer...I don't think I would want to want to join it. I wouldn't think it has any credibility. Yeah...safeguarding and, you know, trusting the people that are involved in it\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThere were further concerns that a lack of experience \u0026ndash; and fears of the unknown - of being outdoors from prospective attendees would also be a factor in whether groups would be well attended.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCommunity support required\u003c/h2\u003e \u003cp\u003eIn focusing on delivering \u0026lsquo;everyday activities\u0026rsquo; the principles of keeping it simple and working through the community were expressed. Here, community networks and volunteer support were important, like starting locally with neighbours, friends and family, and forming local partnerships; and there was acknowledgment that recruitment to the activity should begin in the hyperlocal community.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I also spoke to my neighbours, a lot of my neighbours around me are rural poor kids, having troubles. And I just asked them to come out for a walk with me. And now they go on their own. And now they take their grandchildren\u0026rdquo;\u003c/em\u003e [participant with experience as a peer leader]\u003c/p\u003e \u003cp\u003eStarting locally was offered as a solution to concerns on how to find appropriate, and most in-need, people for activities.\u003c/p\u003e \u003cp\u003eThinking about who people wanted to help, there was a recognised need for support when working with programme participants. Again, in relation to securing the credibility and confidence needed to deliver activities, but also in securing buy-in and interest from attendees and to keep the activities and groups sustained.\u003c/p\u003e \u003cp\u003eHere \u0026ndash; and most prominently in relation to risk and liabilities - third sector organisations were identified as a key support mechanism for peer-led activity by being a source of policy structures for e.g., risk, insurance and safeguarding, and providing a supportive \u0026lsquo;umbrella\u0026rsquo; under which peer leaders could operate and gain confidence while also linking peer leaders with site staff to facilitate nature access.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eYeah, presumably, you've got a code of conduct or you know, protocols, about how events are going to be run, and your own internal risk management. And we\u0026rsquo;d be expected to conform to that, you would give us support. I'm guessing\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We were volunteers, so we fall under an umbrella. But then that's the setting the expectation to the facilitator, that they feel protected\u0026rdquo;.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eResourcing needs\u003c/h2\u003e \u003cp\u003eUnderstandably, there were questions about finances and resourcing of peer-led activity, and where the money would come from to help support the peer leaders. The resourcing needed fell into sub-themes of: funding, equipment, site and facilities, and transport. Peer leaders recognised that there would need to be some financial support \u0026ldquo;\u003cem\u003eTo ensure activity is not entirely voluntary\u003c/em\u003e\u0026rdquo; and to purchase equipment and pay for transport to and from the activity. Peer leaders were conscious of site issues, regarding landownership permissions to use the site (associated to the risk and liabilities concerns outlined above). Finding suitable sites with appropriate facilities (e.g., toilets and shelter) and there was recognition that some local nature sites had pay barriers that would prevent community activity.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eGroup-based activity in nature can bring broad health benefit to people with health challenges, and this approach now features alongside traditional treatment options in UK healthcare long-term plans (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e). However, establishing sustainable delivery models remains a challenge (\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e), so developing community approaches like peer leadership may expand options (\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e) and contribute to environmental gains (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Peer-led NBIs for mental health, and in the context of NBSP, have yet to be explored. This study captured the perspectives of participants and carers associated with a nature-based social prescribing programme in London (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e), who, post-intervention, expressed interest in peer leadership.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eMotivations to be a peer leader and activities of interest\u003c/h2\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003eMotivations to improve wellbeing\u003c/h2\u003e \u003cp\u003eWe constructed two themes on peer leader motivations one, to improve personal wellbeing and two, to improve community wellbeing (i.e., promoting wellbeing in others). Personal wellbeing consisted of e.g., doing good, building self-esteem, meaningful activity, and self-learning - both new skills and about nature. Community wellbeing centred on creating community, supporting others to get into nature, practicing art, creating nature/sensory experiences, sharing interests and knowledge of nature. Work on conservation volunteers also reports learning, improving self-esteem, increasing social connections and creating appreciation for nature and place as motivational factors for involvement (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan additionalcitationids=\"CR90 CR91\" citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e–\u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e). ‘Giving back’ is a common motivation for conservation volunteers (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e, \u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e) and our study participants also mentioned ‘doing good’ and ‘sharing interests and knowledge’.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eAn absence of ‘physical activity’ as a motivation\u003c/h2\u003e \u003cp\u003eWe might have expected ‘increase physical activity’ to be a prominent motivation but this was largely absent in responses to the question to why they would want to be a peer leader. Seeking physical activity is common for environmental volunteering (\u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan citationid=\"CR101\" class=\"CitationRef\"\u003e101\u003c/span\u003e), for becoming a peer walk leader (\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e), and for visits to a variety of nature types (\u003cspan additionalcitationids=\"CR103 CR104\" citationid=\"CR102\" class=\"CitationRef\"\u003e102\u003c/span\u003e–\u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e). This result may reflect differences in the activity. Conservation volunteering commonly involves ‘practical action to achieve environmental gains’ (\u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e). When we asked participants about prospective activities (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) simple conservation practical work (e.g. litter picking) and physical wellbeing pursuits (e.g. walking and cycling) were mentioned, but to a lesser extent than nature appreciation, creative or ecological pursuits. This may also be a reflection of the NBSP programme from which the study group was formed which had a mental health focus so the activities of the intervention may have influenced participant’s conceptualisation of peer leadership. Nevertheless, the results suggest that initiatives looking to motivate nature-based peer leaders might communicate the personal and community mental wellbeing benefits rather than physical wellbeing to attract volunteers. The physical health benefits of spending time in natural environments are well established (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e), and community health champions also report this as a health benefit to volunteering (\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e), so physical health may well accrue by stealth as a co-benefit for both participants and leaders.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eSharing experiences and creating community\u003c/h2\u003e \u003cp\u003eTypically for greenspace health programmes (\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e), we found motivations and intentions to share experiences (i.e. lead others, improve access and share nature) and to create community by creating more social connections. These are important factors to consider for any future programme success. The creation of a ‘community feeling’ is valued highly by participants in environmental activities (\u003cspan citationid=\"CR107\" class=\"CitationRef\"\u003e107\u003c/span\u003e) and this sharing of experiences is one putative mechanism for how NBIs might promote such social cohesion (\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e); social connections and shared identities are also important factors for recruiting and sustaining peer-led and volunteer activity (\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e). In successful community health programmes, health champions can make significant contributions to the formation and strengthening of social networks within communities (\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e). The results highlight the potential for nature-based peer leadership programmes to make positive contributions to social connections and cohesion, which would positively feedback to reinforce the successful delivery of the interventions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eProspective Activities\u003c/h2\u003e \u003cp\u003eThe prospective peer leaders proposed a diverse range of nature-based interests that mirror NBSP activity already delivered in the UK (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e). They consisted of learning, creative, conservation, and nature appreciation activities that are known to be health promoting (e.g. forest bathing (\u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e), birdwatching (\u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e, \u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e), nature connection activities (\u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e112\u003c/span\u003e)). Furthermore, activities were suggested that - if conducted in natural settings – have been shown to provide greater health benefit than if conducted in non-natural settings e.g. nature-based meditation (\u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e113\u003c/span\u003e), walking and general exercise (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan additionalcitationids=\"CR115\" citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e–\u003cspan citationid=\"CR116\" class=\"CitationRef\"\u003e116\u003c/span\u003e). Creative and arts activities lend themselves especially well to community activity, promoting health and wellbeing, quality of life, levels of empowerment and social inclusion when socially prescribed (\u003cspan citationid=\"CR117\" class=\"CitationRef\"\u003e117\u003c/span\u003e, \u003cspan citationid=\"CR118\" class=\"CitationRef\"\u003e118\u003c/span\u003e); creative activities are easily tailored in nature to create meaningful mental health programmes for all ages, interests and abilities (\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e119\u003c/span\u003e). Participants also described interest in improving nature access to people with mobility problems. This can be especially beneficial public health activity through the ‘equigenic’ effects of nature reducing health inequalities (\u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e, \u003cspan citationid=\"CR121\" class=\"CitationRef\"\u003e121\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eNeeds and concerns of participants\u003c/h2\u003e \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e \u003ch2\u003eMaking peer leaders feel protected and supported\u003c/h2\u003e \u003cp\u003eThe potential described above was tempered by the support needs expressed by peer leaders regarding the practicalities of setting up and safely delivering nature-based activity. Fears around risks and liabilities, permissions, safeguarding, lone working and health and safety were raised. This echoes findings from other UK community health champion initiatives who report the critical role that infrastructure, training and support have to their effectiveness (\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e). Volunteering through a VCSE organisation was recognised by study participants as a mode for peer leaders to find this support and feel protected through built-in processes like risk assessment, public liability insurance or health and safety staff/training. This would provide reciprocal health benefit to peer leaders by making them feel more empowered (\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e). This aligns with ABCD approaches to health, which aim to place institutional assets at the service of the community (\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e), offering umbrella support to “\u003cem\u003ecreate a dome of protection around community inventiveness\u003c/em\u003e” and by sharing personnel skills (\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePeer leaders expressed support needs in finding like-minded people, micro-providers, community groups, volunteers, families and individuals, and in forming partnerships. This is not uncommon as work on NBSP has shown small providers tend to rely on volunteers and a lack of support capacity can be a hindrance to delivery (\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e). Once in place, continued social support for peer leader volunteers will be needed to ensure adherence to the role, while recognising that peer-leading will not suit all volunteers (\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eSupport to overcome concerns with social prescribing\u003c/h2\u003e \u003cp\u003eSpecific concerns were raised in relation to programme participant communication and publicity, and about recruiting through social prescribing, due to its associated medicalised and professionalised language, and on participant adherence. The issue of medicalised language is known to cause difficulties in communications with participants (\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR122\" class=\"CitationRef\"\u003e122\u003c/span\u003e, \u003cspan citationid=\"CR123\" class=\"CitationRef\"\u003e123\u003c/span\u003e) and hinder NBSP programmes by undermining user and volunteer buy-in (\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e). One explanation is the diversity of public actors (healthcare, environmental, volunteer) potentially involved in any given NBI (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR124\" class=\"CitationRef\"\u003e124\u003c/span\u003e). To overcome this a more informal ‘health by stealth’ approach has been advocated when instigating interventions e.g. fun with families in local parks (\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e) and informal activities, with wellbeing as ‘by-product’ (\u003cspan citationid=\"CR125\" class=\"CitationRef\"\u003e125\u003c/span\u003e)). Indeed health interventions in allotment settings demonstrate that a ‘real life/everyday feel’ can also be destigmatising for participants (\u003cspan citationid=\"CR126\" class=\"CitationRef\"\u003e126\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis favouring of a ‘health by stealth’ approach, and aversion to medicalised/professionalised social prescribing, was exemplified by the study participants’ citing a preference for ‘everyday activities’ - this was interrelated with further concerns from the study participants in two areas. First, that social prescribing services were not sufficiently people-centred. This an issue that has also been raised by NBSP activity providers (\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e) and commentators in community-based health promotion. Both fields highlight the need to shift away from being ‘intervention driven’ (\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e). Second, study participants considered more formal therapeutic activities inappropriate for peer leaders due to perceived insufficient qualifications. Although an understandable concern, it could be argued that this may be overly circumspect because of the already high levels of variation in the skill and training among providers of UK NBSP provision (\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e). Expert panels - convened on the topic of NBSP – also recognise that group leaders need not be required to have a medical qualification (just appropriate training) (\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e). Furthermore, some of the (limited) guidance that is available on quality assurance (for social prescribing) does encourage awareness of statutory responsibilities but also guards against letting this stifle community action (\u003cspan citationid=\"CR127\" class=\"CitationRef\"\u003e127\u003c/span\u003e). Ultimately, there is likely to be a trade-off. While less stringent quality control would facilitate more community action, a lack of quality assurance may also deter participation through perceived lack of leader competency (\u003cspan citationid=\"CR123\" class=\"CitationRef\"\u003e123\u003c/span\u003e, \u003cspan citationid=\"CR128\" class=\"CitationRef\"\u003e128\u003c/span\u003e). Indeed, our study participants recognised this risk themselves. They also recognised that this boundary-setting, planning and defining scope and aim for activities was key to its mitigation, a point that has also been raised by NBSP providers as a key success factor for nature-based health programmes (\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e). Supporting peer leaders to plan and scope appropriate activities for participants will be important in ensuring a successful programme, as will the co-creation of activities with participants and peer leaders to ensure needs and motivations are fully addressed (\u003cspan citationid=\"CR129\" class=\"CitationRef\"\u003e129\u003c/span\u003e, \u003cspan citationid=\"CR130\" class=\"CitationRef\"\u003e130\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTaken together, our study participants concerns highlight an opportunity for social prescribing systems to be more inclusive and supportive of community-led nature-based activities in ways that enhance peer leaders’ proficiency and confidence in planning and delivery, and in helping link peer-led activities and suitable participants (\u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e). Evidence from community health championing projects suggests that support and training provided will lead to further health promotion from improvements to peer leader self-esteem, self-awareness and confidence (through increased empowerment) (\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eResourcing\u003c/h2\u003e \u003cp\u003eThe sustainable funding of community-based health initiatives is a central issue limiting the development and expansion of NBSP in both the UK (\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR128\" class=\"CitationRef\"\u003e128\u003c/span\u003e, \u003cspan citationid=\"CR131\" class=\"CitationRef\"\u003e131\u003c/span\u003e, \u003cspan citationid=\"CR132\" class=\"CitationRef\"\u003e132\u003c/span\u003e) and other countries (\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e). Volunteer-led nature-based health activities will be less exposed to this issue. However, as our study participants highlight many peer leaders may not be able to fully dedicate time, resources and equipment voluntarily and financial support will still be needed. The funding for NBSP are often small grants which may be sufficient to support peer-led activities, but for small NBSP providers funding applications are onerous, daunting and time-consuming (\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e). Here again there is a potential role for both the social prescribing system and community-facing organisations to support peer-led activity to secure funding (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e). Post-pandemic, many VCSE organisations are underfunded and overstretched (\u003cspan citationid=\"CR133\" class=\"CitationRef\"\u003e133\u003c/span\u003e). If organisations are to support peer leaders a full-time permanent position may well be required to animate peer leadership and build expertise, especially at the outset (Russell 2022). This staff resource will come at a cost the organisation and represents an opportunity for NBSP networks to further expand their reach to develop existing local community assets and help these become more viable and sustainable (\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStudy participants also recognised the critical factors for the peer-led approach of unrestricted, local, convenient, well-provisioned nature sites, and the travel resources to get participants to the sites. This is also a well-established success factor in NBSP programmes (\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR128\" class=\"CitationRef\"\u003e128\u003c/span\u003e). Unrestricted access would allow activities to be instigated, for participants to return after group activity has ended, or for supplementary access (\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e). Regular and repeat visits are important for inducing and sustaining health benefit (\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR134\" class=\"CitationRef\"\u003e134\u003c/span\u003e), so if organisations can share their natural spaces and resources this would support communities and peer leaders to locate suitable natural spaces, gain permissions and to instigate community activity (\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e). It would also facilitate reciprocal benefit to the organisation through demonstration of the societal value of the organisation’s natural assets (e.g. (\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e), and raise the prospect of more local environmental stewardship initiatives i.e. community actions to bring about environmental and/or social gains (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). The NHS too might also explore how primary and community services could make better use of their grounds to support social prescribing and community resilience (\u003cspan citationid=\"CR135\" class=\"CitationRef\"\u003e135\u003c/span\u003e). Finally, and fundamentally, this recognised need for unrestricted, local and well-provisioned nature sites highlights the foundational interdependence of any NBI on abundant, local and quality nature. It emphasises the importance of upholding political commitments to protect, restore and extend nature wildlife areas, especially in urban areas (e.g. the UK Government’s Environment Improvement Plan (\u003cspan citationid=\"CR136\" class=\"CitationRef\"\u003e136\u003c/span\u003e)) for the wide-ranging health benefits provided by nature (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR137\" class=\"CitationRef\"\u003e137\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStrengths and Limitations\u003c/p\u003e \u003cp\u003e The research benefited from the study participants lived experienced of mental health problems, navigating the social prescribing system and of NBSP, the latter through which the group was formed. The group had good age representation of UK society, but was underrepresented in terms of UK ethnic diversity. It was also limited in one area of the UK, centred on Southwest London. Three of the participants responded by online questionnaire and web chat interview, meaning they were less informed on the wider discussion. Most of the group were not in full time employment so the perspective of peer-leading from those in full time employment will be underrepresented.\u003c/p\u003e \u003cp\u003e The group discussions were facilitated to enable comments from all participants; however, we anticipate some individuals may not have felt free to express personal opinions in a group setting during open conversation. We mitigated this limitation with workshop sessions using sticky notes, to allow anonymous comment and increase inclusion, however this traded off with depth of insight from the written notes, which lacked richness in relation to the open conversation. The written part of the workshop might have biased the less literate members of the group.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusions and recommendations","content":"\u003cp\u003eTo our knowledge this study is the first exploration of health promotion through nature-based peer leadership. The findings have implications for public health practitioners, social prescribing, nature organisations, volunteers and communities. They show peer leaders are motivated to promote personal wellbeing but also, altruistically, promote wellbeing in others by leading and sharing nature experiences, creating community connections through the delivery of a wide range of health promotion activity. The absence of motivations towards physical activity suggests that initiatives looking to encourage and initiate nature-based peer leaders might focus on personal and community mental wellbeing incentives by starting hyper-locally on ‘everyday activities’ (e.g. nature walks with neighbours). We also conclude that to animate peer-led NBIs concerns need to be addressed regarding the practicalities of establishing and safely delivering nature-based activity, on the personal competencies required and nervousness with the medicalised nature of social prescribing. Here there is an opportunity for allied NGOs, and potentially social prescribing networks, to use their human and capital resources to support communities to help e.g. train and upskill, define scope, find participants and small grants. The principles of asset-based community management might also be used to help nurture this community potential. This would also bring mutual benefit to environmental ambitions to create greater social movement and action for the environment.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eABCD: asset-based community development\u003c/p\u003e\n\u003cp\u003eGP: general practitioner\u003c/p\u003e\n\u003cp\u003eME: myalgic encephalomyelitis\u003c/p\u003e\n\u003cp\u003eNBSP: nature-based social prescribing\u003c/p\u003e\n\u003cp\u003eNGO: non-governmental organisation\u003c/p\u003e\n\u003cp\u003eNBI: nature-based intervention\u003c/p\u003e\n\u003cp\u003eNHS: National Health Service\u003c/p\u003e\n\u003cp\u003eVCSE: voluntary, community or social enterprise\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eAuthor contributions\u003c/h2\u003e\n\u003cp\u003eConceptualisation: JPR, BP, WWF, RPC.\u0026nbsp;Methodology: JPR, BP, WWF, RPC. Data curation: JPR, BP. Data analysis: JPR, BP, WWF. \u0026nbsp;Project administration: BP, RPC. Writing: original draft: JPR. Writing: review and editing: JPR, BP, WWF, JLN, RPC. BP was working for Mental Health Foundation during conceptualisation, data curation, analysis, and the majority of the writing stages.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eEthics Statement\u003c/h2\u003e\n\u003cp\u003eAll participants gave informed consent for inclusion in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Human Research Ethics Committee of the Wildfowl and Wetlands Trust (WWT1408032023). Recruitment emails were only sent to Project participants who consented to receiving further communication from the Project delivery team. Travel costs, lunch, refreshments and a visit to the Wetland Centre were included for Study participants. To ensure anonymity, the identity of participants is not reported. All participants were aged 18 years or over.\u003c/p\u003e\n\u003ch2\u003e\u0026nbsp;Competing interests\u003c/h2\u003e\n\u003ch2\u003eThe authors declare that they have no competing interests\u003c/h2\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe research was conducted as part of the \u0026lsquo;Blue Prescribing Project\u0026rsquo;\u0026nbsp;(96), delivered by WWT and the Mental Health Foundation and funded by Simply Health.\u003c/p\u003e\n\u003ch2\u003eAcknowledgments\u003c/h2\u003e\n\u003cp\u003eThe authors would like to extend their thanks to the study participants who were so generous with their time, energy and enthusiasm for the workshop and the subject matter.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eData availability\u003c/h2\u003e\n\u003cp\u003eEthical approval WWT1408032023 prevents data sharing to protect participant anonymity.\u003c/p\u003e\n\u003ch2\u003eAdditional files\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eTitle of data: Reeves et al 2024 Supplementary Material 1: Topic Guide\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDescription of data: Workshop topic guide\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Title of data: Reeves et al 2024 Supplementary Material 2: Results from making a landscape session\u003c/p\u003e\n\u003cp\u003eDescription of data: Results from the \u0026apos;making a landscape\u0026apos; session of the\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBratman GN, Anderson CB, Berman MG, Cochran B, de Vries S, Flanders J, et al. 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Participation in environmental enhancement and conservation activities for health and well-being in adults: A review of quantitative and qualitative evidence. Cochrane Database of Systematic Reviews. 2016 May 21;2016(5). \u003c/li\u003e\n\u003cli\u003eBowe M, Gray D, Stevenson C, McNamara N, Wakefield JRH, Kellezi B, et al. A social cure in the community: A mixed-method exploration of the role of social identity in the experiences and well-being of community volunteers. European Journal of Social Psychology. 2020 Dec 1;50(7):1523\u0026ndash;39. \u003c/li\u003e\n\u003cli\u003eKotera Y, Richardson M, Sheffield D. Effects of Shinrin-Yoku (Forest Bathing) and Nature Therapy on Mental Health: a Systematic Review and Meta-analysis. International Journal of Mental Health and Addiction. 2022 Feb 1;20(1):337\u0026ndash;61. \u003c/li\u003e\n\u003cli\u003eCox DTC, Gaston KJ. Urban bird feeding: Connecting people with nature. 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Available from: https://www.frontiersin.org/article/10.3389/fpsyg.2017.00268\u003c/li\u003e\n\u003cli\u003eJuster-Horsfield HH, Bell SL. Supporting \u0026lsquo;blue care\u0026rsquo; through outdoor water-based activities: practitioner perspectives. Qualitative Research in Sport, Exercise and Health. 2022 Jan 2;14(1):137\u0026ndash;50. \u003c/li\u003e\n\u003cli\u003eFieldhouse. J. The Impact of an Allotment Group on Mental Health Clients\u0026rsquo; Health, Wellbeing and Social Networking. British Journal of Occupational Therapy. 2003;66(7). \u003c/li\u003e\n\u003cli\u003eLister C. Quality Assurance for Social Prescribing. A Guide to Support Social Prescribing Programmes in England [Internet]. 2019 [cited 2024 Jul 12]. Available from: https://docs.wixstatic.com/ugd/14f499_a5e3a40ac260401a80e01853bb7ef8b9.pdf\u003c/li\u003e\n\u003cli\u003eHusk K, Blockley K, Lovell R, Bethel A, Lang I, Byng R, et al. What approaches to social prescribing work, for whom, and in what circumstances? 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Negotiating Complexity: Challenges to Implementing Community-Led Nature-Based Solutions in England Pre- and Post-COVID-19. International Journal of Environmental Research and Public Health. 2022 Nov 1;19(22). \u003c/li\u003e\n\u003cli\u003eThiery H, Cook J, Burchell J, Ballantyne E, Walkley F, McNeill J. \u0026lsquo;Never more needed\u0026rsquo; yet never more stretched: Reflections on the role of the voluntary sector during the COVID-19 pandemic. Voluntary Sector Review. 2021 Nov 1;12(3):459\u0026ndash;65. \u003c/li\u003e\n\u003cli\u003eWhite MP, Alcock I, Grellier J, Wheeler BW, Hartig T, Warber SL, et al. Spending at least 120 minutes a week in nature is associated with good health and wellbeing. Scientific reports. 2019;9(1):7730. \u003c/li\u003e\n\u003cli\u003eThe King\u0026rsquo;s Fund. Social prescribing and NHS facilities: How could the NHS better use its facilities to support social prescribing, holistic care and community resilience? [Internet]. 2020 Nov [cited 2024 Jul 12]. Available from: https://www.property.nhs.uk/media/2889/social-prescribing-and-nhs-facilities-report-summary.pdf\u003c/li\u003e\n\u003cli\u003eHM Government. Environmental Improvement Plan. 2023 [cited 2024 Jul 12]; Available from: https://www.gov.uk/government/publications/environmental-improvement-plan\u003c/li\u003e\n\u003cli\u003eShanahan DF, Lin BB, Bush R, Gaston KJ, Dean JH, Barber E, et al. Toward improved public health outcomes from urban nature. American journal of public health. 2015 Mar 9;105(3):470\u0026ndash;7. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"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 health intervention, nature based social prescribing, social prescribing, mental health, ecological restoration, peer leadership, peer support, asset-based community development","lastPublishedDoi":"10.21203/rs.3.rs-4763846/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4763846/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003eThere is renewed, cross-sectoral interest in nature's contributions to health and how they can be maximised for public and planetary health. Current enquiry is focused on practicalities and what strategies and collaborations are needed to operationalise the nature-health relationship for both people and the environment. Nature-based health interventions (NBIs), especially those within the framework of nature-based social prescribing (NBSP), show promise. However, in the UK, there are limitations to initiating and scaling activities due to issues like: navigating multi-stakeholder partnerships, building a work force and sustaining the provision. The short ‘course’, finite format of NBSP programmes also creates a ‘what next’ moment for participants despite willingness and interest from many participants in peer leadership type activity i.e. offering social support and leadership to help others in their community to partake in nature-based health activities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim: \u003c/strong\u003eTo explore peer-led community delivery options for NBIs with prospective peer leaders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eWe recruited seventeen study participants for a daylong workshop exploring motivations, activities and perceived challenges of prospective peer leaders of NBIs. The study participants had a) been through, or supported delivery/participation of, a UK wetland-based NBSP programme for poor mental health and b) expressed an interest in peer leadership activities. The data underwent reflexive thematic analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults.\u003c/strong\u003eMotivations of prospective peer leaders to offer nature-based health activities related to the promotion of personal and community wellbeing through learning, sharing nature experiences, creating social connections, and through interests in facilitating a wide range of nature-based and salutogenic activities (e.g. arts/creative, conservation, nature appreciation, mental wellbeing activities). Concerns from peer leaders centred on the practicalities of establishing and safely delivering nature-based activity, on the personal competencies required to deliver NBIs, nervousness with the medicalised nature of social prescribing, and on resource needs for delivery; the latter highlighted the importance of local nature provision for community-led NBI delivery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eCommunity-led NBIs offer potential to broaden public health options, but community concerns need to be addressed first. There is a role for allied NGO organisations, or social prescribing networks, to share resources and support communities and prospective peer leaders to overcome these concerns.\u003c/p\u003e","manuscriptTitle":"The motivations, interests and concerns of prospective peer leaders of nature-based mental health interventions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-13 11:45:24","doi":"10.21203/rs.3.rs-4763846/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","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}}],"origin":"","ownerIdentity":"1ccffe54-743b-4ebf-92bf-aa1f95daddf7","owner":[],"postedDate":"August 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T16:49:52+00:00","versionOfRecord":{"articleIdentity":"rs-4763846","link":"https://doi.org/10.1016/j.wss.2026.100401","journal":{"identity":"wellbeing-space-and-society","isVorOnly":true,"title":"Wellbeing, Space and Society"},"publishedOn":"2026-04-15 00:00:00","publishedOnDateReadable":"April 15th, 2026"},"versionCreatedAt":"2024-08-13 11:45:24","video":"","vorDoi":"10.1016/j.wss.2026.100401","vorDoiUrl":"https://doi.org/10.1016/j.wss.2026.100401","workflowStages":[]},"version":"v1","identity":"rs-4763846","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4763846","identity":"rs-4763846","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}