Current nature prescription programs should heed lessons from pediatric nature-based therapeutic programs from the past

Prescriptions for the therapeutic use of nature were popular in some U.S. cities in the late 19th and early 20th centuries. This theoretical paper explores lessons from the past to improve current nature prescription programs. These lessons call attention to the importance of providing needed resources — such as accessible parks — and building on existing social networks. Past lessons also suggest that the breadth of nature’s health benefits aren’t easily quantified with scientific measures.
Crnic & Kondo, 2019. Nature Rx: Reemergence of pediatric nature-based therapeutic programs from the late 19th and early 20th centuries. 
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Literature review mines other disciplines and cultural knowledges to understand nature’s role in health, historically and culturally

This literature review by U.K. researchers considered the cultural and historical dimensions of nature-based approaches to human health. It suggests that Indigenous knowledges, traditional Asian medicines and nature-based health practices of the ancient Greeks form a foundation for contemporary interventions, including nature prescriptions. Practitioners and researchers should learn from traditional approaches and Indigenous Peoples who acknowledge intricate links between human health and nature.
Boyd et al., 2024. The past, present, and future of nature and place-based interventions for human health. 
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Park prescriptions may be effective in addressing pediatric stress and resilience 

A pediatric clinic in the U.S. prescribed park visits three times a week to 50 low-income parents and children (age 7-17). Pediatricians also provided maps of local parks and information about nature’s health benefits. Analysis of data collected over three months showed that every increase in weekly park visits led to a significant increase in children’s resilience. As resilience scores increased, child stress scores decreased. Park prescriptions may be helpful for pediatricians serving children experiencing stress.
Razani et al., 2019. Clinic and park partnerships for childhood resilience: A prospective study of park prescriptions. 
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Nature prescription programs may support behavioral changes that increase children’s contact with nature

A quasi-experimental study in the U.S. examined how the TRACK Rx program impacted parents’ perceptions of their children’s (first through third grade) participation in nature activities compared to a control school. Although parents’ perceptions did not differ between the schools, participation in TRACK Rx was linked to increased hiking trail visits. TRACK Rx was implemented in conjunction with a related hiking trail network and online resources, which may have encouraged greater involvement in hiking activities.
Urroz & Christiana, 2024. Evaluation of a nature prescription program on parental perceptions for children’s outdoor activities.
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Involving primary care providers may be one way to promote children’s outdoor physical activity  

This U.S. study explored the potential of Project Nature, an intervention delivered by health care providers, to promote outdoor physical activity. Twenty-six parents and their children (age 4-10) received Project Nature materials (a brochure and nature toys) designed to encourage outdoor play. Significant changes in physical activity or outdoor time were not documented; however, parents and health care providers agreed that programs like Project Nature are a practical intervention to promote active outdoor play.
Griffin et al., 2024. Project Nature: Promoting outdoor physical activity in children via primary care.
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School nurses can facilitate schoolwide initiatives to encourage outdoor physical activity through nature prescriptions

This study evaluated the effectiveness of the TRACK Rx nature prescription program in the U.S. A school nurse led the program and shared resources with children and families. Students in the program (first through third grade) demonstrated significant increases in their nature-based physical activity on weekends compared to a control school. The study highlights an innovative approach to school-based nature prescriptions and the potential of school nurses to lead efforts to promote nature-based physical activity.
Christiana, Urroz & Venrick, 2025. Evaluation of a nature prescription program in schools to increase nature-based physical activity and time spent outdoors: Implementation of the kids in parks TRACK Rx program by the school nurse.
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Review identifies implementation strategies to support children and youth’s equitable participation in nature prescription programs

This literature review of ten studies (mostly conducted in the U.S.) examined the barriers and facilitators of nature prescriptions for child and youth health. Findings call attention to disparities that limit the participation of children from marginalized communities and the need to address equity concerns. Barriers included inequitable access to nature and unsafe neighborhoods. Equitable participation might be encouraged by support from health care providers and individualized prescriptions that account for socioeconomic status, location and nature access.
Paquet et al., 2025. Barriers and facilitators to implementing nature prescriptions for child and youth health: a scoping review.
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Structural barriers impede children’s active play in nature in families with low resources

A U.S. study involving 14 pediatricians and 14 low-income families examined the factors that limit children’s active play in nature (APN). Although pediatricians and parents valued APN, parents reported a range of barriers, including time, finances, family situations and limited access to nature and safe play areas. Pediatricians indicated a need to focus on other priorities during well visits. Nature prescriptions may help pediatricians promote APN; however, structural barriers must be addressed.
Tandon et al., 2022. A framework for pediatric health care providers to promote active play in nature for children.
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Park prescriptions should consider families’ demographics, knowledge, attitudes and barriers to park use

A study analyzed park use assessments completed by 78 parents before and after participating in a park prescription intervention for low-income families in the U.S. Analysis revealed that families who visited parks were more likely to know park locations, value visiting parks and feel their neighborhoods were safe for children. Although the prescriptions increased families’ overall park use, finances were a common barrier. Families of color and those who felt their neighborhoods were unsafe were less likely to visit parks.
Razani et al., 2020. The association of knowledge, attitudes and access with park use before and after a park-prescription intervention for low-income families in the U.S.
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Lack of awareness and structural, intrapersonal and interpersonal barriers limit Canadians’ participation in nature prescriptions

Surveys completed by 3,593 Canadian adults examined perceived barriers and enablers to participation in nature prescriptions. While interest was high, a lack of awareness of nature prescriptions and barriers (such as cost of park entry, lack of transportation) were found to limit participation. Key enablers that may reduce such barriers include health insurance coverage, free park access and subsidized transportation. Results suggest that many social, cultural and economic differences influence participation in nature prescriptions.
Lemieux et al., 2025. Prescribing nature for human health: An examination of public interest, barriers, and enablers related to nature prescription programming in Canada. 
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Health care providers’ lack of time and unreliable funding limit the longterm sustainability of nature prescription initiatives

This theoretical article proposes a network of access and engagement with nature for mental health that includes both nature prescribing and organized nature programming activities. The article examines concerns that are critical for long-term success of both approaches. For nature prescriptions, health care providers’ lack of time was a major barrier to sustaining nature prescribing. Inconsistent funding for nature prescription programs also limits their potential to promote population health.
Tate et al., 2024. Nature prescribing or nature programming? Complementary practices to increase time in nature to support mental health. 
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Stakeholders need to leverage research, shared language and partnerships to propel park prescriptions

This literature review and critical analysis of park prescriptions aimed to support interdisciplinary discussion and development of a research agenda to advance the park prescriptions movement. Findings highlight a need for (1) stronger collaborations between medical and parks professionals, (2) shared language to build a coherent movement and improve public awareness, and (3) further research — especially randomized control trials — to provide medical professionals with the types of evidence they find most valuable.
James, Christiana & Battista, 2019. A historical and critical analysis of park prescriptions.
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Nature prescription programs are growing faster than the evidence base to support and guide such programs

This literature review synthesized 11 studies (mainly from the U.S.) that investigated nature prescription programs. The studies evaluated health-related outcomes and focused on at-risk children; however, the evidence was too sparse to identify patterns in health outcomes. Findings indicate that more research is needed to understand different facets of nature prescription programs, including how to measure and increase patient adherence, how to assess health outcomes, and what determines provider participation.
Kondo et al., 2020. Nature prescriptions for health: A review of evidence and research opportunities. 
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Further research is needed to examine health care professional-provided nature prescriptions, especially for children

 This literature review examined 12 studies (mainly conducted in the U.S. and U.K.) that involved health care professional-written nature prescriptions. Although only five studies focused on children (age 4-18), results suggest nature prescriptions can encourage patients to experience nature’s health benefits. Findings also revealed variation in the types of health care professionals who prescribe nature and what they prescribe. Continued research is needed to increase the use of nature prescriptions for children.
Migl et al., 2024. A scoping review of nature prescriptions offered by healthcare providers.
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