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).