Background and aimThe increased burden on mental health both globally and nationally is a
serious challenge that requires attention and action from healthcare professionals,
politicians, and decision-makers. According to the report "The National Health Profile
2021" from the Danish Health Authority, the number of adult Danes (over 16 years) with a
low mental health score has increased by seven percentage points from 2010-2021 and now
stands at 17.4%. A significant proportion of these individuals suffer from anxiety,
depression, and/or stress. This increase in people with reduced mental health has
consequences both for the individual's quality of life and for society as a whole. Thus,
more than 13% of the Danish population is prescribed medication for the treatment of
mental illnesses, and only 28% of them are able to work while experiencing their
illness.There is a growing recognition that the challenges associated with mental health
cannot be solved solely through clinical treatment or medication. In order to offer
citizens and patients the best possible support, it is important to look for sustainable
solutions to promote mental health and ensure access to effective treatment options.
Despite a significant increase in the number of published research studies on the
positive impact of nature on mental health, there has not previously been developed a
theoretical foundation and a comprehensive evidence base for nature-based health
interventions in a Danish context, and there has been a lack of a structured and
systematically developed understanding of the mechanisms of change in nature-based health
interventions (NBHIs), so they can be implemented in a way that aligns with the best
available knowledge in the field.In phase 1 of the project, a systematic review of the
literature has been conducted. Hereby followed an extensive co-creation process,
including the development of a logic model and an underlying program theory, and
established collaboration with three relevant implementation partners.In phase 2 of the
project, the aim was to test the feasibility of three locally adapted NBHIs in a
feasibility study with up to 120 participants (40 participants per partner) at three
different partners. MethodsThe locally adapted NBHIs will be tested at the Psychiatric
Center Glostrup and at the Kolding and Silkeborg municipal health centers from March to
November 2025. The intervention will be carried out as an interdisciplinary initiative
facilitated by two healthcare professionals employed at the respective partners, who
already have experience in delivering NBHIs to the target group.The NBHIs are organized
according to the following structure:• Duration of the program: Minimum 10 weeks, once a
week, 1.5-2.5 hours per session• Group composition: Across conditions: mild to moderate
anxiety, depression, and/or stress• Group size: 8-12 participants in a closed groupIn the
locally adapted programs, activities in nature are based on three main mechanisms of
change (nature interaction and sensory experiences, social communities, and physical
activity and movement), identified in phase 1 of the project. The healthcare
professionals responsible for the programs will tailor the activities individually. All
activities are designed based on a generic logic model, developed through a co-creation
process.Safety plays a central role in the nature-based health interventions. All
activities are planned with a focus on the participants' physical and mental well-being.
Potential risks are assessed and minimized through the selection of suitable natural
environments, appropriate equipment, and thorough instruction. The healthcare
professionals ensure a safe environment where participants can feel comfortable, both
physically and psychologically. Additionally, accessibility and any individual needs are
considered, so all participants can safely engage in the activities. With this study, the
results of a new treatment or examination will not be conduced (and none of the
participants will receive a worse treatment offer than what currently exists). It is
about investigating the feasibility of locally adapted NBHIs at three different partners
who already have nature-based programs.Both quantitative and qualitative data will be
collected. These will include questionnaire data, data from registration of participation
by the partner, participant observation, focus group interviews with participants from
the NBHIs, as well as focus group interviews with the healthcare professionals who are
carrying out the NBHIs. As part of the qualitative research, experiences with and
perceptions of the process, including the feasibility of the NBHI and how the
participants respond to the intervention will be examended. Written consent will be
obtained from the participants and healthcare professionals prior to this.