Green Health Prescription Evaluation (GRAPPEL) for Dundee, Highland, and North Ayrshire

Evaluation completed March 2024

What does the research mean for Local Authorities?

The evaluation will provide value to a range of people and organisations, with detailed findings about how Green Health Prescriptions work, who benefits, and the best way to run them going forward. It will also provide a way for the public to have their voice heard based on their experience of running or receiving parts of the programmes. A summary of resources and costs in each area and how to best organise the services going forward will also be provided. From a research perspective, there has been very little structured evaluation of the impact of green health prescriptions.

What does the evaluation research mean for the Public?

The people interviewed will include health professional referrers, link workers or project officers, the people delivering green health activities, community members who engaged with the green health prescription and if possible, community members who received a green health referral but did not take it up. By speaking to a range of people and looking at both physical and mental health outcomes, the evaluation aims to get a full picture of the ways in which the programme works, the good (or not) things that happen as a result, and how the organisations involved could optimise the service going forward.

How are the public involved in the evaluation?

PPIE (patient and public involvement and engagement) will be embedded through both the PHIRST Connect Public Involvement in Research group’s (PIRg) input and wider lay and public contributors recruited to the project specific advisory group. Two members of our PIRg have been supporting project development since the evaluability phase of our work, attending project meetings, and commenting on ideas and proposals. In addition, three members of the local community from each of the specific areas will support the development, delivery, analysis, and knowledge mobilisation on the project.

Lay summary of research

Three Green Health Partnerships are running in Scotland based in Dundee, North Ayrshire, and Highland as part of the Our Natural Health Service (ONHS) programme. The ONHS programme is being led by NatureScot, working with a range of national and local organisation partners. The aim of the ONHS is to use the extensive range of green spaces in the local environment to encourage healthy activities that incorporate nature. It is anticipated that doing this will have a positive impact on community health and wellbeing outcomes. Green Health Partnerships co-ordinate a range of activities that directly or indirectly affect the public including: raising awareness of the benefits of green health to practitioners and ways to connect their service users to local opportunities; developing new green prescription referral pathways or adding green health options into existing health and social prescribing pathways; working with green health activity providers to deliver new or expand existing services to target specific locations/clinical groups; collating information about accessible green spaces/projects. This evaluation project is going to focus on the green health prescription pathways. The green health prescription pathways operate differently in the three areas of Dundee, North Ayrshire, and Highland. There are a number of parts of the green health prescription pathway that are important to evaluate from the process of how the referral happens, to the link between referral and take up of an activity, all the way to exploring the potential benefits for the service user.

Research questions  

  • Are green health prescriptions considered to be​ acceptable, practicable, effective, affordable, beneficial to people or groups equally, and are there any other positive or negative spillover-effects?
  • Does a green health prescription lead to improvements in mental and physical health and wellbeing, and physical activity, and reductions in the use of health services? ​
  • Does a green health prescription increase contact with nature/green space?
  • How does the delivery of the green health prescription across Dundee, North Ayrshire and Highland compare?

Workstream 1: Interviews with service users, referrers, providers, and coordinators.

Workstream 2: Analysis of data on physical and mental health, physical activity, user of health services, and cost of programmes.

Workstream 3: Collecting information on the resources and costs associated with operating each of three pathways.

Workstream 4: Bringing the results together and telling people about what we found.

Local Authority/Partner(s)

Dundee City Council, Dundee Volunteer and Voluntary Action, NHS Highland, NHS Ayrshire & Arran, NHS Tayside and Cairngorms National Park.


Research Team

Dr Neil Howlett, Professor Katherine Brown, Imogen Freethy, Laura Lamming, Nigel Lloyd, Honey-Anne Greco, Lisa Miners, Dr Adam P Wagner, Sian Harding and Amander Wellings.