Design and evaluation of a park prescription program for stress reduction and health promotion in low-income families: The Stay Healthy in Nature Everyday (SHINE) study protocol

Abstract

Background: Contact with nature improves human health; stress reduction is a mediating pathway. Stay Healthy in Nature Everyday (SHINE) is a stress reduction and health promotion intervention for low-income families at an urban Federally Qualified Health Center. We plan to evaluate two service-delivery models for SHINE and present here the intervention design and evaluation protocol.

Methods: Behavioral change theory and environmental education literature informed the intervention. Outcomes were selected after review of the literature and field tested procedures to determine what was feasible and ethical in a busy clinic serving vulnerable populations.

Design: We designed a randomized controlled trial to examine two levels of intensity in behavioral counseling about the health benefits of nature. Dyads consisting of a caregiver and a child aged 4 to 18 who access our pediatric primary care center are eligible. All dyads receive a pediatrician's recommendation to visit parks to experience nature and written resources (a "park prescription"). The intervention group receives added case management and an invitation to three group outings into nature with transportation, meals and activities provided. Primary outcomes measured at baseline, one month and three months post-enrollment are caregiver stress measured by PSS-10 score and salivary α-amylase; secondary outcomes are park prescriptions adherence, physical activity recorded by pedometer and journaling, loneliness, family cohesion and affinity to nature as measured by a validated scales. Both groups receive incentives to participation.

Discussion: Our intervention represents a feasible integration of recent research findings on the health benefits of nature and primary care practice.

Keywords: Behavioral counseling intervention; Green space; Nature; Poverty; Randomized controlled trial; Stress.