Table 4.

Articles describing interventions to promote sustainable healthcare.

Author	Target audience	Aim	Study design	Results
Floss45 2021 Brazil	Primary care provider; specialist care provider; clinic manager	To describe course creation and development and assesses impact of the Planetary health Massive Open Online Course (MOOC).	Pre/post survey, analysis of “action plans”	Educational intervention. Of 2,777 enrolled, 1,237 consented to study, 49.8% completed course and 241 action plans were created. Deemed successful pilot with future iterations underway. Recognized need to better incorporate Indigenous perspectives. Required good connectivity, alternate resources need to be available to those without or with intermittent, connectivity.
Fogarty46 2008 Australia	Primary care provider; clinic manager	To determine if an environmental educational program for general practitioners would lead to changes in sustainability within their practice.	Pre/post/3-month follow-up survey	Self-report surveys. Determined to be a successful pilot and expansion to GPs more widely may prove useful.
Kay27 2020 Australia	Primary care provider; clinic manager	To investigate the effectiveness of a primary care health promotion project addressing environmental sustainability and equity in primary care partnerships.	Community-based participatory action study; qualitative focus groups and interviews	Thirty-two projects identified, topics covered: (i) caring for environment, access to nature and Indigenous participation, (ii) sustainability of housing, thermal comfort, and reducing energy costs, and (iii) sustainable and active transport. Decline in the number of partnerships that had environmental sustainability as a priority between 2009 and 2013. Did not evaluate the impacts or outcomes of the 32 projects.
Nichols29 2011 United Kingdom	Primary care provider; clinic manager	To examine successful actions plan to reduce carbon emissions, as created and delivered by primary care trusts (PCTs)a.	Survey	50% response rate (7 of 14 directors of public health). 100% stated they had a sustainability strategy. Strategies included low-energy design, waste management, recycling, emissions, water, sourcing of food. “Patchy” evidence of successful implementation. Primary care trusts have since been abandoned.
Pedley42 2019 United States	Primary care provider; clinic manager	To assess benefits of a community garden established by a medical clinic situated in a food desert.	Mixed—analysis of food production and engagement of staff, and Commentary	Garden produced 1,400–1,500 pounds of produce per year. Provided >3,000 opportunities for clinic personnel to interact with volunteers. Promoted green physical activity and working together. No measures of physical activity were measured.
Pistoll32 2017 Australia	Primary care provider; clinic manager	To explore general practitioners’ (GPs’) ideas around active transport and its promotion.	Qualitative study	Ten semistructured interviews with GPs. Awareness of “active transport” as a term was limited but, without naming it, participants often discussed it with patients. Safety concerns limited its promotion.