Question

Domain 1. Target group

In the first round of the Delphi survey, we asked whether the target group benefits more from participating in a diagnosis-specific group program (e.g., only stress or anxiety) or in a group program across diagnoses such as anxiety, depression and/or stress. As shown in the table—with an average score of 4.1 and 4.4 respectively—consensus was not achieved, which requires a score of 5.0 or higher. We recognize that both options have certain advantages and disadvantages, which makes the question complex. We are interested in hearing your reflections and perspectives on the pros and cons of choosing one type of group composition over the other. Please elaborate your considerations here:

Domain 2. Professionals

In the first round of the Delphi survey, we asked whether NBHIs should be carried out by an interdisciplinary group (e.g., a physiotherapist and nurse, or a psychologist and a nature guide). As shown in the table, near consensus was achieved—with an average of 5.6 and 69%—greeing that an interdisciplinary team should provide the NBHI. If you have additional comments, you are very welcome to elaborate here:

In the first round of the Delphi survey, we asked which professionals should deliver the NBHIs for the target group. As shown in the table, we achieved consensus (>5.0) that physiotherapists, nature educators and psychologists are relevant to involve as the primary professionals in delivery of NBHIs for the target group—with nurses, medical doctors and occupational therapists reaching near consensus. If you have additional comments, you are very welcome to elaborate here:

In the first round of the Delphi survey, we asked about the competencies of the professionals, aiming to determine the weighting between knowledge and experience with NBHIs and with the target group. As shown in the table, there is consensus (>5.0) that both aspects should be weighted equally in the education and selection of professionals. If you have additional comments, you are very welcome to elaborate here:

Domain 3. Mechanisms of change

In this round, we ask you to rank the mechanisms of change in order of priority. How would you rank the following mechanisms of change? (1 is the one you find most relevant)

- Nature experiences and nature interaction

- Exchange of experiences

- Sensory experiences

- Social communities

- Physical activity

- Empowerment

- Body awareness

- Self-reflection

- Coping ability/self-efficacy

- Participation in everyday life

- Being present/ mindfulness (new)

Open-ended question: If you have additional comments, you are very welcome to share them here:

Open-ended question: Are there any unintended consequences we should be particularly aware of in relation to NBHIs for the target group?

Domain 4. Outcome selection

In Nature Impact, we investigate which available measurement tools can help evaluate the effect of NBHIs on mental health in people with mild to moderate anxiety, depression and/or stress. As part of this work, we are developing a questionnaire composed of several core instruments. In the project’s first phase, it was determined that nature connectedness should be included as the first outcome. In the first Delphi round, we asked you to rank outcomes (well-being, quality of life, functioning and symptoms) based on their relevance. As shown in the table, there is broad agreement that well-being should be included. Based on this, we chose to omit quality of life as an outcome, since several participants noted a potential overlap. In this round of the Delphi survey, we would like your input on prioritising between symptoms and functioning as the final outcome to be included in the questionnaire. Symptoms scored relatively low, which surprised us and made us discuss its relevance to the Nature Impact research project. On one hand, measuring symptoms is widely used in healthcare and may be important for implementing the intervention and for the impact of the results. On the other hand, using symptoms as a measurement may maintain a less contemporary understanding and approach to mental health. Regarding functioning and the measurement tools available, we see the challenge that the activities in NBHIs are not directly linked to what is typically measured. We would like your perspectives on this discussion, as well as your considerations about whether functioning or symptoms should be included in a questionnaire along with nature connectedness and well-being. Please elaborate your considerations here:

If you have additional comments or points of attention, you are very welcome to share them here: