Table 2.

Proposed action framework to strengthen GRx access, integration, and accountability.

Challenge / gap	Recommendation / Action step	Stakeholders involved
Lack of awareness or training among clinicians (18, 31, 47, 48)	Provide continuing education, clinical frameworks, and plug-in tools for EHR integration	Hospitals, med schools, CE providers
Patients unaware of where, when, or how to engage with nature (18, 19, 40, 46)	Offer tailored resources based on ZIP code, mobility, and preferences	Clinics, health navigators, Park Rx orgs
Barriers due to safety, mobility, or transportation (19, 46, 49, 53)	Partner with local organizations to connect patients with accessible, culturally relevant, and safe spaces	Community orgs, YMCAs, parks departments
Underutilized local greenspaces (parks, trails, courtyards) (5, 6, 29)	Retrofit and enhance existing spaces using biophilic design principles	Urban planners, landscape architects, local gov
Inconsistent GRx follow-through and limited accountability (18, 46, 49)	Use patient portals, REDCap surveys, or text reminders to track engagement	Clinics, IT teams, public health staff
CHNAs overlook nature access (16, 53, 54)	Add canopy, walkability, and greenspace proximity indicators to CHNA frameworks	Hospitals, CHNA teams, GIS analysts
Greenspace development favors affluent areas	Reform zoning policies, mandate green % in new developments, and prioritize underserved areas	City planning departments, policymakers, grad students
Short-term projects lack long-term sustainability	Evaluate GRx infrastructure using Bardach & Patashnik’s criteria (impact, feasibility, maintenance)	Funders, policy analysts, health system leaders
GRx seen as niche or luxury intervention	Align GRx with Sustainable Development Goals (SDGs 3, 11.3, 11.7) and embed into public health infrastructure	Global health leaders, funders, NPOs