BACKGROUND:In-patient treatment and rehabilitation after stroke represent an important period for recovery, yet recommended levels of rehabilitation activity are challenging to achieve, and many patients remain inactive and at risk of low mood. Research in other conditions suggests that the use of green spaces can benefit in-patients, providing opportunities for activity and social interaction, and improving mood and wellbeing. However, little is known about the use of green spaces post-stroke. AIM:To explore how, for whom, and under what conditions hospital based green spaces influence recovery, wellbeing and engagement with rehabilitation among stroke in-patients. METHODS:A mixed-method multiple case study will involve three hospital sites with different types of green spaces including those used for therapy, those newly designed for stroke survivors, and long-established spaces. Data collection will include gathering of contextual data (documentary analysis, mapping of the green space, interviews with green space designers and informal survey) to understand the setting, design, rationale, and maintenance; behavioural mapping (10-day period, two seasons per site) to understand usage; and semi-structured interviews with 45 in-patients and their visitors (including those who have and have not used the green space) and 30 multidisciplinary staff, to understand their experiences. Interview data will be analysed using the Framework approach. Mixed methods data will be integrated within and across cases to develop and refine a programme theory explaining how green space could support stroke recovery and wellbeing. Programme theory will be refined by expert groups of stroke survivors, carers and staff in three other locations. DISCUSSION:This study will generate a transferable programme theory and context-sensitive recommendations to inform the design, implementation and evaluation of green space in stroke care. We will disseminate findings widely to relevant audiences to influence future policy and practice.

Nature-based interventions (NBIs) are increasingly used in mental health services, but their effectiveness in people with psychiatric disorders, and how these individuals experience them, remains unclear. This review synthesised quantitative and qualitative evidence on NBIs in psychiatric populations. Eligible studies evaluated outdoor NBIs against controlled comparators, excluding neurodevelopmental/degenerative conditions and indoor or virtual interventions. Quantitative outcomes were synthesised using random-effects meta-analysis; qualitative data were analysed using thematic synthesis. Twenty-eight studies were included, mostly involving people with diagnoses of schizophrenia or depression. NBIs were associated with greater improvements in clinical symptoms than controlled comparators (pooled effect size 0.71 [95% CI 0.29-1.12]; p = 0.0009), with moderate heterogeneity (I2 = 48.6%). The qualitative synthesis identified five themes: Being in Nature, Personal Growth, Psychological Wellbeing, Social Relationships, and Physical Benefits. Participants reported reduced stress, improved mood and coping, strengthened identity, enhanced social connection, and increased energy. NBIs, particularly horticultural programmes and guided outdoor activities, may offer promising recovery-oriented adjuncts to psychiatric care. The next step is to build a translational evidence base by harmonising recovery-relevant outcomes and developing pragmatic, scalable models of delivery that can be embedded within routine mental health services, informed by mixed methods evaluation.

Background: Attention Deficit Hyperactivity Disorder (ADHD) affects 5% of children in the United Kingdom (UK), impacting upon daily functioning and multiple health outcomes. Support for ADHD in the United Kingdom is currently insufficient, and waiting lists for specialist assessment and treatment are long. Community-based interventions are often not widely delivered although we know psycho-social interventions, such as parenting interventions, can be effective and are recommended in clinical guidelines. Nature-based interventions can support mental health and wellbeing in general populations, and recent empirical research suggests promising mechanistic support for effective use with ADHD populations. Co-production of interventions with children, adolescents and families has been recognised as a key approach for future research. The aim of this study was to co-produce a parent-led nature-based intervention, underpinned by current research, public health policy and theory, that can be taken forward to future feasibility and full trial testing to support mental health and wellbeing and symptom reduction in children with ADHD. Method: The Double Diamond model of design was applied to structure four phases of co-production to collaboratively develop the novel intervention. The penultimate phase included a round of user-testing. The coproduction group (n = 29) included children with diagnosed ADHD, their parents/guardians, and relevant professionals. The user-testing phase recruited 11 parent-child dyads who tried the intervention in their daily lives over six weeks to inform co-produced revision of the intervention in the final phase. Results: Co-production with end-users and professionals led to a bespoke nature-based intervention for use by families for children with ADHD in the form of a box containing activity cards, psychoeducation booklets, and other play-based items. Outcome measures administered during user-testing had mixed completion rates by parents/guardians and children, but the intervention was rated highly for acceptability and accessibility by families. Conclusion: This study demonstrated the effective use of co-production in designing a new wellbeing intervention for children with ADHD. Further testing will be beneficial for exploring whether this intervention could supplement wellbeing and symptom management services for this population.

Older adults are the fastest-growing and most sedentary group in society. As sedentary behaviour is associated with deleterious health outcomes, reducing sedentary time may improve overall well-being. This mixed-methods systematic review aimed to systematically review quantitative and qualitative studies examining interventions to reduce sedentary behaviour in community-dwelling older adults (aged ≥ 65 years). Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Cinahl, SportDiscus, and PEDRO were searched from inception to July 2025. We included quantitative studies (randomised-controlled trials (RCTs) and cluster RCTs), qualitative studies (semi-structured interviews or focus groups), and mixed-method studies exploring interventions to reduce sedentary behaviour in community-dwelling older adults. Studies were appraised using the Mixed Method Appraisal Tool. Quantitative evidence was meta-analysed; qualitative evidence was thematically synthesised, with both combined in a mixed-method synthesis. The Behaviour Change Techniques employed were charted and analysed. Fifty-six studies (16 RCTs, 30 qualitative, and 10 mixed-method studies) were included. When pooled, interventions reduced sedentary behaviour by 27.53 min/day (95

Introduction Thousands of patients with mental illness are admitted to acute adult mental health wards every year in England, where local guidance recommends that all mental health settings be entirely smokefree. Mental health Trusts presently invest substantial effort and resources to implement smoke-free policies and to deliver tobacco dependence treatment to patients. Providing adequate support can help those who smoke remain abstinent or quit smoking during their smoke-free inpatient stay and beyond. At present, little is known about how best to support patients to prevent their return to pre-admission smoking behaviours after discharge from a smoke-free mental health inpatient stay. We have developed an intervention which includes targeted resources to support smoking-related behaviour change in patients following discharge from a smoke-free mental health setting. The aim of this trial is to determine the feasibility of a large-scale clinical trial to test the effectiveness and cost-effectiveness of the SCEPTRE intervention, compared with usual care.Methods and analysis This feasibility study will be an individually randomised, controlled trial in eight National Health Service mental health Trusts recruiting adults (≥18 years) admitted to an acute adult mental health inpatient setting who smoke tobacco on admission, or at any point during their inpatient stay. Consenting participants will be randomised to receive a 12-week intervention consisting of components aimed at promoting or maintaining positive smoking-related behaviour change following discharge from a smoke-free mental health inpatient setting or usual care. Data will be collected at baseline, 3 months and a second timepoint between 4 and 6 months post-randomisation. With 64 participants (32 in each group), the trial will allow a participation rate of 15% and completion rate of 80% to be estimated within a 95% CI of ±3% and ±10%, respectively. The analysis will be descriptive and follow a prespecified plan.Ethics and dissemination Ethics approval was obtained from the North West—Greater Manchester West Research Ethics Committee. We will share results widely through local, national and international academic, clinical and patient and public involvement networks. The results will be disseminated through conference presentations, peer-reviewed journals and will be published on the trial website: https://sceptreresearch.com/.Trial registration number ISRCTN77855199.

BackgroundThere has been increasing interest in creativity, heritage and nature to improve health-related outcomes. However, limited research has examined the intersection of heritage crafting in the context of natural spaces. This study aims to explore the feasibility and acceptability of an archaeologically informed outdoor heritage crafting intervention.MethodsA mixed-methods single group before and after feasibility study was conducted. Participants completed questionnaires, including validated items measuring outcomes related to mental health, wellbeing, social connectedness, mindfulness, perceived state of flow and the connection with nature and the environment. Qualitative interviews were conducted with participants to explore their experiences, and data were analyzed using thematic analysis.ResultsForty-eight participants from a University in the United Kingdom attended the workshops, achieving the recruitment target within the required timeframe. The response rate to all pre-workshop measures was 100% and remained at 100% post-workshop, with the exception of missing data for two participants (4.2%) for measures assessing wellbeing and anxiety, and missing data for five participants (10.4%) for the measure assessing depression. Therefore, response and retention rates indicate high levels of feasibility to conduct a robust evaluation of this intervention. Five themes were identified, including: participant motivation to sign up; engaging with creative activities in a natural setting; skilled facilitation and a flexible approach; group delivery, and duration and frequency of workshops. Overall, the workshops were positively received by participants, primarily attributing their satisfaction to engagement with group-based creative activities in a natural setting with an educational component.ConclusionThis study has shown it is feasible and acceptable to deliver and evaluate an archaeologically informed heritage crafting intervention to support wellbeing. These results suggest the need for formal testing of the potential health benefits of the intervention to address policy imperatives for developing and implementing community- and place-based approaches to support mental health.

Older adults are the most sedentary and fastest-growing demographic, yet adults aged ≥ 75 years are underrepresented in sedentary behaviour research. This study qualitatively explored how this age group perceives sedentary behaviour, the activities they perform in sitting and standing, and the barriers and facilitators to reducing their sedentary behaviour. Four focus groups were conducted with a consistent group of 6 community-dwelling older adults aged ≥ 75 years from West Yorkshire were held between October-December 2022. Audio recordings and focus group notes were transcribed verbatim and an inductive and deductive thematic analysis was conducted. The activities performed in sitting and standing were charted to the ecological model of sedentary behaviour, and barriers and facilitators to reducing sedentary time were charted to the Capability Opportunity Motivation-Behaviour (COM-B) framework. Participants were largely unaware of their sedentary behaviour or the associated health risks. Sitting activities were predominantly leisurely in nature, and occurred in older adults’ homes. Barriers and facilitators to reducing sedentary behaviour were mapped to the COM-B model. Key influences included physical and mental health, environmental constraints, social support, ingrained routines, and limited awareness of the health impacts of prolonged sitting. Analytical themes included the perceived progression of sedentary behaviour throughout older adulthood; the impact of prolonged sitting on sleep; and the role of social connectedness in reducing sedentary time. This study provided insights into older adults’ reports of sedentary behaviour progressing throughout older adulthood. When compared to the wider literature, sedentary behaviour in adults aged ≥ 75 years present similarly to a younger subset of older adults with regards to the activities performed in sitting, and the barriers and facilitators to reducing their sedentary time. However, the activities performed in sitting may be performed for longer, and the barriers to reducing sedentary behaviour may present more frequently. Social support appears valuable when attempting to reduce sedentary time, however, further research is necessary to explore the views of older adults who are socially isolated.

Abstract Introduction During the COVID-19 pandemic, older adults were at risk of being socially isolated or experiencing loneliness, increasing the risk of depression. We adapted the delivery of Behavioural Activation (BA), an effective evidence-based intervention for depression in older adults and people with multiple long-term conditions (LTCs), so it could be delivered remotely under COVID-19 restrictions. Method The qualitative study was nested within the BASIL+ definitive randomised controlled trial (https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(23)00238-6/fulltext). Semi-structured telephone interviews were conducted with 24 older adults, two caregivers and 16 BASIL Support Workers (BSWs). They were digitally recorded and transcribed professionally. Data were analysed thematically using constant comparison. Results Conclusion Findings suggest a BASIL+ style intervention should become more widely available for older adults with LTCs and low mood, given its positive impact on most participants and its remote delivery by non-specialist practitioners.

Abstract Background Older adults were more likely to be socially isolated during the COVID-19 pandemic, with increased risk of depression and loneliness. The Behavioural Activation in Social Isolation (BASIL+) trial investigated whether a Behavioural Activation (BA) intervention delivered remotely could mitigate depression and loneliness in at-risk older people during the COVID-19 pandemic. Methods We undertook a multicentre randomised controlled trial [ISRCTN63034289] of BA to mitigate depression and loneliness among older adults (65+) with multiple long-term health conditions, including low mood or depression. BA was delivered remotely (telephone or video call) with intervention participants (n = 218). Control participants received usual care, with existing COVID wellbeing resources (n = 217). Results Participants engaged with an average of 5.2 (SD 2.9) of 8 remote BA sessions. Adjusted mean difference (AMD) for depression (Patient Health Questionnaire-9, PHQ-9) at 3 months [primary outcome] was −1.65 (95% CI -2.54 to −0.75, p < 0.001). There was an effect for BA on emotional loneliness at 3 months (AMD -0.37, 95% CI -0.68 to −0.06, p = 0.02), but not social loneliness (AMD -0.05, 95% CI -0.33 to 0.23, p = 0.72). For participants with lower severity depression symptoms (5–9 on the PHQ-9) at baseline, there was an effect AMD PHQ9 1.13 (95% CI –2.26 to 0.01, p = 0.051), though this was less pronounced than for those scoring 10 or more at baseline (−2.48, 95% CI -3.81 to 1.16, p = 0.0002). Conclusion Behavioural activation is an effective and potentially scalable intervention that can reduce symptoms of depression and emotional loneliness in at-risk groups in the short term. The findings of this trial add to the range of strategies to improve the mental health of older adults with multiple long-term conditions. These results can be helpful to policy makers beyond the pandemic in reducing the global burden of depression and addressing the health impacts of loneliness, particularly in at-risk groups.

Background Child and adolescent mental health is a public health priority, and prevention, early intervention, and treatment are identified as national strategic priorities. Children and young people (CYP) in the United Kingdom are experiencing poorer mental health outcomes than ever, and the demand for services is the highest on record. Understanding the effectiveness of school-based interventions for promoting and developing emotional well-being is a core research priority. A school-based intervention that is inclusive and has the potential for widespread delivery is ‘Forest School’. Forest schools provide children with immersive experiences in nature that are non-classroom-based and have a core focus on child-led activities and exploration. Despite widespread implementation, evidence about optimal delivery methods for Forest Schools and their impact on mental health and emotional well-being is scarce. This study will generate new knowledge about the feasibility of running a definitive Forest School trial with Key Stage 2 (KS2) children aged between 7–11 inclusive of children with special educational needs and disabilities. Research Questions Is Forest School an acceptable and feasible intervention to improve the mental health of KS2 children? Is it feasible to run a cluster Randomised Controlled Trial (RCT) of Forest School for children in key stage 2 (aged 7–11)? Objectives 1. Test feasibility of trial procedures for recruitment, randomisation, and data collection 2. Conduct a mixed methods process evaluation to evaluate implementation and fidelity 3. Collect feasibility data to support an economic evaluation in a full trial 4. Refine the current logic model and optimise the intervention Methods In Work Package (WP) 1, we will conduct a feasibility cluster RCT of a Forest School intervention with 200 children in five schools across Hull, East Yorkshire, and North Yorkshire. We will test the acceptability and feasibility of intervention delivery, assess the feasibility of the trial processes, and establish key parameters for effectiveness. In WP2, we will evaluate the quality and fidelity of intervention delivery through process evaluation, including observations and qualitative interviews. WP3 focused on the preliminary collection of health economic data. WP4 uses focus groups to refine the logic model and optimize the content of the intervention. We seek to produce a manualised toolkit informed by interconnected work packages to inform further research and implementation. The trial was registered in ISRCTN (The United Kingdom’s Trial Registry). Clinical Trials Registration Number ISRCTN87263624. Patient and Public Involvement This proposal was developed with the active involvement of parents/guardians, children, and schools alongside key stakeholders from the local authority, education, and the community sector. Dissemination We will develop accessible presentations, online workshops with interactive elements, and newsletters. Producing a set of easily read infographics and creative outputs (video/social media) alongside our children’s Patient and Public Involvement (PPI) groups will be a key output. We anticipate that two publications in open-access peer-reviewed journals will share the quantitative and qualitative findings of the study.

Introduction Type 2 diabetes mellitus (T2DM) is two to three times more common in people with severe mental illness (SMI) than in the general population. Supporting self-management in diabetes is fundamental to improving clinical outcomes. The DIAMONDS trial aims to evaluate the clinical and cost effectiveness of a novel, codesigned, supported diabetes self-management programme for people with T2DM and SMI.Methods and analysis This multicentre, two-armed, parallel, individually randomised controlled trial will be conducted in National Health Service mental health trusts across England. We will recruit 380 participants (≥18 years old) with a diagnosis of SMI (schizophrenia, bipolar disorder, schizoaffective disorder, psychosis and severe depression) and T2DM. Eligible and consenting participants will be randomised to the DIAMONDS intervention or treatment as usual. The intervention group will receive one-to-one sessions with a trained DIAMONDS Coach for six months. These sessions will focus on goal setting, action planning and diabetes self-management education, supported by a paper-based workbook and an optional digital application. Individuals allocated to the control group will continue to receive usual care and may be offered National Institute for Health and Care Excellence-recommended generic diabetes self-management education programmes in line with usual practice. The primary outcome is the difference in glycated haemoglobin (HbA1c) between both groups at 12 months postrandomisation. The secondary outcomes include measures of physical and mental health, diabetes complications and physical activity. Economic and process evaluations will also be performed. Outcomes will be collected at baseline and at six and 12 month post-randomisation.Ethics and dissemination This study received ethics approval by the West of Scotland Research Ethics Committee 3 (22/WS/0117). Findings will be published in peer-reviewed, academic and professional journals. We will also be producing plain language summaries, infographics and audio summaries on the website, as well as attending conferences and dissemination events. A summary of the results will be distributed to all participants and other relevant stakeholders, and we will use social media channels, websites and knowledge exchange events to communicate our findings beyond academic audiences.Trial registration number ISRCTN22275538.

Introduction Compared with the general population, people with serious mental illness (SMI) are 2-3 times more likely to develop type 2 diabetes, have poorer outcomes, and die 15 to 20 years younger, often as a result of long-term physical health conditions. Standard diabetes care does not meet the needs of people with SMI and they are frequently excluded from research, missing out on innovation. As diabetes care increasingly uses technology like continuous glucose monitoring (CGM) it is important to consider the views of people with SMI when new interventions are developed. This is a study protocol to identify candidate components of a structured CGM intervention for people with SMI, including the co-design of a logic model and programme theory.Methods Drawing on experience-based co-design (EBCD) methods, we propose to collaborate with service-users, carers, and healthcare professionals to undertake early-phase development work for a novel intervention that maximises the potential of CGM to facilitate behaviour change. Fifteen participants will be recruited through existing cohorts and networks in England. The co-design will be informed by existing evidence and based on links between mechanisms of action and behaviour change techniques. Through a series of events (discovery sessions, co-design workshop, celebration event), we will identify candidate components for a prototype intervention ready for further development and testing. A logic model and programme theory will be developed and refined iteratively.Discussion The main output of this study will be a logic model and programme theory for a novel prototype intervention, ready for further testing following best practice intervention development, such as the Medical Research Council guidance for the development and evaluation of complex interventions. An intervention that makes CGM accessible for people with SMI has the potential to make a considerable contribution to reducing the profound health inequalities experienced by this population.### Competing Interest StatementThe authors have declared no competing interest.### Funding StatementYes### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:Department of Health Sciences, University of York, York, UK Research Governance Committee (HSRGC) approval obtained 9th April 2024. Reference number HSRGC/2024/616/GI confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesNo datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion.

Older adults are the fastest-growing and most sedentary group in society. With sedentary behaviour associated with negative health outcomes, reducing sedentary time may improve overall well-being. Adults aged ≥ 75 years are underrepresented in sedentary behaviour research, and tailored strategies to reduce sedentary time may be warranted. The development of an intervention to reduce sedentary behaviour in adults aged ≥ 75 years using co-production and behaviour change theory is reported. Four co-production workshops with community-dwelling older adults aged ≥ 75 years were held between October-December 2022. The intervention development process was informed by the Behaviour Change Wheel (BCW) and Theoretical Domains Framework (TDF). Audio recordings and workshop notes were iteratively analysed, with findings used to inform subsequent workshops. The co-production group consisted of six community-dwelling older adults aged ≥ 75 years and two researchers. The developed intervention consists of four components (activity monitoring, educational material, group sessions and researcher follow-up), maps to 24 behaviour change techniques and targets barriers to reducing sedentary time. Participants were receptive of the co-production process. Integrating co-production with the BCW can provide several benefits, with the BCW providing structure to the intervention development process, and co-production increasing the likelihood of the developed intervention being viewed as feasible by older adults. Furthermore, coding intervention components to the BCW may further our understanding of what approaches are successful at influencing behavioural change. Transparent reporting of the intervention development process may benefit researchers developing interventions with older adults. Future research will pilot the co-produced intervention.

Background Depression alongside multiple long-term conditions (MLTCs) in older adults poses a critical public health challenge, worsening physical and mental health and increasing healthcare costs. COVID-19 restrictions further exacerbated these impacts. Behavioural activation (BA) shows promise as a remote intervention for depression during isolation, but its cost-effectiveness for depressed, socially isolated older adults remains uncertain.Objective This study aimed to assess the cost-utility of BA versus usual care for older adults with depression and MLTCs during COVID-19 restrictions.Methods A randomised controlled trial recruited and randomised individuals aged 65 and over with depressive symptoms and MLTC (n=435) to either the BA intervention or usual care. Costs were measured from the perspective of the National Health Service and personal social services. Quality-adjusted life years (QALYs) were measured using the EQ-5D-3L at baseline, and 1, 3 and 12 months postrandomisation. Incremental cost-effectiveness ratios were calculated, with uncertainty addressed through non-parametric bootstrapping. Sensitivity analyses were conducted to assess the robustness of the primary analysis.Findings Primary analysis indicated that BA generated a small cost-saving (£62.34 per older adult; 95% CI: −£120.44 to £239.70) while QALY improvements remained unchanged (0.007; 95% CI −0.036 to 0.022) compared with usual care. The probability of BA being the preferred option is 0.71. Sensitivity analyses supported the primary analysis findings, confirming their robustness.Conclusions and clinical implications Compared with usual care, BA demonstrated a slight cost reduction while maintaining QALY improvement. The findings provide promise for BA interventions for older people with depression and MLTCs facing isolation.

Older adults are at risk of low mood and depression, which can be exacerbated by long-term physical health conditions, leading to poorer health outcomes and increased mortality. The restrictions on social mixing during the COVID-19 pandemic heightened these risks. BASIL+ (Behavioural Activation in Social IsoLation) was a pragmatic randomised controlled trial conducted with patients recruited from general practices in England and Wales. It was designed to assess the effectiveness of behavioural activation in mitigating depression and loneliness among older people during the COVID-19 pandemic. A behavioural activation intervention, within a collaborative care framework, was delivered by telephone. Participants were offered up to eight weekly sessions with trained BASIL+ Support Workers. A qualitative process evaluation (conducted within the BASIL+ trial), used one-to-one semi-structured interviews to explore the experiences of trial participants, caregivers and BASIL Support Worker experiences. Three main themes emerged from the data analysis: 1) Engagement Dynamic: from Altruism to Self-Realisation; 2) Changing Behaviour and Improving Mood; and 3) Synergistic Nature of the Intervention Components. Findings suggest that the intervention effectively fostered self-awareness among older adults, giving them the confidence and skills to address low mood. Participant engagement with intervention materials varied, highlighting the importance of flexibility in delivery. BASIL+ Support Workers acted as key facilitators, guiding participants through the intervention process, fostering understanding, and providing crucial support. The collaborative care element ensured participants received comprehensive and holistic support, promoting improved mental and physical well-being. These findings underscore the adaptability and flexibility of the BASIL+ intervention, demonstrating its potential to address mental and physical health problems among individuals with varying needs and different starting points. The BASIL+ trial is registered with the ISRCTN registry (ISRCTN63034289).

There is a strong body of evidence that points to the mental health and well‐being benefits of nature alongside a growing evidence based on the health and well‐being benefits of green social prescribing. Central to the UK government’s commitment to transform mental health services, seven successful ‘test and learn’ green social prescribing sites were identified across England, including the Humber and North Yorkshire green social prescribing programme. We used a cohort design to compare participants’ mental health and well‐being outcomes before and after exposure to nature‐based interventions offered via a referral from social prescribing organisations linked to the green social prescribing initiative. Data were collected between February 2022 and March 2023 using before and after questionnaires to determine the impact of green social prescribing on mental health and well‐being outcomes using ONS‐4 and Hospital and Anxiety Depression scales. In total, two hundred and twenty‐three participants from across Humber and North Yorkshire were included in the cohort evaluation. Survey data were analysed quantitatively using descriptive and multivariable analyses. After adjustments for deprivation and health status, larger benefits for improvements in well‐being were found to be associated with nature‐based activities with durations of nine to 12 weeks compared to those with durations of one to four weeks. Horticultural and care farming activities were also shown to be associated with some improvements in well‐being over nature‐based sports and exercise activities. We have undertaken the first longitudinal and quantitative evaluation of the NHS England green social prescribing “test and learn” programme across Humber and North Yorkshire. Our evaluation in Humber and North Yorkshire showed green social prescribing is beneficial for mental health and well‐being among community‐based adults, suggesting potential as a timely and relevant community‐based intervention to address the demand for mental health care in an era of high unmet need.

Introduction: Availability of green and blue space in the urban residential neighbourhood can reduce the risk of poor mental and physical health, however, little is still known about different types of urban green and blue spaces and their differential impact on individuals that have multiple physical and mental chronic health conditions. Methods: We conducted a cross-sectional study of 48,589 UK Biobank participants to analyse the relationship between exposure to seven types of urban green and blue spaces (parks, street trees, domestic gardens, total green space, inland blue space, proximity to coast and total green and blue space) with five multimorbidity outcomes: simple (2 long-term health conditions (LTCs)), complex (3 LTCs or 4+LTCs), cardio-metabolic, respiratory, and mental multimorbidity. Amount (% in 1500 m circular buffers) and proximity (Euclidean distance) of green and blue spaces in the residential neighbourhood were computed individually for each UK Biobank participant using remote sense data from European Urban Atlas. Analyses were adjusted for the Bonferroni correction for multiple testing to reduce the risk of false positive results. Sensitivity analyses were conducted by buffer size (300 m and 3000 m). Findings: Individuals that have a higher proportion of inland blue spaces in their residential neighbourhood had lower odds of multimorbidity. For every percent increase in the amount of inland blue space in 3000 m buffer, the odds of having complex multimorbidity (3LTCs) decreased by 3 % (OR:0·97; 95 % CI:0·95–0·98; p-value:0·0002) after applying the Bonferroni correction. In contrast, individuals with a higher amount of total green space within a 1500 m buffer had a higher risk of having 4+ LTCs (OR:1·01; 95 % CI:1·00–1·01; p-value:0.00005). Other types of green and blue spaces had no effect on our outcomes. Conclusion: Urban inland blue spaces, such as rivers and canals, are integral parts of life in UK but they have often been overlooked in observational health research. Future policy should aim to incorporate blue spaces in the design of urban regeneration and public health interventions.

Background:Child and adolescent mental health is a public health priority, and prevention, early intervention, and treatment are identified as national strategic priorities. Children and young people (CYP) in the United Kingdom are experiencing poorer mental health outcomes than ever, and the demand for services is the highest on record. Understanding the effectiveness of school-based interventions for promoting and developing emotional well-being is a core research priority. A school-based intervention that is inclusive and has the potential for widespread delivery is 'Forest School'. Forest schools provide children with immersive experiences in nature that are non-classroom-based and have a core focus on child-led activities and exploration. Despite widespread implementation, evidence about optimal delivery methods for Forest Schools and their impact on mental health and emotional well-being is scarce. This study will generate new knowledge about the feasibility of running a definitive Forest School trial with Key Stage 2 (KS2) children aged between 7-11 inclusive of children with special educational needs and disabilities. Research Questions:Is Forest School an acceptable and feasible intervention to improve the mental health of KS2 children?Is it feasible to run a cluster Randomised Controlled Trial (RCT) of Forest School for children in key stage 2 (aged 7-11)? Objectives:1. Test feasibility of trial procedures for recruitment, randomisation, and data collection2. Conduct a mixed methods process evaluation to evaluate implementation and fidelity3. Collect feasibility data to support an economic evaluation in a full trial4. Refine the current logic model and optimise the intervention. Methods:In Work Package (WP) 1, we will conduct a feasibility cluster RCT of a Forest School intervention with 200 children in five schools across Hull, East Yorkshire, and North Yorkshire. We will test the acceptability and feasibility of intervention delivery, assess the feasibility of the trial processes, and establish key parameters for effectiveness. In WP2, we will evaluate the quality and fidelity of intervention delivery through process evaluation, including observations and qualitative interviews. WP3 focused on the preliminary collection of health economic data. WP4 uses focus groups to refine the logic model and optimize the content of the intervention. We seek to produce a manualised toolkit informed by interconnected work packages to inform further research and implementation. The trial was registered in ISRCTN (The United Kingdom's Trial Registry). Clinical Trials Registration Number ISRCTN87263624. Patient and Public Involvement:This proposal was developed with the active involvement of parents/guardians, children, and schools alongside key stakeholders from the local authority, education, and the community sector. Dissemination:We will develop accessible presentations, online workshops with interactive elements, and newsletters. Producing a set of easily read infographics and creative outputs (video/social media) alongside our children's Patient and Public Involvement (PPI) groups will be a key output. We anticipate that two publications in open-access peer-reviewed journals will share the quantitative and qualitative findings of the study.

Importance Collaborative care is a multicomponent intervention for patients with chronic disease in primary care. Previous meta-analyses have proven the effectiveness of collaborative care for depression; however, individual participant data (IPD) are needed to identify which components of the intervention are the principal drivers of this effect. Objective To assess which components of collaborative care are the biggest drivers of its effectiveness in reducing symptoms of depression in primary care. Data Sources Data were obtained from MEDLINE, Embase, Cochrane Library, PubMed, and PsycInfo as well as references of relevant systematic reviews. Searches were conducted in December 2023, and eligible data were collected until March 14, 2024. Study Selection Two reviewers assessed for eligibility. Randomized clinical trials comparing the effect of collaborative care and usual care among adult patients with depression in primary care were included. Data Extraction and Synthesis The study was conducted according to the IPD guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. IPD were collected for demographic characteristics and depression outcomes measured at baseline and follow-ups from the authors of all eligible trials. Using IPD, linear mixed models with random nested effects were calculated. Main Outcomes and Measures Continuous measure of depression severity was assessed via validated self-report instruments at 4 to 6 months and was standardized using the instrument's cutoff value for mild depression. Results A total of 35 datasets with 38 comparisons were analyzed (N = 20 046 participants [57.3% of all eligible, with minimal differences in baseline characteristics compared with nonretrieved data]; 13 709 [68.4%] female; mean [SD] age, 50.8 [16.5] years). A significant interaction effect with the largest effect size was found between the depression outcome and the collaborative care component therapeutic treatment strategy (-0.07; P < .001). This indicates that this component, including its key elements manual-based psychotherapy and family involvement, was the most effective component of the intervention. Significant interactions were found for all other components, but with smaller effect sizes. Conclusions and Relevance Components of collaborative care most associated with improved effectiveness in reducing depressive symptoms were identified. To optimize treatment effectiveness and resource allocation, a therapeutic treatment strategy, such as manual-based psychotherapy or family integration, may be prioritized when implementing a collaborative care intervention.

Abstract Introduction Older adults are the fastest growing and most sedentary group in society. With sedentary behaviour associated with deleterious health outcomes, reducing sedentary time may improve overall well-being. Adults aged ≥75 years are underrepresented in sedentary behaviour research. This study aimed to qualitatively profile the sedentary behaviour of adults aged ≥75 years. This included ascertaining older adults’ understanding of sedentary behaviour; identifying the activities performed in sitting and standing and identifying the barriers and facilitators towards reducing sedentary time. Methods Four focus groups with community-dwelling older adults aged ≥75 years were held between October–December 2022. Audio recordings and workshop notes were transcribed verbatim and inductive and deductive thematic analyses were conducted. Results Six community-dwelling older adults with a mean age of 83 were recruited. Group members were largely unaware of their sedentary behaviour, and the risk associated with prolonged sedentary behaviour. The activities performed in sitting and standing, and barriers and facilitators to reducing sedentary time were charted to the Capability Opportunity Motivation-Behaviour (COM-B). Analytical themes explored sedentary behaviour throughout older adulthood, the influence of sedentary behaviour on sleep, and the importance of social connectedness to reduce sedentary time. Conclusions This study provided novel insights into older adults’ reports of sedentary behaviour progressing throughout older adulthood. Sedentary behaviour in adults aged ≥75 years present similarly to a younger subset of older adults with regards to the activities performed in sitting, and the barriers and facilitators to reducing their sedentary time. However, the activities performed in sitting may be performed for longer, and the barriers to reducing sedentary behaviour may present more frequently. Social support appears valuable when attempting to reduce sedentary time, however, further research is necessary to explore the views of older adults who are socially isolated.