Development of the GreenIF: A Framework to Identify Implementation Factors for Nature-Based Interventions in Healthcare Settings

Nature-based interventions (NBIs) in healthcare settings have the potential to enhance physical and mental wellbeing of patients, healthcare staff, and visitors but are often underutilized. Knowledge about factors influencing effective implementation of NBIs in healthcare settings is scarce. This study aimed to develop a framework for identifying implementation factors relevant to NBIs in hospitals, long-term care facilities for elderly, and rehabilitation centers. A two-round Delphi study was conducted. In the first round, potential implementation factors were identified based on input from 33 experts from the following groups: healthcare managers, landscape designers, nature and health consultants, and healthcare staff. These factors were then supplemented with additional factors identified from previous studies and the Consolidated Framework for Implementation Research (CFIR). In the second round, 21 experts rated the importance of these factors. The items that reached expert consensus were included in the new implementation framework. In the first round, an initial set of 99 implementation factors was identified. Most factors derived from experts and literature were design related. These factors were complemented with factors derived from the CFIR. In the subsequent round, 98 implementation factors were considered important by experts and retained. These factors were incorporated into a new framework, the Green Implementation Framework (GreenIF). The GreenIF provides an overview of factors that contribute to the successful design and implementation of NBIs in healthcare settings and can be used to enhance their usage and maximize their benefits.