How to implement nature-based interventions in hospitals, long-term care facilities for elderly, and rehabilitation centers: A scoping review

Healthcare settings are increasingly adopting nature-based interventions (NBIs) to support users' health and well-being, but these interventions are often underutilized. To get a grip on utilization problems, insight into factors that affect use and uptake of NBIs in routine care is needed. This scoping review aimed to provide an overview of factors that facilitate or impede successful implementation of NBIs in hospitals, long-term care facilities for the elderly (LTCF), and rehabilitation centers. Systematic searches were conducted across various databases to identify studies that collected qualitative and/or quantitative data on the implementation of NBIs in healthcare settings. Findings were classified into the five domains of the Consolidated Framework for Implementation Research. A total of 57 articles were included in the review. The articles provide detailed insight into facilitating and impeding implementation factors related to the intervention (e.g., awareness, adaptability, type of natural elements, accessibility, safety, weather conditions, comfort, privacy, supportive design factors, activities). Other found factors related to the inner setting (e.g., culture, implementation climate) and individuals (e.g., characteristics and opportunities of stakeholders). Factors related to the outer setting (e.g., financing) and implementation process (e.g., teaming, assessing needs, planning, engaging, doing, integration in care and therapy, reflection and evaluation, maintenance) also emerged, but to a lesser extent. This review identified a broad range of factors important for the successful implementation of NBIs, which can guide implementation of future NBIs. To complement these findings, future studies should consider conducting implementation studies.