Table 4 Final consolidated programme theories and corresponding CMOcs shown as ‘if-then-because’ statements
Programme Theory Theme | Programme Theory Name | CMOc shown as an ‘if-then-because’ statement |
|---|---|---|
Nature | Escape and getting away | If there is easy access to a quality greenspace environment with a planned programme, then mental wellbeing will be improved and stress will be reduced, because of feelings of ‘being away’, being present, reduced rumination, feelings of awe, and a connection to nature. |
Nature | Space to reflect | If there is greenspace to provide physical space and a neutral, non-clinical backdrop for therapeutic conversations then, as long as there is adequate time spent on the programme, this results in increased discussion and opening up, because clients no longer feel ‘boxed in’ and confined, and they have space to reflect. |
Individual self | Physical activity | If there are a variety of activities available, and programmes have the right resources such as staff and equipment suitable for poor weather, and if clients have enough time on the programme, then this will lead to increased engagement and improved physical and mental health, because clients will enjoy the activities they do. |
Individual self | Self-efficacy | If there are available, trained facilitators to lead programmes, and the programme environment is supportive, and if clients have enough time on the programme, then clients will learn new skills and be more confident in applying skills to their lives outside of the programme, because of increased feelings of empowerment and confidence from learning new skills or relearning old skills. |
Individual self | Having a purpose | If a programme provides structure and routine and provides a person-centred focus, then the self-esteem of clients will increase, because of an increased sense of purpose and changes in self-identity. |
Social self | Relationships with facilitators | If a programme has a ‘doing with’ and not ‘doing for’ culture, is trauma-informed, is of adequate length, and if facilitators are from a range of backgrounds, then clients are more like to engage with, and buy into programmes, because there is decreased power imbalance, increased communication and feelings of trust and safety, and clients feel respected. |
Social self | Increased communication through shared experiences | If the greenspace programme provides an enabling environment, in comparison to typical treatment environments, and if there are trained facilitators to guide group dynamics and interactions with peers, then this leads to improved relationships with peers and others, because of increased communication through shared experiences. |
Social self | Reduced isolation | If the greenspace programme provides an enabling environment, in comparison to typical treatment environments, and if there are trained facilitators to guide group dynamics, then isolation is reduced and clients integrate and ‘reconnect’ back into their community, because there is increased understanding of others and decreased stigma and judgement. |
Macro-level | COVID-19 impact | If COVID-19 and related restrictions exist, then mental wellbeing is reduced, because programmes are unable to provide the same level of support and there is reduced trust of programmes and reduced feelings of hope for the future in clients. |
Meso-level | Intervention approach | If programmes have an explicit focus and a multidisciplinary team approach consisting of the right expertise, then clients will feel satisfied with the programme and will be more likely to commit to the programme, because they feel adequately supported. |
Meso-level | Stakeholder buy-in | If there is funding available to support the continuation of programmes, if programmes have clear objectives and outcome measures, and if wider stakeholders (such as funders or those signposting onto programmes) have experience or knowledge of the benefits of greenspace, then this will lead to stakeholder buy-in, because they will believe the programmes are worthwhile. |