# How can funding for nature-based programmes impact health inequalities? A realist protocol

## TL;DR

This study explores how funding sources for nature-based health programs might affect health inequalities and how to design equitable programs.

## Contribution

The novel contribution is a realist protocol to understand how funding influences health equity in nature-based programs.

## Key findings

- Funding sources may influence who accesses nature-based programs.
- Inappropriate program design could worsen health inequalities.
- The study will develop strategies to equitably design and deliver these programs.

## Abstract

Nature-based programmes facilitate access to group-based structured activities that take place in the natural environment. These programmes have been found to improve the health and wellbeing of participants. However, downstream individualised interventions can be associated with intervention-generated inequalities. There is a concern that if nature-based programmes are not designed and delivered appropriately, they could worsen health inequalities. Many nature-based programmes are either reliant on charitable funders or public sector funding. It is likely that the source of funding will have consequences for who the programme is for and who is able to access the programme. However, there is a lack of robust understanding of how the funding system contributes to the outcomes of nature-based programmes.

The aim of this project is to explore what is known about the impact funding of nature-based programmes can have on health inequalities, primarily through impacts on the targeting of, and recruitment to the activities. Secondary and primary data will be used to develop, refute and refine programme theory. Initial programme theories will be developed through scoping the literature and theory gleaning qualitative interviews. These theories will be tested and refined through a realist review of evidence and further qualitative realist testing interviews.

This project aims to inform practical strategies and frameworks (underpinned by programme theory) to help programme funders, designers and implementers understand how to design and deliver their programmes as equitably as possible.