Methodology reflection: strength and limitations

The methods implemented aimed to capture the full extent of the social prescribing system in Sheffield and the feasibility of implementing green prescriptions for university students. The initial context study use in this research provided a strong knowledge base in the pre-existing procedures and opportunities in Sheffield. This allowed the intervention stage of the research to be adapted to the location and university context. The original intention was adapted to include a green prescription from the nationwide rather than local initiatives and the intervention used nearby university green space.

Capturing the experience

To answer the research questions; (2) How do a walking intervention and an app intervention in urban

nature compare in terms of their effect on student wellbeing? and (3) How did participants experience these interventions? It was important that this mixed method approach captured the entire experience;

both through the outcome measures and from the participants’ perspectives. As found in the literature review there is a great deal of variety within the social prescribing sector, from the funding systems through to the interventions themselves. Capturing the detail of this variation in Sheffield was achieved in this research through the detailed expert interviews and the comparison with Rotherham’s system. To understand the opportunity for social prescriptions amongst the university student population, value and attention was given to the participants’ evaluation of the experience alongside the outcome measures. A priority within this research was understanding the experience of the green prescription style

intervention from the perspective of university students. The range of participants (reflected through course, age and ethnicity) involved in the research, and the extensive use of focus groups, allowed for the variety of experiences to be captured. The dedication to the focus group data and the grounded theory approach to identifying emergent themes allowed findings to emerge iteratively over the course of the research. Grounded theory uses a reflect and adapt approach to allow the emerging themes to be comprehensively covered (Sbaraini et al., 2011). A limitation of implementing the theory within this thesis is the restriction on time and resource may have meant that saturation was not met. Capturing the participants’ experience was also achieved through being adaptive in allowing participants to complete the survey if they were unable to attend a focus group.

143 A strength of this research is that it allowed for comparison between the outcome measures and the participant’s experience of the intervention. It is this comparison that revealed some of the more interesting dimensions of this research. As discussed further in chapter seven, the variation between the statistical outcome measures (chapter five) and the qualitative data from the focus groups (chapter six) changed the narrative of this thesis. An opportunity to further explore this research development would be provided by a closer examination of an individual’s accumulated data across the study from

understanding the pathway the participants took to signing up (leaflet, society approach or email advert) through to their change over the course of the intervention and finally their reflection on the experience. This was not a consideration during the design of this research and therefore the process of maintaining anonymity of the participants (limited personal details collected at expression of interest, registers of walk and focus groups were destroyed after use) resulted in this being unachievable.

To further test the effect of green prescriptions on individuals with a low nature connection it would be beneficial to repeat the study with additional participants (to increase opportunities to reach statistical significance) and to collect nature connection scores at the point of sign up. This would allow the researcher to predispose the composition of the study group more reliably towards those who are less likely to participate in this research area, which is important as this represents a current knowledge gap within the literature.

Overall, this research captured a detailed account of the opportunity for green prescriptions amongst university students. In providing this level of detail it also allowed additional themes to develop. An unpredicted highlight of the findings from the data was the opportunity to give attention to design details of green spaces on campus.

Context study

The context study was required as the information sought was not readily available through literature review. The conduct of expert interviews provided a detailed account of the principles and systems behind the social prescribing offer in Sheffield and Rotherham. The interview with VAR portrayed a different system and illustrated the challenges faced by the incoming social prescribing academy in standardising the offer nationwide. It was important to understand the current system in Sheffield in order that the implementation of green prescriptions for university students could be considered within this. Current provision of mental health services to university students includes the opportunity to refer on to NHS primary care. It was the original intention to use a green prescription similar to those found in Sheffield as the comparative intervention to the app. As none were found, an alternative was

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Intervention study

The second part of this research aimed to test the effectiveness of two styles of intervention for university students. The mobile phone app and a walk based intervention provided opportunities to engage with and notice nature. Group two (App Walk) was expected to be the most effective group as it included an opportunity to engage with nature, have social interaction and take part in the app as a meaningful activity to engage the participants with nature every day. The addition of the Shmapped (group four) based data provided a comparison which removed the time restriction, thus reducing the influence of the university timetable and the weather. This group also had reduced level of researcher influence. The walk group also provided a good group comparison, but for the opposite reason, in that they undertook the study at exactly the same time and experienced different outcomes as discussed. The findings of the previous literature on nature connectedness (NR-6) being positively associated with wellbeing (ReQoL) were not supported in the statistical analysis in this thesis, suggesting further research is required to increase sample sizes for robustness and account for the confounding factors affecting university students’ wellbeing.

Mobile phone app

The mobile phone app functioned as a research tool that was accessed easily by most of the participants. A small number of people were unable to participate due to the lack of a suitable smartphone (Windows operating system was not compatible). Some participants experienced a flaw in the design which it was not possible to rectify (screenshot available in appendix E). The clustering of data around a single point often represented the home location for the participants as it was common across the study for

participants to enter their answers once at home. This is worth considering from the point of views of its design as a research tool. To engage with the natural environment required the participants not to be distracted by their phone, and as mentioned in one focus group the notification alert distracted them, therefore they were likely to silence the app. This reduced the ability of researchers to pinpoint the actual locations the participants were noticing and therefore, deduce participants’ responses to different urban green spaces. The use, perception and effects of green space are factors that can be studied using a mobile phone app, however there was some reservations from the participants about being tracked regularly and the battery draining effect of having the GPS on so often.

A dimension of the research methods were reliant on the app design. The negotiation between function for participants and function as a research tool is a challenge in this method. Participants doubted the appeal of the app beyond being a research tool. As discussed by Andrachuk et al. (2019), as a research method the use of an app is limited by budget and at the mercy of operating system updates. The system is also vulnerable to data loss through phone signal and the storage cloud. It is not possible to know

145 where the data was lost in the case of this study. To conclude, mobile phone apps as a research method have exciting possibilities to engage with large cohorts, but there can be unexpected technical challenges with this method.

Walking

As previous studies have found, as a research method walking allowed the researcher in this intervention study to be alongside the participants, which reduced the researcher-participant hierarchy and created a shared experience, as reflected on in chapter 6 (Pink et al., 2010). Walking provides a common

experience of exploring the landscape being travelled through (Medford, 2018). The public parks that formed the settings for the group walk were dynamic and changing environments. There were

unpredictable conditions and events stemming from the weather and other park users. For example, one morning it snowed, and during another walk two people in the park had a loud argument next to the path the group walked along.

Seven days is a limited time frame to have a long-term effect on a participant’s daily habits. This may have limited this intervention’s ability to create a behaviour change, which would be evident in the day 30 results. The opportunity may instead lie in timetabled opportunities to visit the natural environment, or maps detailing urban green space walks students could undertake near the campus and student residential areas. Participants commented on their time constraints and these time priorities became apparent as from discussed in the cancellation of walk attendance. A walk intervention would have to be able to mitigate for the time pressures university students experience.

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