Barriers and enablers to engagement with green social prescribing in primary care: a scoping review using the socio-ecological model

Background Green social prescribing (GSP) connects individuals with nature-based interventions (NBIs) through healthcare providers, link workers, and social and community networks. While evidence supports the health benefits of NBIs, further research is needed to understand the factors that influence engagement. Aim To explore barriers and enablers to GSP and NBIs for prescribers, service users and community providers. Design & setting A scoping review in primary care and community settings. Method We systematically searched Medline, Embase, CINAHL, Web of Science, and SCOPUS from 2019. We assessed quality using the Critical Appraisal Skills Programme and the Mixed Methods Appraisal Tool. We mapped data to the socioecological framework during synthesis. Results Out of 4864 screened records, 45 studies from 11 countries were included. GSP and NBIs face micro-level barriers such as knowledge gaps, cultural and social issues, time and cost constraints and perceptions of adverse weather; meso-level and macro-level challenges include unequal access, underfunded NBIs, an emphasis on biomedical models, safety concerns, limited training, and insufficient policy support and leadership. Engagement was enabled by flexible, person-centred approaches, tailored NBIs with clear pathways, including link workers, strong cross-sector partnerships, community co-design, and public health campaigns. Conclusion Promoting engagement with GSP and NBIs requires a multi-level approach that addresses systemic barriers through collaboration between prescribers, third-sector organisations and policymakers. Investment in workforce training and sustainable funding models is critical to support long-term success in primary care and community settings. Addressing health inequalities by improving access for people in areas of high socioeconomic deprivation remains a priority.