Abstract
<title>Abstract</title> <p> <bold>Background:</bold> Green prescribing (referral to non-clinical outdoor interventions to improve health or wellbeing) has been shown to benefit participants’ physical and mental health. One unintended consequence, however, has been the widening of health inequalities due to difficulties experienced by some groups in accessing or engaging with these interventions. While inclusion health groups (those who experience ‘multiple, interacting risk factors for poor health’ for example people experiencing homelessness or the prison population) could be expected to gain significantly from green prescribing interventions, they potentially face significant additional barriers in accessing and engaging with green prescriptions. <bold>Objectives</bold> To develop a protocol to systematically search and thematically synthesise qualitative primary studies that investigate barriers and facilitators to accessing and engaging in green prescribing interventions for people from inclusion health groups. <bold>Methods</bold> A search will be conducted in APA PsycInfo, Cochrane Central Register of Controlled Trials, Cumulated Index to Nursing and Allied Health Literature, BASE, Web of Science, SCOPUS Preview, Medline, Applied Social Sciences Index and Abstracts and Embase. Search terms will cover green prescribing, health and wellbeing, and inclusion health groups. Abstracts will be extracted into Covidence and screened for eligibility prior to full text screening. Inclusion criteria are empirical studies with some qualitative reporting of results exploring an intervention involving green prescribing with participants from inclusion health groups. Studies will be excluded if there is no empirical element, if only quantitative findings reported, or if the intervention was entirely indoors. Papers will be assessed for quality using the CASP qualitative checklist. A thematic synthesis of results of relevant papers will be undertaken in NVivo 14 and analytical themes will be developed and synthesised. <bold>Discussion:</bold> The output of this systematic review will help to identify barriers and facilitators to accessing and engaging in green prescribing and could have a role in finding targets to address health inequalities in those facing the largest social gradients in future interventions. Barriers faced by inclusion health groups mean that green prescribing may exacerbate rather than help existing gradients in health, and this review could help to identify and guide future research aiming to reduce those barriers. Systematic review registration: Prospero CRD420251153101 </p>