Nature-Based Social Prescribing in Viet Nam: Where Could Green and Blue Activities Add Value, and What Would Safe Implementation Require?

Nature-Based Social Prescribing in Viet Nam: Where Could Green and Blue Activities Add Value, and What Would Safe Implementation Require?

Category: Implementation & Practice

A person recovering from a prolonged illness tells a healthcare professional that they would like to spend more time outdoors and reconnect with others. Before becoming ill, they enjoyed gardening and occasionally joined friends for walks. They are now medically stable but have lost confidence in returning to those activities. A nearby community group organizes gardening sessions and short walks, and the person is interested in joining.

Would a referral to one of these activities be appropriate?

The answer depends on more than whether spending time outdoors is generally considered beneficial. The person's health, functional abilities and preferences matter, as do the accessibility of the activity, conditions at the venue and support available if something goes wrong. A short gardening session in an accessible community space is very different from a long walk across difficult terrain or an activity involving open water.

This is where Nature-Based Social Prescribing deserves careful consideration. The approach seeks to connect people with appropriate non-clinical activities involving natural environments, often through healthcare, social-care or community navigation pathways. These connections may offer opportunities for meaningful participation, social relationships and well-being, but their value depends on how the activities are selected, organized and experienced.

For Viet Nam, the possibilities are varied. Urban parks, community gardens, public green spaces, riverside areas, coastal environments and other natural settings may provide opportunities for community participation. However, their availability does not automatically mean they are appropriate for social prescribing. An attractive natural environment is not necessarily a safe or accessible one.

The central question is therefore when a nature-based activity is an appropriate response to someone's needs, what conditions should be in place before a referral is made, and how healthcare and community partners can evaluate the experience without claiming benefits that the evidence has not established.

What makes an activity Nature-Based Social Prescribing?

Nature-Based Social Prescribing is often discussed alongside Green Social Prescribing, and the two terms are sometimes used with overlapping meanings. Definitions vary internationally, but the central idea is to connect people with suitable community activities involving natural environments.

These activities may take place in green spaces, such as gardens, parks and other vegetated areas, or in blue spaces associated with water, including rivers, lakes, wetlands and coastal environments.

Green activities may include community gardening, horticulture, conservation volunteering, guided nature engagement or suitable group activities in parks. Blue activities may involve supported experiences near water, waterside walking, environmental education or, where appropriate and safely organized, activities on or in water.

The distinction matters because the requirements and risks can differ considerably. Someone attending a gardening session may need accessible seating, shade and suitable tools. A person joining a guided walk may need a manageable route, opportunities to rest and reliable transportation. Swimming, boating and other activities involving direct contact with water introduce additional hazards and may require specialist supervision and equipment.

Nature-Based Social Prescribing should also be distinguished from ordinary recreation and general health promotion.

Someone who independently walks through a park may enjoy the experience without participating in social prescribing. A public campaign encouraging outdoor activity is not necessarily a referral or navigation pathway. Similarly, a community gardening group does not automatically become a healthcare-related service because some of its members have health conditions.

Social prescribing involves an intentional connection between a person's needs and an appropriate community resource. Depending on the model, this may include a conversation about what matters to the individual, consideration of practical barriers, an introduction or referral, navigation assistance and proportionate follow-up.

The activity itself remains non-clinical unless it is separately organized and delivered as a clinical or other regulated professional service.

Nature is the setting or component of the activity. Social prescribing is the process through which someone is connected with suitable support. The two should not be treated as interchangeable.

What does the international evidence actually tell us?

Research on Nature-Based Social Prescribing has expanded, but the evidence remains heterogeneous. Programs differ in their participants, activities, referral arrangements, facilitation, duration and outcome measures.

A scoping review by Kenyon and colleagues, published in Social Science & Medicine in 2026, examined how connection to nature is conceptualized, measured and incorporated into Nature-Based Social Prescribing.

The review identified 21 eligible publications from literature published between 2016 and 2025. These covered several types of research, including reviews, gardening and horticulture interventions, green care, and structured nature engagement or educational activities.

Across the literature, connection to nature was associated with potentially favorable psychological and social experiences, including improvements in mood, confidence, stress-related outcomes and social connectedness.

However, the authors identified important limitations in how connection to nature was defined and measured. Some studies relied heavily on qualitative accounts, while others did not clearly distinguish the experience of connecting with nature from the effects of physical activity, social interaction, learning new skills or receiving support from facilitators.

This distinction is important when interpreting reported benefits. If someone feels better after joining a gardening group, the improvement may relate to working with plants, meeting other people, developing a regular routine, receiving encouragement or a combination of these experiences. The research does not automatically establish which component produced the change.

The Kenyon review therefore provides useful reasons to examine connection to nature as part of program design and evaluation. It does not establish that nature exposure alone explains the benefits reported in these programs.

An earlier implementation-focused study by de Bell and colleagues, published in Environment International in 2024, examined opportunities and challenges through a participatory process involving researchers, practitioners and policymakers from the United Kingdom and Germany.

The authors identified five broad areas requiring attention: capacity building; accessibility and acceptability; networks and collaborations; standardized implementation and evaluation; and sustainability.

These findings are relevant to planning, but the study was not a clinical effectiveness trial. Its contribution lies in examining the organizational and practical conditions under which Nature-Based Social Prescribing may be developed.

Together, these reviews suggest that nature-based programs are worth investigating. They do not justify treating every outdoor activity as an effective health intervention or assuming that the presence of natural surroundings is sufficient to produce meaningful outcomes.

What have recent randomized trials added?

Two randomized controlled trials published in 2026 provide particularly useful evidence because they examined defined nature-based interventions with comparison groups.

The first is the RECETAS-BCN trial, published online in August 2026 in The Lancet Regional Health – Europe. The study recruited 320 adults experiencing loneliness from 12 neighborhoods with relatively low socioeconomic conditions in the Barcelona metropolitan area.

Participants were randomly assigned to two different Nature-Based Social Prescribing pathways.

The intervention group participated in Friends in Nature, a facilitator-led program involving weekly group sessions over nine weeks. The program combined peer support and group processes with nature-based activities selected according to participants' preferences.

The active-control group received an individual motivational interview and information about accessible nature-based activities through active signposting.

At the primary three-month assessment, loneliness had decreased in both groups, but there was no statistically significant difference between them. The trial also found no statistically significant improvement in health-related quality of life.

An important implementation finding was that fewer participants withdrew early from the facilitator-led group than from the active-control group: 14% compared with 28%. However, the researchers noted that disappointment with the assigned study group contributed to withdrawal, particularly among active-control participants. This difference should therefore not be interpreted simply as proof that the facilitated model always achieves better engagement.

Exploratory analyses suggested that participants with greater loneliness and poorer emotional well-being at baseline may have benefited more from the facilitated approach. These findings are relevant to tailoring support, but they require further confirmation.

The trial offers an important lesson: a more intensive, facilitator-led intervention is not automatically more effective than a lighter approach for every participant.

Because both groups received some form of nature-based social-prescribing support, the trial also cannot establish how either approach would compare with usual care or no such support.

The second study, the RECETAS Friends in Nature trial in Helsinki, was published by Pitkälä and colleagues in Age and Ageing in February 2026.

The trial involved 319 older adults experiencing loneliness who lived in assisted living facilities in Finland. Of these, 162 were assigned to a nine-week nature-based group intervention and 157 to usual care.

The participants had substantial support needs. Their average age was approximately 83 years, 66% were living with frailty and 55% had dementia.

At three months, loneliness had decreased significantly more in the intervention group than in the usual-care group. The study also reported favorable findings concerning sleep during follow-up, although overall health-related quality of life did not improve significantly. The difference in loneliness became less pronounced over longer follow-up periods.

A secondary analysis from the same trial, published in the Journal of the American Medical Directors Association in 2026, examined cognition, connection to nature and self-efficacy. At three months, the intervention group showed a more favorable change on a clock-drawing measure and in connection to nature compared with controls. However, there was no corresponding improvement in verbal fluency or self-efficacy, and the cognitive difference diminished at later assessments.

These secondary findings are worth noting, but they should not be interpreted as evidence that Nature-Based Social Prescribing prevents dementia, slows cognitive decline or provides effective cognitive treatment.

The Helsinki findings are encouraging, particularly for older adults living in supported residential environments. However, the Helsinki and Barcelona trials examined different populations and used different comparison groups. One involved older adults in assisted living facilities compared with usual care, while the other involved community-dwelling adults compared with an active signposting intervention.

Their findings should not be treated as contradictory or used to conclude that one particular model will work for everyone.

Neither trial can isolate the effects of exposure to nature from the other components of the intervention, including group participation, facilitation and opportunities for social interaction.

For Viet Nam, the practical implication is that the level of navigation and facilitation should reflect the person's needs, rather than an assumption that more intensive support is always better.

What does the latest research tell us about long-term outcomes?

A further study published by Papon and colleagues in Frontiers in Psychology on 8 October 2026 adds a useful but different perspective.

The researchers developed a decision-analytic model using data from the RECETAS-BCN trial and other epidemiological sources to estimate possible long-term outcomes of facilitator-led Nature-Based Social Prescribing compared with active signposting in Spain.

The model projected more favorable outcomes for the facilitated approach in terms of life expectancy, quality-adjusted life years and time spent with reduced loneliness.

However, these results were model-based projections, not long-term benefits directly observed in the trial.

The estimated benefits depended on assumptions about how long reductions in loneliness would last, whether loneliness would recur and how loneliness relates to subsequent health outcomes. The researchers also acknowledged uncertainty associated with missing trial data and differences in dropout between the groups. Credible intervals for the estimated incremental benefits included zero.

This distinction is particularly important because the original Barcelona trial did not demonstrate a statistically significant difference between groups in loneliness at its primary three-month endpoint.

The new modeling study suggests that longer-term benefits remain possible under certain assumptions, but it does not overturn the primary trial findings or establish that the facilitated model will produce those outcomes in practice.

For Viet Nam, the study reinforces the importance of collecting credible follow-up data rather than assuming that short-term changes will translate into sustained health improvements.

Blue activities require their own evidence and safety assessment

Nature-Based Social Prescribing is sometimes discussed as though green and blue activities form one relatively uniform category. In practice, the evidence, physical demands and implementation requirements can differ considerably.

A systematic realist review by Alejandre and colleagues, published in Health & Social Care in the Community in 2023, examined contextual factors and program theories associated with Blue Prescription Programs.

The review included 16 studies and explored how activities involving blue environments may be introduced through health and social-care referral arrangements.

The authors identified factors influencing participation and implementation, including individual circumstances, accessibility, transportation, equipment, suitable environments, provider skills, communication and collaboration between organizations.

These findings offer useful insights into how blue-space programs may operate. However, they do not establish that every form of participation near water produces reliable health benefits.

A quiet walk along an accessible lakeside path is very different from swimming, kayaking, surfing or fishing from a boat. All may involve blue environments, but their physical demands, supervision requirements and safety risks are not equivalent.

Even activities that remain on land can differ considerably. A well-maintained public path beside a lake may be suitable for some people, while an exposed riverbank, unstable shoreline or area subject to sudden changes in water level may not be.

The label blue prescribing should therefore never replace an assessment of the actual activity and environment.

For an early Vietnamese program, activities near water that do not require entering the water may offer a more manageable starting point than swimming or other water-based recreation, provided that the location and activity have been assessed appropriately.

This is a practical implementation consideration, not evidence that land-based blue activities are clinically more effective.

When might a nature-based referral be appropriate?

The starting point should be the person's needs, interests and circumstances, not simply the availability of an attractive park or organized outdoor activity.

Someone may want to rebuild confidence after illness, reconnect with friends, establish a regular activity outside the home or return to a previously valued interest such as gardening.

Nature-Based Social Prescribing may be worth discussing when the person's goals are compatible with a suitable non-clinical activity and any relevant health, functional or practical considerations can be addressed.

For example, an older adult who enjoys plants but has difficulty standing for long periods may prefer a short gardening session with accessible seating rather than an extended walking group.

Another person may prefer a quiet guided nature activity over a large social gathering. Someone who values companionship may enjoy participating in a regular group, while another may be more interested in observing wildlife or learning about the local environment.

These preferences should guide the proposed connection.

Someone who dislikes gardening should not be encouraged to join a gardening group simply because it is described as therapeutic. Nor should a person with limited mobility be expected to complete a demanding walk to demonstrate positive engagement.

Care navigation may add value when someone wishes to participate but faces barriers involving information, confidence, transportation, accessibility or unfamiliarity with the activity.

Where a person can independently access a suitable activity, a formal referral or extended navigation process may add little value.

Participation should remain voluntary, and people should be free to change their minds when an activity does not meet their expectations.

A referral should create access to something the person finds worthwhile. It should not turn outdoor participation into another requirement that they feel pressured to fulfill.

When should professional healthcare remain central?

Nature-Based Social Prescribing must not replace appropriate healthcare assessment, treatment or rehabilitation.

A person with new or worsening symptoms, an unstable medical condition or significant functional limitations may require professional assessment before undertaking particular activities.

For example, someone experiencing unexplained breathlessness, chest pain, dizziness or recurrent falls should not simply be directed to a walking group as a response to those problems.

Similarly, someone recovering from surgery or a significant illness may need individualized rehabilitation advice before participating in activities involving substantial physical exertion.

The relevant question is not whether someone has a medical diagnosis. Many people living with long-term conditions can participate in appropriate community activities without requiring unnecessary restrictions or repeated medical clearance.

What matters is whether the proposed activity is suitable for the person's current condition, abilities and goals, and whether professional assessment is indicated by the circumstances.

Where clinical care or rehabilitation is required, community participation may complement that care but should not be presented as an equivalent substitute.

Serious psychological distress also requires appropriate professional attention. A nature-based group may provide social opportunities, but it should not be expected to deliver specialist mental-health treatment or manage a crisis beyond the competence of its facilitators.

Community organizations should understand the limits of their role. A walking-group leader, gardening facilitator or environmental volunteer does not automatically become responsible for clinical decisions because a participant was referred through healthcare.

The aim is to connect people with suitable community experiences while keeping clinical responsibility with appropriately qualified professionals.

Environmental conditions can change the suitability of an activity

One important difference between nature-based activities and many indoor community programs is that outdoor conditions can change substantially between sessions.

A route that was comfortable during one visit may become unsuitable because of extreme heat, poor air quality, heavy rain, flooding or damaged surfaces.

In Viet Nam, outdoor activities may be affected by high temperatures and humidity, thunderstorms, storms, flooding and seasonal variations in local environmental conditions. The timing and severity of these hazards differ considerably between regions.

The World Health Organization's updated Heat and Health fact sheet, published in July 2026, emphasizes that extreme heat can worsen existing health conditions and increase the risk of heat-related illness. Older adults, people with certain chronic conditions and individuals exposed to prolonged outdoor activity may face greater risks.

For a nature-based program, these risks have practical implications.

A walking activity may need to be scheduled outside the hottest part of the day, with suitable access to shade, drinking water and opportunities to rest. A gardening session may need to be shortened, moved to a safer setting or postponed when heat conditions become unsuitable.

A program should not continue simply because participants have already been referred and the activity appears on a fixed schedule.

Air quality requires similar consideration. A park may contain trees and appear attractive while outdoor air pollution remains unsuitable for some participants, particularly those with respiratory or cardiovascular conditions.

The presence of green space does not automatically mean that air quality is good.

Organizers should therefore consider relevant local weather warnings, available environmental information and the circumstances of participants before deciding whether an activity can proceed.

The same principle applies to rainfall, thunderstorms and flooding. Walking routes, riverbanks and outdoor meeting places may become hazardous even when they were previously considered suitable.

Environmental assessment should not be a one-time exercise completed when the program begins. It should inform decisions about whether activities remain appropriate under the conditions expected on each occasion.

A responsible program also needs practical arrangements for changing or canceling activities when conditions become unsafe. These should be understood by the organizers and communicated clearly to participants before the program begins.

Depending on the circumstances, an alternative may involve rescheduling, selecting a different suitable activity or informing participants that the session cannot proceed safely.

Flexibility is part of responsible implementation, not evidence that the program has failed.

Activities involving water need additional safeguards

Blue-space activities deserve particular attention in Viet Nam because of the country's extensive coastal, riverine and other water environments.

However, proximity to water introduces hazards that may not be present in a conventional community garden or accessible public park.

These can include drowning, unstable banks, slippery surfaces, sudden changes in water level, strong currents, tides, contaminated water and difficulties obtaining emergency assistance.

The risks differ according to whether participants remain on an established path, approach the water's edge or take part in activities on or in the water.

A group observing a river from a suitable, designated public area may require relatively straightforward arrangements concerning route selection, accessibility and supervision.

By contrast, a program involving swimming, boating or other direct water activities requires more demanding consideration of participant suitability, equipment, competent supervision, rescue arrangements and applicable regulations.

A healthcare referral does not authorize an organization to provide activities that it is not otherwise permitted or competent to deliver.

For an early Nature-Based Social Prescribing initiative, it would be sensible to avoid selecting high-risk water activities simply because they appear attractive or distinctive.

Blue-space participation can also involve less demanding experiences, including suitable waterside observation, environmental education or guided activities in accessible areas near water.

Even then, the suitability of the specific location must be assessed. A public waterside area is not automatically safe because it is popular or frequently visited.

The purpose should be meaningful participation, not exposure to unnecessary hazards.

Accessibility involves more than the natural environment

Selecting an appropriate location requires understanding the entire experience from the participant's perspective.

A community garden may be attractive but difficult for someone who needs accessible toilets or appropriate seating. A walking route may be scenic but unsuitable for people using mobility aids. A park may be publicly accessible but difficult to reach without affordable transportation.

Even a relatively simple outdoor activity may require consideration of shade, drinking water, sanitation, surface conditions, rest opportunities and access to assistance when needed.

Organizers should also understand the actual requirements of the activity.

A short guided walk on a level path should not be presented in the same way as an extended hike. A gardening activity involving digging and lifting is different from a seated horticultural session.

Accurate information allows participants to make meaningful choices and helps referring professionals and navigators consider suitability without relying on assumptions.

Accessibility also includes cost, transportation, communication and scheduling.

A free outdoor activity may remain inaccessible if reaching it requires an expensive journey. Someone with employment or caregiving responsibilities may find regular weekday sessions difficult to attend.

A person may also prefer a quieter activity or smaller group because of personal comfort, sensory needs or previous experiences.

These considerations should shape the activity rather than be treated as evidence that the individual is unwilling to participate.

The useful question is not simply whether a natural setting exists. It is whether the person can reach it, participate comfortably and return safely.

What does the current Vietnamese legal framework mean for implementation?

Viet Nam's existing legal framework does not establish Nature-Based Social Prescribing as a standardized national healthcare or community service. However, several laws and institutional arrangements may apply to particular activities, locations and professional responsibilities.

Law No. 72/2020/QH14 on Environmental Protection provides the national framework for environmental protection. Law No. 16/2017/QH14 on Forestry regulates forest management and protection, including activities within relevant forest categories. Law No. 28/2023/QH15 on Water Resources provides a framework concerning the management, protection and use of water resources.

These laws must be considered in their current amended forms. In particular, Law No. 146/2025/QH15, effective from 1 January 2026, amended provisions of 15 laws in the fields of agriculture and environment, including the laws on environmental protection, forestry and water resources.

The relevance of these laws depends on the proposed activity and location. They do not establish Nature-Based Social Prescribing as a healthcare service or independently authorize every outdoor program.

For example, an activity organized in a protected forest or managed conservation area may be subject to restrictions different from those applying in a public urban park.

Similarly, activities near water may be subject to different requirements from swimming, boating or other recreational services. Relevant obligations may extend beyond environmental legislation to include waterway safety, recreational activities, venue management and permissions required for the particular location.

Before operating a program, participating organizations should confirm that the intended activity is lawful at the proposed location and that applicable operating and safety requirements can be met.

Healthcare and professional responsibilities must also remain clear.

Circular No. 51/2024/TT-BYT, effective from 1 March 2025, regulates social-work activities in medical examination and treatment establishments licensed to operate as hospitals. These activities include assessing psychosocial needs and coordinating appropriate support with external organizations.

This provides a potential institutional connection for hospital-based community referrals, but it does not automatically establish Nature-Based Social Prescribing as a nationally regulated service.

Where a proposed navigation function falls within professional social-work practice, Decree No. 110/2024/ND-CP on Social Work and Circular No. 29/2026/TT-BYT, effective from 25 August 2026, are relevant. The applicable practice-registration requirement under Decree 110 becomes mandatory from 1 January 2027 for practitioners covered by its provisions.

The legal requirements depend on the work performed, not simply on whether someone is called a navigator, link worker or community facilitator.

Personal information also requires appropriate protection. Law No. 91/2025/QH15 on Personal Data Protection and Decree No. 356/2025/ND-CP, both effective from 1 January 2026, are relevant when healthcare and community organizations process or share personal information, including health-related data.

A gardening or walking-group facilitator may need to understand a participant's accessibility requirements or relevant safety arrangements. That does not automatically mean the facilitator needs access to the person's complete medical history.

These existing legal frameworks provide important boundaries for implementation. They should not be confused with evidence that a national Nature-Based Social Prescribing program has already been established or validated in Viet Nam.

Community partners need appropriate competence, not a clinical role

Nature-based activities may be organized by community groups, environmental organizations, local associations, public institutions, qualified outdoor-activity providers or other suitable partners.

Some organizations may have substantial experience in conservation, horticulture, environmental education or outdoor recreation without having experience receiving referrals from healthcare.

That does not automatically make them unsuitable. However, participating in a structured referral pathway may introduce expectations different from those associated with ordinary community activities.

A gardening group may be experienced in horticulture but unfamiliar with accommodating participants who have significant mobility limitations. An environmental organization may be skilled in conservation work but not prepared to support someone experiencing severe psychological distress. A nature guide may understand local routes and environmental hazards without being qualified to assess medical fitness.

These differences should inform how responsibilities are agreed.

Healthcare professionals should remain responsible for clinical decisions within their scope. Community organizations should remain responsible for activities they are competent and authorized to provide. Navigators may help establish suitable connections without taking over either function.

Before referrals begin, partners should understand the activity, who it is suitable for, what support is available and what should happen if a participant's needs exceed the organizer's capabilities.

Outdoor activities may also require facilitator time, equipment, site preparation, transportation coordination and additional safety arrangements.

These responsibilities involve resources. A program should not assume that community partners can absorb unlimited referrals or provide specialized support without preparation and appropriate arrangements.

A sustainable partnership depends on recognizing what each organization can realistically deliver rather than transferring responsibilities from healthcare to under-resourced community groups.

How much navigation and facilitation is actually needed?

The 2026 RECETAS trials raise an important question about the intensity of support required.

Someone who is confident, mobile and familiar with an appropriate activity may need little more than information and an introduction. Another person experiencing significant isolation, limited confidence or difficulty navigating unfamiliar environments may benefit from additional assistance.

A facilitated group may offer structure, repeated opportunities for participation and support from peers. However, the Barcelona trial demonstrates that a more intensive approach does not automatically produce better overall outcomes than active signposting.

The difference between referral models should therefore be considered in relation to people's needs rather than treated as a hierarchy in which more intensive support is always preferable.

For Viet Nam, a proportionate approach might distinguish between people who can independently access suitable activities and those who need assistance making the connection.

Someone interested in joining a nearby gardening group may be able to contact the organizer directly. Another person may need a navigator to explain the activity, address transportation barriers or arrange an introduction.

A person with substantial functional limitations may require more specialized arrangements or a different activity.

The important question is what support is needed to make participation possible and worthwhile.

Introducing more staff, more meetings or a longer referral pathway should not become an objective in itself.

Nature-based activities should also respect the environment

A nature-based program should not create environmental harm in the process of attempting to support human health and well-being.

Some activities, such as community gardening or appropriately organized conservation volunteering, may offer opportunities to contribute positively to local environments. Others may place additional pressure on natural areas if poorly planned.

Large groups, repeated visits to sensitive habitats, disturbance of wildlife, litter, inappropriate collection of plants or use of restricted areas can create environmental concerns.

An activity should therefore be compatible with the purpose and management requirements of the location.

Where a program involves ecological restoration or conservation, it should be developed with people who have appropriate expertise and authorization.

Well-intentioned participants should not be encouraged to alter habitats or undertake environmental work requiring specialist knowledge merely because the activity has been described as beneficial for well-being.

This is relevant to Viet Nam's parks, forests, waterways, coastal areas and other natural settings, where ecological conditions and management arrangements vary considerably.

Nature-Based Social Prescribing should support meaningful community participation while respecting the environments that make those experiences possible.

Environmental responsibility is part of implementation quality, not an optional addition.

What would be a realistic starting point for Viet Nam?

An early Vietnamese Nature-Based Social Prescribing initiative would be more credible if it began with a clearly defined group of participants, a suitable community partner and an activity that can be delivered safely and consistently.

The initial goal should not be to demonstrate that nature-based activities improve health across multiple medical conditions.

A more practical objective would be to examine whether a defined referral or navigation arrangement helps interested people access an appropriate activity that would otherwise be difficult for them to reach.

For example, a healthcare organization might explore a partnership with a community group offering short, accessible gardening sessions for adults who wish to rebuild routine and social participation after illness.

Another setting might consider a guided nature-engagement activity in a suitable public green space, provided that the route, accessibility, environmental conditions and organizational responsibilities have been assessed.

These are illustrative possibilities, not descriptions of validated Vietnamese programs.

An early initiative should generally favor activities whose demands and hazards can be managed reliably. A high-risk water activity, remote hike or physically demanding conservation project may introduce requirements that are difficult to justify in an initial pilot.

Before accepting participants, partners should understand what the activity involves, whether it is suitable for the intended population and what adjustments can reasonably be provided.

Practical arrangements should address weather, cancellation, transportation, appropriate supervision and access to professional or emergency assistance when needed.

People with lived experience should also contribute to the design. Their perspectives may reveal barriers that organizers overlook, such as discomfort with group activities, concerns about travel or a preference for quieter forms of participation.

The initial objective should be to understand whether a particular connection works under local conditions, not to demonstrate in advance that the activity produces clinical benefits.

Evaluation should distinguish referral, participation and meaningful outcomes

Evaluation of Nature-Based Social Prescribing should not stop at the number of referrals made or activities offered.

A referral may be accepted but never lead to attendance. Someone may attend once and decide the activity is not suitable. Another participant may enjoy the experience but be unable to return because of transportation costs, weather or changing personal circumstances.

These experiences should not be treated as equivalent outcomes.

An early Vietnamese evaluation could examine whether the activity was accessible, whether referred individuals participated, whether the experience matched their interests and whether participation could reasonably continue.

It should also examine whether the receiving organization was able to deliver the activity as intended.

Participant-reported outcomes might include enjoyment, perceived well-being, social connection, confidence, meaningful participation or other goals relevant to the program.

Where connection to nature is an explicit objective, it may be appropriate to measure that construct as well. However, the measure should reflect what the program is trying to achieve, and instruments developed internationally should not be assumed valid for Vietnamese participants without appropriate consideration of language and cultural context.

The distinction between these outcomes matters.

Someone may feel more socially connected because they have joined a group, regardless of whether it meets in a garden or another community setting. Another person may value quiet engagement with nature without wanting extensive social interaction.

A program should therefore be clear about its intended contribution rather than assuming that everyone will benefit in the same way.

Safety outcomes also deserve attention. These may include heat-related symptoms, falls, injuries, unsuitable referrals, participant distress, environmental hazards and situations in which an activity had to be canceled or modified.

An adverse event should not be ignored simply because the activity is non-clinical. The RECETAS-BCN trial, for example, reported an injury during a nature walk, illustrating that physical risks can arise even in carefully organized programs.

Evaluation should consider not only incidents that occur but also whether preventive arrangements are practical and consistently applied.

The resources required for delivery also matter. Facilitator time, preparation, equipment, transportation, accessibility adjustments and coordination may all influence feasibility.

A more intensive program may be appropriate for some participants, but the additional support it requires should be recognized when considering sustainability.

What can evaluation legitimately conclude?

A small pilot may demonstrate that a nature-based activity is acceptable, that a community partnership can operate safely or that previously disconnected individuals are able to participate in something they value.

It may also identify promising changes in well-being or social connection.

However, improvement after participation does not automatically mean improvement because of participation.

Without an appropriate comparison group, it may be difficult to determine whether observed changes relate to nature engagement, physical activity, social contact, facilitator support, other services or changes that would have occurred anyway.

The RECETAS-BCN trial illustrates why comparison design matters. Both groups showed reductions in loneliness, but the trial did not find a statistically significant overall difference between the facilitator-led intervention and active signposting at its primary three-month endpoint.

This does not establish that Nature-Based Social Prescribing is ineffective. It means the trial did not demonstrate the superiority of the more intensive model for the main outcome in the overall study population.

It also does not establish that both approaches would outperform usual care or no intervention, because the study did not include such a comparison group.

Likewise, the favorable findings from the Helsinki trial should not automatically be generalized to every community-dwelling adult or every nature-based activity. That study involved a particular population, intervention and comparison condition.

The secondary findings concerning cognition and nature connectedness should also remain within their proper scope. Changes on selected measures do not establish that the intervention treats cognitive impairment or prevents dementia.

The modeled long-term benefits reported by Papon and colleagues also require appropriate interpretation. They represent projections based on assumptions and available evidence, not outcomes observed over a lifetime. They should not be used to promise long-term health improvements from an individual nature-based program.

For Viet Nam, claims about reduced depression, improved clinical outcomes, fewer hospital admissions or healthcare cost savings would require research designs and evidence capable of supporting those conclusions.

An early implementation evaluation should focus on what can realistically be learned: whether the pathway is feasible, acceptable and safe; whether it helps people access meaningful activities; and what level of support appears appropriate for different participants.

These findings can inform later, more rigorous evaluations without overstating the results of an initial pilot.

Nature-Based Social Prescribing should begin with suitability, not enthusiasm

Viet Nam has natural environments and community resources that may offer opportunities to connect healthcare with meaningful non-clinical participation.

However, the existence of parks, gardens, rivers, lakes, coastal areas or other natural settings does not establish that they are ready to receive social-prescribing referrals.

A suitable activity must fit the person's interests and circumstances. The receiving organization must be able to provide it safely, the location must be accessible under the relevant environmental conditions, and the connection should offer something useful beyond ordinary recreational access.

The evidence available in 2026 provides reasons to explore Nature-Based Social Prescribing, particularly in relation to loneliness, social participation and well-being. At the same time, it does not support presenting the approach as universally effective or assuming that more intensive facilitation will always produce better results.

The international findings should also be interpreted within their original settings. A program for older adults living in Finnish assisted living facilities cannot simply be transferred to a Vietnamese community walking group. Likewise, a trial involving adults experiencing loneliness in Barcelona does not establish the effectiveness of every nature-based activity in Viet Nam.

Nor should everyone living with a health condition be expected to participate in outdoor activities. Individual preferences and the suitability of the available resources should remain central.

The value of participation also need not be reduced to clinical outcomes alone. Someone may enjoy learning about plants, spending time outdoors, meeting neighbors or contributing to a community garden. These experiences can be meaningful even when no measurable clinical improvement occurs.

Recognizing that value is compatible with scientific caution. It does not require presenting the activity as medical treatment.

For Viet Nam, the central question should therefore not be how to prescribe more time in parks, gardens or natural environments. It should be when a nature-based connection is genuinely appropriate, what makes the activity safe and accessible for the person concerned, and how healthcare and community partners can demonstrate value without overstating what the evidence shows.

A responsible approach would begin with modest, well-defined partnerships, suitable activities, clear professional boundaries and realistic evaluation.

If developed in this way, Nature-Based Social Prescribing could become a useful area for collaboration within Social Prescribing & Community-Connected Care in Viet Nam, not by treating nature as a substitute for healthcare, but by helping people access meaningful community experiences through connections that are appropriate, safe and sustainable.

References

1. Kenyon A, Chauhan T, Reynolds K, Pywell S, Shaikh R, Ajiboye A. Connection to nature in nature based social prescribing: A scoping review of evidence, gaps, and policy implications. Social Science & Medicine. 2026;397:119133. doi:10.1016/j.socscimed.2026.119133.

2. Coll-Planas L, Masó-Aguado M, Briones-Buixassa L, et al. Effectiveness of a nature-based social prescribing intervention on loneliness and health-related quality of life among vulnerable urban adults (RECETAS-BCN): an observer-blinded randomised controlled trial. The Lancet Regional Health – Europe. 2026;69:101821. doi:10.1016/j.lanepe.2026.101821.

3. Pitkälä KH, Rautiainen L, Kautiainen H, et al. Effectiveness of nature-based group intervention in loneliness and health-related quality-of-life in lonely older adults living in assisted living facilities—a randomised controlled trial. Age and Ageing. 2026;55(2). doi:10.1093/ageing/afag009.

4. Pitkälä KH, Aalto UL, Rautiainen LJ, et al. Effects of Nature-based Group Intervention on Cognition and Nature Connectedness Among Lonely Older Adults Living in Assisted Living Facilities—Secondary Analyses of an RCT. Journal of the American Medical Directors Association. 2026;27(6):106203. doi:10.1016/j.jamda.2026.106203.

5. Papon V, Jahn B, Sroczynski G, et al. Comparative effectiveness of nature-based social prescribing to alleviate loneliness in Spain: a decision analysis informed by the RECETAS trial. Frontiers in Psychology. 2026;17:1891830. Published 8 October 2026. doi:10.3389/fpsyg.2026.1891830.

6. de Bell S, Alejandre JC, Menzel C, et al. Nature-based social prescribing programmes: opportunities, challenges, and facilitators for implementation. Environment International. 2024;190:108801. doi:10.1016/j.envint.2024.108801.

7. Alejandre JC, Chastin S, Irvine KN, et al. Contextual Factors and Programme Theories Associated with Implementing Blue Prescription Programmes: A Systematic Realist Review. Health & Social Care in the Community. 2023;2023:6551521. doi:10.1155/2023/6551521.

8. World Health Organization Regional Office for the Western Pacific. A Toolkit on How to Implement Social Prescribing. Manila: World Health Organization Regional Office for the Western Pacific; 2022.

9. World Health Organization. Heat and Health. WHO Fact Sheet. Updated 31 July 2026.

10. National Assembly of Viet Nam. Law No. 72/2020/QH14 on Environmental Protection, as amended. Effective 1 January 2022.

11. National Assembly of Viet Nam. Law No. 16/2017/QH14 on Forestry, as amended. Effective 1 January 2019.

12. National Assembly of Viet Nam. Law No. 28/2023/QH15 on Water Resources, as amended. Effective 1 July 2024.

13. National Assembly of Viet Nam. Law No. 146/2025/QH15 amending and supplementing certain provisions of 15 laws in the fields of agriculture and environment. Enacted 11 December 2025. Effective 1 January 2026.

14. Ministry of Health of Viet Nam. Circular No. 51/2024/TT-BYT on the implementation of social work in medical examination and treatment establishments. Effective 1 March 2025.

15. Government of Viet Nam. Decree No. 110/2024/ND-CP on Social Work. Effective 15 October 2024.

16. Ministry of Health of Viet Nam. Circular No. 29/2026/TT-BYT on social-work practice and updating professional social-work knowledge. Effective 25 August 2026.

17. National Assembly of Viet Nam. Law No. 91/2025/QH15 on Personal Data Protection. Effective 1 January 2026.

18. Government of Viet Nam. Decree No. 356/2025/ND-CP detailing certain articles and measures for implementation of the Law on Personal Data Protection. Effective 1 January 2026.

This article provides an educational and implementation-focused discussion of Nature-Based Social Prescribing in Viet Nam. It does not establish that a particular green- or blue-space social-prescribing model has been validated or implemented nationally in Viet Nam, nor does it constitute medical or legal advice. The suitability of activities, environmental conditions, professional responsibilities, safety arrangements and applicable legal requirements should be assessed according to the circumstances of each proposed program and the people it intends to support.