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Project
Nature on prescription to increase the resilience of elderly: exploring the causal pathways using realist methodology
Research questions
General question: How, why and under what circumstances can NoP increase the resilience of elderly
Specific questions: (1) How can NoP increase the physical activity of elderly? (2) How can NoP increase the social capital of elderly? (3) How can physical activity and enhancing social capital in a natural environment increase the resilience and health of elderly?
Research methodology and work plan
We introduce the methodological innovation of combining realist methodology and co-creation. In the Intervention design phase, we develop an intervention and its programme theory in a co-designing process that is supported by a realist review of the literature. In the Intervention implementation and evaluation phase, we implement and co-evaluate the intervention, ending with a refined programme theory. Below, we first describe the realist methodology, the co-creation approach, and our study design in general and then explain how they are combined in the three phases of our study.
Realist methodology
We adopt realist methodology (RM), and its two applications: realist evaluation (RE) and realist synthesis (RS). (19, 20) RM broadens the research question from 'what works' to 'what works, how, why, under what circumstances and for whom?'. (19) RM is theory-driven. It looks for answers by eliciting hypotheses in the form of initial programme theories (IPT) - `How do we think the intervention works?' - and testing these IPT through empirical research (in the case of RE) or the use of secondary data (in the case of RS). Qualitative and quantitative data are used to test the IPT.
Co-creation
Co-creating a research project is an approach in which researchers, service providers, end-users and other stakeholders work together across all phases of a project (from problem identification to evaluation). (21, 22) Co- creation will provide us with first-hand contextual information on how and why the different steps of our intervention will work. The joint-decision-making will enhance the relevance, feasibility and acceptability of the research and the resulting intervention. (22)
A multiple case study design
We define the case as nature-based prescription. As study site, we select the urban area in the vicinity of provincial domain Rivierenhof in the primary care zone Antwerp East. In line with RE principles, we will purposively select 3 general practices based on their fit with the requirements for testing the IPT.
General question: How, why and under what circumstances can NoP increase the resilience of elderly
Specific questions: (1) How can NoP increase the physical activity of elderly? (2) How can NoP increase the social capital of elderly? (3) How can physical activity and enhancing social capital in a natural environment increase the resilience and health of elderly?
Research methodology and work plan
We introduce the methodological innovation of combining realist methodology and co-creation. In the Intervention design phase, we develop an intervention and its programme theory in a co-designing process that is supported by a realist review of the literature. In the Intervention implementation and evaluation phase, we implement and co-evaluate the intervention, ending with a refined programme theory. Below, we first describe the realist methodology, the co-creation approach, and our study design in general and then explain how they are combined in the three phases of our study.
Realist methodology
We adopt realist methodology (RM), and its two applications: realist evaluation (RE) and realist synthesis (RS). (19, 20) RM broadens the research question from 'what works' to 'what works, how, why, under what circumstances and for whom?'. (19) RM is theory-driven. It looks for answers by eliciting hypotheses in the form of initial programme theories (IPT) - `How do we think the intervention works?' - and testing these IPT through empirical research (in the case of RE) or the use of secondary data (in the case of RS). Qualitative and quantitative data are used to test the IPT.
Co-creation
Co-creating a research project is an approach in which researchers, service providers, end-users and other stakeholders work together across all phases of a project (from problem identification to evaluation). (21, 22) Co- creation will provide us with first-hand contextual information on how and why the different steps of our intervention will work. The joint-decision-making will enhance the relevance, feasibility and acceptability of the research and the resulting intervention. (22)
A multiple case study design
We define the case as nature-based prescription. As study site, we select the urban area in the vicinity of provincial domain Rivierenhof in the primary care zone Antwerp East. In line with RE principles, we will purposively select 3 general practices based on their fit with the requirements for testing the IPT.
Date:15 Oct 2025 → Today
Disciplines:Health management
Project type:PhD project