BACKGROUND: The negative effects of loneliness on population health and wellbeing requires interventions that transcend the medical system and leverage social, cultural, and public health system resources. Group-based social interventions are a potential method to alleviate loneliness. Moreover, nature, as part of our social and health infrastructure, may be an important part of the solutions that are needed to address loneliness. The RECETAS European project H2020 (Re-imagining Environments for Connection and Engagement: Testing Actions for Social Prescribing in Natural Spaces) is an international research project aiming to develop and test the effectiveness of nature-based social interventions to reduce loneliness and increase health-related quality of life. METHODS: This article describes the three related randomized controlled trials (RCTs) that will be implemented: the RECETAS-BCN Trial in Barcelona (Spain) is targeting people 18+ from low socio-economic urban areas; the RECETAS-PRG Trial in Prague (Czech Republic) is addressing community-dwelling older adults over 60 years of age, and the RECETAS-HLSNK trial is reaching older people in assisted living facilities. Each trial will recruit 316 adults suffering from loneliness at least sometimes and randomize them to nature-based social interventions called "Friends in Nature" or to the control group. "Friends in Nature" uses modifications of the "Circle of Friends" methodology based on group processes of peer support and empowerment but including activities in nature. Participants will be assessed at baseline, at post-intervention (3 months), and at 6- and 12-month follow-up after baseline. Primary outcomes are the health-related quality-of-life according to 15D measure and The De Jong Gierveld 11-item loneliness scale. Secondary outcomes are health and psychosocial variables tailored to the specific target population. Nature exposure will be collected throughout the intervention period. Process evaluation will explore context, implementation, and mechanism of impact. Additionally, health economic evaluations will be performed. DISCUSSION: The three RECETAS trials will explore the effectiveness of nature-based social interventions among lonely people from various ages, social, economic, and cultural backgrounds. RECETAS meets the growing need of solid evidence for programs addressing loneliness by harnessing the beneficial impact of nature on enhancing wellbeing and social connections. TRIAL REGISTRATION: Barcelona (Spain) trial: ClinicalTrials.gov, ID: NCT05488496. Registered 29 July 2022. Prague (Czech Republic) trial: ClinicalTrials.gov, ID: NCT05522140. Registered August 25, 2022. Helsinki (Finland) trial: ClinicalTrials.gov, ID: NCT05507684. Registered August 12, 2022.

Barcelona Institute for Global Health Doctor Aiguader 88 08003 Barcelona Spain

Center for Health Decision Science Departments of Epidemiology and Health Policy and Management Harvard T H Chan School of Public Health Boston MA USA

Charles University Faculty of Humanities Centre of Expertise in Longevity and Long Term Care Pátkova 2137 5 182 00 Prague Czech Republic

CIBER Epidemiología y Salud Pública Madrid Spain

Department of General Practice University of Helsinki PO BOX 20 00014 Helsinki Finland

Fundació Salut i Envelliment UAB Casa Convalescència UAB C Sant Antoni M Claret 171 4a planta Barcelona Spain

Helsinki University Hospital Unit of Primary Health Care Helsinki Finland

Innovation in Mental Health and Social Wellbeing Research group Vic Spain

Institute for Technology Assessment Department of Radiology Harvard Medical School Massachusetts General Hospital Boston MA USA

Institute of Public Health Medical Decision Making and Health Technology Assessment Department of Public Health Health Services Research and Health Technology Assessment UMIT TIROL University for Health Sciences and Technology Hall in Tirol Austria

Research group on Methodology Methods Models and Outcomes of Health and Social Sciences Vic Spain

Subdirecció General d'Addiccions VIH ITS i Hepatitis Víriques Agència de Salut Pública de Catalunya Carrer de Roc Boronat 81 95 08005 Barcelona Spain

Universitat Pompeu Fabra Barcelona Spain

Western Uusimaa Wellbeing Services Health Services Espoo Finland

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Evaluating the feasibility of "Friends in Nature," a complex nature-based social intervention to address loneliness and quality of life in six cities worldwide

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ClinicalTrials.gov
NCT05488496, NCT05507684, NCT05522140