Interventions need to be developed in a timely and relatively low-cost manner in order to respond to, and quickly address, major public health concerns. We aimed to quickly develop an intervention to support people with severe mental ill-health, that is systematic, well founded both in theory and evidence, without the support of significant funding or resource. In this article we aim to open and elucidate the contents of the ‘black box’ of intervention development. A multidisciplinary team of seven academics and health practitioners, together with service user input, developed an intervention in 2018 by scoping the literature, face-to-face meetings, email and telephone. Researcher fieldnotes were analysed to describe how the intervention was developed in four iterative steps. In step 1 and 2, scoping the literature showed that, a) people with severe mental illness have high mortality risk in part due to high levels of sedentary behaviour and low levels of exercise; b) barriers to being active include mood, stress, body weight, money, lack of programmes and facilities and stigma c) ‘nature walks’ has potential as an intervention to address the problem. In Step 3, the team agreed what needed to be included in the intervention so it addressed the “five ways to mental wellbeing” i.e., help people to connect, be active, take notice, keep learning and give. The intervention was mapped to key behavioural change concepts such as, personal relevance, relapse prevention, self-efficacy. In Step 4, the team worked out how best to implement the intervention. The intervention would be delivered over 12 weeks by members of the hospital team and community walk volunteers. Participants would receive a nature walks booklet and text messages. We developed a theoretically-informed, evidence-based nature walks programme in a timely and relatively low-cost manner relevant in an era of growing mental illness and funding austerity. Further research is required to test if the intervention is effective and if this approach to intervention development works.

中文翻译：

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与重度精神疾病患者共同制作“大自然的福祉”公共卫生干预措施：理论和实践知识的运用。

为了及时响应并迅速解决重大公共卫生问题，需要以相对较低的成本及时开发干预措施。我们的目标是迅速开发一种干预措施，以支持严重精神疾病患者，这是系统的，理论和证据充分的基础，无需大量资金或资源的支持。在本文中，我们旨在打开并阐明干预发展“黑匣子”的内容。由7位学者和卫生从业人员组成的跨学科团队，以及服务用户的投入，在2018年通过对文献，面对面的会议，电子邮件和电话进行了研究，制定了一项干预措施。分析了研究人员的现场记录，以描述如何通过四个迭代步骤开发干预措施。在第1步和第2步中，对文献进行研究发现，a）患有严重精神疾病的人死亡风险高，部分原因是久坐行为水平高和运动量少；b）积极活动的障碍包括情绪，压力，体重，金钱，缺乏计划和设施以及污名c）“自然漫步”有潜力作为解决问题的干预手段。在第3步中，团队同意干预措施中需要包括的内容，从而解决了“五种心理健康方法”，即帮助人们建立联系，保持活跃，留神，不断学习并给予帮助。干预措施被映射到关键的行为改变概念，例如个人相关性，预防复发，自我效能感。在第4步中，团队确定了如何最好地实施干预措施。医院团队成员和社区步行志愿者将在12周内进行干预。参加者将收到自然漫步手册和短信。在精神疾病和资金紧缩的时代，我们以及时且成本相对较低的方式开发了一种理论上有据可依的循证自然漫步计划。需要进行进一步的研究以测试干预是否有效以及这种干预开发方法是否有效。