Co-designing a nature-based intervention to promote postnatal mental health for mothers and their infants: a complex intervention development study in England

The output of the intervention development process is reported using Michie et al’s guidance on reporting complex interventions,21 shown in box 1.

Box 1

Pilot intervention prototype

Characteristics of those delivering the intervention

Co-facilitation by one forest bathing/nature-based accredited practitioner and one peer-support worker from a local perinatal mental health charity.

Characteristics of the recipients

Between 5 and 9 mother–baby dyads (mothers self-identifying with some form of postnatal mental health difficulty or stress, and babies under the age of either 1 or 2 years, depending on how the postnatal period is defined and local needs).


Outdoors, in an accessible location, with optional shelter.

Practitioners will complete a risk assessment of the site and check walking routes before the sessions.

Mode of delivery

Face-to-face, group-based programme.

Intensity and duration

Five/six, once weekly sessions, each lasting 2 hours.

Adherence/fidelity to delivery protocols

After piloting, facilitation strategies such as the development of a manual will be used to standardise implementation and increase fidelity.

Session content and structure

Half-hour welcome and checking in period, with refreshments provided.

Introduction by co-facilitators

Mothers will be encouraged to involve their babies and to respond to any of their infant’s needs throughout the sessions.

The nature-based practitioner will invite participants to partake in a series of three ‘invitations’:

  • Seated mindfulness exercise.

  • Slow, guided walk, noticing natural surroundings.

  • A different nature-based activity each week, themed according to the pathways to nature connectedness.

Each invitation is designed to facilitate mindful immersion in the natural environment and aid mothers to engage their senses, noticing colours and patterns, sounds, smells, and textures of the natural environment.

Following each invitation, participants will be invited, but not required, to share their experiences in a ‘sharing circle’, which facilitates peer learning and benefiting from the experiences of others.34

Any ‘think-aloud’ insights arising about the experience of the intervention by participants will be documented in order to contribute to iterative development of the intervention in accordance with the needs of mothers and their infants.23

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