Andrew K. Palmer

Background: Shared decision‐making between patient and clinicians is crucial for older adults with multiple long‐term conditions, particularly those from culturally diverse, under‐represented groups who face health inequalities. Objective: This study evaluates the inter‐cultural feasibility of patient‐facing materials from a complex shared decision‐making intervention among culturally diverse older adults living with multiple long‐term health conditions. Method: Qualitative think aloud interviews were conducted with 20 participants aged 65 and older from White British, Afro‐Caribbean, and South Asian heritages across urban, rural, and coastal settings. We used thematic analysis to explore feasibility issues and inform the development of targeted approaches in the developing of intervention materials. Results: Our results demonstrate a range of diverse perspectives with respect to our intervention materials, from how the presence of inclusive messaging may mediate initial acceptance to how pressures on the health care system can affect relational continuity, which in turn undermines the efficacy of this messaging. Our data also demonstrates the importance of point‐of‐care delivery and the potential risks associated with transitioning from analogue to digital. The role family and third parties in care coordination was also observed as important factors in the design of interventions and the process of shared decision‐making more broadly. Conclusions: Our study reinforces the importance of seeking diverse perspectives to improve patient‐facing materials to ensure alignment between patients' lived realities and the healthcare provider's messaging. Reflecting the complexity of shared decision‐making as an intervention, the suitability of our patient‐facing materials centres around its visual acceptability, structural applicability, and intersectional accessibility. Targeted approaches are needed to involve diverse patients and carers in shared decision‐making, particularly given current changes to UK healthcare policy, and the need to address health and care inequalities among older adults with multiple long‐term conditions. Lived Experience Contribution: A Patient and Public Involvement (PPI) group, including twelve individuals with multiple long‐term conditions and/or carers, influenced all study stages from refining the research questions to interpreting results. A public representative and a PPI lead are listed as co‐authors on this manuscript and our public‐facing infographic, created with the help of these members, is available here: https://view.genially.com/6a9049b186120ca2ef1731db .

While the physical and mental health benefits of greenspace exposure are well documented, ethnic minority communities in the United Kingdom continue to engage with these environments at disproportionately lower rates. This persistent disparity points to an oversight in existing literature, specifically regarding how these communities navigate everyday encounters with nature. This qualitative study employs interviews and diary methods to explore the restorative processes, motivations and preferences of ethnic minority residents in Bristol, United Kingdom. By communicating these experiences through the novel approach of composite narratives, the research endeavours to situate lived realities within intersectional contexts, ensuring the findings remain nuanced and resistant to essentialist assumptions. Our findings reveal that engagement with nature is a purposeful element of daily life, with psychological restoration serving as a conscious and instrumental strategy for well‐being. Distinct preferences revealed a range of landscape typologies, including blue spaces, urban woodlands and family‐oriented parks, while a range of constraints to engagement and visitation were also present. Using composite narratives further illuminates the role of social relationships in shaping greenspace experiences, highlighting a tension between positive experiences and overlapping constraints. While participants negotiate challenges that are both universal and culturally specific, these obstacles do not simply override restorative encounters; instead, they form a constellation that evolves across multiple scales. This study demonstrates that, despite these constraints, urban greenspaces remain vital resources for these communities. The findings underscore the necessity of enhancing everyday access for those who need it most, living in densely populated or low‐income urban areas. By developing safe, welcoming environments and including communities in environmental planning, we can instil more equitable approaches to provision that enhance well‐being for all urban residents. Read the free Plain Language Summary for this article on the Journal blog.

People from all sections of society should feel welcome and included to enjoy greenspaces. However, people from ethnic minority backgrounds may experience exclusionary practices and discriminatory processes, limiting their access, enjoyment, and benefits from such spaces. This paper aims to address these issues through an in-depth qualitative study exploring how 53 individuals from UK ethnic minority backgrounds residing in Bristol perceive and experience exclusion in UK greenspaces. Going beyond narratives that pathologise the exclusion of ethnic minorities from greenspaces, this research reveals a spectrum of experiences related to perceived exclusion, including both positive and negative, and challenges and expressions of empowerment and agency. Common experiences of exclusion are often intangible, necessitating sensitivity to their elusive and relational nature, with variation between urban and rural contexts. Drawing on Bourdieusian theories of practice, this study illuminates how social and cultural capital, habitus, and symbolic violence shape exclusionary practices and discriminatory processes, contributing to feelings of otherness, discomfort among UK ethnic minority group members in greenspaces. By highlighting the diverse nature of these processes and their variations across social and geographic contexts, this study emphasises the need for tailored, coproduced interventions to enhance greenspace accessibility and engagement. It advocates for recognising diverse experiences, integrating critical thought into environmental planning, and leveraging social and cultural capital to promote inclusivity and address systemic inequalities.

As calls grow for relational approaches to nature and wellbeing research that consider reciprocity in human‐environment interactions, the concept of affordances is gaining importance as a useful way of thinking about nature experiences. Affordances provide a framework to enable individualised conceptions of nature by focusing on what is functionally meaningful to people. However, affordance thinking is currently limited in its ability to help us understand how peoples' background, culture and circumstances shape interactions with nature ‐ a critical issue with respect to inclusivity and the under‐representation of some sections of society. Bourdieu's theory of practice is a well‐established set of ‘thinking tools’ which potentially help addresses these influences. It examines how our social environment may pattern our practices, attitudes, and perceptions. In this paper, we review the various applications of affordances before providing an overview of how Bourdieu's concepts of habitus , capital and field can complement, and be integrated with, affordance thinking for novel applications to greenspace research. Bridging these areas of thinking will facilitate development of a more intersectional and complete understanding of nature experiences, including the quality and inclusivity of green and natural spaces.

Greenspaces facilitate well‐being benefits for humans in several ways including through cognitive restoration, physical exercise and social interaction. However, some groups are under‐represented in greenspaces, including women, older people, those with health conditions, people with lower socioeconomic status and people from ethnic minority backgrounds, and so are less likely to accrue these benefits. Using thematic analysis and semi‐structured interviews with 40 individuals from under‐represented groups in Leeds, UK, we explore (1) a range of perceived barriers to greenspace access, (2) how spending time in greenspace contributes to well‐being for these groups, (3) the perceived positive and negative aspects of greenspace, (4) what impact COVID‐19 had on access to greenspace and (5) how greenspaces could be improved. We also highlight inter‐group differences and how some barriers disproportionately affect some of the groups in this study. Safety concerns were particularly important for women and people with low incomes, which included problems with anti‐social behaviour (e.g. incivilities and disorder). Cultural barriers were also evident with ethnic minority participants often citing concerns about dogs and issues with visibility and prejudice. Participants desired physical improvements to the quality of greenspaces, along with easier access and transport options, changes in policy regarding dogs and increased security and park wardens to limit anti‐social behaviour. We argue that to increase visitation for under‐represented groups, upgrades in the physical environment must be coupled with harnessing community involvement and co‐design. Some group differences and tensions in greenspaces, and problems with anti‐social behaviours and safety concerns might be limited by more considerate planning and incorporating research findings that address these tensions through intergroup contact. Read the freePlain Language Summaryfor this article on the Journal blog.