How it works
- The health professional (usually GP or practice nurse) issues their patient with a Green Prescription (GRx), provided the patient’s medical condition is stable.
- The script is either written or issued electronically. If the patient wants ongoing support to increase their physical activity and improve nutrition, the script is forwarded through to the nearest GRx provider.
- The GRX Support Person encourages the patient to become more active through:
- monthly telephone calls for 3-4 months or;
- face to face meetings for 3-4 months or;
- group support in a community setting for 3-6 months.
- The patient’s progress on their path to a healthier lifestyle is reported back to the referring health professional.
- If the patient feels they would benefit from ongoing support, they are encouraged to ask their health professional for another GRx.
The Green Prescription (GRx) initiative is a health professional's written advice to a patient or their family to encourage and support them becoming more physically active and eat healthier as part of a total health plan. The initiative consists of two components: GRx (for adults) and the GRx Active Families programme which aims to increase physical activity for children, young people and their families, and was introduced in 2004.
GRx began in 1998. The initiative was transferred from Sport and Recreation New Zealand (SPARC) in 2009 to the Ministry of Health with the expectation in future that funding would be more closely aligned with other services helping manage long term conditions. Most referrals for GRx are to support prevention and management in patients with chronic disease and long term conditions such as cardiovascular disease and diabetes. In particular, GRx encourage patients to manage their own conditions by increasing physical activity and improving nutrition.
Core GRx funding of $3.784 million was transferred from SPARC to the Ministry with additional one-off funding of $1.6 million which ended in July 2012. In May 2013 an additional $7.2 million, over the next four years, was allocated to the GRx budget to increase adult referrals, particularly for patients with pre-diabetes or diabetes.
On 1 July 2012 the Ministry devolved GRx funding and management to district health boards (DHBs) to enable better co-ordination of initiatives at a regional level and fit with plans for better integration of health services. The Ministry supports the initiative with advice, resources and bi annual surveys. In 2017 the Ministry allocated $2.1 million to 10 DHBs to provide B4SC Active Families programmes. These provide nutrition advice and activities for obese 4 year olds referred from before school checks.
Some DHBs and PHOs contribute funding to the initiative to provide more intensive group programme support and strengthen the nutrition component of GRx. There are currently sixteen providers contracted to deliver the GRx initiative to referred patients and families. Fourteen of these are regional sports trusts, and two are PHOs (Nelson Bays and Marlborough). Providers cover all District Health Boards.
The programme encourages general practitioners and the community to work together. Key players are:
- general practitioners
- practice nurses
- physical activity providers
- regional sports trusts (such as Sport Northland and Sport Otago)
- primary health organisations
- district health boards
- Māori health providers
- community groups.
Green Prescription resources for health professionals
Eating and Activity Guidelines
The Eating and Activity Guidelines for New Zealand Adults provides evidence-based population health advice on healthy eating and being physically active. The document is written for health practitioners and others who provide advice on nutrition and physical activity for New Zealand adults.
States of Change
Stages of Change (PDF, 501 KB) is a resource to help health professionals identify whether a patient is ready to change their behaviour.
Green Prescription research
GRx Patient Survey background
The Green Prescription Active Families survey by Research New Zealand is an ongoing evaluation of the participants in the Active Families programme.
These early results show the key performance indicators of the programme. The survey seeks the views of participants about how well the programme worked for their child and family.
Some of the key questions explored in these surveys are:
- Main health reasons why doctors prescribe a GRx to their patients
- What physical activities are prescribed by GPs
- Have patients noticed any health changes and if so, what changes
- What is the current status of their GRx – are they still active after 6–8 months
- How much time do patients now spend doing physical activity
- How many days a week are patients doing at least 30 minutes of physical activity
- Have patients made any changes to their diet
- What activities were suggested by the patient support person
- What was their opinion about the service received
- Did they take up the activities suggested by the patient support person
- Were they satisfied with the overall level of patient support service
- Who are they active with (eg, partner, family, children, friends).
Green Prescription Active Families Survey 2018
Early results on key performance indicators are excellent with 98% of participants satisfied with the service, 85% of families getting more active, and 90% improving their diet.
|GRx Active Families target
|Are more active since receiving their GRx
|Minimum of 80% of GRx Active Families participants are more active after 6-8 months of receiving their GRx
|Adopt better nutritional habits
|Minimum of 85% of GRx Active Families participants have made changes to their diet since receiving their GRx
|Receive effective support to maintain activity
|Minimum of 85% of GRx Active Families participants feel more confident about doing physical activity
|Have a choice of activities that are relevant and appropriate for them
|Minimum of 90% of GRx Active Families participants felt the physical activities suggested were appropriate for them
|Have a choice of activity providers that are relevant and appropriate for them
|Minimum of 85% of GRx Active Families participants felt the activity provider suggested was appropriate for them
|Are motivated to participate in and follow their GRx
|Minimum of 85% of GRx Active Families participants are motivated to get/stay physically active
|Are aware of and understand the benefits of physical activity
|Minimum of 85% of GRx Active Families participants are aware of and understand the benefits of physical activity
|Have noticed health changes since being more active
|Minimum of 85% of GRx Active Families participants have noticed health and fitness level changes
|Ensure consistent high quality services and support are delivered to GRx participants
|Minimum of 90% of GRx Active Families participants are satisfied with the overall service and support provided
Patient survey reports
- Green Prescription Patient Survey 2018 Report
- Green Prescription Patient Survey 2016 Report
- Green Prescription Patient Survey 2015 Report
- Green Prescription Active Families Survey Report: May 2018
- Green Prescription Active Families Survey Report: 2016
- Green Prescription Active Families Survey Report: 2015
A Novel Home-Based Intervention for Child and Adolescent Obesity: The Results of the Whānau Pakari Randomised Controlled Trial
The research by Yvonne Anderson et al was published in Obesity in November 2017.
The research studied children with obesity aged 5-16 who participated in programmes similar to Green Prescription Active Families.
The Whānau Pakari programme had home visits with a comprehensive assessment (medical, dietary, physical and psychology screen) and advice.
In addition, for the high-intensity group, family-based group activities including cooking sessions, virtual supermarket tours, growing vegetables, sports and physical activity, and psychology sessions, all to support healthy lifestyle changes were offered.
The main 12 month findings comparing high and low intensity groups were:
- consistent improvements in cardiovascular fitness in both groups
- important improvements in quality of life in both groups (the change in the high intensity group shifted them to within the range of peers who do not have weight issues)
- modest reductions in body mass index (BMI), adjusted for age and sex in both groups
- the 22% of participants who attended more than 70% of weekly high intensity sessions had double the reduction in adjusted BMI. Some of them moved out of the obese BMI range into the overweight or normal weight ranges
- the Whānau Pakari programme reached at risk children who may have missed out on healthcare: almost 3 in 10 children came from deprived neighbourhoods in Taranaki, 47% were Māori, 43% were New Zealand European.
Dr Anderson notes “These findings are really important. If we are going to make a difference to those most affected by obesity, services that families feel comfortable with, and that fit in with their lives, are key’.”
The Whānau Pakari programme had a wider multidisciplinary approach compared to Green Prescription Active Families, but was founded on the principals of the programme.
Long-term effectiveness of the New Zealand Green Prescription primary health care exercise initiative
This research, undertaken by Michael Hamlin et al., was published in Public Health, 25 August 2016.
The research indicates that:
- The Green Prescription primary care intervention is effective over the longer term (2–3 years) for men and women.
- Compliance in Green Prescription could be improved with more communication and collaboration between service providers.
Are physical activity interventions in primary care and the community cost-effective? A systematic review of the evidence
This research, undertaken by Sue Garrett et al., was published in the British Journal of General Practice (Volume 61, Number 584, March 2011).
The research indicates that:
- Most interventions to increase physical activity were cost-effective, especially where direct supervision or instruction was not required.
- Walking, exercise groups, or brief exercise advice on prescription delivered in person, or by phone or mail appeared to be more cost-effective than supervised gym-based exercise classes or instructor-led walking programmes.
- Many physical activity interventions had similar cost-utility estimates to funded pharmaceutical interventions and should be considered for funding at a similar level.
Effectiveness of counselling patients on physical activity in general practice
This research, undertaken by Dr Raina Elley et al. and Waikato general practices, was published in the British Medical Journal (Volume 326, 12 April 2003).
The research indicates that:
- a Green Prescription increases physical activity levels and improves quality of life over 12 months, without evidence of adverse effects
- prompting practice staff to deliver the intervention will increase its effectiveness
- for every 10 Green Prescriptions written, one person achieved and sustained 150 minutes of moderate or vigorous leisure activity (using up an additional 1000 kcal) per week. This is associated with a 20–30 percent risk reduction in all cause mortality, compared with sedentary individuals
- the Green Prescription initiative is sustainable in usual general practice.
Green Prescription contacts
Many sports providers share success stories on their websites from people now living a healthier, more active lifestyle thanks to the Green Prescription and Active Families programmes.