April 2018 - Parks & Recreation - 31

(PA, eating, weight, diabetes prevention)
initiatives. Discuss resources parks have
to offer that align with health initiatives.
Then determine a path for Park Rx.
Setting the Primary Goal
for Park Rx Program
A crucial step in developing a Park Rx program is to identify the primary goal. Is it
creating park/agency awareness, increasing participation in park programming
or enhancing health of the community?
Health and parks do go hand in hand, but
it may be vital to the program design and
success to prioritize one over the other. For
programs to engage HCPs, the primary
goal must be health oriented with a primary health outcome, otherwise the program
risks losing its support. It may be more
accurate to place promoting parks as the
secondary outcome and promoting health
(through promoting parks) as the primary
outcome. Once a goal is determined, then
an organization can design a distinct program based on the leadership, partnerships
and resources available in its community.
Designing the Program
A variety of Park Rx programs exist across
the United States. Some programs have
created resource packets that include places for PA and a Park Rx sheet for HCPs to
give to patients (Park Rx America, http://
parkrxamerica.org), and some have the
physician prescribe PA and refer the patient
to a local recreation and park agency (Portland Rx Play, http://bit.ly/2p5WnuO).
Some programs use park surroundings
to encourage PA (TRACK Trails, www.
kidsinparks.com) or encourage HCPs to
prescribe walking (Prescription Trails,
https://prescriptiontrails.org), while others provide events at parks with HCPs
(Docs in the Park, http://bit.ly/2DfbxTI).
However, the challenges with designing
the program are not only in accessing the
HCPs, but also the legal constraints of the
Health Insurance Portability and Accountability Act of 1996 (HIPPA).

HIPPA (www.hhs.gov), legislation designed to safeguard medical information,
limits what HCPs can share, as well as
requires patient consent for something
as simple as passing along a name to
agencies. When designing a program, if
the HCP is conducting follow-ups, there
are no HIPPA concerns. However, if the
park and recreation agency is conducting
follow-ups with a patient, then HIPPA requires the patient's consent.
In a study we conducted, we asked
HCPs for their perspective on Park Rx
programs. The study participants identified the following challenges to encouraging physical activity:
* limited time with patients
* lack of training or awareness of resources to have conversations with patients
* patients' healthcare needs beyond exercise
* a lack of awareness of where to send
patients for PA
* hesitation to write a prescription
for something they do not believe a
patient can comply with daily
Some strategies the HCP study participants recommended to help in designing include:
* tailoring the discussion of outdoor PA
to each individual child and family (focus on barriers to getting outdoor PA
followed by provider suggestions of
techniques to deal with these barriers)
* setting goals related to PA with patients and families and following up at
the next office visit
* having the healthcare providers' staff or
recreation and park staff conduct follow-ups with patients (see HIPPA Concerns for implementing this strategy)

Detailed references for this article are
available at www.parksandrecreation.
org/2018/April/developing-a-park-pre
scription-program-for-your-community.

Park Rx Program Examples
An additional benefit of a Park Rx program is that it can be an outdoor recreation resource. Following are a few
programs that use natural settings to encourage people to exercise:
Park Rx America (http://parkrxamer
ica.org) hosts a publicly available search-

The authors are a team at the Appalachian State
University HOPE Lab - " Promoting HOPE (Healthy
Outdoor Play and Exercise) for children and
youth " : J. Joy James, Ph.D., is an Associate
Professor of Recreation Management (jamesjj@
appstate.edu), Becki A. Battista, Ph.D., is an
Associate Professor of Exercise Science
(battistara@appstate.edu), and Richard W.
Christiana, Ph.D., is an Assistant Professor of
Public Health (christianarw@appstate.edu).

able database of parks and outdoor spaces
to help HCPs and patients locate places
for outdoor PA. The goal for this online
database is to include parks/outdoor spaces across America, support for linkage to
patient electronic medical records, patient
tracking of visits to outdoor spaces to " fill "
the prescription, and a way for healthcare
providers to follow up with patients with
reminders and motivation. Park Rx America relies on local community partners to
assess their parks and outdoor spaces to
add to the online database, but it provides
tools for assessing parks, recruitment materials for getting healthcare providers on
board, and Park Rx materials.
The Kids in Parks' TRACK Trails
(www.kidsinparks.com/track-rx) encourages children and families to get outdoors.
Age-appropriate resources are available
for each TRACK Trail, and the
children can register online to earn
prizes. Kids in Parks is working with
HCPs and communities to use TRACK
Trail resources to encourage physical
activity in natural settings.
In addition to encouraging PA in outdoor settings, a byproduct of programs like
these is that participants may become more
comfortable in natural settings and outdoor
recreation pursuits. These programs, while
mainly focused on people's health, have the
potential to develop commitment to conservation of public lands, as well as increase
interest in outdoor recreation activities.

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April 2018 - Parks & Recreation

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