. Health care services would benefit from moving away the biomedical model and towards a new model of health that encompasses not only the physical and mental needs of the service user, but also the social needs.

Promoting Wellbeing by Focusing on the Environment

When discussing the impact of the environment on people living with chronic conditions specifically, contact with nature and environmental modifications are key areas. The biophilia hypothesis provides a theoretical background for the importance of being immersed in the natural environment, with our innate need for contact with nature and life (Wilson, 1984). We have previously discussed the impact of nature on general health and wellbeing, and whilst these benefits are useful for the general population, a greater focus needs to be placed on contact with nature for those with chronic conditions as they face health issues on a daily basis, and have additional barriers in their life which may prevent them from easily accessing opportunities such as green spaces \citep*{Meek_2018}. These potential barriers include a lack of time due to physician visits and/or hospitalisations, and accessibility due to a physical disability. Along with this, research has highlighted an association between contact with nature and prevalence of disease. For example, a systematic review analysed the evidence linking green spaces with mortality, in which 12 studies were included with study populations ranging from the thousands to the millions (Gascon et al., 2016). Results found a negative correlation between cardiovascular disease mortality and residential greenness in the majority of studies, the pathways through which this relationship occurs can be explained by Kuo (2015). A review on 17 studies based in Japan concluded there is a positive impact of natural environments on brain activity, the cardiovascular system, endocrine system and immune function \citep*{Haluza2014}. However, when going in to more detail the results are mixed. For example, the review concluded beneficial impacts of nature on cardiovascular functions, however, when concerning blood pressure, only two out of nine studies reported clear positive effects (a decrease), with six reporting mixed effects and three reporting no significant effects. A similar pattern arises with heart rate, with four studies reporting positive effects (a decrease), three reporting mixed results and two reporting no significant effects. When focusing on heart rate variability, two studies reported a positive effect (an increase) with four studies reporting mixed effects. Similar patterns arise with data linking nature with the endocrine system and immune function. Despite these mixed results, the review concluded an overall health benefit of contact with nature, with a clear potential to target at-risk people or those living with cardiovascular problems.
Introducing green spaces into communities and care homes is one route through which those with chronic illness and/or disabilities can easily access contact with nature when living in an urban environment. Research on 126 care facilities for the elderly across 17 European cities found green spaces within the facility grounds had a significant impact on the quality of life for the residents, along with benefits for the staff and visitors (Artmann et al., 2017). The green spaces facilitated physical activities, recreation and social engagement, which provide subsequent health benefits associated with such factors. It is important to consider contact with nature when designing care packages for service users with chronic conditions as they are more vulnerable to losing contact with nature as day-to-day living is more difficult. Care homes would benefit from designing a timetable which guarantees all residents access to nature for a certain period every day or by including green spaces on their property.
Traditionally, care homes were designed for the health and safety of residents, neglecting what is important to the people that live there and what could potentially improve their health and wellbeing, but this is beginning to change (Ausserhofer et al., 2016). Modifying the environment for residents or patients in care facilities should be a focal point, taking into account their condition and which modifications will facilitate health and wellbeing improvements. Simple additions, such as indoor plants, have reportedly reduced stress for patients in hospital \citep*{Dijkstra2008}. A review of 30 studies found positive effects for sunlight, windows, odour and seating arrangements \citep*{Dijkstra2006}. Whilst evidence for sound, nature, spatial layout, television and stimuli interventions was inconsistent. The impact of the modifications was dependent on patient population characteristics and the context, highlighting the need for a person-centred approach when designing the building and rooms for service users. This is highlighted in a qualitative study which reported both positive and negative outcomes from home modifications; the researchers concluded that the negative impact to be attributable to a lack of understanding about the individual client \citep*{Aplin2015}. It would be useful for health facilities to modify their design to accommodate the service users, particularly care homes where residents live for the remainder of their lives. For example, individuals with dementia would benefit from modifications that normalise their circadian rhythms, including lighting and ambient temperature, along with modifying walkways and exits to make it clearer and safer (Luxenberg, 1997). A review of 57 articles focusing on environmental design or changes for people with dementia concluded that there is sufficient evidence for the effectiveness of varying ambience, size and shape of spaces in a home, unobtrusive safety measures and controlling levels of stimulation \citep*{Fleming2010}.
Overall, the evidence linking nature and health continues to grow, but with mixed results. Reasons for such could be attributed to a lack of concrete recommendations concerning what level of exposure to nature would be sufficient to elicit health changes and what type of nature environment has a greater benefit. Shanahan and colleagues (2015) have propose using dose-response modelling when providing nature-based interventions to identify a cost-effective level of urban nature. They argue that manipulating the type and amount of nature exposure will subsequently impact differently on health outcomes. By applying this method in future research, it will allow researchers to better identify what types of nature-based interventions are effective and at what dose. With sufficient research, recommendations can then be made for future generations to utilise nature, and particularly green spaces for urban environments, to build health and wellbeing among all populations. The introduction of green spaces should be a focal point for urban areas, which will moderate the climate change impact, help prevent disease over a life course model, improve health and wellbeing and subsequently lessen the burden on the health care services. Feasibility research has been carried out to investigate the impact of urban green spaces on health \citep*{Pearce2016} and further development in this area may provide substantial health-related data associated with green spaces across a life course model.
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Facilitating Behavioural Change 

FOR INTEGRATION:
INTRO TO BEHAVIOUR CHANGE:
Changing one's behaviour and adopting recommended, 'healthy' behaviours based upon educational information is not simply an easy choice an individual makes (Kelly & Barker, 2016); else undesirable health behaviours would surely be amiss for many. Providing individuals with information does not necessarily equate to behaviour change. Rather, behaviour change must be understood through comprehensive models and facilitated through guiding framework's and appropriate change-inducing strategies.