Providing health services to an ageing population is challenging, and in rural areas even more so. It is expensive to provide high quality services to small populations who are widely dispersed; staff and patients are often required to travel considerable distances to access services, and the economic downturn has created a climate where delivery costs are under constant review. There is potential for technology to overcome some of these problems by decreasing or ceasing the need for patients and health professionals to travel to attend/deliver in-person appointments. A variety of eHealth initiatives (for example Pathways through Pain an online course aimed to aid self-help amongst those living with persistent pain) have been launched across the UK, but roll out remains at an early stage. This mixed-methods study of older adults with chronic pain examines attitudes towards, current use of and acceptance of the use of technology in healthcare. A survey (n = 168, 40% response rate) captured broad experiences of the use of technology in health and social care. Semi-structured interviews (four with technology and seven without technology participants) elicited attitudes towards technology in healthcare and explored attributes of personal and social interaction during home visits. People suffering from chronic pain access healthcare in a variety of ways. eHealth technology use was most common amongst older adults who lived alone. There was broad acceptance of eHealth being used in future care of people with chronic pain, but older adults wanted eHealth to be delivered alongside existing in-person visits from health and social care professionals. eHealth has the potential to overcome some traditional challenges of providing rural healthcare, however roll out needs to be gradual and begin by supplementing, not substituting, existing care and should be mindful of individual’s circumstances, capability and preferences. Acceptance of technology may relate to existing levels of personal and social contact, and may be greater where technological help is not perceived to be replacing in-person care.

Physical distancing practices during the COVID-19 global pandemic contributed to a high degree of social isolation among older adults. To reduce loneliness and other ill effects of social isolation, public health experts recommended outdoor social gathering, with physical distancing. Adopting a case study approach, we explored how social aspects of group outdoor health walks (GOHWs) mitigate social isolation for older adults and improve individual social wellbeing. We used semi-structured interviews to understand the experiences of social isolation and social relationships in nine older (50–80 s) adults participating in a GOHW in Scotland, United Kingdom (UK). Verbatim transcripts were analysed through an iterative process of thematic analysis carried out by an interdisciplinary team of qualitative researchers from environmental psychology, medicine, and geography. Themes provide insight into the social dimensions of GOHWs, the mediating effects of social experiences, and the contribution these make to individual social wellbeing. GOHWs provide opportunities to be part of a group and attend to the needs of inexperienced or physically challenged individuals. Being part of the group walk fosters casual interpersonal interactions through spontaneous mixing during and after the walk. This programmatic structure counters loneliness, engenders pleasurable anticipation of regular contact with others, supports physical activity, and fosters group cohesion. These in turn contribute to individual social wellbeing, including expanding social networks, meaningful relationships, a sense of belonging, and acting on empathy for others. GOWHs may be beneficial for mitigation of social isolation as we emerge from the COVID-19 pandemic. Findings were used to propose a conceptual model to parse social constructs and inform selection or development of quantitative social measures for future studies of nature-based interventions such as GOHWs.

Outdoor recreation provides a range of health and wellbeing benefits and facilitates engagement with natural environments. We explore older people's participation in outdoor recreation throughout their lives to examine how past experiences shape engagement later in life. A qualitative life history approach, consisting of semi-structured interviews and a focus group in three place-specific (urban, rural, and small town coastal) case studies in Scotland, was adopted. Thematic analysis revealed ways in which childhood experiences shaped adult engagement and highlighted life course transitions where behaviour change was most pronounced. Place and gender were considered as factors which may affect responses. Participants identified the points of getting married, becoming a parent, children entering adolescence, retirement, the onset of disabilities or ill health, and the death of others as “moments of change” in the extent and/or form of their outdoor recreation. The findings highlight potential for targeted interventions to promote outdoor recreation throughout life.

This paper presents a methodology to assess the internal and external coherence, and the robustness to future uncertainty, of place-based interventions addressing spatial (in)justice. The methodology merges elements of Theory of Change (ToC) and mechanism mapping with scenario planning. It was designed based on analysis of a range of European interventions (public policies and bottom-up initiatives), selected to highlight the ways spatial injustices have been tackled across different scales. The first phase of the methodology uses a ToC mechanism map to illustrate the logic of the intervention, including its baseline assumptions (internal) and contextual conditions (external). In the second phase, scenarios for the locality are developed based on potential states of global and local macro-trends, revealing how the contextual conditions are expected to change, and whether the intervention's baseline assumptions are likely to hold. This then allows the elaboration of spatial justice trajectories, and for the ToC mechanism map to be updated. To effectively illustrate the methodology, we show how it has been applied using a case study intervention implemented in a territorially disadvantaged area. We present the methodology as a flexible tool allowing detection of more general stylised facts, and spatial comparisons between a broad range of interventions.

Active ageing can lead to better health outcomes in older people. Examining constraints to outdoor recreation for older people, including outdoor physical activity, may therefore assist with developing strategies for active ageing. Findings are presented from a study seeking to understand the constraints to older peoples’ access to outdoor recreation in Scotland, and this paper aimed to examine the multitude of constraints that discourage or prevent older people from accessing the outdoors and the ways in which these constraints are hierarchical (or not). This paper adopted a qualitative methodology using the hierarchical leisure constraints model (HLCM) as a lens to analyse the data, presenting the data in three vignettes. The paper identified multiple co-occurring constraints and considered these in relation to expectations based on the HLCM. Recognising that constraints to outdoor recreation for older people are multiple, co-occurring and mutually reinforcing may enable more effective solutions to be developed to overcome them.