Probation Services users have been engaged in the design of the project and the team will continue to draw on the advice of a service user group facilitated by the Probation Service. Discussion This study will contribute to understanding of the impacts care farms may have on health and well-being and the pathways through which theses impacts are delivered. This study will provide the information needed CYP450 inhibitor to design a larger natural experiment to test the cost-effectiveness of care farms in improving the quality of life of offenders. These

findings will provide valuable information for policymakers and practitioners seeking interventions for offenders, and may well provide valuable for when considering other disadvantaged groups. The study is being implemented during a time of significant change within Probation Services in England. The implementation of the UK governments’ ‘Transforming Rehabilitation’ reform

program has led to the creation of a new public sector National Probation Service to work with the most high-risk offenders and the establishment of 21 new Community Rehabilitation Companies (CRCs). These CRCs are currently within the public sector, but the sale of shares is imminent. They will manage medium and low-risk offenders. While these organisational changes may necessitate some adaptation and flexibility during study implementation, the timing of the study will allow detailed observation of these changes and their impacts on providers such as care farms. The combination of primary research and evidence review within this study will facilitate the emergence of holistic findings on the mechanisms through which interactions with nature may influence the health and well-being of disadvantaged populations. This level of understanding has the potential to influence the extent

and nature of the provision of green care, adding to the tool-kit of interventions available to lessen health inequities in our societies. Supplementary Material Author’s manuscript: Click here to view.(1.6M, pdf) Reviewer comments: Click here to GSK-3 view.(5.2K, pdf) Acknowledgments The authors would like to acknowledge the support of the Probation Services’ service user group members who have commented on research tools and ideas and advised the team. Footnotes Contributors: HE, RB, ME, TF, JEC, ST, CB, RG and DS conceived the study and participated in its design. HE drafted and revised the manuscript. JM, NT and ZR implemented the study. All authors commented on the draft. Funding: This project is funded by the National Institute for Health Research’s Public Health Research Programme (project number 11/3050/08). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Public Health Research Programme, NIHR, the NHS or the Department of Health. Competing interests: None. Patient consent: Obtained.