Conceptualising a Community-Based Response to Loneliness: The Representational Anchoring of Nature-Based Social Prescription by Professionals in Marseille, Insights from the RECETAS Project
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThank you for submitting your manuscript to the International Journal of Environmental Research and Public Health.
Introduction
The introduction provides a detailed account of the social context and health consequences of loneliness, as well as the potential of Nature-Based Social Prescription (NBSP) as a response, with a focused lens on the urban inequalities in Marseille, France. The overall logic is generally clear. However, the introduction appears somewhat lengthy and information-dense. Certain sections repeat established concepts or lack necessary transitional phrases. It is recommended to streamline the structure and improve the logical flow between sections.
Line 48, The term “institutional recognition” could be more specific—does it refer to government policy, public health strategies, or social service frameworks?
Lines 103–118, The connection between the project and the research objectives should be strengthened. The description of the “diagnosis” phase is extensive but does not transition clearly into the specific research questions or aims of the present study.
Methods
2.1 Study design
Line 139, The phrase “constructivist and interpretivist epistemological stance” lacks concrete explanation. It would benefit from briefly clarifying how these epistemologies shape the study’s methodological choices—for instance, how they inform the interpretation of practitioners’ discourse or the co-construction of meaning.
The connection between Social Representation Theory (SRT) and the research design could be made clearer. While SRT is introduced as a theoretical lens, it is not sufficiently integrated into the rationale for the choice of qualitative interviews or the inductive approach. Consider elaborating on how SRT directly informs the data collection and analysis strategy.
Since the full name of Nature-Based Social Prescription (NBSP) has already been provided once, it is advisable to consistently use the abbreviation NBSP throughout the rest of the manuscript to avoid redundancy.
2.2 Participants and recruitment
While the study states that “12 professionals” were included and that thematic saturation was achieved, it would strengthen the methodological rigor to clarify how saturation was determined —e.g., was it based on redundancy of themes, lack of new codes, or another criterion? Briefly describing the signs or process that indicated saturation would make the claim more convincing.
Additionally, the balance between purposive sampling and snowball sampling remains unclear. Was purposive sampling primarily used at the initial stage to ensure sectoral representation, with snowball sampling introduced later to expand the network? If so, specifying the sequence and proportion of each strategy would help readers better understand the recruitment process and the diversity of perspectives represented.
2.3 Data collection
The description of the “free-association task” lacks clarity regarding the prompt given to participants. To enhance transparency and replicability, it is recommended to provide the exact wording of the instruction or an example (e.g., “When you hear the term ‘Nature-Based Social Prescription,’ what four words or images come to mind?”). This will help readers understand the depth and spontaneity of the evoked associations.
The interviewer’s background is mentioned (a health psychologist), but the section would benefit from a brief reflexivity statement. For example, reflecting on how the interviewer’s professional training, assumptions, or relationship with the topic may have influenced the interview process or the participants’ responses would strengthen the trustworthiness of the study.
The ethical considerations are somewhat general. While verbal informed consent is acknowledged, it is important to state explicitly whether the study was reviewed and approved by an ethics committee (e.g., a Research Ethics Committee or Institutional Review Board) and provide the approval number or institutional affiliation if applicable. If no formal review was required, briefly justify why.
2.4 Data Analysis
After the “repeated readings” phase, the manuscript does not elaborate on how contextual meaning was constructed. It is recommended to further explain how consistency and divergence of themes were identified across interviews — for instance, whether a theme matrix or other visual tools were used to support cross-case analysis. This would enhance the transparency and rigor of the analytical process.
Results
3.1 A Holistic Conception of Health, Community, and Nature
The notions of an “ecosystemic view of health” and “social belonging” tend to overlap in the current narrative. It is recommended to further differentiate these themes or consider integrating them under a broader construct such as “interdependent well-being,” to clarify their conceptual boundaries.
The use of “spirituality” as a sub-narrative lacks clear definition. It is important to indicate whether this discourse was commonly mentioned across participants or merely reflects a minority view that has been overrepresented. Precise framing would help avoid analytical overreach.
The term “consensually articulated” should be substantiated with clearer empirical grounding. It is advised to specify the number of participants who mentioned these points or indicate whether such views were consistently found across different sectors or professional roles. This would strengthen the validity of expressions such as “vast majority” or “clear majority.”
The discussion on nature’s function as a “social mediator” would benefit from tighter theoretical integration. Specifically, it is suggested to refer back to the Social Representation Theory (SRT) framework and examine how nature is “anchored” as a familiar, positively valued, and socially meaningful symbol (i.e., a symbolic anchor) within participants’ discourse. This would reinforce the analytical coherence between empirical findings and the theoretical lens.
3.2. Structural Inequalities in Marseille
The dual structure of “urban hostility” and “resource inequality” is compelling. However, care should be taken with the term “hostile environment,” which is quite strong. It is recommended to qualify this phrase—e.g., “as perceived by professionals working in disadvantaged neighborhoods”—to avoid overgeneralization. The notion of “symbolic barriers” is underdeveloped. It would be helpful to further specify the sources of these symbolic obstacles, such as “internalized exclusion” or the “perceived illegitimacy of access,” and to engage these ideas in dialogue with relevant literature.
3.3. Populations Facing Cumulative Disadvantage
There appears to be conceptual confusion between “valorisation” and “self-esteem.” It is unclear whether “personal valorisation” refers to external validation or self-recognition. Clarification is needed. Consider using more precise terms such as “social recognition” or “recovery of competence” to better reflect the intended meaning.
Cognitive biases in social perception are not thoroughly explored. Some interview excerpts suggest a risk of “othering” the target population—for instance, the quote “they don’t dare to go out... even their knowledge of their own city” may reveal a cultural disconnect between service providers and beneficiaries. The authors are encouraged to reflect on their own positionality and potential biases in the research process.
3.4. Pathways toward Participation and Recognition
The semantic tension surrounding the term “prescription” is analyzed somewhat superficially. It would be valuable to further explore how this tension varies across different professional identities (e.g., medical doctors vs. NGO workers). Are certain sectors more inclined to retain the prescription framework? Are there distinct professional cultural differences? Additionally, the mechanisms of empowerment practices lack specificity. The authors are encouraged to provide concrete examples of the “core group” in practice—such as whether this group participates in project design or holds decision-making authority.
3.5. Barriers and Facilitators to NBSP Implementation
The concept of “territorial constraints” remains underdefined. Does it refer to transportation issues, spatial layout, safety concerns, or other factors? It is recommended to specify the scope of “territorial” constraints more clearly. Moreover, there is a lack of theoretical linkage to Social Representation Theory (SRT). This section could discuss which conditions facilitate the successful anchoring of NBSP within existing professional knowledge frameworks. Such discussion would help bridge the “semantic level” with the “institutional practice level.”
Discussion
Line 317: The sentence “This anchoring process unfolds along three main axes…” would benefit from explicitly specifying what these three axes are, to enhance clarity and guide the reader more clearly.
Line 327: The phrase “…including health promotion, environmental psychology, and the One Health approach.” could be expanded with a brief summary of how these three theoretical frameworks complement each other to form an integrated conceptual framework.
Line 395: The statement “Structural barriers such as mobility constraints further exacerbate this dynamic.” would be clearer if it explicitly described how these structural barriers are perceived by the target populations and how they influence their behaviors or access.
Line 431: The paragraph starting with “The paradox between participatory ideals and pragmatic constraints…” is dense and could be divided into two separate paragraphs to distinctly emphasize the two major dimensions: the semantic tension surrounding terminology and the practical contradictions encountered during implementation.
Author Response
Dear reviewer,
Please see the attachment.
Best,
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsDear Authors,
Thank you for the opportunity to review your manuscript, "Conceptualizing a community-based response to loneliness...". This is a well-written, methodologically sound, and highly relevant study that provides crucial insights into the professional appropriation of Nature-Based Social Prescription (NBSP) in a setting of significant structural inequality. The use of Social Representation Theory as an analytical lens is a major strength and yields a nuanced and compelling discussion.
The manuscript is of high quality and I recommend it for publication. I offer the following minor comments and suggestions, which I hope will be useful in further strengthening your excellent work.
Major Points (for consideration):
1. The "Prescription" Paradox and Its Practical Implications: Your analysis of the semantic tension surrounding the term "prescription" is one of the most insightful findings of the study. It perfectly captures the conflict between a top-down medical model and a bottom-up, co-creative ideal. To further strengthen this point, could you briefly elaborate in the discussion or implications section on how the RECETAS project in Marseille navigated this tension in practice? Did the project adapt its terminology based on this feedback? Discussing this could provide a powerful, actionable lesson for other social prescribing initiatives.
2. Juxtaposing Professional and Beneficiary Voices: The study's focus on professionals is clear and well-justified. However, a natural and important extension of this work is the perspective of the target populations themselves. In the limitations section, you rightly note the context-specificity and sample size. It may be worth explicitly stating the absence of beneficiary voices as a limitation and suggesting future research that directly compares the social representations of NBSP held by professionals with those held by residents experiencing loneliness. This would highlight a clear and valuable direction for subsequent research in this area.
Similarly, in South Korea, there are significant ongoing efforts to utilize 'forest healing' as a form of nature-based social prescription, with a strong push to establish it within public policy. As a researcher who spent many years in a government role and has now transitioned to a university, I wholeheartedly agree that there is a critical need to further activate and develop this field.
In summary, this is an excellent paper that makes a valuable contribution to the field. The research is robust, the analysis is sophisticated, and the findings are highly relevant for both researchers and practitioners working to implement health interventions in inequitable urban environments. I congratulate you on this fine piece of work.
Author Response
Dear reviewer,
Please see the attachment.
Best,
Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for Authorssee attached file
best
Comments for author File: Comments.pdf
Author Response
Dear reviewer,
Please see the attachment.
Best,
Author Response File: Author Response.pdf
