Abstract
BACKGROUND: Physical activity promotion through primary care represents a key public health strategy. Aotearoa New Zealand’s Green Prescription (GRx) program, a nationwide primary care-based physical activity intervention, has operated for over 25 years but lacks comprehensive evaluation of participant experiences and long-term impacts. METHODS: This qualitative study used semi-structured interviews with 15 former GRx Otago participants. Interviews explored experiences of the program, perceived impacts on physical activity, mental health, and quality of life, and recommendations for improvement. Data were analyzed using Interpretive Thematic Analysis following Braun and Clarke’s six-step approach. RESULTS: Six main themes emerged: barriers to engagement, general experiences, mental health experiences, physical activity experiences, quality of life experiences, and recommendations for program improvement. Most participants described increased physical activity levels and mental health improvements following program participation. Key barriers included financial constraints, transportation difficulties, and complex medical conditions. Participants valued the program’s strengths-based approach, social connections, and individually tailored support. Primary recommendations included extending program duration, enhancing in-person support, diversifying activity options, and strengthening community organization partnerships. CONCLUSIONS: Participants described largely positive experiences with the GRx program, suggesting potential for promoting physical activity and associated health benefits. However, significant opportunities exist for enhancement through addressing identified barriers, extending support duration, and developing more comprehensive community partnerships. These findings provide evidence-based strategies for improving primary care-based physical activity interventions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-24524-z.