{
  "abstract": "Background: In pragmatic intervention studies, adherence often varies over time and depends on participant characteristics that also influence outcomes, potentially biasing conventional per-protocol analyses. Target trial emulation(TTE) provides a structured framework for estimating causal effects of adherence strategies, while avoiding selection bias during follow-up.\n\nMethods: We analyzed data from the RECETAS Prague trial(n = 131), evaluating the 9-week nature-based social prescribing intervention Friends in Nature. Adherence strategies were defined by sessions attended and grouped (0-1, 2–5, 6–7, and 8–9). Outcomes included quality of life(EQ-5D-5L) and loneliness(De Jong Gierveld Score) at 3-months. A TTE framework with cloning, artificial censoring, and inverse-probability-of-censoring weighting estimated causal per-protocol effects. Missing data were handled using MICE(n = 5). Weighted generalized estimating equation models were fitted in each imputed dataset, and estimates were pooled using Rubin’s rules. Overall influence was assessed using a test for trend.\n\nResults: Compared with attendance of 0-1 sessions, EQ-5D scores at 3 months were similar for 2–5(0.008; 95%CI −0.02 to 0.04), 6–7(0.014; 95%CI −0.02 to 0.05), and 8–9(0.008; 95%CI −0.03 to 0.05). Loneliness scores were also similar (2–5: −0.587; 95%CI −2.10 to 0.92; 6–7: 0.157; 95%CI −1.19 to 1.50; 8–9: −0.090; 95%CI −1.73 to 1.55) (test for trend: p = 0.303).\n\nConclusions: This study shows that TTE can provide a transparent framework for estimating adherence-related effects under time-varying participation in pragmatic trials. No differences in quality of life or loneliness were observed across attendance levels at 3 months, suggesting that longer intervention or follow-up periods may be needed to detect potential effects. However, residual confounding from unmeasured attitudes and differential compliance, particularly lower comparator adherence due to the non-blinded study design, may limit causal interpretation.\n\nKey messages: • TTE offers a transparent framework to estimate adherence-related effects under time-varying participation in pragmatic public health trials.\n\n• No 3-month differences in quality of life or loneliness were observed across attendance levels, suggesting longer intervention or follow-up may be needed.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "abstract",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "name": "M Arvandi"
    },
    {
      "name": "S Puntscher"
    },
    {
      "name": "JS Litt"
    },
    {
      "name": "A Bártová"
    },
    {
      "name": "B Novotná"
    },
    {
      "name": "V Papon"
    },
    {
      "name": "LR Hallsson"
    },
    {
      "name": "U Rochau"
    },
    {
      "name": "U Siebert"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/62vr7q5r0ev3q.bib",
  "cited_by": 0,
  "doi": "10.1093/eurpub/ckag169.1560",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13699575/",
  "id": "62vr7q5r0ev3q",
  "issns": [
    "1101-1262",
    "1464-360X"
  ],
  "landing_url": "https://doi.org/10.1093/eurpub/ckag169.1560",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "6. Poster Displays"
    ],
    [
      "heading",
      "AcademicSubjects/MED00860"
    ],
    [
      "heading",
      "AcademicSubjects/SOC01210"
    ],
    [
      "heading",
      "AcademicSubjects/SOC02610"
    ],
    [
      "heading",
      "DM. Health services and systems research"
    ],
    [
      "openalex",
      "2613|Advanced Causal Inference Techniques"
    ]
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  "openalex": "W7223705446",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13699575/pdf/?tool=EBI",
  "pmcid": "PMC13699575",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "Oxford University Press",
  "ris": "https://research.draconitic.com/paper/62vr7q5r0ev3q.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:10Z",
      "native_id": "PMC13699575",
      "source": "pmc",
      "url": "https://doi.org/10.1093/eurpub/ckag169.1560"
    },
    {
      "first_seen": "2026-10-30T12:21:48Z",
      "native_id": "PMC:PMC13699575",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13699575"
    }
  ],
  "subjects": [
    {
      "field": "mathematics",
      "origin": "openalex:2613|Advanced Causal Inference Techniques",
      "subfield": "statistics"
    }
  ],
  "title": "Adherence to nature-based social prescribing: a target trial emulation of RECETAS Prague study",
  "title_text": "Adherence to nature-based social prescribing: a target trial emulation of RECETAS Prague study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:36:08Z",
  "url": "https://research.draconitic.com/paper/62vr7q5r0ev3q",
  "venue": "The European Journal of Public Health",
  "versions": []
}