1
|
Yadav UN, Paudel G, Ghimire S, Khatiwada B, Gurung A, Parsekar SS, Mistry SK. A rapid review of opportunities and challenges in the implementation of social prescription interventions for addressing the unmet needs of individuals living with long-term chronic conditions. BMC Public Health 2024; 24:306. [PMID: 38279079 PMCID: PMC10821289 DOI: 10.1186/s12889-024-17736-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/10/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND People with long-term chronic conditions often struggle to access and navigate complex health and social services. Social prescription (SP) interventions, a patient-centred approach, help individuals identify their holistic needs and increase access to non-clinical resources, thus leading to improved health and well-being. This review explores existing SP interventions for people with long-term chronic conditions and identifies the opportunities and challenges of implementing them in primary healthcare settings. METHODS This rapid review followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines and searched relevant articles in three databases (PubMed/MEDLINE, EMBASE, and Web of Science) by using subject headings and keywords combined with Boolean operators. The search encompassed articles published between January 2010 and June 2023. Two authors independently conducted study screening and data abstraction using predefined criteria. A descriptive synthesis process using content analysis was performed to summarise the literature. RESULTS Fifteen studies were included, with all but one conducted in the United Kingdom, and revealed that social prescribers help guide patients with long-term chronic conditions to various local initiatives related to health and social needs. Effective implementation of SP interventions relies on building strong relationships between social prescribers and patients, characterised by trust, empathy, and effective communication. A holistic approach to addressing the unmet needs of people with long-term chronic conditions, digital technology utilisation, competent social prescribers, collaborative healthcare partnerships, clinical leadership, and access to local resources are all vital components of successful SP intervention. However, the implementation of SP interventions faces numerous challenges, including accessibility and utilisation barriers, communication gaps, staffing issues, an unsupportive work environment, inadequate training, lack of awareness, time management struggles, coordination and collaboration difficulties, and resource constraints. CONCLUSION The present review emphasises the importance of addressing the holistic needs of people with long-term chronic conditions through collaboration and coordination, training of social prescribers, community connections, availability of local resources, and primary care leadership to ensure successful interventions, ultimately leading to improved patient health and well-being outcomes. This study calls for the need to develop or utilise appropriate tools that can capture people's holistic needs, as well as an implementation framework to guide future contextual SP interventions.
Collapse
Affiliation(s)
- Uday Narayan Yadav
- National Centre for Aboriginal and Torres Strait Islander Well-Being Research, The Australian National University, Canberra, ACT, Australia.
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
| | - Grish Paudel
- School of Health Medical and Applied Sciences, Central Queensland University, Sydney, Australia
| | - Saruna Ghimire
- Department of Sociology & Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | | | - Ashmita Gurung
- Department of Public Health, Torres University, Sydney, Australia
| | - Shradha S Parsekar
- Independent Freelance Consultant, Goa, India
- Public Health Evidence South Asia, Prasanna School of Public Health, Manipal, Karnataka, India
| | - Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh
| |
Collapse
|
2
|
Connolly H, Delimata N, Galway K, Kiely B, Lawler M, Mulholland J, O’Grady M, Connolly D. Exploration of Evaluation Practices in Social Prescribing Services in Ireland: A Cross-Sectional Observational Study. Healthcare (Basel) 2024; 12:219. [PMID: 38255106 PMCID: PMC10815325 DOI: 10.3390/healthcare12020219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
National health services in Ireland and the UK fund the majority of social prescribing services and have issued recommendations for evaluation. However, it is not known what outcomes are prioritised for evaluation within individual services and what evaluation methods are used to capture recommended outcomes. A survey was carried out to examine evaluation practices of social prescribing services on the island of Ireland. This study used a cross-sectional observational design. The sample was all the staff involved in delivering and/or managing SP services on the island of Ireland. Questionnaires were distributed at a national SP conference and online. Closed-response questions were analysed using descriptive statistics. Content analysis was used for open-ended questions. Eighty-four usable surveys were returned (50% from the Republic of Ireland and 50% from Northern Ireland). All respondents (100%) agreed on the importance of measuring SP outcomes. The most frequently measured outcomes were health and well-being (89.2%) and loneliness (84%). The least frequently measured outcome was the satisfaction of healthcare professionals referring to SP: 78.4% of respondents never measured this outcome. The most frequently used measurement tool was the Short Warwick Edinburgh Mental Well-Being Scale, with 38/76 (50%) respondents using this measure. There was a lack of standardised measures identified for some outcomes. For example, 70% of respondents reported always measuring physical activity (PA), but only four respondents identified a specific PA measure. In open-ended questions, respondents recommended flexibility in evaluation methods to reflect the complexity and individualised focus of SP. They also identified the need for protected time to complete evaluations and recommended a national strategy to inform priorities in evaluations. This study demonstrates a wide variation on the island of Ireland on how SP services are measuring outcomes, with many outcomes rarely or never measured using standardised measures. Agreement is needed on a core outcome set for social prescribing in order to guide service delivery and evaluations.
Collapse
Affiliation(s)
- Hayley Connolly
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, F91 YW50 Sligo, Ireland; (H.C.); (M.L.)
| | - Natalie Delimata
- Department of Social Sciences, Atlantic Technological University, F91 YW50 Sligo, Ireland;
| | - Karen Galway
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (K.G.); (J.M.)
| | - Bridget Kiely
- Department of General Practice, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland;
| | - Margaret Lawler
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, F91 YW50 Sligo, Ireland; (H.C.); (M.L.)
| | - Jill Mulholland
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (K.G.); (J.M.)
| | - Megan O’Grady
- Discipline of Physiotherapy, Trinity Centre for Health Sciences, St. James’ Hospital, D08 W9RT Dublin, Ireland;
| | - Deirdre Connolly
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, F91 YW50 Sligo, Ireland; (H.C.); (M.L.)
| |
Collapse
|
3
|
Scott S, McGowan VJ, Wildman J, Bidmead E, Hartley J, Mathews C, James B, Sullivan C, Bambra C, Sowden S. "I'll meet you at our bench": adaptation, innovation and resilience among VCSE organisations who supported marginalised and minoritised communities during the Covid-19 pandemic in Northern England - a qualitative focus group study. BMC Health Serv Res 2024; 24:7. [PMID: 38172856 PMCID: PMC10765907 DOI: 10.1186/s12913-023-10435-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The Covid-19 pandemic has exacerbated pre-existing inequalities and increased adversity and challenges for vulnerable and marginalised communities worldwide. In the UK, the Voluntary Community and Social Enterprise (VCSE) sector play a vital role in supporting the health and wellbeing of people who are marginalised or experiencing multiple complex needs. However, only a small number of studies have focused on the impact that Covid-19 had on the VCSE sector. METHODS As part of a Health Inequalities Impact Assessment (HIIA), we conducted qualitative focus groups with staff and volunteers from five organisations to examine short, medium and longer-term impacts of Covid-19 upon the VCSE sector in Northern England. Nine online focus groups were conducted between March and July 2021. FINDINGS Focus group transcripts were analysed using Framework Analysis and yielded three central themes: (1) exacerbation of pre-existing inequalities, adversity and challenges for vulnerable and marginalised populations; (2) the 'price' of being flexible, innovative and agile for VCSE staff and volunteers; and (3) the voluntary sector as a 'lifeline' - organisational pride and resilience. CONCLUSIONS While the voluntary sector 'adapted at pace' to provide support during Covid-19 and in its continued aftermath, this resilience has potentially come at the cost of workforce and volunteer wellbeing, compounded by political obstacles and chronic shortage in funding and support. The VCSE sector has a vital role to play in the post-lockdown 'levelling up' agenda. The expertise, capacity and resilience of VCSE organisations, and their ability to respond to Covid-19, should be celebrated, recognised and supported adequately to maintain its resilience. To not do so threatens the sector's sustainability and risks jeopardising attempts to involve the sector in addressing the social determinants of health.
Collapse
Affiliation(s)
- S Scott
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Sir James Spence Building, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK.
- NIHR Applied Research Collaboration North East and North Cumbria, St Nicholas' Hospital, Jubilee Road, Gosforth, Newcastle Upon Tyne, NE3 3XT, UK.
| | - V J McGowan
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Sir James Spence Building, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
| | - J Wildman
- ScotCen, Scotiabank House, 6 South Charlotte Street, Edinburgh, EH2 4AW, UK
| | - E Bidmead
- Institute of Health, University of Cumbria, Fusehill Street, Carlisle, CA1 2HH, UK
- NIHR Applied Research Collaboration North East and North Cumbria, St Nicholas' Hospital, Jubilee Road, Gosforth, Newcastle Upon Tyne, NE3 3XT, UK
| | - J Hartley
- VONNE, 4th Floor, MEA House, Ellison Place, Newcastle upon Tyne, Tyne and Wear, NE1 8XS, UK
| | - C Mathews
- Office for Health Improvement and Disparities, Department of Health and Social Care, Waterfront 4, Goldcrest Way, Newburn Riverside, NE15 8NY, Newcastle upon Tyne, UK
| | - B James
- Office for Health Improvement and Disparities, Department of Health and Social Care, Waterfront 4, Goldcrest Way, Newburn Riverside, NE15 8NY, Newcastle upon Tyne, UK
| | - C Sullivan
- Office for Health Improvement and Disparities, Department of Health and Social Care, Waterfront 4, Goldcrest Way, Newburn Riverside, NE15 8NY, Newcastle upon Tyne, UK
| | - C Bambra
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Sir James Spence Building, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
- NIHR Applied Research Collaboration North East and North Cumbria, St Nicholas' Hospital, Jubilee Road, Gosforth, Newcastle Upon Tyne, NE3 3XT, UK
| | - S Sowden
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Sir James Spence Building, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
- Office for Health Improvement and Disparities, Department of Health and Social Care, Waterfront 4, Goldcrest Way, Newburn Riverside, NE15 8NY, Newcastle upon Tyne, UK
| |
Collapse
|
4
|
Sun Q, Loveday M, Nwe S, Morris N, Boxall E. Green Social Prescribing in Practice: A Case Study of Walsall, UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6708. [PMID: 37681848 PMCID: PMC10487442 DOI: 10.3390/ijerph20176708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023]
Abstract
This paper presents a case study of Green Social Prescribing (GSP) in Walsall, a medium-sized urban area located in the West Midlands, UK. GSP is a means of enabling health professionals to refer people to a range of local non-clinical nature-based activities, e.g., community gardening and conservation volunteering. As a new practice to address multiple challenges in health and sustainability, GSP has been promoted by the UK government and the NHS in the past few years. There is as yet limited evidence and knowledge about how this approach is implemented at a local level. This paper addresses this gap of knowledge, by exploring how GSP is implemented in Walsall as a case study. Based on extensive engagement and research activities with the local partners to collect data, this paper reveals the local contexts of GSP, the referral pathways, and people's lived experience, discussing the challenges, barriers, and opportunities in delivering GSP at the local level. This study suggests that a more collaborative and genuine place-based approach is essential, and alongside GSP, investment into infrastructure is needed to move the health paradigm further from 'prevention' to 'promotion' so that more people can benefit from what nature can offer.
Collapse
Affiliation(s)
- Qian Sun
- School of Design, Royal College of Art, Kensington Gore, London SW7 2EU, UK; (M.L.)
| | | | | | | | | |
Collapse
|
5
|
Davies M, Elliott M, Wallace S, Wallace C. Enhancing Student Wellbeing Through Social Prescribing: A Rapid Realist Review. Public Health Rev 2023; 44:1605189. [PMID: 37614322 PMCID: PMC10442486 DOI: 10.3389/phrs.2023.1605189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 07/17/2023] [Indexed: 08/25/2023] Open
Abstract
Objectives: A Rapid Realist Review of social prescribing in Higher Education (HE) was undertaken to determine what works, for whom, how, why, and within what circumstances. The review resulted in the development of a Realist Programme Theory articulating the way in which social prescribing can be implemented within the HE environment. Methods: Searches of 12 electronic databases were supplemented by citation chaining and grey literature surfaced by the Project Advisory Group. The RAMESES Quality Standards for Realist Review were followed, and the retrieved articles were systematically screened and iteratively analysed to develop Context-Mechanism-Outcome Configurations (CMOCs) and an overarching Realist Programme Theory. Results: A total of 57 documents were included. The overarching programme theory was developed from the analysis of these documents and comprised of a social prescribing pathway with the following components: (1) An Accessible Gateway, (2) A Skilled Peer, (3) Trusted-Safe-Credible Resources, and (4) A Healthy Setting. Conclusion: A Realist Programme Theory was developed-this model and associated principles will provide a theoretical basis for the implementation of social prescribing pathways within higher education. Whilst the direct project outputs are of particular significance to the UK HE audience, the underpinning principles can support practice within the global arena.
Collapse
Affiliation(s)
- Mark Davies
- PRIME Centre Wales, University of South Wales, Pontypridd, United Kingdom
| | - Megan Elliott
- PRIME Centre Wales, University of South Wales, Pontypridd, United Kingdom
- Wales School for Social Prescribing Research (WSSPR), University of South Wales, Pontypridd, United Kingdom
| | - Sarah Wallace
- Welsh Institute for Health and Social Care, University of South Wales, Pontypridd, United Kingdom
| | - Carolyn Wallace
- PRIME Centre Wales, University of South Wales, Pontypridd, United Kingdom
- Wales School for Social Prescribing Research (WSSPR), University of South Wales, Pontypridd, United Kingdom
| |
Collapse
|
6
|
Ebrahimoghli R, Pezeshki MZ, Farajzadeh P, Arab-Zozani M, Mehrtak M, Alizadeh M. Factors influencing social prescribing initiatives: a systematic review of qualitative evidence. Perspect Public Health 2023:17579139231184809. [PMID: 37497769 DOI: 10.1177/17579139231184809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
AIMS Social prescribing is a growing health policy agenda to improve the quality and effectiveness of health systems. However, systematically collected knowledge on factors influencing the effective implementation of SP is scarce. A systematic review was conducted to identify and categorize factors influencing social prescribing initiatives. METHODS A search of three electronic databases (PubMed, Scopus, and ISI Web of Knowledge) was carried out to retrieve studies from inception to May 2022, supplemented by grey literature searching and snowballing of the relevant references. The inclusion criteria were original empirical research, qualitative data collection, and a description of factors affecting social prescribing initiatives. Study quality was evaluated using the Critical Appraisal Skills Programme tool. We categorized the results of individual studies using a narrative approach. RESULTS A total of 23 studies were included for analysis. Along with patient-related factors (patient-centeredness, clinical complexity, perception, knowledge), three main settings of social prescribing initiatives (including healthcare providers, link workers, and voluntary and community sectors) are affected by (1) individual characteristics (knowledge, perception, skill mix); (2) interpersonal relations (collaboration, trust, feedback, supportive climate, follow-up, sustained connection, peer support within and across sectors); (3) organizational contingencies (resource adequacy, staffing, training, role description, continuity of support, caseload management, monitoring, affordability, accessibility, referral criteria, and tailored support); and (4) political context (national policy and guidance, stewardship, planning, cocreation, bureaucracy, economic condition, and the number of support organizations). CONCLUSION Many factors influencing social prescribing initiatives were identified. The results of this review can be applied by different stakeholders of social prescribing to guide development, implementation, description, and evaluation.
Collapse
Affiliation(s)
- R Ebrahimoghli
- Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Nursing, Institute of Health Education, Ardabil University of Medical Sciences, Ardabil, Iran
| | - M Z Pezeshki
- Department of Community and Family Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - P Farajzadeh
- Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - M Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - M Mehrtak
- School of Medicine and Allied Medical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran
| | - M Alizadeh
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Golgasht St, Azadi Avenue, 5166614711, Tabriz, Iran
| |
Collapse
|
7
|
Oster C, Skelton C, Leibbrandt R, Hines S, Bonevski B. Models of social prescribing to address non-medical needs in adults: a scoping review. BMC Health Serv Res 2023; 23:642. [PMID: 37316920 DOI: 10.1186/s12913-023-09650-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/05/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The health and wellbeing consequences of social determinants of health and health behaviours are well established. This has led to a growing interest in social prescribing, which involves linking people to services and supports in the community and voluntary sectors to address non-medical needs. However, there is considerable variability in approaches to social prescribing with little guidance on how social prescribing could be developed to reflect local health systems and needs. The purpose of this scoping review was to describe the types of social prescribing models used to address non-medical needs to inform co-design and decision-making for social prescribing program developers. METHODS We searched Ovid MEDLINE(R), CINAHL, Web of Science, Scopus, National Institute for Health Research Clinical Research Network, Cochrane Central Register of Controlled Trials, WHO International Clinical Trial Registry Platform, and ProQuest - Dissertations and Theses for articles and grey literature describing social prescribing programs. Reference lists of literature reviews were also searched. The searches were conducted on 2 August 2021 and yielded 5383 results following removal of duplicates. RESULTS 148 documents describing 159 social prescribing programs were included in the review. We describe the contexts in which the programs were delivered, the program target groups and services/supports to which participants were referred, the staff involved in the programs, program funding, and the use of digital systems. CONCLUSIONS There is significant variability in social prescribing approaches internationally. Social prescribing programs can be summarised as including six planning stages and six program processes. We provide guidance for decision-makers regarding what to consider when designing social prescribing programs.
Collapse
Affiliation(s)
- Candice Oster
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Claire Skelton
- College of Medicine & Public Health, Flinders University, Adelaide, SA, Australia
| | - Richard Leibbrandt
- College of Science & Engineering, Flinders University, Adelaide, SA, Australia
| | - Sonia Hines
- College of Medicine & Public Health, Flinders Rural and Remote Health, Flinders University, Alice Springs, Northern Territory, Australia
| | - Billie Bonevski
- College of Medicine & Public Health, Flinders University, Adelaide, SA, Australia
| |
Collapse
|
8
|
Smit C, Cartwright T. Recommending yoga for health: A survey of perceptions among healthcare practitioners in the UK. Complement Ther Clin Pract 2023; 52:101765. [PMID: 37172418 DOI: 10.1016/j.ctcp.2023.101765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/14/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Yoga has the potential to support patients across various health conditions. It is slowly being integrated into healthcare worldwide. While healthcare practitioners (HCPs) are critical to integration, there are currently no studies investigating their perceptions of yoga for health, their openness to recommending yoga to patients, and barriers to doing so. This novel UK study aims to address this. METHOD An online survey was conducted among practising UK HCPs. Recruitment was through multi-modal convenience sampling. The COM-B model was used as a framework. Regression analysis examined predictors of HCPs' likelihood to recommend yoga. Open-end responses were analysed through thematic analysis. RESULTS 198 HCPs were included in the analysis, including general practitioners (GPs, 18.8%), psychologists (18.3%), and nurses/health visitors (14.7%). A high proportion (68.8%) practised yoga at least monthly. The likelihood of recommending yoga to patients was high (M = 4.03, SD = 0.94; 5-point scale). Older age, not being a GP, and greater capability and motivation significantly predicted a greater likelihood of recommending yoga, explaining 41.4% of the variance (p < 0.001). Barriers to recommending yoga were mostly related to the lack of opportunity. CONCLUSIONS HCPs in this study had high levels of personal engagement with yoga and were open to recommending yoga to patients, but still faced several barriers. Workplace support, particularly for GPs, and information about how patients can access appropriate and affordable yoga instruction would facilitate referral. Further research with a representative sample is warranted to understand perceptions of HCPs less engaged with yoga.
Collapse
Affiliation(s)
- Carryn Smit
- Psychology, School of Social Sciences, University of Westminster, 115 New Cavendish Street, London, W1W 6UW, United Kingdom.
| | - Tina Cartwright
- Psychology, School of Social Sciences, University of Westminster, 115 New Cavendish Street, London, W1W 6UW, United Kingdom.
| |
Collapse
|
9
|
Hughes G, Rybczynska-Bunt S, Shasha'h S, Greene S, Shaw S, Greenhalgh T. Protocol: How can people with social care needs be supported through processes of digital care navigation to access remote primary care? A multi-site case study in UK general practice of remote care as the 'new normal'. NIHR OPEN RESEARCH 2023; 3:17. [PMID: 37881454 PMCID: PMC10593327 DOI: 10.3310/nihropenres.13385.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 10/27/2023]
Abstract
Background Care navigation refers to support for patients accessing primary care and other related services. The expansion of digitally enabled care in the UK since the coronavirus disease 2019 (COVID-19) pandemic has led to a greater need for digital care navigation: supporting people to access primary care digitally and, if necessary, to help them find alternative non-digital routes of access. Support to patients with social care needs (including but not limited to those who are homeless and insecurely housed, living in residential care and supported by domiciliary carers) increasingly involves work to navigate primary care provided remotely and accessed digitally. There is little knowledge about how this work is being done. Methods Care Navigation involves embedded researchers identifying digital care navigation for patients accessing services in 11 GP practices recruited to a linked study of remote primary care ( Remote care as the 'new normal?'). Digital care navigation will be studied through go-along (in-person or remote) interviews with a sample of 20 people offering formal (paid or voluntary) support, 6 national and regional stakeholders who plan, commission or provide digital care navigation and a focus group with 12 social prescribers engaged in digital care navigation. A co-design workshop with people working in, or commissioning, social care settings will consider how findings can inform improved digital care navigation, for example through the development of resources or guidance for care navigators. Results anticipated Findings are anticipated to include evidence of how digital care navigation is practised, the work that is done to support patients in accessing remote primary care, and how this work is shaped by material resources and variations in the configuration of services and infrastructure. Conclusions New explanations of the work needed to navigate digital care will inform policy and service developments aimed at helping patients benefit from remote primary care.
Collapse
Affiliation(s)
- Gemma Hughes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Sarah Rybczynska-Bunt
- Penisula Medical School (Faculty of Health), University of Plymouth, Plymouth, PL6 8BX, UK
| | - Sara Shasha'h
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Sarah Greene
- Penisula Medical School (Faculty of Health), University of Plymouth, Plymouth, PL6 8BX, UK
| | - Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| |
Collapse
|
10
|
Bernard K, Wildman JM, Tanner LM, Stoniute A, Still M, Green R, Eastaugh C, Sowden S, Thomson KH. Experiences of Non-Pharmaceutical Primary Care Interventions for Common Mental Health Disorders in Socioeconomically Disadvantaged Groups: A Systematic Review of Qualitative Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5237. [PMID: 37047854 PMCID: PMC10094719 DOI: 10.3390/ijerph20075237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/07/2023] [Accepted: 03/12/2023] [Indexed: 06/19/2023]
Abstract
Common mental health disorders (CMDs) disproportionately affect people experiencing socioeconomic disadvantage. Non-pharmaceutical interventions, such as 'social prescribing' and new models of care and clinical practice, are becoming increasingly prevalent in primary care. However, little is known about how these interventions work and their impact on socioeconomic inequalities in health. Focusing on people experiencing socioeconomic disadvantage, this systematic review aims to: (1) explore the mechanisms by which non-pharmaceutical primary care interventions impact CMD-related health outcomes and inequalities; (2) identify the barriers to, and facilitators of, their implementation in primary care. This study is a systematic review of qualitative studies. Six bibliographic databases were searched (Medline, ASSIA, CINAHL, Embase, PsycInfo and Scopus) and additional grey literature sources were screened. The included studies were thematically analysed. Twenty-two studies were included, and three themes were identified: (1) agency; (2) social connections; (3) socioeconomic environment. The interventions were experienced as being positive for mental health when people felt a sense of agency and social connection. The barriers to effectiveness and engagement included socioeconomic deprivation and underfunding of community sector organisations. If non-pharmaceutical primary care interventions for CMDs are to avoid widening health inequalities, key socioeconomic barriers to their accessibility and implementation must be addressed.
Collapse
Affiliation(s)
- Kate Bernard
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
| | - Josephine M. Wildman
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) for the North-East and North Cumbria (NENC), Newcastle NE4 5TG, UK
| | - Louise M. Tanner
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
- National Institute for Health and Care Research (NIHR) Innovation Observatory, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
| | - Akvile Stoniute
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
- National Institute for Health and Care Research (NIHR) Innovation Observatory, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
| | - Madeleine Still
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
| | - Rhiannon Green
- National Institute for Health and Care Research (NIHR) Innovation Observatory, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
| | - Claire Eastaugh
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) for the North-East and North Cumbria (NENC), Newcastle NE4 5TG, UK
| | - Katie H. Thomson
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) for the North-East and North Cumbria (NENC), Newcastle NE4 5TG, UK
| |
Collapse
|
11
|
Moffatt S, Wildman J, Pollard TM, Gibson K, Wildman JM, O’Brien N, Griffith B, Morris SL, Moloney E, Jeffries J, Pearce M, Mohammed W. Impact of a social prescribing intervention in North East England on adults with type 2 diabetes: the SPRING_NE multimethod study. PUBLIC HEALTH RESEARCH 2023; 11:1-185. [DOI: 10.3310/aqxc8219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Background
Link worker social prescribing enables health-care professionals to address patients’ non-medical needs by linking patients into various services. Evidence for its effectiveness and how it is experienced by link workers and clients is lacking.
Objectives
To evaluate the impact and costs of a link worker social prescribing intervention on health and health-care costs and utilisation and to observe link worker delivery and patient engagement.
Data sources
Quality Outcomes Framework and Secondary Services Use data.
Design
Multimethods comprising (1) quasi-experimental evaluation of effects of social prescribing on health and health-care use, (2) cost-effectiveness analysis, (3) ethnographic methods to explore intervention delivery and receipt, and (4) a supplementary interview study examining intervention impact during the first UK COVID-19 lockdown (April–July 2020).
Study population and setting
Community-dwelling adults aged 40–74 years with type 2 diabetes and link workers in a socioeconomically deprived locality of North East England, UK.
Intervention
Link worker social prescribing to improve health and well-being-related outcomes among people with long-term conditions.
Participants
(1) Health outcomes study, approximately n = 8400 patients; EuroQol-5 Dimensions, five-level version (EQ-5D-5L), study, n = 694 (baseline) and n = 474 (follow-up); (2) ethnography, n = 20 link workers and n = 19 clients; and COVID-19 interviews, n = 14 staff and n = 44 clients.
Main outcome measures
The main outcome measures were glycated haemoglobin level (HbA1c; primary outcome), body mass index, blood pressure, cholesterol level, smoking status, health-care costs and utilisation, and EQ-5D-5L score.
Results
Intention-to-treat analysis of approximately 8400 patients in 13 intervention and 11 control general practices demonstrated a statistically significant, although not clinically significant, difference in HbA1c level (–1.11 mmol/mol) and a non-statistically significant 1.5-percentage-point reduction in the probability of having high blood pressure, but no statistically significant effects on other outcomes. Health-care cost estimates ranged from £18.22 (individuals with one extra comorbidity) to –£50.35 (individuals with no extra comorbidity). A statistically non-significant shift from unplanned (non-elective and accident and emergency admissions) to planned care (elective and outpatient care) was observed. Subgroup analysis showed more benefit for individuals living in more deprived areas, for the ethnically white and those with fewer comorbidities. The mean cost of the intervention itself was £1345 per participant; the incremental mean health gain was 0.004 quality-adjusted life-years (95% confidence interval –0.022 to 0.029 quality-adjusted life-years); and the incremental cost-effectiveness ratio was £327,250 per quality-adjusted life-year gained. Ethnographic data showed that successfully embedded, holistic social prescribing providing supported linking to navigate social determinants of health was challenging to deliver, but could offer opportunities for improving health and well-being. However, the intervention was heterogeneous and was shaped in unanticipated ways by the delivery context. Pressures to generate referrals and meet targets detracted from face-to-face contact and capacity to address setbacks among those with complex health and social problems.
Limitations
The limitations of the study include (1) a reduced sample size because of non-participation of seven general practices; (2) incompleteness and unreliability of some of the Quality and Outcomes Framework data; (3) unavailability of accurate data on intervention intensity and patient comorbidity; (4) reliance on an exploratory analysis with significant sensitivity analysis; and (5) limited perspectives from voluntary, community and social enterprise.
Conclusions
This social prescribing model resulted in a small improvement in glycaemic control. Outcome effects varied across different groups and the experience of social prescribing differed depending on client circumstances.
Future work
To examine how the NHS Primary Care Network social prescribing is being operationalised; its impact on health outcomes, service use and costs; and its tailoring to different contexts.
Trial registration
This trial is registered as ISRCTN13880272.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme, Community Groups and Health Promotion (grant no. 16/122/33) and will be published in full in Public Health Research; Vol. 11, No. 2. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Suzanne Moffatt
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John Wildman
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Kate Gibson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Josephine M Wildman
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola O’Brien
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Bethan Griffith
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Eoin Moloney
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jayne Jeffries
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mark Pearce
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Wael Mohammed
- Public Health Economics and Decision Science (DTC), Sheffield University, Sheffield, UK
| |
Collapse
|
12
|
Griffith B, Pollard T, Gibson K, Jeffries J, Moffatt S. Constituting link working through choice and care: An ethnographic account of front-line social prescribing. SOCIOLOGY OF HEALTH & ILLNESS 2023; 45:279-297. [PMID: 36284215 PMCID: PMC10092014 DOI: 10.1111/1467-9566.13569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Link worker social prescribing has become a prominent part of NHS England's personalisation agenda. However, approaches to social prescribing vary, with multiple discourses emerging about the potential of social prescribing and different interpretations of personalisation. The transformational promise of social prescribing is the subject of ongoing debate, whilst the factors that shape the nature of front-line link working practices remain unclear. Based on 11 months of in-depth ethnographic research with link workers delivering social prescribing, we show how link workers' practices were shaped by the context of the intervention and how individual link workers navigated varied understandings of social prescribing. Following the work of Mol, we show how link workers drew differentially on the interacting logics of choice and care and trace a multiplicity in front-line link working practices within a single intervention. However, over time, it appeared that a logic of choice was becoming increasingly dominant, making it harder to deliver practices that aligned with a logic of care. We conclude that interpreting personalisation through a logic of choice could potentially undermine link working practices that privilege care whilst obscuring the need for wider investment in health care systems and the social determinants of health.
Collapse
Affiliation(s)
- Bethan Griffith
- Population Health Sciences InstituteFaculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
| | | | - Kate Gibson
- Department of Social Work, Education and Community WellbeingNorthumbria UniversityNewcastle‐Upon‐TyneUK
| | - Jayne Jeffries
- Population Health Sciences InstituteFaculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
| | - Suzanne Moffatt
- Population Health Sciences InstituteFaculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
| |
Collapse
|
13
|
Lawler C, Sherriff G, Brown P, Butler D, Gibbons A, Martin P, Probin M. Homes and health in the Outer Hebrides: A social prescribing framework for addressing fuel poverty and the social determinants of health. Health Place 2023; 79:102926. [PMID: 36442316 DOI: 10.1016/j.healthplace.2022.102926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 08/18/2022] [Accepted: 10/03/2022] [Indexed: 11/27/2022]
Abstract
Health services are increasingly being reshaped with reference to addressing social determinants of health (SDoH), with social prescribing a prominent example. We examine a project in the Outer Hebrides that reshaped and widened the local health service, framing fuel poverty as a social determinant of health and mobilising a cross-sector support pathway to make meaningful and substantive improvements to islanders' living conditions. The 'Moving Together' project provided support to almost 200 households, ranging from giving advice on home energy, finances and other services, to improving the energy efficiency of their homes. In so doing, the project represents an expansion of the remit of social prescribing, in comparison with the majority of services currently provided under this banner, and can be seen as a more systemic approach that engages with the underlying conditions of a population's health. We present a framework through which to understand and shape initiatives to address fuel poverty through a social prescribing approach.
Collapse
Affiliation(s)
- Cormac Lawler
- Salford Social Prescribing Hub, School of Health & Society, University of Salford, Salford, M6 6PU, UK.
| | - Graeme Sherriff
- Sustainable Housing & Urban Studies Unit (SHUSU), School of Health & Society, University of Salford, Salford, M6 6PU, UK.
| | - Philip Brown
- School of Human and Health Sciences, University of Huddersfield, HD1 3DH, UK.
| | - Danielle Butler
- National Energy Action, West One, Forth Banks, Newcastle upon Tyne, NE1 3PA, UK.
| | - Andrea Gibbons
- Sustainable Housing & Urban Studies Unit (SHUSU), School of Health & Society, University of Salford, Salford, M6 6PU, UK.
| | - Philip Martin
- Sustainable Housing & Urban Studies Unit (SHUSU), School of Health & Society, University of Salford, Salford, M6 6PU, UK.
| | - Margaret Probin
- Sustainable Housing & Urban Studies Unit (SHUSU), School of Health & Society, University of Salford, Salford, M6 6PU, UK.
| |
Collapse
|
14
|
Wildman J, Wildman JM. Impact of a link worker social prescribing intervention on non-elective admitted patient care costs: A quasi-experimental study. Soc Sci Med 2023; 317:115598. [PMID: 36527893 DOI: 10.1016/j.socscimed.2022.115598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/28/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
Healthcare systems in many countries are enthusiastically adopting link worker social prescribing interventions that aim to tackle the social determinants of health by linking patients to voluntary and community sector activities and sources of support to address their social needs and improve condition management. Social prescribing interventions aim to improve health and reduce healthcare spending. However, despite the diversion of healthcare budgets to fund social prescribing, we still lack robust evidence for its effectiveness. In this study we evaluate whether participation in a social prescribing intervention reduced non-elective admitted patient care use and costs for 8283 patients aged between 40 and 74 years, with a diagnosis of type 2 diabetes and living in an area of high socioeconomic deprivation in north-east England. Patients were followed for a total of 6 years: 2 years pre-intervention and 4 years post intervention. Exploiting a natural experiment, we used a two-part difference-in-differences regression model to estimate costs conditional on healthcare use. We also estimated intervention effects across several intervention and control groups and sample subgroups. Participation in the intervention resulted in reductions of up to -£77.57 [95% CI: -152.30, -2.84] (for high engagement patients) per patient, per year, in non-elective care costs. Reductions were greater for patients with higher levels of engagement with the intervention. Sub-group analyses showed greater cost reductions for non-White patients, older patients, and patients without additional co-morbidities. Our findings suggest that engagement with a link worker social prescribing intervention may reduce non-elective healthcare spending, perhaps through enabling better condition management that results in fewer avoidable health crises.
Collapse
Affiliation(s)
- John Wildman
- Economics, Newcastle University Business School, Newcastle University, UK.
| | | |
Collapse
|
15
|
Robinson T, Robertson N, Curtis F, Darko N, Jones CR. Examining Psychosocial and Economic Barriers to Green Space Access for Racialised Individuals and Families: A Narrative Literature Review of the Evidence to Date. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:745. [PMID: 36613069 PMCID: PMC9819928 DOI: 10.3390/ijerph20010745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Social prescribing (such as green social prescribing), aims to address health disparities cross-culturally to improve well-being. However, evidence highlights racial disparities in relation to access to quality green space (including local/national parks and recreational spaces). This review aimed to identify the psycho-socioeconomic barriers to green space access for racialised individuals/families and Black Indigenous People of Colour (BIPOC), to understand what cultural adaptations might be made to help support them to access green social prescribing within the UK. METHOD A narrative systematic review was conducted to identify barriers to green space access for racialised individuals/families and BIPOC. Searches of publication databases (APA PsycInfo, Cochrane Database of Systematic Reviews [CDSR], Cochrane Central Register of Controlled Trials [CENTRAL], Cumulated Index to Nursing and Allied Health Literature [CINAHL], and SCOPUS Preview) were undertaken from January to February 2022, to identify quantitative peer reviewed studies. Of the 4493 abstracts identified, ten studies met the inclusion criteria and were included for final review. RESULTS The results suggest that interpersonal, practical (such as transportation costs, entrance fees and lodging costs) and environmental factors can act as barriers to green space access for racialised individuals/families. Most frequently reported barriers were perceptions of safety and costs associated with travel and accessing green spaces, particularly for families. CONCLUSION Factors such as diversity-friendly schemes (e.g., multiple languages on signs and additional prayer spaces in parks), funding and strategies to improve safety should be considered in the design and commissioning of green space and green social prescribing initiatives in primary care. By mitigating these barriers green space can become more accessible and improve inclusivity for racialised individuals/families. Future research could explore the inter-racial differences between racialised populations and which mechanisms reduce barriers to access and in what contexts.
Collapse
Affiliation(s)
- Tila Robinson
- Department of Psychology and Vison Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Noelle Robertson
- Department of Psychology and Vison Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Ffion Curtis
- Centre for Ethnic Health, University of Leicester, Leicester LE1 7RH, UK
| | - Natalie Darko
- School of Sociology, University of Leicester, Leicester LE1 7RH, UK
| | - Ceri R. Jones
- Department of Psychology and Vison Sciences, University of Leicester, Leicester LE1 7RH, UK
| |
Collapse
|
16
|
Sharman LS, McNamara N, Hayes S, Dingle GA. Social prescribing link workers-A qualitative Australian perspective. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6376-e6385. [PMID: 36271695 PMCID: PMC10092430 DOI: 10.1111/hsc.14079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/12/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Social prescribing (or community referral) is a model of healthcare designed to address social needs that contribute to poor health. At the heart of social prescribing programs is the link worker, who liaises between clients, health professionals and community organisations. Social prescribing is newly emerging in Australia but there are already calls for a large-scale roll out. This research, therefore, aimed to understand Australian link workers' role and skills required, to determine where such a workforce could be drawn from in Australia, and to identify what training and resources are needed to support this potential new workforce. To explore these questions, interviews were conducted with 15 link workers in Queensland, New South Wales and Victoria, and the transcripts were analysed using thematic analysis. Participants were predominantly female (87%); and primarily had qualifications in social work (47%) or nursing (27%). Three overarching themes were identified: (1) skills of successful social prescribing, identifying that link work requires multifaceted social and emotional skills; (2) workforce issues, presenting that link workers experienced challenges such as a lack of available support and training, lack of public awareness of social prescribing and a lack of sustained funding; and (3) job fulfilment, related to link workers' sense of reward and accomplishment from the job. We suggest that fostering job fulfilment in conjunction with the provision of increased support, training and security will reduce feelings of overwork and burnout among link workers and likely lead to longevity in the role. Social prescribing has the potential to be hugely beneficial to clients and the community and fulfilling for link workers, provided that sufficient advocacy and resources are put in place.
Collapse
Affiliation(s)
- Leah S. Sharman
- School of PsychologyUniversity of QueenslandSt LuciaAustralia
| | | | - Shaun Hayes
- School of PsychologyUniversity of QueenslandSt LuciaAustralia
| | | |
Collapse
|
17
|
White C, Bell J, Reid M, Dyson J. More than signposting: Findings from an evaluation of a social prescribing service. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5105-e5114. [PMID: 35915879 DOI: 10.1111/hsc.13925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/03/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
This paper presents findings from an evaluation of a social prescribing service, undertaken between January 2019 and December 2020. Data was collected through interviews and focus groups with a range of groups including social prescribing managers, link workers (LWs), referrers (GPs and social work practitioners), clients, Voluntary and Community Sector (VCS) agencies and groups. Thematic analysis of data was undertaken, and findings were presented in respect of clients' journeys into social prescribing; the support received from LWs; their onward journeys to VCS support. The findings highlight the challenges for individuals in contacting new agencies/groups and the importance of practitioner referral into and onwards from social prescribing, as well as buddying to support clients on initial agency visits. The depth of the LW role is highlighted, as well as the complexity of client circumstances, highlighting a need for 'more than signposting', and challenging the notion of self-referral as an indicator of motivation. Social prescribing has been positioned as amongst the solutions to the challenges of primary care. However, referrals from GPs were low and significantly outnumbered by those from social workers; this suggests a need to explore in greater depth the use of social prescribing by social workers, who have, to date, been absent from social prescribing research.
Collapse
Affiliation(s)
- Caroline White
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Jo Bell
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Marie Reid
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Judith Dyson
- Faculty of Health Sciences, University of Hull, Hull, UK
- Centre for Social Care, Health and Related Research, Birmingham City University, Birmingham, UK
| |
Collapse
|
18
|
Westlake D, Elston J, Gude A, Gradinger F, Husk K, Asthana S. Impact of COVID-19 on social prescribing across an Integrated Care System: A Researcher in Residence study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4086-e4094. [PMID: 35355347 PMCID: PMC9111657 DOI: 10.1111/hsc.13802] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/25/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
Emerging evidence suggests that connecting people to non-medical activities in the community (social prescribing) may relieve pressure on services by promoting autonomy and resilience, thereby improving well-being and self-management of health. This way of working has a long history in the voluntary and community sector but has only recently been widely funded by the National Health Service (NHS) in England and implemented in Primary Care Networks (PCNs). The COVID-19 global pandemic coincided with this new service. There is wide variation in how social prescribing is implemented and scant evidence comparing different delivery models. As embedded researchers within an Integrated Care System in the Southwest of England, we examined the impact of COVID on the implementation of social prescribing in different employing organisations during the period March 2020 to April 2021. Data were collected from observations and field notes recorded during virtual interactions with over 80 social prescribing practitioners and an online survey of 52 social prescribing practitioners and middle managers. We conceptualise social prescribing as a pathway comprising access, engagement and activities, facilitated by workforce and community assets and strategic partnerships. We found that these elements were all impacted by the pandemic, but to different degrees according to the way the service was contracted, whether referrals (access) and approach (engagement) were universal ('open') or targeted ('boundaried') and the extent to which practitioners' roles were protected or shifted towards immediate COVID-specific work. Social prescribers contracted in PCNs were more likely to operate an 'open' model, although boundaries were developing over time. We suggest the presence of an explicit, agreed delivery model (whether 'open' or 'boundaried') might create a more coherent approach less likely to result in practitioner role drift, whilst allowing flexibility to adjust to the pandemic and enhancing practitioner satisfaction and well-being. The potential consequences of different models are examined.
Collapse
Affiliation(s)
- Debra Westlake
- Community and Primary Care Research GroupFaculty of Health, Medicine, Dentistry and Human SciencesUniversity of PlymouthPlymouthUK
- Centre for Evidence‐Based MedicineNuffield Department of Primary Care Health SciencesUniversity of OxfordRadcliffe Observatory QuarterOxfordUK
- Present address:
Centre for Evidence‐Based MedicineNuffield Department of Primary Care Health SciencesUniversity of OxfordRadcliffe Observatory QuarterOxfordUK
| | - Julian Elston
- Community and Primary Care Research GroupFaculty of Health, Medicine, Dentistry and Human SciencesUniversity of PlymouthPlymouthUK
| | - Alex Gude
- Community and Primary Care Research GroupFaculty of Health, Medicine, Dentistry and Human SciencesUniversity of PlymouthPlymouthUK
| | - Felix Gradinger
- Community and Primary Care Research GroupFaculty of Health, Medicine, Dentistry and Human SciencesUniversity of PlymouthPlymouthUK
| | - Kerryn Husk
- Applied Research Collaboration South West Peninsula (PenARC)Faculty of Health, MedicineDentistry and Human SciencesUniversity of PlymouthNational Institute for Health ResearchPlymouthUK
| | - Sheena Asthana
- Plymouth Institute of Health and Care ResearchPlymouthUK
| |
Collapse
|
19
|
Sandhu S, Lian T, Drake C, Moffatt S, Wildman J, Wildman J. Intervention components of link worker social prescribing programmes: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3761-e3774. [PMID: 36181384 DOI: 10.1111/hsc.14056] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 08/15/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
In the United Kingdom (UK), link worker social prescribing has emerged as an option to improve long-term condition management and address primary care patients' non-medical needs by linking patients with community-based activities and support. Social prescribing is a complex, heterogenous intervention, and there is currently no taxonomy of components to guide its implementation and evaluation. This study aimed to identify and categorise the components of link worker social prescribing schemes in the United Kingdom. A scoping review of peer-reviewed literature was conducted. Six databases were used to identify papers that met inclusion criteria. Eligible articles were original research studies in the United Kingdom describing interventions that included (1) initial referral of adults with chronic physical health conditions and/or unmet social needs from primary care to a link worker or equivalent role, (2) consultation with a link worker or equivalent role and (3) referral to a community-based or government service. Of the 1078 articles identified, 32 met study eligibility criteria, representing 22 social prescribing schemes. We drew from the template for intervention description and replication (TIDieR) to identify, organise and report intervention components. We found wide variations in geography, target populations and intervention components such as activities and procedures conducted by primary care staff and link workers, organisational and staffing configurations and use of tools and financing approaches to facilitate adoption. Intervention components are summarised into a taxonomy to guide future research, policy and practice efforts in addition to supporting standardised intervention reporting.
Collapse
Affiliation(s)
- Sahil Sandhu
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
- Harvard Medical School, Boston, Massachusetts, USA
| | - Tyler Lian
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Connor Drake
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Suzanne Moffatt
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - John Wildman
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Josephine Wildman
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| |
Collapse
|
20
|
Managing disruption at a distance: Unequal experiences of people living with long-term conditions during the COVID-19 pandemic. Soc Sci Med 2022; 302:114963. [PMID: 35500314 PMCID: PMC8990438 DOI: 10.1016/j.socscimed.2022.114963] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/21/2022] [Accepted: 04/04/2022] [Indexed: 01/10/2023]
Abstract
The COVID-19 pandemic and 'lockdown' restrictions have affected people's health and wellbeing globally. Those who are clinically vulnerable to COVID-19 mortality due to living with long term conditions (LTCs) are at greater risk of negative impacts on their health and wellbeing, and of disruption in management of their LTCs. This study explores how people with LTCs managed their health and wellbeing under social distancing restrictions and self-isolation during the first wave of the COVID-19 pandemic, and examines why some people were more able to manage than others. Interviews were conducted between May and July 2020 with people (n = 44) living in North East England, who had one or more LTCs and were recruited via a social prescribing intervention. Data were analysed using a social constructivist thematic analysis. We present our analysis of the possibilities afforded to people to manage the impacts of lockdown on their health and wellbeing. We find that while some people deployed a range of capitals and/or etched out 'tactics' to make life 'habitable', others experienced 'zones of impossibility' requiring that they rely on contingent events or formal support. Our analysis highlights inequalities amongst people with LTCs, particularly regarding access to and deployment of important resources for health and wellbeing under COVID-19 social distancing restrictions, including outdoor space or greenspace, exercise and social connection. The study is novel in showing the mechanisms for coping with a significant period of disruption in the life-course whilst highlighting that although resilience was common in people with LTCs, this was sometimes at detrimental costs to themselves.
Collapse
|
21
|
Featherstone C, Sharpe RA, Axford N, Asthana S, Husk K. Health and wellbeing outcomes and social prescribing pathways in community-based support for autistic adults: A systematic mapping review of reviews. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e621-e635. [PMID: 34738679 DOI: 10.1111/hsc.13635] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/08/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
Adults on the autism spectrum are affected by health disparities which significantly reduce life expectancy and experience barriers to accessing healthcare. Social prescribing is a holistic approach that diverts patients from primary care to health-enhancing activities in communities. However, there has been a lack of research attention to how autistic people navigate the social prescribing pathway and the ability of these approaches to address existing disparities. This mapping review aimed to synthesise features of non-medical, community-based interventions for autistic adults to assess their suitability for a social prescribing approach. A systematic search and screening process was used to identify literature reviews from medical databases (Embase, Medline, PsycINFO, CINAHL and Cochrane reviews) and grey literature. We extracted data from 24 reviews and 19 studies including types of services, participants, outcomes, settings and procedures. A narrative and visual synthesis is used to map the variety of services and interventions identified, the outcome measures used, and the barriers and facilitators to progression through services in relation to a realist social prescribing framework. The review found that there has been minimal evaluation of holistic, low intensity services for autistic adults, such as those offered in social prescribing approaches. Outcome measures remain focused on features of autism and reveal less about the effects of interventions on health and wellbeing. Aspects of the social prescribing model were identified in the features of service pathways, but findings also suggested how social prescribing could be adapted to improve accessibility for autistic people.
Collapse
Affiliation(s)
- Charlotte Featherstone
- NIHR Applied Research Collaboration (ARC) South West Peninsula, University of Plymouth, Plymouth, UK
| | - Richard A Sharpe
- Public Health, Cornwall Council and European Centre for Environment and Human Health, University of Exeter Medical School, Royal Cornwall Hospital, Truro, UK
| | - Nick Axford
- NIHR Applied Research Collaboration (ARC) South West Peninsula, University of Plymouth, Plymouth, UK
| | - Sheena Asthana
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Kerryn Husk
- NIHR Applied Research Collaboration (ARC) South West Peninsula, University of Plymouth, Plymouth, UK
| |
Collapse
|
22
|
Calderón‐Larrañaga S, Greenhalgh T, Finer S, Clinch M. What does the literature mean by social prescribing? A critical review using discourse analysis. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:848-868. [PMID: 35404485 PMCID: PMC9321825 DOI: 10.1111/1467-9566.13468] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/18/2022] [Indexed: 06/02/2023]
Abstract
Social prescribing (SP) seeks to enhance the role of the voluntary and community sector in addressing patients' complex needs in primary care. Using discourse analysis, this review investigates how SP is framed in the scientific literature and explores its consequences for service delivery. Theory driven searches identified 89 academic articles and grey literature that included both qualitative and quantitative evidence. Across the literature three main discourses were identified. The first one emphasised increasing social inequalities behind escalating health problems and presented SP as a response to the social determinants of health. The second one problematised people's increasing use of health services and depicted SP as a means of enhancing self-care. The third one stressed the dearth of human and relational dimensions in general practice and claimed that SP could restore personalised care. Discourses circulated unevenly in the scientific literature, conditioned by a wider political rationality which emphasised individual responsibility and framed SP as 'solution' to complex and contentious problems. Critically, this contributed to an oversimplification of the realities of the problems being addressed and the delivery of SP. We propose an alternative 'care-based' framing of SP which prioritises (and evaluates) holistic, sustained and accessible practices within strengthened primary care systems.
Collapse
Affiliation(s)
- Sara Calderón‐Larrañaga
- Centre for Primary Care and Mental HealthWolfson Institute of Population HealthQueen Mary University of LondonLondonUK
- Bromley‐by‐Bow Health PartnershipXX Place Health CentreMile End HospitalLondonUK
| | - Trish Greenhalgh
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordRadcliffe Primary Care BuildingRadcliffe Observatory QuarterOxfordUK
| | - Sarah Finer
- Centre for Primary Care and Mental HealthWolfson Institute of Population HealthQueen Mary University of LondonLondonUK
- Barts Health NHS TrustNewham University HospitalLondonUK
| | - Megan Clinch
- Centre for Primary Care and Mental HealthWolfson Institute of Population HealthQueen Mary University of LondonLondonUK
| |
Collapse
|
23
|
Morris SL, Gibson K, Wildman JM, Griffith B, Moffatt S, Pollard TM. Social prescribing during the COVID-19 pandemic: a qualitative study of service providers' and clients' experiences. BMC Health Serv Res 2022; 22:258. [PMID: 35216608 PMCID: PMC8873347 DOI: 10.1186/s12913-022-07616-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 02/02/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND COVID-19 public health restrictions, such as social distancing and self-isolation, have been particularly challenging for vulnerable people with health conditions and/or complex social needs. Link worker social prescribing is widespread in the UK and elsewhere and is regarded as having the potential to provide support to vulnerable people during the pandemic. This qualitative study explores accounts of how an existing social prescribing service adapted to meet clients' needs in the first wave of the pandemic, and of how clients experienced these changes. METHODS Data were collected in a deprived urban area of North East England via remote interviews with clients (n = 44), link workers (n = 5) and service provider managerial staff (n = 8) from May-September 2020. Thematic data analysis was conducted. RESULTS The research found that service providers quickly adapted to remote intervention delivery aiming to serve existing clients and other vulnerable groups. Service providers experienced improved access to some existing clients via telephone in the first months of remote delivery and in some cases were able to engage clients who had previously not attended appointments at GP surgeries. However, link workers also experienced challenges in building rapport with clients, engaging clients with the aims of the intervention and providing a service to digitally excluded people. Limited link worker capacity meant clients experienced variable contact with link workers with only some experiencing consistent support that was highly valued for helping to manage their conditions and mental wellbeing. Limited access to linked services also adversely affected clients. Clients living in less affluent circumstances and/or with worse health were more likely to experience negative impacts on their long-term condition. Some found their health and progress with social prescribing was 'on hold' or 'going backwards', which sometimes negatively affected their health. CONCLUSIONS Social prescribing offered valued support to some during the pandemic, but remote support sometimes had limited impact for clients and findings highlight the vulnerability of social prescribing's success when linked services are disrupted. Findings also show the need for more to be done in the upscaling of social prescribing to provide support to digitally excluded populations.
Collapse
Affiliation(s)
- Stephanie L Morris
- Department of Anthropology, Durham University, Dawson Building, South Road, Durham, DH1 3LE, UK.
| | - Kate Gibson
- Population Health Sciences Institute, Faculty of Medical Sciences, Ridley 1, Newcastle University, Newcastle Upon Tyne, NE1 7RU, UK
| | - Josephine M Wildman
- Population Health Sciences Institute, Faculty of Medical Sciences, Ridley 1, Newcastle University, Newcastle Upon Tyne, NE1 7RU, UK
| | - Bethan Griffith
- Population Health Sciences Institute, Faculty of Medical Sciences, Ridley 1, Newcastle University, Newcastle Upon Tyne, NE1 7RU, UK
| | - Suzanne Moffatt
- Population Health Sciences Institute, Faculty of Medical Sciences, Ridley 1, Newcastle University, Newcastle Upon Tyne, NE1 7RU, UK
| | - Tessa M Pollard
- Department of Anthropology, Durham University, Dawson Building, South Road, Durham, DH1 3LE, UK
| |
Collapse
|
24
|
Rothe D, Heiss R. Link workers, activities and target groups in social prescribing: a literature review. JOURNAL OF INTEGRATED CARE 2022. [DOI: 10.1108/jica-09-2021-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Social prescribing is a model of integrated care, in which primary healthcare staff can link patients to the social care sector. However, social prescribing can occur in different forms. To better understand the concept of social prescribing, this literature review examines the role of the link workers, activities and target groups.Design/methodology/approach A literature review was conducted. Studies before May 2020 were considered. In total, 1,700 studies were identified using the databases Pubmed, PsycInfo, Cinahl, Web of Science and Cochrane Library. After eligibility checks, 16 studies were included in the final analysis.Findings A few studies warned of a deeper engagement of the link worker due to service dependency, but most studies encouraged an active and supportive role of the link worker. Participants engaged in social, physical and counseling activities. The majority of studies emphasized the importance of linking group activities with personal preferences and identity needs. The main target groups were composed of individuals with psychosocial needs, but some studies also included patients with physical or mental illnesses.Originality/value Social prescribing is widely advocated as an innovative model of integrated care. However, few studies have looked into the complex system of social prescribing. This study analyzes the linking processes, activities and target groups in extant social prescribing programs.
Collapse
|
25
|
Exploring the enablers and barriers to social prescribing for people living with long-term neurological conditions: a focus group investigation. BMC Health Serv Res 2021; 21:1230. [PMID: 34774034 PMCID: PMC8590354 DOI: 10.1186/s12913-021-07213-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/14/2021] [Indexed: 12/03/2022] Open
Abstract
Background People living with Long Term Neurological Conditions (LTNCs) value peer support and social activities. Psychological support and wellbeing enables them to manage their condition. Social prescribing is a formal process of referring patients to a link worker to co-design a plan to improve their health and wellbeing. Intervention involves supporting participation in activities based within the individual’s local community. This study aimed to explore the barriers and enablers to accessing social prescribing for people living with LTNCs (plwLTNCs). Methods A total of four focus groups were carried out with 17 participants, including different neurological conditions such as multiple sclerosis, Fragile X Syndrome, epilepsy, and traumatic brain injury. Two participants were family carers and supported people living with epilepsy and motor neurone disease. Findings were analysed using thematic analysis. Results Five themes were identified: (1) Lack of knowledge; (2) Service provision difficulties; (3) Benefits of social prescribing activities; (4) Physical barriers and (5) Psychological barriers. There was a lack of knowledge about social prescribing and what it actually was. Participants anticipated service provision difficulties relating to funding, link workers need for knowledge of LTNC’s and for activities to be varied and individualised. The potential benefits of social prescribing activities were recognised across the groups especially its potential to tackle loneliness and to offer plwLTNC’s purpose. Participants highlighted a number of physical barriers such as transport and accessibility; and psychological barriers such as anxiety and stigma. Conclusion Social prescribing aims to address the health inequalities of those living with long-term conditions, however currently it is likely to exclude plwLTNCs. Recommendations for practice and future research are made. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07213-6.
Collapse
|
26
|
Rhodes J, Bell S. ''It sounded a lot simpler on the job description'': A qualitative study exploring the role of social prescribing link workers and their training and support needs (2020). HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:e338-e347. [PMID: 33761145 DOI: 10.1111/hsc.13358] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 02/05/2021] [Accepted: 02/24/2021] [Indexed: 06/12/2023]
Abstract
Social prescribing is an increasingly popular approach to promoting health and well-being, by addressing the wider determinants of health such as physical inactivity, social isolation and financial insecurity. Social prescribing link workers (SPs) connect people to local, non-clinical services. As part of the NHS Long Term Plan, NHS England aims to recruit 1,000 SPs across England by 2021. Understanding the role of SPs, including challenging aspects of the role and the types of training and support needed by SPs is crucial to optimising the effectiveness of social prescribing. Semi-structured qualitative interviews were conducted with nine SPs from five NHS and voluntary sector organisations in London to explore the role of SPs and identify SP training and support needs. Interviews were analysed thematically and three key themes emerged for which SPs needed particular support: defining and promoting their role; supporting clients with complex needs and coping with the emotional demands of their role. SP perceptions of training and future training needs is presented as a fourth theme. Most SPs felt that the initial training received for their role did not prepare them for the most demanding aspects of their roles. The findings of this study support the assertion that the social prescribing link worker role is complex and challenging. SPs are required to have in-depth knowledge of local services, which is built over time and makes retention in the role of high importance. Steps have been taken to develop online resources to support SPs, however, there may be a need for more comprehensive training, especially in mental health. SPs benefit from access to peer or one-to-one support to help them manage the emotional demands of the role and could benefit from the formation of local networks, especially for SPs working in isolation.
Collapse
Affiliation(s)
- Jenna Rhodes
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Sadie Bell
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
27
|
Parry J, Vanstone M, Grignon M, Dunn JR. Primary care-based interventions to address the financial needs of patients experiencing poverty: a scoping review of the literature. Int J Equity Health 2021; 20:219. [PMID: 34620188 PMCID: PMC8496150 DOI: 10.1186/s12939-021-01546-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is broadly accepted that poverty is associated with poor health, and the health impact of poverty has been explored in numerous high-income country settings. There is a large and growing body of evidence of the role that primary care practitioners can play in identifying poverty as a health determinant, and in interventions to address it. PURPOSE OF STUDY This study maps the published peer-reviewed and grey literature on primary care setting interventions to address poverty in high-income countries in order to identify key concepts and gaps in the research. This scoping review seeks to map the tools in use to identify and address patients' economic needs; describe the key types of primary care-based interventions; and examine barriers and facilitators to successful implementation. METHODS Using a scoping review methodology, we searched five databases, the grey literature and the reference lists of relevant studies to identify studies on interventions to address the economic needs-related social determinants of health that occur in primary health care delivery settings, in high-income countries. Findings were synthesized narratively, and examined using thematic analysis, according to iteratively identified themes. RESULTS Two hundred and fourteen papers were included in the review and fell into two broad categories of description and evaluation: screening tools, and economic needs-specific interventions. Primary care-based interventions that aim to address patients' financial needs operate at all levels, from passive sociodemographic data collection upon patient registration, through referral to external services, to direct intervention in addressing patients' income needs. CONCLUSION Tools and processes to identify and address patients' economic social needs range from those tailored to individual health practices, or addressing one specific dimension of need, to wide-ranging protocols. Primary care-based interventions to address income needs operate at all levels, from passive sociodemographic data collection, through referral to external services, to direct intervention. Measuring success has proven challenging. The decision to undertake this work requires courage on the part of health care providers because it can be difficult, time-consuming and complex. However, it is often appreciated by patients, even when the scope of action available to health care providers is quite narrow.
Collapse
Affiliation(s)
- Jane Parry
- Department of Health, Aging and Society, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - Michel Grignon
- Department of Health, Aging and Society, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - James R. Dunn
- Department of Health, Aging and Society, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| |
Collapse
|
28
|
BROWN REBECCAC, MAHTANI KAMAL, TURK AMADEA, TIERNEY STEPHANIE. Social Prescribing in National Health Service Primary Care: What Are the Ethical Considerations? Milbank Q 2021; 99:610-628. [PMID: 34170055 PMCID: PMC8452361 DOI: 10.1111/1468-0009.12516] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Policy Points Social prescribing is proposed as a way of improving patients' health and well-being by attending to their non-clinical needs. This is done by connecting patients with community assets (typically voluntary or charitable organizations) that provide social and personal support. In the United Kingdom, social prescribing is used to improve patient well-being and reduce use of National Health Service resources. Although social prescribing schemes hold promise, evidence of their effects and effectiveness is sparse. As more information on social prescribing is gathered, it will be important to consider the associated ethical issues for patients, clinicians, link workers, and community assets.
Collapse
Affiliation(s)
| | - KAMAL MAHTANI
- Centre for Evidence Based MedicineNuffield Department of Primary Care Health SciencesUniversity of Oxford
| | - AMADEA TURK
- Centre for Evidence Based MedicineNuffield Department of Primary Care Health SciencesUniversity of Oxford
| | - STEPHANIE TIERNEY
- Centre for Evidence Based MedicineNuffield Department of Primary Care Health SciencesUniversity of Oxford
| |
Collapse
|
29
|
Foster A, Thompson J, Holding E, Ariss S, Mukuria C, Jacques R, Akparido R, Haywood A. Impact of social prescribing to address loneliness: A mixed methods evaluation of a national social prescribing programme. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1439-1449. [PMID: 33084083 DOI: 10.1111/hsc.13200] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/17/2020] [Accepted: 09/21/2020] [Indexed: 06/11/2023]
Abstract
Loneliness is considered a global public health issue because of its detrimental impact on physical and mental health but little is known about which interventions can reduce loneliness. One potential intervention is social prescribing, where a link worker helps service-users to access appropriate support such as community activities and social groups. Some qualitative studies have identified that social prescribing may help to reduce service-users' loneliness. Given this, the British Red Cross (a third sector organisation) developed and delivered a national social prescribing service in the United Kingdom to support people who were experiencing, or at risk of, loneliness. Service-users could receive up to 12 weeks of support from a link worker. A mixed methods study was conducted to understand the impact of the support on loneliness, and to identify the facilitators and barriers to service delivery. The study included: (a) analysis of quantitative data collected routinely between May 2017 and December 2019 (n = 10,643) including pre-post analysis of UCLA data (n = 2,250) and matched comparator work to measure changes in loneliness; (b) semi-structured interviews with service-users, link workers and volunteers (n = 60) and (c) a Social Return on Investment Analysis. The majority of the service-users (72.6%, n = 1634/2250) felt less lonely after receiving support. The mean change in UCLA score was -1.84 (95% CI -1.91 to -1.77) of a maximum change of 6.00 (decrease indicates an improvement). Additional benefits included improved wellbeing, increased confidence and life having more purpose. The base case analysis estimated a social return on investment of £3.42 per £1 invested in the service. Having skilled link workers and support tailored to individual needs appeared key. However, challenges included utilising volunteers, meeting some service-users' needs in relation to signposting and sustaining improvements in loneliness. Nonetheless, the service appeared successful in supporting service-users experiencing loneliness.
Collapse
Affiliation(s)
- Alexis Foster
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Jill Thompson
- School of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
| | - Eleanor Holding
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Steve Ariss
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Clara Mukuria
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Richard Jacques
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Robert Akparido
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Annette Haywood
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| |
Collapse
|
30
|
Wildman J, Wildman JM. Evaluation of a Community Health Worker Social Prescribing Program Among UK Patients With Type 2 Diabetes. JAMA Netw Open 2021; 4:e2126236. [PMID: 34468751 PMCID: PMC8411296 DOI: 10.1001/jamanetworkopen.2021.26236] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
IMPORTANCE Despite lacking robust evidence of effectiveness, health care systems in developed countries are funding holistic community health worker (CHW) social prescribing programs that address social needs and health behaviors as adjuncts to clinical care. OBJECTIVE To determine whether a UK National Health Service (NHS) CHW social prescribing program was associated with improved hemoglobin A1c (HbA1c) levels among patients with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS This cohort study with difference-in-differences analysis was conducted among 8086 patients (4752 in the referral program, 3334 in the control group) in 24 NHS primary care practices in a city in North East England. Patients aged 40 to 74 years with a diagnosis of type 2 diabetes were observed for 8 years, from 2011 through 2019. The statistical analysis was conducted between June 1, 2019, and January 31, 2021. INTERVENTIONS A social prescribing program, launched in April 2015, enabling primary care staff to refer patients to CHW support to identify condition management and social needs goals and access voluntary and community sector support to address these goals. Intervention referral was only available in primary care practices in the city's west. The control group included patients in the city's east where referral was unavailable. MAIN OUTCOMES AND MEASURES HbA1c level, a marker of glycemic control. RESULTS A total of 8086 patients were included in the analysis (mean [SD] age, 57.8 [8.78] years; 3477 women [43%]; 6631 White patients [82%]). Mean (SD) baseline HbA1c levels were 7.56% (1.47%) in the referral program group and 7.44% (1.43%) in the control group. Following introduction of the social prescribing referral program, the referral group experienced an HbA1c reduction of -0.10 percentage points (95% CI, -0.17 to -0.03 percentage points) compared with the control group. The association increased over time: after 3 years the estimated association was -0.14 percentage points (95% CI, -0.24 to -0.03 percentage points). The association was stronger for White patients compared with non-White patients (-0.15 percentage points [95% CI, -0.26 to -0.04 percentage points] after 3 years), those with fewer additional comorbidities (-0.16 percentage points [95% CI, -0.29 to -0.04 percentage points] after 3 years), and those living in the most socioeconomically deprived areas (-0.19 percentage points [95% CI, -0.32 to -0.07 percentage points] after 3 years). CONCLUSIONS AND RELEVANCE In this study of UK adults with type 2 diabetes, a social prescribing program with referral to CHWs targeting patients' social needs and health behaviors was associated with improved HbA1c levels, suggesting that holistic CHW interventions may help to reduce the public health burden of type 2 diabetes.
Collapse
Affiliation(s)
- John Wildman
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Josephine M. Wildman
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
31
|
Tensions and opportunities in social prescribing. Developing a framework to facilitate its implementation and evaluation in primary care: a realist review. BJGP Open 2021; 5:BJGPO.2021.0017. [PMID: 33849895 PMCID: PMC8278514 DOI: 10.3399/bjgpo.2021.0017] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 11/28/2022] Open
Abstract
Background Social prescribing (SP) involves linking patients in primary care with services provided by the voluntary and community sector (VCS). Despite growing interest within NHS primary care, it remains unclear how and under what circumstances SP might contribute to good practice. Aim To define ‘good’ practice in SP by identifying context-specific enablers and tensions. To contribute to the development of an evidence-based framework for theorising and evaluating SP within primary care. Design & setting Realist review of secondary data from primary care-based SP schemes. Method Academic articles and grey literature were searched for qualitative and quantitative evidence following the Realist And Meta-narrative Evidence Syntheses — Evolving Standards (RAMESES). Common SP practices were characterised in three settings (general practice, link workers, and community sector) using archetypes that ranged from best to worst practice. Results A total of 140 studies were included for analysis. Resources were identified influencing the type and potential impact of SP practices and four dimensions were outlined in which opportunities for good practice arise: 1) individual characteristics (stakeholder’s buy-in, vocation, and knowledge); 2) interpersonal relations (trustful, bidirectional, informed, supportive, and transparent and convenient interactions within and across sectors); 3) organisational contingencies (the availability of a predisposed practice culture, leadership, training opportunities, supervision, information governance, resource adequacy, accessibility, and continuity of care within organisations); and 4) policy structures (bottom-up and coherent policymaking, stable funding, and suitable monitoring strategies). Findings were synthesised in a multilevel, dynamic, and usable SP framework. Conclusion The realist review and resulting framework revealed that SP is not inherently advantageous. Specific individual, interpersonal, organisational, and policy resources are needed to ensure SP best practice in primary care.
Collapse
|
32
|
Using self-determination theory to understand the social prescribing process: a qualitative study. BJGP Open 2021; 5:BJGPO.2020.0153. [PMID: 33402331 PMCID: PMC8170608 DOI: 10.3399/bjgpo.2020.0153] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/02/2020] [Indexed: 11/15/2022] Open
Abstract
Background Social prescribing (SP) assists patients to engage in social activities and connect to community supports as part of a holistic approach to primary care.Rx: Community was a SP project, which was implemented within 11 community health centres (CHCs) situated across Ontario, Canada. Aim To explore how SP as a process facilitates positive outcomes for patients. Design & setting Qualitative methods were used. Eighteen focus groups were conducted at CHCs or by video-conferencing, and involved 88 patients. In addition, eight in-depth telephone interviews were undertaken. Method Interviews and focus groups were transcribed verbatim, and analysed thematically using a theoretical framework based on self-determination theory (SDT). Results Participants who had received social prescriptions described SP as an empathetic process that respects their needs and interests. SP facilitated the patient’s voice in their care, helped patients to develop skills in addressing needs important to them, and fostered trusting relationships with staff and other participants. Patients reported their social support networks were expanded, and they had improved mental health and ability in self-management of chronic conditions. Patients who became involved in SP as voluntary 'health champions' reported this was a positive experience and they gained a sense of purpose by giving back to their communities in ways that felt meaningful for them. Conclusion SP produced positive outcomes for patients, and it fits well within the community health centre model of primary care. Future research should examine the impact on health outcomes and examine the return on investment of developing and implementing SP programmes.
Collapse
|
33
|
Islam MM. Social Prescribing-An Effort to Apply a Common Knowledge: Impelling Forces and Challenges. Front Public Health 2020; 8:515469. [PMID: 33330299 PMCID: PMC7728793 DOI: 10.3389/fpubh.2020.515469] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/05/2020] [Indexed: 11/15/2022] Open
Abstract
In recent times, social prescribing has been introduced in some countries, and substantially in the U.K. The objective of this scheme is to offer non-medical care mainly to primary care patients. Although the idea of this scheme is not new, its formalization is. Using a narrative synthesis of peer-reviewed and gray literature, this article discusses the social prescribing scheme, some of its compelling aspects and challenges in offering non-medical care, particularly regarding referrals being made from primary care settings. The social prescribing scheme has several impelling forces that include its potential to turn primary care to primary healthcare, tackle social determinants of health and social needs, improve wellbeing and physical health, offer person-centered care, strengthen preventive care, and bridge healthcare organizations with the third sector. This scheme also faces several challenges including service standards and boundaries, sustainability, availability of appropriate services, low engagement of clients and insufficient evidence. While this scheme lacks validated evidence, it is theoretically compelling. Given that the demand for non-medical care is growing in most societies and that the usefulness of non-medical care is gaining prominence, social prescribing is likely to continue to proliferate.
Collapse
Affiliation(s)
- M Mofizul Islam
- Department of Public Health, La Trobe University, Melbourne, VIC, Australia
| |
Collapse
|
34
|
Aughterson H, Baxter L, Fancourt D. Social prescribing for individuals with mental health problems: a qualitative study of barriers and enablers experienced by general practitioners. BMC FAMILY PRACTICE 2020; 21:194. [PMID: 32957923 PMCID: PMC7507286 DOI: 10.1186/s12875-020-01264-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/03/2020] [Indexed: 11/10/2022]
Abstract
Background There is growing evidence for the use of social prescribing as a means to improve the mental health of patients. However, there are gaps in understanding the barriers and enablers faced by General Practitioners (GPs) when engaging in social prescribing for patients with mental health problems. Methods This study uses a qualitative approach involving one-to-one interviews with GPs from across the UK. The COM-B model was used to elucidate barriers and enablers, and the Theoretical Domains Framework (TDF) and a Behaviour Change Theory and Techniques tool was used to identify interventions that could address these. Results GPs recognised the utility of social prescribing in addressing the high levels of psychosocial need they saw in their patient population, and expressed the need to de-medicalise certain patient problems. GPs were driven by a desire to help patients, and so they benefited from regular positive feedback to reinforce the value of their social prescribing referrals. They also discussed the importance of developing more robust evidence on social prescribing, but acknowledged the challenges of conducting rigorous research in community settings. GPs lacked the capacity, and formal training, to effectively engage with community groups for patients with mental health problems. Link workers, when available to GPs, were of fundamental importance in bridging the gap between the GP and community. The formation of trusting relationships was crucial at different points of the social prescribing pathway, with patients needing to trust GPs in order for them to agree to see a link worker or attend a community activity, and GPs requiring a range of strong inter-personal skills in order to gain patients’ trust and motivate them. Conclusion This study elucidates the barriers and enablers to social prescribing for patients with mental health problems, from the perspectives of GPs. Recommended interventions include a more systematic feedback structure for GPs and more formal training around social prescribing and developing the relevant inter-personal skills. This study provides insight for GPs and other practice staff, commissioners, managers, providers and community groups, to help design and deliver future social prescribing services.
Collapse
Affiliation(s)
- Henry Aughterson
- Department of Behavioural Science and Health, Institute of Epidemiology, University College London (UCL), 1-19 Torrington Place, London, W1CE 7HB, UK.
| | - Louise Baxter
- Department of Behavioural Science and Health, Institute of Epidemiology, University College London (UCL), 1-19 Torrington Place, London, W1CE 7HB, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, Institute of Epidemiology, University College London (UCL), 1-19 Torrington Place, London, W1CE 7HB, UK.
| |
Collapse
|
35
|
The New Educational Pastorate: Link Workers, Pastoral Power and the Pedagogicalisation of Parenting. GENEALOGY 2020. [DOI: 10.3390/genealogy4020037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Home-school relations, home learning and parental engagement are prominent educational policy issues, constituting one aspect of a wider parenting support agenda that has suffused the landscape of social policy over the last two decades. This article examines a parenting support initiative distinctive for its use of link workers in mobilising ‘hard to reach’ parents to engage more effectively with their children’s education. Drawing on qualitative data gathered during the evaluation of the initiative, the article frames link worker–parent interactions as a form of everyday government and pastoral power. Link workers constitute a new educational pastorate; through friendship, care and control they exercise pastoral power over parents. Building on recent research into the role of ‘pastors’ in producing neoliberal subjectivities within the National Health Service, the article foregrounds their efforts to foster responsible, self-disciplined agency in parents. Link workers, it is argued, contribute to a responsibilisation and pedagogicalisation of the family, which has produced new figures of mothering/parenting, reconfigured the meaning of the home and extended the scope of state intervention into family life.
Collapse
|
36
|
Adams C. Toward an institutional perspective on social capital health interventions: lay community health workers as social capital builders. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:95-110. [PMID: 31674684 DOI: 10.1111/1467-9566.12992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This article argues that social capital health research should move beyond a mere focus on social cohesion and network perspectives to integrate an institutional approach into the development of social capital health interventions. An institutional perspective, which is unique in its emphasis on linking social capital in addition to the bonding and bridging forms, contextualises social capital, allowing researchers to confront the complexity of social relationships. This perspective allows for the construction of interventions that draw on the resources of diverse actors, particularly the state. One intervention strategy with the potential to create community linkages involves lay community health workers (LCHWs), individuals who are trained to perform a variety of health-related functions but lack a formal professional health education. This article begins with a review of the institutional social capital-building literature. It then goes on to briefly review the social capital and health literature and discuss the state of intervention research. Thereafter, it describes LCHWs and discusses studies that have utilised LCHWs to tackle community health problems. In doing so, this article presents an institutional-based systematic framework for how LCHWs can build social capital, including a discussion of the ways in which LCHWs can successfully promote bonding, bridging and linking social capital.
Collapse
Affiliation(s)
- Crystal Adams
- Department of Sociology and Anthropology, Muhlenberg College, Allentown, Pennsylvania, USA
| |
Collapse
|
37
|
Wildman JM, Moffatt S, Steer M, Laing K, Penn L, O’Brien N. Service-users' perspectives of link worker social prescribing: a qualitative follow-up study. BMC Public Health 2019; 19:98. [PMID: 30670001 PMCID: PMC6341763 DOI: 10.1186/s12889-018-6349-x 10.1186/s12889-018-6349-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 12/20/2018] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Social prescribing enables health-care professionals to address non-medical causes of ill-health by harnessing the resources of the voluntary and community sectors in patient care. Although increasingly popular in the UK, evidence for the effectiveness of social prescribing is inconclusive and longer-term studies are needed. This study aimed to explore experiences of social prescribing among people with long-term conditions one to two years after their initial engagement with a social prescribing service. METHODS Qualitative methods comprising semi-structured follow-up interviews were conducted with 24 users of a link worker social prescribing service who had participated in an earlier study. Participants were aged between 40 and 74 years and were living in a socioeconomically-deprived area of North East England. RESULTS Participants reported reduced social isolation and improvements in their condition management and health-related behaviours. However, many participants had experienced setbacks, requiring continued support to overcome problems due to multi-morbidity, family circumstances and social, economic or cultural factors. Findings indicated that, in this sample of people facing complex health and socioeconomic issues, longer-term intervention and support was required. Features of the link worker social prescribing intervention that were positively appraised by participants, included a highly personalised service to reflect individual goal setting priorities and a focus on gradual and holistic change dealing with issues beyond health. The important role of a strong and supportive relationship with an easily-accessible link worker in promoting sustained behaviour change highlights the importance of link worker continuity. A lack of suitable and accessible voluntary and community services for onward referral acted as a barrier to involvement for some participants. CONCLUSIONS This study highlights issues of interest to commissioners and providers of social prescribing. Engagement with social prescribing for up to two years was examined and continued involvement was identified for those with complex issues, suggesting that a long-term intervention is required. The availability of onward referral services is an important consideration for social prescribing in a time of constrained public spending. From a research perspective, the range of improvements and their episodic nature suggest that the evaluation of social prescribing interventions requires both quantitative and qualitative data collected longitudinally.
Collapse
Affiliation(s)
| | - Suzanne Moffatt
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mel Steer
- Newcastle Institute for Social Renewal, Newcastle University, Newcastle upon Tyne, UK
| | - Kirsty Laing
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Penn
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola O’Brien
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
38
|
Wildman JM, Moffatt S, Steer M, Laing K, Penn L, O'Brien N. Service-users' perspectives of link worker social prescribing: a qualitative follow-up study. BMC Public Health 2019; 19:98. [PMID: 30670001 PMCID: PMC6341763 DOI: 10.1186/s12889-018-6349-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 12/20/2018] [Indexed: 11/28/2022] Open
Abstract
Background Social prescribing enables health-care professionals to address non-medical causes of ill-health by harnessing the resources of the voluntary and community sectors in patient care. Although increasingly popular in the UK, evidence for the effectiveness of social prescribing is inconclusive and longer-term studies are needed. This study aimed to explore experiences of social prescribing among people with long-term conditions one to two years after their initial engagement with a social prescribing service. Methods Qualitative methods comprising semi-structured follow-up interviews were conducted with 24 users of a link worker social prescribing service who had participated in an earlier study. Participants were aged between 40 and 74 years and were living in a socioeconomically-deprived area of North East England. Results Participants reported reduced social isolation and improvements in their condition management and health-related behaviours. However, many participants had experienced setbacks, requiring continued support to overcome problems due to multi-morbidity, family circumstances and social, economic or cultural factors. Findings indicated that, in this sample of people facing complex health and socioeconomic issues, longer-term intervention and support was required. Features of the link worker social prescribing intervention that were positively appraised by participants, included a highly personalised service to reflect individual goal setting priorities and a focus on gradual and holistic change dealing with issues beyond health. The important role of a strong and supportive relationship with an easily-accessible link worker in promoting sustained behaviour change highlights the importance of link worker continuity. A lack of suitable and accessible voluntary and community services for onward referral acted as a barrier to involvement for some participants. Conclusions This study highlights issues of interest to commissioners and providers of social prescribing. Engagement with social prescribing for up to two years was examined and continued involvement was identified for those with complex issues, suggesting that a long-term intervention is required. The availability of onward referral services is an important consideration for social prescribing in a time of constrained public spending. From a research perspective, the range of improvements and their episodic nature suggest that the evaluation of social prescribing interventions requires both quantitative and qualitative data collected longitudinally.
Collapse
Affiliation(s)
- Josephine M Wildman
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.
| | - Suzanne Moffatt
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mel Steer
- Newcastle Institute for Social Renewal, Newcastle University, Newcastle upon Tyne, UK
| | - Kirsty Laing
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Penn
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola O'Brien
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|