What approaches to social prescribing work, for whom, and in what circumstances? A realist review

The Impact of a Bidirectional Clinic to Community Social Care Referral Program

BACKGROUND

Practical knowledge of how to address patients' social needs could have a large health impact.

OBJECTIVE

Describe a scalable electronic health record (EHR)-facilitated, clinic-to-community linkage (CCL) program that addresses social needs at 6 clinics in 4 health systems.

RESEARCH DESIGN

Primary care teams referred eligible patients to United Way 211 (UW 211) via a point-of-care EHR referral between 2018 and 2023. Patients were eligible if they were adults with uncontrolled blood pressure or blood sugar or 2-17 years old with overweight/obesity or asthma. UW 211 referred patients to assess and connect them with community resources and provided electronic feedback to the EHR. We conducted descriptive analyses of process measures (eg, patients referred, needs identified, need resolution). We then conducted pre-post analyses of selected health outcomes (ie, blood pressure, weight, and asthma exacerbations) versus comparison clinics.

RESULTS

Referral ranges varied by clinic from 3% to 43%, with 1224 total patients referred and 38% (n=461) reached by UW 211. All 461 had at least one need, and 87% (n=400) had one need resolved or a resolution in progress. Reached patients had an average of 2.9 (SD 1.3) needs and an average of 10.1 resource referrals provided (SD 6.1). Top needs included food, physical activity, housing and utilities. No differences were found pre to post within the intervention clinics except for improvements in blood pressure control. However, comparison clinics had greater improvements in blood pressure control during the same time frame.

CONCLUSIONS

An EHR-facilitated, closed-loop CCL program to address patients' social needs is feasible. Further research on the comparative effectiveness and sustainability of models to address social needs will be critical in advancing health equity.

Social prescribing in the USA: emerging learning and opportunities

The global prevalence of chronic diseases and high costs of health care are complex challenges that are driving countries to focus on addressing the social determinants of health and downstream social needs. These challenges require innovative health-care practices that integrate disease prevention, treatment, and management with salutogenic initiatives to promote population health. Many countries have turned to social prescribing as a promising approach. Social prescribing connects people with non-clinical support and services within their communities. While social prescribing has more commonly been adopted in countries with government-funded national health services, in this Viewpoint, we share learning from examples in the USA. We argue that social prescribing in the USA is unique given the heterogeneity of the country and its health systems, and that this aspect influences programme activities, target-populations, and models. These examples offer valuable lessons about the barriers and enablers to implementing social prescribing in different contexts, including privatised health-care systems. Ultimately, we call upon US stakeholders to recognise the benefits that social prescribing could bring to public health and take action to support its development. We also invite stakeholders from other countries to consider learnings from the USA and how social prescribing can be successfully implemented in their contexts.

Reimagining Dementia Care: A Complex Intervention Systematic Review on Optimising Social Prescribing (SP) for People Living With Dementia (PLWD) in the United Kingdom

INTRODUCTION

Dementia is a complex medical condition that poses significant challenges to healthcare systems and support services. People living with dementia (PLWD) often face complex needs, exacerbated by social isolation and difficulty accessing support. Social prescribing (SP) has been increasingly integrated into the United Kingdom's National Health Service (NHS) as a means to connect individuals with non-clinical services to address these challenges. However, current research provides limited detail on specific SP interventions tailored to dementia care, leaving gaps in understanding the targeted needs, participation drivers, effectiveness and potential benefits for PLWD.

METHODS

A complex intervention systematic review of SP in dementia care was performed in the United Kingdom using an iterative logic model approach. Six databases and grey literature were searched, supplemented by hand searching for reference lists of included studies. Results were screened in a two-step process, followed by data extraction. Risk of bias was assessed using Gough's Evidence of Framework. Reporting was informed by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA-CI) extension statement and checklist.

RESULTS

Forty-nine studies, reporting on PLWD, met the inclusion criteria. Findings indicate that SP for PLWD in the United Kingdom is varied and lacks focus, reflecting the diverse demographics involved. Interventions encompass cognitive, educational, psychosocial, physical, community and complementary therapies, of inconsistent classification, with some being umbrella interventions and others standalone services. Provided by the NHS, charities and integrated services, SP involves a range of referrers and connectors. Finally, individual outcomes show benefits such as increased independence and improved mood, but challenges pertaining to suitability and logistical issues, whereas systemic outcomes include cost savings and better service delivery, despite high implementation costs.

CONCLUSION

SP pathways for PLWD are varied, with success relying heavily on adequately resourced and trained connectors. While benefits extend beyond health improvements, further research is needed to assess long-term impacts, refine mechanisms and standardise evaluation metrics for SP effectiveness in dementia care.

PATIENT AND PUBLIC CONTRIBUTIONS

A PPI advisory group, consisting of a person living with dementia and a caregiver, was actively involved throughout the review process, providing insights into the review questions, the logic model, emerging findings and interpretation of results.

Reimagining Dementia Care: A Complex Intervention Systematic Review on Optimising Social Prescribing (SP) for Carers of People Living With Dementia (PLWD) in the United Kingdom

INTRODUCTION

Carers of people living with dementia (PLWD) face a range of complex needs, including medical, emotional, social and practical challenges, often exacerbated by social isolation and barriers to accessing support. Social prescribing (SP) addresses these needs by increasing access to non-clinical support and services. However, existing research lacks detailed descriptions of SP interventions for carers of PLWD, with limited understanding of the needs they target, the reasons for participation, their effectiveness and their potential to improve outcomes for carers of PLWD.

METHODS

A complex intervention systematic review of SP for carers of PLWD was undertaken using iterative logic modelling and reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA-CI) extension statement and checklist. Six databases and grey literature were searched, supplemented by hand searching reference lists of included studies. Results were screened in a two-step process, followed by data extraction. Gough's Weight of Evidence Framework was used to assess the risk of bias in the included studies.

RESULTS

Fifty-two studies were included. Findings indicated SP for carers of PLWD in the United Kingdom is varied and operates in a largely uncoordinated process involving initiation by diverse stakeholders and institutions across multiple sectors. The classification of SP interventions for carers of PLWD is inconsistent, and participation is often opportunistic. Positive outcomes included improved carer mood, social connections, practical support, quality of life and better PLWD-carer relationships. However, negative outcomes were associated with intervention suitability, emotional impact, relevance and strained PLWD-carer relationships.

DISCUSSION

While the evidence suggests SP is a promising intervention for carers of PLWD, its long-term impacts, challenges of tailoring prescriptions to carers' needs and overcoming logistical issues remain. Additionally, further research is required to evaluate long-term impact, investigate specific mechanisms to tailor SP to specific carer needs and explore in greater detail the PLWD-carer relationship and its effects on SP uptake and maintenance.

PATIENT AND PUBLIC CONTRIBUTIONS

A PPI advisory group was involved in the review, including providing insights into review questions, the logic model, findings and results. The group consisted of one person living with dementia and a caregiver.

The potentials of digital technology in social prescribing: a qualitative study of key stakeholders' perspectives

BACKGROUND

The automation and effective communication provided by technological facilities allow service providers to deliver social wellbeing activities in a prompt and cost-effective manner. This study explored the perspectives of social prescribers, coordinators, and community providers on the potential of digital technology in social prescribing and the challenges to its implementation.

METHODS

We conducted a qualitative study and held three Focus Group Discussion (FGD) sessions with a sample of 18 stakeholders in the Northwest of England, UK including social prescribing coordinators, social prescribers, and voluntary, community, faith, and social enterprise (VCFSE) sector providers1 to qualitatively explore the responses of different participant groups and reveal a wealth of deep insight around the study objective. A purposive sampling strategy was used to select information-rich participants, providing in-depth insights. Transcriptions were analysed through thematic analysis supported by Max QDA to identify common themes and ideas that were generated across the focus groups.

RESULTS

Eight themes were identified regarding the potentials and challenges of digital social prescribing from the study participants' viewpoints. The main themes highlighting advantages include capacity and resource management, coordination and integration of support services, access and equity, and outcome evaluation. The challenges identified are digital illiteracy, awareness concerns, financial matters, and a lack of evidence.

CONCLUSIONS

Our findings confirm that digital social prescribing offers significant potential to improve accessibility, time efficiency, and personalization in service delivery. However, they also underscore critical challenges, including technical barriers, financial constraints, and a lack of digital literacy among users and providers. Stakeholders emphasized that while digital SP can streamline referrals and enhance data sharing, its success depends on addressing inequalities in access to technology.

Prerequisites for social prescribing in Swedish primary care - stakeholders' perspectives

BACKGROUND AND PURPOSE

Loneliness is a complex public health issue that can lead to increased morbidity, with higher prevalence among older adults. Social prescribing may be one way to ease loneliness. This study aims to explore stakeholders' perceptions of prerequisites for implementing a social prescribing program in a Swedish context.

METHOD

Reflexive thematic analysis was used to analyse individual semi-structured interviews with eleven stakeholders whose experience were considered relevant for implementing a social prescribing program in the Swedish context. They were selected to provide diverse perspectives related to organisation, position, and geography.

RESULTS

From the analysis three themes were constructed; Where to implement - Necessity to bridge organisational gaps, How to implement - Balancing professional expectations, and For whom to implement - Addressing those with 'real' needs. These themes highlight the perceived prerequisites, including barriers and facilitators, for successful implementation of social prescribing.

CONCLUSIONS

The participants' perceptions are suggesting that Sweden has several practical advantages in place for implementing social prescribing, such as robust organisations responsible for citizens' health and well-being and a range of activities available. If organisations can collaborate by prioritizing patients' needs and overcoming organisational divisions and responsibilities, there is potential for successfully implementing social prescribing in Sweden in the future. Nevertheless, implementation may be hampered by limited resources within health care, and challenges to evaluate program effects.

Identifying the active ingredients and contextual factors of social prescribing when used to support the mental health of children and young people: a qualitative study

Recent years have seen a rise in mental health challenges among children and young people (CYP), while frontline treatments remain limited. Social prescribing (SP), a holistic approach using community resources to empower individuals in managing their health, offers a potentially more sustainable and acceptable option for supporting CYP's mental health. Although early evidence is promising, little is known about how SP works. Following the UK Medical Research Council (MRC) framework for developing and evaluating complex interventions (Skivington et al., 2021), this study explores the active ingredients and contextual factors of SP in supporting CYP mental health. Nineteen professionals involved in delivering SP to CYP with mental health difficulties were interviewed. Through template analysis, four active ingredients were identified: (1) SP offers a holistic approach that involves tailoring programmes to a young person's needs, interests and their readiness, (2) SP offers young people an opportunity to exercise agency in defining their care pathway and engaging in their recovery journey, (3) The development of a professional but unpressured supportive relationship with a skilled adult is an important factor in SP, and (4) SP offers a safe space for young people to discuss their emotional needs and health. Additionally, four contextual factors influencing SP delivery were identified: (1) Supportive organisational environments, (2) Parental buy-in, (3) Public awareness, and (4) Barriers to access. Defining these active ingredients and contextual factors can help consolidate SP for CYP's mental health, contributing to its wider adoption and impact.

Social prescribing for people living with long-term health conditions: a scoping review

INTRODUCTION

Social prescribing links people to activities and services typically provided by local voluntary and community sectors to address social determinants of health and wellbeing. People living with long-term health conditions are a target population. This relatively new approach is rapidly expanding, and there is varied evidence regarding how social prescribing is being delivered for people living with long-term conditions. This scoping review aims to report on what is known about the approach for these patient populations.

METHODS

Electronic databases MEDLINE, CINAHL, Scopus, Web of Science, and PsycINFO were searched in December 2023, and relevant sources of gray literature in January 2024, with both updated in February 2025. Studies eligible for inclusion included adults (18 +) with long-term conditions engaging with social prescribing in health and community contexts. Studies published in English in any year were included. A data charting template captured key characteristics including reasons for referral, referral pathways, activities and services being utilized, and outcome measures. A descriptive narrative synthesis was conducted, guided by the review questions to explore the current evidence.

RESULTS

Thirty-seven sources of evidence were included. Diabetes was the most common of 65 conditions identified (n = 23). The presence of a long-term condition was the most frequent reason for referral (n = 30), followed by mental health concerns (n = 15), and social isolation or loneliness (n = 11). Most referrals were made within primary care (n = 33), to a link worker or social prescriber (n = 29), who supported participants to access activities and services including exercise (n = 22), information, support, and advice (n = 19), mental health support (n = 15), social and leisure activities (n = 15) and condition-specific support (n = 14). Wellbeing was the most commonly identified measured outcome (n = 23), with studies utilizing the Warwick Edinburgh Mental Wellbeing Scales (n = 7) and Wellbeing Star (n = 7) most frequently.

CONCLUSIONS

While common factors were identified, there is considerable variation in social prescribing approaches for people living with long-term conditions, reflecting the diversity of needs, availability of community services, and necessity for personalized care. Further research is needed to inform the development of evidence-based practice which addresses the complex needs of diverse patient populations and supports access to a broad range of referral pathways.

Assessing the implementation and impact of a social prescribing protocol in primary care

BACKGROUND

Social prescribing allows clinicians to refer people to resources or activities in their community to improve their abilities and health. Implementation of social prescribing is growing. However, there is not enough evidence on several related issues. The aim of study was to analyse the implementation of the asset-based model in the primary care teams in Aragón and to describe the profile of people who benefit most and are most satisfied with social prescribing.

METHODS

It is an analytical observational study in the 123 primary healthcare teams of Aragon from September2018 to December2022. The data were obtained from Electronical Health Record, checked and cleaned. A descriptive analysis was performed for qualitative and mean and standard deviation for quantitative variables. To analyse the associations between attendance, satisfaction, and improvement with all variables, several analyses were conducted using different methods. Finally, a cluster analysis was developed with the most benefited and satisfied people.

RESULTS

During the study period, 2,735 asset recommendations were made to 2,578 different people and 1,050 follow-ups to 552. There was an increase in the use of the protocol over time, except during the COVID pandemic. Most recommendations were made to women (73.3%-2,006). The average age was 65. There were more referrals in the smallest places (3.11 referrals/1000inhabitants). The most frequent linked health issues were psychological problems (572 - 20.9%). Physical skills were the abilities that professionals most tried to promote (28.4-1,709). In the follow-ups, the 81.4%(373) reported attending to the asset regularly. There were differences according to age and health problems. The average of improvement was 3.87/5 with differences by age, municipality size and health problems. For satisfaction, the average was 4.57/5 with differences by age and health problems. The lowest level of improvement and satisfaction was found for social problems. The cluster analysis highlighted several groups. Three profiles were distinguished in terms of high improvement and four of high satisfaction. In both cases, the variables related to areas for enhancement primarily defined the profiles.

CONCLUSIONS

It is necessary to continue research with strong methodological and complementary approaches. This manuscript is optimistic about the use and impact of the social prescription in primary health care.

Social prescribing of cultural opportunities to support health and wellbeing: the importance of language, community engagement, and inclusion in developing local approaches

BACKGROUND

There is growing evidence for the role of culture in supporting health and wellbeing, including as part of social prescribing provision. This study set out to explore the existing cultural provision and mechanisms for connecting people to cultural opportunities as part of a local social prescribing offer in the UK and how it could it be strengthened to better support health and wellbeing. A broad view of culture was adopted encompassing the creative and digital industries, heritage, food, hospitality, nature, greenspaces, and sport. It covers activity associated with the artforms and organisations such as collections, combined arts, dance, libraries, literature, museums, music, theatre and the visual arts.

METHODS

A qualitative exploratory descriptive approach using focus groups was employed to explore the perspectives and experiences of social prescribing and the cultural provision in an area of the East of England. Six focus groups were conducted with social prescribers, community connectors, healthcare professionals, cultural providers, adults with lived experience of adverse health, and young people. Data was analysed using a reflexive thematic approach.

RESULTS

Findings from the research highlight the need for a clear and shared understanding of culture and health and the link to social prescribing. Barriers for connecting people with culture and health opportunities in the area were identified including gaps in provision and processes, challenges due to language and terminology, accessibility issues for marginalised groups, and issues around funding for transport and sustainable and equitable provision of cultural opportunities.

CONCLUSIONS

This study indicated that to engage local communities in social prescribing and the development of cultural provision for social prescribing, proactive outreach community strategies are required. This could be achieved by involving community leaders, organisers, connectors, and representatives. In addition to promote the concept of culture for health and social prescribing and engage the wider community it was suggested that community members should be involved in and contribute to culture and health social prescribing locally through volunteering, roles for students, training opportunities, and befriending or buddy schemes.

Social prescribing for suicide prevention: a proposed model for Australia

Suicidality is a devastating and burdensome experience that can be a result of complex psychological, biological and social factors. Social prescribing could be well suited to address the diverse non-clinical needs of people experiencing suicidality. International and Australian evidence indicates social prescribing provides an effective and acceptable approach. To address suicide risk and rates in the Australian community, community-based approaches that are visible, readily accessible and that address complex social, practical or non-medical needs are needed. We propose a social prescribing model for suicide prevention that could be implemented in Australia either as a specific purpose service or within existing social prescribing trials, with relevant modifications tailored to suicide prevention. Drawing upon evidence from the literature and a panel of social prescribing experts, we make practical recommendations for implementing a social prescribing model for suicide prevention in Australia, and discuss some of the system-wide requirements to support access and scaling up of these models.

Healthcare providers' perceived importance and barriers to addressing social connection in medical settings

Despite the well-established significance of indicators of social connection for health and mortality, healthcare providers' (HCPs) perceptions of the role of social connection in physical health and the extent to which it is considered medically relevant remain unclear. This study examines the perceived importance and barriers to addressing social connection among HCPs in clinical settings. Surveys were completed by 681 HCPs across multiple locations and medical settings. HCPs ranked social connection low in importance among factors known to influence mortality and chronic illness. Furthermore, HCPs report significant barriers to addressing social connection; including lack of time, resources, training, and confidence. The findings have implications for developing educational programs, institutional policies, and structural changes to facilitate the integration of social connection into clinical practices, ultimately improving patient outcomes and overall public health.

Effectiveness of Physical Activity Interventions on Acute Inpatient Mental Health Units on Health Outcomes: A Systematic Review

Physical activity has been shown to improve outcomes across a range of physical and mental health conditions as an adjunct or standalone intervention for many mental disorders. The outcome and effectiveness of physical activity in acute mental health units are less well understood. Systematic searches were completed in three databases (CINAHL, MEDLINE, and PsycINFO). Eligible studies were published between March 2013 and February 2024, included a physical activity intervention for inpatients on acute mental health units, and reported primary quantitative, qualitative, or mixed methods data for patients between 18 and 65 years of age. Participants must have had a primary diagnosis of a mental health condition with or without physical comorbidities. Data extracted included reported components of the interventions and individual health outcomes. Methodological quality and risk of bias was assessed using the mixed methods appraisal tool and cochrane risk of bias tools for randomised and non-randomised controlled trials. Twelve studies were identified for review (combined sample size of 560). Seven studies reported improvements in mental health outcomes, and two reported improvements in physical health outcomes in favour of the intervention group. There was a large variation between intervention characteristics and clarity in reporting. Assessment and measurement of outcomes contributed to a high risk of bias among included studies due largely to self-assessment. Physical activity interventions on AMHUs have the potential to contribute to improvements in mental and physical wellbeing beyond that experienced from usual treatment practices (e.g., medication). However, further work is needed in the specific context of acute mental health units regarding the development and evaluation of physical activity interventions.

Understanding how intermediaries connect adults to community-based physical activity: A qualitative study

Intermediaries facilitate connections to community-based services and supports, including physical activity and exercise groups, and are an emerging method to promote physical activity participation. However, their processes when establishing connections to community-based physical activities are unclear. The aim of this study was to explore the processes, practices, and procedures of Irish intermediaries when connecting people to community-based physical activity. This was a qualitative descriptive design study. Semi-structured interviews were carried out with n = 27 intermediaries from a variety of sectors-Health Promotion and Improvement [HPO], Local Sports Partnerships [LSO] and Social Prescribing [SP]. Four themes were identified using qualitative content analysis; 1) the processes of connecting to an intermediary, 2) connecting individuals to physical activity, 3) exiting from the intermediary service and 4) working in the local context. Intermediaries reported that they received referrals for individuals with physical, mental, and social health needs, but that referrals to improve physical activity specifically were low. They used a person-centred approach throughout their process, often addressing barriers to physical activity. However, only LSO and SP facilitated connections to physical activity, as HPO mainly focused on delivering smoking cessation support and services. Levels of support given and length of follow-up varied between LSO and SP, with the latter providing more intensive support. To facilitate their work, they developed extensive local knowledge and networks of partners, which enabled connections to a variety of community-based physical activities. Intermediaries may be an under-utilized resource to promote physical activity. Understanding the processes used in their interventions can inform future research, which is needed to investigate the effectiveness of intermediaries in improving physical activity levels and to inform future referral pathways.

Interrogating green social prescribing in South Wales; A multi-stakeholder qualitative exploration

BACKGROUND

As an umbrella term, social prescribing offers varied routes into society which promise to support, enhance, and empower individual citizens to take control of their own health and wellbeing. Globally healthcare systems are struggling to cope with the increasing demands of an ageing population and the NHS (UK) is no exception. Social prescribing is heralded as a means to relieve the burden on primary care and provide support for the 20% of patients whose needs are non-medical. As such an increasing array of schemes are available, spanning five sub-sets: creative or nature-based referrals, welfare services, exercise referrals, education programmes or befriending support. Green social prescription offers significant potential to promote wellbeing and improve health outcomes. However limited research has explored this emergent sub-set.

AIM

Explore and interrogate the concept of social prescribing to understand how it is conceptualised, perceived, and experienced by different stakeholders involved in its coordination, delivery, and provision; At a time when it is being formalised in Wales, UK.

METHODS

Using qualitative enquiry, from a social constructivist paradigm, stakeholder perspectives pertaining to current social prescribing models, pathways and actions in Wales were explored. Three multi-discipline research workshops and ten semi-structured, one-to-one interviews were conducted either in person or via zoom. Qualitative data were analysed thematically.

RESULTS

39 different stakeholders contributed. These included social prescribers, community connectors, service coordinators, third sector and voluntary organisation representatives, a general practitioner, occupational therapist, social enterprisers, academics and local area coordinators. Five themes were identified which revolved around stakeholders discussions of critical challenges pertaining to the delivery, provision, and evaluation of green social prescribing schemes in south Wales, UK. Tension between varying stakeholders was also evident, often preceded, or complicated by funding discrepancies, competition, and uncertainty. Stakeholders demanded clarity regarding evaluation outcomes and benchmarking across the sector.

CONCLUSIONS

To ensure the continued provision of social prescribing schemes which are highly valued by service users, voluntary and third sector organisations require funding security and stability. The delivery of green, nature-based, schemes require maintenance of trusting, long-term relationships with local service co-ordinators and referrers, secure equitable funding models and agreement over conceptual basis of social prescribing itself, particularly in relation to 'where' social prescribing is located within health and social care models. Without resolution and positive progress across these areas the continuation of local green schemes within local communities, which build resilience and support positive change for service users' health and wellbeing, is questionable.

Association Between Loneliness and the Use of Medical Institutions and Pharmacies in Urban Japan

OBJECTIVE

 This study aimed to investigate the association between loneliness and utilization of medical institutions and pharmacies in urban areas of Japan.

METHODS

A 52-item survey was distributed to 10,000 residents, aged 15-64 years, in Nakano Ward, Tokyo, Japan. The survey included a three-item version of the UCLA Loneliness Scale, as well as questions on demographic, socioeconomic, and educational background, medical institution and pharmacy use, and community activities.

RESULTS

Of the 3,369 survey respondents, 379 answered "Always feel that way" to at least one of the three items on the loneliness scale. Participants who felt lonely were significantly more likely to be men (p < 0.001), economically disadvantaged (p < 0.001), and perceived their health status as poor (p < 0.001). Loneliness was associated with a significantly lower self-reported frequency of medical institution use (p = 0.003) and pharmacy use (p < 0.001).

CONCLUSION

Loneliness was associated with male gender, economic disadvantage, poorer perceived health status, and lower self-reported frequency of medical institution and pharmacy use. These findings suggest the existence of barriers preventing lonely people from accessing necessary medical and pharmacy services. Further research is needed to explore these barriers in greater detail.

Occupational therapist's involvement in social prescribing: A qualitative interview study

Introduction

Social prescribing is a process of helping people to access non-medical activities to promote well-being. For occupational therapists, this is not new, although the social prescribing agenda is creating new roles around these approaches. This study aimed to explore how occupational therapists were involved in social prescribing in the United Kingdom and how they would like to contribute to future developments.

Method

Semistructured interviews were carried out with 19 occupational therapists who identified they were involved in social prescribing activities.

Findings

Thematic analysis led to two over-arching themes: (1) position and identity; and (2) making it work.

Conclusion

Participants perceived similarity with social prescribing, leading to difficulty in positioning occupational therapy alongside this role, emotional responses and identity challenge. Points of distinction between the roles were articulated, including occupational therapy being more medical, having oversight of more complex needs and having more senior roles within teams. To manage workflow, occupational therapists delegate to social prescribing workers, although there is a lack of clarity about competence and varying involvement in supervision. Part of desired future involvement included clearer workflow, occupational therapy involvement in supervision and service development and creating legitimacy for both roles to address social determinants of health.

Acceptability, Feasibility, and Preliminary Effectiveness of a Wellbeing Coordination Program in an Integrated Health and Social Care Hub: A Mixed Methods Study

Introduction

Families experiencing adversity often have complex needs and face barriers to accessing health and social care. This study evaluated the acceptability, feasibility and preliminary effectiveness of a Wellbeing Coordination (WBC) program to improve access to services. The program combined care navigation and social prescribing within an integrated health and social care Child and Family Hub.

Methods

Mixed-methods design, with data collected through surveys and interviews from: 1) caregivers who participated in the WBC program (n = 11) and those who did not (n = 18), and 2) practitioners working in the Hub (n = 21).

Results

Caregivers and practitioners found the WBC program acceptable and mostly feasible, demonstrating the potential to alleviate caregivers' loneliness and enhance their health, connection to the community, and knowledge and confidence in supporting child and family health and wellbeing.

Discussion

Future WBC program enhancements could include a robust communication strategy to ensure what the program offers is clearly understood by practitioners and caregivers, establishing organisational structures to provide adequate support for the wellbeing coordinator and adopting flexible eligibility criteria.

Conclusion

The WBC program appears acceptable and feasible. Future research should establish program effectiveness with larger and more diverse caregiver samples.

Routes to social prescribing outside National Health Service (NHS) structures: a systematic map

Objectives

Social prescribing, linking to community-based interventions to support individuals' health and well-being, has become established across social medicine in the UK. Currently, most of the evidence and knowledge about how social prescribing pathways' function focuses on primary care, and we know less about how social prescribing operates outside of these structures. This review explored the evidence concerning non-health service delivered social prescribing with a view to developing guidance that would support social prescribing pathways that function outside of the health service framework.

Design

This paper reports a systematic mapping review of evidence concerning how community-based social prescribing pathways were delivered, exploring what these looked like, what needed to be in place for these to function, what outcomes were measured and how could non-health service pathways be supported to deliver these outcomes. The review searched database and grey sources and synthesised findings relating to how social prescribing pathways' function.

Setting

Community settings, outside of formal National Health Service (NHS) structures without statutory service input.

Participants

All participants that experienced pathways were included; no limits were applied.

Interventions

Non-NHS social prescribing pathways that included the core components of social prescribing.

Main outcome measures

Rich descriptions of functions of pathways.

Results

This mapping review included 17 studies. The synthesis indicated that NHS and non-NHS social prescribing pathways are intertwined and mutually reliant, such that it was neither sensible nor valuable to view them as separate.

Conclusions

Our review provides further evidence for social prescribing as a concept, variable across all components, rather than a single, coherent model. While there exists a 'core' health service pathway, we suggest that further work should be done with those delivering services to understand the roles and functions that contribute but may not presently be funded.

Digging for Literature on Tailoring Cultural Offers With and for Older People From Ethnic Minority Groups: A Scoping Review

Introduction

Social prescribing addresses non-medical issues (e.g., loneliness, financial worries, housing problems) affecting physical and/or mental health. It involves connecting people to external support or services, including 'cultural offers'-events, groups and activities run within or by cultural organisations. Such offers need to be acceptable and accessible to diverse populations if forming part of a social prescription.

Methods

A scoping review was conducted to identify what existing literature, conducted in the United Kingdom, tells us about tailoring cultural offers for older people (aged 60+ years) from ethnic minority groups. Relevant literature was searched for on electronic databases, through Google, via a questionnaire to cultural organisations and by contacting the study's advisory group.

Results

Screening of 906 references-59 of which were read as full documents-resulted in six sources being included in the review. Some cultural activities described within them were run in traditional cultural spaces (e.g., museums, art galleries). Others were held in community centres. Data suggested that attending with others could reduce concerns about belonging. Barriers to engagement included low energy, language, poor confidence, accessing transport and unfamiliarity with a setting and/or activities. Provision of familiar food could help make people feel welcomed.

Conclusions

Reviewed papers showed that consulting with target groups is important to ensure that activities are inclusive and sympathetically delivered. The review also highlighted a paucity of published research on the topic; this means that cultural providers have little evidence to draw on when developing cultural offers for older people from ethnic minority groups.

GPs' perspectives on care models integrating medical and non-medical services in primary care-a representative survey in Germany

BACKGROUND

Health-related social problems are common in primary care. Different care models integrating medical and non-medical services in primary care have been tested and established nationally and internationally, such as social prescribing, social work in primary care, health kiosks and integrated primary care centres. The aim of our study was to explore the perspective of general practitioners (GPs) working in Germany on these four care models regarding their meaningfulness and if they would like to use them. Secondary objective was to explore factors influencing this assessment.

METHODS

We conducted a survey of a representative sample of GPs working in Germany. The questionnaire included questions on the assessment of the care models' meaningfulness and whether the GPs would like to use them. The analysis was carried out descriptively and using linear regression.

RESULTS

One thousand four hundred thirty-nine GPs took part in the survey. Social prescribing and social work in primary care were rated as the most meaningful concepts. Over 65% of the GPs believed that using at least one of the care models would be beneficial. One in four GPs would even welcome the idea of integrating their practice into an integrated primary care center. Older age and male gender were associated with a more negative assessment of the care models.

CONCLUSIONS

German GPs consider integrating medical and non-medical services in primary care to be meaningful, yet they are somewhat skeptical about its practical implementation in daily practice. However, younger GPs in Germany are significantly more receptive to these models.

TRIAL REGISTRATION

German Register of Clinical Studies (DRKS-ID: DRKS00032585; Registration Date: September 1, 2023).

Primary healthcare's carbon footprint and sustainable strategies to mitigate its contribution: a scoping review

BACKGROUND

The escalating climate crisis poses a significant threat to global public health. The healthcare sector, designed to protect human health is a major contributor to greenhouse gas emissions, and thus, a key driver of climate degradation. This paradox endangers both planetary and human health, making the decarbonization of healthcare, including primary care, critical. However, research on primary care's contribution to emissions and strategies for mitigation remains limited.

AIM

This scoping review aimed to map how primary care contributes to healthcare's environmental footprint and determine contributing factors. Additionally, it sought to identify existing and innovative strategies to reduce the carbon footprint of primary healthcare.

METHODS

A comprehensive strategy was developed to systematically search both published databases and grey literature. Key terms were identified and employed in the exploration of relevant databases and internet search engines.

RESULTS

An initial search yielded 246 published articles and 25 grey literature sources. 14 additional articles were included following forward and backward searching of prominent authors and key articles. After screening and full-text review, 39 articles and 12 reports/toolkits were included. The majority of sources were opinion pieces, with limited quantitative, observational, or qualitative studies. Primary care's carbon footprint can be classified into clinical and non-clinical sources, with significant impacts from pharmaceuticals and inhaler propellant gases. Contributing factors include limited knowledge of emission sources, lack of awareness of sustainable practices, low prioritization of sustainability, barriers including ethical concerns and over-medicalization. Identified strategies to reduce emissions include decarbonization of patient care, increasing education and awareness, implementing non-clinical decarbonization efforts, and conducting more research to support sustainable initiatives. Developing metrics to track progress and securing policy supports to improve adoption and implementation were also highlighted as critical.

CONCLUSION

The identification of sources of carbon hotspots in primary care is an essential precursor to enable the development of targeted decarbonization strategies. Decarbonizing primary care requires a multifaceted approach that addresses the underlying factors driving unsustainable practices. This would allow healthcare professionals to effectively balance the provision of high-quality patient care, while reducing their environmental impact, ultimately improving both human and planetary health.

Social prescribing initiatives connecting general practice patients with community-based physical activity: A scoping review with expert interviews

AIMS

The World Health Organization states that physical inactivity is one of the leading behavioural risk factors for disability and mortality in Europe. Social prescribing holds promise as a possible solution by connecting patients from general practice to community-based physical activity. Although research within social prescribing exists, the process of connecting general practice patients to community-based physical activity is not well investigated. This scoping review aimed to summarise and synthesise knowledge on social prescribing provided by health professionals in general practice towards community-based physical activity.

METHODS

A systematic search for literature in PubMed, Embase, Scopus, SportsDiscus and other sources was conducted to identify initiatives connecting general practice to community-based physical activity. Semi-structured interviews were then conducted with subject-specific national experts. Finally, preliminary findings from the literature and the interviews were used in a co-creation process with experts to synthesise and finalise the results of a thematic analysis across data sources.

RESULTS

Based on 19 records, five expert interviews and subsequent co-creation, we identified three themes: (a) barriers and facilitators, (b) organisational perspectives and (c) value-based considerations.

CONCLUSIONS

This review illuminates the complex nature of social prescribing programmes that connect general practice patients to community-based physical activity in Denmark. It also presents practical and fundamental considerations when applying social prescribing across different settings.

Factors influencing likelihood of participation in green social prescriptions in an international sample

Green social prescriptions (GSPs) include interventions designed to combat sedentary behavior and preventable diseases by leveraging the benefits of nature-based physical activity. As these programs are still evolving, there is limited data regarding the likelihood of participation from an international perspective. This study examined factors influencing participation likelihood in GSPs across various geographic contexts, levels of greenness, nature-relatedness, well-being, and socio-demographic variables. We conducted an online, cross-sectional survey with 2,467 participants from Australia, India, Singapore, the United Kingdom, and the United States in September 2022. Participants reported their likelihood of participating in GSPs with four distinct outcomes, and we calculated an aggregate participation likelihood score. We used linear regression models to analyze associations between variables and participation likelihood, including models stratified by gender and country. Results showed that a more positive attitude towards nature was the strongest predictor of participation likelihood. Positive associations were found with educational attainment, financial comfort, and time spent in greenspace, while male gender and better well-being were linked to lower participation likelihood. Some differences in associations were revealed when stratified by country. An interaction between urban setting and greenness indicated that individuals in greener urban areas, particularly males, were less likely to feel the need for GSPs. These findings highlight that GSPs are likely to reach people who already share positive attitudes towards nature. Results indicate targeted interventions may be useful for individuals with less favorable attitudes towards nature, and males in particular, to increase likelihood of participation. Further research should explore cultural differences and the impact of health status on GSP participation. Understanding these factors can inform more equitable and effective GSP implementation.

Understanding How, Why and for Whom Link Work Interventions Promote Access in Community Healthcare Settings in the United Kingdom: A Realist Review

INTRODUCTION

Inequity in access to healthcare in the United Kingdom can have a profound impact on people's ability to manage their health problems. Link work interventions attempt to overcome the socioeconomic and structural barriers that perpetuate health inequalities. Link workers are typically staff members without professional clinical qualifications who support patients to bridge the gap between services. However, little is currently known about how and why link work interventions might be effective. This realist review attempts to understand the contexts and resultant mechanisms by which link work interventions affect access to community healthcare services.

METHODS

The authors completed a systematic search of empirical literature in Embase, CINAHL, Medline, PsychInfo and SocIndex, as well as grey literature and CLUSTER searches. Context, mechanism and outcome (CMO) configurations were generated iteratively in consultation with an expert panel and grouped into theory areas.

RESULTS

Thirty-one eligible manuscripts were identified, resulting in nine CMO configurations within three theory areas. These pertained to adequate time in time-pressured systems; the importance of link workers being embedded across multiple systems; and emotional and practical support for link workers.

CONCLUSION

Although link work interventions are increasingly utilised across community healthcare settings, the contexts in which they operate vary considerably, triggering a range of mechanisms. The findings suggest that careful matching of resources to patient need and complexity is important. It affords link workers the time to develop relationships with patients, embed themselves in local communities and referring teams, and develop knowledge of local challenges.

PATIENT OR PUBLIC CONTRIBUTION

The team included people with lived experience of mental health conditions and a carer who were involved at all stages of the review.

Survey of general practitioners' awareness, practice and perception of social prescribing across Europe

BACKGROUND

Social prescribing (SP) is a patient pathway by which healthcare professionals connect patients with other sources of support, groups, or activities within their community. The awareness, practice, and perception of SP among GPs across Europe remains unclear.

OBJECTIVES

To explore the awareness, practice, and perception of GPs on SP in the WONCA Europe region.

METHODS

An anonymous, cross-sectional online survey was distributed through a snowballing system, mailing lists, and at three international conferences in 2022/2023 to explore GPs' awareness, practice, and perception of SP. The questionnaire in English contained 21 open and closed questions.

RESULTS

Of the 208 participating GPs from 33 countries, 116 (56%) previously heard of 'social prescribing' and 66 (32%) regularly referred patients to community activities through a formal system. These 66 GPs reported different funding sources and varied activities, with an average of four activities and physical exercise being the most prevalent. Among them, 25 (38%) knew about national or local SP awareness campaigns. Of these 25, 17 (68%) agreed that SP increases their job satisfaction and 21 (84%) agreed that it has a positive impact on their patients. Variations in SP awareness and referral practice were evident across and within countries.

CONCLUSION

Despite disparities in awareness and referral practice as well as a diversity of activities and funding sources, most GPs who actively referred patients and were informed about SP campaigns agreed that SP positively impacts them and their patients.

A Qualitative Exploration of the Role of Culturally Relevant Social Prescribing in Supporting Pakistani Carers Living in the UK

BACKGROUND

Approximately 5.7 million people in the UK are providing informal care. Carers across all ethnic groups can experience negative impacts on their physical and mental health but some minority ethnic groups face greater challenges. Higher levels of social isolation exist among Pakistani carers compared to White British carers, yet the needs of Pakistani carers and how well support services meet these needs is less well understood. Social prescribing can help people get more control over their health care in a nonmedical way. South Asian and other ethnically diverse populations are under-served in social prescribing and there is little evidence available on why this is the case.

AIM

To explore the potential role of culturally relevant and adapted social prescribing in assisting Pakistani carers and identify the cultural and religious influences and barriers on carer health behaviours.

METHODS

Semi-structured one-to-one interviews with Pakistani family carers (n = 27) and social prescribing stakeholders (n = 10) living in London and Sheffield, UK. Participants were recruited through voluntary and community sector organisations (VCSOs), social media, religious organisations, and word of mouth. Interview data was analysed in NVivo using reflexive thematic analysis methods.

FINDINGS

Two themes were developed; (1) Individual and community level influences: Navigating and accessing carer support within Pakistani communities, including carer identity and cultural barriers to accessing support provision, and cultural adaptation to facilitate support for Pakistani carer health and well-being, (2) societal and structural level challenges: Accessing and providing social prescribing for Pakistani carers, including funding challenges for the provision of culturally relevant carer support, integration of primary care and social prescribing, and enhancing cultural awareness and competence in social prescribing for Pakistani carers.

CONCLUSIONS

There are complexities surrounding carer identity, family dynamics, stigma, and a lack of knowledge of social prescribing within Pakistani communities. There is a need for more culturally competent support, culturally relevant education, awareness-raising, and collaboration among primary care and VCSO's to better support Pakistani carers through social prescribing, which acknowledges and addresses the complexities.

PATIENT AND PUBLIC CONTRIBUTION

The study included a patient advisory group comprised of two South Asian family carers who contributed towards all stages of the study. They provided feedback on study documents (topic guides and recruitment materials) and recruitment strategy, supported with translation of study documents and interpretation of the interview data, and helped with facilitation of our dissemination activities.

People Living With Mental Illness Perceptions of Physical Health, Mental Health and Well-Being

Understanding the perspectives of regional people living with mental illness is crucial to adapting services, improving holistic care and meeting individual needs. This study explored people living with mental illness perceptions of physical health, mental health and well-being. A descriptive qualitative study design underpinned by empowerment theory was conducted. Qualitative data were collected verbally via semi-structured interviews, with demographic details provided verbally at the end of the interview. Thematic analysis was utilised to identify themes. The COREQ checklist was used for reporting. Fourteen participants admitted to regional mental health inpatient units aged between 25 and 84 years old were interviewed. Participants felt their overall well-being was good despite feeling their physical health or mental health was suboptimal, suggesting that their perceived well-being is influenced by factors beyond their physical and mental health. Most participants reported looking after their physical health, mental health and well-being and identified various behavioural lifestyle strategies they found helpful. Thematic analysis identified three themes: functioning well, feeling in control and meeting basic needs. Mental health services and clinicians play an important role in empowering people with mental illness to improve their physical health, mental health and well-being while admitted to inpatient services; however, it is acknowledged resources can be limited. Mental health services may consider referring people with mental illness to social prescribing programmes to meet their individualised needs on discharge.

Connected Communities | Learning lessons from person-centred community-based support services' implementation: a mixed-methods study protocol

Background

Person-centred community-based support services (PCCBSS) are an array of non-clinical services provided by organisations such as NHS Trusts, voluntary sector organisations, or local authorities.All PCCBSS involve an individual (variously known as a 'social prescriber', 'link worker', 'signposter', 'navigator', 'connector' or 'neighbourhood coach') who talks with a service user before directing them to a range of relevant community sources of social, emotional, and practical support.Despite much recent investment in social prescribing, and its increased prominence within the policy context across England, little is understood about how PCCBSS are implemented. Research is required across different contexts to describe PCCBSS implementation; in particular, how social care providers successfully interact to support the implementation of PCCBSS, and how services responded to circumstances imposed by the COVID-19 pandemic.

Purpose

The aim of this post-implementation mixed-methods study is to explore how PCCBSS are implemented and become part of usual working practice. Using three services in North West England as case studies, we will examine factors influencing PCCBSS implementation and establish where there is learning for the wider adult social care system.

Focus

The study comprises two work packages (WPs):WP1: collecting data by reviewing service documents from three PCCBSS case studies;WP2: interviewing staff and service users (≤20 participants per PCCBSS);Key implementation data will be systematically abstracted (from WPs1&2) into a coding frame; combining contextual determinants from the Consolidated Framework for Implementation Research (CFIR) with process-related domains from Normalization Process Theory (NPT).

Key outputs

The findings from WP1 and WP2 will be presented in the form of an illustrated 'pen portrait', developed collaboratively with Applied Research Collaboration North West Coast ARC NWC public advisers, to illustrate how implementation evolved for each of the PCCBSS across key time-points in the process (initiation; operation; maintenance). The findings will also inform an online implementation toolkit providing recommendations for setting up future PCCBSS.

Addressing Social and Structural Determinants of Health in the Delivery of Reproductive Health Care: ACOG Committee Statement No. 11

Social and structural determinants of health include historical, social, political, and economic forces, many of which are rooted in racism and inequality, that shape the relationship between environmental conditions and individual health. Unmet social needs can increase the risk of many conditions treated by obstetrician-gynecologists (ob-gyns), including, but not limited to, preterm birth, unintended pregnancy, infertility, cervical cancer, breast cancer, and maternal mortality. An individual health care professional's biases (whether overt or unconscious) affect delivery of care and may exacerbate and reinforce health disparities through inequitable treatment. Obstetrician-gynecologists and other health care professionals should seek to understand patients' health care decision making not simply as patients' individual-level behavior, but rather as the result of intersecting sociopolitical conditions, structural inequities, and social needs that create and maintain inequalities in health and health care. Recognizing the importance of social and structural determinants of health can help ob-gyns and other health care professionals to better understand patients, effectively communicate about health-related conditions and behavior, and contribute to improved health outcomes, including patients' experience of care and their trust in the health care system.

Impact of pandemics on primary care: changes in general practitioner antidepressant prescriptions and mental health referrals during lockdowns in England, UK

OBJECTIVES

In recent times, the world has witnessed unprecedented challenges, with the COVID-19 pandemic being a major disruptor to various aspects of daily life. This article delves into the profound impact of pandemics on primary care, specifically focussing on changes in antidepressant prescriptions and mental health referrals before, during, and after lockdowns in England, UK.

METHODS

In this retrospective study, we used anonymised individual-level electronic health record data from general practitioner (GP) practices in the North of England, UK. We applied a negative binomial-logit hurdle model and a multinominal logit regression model to assess the impact on antidepressant prescriptions and GP referral types, respectively.

RESULTS

The initiation of antidepressant prescriptions showed a notable decrease during and post lockdowns, with a minor uptick in ongoing antidepressant prescriptions during the lockdown periods. Over the course of lockdowns and beyond, there was a growing trend of patients being referred to social prescribing interventions. Notably, individuals from ethnic minorities were more inclined to receive fewer medical treatments and more social prescribing interventions.

CONCLUSION

The increase in antidepressant prescriptions during the pandemic-related lockdowns was expected due to these challenging circumstances. Reduced referrals to secondary mental health services occurred as online counselling services were deemed inappropriate by some doctors, and patients were hesitant to seek face-to-face help. Notably, there was a rise in social prescribing referrals, emerging as a valuable resource for psychological support amid heightened mental health strain. Additionally, ethnic minority patients were less likely to receive medical treatments but more likely to be referred to social prescribing services. Despite the inevitable negative impacts of the COVID-19 pandemic, these findings highlight the active role of non-clinical support in a social model of health, addressing unmet needs and reducing barriers to mental health care for certain groups.

Building common understanding: seeking consensus and defining social prescribing across contexts - a collective commentary on a Delphi study

Social prescribing has become a global phenomenon. A Delphi study was recently conducted with 48 social prescribing experts from 26 countries to establish global agreement on the definition of social prescribing. We reflect on the use and utility of the outputs of this work, and where we go from here.

Social prescription for the elderly: a community-based scoping review

AIM

This scoping review aimed to identify the social prescription activities that exist for the elderly in a community context.

BACKGROUND

The increase in population ageing imposes the need to implement specific actions that guarantee elderly people the possibility of experiencing this phase with quality. The pandemic significantly exacerbated the needs of the elderly, leading to, regarding the loss of functional capacity, quality of life, well-being, mental health, and increased loneliness. Social prescription emerges as an innovative and non-clinical strategy, being a personalized approach that focuses on individual needs and objectives (Islam, ). By referring primary health care users to resources available in the community, obtaining non-medical support that can be used in conjunction with, or instead of, existing medical treatments (Chng et al., ).

METHODS

A scoping review was conducted based on preferred reporting items for systematic reviews and meta-analyses, extension for scoping reviews (PRISMA-ScR). Searches were performed in electronic databases for potential studies: Scopus, PubMed, Medline, and Psychology and Behavioral Sciences Collection. Studies were included if they: (1) addressed social prescription interventions; (2) were community based; and (3) included elderly participants. Data extraction followed predefined criteria.

FINDINGS

Of a total of 865 articles identified, nine were selected. The social prescription activities identified fall into eight main domains: arts, personal development, social interaction, physical activity, gardening, cultural activities, religious activities, and technological activities. The interventions resulted in improved well-being, enhanced quality of life, health promotion, and reduced isolation and loneliness. Social prescription, while innovative, is still an evolving intervention, which can respond to the needs of the elderly population, given the range of activities that may exist in the community. Primary care professionals must develop these interventions, establish a link between health and the community, respond to these needs, and promote healthy ageing.

Piloting a community health and well-being worker model in Cornwall: a guide for implementation and spread

BACKGROUND

This paper evaluates the introduction of ten Community Health and Well-being Workers (CHWW) in four pilot sites across Cornwall. The period evaluated was from the initial start in June 2022 until June 2023, covering the project setup and implementation across a range of Primary Care Networks (PCNs) and Voluntary sector partners (VSCO).

METHODS

All ten CHWWs and their managers at each site were interviewed (n = 16) to understand the barriers and enablers to implementation and wider learning that could be captured around the project setup. Qualitative methods were used for data collection, including semi-structured interviews and focus groups. Transcripts were thematically analysed for cross-cutting themes, as well as site-specific effects.

RESULTS

In terms of learning, we cover the following key areas, which were of most importance to the successful implementation of the pilot: The CHWWs were introduced into an already established, successful social prescribing (SP) system by the time the CHWW project began. CHWWs can access some of the same training and office space as SPs, with overlapping meeting schedules allowing them joint input on some topics. It seemed that all the pre-work in terms of relationships and learning about a similar role helped a rapid implementation. Each site's CHWW management structure uses the same line management as the SPs. Roles were clustered together to remove duplication, maximise coverage and triaging of residents. The largest barrier to overcome was integrating VSCO staff into NHS systems. Conversely, hosting CHWWs within an NHS organisation has pros and cons, namely better access to NHS data and staff, but longer lead-in time for registration on systems, and more bureaucracy for procurement/spend.

CONCLUSIONS

Looking to the future, the pilot's success has spread the programme to other integrated care areas in the country, with ongoing plans for further rollout and evaluation in the coming years.

The role of intermediaries in connecting individuals to local physical activity - protocol for a pilot feasibility trial

Background

Intermediaries are health-related workers who facilitate connections to local physical activities. Intermediaries deliver interventions by receiving referrals, conducting assessments, connecting referred individuals to activities and/or services in the community, and following up with them over time. However, it is unclear whether individuals who are referred to physical activities by an intermediary improve their physical activity levels, and what their perspectives and experiences are of participating in this intervention. To date there has been a lack of studies investigating the effect of this intervention on physical activity using appropriate outcome measures.

Methods

This will be a mixed methods pilot feasibility study. Participants will be individuals referred or self-referred to an intermediary and connected to local physical activities. Participants will be recruited through two types of intermediary services in Ireland; social prescribing and local sports partnerships. A total of 30 participants will be recruited (15 per service). Baseline demographic information will be taken upon enrolment to the study and three questionnaires will be completed: the International Physical Activity Questionnaire - Short Form, Self-Efficacy for Exercise Scale and Short Warwick Edinburgh Mental Well-being Scale. The questionnaires will be repeated after 12 weeks and in addition semi-structured interviews will be carried out to explore intervention content and delivery, as well as acceptability of the intervention and evaluation design.

Discussion

This overall aim of this proposed study is to investigate the feasibility of an intervention delivered by an intermediary to improve physical activity and health-related outcomes of community-dwelling individuals.

Registration

ClinicalTrials.gov (NCT06260995).

Understanding access to general practice through the lens of candidacy: a critical review of the literature

BACKGROUND

Dominant conceptualisations of access to health care are limited, framed in terms of speed and supply. The Candidacy Framework offers a more comprehensive approach, identifying diverse influences on how access is accomplished.

AIM

To characterise how the Candidacy Framework can explain access to general practice - an increasingly fraught area of public debate and policy.

DESIGN AND SETTING

Qualitative review guided by the principles of critical interpretive synthesis.

METHOD

We conducted a literature review using an author-led approach, involving iterative analytically guided searches. Articles were eligible for inclusion if they related to the context of general practice, without geographical or time limitations. Key themes relating to access to general practice were extracted and synthesised using the Candidacy Framework.

RESULTS

A total of 229 articles were included in the final synthesis. The seven features identified in the original Candidacy Framework are highly salient to general practice. Using the lens of candidacy demonstrates that access to general practice is subject to multiple influences that are highly dynamic, contingent, and subject to constant negotiation. These influences are socioeconomically and institutionally patterned, creating risks to access for some groups. This analysis enables understanding of the barriers to access that may exist, even though general practice in the UK is free at the point of care, but also demonstrates that a Candidacy Framework specific to this setting is needed.

CONCLUSION

The Candidacy Framework has considerable value as a way of understanding access to general practice, offering new insights for policy and practice. The original framework would benefit from further customisation for the distinctive setting of general practice.

Psychological well-being and its associations with sociodemographic characteristics, physical health, substance use and other mental health outcomes among adults in Canada

INTRODUCTION

Psychological well-being (PWB) is an important component of positive mental health (PMH) and an asset for population health. This study examined correlates of PWB among community-dwelling adults (18+ years) in the 10 Canadian provinces.

METHODS

Using data from the 2019 Canadian Community Health Survey Rapid Response on PMH, we conducted linear regression analyses with sociodemographic, mental health, physical health and substance use variables as predictors of PWB. PWB was measured using six questions from the Mental Health Continuum-Short Form, which asked about feelings of self-acceptance, personal growth, environmental mastery, autonomy, positive relations and purpose in life during the past month.

RESULTS

In unadjusted and adjusted analyses, older age, being married or in a commonlaw relationship and having a BMI in the overweight category (25.00-29.99) were associated with higher PWB, while reporting a mood disorder, anxiety disorder, high perceived life stress, engaging in heavy episodic drinking and frequent cannabis use were associated with lower PWB. Sex, having children living at home, immigrant status, racialized group membership, educational attainment, household income tertile, having a BMI in the obese category (≥30.00), major chronic disease and smoking status were not significantly associated with PWB.

CONCLUSION

This research identifies sociodemographic, mental health, physical health and substance use factors associated with PWB among adults in Canada. These findings highlight groups and characteristics that could be the focus of future research to promote PMH.

Implementing a General Practice-Based Link Worker Intervention for People with Multimorbidity During the Covid-19 Pandemic- a Mixed Methods Process Evaluation of the LinkMM RCT

Background

Social prescribing link workers support patients to connect with community resources to improve their health and well-being. These roles are prominent in policy, but there is limited evidence on what support is provided by link workers and what factors influence implementation of link worker interventions.

Methods

A convergent, mixed methods process evaluation of an exploratory randomised trial of a one-month general practice-based link worker intervention targeting adults with multimorbidity in deprived areas. Qualitative data from interviews with 25 patients, 10 general practitioners, 10 link workers and eight community resource providers were thematically analysed and integrated with quantitative data to explore implementation, adaptations, context and mediators.

Results

GPs reported recruitment challenges related to complicated research documentation and COVID-19 related workload and restrictions. Despite most components of the intervention being delivered, the intervention was considered too short to support people with complex needs to connect with resources, particularly in the context of COVID-19 restrictions. Timing of the referral, location within general practice and link workers' person-centred approach facilitated the intervention.

Conclusions

For future evaluations, recruitment procedures need to be simplified and integrated into everyday practice. For patients with multimorbidity, a longer intervention is indicated to achieve connection with community resources.

Patient buy-in to social prescribing through link workers as part of person-centred care: a realist evaluation

Background

Social prescribing link workers have become part of primary health care in recent years. They help patients to recognise non-medical factors affecting their health and identify sources of support, often in the voluntary, community and social enterprise sector. They form part of wider work to strengthen person-centred care, which actively seeks to engage individuals in decision-making about their health, taking into account their medical, social, psychological, financial and spiritual circumstances.

Objective

To understand how buy-in to social prescribing and the link worker role is established for a patient, and how this relates to person-centred care.

Design

A realist evaluation.

Setting

Patients engaging with link workers in seven different parts of England were involved.

Methods

As part of data collection, we observed link workers interacting with 35 patients. We also interviewed 61 patients and re-interviewed 41 of them 9-12 months later. Data were coded and developed into context-mechanism-outcome configurations, which were used to produce a programme theory.

Results

Data highlighted how patients might be uncertain about the link worker role but agree to a referral as they sought assistance with their non-medical issues. Patients talked about experiencing a sense of hope through the trust they developed in a link worker. This trust was established through the communication skills and knowledge demonstrated by a link worker, and by their ability to act as an anchor point when required - a reliable, consistent source of support to whom patients could offload. The link worker role also involved connecting patients to external support, which called for sensitivity around how ready someone was to move forward; this was shaped by a patient's motivation but also their capacity to make changes given other demands in their life. Connecting patients to external support could be affected by structural factors outside the link workers' control (e.g. housing options or employment opportunities).

Limitations

We did not interview patients who had rejected the offer of social prescribing, and most had a positive view of meeting with a link worker.

Conclusions

Person-centred care is engendered by link workers through their skills, knowledge and ability to respond to the individual readiness of patients to engage with external support. It can be curtailed by structural factors outside link workers' sphere of control, such as access to housing or caring responsibilities of patients. This can hinder patients' ability to 'connect to', leaving link workers to continue 'connecting with' patients as they act as an anchor point.

Future work

Exploration is required of factors affecting patients who interact with a link worker but do not access external support. Longitudinal work with a cohort of patients, speaking to them on a regular basis, may provide further understanding in this respect.

Funding

This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR130247.

Health and Community Care Workers&apos; Knowledge and Perceptions of Social Prescribing in Singapore

BACKGROUND

This study aimed to survey knowledge and perceptions of social prescribing (SP) amongst health and community care workers, and is a cross-sectional online survey conducted in November 2023.

METHODS

The survey on basic demographics, awareness, knowledge, and practices of SP was completed by 123 health and community care workers.

RESULTS

The mean age of respondents was 39.0 years. Nearly two-thirds had heard of SP. A lower proportion of acute hospital doctors (55.6%) and nurses (56.8%) had heard of SP compared with primary and subacute care doctors (75.0%). The majority agreed that SP benefits patients' mental health and reduces healthcare utilization. Primary care physicians, community nurses, and active ageing centres were the top three professionals selected as most responsible for SP by survey respondents. The most commonly cited barriers to SP were seniors' reluctance (63.4%), lacking knowledge on how to refer (59.3%), lack of time (44.7%), and cost to seniors (44.7%).

CONCLUSION

Overall, health and community care workers demonstrated positive attitudes toward SP and were keen to refer patients for SP. However, additional efforts are needed to improve knowledge about how to refer to and provide training on SP.

Understanding exercise referrals in primary care: a qualitative study of General Practitioners and Physiotherapists

BACKGROUND

Physical inactivity is estimated to cost the UK National Health Service over £7.4 billion per year. Healthcare practitioners have a key role in supporting increases in physical activity (PA) levels, including referring to exercise referral schemes. To date, there has been little research into practitioner perspectives on referrals to exercise schemes.

OBJECTIVES

To explore the views and experiences of General Practitioners (GPs) and physiotherapists in relation to factors which influence referral and adherence to exercise referral schemes.

DESIGN SETTING AND PARTICIPANTS

Qualitative study of primary care-based practitioners in Glasgow, UK.

METHODS

Semi-structured interviews were conducted with 14 practitioners (seven GPs and seven physiotherapists). Interviews were recorded and analysed thematically.

RESULTS

Four themes are presented. Firstly, all people, including healthcare practitioners, bring inherent biases which are influenced by their background, experiences and worldviews to a consultation which impact their approach to PA promotion. Secondly, clinical time pressures are a major barrier to effective PA promotion. Thirdly, patient-led, compassionate care which seeks to fully understand a patient is the most vital component of behaviour change, with suggestions that promoting peer support and the use of personal anecdotes to normalise vulnerabilities might be helpful. Lastly, providing ongoing support for change was felt to be beneficial to PA promotion. This is often accessed through exercise referral schemes and improved by better collaboration between exercise providers and referring practitioners.

CONCLUSION

Practitioners believed exercise referrals could be improved with more targeted training in behaviour change facilitation, support for multidisciplinary working, and enhanced communication between the programmes and referrers. Additionally, supporting behaviour change requires time for compassionate care and fully understanding patients' motivations and beliefs. Lack of time was felt to be the greatest current barrier to effective PA promotion. CONTRIBUTION OF THE PAPER.

Guides for facilitating the implementation and evaluation of social prescribing: lessons from the "Access to Resources in the Community" model

Social prescribing (SP) embodies a comprehensive approach to addressing the social determinants of health. Access to Resources in the Community (ARC) is an innovative SP program offering bilingual services that involves a single point of entry for health and social needs and introduces practice changes to assist primary care providers in engaging patients, along with a nonclinical lay navigator who supports patients in accessing relevant community resources. The ARC team has created a SP toolkit offering practical guidance for setting up, implementing, monitoring the progress of and evaluating SP programs. The four ARC guides can be easily customized for application in diverse practice and research settings.

Link workers' and clients' perspectives on how social prescribing offers a social cure for loneliness

Social prescribing is a healthcare model designed to reduce loneliness and improve individuals' health by addressing unmet social needs. The present study adopted the Social Cure framework to provide an understanding of the psychosocial processes involved in helping participants to engage with social activities, from both the link workers' and clients' perspectives. Semi-structured interviews were conducted with 15 link workers (Mage = 40.12; 87% female) and 15 clients (Mage = 55.33; 73% female, 7% non-binary) of social prescribing programmes across Australia and the transcripts were analysed using reflexive thematic analysis. Three overarching themes were identified: (1) Breaking Down Barriers, (2) Finding Fit with Others, and (3) Rebuilding a Sense of Self. These findings communicate how social prescribing addressed the psychosocial barriers of clients, and how joining groups that fostered positive shared social identities resulted in meaningful improvements to clients' well-being.

A Qualitative Study of National Perspectives on Advancing Social Prescribing Using Co-Design in Canada

INTRODUCTION

Social prescribing offers a formal pathway of connecting patients in the health system with sources of support within the community to help improve their health and well-being. Since its launch in March 2022, the Canadian Institute for Social Prescribing has acted as a collective impact network to identify, connect and build upon established social prescribing initiatives using a co-design methodology. The institute received input from a participant advisory council, co-design partners and several communities of interest groups. This study aimed to describe the perceptions of the Canadian Institute for Social Prescribing's role in advancing social prescribing using a co-design approach and the barriers and facilitators to implementing social prescribing in Canada.

METHODS

We used a qualitative descriptive study design, document analysis, participant observation and semi-structured individual interviews (n = 7) with members of the Canadian Institute for Social Prescribing co-design group and the institute's leadership. We also analysed documents, field notes and transcripts using codebook thematic analysis.

RESULTS

Four themes were developed representing the facilitators of implementing the Canadian Institute for Social Prescribing to support social prescribing: Creating relational mechanisms (i.e., partnerships and connections), Bringing awareness to social prescribing and contributing to the evidence (i.e., values and beliefs), Addressing systemic conditions (i.e., having a common language for social prescribing and organizing the community health sector) and Enabling funding and policy to drive social prescribing initiatives (i.e., shifting evidence into policy and securing sustainable funding).

CONCLUSION

Participants' reflections on the co-design process demonstrated that the Canadian Institute for Social Prescribing development provided networking opportunities and shared resources relevant to social prescribing. Co-design efforts also fostered relational and informational support, which laid the necessary groundwork in Canada to overcome the complex interplay between the macro- and micro-level settings in which social prescribing is practiced.

PATIENT OR PUBLIC CONTRIBUTION

The interviews and observations involved participants with lived experience of delivering, receiving or advocating for social prescribing.

Nature-based social prescribing programmes: opportunities, challenges, and facilitators for implementation

BACKGROUND

Evidence on the health benefits of spending time in nature has highlighted the importance of provision of blue and green spaces where people live. The potential for health benefits offered by nature exposure, however, extends beyond health promotion to health treatment. Social prescribing links people with health or social care needs to community-based, non-clinical health and social care interventions to improve health and wellbeing. Nature-based social prescribing (NBSP) is a variant that uses the health-promoting benefits of activities carried out in natural environments, such as gardening and walking. Much current NBSP practice has been developed in the UK, and there is increasing global interest in its implementation. This requires interventions to be adapted for different contexts, considering the needs of populations and the structure of healthcare systems.

METHODS

This paper presents results from an expert group participatory workshop involving 29 practitioners, researchers, and policymakers from the UK and Germany's health and environmental sectors. Using the UK and Germany, two countries with different healthcare systems and in different developmental stages of NBSP practice, as case studies, we analysed opportunities, challenges, and facilitators for the development and implementation of NBSP.

RESULTS

We identified five overarching themes for developing, implementing, and evaluating NBSP: Capacity Building; Accessibility and Acceptability; Networks and Collaborations; Standardised Implementation and Evaluation; and Sustainability. We also discuss key strengths, weaknesses, opportunities, and threats for each overarching theme to understand how they could be developed to support NBSP implementation.

CONCLUSIONS

NBSP could offer significant public health benefits using available blue and green spaces. We offer guidance on how NBSP implementation, from wider policy support to the design and evaluation of individual programmes, could be adapted to different contexts. This research could help inform the development and evaluation of NBSP programmes to support planetary health from local and global scales.

Speaking the Same Language - The Development of a Glossary of Terms for Social Prescribing in Wales

Introduction

Social prescribing can facilitate the integration of health, social care and community support but has a diverse and confusing terminology that impairs cross-sectoral communication and creates barriers to engagement.

Methods

To address this issue a mixed-methods approach that incorporated a scoping review, a group concept mapping study and consultation was employed to identify and classify the terminology associated with social prescribing. The findings were then used to inform the development of a glossary of terms for social prescribing.

Results

Many terms are used interchangeably to describe the same specific aspects of social prescribing. Much of the terminology originates from the health and social care literature of England.

Discussion

The terminology used in the academic literature may not accurately reflect the terminology used by the social prescribing workforce. The innovative and interactive glossary of terms identifies the terminology associated with social prescribing and provides additional contextual information. The process of developing the dual language glossary presented several considerations and challenges.

Conclusion

The glossary of terms will facilitate cross-sector communication and reduce barriers to engagement with social prescribing. It takes an important first step to help clarify and standardise the language associated with social prescribing, for professionals and members of the public alike.

"When she goes out, she feels better:" co-designing a Green Activity Program with Hispanic/Latino people living with memory challenges and care partners

Purpose

Utilizing a participatory approach, we sought to co-design a 12-week Green Activity Program (GAP) with Hispanic/Latino individuals living with memory challenges and their care partners, local outdoor professionals, and healthcare providers.

Methods

Participants were recruited via convenience and snowball sampling in the Bronx, New York with Hispanic/Latino persons living with memory challenges and care partners, outdoor activity professionals, and interdisciplinary healthcare providers/dementia experts. Co-design occurred iteratively with 5 focus groups and 4 individual interviews lasting 30-90 min and focused on program and research design. Sessions were recorded and transcribed. Utilizing directed content analysis data was coded using a priori codes program design and research design.

Results

21 participants completed co-design activities: (n = 8 outdoor activity professionals, n = 6 Hispanic/Latino persons living with memory challenges and care partners, and n = 7 interdisciplinary healthcare providers/dementia experts). Participant preferences for program design were captured by subcodes session duration (30-90 min), frequency (4-8 sessions), and delivery modes (in-person and phone). Participants' preferred nature activities included group exercise and outdoor crafts [crocheting], outcomes of social participation, connectedness to nature, decreased loneliness, and stewardship were identified. Preferred language for recruiting and describing the program were "memory challenges," "Hispanic/Latino," and "wellbeing." Referral pathways were identified including community-based organizations and primary care.

Conclusion

Co-design was a successful form of engagement for people living with memory challenges that enabled participants to help design key elements of the GAP and research design. Our processes, findings, and recommendations for tailoring co-design to engage Hispanic/Latino people living with memory challenges can inform the development of other programs for this population.

PROTOCOL: Effects of social prescribing for older adults: An evidence and gap map

Objectives This is the protocol for an evidence and gap map. The objectives are as follows: The aim of this evidence and gap map is to map the available evidence on the effectiveness of social prescribing interventions addressing a non-medical, health-related social need for older adults in any setting. Specific objectives are as follows: 1.To identify existing evidence from primary studies and systematic reviews on the effects of community-based interventions that address non-medical, health-related social needs of older adults to improve their health and wellbeing.2.To identify research evidence gaps for new high-quality primary studies and systematic reviews.3.To highlight evidence of health equity considerations from included primary studies and systematic reviews.

"You don't get side effects from social prescribing"-A qualitative study exploring community pharmacists' attitudes to social prescribing

OBJECTIVES

Social prescribing is an approach that enables the referral of patients to non-clinical support and places a focus on holistic care. This study explored views of community pharmacists regarding social prescribing in pharmacies.

STUDY DESIGN

A qualitative phenomenological approach was used.

METHODS

A convenience sample of eleven community pharmacists from Northern England were recruited via social media (Twitter, Facebook) and took part in a semi-structured, one-to-one qualitative interviews that asked about their knowledge of social prescribing, the advantages of community pharmacist involvement and any barriers they predicted to its implementation. Interviews were transcribed verbatim and thematically analysed.

RESULTS

The sample included largely male pharmacists (63.3%) with less than five years' experience (45.5%) and included pharmacists working as employees (63.6%), locums (27.3%) and owners (9%) in both chain (36%) and independent stores (54.5%). The main findings indicate an enthusiasm for but limited understanding of social prescribing. Factors which appeared to influence involvement were training requirements and time available to complete an additional service in busy pharmacies. Opportunities centred on the broader pharmacy team's role to optimise health outcomes.

CONCLUSIONS

The findings indicate pharmacists may be an underused resource due to a poor understanding of the full scale and scope of social prescribing beyond health promotion, lifestyle interventions. Further work is needed to explore the transferability of the findings to the broader pharmacy workforce to understand how social prescribing can be positioned within pharmacy practice.

A Secondary Data Analysis of Technology Access as a Determinant of Health and Impediment in Social Needs Screening and Referral Processes

Introduction

Although health systems increasingly integrate social needs screening and referrals into routine care, the effectiveness of these interventions and for whom they work remains unclear.

Methods

Patients (N=4,608) seen in the emergency department were screened for social needs (e.g., transportation, housing, food) and offered an opportunity to receive outreach from community service specialists.

Results

Among 453 patients with 1 or more social needs who requested assistance, outreach specialists connected with 95 (21.0%). Patients preferred to be contacted through their telephone (n=21, 60.2%), email (n=126, 28.0%), someone else's telephone (n=30, 6.7%), or first by telephone followed by email (n=23, 5.1%). Preferred contact method varied by patient age; endorsement of unmet transportation, housing, and utility needs; receipt of service outreach; and differences in emergency department utilization from the 6 months before the index visit to the 6 months after.

Conclusions

Because limited access to a stable telephone or internet connection may prevent patients from connecting with resource referrals, social needs interventions may not benefit the most underserved populations who are at the highest risk of negative health outcomes. Future research should investigate whether communication preferences are an important indicator of needs and how to adapt social needs screening and referral processes so that they are more accessible to populations who may experience more frequent disruptions in methods utilized for digital communication.