Social prescribing for frequent attenders in primary care: An economic analysis

Art for health's sake or health for art's sake: Disentangling the bidirectional relationships between arts engagement and mental health

Increasing evidence links arts engagement with mental health, but the directionality of the link remains unclear. Applying a novel approach to causal inference, we used nonrecursive instrumental variable models to analyze two waves of data from the United Kingdom Household Longitudinal Study (n = 17,927). Our findings reveal bidirectional causal relationships between arts engagement (arts participation, cultural attendance, and heritage visits) and mental health (GHQ-12 mental distress and SF-12 Mental Component Summary mental well-being). After adjusting for time 1 measures and identifying confounders, cultural attendance and heritage visits were reciprocally associated with mental distress and mental well-being, while arts participation was only reciprocally associated with mental well-being. The bidirectional effects between arts engagement and mental health are modest but clearly demonstrated not only from mental health to arts but also from arts to mental health. Our findings indicate that previous evidence of an association between arts engagement and mental health is due to bidirectional causal effects. Interventions that boost arts participation, cultural attendance, and heritage visits may help break the negative feedback loop and enhance mental health.

Stakeholder views on addressing challenges to the implementation of social prescribing in the United Kingdom

Objectives

This study aimed to understand the key barriers to successfully implementing Social Prescribing (SP) initiatives from different perspectives.

Methods

An in-depth process evaluation using a multi-method qualitative design was conducted. Qualitative data was collected via semi-structured interviews (N = 23) and Focus Group Discussion (FGD' N = 4). Twenty-three stakeholders took part in the study, including community support providers (n = 7), SP link workers (n = 6), service users (n = 6), NHS employees/referrals, and those who were involved in SP leadership and coordination (n = 4). MAXQDA Version 20.0 was used for management and data analysis.

Results

We identified eight themes representing challenges for a successful implementation of a SP programme. The themes included (i) financial issues and sustainability, (ii) human resources challenges, (iii) partnership working challenges, (iv) inadequate and inconsistent implementation, (v) information system challenges, (vi) referral system issues, (vii) training and knowledge gaps, and (viii) accessibility and privacy concerns.

Conclusion

Study findings provide insight for commissioners, providers, and link workers to guide the delivery of appropriate SP services by identifying a range of factors that hinder the successful implementation of the programme. Future policy, service development, and research should consider tackling these challenges and generating different ideas for potential solutions to address the root causes of problems.

Knowledge, attitudes, and perceptions of student nurses regarding community activities in primary care: A cross-sectional study

OBJECTIVE

To ascertain student nurses' degree of knowledge, attitudes, and perceptions regarding the implementation of community activities (CA) in primary care.

DESIGN

Questionnaire-based cross-sectional study.

SAMPLE

The study was conducted with 152 students seeking a nursing degree at the University of Santiago de Compostela (North Spain) in the 2022/2023 academic year.

MEASUREMENTS

We distributed a self-administered online questionnaire on CA, which are actions undertaken in collaboration with the local community and targeted at groups of people with common needs, in order to improve the health and wellbeing of the population.

RESULTS

Only 15.1% of the sample was able to identify CA correctly. However, 93.4% considered these an effective approach for the control of chronic diseases. Special mention should be made of the positive attitude shown by students toward the implementation of these types of activities.

CONCLUSION

Nurses play a key role in preventing chronic diseases, and it is therefore necessary to ensure that they are trained in the implementation of CA aimed at reducing the incidence of such diseases. Future training plans for nurses should emphasize the community perspective in order to improve the skills of future professionals in this field and to increase the success of these interventions.

Social prescribing outcomes: a mapping review of the evidence from 13 countries to identify key common outcomes

Introduction

As a means for supporting a range of health and wellbeing goals, social prescribing programs have been implemented around the world. Reflecting a range of contexts, needs, innovation, and programing, a broad array of outcomes has been studied in relation to these programs. As interest in social prescribing grows, more targeted study of key outcomes and in turn evidence synthesis that can inform evidence-based practice, policy, and investment is needed.

Methods and Results

This mapping review identified, described, and synthesized the broad array of social prescribing outcomes that have been studied in 13 countries and maps the outcomes that have been most commonly studied. From 87 articles included in this review, a total of 347 unique outcomes were identified, including 278 unique patient outcomes and 69 unique system outcomes. The most commonly studied categories of patient outcomes were found to be mental health, lifestyle and behavior, and patient/service user experience. The most commonly studied system outcomes were healthcare/service utilization and financial/economic outcomes.

Discussion

This review highlights the value of heterogeneity and mixed methods approaches in outcomes studies for capturing nuanced experiences and outcomes in this nascent area of practice, while contributing to the advancement of evidence synthesis for social prescribing globally by quantifying and offering insight into the outcomes that have been studied to date. It also lays a foundation for the development of key common outcomes and a Core Outcomes Set for social prescribing. Additionally, it identified key outcomes that, given their relationship to critical health and social issues, warrant both broader and deeper study.

Targeted health promotion with guided nature walks or group exercise: a controlled trial in primary care

Background

Contact with nature promotes wellbeing through diverse pathways, providing a potential way of supporting health especially in primary care, where patients commonly suffer from multimorbidity and poor general health. Social prescribing is a non-pharmaceutical approach for improving health as well as social inclusion. This field study explores and compares the effects of a nature-based and an exercise-based social prescribing scheme on mental wellbeing and sleep, in a primary care population.

Methods

Primary care patients identified to benefit from a general improvement to their health were recruited by nurses, doctors, or social workers to this non-randomized, intention-to-treat, pilot field-study. Participants (n = 79) chose between the group interventions, either taking part in guided walks in nature, including immersion in a forest with high biodiversity, or participating in a versatile sports program. Mental wellbeing was assessed with the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS), with additional questions evaluating self-rated health and sleep. Impact on mental wellbeing was explored in relation to perceived health. The amount and quality of sleep was measured with wrist-worn accelerometers. With a focus on everyday life impacts, the assessments took place before and after the 8-week intervention. All participants lived in Sipoo, Finland, an area with abundant accessible green space.

Results

Participants (mean age 57 years, 79% female) rated their general and mental health lower than the general population. Participation in the Nature-group resulted in improved mental wellbeing (change in WEMWBS by 3.15, p = 0.008), with a positive change for feeling relaxed, being cheerful, having energy to spare, feeling able to deal well with problems, feeling good about oneself and feeling close to other people. The Sports-group was beneficial for those initially rating their health as good. Sleep duration improved in the Sports-group, while participants in the Nature-group reported better sleep quality. Following the interventions there was improvement in perceived health and ability to function in both groups, while perceived mental health improved only in the Nature-group.

Conclusion

We attest that even in areas surrounded by greenery, active interventions can further improve health in a primary care population, and that nature-based interventions are beneficial for those in poor health.

Clinical trial registration

ClinicalTrials.gov, Identifier NCT05893212.

Improving health and wellbeing through social prescribing

As part of the NHS long-term strategy to meet the medical and non-medical needs of patients, there is growing acceptance that the traditional model of service delivery can no longer meet current challenges. This has led to the co-creation of services with patients and other stakeholders such as the voluntary and community sector to help deliver these. Social prescribing, which is now available through the NHS, is one such option that allows individual patients with a social need to access local health resources and social support outside the NHS.

Examining Psychosocial and Economic Barriers to Green Space Access for Racialised Individuals and Families: A Narrative Literature Review of the Evidence to Date

BACKGROUND

Social prescribing (such as green social prescribing), aims to address health disparities cross-culturally to improve well-being. However, evidence highlights racial disparities in relation to access to quality green space (including local/national parks and recreational spaces). This review aimed to identify the psycho-socioeconomic barriers to green space access for racialised individuals/families and Black Indigenous People of Colour (BIPOC), to understand what cultural adaptations might be made to help support them to access green social prescribing within the UK.

METHOD

A narrative systematic review was conducted to identify barriers to green space access for racialised individuals/families and BIPOC. Searches of publication databases (APA PsycInfo, Cochrane Database of Systematic Reviews [CDSR], Cochrane Central Register of Controlled Trials [CENTRAL], Cumulated Index to Nursing and Allied Health Literature [CINAHL], and SCOPUS Preview) were undertaken from January to February 2022, to identify quantitative peer reviewed studies. Of the 4493 abstracts identified, ten studies met the inclusion criteria and were included for final review.

RESULTS

The results suggest that interpersonal, practical (such as transportation costs, entrance fees and lodging costs) and environmental factors can act as barriers to green space access for racialised individuals/families. Most frequently reported barriers were perceptions of safety and costs associated with travel and accessing green spaces, particularly for families.

CONCLUSION

Factors such as diversity-friendly schemes (e.g., multiple languages on signs and additional prayer spaces in parks), funding and strategies to improve safety should be considered in the design and commissioning of green space and green social prescribing initiatives in primary care. By mitigating these barriers green space can become more accessible and improve inclusivity for racialised individuals/families. Future research could explore the inter-racial differences between racialised populations and which mechanisms reduce barriers to access and in what contexts.