Evaluating the impact of a community-based social prescribing intervention on people with type 2 diabetes in North East England: mixed-methods study protocol

Abstract

IntroductionSocial prescribing enables healthcare professionals to use voluntary and community sector resources to improve support for people with long-term conditions. It is widely promoted in the UK as a way to address complex health, psychological and social issues presented in primary care, yet there is insufficient evidence of effectiveness or value for money. This study aims to evaluate the impact and costs of a link-worker social prescribing intervention on the health and healthcare use of adults aged 40–74 with type 2 diabetes, living in a multi-ethnic area of high socioeconomic deprivation.Methods and analysisMixed-methods approach combining (1) quantitative quasi-experimental methods to evaluate the effects of social prescribing on health and healthcare use and cost-effectiveness analysis and (2) qualitative ethnographic methods to observe how patients engage with social prescribing. Quantitative data comprise Secondary Uses Service data and Quality Outcomes Framework data. The primary outcome is glycated haemoglobin, and secondary outcomes are secondary care use, systolic blood pressure, weight/body mass index, cholesterol and smoking status; these data will be analysed longitudinally over 3 years using four different control conditions to estimate a range of treatment effects. The ranges where the intervention is cost-effective will be identified from the perspective of the healthcare provider. Qualitative data comprise participant observation and interviews with purposively sampled service users, and focus groups with link-workers (intervention providers). Analysis will involve identification of themes and synthesising and theorising the data. Finally, a coding matrix will identify convergence and divergence among all study components.Ethics and disseminationUK NHS Integrated Research Approval System Ethics approved the quantitative research (Reference no. 18/LO/0631). Durham University Research Ethics Committee approved the qualitative research. The authors will publish the findings in peer-reviewed journals and disseminate to practitioners, service users and commissioners via a number of channels including professional and patient networks, conferences and social media. Results will be disseminated via peer-reviewed journals.

Social prescribing

“…Measuring these outcomes is not straightforward and will require further work if a robust evidence base is to be developed. Mixed methods research that integrates qualitative and quantitative approaches is likely to capture the context and range of outcomes necessary to develop evidence and learning about social prescribing services 21…”

Tensions and opportunities in social prescribing. Developing a framework to facilitate its implementation and evaluation in primary care: a realist review

“…However, recent systematic reviews have failed to prove consistent health, service utilization or cost benefits (8)(9)(10)(11)(12)(13), in part due to the use of methods and research designs not suited for the evaluation of such complex interventions (14,15). Further research is also needed on the applicability of SP to specific areas of health need and contexts (16,17).…”

The Year of Care approach: developing a model and delivery programme for care and support planning in long term conditions within general practice

“…Self-management may involve individual actions alone as well as non-traditional formal and informal support from groups and peers. For those with complex needs link workers [74] can build on the issues identified in CSP and support individuals to access an increasing range of community activities. For those who also need specialist, or traditional MDT and social care involvement, CSP initiates an important coordinating function.…”