The social cure of social prescribing: a mixed-methods study on the benefits of social connectedness on quality and effectiveness of care provision

Abstract

ObjectivesThis study aimed to assess the degree to which the ‘social cure’ model of psychosocial health captures the understandings and experiences of healthcare staff and patients in a social prescribing (SP) pathway and the degree to which these psychosocial processes predict the effect of the pathway on healthcare usage.DesignMixed-methods: Study 1: semistructured interviews; study 2: longitudinal survey.SettingAn English SP pathway delivered between 2017 and 2019.ParticipantsStudy 1: general practitioners (GPs) (n=7), healthcare providers (n=9) and service users (n=19). Study 2: 630 patients engaging with SP pathway at a 4-month follow-up after initial referral assessment.InterventionChronically ill patients experiencing loneliness referred onto SP pathway and meeting with a health coach and/or link worker, with possible further referral to existing or newly created relevant third-sector groups.Main outcome measureStudy 1: health providers and users’ qualitative perspectives on the experience of the pathway and social determinants of health. Study 2: patients’ primary care usage.ResultsHealthcare providers recognised the importance of social factors in determining patient well-being, and reason for presentation at primary care. They viewed SP as a potentially effective solution to such problems. Patients valued the different social relationships they created through the SP pathway, including those with link workers, groups and community. Group memberships quantitatively predicted primary care usage, and this was mediated by increases in community belonging and reduced loneliness.ConclusionsMethodological triangulation offers robust conclusions that ‘social cure’ processes explain the efficacy of SP, which can reduce primary care usage through increasing social connectedness (group membership and community belonging) and reducing loneliness. Recommendations for integrating social cure processes into SP initiatives are discussed.

Social prescribing for individuals with mental health problems: a qualitative study of barriers and enablers experienced by general practitioners

“…Nevertheless, this preliminary research does demonstrate that GPs found it challenging to have good knowledge of community groups or the time to engage fully, but valued face-to-face meetings with them [24]. GPs were also reported to find it difficult to address patient's social and mental health needs, due to lack of training and limited time in appointments; GPs acknowledged the limitations of the "traditional medical model" [25]. And so, this stresses the importance of pursuing this line of inquiry, to understand the role of GPs in social prescribing more clearly.…”

“…It also appears to rely on GP "buy-in" to validate the service among other professionals and patients, and requires GPs to believe in the link worker's ability and in the benefits of social prescribing [22]. Further, a few studies have included interviews with GPs, but these have tended to involve a very small number of GP interviews, or focused solely on 1 practice or locale [24,25]. Nevertheless, this preliminary research does demonstrate that GPs found it challenging to have good knowledge of community groups or the time to engage fully, but valued face-to-face meetings with them [24].…”

Using self-determination theory to understand the social prescribing process: a qualitative study

“…1 The prescription can take many forms, depending on the community and resources available and patient's needs, but can include a knitting circle, walking group, bereavement support group, or volunteering. Multiple studies indicate that these prescriptions improve social inclusion [2][3][4][5] , mental well-being, 6 physical activity levels, 7 and selfmanagement of health. 8,9 However, beyond identifying the impact of these prescriptions, it is equally important to understand how SP as a process facilitates these outcomes.…”

“…8,9 However, beyond identifying the impact of these prescriptions, it is equally important to understand how SP as a process facilitates these outcomes. As such, this paper builds on the work done by Hanlon et al, 10 Kellezi et al 3 and Payne et al 11 in trying to understand the "how" of SP.…”

The Leveraging Exercise to Age in Place (LEAP) Study: Engaging Older Adults in Community-Based Exercise Classes to Impact Loneliness and Social Isolation

“… 35 Our program health coach functioned similarly to the “social prescribing” pathway recently described in England, where primary care providers can refer patients to a health coach for connection to community programming which led to decreased loneliness. 36 The purpose-driven nature of the classes 12 may also represent key element, contrasting with less successful approaches such as “Senior Meetings” 37 where the purpose is explicitly fostering companionship.…”