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

Abstract

The use of non‐medical referral, community referral or social prescribing interventions has been proposed as a cost‐effective alternative to help those with long‐term conditions manage their illness and improve health and well‐being. However, the evidence base for social prescribing currently lags considerably behind practice. In this paper, we explore what is known about whether different methods of social prescribing referral and supported uptake do (or do not) work. Supported by an Expert Advisory Group, we conducted a realist review in two phases. The first identified evidence specifically relating to social prescribing in order to develop programme theories in the form of ‘if‐then’ statements, articulating how social prescribing models are expected to work. In the second phase, we aimed to clarify these processes and include broader evidence to better explain the proposed mechanisms. The first phase resulted in 109 studies contributing to the synthesis, and the second phase 34. We generated 40 statements relating to organising principles of how the referral takes place (Enrolment), is accepted (Engagement), and completing an activity (Adherence). Six of these statements were prioritised using web‐based nominal group technique by our Expert Group. Studies indicate that patients are more likely to enrol if they believe the social prescription will be of benefit, the referral is presented in an acceptable way that matches their needs and expectations, and concerns elicited and addressed appropriately by the referrer. Patients are more likely to engage if the activity is both accessible and transit to the first session supported. Adherence to activity programmes can be impacted through having an activity leader who is skilled and knowledgeable or through changes in the patient's conditions or symptoms. However, the evidence base is not sufficiently developed methodologically for us to make any general inferences about effectiveness of particular models or approaches.

Group Outdoor Health Walks Using Activity Trackers: Measurement and Implementation Insight from a Mixed Methods Feasibility Study

“…Many other staff members in a medical practice have the opportunity to influence patients, and may have more time than the physicians, thus future efforts would benefit from the engagement of all staff members. This is consistent with a growing interest in social prescribing and use of 'link workers' [68,69]. For future trials, it would be beneficial to have a more proactive discussion with the practice staff to ensure that they identify a small cohort over 2-3 weeks prior to the commencement of a specific, time-limited programme.…”

Supporting social prescribing in primary care by linking people to local assets: a realist review

“…A previous realist review by Husk et al. [15] proposed a model for understanding social prescribing more generally, generating statements about enrolment, engagement and completion of activities. Our review has a more specific focus on the link worker role, because these individuals have been identified as key to social prescribing delivery and are being implemented across primary care in England. It sought to answer the following questions:…”

Once is Rarely Enough: Can Cocial Prescribing Facilitate Adherence to Non-clinical Community and Voluntary Sector Health Services? Empirical Evidence from Germany

“…We used the number of times patients attended the health advice and navigation service during the three months following their initial visit (henceforth described as the number of return visits) as a proxy for patient adherence to it within the observation period. A similar understanding of patients' adherence to such services has been used by other authors in the eld of social prescribing, including 22 [22] and 13 [13]. As our observation period, we used the mean time between patients' initial and last visit in our sample, which was 3 months.…”

“…To date, research on social prescribing schemes has focused primarily on the English NHS and yielded mixed results regarding their effectiveness and e ciency in improving patient outcomes and reducing GP workload [8,[14][15][16]. However, despite this inconclusive evidence, there is a consensus that any positive effects of referring patients to sources of support in the community can only be expected if patients show ongoing involvement with (i.e., adhere to) them [13,17]. Indeed, studies have reported that the likelihood of achieving positive health-related outcomes increases with the frequency with which a patient uses such services [18][19][20][21].…”

“…Indeed, studies have reported that the likelihood of achieving positive health-related outcomes increases with the frequency with which a patient uses such services [18][19][20][21]. Additionally, research also suggests that social prescribing probably has a positive effect on the use of community and voluntary sector services [13]. Moreover, the ndings of a number of qualitative studies suggest that patients' relationship to their GP facilitates adherence to GPs' recommendations [22][23][24][25][26].…”