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Bos C, de Weger E, Wildeman I, Pannebakker N, Kemper PF. Implement social prescribing successfully towards embedding: what works, for whom and in which context? A rapid realist review. BMC Public Health 2024; 24:1836. [PMID: 38982399 PMCID: PMC11234751 DOI: 10.1186/s12889-024-18688-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/23/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Some clients who access healthcare services experience problems due to the wider determinants of health which cannot be addressed (solely) by the medical sector. Social Prescribing (SP) addresses clients ' wider health needs and is based on linkworkers who support primary care clients in accessing social, community and voluntary care services that support their needs. Previous literature has provided valuable insights about what works (or not) in an early stage of implementing SP. However, there is limited insight into what works for the implementation of SP towards embedding. This study provides guiding principles by which SP can be successfully implemented towards the embedding stage and identifies which contextual factors and mechanisms influence these guiding principles. METHODS A Rapid Realist Review was conducted to examine what works, for whom, why, and in which contexts. A local Dutch reference panel consisting of health and care organisations helped to inform the research questions. Additionally, a workshop was held with the panel, to discuss what the international insights mean for their local contexts. This input helped to further refine the literature review's findings. RESULTS Five guiding principles were identified for successful implementation of SP at the embedding stage: • Create awareness for addressing the wider determinants of health and the role SP services can play; • Ensure health and care professionals build trusting relationships with all involved stakeholders to create a cyclical referral process; • Invest in linkworkers' skills and capacity so that they can act as a bridge between the sectors; • Ensure clients receive appropriate support to improve their self-reliance and increase their community participation; • Invest in the aligning of structures, processes and resources between involved sectors to support the use of SP services. CONCLUSION To embed SP, structural changes on a system level as well as cultural changes are needed. This will require a shift in attitude amongst health and care professionals as well as clients towards the use, role and benefit of SP services in addressing the wider determinants of health. It will also require policymakers and researchers to involve communities and include their perspectives.
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Affiliation(s)
- C Bos
- National Institute for Public Health and the Environment (RIVM), Centre for Public Health, Care and Society, Department of health and Care Nationally, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands.
- Research group Innovation in Preventive Healthcare, HU University of Applied Sciences Utrecht, Heidelberglaan 7, Utrecht , 3584 CS, The Netherlands.
| | - E de Weger
- Vrije universiteit Amsterdam, Athena Instituut, de Boelelaan 1085, Amsterdam, 1081 HV, The Netherlands
| | - I Wildeman
- TNO child health, Sylviusweg 71, Leiden, 2333 BE, The Netherlands
| | - N Pannebakker
- TNO child health, Sylviusweg 71, Leiden, 2333 BE, The Netherlands
| | - P F Kemper
- National Institute for Public Health and the Environment (RIVM), Centre for Public Health, Care and Society, Department of health and Care Nationally, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
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Costa A, Henriques J, Alarcão V, Madeira T, Virgolino A, Polley MJ, Henriques A, Feteira-Santos R, Arriaga M, Nogueira P. "You get out of the house, you talk to each other, you laugh…And that's fantastic" - a qualitative study about older people's perceptions of social prescribing in mainland Portugal. BMC Health Serv Res 2024; 24:645. [PMID: 38769571 PMCID: PMC11106980 DOI: 10.1186/s12913-024-11086-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 05/07/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Social prescribing (SP) is a non-clinical approach, most commonly based in healthcare units, that aims to address non-medical health-related social needs by connecting individuals with community-based services. This qualitative study explores the perception of Portuguese older adults regarding the benefits of SP and their willingness to participate in SP initiatives. METHODS Three face-to-face focus group sessions were conducted with 23 participants in different cities in Portugal. Open and semi-open questions were used to guide the discussions and thematic analysis was used to analyze the data. RESULTS The participants recognized the potential benefits of SP for older adults, including diversifying leisure activities, improving mental health, and complementing existing support systems. They highlighted the need for external support, usually in the form of link workers, to facilitate personalized referrals and consider individual characteristics and preferences. While some participants expressed reluctance to engage in SP due to their existing busy schedules and a perceived sense of imposition, others showed openness to having new experiences and recognized the potential value of SP in promoting activity. Barriers to participation, including resistance to change, mobility issues, and family responsibilities, were identified. CONCLUSIONS The study emphasizes the importance of a person-centered and co-designed approach to SP, involving older adults in the planning and implementation of interventions. The findings provide valuable insights for the development of SP programs tailored to the unique needs and aspirations of older adults in Portugal, ultimately promoting active and healthy aging. Future research should consider the perspectives of family doctors and include a broader representation of older adults from diverse geographic areas.
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Affiliation(s)
- Andreia Costa
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Avenida Prof Egas Moniz, Lisbon, Lisboa, 1600 - 190, Portugal.
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, Lisboa, 1649-028, Portugal.
- Laboratório para a Sustentabilidade do Uso da Terra e dos Serviços dos Ecossistemas - TERRA, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, Lisboa, 1649-028, Portugal.
- Católica Research Centre for Psychological-Family and Social Wellbeing (CRC-W), Faculdade de Ciências Humanas, Universidade Católica Portuguesa, Lisboa, 1649-023, Portugal.
| | - Joana Henriques
- Escola Nacional de Saúde Pública, ENSP, Centro de Investigação em Saúde Pública, CISP, Comprehensive Health Research Center, CHRC, Universidade NOVA de Lisboa, Avenida Padre Cruz, Lisboa, 1600-560, Portugal
| | - Violeta Alarcão
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, Lisboa, 1649-028, Portugal
- Laboratório para a Sustentabilidade do Uso da Terra e dos Serviços dos Ecossistemas - TERRA, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, Lisboa, 1649-028, Portugal
- Centro de Investigação e Estudos de Sociologia (CIES-Iscte), Instituto Universitário de Lisboa (Iscte), Lisboa, 1649-026, Portugal
| | - Teresa Madeira
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, Lisboa, 1649-028, Portugal
- Laboratório para a Sustentabilidade do Uso da Terra e dos Serviços dos Ecossistemas - TERRA, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, Lisboa, 1649-028, Portugal
- Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal
| | - Ana Virgolino
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, Lisboa, 1649-028, Portugal
- Laboratório para a Sustentabilidade do Uso da Terra e dos Serviços dos Ecossistemas - TERRA, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, Lisboa, 1649-028, Portugal
| | - Marie J Polley
- Research and Development, Meaningful Measures Ltd, Bristol, UK
| | - Adriana Henriques
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Avenida Prof Egas Moniz, Lisbon, Lisboa, 1600 - 190, Portugal
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, Lisboa, 1649-028, Portugal
- Laboratório para a Sustentabilidade do Uso da Terra e dos Serviços dos Ecossistemas - TERRA, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, Lisboa, 1649-028, Portugal
| | - Rodrigo Feteira-Santos
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, Lisboa, 1649-028, Portugal
- Laboratório para a Sustentabilidade do Uso da Terra e dos Serviços dos Ecossistemas - TERRA, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, Lisboa, 1649-028, Portugal
| | - Miguel Arriaga
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, Lisboa, 1649-028, Portugal
- Laboratório para a Sustentabilidade do Uso da Terra e dos Serviços dos Ecossistemas - TERRA, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, Lisboa, 1649-028, Portugal
- Católica Research Centre for Psychological-Family and Social Wellbeing (CRC-W), Faculdade de Ciências Humanas, Universidade Católica Portuguesa, Lisboa, 1649-023, Portugal
| | - Paulo Nogueira
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Avenida Prof Egas Moniz, Lisbon, Lisboa, 1600 - 190, Portugal
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, Lisboa, 1649-028, Portugal
- Laboratório para a Sustentabilidade do Uso da Terra e dos Serviços dos Ecossistemas - TERRA, Av. Prof. Egas Moniz, Ed. Egas Moniz, Piso 0, Ala C, Lisboa, 1649-028, Portugal
- Escola Nacional de Saúde Pública, ENSP, Centro de Investigação em Saúde Pública, CISP, Comprehensive Health Research Center, CHRC, Universidade NOVA de Lisboa, Avenida Padre Cruz, Lisboa, 1600-560, Portugal
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Bradley G, Scott J. Social Prescribing Nomenclature, Occupational Therapy and the Theory of Institutional Work: Creating, Maintaining and Disrupting Medical Dominance. Occup Ther Health Care 2023; 37:40-53. [PMID: 34010085 DOI: 10.1080/07380577.2021.1926046] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Social prescribing is a process of helping people to access non-medical activities and services which address health and wellbeing needs. The process is frequently (although not exclusively) initiated by primary health care professionals and often involves prescribing activities or initiatives provided by community and voluntary organizations. To occupational therapy, the links between activity, social-connectedness and health are clearly not new, although there are emerging international examples of social prescribing initiatives, and examples of newly developed roles, processes and funding opportunities, all of which are creating momentum behind the agenda.In this commentary, we draw upon the theory of Institutional Work to examine how the language of "prescription," and the purposive action of policy-makers and practitioners, is shaping thinking and action in relation to activity and health. Arguably, this language has helped to translate the recommendation of activity to meet a range of health needs in to an accessible and implementable concept. However, it has also potentially contributed to positioning the concept within a medical model of health, upholding medical dominance, and leaving occupational therapy on the margins of the debate.
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Affiliation(s)
- Gemma Bradley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle-Upon-Tyne, UK
| | - Jason Scott
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle-Upon-Tyne, UK
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White C, Bell J, Reid M, Dyson J. More than signposting: Findings from an evaluation of a social prescribing service. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5105-e5114. [PMID: 35915879 DOI: 10.1111/hsc.13925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/03/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
This paper presents findings from an evaluation of a social prescribing service, undertaken between January 2019 and December 2020. Data was collected through interviews and focus groups with a range of groups including social prescribing managers, link workers (LWs), referrers (GPs and social work practitioners), clients, Voluntary and Community Sector (VCS) agencies and groups. Thematic analysis of data was undertaken, and findings were presented in respect of clients' journeys into social prescribing; the support received from LWs; their onward journeys to VCS support. The findings highlight the challenges for individuals in contacting new agencies/groups and the importance of practitioner referral into and onwards from social prescribing, as well as buddying to support clients on initial agency visits. The depth of the LW role is highlighted, as well as the complexity of client circumstances, highlighting a need for 'more than signposting', and challenging the notion of self-referral as an indicator of motivation. Social prescribing has been positioned as amongst the solutions to the challenges of primary care. However, referrals from GPs were low and significantly outnumbered by those from social workers; this suggests a need to explore in greater depth the use of social prescribing by social workers, who have, to date, been absent from social prescribing research.
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Affiliation(s)
- Caroline White
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Jo Bell
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Marie Reid
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Judith Dyson
- Faculty of Health Sciences, University of Hull, Hull, UK
- Centre for Social Care, Health and Related Research, Birmingham City University, Birmingham, UK
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Cooper M, Avery L, Scott J, Ashley K, Jordan C, Errington L, Flynn D. Effectiveness and active ingredients of social prescribing interventions targeting mental health: a systematic review. BMJ Open 2022; 12:e060214. [PMID: 35879011 PMCID: PMC9328101 DOI: 10.1136/bmjopen-2021-060214] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE This study aims to establish the effectiveness and active ingredients of UK-based social prescribing interventions targeting mental health and well-being outcomes. DESIGN Systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analysies guidelines and a published protocol. DATA SOURCES Nine databases were systematically searched up to March 2022. ELIGIBILITY CRITERIA Social prescribing interventions in the UK involving adults aged ≥18 years, which reported on mental health outcomes. DATA EXTRACTION AND SYNTHESIS Two reviewers extracted data on study characteristics; outcomes; referral pathways; treatment fidelity strategies; person-centredness; intervention development processes and theory-linked behaviour change techniques (BCTs). Data were narratively synthesised. RESULTS 52 074 records were retrieved by the search, 13 interventions reported across 17 studies were included in this review (N=5036 participants at post-intervention). Fifteen studies were uncontrolled before-and-after designs, one a randomised controlled trial and one a matched groups design. The most frequently reported referral pathway was the link worker model (n=12), followed by direct referrals from community services (n=3). Participants were predominantly working age adults, and were referred for anxiety, depression, social isolation and loneliness. 16 out of 17 studies reported statistically significant improvements in outcomes (mental health, mental well-being, general health, or quality of life). Strategies to enhance treatment fidelity were suboptimal across studies. Only two studies used a specific theoretical framework. A few studies reported engaging service users in codesign (n=2) or usability and/or feasibility testing (n=4). Overall, 22 BCTs were coded across 13 interventions. The most frequently coded BCTs were social support-unspecified (n=11), credible source (n=7) and social support-practical (n=6). CONCLUSIONS Robust conclusions on the effectiveness of social prescribing for mental health-related outcomes cannot be made. Future research would benefit from comprehensive intervention developmental processes, with reference to appropriate theory, alongside long-term follow-up outcome assessment, using treatment fidelity strategies and a focus on principle of person-centred care. PROSPERO REGISTRATION NUMBER CRD42020167887.
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Affiliation(s)
- Matthew Cooper
- School of Health & Life Sciences, Teesside University, Middlesbrough, UK
| | - Leah Avery
- School of Health & Life Sciences, Teesside University, Middlesbrough, UK
| | - Jason Scott
- Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Kirsten Ashley
- School of Health & Life Sciences, Teesside University, Middlesbrough, UK
| | - Cara Jordan
- School of Health & Life Sciences, Teesside University, Middlesbrough, UK
| | - Linda Errington
- School of Biomedical, Nutritional, and Sport Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Darren Flynn
- Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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