A comparison of social prescribing approaches across twelve high-income countries

BACKGROUND

Social prescribing connects patients with community resources to improve their health and well-being. It is gaining momentum globally due to its potential for addressing non-medical causes of illness while building on existing resources and enhancing overall health at a relatively low cost. The COVID-19 pandemic further underscored the need for policy interventions to address health-related social issues such as loneliness and isolation.

AIM

This paper presents evidence of the conceptualisation and implementation of social prescribing schemes in twelve countries: Australia, Austria, Canada, England, Finland, Germany, Portugal, the Slovak Republic, Slovenia, the Netherlands, the United States and Wales.

METHODS

Twelve countries were identified through the Health Systems and Policy Monitor (HSPM) network and the EuroHealthNet Partnership. Information was collected through a twelve open-ended question survey based on a conceptual model inspired by the WHO's Health System Framework.

RESULTS

We found that social prescribing can take different forms, and the scale of implementation also varies significantly. Robust evidence on impact is scarce and highly context-specific, with some indications of cost-effectiveness and positive impact on well-being.

CONCLUSIONS

This paper provides insights into social prescribing in various contexts and may guide countries interested in holistically tackling health-related social factors and strengthening community-based care. Policies can support a more seamless integration of social prescribing into existing care, improve collaboration among sectors and training programs for health and social care professionals.

[Public Health and Participation of Experts from Experience in Austria: a First Exploratory Survey]

Participation is a basic principle of health promotion and public health. Citizen and patient participation in health care is considered to be poor in Austria and the existing practice is not very visible. An explorative online survey was conducted among members of the Austrian Public Health Association. The aim was to identify the current state of participation of experts from experience ("affected persons") in research, strategy development and practice. 29 organisations working on participation were identified. The survey revealed participation practice was methodologically diverse. Orientation towards participatory models, as the lowest common denominator, can provide a basis for further exchange and shared learning of participation.

[Advanced training program seeking to strengthen nationwide self-help organizations: development of the ÖKUSS advanced training concept]

BACKGROUND

Self-help organizations act in a self-determined manner, but can be strengthened by conducive framework conditions such as advanced training programs. The Austrian Competence and Service Agency for Self-help ÖKUSS was created as part of the framework of the concept for public promotion of self-help. It developed an advanced training program for the systematic support of nationwide self-help organizations (NSHO). The article describes the conceptual development of an advanced training program and discusses how to deal with ambivalences arising in the process.

METHOD

Three training tracks were derived from the objectives of the concept for the public promotion of self-help (promoting the visibility of self-help organizations, strengthening self-help organizations in their activities, and patient participation). To determine the contents, the advanced training needs of NSHO were identified on the basis of process-produced data (including feedback forms), relevant literature, and the results of workshops with self-help representatives. An Internet search was conducted to build on existing offerings. The ÖKUSS concept was developed in several workshops with representatives of self-help organizations and its contents and framework conditions were discussed.

RESULTS

Training Track 1 "Strengthening self-help activities" aims to strengthen the self-image of NSHO as a self-help organization and to support the implementation of activities with introductory seminars and additional workshops. Training Track 2 "Promoting cooperation" supports the meeting and dialogue between NSHO representatives and experts with expert dialogues and annual projects. Training Track 3 "Strengthening collective patient participation" prepares NSHO representatives for participation in health policy decision-making processes in a modular course.

DISCUSSION AND CONCLUSIONS

During the development process, ambivalences in a social, factual, time and space dimension were dealt with: On the social dimension, the aim was to take decisions regarding the objectives, form and content of the continuing education program as closely as possible to the participants and to offer low-threshold participation. On the factual level, the focus was on the competence of those affected and/or the transfer of competence for implementing activities. In terms of time, a balance had to be struck between the time resources available to the NSHO representatives and the time required to develop competence. In terms of space, on-site events were preferred to online events (before COVID-19). Finally, a different approach was chosen for each training track. For the further development of the advanced training program, a piloting and a participatory development with NSHO representatives is recommended.

Legislating Patient Representation: A Comparison Between Austrian and German Regulations on Self-Help Organizations as Patient Representatives

Governments are increasingly inviting patient organizations (POs) to participate in healthcare policymaking. By inviting POs that claim to represent patients, representation comes into being. However, little is known about the circumstances under which governments accept POs as patient representatives. Based on the analysis of relevant legislation, this article investigates the criteria that self-help organizations (SHOs), a special type of PO, must fulfil in order to be accepted as patient representatives by governments in Austria and Germany. Thereby, it aims to contribute to the discussion on the role of governments in steering SHOs. There are different degrees of regulation (very little in Austria, more in Germany). Governments in both countries not only formulate explicit criteria for SHOs with respect to patient representation but also guide SHOs representing patients through implicit criteria for associations. We discuss the findings against concepts of responsiveness, authorization, and accountability. Our findings indicate that governmental steering is not negative per se as indicated by previous research but-depending on legislative criteria-can promote transparency and democratic quality in patient representation.

Factors influencing workplace health promotion intervention: a qualitative systematic review

Although workplace health promotion (WHP) has evolved over the last 40 years, systematically collected knowledge on factors influencing the functioning of WHP is scarce. Therefore, a qualitative systematic literature review was carried out to systematically identify and synthesize factors influencing the phases of WHP interventions: needs assessment, planning, implementation and evaluation. Research evidence was identified by searching electronic databases (Scopus, PubMed, Social Sciences Citation Index, ASSIA, ERIC, IBBS and PsycINFO) from 1998 to 2013, as well as by cross-checking reference lists of included peer-reviewed articles. The inclusion criteria were: original empirical research, description of WHP, description of barriers to and/or facilitators of the planning, implementation and/or evaluation of WHP. Finally, 54 full texts were included. From these, influencing factors were extracted and summarized using thematic analysis. The majority of influencing factors referred to the implementation phase, few dealt with planning and/or evaluation and none with needs assessment. The influencing factors were condensed into topics with respect to factors at contextual level (e.g. economic crisis); factors at organizational level (e.g. management support); factors at intervention level (e.g. quality of intervention concept); factors at implementer level (e.g. resources); factors at participant level (e.g. commitment to intervention) and factors referring to methodological and data aspects (e.g. data-collection issues). Factors regarding contextual issues and organizational aspects were identified across three phases. Therefore, future research and practice should consider not only the influencing factors at different levels, but also at different phases of WHP interventions.

Effects of student participation in school health promotion: a systematic review

The aim of this systematic review was to summarize systematically the existing evidence for the effects of student participation in designing, planning, implementing and/or evaluating school health promotion measures. The focus was on the effects of participation in school health promotion measures rather than on student involvement at school in general. Participation is a core value for health promotion but empirical evidence of its outcomes is scarce. We searched major bibliographic databases (including ASSIA, ERIC, PsycINFO, Scopus, PubMed and the Social Sciences Citation Index). Two reviewers independently decided about inclusion and exclusion of the identified abstracts (n = 5075) and full text articles. Of the 90 full text articles screened, 26 papers met the inclusion criteria. We identified evidence for positive effects, especially for the students themselves, the school as organization, and interactions and social relations at school. Almost all included studies showed personal effects on students referring to an increased satisfaction, motivation and ownership, an increase in skills, competencies and knowledge, personal development, health-related effects and influence on student perspective. Given that student participation has more been discussed as a value, or ideal of health promotion in schools, these findings documenting its effectiveness are important. However, further research is needed to consider the level or intensity of involvement, different approaches and stages of participation in the health promotion intervention, as well as mediating factors such as gender, socio-cultural background or academic achievement, in a more systematic manner.

Self-help organisations as patient representatives in health care and policy decision-making

A crucial question about participation is who is legitimised, willing and capable of representing particular collectives. Social insurance health care systems tend to focus on representation by patient organisations. Self-help organisations (SHOs), as one type of 'health consumer and patient organisation', often take over this role. Research findings indicate that participation by SHOs is accompanied by high expectations, but also by concerns about the risks of instrumental abuse, overload and professionalisation. However, there is a dearth of in-depth knowledge about both potential and risks of participating for the SHO. To tackle this research gap, a qualitative study design was used to investigate fifteen SHOs in Austria. Data were generated by expert interviews with SHO representatives and documentary analysis of SHO websites. Content analysis was applied. SHOs in Austria advocate for patients' interests, participate in invited spaces and have various forms of cooperative relations with the health care system. Thereby, they draw on the experiential knowledge of their members without, however, systematising it. Experiences with professionalisation and instrumental use are ambiguous, whereas overload is prevalent. SHOs need resources for reflection in order to define their position visà- vis the health system and to realise their potential as patient representatives. Deepening co-operation with the health care system might lead to new participatory practices acknowledging differences in culture and the resources of both sides.