Researchers from ECEHH and the wider Universities of Exeter and Plymouth are undertaking a review of evidence of the most effective approaches to social prescribing, focusing on nature based interventions for mild to moderate depression.

Social prescribing is a means of enabling primary care services to refer patients with social, emotional or practical needs to a range of non-clinical services. The use of non-drug, non-health-service interventions is argued to be a cost-effective alternative to help those with long-term conditions manage their condition and improve health and wellbeing, contributing to the “Triple Aim” by applying integrated approaches to simultaneously improve care, improve population health, and reduce costs per capita.

Social prescriptions (or ‘community referrals’ as they are sometimes known) typically involve accessing activities run by the third sector or community agencies. Patients may self-refer or be referred through a healthcare or other professionals. A wide range of social prescription activities have been developed, including art therapy, walking groups, reading groups, nature-based activities and volunteering. These are multi-component, complex interventions and are similar to more established exercise referral schemes

The team will use ‘realist review‘ methodologies to explain why different methods of referral and retention in social prescribing activities do (or do not) work in certain circumstances for certain populations as well as the uncertainties relating to methods of referral and retention. A ‘realist review’, or ‘realist synthesis’, seeks to answer specified research questions by applying a realist philosophy of science to the synthesis of relevant evidence. A realist philosophy is based on the principle that intended and unintended outcomes of interest (O) are generated through the interaction between context (C) and mechanism(s) (M). Consequently, what works well for one group of people may not work at all in different circumstances or for a different group of people.

The protocol for the review has been published in the journal Systemic Reviews: Husk, K., Blockley, K., Lovell, R., Bethel, A., Bloomfield, D., Warber, S., Pearson, M., Lang, I., Byng, R., Garside, R., 2016. What approaches to social prescribing work, for whom, and in what circumstances? A protocol for a realist review. Systematic Reviews 5, 1-7.