Realist review of what approaches to social prescribing work, for whom, and in what circumstances.

Our review of what approaches to social prescribing work, for whom, and in what circumstances, led by Kerryn Husk at the University of Plymouth and Ruth Garside here at ECEHH, has been published in the journal Health and Social Care in the Community!

The aims of the review were to explore what is known about whether different methods of the social prescribing process – i.e. referral and supported uptake – do (or do not) work. The review did not consider the efficacy of the activities people were referred to (those questions are addressed in other work such as our previous review of conservation activities for health).

Social prescribing is gaining popularity in the UK, however the evidence base for social prescribing approaches lags behind practice and rollout. Given the rapid planned expansion of programmes, there is a need to understand what works, for whom, in what ways.

We undertook a realist review as we were seeking to explicate the ways in which the process of social prescribing works, for whom, and in what circumstances. Our methodological approach is set out in detail in the published protocol. We identified around 40 key elements of how social prescribing processes work, but focused on 12 elements in more depth.

Our review of 109 primary studies suggests that multiple interacting factors at three key stages contribute to pathway ‘success’:

  1. the successful initial referral of patients (referral),
  2. participants attending the first activity session (uptake), and
  3. participants maintaining this participation over time (adherance).

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Some of the factors that can affect how well social prescribing process work

We found that ‘patients are more likely to enrol if they believe the social prescription will be of benefit, if the referral is presented in an acceptable way that matches their needs and expectations, with concerns elicited and addressed appropriately by the referrer. Patients are more likely to engage if their chosen activity is accessible and transit to the first session supported. Adherence to programmes is impacted through skilled and knowledgeable activity leadership or through changes in conditions or symptoms’.

Social prescribing is not a single intervention but a pathway and series of relationships, all of which need to function to meet patient need. We also confirm that the role of the link worker is key to avoid the delicate process of referral, uptake and adherence being disrupted. However, the evidence base is not sufficiently developed to make general inferences about effectiveness of particular approaches.

Husk, K., Blockley, K., Lovell, R., Bethel, A., Lang, I., Byng, R. and Garside, R., 2019. What approaches to social prescribing work, for whom, and in what circumstances? A realist review. Health and Social Care in the Community. Online First. https://doi.org/10.1111/hsc.12839

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