SHN:5023 Personalised Care and Social Prescribing
INTRODUCTION
Social prescribing is considered as that practice in which healthcare professionals refers patient to non-clinical community services. This includes community groups and activities that focuses on enhancing patient health outcomes by addressing social determinants of health. The present literature review will be based on critically analysing effectiveness and appropriateness of social prescribing interventions on an individual’s health and wellbeing along with considering methods related to assessing, planning and evaluating outcomes.
LITERATURE REVIEW
Theme 1- Understanding social prescribing
As per the views of Vidovic, Reinhardt and Hammerton (2021) social prescribing is further known as community referrals; under these GPs, nurses and other healthcare professional refer people to varied non-clinical services. This approach focuses on connecting people to the activities, services, groups within their community for meeting practical, emotional and social needs; this ultimately results in enhancing health outcomes of people. It is considered as a way to connect people with available community resources for improving their health and wellbeing. However, Cooper et al, (2022) stated that growing evidences suggesting about potential benefits of social prescribing on an individual wellbeing; still the evidence base has been remaining critiqued for their limitations. These are concerned with inconsistent study design, methodological weakness, and lack of robust data regarding a particular population. It is making it difficult to assess the effectiveness and appropriateness of social prescribing intervention in diverse context. Hence, there is further evidence-based research is needed to be undertaken for assessing, planning and evaluating social prescribing interventions.
In the perception of Costa et al, (2021) social prescribing interventions comprised with range of activities which are specifically provided by community sector organisations. It particularly involves art activities, gardening, group learning, befriending, healthy eating advice and range of sports. Social prescribing adopts person-centred approach and accordingly, individuals’ needs and requirements are prioritised to greater extent. There are wider benefits of social prescribing that comprehends with relieving pressure on primary care services, it helps people who are suffering from such conditions that are resistant to medication, it further supports people in managing their health in holistic manner. Social prescription intervention links with enhancing mental wellbeing of individuals which is prior for enhancing overall health.
On the other hand, Baska et al, (2021) depicted that despite varied benefits of social prescribing there are certain key criticism witnessed in this context. Wider studies lacking due to rigorous control groups, using diverse outcome measures and self-reported data. This makes it complex for individuals in terms of comparing results within different social prescribing interventions. Nowak and Mulligan, (2021) revealed that most studies focusing on determining immediate impact of wellbeing instead of focusing on long-term sustainability of social prescribing interventions. Furthermore, evidences regarding social prescribing for particular groups that are suffering from complex health needs are often lacking. Thus, these are drawbacks comprised with social prescribing and due to this social prescribing is lacking in evidences.
Theme 2- Impact of social prescribing interventions on individuals’ health and wellbeing
In the study of Wakefield et al, (2022) it has been witnessed that social prescribing interventions lead to significantly improve individual’s health and wellbeing by addressing social determinants of health. This is leading to create positive impact on individual wellbeing by reducing loneliness, increases social connectedness, improves mental health and enhanced self-esteem while improving quality of life. Specifically, it supports those people who are suffering from social isolation. By connecting with people in community or engaging in community-based activities support can be ensured to such people. Social prescribing empowers individuals for taking greater control in their life while enhancing their wellbeing.
Bhatti et al, (2021) emphasised on key benefits of social prescribing such as mental health improvement, reducing isolation and loneliness, physical activity encouragement, increases self-esteem and empowerment and improves lifestyle choices. Social prescribing can significantly lead to reduce the symptom of anxiety, depression and stress in an individual by fostering sense of belongingness. On the other hand, Calderón‐Larrañaga et al, (2022) stated that social prescribing does not work in severe conditions. For instance- if an individual is suffering from severe trauma and depression then in such situation social prescribing does not ensure effective results. In such crucial situation, behavioural therapies or medications such as SSRIs works. Furthermore, each individual has unique experience and therefore, same intervention cannot be implied in everyone’s case.
As said by Oster et al, (2023) by facilitating participation within community activities, social prescribing leads to combat feelings of isolation and loneliness. By referring to individuals to appropriate exercise and physical activity the program can support in enhancing physical health and wellbeing of individuals. Participating within social prescribing activities boosting confidence of individuals and develops sense of trust in them that significantly contributes in their recovery procedure. Author further stated that by addressing social determinants of health, social prescribing encourages healthier lifestyle behaviour that involves adopting effective diet and smoking cessation programs. Thus, these are key benefits identified in context of social prescribing interventions which lead to enhance individuals’ wellbeing.
In the perception of Rhodes and Bell (2021) social prescribing empowers individuals for improving their health, wellbeing and social welfare by increasing their interaction with non-medical and community support services. Social prescribing is undertaken by involving a line worker; patients suffering from psychosocial issues are referred to line worker. Whereas, Hazeldine et al, (2021) depicted that social prescribing works by identifying the needs; healthcare professionals assess patient situation along with their lifestyle factors that influencing health. Hence, requirements of individuals are identified and accordingly, services are prescribed to them. Based on the needs, community services are referred and a dedicated link worker ensures consistent support to individuals and helps them in navigating referral procedure while maintaining their engagement level within community services. Link workers monitor individual and ensures that their needs and requirements have been met; also, it has been assured that no biasness is undertaken while providing services to individuals.
In the study of Pescheny et al, (2021) it has been witnessed that social prescribing interventions significantly enhancing individuals’ health and wellbeing by addressing social determinants of health. These interventions lead to enhance self-esteem of individuals and further enhances their social connectedness. It has been proven highly effective in enhancing mental health of individuals; the main cause of depression and anxiety is loneliness. Thus, social prescribing focuses on increasing social connection of individuals and this lead to develop sense of belongingness in them. By engaging in different communities’ activities such as gardening, art and playing an individual can be empowered and consistent support could be ensured to them. Whereas, Gibson et al, (2021) depicted that aim of social prescribing is to focus on social determinants of health which are causing subsequent issues. For example- lack of access to healthcare services, education and poverty are topmost social determinants of health that are leading to increase mental health complexities among individuals. Social prescribing focuses on these factors and accordingly individuals’ engagement within community services are increased.
Hence, based on the above presented information this can be said that social prescribing interventions develops positive influence on individuals’ health and wellbeing. However, it is important to consider focus on analysing the individual requirements as each individual concerned with different experience and therefore, their preferred needs are different. By focusing on this area appropriate community services can be referred to individuals and this leads to enhance mental wellbeing of patients (Brown et al, 2021). Furthermore, it is important to adopt person-centred approach as this support in keeping individuals’ needs at the forefront and accordingly, appropriate actions are taken. Therefore, significant focus requires to be implied on this area and healthcare professionals and practitioner should consider person-centred approach so that consistent care to individual can be ensured. This supports in gaining effective results and subsequently, patient health outcomes can be enhanced to greater extent.
Theme 3- Criticism regarding social prescription methods and challenges associated with social prescribing
As said by Napierala et al, (2022) social prescribing is implemented within pilot trials and accordingly, published evaluation demonstrated improvement in areas such as quality of life, depression, anxiety, reduction in healthcare use and so on contexts. There are two different evaluation methods associated with social prescribing and those are qualitative and quantitative. The qualitative method of social prescribing involves interviews, surveys, focus groups and questionnaire. Whereas, quantitative method of social prescribing aligns with reviewing number of prescriptions, GP attendance rates and unscheduled care attendance. However, in present era studies have been using qualitative and quantitative data methods for evaluating their successes of social prescribing. Wood et al, (2022) emphasised on the limitations of using individual data; only using qualitative data provides biased results while; solely using quantitative data does not provide detailed information regarding the effectiveness of social prescribing. Ideal evidence-based research involves randomized control trials [RCT] and subsequently, specific groups of people who are using social prescription services are approached and research is undertaken on those group.
However, Muhl et al, (2023) depicted that this method is expensive and this is further ethically challenging and many times self-reporting data by participants misleads the information. Hence, evaluating social prescribing is challenging; it complies with multiple stakeholders and there is need to use different models of social prescribing that varies within the level of intensity of interventions. Aggar et al, (2021) highlighted different issues which can impact evaluations; lack of awareness or branding regarding social prescribing develops implication specifically while collecting quantitative data. Furthermore, if GPs does not see positive results within implication of social prescribing, then this impact their feedbacks.
Community organisations does not have sufficient resources and structured for collecting data; this can make it difficult to know that how many individuals have attended the session. Moreover, community organisations disappear because of lack of funding and therefore, social prescribers find it difficult to interact with individuals. Thus, these are the major issues that creates impact on evaluation. Whereas, Howlett et al, (2024) stated that criticism of social prescribing method involves concerns related to lack of robust evidence and potential to increase in health inequalities. Despite growing awareness, there is lack of strong research undertaken that demonstrate about consistent efficacy of social prescribing significantly related to addressing complex health challenges and long-term outcomes. Furthermore, this can lead to increase health inequalities; if social prescribing has not been designed carefully then this results in health disparities and marginalised communities are not able to receive benefits.
Brettell, Fenton and Foster, (2022) depicted that critics often argue that social prescribing emphasise on an individual’s lifestyle changes instead of resolving wider structural factors such as discrimination, poverty and lack of access to housing, education and employment. These are the contextual factors which requires to be focused out for understanding the complexities experienced by individuals. The lifestyle changes of an individual are results of all these factors and therefore, specific focus needs to be implied on this area. The diverse nature of social prescribing intervention makes it difficult to implement a standardised procedure and clear metrics for enhancing the effectiveness of procedure.
Sandhu et al, (2022) elucidated that not all patients are receptive to social prescribing, some of them might face barrier in accessing and participating referred activities due to lack of awareness and personal factors. There are different methods available for assessing, planning, and evaluating social prescribing outcomes. The health outcomes are measured on the basis of mental health wellbeing, social isolation, physical activity levels and social isolation. The depression and anxiety levels are checked, by using Short Warwick Edinburgh Mental Well-being Scale; wellbeing of individual can be measured, loneliness scale supports in determining about social isolation while quality of life measures and self-reported measures supports in determining about quality of life and physical activity levels. Whereas, Paquet et al, (2023) stated that planning and implementation considerations of social prescribing comprised with needs assessment; there is need to identify local community needs and accordingly interventions are tailored. Furthermore, collaboration with community partners and inking worker role supports in providing consistent care services to individuals and enhances their health outcomes.
Hence, overall social prescribing showing effectual results in addressing social determinants of health and further improving overall wellbeing. However, further research is needed to undertake for developing robust evidences regarding effectiveness and appropriateness of social prescribing on diverse population.
Theme 4- Recommendation for social prescribing interventions that lead to enhance individual wellbeing
In the views of Tierney et al, (2025) enhancing individual wellbeing through social prescribing intervention should focus on promoting he social connections within community. Regular social gathering can support in enhancing trust within individuals and supports in developing sense of belongingness in them. Therefore, it is important to focus on this area and accordingly, support must be ensured individuals. By organising structured discussion on varied topics meaningful connections and participations of the individuals could be supported. This results in enhancing their engagement level and increases their self-esteem to greater extent. Intergenerational program supports in connecting younger generation with older individuals and supports in developing interaction among them. These are the ways through which social connections could be enhanced to greater extent. On the other hand, Wood et al, (2021) stated that waking groups such as organised walks in different paces suits varied fitness levels. Organising dance classes and yoga supports in encouraging physical exercise in individuals. Community gardens, nature walks and birdwatching ensures nature engagement of individuals and provides them opportunity in terms of connecting with nature.
Halder et al, (2021) stated that community support groups such as mental health support groups lead to undertake peer-led discussion for individuals suffering from mental health complexity. Furthermore, caregiver support groups focus on connecting caregivers so they can share their experience with each other and this supports in undertaking coping strategies. Moreover, it is important to collaborate with community organisations so that wider range of strategies can be adopted for providing support to individuals. Whereas, Wood et al, (2021) specified that healthcare professionals must assess individual needs and preferences; subsequently, decision should be taken. Monitoring or regular basis is important as this supports in identifying the areas in which improvement is needed to be taken. Thus, these strategies must be implemented for undertaking improvement within social prescribing interventions. This results in gaining the trust of individuals and enhances their health outcomes.
CONCLUSION
Conclusively; this can be said that social prescribing interventions are effective in enhancing individual’s health and wellbeing. It focuses on increasing the engagement of an individual within community setting and develops consequent support for them. The prior focus has been implied on empowering individuals and accordingly, their health outcomes are enhanced. However, criticism related to lack of robust evidence leading to raise questions regarding social prescribing. These interventions focus on lifestyle factors rather that social factors which are broader in context. Thus, there is need to undertake evidence-based research in this area so that wider evidences can be allocated and implication of social prescribing could be done in wider context
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REFERENCES
Books and Journals
Aggar, C., Thomas, T., Gordon, C., Bloomfield, J., & Baker, J. (2021). Social prescribing for individuals living with mental illness in an Australian community setting: a pilot study. Community mental health journal, 57, 189-195.
Baska, A., Kurpas, D., Kenkre, J., Vidal-Alaball, J., Petrazzuoli, F., Dolan, M., ... & Robins, J. (2021). Social prescribing and lifestyle medicine—a remedy to chronic health problems?. International Journal of Environmental Research and Public Health, 18(19), 10096.
Bhatti, S., Rayner, J., Pinto, A. D., Mulligan, K., & Cole, D. C. (2021). Using self-determination theory to understand the social prescribing process: a qualitative study. BJGP open, 5(2).
Brettell, M., Fenton, C., & Foster, E. (2022). Linking Leeds: a social prescribing service for children and young people. International Journal of Environmental Research and Public Health, 19(3), 1426.
Brown, R. C., Mahtani, K., Turk, A., & Tierney, S. (2021). Social prescribing in National Health Service primary care: what are the ethical considerations?. The Milbank Quarterly, 99(3), 610.
Calderón‐Larrañaga, S., Greenhalgh, T., Finer, S., & Clinch, M. (2022). What does the literature mean by social prescribing? A critical review using discourse analysis. Sociology of Health & Illness, 44(4-5), 848-868.
Cooper, M., Avery, L., Scott, J., Ashley, K., Jordan, C., Errington, L., & Flynn, D. (2022). Effectiveness and active ingredients of social prescribing interventions targeting mental health: a systematic review. BMJ open, 12(7), e060214.
Costa, A., Sousa, C. J., Seabra, P. R. C., Virgolino, A., Santos, O., Lopes, J., ... & Alarcão, V. (2021). Effectiveness of social prescribing programs in the primary health-care context: a systematic literature review. Sustainability, 13(5), 2731.
Gibson, K., Pollard, T. M., & Moffatt, S. (2021). Social prescribing and classed inequality: A journey of upward health mobility?. Social science & medicine, 280, 114037.
Halder, M. M., Wakefield, J. R., Bowe, M., Kellezi, B., Mair, E., McNamara, N., ... & Stevenson, C. (2021). Evaluation and exploration of a social prescribing initiative: study protocol. Journal of health psychology, 26(3), 345-356
Hazeldine, E., Gowan, G., Wigglesworth, R., Pollard, J., Asthana, S., & Husk, K. (2021). Link worker perspectives of early implementation of social prescribing: A ‘Researcher‐in‐Residence’study. Health & Social Care in the Community, 29(6), 1844-1851.
Howlett, N., Brown, K., Freethy, I., Mercer, S., & Özakıncı, G. (2024). We need better evidence for social prescribing: Call for Action for better systems for collaboration and building evidence. Perspectives in Public Health.
Muhl, C., Mulligan, K., Bayoumi, I., Ashcroft, R., & Godfrey, C. (2023). Establishing internationally accepted conceptual and operational definitions of social prescribing through expert consensus: a Delphi study. BMJ open, 13(7), e070184.
Napierala, H., Krüger, K., Kuschick, D., Heintze, C., Herrmann, W. J., & Holzinger, F. (2022). Social prescribing: systematic review of the effectiveness of psychosocial community referral interventions in primary care. International journal of integrated care, 22(3), 11.
Nowak, D. A., & Mulligan, K. (2021). Social prescribing: A call to action. Canadian Family Physician, 67(2), 88-91.
Oster, C., Skelton, C., Leibbrandt, R., Hines, S., & Bonevski, B. (2023). Models of social prescribing to address non-medical needs in adults: a scoping review. BMC Health Services Research, 23(1), 642.
Paquet, C., Whitehead, J., Shah, R., Adams, A. M., Dooley, D., Spreng, R. N., ... & Dubé, L. (2023). Social prescription interventions addressing social isolation and loneliness in older adults: Meta-review integrating on-the-ground resources. Journal of medical Internet research, 25, e40213.
Pescheny, J. V., Gunn, L. H., Pappas, Y., & Randhawa, G. (2021). The impact of the Luton social prescribing programme on mental well-being: a quantitative before-and-after study. Journal of P
Rhodes, J., & Bell, S. (2021). ''It sounded a lot simpler on the job description'': A qualitative study exploring the role of social prescribing link workers and their training and support needs (2020). Health & Social Care in the Community, 29(6), e338-e347.
Sandhu, S., Lian, T., Drake, C., Moffatt, S., Wildman, J., & Wildman, J. (2022). Intervention components of link worker social prescribing programmes: a scoping review. Health & social care in the community, 30(6), e3761-e3774.
Tierney, S., Westlake, D., Wong, G., Turk, A., Markham, S., Gorenberg, J., ... & Mahtani, K. R. (2025). Experiences of integrating social prescribing link workers into primary care in England—bolting on, fitting in, or belonging: a realist evaluation. British Journal of General Practice, 75(752), e195-e202.
Vidovic, D., Reinhardt, G. Y., & Hammerton, C. (2021). Can social prescribing foster individual and community well-being? A systematic review of the evidence. International journal of environmental research and public health, 18(10), 5276.
Wakefield, J. R. H., Kellezi, B., Stevenson, C., McNamara, N., Bowe, M., Wilson, I., ... & Mair, E. (2022). Social Prescribing as ‘Social Cure’: A longitudinal study of the health benefits of social connectedness within a Social Prescribing pathway. Journal of health psychology, 27(2), 386-396.
Wood, C. J., Polley, M., Barton, J. L., & Wicks, C. L. (2022). Therapeutic community gardening as a green social prescription for mental ill-health: impact, barriers, and facilitators from the perspective of multiple stakeholders. International journal of environmental research and public health, 19(20), 13612.
Wood, E., Ohlsen, S., Fenton, S. J., Connell, J., & Weich, S. (2021). Social prescribing for people with complex needs: a realist evaluation. BMC Family Practice, 22, 1-12.
