An evaluation of the implementation and practice of social prescribing

A thesis submitted to the University of Bedfordshire, in partial fulfilment of the requirements for the degree of doctor of Philosophy.It is a current policy priority in the UK to break down the traditional divide between primary care and community services, in order to deliver continuous, integrated, and need-driven care and to provide opportunities for health professionals to respond to the wider determinants of health more effectively. Social prescribing is an example of an approach in primary care that promotes partnership working between the health and community and voluntary sector. It provides health professionals with a non-medical referral option to address the non-medical needs of patients, determining their health and wellbeing. Given that social prescribing is increasingly implemented across the UK, it is a key priority for commissioners and service providers to understand the implementation, uptake and adherence, and potential outcomes of social prescribing, as well as the existing evidence base. This study uses a mixed-methods design, reviewing previous evaluations on social prescribing to provide an overview of the evidence base. In addition, face-to-face semistructured interviews were conducted with health professionals, navigators, service providers, managers, and decision-makers to explore the facilitators and barriers to the implementation of the social prescribing programme in Luton. Face-to-face, semi-structured interviews were also held with service users of the Luton programme, to explore the factors affecting uptake and adherence to social prescribing, as well as the patient outcomes from a service user perspective. Lastly, secondary data from the Luton programme was reviewed, to analyse the change in energy expenditure and mental wellbeing for service users after the programme. The systematic literature review identified a range of service user outcomes and specific facilitators and barriers to the implementation of social prescribing, enabling increased and efficient access to available evidence. In addition, this study found that the implementation of the Luton programme was affected by operational processes, the evaluation process, communication, relationships, shared knowledge, and understanding among stakeholders, human resources, organisational readiness, and contextual factors. The uptake of social prescribing was affected by the trust in general practitioners, programme design, patient expectations, perceived need, and benefits, and fear of stigma of psychosocial problems. The support of navigators, the availability and accessibility of services, perceived benefits, and health and wellbeing of service users affected the adherence to the Luton programme. In addition, the study found that service users experienced improvements in their health related behaviours, mental wellbeing, and pain relief due to social prescribing. Lastly, the quantitative analysis showed that the Luton social prescribing programme has the potential to increase energy expenditure of participants and to activate sedentary patient groups. The iv analysis also found a statistically significant improvement in mental wellbeing postintervention. Findings of this study contribute to the development of an evidence base for social prescribing and can support policy-makers, decision-makers, and providers to improve the implementation, uptake, and adherence for social prescribing in the future. In addition, the identified gaps in the evidence base and the limitations of this study can inform future research in this field

Patient uptake and adherence to social prescribing: a qualitative study

Social prescription is an initiative that aims to link patients in primary care with sources of support within the community and voluntary sector to improve their health, wellbeing, and care experience. Such programmes usually include navigators, who work with referred patients and issue onward referrals to sources of non-medical support. Most research on social prescribing (SP) has focused on outcome evaluations, resulting in a knowledge gap of factors affecting uptake and adherence. Understanding such factors enables the refinement of programmes, which has the potential to enhance uptake and adherence, reduce health inequalities, and optimise investment. Aim To explore the experiences and views of service users, involved GPs, and navigators on factors influencing uptake and adherence to SP. Design & setting Qualitative interviews were conducted with stakeholders involved in an SP programme in the east of England (Luton). Method Data were collected from semi-structured face-to-face interviews with service users, navigators, and GPs. Thematic analysis was used to analyse the data. Results Factors affecting uptake and adherence to SP were related to patients’ trust in GPs, navigators' initial phone call, supportive navigators and service providers, free services, and perceived need and benefits. Reported barriers to uptake and adherence were fear of stigma of psychosocial problems, patient expectations, and the short-term nature of the programme. Conclusion This study provides an insight into factors affecting patient uptake and adherence to SP programmes. More research in this field, including patients who refused to participate in SP, is needed. Go to: Social prescription is an initiative that aims to link patients in primary care with sources of support within the community and voluntary sector to improve their health, wellbeing, and care experience. Such programmes usually include navigators, who work with referred patients and issue onward referrals to sources of non-medical support. Most research on social prescribing (SP) has focused on outcome evaluations, resulting in a knowledge gap of factors affecting uptake and adherence. Understanding such factors enables the refinement of programmes, which has the potential to enhance uptake and adherence, reduce health inequalities, and optimise investment. Aim To explore the experiences and views of service users, involved GPs, and navigators on factors influencing uptake and adherence to SP. Design & setting Qualitative interviews were conducted with stakeholders involved in an SP programme in the east of England (Luton). Method Data were collected from semi-structured face-to-face interviews with service users, navigators, and GPs. Thematic analysis was used to analyse the data. Results Factors affecting uptake and adherence to SP were related to patients’ trust in GPs, navigators' initial phone call, supportive navigators and service providers, free services, and perceived need and benefits. Reported barriers to uptake and adherence were fear of stigma of psychosocial problems, patient expectations, and the short-term nature of the programme. Conclusion This study provides an insight into factors affecting patient uptake and adherence to SP programmes. More research in this field, including patients who refused to participate in SP, is needed

The impact of the Luton social prescribing programme on energy expenditure: a quantitative before-and-after study

The objective of this study was to assess the change in energy expenditure levels of service users after participation in the Luton social prescribing programme. Uncontrolled before-and-after study. This study was set in the East of England (Luton). Service users with complete covariate information and baseline measurements (n=146) were included in the analysis. Social prescribing, which is an initiative that aims to link patients in primary care with sources of support within the community sector to improve their health, well-being and care experience. Service users were referred to 12 sessions (free of charge), usually provided by third sector organisations. Energy expenditure measured as metabolic equivalent (MET) minutes per week. Using a Bayesian zero-inflated negative binomial model to account for a large number of observed zeros in the data, 95% posterior intervals show that energy expenditure from all levels of physical activities increased post intervention (walking 41.7% (40.31%, 43.11%); moderate 5.0% (2.94%, 7.09%); vigorous 107.3% (98.19%, 116.20%) and total 56.3% (54.77%, 57.69%)). The probability of engaging in physical activity post intervention increased, in three of four MET physical activity levels, for those individuals who were inactive at the start of the programme. Age has a negative effect on energy expenditure from any physical activity level. Similarly, working status has a negative effect on energy expenditure in all but one MET physical activity level. No consistent pattern was observed across physical activity levels in the association between gender and energy expenditure. This study shows that social prescribing may have the potential to increase the physical activity levels of service users and promote the uptake of physical activity in inactive patient groups. Results of this study can inform future research in the field, which could be of use for commissioners and policy makers

Facilitators and barriers of implementing and delivering social prescribing services: a systematic review

BACKGROUND: Social Prescribing is a service in primary care that involves the referral of patients with non-clinical needs to local services and activities provided by the third sector (community, voluntary, and social enterprise sector). Social Prescribing aims to promote partnership working between the health and the social sector to address the wider determinants of health. To date, there is a weak evidence base for Social Prescribing services. The objective of the review was to identify factors that facilitate and hinder the implementation and delivery of SP services based in general practice involving a navigator. METHODS: We searched eleven databases, the grey literature, and the reference lists of relevant studies to identify the barriers and facilitators to the implementation and delivery of Social Prescribing services in June and July 2016. Searches were limited to literature written in English. No date restrictions were applied. Findings were synthesised narratively, employing thematic analysis. The Mixed Methods Appraisal Tool Version 2011 was used to evaluate the methodological quality of included studies. RESULTS: Eight studies were included in the review. The synthesis identified a range of factors that facilitate and hinder the implementation and delivery of SP services. Facilitators and barriers were related to: the implementation approach, legal agreements, leadership, management and organisation, staff turnover, staff engagement, relationships and communication between partners and stakeholders, characteristics of general practices, and the local infrastructure. The quality of most included studies was poor and the review identified a lack of published literature on factors that facilitate and hinder the implementation and delivery of Social Prescribing services. CONCLUSION: The review identified a range of factors that facilitate and hinder the implementation and delivery of Social Prescribing services. Findings of this review provide an insight for commissioners, managers, and providers to guide the implementation and delivery of future Social Prescribing services. More high quality research and transparent reporting of findings is needed in this fiel

The impact of social prescribing services on service users: a systematic review of the evidence

Social prescribing initiatives are widely implemented in the UK National Health Service to integrate health and social care. Social prescribing is a service in primary care that links patients with non-medical needs to sources of support provided by the community and voluntary sector to help improve their health and wellbeing. Such programmes usually include navigators, who work with referred patients and issue onward referrals to sources of non-medical support. This systematic review aimed to assess the evidence of service user outcomes of social prescribing programmes based on primary care and involving navigators. We searched 11 databases, the grey literature, and the reference lists of relevant studies to identify the available evidence on the impact of social prescribing on service users. Searches were limited to literature written in English. No date restrictions were applied, and searches were conducted to June 2018. Findings were synthesized narratively, employing thematic analysis. The Mixed Methods Appraisal Tool Version 2011 was used to evaluate the methodological quality of included studies. Sixteen studies met the inclusion criteria. The evidence base is mixed, some studies found improvements in health and wellbeing, health-related behaviours, self-concepts, feelings, social contacts and day-to-day functioning post-social prescribing, whereas others have not. The review also shows that the evaluation methodologies utilized were variable in quality. In order to assess the success of social prescribing services, more high quality and comparable evaluations need to be conducted in the future.International Prospective Register of Systematic Reviews number: CRD42017079664

Understanding the Experience of Service Users in an Integrated Care Programme for Obesity and Mental Health: A Qualitative Investigation of Total Wellbeing Luton

Obesity is a complex public health issue with multiple contributing factors. The emphasis on joined care has led to the development and implementation of a number of integrated care interventions targeting obesity and mental health. The purpose of this study was to examine user experience in an integrated care programme for obesity and mental health in Luton, UK. Semi-structured interviews were conducted with a purposeful sample of service users (N = 14). Interview transcripts were analysed using thematic analysis. Analysis of the interviews identified six main themes for understanding service users’ experiences of integrated care: (1) ‘A user-centered system’, (2) ‘Supports behaviour change’, (3) ‘Valued social support’, (4) ‘Communication is key’, (5) ‘Flexible referral process’, and (6) ‘Positive impact on life’. These themes describe how the service is operated, evidence perceived value service users place on social support in behavior change intervention, and address which service areas work well and which require improvement. The findings of these interviews have offered a significant contribution to understanding what service users value the most in an integrated healthcare setting. Service users value ongoing support and being listened to by healthcare professionals, as well as the camaraderie and knowledge acquisition to support their own behaviour change and promote self-regulation following their participation in the programme