Searching for real-world effectiveness versus efficacy of healthcare innovations: the case of social prescribing for diabetes

Background: Social prescribing is a process whereby primary care patients are linked or referred to nonmedical sources of support in the community and voluntary sector. It is a concept that has arisen in practice and implemented widely in the United Kingdom and has been evaluated by various organizations. Objective: The aim of our study was to characterize, collate, and analyze the evidence from evaluation of social prescribing for type 2 diabetes in the United Kingdom and Ireland, comparing information available on publicly available websites with the published literature. Methods: We used a broad, pragmatic definition of social prescribing and conducted Web-based searches for websites of organizations providing potentially relevant services. We also explored linked information. In parallel, we searched Medline, PubMed, Cochrane Library, Google Scholar, and reference lists for relevant studies published in peer-reviewed journals. We extracted the data systematically on the characteristics, any reported evaluation, outcomes measured and results, and terminology used to describe each service. Results: We identified 40 UK- or Ireland-based projects that referred people with type 2 diabetes and prediabetes to nonmedical interventions or services provided in the community. We located evaluations of 24 projects; 11 as published papers, 12 as Web-based reports, and 1 as both a paper and a Web-based report. The interventions and services identified included structured group educational programs, exercise referral schemes, and individualized advice and support with signposting of health-related activities in the community. Although specific interventions such as community-based group educational programs and exercise referral have been evaluated in randomized controlled trials, evaluation of individualized social prescribing services involving people with type 2 diabetes has, in most cases, used pre-post and mixed methods approaches. These evaluations report generic improvement in a broad range of outcomes and provide an insight into the criteria for the success of social prescribing services. Conclusions: Our study revealed the varied models of social prescribing and nonmedical, community-based services available to people with type 2 diabetes and the extent of evaluation of these, which would not have been achieved by searching databases alone. The findings of this scoping study do not prove that social prescribing is an effective measure for people with type 2 diabetes in the United Kingdom, but can be used to inform future evaluation and contribute to the development of the evidence base for social prescribing. Accessing Web-based information provides a potential method for investigating how specific innovative health concepts, such as social prescribing, have been translated, implemented, and evaluated in practice. Several challenges were encountered including defining the concept, focusing on process plus intervention, and searching diverse, evolving Web-based sources. Further exploration of this approach will inform future research on the application of innovative health care concepts into practice

Una sesión de Reiki en enfermeras diagnosticadas con síndrome de Burnout tiene efectos beneficiosos sobre la concentración de IgA salival y la presión arterial

This study aimed to investigate the immediate effects of the secretory immunoglobulin A (sIgA), α-amylase activity and blood pressure levels after the application of a Reiki session in nurses with Burnout Syndrome. A randomized, double-blind, placebo-controlled, crossover design was conducted to compare the immediate effects of Reiki versus control intervention (Hand-off sham intervention) in nurses with Burnout Syndrome. Sample was composed of eighteen nurses (aged 34-56 years) with burnout syndrome. Participants were randomly assigned to receive either a Reiki treatment or a placebo (sham Reiki) treatment, according to the established order in two different days. The ANOVA showed a significant interaction time x intervention for diastolic blood pressure (F=4.92, P=0.04) and sIgA concentration (F=4.71, P=0.04). A Reiki session can produce an immediate and statistically significant improvement in sIgA concentration and diastolic blood pressure in nurses with Burnout Syndrome.El objetivo fue investigar los efectos inmediatos en inmunoglobulina A salival (IgAs), actividad de α-amilasa y presión arterial de una aplicación de reiki en enfermeras sufriendo síndrome de Burnout. Se utilizó un ensayo preliminar placebo randomizado con cegamiento doble utilizando un diseño cruzado. Dieciocho enfermeras (edad 34-56) con síndrome de Burnout participaron en el estudio. Las participantes recibieron tratamiento con Reiki o Reiki fingido según el orden establecido por la randomización en dos días distintos. El test de ANOVA mostró un interacción significativa momento intervención para la presión arterial diastólica (F=4.92, P=0.04) a y la concentración de sIgA (F=4.71, P=0.04). Una sesión de Reiki de 30 minutos puede mejorar de manera inmediata la respuesta de IgAs y la presión arterial diastólica en enfermeras con síndrome de Burnout.O objetivo deste estudo foi investigar os efeitos imediatos na imunoglobulina A salivar (IgAs), na atividade de α-amilase e na pressão arterial, após uma aplicação de Reiki em enfermeiras que sofrem da síndrome de Burnout. Foi realizado ensaio clínico randomizado duplo-cego e placebo controlado, com desenho cruzado. Dezoito enfermeiras (idade entre 34 e 56 anos), com síndrome de Burnout, participaram do estudo. As participantes receberam tratamento com Reiki ou Reiki falso, de acordo com a ordem estabelecida, através da randomização em dois dias distintos. O teste de Anova mostrou interação significativa entre o momento da intervenção e a pressão arterial diastólica (F=4,92, p=0,04) e os níveis de sIgA (F=4,71, p=0,04). Conclui-se que uma sessão de Reiki de 30 minutos pode melhorar de forma imediata a resposta de IgAs e da pressão arterial diastólica em enfermeiras com síndrome de Burnout

Social prescribing and physical activity: scoping an agenda for policy, practice and research

The Chief Medical Officer recommends that we should do at least 150 minutes of moderate physical activity a week to keep us healthy and promote our wellbeing. Whilst the percentage of people achieving this target has increased in recent years many people do not reach this level on a regular basis and levels of inactivity remain stubbornly high. As it is well established that physical activity can contribute positively to an individual’s physical wellbeing, mental wellbeing, personal development and social and community cohesion as well as national economic development, increasing physical active is now a worldwide priority and it is widely acknowledged that more needs to be done to support and motivate those not currently meeting physical activity target

Therapeutic Community Gardening as a Green Social Prescription for Mental Ill-Health: Impact, Barriers, and Facilitators from the Perspective of Multiple Stakeholders

The UK government has invested £5.77 million in green social prescribing to prevent and tackle mental ill-health. Therapeutic community gardening, one type of green social prescription, provides a range of health outcomes. However, for increased accessibility, a greater understanding of how it impacts mental health and the facilitators and barriers to referral, uptake, and attendance by individuals with mental health problems is required. We conducted and thematically analysed interviews with thirteen stakeholders including social prescribing link workers and garden staff; and focus groups with twenty garden members. The mechanisms by which therapeutic community gardening were suggested to impact mental health were by engaging members with nature and the outdoors, providing hope for the future and facilitating social support and relationships. Factors facilitating referral, uptake, and attendance included a holistic and person-centred approach, which is flexible around health needs. Barriers included awareness of the full offering of therapeutic community gardens and accessibility, in terms of physical location and waiting lists. Given that nature-based interventions have the potential to protect and enhance population health and offer cost savings through reduced reliance on other health services; overcoming these barriers is key to ensuring that therapeutic community gardening is more widely available as an additional mental health treatment

Making sense of social prescribing

This booklet provides advice and guidance on all things social prescribing

Two nonrecombining sympatric forms of the human malaria parasite Plasmodium ovale occur globally.

BACKGROUND: Malaria in humans is caused by apicomplexan parasites belonging to 5 species of the genus Plasmodium. Infections with Plasmodium ovale are widely distributed but rarely investigated, and the resulting burden of disease is not known. Dimorphism in defined genes has led to P. ovale parasites being divided into classic and variant types. We hypothesized that these dimorphs represent distinct parasite species. METHODS: Multilocus sequence analysis of 6 genetic characters was carried out among 55 isolates from 12 African and 3 Asia-Pacific countries. RESULTS: Each genetic character displayed complete dimorphism and segregated perfectly between the 2 types. Both types were identified in samples from Ghana, Nigeria, São Tomé, Sierra Leone, and Uganda and have been described previously in Myanmar. Splitting of the 2 lineages is estimated to have occurred between 1.0 and 3.5 million years ago in hominid hosts. CONCLUSIONS: We propose that P. ovale comprises 2 nonrecombining species that are sympatric in Africa and Asia. We speculate on possible scenarios that could have led to this speciation. Furthermore, the relatively high frequency of imported cases of symptomatic P. ovale infection in the United Kingdom suggests that the morbidity caused by ovale malaria has been underestimated

Individualised and complex experiences of integrative cancer support care: combining qualitative and quantitative data

Objectives: The widespread use of complementary therapies alongside biomedical treatment by people with cancer is not supported by evidence from clinical trials. We aimed to use combined qualitative and quantitative data to describe and measure individualised experiences and outcomes. Materials and methods In three integrative cancer support centres (two breast cancer only) in the UK, consecutive patients completed the individualised outcome questionnaire Measure Yourself Concerns and Wellbeing (MYCaW) before and after treatment. MYCaW collects quantitative data (seven-point scales) and written qualitative data and the qualitative data were analysed using published categories. Results: Seven hundred eighty-two participants, 92% female, mean age 51 years, nominated a wide range of concerns. Psychological and emotional concerns predominated. At follow-up, the mean change (improvement) in scores (n = 588) were: concern 1, 2.06 (95% CI 1.92–2.20); concern 2, 1.74 (95% CI 1.60–1.90); and well-being, 0.64 (95% CI 0.52–0.75). The most common responses to ‘what has been the most important aspect for you?’ were ‘receiving complementary therapies on an individual or group basis’ (26.2%); ‘support and understanding received from therapists’ (17.1%) and ‘time spent with other patients at the centres’ (16.1%). Positive (61.5%) and negative (38.5%) descriptions of ‘other things affecting your health’ correlated with larger and smaller improvement in concerns and well-being, respectively. Conclusions: In a multicentre evaluation, the MYCaW questionnaire provides rich data about patient experience, changes over time and perceptions of what was important to each individual with cancer within that experience. It is unlikely that meaningful evaluations of this complex intervention could be carried out by quantitative methods alone

Development of Measure Yourself Concerns and Wellbeing for informal caregivers of people with cancer – a multicentred study

Purpose: Measure Yourself Concerns and Wellbeing (MYCaW) is a validated person-centred measure of the concerns and wellbeing of people affected by cancer. Research suggests that the concerns of informal caregivers (ICs) are as complex and severely rated as people with cancer, yet MYCaW has only been used to represent cancer patients’ concerns and wellbeing. This paper reports on the development of a new qualitative coding framework for MYCaW to capture the concerns of ICs, to better understand the needs of this group. Methods: This multicentred study involved collection of data from ICs receiving support from two UK cancer support charities (Penny Brohn UK and Cavendish Cancer Care). Qualitative codes were developed through a detailed thematic analysis of ICs’ stated concerns. Results: Thematic analysis of IC questionnaire data identified key themes which were translated into a coding framework with two overarching sections; 1. ‘informal caregiver concerns for self’ and 2. ‘informal caregiver concerns for the person with cancer’. Supercategories with specific accompanying codes were developed for each section. Two further rounds of framework testing across different cohorts allowed for iterative development and refinement of the framework content. Conclusions: This is the first person-centred tool specifically designed for capturing IC’s concerns through their own words. This coding framework will allow for IC data to be analysed using a rigorous and reproducible method, and therefore reported in a standardised way. This may also be of interest to those exploring the needs of ICs of people in other situations

Global Developments in Social Prescribing

Social prescribing is an approach that aims to improve health and well-being. It connects individuals to non-clinical services and supports that address social needs, such as those related to loneliness, housing instability and mental health. At the person level, social prescribing can give individuals the knowledge, skills, motivation and confidence to manage their own health and well-being. At the society level, it can facilitate greater collaboration across health, social, and community sectors to promote integrated care and move beyond the traditional biomedical model of health. While the term social prescribing was first popularised in the UK, this practice has become more prevalent and widely publicised internationally over the last decade. This paper aims to illuminate the ways social prescribing has been conceptualised and implemented across 17 countries in Europe, Asia, Australia and North America. We draw from the ‘Beyond the Building Blocks’ framework to describe the essential inputs for adopting social prescribing into policy and practice, related to service delivery; social determinants and household production of health; workforce; leadership and governance; financing, community organisations and societal partnerships; health technology; and information, learning and accountability. Cross-cutting lessons can inform country and regional efforts to tailor social prescribing models to best support local needs