Social Prescribing in Practice: A Critical Examination of Service Data and Stakeholder Perspectives

A current priority within UK policy is to promote partnership working between healthcare and the community sector to support the delivery of integrated and person-centred care, and to tackle the wider determinants of health. This represents a shift in focus from a curative to a preventative system. Social prescribing has been put forward to address this. Definitions, models, and understanding of social prescribing vary which leads to differences in the implementation of the concept. However, at its core, it enables healthcare professionals to refer patients with non-medical needs to non-medical sources of support, to improve their health and wellbeing. In some models of social prescribing a link worker is employed to facilitate this process. Social prescribing is increasingly present in policy and the media. However, much research reports barriers to the implementation of services in practice, and, despite some evidence of the effectiveness of individual services, there is insufficient evidence to support the wide-scale implementation of the concept. As social prescribing is gradually implemented across the UK, it is paramount that the concept is understood, including the roles of stakeholders and the barriers that services face. A scoping review of the current literature was first conducted. Following this, the aim of the research was determined: to examine social prescribing in practice with a view to producing a framework of knowledge to progress understanding and implementation. A convergent parallel mixed-methods research design was adopted which was underpinned by a critical realist perspective and guided by the Rainbow Model of Integrated Care as the theoretical foundation. In study I secondary data from a social prescribing service were obtained for analysis to explore the underlying contributing factors to requiring a non-medical health intervention. Due to the poor quality of the data obtained, the planned quantitative analysis was not possible. However, the data highlighted the need for proper data collection and management. In study II three stakeholder groups took part in semi-structured interviews: GPs (n = 18), link workers (n = 15), and service users (n= 18). Inductive thematic analysis was adopted to analyse interview data, after which themes were deductively mapped against the domains of the Rainbow Model of Integrated Care. Non-thematic data present in interviews were analysed categorically. Study II identified a range of barriers to social prescribing. However, when the findings of study I and II were combined it was apparent that, instead of a fixed list of barriers, there are a set of factors that influence social prescribing in practice which turn into barriers when not present. These were identified from the research findings, but it was noted that there are complex interrelationships between all factors and, therefore, they could not be considered individually. Instead, they were summarised as the following five mechanisms: a clear definition and shared understanding, supportive context, sufficient and secure funding, IT infrastructure, and stakeholder ‘buy-in’. When considered at a broad level, these mechanisms suggest that social prescribing needs to be established as a reputable intervention with formal links to healthcare. In the discussion, a new definition of social prescribing, developed through the research, was also introduced. This research contributes to the advancement of the evidence base and provides support to facilitate the implementation and delivery of social prescribing. Additionally, the limitations of this research, and the identified gaps in the evidence base, can inform future research into this area

Exploring the Subjective Experiences of Peer-Led Social Support Groups for Individuals Bereaved by Suicide

Objectives: The insights of individuals bereaved by suicide who use peer-led social support groups are lacking in much of the clinical research. This review provided a synthesis of the existing knowledge base to support the development of strategies to improve peer-led social support group services. Design and Methods: A systematic search was carried out on eight electronic databases. Data were extracted and a systematic qualitative meta-aggregation was undertaken. Results: Key components of social support for individuals bereaved by suicide were the contribution of group dynamics to the attribution of meaning; the ways in which shared experience leads to the normalization of feelings; and the importance of support group homogeneity, consistency, and training to the participants’ experience. Conclusion: Peer-led social support groups can be invaluable for suicide-bereaved individuals, but attention must be paid to the structure, conduct, and training of group leaders and members in order to optimize outcomes

The problem with the definition of ‘social prescribing’: Exploring the language used, and key roles within the concept

Aim of project/research: To examine SP in practice with a view to producing a novel definition of the concept. Method(s) used: Semi-structured interviews and focus groups were undertaken with key stakeholders. Eighteen GPs from 16 general practices undertook individual interviews. Fifteen link workers from seven social prescribing organisations undertook face-to-face focus groups. Eighteen service users participated in face-to-face or telephone interviews. Interviews were analysed using inductive thematic analysis. Non-thematic data present in interviews were analysed categorically. Key Findings/Learning: Three overarching themes were identified: discrepancies in knowledge and understanding, mismatch of expectations, and reliance on medical language and processes. Participants described the typical SP ‘journey’. Descriptions varied dependent upon the involvement of a SP service. The type of ‘journey’ most described related SP light and signposting. Descriptions of holistic SP were given by a few GPs and service users, but were provided by all link workers. A new definition was developed: SP is a process by which a healthcare professional or SP link worker assesses an individuals’ non-medical needs and connects them with non-medical sources of support, often within the community, to improve health and wellbeing. This definition differs from those pre-existing in the following ways: the definition more tightly applies the term to the point at which the social prescription is performed, the term ‘healthcare professionals’ is adopted, both healthcare professionals and link workers are identified as providing social prescriptions, the anticipated outcome is included, those accessing SP are labelled ‘individuals’, and the importance of community resources is highlighted. Conclusions: A common definition of SP is currently lacking and the application of the concept in practice is inconsistent. Definitions influence service implementation and delivery, as individuals deliver a service which aligns with their understanding of a concept. Consequently, this new definition could support consistent delivery and enable stakeholders to articulate the mechanisms involved, and the anticipated outcomes

Designing Inclusive Qualitative Research with Carers of People Living with Dementia: Methodological Insights

The support provided by carers of people living with dementia results in savings for the UK economy; however, providing this care has a significant impact on carers. Supports are needed to ensure that carers can continue to provide care, and carers should be involved in the generation of the evidence necessary to develop such support. However, this relies on their ability to meaningfully engage with research, yet current data collection methods create obstacles to engagement. In this paper, we aim to provide a critical examination of approaches to qualitative data collection with carers and produce recommendations for the design of inclusive research. First, different approaches to qualitative data collection are discussed and appraised. Following this, a case study of inclusive research is presented, illustrating how carers can be facilitated to engage in research. Finally, recommendations for inclusive research are offered, including the collection of data without the cared-for person present, building additional care into a study design, providing ‘incidental funds,’ offering sustenance and remuneration, and undertaking research in a neutral space. These recommendations are designed to facilitate the involvement of carers in research and promote the use of more varied or multifaceted methods to develop the current evidence base

The Support Priorities of Older Carers of People Living with Dementia: A Nominal Group Technique Study

The aim of this study was to understand the support priorities of older (65+ years old) carers of people living with dementia. Two nominal group technique focus groups were carried out with older carers of people living with dementia. 12 carers participated across two focus groups. Participants individually identified support priorities, and through several steps, reached a consensus to produce a ranked list of support priorities. The results consisted of two lists (one list per group), which when combined made up 15 support priorities. These priorities are presented alongside their overall and mean ranking. The authors did not refine these priorities after the focus groups, however, as there was overlap between priorities across the two lists, the results benefited from being themed. These overarching themes consisted of prioritising the carers’ holistic needs; having a sense of belonging; support needs to be accessible and timely; support to meet the wellbeing and personhood of the person living with dementia; and understanding and training for the wider community. These results have highlighted support prioritise, developed by older carers, that services and organisations can use to better inform the support and services that older carers want

Dogs at school: a quantitative analysis of parental perceptions of canine-assisted activities in schools mediated by child anxiety score and use case

Canine-assisted activities in schools can benefit students’ educational, emotional, and social needs. Furthermore, they could be an effective form of non-clinical mental health treatment for children and adolescents. In the United Kingdom, school dogs are growing in popularity, however, little is known about how parents perceive canine-assisted activities as a treatment option. This is important as parental perceptions can influence engagement, whilst lack of awareness can become a barrier to treatment. This study uses a cross-sectional design to quantitatively explore the acceptability of canine-assisted activities amongst UK-based parents (n = 318) of children aged six to 16 (M = 10.12, SD = 3.22). An online survey used a treatment evaluation to determine acceptability across three use-cases. These included a child reading to dogs to improve literacy skills, a child interacting one-to-one to foster greater self-esteem and social skills, and a classroom dog to improve student behaviour and motivation. Additionally, the scale for generalised anxiety disorder was used to rank child anxiety as high or low, where high was a score equal to or above the UK clinical borderline threshold. The results found canine-assisted activities were less acceptable for the behavioural than the reading and social use-cases. Furthermore, parents of children with high anxiety had higher acceptability scores than parents of children with low anxiety for the reading and social use-cases but not for the behavioural use case. These findings suggest that UK parents' acceptability of canine-assisted activities in schools is mediated by child anxiety score. Furthermore, that parents may be less aware of the benefits of classroom dogs than other types of school-based canine-assisted activities

Exploring the Subjective Experiences of Peer-Led Social Support Groups for Individuals Bereaved by Suicide

Objectives: The insights of individuals bereaved by suicide who use peer-led social support groups are lacking in much of the clinical research. This review provided a synthesis of the existing knowledge base to support the development of strategies to improve peer-led social support group services. Design and Methods: A systematic search was carried out on eight electronic databases. Data were extracted and a systematic qualitative meta-aggregation was undertaken. Results: Key components of social support for individuals bereaved by suicide were the contribution of group dynamics to the attribution of meaning; the ways in which shared experience leads to the normalization of feelings; and the importance of support group homogeneity, consistency, and training to the participants’ experience. Conclusion: Peer-led social support groups can be invaluable for suicide-bereaved individuals, but attention must be paid to the structure, conduct, and training of group leaders and members in order to optimize outcomes

Paramedics as researchers: A systematic review of paramedic perspectives of engaging in research activity from training to practice

Background: The need for a stronger evidence-base in paramedicine has precipitated a rapid development of pre-hospital research agendas. Paramedics are increasingly involved in research, leading to changes in their role. Yet the integration of research responsibilities has proven to be challenging, resulting in varying attitudes and levels of engagement. Objective: This systematic review aimed to explore paramedics’ views and experiences of research as researchers during training and within practice Methods: A systematic search was undertaken across 6 databases. Qualitative empirical peer-reviewed articles which discussed paramedic perspectives on engaging with research activity were included. Of 10,594 articles initially identified, 11 were included in the final synthesis following quality appraisal. Data were extracted and subjected to narrative synthesis Results: Four themes were identified: motivation to engage, moral dilemmas, structural issues within the profession, and reflections on trial involvement. Attitudes towards research, understanding of related concepts, and the drive for patient benefit were interwoven core issues Conclusion: Research was highly valued when links to patient benefit were obvious, however, this review highlighted some cultural resistance to research, particularly regarding informed consent and changes to standard practice. Paramedic research methods training should provide structured opportunities to explore concerns and emphasize the role of research in developing a high-quality evidence base to underpin safe practice. Currently there is inadequate organisational support for paramedics to engage effectively in research activity, with minimal allocations of time, training, and remuneration. Without properly integrating research activity into the paramedic role, their capacity to engage with research activity is limited

The Secondary Impact of Mild Traumatic Brain Injury: An Interpretative Phenomenological Analysis of the Experiences of Family Members

Mild traumatic brain injury (mTBI), with symptoms beyond 3 months, may be more common than previously believed, but is poorly understood. This has resulted in contradictory and confused information for service users, which has had an impact on those with mTBI and their families. This qualitative study aimed to improve understanding of the lived experiences of families of people with mTBI, with symptoms beyond 3 months. It extends a previous study, which focussed on all degrees of traumatic brain injury (TBI) (mild, moderate, and severe). Four individuals participated in semi-structured, virtual interviews. Following an interpretative phenomenological analysis (IPA), three superordinate themes were identified: (1) Going round in circles, (2) The second secondary impact, and (3) Dialogue with myself. Findings indicate that families of people with mTBI, with symptoms beyond 3 months, may experience many of the same challenges as families of people with moderate or severe TBI, albeit at a lesser intensity. This includes difficulty making sense of TBI and challenges to their identity, both of which mirror the comparator TBI study findings. However, findings also indicated that this group may experience different challenges to families of people with moderate or severe TBI, aspects of which have not previously been reported. Feelings of ambiguous loss may be increased by incongruity between information provided and families’ experiences, and by the varied availability and content of information. Implications for service providers are that consistent, transparent, and realistic information and education may aid adjustment and assist families to support people with mTBI

Exploring the Experience of Healthcare-Related Epistemic Injustice among People with Myalgic Encephalomyelitis / Chronic Fatigue Syndrome

Myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) is a chronic, disabling yet clinically “contested” condition, previously theorised through a lens of epistemic injustice. Phenomena conceptually close to epistemic injustice, including stigma, are known to have deleterious consequences on a person’s health and life-world. Yet, no known primary studies have explored how people with ME/CFS experience healthcare through a lens of epistemic injustice, whilst a dearth of research explicitly exploring healthcare-related injustice from a patient perspective has been noted. This qualitative study seeks to address this gap. Semi-structured interviews and interpretative phenomenological analysis (IPA) were used to explore the experiences of five people with ME/CFS in the UK, vis-à-vis healthcare-related epistemic injustice. One superordinate theme is presented, “Being de-centred in patient-centred care,” alongside two sub-themes: “Struggling for epistemic-existential validation” and “Negotiating socio-epistemic hierarchies, politics and ‘power’.” Findings suggest that healthcare-related epistemic injustice may differentially impact according to the patient’s social positionality (here, notably gender), and that a potential pathway of existential harm operates through threats to identity and personhood. Findings also indicate that cultural and political factors may further epistemic injustice in healthcare. Finally, epistemic injustice impacting as a chronic stressor cannot be ruled out and is worthy of further research. The experience of healthcare-related epistemic injustice can carry far-reaching yet varied consequences for patients. Future research should consider drawing upon more socio-demographically diverse samples and an intersectional approach is recommended. Further exploration of structural drivers of epistemic injustice may highlight a need for politically and socio-culturally cognisant clinical approaches