Equal, equitable or exacerbating inequalities: patterns and predictors of social prescribing referrals in 160 128 UK patients.

BACKGROUND: Social prescribing is growing rapidly globally as a way to tackle social determinants of health. However, whom it is reaching and how effectively it is being implemented remains unclear. AIMS: To gain a comprehensive picture of social prescribing in the UK, from referral routes, reasons, to contacts with link workers and prescribed interventions. METHOD: This study undertook the first analyses of a large database of administrative data from over 160 000 individuals referred to social prescribing across the UK. Data were analysed using descriptive analyses and regression modelling, including logistic regression for binary outcomes and negative binomial regression for count variables. RESULTS: Mental health was the most common referral reason and mental health interventions were the most common interventions prescribed. Between 72% and 85% of social prescribing referrals were from medical routes (primary or secondary healthcare). Although these referrals demonstrated equality in reaching across sociodemographic groups, individuals from more deprived areas, younger adults, men, and ethnic minority groups were reached more equitably via non-medical routes (e.g. self-referral, school, charity). Despite 90% of referrals leading to contact with a link worker, only 38% resulted in any intervention being received. A shortage of provision of community activities - especially ones relevant to mental health, practical support and social relationships - was evident. There was also substantial heterogeneity in how social prescribing is implemented across UK nations. CONCLUSIONS: Mental health is the leading reason for social prescribing referrals, demonstrating its relevance to psychiatrists. But there are inequalities in referrals. Non-medical referral routes could play an important role in addressing inequality in accessing social prescribing and therefore should be prioritised. Additionally, more financial and infrastructural resource and strategic planning are needed to address low intervention rates. Further investment into large-scale data platforms and staff training are needed to continue monitoring the development and distribution of social prescribing.

Building common understanding: seeking consensus and defining social prescribing across contexts - a collective commentary on a Delphi study.

Social prescribing has become a global phenomenon. A Delphi study was recently conducted with 48 social prescribing experts from 26 countries to establish global agreement on the definition of social prescribing. We reflect on the use and utility of the outputs of this work, and where we go from here.

Stakeholder views on addressing challenges to the implementation of social prescribing in the United Kingdom.

Objectives: This study aimed to understand the key barriers to successfully implementing Social Prescribing (SP) initiatives from different perspectives. Methods: An in-depth process evaluation using a multi-method qualitative design was conducted. Qualitative data was collected via semi-structured interviews (N = 23) and Focus Group Discussion (FGD' N = 4). Twenty-three stakeholders took part in the study, including community support providers (n = 7), SP link workers (n = 6), service users (n = 6), NHS employees/referrals, and those who were involved in SP leadership and coordination (n = 4). MAXQDA Version 20.0 was used for management and data analysis. Results: We identified eight themes representing challenges for a successful implementation of a SP programme. The themes included (i) financial issues and sustainability, (ii) human resources challenges, (iii) partnership working challenges, (iv) inadequate and inconsistent implementation, (v) information system challenges, (vi) referral system issues, (vii) training and knowledge gaps, and (viii) accessibility and privacy concerns. Conclusion: Study findings provide insight for commissioners, providers, and link workers to guide the delivery of appropriate SP services by identifying a range of factors that hinder the successful implementation of the programme. Future policy, service development, and research should consider tackling these challenges and generating different ideas for potential solutions to address the root causes of problems.

Coproduction in Social Prescribing Initiatives: Protocol for a Scoping Review.

BACKGROUND: Social prescribing (SP) takes a holistic approach to health by linking clients from clinical settings to community programs to address their nonmedical needs. The emerging evidence base for SP demonstrates variability in the design and implementation of different SP initiatives. To effectively address these needs, coproduction among clients, communities, stakeholders, and policy makers is important for tailoring SP initiatives for optimal uptake. OBJECTIVE: This study aims to explore the role of coproduction in SP initiatives. The research question is as follows: How and for what purpose has coproduction been incorporated across a range of SP initiatives for different clients? METHODS: A review of international literature will be conducted following the JBI guidelines for scoping reviews. We will search multiple databases including Scopus, MEDLINE, and the PAIS Index, as well as gray literature, from 2000 to 2023. The primary studies included will describe a nonmedical need for clients, a nonmedical SP program or initiative, coproduction of the SP program, and any follow-up. Review articles and commentaries will be excluded. Titles, abstracts, and full-text articles will be screened, and data will be extracted by at least 2 research team members using Covidence and a pilot-tested extraction template. Clients with lived experience will also participate in the research process. Findings will be descriptively summarized and thematically synthesized to answer the research question. RESULTS: The project was funded in 2023, and the results are expected to be submitted for publication in early 2025. CONCLUSIONS: Descriptions of what coproduction is meant to accomplish may differ from theoretical aspirations. Continued understanding of how coproduction has been designed and executed across varied international SP models is important for framing engagement in practice for future SP arrangements and their evaluation. We anticipate this review will guide clients, communities, stakeholders, and policy makers in further developing SP practice within health care systems. TRIAL REGISTRATION: Open Science Framework Registries B8U4Z; https://osf.io/b8u4z. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/57062.

Developing a new tool to capture the nature dose to reduce loneliness and improve quality of life.

Recognition of the health benefits of nature contact has increased. Simultaneously, growing numbers of people worldwide experience loneliness. There is a movement towards prescribing nature-based activities to improve/promote social connections, health, and quality of life. Yet, what constitutes a therapeutic nature dose is not well understood, due in part, to the lack of instruments that capture the characteristics of nature-based activities and measure 'nature dose.' We created a nature dose measurement tool to fill this gap by capturing various aspects of contact with nature and perceptions regarding park access, quality, naturalness, psychological distance to nature, and biodiversity. This tool will facilitate greater understanding of how natural areas, nature-based activities, and nature exposure reduce loneliness and promote health-related quality of life. Measuring nature dose with standardized tools and documenting benefits will generate the evidence base needed to design, implement and evaluate nature-based social interventions for improving health and quality of life.•This tool captures the nature dose to reduce loneliness and promote quality of life.•Constructs range from park quality and access, to mood, to biodiversity perceptions.•The standardized nature dose tool will help design nature-based social interventions.

Social prescribing: Moving pediatric care upstream to improve child health and wellbeing and address child health inequities.

Social prescribing is a means for trusted individuals in clinical and community settings to connect people who have non-medical, health-related social needs to non-clinical supports and services within the community through a non-medical prescription. Evaluations of social prescribing programs for the pediatric population have demonstrated statistically significant improvements in participants' mental, physical, and social wellbeing and reductions in healthcare demand and costs. Experts have pointed to the particularly powerful impact of social prescribing on children's mental health, suggesting that it may help to alleviate the strain on the overburdened mental health system. Social prescribing shows promise as a tool to move pediatric care upstream by addressing non-medical, health-related social needs, hence why there is an urgent need to direct more attention towards the pediatric population in social prescribing research, policy, and practice. This demands rapid action by researchers, policymakers, and child health professionals to support advancements in this area.

The impact of COVID-19 on physical activity and mental health: A mixed-methods approach.

This mixed-methods study investigated how and why physical activity (PA), anxiety, depression and self-perceived loneliness are related, and the feasibility of social prescribing (SP). Whilst SP may involve PA with broader effects on health and wellbeing, there is little research exploring perceptions of this intervention. Data from the UCL-Penn Global COVID Study wave 1 (17 April-17 July 2020, N = 1037) were analysed. Twenty-one UK adults who self-identified as low (n = 15) and high (n = 6) on PA at wave 1 were interviewed at wave 4 (18 March-1 August 2022). At wave 1, depression was associated with higher odds of low-PA (OR = 1.05; 95% CI 1.01-1.10, p = 0.02). Both high/low-PA groups cited the threat of contracting COVID-19, general impacts of COVID-19 policies and heightened awareness of the mind-body connection. Five recommendations are made to address challenges in engaging with SP.

Patient buy-in to social prescribing through link workers as part of person-centred care: a realist evaluation.

Background: Social prescribing link workers have become part of primary health care in recent years. They help patients to recognise non-medical factors affecting their health and identify sources of support, often in the voluntary, community and social enterprise sector. They form part of wider work to strengthen person-centred care, which actively seeks to engage individuals in decision-making about their health, taking into account their medical, social, psychological, financial and spiritual circumstances. Objective: To understand how buy-in to social prescribing and the link worker role is established for a patient, and how this relates to person-centred care. Design: A realist evaluation. Setting: Patients engaging with link workers in seven different parts of England were involved. Methods: As part of data collection, we observed link workers interacting with 35 patients. We also interviewed 61 patients and re-interviewed 41 of them 9-12 months later. Data were coded and developed into context-mechanism-outcome configurations, which were used to produce a programme theory. Results: Data highlighted how patients might be uncertain about the link worker role but agree to a referral as they sought assistance with their non-medical issues. Patients talked about experiencing a sense of hope through the trust they developed in a link worker. This trust was established through the communication skills and knowledge demonstrated by a link worker, and by their ability to act as an anchor point when required - a reliable, consistent source of support to whom patients could offload. The link worker role also involved connecting patients to external support, which called for sensitivity around how ready someone was to move forward; this was shaped by a patient's motivation but also their capacity to make changes given other demands in their life. Connecting patients to external support could be affected by structural factors outside the link workers' control (e.g. housing options or employment opportunities). Limitations: We did not interview patients who had rejected the offer of social prescribing, and most had a positive view of meeting with a link worker. Conclusions: Person-centred care is engendered by link workers through their skills, knowledge and ability to respond to the individual readiness of patients to engage with external support. It can be curtailed by structural factors outside link workers' sphere of control, such as access to housing or caring responsibilities of patients. This can hinder patients' ability to 'connect to', leaving link workers to continue 'connecting with' patients as they act as an anchor point. Future work: Exploration is required of factors affecting patients who interact with a link worker but do not access external support. Longitudinal work with a cohort of patients, speaking to them on a regular basis, may provide further understanding in this respect. Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR130247.

People's health and well-being can be affected by non-medical issues (e.g. loneliness, money worries, housing problems). Social prescribing helps people with these issues by connecting them to support, often in the voluntary-community sector. Link workers are key to social prescribing. They listen to people talk about non-medical issues affecting how they feel physically and/or psychologically. They also connect people to external support ­ such as a befriending service, volunteering opportunities, organisations that give advice on money/housing, or other community groups. It is an important role, but we need to know more about how link workers work best, which our study set out to do. In our study, we collected data around seven link workers in different areas of England. As part of data collection, we interviewed 61 patients and re-interviewed 41 of them 9­12 months later. We also watched 35 patients meeting with a link worker. We found that patients were often unsure about what to expect when a doctor referred them to a link worker. However, they hoped this person could help them with their non-medical issues. When link workers were warm, non-judgmental and listened, patients were more likely to trust them. This trust was increased when link workers shared knowledge of and directed patients towards options in the community that could support their non-medical issues. Patients thought it was important for link workers to be a consistent source of support, who did not push them to do things they were not ready to try. Our research provides an insight into how link workers can provide a person-centred approach when supporting patients. This means that the needs, values and individual situation of patients take priority. It calls for an equal partnership to be created between a patient and link worker in deciding how to address the former's non-medical issues.

Social prescribing needs and priorities of older adults in Canada: a qualitative analysis. / Besoins et priorités des aînés en matière de prescription sociale au Canada : une analyse qualitative.

INTRODUCTION: Social prescribing (SP) is a holistic and collaborative approach to help individuals access community-based supports and services for their nonmedical social needs. The aim of this study was to assess the needs and priorities of Canadian older adults (aged 55 years and older), with a focus on optimizing SP programs for those who are systemically disadvantaged and socially marginalized. METHODS: Semistructured focus groups (N = 10 groups, 43 participants) were conducted online via Zoom with participants from across Canada. Data transcription and thematic analysis were completed in NVivo. Analyses were informed by self-determination theory. RESULTS: Our results suggest that older adults desire SP programs that respect their ability to maintain their autonomy and independence, aid and facilitate the development of connectedness and belonging, are built on a foundation of trust and relationship-building in interactions with providers and link workers, and prioritize the person and thus personalize SP to the unique needs of each individual. CONCLUSION: SP programs should be informed by the values of older adults. As work is currently underway to formalize and scale SP in Canada, personalizing these programs to the unique circumstances, needs and priorities of participants should be a top priority.

Leveraging integrated youth services for social prescribing: a case study of Youth Wellness Hubs Ontario. / La prescription sociale dans le contexte des services intégrés pour la jeunesse : une étude de cas sur les Carrefours bien-être pour les jeunes de l'Ontario.

INTRODUCTION: Integrated youth services (IYS) presents a unique opportunity to adopt social prescribing (SP) strategies within the IYS service model by developing and leveraging a highly connected multidisciplinary network of clinical and community-based service providers to tackle health inequities and enhance service access and outcomes for youth. This paper outlines a case study of Youth Wellness Hubs Ontario (YWHO), Canada, a collective of youth-serving organizations integrated and networked, and operating as a learning health system implementing SP services. The main study objective was to document how YWHO hubs engage in social prescribing through service provision. METHODS: We adopted an embedded case study approach. Data were collected from youth (n = 6361) aged between 12 and 25 years who were seeking services at a YWHO hub. Descriptive analyses, including frequencies across categories, were generated from service data, including reason for visit, needs addressed and service provided. RESULTS: A comparative analysis of services requested and provided found that youth across visits to YWHO hubs were engaging with multiple services and service providers, with a wide range of health, mental health and social support needs being addressed. CONCLUSION: YWHO implements SP services that aim to improve mental health resilience by supporting the vocational, educational and socialization needs of young people accessing IYS through YWHO hubs.

Guides for facilitating the implementation and evaluation of social prescribing: lessons from the "Access to Resources in the Community" model. / Guides visant à faciliter la mise en oeuvre et l'évaluation de la prescription sociale : leçons tirées du modèle « Accès aux ressources communautaires ¼.

Social prescribing (SP) embodies a comprehensive approach to addressing the social determinants of health. Access to Resources in the Community (ARC) is an innovative SP program offering bilingual services that involves a single point of entry for health and social needs and introduces practice changes to assist primary care providers in engaging patients, along with a nonclinical lay navigator who supports patients in accessing relevant community resources. The ARC team has created a SP toolkit offering practical guidance for setting up, implementing, monitoring the progress of and evaluating SP programs. The four ARC guides can be easily customized for application in diverse practice and research settings.

We developed a set of guides for use in "Access to Resources in the Community" (ARC), one of the first social prescribing (SP) programs established and evaluated in Ontario, Canada. The four guides are: (1) PC Practice Set Up, (2) Navigator Training, (3) Navigation Processes and (4) Evaluation. The guides provide practical guidance for establishing, conducting and monitoring progress, and evaluating SP programs; they form the basis of a toolkit we created to support organizations and researchers in establishing and evaluating SP programs. The guides and toolkit are currently being adopted for the ARC/211- Ontario program that we are cocreating through a nonprofit research partnership with Community Connections, an innovative hub of 211 Ontario in Collingwood. The program will help generate evidence on the feasibility, effectiveness, impact on health inequities and cost-effectiveness of adapting and scaling up SP programs in Canada.

Nous avons mis au point quatre guides à utiliser dans le cadre du programme « Accès aux ressources communautaires ¼ (ARC), l'un des premiers programmes de prescription sociale reconnus et évalués en Ontario (Canada). Les quatre guides sont 1) Préparation du cabinet de soins primaires, 2) Formation des intervenants pivots, 3) Processus d'intervention pivot et 4) Évaluation. Ces guides fournissent des conseils pratiques sur l'établissement, la tenue et l'évaluation de programmes de prescription sociale ainsi que sur le suivi des progrès, constituant ansi la base d'une trousse d'outils créée pour aider les organisations et les chercheurs à établir et à évaluer des programmes de prescription sociale. Les guides et la trousse d'outils sont en cours d'adoption dans le cadre du programme ARC/211-Ontario que nous sommes en train de cocréer grâce à un partenariat de recherche sans but lucratif avec Community Connection, un carrefour novateur situé à Collingwood et qui relève de 211 Ontario. Ce programme contribuera à générer des données probantes sur la faisabilité, l'efficacité, la rentabilité et l'incidence (du point de vue des inégalités en matière de santé) de l'adaptation et de l'application à grande échelle des programmes de prescription sociale au Canada.

Building the capacity of older adults and community: findings from a developmental evaluation of United Way British Columbia's social prescribing programs for older adults. / Renforcer les capacités des aînés et de la collectivité : résultats d'une évaluation de l'élaboration des programmes de prescription sociale conçus par Centraide Colombie-Britannique à l'intention des aînés.

INTRODUCTION: Older adults with higher needs are ideal candidates for social prescribing interventions, given the complex and intersectoral nature of their needs. This article describes findings from a developmental evaluation of 19 social prescribing programs for older adults at risk of frailty. METHODS: An evaluation of the programs was conducted from 2020 to 2023. We used data from three components of the evaluation: (1) initial evaluation data collected in 2020 and 2021; (2) program profiles developed in 2022; and (3) co-creation sessions conducted in 2023. RESULTS: From startup until March 2023, the programs served a total of 2544 older adults. The community connectors identified factors at the individual, interpersonal, institutional, community and policy levels that contributed to the successful implementation and delivery of their programs (e.g. physician champions, communities of practice, strong pre-existing relationships with the health care system), as well as challenges (e.g. limited capacity of family physicians, lack of community resources). There was strong agreement among community connectors that successful social prescribing programs should include the following core elements: (1) making connections to needed community resources; (2) co-creation of a wellness plan with long-term clients or clients who require intensive supports; (3) ongoing follow-up and check-ins for clients with wellness plans; and (4) an assessment and triaging process for the prioritization of clients. CONCLUSION: To leverage the full potential of social prescribing interventions, it is essential that programs engage with a range of health and social care providers, that community connectors are skilled and well supported, and that adequate investments are made in the nonprofit and voluntary sector.

The consequences of micro-discretions and boundaries in the social prescribing link worker role in England: a realist evaluation.

Background: Social prescribing addresses non-medical factors affecting health and well-being. Link workers are key to its delivery by connecting people to relevant support, often in the voluntary, community and social enterprise sector. Funding from the National Health Service means that link workers are becoming a common part of primary care in England. Objective: To explore and understand the implementation of link workers in primary care in England. Design: A realist evaluation addressed the question - When implementing link workers in primary care to sustain outcomes - what works, for whom, why and in what circumstances? Setting: Link workers and staff associated with seven primary care sites across England. Methods: Researchers spent 3 weeks with each link worker, going to meetings with them, watching them interact with patients, with healthcare staff and with voluntary, community and social enterprise organisations. In addition, interviews were conducted with 61 patients and 93 professionals (voluntary, community and social enterprise representatives and healthcare staff, including link workers). Follow-up interviews were conducted with 41 patients and with link workers 9-12 months later. Data were coded and developed into statements to identify how context around the link worker triggers mechanisms that lead to intended and unintended outcomes. Results: We found that link workers exercise micro-discretions in their role - actions and advice-giving based on personal judgement of a situation, which may not always reflect explicit guidance or protocols. Our analysis highlighted that micro-discretions engender positive connections (with patients, healthcare staff, the voluntary, community and social enterprise sector) and promote buy-in to the link worker role in primary care. Micro-discretions supported delivery of person-centred care and enhanced job satisfaction. Data also highlighted that lack of boundaries could place link workers at risk of overstepping their remit. Limitations: Our research focused on link workers attached to primary care; findings may not be applicable to those working in other settings. Data were collected around seven link worker cases, who were selected purposively for variation in terms of geographical spread and how/by whom link workers were employed. However, these link workers were predominately white females. Conclusions: Enabling link workers to exercise micro-discretions allows for responsiveness to individual patient needs but can result in uncertainty and to link workers feeling overstretched. Future work: Poor link worker retention may, in part, be associated with a lack of clarity around their role. Research to explore how this shapes intention to leave their job is being conducted by authors of this paper. Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR130247.

Problems in life affecting people's health and well-being cannot always be fixed with medication. For example, loneliness can lower people's mood, or worries about money can cause them to feel anxious. Social prescribing link workers are employed to support individuals with these 'non-medical' issues. They listen to people to find out about them and their circumstances. They may connect them to community groups, organisations or services, or help them get advice about things like benefits or housing. Our study explored how link workers are being implemented in primary care in England. We studied seven link workers based in different parts of England. We spent 3 weeks with each link worker, observing them at their workplace. We also interviewed these link workers and people they worked with; this included 61 patients, 61 primary care staff, 5 other link workers and 20 individuals from the voluntary or community sector. We found big differences in what link workers did in their roles; in how long they saw patients for and how often, how many patients they were supporting at one time, their professional and personal backgrounds, whether they worked in a practice alone or were part of a bigger team of people delivering social prescribing. Link workers had varying levels of flexibility (or discretion) in their jobs; this allowed them to support patients' individual needs. Such flexibility gave them job satisfaction as they were able to use their judgement about how to work with patients to provide person-centred support. However, if this went too far ­ and link workers had too few boundaries and not enough guidance ­ they ended up feeling overwhelmed by their job.

The role of intermediaries in connecting individuals to local physical activity - protocol for a pilot feasibility trial.

Background: Intermediaries are health-related workers who facilitate connections to local physical activities. Intermediaries deliver interventions by receiving referrals, conducting assessments, connecting referred individuals to activities and/or services in the community, and following up with them over time. However, it is unclear whether individuals who are referred to physical activities by an intermediary improve their physical activity levels, and what their perspectives and experiences are of participating in this intervention. To date there has been a lack of studies investigating the effect of this intervention on physical activity using appropriate outcome measures. Methods: This will be a mixed methods pilot feasibility study. Participants will be individuals referred or self-referred to an intermediary and connected to local physical activities. Participants will be recruited through two types of intermediary services in Ireland; social prescribing and local sports partnerships. A total of 30 participants will be recruited (15 per service). Baseline demographic information will be taken upon enrolment to the study and three questionnaires will be completed: the International Physical Activity Questionnaire - Short Form, Self-Efficacy for Exercise Scale and Short Warwick Edinburgh Mental Well-being Scale. The questionnaires will be repeated after 12 weeks and in addition semi-structured interviews will be carried out to explore intervention content and delivery, as well as acceptability of the intervention and evaluation design. Discussion: This overall aim of this proposed study is to investigate the feasibility of an intervention delivered by an intermediary to improve physical activity and health-related outcomes of community-dwelling individuals. Registration: ClinicalTrials.gov (NCT06260995).

Link workers' and clients' perspectives on how social prescribing offers a social cure for loneliness.

Social prescribing is a healthcare model designed to reduce loneliness and improve individuals' health by addressing unmet social needs. The present study adopted the Social Cure framework to provide an understanding of the psychosocial processes involved in helping participants to engage with social activities, from both the link workers' and clients' perspectives. Semi-structured interviews were conducted with 15 link workers (Mage = 40.12; 87% female) and 15 clients (Mage = 55.33; 73% female, 7% non-binary) of social prescribing programmes across Australia and the transcripts were analysed using reflexive thematic analysis. Three overarching themes were identified: (1) Breaking Down Barriers, (2) Finding Fit with Others, and (3) Rebuilding a Sense of Self. These findings communicate how social prescribing addressed the psychosocial barriers of clients, and how joining groups that fostered positive shared social identities resulted in meaningful improvements to clients' well-being.

A Qualitative Study of National Perspectives on Advancing Social Prescribing Using Co-Design in Canada.

INTRODUCTION: Social prescribing offers a formal pathway of connecting patients in the health system with sources of support within the community to help improve their health and well-being. Since its launch in March 2022, the Canadian Institute for Social Prescribing has acted as a collective impact network to identify, connect and build upon established social prescribing initiatives using a co-design methodology. The institute received input from a participant advisory council, co-design partners and several communities of interest groups. This study aimed to describe the perceptions of the Canadian Institute for Social Prescribing's role in advancing social prescribing using a co-design approach and the barriers and facilitators to implementing social prescribing in Canada. METHODS: We used a qualitative descriptive study design, document analysis, participant observation and semi-structured individual interviews (n = 7) with members of the Canadian Institute for Social Prescribing co-design group and the institute's leadership. We also analysed documents, field notes and transcripts using codebook thematic analysis. RESULTS: Four themes were developed representing the facilitators of implementing the Canadian Institute for Social Prescribing to support social prescribing: Creating relational mechanisms (i.e., partnerships and connections), Bringing awareness to social prescribing and contributing to the evidence (i.e., values and beliefs), Addressing systemic conditions (i.e., having a common language for social prescribing and organizing the community health sector) and Enabling funding and policy to drive social prescribing initiatives (i.e., shifting evidence into policy and securing sustainable funding). CONCLUSION: Participants' reflections on the co-design process demonstrated that the Canadian Institute for Social Prescribing development provided networking opportunities and shared resources relevant to social prescribing. Co-design efforts also fostered relational and informational support, which laid the necessary groundwork in Canada to overcome the complex interplay between the macro- and micro-level settings in which social prescribing is practiced. PATIENT OR PUBLIC CONTRIBUTION: The interviews and observations involved participants with lived experience of delivering, receiving or advocating for social prescribing.

Speaking the Same Language - The Development of a Glossary of Terms for Social Prescribing in Wales.

Introduction: Social prescribing can facilitate the integration of health, social care and community support but has a diverse and confusing terminology that impairs cross-sectoral communication and creates barriers to engagement. Methods: To address this issue a mixed-methods approach that incorporated a scoping review, a group concept mapping study and consultation was employed to identify and classify the terminology associated with social prescribing. The findings were then used to inform the development of a glossary of terms for social prescribing. Results: Many terms are used interchangeably to describe the same specific aspects of social prescribing. Much of the terminology originates from the health and social care literature of England. Discussion: The terminology used in the academic literature may not accurately reflect the terminology used by the social prescribing workforce. The innovative and interactive glossary of terms identifies the terminology associated with social prescribing and provides additional contextual information. The process of developing the dual language glossary presented several considerations and challenges. Conclusion: The glossary of terms will facilitate cross-sector communication and reduce barriers to engagement with social prescribing. It takes an important first step to help clarify and standardise the language associated with social prescribing, for professionals and members of the public alike.

Sex differences in formal recommendation of assets for health (social prescribing) in Aragon.

BACKGROUND: In primary health care, social prescribing is an important tool which is gaining popularity. It is being studied significantly, however there is not enough evidence about different related issues. The aim of this study is to analyse the differences by sex in the application of a social prescription protocol in Primary Care. METHODS: This is a cross-sectional study carried out with data from the Electronic Health Record between September 2018 and March 2021. Descriptive, bivariate and multivariate analyses of data from 2,109 records of Social Prescription protocol in primary health care centers located in Aragón in northern Spain (Europe) were performed using Jamovi Statistics software (version 2.3.28). The comparisons by sex were carried out using a Mann-Whitney U or chi-squared test to analyse differences. RESULTS: The protocol was used correctly 1,482 times, where it was applied more in females (74.8% female vs. 25.2% male). The median age in females was higher than males (female 72 vs. males 70; p = 0.003). There were significant differences by sex in several aspects to strengthen with the social prescribing, physical, emotional and relational skills. Most females and males regularly attended the recommended asset and there were significant differences in the group that never attended. Mean satisfaction was statistically different, with 4.74 points out of 5 for females and 4.86/5 for males (p = 0.010). It can be observed that older females in rural areas (OR = 34.15), whose social prescription acts on Emotional Skills and Relational and Social Skills (OR = 6.10-8.23), with good prior self-care and greater participant satisfaction (OR = 8.96), have greater chance of improving their health. CONCLUSIONS: Some results showed sex differences in the use and outcomes of formal asset recommendation. However, further research is needed to assess the relationship between social prescription, sex and gender and their implications.

Social prescribing for individuals with mental health problems: An ethnographic study exploring the mechanisms of action through which community groups support psychosocial well-being.

Background: Social prescribing involves connecting individuals to community groups and activities, often to support their mental health and well-being. It has received increasing support in recent years across the NHS. There is a strong evidence base for the benefits of different types of community activities, including exercise groups, arts groups and nature interventions, on mental health outcomes, however, less is known about how these groups impact mental health and well-being. This study explores through what individual-level mechanisms (the 'how') these groups support psychosocial well-being. Methods: An ethnographic study was conducted over 12-months to explore key shared, individual-level mechanisms across 4 social prescribing community groups: football, singing, gardening and reading. This study focused mostly on those with severe mental illness, whereas previously most social prescribing studies have focused on mild to moderate mental health problems. To frame the findings, a 'multi-level theoretical framework of mechanisms of action' of leisure activities was used. Results: Key shared psychological mechanisms were: increased self-confidence and self-esteem, increased purpose/meaning, increased sense of achievement, experience of pleasure; social mechanisms included: increased social support, formation of friendships and reduced loneliness, enhanced sense of community and belonging; behavioural mechanisms were: increased independence and openness to experience, reduction in addictive behaviours and building healthier habits, increased work-seeking behaviour, and provision of structure & routine. Conclusions: It is hoped that the findings of this study can help referring professionals increase their understanding of exactly how such groups support individuals' mental health, thus enhancing referring practices.

This study uses ethnographic methods, wherein the lead researcher spent over a year participating in 4 different community groups, using interviews, conversations and observation to explore the mental health impact of such groups on individuals' lives. The participants had moderate to severe mental health conditions, and the groups consisted of a reading, gardening, singing and football group. The study explored 'mechanisms' underlying the mental health benefits of these groups. Key shared psychological mechanisms were: increased self-confidence and self-esteem, increased purpose/meaning, increased sense of achievement, experience of pleasure; social mechanisms included: increased social support, formation of friendships and reduced loneliness, enhanced sense of community and belonging; behavioural mechanisms were: increased independence and openness to experience, reduction in addictive behaviours and building healthier habits, increased work-seeking behaviour, and provision of structure & routine. It is hoped that the findings of this study can help referring professionals (e.g. GPs, social workers, link workers) increase their understanding of exactly how such groups support individuals' mental health, thus improving referring skills.

A meta-ethnography of the factors that shape link workers' experiences of social prescribing.

BACKGROUND: Social prescribing is gaining traction internationally. It is an approach which seeks to address non-medical and health-related social needs through taking a holistic person-centred and community-based approach. This involves connecting people with and supporting them to access groups and organisations within their local communities. It is hoped that social prescribing might improve health inequities and reduce reliance on healthcare services. In the UK, social prescribing link workers have become core parts of primary care teams. Despite growing literature on the implementation of social prescribing, to date there has been no synthesis that develops a theoretical understanding of the factors that shape link workers' experiences of their role. METHODS: We undertook a meta-ethnographic evidence synthesis of qualitative literature to develop a novel conceptual framework that explains how link workers experience their roles. We identified studies using a systematic search of key databases, Google alerts, and through scanning reference lists of included studies. We followed the eMERGe guidance when conducting and reporting this meta-ethnography. RESULTS: Our synthesis included 21 studies and developed a "line of argument" or overarching conceptual framework which highlighted inherent and interacting tensions present at each of the levels that social prescribing operates. These tensions may arise from a mismatch between the policy logic of social prescribing and the material and structural reality, shaped by social, political, and economic forces, into which it is being implemented. CONCLUSIONS: The tensions highlighted in our review shape link workers' experiences of their role. They may call into question the sustainability of social prescribing and the link worker role as currently implemented, as well as their ability to deliver desired outcomes such as reducing health inequities or healthcare service utilisation. Greater consideration should be given to how the link worker role is defined, deployed, and trained. Furthermore, thought should be given to ensuring that the infrastructure into which social prescribing is being implemented is sufficient to meet needs. Should social prescribing seek to improve outcomes for those experiencing social and economic disadvantage, it may be necessary for social prescribing models to allow for more intensive and longer-term modes of support.