How do patients benefit from social prescribing?

Problem

Social prescribing has been widely recommended as a means of addressing a wide range of illness, distress and health behaviours in individuals and populations. It provides an adjunct to conventional medical treatment. The popularity of social prescribing has grown in recent years and is set to increase with its inclusion in the NHS Long Term Plan and GP Contract.Research suggests that socially prescribed activity is beneficial for some of those who engage in it, but little is known about how that benefit comes about. We aimed to explore the mechanisms by which social prescribing is perceived as beneficial by people who have been referred to it.

Approach

We conducted semi-structured interviews with people undertaking a range of socially prescribed activities to understand how they perceived its benefits. The study was conducted within a social prescribing organisation in one English city which provides a range of services and acts as a gateway to others. We recruited participants using purposive sampling based on length of engagement, primary reason for referral and the type of service accessed within the organisation. The analysis was based on interpretive phenomenological analysis and adopted a realist view of mechanisms operating within contexts to produce perceived outcomes. Emerging themes were compared against a concurrent synthesis of other qualitative studies to provide coherence with previous research.

Findings

We interviewed 17 adults aged between 45 and 84. We identified five themes which formed a journey of engagement and participation. While not always present for any one individual, the themes occurred in a consistent order. (1) Receiving personal and professional support for specific problems. (2) Engaging with others through participation in socially prescribed activity. (3) Learning different ways to relate to other people and developing new skills. (4) Changing perceptions by recognising personal assets and becoming open to the possibility of new futures. (5) Developing a positive outlook on the present and looking to move forwards in pursuit of future goals and better health. These themes were inherently social, involving interaction with others and self-reflection in the light of this. While we found a consistent order, this was not externally enforced nor pre-specified in a programme underpinning the interventions. Rather, individuals found their own personal journeys of social re-engagement and reappraisal.

Consequences

Socially prescribed activity appears to benefit patients by moving from personal problems through social engagement to recognition of assets and opportunities. In doing so it is inherently social and idiosyncratic rather than following a pre-specified programme or course.As social prescribing moves into the mainstream there is a danger that it will become standardised and lose this fundamentally social nature. This would represent a missed opportunity.