How do we evaluate social prescribing interventions: a utilisation-focused approach

Problem

The surge of social prescribing in primary care reflects its recent promotion within national UK policy. Interventions support collaboration between individuals, families, and stakeholders to improve self-management of problems resulting from socioeconomic factors.Some evidence suggests social prescribing can reduce pressure on healthcare services, build up the local community, and produce economic benefits. However, schemes tend to be heterogenous, localized and small scale, and subject to influence from stakeholders and external factors. This complexity makes it challenging to meaningfully evaluate the impact of interventions. However, the rising prevalence, popularity, and financial resourcing of social prescribing heightens the importance of developing effective methods for doing so.

Approach

Live Well in Braunton [LWIB] is an independent networking initiative in North Devon that aims to improve community wellbeing. In this study we are using a mixed-methods utilisation-focused approach to evaluate LWIB to better understand the intervention and utility of this method. Working closely with practitioners and the users of our findings, this reciprocally reactive strategy aims to minimize the translation gap between research and practice. Outcomes derived from stakeholder interviews and the Common Outcomes Framework will provide quantitative and qualitative data about processes and impact on individuals, health service use and the local community. Thematic and contribution analysis will be used to provide a narrative and explanatory assessment of the intervention and determine the extent to which it is responsible for observed impacts.

Findings

For local stakeholders, important outcomes reflected personal wellbeing and community development above health service use. Qualitative findings were valued above quantitative. However, financial backers mandated objective wellbeing scales and numerical process data. All interviewees recognized the value and importance of meaningful evaluation. Collecting and analysing data is challenging. Data collection tools developed for social prescribing may be too costly for individual projects. Following fundraising, a user-specific database is in development for LWIB to facilitate this. Close relationships with practitioners are essential to enable rigorous, unbiased data collection and generate the deeper contextual understanding required for meaningful qualitative analysis. However, this is time and resource intensive, which is frequently inadequately recognized by many social prescribing commissioners.

Consequences

Meaningful evaluation must be acknowledged as a crucial component of social prescribing. Generating useful findings for practitioners and funding stakeholders should allow for effective adaptation of processes and outcomes should offer narrative and explanatory value. Relationship development, data collection and analysis are time and resource intensive, and this needs to be recognized at the planning and funding stages. Given the complexity of social prescribing, it is likely evaluations will inadequately capture the entirety of impacts – positive and negative. Openly acknowledging this whilst transparently demonstrating any narrative attempt at generating useful, contextually grounded knowledge i.e. through utilization-focused methods, may be the most appropriate and meaningful approach.