Supporting social prescribing in primary care by linking people to local assets: a realist review

Abstract

Background: Social prescribing is a way of addressing the 'non-medical' needs (e.g. loneliness, debt, housing problems) that can affect people's health and well-being. Connector schemes (e.g. delivered by care navigators or link workers) have become a key component to social prescribing's delivery. Those in this role support patients by either (a) signposting them to relevant local assets (e.g. groups, organisations, charities, activities, events) or (b) taking time to assist them in identifying and prioritising their 'non-medical' needs and connecting them to relevant local assets. To understand how such connector schemes work, for whom, why and in what circumstances, we conducted a realist review.

Method: A search of electronic databases was supplemented with Google alerts and reference checking to locate grey literature. In addition, we sent a Freedom of Information request to all Clinical Commissioning Groups in England to identify any further evaluations of social prescribing connector schemes. Included studies were from the UK and focused on connector schemes for adult patients (18+ years) related to primary care.

Results: Our searches resulted in 118 included documents, from which data were extracted to produce context-mechanism-outcome configurations (CMOCs). These CMOCs underpinned our emerging programme theory that centred on the essential role of 'buy-in' and connections. This was refined further by turning to existing theories on (a) social capital and (b) patient activation.

Conclusion: Our realist review highlights how connector roles, especially link workers, represent a vehicle for accruing social capital (e.g. trust, sense of belonging, practical support). We propose that this then gives patients the confidence, motivation, connections, knowledge and skills to manage their own well-being, thereby reducing their reliance on GPs. We also emphasise within the programme theory situations that could result in unintended consequences (e.g. increased demand on GPs).

Keywords: Care navigators; Evidence synthesis; Link workers; Realist review; Social capital; Social prescribing.

Fig. 1

Processes and literature searches used to develop CMOCs and the emerging and final programme theory (grey boxes in the diagram highlight references that were coded in step 3 of the review)

Fig. 2

How the 118 documents coded in step 3 to help with developing CMOCs were located

Fig. 3

Type of documents coded to develop CMOCs

Fig. 4

Our intermediate programme theory (prior to extending our understanding by drawing on existing theories)

Fig. 5

Revised final programme theory that draws on the reviewed literature and relevant substantive theory