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. 2025 Aug 23;26(1):262.
doi: 10.1186/s12875-025-02954-3.

Consensus-based framework for assessing social prescribing schemes in primary healthcare

A M Carrera-Noguero  1   2   3 , M Guilabert Mora  4   5 , V Pérez-Jover  4   5 , M Pola-Garcia  1   2 , J J Mira Solves  4   5 , M P Astier-Peña  6   7   8   9   10   11 ; Consortium EvaLRA
Collaborators, Affiliations

Consensus-based framework for assessing social prescribing schemes in primary healthcare

A M Carrera-Noguero et al. BMC Prim Care. .

Abstract

Background: Social Prescribing Schemes (SPS) incorporate community-based activities (Health Assets, HAs) into primary healthcare (PHC) to address social determinants of health and enhance well-being. Structured evaluation frameworks are needed to ensure equity, accessibility, and measurable outcomes. This study aimed to develop a framework to assess SPS in the Spanish public healthcare system using key stakeholder input.

Methods: A mixed-method approach was applied, including five nominal group discussions (NGDs) with 48 national stakeholders (public health officials, PHC teams, HA providers, and patients). Thematic analysis of NGD data identified key challenges and opportunities and with the literature review was the foundation of a two-round Delphi survey with 130 participants. The Delphi process refined 116 initial criteria across three domains (structure, process, outcomes), guided by Donabedian’s quality model.

Results: The final model contained 91 criteria: 41 structural criteria focused on equity, accessibility, and validation of HAs; 36 process criteria highlighted patient consent, collaboration between PHC teams and HA providers, and adherence tracking; 14 outcome criteria emphasized improvements in quality of life, autonomy, and reduced healthcare use. Key barriers included information health system fragmentation, resource limitations, and regional disparities, emphasizing the need for cross-sector collaboration.

Conclusions: This framework prioritizes equity and patient-centred approaches, emphasizing the value of SPS in PHC. Policy and research efforts should focus on addressing barriers and scaling SPS to strengthen integration and improve population health.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12875-025-02954-3.

Keywords: Delphi survey; Evaluation framework; Health assets; Primary healthcare; Social determinants of health; Social prescribing.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the ethical principles of the Spanish Biomedical Research Law 14/2007 and approved by the Ethics Committee of Clinical Research of Aragón (CEICA) in its meeting on January 13, 2021 (Act No. 01/2021) C.I. PI20/606. Our study follows the Helsinki Declaration ( https://www.wma.net/policies-post/wma-declaration-of-helsinki/ ). For all the phases involving participation of experts in the nominal group sessions and the Delphi survey, an informed consent form has been applied which explains the project, the participants’ implications and how the collected information will be used and managed. PHC teams, health asset providers and citizens who participate in the implementation of indicators in the second phase of the study have their informed consent. Most stakeholders that participate in the SPS process are represented in the research team and a local working group is actively collaborating with the study. The project is also receiving institutional support. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Process to define an SPS model in PHC
See this image and copyright information in PMC

References

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