Objectives This study aimed to assess the degree to which the ‘social cure’ model of psychosocial health captures the understandings and experiences of healthcare staff and patients in a social prescribing (SP) pathway and the degree to which these psychosocial processes predict the effect of the pathway on healthcare usage.
Design Mixed-methods: Study 1: semistructured interviews; study 2: longitudinal survey.
Setting An English SP pathway delivered between 2017 and 2019.
Participants Study 1: general practitioners (GPs) (n=7), healthcare providers (n=9) and service users (n=19). Study 2: 630 patients engaging with SP pathway at a 4-month follow-up after initial referral assessment.
Intervention Chronically ill patients experiencing loneliness referred onto SP pathway and meeting with a health coach and/or link worker, with possible further referral to existing or newly created relevant third-sector groups.
Main outcome measure Study 1: health providers and users’ qualitative perspectives on the experience of the pathway and social determinants of health. Study 2: patients’ primary care usage.
Results Healthcare providers recognised the importance of social factors in determining patient well-being, and reason for presentation at primary care. They viewed SP as a potentially effective solution to such problems. Patients valued the different social relationships they created through the SP pathway, including those with link workers, groups and community. Group memberships quantitatively predicted primary care usage, and this was mediated by increases in community belonging and reduced loneliness.
Conclusions Methodological triangulation offers robust conclusions that ‘social cure’ processes explain the efficacy of SP, which can reduce primary care usage through increasing social connectedness (group membership and community belonging) and reducing loneliness. Recommendations for integrating social cure processes into SP initiatives are discussed.
- social prescribing
- social cure
- primary care
- social determinants of health
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
Twitter @Blerina_Kellezi, @drjwakefield, @DrCliffordSteve, @DrNiamhMcNamara, @ElizabethMair_, @MhairiBowe, @Dr_Iain_Wilson, @moonhalder
Contributors BK: designed, conducted the research, analysed the data and drafted and revision of this paper. JHRW: designed, conducted the research, analysed the data, and co-drafted and revised this paper. CS: obtained the funding, designed, conducted the research and contributed to the drafting and revision of this paper. NM: designed, conducted the research, analysed the data and contributed to the drafting and revision of this paper.
MB: designed, conducted the research and contributed to the drafting and revision of this paper. EM: designed, conducted the research, analysed the data and contributed to the drafting of this paper. IW: designed, conducted the research and contributed to the drafting of this paper. MH: conducted the research and contributed to the drafting of this paper.
Funding This research was funded by ImROC (Implementing Recovery Through Organisational Change). ImROC played no role in the design of the study, the analysis/interpretation of the data, the writing of the paper or the decision to submit this article to BMJ, but ImROC employees gathered the Study 2 data. Sponsor: The study was sponsored by Nottingham Trent University and the sponsor reviewed and approved all study documents. Statement of independence: The researchers conducted the research independently from funders.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request. No data are available.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.