What does social prescribing look like in practice? A qualitative case study informed by practice theory

Area of Science:

• Public Health
• Sociology of Health
• Health Services Research

Background:

• Social prescribing (SP) links primary care patients with community resources.
• Effectiveness of SP is studied, but mechanisms in complex systems are unclear.
• Focus on high-risk type 2 diabetes (T2D) populations in diverse settings is needed.

Purpose of the Study:

• Investigate how SP practices are enacted for individuals at high risk of T2D.
• Explore the influence of practice theory on understanding SP enactment.
• Examine SP in a multi-ethnic, socioeconomically deprived primary care setting.

Main Methods:

• Qualitative case study using practice theory.
• 35 semi-structured interviews with clinicians, link workers, and SP organizations.
• 30 hours of ethnographic observation and document analysis.

Main Results:

• Identified varied SP practice approaches: adaptive ('I do what it takes'), constrained ('I do what I can'), and compliant ('I do as I'm told').
• Practices showed tension, with adaptive approaches having greater potential for supporting high-T2D-risk patients.
• Successful SP adoption required resources and conditions for adaptation, negotiation, and patient-centered reinvention.

Conclusions:

• SP enactment varies, influencing its potential to support high-T2D-risk patients.
• Adapting SP to patient needs is crucial for successful implementation.
• Individual, relational, organizational, and institutional factors are essential for effective SP.