The SPHERE model: Social Prescribing and Health Equity through Responsive Evaluation

Social prescribing has emerged as a promising approach to improve health and advance health equity by connecting individuals to non-clinical services that address social determinants of health, such as housing, food access, legal aid, and community-based supports. While referral pathways and link worker roles have received significant attention, far less focus has been given to the public policies that govern access to these services. The success and sustainability of social prescribing efforts depend on whether these enabling policies are well-implemented, community-responsive, and rigorously evaluated, yet few models exist to guide this work. The SPHERE model-Social Prescribing and Health Equity through Responsive Evaluation-addresses this gap. Drawing from implementation science, evaluation theory, and health equity-centered design, SPHERE extends existing implementation frameworks by focusing on how public policies themselves function as implementation infrastructure for social prescribing. The model was refined through considering policy examples and aligning with operational realities of cross-sector, referral-based health systems. SPHERE consists of eight interrelated components: (i) Policy Foundation; (ii) Implementation Infrastructure; (iii) Community Engagement and Co-Production; (iv) Contextual Assessment; (v) Implementation Strategies; (vi) Process Measures; (vii) Outcome Measures; and (viii) Feedback Loops and Learning Mechanisms. These components are grounded in health equity principles and designed to support adaptive and accountable policy delivery. This article illustrates the model's relevance through three examples of policies that enable social prescribing: Housing First initiatives, Medicaid reentry provisions, and local food policy councils. SPHERE positions policy as a critical, actionable driver of social prescribing systems, helping ensure enabling policies are not only enacted but implemented in community-responsive ways. By integrating SPHERE into the design, implementation, and evaluation of policies that enable social prescribing, governments and communities can transform referral systems into adaptive, health equity-driven platforms for structural change.