Co-Design for Equity, Inclusion and Engagement: Strategies for Social Prescribing

Social prescribing is increasingly promoted as an integrated care strategy that connects individuals to non-clinical community resources to improve health and well-being. Co-design is frequently recommended for developing social prescribing pathways that are acceptable, feasible and responsive to local needs. However, how co-design is operationalised in inclusive and equity-centred ways remains poorly understood. This narrative review synthesises health-related literature on co-design strategies that promote equity and foster inclusion in the development of social prescribing initiatives.

A narrative review of health-related literature on inclusive and equity-centred co-design published within the last 10 years was undertaken. Searches of MEDLINE, CINAHL and Google Scholar (8-28 October 2025), supplemented by reference list screening, yielded approximately 530 records. Sources were reviewed for relevance to the review question, resulting in the inclusion of 52 sources. Findings were analysed using an iterative narrative synthesis approach to identify recurring concepts and patterns, which were integrated into a conceptual framework for inclusive co-design.

The synthesis identified three interconnected domains of inclusive co-design: foundational principles, enabling structures and operational practices. Foundational principles establish the values underpinning inclusive co-design, enabling structures create the conditions for participation, and operational practices translate these commitments into action. Together, these domains formed a conceptual framework for inclusive co-design in social prescribing.

Inclusive co-design offers a values-informed and practical approach for developing social prescribing initiatives that seek to be equitable, relational and responsive to community realities. Although empirical evidence comparing co-design approaches remains limited, the framework of principles, structures and practices provides guidance for practitioners, researchers, policymakers and community partners. Future research should evaluate co-design processes and outcomes using measures defined collaboratively with interest holders.

No patients or members of the public were directly involved in conducting this narrative review. However, the review was intentionally centred on inclusion, equity, lived experience and participatory approaches. The manuscript draws substantially on literature that foregrounds the perspectives of service users, caregivers, communities and practitioners involved in co-design processes.