A realist review and collaborative development of what works in the social prescribing process

Abstract Background In social prescribing, people are referred by primary-care professionals to non-medical, community-based activities. The transfer between primary care and the community-based provider can be difficult, with low uptake and poor engagement with and adherence to interventions. There is an ambition to increase the use of social prescribing in the UK health service; however, to achieve this ambition the process of referral and retention needs improving. This study aimed to increase our understanding of what works and why in the social prescribing process and to apply this knowledge in primary-care settings where the use of the approach is being developed. Methods In a realist review of literature considering the process of social prescribing, bibliographic and grey literature searches were used to locate evidence. The relevance of the evidence was assessed and then used to develop theory. Findings were contextualised through focus groups in the partner primary-care setting. Findings Bibliographic and grey literature searches identified a total of 253 primary sources, and data were fully extracted from the most conceptually rich (n=109). Overarching programme theory integrating 40 active elements of the social prescribing process was developed through synthesis of the primary literature. This list was then refined through expert prioritisation leading to targeted searches conducted on key elements of the process relating to enrolment in, engagement with, and adherence to social prescribing. Key contexts and mechanisms contributing to successful uptake and enrolment included patient beliefs about suitable treatment options, presentation of the intervention and social prescribing process, accessibility of social prescribing (physically and psychologically), and supported uptake (eg, a link worker). Skilful and flexible intervention leadership and a change in the patient's condition were key contexts or mechanisms in maintaining adherence. Interpretation Use of a realist approach, with findings iteratively refined and applied in a primary-care setting, has facilitated a better understanding of what works in the social prescribing process. However, despite increasing interest in the approach, there is a paucity of information in the current evidence base about how social prescribing interventions are developed, offered, and delivered. Therefore, future social prescribing interventions should integrate process evaluations. Funding Part funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust.