Abstract
Background
Social prescribing involves non-medical link workers addressing patients’ personalised support needs, largely by connecting them with relevant voluntary and community sector services. Such schemes are particularly aimed at people with long-term health conditions, mental health issues, and other social needs which affect their health and wellbeing. Recently identified in the NHS Long Term Plan (2019) as a means by which to address health inequalities, social prescribing is currently being implemented on a large scale in the UK. Yet evidence of its effectiveness, how it is delivered and how it is received is scant. The qualitative study reported here is part of a larger mixed methods study, funded by the National Institute of Health Research (PHR Project: 16/122/33 https://research.ncl.ac.uk/nuspe/), evaluating the impact of link worker social prescribing on people with type 2 diabetes living in an area of high socio-economic deprivation.
Methods
Ethnographic methods comprising observation of 19 services-users, two waves of semi-structured interviews at the start and end of fieldwork (n=33), photo-elicitation interviews (n=9), and interviews with family members (n=7) were undertaken. The ethnography was conducted over 16 months (November 2018-March 2020) in a range of contexts enabling access to the daily practices of participants. Purposive sampling was used to ensure a sample of maximal variation. Data were thematically coded.
Results
The research illuminates the nuanced ways in which broader inequalities shape participants experience of both type 2 diabetes and social prescribing. Some participants responded to the intervention as anticipated, changed their behaviours and engaged in health-generating practices with positive results. In contrast, participants most affected by inequalities and the effects of factors such as changes to the benefits system, other long term health conditions, and poor housing, experienced multiple setbacks. Their very challenging immediate social circumstances took priority over the intervention. Importantly, while inequalities shaped participants’ capacity to engage with the intervention, all participants recognised the value of the health capital offered by the intervention.
Conclusion
In a socio-political climate where significant ‘upstream’ changes continue to increase inequalities, our detailed observations reveal how such inequalities shape participants’ priorities to engage with health and how social class features in this process. Our findings suggest that, despite aiming to address the effects of the wide range of social and economic factors that influence health, social prescribing operates as a ‘downstream’ intervention and, as such, has a limited impact on the health of the most disadvantaged.
Social prescribing involves non-medical link workers addressing patients’ personalised support needs, largely by connecting them with relevant voluntary and community sector services. Such schemes are particularly aimed at people with long-term health conditions, mental health issues, and other social needs which affect their health and wellbeing. Recently identified in the NHS Long Term Plan (2019) as a means by which to address health inequalities, social prescribing is currently being implemented on a large scale in the UK. Yet evidence of its effectiveness, how it is delivered and how it is received is scant. The qualitative study reported here is part of a larger mixed methods study, funded by the National Institute of Health Research (PHR Project: 16/122/33 https://research.ncl.ac.uk/nuspe/), evaluating the impact of link worker social prescribing on people with type 2 diabetes living in an area of high socio-economic deprivation.
Methods
Ethnographic methods comprising observation of 19 services-users, two waves of semi-structured interviews at the start and end of fieldwork (n=33), photo-elicitation interviews (n=9), and interviews with family members (n=7) were undertaken. The ethnography was conducted over 16 months (November 2018-March 2020) in a range of contexts enabling access to the daily practices of participants. Purposive sampling was used to ensure a sample of maximal variation. Data were thematically coded.
Results
The research illuminates the nuanced ways in which broader inequalities shape participants experience of both type 2 diabetes and social prescribing. Some participants responded to the intervention as anticipated, changed their behaviours and engaged in health-generating practices with positive results. In contrast, participants most affected by inequalities and the effects of factors such as changes to the benefits system, other long term health conditions, and poor housing, experienced multiple setbacks. Their very challenging immediate social circumstances took priority over the intervention. Importantly, while inequalities shaped participants’ capacity to engage with the intervention, all participants recognised the value of the health capital offered by the intervention.
Conclusion
In a socio-political climate where significant ‘upstream’ changes continue to increase inequalities, our detailed observations reveal how such inequalities shape participants’ priorities to engage with health and how social class features in this process. Our findings suggest that, despite aiming to address the effects of the wide range of social and economic factors that influence health, social prescribing operates as a ‘downstream’ intervention and, as such, has a limited impact on the health of the most disadvantaged.
| Original language | English |
|---|---|
| Article number | A39 |
| Number of pages | 1 |
| Journal | Journal of Epidemiology & Community Health |
| Volume | 74 |
| Issue number | Suppl 1 |
| Early online date | 24 Aug 2020 |
| DOIs | |
| Publication status | Published - 1 Sept 2020 |
