Social Prescribing for people with complex needs: a realist evaluation

Emily Wood, Sally Ohlsen, Sarah-Jane Fenton, Janice Connell, Scott Weich

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Background: Social Prescribing is increasingly popular, and several evaluations have shown positive results. However, Social Prescribing is an umbrella term that covers many different interventions. We aimed to test, develop and refine a programme theory explaining the underlying mechanisms operating in Social Prescribing to better enhance its effectiveness by allowing it to be targeted to those who will benefit most, when they will benefit most.

Methods: We conducted a realist evaluation of a large Social Prescribing organisation in the North of England. Thirty-five interviews were conducted with stakeholders (clients attending Social Prescribing, Social Prescribing staff and general practice staff). Through an iterative process of analysis, a series of context-mechanism-outcome configurations were developed, refined and retested at a workshop of 15 stakeholders. The initial programme theory was refined, retested and ‘applied’ to wider theory.

Results: Social Prescribing in this organisation was found to be only superficially similar to collaborative care. A complex web of contexts, mechanisms and outcomes for its clients are described. Key elements influencing outcomes described by stakeholders included social isolation and wider determinants of health; poor interagency communication for people with multiple needs. Successful Social Prescribing requires a non-stigmatising environment and person-centred care, and shares many features described by the asset-based theory of Salutogenesis.

Conclusions: The Social Prescribing model studied is holistic and person-centred and as such enables those with a weak sense of coherence to strengthen this, access resistance resources, and move in a health promoting or salutogenic direction.
Original languageEnglish
Article number53
JournalBMC Family Practice
Issue number1
Publication statusPublished - 18 Mar 2021

Bibliographical note

Funding information: This article presents independent research funded by Sheffield Hospitals Charity and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humber (NIHR CLAHRC YH). The views and opinions expressed are those of the authors, and not necessarily those of Sheffield Hospitals Charity or the NIHR or the Department of Health. The funding bodies had no role in the design of the study, collection, analysis or interpretation of the data, or in writing the manuscript.


  • co-morbidity
  • depression
  • multi-morbidity
  • realist evaluation
  • salutogenesis
  • social prescribing


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