Social prescribing: A practice in need of a theory

We read with interest the editorial by Husk et al.,¹ concerning the current state of social prescribing (SP) the in UK. We likewise welcome NHS recognition of the need to attend to the social factors impacting upon patients’ health. Like Husk et al., we note the diversity of resultant models of SP, but unlike these authors, we do not see further evidence as the most pressing need within the area. The more urgent requirement is for a theoretical understanding of why it works.

 

Social prescribing is currently an atheoretical practice. It lacks an evidenced-based model to explain why social factors impact negatively upon health and, from this, to recommend which social activities will work for whom. This can be provided by Social Psychology where evidence has accumulated to show how social relationships in themselves have positive impacts upon health and wellbeing.² Group memberships in particular can provide individuals with a sense of belonging and purpose as well as emotional reassurance, information and practical support, all of which enable them to cope with the challenges of their everyday lives. Social isolation on the other hand leaves individuals prone to mental and physical illness – loneliness kills.

 

Using this theoretical perspective (the Social Identity Approach to Health or the ‘Social Cure³’) we designed two large-scale, multimethod investigations of different forms of SP: one NHS-based⁴ and one community-based. Using established measures of heath and wellbeing (the WHO5 and the EQ5D) we tracked clients’ pathways through each of these initiatives. In both, we found statistically significant changes in client wellbeing which closely accord with the in-depth interviews provided by the SP providers and clients themselves. We also identified the key factors which mediate this effect across each initiative: group memberships, a sense of belonging and feelings of social support. These factors affect patients’ interactions with GPs and SP staff, their adherence to the programmes and the efficacy of treatment. Our research is ongoing and the findings are in preparation, but for now we propose the Social Cure as a theoretical framework which can provide the basis for the understanding and future development of SP.

 

1. Husk, K., Blockley, K., Lovell, R. et al. What approaches to social prescribing work, for whom, and in what circumstances? A protocol for a realist review. Systematic Reviews 2016: 5(1), 93. 
2. Haslam, C., Jetten, J., Cruwys, T., Dingle, G. A., Haslam, S. A. (2018). The New Psychology of Health: Unlocking the Social Cure. New York: Routledge.
3. Wakefield, J. R. H., Bowe, M., Kellezi, B., McNamara, N., Stevenson, C. When groups help and when groups harm: Origins, developments, and future directions of the ‘Social Cure’ perspective of group dynamics. Soc Personal Psychol Compass 2019; (in press). DOI: 10.1111/spc3.12440
4. Halder, M. M., Wakefield, J. R., Bowe, M., et al. Evaluation and exploration of a social prescribing initiative: Study protocol. J Health Psychol 2018. DOI: 10.1177/1359105318814160.