National Feasibility Study of Methods for Evaluation of Social Prescribing
Leads: Dr Lena Al-Khudairy, Dr Abimbola Ayorinde, Dr Adam Briggs, Prof Aileen Clarke (Public Health), Dr Nick Parsons (Meths)
During the project, public contributors with relevant lived experience of social prescribing were invited to two online workshops to discuss the priorities for research evaluating social prescribing. The team have worked closely with a public contributor to shape plans for the project and interpret key messages for dissemination.
Dates: February 2020 - October 2020
Social prescribing encourages health professionals to refer patients to a link worker who will develop a personalised plan for each individual. NHSE aimed to increase the number of link workers to build significant capacity and deal with service uptake.
The Department of Health and Social Care wished to explore whether an evaluation of the link worker model of SP is possible:
- What are the most important evaluation questions that an impact study could investigate?
- What data is already available at a local or national level and what else would be needed?
- Are there sites delivering at enough scale and in a position to take part in an impact study?
- How could the known challenges to evaluation be addressed?
Policy and Practice Partners:
This work was commissioned by the NIHR and NHS England (we would also like to acknowledge the National Link Worker Association).
Aims and Objectives:
- A scoping service assessment to identify sites and understand the scale of current service (question 1 and 3)
- A scoping outcome assessment to identify routine data that are captured within the current service (question 2)
- Understand the feasibility and potential limitations of an evaluation the SP link worker model (question 4)
1. Evidence synthesis
We conducted a rapid evidence synthesis to better understand the volume of the current literature and to inform the development and structure of our data collection. We searched MEDLINE ALL (Ovid) and the first 100 hits in Google from inception up to February 2019. We also searched key studies for additional evidence. One reviewer screened potentially eligible studies and discussed with a second reviewer when in doubt. Two reviewers assessed studies for eligibility and data were extracted by two reviewers. Eligible studies included ‘social prescription’, ‘social prescribing’ or ‘social prescriber’ with any study design and any reported outcomes.
2. Qualitative interviews
Participants were purposively sampled through the NHSE wider network, contacts of staff at University of Warwick and snowball sampling from previously identified participants. participants included: a) national SP leads identified via NHSE, b) regional leads of the Social Prescribing Network (East of England, London, Midlands, Yorkshire and Humber, North West, South East, South West, North East), and c) sites delivering SP, both those with an established/mature link worker SP model scheme (LWSPM) and those which did not yet have a mature scheme. Additionally, we contacted the voluntary sector, stakeholders, topic experts and academic colleagues.
3. Data collection
Data were collected using a semi-structured interview guide informed by our rapid evidence synthesis. This approach ensured systematic data collection across participants and sites, whilst allowing for flexibility in structuring the discussion.
Key areas of the interview topic guide included:
- The nature of the service in terms of structure, models implemented, organisations involved, and health domains that it covers.
- Patient journey throughout the service.
- Any measured outcomes.
- Data collection methods and human resources.
- Volume of service uptake.
- Type of service utilisation (highest vs. lowest).
- Nature and length of follow-up.
- Potential strengths and limitations of current service.
- Major enablers and challenges of developing and implementing SP service.
- Costs and savings of recruiting SP and of implementing service (both to PCN and to other organisations involved).
- Non-attendance data (for instance resulting from people who do not take up their social prescribing referral).
- The make-up of people taking up social prescribing (how they compare to the overall practice population, availability of social class data).
The interviews were audio recorded with interviewees’ consent, all audio recorded data were manually transcribed and interview notes were generated.
We conducted a narrative approach for the evidence synthesis. Analysis of the interview transcripts was supported through NVivo software. We selected a thematic analysis approach to analyse the data. A coding framework was developed using the interview guide and the protocol and helped to structure the analysis around the key areas of interested listed above.
Implications for Implementation:
This work was commissioned to support and inform the NHR and NHS England in their development of a national evaluation of the Social Prescribing Link Worker model service across England. We will be working closely with them to support the optimal commissioning of this work.