Title: Will NHS social prescribing benefit patients in socially and economically disadvantaged settings? - A mixed-methods study of link worker interactions and networks
Funder: Department of Health and Social Care

Abstract: Research Question How do link workers create and sustain networks and relationships for social prescribing in socially and economically disadvantaged settings and how do these affect patient outcomes and experiences? Background Social prescribing (SP) is being implemented throughout primary care. The success of SP relies on link workers (LW) being able to build relationships and connections with organisations in the community and with patients. It is currently unclear whether or how SP operates high levels of socioeconomic disadvantage where community infrastructure may be limited and where patients may struggle to engage. More research is needed to understand how SP operates in these areas and whether it will benefit patients experiencing socioeconomic disadvantage.Aim To explore the level, nature, and process of LW interactions across organisations and understand the implication of SP processes for disadvantaged populations. To produce evidence-based recommendations to inform the equitable implementation of SP. Objectives Conduct a meta-ethnography synthesising current literature and develop a conceptual framework to understand LWs' experiences of carrying out their role Interview LWs about their experiences of establishing networks between primary care and the voluntary and community sector for the delivery of social prescribing Explore and assess connections between LWs, primary care, and voluntary and community sector organisations for the delivery of SP in socioeconomically disadvantaged settings Explore and assess the interactions between LWs and patients experiencing socio-economic disadvantage Integrate findings to produce recommendations to support the equitable provision of SP and develop an initial framework for designing and evaluating a social prescribing intervention tailored to socioeconomically disadvantaged settingsMethods I will conduct a mixed-methods study with three interlinked workstreams (WS). WS1: A meta-ethnography to produce a conceptual model of LWs' experiences of SP. This conceptual model will be further developed through interviews with 25 LWs to understand their experiences of building connections between primary care and community organisations in socioeconomically disadvantaged settings. WS2: Mixed-methods case studies exploring the ways in which LWs establish relationships and networks for SP and the implications of these networks on patient outcomes. I will recruit five LWs as cases and up to eight patients per LW. Interviews, surveys, and observations will be used to collect data relating to LW interactions and patient experiences. Social network analysis will be applied to measure and understand how LW networks and interactions shape patient outcomes. Follow-up data collection will take place after 6-9 months to observe changes in relationships and outcomes over time. WS3: Findings will be brought together using triangulation and consultation with key stakeholders to produce recommendations and an initial framework to inform the development and evaluation of SP interventions tailored to socioeconomically disadvantaged settings. Timelines: Year1: protocol developments; complete WS1 and begin WS2 Year2: WS2 Year 3: WS 3 - develop recommendations and an initial framework for the evaluation and development of SP interventions; dissemination. Anticipated impact/dissemination Recommendations to support policy and increase the equitable provision and implementation of SP for patients will be disseminated using innovative approaches (e.g. RapidMooc videos and policy briefs) and through academic publications/presentations.

Lay abstract: Background Social prescribing (SP) is an important part of the NHS. SP involves GPs and other healthcare professionals prescribing social activities with the aim of improving people's health by addressing social aspects that may be making them unwell For example, by reducing loneliness or helping to address worries about money or housing. Examples of social prescriptions include volunteering, social clubs, walking groups, as well as benefits and housing advice.The NHS employs link workers (LW) in GP surgeries to provide SP to patients. LWs spend time talking to patients to understand what matters to them in terms of their health and wellbeing. They then link patients to community organisations that might be able to help. For SP to work, link workers must be able to form connections and relationships with community organisations as well as with patients. We don't know whether, or how, social prescribing works in areas with high poverty levels. In these areas, LWs might struggle to make connections with community organisations as there may be fewer of these compared to less disadvantaged areas. Link workers may also find it challenging to build relationships with patients who may be struggling to get by.Aim My research will explore whether, and how, SP works in areas with high levels of poverty by looking at how LWs form relationships and connections with patients and community organisations. Findings from this research will help services be designed to allow for patients from disadvantaged areas to benefit from SP. Health services will benefit because the research will highlight the resources needed to be able to deliver SP.Methods To answer my research questions, my project includes three different streams of work. Stream 1: I will do a systematic review of the literature to understand how LWs in disadvantaged areas experience and undertake their role. I will also interview 25 LWs who work in disadvantaged areas. The interviews will help us understand how they connect with organisations. The review and the interviews will give me a new understanding of the topic and an initial framework to understand link worker experiences. It will also help me plan work for stream 2.Stream 2: I will use case studies of link workers in disadvantaged areas to understand, in detail, how they form connections and relationships with organisations and patients.I will use a research approach called social network analysis to map, measure, and understand how LWs make connections with organisations and patients. This will help me understand whether, and how, social prescribing is working in disadvantaged areas. I will collect data using interviews, observations and surveys with both link workers and patients and repeat these after 6-9 months. Stream 3: I will bring all my research findings together using workshops with key stakeholders and members of the public. They will help produce an initial framework to inform the development and evaluation of a social prescribing intervention tailored to disadvantaged areas. Patient and Public Involvement I held three PPI engagement workshops to help inform this project, attended by 30-35 PPI contributors. Two members of the public reviewed the plain English summary. I will establish a project PPI group that will give me feedback on areas such as materials for participants, my interpretation of the data and dissemination.Dissemination I have support for this research from key organisations such as NHS England, the Royal College of General Practitioners and the National Social Prescribing Network. I will use these contacts to help me disseminate my findings. I will also take part in public engagement events, such as 'Pint of Science' so that my research reaches a wider audience.

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: DISPUTED AETIOLOGY AND OTHER