Effective and achievable evaluation in social prescribing: What is needed, for whom and how?

A person-centred approach to addressing people’s holistic needs is a cornerstone of social prescribing. It underpins the activities of link workers who are key to social prescribing’s delivery. How then do we reflect this within evaluations that often collect standardised data and provide aggregated scores on questionnaires or other measures? This tension was one of the issues raised at a meeting held by the All Ireland Social Prescribing Network Research and Evaluation Working Group in June 2023. I was honoured to give a keynote talk at the start of the day. In it, I highlighted some major issues to consider in evaluating social prescribing, based on research our team at the Oxford Social Prescribing Research Network had been conducting. 

Overview of the day

The meeting was attended by over 60 people. Many were engaged in delivering social prescribing; there were also some people present who had received this support as service users or patients. A World Café approach directed the format of the meeting, which is based on the idea of creating a hospitable environment, where people feel free to converse. It was facilitated by Pat Tobin. A pleasant working space, as highlighted in this photo of the room set up, helped to engender a relaxed and welcoming atmosphere to the day.

As part of a World Café approach, small group discussions were held. Everyone’s views and contribution were valued and people were able to listen and explore thoughts together. Small group discussion points included:

• What is your vision/purpose for social prescribing?
• What are the outcomes associated with this purpose? What would success look like?
• What approaches/measures could or should be used to evaluate these outcomes?
• What have you heard from today that can help you with evaluating your social prescribing service?
• What are the key recommendations regarding evaluation that you want the All Ireland Social Prescribing Network to advocate for on your behalf with national social prescribing funders? 

Diverse contributions and perspectives were captured during the day by a graphic facilitator, Tamsin Cavaliero. At the end of the day she shared and talked the group through the illustrated representation she had produced of key topics covered (see photo below).

A summary of key topics

During the day I acted as a table host. This meant that I facilitated small group discussions. Through this, I was privy to some interesting conversations about social prescribing and evaluation. Here are some key topics that were raised with the people who joined my table:

Potential outcomes for people receiving social prescribing: These outcomes were described as diverse, and could include emotional support, social connection, a more fulfilled life, increased resilience, feeling less isolated, and having a valued social role.

Community building: Part of the link worker role was depicted as building community connections and developing provision (e.g. groups or other support) when gaps were identified. The paperwork associated with establishing groups could be off-putting according to link workers in the group. However, they also noted that for link workers, building a good range and knowledge of available community resources was a valuable outcome in their role. Reimbursement for community organisations involved in social prescribing was mentioned as part of this discussion.

Link workers as a conduit not a resource: It was stated at the table I hosted that link workers are not the intervention so should not be responsible for supporting people indefinitely. It was felt that training for link workers should be clear about this.

Successfully managed waiting list: This was seen as an outcome of interest to link workers; appropriate referrals, because colleagues were aware of the purpose of the role, was depicted as essential for this to be achieved.  

Support for link workers: Advisory groups were mentioned as important – somewhere link workers could present challenging cases for advice. Likewise, it was suggested that administrative support should be provided rather than expecting link workers to collect outcome data themselves. Furthermore, training provided was an area that attendees at the meeting felt should be regularly evaluated, to ensure it met the support and development needs of link workers.

The ethics of collecting data: It was noted that people engaged in social prescribing may feel they have to provide details about their situation and background when asked. Being clear as data collectors about what is required and why was raised. It was stated that funders need a rationale for any pieces of data requested, which must be communicated to people being supported by a link worker. It was also suggested that link workers require emotional intelligence to understand when to stop asking questions on a measurement tool if the individual they were helping showed signs of distress or unease. It was proposed that any evaluation or measurement of social prescribing had to be easy to implement and simple for people to understand.

Time to act on learning: Group members argued that part of the link worker role should include time to reflect on any data collected. Having the opportunity for critical learning, rather than collecting data for the sake of it, was called for – to understand and build on positive and negative outcomes. 

Conclusion

The day was a wonderful opportunity for those involved in social prescribing to come together. Peer learning and support were in evidence as people shared experiences and resources. A wealth of learning points came from the day that will be distilled and acted upon by the All Ireland Social Prescribing Network. Discussions during the day highlighted challenges associated with evaluation and measurement in this area. That said, there was commitment and energy to doing the best for people engaged in or providing social prescribing by developing solutions and guidance around this complex and difficult topic of its evaluation.  

Stephanie Tierney co-leads the Oxford Social Prescribing Research Network. Thanks to Professor Deirdre Connolly, Trinity Centre for Health Sciences, for the invitation to talk at this meeting.