Identifying meaningful change in social prescribing: A Storytelling discussion meeting

Social prescribing is a person-centred approach to the non-medical issues affecting people’s health and well-being. It is shaped around the notion of ‘what matters to me’, focusing on an individual’s specific circumstances and needs, and their priorities. It involves connecting people, when appropriate, to relevant support or services, often based in the voluntary-community sector. Social prescribing link workers undertake this connecting role with people they support.

The varied ways in which people are supported through social prescribing can mean that what constitutes success differs from individual to individual. This means that the use of standardised methods (e.g. predefined questionnaires) can be problematic as this may not pick up benefits that an individual has encountered through their social prescribing journey. This has resulted in debates about how and what to measure in research or evaluations in this area. One approach we have tried recently is the use of Storytelling.

What is Storytelling?

Storytelling is an evaluation technique inspired by Most Significant Change (MSC) and developed by the Old Fire Station (OFS) Arts Centre in Oxford. It involves collecting stories from people about their experience of a project (or area of focus) and bringing a diverse group of people together to discuss the stories and what can be learned from them. Storytelling is creative, accessible, and aims to preserve the complexity of people’s experience rather than reducing rich, context-specific interactions to abstract data points. It is person-centred and underpinned by the belief that meaningful human connection supports empirical discovery. Unlike many conventional approaches to measurement, it centres on the experiences of those most involved rather than the perspectives of external evaluators. Storytelling is collaborative and enjoyable in and of itself, which can lead to rich and versatile learning.

Storytelling involves trained ‘story collectors’ talking to relevant ‘storytellers’ (in this instance, providers and users of social prescribing) about their experiences. Its conversational format helps participants to reflect on (and potentially discover) what was meaningful for them. Story collection is framed around four open questions (although these might be asked using different words or in a different order): 

• What was your involvement?
• What changed for you?
• Why was that change important?
• How did this change happen?

Storytelling evaluations usually collect stories from about ten people in total. Each conversation is condensed into an edited two-page story that reflects the storyteller’s key insights and preserves their voice. The stories are then shared with key stakeholders, who are invited to discuss them at a meeting. The meeting seeks to understand what can be learnt from the insights of the storytellers, and how this can inform practice development (e.g. in social prescribing). More information about Storytelling can be found here. 

Storytelling and social prescribing

Following a knowledge exchange event held by the Oxford Social Prescribing Research Network in June 2022, we have been discussing the potential role that Storytelling might play in social prescribing evaluation. Thanks to funding from Lankelly Chase Foundation and Oxford University’s Innovation and Engagement team, we had the opportunity to try it out with a social prescribing service provided by Age UK Oxfordshire (AUKO). This pilot was part of the Meaningful Measurement Inquiry – an initiative which works with partners across Oxfordshire to experiment with different ways of measuring impact to learn what is needed for us to do this in meaningful ways.

Members of AUKO’s team were trained in Storytelling (and collecting stories) by staff from OFS. Stories were collected from eight people (five from older people who had experienced social prescribing, the others from individuals delivering this support). On June 8 2023, twenty people (including some individuals who had told their story) attended a three-hour meeting. Participants included colleagues from AUKO, OFS, Oxford Hub, University of Oxford (Centre for Evidence Based Medicine, Gardens, Libraries and Museums - GLAM) and Oxford Community and Voluntary Action. At the meeting, hosted and facilitated by OFS, we discussed eight stories (16 pages in total). Here, we reflect on the meeting and what it told us about a) the social prescribing service, b) using Storytelling to evaluate social prescribing. 

Key issues from the stories

Stakeholders were surprised at the range of issues raised in the stories, which gave us a number of areas for discussion in terms of social prescribing and its delivery. Key issues included:

• Loss: Stories often had an element of loss within them, which acted as a trigger to someone seeking external support through social prescribing. This included loss of health, identity, partner, financial stability, social status, function, way of life. This loss had resulted in a narrowing of people’s social world due to illness, bereavement, retirement, unemployment.
• Not for me: A potential barrier to accessing social prescribing was people not thinking they were a suitable candidate for it. Stories we looked at suggested that people thought they were not ‘bad’ enough to receive support from a link worker, or they had resigned themselves to the belief that this was how life was going to be from now on.
• Halting a decline: The ability of link workers to stop people’s downwards trajectory (physical and/or psychological) was outlined in stories we read. These stories suggested that before engaging in social prescribing, people’s life seemed to be in freefall in a negative direction and they felt unable to stop this from occurring on their own.
• Fostering optimism: Link workers helped people to feel they had options, suggesting tangible things to try, which gave people hope that their life did not have to continue in a downward trajectory.
• A skilled role: The talents/abilities required of link workers were described as many and varied. For example, they had to be able to forge and manage several relationships at the same time across different groups – with patients, with healthcare professionals, with staff from community organisations and groups. As part of this, link workers tread a fine balance between encouraging people to try things without pushing them into doing something they were not ready for or that was not right for them. 

Learning points for use of Storytelling in social prescribing

The meeting ended by asking those present to comment on the benefits, challenges and opportunities of using Storytelling to evaluate social prescribing services. Thoughts on this included:

• Benefits: Storytelling offered visceral, emotive accounts of experience that helped participants in the discussion to see things from the perspective of social prescribing clients. The stories preserved the complexity of social prescribing and highlighted the seemingly ‘little things’ that can mean the most to people. In this sense, participants in the discussion felt that Storytelling was aligned with the values of social prescribing, a practice that is itself about making space for evolving relationships and social discovery. This evaluation method was also shown to be a reflective exercise in its own right, and therefore had benefits for the storytellers (who enjoyed telling their stories) rather than being an extractive or irritating add-on.
• Challenges: It was noted that the process of collecting stories is skilful and emotionally taxing, and that story collection requires training and support. The Storytelling methodology as a whole is time consuming and text heavy, meaning that it could be less accessible to some, and that those engaging with it need to devote significant time to reading and analysing the stories. This can be a big ask, especially for busy clinical staff whose perspectives would be very valuable, but who are often unable to make time for processes like this. Participants also emphasised, however, that time is necessary for certain kinds of complex, relationship-based work to succeed, and that persuading commissioners and clinicians of the value of this approach (and therefore the importance of allocating resources) is an important challenge to address.
• Opportunities: Many participants observed that people in commissioning roles were frustrated with some conventional evaluation methods and had an appetite for good qualitative data. Hence, Storytelling was proposed as a way to ‘win the hearts and minds’ of commissioners. While some suggested that Storytelling was difficult to apply at scale, others argued that the depth and the repetition contained in its small samples affirmed the value of this approach. Storytelling was seen as a tool that could be used alongside larger scale quantitative methods.

A report detailing the learning from this pilot will be produced. It will inform the development of wider work using Storytelling to evaluate social prescribing.

• Stephanie Tierney is a Senior Researcher based at the Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford. 
• Will Long is Creative Engagement and Learning Coordinator at the Old Fire Station, Oxford.

This pilot of using Storytelling to evaluate social prescribing was funded by the Lankelly Chase Foundation and Oxford University’s Innovation and Engagement team. The views expressed are those of the authors and not necessarily those of their funders or their host institutions.