Programme theory from rapid realist review on older people, social prescribing and the cultural sector in the context of the COVID-19 pandemic

This blog present some early findings from our rapid realist review. We are writing up what we found for publication in an academic journal. In the process of doing this, some of the findings below may change slightly in our final publication. 

The cultural sector’s potential to support health and well-being

An inability to visit, in person, cultural venues over various lockdowns in the UK during 2020/2021 has highlighted the importance of such settings to many people’s lives. Examples of the broad benefits gained from engaging with cultural venues include taking time to be still in a public garden, becoming absorbed in a book group discussion at a local library, or sitting in a museum café and enjoying being in a space with others. This makes cultural venues a suitable option for social prescribing.

Social prescribing involves linking people experiencing psychosocial difficulties (e.g. loneliness, low mood, anxiety) to ‘community assets’ – groups, organisations, settings, clubs, charities – that might help. Link workers are employed to connect people to community assets as part of social prescribing.

The potential role of cultural venues in social prescribing has been curtailed due to COVID-19, although attempts have been made by places like museums, public gardens and libraries to provide online services and activities. As venues reopen and people return over the coming months, the benefits experienced in the past will be available, although the landscape will be shaped by the legacy of the pandemic (e.g. having safety procedures in place, potential concerns about being in a space with others).

Our research

We have been funded by the Arts and Humanities Research Council to explore the following question: Cultural institutions as social prescribing venues to improve older people’s wellbeing in the context of the COVID-19 pandemic: What works, for whom, in what circumstances and why? Here, we describe in brief some of the findings from our rapid realist review, which forms the first part of this research. Further details on the study, and how we located papers to include in the review, are described in previous blogs.

What we found in the literature

From reading existing, relevant literature, we have produced a theoretically plausible depiction of how older people (aged 60 or above) gain positive outcomes from engaging with a cultural offering as part of social prescribing. The importance of tailoring is central to this; it refers to the shaping of an intervention and its distribution to meet the needs of recipients and providers in a way that reflects the environment and circumstances in which it is delivered.

Tailoring can apply to older people’s pathway to a cultural offering as part of social prescribing (e.g. link workers knowing how to present the idea of engaging with the cultural sector based on an individual’s preferences, needs and concerns, link workers being aware of the range of cultural offerings available locally) and in the offering itself (e.g. how to transfer activities online). The necessity for tailoring reflects the diverse nature of the actors involved (older people, cultural sector staff and link workers), who will have differing demands, expectations and investment in cultural offerings delivered as part of social prescribing.

The following table summarises key concepts we developed from engaging with the literature. They help to explain ways in which tailoring may occur to encourage someone to accept a referral from a link worker to a cultural offering, and potential benefits from doing so.

Our programme theory

A programme theory is a proposition of how an intervention (in this case the cultural sector through social prescribing pathways) is thought to work, under what conditions and for whom. Based on the concepts listed above, derived from our engagement with the literature, we produced the programme theory presented in Figure 1. The next stage in our research is to test and refine this programme theory by collecting our own data. This will involve interviewing older people and cultural sector staff, and conducting a survey with link workers. We would welcome any comments you have to make on our work so far:

• Stephanie Tierney (stephanie.tierney@phc.ox.ac.uk)
• Kamal R. Mahtani (kamal.mahtani@phc.ox.ac.uk)

Figure 1: Programme theory created from the rapid realist review

This research is funded by UKRI/AHRC (AH/V008781/1). Views expressed are those of the authors and not necessarily those of their host institution, organisations mentioned or funding bodies.