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Members of the Oxford Social Prescribing Research Network are developing and refining a programme theory that centres on the use of culture to support the well-being of older people during the pandemic.

Pitt Rivers museum © Ian Wallman

The important role of culture in helping people to navigate and recover through the COVID-19 pandemic is increasingly being recognised. As examples, we are seeing greater uptake of virtual home-based activities such as singing in choirs and dance classes (one of us attends Zoom tap classes – see photo), the purchasing of craft kits/materials, and the streaming of theatre performances. Furthermore, there has been considerable interest in people wanting to spend more time outdoors enjoying green spaces and curated gardens. Libraries and museums have also tried to be agile in responding to the difficulties faced during 2020/21, by running online tours and activities.

(Stephanie Tierney taking part in a weekly online tap dancing class – improvising with a hat and cane)(Stephanie Tierney taking part in a weekly online tap dancing class – improvising with a hat and cane)

In a previous review, we highlighted how gardens, libraries and museums can contribute to well-being. During the pandemic, use of these community assets has been beneficial in helping people to cope – distracting, educating, providing hope and bringing enjoyment. Yet, at the same time, a lot of cultural organisations face financial challenges and may be at risk of closure due to COVID-19.

In recognition of the cultural sector’s role in supporting well-being, during the pandemic but more broadly, we are conducting a study funded by the Arts and Humanities Research Council to address the question: Cultural institutions as social prescribing venues to improve older people’s well-being in the context of the COVID-19 pandemic: What works, for whom, in what circumstances and why?

For this research, we are completing a realist review. It will help us to consider what we can learn from the pandemic about cultural offerings as part of social prescribing for older people. Social prescribing involves connecting patients to ‘community assets’ – groups, organisations, clubs, charities – to address the ‘non-medical’ issues (e.g. loneliness, debt, hoarding, anxiety) that can affect how individuals feel physically and psychologically. Link workers are being employed within the NHS to facilitate social prescribing. They help patients to develop an action plan, which prioritises what matters to someone in terms of their health and well-being, and then links them to appropriate community assets. Link workers might meet with a patient on more than one occasion and could use motivational techniques to encourage individuals to try or attend new things.

To conduct the realist review, we started by producing an initial programme theory based on our existing knowledge of the topic and stakeholder consultations (with members of the public, those involved in social prescribing delivery and with cultural sector providers). A programme theory is a proposition (often in the form of a model or diagram) of how an intervention (in this case the cultural sector through social prescribing pathways) is thought to work, under what conditions and for whom (we are particularly interested in older people). We are now testing and refining this initial programme theory by drawing on relevant existing literature.

The figures shown here illustrate our initial programme theory (please click on the titles to expand into a bigger version). Our initial programme theory for this study has two parts. The first relates to the pathway through which older people get connected to the cultural sector via social prescribing. Within this first part of the initial programme theory there are the key players involved – link workers (who connect patients to community assets), cultural sector staff (in our review, we are focusing on gardens, libraries and museums – GLAM venues) and older people (aged 60 and above). It highlights that there needs to be an interaction between link workers and cultural sector staff. Link workers must know what is available and be happy that a cultural sector offering is safe and appropriate for people they might refer. Likewise, the cultural sector must communicate what it can offer and make its offerings attractive to link workers. In addition, link workers must explore if the cultural sector fits the individual they are trying to help. This might not be the case for everyone, or it might entail encouraging someone to consider new options and to go outside of their comfort zone.

Part 1 of the programme theory: How older people get to social prescribing opportunities offered in the cultural sector

Part 1 of the programme theory: How older people get to social prescribing opportunities offered in the cultural sector

The second part of our initial programme theory emphasises what might happen when an older person accepts a referral to a cultural venue or activity as part of social prescribing. It includes concepts such as distraction, feeling cared for, enjoyment, building skills and knowledge, which can help with some of the things that link workers address routinely with patients (e.g. poor self-esteem, loneliness, lack of structure to a person’s week). In the part 2 figure, we have listed on the right things that we think the cultural sector (as noted above, in our review we focus on GLAM venues) needs to consider when planning to provide social prescribing offerings within the context of the pandemic and as we move out of this situation.

Part 2 of the programme theory: How older people benefit from social prescribing opportunities offered in the cultural sector

Part 2 of the programme theory: How older people benefit from social prescribing opportunities offered in the cultural sector

These are issues to be explored as we engage with the literature as part of the realist review and test/refine our initial programme theory. We would welcome your comments, thoughts and insights on our initial programme theory, which we can then reflect on and add to our thinking. 

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