Social Prescribing in Primary Care: A Realist Review

Research areas: Prevention and screening, Psychological & psychiatric interventions

Duration: April – November 2025 (5.5 PM)
Language: English (with a detailed German summary)

 

Background:
Primary care is the first point of contact between patients and the health care system. In addition to initial care, primary care tasks include prevention, patient information and multidisciplinary and integrated care [1]. However, patients often approach primary care with health-related but non-medical problems. Yet, primary care practitioners often do not have the knowledge or time to recommend appropriate interventions [2]. 

One approach to reducing the burden on primary care and promoting a holistic approach to health is social prescribing (SP). In SP, patients with non-medical health related needs are referred to a link-worker. The link-worker then discusses with the patient what their exact needs are and refers them to services in the area. Depending on the needs, the services may address material and/or social, or self-actualisation needs. In addition to reducing the burden on the health system, SP aims to improve patient access to regional services, promote health equity and achieve economic sustainability [3].

SP is a complex health intervention. The complexity of an intervention increases with (1) the number of components involved, (2) the variation in behaviours and knowledge required, (3) the number of groups of people involved, and (4) the degree of flexibility in its delivery. In addition, the intervention outcomes may vary depending on contextual factors. This includes changes in the outcomes and contexts through increasing participant’s familiarity with the intervention [4].

In Austria, following two funding calls, SP has been implemented in 24 primary health care centres between 2021 and 2024 under the supervision and support of Gesundheit Österreich GmbH (GÖG). Initial results show that SP is well suited for multidisciplinary teams, the majority of the patients could be referred, and almost all would recommend SP to others [5]. In addition, an Austrian ideal model was defined to provide a common understanding of SP in Austria. According to this model, the process of SP in Austria is as follows [3, 6]:

1.     Patient with non-medical needs is recognised

2.     Patient is referred to a link worker

3.     Consultation with link-worker takes place

4.     Result is reported back to the health care team and documented

5.     Patient takes part in the regional service

Additionally, they defined four core mechanisms of SP [3]:

• Increasing awareness among health care professionals
• Link-working consultations
• Network management
• Quality assurance

Project aims:
Based on the theoretical and practical preliminary work of the GÖG on SP in Austria, the theoretical model behind SP will be further developed. Empirical data from SP evaluations will be used to determine which SP approaches work for which target groups, in which contexts and in what ways. The following research questions (RQ) will be answered:

RQ1    What are the theoretical mechanisms of SP based on the Austrian ideal model?

RQ2    What outcomes can be expected in which contexts, and for which target groups?

Non-objectives

• It is not the aim of this review to summarise whether SP is effective overall, i.e. no classical systematic review will be conducted, but rather, the aim is to reveal what results can be expected under which conditions.
• No alternative context for SP apart from primary care will be identified or assessed.
• No new process will be defined for Austria, the already defined process and the proposed ideal model of the GÖG will be further elaborated, refined and the individual aspects expanded with evidence from international literature.
• The implementation of SP in Austria will not be evaluated, but the implementation experiences in Austria will be used to develop the program theory.

Methods:
The Realist Evidence Synthesis or Realist Review (RR) method is used to address the RQs. A RR is an approach to evaluating the evidence for complex social interventions, in which the theoretical and often implicit mechanisms behind an intervention will be made explicit. However, instead of assessing whether an intervention is effective in principle, it is investigated why, for whom, in what context and in what way it works [7]. The results of this work are intended to provide concrete recommendations for different implementation scenarios to support a possible nationwide implementation of SP in Austria in the future.

The RR methodology follows an iterative process: based on the RQ, an initial programme theory (IPT) is developed, which is then tested and continuously refined through an iterative literature search and selection process. It is not limited to specific types of evidence but includes both quantitative and qualitative evidence. The quality of the literature is assessed according to its relevance and precision. Data are extracted, coded and analysed using Context-Mechanism-Outcome-Configurations (CMOCs) to identify patterns (semi-regularities). The result is a refined programme theory that shows under what circumstances and by what mechanisms SP leads to certain outcomes.

Preliminary data extraction:

General information	Authors, publication year, country
Study characteristics	Study design, sample size, results, target population
Intervention	Description of the intervention, intensity and process, setting
Process details	Comments on fidelity to intervention & changes made by implementers
Context	Study background
Theories	Theories about mechanisms of action that affect the success/failure of the intervention

Timetable:
A realist review is an iterative process. The timetable serves as a rough structure, but the steps often take place in parallel, depending on new findings.

Period	Tasks
April 2025	Scoping and finalising of the project protocol
May 2025	First definition of the program theory Systematic literature search
June 2025	Data extraction and quality appraisal Re-evaluation of the program theory
July – August 2025	Writing
September - October 2025	Internal and external review
November 2025	Layout & publication

References:
[1]  Franczukowska A., Krczal E. and Braun A. Primärversorgung in Österreich – Quo vadis? Zeitschrift für Allgemeinmedizin. 2020;96(11):467-471. DOI: 10.3238/zfa.2020.0467-0471
[2]  Capper K. and Plunkett J. A very general practice. How much time do GPs spend on issues other than health? : 2015 [cited 17.04.2025]. Available from: https://www.citizensadvice.org.uk.cach3.com/Global/CitizensAdvice/Public%20services%20publications/CitizensAdvice_AVeryGeneralPractice_May2015.pdf.
[3]  Rojatz D., Antosik J., Ecker S., Fenz L. and Haas S. Social Prescribing. Entwurf eines Idealmodells für Österreich. Vienna: 2023 [cited 07.04.2025]. Available from: https://jasmin.goeg.at/id/eprint/3049/1/Idealmodell%20barrierefrei.pdf.
[4]  Skivington K., Matthews L., Simpson S. A., Craig P., Baird J., Blazeby J. M., et al. Framework for the development and evaluation of complex interventions: gap analysis, workshop and consultation-informed update. 2021;25:57. DOI: 10.3310/hta25570.
[5]  Kettl J., More-Hollerweger E., Miericke A. and Schöggl S. Social Prescribing in Österreich: Eine Wirkungsanalyse der aktuellen Umsetzung. Wien: 2024. Available from: https://research.wu.ac.at/ws/portalfiles/portal/69768996/NPO-CC_Social_Prescribing_Evaluation-Endbericht_2024_G_G.pdf.
[6]  Rojatz D., Unger T., Ecker S., Fenz L., Haintz G. and Haas S. Handbuch Social Prescribing in der Primär- und pädiatrischen Versorgung. Wien: 2025 [cited 03.04.2025]. Available from: https://jasmin.goeg.at/id/eprint/4501/1/Handbuch%20Social%20Prescribing_bf.pdf.
[7]   Pawson R., Greenhalgh T., Harvey G. and Walshe K. Realist synthesis: an introduction. University of Manchester, 2004.