sus ainabili y
Sys ema ic Re iew
E ec i eness o Social P esc ibing P og ams in he P ima y
Heal h-Ca e Con ex : A Sys ema ic Li e a u e Re iew
And eia Cos a 1,2,3,* , C Joana Sousa 1, Paulo Rosá io Ca alho Seab a 2, Ana Vi golino 1, Os aldo San os 1,4,
Joaquim Lopes 2, Ad iana Hen iques 1,2 , Paulo Noguei a 1,5 and Viole a Ala cão1,6


Ci a ion: Cos a, A.; Sousa, CJ.;
Seab a, P.R.C.; Vi golino, A.; San os,
O.; Lopes, J.; Hen iques, A.; Noguei a,
P.; Ala cão, V. E ec i eness o Social
P esc ibing P og ams in he P ima y
Heal h-Ca e Con ex : A Sys ema ic
Li e a u e Re iew. Sus ainabili y 2021,
13, 2731. h ps://doi.o g/10.3390/
su13052731
Academic Edi o : Vincenzo To e a
Recei ed: 11 Feb ua y 2021
Accep ed: 27 Feb ua y 2021
Published: 3 Ma ch 2021
Publishe ’s No e: MDPI s ays neu al
wi h ega d o ju isdic ional claims in
published maps and ins i u ional a il-
ia ions.
Copy igh : © 2021 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
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dis ibu ed unde he e ms and
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A ibu ion (CC BY) license (h ps://
c ea i ecommons.o g/licenses/by/
4.0/).
1Ins i u o de Saúde Ambien al (ISAMB), Faculdade de Medicina, Uni e sidade de Lisboa,
1649-028 Lisboa, Po ugal; [email p o ec ed] (CJ.S.); [email p o ec ed] (A.V.);
[email p o ec ed] (O.S.); [email p o ec ed] (A.H.); [email p o ec ed] (P.N.);
[email p o ec ed] (V.A.)
2Nu sing Resea ch, Inno a ion and De elopmen Cen e o Lisbon (CIDNUR), Nu sing School o
Lisbon (ESEL), 1600-096 Lisboa, Po ugal; [email p o ec ed] (P.R.C.S.); [email p o ec ed] (J.L.)
3Ca ólica Resea ch Cen e o Psychological, Family and Social Wellbeing, Faculdade de Ciências Humanas,
Uni e sidade Ca ólica Po uguesa, Palma de Cima, 1649-023 Lisboa, Po ugal
4Unb eakable Idea Resea ch, Lda, 2550-426 Painho, Po ugal
5Labo a ó io de Bioma emá ica, Ins i u o de Medicina P e en i a e Saúde pública, Faculdade de Medicina,
Uni e sidade de Lisboa, A enida Egas Moniz, 1649-028 Lisboa, Po ugal
6Cen o de In es igação e Es udos de Sociologia, ISCTE—Ins i u o Uni e si á io de Lisboa (ISCTE-IUL),
A enida das Fo ças A madas, 1649-026 Lisboa, Po ugal
*Co espondence: and [email p o ec ed]; Tel.: +351-919-464-206
Abs ac :
Social p esc ibing (SP) is an app oach ha p omo es he use o local non-clinical ac i i ies by
people. The e e al is usually made by p ima y heal h-ca e p o essionals, in a p ocess whe ein local
p o ide s play a pi o al ole. The main objec i e o his s udy was o iden i y domains o in e en ion
and e idence abou he e ec i eness o SP p og ams ega ding heal h- ela ed ou comes. A sys ema ic
li e a u e e iew was ca ied ou ollowing P e e ed Repo ing I ems o Sys ema ic Re iews and
Me a-Analyses (PRISMA) guidelines. A li e a u e sea ch was conduc ed in PubMed, CINHAL,
and SCOPUS. Inclusion c i e ia o he e iewed pape s we e as ollows: (i) e ec i eness s udies o
in e en ions designa ed as SP o in e en ions en ailing SP concep ual componen s;
(ii) in e en ions
wi h adul s. Quali y assessmen was pe o med wi h he Coch ane ool o assessing isk o bias
in andomized ials; an assessmen ool de eloped by he US Na ional Hea , Lung and Blood
Ins i u e was applied o obse a ional s udies. O e all, 13 a icles we e included o analysis, wi h
a o al o 4603 pa ien s. Al hough h ee s udies comp ised a con ol g oup, only wo ollowed a
andomized con olled ials (RCT) design. Nine p incipal domains o in e en ion wi hin SP we e
iden i ied, wi h h ee ca ego ies o ou come measu es: Physical and psychological wellbeing; Heal h
beha io s and sel -e icacy; and Heal h ca e esou ces end economic e alua ion. SP is an eme gen
and p omising heal h-ca e in e en ion, and i has been used o p omo e di e en heal h beha io s.
E idence o SP e ec i eness on pa ien ’s heal h and wellbeing is no s ong. Fu he esea ch is
needed o unde s anding how SP can be applied e icien ly.
Keywo ds:
social p esc ibing; communi y e e al; heal h-ca e; heal h p omo ion;e ec i eness as-
sessmen ; heal h equi y; social de e minan s o heal h
1. In oduc ion
Gains in li e expec ancy inc eased d ama ically wi hin he las cen u y, aising mo e
and mo e a en ion on he wellbeing ha needs o be ensu ed h oughou he ex a yea s o
li e expec ancy [
1
]. These public heal h gains pu addi ional p essu e on he heal h-ca e
sys em. Ac ions o p omo e a heal hy and sus ainable en i onmen al heal h-ca e con ex
a e essen ial, alongside a icula ed and in e sec o al esponses and adequa e heal h and
social policies.
Sus ainabili y 2021,13, 2731. h ps://doi.o g/10.3390/su13052731 h ps://www.mdpi.com/jou nal/sus ainabili y
Sus ainabili y 2021,13, 2731 2 o 18
The aging p ocesses aise se e al non-clinical needs o in e en ion, which a e ela ed
o heal h and wellbeing [
2
]. Some o hese needs a e linked o a seden a y li es yle, social
isola ion, low communi y cohesion and pa icipa ion, poo cogni i e s imula ion, and
loneliness, among o he ac o s [
3
]. As hese ac o s a e ypically conside ed ou o he
scope o clinical in e en ions, hey a e no me wi h a sui able esponse in he con ex
o he se ices adi ionally p o ided by exis ing heal h s uc u es, which a e mos ly
cen e ed on he disease and i s mani es a ions. Ne e heless, bo h clinical and non-clinical
in e en ions a ge ing people’s eal needs a e depic ed as pi o al ac ions in he 2030
Agenda o Sus ainable De elopmen [
4
]. Wi hin his amewo k, he e is a need o
complex in e en ions in complex sys ems, which a e adap ed o he di e en con ex s in
which he heal h in e en ion is implemen ed [5,6].
C ea ing heal hy en i onmen s can be complex and should ely on con inuing esea ch
o he e ec s o exposu e o en i onmen al haza ds on people’s heal h. These haza ds
can be o social na u e, such as dep i ed socioeconomic condi ions, and no inclusi e and
dis up i e socie ies. Ac ing upon hese ecological pa hogenic and inequi y-p omo ing
ac o s and main aining a heal hy en i onmen is c ucial o e icien ly p omo e public heal h
and o inc ease he quali y o li e and mo e yea s o heal hy li e [
7
,
8
]. A key de e minan
o p omo ing men al and physical heal h is he s abili y o social connec ions (i.e., social
cohesion), such as he exis ence o a s able and suppo i e local social en i onmen [9].
Social p esc ibing (SP) is a ela i ely new app oach in heal h-ca e. Sho ly, SP can be
desc ibed as he c ea ion o e e al pa hways ha enable connec ing people wi h heal h,
social, o p ac ical needs wi h local (i.e., accessible) p o ide s o non-clinical se ices [
10
].
The e e al is mainly done by p ima y heal h ca e p o essionals (e.g., doc o s, nu ses, social
se ice wo ke s), who p esc ibe ac i i ies de eloped by he e ia y sec o (councils, cul u al
and ec ea ional associa ions, pa ishes, e c.) in he local se ices o he communi y [
11
].
By ecognizing ha people’s heal h is de e mined syne gis ically by se e al biological,
social, economic, and en i onmen al ac o s, SP seeks o espond o heal h needs in a
holis ic way, also aiming o help people assume a g ea e con ol and sel -managemen
abili y o e hei heal h. The e a e di e en models o SP e e al pa hways, including
(1) di ec e e al om p ima y ca e o (2) e e al media ed h ough link-wo ke -based
models [
12
]. In his las ype o SP model, he link-wo ke suppo s pa ien s o es ablish
hei pe sonal needs, se s goals, and a emp s o keep pa ien s’ mo i a ion high. The
link-wo ke may be loca ed wi hin a GP p ac ice, in he local communi y, o a mix o hese
al e na i es, depending on how he SP scheme has been de eloped [
13
]. Some examples o
SP-p omo ed ac i i ies include olun ee ing, a is ic ac i i ies, g oup lea ning, ga dening,
cooking, ad ice on heal hy ea ing, o in ol emen in physical o spo s ac i i ies. The SP
app oach o e s he popula ion a g ea e possibili y o communi y pa icipa ion, social
inclusion and social cohesion, and he possibili y o enhance, by he communi y i sel ,
indi iduals’ heal h and wellbeing [
14
]. SP is also p oposed as a con ibu ion o inc easing
he e iciency and u iliza ion o al eady exis en esou ces, in he communi y, educing
p essu e on heal h-ca e se ices [15].
Social p esc ibing has been de eloped mos ly in he Uni ed Kingdom (UK), ha -
ing been conside ed by he Na ional Heal h Se ice (NHS) as an inno a i e app oach o
suppo he sus ainabili y o he heal h sys em [
16
]. I also has he po en ial o p omo e
pa ne ships be ween communi y s uc u es, hus con ibu ing o link heal h and social
sec o s [
17
], o ming a local SP sys em [
18
,
19
]. As SP is apidly g owing in he UK, i is
also a ac ing in e na ional in e es . Ye ou side he Uni ed Kingdom (UK), SP is s ill no a
common p ac ice. So, i is impo an o lea n om wha has been done in he UK in o de
o unde s and wha ype o p og ams and SP in e en ions a e mos e ec i e. Indeed, a
cu en challenge is o sys ema ically colla e in o ma ion abou how SP is concep ualized,
ope a ionalized, and assessed in e ms o i s e ec i eness ega ding heal h and wellbeing
indica o s, and heal h se ices p oduc i i y [
20
]. SP has been associa ed wi h pa ien ’s
educed anxie y and dep ession, be e social ela ionships, and inc eased op imism and
hope [
20
], wi h educ ion o deple ion o se ices and p oduc s (medicines, medical ap-
Sus ainabili y 2021,13, 2731 3 o 18
poin men s, e c.) [
21
] and wi h e i alizing he link be ween he social and heal h sec o s
(i.e., p omo ing he eme gence o new communi y pa ne s) [
17
]. Howe e , he e is s ill
limi ed e idence on which ac i i ies a e mo e sui able o each popula ion g oup and cul u e,
and abou SP’s eal impac in e ms o he heal h and wellbeing o pa ien s.
The inali y o his s udy was o con ibu e o he unde s anding o how SP in e en-
ions may be e ec i ely applied in di e en popula ion and cul u al con ex s, aking in o
conside a ion he cumula i e e idence abou his heal h-ca e app oach. The main objec i e
was o loca e and summa ize e idence ega ding he e ec i eness o SP a ge ing he adul
popula ion assis ed in p ima y heal h-ca e se ings. Seconda y objec i es we e o iden i y
domains o SP in e en ions and ou comes mos equen ly used o assess i s e ec i eness.
2. Ma e ials and Me hods
2.1. S udy Design
A sys ema ic li e a u e e iew (SLR) was ca ied ou ollowing he epo ing guidelines
o P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-Analyses (PRISMA) [
22
].
Fi s , a scoping e iew was unde aken o asce ain which we e he mos equen ly used
s udy designs o e alua ing he e ec i eness o SP in e en ions. Since we ound a
di e si y o s udy designs, we decided o include in his SLR all pape s epo ing SP
in e en ions wi h any kind o assessmen o e ec i eness ou comes.
2.2. Sea ch Me hods
The li e a u e sea ch was conduc ed in h ee elec onic da abases: PubMed, CINHAL,
and SCOPUS. To ob ain he mos cu en up- o-da e e idence, a se o keywo ds di ided
in o wo main wo d-blocks was selec ed: equi alen o p oxy e ms ega ding SP and
equi alen o p oxy e ms abou e ec i eness. Each wo d o each block was combined
pai wise wi h he wo ds o he o he block (see Appendix A). The selec ion o e ms
was based on he scoping e iew ( aking in o accoun he keywo ds o pape s’ abs ac s)
and was de ined wi h he consensus o he esea ch eam. Fo PubMed, keywo ds we e,
whene e possible, Medical Subjec Headings (MeSH) e ms. The e was no a empo al
limi imposed o he sea ch as well as he e was no es ic ion o languages o he pape s.
The sea ch was conduc ed on 21 May 2020 in PubMed, on 25 h 2020 in CINHAL, and on
1 June 2020
in SCOPUS. All loca ed i les we e expo ed in o an excel ile and hen ga he ed
in o a single ile. Then, duplica ed en ies we e emo ed.
2.3. Selec ion o A icles and Inclusion and Exclusion C i e ia
To iden i y ele an a icles ha could mee he objec i es o his SLR, an ini ial selec-
ion by i le and abs ac was comple ed by wo membe s o he esea ch eam. Then, he
selec ed a icles we e iaged by eading he ull ex o he a icles. In addi ion, a manual
sea ch was used o iden i y addi ional pape s om he e e ences o he s udies ini ially
selec ed, and om o he SLR abou SP. These SLRs we e no included in he RSL analysis
bu we e used o loca ing addi ional pape s no e ie ed by he keywo d-based sea ch.
Pape s we e included i hey me he ollowing inclusion (cumula i e) c i e ia: (i) any
me hodological design e alua ing an SP in e en ion; (ii) add essing in e en ions desig-
na ed as “Social P esc ibing” o in e en ions en ailing SP p inciples (namely, men ioning
a e e al om he p ima y ca e sec o , ac i i y agen s/ acili a o s/link-wo ke wi hin he
communi y, o wi h a con inui y and accessibili y’s pe spec i e wi hin he communi y);
(iii) assessing
he impac o in e en ions; and (i ) including he adul popula ion. Exclu-
sion c i e ia included s udy p o ocols, na a i e e iews, sys ema ic e iews, and g ay
li e a u e (e.g., epo s, disse a ions, hesis).
2.4. Da a Ex ac ion, Quali y App aisal, and Da a Syn hesis
Two in es iga o s assessed independen ly he ull ex o he a icles. A hi d e-
iewe was equi ed o achie e consensus abou s udies o be included when he i s wo
in es iga o s we e no in ag eemen .
Sus ainabili y 2021,13, 2731 4 o 18
Da a we e ex ac ed, by he same wo in es iga o s, using a synop ic able wi h
p ede ined a iables ( ega ding iden i ica ion o he pape , s udy design, SP pa hway,
pa icipan s, ou comes, ma e ials, main esul s, limi a ions, and u u e ecommenda ions).
The ROB2.0 ool [
23
] was used o assess he quali y o a icles desc ibing andomized
con olled ials (RCT), by wo esea che s. To assess he quali y o a icles desc ibing obse -
a ional longi udinal designs (wi h p e- and pos -assessmen o ou comes, wi h o wi hou
a con ol g oup), o a icles desc ibing mixed-me hods designs, a quali y assessmen ool
de eloped by US Na ional Hea , Lung, and Blood Ins i u e was applied [24].
Finally, a na a i e syn hesis o he e idence was pe o med, summa izing he in e -
en ion domains (i.e., ac i i ies p oposed, h ough SP), models, selec ed ou comes, and
conclusions abou SP e ec i eness.
3. Resul s
O e all, 13 a icles we e conside ed eligible o da a ex ac ion and na a i e syn hesis
(Figu e 1).
Figu e 1. P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-Analyses (PRISMA) low diag am.
These selec ed a icles include wo RCT, i e non-con olled be o e and a e s udies
(one o hem wi h a longe - e m ollow-up), and six wi h mixed-me hods (quan i a i e and
quali a i e) app oach, one o hem using a ma ched con ol g oup (Table 1).
Sus ainabili y 2021,13, 2731 5 o 18
Table 1. Social p esc ibing s udies cha ac e is ics.
Au ho , Yea S udy Design Coun y, Region Ta ge Popula ion Social Con ex Social P esc ibing App oaches
Pescheny e al.,
2019 [25]
Obse a ional
non-con olled
be o e-and-a e s udy
UK, Lu on
Pa ien s who heal h p o essionals hough would bene i
om he p og am
A dep i ed a ea wi h a la ge
e hnic mino i y popula ion
“Enabling heal hca e p o essionals o e e
pa ien s o a link wo ke , o co-design a
non-clinical social p esc ip ion o imp o e
hei heal h and wellbeing” (p. 2)
Sumne e al.,
2019 [26]
Obse a ional
non-con olled
be o e-and-a e s udy
UK, Sou h Wes o
England
Pa ien s expe iencing anxie y, dep ession, o s ess; low
sel -es eem and/o con idence, o o e all educed
wellbeing; s ess om ch onic illness o pain; in need o
dis ac ion om beha io - ela ed heal h issues; o who
had expe ienced a ecen majo li e change o loss
Communi y mos ly wi h
caucasian people, wi h a iable
le el o dep i a ion, be ween
medium and e y low quin ile o
Indice o Mul iple Dep i a ion
“A s on p esc ip ion (AoP) is a ype o social
p esc ip ion ha e e s pa ien s o pa icipa e
in cou ses o a ” (p. 2)
P io e al.,
2019 [27]
Obse a ional
non-con olled
be o e-and-a e s udy,
wi h a longe ollow up
UK, bo ough o
Tameside
Use s aged ≥18 yea s, iden i ied as inac i e wi h a
ch onic heal h condi ion o signi ican heal h isk ac o s
Region wi h heal h inequali ies
and high le els o ch onic heal h
condi ions and physical inac i i y
“One app oach o Physical Ac i i y
p omo ion has been exe cise e e al schemes,
a o m o nonmedical in e en ion o ‘social
p esc ip ion’.” (p. 1)
Me ce e al.,
2019 [28]
Quasi-expe imen al
clus e - andomized
con olled ial
UK, Glasgow, Sco land
Use s > 18 yea s old A ea o high socioeconomic
dep i a ion
“ . . . aims o link pa ien s o non-medical
sou ces o suppo wi hin a communi y, hus
expanding op ions and esou ces beyond
hose adi ionally p o ided in
p ima y heal h ca e” (p. 1)
Ca nes e al.,
2017 [29]
Mixed-me hods s udy,
wi h a ma ched con ol
g oup
UK, London
Bo ough o Ci y and
Hackney
Use s in gene al p ac ices who we e equen a ende s
and/o socially isola ed
A ea wi h ex eme ange o
socio-economic dep i a ion and
a luence and a conside able
e hnic mix
“a non-medical e e al, o linking se ice, o
help people iden i y hei social needs and
de elop ‘well-being’ ac ion plans o p omo e,
es ablish o e-es ablish in eg a ion and
suppo in hei communi ies, wi h he aim o
imp o ing pe sonal well-being” (p. 2)
Kellezi e al.,
2019 [30]Mixed-me hods s udy UK, English Eas
Midlands
Abo e 18 yea s and ha we e managing one o mo e
long- e m heal h condi ions and eel isola ed,
lonely, o anxious
Rela i ely a luen subu ban a ea
ha expe ienced much lowe
le els o c ime/dep i a ion han
nea by u ban a eas
“A non-clinical app oach designed o suppo
indi iduals expe iencing ch onic
men al/physical heal h p oblems exace ba ed
by loneliness, o en leading o inc eased
heal h-ca e appoin men a endance (
. . .
) As
he name would sugges , SP also has a s ong
social elemen : i in ol es heal h
p o essionals encou aging pa ien s o join
olun a y, communi y and social en e p ise
g oups wi hin he hi d-sec o ”
(p. 2 o s udy p o ocol [31])
Woodall e al.,
2018 [20]Mixed-me hods s udy
UK, No he n England
Abo e 14 yea s old
A ea wi h a s ong hi d sec o
in as uc u e which enabled
se ice use s o be suppo ed
“To ha ness asse s wi hin he olun a y and
communi y sec o s o imp o e and encou age
sel -ca e and acili a e heal h-c ea ing
communi ies” (p. 2)

Sus ainabili y 2021,13, 2731 6 o 18
Table 1. Con .
Au ho , Yea S udy Design Coun y, Region Ta ge Popula ion Social Con ex Social P esc ibing App oaches
Lo us e al.,
2017 [32]
Obse a ional
non-con olled
be o e-and-a e s udy
UK, No he n I eland
Pa ien s o e 65 yea s o age wi h a ch onic condi ion
who a ended hei GP equen ly o had mul iple
medica ions
No epo ed
“
. . .
clea , cohe en and collabo a i e p ocess
in which heal h-ca e p ac i ione s wo k wi h
pa ien s and se ice use s o selec and make
e e als o communi y based se ices” (p. 97)
Mo on e al.,
2015 [33]Mixed-me hods s udy UK, no speci ied
Pa ien s who expe ienced mild o mode a e men al
heal h di icul ies such as anxie y/s ess, dep ession,
and low sel -es eem
No epo ed
“ . . . in ol es GP’s and o he heal h
p o essionals ‘p esc ibing’ suppo i e
ac i i ies such as: a s and c a s, leisu e,
s ess managemen , cul u al, educa ional o
en i onmen al ac i i ies wi hin he pa ien s’
communi y.” (p. 286)
G aye e al.,
2008 [34]
Obse a ional
non-con olled
be o e-and-a e s udy
UK, no speci ied
Pa ien s wi h psychosocial p oblems (anxie y,
dep ession, social p oblems, isola ion, housing, inancial
di icul ies)
No epo ed No de ined as SP in e en ions
G an e al.,
2000 [35]
Randomized con olled
ial UK, A on
Pa ien s (16+ yea s old) wi h a ied socioeconomic
cha ac e is ics wi h psychosocial p oblems (mos ly wi h
men al heal h p oblems)
No epo ed
Au ho s do no e e o SP speci ically,
al hough he in e en ion used ma ches
speci ica ions o SP by de ini ion (pa ien s a e
andomly e e ed o a olun a y sec o
o ganiza ion wi h he media ion o he
Amal hea P ojec )
Vogelpoel e al.,
2014 [36]Mixed-me hods s udy UK, no speci ied
Olde pa ien s expe iencing social isola ion and
associa ed heal h p oblems who ha e single o
mul i-senso y impai men
No epo ed
Au ho s do no p o ide a clea de ini ion o
SP as hey e e o social p esc ibing:
“In eg a ed ca e app oaches ( . . . ) can
unc ion as a p e en a i e and
heal h-p omo ing se ice whe e p ac ical
implica ions o cu en and eme ging policy
guidelines can come o ui ion. (
. . .
) linking
pa ien s accessing p ima y ca e wi h
non-medical suppo se ices in he
communi y, a e an example o in eg a ion
ac oss sec o s and a mo e holis ic al e na i e
o p esc ip ion medica ion.” (p. 41)
Van de Ven e
e al., 2014 [37]Mixed-me hods s udy UK, no speci ied People wi h mild- o-mode a e men al heal h p oblems No epo ed Ins ead o SP, he au ho s use he exp ession
A s-on- e e al (AoR) schemes
Abb e ia ions: UK—Uni ed Kingdom; GP—gene al p ac i ione ; SP—social p esc ibing.
Sus ainabili y 2021,13, 2731 7 o 18
A o al o 4603 pa icipan s we e in ol ed in he pape s. The sample size, age, and
gende o pa icipan s a e p esen ed in Table 2. In e e y included pape , mo e women han
men we e in ol ed as pa icipan s, and wo pape s epo exclusi ely pa icipan s abo e
60 yea s old.
Th ee o he pape s [
26
,
36
,
37
] e e pa ien s o a - ela ed ac i i ies as SP, while ano he
s udy e e s o physical ac i i ies [
27
]. All o he o he emaining s udies use se e al
esou ces o he hi d sec o , which a e based on olun a y and communi y se ices,
wi hou speci ied ac i i ies p esc ibed [20,25,28–30,32–35].
In all a icles, e e als o SP p og ams a e mos ly made by heal h-ca e p o essionals,
namely by a Gene al P ac i ione (GP). In nine a icles, a link-wo ke (LW) is in ol ed
o make he b idge be ween GP, pa ien s, and he hi d sec o [
20
,
25
,
27
–
30
,
32
,
34
,
35
]. The
cha ac e is ics o he LW we e no always speci ically e e enced [
20
,
25
,
30
,
35
–
37
]. In one
o he a icles, LWs a e known as physical exe cise p o essionals [
27
], in ano he , hey a e
known as men al heal h wo ke s [
34
], and in ano he pape , he LW is desc ibed as an
indi idual wi h communi y-de elopmen wo k expe ience [28,29].
A icles epo an adhe ence o SP in e en ions a es anging om 30% o 78%. Mos
o he included pape s epo only wo momen s o da a collec ion, be o e and a e he
in e en ion. The pe iod o da a collec ion a ies be ween 9 and 84 mon hs. The leng h o
in e en ions is no epo ed in a well-de ined manne , in he majo i y o pape s, aking
place be ween 6 and 12 sessions o be ween 8 o 24 weeks. In six pape s, his in o ma ion
is no epo ed a all [
20
,
28
–
30
,
33
,
34
]. The ollow-up ques ionnai e was adminis a ed a
di e en momen s: in some cases [
25
,
36
], his was done immedia ely a he end o he
in e en ion; o he a icles [
28
–
30
,
32
] epo ha he second momen o obse a ions was
done up o 12 mon hs la e . One o he s udies [
27
] has h ee poin s o da a collec ion, being
he only one ha has a long- e m ollow-up pos -in e en ion (52 weeks, 1 yea ).
Ten o he included pape s desc ibe changes in wellbeing [
20
,
26
,
27
,
29
,
30
,
33
–
37
],
wo [
25
,
27
] ocused on changes in physical ac i i y, six [
20
,
29
,
30
,
32
,
34
,
35
] highligh he us-
age o p ima y heal h-ca e se ices and he economic impac o SP. Fou pape s [
20
,
27
,
30
,
34
]
epo s udies ocusing on he impac o SP on gene al heal h, and i e [
27
–
29
,
34
,
36
] mea-
su ed he impac on he quali y o li e o pa ien s’ sel -e icacy o adop ion o heal h
beha io s. Finally, one a icle desc ibed a endance and engagemen wi h he SP p o-
g am [
26
], and ano he ocused on he imp o emen o heal h ou comes and in he social
ne wo k [36].
Nine domains o in e en ions we e iden i ied (Table 2). The mos equen ly epo ed
domain o in e en ions in SP p og ams is a - ela ed ac i i ies (used in eigh o hi een
s udies [
20
,
25
,
26
,
28
,
32
,
33
,
36
,
37
], ollowed by physical ac i i ies [
20
,
25
,
27
–
29
,
32
] and pe -
sonal de elopmen (used in six s udies) [
20
,
25
,
28
,
29
,
32
,
33
]. Social in e ac ion ac i i ies
we e epo ed in i e s udies [
20
,
25
,
28
,
29
,
32
] and cul u al, eligious [
29
], and echnologi-
cal/ echnical ac i i ies [
32
] we e used in only one s udy each. Th ee a icles do no speci y
he domains o in e en ions wi hin SP p og ams.
Sus ainabili y 2021,13, 2731 8 o 18
Table 2. O e iew o pa icipan s, domains o social p esc ibing (SP) ac i i ies, du a ion o SP in e en ions, and p incipal ou comes.
Au ho s, Yea Sample Size Mean Age
(Yea s) Gende (% Female) SP Ac i i y (Domains) SP In e en ion Ou comes (Ins umen s) Main Findings
Pescheny e al.,
2019 [25]146 51.2 70.4 A , physical ac i i y,
social in e ac ion, and
pe sonal de elopmen
In e en ion: 12 sessions
Pos -in e en ion assessmen :
a e 12 sessions
Follow up: no
IPAQ Posi i e and signi ican imp o emen
in physical ac i i y
Sumne e al.,
2019 [26]1297 51.1 77.3 A s
In e en ion: 8–10 weeks
Pos -in e en ion assessmen :
las day o in e en ion
Follow up: no
WEMWBS
A endance and engagemen , esul ed in inc eased
wellbeing o hose ha engaged and comple ed he
in e en ion. A lowe a e o a endance was ound
when wellbeing sco e was lowe a baseline
P io e al.,
2019 [27]273 57.7 56.0 Physical ac i i y
In e en ion: 24 weeks
Pos -in e en ion assessmen :
24 weeks
Follow up: 52 weeks a e he
beginning
IPAQ; EQ-5D-3L; EQ-5D
VAS; WMWBS; BMI, BP,
alcohol and obacco
consump ion
Imp o emen s in physical ac i i y o e he
i s 6 mon hs; main ained in he
long e m (≥12 mon hs).
Signi ican imp o emen s in body composi ion,
sys olic blood p essu e, quali y o li e,
and men al wellbeing
Me ce e al.,
2019 [28]
900 (In e en ion
G oup: 288; Con ol
G oup: 612)
In e en ion G oup:
49.0; Con ol G oup:
56.0
In e en ion G oup:
59.2; Con ol G oup:
61.1
A , physical ac i i y,
social in e ac ion, and
pe sonal de elopmen
In e en ion: lexible
Pos -in e en ion assessmen :
9 mon hs a e he beginning
Follow up: no
WEMWBS; EQ-5D-3L;
HADS; Wo k and Social
Adjus men Scale, bu den
o mul i-mo bidi y, and
sel - epo ed
li es yle ac i i ies
Unable o p o e he e ec i eness o e e al o LW
Ca nes e al.,
2017 [29]
486 (In e en ion
G oup:184 Con ol
G oup:302)
In e en ion G oup:
56.0; Con ol G oup:
58.0
In e en ion G oup:
46.0; Con ol G oup:
54.0
Physical ac i i ies, social
in e ac ion ac i i ies;
pe sonal de elopmen ,
cul u al ac i i ies,
eligious ac i i ies
In e en ion: no epo ed
Pos -in e en ion assessmen :
8 mon hs a e he beginning o
he p og am
Follow up: no
Gene al heal h sco e;
HADS; Ac i e engagemen
in li e sco e; Numbe o
egula ac i i ies Acciden
and Eme gency isi s.
No di e ences be ween pa ien s e e ed (SP) and
con ols, o dep ession, anxie y o posi i e and
ac i e engagemen in li e.
No e ec s in p esc ibed medical d ugs. Numbe o
p esc ibed medical d ugs signi ican ly highe o
hose e e ed in o SP (be o e and a e
he in e en ion).
Kellezi e al.,
2019 [30]630 52.7 53.5 No speci ied
In e en ion: up o 8 weeks
Pos -in e en ion assessmen :
4 mon h a e ini ial e e al
assessmen
Follow up: no
Communi y belonging;
ULS-8; numbe o imes
hey ha e used
p ima y ca e
Me hodological iangula ion o e ed conclusions
ha ‘social cu e’ p ocesses explained he e icacy o
SP. Social p esc ip ion was ound o educe p ima y
ca e usage h ough inc easing social connec edness
and educing loneliness.
Woodall e al.,
2018 [20]342 53.1 63.9
A ac i i ies, physical
ac i i ies, social in e ac ion
ac i i ies, and pe sonal
de elopmen
In e en ion: On a e age,
6 sessions
Pos -in e en ion assessmen :
no epo ed
Follow up: no
WMWBS; EQ-5D-3L;
Campaign o End
Loneliness Measu emen
Tool
Imp o emen s in wellbeing, pe cei ed heal h and
social connec edness, and educ ion o anxie y.
Lo us e al.,
2017 [32]68 72.9 70.6
A ac i i ies, physical
ac i i ies, social in e ac ion
ac i i ies, echnological
and echnical ac i i ies;
and pe sonal de elopmen
In e en ion: 12 weeks
Pos -in e en ion assessmen :
a e 12 weeks (6–12 mon hs
a e he end o he ac i i y)
Follow up: no
Rou inely collec ed heal h
da a, acco ding o
RECORD guidelines
Imp o emen o pa ien s’ sel -es eem and wellbeing.
Small e ec on GP wo kload
Sus ainabili y 2021,13, 2731 9 o 18
Table 2. Con .
Au ho s, Yea Sample Size Mean Age
(Yea s) Gende (% Female) SP Ac i i y (Domains) SP In e en ion Ou comes (Ins umen s) Main Findings
Mo on e al.,
2015 [33]136 52.0 72.8 A ac i i ies,
and pe sonal de elopmen
In e en ion: no epo ed
Pos -in e en ion assessmen :
no speci ied
Follow up: no
HADS; GSE; WEMWBS Posi i e imp o emen s in all scales
G aye e al.,
2008 [34]108 43.1 62.0 Educa ional, ec ea ional
and olun a y
sec o esou ces
In e en ion: no epo ed
Pos -in e en ion assessmen :
3 mon hs a e he ini ial
appoin men in
communi y se ices
Follow up: no
GHQ12; COREOM; WSAS;
CSQ; Communi y Link
E alua ion; Measu emen
o P ima y ca e
esou ces uses
Reduc ion o pe cen age o pa ien s wi h men al
heal h p oblem.Imp o emen in social
adjus men Reduc ion o numbe o p ima y
heal h-ca e consul a ions and o
psycho opic medica ion
Clinical changes accompanied by imp o emen s in
wo k and social adjus men sco es.
G an e al.,
2000 [35]
161
(In e en ion
G oup:90; Con ol
G oup: 71)
In e en ion G oup:
40.8; Con ol G oup:
45.6
In e en ion G oup:
72.0; Con ol G oup:
79.0
Di e en a eas o
in e en ion (acco ding o
he olun a y
sec o associa ion)
In e en ion: no epo ed
Pos -in e en ion assessmen : 1
mon h a e he end o
he in e en ion
Follow up: 4 mon hs a e he
end o he in e en ion
HADS; DUKE-UNC
unc ional social suppo
scale; COOP/WONCA
unc ional heal h
assessmen cha s;
Deligh ed- e ible aces
scale; Heal h-economic
and p ocess measu es
Imp o emen s in anxie y, o he emo ional eelings,
abili y o ca y ou e e yday ac i i ies, eelings abou
gene al heal h, and quali y o li e.
No di e ence o dep ession o pe cei ed
social suppo .
Cos s o NHS we e g ea e in in e en ion a m
Vogelpoel e al.,
2014 [36]12 80.0 75.0 A s
In e en ion: 12 weeks
Pos -in e en ion assessmen :
In las session
Follow up: no
WEMWBS; Thiele and
Ma sden’s. Dynamic
Obse a ion scale;
Semi-s uc u ed in e iews
Bene i s o wellbeing.
Inc eased sel -con idence, de elopmen o new
iendships, inc eased men al wellbeing and educed
social isola ion,
an de Ven e
e al., 2014 [37]44 43.0 82.0 A s
In e en ion: 20 weeks
Pos -in e en ion assessmen :
no epo ed
Follow up: no
WEMWBS Imp o emen s in wellbeing
Abb e ia ions: IPAQ: In e na ional Physical Ac i i y Ques ionnai e; WEMWBS: Wa wick Edinbu gh Men al Well-being Scale; EQ-5D-3L: heal h- ela ed quali y o li e Eu oQol 5 dimensions, 3 le el ques ionnai e;
EQ-5D VAS: Eu oQol 5 dimensions isual analog scale (EQ-5D VAS); BMI: Body Mass Index; BP: Blood p essu e; HADS: Hospi al Anxie y and Dep ession Scale; ULS-8: eigh -i em UCLA Loneliness Scale; GSE:
The Gene al Sel -E icacy Scale; GHQ-12: Gene al Heal h Ques ionnai e-12; COREOM: Co e Ou come Measu e; WSAS: Wo k and Social Adjus men Scale; CSQ: Clien Sa is ac ion Ques ionnai e.
Sus ainabili y 2021,13, 2731 16 o 18
Appendix A. Comp ehensi e Sea ch S a egy o SRL
Sea ch Que y PubMed
I ems Found
CINHAL
Found Scopus
#1 “social p esc ibing” [Ti le/Abs ac ] 125 133 159
#2 “social p esc ip ion” [Ti le/Abs ac ] 23 16 85
#3 “communi y e e al” [Ti le/Abs ac ] 97 60 211
#4
“wellbeing p og am” OR “well being
p og am” OR “well-being p og am”
[Ti le/Abs ac ]
131 42 236
#5
“Communi y p esc ibing”
[Ti le/Abs ac ] OR “communi y
p esc ip ion” [Ti le/Abs ac ]
54 32 89
#6 “social e e al” [Ti le/Abs ac ] 4 2 31
#7 “non-medical e e al” [Ti le/Abs ac ] 0 4 5
#8 #1 OR #2 OR #3 OR #4
OR #5 OR #6 OR #7 415 274 781
#9 “link wo ke ” [Ti le/Abs ac ] 34 33 114
#10 “ca e na iga o s” [Ti le/Abs ac ] 29 43 57
#11 #9 OR #10 63 76 169
#12 #8 OR #11 466 345 931
#13 “communi y ca e” [Ti le/Abs ac ] 4677 3709 65,644
#14 “p ima y ca e” [Ti le/Abs ac ] OR
“p ima y-ca e” [Ti le/Abs ac ] 114,652 73,391 135,678
#15 “p ima y heal h se ices”
[Ti le/Abs ac ] 340 173 631
#16 gene al p ac ice [Ti le/Abs ac ] 37,966 16,537 110,772
#17 p ima y heal h ca e [Ti le/Abs ac ] OR
“p ima y heal hca e” [Ti le/Abs ac ] 32,179 15,804 110,713
#18 “communi y ac i i ies” [Ti le/Abs ac ] 672 506 2,173
#19 #13 OR #14 OR #15 OR
#16 OR #17 OR #18 174,316 101,311 345,138
#20 #12 AND #19 98 90 215
#21 #20 AND ial [Ti le/Abs ac ] 11 10 19
#22 #20 AND RCT [Ti le/Abs ac ] 1 1 3
#23 #20 AND con olled [Ti le/Abs ac ] 8 7 41
#24 #20 AND e ec i eness [Ti le/Abs ac ] 18 10 31
#25 #20 AND e icacy [Ti le/Abs ac ] 2 1 4
#26 #20 AND e alua ion [Ti le/Abs ac ] 26 23 52
#27 #20 AND (# 21 OR #22 OR #23
OR #24 OR #25 OR #26) 41 37 101
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