Effectiveness of social prescribing programs in the primary health-care context : a systematic literature review

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. This a icle is an open access a icle dis ibu ed unde he e ms and condi ions o he C ea i e Commons 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 Re e ences 1. 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