Using self-determination theory to understand the social prescribing process: a qualitative study

Background: Social prescribing (SP) assists patients to engage in social activities and connect to community supports as part of a holistic approach to primary care. Rx: Community was a SP project, which was implemented within 11 community health centres (CHCs) situated across Ontario, Canada.

Aim: To explore how SP as a process facilitates positive outcomes for patients.

Design & setting: Qualitative methods were used. Eighteen focus groups were conducted at CHCs or by video-conferencing, and involved 88 patients. In addition, eight in-depth telephone interviews were undertaken.

Method: Interviews and focus groups were transcribed verbatim, and analysed thematically using a theoretical framework based on self-determination theory (SDT).

Results: Participants who had received social prescriptions described SP as an empathetic process that respects their needs and interests. SP facilitated the patient's voice in their care, helped patients to develop skills in addressing needs important to them, and fostered trusting relationships with staff and other participants. Patients reported their social support networks were expanded, and they had improved mental health and ability in self-management of chronic conditions. Patients who became involved in SP as voluntary 'health champions' reported this was a positive experience and they gained a sense of purpose by giving back to their communities in ways that felt meaningful for them.

Conclusion: SP produced positive outcomes for patients, and it fits well within the community health centre model of primary care. Future research should examine the impact on health outcomes and examine the return on investment of developing and implementing SP programmes.