Abstract
Background: Social Prescribing (SP) has been implemented in SingHealth Community Hospitals (SCH) as a non-pharmacological intervention to integrate patients with suboptimal social determinants of health (SDOH) back into the community in Singapore. In SCH, social prescribing was first introduced in July 2019 and the practice was locally adapted to meet the social needs of the aging population. Hence, we aim to evaluate the program conducted in SCH in improving patients’ wellbeing and social connectedness using an outcome evaluation study. We also aim to contribute to the evidence pool in guiding best practices in SP.
Approach: A mixed-methods approach is employed for our evaluation, guided by the Practical, Robust Implementation and Sustainability Model (PRISM) framework. Sixteen program implementors were sampled for the qualitative component in our study. They comprised of admin staff, wellbeing coordinators (WBCs) from SCH and social service providers (SSPs) in the community. We also chose the Patient Navigation Sustainability Assessment Tool (PNSAT) to evaluate programs’ sustainability capacity. The information gathered from PRISM and PNSAT will contribute to informing on program’s effectiveness and efficiency and enhancing long-term viability of the SP program.
Results: From patient’s perspective, SP as a program intervention addresses patient’s barrier by reducing social isolation, one of the social determinants of health (SDOH) for the older adults in SCH. Organizational characteristics such as building good organizational health and culture is also highlighted to be one of the most important elements in shaping and defining WBC’s roles within the multidisciplinary team in SCH to facilitate better coordination. Participants also reported that patients are more inclined to participate in SP activities when they have good rapport with the WBCs as they feel more encouraged and supported.
External environment such as community resources is reported to influence the older adults’ participation in SP. Barriers such as restricted boundaries hinder the participation for older adults. They are limited in their Active Aging Centers (AACs) choices due to service boundaries. This reduces the range of activities they can participate in. For sustainable implementation of SP in Singapore, the program implementors anticipate that the future of SP lies in adapting their activities to include more technology-based interactions and be tailored to local interests and age group.
Implications: The preliminary findings of our evaluation highlight several key areas for refinement to maximize benefits for patients. The identified components including addressing patient's barriers, defining WBCs roles, and building good rapport with the older adults underscores the importance of tailored approaches. Notably, external factors such as restricted boundaries imposed on the older adults hinders their participation, emphasizing on the need for inclusive designs. This study contributes to the understanding of culturally adapting social prescribing to Singapore's context and aging population. The future of SP will benefit from sharing of research findings to relevant stakeholders to inform policy, foster collaboration and developing culturally inclusive interventions with the local community.