Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.
Public Health England, Newcastle upon Tyne, UK.
Health Soc Care Community. 2019 Jul;27(4):991-998. doi: 10.1111/hsc.12716. Epub 2019 Jan 14.
For a social prescribing intervention to achieve its aims, clients must first be effectively engaged. A 'link worker' facilitating linkage between clients and community resources has been identified as a vital component of social prescribing. However, the mechanisms underpinning successful linkage remain underspecified. This qualitative study is the first to explore link workers' own definitions of their role in social prescribing and the skills and qualities identified by link workers themselves as necessary for effective client linkage. This study also explores 'threats' to successful linked social prescribing and the challenges link workers face in carrying out their work. Link workers in a social prescribing scheme in a socioeconomically deprived area of North East England were interviewed in two phases between June 2015 and August 2016. The first phase comprised five focus groups (n = 15) and individual semi-structured interviews (n = 15) conducted with each focus group participant. The follow-up phase comprised four focus groups (n = 15). Thematic data analysis highlighted the importance of providing a holistic service focusing on the wider social determinants of health. Enabling client engagement required 'well-networked' link workers with the time and the personal skills required to develop a trusting relationship with clients while maintaining professional boundaries by fostering empowerment rather than dependency. Challenges to client engagement included: variation in the volume and suitability of primary-care referrals; difficulties balancing quality of intervention provision and meeting referral targets; and link workers' training inadequately preparing them for their complex and demanding role. At a broader level, public sector cuts negatively impacted upon link workers' ability to refer patients into suitable services due to unacceptably long waiting lists or service cutbacks. This study demonstrates that enabling client engagement in social prescribing requires skilled link workers supported by healthcare referrer 'buy-in' and with access to training tailored to what is a complex and demanding role.
为了使社会处方干预达到其目的，客户必须首先得到有效参与。促进客户与社区资源之间联系的“联络人”已被确定为社会处方的重要组成部分。然而，支持成功联系的机制仍未得到明确规定。这项定性研究首次探讨了联络人对自己在社会处方中的角色的定义，以及联络人自己认为对有效客户联系必要的技能和素质。本研究还探讨了成功的社会处方链接的“威胁”以及联络人在开展工作时面临的挑战。在英格兰东北部一个社会经济贫困地区的社会处方计划中的联络人在 2015 年 6 月至 2016 年 8 月之间进行了两个阶段的采访。第一阶段包括五个焦点小组（n=15）和与每个焦点小组参与者进行的个人半结构化访谈（n=15）。后续阶段包括四个焦点小组（n=15）。主题数据分析强调了提供专注于健康的更广泛社会决定因素的整体服务的重要性。使客户参与需要“人脉广泛”的联络人，他们有时间和个人技能，能够与客户建立信任关系，同时通过培养授权而不是依赖来保持专业界限。客户参与的挑战包括：初级保健转介的数量和适用性的变化；平衡干预措施提供的质量和满足转介目标的困难；以及联络人培训不足，无法为他们复杂而苛刻的角色做好准备。在更广泛的层面上，公共部门的削减对联络人将患者转介到合适服务的能力产生了负面影响，因为等待名单过长或服务削减，无法接受。本研究表明，使客户参与社会处方需要有技能的联络人，他们得到医疗保健转介者的“认可”，并能够获得针对其复杂和苛刻角色量身定制的培训。
