BACKGROUND:Social prescribing (SP) is increasingly recognised as a key component of primary care, implemented in at least 25 countries by 2023. In England, SP has been nationally rolled out through Primary Care Networks (PCNs), though many areas, including Redbridge in East London, had pre-existing VCSE-led models. How national and local approaches integrate in practice remains underexplored. METHODS:This study used a two-step qualitative design. First, documentary analysis of service planning and evaluation documents mapped the SP referral pathway in Redbridge before and after the national rollout. Second, 16 semi-structured interviews were conducted with purposively sampled stakeholders from PCNs, RedbridgeCVS, the local authority, and the Clinical Commissioning Group, exploring service integration and delivery experiences. Data were analysed using the Framework Method, combining deductive coding against predefined themes with inductive identification of emergent categories. RESULTS:RedbridgeCVS was widely valued for its expertise, especially in managing complex cases, training link workers, and facilitating access to local services. However, integration across PCNs was inconsistent. Participants reported variation in GP engagement, referral processes, and support structures. PCN link workers faced capacity pressures, unclear role boundaries, and limited access to clinical supervision, affecting the sustainability and coherence of service delivery. CONCLUSIONS:Integrating national and local SP models requires clearer leadership, standardized referral pathways, and consistent support for link workers. Without greater alignment across primary care and VCSE partners, the full potential of SP risks being undermined. Link workers must be recognized and supported as core members of the primary care team.

Background:Young people Not in Education, Employment or Training (NEET) constitute a heterogeneous population facing intertwined psychological, social and structural barriers to labor market participation. Disengagement from work is often linked to mental health difficulties, social isolation and reduced agency. Although social prescribing has gained attention as a public health approach to address social determinants of health, its role in supporting employment pathways remains underexplored, particularly for young people in NEET situations. Methods:This qualitative study explores young people's experiences of the C.O.P.E. social prescribing intervention implemented in the Autonomous Province of Trento, Italy. Semi-structured interviews were conducted with 15 participants aged 16-34 (in line with the extended NEET definition used in Italian policy frameworks), selected through maximum variation sampling to capture diversity in age, gender, educational background and levels of social isolation. Data were analyzed using inductive thematic analysis. Results:Findings highlight the heterogeneity of NEET trajectories and a strained relationship with the labor market, characterized by fear, low self-confidence and disorientation. Participants described the intervention not as a direct route to employment, but as a relational and preparatory space supporting trust-building, emotional stabilization and gradual re-engagement. The Link Worker emerged as a key 'in-between' figure, combining practical guidance with person-centered support. Reported outcomes included increased self-esteem, agency and clarity about future steps, rather than immediate employment. Conclusion:From users' perspectives, social prescribing may support psychosocial readiness for labor market engagement rather than direct employment outcomes. The findings suggest that policies addressing youth disengagement should integrate relational and wellbeing-oriented support with activation and employment projects and services. Embedding social prescribing within coordinated health and labor systems may improve engagement among vulnerable young people.

IntroductionSocial prescribing is increasingly adopted as a strategy to address psychosocial determinants of health, yet evaluating complex community-based interventions remains methodologically challenging. Digital ecological momentary assessment (EMA) offers potential for capturing real-time, multi-modal data in naturalistic settings. This study aimed to develop and assess the feasibility of a novel digital EMA approach integrating wearable-derived physiological data with repeated self-report wellbeing measures within a digital social prescribing (DSP) context. Despite increasing interest in EMA and wearable technologies, their integration within social prescribing evaluations remains underexplored.MethodsA mixed-methods feasibility study was conducted alongside a four-week online chair-based yoga programme delivered through a social prescribing service in East London, UK. Participants wore smartwatches to collect physiological indicators (stress, sleep, heart rate) and completed twice-daily wellbeing assessments using an adapted Short Warwick-Edinburgh Mental Wellbeing Scale. Quantitative data were analysed using exploratory linear mixed-effects models to examine data behaviour and integration within the intensive longitudinal dataset. Participant workshops explored feasibility and acceptability.ResultsThirteen participants were recruited, with eleven included in quantitative analyses. The study indicated that integrating wearable and self-report EMA data within routine-style DSP delivery is feasible, although challenges were identified regarding device synchronisation, questionnaire adherence, and missing data. Exploratory modelling illustrated substantial within- and between-person variability in wellbeing trajectories and provided an indication of the feasibility of analysing intensive longitudinal EMA data, with no consistent associations between same-day yoga participation and physiological stress markers. Qualitative findings suggested that participants found the approach acceptable and highlighted factors influencing engagement, including flexibility, motivation, and perceived burden.ConclusionIntegrated wearable and self-report EMA methodologies can be deployed in DSP contexts, but their implementation is associated with important methodological and technical challenges. Findings highlight the need for validated EMA measures, improved data infrastructure, and careful management of participant burden. While not designed to assess intervention effectiveness, this study provides one of the first applied demonstrations of integrating wearable-derived physiological data with EMA self-report measures in a DSP context, offering a methodological foundation for real-time evaluation of complex community-based health interventions.

Introduction:Social prescribing for children and young people (CYP) is expanding across England, yet there is limited understanding of how local services interpret and configure its core components-individual need, referrer, linking function and community activity-particularly for CYP presenting with mental health difficulties. Methods:Using a multi-site case study design, we examined five CYP-focused social prescribing pathways selected for their diversity of institutional anchors and implementation maturity. Data collection included pathway visualization with site leads and 34 semi-structured interviews with referrers, link workers, managers and practitioners. Thematic analysis was used to compare pathway structures and functions across cases to support development of an empirically grounded taxonomy. Results:Across sites, CYP accessed social prescribing through varied and uneven referral routes, with needs dominated by low-level mental health concerns amid gaps in statutory provision. Link worker roles differed substantially in embeddedness, remit and degree of mental health related support, often extending beyond traditional "linking" models. Pathways showed significant variation in institutional anchor points, eligibility criteria, linking functions and community asset connections. This variability enabled identification of key taxonomy dimensions, including institutional setting, referral pathway configuration, link worker function and community asset integration. Discussion:Findings show that CYP social prescribing is shaped by local context, unmet mental health need and flexible practitioner practice, resulting in diverse models rather than a standardized pathway. These differences have implications for commissioning and evaluation: rather than seeking uniformity, systems should support a 'no wrong-door' approach and relational work, and evaluative approaches should prioritize implementation focused evidence over linear pre-post outcome measurement.

BACKGROUND:Community-led organisations (CLOs) are place-based, community governed entities that aim to enhance health and well-being in disadvantaged communities using asset-based approaches. Currently the relationship between CLO participation and health and well-being outcomes is unclear. METHODS:A prospective, longitudinal survey was designed as part of a multimethod, realist study: CommonHealth Assets. Questionnaires at baseline, 1, 6 and 12 months assessed capability, health-related quality of life (HR-QoL), mental well-being, social connectedness and CLO attendance patterns (n=316 adults, 14 UK CLOs). Multilevel mixed-effects models assessed associations between participation and well-being outcomes, adjusting for participant and CLO characteristics. RESULTS:Higher total CLO engagement was positively associated with mental well-being (Coeff: 0.895, 95% CI 0.178 to 1.612, p=0.015) and capability well-being (Coeff: 0.025, 95% CI -0.003 to 0.053, p=0.081). Child and family activities showed positive associations with capability well-being (Coeff: 0.087, 95% CI 0.035 to 0.138, p=0.001) and social connectedness (Coeff: 0.357, 95% CI 0.117 to 0.597, p=0.004). Frequency analysis revealed linear dose-response relationships for outdoor activities on HR-QoL (Coeff: 0.113, 95% CI 0.037 to 0.189, p=0.004) and non-linear relationships for others such as volunteering on capability well-being (linear Coeff: 0.101, p=0.023; squared Coeff: -0.057, p=0.041) and educational activities on HR-QoL (squared Coeff: 0.308, 95% CI 0.122 to 0.495, p=0.001). CONCLUSION:CLO engagement is associated with better well-being outcomes. Associations vary by activity, revealing temporal and dose-response patterns. Findings provide robust quantitative evidence consistent with the premise that CLOs can enhance different dimensions of well-being, informing intervention design, resource allocation and policy.

Social prescribing (SP) initiatives which aim to connect individuals to community-based assets have received increased research and policy attention, however schemes have mostly centred on adults. There is little research examining how social prescribing might work for children and young people (CYP), and specifically, what pathways into social prescribing look like for this group. We conducted a systematic mapping review to understand what social prescribing pathways look like for CYP. Searches were carried out in February 2022. We reviewed published journal articles and grey literature on pathways for CYP accessing activities or services in the community. We synthesised studies through tabulation and narrative descriptions of similarities and differences. We identified 14,518 unique hits through electronic database searches, and an additional 230 through grey literature searches. Following exclusions at title/abstract and full text stage, a total of 35 articles from the database searches and 33 sources from the grey literature search were included in the review. Included papers described a broad range of approaches, cohorts, implementation, and roles included in services. Pathways into SP for CYP seem to vary from the adult SP model, which primarily utilises a primary care pathway, with referrals for CYP SP mostly through educational institutions but also through GPs and self-referral. Link workers or another ‘linking function’ was often (but not always) involved in the pathway. Future research should examine how and in what ways particular cohorts access, or not, these sorts of pathways, the economic impact, and examine any potential risks or harms that might be associated with CYP-SP. Funding: National Institute for Health and Care Research (NIHR) School for Primary Care Research (project reference MH003). PROSPERO 2022 CRD42022312745.

The persistent trend of young people aged 15 to 29 years neither in employment nor in education or training (NEET) in Europe remains high despite some regional improvements. This study employs a critical realist approach to synthesize 13 reviews, covering 811 studies, on interventions for youth in NEET situations worldwide. This review aims to inform future interventions. The realist synthesis identifies key contextual factors and mechanisms influencing the effectiveness of these interventions and reveals gaps in policy and practice. The findings highlight a lack of focus on non-cognitive skills and the agency of young people. Effective interventions should be tailored to individual needs, with some requiring intensive, long-term support, while multicomponent strategies prove most effective for addressing the complex needs of this population. The study emphasizes the importance of social innovation and psychosocial support to foster youth transitions into education and employment. Long-term, multi-stakeholder collaboration, including mental health support, is crucial to ensure sustainable outcomes for youth in NEET situations.

Recent work outlines definitions of social prescribing, but the role of a social prescribing link worker (SPLW) remains ill defined. Core components of the role must be clarified to enable the study of its impact in connecting people to community-based support and subsequent outcomes. This review compiles and summarises published information on the SPLW role. A scoping review was completed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Review. Suitable online databases were searched using identified terms, a review of the reference lists of identified papers was completed and relevant grey literature was identified through Google Scholar. Relevant reports from UK-based social prescribing networks and government organisations were gathered. Eligibility of each paper was determined based on the specified criteria. Inclusion criteria were identified using the PCC (Population; Concept; Context) framework. Of the 251 search results originally identified, 15 peer-reviewed papers met the criteria for inclusion. Five additional published reports from government and community organisations and networks were identified. Data were extracted and collated in tabular form. Thematic data analysis highlighted four common themes clarifying the role of the SPLW and identifying improvements required to advance social prescribing referral processes. (1) SPLW works in collaboration with the participant, to identify personal needs and goals, and monitors progress over time. (2) SPLW connects service users to community/statutory support. (3) SPLW views health in a holistic manner. (4) The importance of training for SPLWs, and those referring into the system, to improve the referral process. Disparity in language and roles is evident, making it difficult to describe and compare the role across social prescribing services. The importance of training is outlined, and training recommendations are made. Additional effort is needed to clarify the role, impact and training requirements within social prescribing, to strengthen the evidence base, and allow applicability and transferability across services.

This paper presents an economic evaluation of community-led and -owned organisations that deliver activities to support health and wellbeing. Because community-led organisations (CLOs) are a vital part of the social and solidarity economy, they increasingly feature in public health policies targeting disadvantaged populations. However, little is known about the value CLOs generate as few economic evaluations of them exist and those available focus on isolated activities (such as exercise classes) and/or specific populations (e.g., men-only collectives). The novelty of our work lies in the inclusion of multiple CLOs, comprehensive coverage of their activities, breadth of participants studied, and control group methodology applied in creating new knowledge of the health and wellbeing outcomes of CLOs and resources consumed to achieve them. We conducted cost-effectiveness and cost-consequence analyses of data collected via a 12-month longitudinal study. We compared 331 CLO participants in 14 UK-based CLOs to a 'do nothing' synthetic control group (n = 100). Health and wellbeing were measured using the ICECAP-A capability measure for adults, EuroQol EQ-5D-5L, Short-form Warwick Edinburgh Mental Wellbeing Scale and the Revised Social Connectedness Scale. Resource use data included health, social care, and other community sector resources. Data collection occurred at four-points over the study period supported by publicly available accounts and data provided by each CLO. We found an incremental cost per year in full capability of £35,813 and an incremental cost per quality adjusted life year of £29,827. Statistically significant improvement in both social connectedness, and mental wellbeing were observed over the 12 month follow up. This work supports CLOs as an intervention to improve health and wellbeing in disadvantaged communities and identifies challenges for traditional evaluation methodology with regards to costing and comparator groups.

Social prescribing (SP) has emerged as a transformative approach, aiming to address non-clinical determinants of health by linking persons to community resources and activities. This approach acknowledges that social factors, such as loneliness, social isolation, and lack of community engagement, significantly impact physical and mental health. The European Project C.O.P.E. has efficiently implemented SP strategies in Europe reaching a total of 410 young people in Italy and 576 in Portugal, involving 21 Link workers in Portugal and 56 in Italy, building more than 80 Agreements at territorial level. The results reported by the C.O.P.E. project requested a deeper reflection on sustainability of networks and collaborations put in place in order to allow the project to continue and to provide a solution to expectations of young people. A scoping review, a SWOT Analysis and a Delphi study have been planned in order to understand specific aspects related to sustainability.

NEET (Not in Employment, Education, or Training) status is associated with psychological distress and suicidality. Social prescribing may offer a policy solution to this. To test this proposition, this study evaluates the mental health outcomes of a social prescribing intervention—C.O.P.E. (Capabilities, Opportunities, Places, and Engagement) project—on young people in a NEET situation in Italy and Portugal. Adopting a realist evaluation approach, this study explores how context and mechanisms interact to generate outcomes. A realist synthesis of NEET interventions and co-production with stakeholders helped to create a programme theory which was tested through a mixed-methods study, combining quantitative cohort data from 416 young people with qualitative interviews with 30 young people, 13 link workers, and 9 team members. The findings indicate significant improvements in mental wellbeing and reductions in psychological distress, particularly among those with clinical mental health issues. Qualitative insights emphasise the importance of trust between link workers and young people, highlighting flexibility, emotional support, and a holistic approach as key factors in fostering engagement. This led to the creation of three programme theories. One of these focuses on young people and is discussed in this article. The study concludes that despite some challenges related to sustainability, training and long-term impact, social prescribing can be an effective tool for supporting youth in a NEET situation, particularly those suffering clinical mental health issues. This paper contributes to the growing evidence supporting social prescribing as an approach to enhance mental health and social inclusion for youth in vulnerable situations.

BACKGROUND:Social prescribing inherently embodies a co-productive nature, particularly within the 'holistic' model facilitated by the pivotal role of Link Workers. Most attention is focused on collecting evidence about the micro-level relationship between Link Workers and their clients. However, little is known about how this co-productive relationship influences or is influenced by value co-creation at different levels, given the involvement of multiple actors in delivering the intervention. To advance research on the operational processes underlying social prescribing, we propose a conceptual framework utilizing the Service Ecosystems perspective to investigate the application of social prescribing with young people in NEET situations in Italy. METHODS:A single case study was conducted as part of the European C.O.P.E. (Capabilities, Opportunities, Places, and Engagement) initiative, examining the implementation of social prescribing targeting young NEETs (Not in Education, Employment, or Training) in Italy. Semi-structured interviews were conducted with 27 participants, including six members of the C.O.P.E. coordination team, six Link Workers, and 15 young people aged 15-34 years. RESULTS:Findings are presented showing the ecosystem dynamics at each intervention phase: the referral process, co-production of an individualized action plan, and connection with and activation of community assets. DISCUSSION:This research illustrates how social prescribing is not a linear path but rather a complex intervention with multiple interacting elements across ecosystem layers. The dyadic relationship between Link Workers and clients operates within broader care services, fostering continuity of care. The service ecosystem perspective offers a valuable framework for examining the dynamic interactions between actors and understanding how their resource integration processes and institutional arrangements foster the emergence of opportunities to support an invisible and hard-to-reach target group, such as young people in NEET situations.

In this paper we explore whether government policy acts as a barrier or facilitator to the work of nonprofits, and in what ways (if at all) different policy contexts influence the work of place-based community-led nonprofit organizations working to improve the health and wellbeing of their communities. Employing 'abductive' analysis of qualitative data collected through in-depth semi-structured interviews and focus groups with 20 non-profit leaders located in different parts of the UK, we found that government policy can act both as barrier and facilitator at various times. There is often a disconnection between policy intent and the realities of local context, funding arrangements for nonprofits was often dependent on developing and maintaining successful relationships, and there were clear tensions between the pursuit of mission and alignment to government priorities.

Social prescribing has become a global phenomenon. A Delphi study was recently conducted with 48 social prescribing experts from 26 countries to establish global agreement on the definition of social prescribing. We reflect on the use and utility of the outputs of this work, and where we go from here.

Abstract Background Loneliness and social isolation are increasing among young people, particularly those in vulnerable NEET (Not in Education, Employment or Training) situations, potentially leading to poor health and well-being outcomes. We aim to explore these challenges from the perspective of NEET youngsters and link workers who support them in co-creating individual action plans for their social and economic integration. Methods Data were collected through in-depth and semi-structured interviews with 15 young people in NEET situations, aged 18-34, and 7 link workers from several social organisations in rural and urban areas in Portugal. The young participants were selected based on their age, educational level, mental health needs, and urban/rural regions. Thematic analysis was used to analyse the interviews. Results The results showed a convergence between the perspectives of young people and link workers on the factors that influence social isolation and loneliness, including social and emotional skill deficits, excessive use of social media platforms, and mental health problems. Young people reported to being heavily involved in social media platforms, which often did not translate into meaningful relationships in real life. Youngsters also highlighted the lack of local support and community resources in rural areas. Link workers identified specific challenges young migrants face in community integration, including language barriers (for the youth with a migrant origin) and lack of familiarity with local resources. Conclusions This study highlights social media platforms, mental health and social and emotional skill deficits as main factors contributing to the social isolation and loneliness of young people in a NEET situation. This emphasizes the importance of integrated proximity-based interventions that incorporate community resource mapping and local support networks, including mental health support services, and promote multi-sector collaboration. Key messages • Social media platforms, mental health needs, and social and emotional skill deficits drive social isolation in NEET youth, stressing integrated, community-focused interventions. • Proximity-based strategies with community mapping and mental health support enhance NEET youths’ social integration, urging cross-sector collaboration.

Introduction:Social Prescribing has an established recognition regarding the benefits provided to the health-related social needs of adults, but little is known about how the intervention addresses young people's needs. There is optimism regarding the central role of two core mechanisms that allows social prescribing to be effective, such as the empathetic role of Link Workers and the connection with community resources.This paper aims to describe the role played by Link Workers working a Social Prescribing intervention targeting young people.Description:This paper adopts a case study methodology to describe the role of Link Workers addressing young people's needs and implementing Social Prescribing scheme in Sheffield (UK). Data were collected through semi-structured interviews with four of the seven link workers of one organisation based in Sheffield. Data were analysed through an inductive approach for emerging themes.Discussion:We provided a description of the profiles and background of Link Workers and described the three models of referral pathways into the intervention. The paper also shows how Link Workers identify young people's needs and how they connect with the community.Conclusion:Based on the insights and the internationally accepted definition of Social Prescribing, we provide a visual representation of the Social Prescribing model and discuss challenges. The paper highlights lessons learned and future directions regarding the role of Link Workers from the case study.