Theories used for Social Prescribing in studies - a scoping review

BACKGROUND: General practitioners increasingly engage with patients who have social problems. Social Prescribing (SP) is a pathway for them to connect these patients with appropriate social support and activities in their community. However, there is a lack of adequate evidence for the effectiveness of SP. For the design of high-quality studies for complex interventions, theory-guided development of the intervention and evaluation is essential. Nevertheless, there are differences in the conceptualization and intended mechanisms of SP. Therefore, the question is how theories are used in studies for the development and evaluation of SP. METHODS: A scoping review was conducted according to the JBI manual. Nine databases were searched without date limits. The extracted publications were independently screened by two reviewers. The inclusion criterion was the description of the use of a theory for a specific SP intervention. RESULTS: The search lead to 4,240 hits, of which 18 full-texts with 11 theories were included. The theories explain how SP works as an intervention (e.g., the Social Cure), inequalities in its effects (e.g., based on Bourdieu), or the implementation process (e.g., Normalization Process Theory). Similar endpoints are explained with different mechanisms by the theories. For example, the aim to improve a person's health is explained in the Social Cure theory through identification with social groups, while the Self-Determination theory describes how increasing intrinsic motivation through SP leads to behaviour change. All studies describe the use of theories for evaluation. CONCLUSIONS: Few studies describe theories for SP interventions. The included theories differ significantly in their explanation of interrelations. The development of theory-guided intervention models for SP should be promoted to improve the evidence base through high-quality studies and to address social problems in general practice as effectively as possible. KEY MESSAGES: • The chosen theory for a complex intervention has an integral influence on endpoints and outcomes. • Despite a proliferation of SP evaluation and research, little is described regarding the use of theory.