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Applying critical systems thinking to social prescribing: a relational model of stakeholder “buy-in”

BACKGROUND: Social prescribing (SP) allows health professionals to refer primary care patients toward health and wellbeing interventions and activities in the local community. Now widely implemented across the UK and adopted in other nations, questions arise concerning the modelling of present and f...

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Autores principales: Fixsen, Alison, Seers, Helen, Polley, Marie, Robins, Jo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312116/
https://www.ncbi.nlm.nih.gov/pubmed/32580718
http://dx.doi.org/10.1186/s12913-020-05443-8
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author Fixsen, Alison
Seers, Helen
Polley, Marie
Robins, Jo
author_facet Fixsen, Alison
Seers, Helen
Polley, Marie
Robins, Jo
author_sort Fixsen, Alison
collection PubMed
description BACKGROUND: Social prescribing (SP) allows health professionals to refer primary care patients toward health and wellbeing interventions and activities in the local community. Now widely implemented across the UK and adopted in other nations, questions arise concerning the modelling of present and future schemes, including challenges to full engagement encountered by stakeholders, which lie beyond the scope of traditional evaluations. Critical Systems Thinking (CST) allows for holistic analysis of fields where multiple stakeholders hold diverse interests and unequal power. METHODS: We use CST to (a) critically examine a developing rural social prescribing scheme from multiple stakeholder perspectives and (b) present a relational model for local social prescribing schemes. Our fieldwork included 24 in-depth interviews, regular planning meetings with key stakeholders, and discussions with those involved with national and international SP landscaping. A modified grounded theory approach was used for the analysis, and to consider the core elements of social prescribing sustainability. RESULTS: Our study confirms that local social prescribing schemes must operate with numerous stakeholder interests in mind, seeking to address real life social complexity and offer integrated solutions to multifaceted issues. Three main areas are discussed: holistic vision and boundary judgments; barriers and facilitators; relational issues and “emotional buy in”. Problems for staff include selecting suitable clients, feedback and technological issues and funding and evaluation pressures. Barriers for clients include health, transport and expense issues, also lack of prior information and GP involvement. Emotional “buy-in” emerged as essential for all stakeholders, but hard to sustain. Based on our findings we propose a positive relational model comprising shared vision, confidence and commitment; motivation and encouragement, support and wellbeing focus, collaborative relationships, communication and feedback, access to information /resources, learning in and from action, with emotional “buy-in” at its heart. CONCLUSION: Those implementing social prescribing in different localities inevitably face hard choices about what and whom to include. Research on the sustainability of social prescribing remains limited, studies are required to ascertain which “holistic” models of social prescribing work best for which communities, who are the main beneficiaries of these approaches and how “buy-in” is best sustained.
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spelling pubmed-73121162020-06-24 Applying critical systems thinking to social prescribing: a relational model of stakeholder “buy-in” Fixsen, Alison Seers, Helen Polley, Marie Robins, Jo BMC Health Serv Res Research Article BACKGROUND: Social prescribing (SP) allows health professionals to refer primary care patients toward health and wellbeing interventions and activities in the local community. Now widely implemented across the UK and adopted in other nations, questions arise concerning the modelling of present and future schemes, including challenges to full engagement encountered by stakeholders, which lie beyond the scope of traditional evaluations. Critical Systems Thinking (CST) allows for holistic analysis of fields where multiple stakeholders hold diverse interests and unequal power. METHODS: We use CST to (a) critically examine a developing rural social prescribing scheme from multiple stakeholder perspectives and (b) present a relational model for local social prescribing schemes. Our fieldwork included 24 in-depth interviews, regular planning meetings with key stakeholders, and discussions with those involved with national and international SP landscaping. A modified grounded theory approach was used for the analysis, and to consider the core elements of social prescribing sustainability. RESULTS: Our study confirms that local social prescribing schemes must operate with numerous stakeholder interests in mind, seeking to address real life social complexity and offer integrated solutions to multifaceted issues. Three main areas are discussed: holistic vision and boundary judgments; barriers and facilitators; relational issues and “emotional buy in”. Problems for staff include selecting suitable clients, feedback and technological issues and funding and evaluation pressures. Barriers for clients include health, transport and expense issues, also lack of prior information and GP involvement. Emotional “buy-in” emerged as essential for all stakeholders, but hard to sustain. Based on our findings we propose a positive relational model comprising shared vision, confidence and commitment; motivation and encouragement, support and wellbeing focus, collaborative relationships, communication and feedback, access to information /resources, learning in and from action, with emotional “buy-in” at its heart. CONCLUSION: Those implementing social prescribing in different localities inevitably face hard choices about what and whom to include. Research on the sustainability of social prescribing remains limited, studies are required to ascertain which “holistic” models of social prescribing work best for which communities, who are the main beneficiaries of these approaches and how “buy-in” is best sustained. BioMed Central 2020-06-24 /pmc/articles/PMC7312116/ /pubmed/32580718 http://dx.doi.org/10.1186/s12913-020-05443-8 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Fixsen, Alison
Seers, Helen
Polley, Marie
Robins, Jo
Applying critical systems thinking to social prescribing: a relational model of stakeholder “buy-in”
title Applying critical systems thinking to social prescribing: a relational model of stakeholder “buy-in”
title_full Applying critical systems thinking to social prescribing: a relational model of stakeholder “buy-in”
title_fullStr Applying critical systems thinking to social prescribing: a relational model of stakeholder “buy-in”
title_full_unstemmed Applying critical systems thinking to social prescribing: a relational model of stakeholder “buy-in”
title_short Applying critical systems thinking to social prescribing: a relational model of stakeholder “buy-in”
title_sort applying critical systems thinking to social prescribing: a relational model of stakeholder “buy-in”
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312116/
https://www.ncbi.nlm.nih.gov/pubmed/32580718
http://dx.doi.org/10.1186/s12913-020-05443-8
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