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Abstract 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.

IntroductionSocial prescribing (SP) is a holistic and collaborative approach to help individuals access community-based supports and services for their nonmedical social needs. The aim of this study was to assess the needs and priorities of Canadian older adults (aged 55 years and older), with a focus on optimizing SP programs for those who are systemically disadvantaged and socially marginalized. MethodsSemistructured focus groups (N = 10 groups, 43 participants) were conducted online via Zoom with participants from across Canada. Data transcription and thematic analysis were completed in NVivo. Analyses were informed by self-determination theory. ResultsOur results suggest that older adults desire SP programs that respect their ability to maintain their autonomy and independence, aid and facilitate the development of connectedness and belonging, are built on a foundation of trust and relationship-building in interactions with providers and link workers, and prioritize the person and thus personalize SP to the unique needs of each individual. ConclusionSP programs should be informed by the values of older adults. As work is currently underway to formalize and scale SP in Canada, personalizing these programs to the unique circumstances, needs and priorities of participants should be a top priority.

IntroductionLa prescription sociale est une approche holistique et collaborative qui vise à aider les individus à avoir accès aux mesures de soutien et aux services communautaires nécessaires pour combler leurs besoins sociaux non médicaux. Cette étude visait à évaluer les besoins et les priorités des aînés canadiens (55 ans et plus), en portant une attention particulière à l’optimisation des programmes de prescription sociale à l’intention des personnes qui sont systémiquement défavorisées et socialement marginalisées. MéthodologieDes groupes de discussion semi-structurés (N = 10 groupes, 43 participants) ont été organisés en ligne sur Zoom avec des participants de l’ensemble du Canada. La transcription des données et l’analyse thématique ont été réalisées à l’aide du logiciel NVivo. Les analyses s’appuient sur la théorie de l’autodétermination. RésultatsD’après nos résultats, les aînés souhaitent avoir accès à des programmes de prescription sociale qui respectent leur capacité à maintenir leur autonomie et leur indépendance; qui favorisent le développement de liens et d’un sentiment d’appartenance; qui sont fondés sur la confiance et l’établissement de relations solides dans les interactions avec les fournisseurs et les agents de liaison communautaires et qui donnent la priorité à la personne, personnalisant ainsi la prescription sociale en fonction des besoins spécifiques de chacun. ConclusionLes programmes de prescription sociale doivent être fondés sur les valeurs des aînés. Alors que des travaux sont actuellement en cours pour formaliser et étendre la prescription sociale au Canada, la personnalisation de ces programmes en fonction de la situation, des besoins et des priorités spécifiques des participants devrait être une priorité majeure.

BackgroundSocial prescribing (SP) takes a holistic approach to health by linking clients from clinical settings to community programs to address their nonmedical needs. The emerging evidence base for SP demonstrates variability in the design and implementation of different SP initiatives. To effectively address these needs, coproduction among clients, communities, stakeholders, and policy makers is important for tailoring SP initiatives for optimal uptake. ObjectiveThis study aims to explore the role of coproduction in SP initiatives. The research question is as follows: How and for what purpose has coproduction been incorporated across a range of SP initiatives for different clients? MethodsA review of international literature will be conducted following the JBI guidelines for scoping reviews. We will search multiple databases including Scopus, MEDLINE, and the PAIS Index, as well as gray literature, from 2000 to 2023. The primary studies included will describe a nonmedical need for clients, a nonmedical SP program or initiative, coproduction of the SP program, and any follow-up. Review articles and commentaries will be excluded. Titles, abstracts, and full-text articles will be screened, and data will be extracted by at least 2 research team members using Covidence and a pilot-tested extraction template. Clients with lived experience will also participate in the research process. Findings will be descriptively summarized and thematically synthesized to answer the research question. ResultsThe project was funded in 2023, and the results are expected to be submitted for publication in early 2025. ConclusionsDescriptions of what coproduction is meant to accomplish may differ from theoretical aspirations. Continued understanding of how coproduction has been designed and executed across varied international SP models is important for framing engagement in practice for future SP arrangements and their evaluation. We anticipate this review will guide clients, communities, stakeholders, and policy makers in further developing SP practice within health care systems. Trial RegistrationOpen Science Framework Registries B8U4Z; https://osf.io/b8u4z International Registered Report Identifier (IRRID)DERR1-10.2196/57062

RésuméLe rapport Lalonde, publié en 1974 par le ministre canadien de la Santé nationale et du Bien-être social, a fait oeuvre de pionnier en matière de santé publique au Canada en reconnaissant que les déterminants de la santé vont bien au-delà des services de soins de santé. Cinquante ans plus tard, ce numéro spécial de Promotion de la santé et prévention des maladies chroniques au Canada montre comment on peut agir sur les déterminants de la santé en amont au moyen d’une nouvelle intervention appelée « prescription sociale ». La prescription sociale oriente les patients vers des ressources communautaires qui correspondent à leurs priorités personnelles. Elle favorise ainsi un changement de paradigme par lequel l’approche de promotion de la santé n’est plus axée sur les déficits mais sur les forces. La première partie de ce numéro porte sur la croissance rapide de la prescription sociale et ses applications variées au Canada, que ce soit des initiatives ciblant diverses populations ou des interventions privilégiant le contact avec la nature, les arts, l’activité physique ou encore la connectivité sociale. Les contributions d’un large éventail de partenaires (chercheurs, professionnels de la santé et membres de la communauté, etc.) explorent l’adaptabilité de la prescription sociale à différents groupes, soulignent le rôle que jouent la communauté et les expériences vécues dans la recherche et signalent également la nécessité d’un plus grand nombre d’études sur l’efficacité et les résultats de la prescription sociale. Les études de cas présentées prouvent l’existence d’avantages tangibles sur les plans de l’équité en santé et de l’accès aux services sociaux. Ce numéro ne reflète pas seulement la portée et l’incidence actuelles de la prescription sociale au Canada : il jette aussi les bases de son évolution future et de son intégration dans les pratiques de santé en général.

ABSTRACT Introduction Social prescribing offers a formal pathway of connecting patients in the health system with sources of support within the community to help improve their health and well‐being. Since its launch in March 2022, the Canadian Institute for Social Prescribing has acted as a collective impact network to identify, connect and build upon established social prescribing initiatives using a co‐design methodology. The institute received input from a participant advisory council, co‐design partners and several communities of interest groups. This study aimed to describe the perceptions of the Canadian Institute for Social Prescribing's role in advancing social prescribing using a co‐design approach and the barriers and facilitators to implementing social prescribing in Canada. Methods We used a qualitative descriptive study design, document analysis, participant observation and semi‐structured individual interviews (n = 7) with members of the Canadian Institute for Social Prescribing co‐design group and the institute's leadership. We also analysed documents, field notes and transcripts using codebook thematic analysis. Results Four themes were developed representing the facilitators of implementing the Canadian Institute for Social Prescribing to support social prescribing: Creating relational mechanisms (i.e., partnerships and connections), Bringing awareness to social prescribing and contributing to the evidence (i.e., values and beliefs), Addressing systemic conditions (i.e., having a common language for social prescribing and organizing the community health sector) and Enabling funding and policy to drive social prescribing initiatives (i.e., shifting evidence into policy and securing sustainable funding). Conclusion Participants' reflections on the co‐design process demonstrated that the Canadian Institute for Social Prescribing development provided networking opportunities and shared resources relevant to social prescribing. Co‐design efforts also fostered relational and informational support, which laid the necessary groundwork in Canada to overcome the complex interplay between the macro‐ and micro‐level settings in which social prescribing is practiced. Patient or Public Contribution The interviews and observations involved participants with lived experience of delivering, receiving or advocating for social prescribing.

AbstractThe Lalonde report, published in 1974 by the Canadian Minister of National Health and Welfare, broke ground for public health in Canada by acknowledging that the determinants of health are much broader than health care services. Fifty years later, this special issue of Health Promotion and Chronic Disease Prevention in Canada charts a clear path towards addressing upstream determinants of health through an emerging intervention called “social prescribing.” Social prescribing connects patients with community resources tailored to their individual priorities, fostering a paradigm shift from a deficitbased to a strengths-based approach in health promotion. Part 1 of this issue covers the rapid growth and diverse applications of social prescribing across Canada, with targeted initiatives for various populations and interventions ranging from nature and arts to physical activity and social connectivity. Contributions from a wide range of partners, including researchers, health professionals and community members, explore the adaptability of social prescribing for different groups, underscore the role of community and lived experiences in research, and call for more studies on social prescribing’s effectiveness and outcomes. Highlighted case studies demonstrate tangible benefits in health equity and access to social services. This issue not only reflects the current scope and impact of social prescribing in Canada but also sets the stage for its future development and integration into broader health practices.

Abstract Objectives This is the protocol for an evidence and gap map. The objectives are as follows: The aim of this evidence and gap map is to map the available evidence on the effectiveness of social prescribing interventions addressing a non‐medical, health‐related social need for older adults in any setting. Specific objectives are as follows: 1. To identify existing evidence from primary studies and systematic reviews on the effects of community‐based interventions that address non‐medical, health‐related social needs of older adults to improve their health and wellbeing. 2. To identify research evidence gaps for new high‐quality primary studies and systematic reviews. 3. To highlight evidence of health equity considerations from included primary studies and systematic reviews.

Abstract Background Social isolation and loneliness can occur in all age groups, and they are linked to increased mortality and poorer health outcomes. There is a growing body of research indicating inconsistent findings on the effectiveness of interventions aiming to alleviate social isolation and loneliness. Hence the need to facilitate the discoverability of research on these interventions. Objectives To map available evidence on the effects of in‐person interventions aimed at mitigating social isolation and/or loneliness across all age groups and settings. Search Methods The following databases were searched from inception up to 17 February 2022 with no language restrictions: Ovid MEDLINE, Embase, EBM Reviews—Cochrane Central Register of Controlled Trials, APA PsycInfo via Ovid, CINAHL via EBSCO, EBSCO (all databases except CINAHL), Global Index Medicus, ProQuest (all databases), ProQuest ERIC, Web of Science, Korean Citation Index, Russian Science Citation Index, and SciELO Citation Index via Clarivate, and Elsevier Scopus. Selection Criteria Titles, abstracts, and full texts of potentially eligible articles identified were screened independently by two reviewers for inclusion following the outlined eligibility criteria. Data Collection and Analysis We developed and pilot tested a data extraction code set in Eppi‐Reviewer. Data was individually extracted and coded. We used the AMSTAR2 tool to assess the quality of reviews. However, the quality of the primary studies was not assessed. Main Results A total of 513 articles (421 primary studies and 92 systematic reviews) were included in this evidence and gap map which assessed the effectiveness of in‐person interventions to reduce social isolation and loneliness. Most (68%) of the reviews were classified as critically low quality, while less than 5% were classified as high or moderate quality. Most reviews looked at interpersonal delivery and community‐based delivery interventions, especially interventions for changing cognition led by a health professional and group activities, respectively. Loneliness, wellbeing, and depression/anxiety were the most assessed outcomes. Most research was conducted in high‐income countries, concentrated in the United States, United Kingdom, and Australia, with none from low‐income countries. Major gaps were identified in societal level and community‐based delivery interventions that address policies and community structures, respectively. Less than 5% of included reviews assessed process indicators or implementation outcomes. Similar patterns of evidence and gaps were found in primary studies. All age groups were represented but more reviews and primary studies focused on older adults (≥60 years, 63%) compared to young people (≤24 years, 34%). Two thirds described how at‐risk populations were identified and even fewer assessed differences in effect across equity factors for populations experiencing inequities. Authors’ Conclusions There is growing evidence that social isolation and loneliness are public health concerns. This evidence and gap map shows the available evidence, at the time of the search, on the effectiveness of in‐person interventions at reducing social isolation and loneliness across all ages and settings. Despite a large body of research, with much of it published in more recent years, it is unevenly distributed geographically and across types of interventions and outcomes. Most of the systematic reviews are of critically low quality, indicating the need for high quality reviews. This map can guide funders and researchers to consider the areas in which the evidence is lacking and to address these gaps as future research priorities.

Public health leaders face many challenges in influencing policy and public opinion, especially in times of crisis such as the COVID-19 pandemic. However, public health training does not always prepare practitioners to advocate, communicate with the public or move beyond technocratic approaches to policy development. To address these challenges, we designed and delivered a new course on public health advocacy to help professional-stream doctoral students understand and use journalistic skills in developing a relationships-based approach to political and policy change. The course drew on students’ career experiences to anchor conversations that explored journalism as a novel approach for open-mindedness in public health advocacy, situated the political process as a legitimate democratic space for public health advocacy, and contextualized advocacy work in the broader context of relationship building and systems change. In this commentary, we share insights from the course to demonstrate how public health leaders can draw on journalism training to better shape and participate in public discussion.

Abstract Background Social isolation and loneliness affect one in four older adults in many regions around the world. Social isolation and loneliness are shown to be associated with declines in physical and mental health. Intersecting social determinants of health influence both the risk of being socially isolated and lonely as well as the access and uptake of interventions. Our objective is to evaluate what evidence is available within systematic reviews on how to mitigate inequities in access to and effectiveness of interventions. Methods We performed an overview of reviews following methods of the Cochrane Handbook for Overviews of Reviews. We selected systematic reviews of effectiveness of interventions aimed at mitigating social isolation and loneliness in older adults (aged 60 or above) published in the last 10 years. In addition, we assessed all primary studies from the most recent systematic review with a broad intervention focus. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Scopus in collaboration with a librarian scientist. We used a structured framework called PROGRESS-Plus to assess the reporting and consideration of equity. PROGRESS-Plus stands for place of residence, race/ethnicity/culture/language, occupation, gender or sex, religion, education, socioeconomic status (SES), social capital, while “plus” stands for additional factors associated with discrimination and exclusion such as age, disability, and sexual orientation. We assessed whether PROGRESS-Plus factors were reported in description of the population, examination of differential effects, or discussion of applicability or limitations. Results We identified and assessed 17 eligible systematic reviews. We assessed all 23 primary studies from the most recent systematic review with a broad intervention focus. All systematic reviews and primary studies described the population by one or more PROGRESS-Plus factor, most commonly across place of residence and age, respectively. None of the reviews and five primary studies examined differential effects across one or more PROGRESS-Plus dimension. Nine reviews and four primary studies discussed applicability or limitations of their findings by at least one PROGRESS-Plus factor. Conclusions Although we know that social isolation and loneliness are worse for the poorest and most socially disadvantaged older adults, the existing evidence base lacks details on how to tailor interventions for these socially disadvantaged older people.

Abstract This is the protocol for an evidence and gap map. The objectives are as follows: This EGM aims to map available evidence on the effects of in‐person interventions to reduce social isolation and/or loneliness across all age groups in all settings.

Objective The aim of this study was to establish internationally accepted conceptual and operational definitions of social prescribing.Design A three-round Delphi study was conducted.Setting This study was conducted virtually using an online survey platform.Participants This study involved an international, multidisciplinary panel of experts. The expert panel (n=48) represented 26 countries across five continents, numerous expert groups and a variety of years of experience with social prescribing, with the average being 5 years (range=1–20 years).Results After three rounds, internationally accepted conceptual and operational definitions of social prescribing were established. The definitions were transformed into the Common Understanding of Social Prescribing (CUSP) conceptual framework.Conclusion This foundational work offers a common thread—a shared sense of what social prescribing is, which may be woven into social prescribing research, policy and practice to foster common understanding of this concept.

PurposeThis is a study protocol to co-create with knowledge users a core outcome set focused on middle-aged and older adults (40 years+) for use in social prescribing research.MethodsWe will follow the Core Outcome Measures in Effectiveness Trials (COMET) guide and use modified Delphi methods, including collating outcomes reported in social prescribing publications, online surveys, and discussion with our team to finalize the core outcome set. We intentionally center this work on people who deliver and receive social prescribing and include methods to evaluate collaboration. Our three-part process includes: (1) identifying published systematic reviews on social prescribing for adults to extract reported outcomes; and (2) up to three rounds of online surveys to rate the importance of outcomes for social prescribing. For this part, we will invite people (n = 240) who represent the population experienced in social prescribing, including researchers, members of social prescribing organizations, and people who receive social prescribing and their caregivers. Finally, we will (3) convene a virtual team meeting to discuss and rank the findings and finalize the core outcome set and our knowledge mobilization plan.ConclusionTo our knowledge, this is the first study designed to use a modified Delphi method to co-create core outcomes for social prescribing. Development of a core outcome set contributes to improved knowledge synthesis via consistency in measures and terminology. We aim to develop guidance for future research, and specifically on the use of core outcomes for social prescribing at the person/patient, provider, program, and societal-level.

Introduction: There is currently no agreed definition of social prescribing. This is problematic for research, policy, and practice, as the use of common language is the crux of establishing a common understanding. Both conceptual and operational definitions of social prescribing are needed to address this gap. Therefore, the aim of the study that is outlined in this protocol is to establish internationally accepted conceptual and operational definitions of social prescribing. Methodology: A Delphi study will be conducted to develop internationally accepted conceptual and operational definitions of social prescribing with an international, multidisciplinary panel of experts. It is anticipated that this study will involve approximately 40 participants (range = 20-60 participants) and consist of 3-5 rounds. Consensus will be defined a priori as ≥80% agreement. Discussion: Not only will these definitions serve to unite the social prescribing community, but they will also inform research, policy, and practice. By laying the groundwork for the formation of a robust evidence base, this foundational work will support the advancement of social prescribing and help to unlock the full potential of the social prescribing movement. Conclusion: This important work will be foundational and timely, given the rapid spread of the social prescribing movement around the world.

Background: Social prescribing (SP) assists patients to engage in social activities and connect to community supports as part of a holistic approach to primary care. Rx: Community was a SP project, which was implemented within 11 community health centres (CHCs) situated across Ontario, Canada. Aim: To explore how SP as a process facilitates positive outcomes for patients. Design & setting: Qualitative methods were used. Eighteen focus groups were conducted at CHCs or by video-conferencing, and involved 88 patients. In addition, eight in-depth telephone interviews were undertaken. Method: Interviews and focus groups were transcribed verbatim, and analysed thematically using a theoretical framework based on self-determination theory (SDT). Results: Participants who had received social prescriptions described SP as an empathetic process that respects their needs and interests. SP facilitated the patient’s voice in their care, helped patients to develop skills in addressing needs important to them, and fostered trusting relationships with staff and other participants. Patients reported their social support networks were expanded, and they had improved mental health and ability in self-management of chronic conditions. Patients who became involved in SP as voluntary 'health champions' reported this was a positive experience and they gained a sense of purpose by giving back to their communities in ways that felt meaningful for them. Conclusion: SP produced positive outcomes for patients, and it fits well within the community health centre model of primary care. Future research should examine the impact on health outcomes and examine the return on investment of developing and implementing SP programmes.

Municipal governments across the Global North are increasingly becoming key actors in shaping urban food and agriculture policy. In the City of Toronto, recent aspirational policies, such as the provincial Local Food Act and the municipal Toronto Agricultural Program, created new opportunities to shape a healthier food system. We sought municipal perspectives on the question of “How might urban agriculture policy and programs be better supported to promote equity and health?” Analysis of findings from semistructured key informant interviews with municipal staff and policy-makers (n=18) illustrated broad support for generating better quantifiable evidence of the impacts of urban agriculture on economic development and employment, health and health equity, land use and production, and partnerships and policies. Place-specific economic and equity data emerged as particularly pressing priorities. At the same time, they sought better approaches to the potential risks involved in urban agriculture. Key informants also shared their views on the use of health impact assessment research to make a case for urban agriculture to a range of stake­holders; to manage real and perceived risks; and to move beyond enabling policies to empower new investments and procedural changes that would facilitate urban agriculture expansion in the city. The results informed the evolving praxis agenda for urban agriculture at the intersections of population health, environmental sustainability, and urban governance.