| dc.description.abstract | Background. Social Prescribing (SP) typically involves linking patients in primary care with services provided by the voluntary and community sector. Preliminary evidence suggests that SP may offer a means of delivering community-based health promotion activities, potentially contributing to the prevention of long-term conditions, such as type 2 diabetes (T2D). This thesis aimed to investigate the possible role of SP in T2D prevention and inform the design, implementation and evaluation of SP initiatives relevant to communities at high risk. Methods. This thesis was informed by complexity science and drew on multiple, theoretically rich methodologies. It was conducted over three interconnected stages. In Stage 1, I undertook two literature reviews on primary care-based SP to investigate SP practices (using realist synthesis) and understandings (using discourse analysis) across different health domains. Building on review findings, Stage 2 investigated the possible contribution of SP to T2D prevention in a multi-ethnic, socioeconomically deprived population at high risk using realist mixed-methods evaluation. Stage 3 built on previous stages and used qualitative case study informed by practice theory to investigate how SP relevant to T2D prevention was accomplished in everyday practice. Results. This thesis illustrated how (and why) accessible, holistic, sustained and integrated SP practices in primary care contributed to individual-level T2D preventative approaches relevant to patients in greatest health and social need. Practicing SP proved highly complex as it involved customising the intervention to the specific context and the patient in a constant process of re-negotiation. Providers’ capacity to be inventive and co-create SP in patients’ best interest varied, conditioned by the dynamic interplay of their own personal beliefs, knowledge and experience, organisational arrangements, and wider financial and regulatory constraints. Conclusion. My thesis suggests that SP may offer an opportunity for accessible, holistic, sustained, and integrated T2D preventative approaches where specific individual, interpersonal, organisational, and policy resources are ensured. Such approaches have the potential to reach patients at high risk of T2D with greatest health and social need, who are typically not referred to existing NHS diabetes prevention schemes. | en_US |
