Extended Abstract
Background
Community prescribing can be described as a non-medical referral service that promotes non-pharmacological treatments and supports patients in communities. The reasons and goals of social prescribing vary but often include improving health, well-being, depression, anxiety, self-esteem, and reducing social isolation and utilization of health care resources. Social prescribing is a new approach in primary care that promotes the use of the voluntary sector, such as charities and associations, and is recognized as an approach that can bridge the gap between health services and the community’s health needs through guidance and support. A study in 2017 by Carnes et al. aimed to implement a community prescription service in public health services. This study evaluated the impact of social prescribing on well-being and resource utilization in primary care. This study was conducted in a mixed socio-economic, multi-ethnic, inner-city area of London with patients who were socially isolated and frequently referred to their GP. The intervention was implemented by 'social prescribing coordinators'. Outcomes of interest were psychological and social well-being and use of health care resources. A study by Foster et al. was prepared and compiled from 2017 to 2019 to quantitatively and qualitatively evaluate the effect of social prescription to alleviate loneliness. This study examined 10,643 patients in the quantitative evaluation part with a cohort design in 3 American countries, and in the quantitative evaluation part, the effects of this prescription on the social life of the patients were examined by examining 60 volunteers in the form of a structured interview. In the qualitative part of this research, improvements in well-being, increased self-confidence, and a greater sense of purpose, along with more cost-effective investments for patients, were reported as results of social prescribing. In the quantitative part, the researcher utilized the approved UCLA-3 tool and a demographic information questionnaire to examine patient payments. The results of quantitative data analysis showed that social prescribing will improve patients' quality of life. Considering the importance of social prescribing in medical science for patients, as well as general physicians' lack of knowledge on this matter, this study aimed to investigate the opinions of final-year medical students at Tabriz University of Medical Sciences regarding the social determinants of health and the role of social prescribing in helping to treat outpatients. Additionally, it sought to identify the relevant factors that influence their knowledge and attitudes, which will assist in preparing and formulating intervention programs for them.
Methods
This descriptive cross-sectional study included all medical internship students at Tabriz University of Medical Sciences in 2023. Ethical approval to conduct the research was obtained from the regional research ethics committee of Tabriz University of Medical Sciences under the number IR.TBZMED.REC.1401.1025. Although the minimum sample size was calculated to be 112, a total of 115 students participated in the study. In this plan, data were collected online after the legal procedures were completed and approval was obtained from the ethics committee. The demographic information form and the questionnaire were designed using Google Docs and shared through virtual networks such as Instagram and WhatsApp. Questionnaires were provided to medical students by colleagues and representatives at the entrances. The questionnaire was answered online, and the answers were automatically entered into Excel. This project utilizes the social prescription questionnaire developed and validated by Abdullahi et al.. Data were analyzed using SPSS version 26 statistical software. The normality of the data was checked using the Kolmogorov-Smirnov test. Frequency (percentage) was used to describe qualitative data, and mean (standard deviation) was used for quantitative data due to its normality. The statistical significance level (P-value) was considered below 5% (0.05).
Results
Most interns, 57 individuals (49.6%), believed that 20%-40% of physically ill patients, and 38 individuals (33.0%) believed that 40%-60% of mental patients, had problems related to the social determinants of health. Also, 37 interns (32.2%) believed that between 40% and 60%, and even up to 60%–80% of physically ill patients, and 36 interns (31.3%) believed that between 40% and 60% of mentally ill patients, were facing problems related to poor living conditions. Furthermore, 45 interns (39.1%) believed that between 20% and 40% of physically ill patients, and 39 interns (33.9%) believed that between 40% and 60% of mentally ill patients, were suffering from severe social stress. According to 32 interns (27.8%), between 40% and 60% of physically or mentally ill patients were unable to afford their basic food expenses. Moreover, 44 interns (38.3%) believed that social prescribing had a greater therapeutic effect than physical treatments or drug prescriptions for 20%–40% of physically ill patients. Similarly, 48 interns (41.7%) believed this was true for 40%–60% of mentally ill patients. In addition, 39 interns (33.9%) believed that the prognosis of both physically and mentally ill patients could significantly improve through social prescribing. Finally, if social prescribing were to be supported and made feasible by the Ministry of Health's Social Affairs Department, the majority of the interns reported that they would be willing to prescribe it for both physical and mental health patients.
Conclusion
From the point of view of most interns, almost half of the physical and mental patients have problems related to social determinants of health, inappropriate living conditions, and severe social stress. Furthermore, most interns believe that for approximately half of these patients, social prescribing plays a more significant therapeutic role than physical treatments or medication, and the prognosis of their condition can be considerably improved with social prescribing.
Practical Implications of Research
The results of this study highlight the importance of integrating structured training on social determinants of health and social prescribing into the medical curriculum. Educating medical students on the practical use of social prescribing may enhance their clinical decision-making skills and promote a more holistic approach to patient care. Additionally, these findings suggest that health policymakers should consider developing national guidelines and support systems for implementing social prescribing in outpatient care, especially for vulnerable populations with social challenges.