YOGA ON SOCIAL PRESCRIPTION


In an attempt to help relieve pressure on the NHS, an increasing number of doctors are offering ‘social prescriptions’ rather than medication, in order to treat people throughout the UK.

Recognising that health is often determined by a complex range of social, economic and environmental factors, social prescribing is the process where GPs, nurses and other primary care professionals can refer people to a range of activities. These often include befriending, group learning, gardening, volunteering, arts activities, cookery, healthy eating advice and yoga.

Social prescribing seeks to address people’s needs in a holistic way, and the hope is that it will not only empower people to take greater control of their health, but will enable them to live happier, healthier lives. One review of studies on social prescribing showed that on average, it was associated with:

28% fall in visits to a GP

24% drop in attendance at emergency wards

Tackling the epidemic of lifestyle-related disease and the social determinants of health lie at the heart of social prescribing. One common prescription is for more exercise, and the other is for mental health – and yoga is increasingly being viewed as a viable social prescription that can address both physical and mental wellbeing.

 

Survey


Given the accumulating evidence that demonstrates yoga effectiveness in tackling a variety of conditions – from lower back pain to diabetes, depression and stress – The Yoga in Healthcare Alliance recently carried out a survey asking members in the Social Prescribing Network for their views on the role of yoga in social prescribing.

Results

The 23 participants in the survey represented a broad cross section of views, and approximately a fifth described themselves as a ‘link worker’ (community navigator, health advisor, health trainer and any other non-clinically trained person who works in a social prescribing service).

 

A fifth described themselves as belonging to the third sector, and the rest reflected a diverse group, including a general practitioner, practice nurse/manager, pharmacist, commissioner, yoga teacher/researcher/therapist, evaluator of social prescribing projects, project coordinator, nurse community team leader, occupational therapist, and public health professional.

These individuals also represented a broad cross section of Clinical Commissioning Groups (CCGs), including Crawley, East Sussex and Kent (‘Let’s Get Working’ project), Kernow (St. Austell Healthcare Hub), Newcastle Gateshead and Hammersmith and Fulham, and groups like Telford & Wrekin Council, Zest Social Prescribing Service (Sheffield), Bromley by Bow Centre (Macmillan Social Prescribing) and CoolTan Arts.

While 56% of respondents said their practice/community/CCG offers some form of social prescribing, 39% replied that they didn’t know. Of this 56% who do offer social prescribing, 32% offer yoga as part of this, 27% do not, and 42% do not know.

Who can most benefit?

When asked who would benefit the most from yoga based social prescribing, the answers were interesting and diverse.

 

‘Everyone’, ‘all those interested’ and ‘anyone’ was mentioned most frequently and qualified by one respondent: ‘Everyone – but practitioners formally trained in motivational interviewing techniques and screening for readiness for change will only make it reality’.

 

Other comments reflected a wide range of opinions:

  • ‘Anyone motivated enough to want to improve their health and wellbeing through self-care’

  • ‘Many people willing to commit to learning how to help themselves to improved health and well-being within their daily lives’

  • ‘Anyone at risk of ill health or poor wellbeing’

  • ‘People in need of better body awareness and control’

  • ‘Many of the patients who repeatedly report to their GP who actually need some gentle exercise and or mental health support’

  • ‘Client with mental health involvement such as stress, anxiety, depression plus those with complex health conditions’

  • ‘Unemployed, older people, those with medical conditions including mental health’

  • ‘Older people (to reduce falls), everyone (mental health, LTCs) General public, people with mental ill health, people with long term conditions, single parents’

  • ‘Hopefully those that do not have the financial ability to go to yoga classes and need to look after their physical and mental well-being’

  • Both practitioners (being able to share the yoga) and patients of all ages and with many different ailments – it would be a holistic treatment for improving quality of life in the majority of cases

Evaluating social prescribing

The top five ways in which currently social prescribing schemes are evaluated are:

  1. Measurement of mental health & wellbeing (including quality of life, confidence & self-esteem and wellbeing scales): 87%

  2. Measurement of engagement with social prescribing scheme (attendance and drop-out rates etc): 73%

  3. Measurement of impact on demand (level of medication prescribing, demand for GP services, referral to secondary care, A & E visits, emergency hospital admissions etc): 47%

  4. Measurement of physiological and physical parameters (eg HbA1c, blood pressure, weight, levels of physical activity etc): 33%

  5. Measurement of economic impact (social return on investment (SROI), cost per QALY, impact on housing, employment and welfare status): 33%

Other measures cited were:

  • Impact on community engagement

  • Pre/post assessment with individual often looking at wemwbs

  • As per original randomised control trial (outcome measures) plus Feedback and Friends and Family Test

  • Variations across each social prescribing initiative

  • Not enough R&D resource to do it properly or with CMFs across initiatives to compare and contrast them properly

Challenges when evaluating social prescribing schemes

The main challenges associated with evaluating social prescribing schemes broadly fall into the following categories:

 

  • Access to NHS data

  • Difficulty in collecting follow up data on vulnerable clients

  • Capturing data on those who choose not to engage with the service

  • Evaluation needs to cover referral processes applicable to all forms of social prescriptions

  • Quality of evidence

  • Clients writing down something in a feedback form which contradicts what is being said within a session

  • Evaluating aspects that are difficult to measure. E.g. Happiness and the ability to manage life changes

  • Social prescribing should only be used to refer patients to appropriate activities/ interventions which have a proven evidence base and are delivered by professional/trained service providers

  • Tendency for doctors to adopt ‘gold standard’ techniques derived from drug research paradigm which are wholly inappropriate for subjective and social interventions

  • Too much emphasis on quantitative data

  • Outcomes may not be realised for a long term

  • Consistency in capturing and/or surveying participants

Training & education

  • Rating schemes can be challenging as not all raters have training in using the rating tools

  • GP knowledge and implication – Patient awareness and motivation to engage

  • Awareness amongst GPs and general public

  • How to educate the link worker / health champions about which yoga programmes are appropriate

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