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Table 2 Proposed interventions to promote increased GP social prescribing and community engagement for patients with mental health problems, linked to Behaviour Change Techniques

From: Social prescribing for individuals with mental health problems: a qualitative study of barriers and enablers experienced by general practitioners

Intervention number Number of barriers/enablers that could be addressed Intervention type Behaviour Change techniques Outline of strategy
1 5 Training Behavioural rehearsal; demonstration of behaviour; instruction on how to perform a behaviour; problem solving; goal setting (behaviour and outcome); discrepancy between current behaviour and goal; social support; verbal persuasion about capability; monitoring of (outcomes of) behaviour Training package for GPs to develop the appropriate inter-personal skills important for effective social prescribing for their patients, including motivational skills, active listening, perseverance and resilience training, ascertaining ‘root causes’; include regular training updates and “check-ins” for GPs; include clear training for GPs on referral criteria for social prescribing
2 4 Training; enablement Self-monitoring of (outcomes of) behaviour; Goal setting (behaviour); goal setting (outcome); action planning; identity associated with changed behaviour; restructuring the social environment Training programme/plan for whole practice and all practice staff – on how to create a more community-centred atmosphere and engage more with the community, as a practice. This should include more time allocated to supporting active engagement with the community; regular whole-practice meetings, activities and team-building exercises that are centred around community approaches/social prescribing. This should also include tailored support for part-time and locum GPs, and a plan for GP retention
3 3 Education Information about social and environmental consequences; information about health consequences; information about antecedents; credible source; pros and cons Educate all GPs on the wider evidence base of social prescribing, the harms of over-prescribing and over-medicalisation; enhance GPs’ and other practice staff’s knowledge of the local community assets and services on offer – this could be run by community group representatives or link workers; also include education about the social prescribing service and the new link worker role
4 3 Incentive; Enablement Feedback on behaviour; feedback on outcomes of behaviour; positive reinforcement; social comparison; reward; identity associated with changed behaviour Develop a system to provide regular, systematic (positive) feedback to GPs on their social prescribing-referred patients; reward GPs who use social prescribing effectively and appropriately
5 2 Enablement Social support (emotional and practical) Set up a buddy system for patients accompanying them to community groups and activities; use link workers and harness volunteers for this
6 2 Persuasion; modelling; training Salience of consequences; information about emotional consequences; pros and cons; material incentives; comparative imagining of future outcomes; framing/reframing; credible source; identity associated with changed behaviour Use patient stories, community group and GP experiences to persuade GPs that social prescribing/community engagement is an effective way to support patients; through use of videos and in-person accounts
7 1 Restriction; Coercion Behaviour substitution; habit formation; habit reversal; punishment; social comparison Dis-incentivise GPs for inappropriate anti-depressant/medical prescribing and not offering social prescribing when referral criteria are met
8 2 Enablement; Environmental restructuring Prompt/queues; behavioural substitution; behavioural cueing; habit formation; habit reversal; social comparison; conserving mental resources; restructuring the physical environment Develop a strong IT system for social prescribing referrals; use on-screen prompts for GPs to see the social prescribing option for every consultation (or every relevant consultation as determined by referral criteria); design quick, simple forms that GPs can send to the link worker
9 2 Environmental restructuring Restructuring the physical environment; restructuring the social environment; adding objects to the environment Physical space in practice re-purposed or created in order to house a link worker and/or for receptionists to have chat with patients, and/or to invite the community in to utilise, e.g. crafting session or community garden
10 1 Environmental structuring Restructuring the physical and social environment Provision of long-term funding to VCS groups that are receiving social prescribing referrals; explore pooled budgets, e.g. combined health, local government and third sector funding