Tailoring cultural offers with and for diverse older users of social prescribing (TOUS): A realist evaluation

Problems in life that affect how people feel cannot always be fixed with tablets or medication. For example, loneliness can lower people's mood, or worries about money can cause them to feel anxious. This may stop people looking after their health. A way of getting them help with such problems is through social prescribing.

Social prescribing involves connecting people to 'community assets' - groups, organisations, services in their local area. Community assets can include exercise and arts classes, volunteering and advice services. Such connections can provide people with social, emotional or practical support. Link workers are a key part of social prescribing. They are employed (by the NHS, local councils or charities) to help people find such support.

Older people might benefit from social prescribing. For example, if they have experienced a bereavement or lack purpose in life following retirement. Or they might have concerns about money as the cost of shopping, electricity and gas increases. As part of social prescribing, a link worker might connect an older person to support in the cultural sector; for example, to a dance or singing group, activities run at a museum or volunteering at a local theatre.

Our previous research has highlighted that being connected to the cultural sector might: a) distract older people from concerns in life for a short period, b) help them make new friends, c) provide them with a space where they feel safe and welcomed, d) increase their confidence as they gain knowledge or skills through trying new things. Our previous research involved mainly talking to older people who described themselves as 'White British'. This new study will build on and expand what we learnt from the previous research. We will focus on cultural offers and opportunities that have been developed for or with people who may not have English as their first language and/or do not identify as White British. This will allow us to develop recommendations about producing accessible, acceptable and appropriate social prescribing cultural offers for older people [aged 60 and older] from ethnic minority groups.

The research will:

1. Identify what is already known about creating cultural activities or events for older people from ethnic minority groups. We will do this by reviewing relevant literature.
2. Map what is provided by the cultural sector in the UK; things that link workers could refer older people from ethnic minority groups to as part of social prescribing. We will do this by contacting a wide range of cultural organisations and asking them to complete a short questionnaire.
3. Explore what we can learn from cultural organisations that have tried to provide cultural offers that appeal to older people from diverse backgrounds. We will do this by spending time at six organisations that complete the questionnaire for the mapping referred to above. They will become our 'cases'. We will watch what happens there. We will also talk to people who work for the organisation or older people from ethnic minority groups engaging with it. We will pick these six cases so they are varied in terms of a) where they are located in the UK, b) groups they aim to attract, c) type of cultural offer provided, d) size of the organisation/operation. We will compare and contrast what we learn from each case. We will explain differences that may arise across these cases.

We will bring information collected from these three elements together; a computer programme called NVIVO will help us with this. We will develop an explanation of how, why and when cultural provision that could form part of a social prescription might be beneficial (or not) to the well-being of older people from ethnic minority groups. We will share what we learn via written documents, videos and conference presentations. We will also hold an end of project meeting to talk to interested people about what we have found from the research.

Background: Social prescribing supports people with non-medical issues (e.g. loneliness, financial worries, housing problems) that can affect their physical and/or mental health. Link workers are employed to facilitate social prescribing. They spend time understanding people's non-medical issues and connect them to relevant community/voluntary organisations. This may include connecting people to 'cultural offers' - events, groups, activities run within or by cultural organisations.

Our previous research has suggested that cultural offers can support older people's well-being as part of social prescribing by taking them away from concerns in life, providing them with an environment where they feel safe and valued, enabling them to meet others, promoting self-growth. It highlighted the importance of tailoring cultural offers so they are acceptable to older people. However, this previous research did not explicitly set out to explore the meaning and potential role of cultural offers within social prescribing for older people from ethnic minority groups.

Research question: What tailoring is needed, how, when and for whom, to optimise cultural offers as part of social prescribing for older people (aged 60+) from ethnic minority groups?

Methods: A realist evaluation will be undertaken composed of three work packages (WPs). It will result in a programme theory that explains how cultural offers work as part of social prescribing, under what conditions, for whom. WP1 will involve a scoping review and mapping of current cultural offers provided with or for older people from ethnic minority groups in the UK. WP2 will involve focused ethnographies undertaken around six cases (cultural organisations/settings) in the UK identified from the mapping undertaken in WP1. WP3 will involve finalising the programme theory and drawing on it to develop evidence-based recommendations for cultural providers, link workers and policy makers.