Reasons for referral to a social prescribing program through the COVID-19 pandemic and associated factors: a cross-sectional study in Portugal

Introduction: Social prescribing (SP) links patients with non-medical needs affecting their health to services and activities within the community as a strategy to prevent disease and promote health and wellbeing. There is limited evidence on the reasons for referral to SP through time and of factors associated with specific reasons of referral. Understanding SP referral patterns is relevant to inform practice and policy. We analyzed factors associated with specific reasons for referral to SP program in Lisbon, including the differences through time. Methods: We conducted a cross-sectional study on referrals to a SP program between September 2018 and December 2023 in Lisbon. Data was collected through SP referrals forms. Reasons for referral and patient characteristics were described and compared in three periods (pre, during and Post-COVID-19 pandemic). Poisson regressions with robust estimation were used to identify factors associated with main reasons for referral including patient characteristics, comorbidities, and co-existing reasons. Results: Overall, 1,298 referrals were made to SP. Reasons for referral were Social and financial support (58.9%), Social Isolation (29.3%), Unemployment (19.8%), Mental health concerns (18.8%), Functional dependency (16.0%), Sedentary lifestyle (13.0%). Strong associations were found between Social Isolation, Mental Health concerns, and sedentary lifestyle as co-existing reasons for referral. These reasons were less common among patients referred for Functional dependency and Social and Financial support. We found a significant reduction in the proportion of sedentary lifestyle as reason for referral in the Post-COVID-19 period when compared to the Pre-COVID-19, but an increase in the proportion of Cardiovascular Disease, Obesity and Diabetes. Conclusions: Our findings suggest that community services and activities that broadly respond to social isolation, mental health, and sedentary lifestyle as commonly associated reasons for referral should be promoted. Changes in reasons for referral to SP through time reflect the influence of social dynamics on populations needs and should be monitored to broaden SP preventive and health promoting potential.