SHINE - social prescribing for adults and the elderly: the path to effective implementation. A study protocol

BACKGROUND: Social prescribing connects healthcare with community-based services to address social determinants of health, such as loneliness, social isolation, and low health-related quality of life. Although widely implemented in countries such as the United Kingdom and Australia, social prescribing remains underdeveloped in Denmark. The Social Prescribing Vesterbro-Sydhavnen project is the first attempt to systematically implement a general practice-embedded model of social prescribing within a tax-funded healthcare system. It aims to reduce loneliness and promote well-being among socially vulnerable adults by integrating link workers into the patient pathway, in close collaboration with general practitioners, local authorities, and voluntary organizations.

METHODS: This research programme uses a Hybrid Type II effectiveness-implementation design to evaluate both clinical and implementation outcomes. The programme comprises nine interrelated work packages using mixed methods. Quantitative components include a quasi-experimental study assessing healthcare service use and patient-reported outcomes (loneliness and quality of life) among 350 referred individuals. Qualitative components include ethnographic fieldwork, semi-structured interviews, and realist evaluation to explore implementation strategies, mechanisms of change, and contextual determinants. Two programme theories guide data collection and analysis and are refined iteratively throughout the studies.

DISCUSSION: This study addresses a gap in implementation research by investigating how a complex, socially embedded intervention can be effectively integrated into routine primary care. The use of a Hybrid Type II design enables simultaneous learning about what works and how implementation strategies interact with local contexts. Particular focus is placed on the roles of link workers, intersectoral collaboration, organizational readiness, and the fit between patient needs and community services. The research contributes to the understanding of strategy selection, adaptation, and sustainment across clinical, organizational, and community settings. Findings will inform the scale-up of social prescribing in Denmark and offer transferable insights on implementing person-centred, equity-oriented interventions in other healthcare systems.

TRIAL REGISTRATION: The effectiveness assessment is registered prospectively at ClinicalTrials.gov (NCT07029334).