Prescribe Heritage Highland: Challenges of rural social prescribing

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Can social prescribing address rural health inequalities? Findings from the Prescribe Heritage Highland project (Dr Sara Bradley, UHI).

Background: The UKRI funded Prescribe Heritage Highland project (2022/23) aimed to establish key conditions for the scaling up of non-pharmaceutical cultural and natural heritage interventions within remote and rural areas. Exercise groups, outdoor activities, art therapies and peer support are increasingly being 'prescribed' to 'treat' both mental health conditions and address sedentary lifestyles. However, little has been done on how to deliver them at scale in remote and rural contexts or whether they can reach those most at risk of deprivation and/or social isolation within rural communities. Service providers face economic and logistical challenges delivering across large geographical areas with dispersed populations. Although rural communities can be perceived as tight-knit and resilient, the problems of mental ill-health, social isolation, deprivation and health inequality can be hidden.

Intervention: In partnership with Museums Heritage Highland, representing independent rural museums, and High Life Highland, a third sector organisation managing cultural and leisure facilities, the project delivered cultural and nature-based activities to patients referred by health professionals, support workers and community link workers. In locations across Highland activities based on museum collections and ranger-led nature walks were offered to promote mental well-being and combat social isolation. The project was built around Edinburgh University’s successful 'Prescribe Culture' programme.

Methods: This study involved a policy review, a scalability assessment, focus groups and 47 interviews with activity facilitators, third sector referrers and providers, healthcare professionals and both regional and national stakeholders. A stakeholder advisory group was set up to inform project development, comprising third sector organisations, museums, NHS Public Health and Highland Council.

The study identified and highlighted a range of key challenges for the delivery of rural social prescribing as follows:
•Geography – large geographical area including islands with dispersed population
•Infrastructure – lack of public transport and poor Broadband/mobile connectivity
•Health service culture - medicalised delivery model/Scepticism – referrers & patients
•Variable, complex & time-consuming referral pathways
•Severity of patient cases & perception of heritage sector
•Museums & third sector sustainability and funding models
•Workforce recruitment/retention –recruiting volunteers & impact of COVID pandemic

Trying to address rural health inequalities through social prescribing is extremely complex. There is a danger of widening inequalities in rural areas due to the variations in service provision and access between communities and areas. A new strategy is required to target those in need and to engage disadvantaged communities. Recommendations for further work include access to more accurate rural deprivation data, improving funding models, more dialogue with healthcare professionals and referrers to improve referral pathways, improving rural access to services, greater community engagement and co-design of services.
Original languageEnglish
Publication statusPublished - 2023
EventHealth Equity Network Conference - Council House , Birmingham, United Kingdom
Duration: 5 Oct 20235 Oct 2023
Conference number: 1st


ConferenceHealth Equity Network Conference
Country/TerritoryUnited Kingdom


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