How Social Prescribers Conceptualise Their Role in Reducing the Health Inequalities that Affect Black Adults with Chronic Pain

Background: Black people with chronic pain experience a range of health inequalities. Most notably, they are significantly more likely than other ethnic groups to experience chronic pain. The roll-out of social prescribing is a key part of recent UK health policy, with a stated aim of directly targeting health inequalities like these. Little is known about how Social Prescribing Link Workers (SPLWs), the people tasked with delivering social prescribing interventions, think about these specific health inequalities and the role of SPLWs in addressing them.

Method: A qualitative methodology was used to explore how SPLWs conceptualise the health inequalities that affect Black people with chronic pain, and how they see their role in reducing these inequalities. Seven SPLWs took part in semi-structured interviews. Data was analysed using reflexive thematic analysis and a critical realist pistemological perspective was adopted.

Results: Three superordinate themes were identified. The first theme, ‘Social prescribing: “it doesn’t fix the undercurrents of society”’, explored contextualised understandings of health inequalities held by SPLWs. ‘Systemic factors affecting the SPLW role’ described how the medical setting and socio-political context of social prescribing influence the SPLW role. ‘Learning lessons and thinking differently’ captured SPLW perspectives on valuing community strengths, rebuilding trust with communities, and thinking critically about race and ethnicity.

Conclusions and Implications: The findings indicate that SPLWs are making a valuable contribution to addressing health inequalities for Black people with chronic pain, but they view change at multiple systemic levels as essential to reducing inequalities in the long term. The SPLW approach to rebuilding trust with Black communities should be learned from, harnessed and developed, while health professionals should be supported and trained to work more sensitively around racialised chronic pain inequalities. Wider structural changes that more directly target the social determinants of health, like housing and education, are essential for reducing health inequalities and supporting the work of social prescribing.