Introduction

Unpaid or informal caregivers play a crucial yet frequently overlooked role in healthcare systems worldwide, spending billions of hours providing essential care for individuals with chronic illnesses, mental health and behavioural conditions, disabilities and other age-related diseases requiring assistance with activities of daily living [1–4]. Health outcomes associated with unpaid caregiving are disproportionately negative, with many caregivers compromising their own financial, health, family and well-being needs to attend to their caregiving duties [5,6]. Evidence demonstrates that unpaid caregivers face an increased incidence of depression, burden, loneliness, as well as a decrease in quality-of-life [7,8,9]. Furthermore, the provision of unpaid care to individuals with varying conditions may give rise to distinct challenges such as stigma and the absence of condition-specific supports [10,11].

Shifting sociodemographic and cultural trends indicate that the proportion of unpaid caregivers around the world are expected to substantially increase over the next few decades, which is attributed to various factors such as the increase in aging populations, an increase in the rising prevalence of chronic or debilitating conditions such as dementia, as well as other work and healthcare system-related changes [12–15]. These trends and facts represent a significant global health challenge and necessitate that interventions, policies, programs and systems must work to evolve to address the complex needs of unpaid caregivers alongside care recipients. Beach and colleagues [16] argue that current policies and programs supporting unpaid caregivers around the world focus on relieving the burden associated with caring instead of considering the holistic needs of the caregiver that enable them to thrive in their caregiving roles. The demanding nature of informal caregiving presents unique challenges for the caregiver that must be addressed by helping them to find a balance between their own self-care while managing their caregiving responsibilities [17].

Social prescribing has emerged as an increasingly recognized model of care worldwide, linking individuals to non-medical community-based support systems aimed at improving health and well-being [18,19]. Social prescribing involves a navigational approach to care, and typically involves an element of referral by oneself, a healthcare provider or link worker, to a community or statutory service meant to attend to social well-being needs [20]. The first internationally recognized conceptual definition describes social prescribing as a ‘non-medical prescription to non-clinical supports and services within the community that is usually co-produced by an individual and a trusted individual in a community or clinical setting to subsequently improve health and well-being’ [21]. Today, social prescribing and navigational-based models of care are increasingly being implemented in different contexts across various parts of the world, both formally and informally [18]. In the United Kingdom where social prescribing has been formally integrated into the NHS for example, social prescribing can take the form of dance classes, hike excursions and more [22].

Allowing unpaid caregivers to participate in social prescribing programs may help to alleviate the disproportionately negative physical and mental health outcomes associated with their caregiving roles. This is especially important given that social prescribing models of care have the potential to address a wide spectrum of caregiving experiences and needs. While a growing body of literature highlights the promising impacts of social prescribing and explores caregiver perceptions regarding potential participation, there remains limited research on the availability, nature and effectiveness of social prescribing programs for this population [23–26]. Furthermore, many existing caregiving interventions or programs focus on improving caregiving competencies rather than providing an avenue to facilitate the overall well-being for this population. This gap in the literature warrants a preliminary investigation of the current landscape regarding social prescribing among this population, especially as social prescribing and related navigational models of care continue to be evaluated and piloted in the literature [18].

We aim to collect and report on the growing body of literature related to answer the following research question:

What are the current practices, outcomes, benefits, and challenges of social prescribing programs involving unpaid caregivers?

The results of our scoping review will help to map out the existing evidence associated with social prescribing programs for unpaid caregivers and allow for the identification of evidence gaps where further research is needed.

Methods

A protocol was created and published on Open Science Framework in 2024 [27].

Given that social prescribing is an emerging model of care that is currently being adopted in different capacities and contexts around the world, a scoping review was determined to be the most appropriate methodology to broadly address relevant aspects of the research question. This proposed scoping review followed framework and reporting guidelines as established by Arksey and O’Malley [28] in addition to the updated JBI methodology for scoping reviews, respectively [29,30]. To ensure transparent and complete reporting, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist [31] was also used, which may be accessed in S1 Checklist.

Eligibility criteria

In accordance with our protocol, this scoping review aimed to identify and present the available English-language academic and grey literature published between January 1, 2000 till June 26, 2024. This limit was selected to ensure relevance to the subject topic, as social prescribing is a newer and developing concept which gained popularity after the year 2006 [32,33]. The search was limited to English-language publications due to various resource constraints related to availability of translation services, and the study team acknowledged that this may have potentially resulted in the exclusion of literature that would impact the generalizability of findings. An updated search was carried out on March 30, 2025.

Articles were included if they involved an unpaid caregiver participating in a specific social prescribing program or service. For this scoping review, we used the inclusive operationalized definition of social prescribing described by Muhl and colleagues [21]. This allowed for the creation of inclusion criteria that was informed by the Population, Concept and Context framework [29], as seen in Table 1.

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Table 1. Evidence Selection using the Population, Concept, Context Framework.

https://doi.org/10.1371/journal.pone.0347299.t001

Studies that did not actively involve caregiver participation, did not discuss caregiver outcomes, or evaluated caregiver needs without actual implementation of a social prescribing program were excluded. Conference papers and related abstracts were excluded, as well as any non-English literature and reviews. Backward reference searches of included studies were also completed to identify any other full-text studies for inclusion.

Results

Following title and abstract screening of 4376 records, a total of 17 studies were selected for inclusion (Fig 1).

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Fig 1. PRISMA 2020 Flow Diagram.

https://doi.org/10.1371/journal.pone.0347299.g001

Characteristics of included studies

Table 2 contains a summary of relevant study and demographic characteristics.

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Table 2. Characteristics of Included Studies.

https://doi.org/10.1371/journal.pone.0347299.t002

Of the 17 studies selected for inclusion, eight (47.06%; 8/17) were published between 2014–2019 [36–43] The remaining nine studies (52.94%; 9/17) were published between 2021–2024 [44–52].

With regards to study methodology, most studies were qualitative, utilizing interviews and focus groups to better understand an unpaid caregiver’s participation in a social prescribing program (47.1%; 8/17) [37–40,42,48,49,51,52]. Five studies were quantitative (29.4%; 5/17) [38,43,44,46,47], and four studies involved mixed methods (23.5%; 4/17) [36,41,45, 50].

Five studies were published and conducted within the United States (29.4%; 5/17) [37,39,41,43,50], with three done in the United Kingdom (17.6%; 3/17) [38,42,47], two in Canada (11.8%; 2/17) [48,51], one in Australia (5.9%; 1/17) [36], one in Finland (5.9%; 1/17) [52], one in France (5.9%; 1/17) [46], one in Ireland (5.9%; 1/17) [49], one in New Zealand (5.9%; 1/17) [40], and one in the Republic of Korea (5.9%; 1/17) [44]. Furthermore, one study was conducted in a multiple-country setting, involving both Canada and the United States (5.9%; 1/17) [45].

Current practices of social prescribing programs involving unpaid caregivers

As indicated in Table 3, a variety of social prescribing programs were offered for unpaid caregivers to participate in. Two studies (11.8%; 2/17) involved nature-based prescriptions, and both these programs were designed for parental caregivers and their children to participate in together [43,44]. Four studies (23.5%; 4/17) involved recreational physical activity, including yoga or other movement-based programming for the unpaid caregiver and care recipient to participate in together [45,47,48,51]. A variety of art-based programs were also reported; four studies (23.5%; 4/17) involved musical programs encompassing choir singing or songwriting [36,38,41,49]; three (17.6%; 3/17) involved museum/gallery-based programs [39,40,42]; and four (23.5%; 4/17) involved other arts based programming [37,46,50,52]. Program duration time varied considerably across included studies, ranging from single-session activities to multi-session programmes delivered over a period of multiple weeks. The majority of included studies were reported to deliver weekly sessions, and one study only featured a one-time activity facilitated over three hours [39].

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Table 3. Components of Social Prescribing Programs Involving Unpaid Caregivers.

https://doi.org/10.1371/journal.pone.0347299.t003

Most social prescribing programs (76.5%; 13/17) were designed for both unpaid caregivers and care recipients to participate in together. Unpaid caregivers in three studies participated in a program without the care-recipient, and this was typically done by offering the unpaid caregivers some type of respite service while they participated in the programming [36,42,46]. One study involving young children caregivers offered the program during their holidays [46].

With regards to the referral pathway involved, most studies involved a combination of self-referral, community and/or primary-care referral pathway to facilitate participation in the social prescribing programs. Community referrals were seen mostly through the use of day-care centers or local associations, and primary-care pathways usually involved a healthcare provider such as a physician. Primary care referrals as a method of referral by itself was described in only two studies [43,49].

Discussion

This scoping review synthesizes a growing body of knowledge by describing current reported practices, outcomes, benefits and challenges of community-based social prescribing programs involving unpaid caregivers. Our review indicates that this is a rapidly evolving field of knowledge, especially since a large proportion of included studies have been published within the last five years in different countries around the world. According to our results, a variety of arts-based, physical activity and nature-based programs are currently and commonly provided to unpaid caregivers, with most programs designed and offered for both caregivers and care recipients to participate in together. In contrast, very few programs were offered to the unpaid caregiver as respite; this is an avenue worth exploring for future research to integrate social prescribing programs for unpaid caregivers, especially since many respite programs take place in community-based settings such as day-care centers. This may help to move respite care from simply a break from caregiving, whereby more structured opportunities for the caregiver are provided to form social connections and engage in activities that promote well-being, as tailored towards the caregiver’s needs.

Our findings also indicate that methods of referral or entry into social prescribing programs for this population varied considerably across studies. We observed that a combination of self-referrals, community-based referrals and primary-care referrals were commonly used. This variability in referral strategy suggests that although access to social prescribing is broad and wide-ranging, it may also be fragmented, informally adopted and difficult to navigate, especially for those who are older or unfamiliar with available services. These observations are reflected in the literature, especially as unpaid caregivers and their care recipients consistently demonstrate a need for embedded community-based resources that are flexible and accessible and led by trained staff, such as specially trained care-coordinators [53,54]. Furthermore, many formalized social prescription programs around the world utilize specialized link-workers, family navigators or liaisons, and this may help unpaid caregivers to access resources they need in community-settings more efficiently. The use of these roles or individuals in future programs may provide more structured pathways for unpaid caregivers and their care recipients to access community-based resources more efficiently and may also help to mitigate negative health outcomes [53].

With regards to the outcomes observed among unpaid caregivers, our review found that social prescribing programs in the community described positive outcomes on the physical and mental well-being of unpaid caregivers as well as on their social well-being. These findings are consistent with existing literature, as social prescribing and other psychosocial programs have positive outcomes on the well-being of individuals and older adults [55–57]. We also observed that common challenges experienced by unpaid caregivers were reported to be related to transportation and scheduling conflicts. This highlights the importance of designing social prescribing programs that are adaptable to the needs of caregivers, potentially by use of participatory and collaborative research and flexible program design. For example, addressing issues such as scheduling conflicts through drop-in or hybrid formats may overcome both transport and scheduling issues.

Our observations throughout the research process offer other important insights in this emerging area of study. Throughout the screening process, it was found that a large proportion of records that made it into full text review were ultimately excluded because the unpaid caregiver did not actively participate in the social prescribing program, as the intervention primarily target care recipients. In these studies, unpaid caregivers were only mentioned in terms of their role in facilitating the care recipient’s participation, such as transporting or assisting them to access socially prescribed programs. Even in some studies that involved active participation of unpaid caregivers in social prescribing programs, there appeared to be a lack of analysis or results that specifically pertained to the unpaid caregiver’s own health and well-being. This may indicate that unpaid caregivers are often sidelined and positioned as secondary participants in research primarily designed for care recipients, and that programs may work to offer them respite to ease their duties rather than focus on the overall well-being of the caregivers themselves. Even though dyadic programs benefit both parties, we also advocate for the design of caregiver-centred models of care. These findings underscore a significant gap in ongoing research and practical initiatives, pointing to a better need for future studies to address the health outcomes of this population and recognize their roles as caregivers rather than only extensions of the care recipient.

Another observation worth consideration throughout the research process was the fact that all studies marked for inclusion were not necessarily described as conventional “social prescribing” programs or used that specific term. Social prescribing is a relatively new and emerging concept and term in modern research that is still being implemented in informal and formal contexts worldwide [18]. Due to this reason, the terminology used to describe these programs may vary significantly across different studies and settings. Throughout the development of the protocol, efforts were made to try to use a broad search strategy. This was done through consultations with librarians, project managers with the Canadian Institute of Social Prescribing, as well as existing literature. During the screening process, efforts were made to map and identify an element of recruitment or referral into community-based programs that involved unpaid caregivers, even if the term “social prescribing” was not explicitly mentioned. As such, if the referral or recruitment pathway of the unpaid caregiver was not clear in the study manuscript, then a potentially eligible study would be excluded. This ensured that there was methodological rigor throughout the screening process to capture a diverse range of community-based programs and initiatives that aligned with the core principles of social prescribing for unpaid caregivers, even when different terminology outside of the specific term “social prescribing” was used. We also excluded virtual programs to focus on in-person, community-embedded supports involving social interaction. However, we acknowledge that this may limit relevance given the growing role of virtual social prescribing initiatives.

Furthermore, as this scoping review involved caregivers across various ages and backgrounds, future studies could also work to better understand the intersectional needs of specific caregiver populations. We found that our evidence base mostly included informal caregivers of people living with dementia, which is also dominant in caregiving research. Being able to expand to more diverse caregiving contexts could help to design tailored programs for caregiving for individuals with different conditions. As such, we suggest expanding programs to diverse caregiving contexts in order to clarify whether program design is better if it is condition-specific or more broadly applicable.

Additionally, research clearly demonstrates that outcomes related to unpaid caregiving are influenced by various intersecting factors such as race, ethnicity and gender [58–60]. Future studies should not only stratify and analyze results according to different health equity factors, but also consider how various structural inequities influence access to and benefit from socially prescribed programs. For example, since most participants in reported studies were women, it is unclear if the programs were gender responsive. These considerations are crucial given the gendered distribution of unpaid caregiving and as such, must be supported in future program design.

Our review has limitations. First, due to the nature of scoping reviews, the studies included in this review were of varying methodologies, with many being qualitative studies that involved focus groups or interviews. This makes it difficult to quantify or see definite and conclusive trends associated with the benefits or challenges of social prescribing programs for this population. It also elucidates the need for more quantitative studies with control groups as well as systematic reviews to measure quantifiable changes and trends in unpaid caregivers’ health and well-being moving forward while assessing the risk of bias and quality of the evidence included. We also push for more quantitative research to better understand mechanisms of effectiveness on health and well-being. Social prescribing may also be conceptualized as a complex intervention and future research may benefit from appropriate frameworks to systematically evaluate the effectiveness of such programs [61,62].

Additionally, the scope of this review only represents one component of the larger social prescribing pathway and does not capture the entirety of the whole social prescribing process such as link referrals, assessment of needs, and evaluation of program participation among caregivers. Future studies could work to assess the entirety of this pathway and fill in existing gaps in knowledge to provide a more holistic understanding on how social prescribing operates in practice, which will also help bridge gaps or inefficiencies that may exist within the system. In our review, we also did not include knowledge-based, home-based or virtual programs, and this may have excluded a range of relevant programs that could be considered as socially prescribed programs. However, the importance of virtual programs such as virtual support groups for example, may be relevant and promising and may overcome barriers to accessibility, especially in a post-pandemic era. Future research efforts should explore how different models of social prescribing can be leveraged using digital platforms or methods of telehealth to improve accessibility for unpaid caregivers and their care recipients.

Conclusion

Overall, this scoping review offers valuable insights into the current landscape of social prescribing for unpaid caregivers, emphasizing their potential benefits for health and well-being while also describing certain challenges that they face in access and participation. Our findings may help to inform future research and guide the development of inclusive and successful programs to better support a population that is often overlooked in health services planning. Unpaid caregivers require meaningful support and resources to address their own health needs, and social prescribing holds the potential to be a transformative rather than supportive process that reimagines how communities and health systems recognize, value and respond to the needs of this population.

Supporting information

Acknowledgments

We would like to thank the librarians at McMaster University for assisting in the development of a search strategy.