Abstract

Background Autistic adults are affected by health and social disparities that impact life expectancy and quality of life, frequently resulting in escalating wellbeing concerns requiring costly acute care. Evidence suggests barriers to healthcare and a lack of post-diagnostic support may contribute to these inequalities. Social prescribing, a low-intensity personalised care model receiving increasing attention from policymakers and commissioners, offers opportunities to address isolation, build skills and promote health through collaborations between services and communities. However, social prescribing research and provision has overlooked wellbeing and access needs of autistic adults. This PhD project aimed to investigate factors affecting accessibility of social prescribing pathways, which can comprise a variety of models and mechanisms, and their suitability for autistic adults from initial referral through to prescribed activities. Methods The research delivered a systematic mapping review and mixed-methods study. The review synthesised previous reviews of literature on outcomes, settings and service pathways within community-based services for autistic adults. An online survey of 128 autistic adults explored barriers to primary healthcare, the point of access to social prescribing, across changing contexts using regression analysis. Semi-structured interviews with 23 autistic participants investigated perspectives on wellbeing, attitudes towards social prescribing as a response to wellbeing barriers, and provision of wider support in the community. Qualitative data were analysed using reflexive thematic analysis, incorporating critical realism and the candidacy framework, to examine individual, relational and systemic factors. Results Findings suggest that access to social prescribing for autistic adults via referral from health and social care services involves patient and provider evaluations, socioeconomic factors and wider contexts. Self-determination was found to link themes relating to meanings of wellbeing for autistic adults. Social prescribing may promote self-determination through its tailored approach. However, pathways require adaptions to maximise engagement, including offering alternative referral routes, novel prescriptions and additional support at key transition points. Providers should work with the autistic community to improve access and acceptability, and bring mutual benefits for individuals and services. Conclusions Service commissioners and policymakers should consider supporting a social prescribing pathway embedded in autism diagnostic services or upskilling existing social prescribing pathways to adapt their practice for autistic adults. The research also adds to understandings of peer support and self-determination as important mechanisms in wellbeing for autistic adults.

Keywords

Social prescribing, Autism, Primary healthcare, Mental health, Health policy, Coproduction, Critical realism, Candidacy, Self-determination

Document Type

Thesis

Publication Date

2024

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