Evaluating Social Prescribing in Viet Nam: From Referral Counts to Meaningful Outcomes

Evaluating Social Prescribing in Viet Nam: From Referral Counts to Meaningful Outcomes

A social prescribing program can look successful on paper very quickly. A healthcare organization may report hundreds of referrals, dozens of community partners and a growing list of available activities. Those numbers can be useful, but they do not tell us whether people actually reached the support, whether they found it useful, whether something important changed in their lives, or whether community organizations were able to manage the additional demand.

This distinction matters particularly in Viet Nam, where formalized social prescribing remains at an early stage and locally generated evidence is still limited. Evaluation should not be something added after a pilot has finished. It should help shape the model from the beginning, identify where connections fail, show which groups are being reached or missed, and help determine what should be improved before an approach develops further.

International evidence also suggests that social prescribing should not be evaluated as though it were one standardized treatment. Programs differ in referral routes, workforce models, populations, community resources, intensity of support and local context. A 2026 global scoping review of 115 empirical studies found substantial variation across these dimensions, while evidence from the Western Pacific remains particularly heterogeneous.[1,2]

Key Points

• Referral volume is an activity measure, not an outcome. Evaluation should follow what happens from identification through connection, participation and meaningful change.

• The evaluation approach should match the maturity of the program. An early pilot needs different questions from an established program considering wider implementation.

• Evaluation should extend beyond individual well-being to include pathway performance, community capacity, equity, safety, experience, resource use and implementation.

• Viet Nam should not automatically adopt outcome measures developed elsewhere. Measures need to be relevant, understandable and appropriate to the population and local context.

• Healthcare utilization and cost savings should not be assumed to be the primary indicators of success.

• Data collection should be proportionate, lawful and useful. More data do not necessarily mean better evaluation.

Referral counts tell us where the pathway starts, not where it ends

Referral numbers are attractive because they are easy to measure. They can show whether clinicians or other partners know that a pathway exists, whether referrals are increasing and whether particular populations are entering the service. But they tell us very little about what happens next.

Consider two programs that each report 500 referrals. In the first, most people are contacted promptly, choose an appropriate resource, participate and report that the connection helped with something that mattered to them. In the second, many people cannot be contacted, community resources are full, activities are inaccessible and few people remain engaged. The headline number is identical, but the programs are clearly not performing in the same way.

A more useful evaluation follows the pathway:

Referral offered → Referral accepted → Contact made → Appropriate connection identified → Connection made → Participation → Continued engagement where relevant → Meaningful outcome

Not every person needs every step. Someone referred for financial advice may resolve a problem after one appointment, while someone joining a social or physical activity may benefit from continued participation. The purpose of the sequence is not to create another rigid protocol. It is to make visible where a pathway succeeds and where people are lost.

This fits with the emerging understanding of social prescribing as a relational and context-dependent process rather than a simple referral transaction. The 2026 global review found that relational continuity, personalized support, meaningful activities and community capacity repeatedly influenced implementation and reported outcomes.[1]

Evaluation should change as the program matures

One of the most useful developments in 2026 was a stage-sensitive approach to social prescribing evaluation published in The Lancet Regional Health – Western Pacific. Commissioned by the World Health Organization Regional Office for the Western Pacific, the Viewpoint proposes four stages: Exploration, Installation, Initial Implementation and Full Implementation.[3]

It is important to understand what this framework is and what it is not. It is a conceptual Viewpoint based on the authors' synthesis of existing literature and expert perspectives. It was not developed through formal stakeholder consensus and has not yet been empirically tested as a complete framework. Its value lies in offering a practical way to match evaluation questions and methods to the maturity of a social prescribing program.[3]

During Exploration, the priority is not proving clinical effectiveness. It is understanding local needs, existing community assets, stakeholder perspectives and readiness. Questions might include: What needs are people experiencing? What support already exists? Which populations face the largest gaps? How do healthcare professionals, community organizations and potential participants understand social prescribing? What would meaningful success look like to them?

During Installation, attention shifts toward program design. Approaches such as Theory of Change and dynamic logic models can help make assumptions explicit. If a program expects that connecting socially isolated older adults with meaningful group activities will improve well-being, for example, the evaluation should examine how that change is expected to occur, what resources are required and what factors might interrupt the pathway.[3]

During Initial Implementation, the questions become more practical. Is the pathway functioning as intended? Who engages and who does not? Where are delays? Which connections appear more useful for which people? What adaptations are occurring? The framework emphasizes moving beyond the binary question of whether social prescribing “works” to ask how, why, for whom and under what conditions it works.[3]

As a program reaches a more stable Full Implementation stage, stronger impact designs, longer-term sustainability assessment and economic evaluation become increasingly feasible and informative. Depending on the question and context, this may include pragmatic randomized trials, quasi-experimental approaches, stepped-wedge designs, implementation science methods and economic evaluation.[3]

This distinction is particularly relevant to Viet Nam. A small new pilot should not be expected to establish national cost-effectiveness after six months. Its first task is to understand whether a locally designed pathway can function safely, appropriately and meaningfully.

Measure whether the connection actually happened

One of the simplest but most important questions is often overlooked: Did the person actually connect with the intended support?

A referral entered into an electronic system is not the same as a successful community connection. Programs should be able to distinguish between people who were offered a referral, accepted it, were successfully contacted, identified an appropriate resource, made contact with that resource and actually participated.

The reasons a connection did not happen can be just as informative. The activity may have been full. Transport may have been difficult. The timing may not have worked. The person may have felt uncomfortable attending alone. The referral may not have matched what mattered to them. The organization may no longer have provided the service listed in the directory.

These are not minor administrative details. They tell us whether the pathway itself works in practice.

For an early Vietnamese pilot, measures such as time from referral to first contact, proportion successfully contacted, proportion making a community connection, reasons connections do not occur and continued engagement where relevant may initially provide more useful information than a large set of sophisticated clinical indicators.

Measure what matters to the person

Social prescribing begins with understanding what matters to an individual. Its evaluation should follow the same principle.

Well-being is an important outcome, but it should not automatically be the primary outcome of every program. If the person's main concern was loneliness, social connection may be more relevant. If the goal was to become more physically active, participation or physical functioning may matter more. If someone was connected with welfare or financial advice, progress on that practical problem may be more meaningful than a generic health score.

Research has struggled with this issue. A 2024 modified umbrella review found considerable variation in both the outcomes and instruments used in social prescribing research. Psychosocial measures, particularly well-being, were heavily represented, while several other domains received much less attention.[4]

The field has begun to address this problem. A Canadian Delphi study published in January 2026 asked diverse stakeholder groups to rate 21 possible outcomes. Seventy-four people from 10 stakeholder groups participated in the first round and 52 from eight groups completed the second. Seven outcomes met the study's predefined critical threshold: mental health, physical functioning, social functioning, emotional functioning and well-being, general health outcomes, overall quality of life, and patient or caregiver satisfaction.[5]

This is useful progress, but it should not be treated as a universal international standard. The study focused primarily on Canadian perspectives, included older adults aged 60 years and over and their families among several stakeholder groups, and the authors describe the resulting set as a first iteration that may change as social prescribing and its contexts evolve.[5]

For Viet Nam, these domains can inform discussion. They should not simply be imported as a national outcome set without local testing and stakeholder input.

Use validated measures, but do not let the questionnaire drive the program

Standardized measures make it easier to compare change over time and, where appropriate, compare findings across programs. NHS England provides one example. Its social prescribing guidance encourages routine outcome measurement, including use of the four-item Office for National Statistics Well-being Scale, while also allowing services to use other locally appropriate measures.[6,7]

That does not make an instrument commonly used in England automatically suitable for Viet Nam.

Before adopting a questionnaire, implementers should ask whether an appropriate Vietnamese version exists, whether it has been validated for the intended population, whether participants interpret the questions as intended and whether the instrument is sensitive to the kind of change the program is expected to produce.

A long questionnaire used because it looks academically impressive may simply produce fatigue and missing data. At the other extreme, relying only on a satisfaction question may miss important changes.

A practical evaluation can combine a small number of appropriate validated measures with person-defined goals and qualitative feedback. A person-reported outcome measure can help show whether well-being or social functioning changed. A person-reported experience measure can help show whether the pathway felt respectful, accessible and useful. A short interview or conversation can explain why an outcome changed or why a connection failed.

Numbers and lived experience answer different questions. Good evaluation often needs both.

Community capacity is part of the outcome picture

Social prescribing affects not only the person receiving support, but also the organizations expected to receive them.

NHS England's approach explicitly encourages measurement of impact on the person receiving support, the health and care system, and community groups receiving referrals.[6]

This third dimension is particularly important. A community organization may appear successful because it receives increasing numbers of referrals while its staff or volunteers are becoming overwhelmed. Waiting lists may grow. Existing participants may receive less attention. The organization may need additional space, coordination, training or funding. Some referrals may simply be inappropriate for what the group can safely provide.

Evaluation should therefore ask community partners about capacity, referral appropriateness, workload, gaps in provision, support needs and sustainability.

The 2026 global scoping review identified limited community-sector capacity, unstable funding and workforce pressures among implementation barriers.[1] The Western Pacific review similarly found resource limitations and fragmented referral mechanisms across different settings.[2]

If individual outcomes improve while the community infrastructure that makes those outcomes possible becomes unsustainable, an important part of the system is failing.

Equity needs its own measures

Average outcomes can conceal substantial inequalities.

Suppose well-being improves among participants who complete a pilot. That finding tells us little about people who were never referred, declined, could not afford transport, were unable to access the activity, lacked digital access or lived in communities where few suitable resources existed.

An equitable evaluation therefore needs to examine reach, not just outcomes.

Depending on the population and purpose of the program, relevant characteristics might include age, sex, disability, location, socioeconomic circumstances or other factors that plausibly affect access. The objective is not to collect every demographic variable available. It is to identify whether particular groups are being systematically left behind.

The international literature has identified socioeconomic disadvantage, transport, digital exclusion and limitations in community capacity among factors that can affect participation and implementation.[1]

For Viet Nam, geography may be particularly important. A pathway relying on a dense network of community resources in Ho Chi Minh City may operate very differently in a rural or remote setting where organized services are fewer and travel is more difficult.

The equity questions are therefore not only “Did outcomes improve?” but also “Who entered the pathway? Who successfully connected? Who dropped out? Who was never reached?”

Safety and unintended consequences should be measured too

Evaluation often focuses on benefits. That can create a blind spot.

A 2026 global umbrella review specifically examined potential harms associated with social prescribing with link workers. The review identified evidence and plausible mechanisms relating to inappropriate referrals, discontinuity of support, inequitable access, exclusion, financial or practical burdens, and psychological or social harms. No direct physical harms were identified in the reviews included, but the authors emphasized that potential harms have been inadequately measured in the field.[8]

This does not mean that social prescribing should be regarded as inherently risky. It means that an evaluation should not ask only whether average scores improved.

For an early Vietnamese pilot, monitoring does not need to resemble the adverse-event system of a clinical trial for every low-risk community activity. It should, however, provide a way to identify inappropriate or failed connections, complaints, concerns about safety or possible harm, deterioration requiring professional assessment and other unintended consequences.

A useful evaluation therefore asks both “Did something improve?” and “Did anything go wrong, and for whom?”

Healthcare utilization should be interpreted carefully

Healthcare organizations may naturally want to know whether social prescribing reduces outpatient visits, emergency department attendance or hospital admissions. These outcomes may be relevant, but they should not automatically become the definition of success.

A reduction in healthcare use could reflect improvement. It could also reflect barriers to appropriate care. Conversely, a social prescribing pathway may uncover previously unmet clinical needs and lead some people to use healthcare more appropriately but more frequently in the short term.

Current international evidence on system-level outcomes remains inconsistent. The 2026 global review found clinical and health-system outcomes more variable than psychosocial outcomes.[1]

Healthcare utilization should therefore be interpreted in relation to the purpose of the program and, where possible, evaluated against an appropriate comparison or counterfactual. Reporting that hospital visits fell after social prescribing does not by itself establish that social prescribing caused the reduction.

This is another reason the stage of implementation matters. An early pilot may first need to demonstrate that people are reaching appropriate support before attempting to determine whether the pathway changes patterns of hospital use.

Economic evaluation should follow a sufficiently stable model

Costs and value matter, particularly if a model is eventually expected to operate at scale. But sophisticated economic evaluation becomes more meaningful when implementers understand what the intervention actually consists of and how consistently it is being delivered.

A systematic review published in January 2026 identified 18 studies examining economic aspects of social prescribing and concluded that robust economic evidence remains limited. Cost-effectiveness, cost-utility and cost-benefit methods have not been applied consistently across programs, making comparisons difficult.[9]

Social Return on Investment can help capture forms of value that conventional healthcare measures may miss, including broader social and well-being benefits. The stage-sensitive Western Pacific framework includes such methods among options for more mature programs.[3] But a Social Return on Investment ratio is not the same as healthcare savings, budget impact or conventional cost-effectiveness.

For an early Vietnamese pilot, basic cost data may initially be more useful. This might include staff time, training, coordination, technology, transport support and resources contributed by community organizations. If the model becomes sufficiently stable, those data can support more sophisticated economic evaluation later.

Data quality can determine whether evaluation is credible

Good outcome measures cannot compensate for poor underlying data.

Programs need clear definitions for terms such as “referral,” “accepted referral,” “successful connection,” “participant” and “completed pathway.” Without shared definitions, two sites can report apparently comparable figures while actually counting different events.

Missing data also deserve attention. People who complete follow-up questionnaires may differ systematically from those who disappear from the pathway. If outcome data come mainly from the people who remain most engaged, the program may appear more successful than it really is.

A large 2026 Nature Health analysis illustrates the issue. Researchers analyzed routine well-being data from more than 300 social prescribing sites in the United Kingdom and found substantial improvements over time. But the study also identified important limitations in routine data completeness, including uncertainty about whether intervention referrals that were not recorded represented missing information or absence of an intervention.[10]

For an early Vietnamese program, a smaller set of clear, consistently completed data can be more useful than a much larger dataset that cannot be interpreted confidently.

Evaluation data must also be governed properly

Social prescribing evaluation may involve information about health, emotional well-being, financial difficulties, family circumstances, social relationships and use of community services. Some of this information may be sensitive even when the activity itself is non-clinical.

Viet Nam's Law on Personal Data Protection No. 91/2025/QH15 and Decree No. 356/2025/ND-CP have both been effective since 1 January 2026.[11,12] The law contains specific provisions concerning health information. Official Government guidance explains that collection and processing of personal health information generally require the data subject's consent, except where an exception provided by law applies.[13]

Evaluation should therefore collect personal information because it answers a defined and legitimate question, not simply because a digital platform makes collection possible. Organizations should determine what data are necessary, the applicable legal basis and consent requirements, who needs access, how information can be shared, how long it should be retained and what protections are required.

There is also an important distinction between routine service evaluation, quality improvement and research. If a project is designed as biomedical research involving human participants, organizations need to assess the applicable scientific, institutional and ethical review requirements. Circular No. 43/2024/TT-BYT, dated 12 December 2024 and effective from 1 February 2025, regulates the establishment, organization and operation of ethics committees in biomedical research in Viet Nam.[14]

The Circular governs ethics committees in biomedical research. It should not by itself be read as a simple classification rule that makes every service evaluation a biomedical research project. Whether a particular social prescribing evaluation requires research ethics review should be determined according to its purpose, design, activities, data involved and applicable institutional and legal requirements before the project begins.

A practical starting point for a Vietnamese pilot

An early social prescribing pilot in Viet Nam does not need dozens of indicators. It needs enough information to understand whether the pathway is functioning, whether it is useful to people and where it needs to improve.

A practical minimum evaluation can be organized around five questions. Reach: Who was offered the pathway, who accepted and who may be missing? Connection: Was contact made, was an appropriate resource identified and did the person actually participate? Person: Did something that mattered to the individual change, using a small number of appropriate outcome and experience measures? Community: Were referrals appropriate, and could receiving organizations manage the demand? Implementation and safety: What barriers, adaptations, costs, unsuccessful connections and unintended consequences occurred?

Healthcare utilization or clinical outcomes can be added when they are genuinely relevant to the purpose of the pilot. They should not be included merely because the data happen to be available.

The measures should be agreed before implementation and revisited as the program develops. The objective is not to create a national indicator set prematurely. It is to establish enough measurement discipline to learn from real implementation.

Do not confuse improvement with causation

Perhaps the most important methodological distinction is between observing change and demonstrating that social prescribing caused it.

If participants' well-being improves between referral and three-month follow-up, that change is worth reporting. Without a credible comparison, however, it may also reflect clinical treatment received at the same time, changing life circumstances, natural recovery, selection effects or regression toward the mean.

This does not make before-and-after evaluation useless. Early implementation needs descriptive data, qualitative feedback and rapid learning. It simply means that the language used to report findings should match the strength of the study design.

An early pilot can reasonably report:

“Participants who completed follow-up reported improved well-being.”

It should be much more cautious about reporting:

“The social prescribing program caused improved well-being.”

As the program matures, stronger designs can be considered where appropriate, including matched comparisons, interrupted time-series approaches, stepped-wedge designs, pragmatic randomized trials and other quasi-experimental methods. The stage-sensitive Western Pacific framework places stronger experimental and economic approaches later in the implementation journey, when staffing, workflows and partnerships are more stable.[3]

Evaluation rigor should grow with implementation maturity.

What should success mean in Viet Nam?

There is a risk that social prescribing becomes successful by definition: more referrals are made, more organizations are added to a directory, and the program is therefore assumed to be growing successfully.

A more useful definition of success would be different.

People who could benefit are actually reached. They have a genuine choice in the support they receive. Appropriate connections happen in practice rather than only in referral records. Community partners can receive people safely and sustainably. Groups facing greater barriers are not systematically excluded. Personal information is handled responsibly. Problems and unintended consequences are identified rather than hidden. Outcomes that matter to people improve sufficiently to justify the resources being used.

Not every pilot will achieve all of these things. Evaluation exists partly to discover where it does not.

This is especially important in Viet Nam because international research cannot answer every local question. The 2026 Western Pacific scoping review identified 42 peer-reviewed studies and 13 gray-literature sources, but only one of the peer-reviewed studies came from Viet Nam.[2]

Viet Nam therefore needs locally generated evidence, but that does not mean large national trials must come first. Small, carefully evaluated implementations can generate essential knowledge about community readiness, workforce arrangements, cultural fit, accessibility, information governance and meaningful outcomes before decisions about wider scale are made.

Key Takeaway

Evaluating social prescribing is not primarily about producing a dashboard with as many indicators as possible. It is about understanding whether a pathway is creating meaningful, appropriate and sustainable connections.

Referral counts have a role, but they are the beginning of the story. Stronger evaluation follows what happens after referral, examines outcomes that matter to the person, considers the capacity and experience of community organizations, looks for inequities and unintended consequences, and matches its methods to the maturity of the program.

For Viet Nam, “Does social prescribing work?” is unlikely to be the most useful question at the earliest stage. The question becomes much more informative when we also ask how the pathway is working, for whom, under what conditions and where it is failing.

Better questions are:

Are we reaching the right people? Are meaningful connections actually happening? What changes for the people involved? Who is not benefiting, and why? Can community partners sustain the pathway? What needs to change before the model grows?

If those questions are answered carefully, evaluation becomes more than measurement. It becomes part of how a Vietnamese model of social prescribing is built.

References

1. Kisa A, Kisa S. Models, implementation, and reported outcomes of social prescribing interventions: a scoping review. Frontiers in Public Health. 2026;14:1871347.

2. Lwin KS, Wong MSJ, Tan MH, et al. Organization and implementation of social prescribing in the Western Pacific Region: a scoping review. The Lancet Regional Health – Western Pacific. 2026;67:101714.

3. Wong MSJ, Low LL, Gan WH, Lee KH. A stage-sensitive approach to evaluating social prescribing in complex and evolving health systems. The Lancet Regional Health – Western Pacific. 2026;67:101725.

4. Ashe MC, Kelly dos Santos I, Alfares H, Chudyk AM, Esfandiari E. Outcomes and instruments used in social prescribing: a modified umbrella review. Health Promotion and Chronic Disease Prevention in Canada. 2024;44(6):244–269.

5. Ashe MC, Chudyk AM, Lin M, et al. Identifying social prescribing core outcomes using a Delphi approach: findings and future directions. Health Promotion and Chronic Disease Prevention in Canada. 2026;46(1):11–22.

6. NHS England. Social prescribing: Frequently asked questions. Accessed September 2026.

7. NHS England. Social prescribing: Reference guide and technical annex for primary care networks. 27 January 2023.

8. Cooper M, Okeowo D, Bennett L, et al. Potential harms of social prescribing: a global umbrella review and dark logic model. BMJ Open. 2026;16:e108998.

9. Lynch M, Keating AJ, Morrow E, Spencer LH. The health economics of social prescribing: systematic review of the international evidence. Frontiers in Public Health. 2026;14:1753435.

10. Bu F, Hayes D, Munford L, Fancourt D. The impact of social prescribing on well-being outcomes in a nationwide analysis. Nature Health. 2026;1:737–744.

11. National Assembly of the Socialist Republic of Viet Nam. Law on Personal Data Protection No. 91/2025/QH15. 26 June 2025. Effective 1 January 2026.

12. Government of Viet Nam. Decree No. 356/2025/ND-CP detailing certain provisions and measures for implementation of the Law on Personal Data Protection. 31 December 2025. Effective 1 January 2026.

13. Government of Viet Nam. Regulations on personal data protection for health information and insurance business activities. 25 July 2025.

14. Ministry of Health of Viet Nam. Circular No. 43/2024/TT-BYT regulating the establishment, organization and operation of ethics committees in biomedical research. 12 December 2024. Effective 1 February 2025.

Article Information

Published: 25 September 2026
Last reviewed: 25 September 2026
Publisher: Social Prescribing Vietnam

Disclaimer

This article is provided for educational and informational purposes. It does not constitute medical advice, clinical guidance, legal advice, research ethics advice or official policy. Approaches to social prescribing evaluation should be adapted to the purpose, population, maturity and context of each program. Organizations collecting or processing personal information, or undertaking activities that may constitute research involving human participants, should determine the applicable Vietnamese legal, ethical and institutional requirements before implementation.