Social Prescribing and Chronic Conditions in Viet Nam: Where Can Community Support Complement Clinical Care?

Social Prescribing and Chronic Conditions in Viet Nam: Where Can Community Support Complement Clinical Care?

Living with a chronic condition involves much more than attending medical appointments or taking medication. A person may need to change daily routines, remain physically active, manage work and family responsibilities, cope with uncertainty or financial pressure, maintain relationships and continue doing things that give life meaning.

Clinical care remains essential for diagnosis, treatment, monitoring, prevention of complications and responding when a person's condition changes. But many of the circumstances that shape life with a chronic condition sit outside the consultation room. This is where social prescribing may have something to add.

Social prescribing can help connect people with appropriate non-clinical community resources when social, practical or participation-related needs affect health and well-being. Depending on what matters to the individual and what is available locally, this might involve physical activity, social participation, peer or caregiver support, learning, volunteering, practical assistance or another community resource.[1]

The distinction, however, needs to remain clear: social prescribing should not manage the disease. Its potential value lies in helping address some of the non-clinical circumstances that influence how a person lives with the disease.

That distinction is particularly important in Viet Nam. The country is rapidly strengthening community-level management of hypertension, diabetes and other noncommunicable diseases through primary health care. In September 2026, WHO reported that approximately 10 million people are screened for hypertension and diabetes each year and more than 2 million have been brought into treatment through the expanding model. Among participating patients, blood-pressure control increased from 53% in 2022 to 72% in 2025.[7]

These are important developments in Vietnamese primary health care. They should not, however, be relabeled as social prescribing.

Key Points

• Chronic conditions require appropriate clinical care. Social prescribing should complement rather than replace diagnosis, treatment, clinical monitoring, rehabilitation or complication management.

• Community support may add value when social isolation, physical inactivity, caregiving pressure, practical or financial difficulties, loss of confidence or limited opportunities for participation affect everyday life with a chronic condition.

• International evidence is promising in some areas but remains heterogeneous and highly concentrated in a small number of countries.

• Controlled evidence has reported some improvements in quality of life, physical activity and disease-specific outcomes, but the overall effectiveness of social prescribing for long-term conditions remains uncertain.

• Diabetes is the most frequently represented chronic condition in the literature, but pooled controlled evidence does not demonstrate a clear overall effect on glycated hemoglobin.

• Community-based disease management, health education and outreach are not automatically social prescribing simply because they occur outside hospitals.

• People living with multimorbidity may have particular reasons to benefit from person-centered community support, but evidence remains limited.

• Social prescribing should respond to an individual's priorities and circumstances rather than automatically assign an activity based on diagnosis.

• Direct Vietnamese evidence on social prescribing for chronic physical conditions is essentially absent.

• Viet Nam should build on existing primary healthcare and community infrastructure rather than create a parallel chronic-disease system.

Chronic conditions are managed clinically, but lived in everyday life

International research often uses the term long-term conditions, while this article uses chronic conditions because it is more familiar in many Vietnamese and international health contexts. The terms overlap substantially, although neither has one universally accepted boundary.

Much of Viet Nam's current health-system focus is on noncommunicable diseases such as cardiovascular disease, diabetes, cancer and chronic respiratory disease. The social prescribing literature is somewhat broader and has also included stroke, dementia, chronic pain, multimorbidity and other persistent health problems.[2,3]

The important issue is not terminology. Chronic conditions are experienced every day, not only when someone sees a healthcare professional.

Someone with diabetes may understand the importance of becoming more active but have nowhere affordable or convenient to exercise. A cancer survivor may be medically stable but have lost confidence, work roles or social relationships. Someone with chronic respiratory disease may gradually stop leaving home because activity has become difficult. A person caring for a spouse while managing hypertension may have very little time to attend to their own health.

These circumstances do not remove the need for clinical care. They can, however, affect whether someone is realistically able to live well with a condition or follow an agreed care plan.

This is why the person-centered conversation matters. A pathway should not assume that everyone with diabetes needs an exercise group or that every cancer survivor needs disease-specific peer support. The better question is what is making everyday life with the condition harder, what matters to the person and whether there is an appropriate non-clinical resource that could help.

Sometimes the answer will point toward community support. At other times it will point back toward healthcare, rehabilitation, social work, social assistance or another professional service.

Where could community support add value?

Physical activity is one obvious area. A clinician may appropriately advise someone with diabetes, hypertension or cardiovascular risk to become more active, but understanding the health benefit of activity is different from having access to something affordable, enjoyable, accessible and realistic.

A social prescribing pathway might help someone find a suitable walking group, gardening activity or community exercise program. Where the person's health condition or functional status requires professional assessment, that clinical responsibility remains with appropriately qualified services. The community resource is supporting participation, not determining whether activity is clinically appropriate or replacing rehabilitation where rehabilitation is indicated.

Social connection can also matter. Chronic illness may disrupt work, mobility, friendships and ordinary social roles. Some people become isolated because their health limits activities they previously enjoyed. A meaningful community connection may provide routine, shared interests, companionship or a renewed sense of belonging.

That connection does not necessarily need to revolve around the disease. Someone with diabetes may prefer volunteering or a gardening group to a diabetes support group. The relevant issue is whether the activity fits what matters to the person.

Practical circumstances can be just as important. Transport, caregiving responsibilities, financial pressures, employment problems, food insecurity and difficulties navigating services can all influence health and participation. Social prescribing may sometimes help identify these barriers and support connection with appropriate practical or social resources.

Those destination services retain their own roles. Welfare advice, professional social work, rehabilitation, employment services and other specialized support should not be recreated by an unqualified linking function simply because they appear within a social prescribing pathway.

Another potential contribution is confidence and participation. Chronic illness can gradually narrow someone's life. Fear, fatigue, loss of confidence or concerns about worsening symptoms can lead people to withdraw from activities even after their medical condition is stable enough for participation. An appropriate community opportunity may help someone rebuild confidence or purpose without implying that the community activity is treating the underlying disease.

These are plausible pathways through which social prescribing could complement chronic-condition care. They should not be confused with evidence that social prescribing directly controls the disease itself.

What does the evidence currently show?

The international literature is growing, but its findings remain difficult to generalize.

A 2025 scoping review specifically examined social prescribing among adults living with long-term health conditions. It identified 37 sources of evidence covering 65 different conditions. Diabetes was the most frequently represented condition, appearing in 23 sources. Thirty-three referral pathways originated in primary care, and common destinations included exercise, information and practical support, mental-health support, social and leisure activities and condition-specific support.[2]

The review also demonstrates how geographically concentrated this evidence remains. Thirty-one of the 37 sources came from England, with the remainder from Ireland, Northern Ireland, Scotland and the United States. No Vietnamese evidence was included.[2]

This type of review helps us understand which models and populations have been studied. It does not tell us that those models are effective.

A more restrictive systematic review and meta-analysis published in Clinical Rehabilitation included 12 randomized or quasi-randomized studies involving 3,566 adults with chronic conditions. Nine of the 12 studies were assessed as having a high risk of bias. Some individual studies reported improvements in quality of life, particularly in cancer- and diabetes-related interventions, and some reported increased physical activity. Overall psychological well-being did not significantly improve, however, and substantial heterogeneity made pooled conclusions difficult.[3]

The authors concluded that it was not possible to determine the effectiveness of social prescribing in the management of long-term conditions based on the available controlled evidence.[3]

That is an important conclusion. Evidence that individual programs have reported favorable outcomes should not be translated into a general statement that social prescribing “improves chronic disease management.”

Diabetes illustrates both the promise and the limitations

Diabetes is useful to examine because it is the chronic condition most extensively represented in the literature.

A systematic literature review focused on type 2 diabetes included 11 papers involving 19,202 participants and reported encouraging findings across quality of life, psychological well-being, physical activity and some behavioral and clinical outcomes. Some studies reported modest reductions in glycated hemoglobin, but the authors also identified heterogeneity, missing data and methodological weaknesses, including high risk of bias in parts of the evidence base.[4]

It is worth noting that this article appears in the 2026 journal volume but was first published online in July 2024. Its evidence base should therefore not be interpreted as research collected through 2026.[4]

The controlled-trial meta-analysis provides an important counterbalance. Seven studies measured glycated hemoglobin and four, involving 1,329 participants, could be included in the pooled analysis. The overall effect was small and not statistically significant: standardized mean difference −0.07, with a 95% confidence interval from −0.23 to 0.10.[3]

This does not mean community support has no value for people with diabetes. It means that we should distinguish possible benefits in physical activity, confidence, participation, social support or access to resources from the stronger clinical claim that social prescribing itself improves glycemic control.

Glycated hemoglobin is influenced by medication, nutrition, disease severity, clinical follow-up, self-management and many other factors. When clinical care continues alongside social prescribing, attribution of biomarker change to a community pathway alone can also be difficult.

The responsible position is therefore not:

“Social prescribing can control diabetes.”

It is:

“Social prescribing may help address some non-clinical circumstances that influence how a person is able to live with and manage diabetes, while clinical management remains essential.”

Multimorbidity strengthens the case for person-centeredness, not the evidence for effectiveness

Many people do not live with only one chronic condition. Someone may have hypertension, diabetes, osteoarthritis and depression at the same time. Another may live with chronic respiratory disease, reduced mobility and financial difficulty.

Disease-specific healthcare can become fragmented when each condition is managed separately while the person has to live with all of them together.

This is one reason social prescribing appears conceptually relevant to multimorbidity. The starting point is what matters to the person rather than one disease label, and some community needs, such as mobility, social participation, caregiving support or practical assistance, may cut across several diagnoses.

A 2026 review examining multimorbidity, mental health and social prescribing in ageing populations described substantial theoretical alignment between social prescribing and complex multimorbidity, while also emphasizing that direct evidence remains limited and implementation does not always succeed in matching people with appropriate resources.[5]

This is another area where conceptual promise should not be mistaken for proven effectiveness.

Someone living with multimorbidity may benefit from support to find an accessible community activity, caregiver support or meaningful social participation. Social prescribing cannot, however, reconcile conflicting treatment recommendations, simplify medication regimens or replace coordinated clinical management.

Person-centered community support and integrated medical care may complement one another. They solve different parts of the problem.

What should remain clinical, and what is simply community-based healthcare?

The distinction becomes clearer when looking at actual activities.

For hypertension, diagnosis, professional interpretation of measurements for clinical decision-making, prescribing or changing antihypertensive medication, investigating complications and determining treatment remain clinical responsibilities. Blood-pressure measurement itself may also occur through self-monitoring, pharmacies or community screening. When measurement forms part of medical examination and treatment, however, the applicable Vietnamese healthcare requirements continue to apply.

For diabetes, diagnosis, clinical interpretation of laboratory findings, prescribing and medication management, complication screening and management of hypoglycemia or other clinical problems remain healthcare functions.

For chronic respiratory disease, clinical assessment, medication management, management of exacerbations and professional pulmonary rehabilitation where indicated remain within healthcare and rehabilitation services. For cancer survivors, surveillance, treatment of complications and clinical rehabilitation similarly remain clinical responsibilities even when the person also takes part in exercise, arts, peer or community activities.

In Viet Nam, medical examination and treatment continue to be governed by the Law on Medical Examination and Treatment and its implementing framework. The current consolidated text was issued as Consolidated Document No. 26/VBHN-VPQH on 26 February 2026, and Decree No. 96/2023/ND-CP provides important implementation provisions.[9,10]

Social prescribing does not create legal authority for a community group, volunteer or linking worker to undertake regulated healthcare activities unless that person or organization is otherwise appropriately qualified and legally authorized.

The principle is simple: community support can complement healthcare without becoming healthcare.

This distinction is particularly important because Viet Nam already has a rapidly expanding community-based chronic-disease management system.

On 8 September 2026, WHO reported that strengthened primary healthcare services for hypertension and diabetes were screening around 10 million people each year and had brought more than 2 million people into treatment. Among participating patients, blood-pressure control rose from 53% in 2022 to 72% in 2025.[7]

The model includes standardized treatment protocols, medicines and essential diagnostics, technical support and supervision, an online noncommunicable-disease reporting system and bidirectional referral between hospitals and commune-level health stations. People needing higher-level care can be referred to hospitals and, once clinically stable, transferred back to local health stations for continuing management.[7]

By 2025, the model had reached approximately 5,000 commune health stations in 52 of the 63 provinces and cities that existed before administrative reorganization, and around 420,000 people were being managed each month at primary-care level.[7]

This is an important achievement in community-based primary healthcare.

It is not, by itself, social prescribing.

Measuring and clinically interpreting blood pressure, diagnosing and monitoring diabetes, prescribing medication, following treatment protocols and recalling someone who has missed clinical follow-up are healthcare activities. The fact that care is delivered close to people's homes or uses community outreach does not turn it into social prescribing.

Social prescribing would add something different. A person whose hypertension is appropriately managed at a commune health station may also be socially isolated and want a realistic way to become more active. Someone with diabetes may be receiving appropriate medication and monitoring but face practical barriers to participating in healthy community activities. A caregiver living with several chronic conditions may need social or practical support. A person who has completed rehabilitation may want help finding a sustainable community activity that supports continued participation.

A social prescribing pathway might help connect people with appropriate non-clinical resources in circumstances like these. The clinical pathway should remain intact.

What does this mean for Viet Nam?

Viet Nam already has a substantial clinical platform on which carefully designed community connection could potentially be tested.

WHO's 2025 review, Primary health care in Viet Nam: a review of the commune health system, identified opportunities to strengthen comprehensive, coordinated, continuous and person-centered primary healthcare through the commune health system.[8]

The current national policy direction also gives grassroots chronic-disease care a strong foundation. The National Assembly approved the investment policy for the National Target Programme on Health Care, Population and Development 2026–2035 under Resolution No. 262/2025/QH15 in December 2025.[13] In June 2026, the Ministry of Health approved Phase I for 2026–2030 through Decision No. 1709/QD-BYT. Among its targets is implementation of prevention, management and treatment of selected noncommunicable diseases in 100% of commune, ward and special-zone health stations according to Ministry of Health guidance by 2030.[14]

Implementation was further supported by Circular No. 34/2026/TT-BYT, effective from 8 September 2026, which provides guidance for selected components of the program.[15]

These developments mean Viet Nam does not need to invent a separate chronic-disease infrastructure in order to explore social prescribing. A more useful question is whether an additional linking function could help some people already receiving appropriate clinical care address non-clinical needs that existing healthcare does not fully resolve.

There is, however, very little direct Vietnamese evidence on which to base such a model.

The 2026 Western Pacific scoping review identified 42 peer-reviewed studies and 13 grey-literature sources across the region. Only one peer-reviewed study came from Viet Nam, and that intervention focused on severe mental illness rather than chronic physical disease management.[6] Direct Vietnamese evidence on social prescribing for chronic physical conditions is therefore essentially absent.

This makes local evaluation important. It also means that Viet Nam should not import a chronic-condition social prescribing model simply because it has been tested in England or another health system.

Person-centered referral, equity and community capacity

Not every person with a chronic condition needs social prescribing. A diagnosis should not become an automatic referral criterion.

Many people with hypertension, diabetes, asthma or other chronic conditions manage well, remain active, have strong family or social networks and have no significant non-clinical need requiring a facilitated connection.

Referring everyone with a particular diagnosis would undermine the person-centered logic of social prescribing and could overwhelm community resources.

The more relevant question is:

“Is there a non-clinical need affecting this person's health, well-being or ability to live with the condition, and is there an appropriate community resource that the person actually wants to use?”

Two people with the same diagnosis may require entirely different responses. One person with diabetes may want help finding an accessible walking group. Another may already exercise regularly but struggle with caregiving pressure. A third may have no need for social prescribing. A fourth may have deteriorating glycemic control and need clinical reassessment rather than a community referral.

Community capacity is just as important. Identifying a need does not create the resource needed to address it.

A person living in a large city may have several nearby community activities, while someone in a remote area may have few formal options. Transport, participation fees, disability, working hours, caring responsibilities and digital requirements can determine whether an apparently suitable resource is actually accessible.

The 2025 chronic-condition scoping review found substantial variation in community provision and emphasized the need for personalized pathways that reflect what exists locally.[2]

Social prescribing should not repeatedly direct people toward barriers and then describe failure to participate as a problem with the patient.

Community organizations also should not be expected to absorb unlimited chronic-disease referrals. A small exercise group or volunteer organization may be highly valuable without having the staff, facilities or expertise to receive large numbers of people with complex health needs.

Clinical services therefore need to understand community capacity, while community partners need to be able to define what they can and cannot reasonably provide.

Information sharing should remain proportionate

A chronic-condition pathway can easily lead to excessive sharing of health information.

A community walking group does not automatically need someone's complete diabetes record. A volunteering organization generally does not need a detailed medication list or every diagnosis in a person's medical history. The information needed depends on the activity, the individual's circumstances and what is genuinely necessary for safe and appropriate participation.

Viet Nam's Law on Personal Data Protection No. 91/2025/QH15 and Decree No. 356/2025/ND-CP have both been in effect since 1 January 2026.[11,12] Article 26 of the Law provides that the collection and processing of personal data relating to health require the data subject's consent, except in the circumstances specified in Article 19(1), alongside compliance with other applicable personal data protection requirements.[11]

Structured social prescribing pathways should therefore determine what information genuinely needs to be shared, why it is necessary, the applicable legal basis and consent requirements, who may access it and how it will be protected.

The practical principle remains straightforward: a community resource should receive the information genuinely necessary for its role, not everything healthcare happens to know about the person.

What could an early Vietnamese model test?

An early model should begin with a focused question rather than a broad promise to “improve chronic disease.”

One possible approach would be to identify people already receiving appropriate clinical care who also have a meaningful non-clinical need affecting everyday life. This might involve social isolation, difficulty becoming physically active, loss of meaningful activity, caregiving strain, practical barriers or another issue for which a realistic community resource exists.

The linking conversation should explore what matters to the person rather than assign an intervention according to diagnosis. Clinical eligibility and safety decisions would remain with appropriately qualified healthcare professionals where those decisions are required. The linking function would focus on the non-clinical need, available options, barriers to participation and the person's preferences.

Community partners should also help determine which connections they can reasonably receive. A pathway should not assume that any exercise group, volunteer organization or social activity is suitable for everyone living with chronic disease.

Evaluation needs to move beyond referral counts. Did the person actually make contact? Could they reach the resource? Did they participate and continue? Did the activity reflect what mattered to them? What prevented participation when a connection failed? Was necessary clinical care maintained?

Relevant outcomes might include quality of life, physical activity, social connection, confidence, participation and participant experience. Disease-specific clinical outcomes may also be measured when scientifically appropriate, but interpretation needs to acknowledge that clinical treatment continues at the same time and attribution may be difficult.

For diabetes, measuring glycated hemoglobin may be reasonable in a research evaluation, but a change should not automatically be attributed to social prescribing. Current controlled evidence does not demonstrate a clear pooled effect on that outcome.[3]

An early Vietnamese evaluation should also examine equity, inappropriate referrals, community workload and unintended consequences. It should ask whether some groups are systematically less able to participate and whether referral demand creates costs or capacity problems for the organizations receiving people.

The strongest evidence would show not merely that someone was referred, but whether a facilitated community connection added meaningful value beyond the clinical care that person was already receiving.

Key Takeaway

Chronic conditions are managed through healthcare, but people live with them in families, workplaces and communities. That is the space in which social prescribing may sometimes add value.

A person with diabetes still needs appropriate clinical monitoring and treatment. Someone with hypertension still needs clinical management where required. A cancer survivor may need surveillance and rehabilitation. A person living with multimorbidity may need coordinated professional care across several conditions.

Social prescribing should not replace any of those responsibilities.

Its potential contribution is more specific: helping address selected non-clinical circumstances that influence a person's ability to live well with a chronic condition by facilitating access to community resources that are appropriate, accessible and meaningful to them.

International evidence provides reasons for cautious interest, not certainty. Some studies report promising findings in quality of life, physical activity and other outcomes, but interventions are heterogeneous, much of the controlled evidence is at risk of bias and pooled clinical outcomes such as glycated hemoglobin remain uncertain. Direct Vietnamese evidence for chronic physical conditions is essentially absent.

Viet Nam does, however, have an important advantage: a rapidly strengthening primary healthcare platform for chronic-disease management close to where people live.

Social prescribing should build alongside that platform, not rename it or compete with it.

The central question is therefore not:

“Can social prescribing manage chronic disease?”

It is:

“When appropriate clinical care is already doing what clinical care should do, is there a non-clinical barrier, need or goal that a meaningful community connection could help address?”

If the answer is yes, social prescribing may have a useful complementary role.

If the answer is no, another referral is not necessarily better care.

References

1. World Health Organization Regional Office for the Western Pacific. A toolkit on how to implement social prescribing. Manila: World Health Organization Regional Office for the Western Pacific; 2022. ISBN 978-92-9061-976-5.

2. Wilson A, Noble H, Galway K, Doherty J. Social prescribing for people living with long-term health conditions: a scoping review. Systematic Reviews. 2025;14:114. doi:10.1186/s13643-025-02848-6.

3. O'Sullivan DJ, Bearne LM, Harrington JM, Cardoso JR, McVeigh JG. The effectiveness of social prescribing in the management of long-term conditions in community-based adults: a systematic review and meta-analysis. Clinical Rehabilitation. 2024;38(10):1306–1320. doi:10.1177/02692155241258903.

4. Oliveira D, Henriques A, Nogueira P, et al. Impact of social prescribing intervention on people with type 2 diabetes mellitus in a primary healthcare context: a systematic literature review of effectiveness. Journal of Public Health. Published online 18 July 2024; 2026;34:801–829. doi:10.1007/s10389-024-02315-x.

5. Radford-Smith DE, Anthony DC. From fragmentation to integration: can social prescribing bridge the gap between multimorbidity and mental health in an ageing population? BMJ Public Health. 2026;4:e003752.

6. 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. doi:10.1016/j.lanwpc.2025.101714.

7. World Health Organization Viet Nam. Strengthened grassroots health care brings NCD services to 10 million in Viet Nam. 8 September 2026.

8. World Health Organization Regional Office for the Western Pacific. Primary health care in Viet Nam: a review of the commune health system. Manila: World Health Organization Regional Office for the Western Pacific; 2025. ISBN 978-92-9062-115-7.

9. Office of the National Assembly of Viet Nam. Consolidated Document No. 26/VBHN-VPQH: Law on Medical Examination and Treatment. 26 February 2026.

10. Government of Viet Nam. Decree No. 96/2023/ND-CP detailing certain provisions of the Law on Medical Examination and Treatment. 30 December 2023. Effective 1 January 2024.

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. National Assembly of the Socialist Republic of Viet Nam. Resolution No. 262/2025/QH15 approving the investment policy for the National Target Programme on Health Care, Population and Development 2026–2035. 11 December 2025.

14. Ministry of Health of Viet Nam. Decision No. 1709/QD-BYT approving the National Target Programme on Health Care, Population and Development 2026–2035, Phase I: 2026–2030. 12 June 2026.

15. Ministry of Health of Viet Nam. Circular No. 34/2026/TT-BYT guiding selected contents of the National Target Programme on Health Care, Population and Development 2026–2035, Phase I: 2026–2030. 8 September 2026. Effective 8 September 2026.

Article Information

Published: 27 September 2026
Last reviewed: 27 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 or official policy. Chronic conditions require individualized assessment and appropriate professional management. Social prescribing should not be used as a substitute for diagnosis, medical treatment, medication management, clinical monitoring, rehabilitation or other regulated healthcare services when these are required. Evidence on social prescribing for chronic conditions remains heterogeneous, and direct evidence specific to chronic physical conditions in Viet Nam is extremely limited. Organizations developing social prescribing pathways should determine the applicable Vietnamese legal, professional, safety, accessibility, information-sharing and personal data protection requirements for their specific activities.