Occupational Therapists as Social Prescribers: Insights from Swedish Primary Care

{“title”:”Therapists Who Prescribe Social Life: Swedish Primary Care Puts Loneliness on the Chart”,”html”:”Loneliness has quietly become one of the most pressing public health problems of our time, affecting roughly one in six people worldwide and carrying measurable consequences for both physical and mental health. Defined as the perception that one’s current social life falls short of one’s social needs, loneliness is particularly prevalent among older adults, who often face the loss of loved ones, declining health, and shrinking social networks. Yet despite its reach, loneliness has received strikingly little attention in occupational therapy research and clinical practice, even though it connects directly to familiar concepts in the field such as occupational imbalance and deprivation. A new qualitative study from Sweden, published in the Scandinavian Journal of Occupational Therapy, now offers one of the first detailed looks at what happens when occupational therapists in primary care take on the role of social prescribers, and the results reveal both remarkable promise and sobering constraints.

The study emerges from the Social Prescribing in Sweden project, known as SPiS, a research initiative led from Umeå University that has pioneered the testing of social prescribing in Swedish primary care. Social prescribing, an approach that has gained global interest over the past decade, connects patients to non-medical community resources in line with their individual needs, ranging from simple signposting to intensive, personalized support. Unlike the English model, where dedicated link workers carry out the process, the Swedish model embeds the prescriber role within existing primary care staff, and at many participating centers occupational therapists took on this role as an extension of their daily work. The model itself, co-developed with healthcare providers and municipalities starting in 2018 and grounded in the Person-Environment-Occupation-Performance framework, follows a structured four-step process: screening, assessment, prescription, and follow-up.

The mechanics of the model are deceptively simple. All clinical staff at participating primary care centers ask every client aged 65 or older a standardized question: “Are you troubled by loneliness?” Those who confirm loneliness and express interest are referred internally to a social prescriber, often an occupational therapist, who conducts an in-depth assessment of the client’s daily life, needs, and interests. The assessment covers preferences for group size, timing, frequency, whether activities should be online or in person, and any activities the person wishes to avoid. From this, the prescriber and client develop an activity profile, and a physical paper prescription is written for a specific ongoing social activity in the local community, complete with participation goals and follow-up dates. A telephone follow-up occurs three weeks later, and a face-to-face review follows at three months, allowing adjustments to be made.

To understand how this plays out in practice, the research team conducted semi-structured digital interviews with ten occupational therapists, all women, working in urban and rural centers across Sweden, with clinical experience ranging from two to fourteen years in primary care. The interviews were analyzed using reflexive thematic analysis, and preliminary findings were shared with the informants in a member-checking process to strengthen the credibility of the conclusions. The analysis produced three overarching themes that together paint a nuanced picture of a profession discovering both a natural fit and a difficult boundary.

The first theme, captured in an informant’s remark that “it is a part of our basics, actually,” reflects how strongly the model aligns with occupational therapy’s core values of activity, participation, and meaningfulness. The therapists described how social life had long hovered in the background of their client interactions without ever being actively addressed; the model made this implicit focus explicit. They saw themselves as uniquely trained for the assessment step, drawing on their holistic view of activity, person, and environment. As one informant put it, it is easy for someone else to suggest playing pétanque, but that suggestion may fail entirely if functional limitations, environmental barriers, and the individual’s broader life situation are not all taken into account. This multidimensional assessment expertise, the informants argued, is what distinguishes occupational therapists from other health professions and enables genuinely tailored prescriptions.

The second theme, however, exposes the friction of turning professional philosophy into everyday practice: the challenge of matching individual assessments with a fragmented and often sparse supply of local social activities. Therapists described hunting for activity information on poorly updated websites and outdated contact lists as a kind of “detective work” that consumed time they did not have in resource-strained primary care settings governed by efficiency norms. One informant lamented the difficulty of being “the spider in the web” who keeps track of everything available. In rural areas, the scarcity of options was so acute that some therapists hesitated to initiate the process at all, and some older adults had misunderstood the model, expecting primary care to create new activities specifically for them rather than matching them to existing ones.

Beneath these practical hurdles lay a deeper emotional burden: the fear of letting lonely older adults down. Several informants worried about raising false hopes, with one confessing she was afraid clients might “feel even more lonely after they have met me.” Others cautioned that recommending a social activity carries real risk, since some contacts and settings could prove bad for a vulnerable person, echoing what the literature calls the dark side of occupation. Interestingly, some therapists resolved this pressure by reframing their role from expert to facilitator, sitting down with clients at the computer and searching together, which transformed prescription-writing into a collaborative, brainstorming process and dissolved the myth of the perfect match. Others coped by partnering with municipalities and civil society organizations to maintain continuously updated activity folders at their centers.

The third theme addressed the gap between receiving a prescription and actually participating. The therapists emphasized that loneliness is not a quick fix and that a prescription for dancing, for example, only becomes meaningful when the barriers preventing the client from dancing are addressed as part of the prescription itself. Support could take many forms: prescribing an electric wheelchair to enable mobility, offering motivational and emotional support for clients anxious about group settings, arranging transportation, recruiting companions for first visits, and mobilizing the client’s own informal networks of relatives and neighbors. At the same time, the informants warned against overextending the role, describing loneliness as “a big deep pit” and stressing the need for clear boundaries, since taking on too much within current primary care resources could leave prescribers feeling swallowed by the complexity of the task.

The study’s conclusions carry weight for health systems far beyond Sweden. The authors argue that occupational therapists are, in many ways, well positioned to contribute meaningfully to social prescribing, and that the approach may even strengthen the profession by refocusing attention on foundational values of meaningful activity and social connectedness that biomedical and market-driven healthcare models have pushed aside. But realizing the model’s potential, they conclude, requires acknowledging the true complexity of loneliness and social activities, lowering thresholds for social participation, and fostering collaboration across organizational and professional boundaries. In a world where loneliness is now recognized by the World Health Organization as a global health concern, the Swedish experience suggests that the prescription pad may need a second column, one written not for pills, but for people, places, and shared purpose.

Subject of Research: Occupational Therapists as Social Prescribers: Insights from Swedish Primary Care

Article Title: Occupational Therapists as Social Prescribers: Insights from Swedish Primary Care

Article References: Viklund, E. W., Degerstedt, F., Jonsson, F., Lundgren, A. S., & Nilsson, I. (2026). Occupational Therapists as Social Prescribers: Insights from Swedish Primary Care. Scandinavian Journal of Occupational Therapy, 33(1), Article 2. https://doi.org/10.1007/s44474-026-00002-6

Image Credits: AI Generated

DOI: 10.1007/s44474-026-00002-6

Keywords: Occupational, Therapists, Social, Prescribers, Insights, Swedish, Primary, Care, scientific research