Social Prescribing for Socially Isolated Older Adults in Rural Japan: A Qualitative Case Study

Naho Ota¹Mayu Ebihara²Mizuki Aoki²Atsushi Iwasawa³Teiichiro Yamazaki²Songee Jung²Sachiko Makabe⁴Mary Lynch⁵Charlotte Rothwell⁶Jan Illing⁷Kyoko Nomura^2*

• ¹School of Medicine, Akita Daigaku, Akita, Japan
• ²Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
• ³Department of Nursing, Faculty of Nursing and Nutrition, Shukutoku University, chiba, Japan
• ⁴Department of Nursing, Akita University Graduate School of Health Sciences, Akita, Japan
• ⁵Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
• ⁶Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
• ⁷Health Professions Education Centre, Royal College of Surgeons in Ireland, Dublin, Ireland

Introduction: Social prescribing (SP) has not yet been officially introduced in Japan. This qualitative case study aimed to identify the challenges and facilitating factors in the implementation of SP among the socially isolated aged population in Akita Prefecture, Japan, based on the perspectives of general practitioners (GP), link workers (LW), and patients. Method: We conducted a qualitative case study using semi-structured interviews and Braun & Clarke-informed thematic analysis in seven medical districts in Akita, Japan, with GP (n=7), LW (n=10), and aged patients (n=4). Results: Participants (GP and LW) emphasized that SP needed to be tailored to individual needs and that LW played a vital role as social resources in sparsely populated rural communities. The project was publicly funded; participants emphasized that, in the absence of financial support, intrinsic motivation would be important to sustaining implementation. Both groups raised concerns about ensuring LW’s competencies, the accessibility and cost of community resources, and the limited availability of such resources in rural areas. Patients highlighted that the effectiveness of SP varied by personal characteristics, and that transport barriers significantly restricted participation, highlighting the need for local support to mitigate this challenge. Establishing patients’ trust in LW and GP, along with effective communication, was viewed as essential for identifying and addressing patient-level barriers. Conclusions: In rural, resource-constrained settings such as Akita, successful SP depends on tailoring to individual needs, ensuring LW competence, and addressing transport barriers. These findings suggest that future policies should focus on sustainable funding for LW, integration with existing health and welfare systems, and mobility solutions.