Is social prescribing accessible for migrant patients? Findings from a feasibility trial in Germany

Abstract Background Social prescribing (SP) is a promising approach to address social problems within primary care. Migrant patients are often affected by social isolation, financial and housing instability and challenges navigating the welfare system. Despite its potential, few rigorous randomized controlled trials have evaluated SP effectiveness. To address this gap, we conducted a feasibility trial on SP in Germany. Methods We conducted a feasibility trial across nine GP practices. Adults aged ≥18 years old presenting with social problems were eligible. Study nurses conducted structured interviews at baseline, three and six months. Participants were randomized in a 2:1 ratio to either an intervention group (link worker sessions) or a control group (informational brochure listing local services). Results Language barriers were the predominant challenge to trial participation and link working engagement. Migrant patients unable to understand German-language consent materials were excluded, reflecting the lack of routinely available translation services. German-only interviews and sessions further limited accessibility. Cultural factors, such as religious obligations (e.g. mourning periods) and family-centred decision-making also influenced engagement. Nonverbal communication strategies and trust-building efforts were crucial for overcoming cultural barriers. Mistrust toward healthcare institutions and a sense social distance were common but could be mitigated through culturally sensitive, relationship-centred approaches. Conclusions Multiple barriers - including language, cultural norms and gaps in healthcare infrastructure - limit the impact of SP among migrants. While AI-based translation tools offer new opportunities, real-time interpretation and culturally adapted link worker models are crucial. System-level changes, including the integration of translation services and greater cultural competence, are essential to use the full potential of SP for migrant communities.