A stage-sensitive approach to evaluating social prescribing in complex and evolving health systems

This Viewpoint, commissioned by the World Health Organization Regional Office for the Western Pacific (WHO WPRO), proposes a stage-sensitive evaluation framework to guide the implementation and scaling of social prescribing (SP) in the Western Pacific Region. The framework aligns with Dean Fixsen's four stages of implementation-exploration, installation, initial implementation, and full implementation-and integrates multiple methodologies, including Theory of Change (ToC), dynamic logic models, implementation science, complexity science, realist evaluation, and participatory action research (PAR). The framework is especially relevant for low- and middle-income countries (LMICs), where resource constraints, cultural diversity, and system fragmentation present unique challenges. It supports participatory exploration, context-sensitive adaptation during installation, and complexity-informed evaluation in early and full implementation phases. Rather than relying on a single method, it promotes a flexible, pluralistic approach that combines the strengths of different evaluation tools. Used in combination, these methods provide a richer understanding of how and why SP works in varied contexts, while allowing for responsiveness, equity, and scalability. The framework also aligns with WHO's emphasis on addressing social determinants of health and achieving people-centred, equitable care. It offers policymakers and practitioners a practical roadmap to build credible, context-relevant evidence for SP across diverse regional settings.