Exploring General Practice Nurses' Experiences of an Intervention to Support Social Connectedness Among Older Adults: A Qualitative Descriptive Study

ABSTRACT

Aim

This paper explores the experience of general practice nurses implementing a nurse‐led social prescribing intervention to improve older people's social connectedness.

Design

Qualitative descriptive study within a multi‐phase mixed methods project.

Methods

Eight Australian general practice nurses working in a health connector role participated in semi‐structured interviews at implementation‐end (n = 8) and 12 months later (n = 5), and two focus groups, held during implementation. Interviews addressed participants' reasons for engaging in the intervention, perceptions of training, the experience of intervention delivery and sustainability. Focus groups explored participants' views of challenges and achievements. Data were analysed inductively using thematic analysis.

Results

Participants reported ‘alignment between their current nursing role and the additional health connector role’ regarding their scope of practice and philosophy of care. ‘Preparedness to be a health connector’ explained how participants' primary care nursing skills equipped them to intervene, however, additional training and resources were essential. Older people were positively impacted by the intervention, and this motivated participants to sustain elements of the intervention. With support, participants leveraged existing skills and worked to their full scope of practice. This resulted in practice improvements in caring for older people at risk of loneliness and social isolation, and professional gains for nurses.

Conclusion

Despite challenges in sustaining the intervention as designed, participants integrated the health connector intervention into their practice within the context of their nursing role and continued this work with older people and other patient groups.

Implications

Facilitating general practice nurses to undertake a social prescribing intervention had benefits for nurses and patients.

Impact

Nurse‐led social prescribing interventions can support older people to reactivate or maintain their social connections within the context of their health.

Reporting Method

Consolidated Criteria for Reporting Qualitative Research (COREQ) Checklist.

Patient or Public Contribution

No patient or public contribution.

What Does This Paper Contribute to the Wider Global Clinical Community?

• The World Health Organization recognises loneliness and social isolation as a global health priority, with primary care at the forefront of addressing this issue.

• General practice nurses reported improved job satisfaction, with the skills developed to support lonely and socially isolated older people being transferable to other patient groups.

• Ensuring a contextually appropriate intervention that is integrated into existing nursing roles may increase uptake.

1. Introduction

Social connectedness is emerging globally as a major public health issue, recognising that physical, mental and social health are intertwined (Holt‐Lunstad ²⁰²⁴; World Health Organization Commission on Social Connection ²⁰²⁵). The adverse health impacts for older adults of loneliness and social isolation gained prominence during the COVID‐19 pandemic (Office of the Surgeon General ²⁰²³). Consequently, there has been growing interest in interventions to reduce loneliness and social isolation among older people (Galvez‐Hernandez et al. ²⁰²²; Shekelle et al. ²⁰²⁴; Thompson et al. ²⁰²³). The World Health Organization Commission on Social Connection (2025), has provided further impetus to intervention delivery, calling for action at individual, community and societal levels through engagement, research, measurement and data, policy and interventions.

2. Background

Globally, more than 1 in 8 people aged over 60 years feel lonely, and 1 in 3 are socially isolated, with countries of all income levels affected (World Health Organization Commission on Social Connection ²⁰²⁵). Within Australia, about 1 in 6 people aged 65 years and over report experiencing loneliness, with 1 in 10 socially isolated (Australian Institute of Health and Welfare ²⁰²⁵). Loneliness is a subjective feeling about limitations in the quality and quantity of a person's social relationships (Perissinotto et al. 2019). Loneliness is a biological signal, akin to hunger or thirst, indicating our fundamental need for human connection (Office of the Surgeon General ²⁰²³). However, social isolation refers to the absence of social contact or social networks and may be objectively measured (Perissinotto et al. 2019). Social connection has structural, functional and quality dimensions and encompasses the extent of one's relationships, the support that these provide, and whether they are perceived to be positive (Holt‐Lunstad ²⁰²¹).

Loneliness and social isolation are associated with increased morbidity and mortality (Holt‐Lunstad ²⁰²¹). They predispose people to depression, anxiety, dementia, cardiovascular diseases and stroke (Holt‐Lunstad ²⁰²⁴). The reduced life expectancy and poorer quality of life arising from loneliness and social isolation result in significant costs to health systems and society more broadly (Holt‐Lunstad ²⁰²⁴). Particular life stages bring increased risks. For example, social isolation increases for older people with declining cognitive ability, functional impairment, and underlying disease, which can limit social participation (Holt‐Lunstad ²⁰²¹). Ageism, stigma and health concerns arising from chronic conditions may also increase loneliness among older people (World Health Organization Commission on Social Connection ²⁰²⁵).

Social prescribing has emerged internationally as a key strategy to meet people's non‐medical support needs, including those of older people at risk of loneliness and social isolation (Morse et al. 2022). Internationally, there are wide‐ranging approaches to social prescribing, with models that include link workers being the most common (Morse et al. 2022; Oster et al. ²⁰²³). Link workers come from diverse professional and non‐professional backgrounds, and their role varies (Golby et al. 2024). Although they frequently receive training, they may not have any health‐related training or clinical qualifications (Golby et al. 2024). While most social prescribing programs are implemented with some combination of healthcare professionals and link workers (Oster et al. 2023), there is potential to integrate social prescribing interventions into existing primary care roles (Thompson et al. 2023).

Primary care practitioners frequently encounter lonely and socially isolated older people due to the complex health needs arising from chronic conditions (Galvez‐Hernandez et al. ²⁰²²; Thompson et al. ²⁰²³). Globally, nurses comprise a significant proportion of the primary care workforce, with potential for greater involvement in interventions to improve older people's health, well‐being and social connections (Gibson et al. 2024; Grivell et al. ²⁰²⁶; Thompson et al. ²⁰²³). Within Australia, general practices provide front‐line primary care services and general practice nurses (GPNs) are a key part of this workforce (Halcomb and Ashley 2019). However, GPNs are underutilised and are generally not working to their full practice scope (Halcomb and Ashley 2019). This represents an opportunity for these health professionals to embed social prescribing within their role. Within Australia, despite the promise, there are limited examples of GPN‐led social prescribing interventions for lonely and socially isolated older people (Thompson et al. 2023). Primary care social prescribing models are most developed in the United Kingdom (Golby et al. 2024; Morse et al. ²⁰²²), largely due to policy and funding support for staffing (Brunton et al. 2022). However, there is limited research about the integration of social prescribing roles in general practice, particularly from the perspective of those undertaking this (Brunton et al. 2022). In their literature review, Thompson et al. (2023) highlighted the need for further research exploring GPN‐led interventions, including social prescribing, to improve older people's social connections. While studies in which older people engaged in group‐based, purposeful activities that drew on community resources showed reductions in loneliness (Mays et al. 2021; Rodríguez‐Romero et al. ²⁰²¹), there was limited insight into the experiences of health professionals in intervention delivery. Given the paucity of evidence, research is needed to not only test the impact of interventions on health outcomes (Shekelle et al. 2024), but also to understand the experience of those who deliver them. Such investigation will increase our understanding of the factors influencing intervention delivery and sustainability.

3. The Study

3.1. Aim

This paper explores the experience of GPNs implementing a nurse‐led social prescribing intervention to improve older people's social connectedness. This study was part of a multi‐phase mixed methods project that evaluated the implementation of a nurse‐led social prescribing intervention in Australian general practice. The quantitative phase, a pre‐post intervention study, assessed the feasibility, acceptability and preliminary intervention impact. The depth of quantitative data resulted in this being reported separately (Thompson, Morris, et al. ²⁰²⁶). Additionally, the individual, organisational and system level factors GPNs identified as influencing implementation are reported elsewhere (Thompson, Halcomb, et al. ²⁰²⁶). The GPN health connectors' experiences reported in this paper describe issues they faced in intervention implementation and the implications of their involvement for their practice and professional identity.

4. Methods

4.1. Design

This study used a qualitative descriptive approach which is particularly useful for exploring GPN health connectors' real‐life experience of implementing the intervention in their natural context. Qualitative descriptive designs are frequently used in nursing research as they are suited to understanding human experiences of both patients and nurses (Kim et al. 2017). This design enabled a full description of the phenomena, remaining close to participants' words and meanings (Sandelowski 2000). Qualitative descriptive designs present findings “in a way that best fits the data” (Sandelowski 2000, 339) which helps with their application to health care policy and practice.

4.2. Study Setting and Intervention

The study was conducted in seven general practices within the Hawkesbury Local Government Area north‐west of Sydney, Australia. The intervention drew from the Health Connections Mendip (2025) initiative pioneered in the UK and was supported by a broader asset‐based community development strategy, informed by the work of Age UK and the Campaign to End Loneliness (Jopling 2015). Implementation extended from January 2020 to May/June 2022, with a six‐month suspension (March to September 2020) due to the COVID‐19 pandemic. While the intervention has been described elsewhere (Thompson, Morris, et al. ²⁰²⁶), an overview is provided here for context.

Registered nurses (baccalaureate‐prepared or equivalent) were trained as GPN health connectors to identify, assess and respond to older people at risk of loneliness and social isolation. One general practice trained two GPNs, and the remaining six practices each trained one GPN in the role. GPN health connectors were provided with education and resources, including an online database of community activities and services. General practices were remunerated for 5 h of GPN time per week during implementation. During the first 10 weeks, the project manager provided one‐on‐one support through weekly visits or telephone calls to build skills and confidence. A facilitated community of practice provided support throughout, with in‐person and virtual meetings.

The intervention targeted people 75 years and over and Aboriginal and Torres Strait Islander peoples 65 years and over, as First Nations peoples have a lower life expectancy (Australian Bureau of Statistics ²⁰²³). Older people at risk of loneliness or social isolation were identified by general practice clinicians, or through an audit of practice records. They could also self‐refer or be referred by a community member/organisation. Following referral, the GPN health connector contacted the older person to elicit their interest. Older people who consented to participate were invited to attend an initial consultation. The GPN health connector engaged the older person in a conversational interview to assess their social connection needs, and together they identified activities of interest and co‐produced a personalised plan to support engagement in their preferred activities. The older person was followed up by the GPN health connector during routine practice consultations or by telephone at least once, but more often if needed, to check that the identified activities met their needs, review progress and address any difficulties. Approximately 12 weeks after the initial consultation, a face‐to‐face follow‐up session assessed progress and collected post‐intervention data.

4.3. Sampling and Recruitment

Participants were purposively selected because of their experience in intervention implementation (Oppong 2013). All eight GPN health connectors were invited to participate, and although they were advised that they were free to choose whether to participate, all consented. It is usually prohibitive to study all cases (Oppong 2013), however, in this study, all GPN health connectors participated in at least one interview. Despite being a small sample, rich data were generated through the multiple instances of data collection (Sandelowski 2000). Researchers emailed participants directly to arrange interviews and focus groups.

4.4. Data Collection

Semi‐structured videoconference interviews were conducted with all eight GPN health connectors at implementation end (July–October 2021). Five GPN health connectors participated in a second interview 12 months later (May–August 2022). The second round of interviews aimed to explore perspectives on intervention sustainability. The average interview duration was 42 minutes.

Interview guides were developed with input from primary care experts and researchers familiar with the intervention and implementation context (Table 1). The interview guides employed open‐ended questions, with prompts and probes to deepen participants' responses. The interviewers conducted a pilot interview before data collection to test the interview guide. The second interview employed a separate interview guide that focused on participants' reflections and sustainability issues.

TABLE 1.

Interview schedule excerpts.

Interview 1	Interview 2
Would you tell me about your experience as a health connector? How prepared did you feel for the health connector role? What are the major lessons you have learned that may help other general practice nurses interested in taking on this role?	Reflecting on how you would have responded to older people experiencing loneliness and social isolation before taking on the health connector role, is there anything that you now do differently? How likely are you to continue to use the knowledge and skills that you may have developed now that the project is at an end?

Additionally, two online focus groups were conducted during implementation. Focus groups are intended to be generative (Tong et al. 2007) and the GPN health connectors were prompted to share their feelings and experiences of perceived implementation successes and challenges. The first focus group was undertaken after implementation resumed following COVID‐19 (December 2020). It included six participants and lasted for 61 minutes. The second focus group occurred just before project implementation ended (April 2021), also with six participants, and lasted 68 minutes. The focus groups began with a narrative focus, ‘Tell me about a time when…’ (Greenhalgh et al. 2005), to prompt participants to reflect on their experiences and share stories.

Two experienced qualitative researchers (CT and DM) conducted the interviews and focus groups. All researchers had backgrounds in health research with extensive experience in qualitative research, and several had relevant clinical expertise. All but one researcher identified as female and none had prior relationships with any participants. All sessions were conducted using a secure videoconferencing platform (Archibald et al. 2019), audio recorded and transcribed verbatim by a professional transcription company. The PhD candidate (CT) kept a reflexive journal recording notes during and after each session.

4.5. Data Analysis

Data were analysed using the six steps of reflexive thematic analysis (Braun and Clarke 2022). The first author reviewed transcripts against audio recordings to check accuracy and support data familiarisation. Two researchers (CT and KP) read and re‐read all transcripts before they were uploaded into NVivo Version 12 Plus. Three transcripts were independently inductively coded by these two researchers. All researchers reviewed and compared these initial codes, identifying overlap and areas for refinement, before all transcripts were coded by the PhD candidate (CT). Member checking was not undertaken to minimise participant burden. Instead, researchers met regularly to discuss coding. Searching for themes was iterative, with the researchers moving back and forth between the transcripts and coded data to ensure that identified patterns were true to the data and relevant to the research question. Potential themes were reviewed by the researchers and named to convey meaning, with quotes extracted to illustrate each theme. The final synthesis yielded the findings as presented in this paper. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist informed the preparation of this manuscript (Tong et al. 2007).

4.6. Ethical Considerations

The Human Research Ethics Committee of the University of Wollongong provided approval for the conduct of this study (Approval No. 2019/248). All participants provided informed consent and were advised of the purposes of this research. Transcripts were anonymised by removing identifying information, and pseudonyms are used to ensure confidentiality. Code sheets were stored securely and independently of data sources.

4.7. Rigour and Reflexivity

The trustworthiness criteria of Lincoln and Guba (1985), were used to assess rigour. Credibility was supported through prolonged engagement with participants, with data collection extending over 32 months. Regular peer debriefing occurred among the researchers. Confirmability was supported by maintaining an audit trail that documented study processes. The PhD candidate maintained a reflexive journal, and regular discussions about the potential biases occurred. Dependability was aided by using semi‐structured interview guides with questions, probes and prompts. Providing thick description of the context, participants and data collection processes supported transferability (Lincoln and Guba 1985).

5. Findings

5.1. Participants

All participants were experienced registered nurses and identified as female. Three (37.5%) participants had over 35 years post‐registration experience, two (25%) participants had been a nurse for 16–20 years, and the remaining three (37.5%) participants had 6–10 years nursing experience. Most participants were relatively new to general practice, with five (62.5%) participants having worked as a GPN for less than five years (Table 2).

TABLE 2.

Participant demographics.

Nursing experience (Registered Nurse years)	Pseudonym	Years as a general practice nurse
6–10 years	Poppy	≤ 5
	Hyacinth	≤ 5
	Marigold	≤ 5
16–20 years	Aster	≤ 5
	Rose	16–20
> 35 years	Iris	≤ 5
	Violet	6–10
	Ivy	16–20

5.2. Themes

Four interconnected themes describe GPN health connectors' experiences in intervention delivery, namely: alignment between the GPN and health connector roles, preparedness to be a GPN health connector, experiences of intervention impact, and perspectives on intervention sustainability.

5.2.1. Alignment Between the GPN and Health Connector Roles: ‘100% It Is Part of Our Holistic Care’

As participants felt that the health connector role aligned with their GPN scope of practice, this positively influenced their engagement with the intervention. There was synchronicity between their beliefs about the importance of caring for older people's holistic health and what was expected of them as a health connector.

Well, I was a bit taken aback that it was going to be a nurse's role to lead this kind of program. So I originally thought it would be therapists or counsellors… But once I kind of understood that it's just connecting with our patients, which we do on a day‐to‐day basis and finding out what they enjoy doing… I thought, ‘Well, it is actually quite a big nurse's role’. (Aster)

Participants spoke of the need to look after the whole person, how this had been integral in their nursing education and remained core to their approach as a GPN. Holistic care was explained as addressing the individual physical, mental and social health needs unique to the older person. ‘I guess it's personalising the practice, not making it just medical. It brings in other mental health issues in that as well’ (Hyacinth). Marigold described how she thought ‘of it as a new opportunity for the patients to be well. Not only physically, but also mentally. We're doing holistic care’. This view was echoed by Rose who stated:

Yeah. 100% it is part of our holistic care [referring to the intervention]. We have got the physical aspects, but you've got to think about somebody's emotional and mental health aspects, which 100% impact on their health.

In their practice, participants had observed the health impacts of loneliness and social isolation on older people and believed that addressing this issue was important and relevant to their role. Consequently, all participants believed there was a need for the intervention.

So I think being socially isolated has huge implications, for just every element of their health …it's so terribly, terribly sad to watch someone come in and say, ‘I have no one. This is me and this is all that is. At least I've got my dog’. (Aster)

Participants believed that their established relationships and experience in caring for older people as a GPN facilitated intervention implementation, given the role's relational nature. Aster noted, ‘We know our patients so well because we see them so often. You kind of understand who's lonely and who's not by how many times they come in just for a general checkup'. This view was reinforced by Ivy, who explained, ‘I mean, what really helped me was the fact that I already had a really good rapport with 90% of my patients. So, they know me, and they sort of trusted me…’.

5.2.2. Preparedness to Be a GPN Health Connector: ‘Empathy and a Good Listening Ear’

While participants were supported with additional training and resources, which were seen as essential, there was an opportunity to leverage their existing nursing skills in the GPN health connector role.

So the training… I think that equipped us to get underway and get started…. And just the fact that we had such a large elderly patient base, I think, equipped us to feel like we can go out and conquer the world. (Violet)

The participants brought their strong soft skills, such as communication and active listening, to intervention delivery. Their ability to display empathy was consistently identified as a key quality. Violet described this as ‘empathy and a good listening ear, like often they just would like to talk’.

Listening more and being more open and empathic to the elderly people. I think they really need someone that will listen to them because lots of the time there's no one who can do that for them. (Marigold)

Several participants reflected on the impact of physical function loss on older people and on what their experience of growing older might be. Participants felt this helped them to respond empathetically.

… it gave me more skills of understanding, and more empathy. Since I'm seeing myself, I will be old one day. And I don't want to be socially isolated, or I don't want to be being holed up inside home, because of my physical disabilities… (Marigold)

Knowledge of chronic condition management was important for participants given the various effects that such conditions have on quality of life, particularly the loss of physical function.

I feel you need an understanding of chronic illness and the impact it can have on an individual physically and socially. You need knowledge of services that are available for people living with chronic illness… (Aster)

Participants emphasised the importance of questioning and patiently probing during interactions. This was particularly important in assessing the risk of loneliness and social isolation, as participants recognised that these issues were not always readily revealed. As Marigold explained: ‘Don't accept the yes or no to questions, always explore, try to expand’.

…I think you still need to be able to question quite well, because some of the older people struggled with maybe talking about the past, or some family members that they don't talk to anymore and things like that…. having those skills to be able to deal with that is obviously going to get the best out of your interviewing… I think that you need the patience with older people, I think, it is probably one of the keys. (Rose)

Skills in observation and assessment enabled participants to determine whether an older person might be lonely or socially isolated, even if the person did not openly admit it.

Their demeanour, the way they approach the conversation, how hard it is I guess to get them to talk, their facial expression.… you look at how well they're groomed… You can tell that they're lonely, because you can see that they're coming in the same pair of clothes every time they come in… and they're the people that you really need to dig a bit deeper for… (Hyacinth)

Participants described how they set goals and developed personalised plans with older people to meet their social needs. People's diverse individual circumstances, coupled with the varying causes of loneliness and social isolation, sometimes required lateral thinking to find suitable, available activities. Iris explained: ‘it is sometimes thinking outside the box and then sort of tailoring to the individual needs…’.

The training and resources provided within the intervention were perceived as being crucial to support implementation of the intervention. ‘I think having the tools was very good, and to have that backup of what's expected, I think was very effective…’ (Aster). The online community database was consistently mentioned as a useful resource used during consultations. As Rose explained: ‘Well, the main one [referring to intervention resources] is obviously the internet address book that had all the places’.

5.2.3. Intervention Impact: ‘There's Just a Bit More of a Twinkle in the Eyes…’

Participants described how the intervention positively impacted older people. The positive outcomes reinforced the participants' beliefs about the intervention's value and added to the participants' enthusiasm in intervention delivery. Aster remarked: ‘I love doing the program. I always look forward to having someone come in and to be involved in something that is so beneficial’. Poppy agreed, explaining that ‘I really enjoy this role because this is a very good program. And as a GPN, you always want to help your patients’. The feedback participants received from patients was an important source of encouragement, motivating them to continue their implementation efforts. With Aster reflecting about patients she had assisted: ‘There's just a bit more of a twinkle in the eyes when they come back after 6 weeks’. Hyacinth explained the favourable impacts for older people as ‘getting better health care and better outcomes, preventing hospitalisation, preventing ending up in aged care’.

Perhaps the most striking intervention impact was on the GPN health connectors themselves. Participants were amazed by the positive changes that they observed in the health and wellbeing of older people through the intervention. As a nurse, they drew satisfaction from this.

I think I've changed lives. I really do… they were on the verge of just being absolutely depressed…bringing them out in the community and giving them a new lease on life…it's been very beneficial for them and the patient's overall health. (Aster)

Similarly, Iris reflected on how her strategy of reconnecting an older man with activities he had previously enjoyed not only reduced his loneliness and social isolation but also provided him with a pathway to connect with his neighbours.

…he went back to a couple of things that he hadn't been to for a few years. Instead of going down different tracks he was saying, ‘you know I really should get back’ so that's what we did…. But he then started making welcome packages for all the new people in the village that came in… And then I just thought wow you know you don't realise how much of an impact that you can have…he actually then thought it was a good way of connecting with his neighbours as well. (Iris)

Participants revealed their professional gains and explained that these included an increased awareness of loneliness and social isolation, and greater confidence in responding to these issues. The impact on participants' knowledge, attitude and skills was also recognised, ‘I think it's made me more aware of what's out there in the community’ (Ivy).

As I was new to the role, I think it gave me confidence to broach sensitive topics and helped me to be able to develop relationships with some of my older patients. It has helped me to have empathy towards them and realise they have so much to offer to the community. (Iris)

Others conceptualised their change in practice as about deeper thinking and reasoning about the issues older people face. For example, this was described as thinking about whether an older person's lifestyle changes could be related to loneliness. Participants outlined their approach to working through problems, ‘…the way you work things out with patients, I think you have a different light on the way that you see people and the way you deal with people and what matters for people’ (Violet). Participants also described their experience of ‘having that training of being able to…look a little deeper and, of course then knowing what to do with it’ (Rose).

I guess it's just being more aware, like looking at loneliness, is that the cause of this issue? Like I said before, are they overeating because they're lonely, rather than… I'm finding a reason behind other sort of symptoms as well. (Hyacinth)

Overall, participants perceived value in the GPN health connector role. ‘I would say, I feel that it is a really worthwhile project’ (Violet). Aster agreed, stating: ‘I would like to continue this program. I think it's great for the practice and the nurse and the patient’.

5.2.4. Intervention Sustainability: ‘I Have It All There at My Fingertips‘

Despite their belief in the intervention's value and their enjoyment of delivering it, participants felt it could only be sustained with continued funding for the GPNs' dedicated time.

Did I learn any lessons? Only that you just need to have that dedicated time. I think that's the main thing to have the success. Because I can see what it's like without it. (Rose)

However, participants spoke of continuing to use the knowledge, skills and resources gained more broadly in their practice. For many, this involved continuing to question older people about their social connections. As Rose noted 'I ask the question anyway, at least now I actually have the knowledge and skills and the tools…when that person does go, “Oh I've been thinking about that”. Others emphasised that the learnings, ‘like using the health directory’ (Aster), would stay with them. ‘Definitely it's going to be with me all the time’ (Poppy).

Participants provided numerous examples of integrating intervention elements into usual practice. Rose noted, ‘what I've done since the project is finished is still use the time within the health assessment’.

… I can ask people, if they are interested in doing any of those things even now because I have it all there at my fingertips. (Violet)

Several participants expressed that a more flexible and adaptable approach was the best way to sustain aspects of the intervention without ongoing funding. ‘I will do it, but only on an opportunistic basis… I can show them the directory, and I will do it’ (Ivy).

Especially like our general practice is really a busy one so sometimes blocking out the five hours a week will be a challenge, especially now I'm working alone. The opportunistic ones will work as well. (Marigold)

However, others felt that this more flexible approach would only permit a short conversation about social connection, as many nursing interactions were relatively brief. Participants recognised that sustaining intervention elements was more likely when other practice staff were involved. Hyacinth explained: ‘…if the whole team was involved, it would just continue as a regular part of the everyday practice. That would be ideal’. That said, the participants' predominant view was that the intervention had to be nurse‐led.

Initially – like we would always ask, ‘If you've got patients that you think would be great for this program, let us know.’ But I think a lot of the role was nurse‐led. So it was very much nurse‐led to get this done. They [other team members] appreciated what we were doing and so forth. (Aster)

Some participants planned to advocate for the use of the intervention's online community database more broadly in their practice. Iris commented, ‘I'm certainly going to be showing the Enrolled Nurse the directory and have discussions with her about you know what we did. So hopefully some more of that will be able to be brought back’.

Other patient populations that could benefit from support to improve social connections were identified, and the participants' experiences confirmed that ‘social isolation is not just the elderly’ (Iris). Marigold explained, ‘new mothers, babies, having a hard time, anxiety, with wellbeing. You can definitely then relate to them. Not only the old people’.

Most participants felt the GPN health connector role provided a ‘value add’ to the social prescribing intervention and that a GPN was effective in this role. The GPN health connector demonstrated understanding of the health impacts of loneliness and social isolation, knowledge of chronic conditions, the ability to distinguish between health and social needs, and an ongoing trusted relationship with patients. Aster noted, ‘I don't know if someone else would be able to take on the role if they didn't know a bit of their background. So I think it would be harder not to know their health background’.

If you have that relationship, you can identify their needs and obviously prevent them ending up in a nursing home, because all they might need is someone to come clean their house, or to pay someone to mow the lawns instead, or get them to do an aged care assessment. You can pick up on those things, or ‘Is this person starting to get dementia?’ Pick up some of the medical things that will prevent them ending up maybe in hospital or dying. (Hyacinth)

6. Discussion

This study provides new knowledge about the GPN health connectors' experiences implementing a nurse‐led social prescribing intervention. Previous social prescribing research has identified the importance of understanding context, given its impact on implementation (Brunton et al. 2022; Oster et al. ²⁰²³). By considering participants' perspectives, opportunities to improve implementation and enhance the intervention's feasibility and sustainability were identified. When taken together, the themes illustrated that when congruence occurs between GPNs' values, skills, practice environment and available resources, their capacity to contribute to meaningful nursing work is enhanced, which improves job satisfaction. This pattern is confirmed by previous research about values congruence, showing that when nurses' personal and professional values accord with their role, increased job satisfaction and performance are experienced (Dunning et al. 2021). In their national cross‐sectional survey of Australian GPNs, Halcomb and Ashley (2019) found that nurses wanted greater involvement in health promotion, patient education and chronic disease management. The capacity to work to their full scope of practice increases GPN job satisfaction, which supports nurse retention (Halcomb and Ashley 2019). Given the predicted shortages in the general practice workforce, retaining skilled GPNs is essential (Grivell et al. 2026). This study found that supporting GPNs to deliver a nurse‐led social prescribing intervention allowed them to leverage their existing skills to work to the extent of their practice scope and contributed to professional fulfilment. The satisfaction experienced by the GPNs was encouraging, as sustaining social prescribing interventions requires retaining those capable of implementing them (Tierney et al. 2025).

Study findings confirmed the importance of trust and relational continuity, when supporting older people in need of improved social connections. As loneliness and social isolation are often considered by older people to be a stigmatising issue, they are unlikely to be discussed without an established trusted relationship (Galvez‐Hernandez et al. ²⁰²²). Building rapport and trust is fundamental to being able to discuss sensitive issues with older patients (Gibson et al. 2024). The GPN health connectors identified that the established trust they had with older patients and their ability to spend time with them, facilitated providing care that aligned with the preferences of the older person. Implementing person‐centred care and shared decision making is key to effective chronic condition management (Gibson et al. 2024). A review of factors influencing GPNs' implementation of chronic condition models of care similarly identified that trusting nurse–patient relationships are facilitated when the nurse has adequate time with the patient (Grivell et al. 2026).

This study demonstrated the potential for social prescribing to be integrated into the GPN role. It has been argued that just as health professionals encourage physical activity, they should also be equipped to encourage social activity (Perissinotto et al. 2019). The assessment of loneliness and social isolation does not routinely occur in general practice and there is scope for greater involvement of the general practice team (Perissinotto et al. 2019). Therefore, to effectively deliver the intervention, the GPN health connectors required training and resources. Demiris et al. (2020) concur that innovative nursing approaches with older adults need to be supported with appropriate training and resources. Brunton et al. (2022) identified that social prescribing interventions require skills in needs assessment, motivational interviewing and behaviour change techniques. While many social prescribing elements, such as risk identification, needs assessment, co‐producing action plans and evaluating progress, are within GPNs' scope of practice (Thompson et al. 2023), additional training facilitated optimal implementation. Similarly, providing resources, such as this study's online community database, can increase nurses' confidence in identifying community‐based organisations and activities. Knowledge of available community resources is crucial to the success of social prescribing interventions (Morse et al. 2022).

Internationally, population growth in older people is driving the need for innovative GPN roles to effectively manage chronic conditions (Grivell et al. 2026), optimise preventative care (Demiris et al. 2020) and strengthen social connection (World Health Organization Commission on Social Connection ²⁰²⁵). In the United Kingdom, social prescribing interventions have become reliant on new workforce roles, such as link workers (Tierney et al. 2025). However, multidisciplinary teamwork interventions that include task shifting and role expansion are becoming increasingly common (Shi et al. 2025). While participants in this study were unable to sustain the intervention as designed, they were able to integrate components into their usual practice with broader patient groups. Given the global interest in interventions addressing loneliness and social isolation, and differences in primary care structures and resources, it is important to explore how to optimise the contribution of the existing health workforce. Ensuring a contextually appropriate social prescribing intervention that incorporates a team‐based approach may optimise resource consumption.

Findings revealed that funding to support nurse time was key to intervention sustainability. Funding interventions is complex, as it may involve capital costs for establishing the intervention, ongoing operating costs, and the need to generate revenue (Terry et al. 2024). International research about social prescribing models confirms the difficulties of securing sustainable funding (Morse et al. 2022) and this is compounded by general practice funding challenges. Attempts to establish GPN‐led interventions are frequently stymied by inflexible funding models that don't adequately fund nursing time (Gibson et al. 2024; Grivell et al. ²⁰²⁶). Funding has long been identified as a major barrier to GPN‐led interventions, particularly in the Australian context (Halcomb and Ashley 2019; Terry et al. ²⁰²⁴). This highlights the need for future research to incorporate cost‐effectiveness measures.

6.1. Strengths and Limitations

This study has several limitations. Findings were drawn from one region that experienced significant and sustained environmental disruptions throughout implementation, which may have affected participants' experiences and limit transferability. Additionally, the Australian health care system provides universal care through its national health insurance scheme, which may not be the case in other countries. The sample size was modest, although it represented all eligible participants. The participants' varying levels of general practice nursing experience may impact transferability. However, conducting multiple interviews/focus groups at different timepoints provided a temporal dimension to this study, which is often not possible and contributed useful insights. These multiple data collections also contributed to the thick description of the intervention.

7. Conclusion

Identifying whether an older person is at risk of loneliness or social isolation may provide GPNs a pathway to holistically improve health. In this study, the starting point was an extended conversation enabled by the relational nature of general practice. This study highlights that GPN‐led interventions to improve social connectedness offer a feasible, practical option that requires minimal upskilling and resources. Participants were overwhelmingly positive about the intervention, felt it fitted well with their nursing role, and enjoyed supporting older people to improve social connections. Despite challenges in sustaining the intervention, participants continued to apply their knowledge, skills and resources to work with various patient groups. The participants' experience as health connectors informed improvements in ongoing intervention delivery. Future research drawing on a larger sample of GPN health connectors in different geographical areas will offer broader insights. Study findings contribute to the growing body of evidence about incorporating actions to identify and support lonely and socially isolated people within the GPN role, which is a practical and potentially sustainable strategy to improve older people's social connectedness and enhance GPN job satisfaction.

8. Relevance to Clinical Practice

GPNs routinely address physical and mental health needs of older people; however, assessing social health needs, including loneliness and social isolation, does not always form part of usual care. As general practice is a trusted source of advice for older people, it provides a promising setting for GPN‐led social prescribing interventions to improve older people's social connections. The ability to develop the GPN role through this intervention generated improvements in how the practices supported older people requiring improved social connection. The application of the training to other patient groups was also identified, suggesting undergraduate and postgraduate nursing education should incorporate assessment of social health into existing curriculums. The knowledge gained in this study can be applied to improving future design and delivery of GPN‐led social prescribing interventions.

Author Contributions

All listed authors have contributed to the manuscript substantially, agreed to the order in which the author names appear, and agreed to the final submitted version. C.T.: conceptualisation, methodology, investigation, formal analysis, writing – original draft, writing – review and editing, project administration. K.P.: methodology, formal analysis, validation, writing – reviewing and editing, supervision. A.M.: formal analysis, writing – reviewing and editing, supervision. E.H.: conceptualisation, methodology, formal analysis, validation, writing – reviewing and editing, supervision.

Funding

This project was funded by the Australian Government Department of Health, Disability and Ageing through the Evaluation of the Improving Social Connectedness of Older Australians Project Pilot [Health/18‐19/04684].

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

File S1: Consolidated Criteria for Reporting Qualitative Research (COREQ): 32‐item checklist.

Data Availability Statement

The data are not publicly available due to privacy or ethical restrictions.