Abstract
BACKGROUND: Social Prescribing Schemes (SPS) incorporate community-based activities (Health Assets, HAs) into primary healthcare (PHC) to address social determinants of health and enhance well-being. Structured evaluation frameworks are needed to ensure equity, accessibility, and measurable outcomes. This study aimed to develop a framework to assess SPS in the Spanish public healthcare system using key stakeholder input. METHODS: A mixed-method approach was applied, including five nominal group discussions (NGDs) with 48 national stakeholders (public health officials, PHC teams, HA providers, and patients). Thematic analysis of NGD data identified key challenges and opportunities and with the literature review was the foundation of a two-round Delphi survey with 130 participants. The Delphi process refined 116 initial criteria across three domains (structure, process, outcomes), guided by Donabedian’s quality model. RESULTS: The final model contained 91 criteria: 41 structural criteria focused on equity, accessibility, and validation of HAs; 36 process criteria highlighted patient consent, collaboration between PHC teams and HA providers, and adherence tracking; 14 outcome criteria emphasized improvements in quality of life, autonomy, and reduced healthcare use. Key barriers included information health system fragmentation, resource limitations, and regional disparities, emphasizing the need for cross-sector collaboration. CONCLUSIONS: This framework prioritizes equity and patient-centred approaches, emphasizing the value of SPS in PHC. Policy and research efforts should focus on addressing barriers and scaling SPS to strengthen integration and improve population health. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-025-02954-3.