ONS4 and other measures

ONS4 and other measures

The framework expects SPLWsSPLW— Social Prescribing Link WorkerA role that supports people to access community-based services, groups and activities to meet practical, social and emotional needs that affect their health and wellbeing. Used internationally; equivalents in some countries include 'link worker', 'community connector' or 'health navigator'. to know appropriate outcome measures for use in social prescribing — and to recognise when those measures are not appropriate.

ONS4 — the four wellbeing questions

ONS4ONS4Four short personal wellbeing questions (life satisfaction, worthwhile, happiness, anxiety) — used widely as a brief outcome measure for personal wellbeing. is a short four-item personal wellbeing measure that is widely used internationally as a brief outcome measure.

The four questions, scored 0–10:

1. Overall, how satisfied are you with your life nowadays?
2. Overall, to what extent do you feel the things you do in your life are worthwhile?
3. Overall, how happy did you feel yesterday?
4. Overall, how anxious did you feel yesterday? (reverse scored)

Strengths:

• Short, validated, comparable across populations.
• Well-recognised — ICS commissioners trust it.
• Can be used at first contact and at follow-up to show change.

Limitations:

• Not condition-specific. Doesn't pick up on, say, improvement in pain or sleep.
• A single point-in-time score is volatile (it asks about yesterday).
• Not always meaningful for people in acute crisis or with cognitive impairment.

Other measures you may use

• Patient Activation Measure (PAMPAM— Patient Activation MeasureA validated tool for assessing patient activation — the knowledge, skills and confidence a person has in managing their own health.) — for activation, see the Patient activation lesson in the Care Planning course.
• Loneliness scales (e.g. UCLA-3, Campaign to End Loneliness measure).
• Condition-specific scales (PHQ-9, GAD-7, etc.) — but these are clinical measures; SPLWsSPLW— Social Prescribing Link WorkerA role that supports people to access community-based services, groups and activities to meet practical, social and emotional needs that affect their health and wellbeing. Used internationally; equivalents in some countries include 'link worker', 'community connector' or 'health navigator'. use them only when trained and supervised, never as diagnostic.
• Bespoke local outcome frameworks — some ICSs have their own.

When measures aren't appropriate

The framework explicitly recognises that outcome measures have limits. Some examples:

• Person in acute crisis — not the moment for a 4-question survey.
• Person with limited literacy or cognitive capacity — adapt or use proxy measures.
• Person from a community with strong cultural reasons to under- or over-report on certain dimensions — interpret with care.

Stories alongside scores

Numbers tell part of the story. Case studies and the person's own words tell the rest. The framework asks SPLWsSPLW— Social Prescribing Link WorkerA role that supports people to access community-based services, groups and activities to meet practical, social and emotional needs that affect their health and wellbeing. Used internationally; equivalents in some countries include 'link worker', 'community connector' or 'health navigator'. to use both — and to use case studies to demonstrate impact, not just numbers.

Use the Case study tool to capture qualitative impact alongside ONS4ONS4Four short personal wellbeing questions (life satisfaction, worthwhile, happiness, anxiety) — used widely as a brief outcome measure for personal wellbeing. numbers.

Where to record outcomes

In the case management system, alongside the records of the support. Where ICS or commissioner reporting requires it, contribute the data — but the purpose of measurement is to understand impact, not to feed dashboards.