Most UK university students had never heard of SP. Only 25% were aware of SP, substantially lower than the 75% of medical students at UK universities with SP Student Champions in 2020,³⁰ although still much higher than the 7% of medical students who had heard of SP in 2017/2018.²⁹ Our findings also show more awareness of SP in the UK than in a Canadian university in 2023, where only 16% of students had heard of SP.³¹ Together, these comparisons demonstrate the importance of measuring awareness amongst students across all disciplines. Findings from medical students cannot be generalised to the wider student body, and awareness of SP may differ across countries. Given that the SP movement began in the UK, before expanding to over 30 countries globally,⁴¹ it is not surprising the awareness was higher in the UK than in Canada. However, the difference to the Canadian sample could also be a result of awareness increasing over time as well as SP becoming more likely to be mentioned in courses, particularly within health and social sciences.

We also extended previous research by describing how awareness of and attitudes towards SP differed across sociodemographic groups for the first time. Given that SP has been proposed to address health inequalities,^42,43 it was concerning that students whose first language was not English and those of Asian/Asian British ethnicity were less likely to have heard about SP. This could indicate that students facing more structural disadvantages may be least likely to access SP, meaning it risks widening inequalities rather than addressing them. However, in weighted analyses, those with more social needs were more likely to have heard of SP, which is in line with previous findings that people living in more deprived areas are increasingly likely to have been referred to SP.^21,44 It was not surprising that students with health difficulties were more likely to be aware of SP as they may have found out about it through searching online or seeking advice from others. But we did not expect those with better wellbeing to also be more likely to have heard of SP. It could be that these students have better wellbeing because they are more aware of the importance of lifestyle, health behaviours, and care pathways such as SP.

As in previous research, we found an awareness-attitude paradox.^26,29–31 Although only a quarter of students had heard of SP, attitudes towards SP were overwhelmingly positive once the concept was explained. Overall, 97% agreed that SP could support mental health and wellbeing, 95% felt that their university should offer SP, and 89% were willing to follow a healthcare professional’s advice if they were to suggest SP. These extremely high rates of agreement suggest that, if SP were to be implemented in UK universities, there could be very high uptake. The principal challenge for implementing university social prescribing may not be persuading students of its value but ensuring that they know the pathway exists and understand how to access it. In contrast to awareness of SP, very few factors were associated with positive attitudes towards SP. This is likely because students rated SP so favourably, with only 24% not reporting entirely positive attitudes. Although awareness of SP was not associated with attitudes, academic field was important, with those studying social sciences more likely to have positive attitudes. This suggests that education about health and healthcare (as is common in the social sciences) may encourage students to think more positively about SP.

Our findings have several clear implications for the development of university SP. Communication around and promotion of SP schemes will be key for ensuring uptake, as lack of awareness about what SP involves is likely to be a key barrier. Previous studies have shown that teaching can increase knowledge of SP,^26,29,30 but it may be particularly important to target outreach to specific groups who are less likely to have heard of SP or have fewer positive attitudes towards SP. In the UK, this could include students who are younger, of Asian/Asian British ethnicity, have a first language other than English, not studying health-related subjects, and students with lower wellbeing or health problems.

We have also identified a clear gap for SP, as only around a third of students reported doing social or community activities to support their health and wellbeing in the last three months. Among these, a small minority did so through SP. So, although some students are already engaged in the type of activities they might be referred to via SP, the majority are not. This highlights a missed opportunity to formalise referral pathways and connect students to existing resources, both within the university and the wider community, through SP. Based on the positive attitudes shown in this study, SP may be better suited to the increasingly diverse student population and less stigmatising than other university mental health services, reducing common barriers to help-seeking.^11,25 Universities also present unique opportunities for peer delivery of SP, as students could themselves be trained as link workers, embedding this pathway as a coproduced model and providing learning and experience in health and social care.²⁵

This study has several strengths, including inclusion of students from numerous academic fields and stages of study at universities across the UK. It was the first UK study to explore student awareness and perceptions of SP in the wider student body, not just medical students. Measures of SP awareness and attitudes were designed following previous approaches,^29,31 making our findings comparable across contexts. However, the binary measures of attitudes towards SP did result in little variation, so could be more detailed in future research. We also relied on a convenient sample who responded to adverts shared on social media and via email, meaning the sample could be biased towards those interested in SP. This could explain why those studying social sciences and professions/applied sciences were overrepresented. Although probability weights made the sample more representative of UK university students, academic field could not be included in the weight generation as it led to unstable estimates. There were some inconsistencies between unweighted and weighted analyses, which indicates that some of the unweighted findings may have been driven by over-represented groups. It will be important for future research on university SP to use more robust approaches to sampling to include larger and more representative samples. Finally, although the survey and findings were discussed with university students, this was not a student-led study. Future research should include student co-researchers to ensure it is coproduced.

UK university student numbers are increasing but the health and wellbeing of this population is declining. Among a field that generally focusses on student mental health problems,⁴⁵ SP offers a positive person-centred approach that could be peer led.^25,26 Although three quarters of students were not yet aware of SP, their positive attitudes towards SP suggest it could be well-suited to address the complex challenges that students face. The combination of low awareness and high acceptability suggests that implementation efforts should prioritise awareness-raising and clear referral pathways, rather than attempting to increase students’ willingness to engage with SP itself. Students, charities, and educators have emphasized the need for whole university approaches to support student health and wellbeing.^11,24,25,46 SP fits perfectly into this framework, connecting students into existing resources across the university and community. We therefore recommend that UK universities consider implementing SP pathways, alongside developing communication and promotion materials for SP, both for future healthcare professionals and the wider student body.