Community Nurses as Gender-Responsive Social Prescribing Facilitators for Women's Psychosocial Health and Well-Being in China: A Qualitative Thematic Study.

Background: In China, women's psychosocial health is shaped by social, cultural, family, economic, and healthcare-related factors that extend beyond biomedical care. Community nurses often encounter hidden emotional distress, caregiving burden, loneliness, family pressure, and unmet social needs during routine practice. Social prescribing, a structured process that connects people with non-clinical community resources, may help address these needs. However, the role of nurses in gender-responsive social prescribing remains underexplored in China. Objective: This study explored how community nurses in China can serve as gender-responsive social prescribing facilitators to support women's psychosocial health and well-being. Methods: An exploratory qualitative descriptive design was used. Semi-structured individual interviews were conducted with 27 purposively selected community nurses working in community health centers, community health stations, township health centers, family doctor teams, and other community-based settings in Yiwu City, Zhejiang Province, China. Because the participants did not consent to audio recording, the interviewer prepared detailed contemporaneous notes and expanded them immediately after each interview. This approach limited independent verification of exact wording and is acknowledged when interpreting participant excerpts. Anonymized notes were analyzed using Braun and Clarke's reflexive thematic analysis. Ethical approval and written informed consent were obtained. Results: Six themes were identified. Women's psychosocial distress was often hidden beneath physical complaints, fatigue, insomnia, emotional withdrawal, caregiving exhaustion, and indirect idioms of suffering. Help-seeking was suppressed by face-saving norms, family reputation, caregiving obligations, economic dependence, migration-related exclusion, and hukou-related barriers. Nurses recognized hidden distress through repeated consultations, non-verbal cues, family dynamics, indirect comments, and long-term patient relationships. They already provided informal psychosocial support through listening, reassurance, family engagement, and ad hoc signposting, but this work remained unsupported and invisible. Women's engagement depended on culturally acceptable framing, trust, warm referrals, privacy, accessibility, and family acceptability. Participants emphasized that nurse-led social prescribing requires formal role recognition, protected time, training, supervision, referral directories, privacy safeguards, and multidisciplinary collaboration. Conclusion: In this single-city study, community nurses perceived themselves as potentially well positioned to facilitate gender-responsive social prescribing for women. Developing and testing such a model would require formal role recognition, protected time, culturally sensitive communication, referral infrastructure, community partnership, and direct involvement of women service users.