Promoting Volunteering Among Older Adults in Hong Kong: A Randomized Controlled Trial

Effects of volunteering over six months on loneliness, social and mental health outcomes among older adults: The HEAL-HOA Dual Randomized Controlled Trial

OBJECTIVE

To determine the beneficial effects of volunteering as lay counselor via telephone on own loneliness, social network engagement, perceived social support, stress, anxiety, and depressive symptoms among Chinese older adults in Hong Kong during the COVID-19 pandemic. DESIGN, SETTING, INTERVENTION, AND PARTICIPANTS: "Helping Alleviate Loneliness in Hong Kong Older Adults" (HEAL-HOA), a dual randomized controlled trial, was implemented to test effects of telephone-based psychosocial interventions delivered by older-adult volunteers for low-income lonely older adults. To evaluate the effects of volunteering on loneliness, we randomized 375 individuals ages 50-70 into a volunteering condition versus an active control (psychoeducation with social gatherings). Following a 6-week training, participants in the volunteering condition, delivered tele-interventions to older intervention recipients.

MEASUREMENT

The primary outcome was loneliness measured with the UCLA Loneliness Scale. Secondary outcomes were loneliness measured with the De Jong Gierveld Scale (DJG), social network engagement, perceived social support, perceived stress, anxiety, and depressive symptoms. Assessments were completed before training (baseline) and immediately after the 6-month volunteering period.

RESULTS

Results from linear mixed models show significant positive effects of volunteering (significant interactions of condition × time) on both measures of loneliness (dppc2 = -0.41 ULCA Loneliness score, dppc2 = -0.70 total DJG score), social network engagement, stress and depressive symptoms as compared to control participants.

CONCLUSIONS

The HEAL-HOA trial demonstrates beneficial effects of volunteer-delivered tele-interventions on decreasing loneliness on the volunteer interventionists themselves. Communicating these benefits for volunteers may attract more older adults into volunteering. This effective tele-based volunteer program is scalable for wider implementation.

SUMMARY

This RCT tested effects of volunteering on loneliness in Hong Kong during the COVID-19-pandemic. Three hundred seventy-five individuals ages 50-70 were randomized into volunteering (delivering tele-interventions against loneliness) versus an active control condition. After 6 months, volunteers compared to controls, showed benefits on loneliness, social network engagement, stress and depressive symptoms. A program engaging lonely older adults in loneliness intervention delivery has beneficial effects on volunteers themselves and could be a scalable solution for our loneliness epidemic.

Study protocol of the 'HEAL-HOA' dual randomized controlled trial: Testing the effects of volunteering on loneliness, social, and mental health in older adults

Background

Interventions to reduce loneliness in older adults usually do not show sustained effects. One potential way to combat loneliness is to offer meaningful social activities. Volunteering has been suggested as one such activity - however, its effects on loneliness remain to be tested in randomized controlled trials (RCT).

Methods

This planned Dual-RCT aims to recruit older adults experiencing loneliness, with subsequent randomization to either a volunteering condition (6 weeks of training before delivering one of three tele-based loneliness interventions to older intervention recipients twice a week for 6 months) or to an active control condition (psycho-education with social gatherings for six months). Power analyses require the recruitment of N = 256 older adults to detect differences between the volunteering and the active control condition (128 in each) on the primary outcome of loneliness (UCLA Loneliness Scale). Secondary outcomes comprise social network engagement, perceived social support, anxiety and depressive symptoms, self-rated health, cognitive health, perceived stress, sleep quality, and diurnal cortisol (1/3 of the sample). The main analyses will comprise condition (volunteering vs. no-volunteering) × time (baseline, 6-, 12-, 18-, 24-months follow-ups) interactions to test the effects of volunteering on loneliness and secondary outcomes. Effects are expected to be mediated via frequency, time and involvement in volunteering.

Discussion

If our trial can show that volunteers delivering one of the three telephone-based interventions to lonely intervention recipients benefit from volunteer work themselves, this might encourage more older adults to volunteer, helping to solve some of the societal issues involved with rapid demographic changes.

Do Internalized Age Stereotypes Mediate the Relationship Between Volunteering and Self-Efficacy for Adults 50+ Years of Age?

This cross-sectional study examined whether internalized age stereotypes mediate the relationship between volunteering and self-efficacy for adults 50+ years of age. A convenience sample of volunteers (n = 173) residing in the United States of America Mountain West completed a 15-min, online survey. The independent variable was number of volunteer hours per week (mean = 6.44, SD = 5.50). The dependent variable was self-efficacy measured by five, four-point items from the general self-efficacy scale (α = .83; mean = 3.57, SD = .38). The indirect effects of five internalized positive and five negative age stereotypes were tested. Results indicate that increased internalized positive, but not negative, age stereotypes partially mediated the relationship between volunteer hours and self-efficacy. Although positive age stereotypes have long been considered a form of ageism, the findings suggest that internalized positive age stereotypes may function as a form of esteem to enhance psychosocial well-being.

Development of the Self-efficacy for Social Participation scale (SOSA) for community-dwelling older adults

BACKGROUND

Social participation is important for the health of older adults and super-aging societies. However, relatively few independent older adults in advanced countries actually participate in society, even though many of them have the capacity to do so. One possible reason for this could be a lack of self-efficacy for social participation. However, few scales have been developed to measure self-efficacy for social participation among community-dwelling independent older adults. Therefore, we developed the "Self-efficacy for Social Participation" scale (SOSA) to assess the self-efficacy of community-dwelling independent older adults, and examined the scale's reliability and validity.

METHODS

We distributed a self-administered mail survey to approximately 5,000 randomly selected independent older adults throughout Japan. The construct validity of the SOSA was determined using exploratory and confirmatory factor analyses. Criterion-related validity was assessed using the General Self-Efficacy Scale (GSES) and according to subjective health status.

RESULTS

In total, 1,336 older adults responded to the survey. Exploratory and confirmatory factor analyses identified 12 items distributed among four factors: instrumental self-efficacy, managerial self-efficacy, interpersonal self-efficacy and cultural self-efficacy. The final model had a Cronbach's alpha of 0.90, goodness-of-fit index of 0.948, adjusted goodness-of-fit index of 0.915, comparative fit index of 0.952, and root mean square error of approximation of 0.078. Significant correlations existed between the SOSA score and GSES (r = 0.550, p < 0.01) and subjective health status (r = 0.384, p < 0.01) scores.

CONCLUSIONS

The SOSA showed sufficient reliability and validity to assess self-efficacy for social participation among older adults. This scale could aid efforts to improve the physical and mental health, and longevity, of older adults through increased behavioralizing social participation.

Types of Voluntary Work and Influence of Participation for Older Volunteers: A Systematic Review of Qualitative Studies

This systematic review synthesized findings on socio-demographic characteristics of older adults who engaged in formal volunteering, types of voluntary work for engagement, and the outcomes resulting from different types of voluntary work participation. Studies published in peer-reviewed journals were identified from six electronic databases. Studies were included if they: (1) involved a study sample of adults aged 65 and older or had a mean age of 65 , (2) reported any type of formal voluntary work at any setting, and (3) reported at least one influence of voluntary work on volunteers. Older adults who were female, married, retired, and have a higher education, fair health, and more volunteering experience participated in voluntary work. The majority of older volunteers preferred to volunteer in a community setting, and they most commonly participated in healthcare or social care related voluntary work. The older volunteers perceived positive influences mostly related to health-relatedoutcomes or helping knowledge and skills.

Psychosocial modification of general self-efficacy in older adults: A restricted review

OBJECTIVES

In recent years, the concept of general self-efficacy has increased in popularity. General self-efficacy is positively associated with quality of life and has the potential to act as a psychological buffer against adverse events and circumstances. However, due to the long-term influences that are said to shape general self-efficacy beliefs, they may be resistant to intervention, particularly within the older population. This restricted review aimed to explore whether psychosocial interventions could improve the general self-efficacy of older adults. Aspects of intervention design associated with improvements were also investigated.

METHODS

A restricted review was undertaken. This included a keyword search of four major health databases (PubMed, CINAHL, PsycINFO and AgeLine). Search terms focused on general self-efficacy and the commonly used measures of this concept and were limited to the older adult population.

RESULTS

In total, 848 articles were screened, with 20 studies proceeding to data extraction. The modification of general self-efficacy in older adults appears possible, with 7 out of the 20 included studies reporting improvements postintervention. Despite issues relating to the quality of included studies and the generalisability of their results, several aspects of intervention design coincided with intervention success, including intervention duration, and employing sufficiently-qualified staff.

CONCLUSIONS

Future research must address the generalisability issues identified in this review. Studies comparing the effectiveness of individual- and group-based interventions, the efficacy of remote delivery platforms and the possibility for long-term transfer of any improvements are needed to contribute the high-quality data required for policy and practice decisions in this area.

Benefits of volunteerism for middle-aged and older adults: comparisons between types of volunteering activities

Volunteering is a popular activity among middle-aged and older adults as means to contribute to the society and to maintain personal health and wellbeing. While the benefits of volunteering have been well-documented in the current literature, it does not tend to distinguish between various types of volunteering activities. This cross-sectional study aims to compare the effects of instrumental (e.g. food preparation, fundraising) and cognitively demanding volunteering activities (e.g. befriending, mentoring) in a sample of 487 middle-aged and older Hong Kong Chinese adults. Participation in instrumental and cognitively demanding volunteering, life satisfaction, depressive symptoms, cognitive functioning and hand-grip strength were measured. The results of two-way between-subject robust analyses of variance demonstrated significant main effects of volunteering type and their interaction effect with age on life satisfaction and depressive symptoms. Comparisons among four volunteering groups (no volunteering, instrumental volunteering, cognitively demanding volunteering and both types) revealed that individuals engaging in instrumental volunteering exhibited lower life satisfaction and more depressive symptoms compared to those who engaged in cognitively demanding volunteering and those who did not volunteer at all. This detrimental pattern of instrumental volunteering was only seen in middle-aged adults, but not in older adults. Findings of this study revealed distinctive effects of two volunteering types, and provide valuable directions for designing future volunteering programmes.

Associations between Volunteering and Mental Health during COVID-19 among Chinese Older Adults

Evidence about the association between volunteering and the mental health of older adults during COVID-19 remains underexplored. This study investigated (1) patterns of volunteering among older adults in Hong Kong during COVID-19; (2) associations between volunteering and mental health of older adults during COVID-19; and (3) associations between key psychological resources (e.g., self-efficacy and self-esteem) and volunteering among older adults during COVID-19. This study applied a cross-sectional design with data collected from 128 older adults in June 2020, who were trained as volunteers in a volunteer program that began before COVID-19. The study found that older adults continued to actively contribute to their communities by engaging in volunteering during COVID-19. The specific type of volunteering activities was linked to few depressive and anxiety symptoms. Older adults with increased self-esteem prior to COVID-19 were more likely to participate in volunteering activities related to COVID-19. Our study suggested that encouraging older adults to volunteer during the pandemic is a key pathway to maintain mental health. Social workers are encouraged to engage older adults in volunteerism regularly to offset the risk of depression and anxiety symptoms in times of crisis.

Narrative Group Intervention to Rediscover Life Wisdom Among Hong Kong Chinese Older Adults: A Single-Blind Randomized Waitlist-Controlled Trial

BACKGROUND AND OBJECTIVES

We developed a new group practice using strength- and meaning-based narrative therapy (NT) for older Chinese living in Hong Kong (HK), to enhance their life wisdom. This paper reports on the intervention and its short- and longer-term effectiveness.

RESEARCH DESIGN AND METHODS

A randomized waitlist-controlled trial was conducted. A total of 157 older adults were randomly recruited, of whom 75 were randomly assigned to the intervention group which received four 2-hr biweekly NT sessions using the "Tree of Life" metaphor. The others were placed on a waitlist. Perceived wisdom was assessed using the Brief Self-Assessed Wisdom Scale. Assessment occurred at baseline (T0), end of treatment (T1), and 4 (T2) and 8 months later (T3). Overtime effects of NT on wisdom scores were assessed using latent growth curve models with time-invariant covariates for impact.

RESULTS

The intervention (NT) group showed significant, sustainable overtime within-group improvement in perceived wisdom. Furthermore, when compared to the control group, the NT group showed significant immediate improvements in perceived wisdom [F(2.726, p = .041)], which were maintained at all follow-up points. This effect remained after controlling for age, gender, and educational level (T ML(11) = 17.306, p = .098, root mean square error of approximation = 0.079, comparative fit index = 0.960). No adverse reaction was recorded.

DISCUSSION AND IMPLICATIONS

NT underpinned by a ToL methodology offers a new theory to understand, promote, and appreciate perceived wisdom in older Chinese living in HK. It contributes to psychotherapy and professional social work practice for older Chinese.

Benefits of volunteering on psychological well-being in older adulthood: evidence from a randomized controlled trial

Objectives: Long-term volunteering has been associated with better physical, mental, and cognitive health in correlational studies. Few studies, however, have examined the longitudinal benefits of volunteering with randomized experimental designs (e.g., intervention studies). Even fewer studies have examined whether such benefits can be shown after short-term volunteering. To fill this gap, we conducted four 1-hour volunteering intervention sessions to promote volunteering among a group of older adults with limited volunteering experience and examined the impact of volunteering on depressive symptoms, meaning in life, general self-efficacy, and perceived autonomy.Methods: A total of 384 participants aged 50-96 years were assigned at random to either an intervention group to promote volunteering behaviors or an active control group to promote physical activity. The participants' monthly volunteering minutes, depressive symptoms, meaning in life, general self-efficacy and perceived autonomy were measured at baseline and six weeks, three months, and six months after the intervention.Results: Being in the volunteering intervention condition was not directly associated with depressive symptoms, meaning in life, general self-efficacy, or perceived autonomy at the 6-week, 3-month, or 6-month follow-ups after the intervention. However, there was an indirect effect of the intervention on depressive symptoms: participants in the intervention group, who had increased their volunteering at the 3-month follow-up, reported fewer depressive symptoms at the 6-month follow-up.Discussion: Our randomized controlled trial suggests that short-term volunteering does not reliably lead to short-term changes in psychosocial health measures as correlational studies would suggest. Efforts need to be made to encourage older adults to maintain long-term volunteering.