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Chua CMS, Chua JYX, Shorey S. Effectiveness of home-based interventions in improving loneliness and social connectedness among older adults: a systematic review and meta-analysis. Aging Ment Health 2024; 28:1-10. [PMID: 37466183 DOI: 10.1080/13607863.2023.2237919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 06/29/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES To evaluate the effectiveness of home-based interventions in improving loneliness and social connectedness (primary outcomes), and depressive symptoms (secondary outcome) among older adults. METHODS Eight electronic databases were searched from inception dates to February 2022. Meta-analyses were conducted using a random-effect model. Heterogeneity was assessed using I2 statistics and Cochran's Q chi-squared test. The Cochrane risk of bias tool and the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to appraise the included studies. RESULTS Fourteen randomized controlled trials were included. Home-based interventions were found to significantly increase older adults' social connectedness (social support and social engagement) and reduce their loneliness and depressive symptoms. Subgroup analyses suggested that interventions which lasted more than three months and were delivered using mixed platforms were more favorable. Both professional-led and volunteer-led interventions showed favorable results. CONCLUSIONS Future studies could be conducted in varied geographical regions and consider carrying out follow-up assessments. Home-based interventions could be improved by being more than months, delivered by mixed personnel, and using mixed platforms. Considering the low-quality rating by the GRADE approach, future research is needed to confirm current findings.
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Affiliation(s)
- Crystal Min Siu Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joelle Yan Xin Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Brand F, Scior K, Loewenberger A. Psychological and social outcomes of befriending interventions for adults with intellectual disabilities: A systematic review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13168. [PMID: 37852744 DOI: 10.1111/jar.13168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/17/2023] [Accepted: 09/29/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Befriending is an intervention intended to provide companionship and support to socially isolated populations. This review aimed to understand the key characteristics and psychological and social outcomes of befriending interventions for adults with intellectual disabilities. METHODS Systematic searches of electronic databases (PsycINFO, MedLine and Web of Science) identified 11 studies for inclusion. A narrative synthesis of the findings was completed, along with critical appraisal of study quality. RESULTS Increased community participation, positive changes to social networks and mood were frequently reported outcomes for befriendees. Increased knowledge, new experiences and opportunities to 'give back' were most reported for befrienders. CONCLUSIONS The review highlighted that existing research in this field is limited in scope and methodologically diverse. Future research should focus upon the effectiveness and long-term impact of befriending interventions, understanding the mechanisms of change, and eliciting the views of people with intellectual disabilities on their experiences.
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Affiliation(s)
- Fiona Brand
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Katrina Scior
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Alana Loewenberger
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Douglas NF, Archer B, Azios JH, Strong KA, Simmons-Mackie N, Worrall L. A scoping review of friendship intervention for older adults: lessons for designing intervention for people with aphasia. Disabil Rehabil 2023; 45:3012-3031. [PMID: 36170126 DOI: 10.1080/09638288.2022.2117866] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Map the landscape of friendship interventions/programs for older adults to guide intervention/program development inclusive of the unique needs of older people with aphasia (PWA). METHODS A search query of multiple databases was completed for articles published before 4 January 2021. Studies included all the following: (1) participants aged 55 years or older; (2) addressed an intervention/program designed to prevent social isolation and/or friendship loss; (3) used an outcome variable related to social isolation and/or friendship; and (4) published in a peer-reviewed journal. Title and abstract screening were conducted using Covidence software, which tracked disagreements across the study team. All studies included in the full-text review were identified as relevant by a minimum of two study authors, and a consensus was reached on all full-text reviews. Data were extracted according to (1) theoretical frameworks used; (2) interventionist and discipline; (3) participant characteristics; (4) intervention/program replicability; (5) format of intervention/program; (6) measures used in the intervention/programs; (7) and, reported effects of intervention/programs on individuals. RESULTS A total of 40 articles with 42 intervention/programs were included and represented 4584 intervention/program participants ranging in age from 40 to 104 years. Intervention/programs involved a wide range of theoretical frameworks (e.g., theories of loneliness, feminist theory, positive psychology). Disciplines such as psychology and exercise science informed intervention/programs. Interventionists included many types of individuals like therapists, volunteers and home health aides. Intervention/programs often lacked adequate description for replication and included individual and group formats, most commonly delievered in the participants homes. Outcomes usually included self-report measures of loneliness, social networks, or well-being, and intervention/programming was primarily educational, activity-based, or networking-based in nature. CONCLUSIONS The intervention/programs reviewed yield important lessons to support innovation in developing friendship intervention/programs for older PWA as most yielded positive results and were acceptable to participants.IMPLICATIONS FOR REHABILITATIONPeople with aphasia want their friendships addressed as part of their rehabilitation; however, the research literature has little guidance in this area.Studies reviewed of friendship intervention/programs for older adults yielded helpful lessons for consideration in developing this type of intervention/programming for people with aphasia.Interprofessional teams made up of rehabilitation professionals should address friendship for people with aphasia in both research and clinical practice.
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Affiliation(s)
- Natalie F Douglas
- Department of Communication Sciences and Disorders, Central Michigan University, Mount Pleasant, MI, USA
| | - Brent Archer
- Department of Communication Sciences & Disorders, Bowling Green State University, Bowling Green, OH, USA
| | - Jamie H Azios
- Department of Speech & Hearing Sciences, Lamar University, Beaumont, TX, USA
| | - Katie A Strong
- Department of Communication Sciences and Disorders, Central Michigan University, Mount Pleasant, MI, USA
| | - Nina Simmons-Mackie
- Department of Health & Human Sciences, Southeastern Louisiana University, Hammond, LA, USA
| | - Linda Worrall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Paquet C, Whitehead J, Shah R, Adams AM, Dooley D, Spreng RN, Aunio AL, Dubé L. Social Prescription Interventions Addressing Social Isolation and Loneliness in Older Adults: Meta-Review Integrating On-the-Ground Resources. J Med Internet Res 2023; 25:e40213. [PMID: 37195738 PMCID: PMC10233446 DOI: 10.2196/40213] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Social prescription programs represent a viable solution to linking primary care patients to nonmedical community resources for improving patient well-being. However, their success depends on the integration of patient needs with local resources. This integration could be accelerated by digital tools that use expressive ontology to organize knowledge resources, thus enabling the seamless navigation of diverse community interventions and services tailored to the needs of individual users. This infrastructure bears particular relevance for older adults, who experience a range of social needs that impact their health, including social isolation and loneliness. An essential first step in enabling knowledge mobilization and the successful implementation of social prescription initiatives to meet the social needs of older adults is to incorporate the evidence-based academic literature on what works, with on-the-ground solutions in the community. OBJECTIVE This study aims to integrate scientific evidence with on-the-ground knowledge to build a comprehensive list of intervention terms and keywords related to reducing social isolation and loneliness in older adults. METHODS A meta-review was conducted using a search strategy combining terms related to older adult population, social isolation and loneliness, and study types relevant to reviews using 5 databases. Review extraction included intervention characteristics, outcomes (social [eg, loneliness, social isolation, and social support] or mental health [eg, psychological well-being, depression, and anxiety]), and effectiveness (reported as consistent, mixed, or not supported). Terms related to identified intervention types were extracted from the reviewed literature as well as descriptions of corresponding community services in Montréal, Canada, available from web-based regional, municipal, and community data sources. RESULTS The meta-review identified 11 intervention types addressing social isolation and loneliness in older adults by either increasing social interactions, providing instrumental support, promoting mental and physical well-being, or providing home and community care. Group-based social activities, support groups with educational elements, recreational activities, and training or use of information and communication technologies were the most effective in improving outcomes. Examples of most intervention types were found in community data sources. Terms derived from the literature that were the most commonly congruent with those describing existing community services were related to telehealth, recreational activities, and psychological therapy. However, several discrepancies were observed between review-based terms and those addressing the available services. CONCLUSIONS A range of interventions found to be effective at addressing social isolation and loneliness or their impact on mental health were identified from the literature, and many of these interventions were represented in services available to older residents in Montréal, Canada. However, different terms were occasionally used to describe or categorize similar services across data sources. Establishing an efficient means of identifying and structuring such sources is important to facilitate referrals and help-seeking behaviors of older adults and for strategic planning of resources.
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Affiliation(s)
- Catherine Paquet
- Département de Marketing, Faculté des Sciences de l'Administration, Université Laval, Québec, QC, Canada
- Centre de Recherche, Centre Hospitalier Universitaire de Québec - Université Laval, Quebec, QC, Canada
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Quebec, QC, Canada
| | - Jocelyne Whitehead
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
- Desautels Faculty of Management, McGill University, Montreal, QC, Canada
- McGill Centre for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada
| | - Rishabh Shah
- Desautels Faculty of Management, McGill University, Montreal, QC, Canada
- McGill Centre for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada
| | - Alayne Mary Adams
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Damion Dooley
- Centre for Infectious Disease Genomics and One Health, Simon Fraser University, Vancouver, BC, Canada
| | - R Nathan Spreng
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | | | - Laurette Dubé
- Desautels Faculty of Management, McGill University, Montreal, QC, Canada
- McGill Centre for the Convergence of Health and Economics, McGill University, Montreal, QC, Canada
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Hoang P, King JA, Moore S, Moore K, Reich K, Sidhu H, Tan CV, Whaley C, McMillan J. Interventions Associated With Reduced Loneliness and Social Isolation in Older Adults: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2236676. [PMID: 36251294 PMCID: PMC9577679 DOI: 10.1001/jamanetworkopen.2022.36676] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Loneliness and social isolation are public health concerns faced by older adults due to physical, cognitive, and psychosocial changes that develop with aging. Loneliness and social isolation are associated with increased morbidity and mortality. OBJECTIVE To evaluate interventions, targeting older adults, associated with a reduction in loneliness and social isolation. DATA SOURCES OVID, CINAHL, CENTRAL, Embase, PsychINFO, Web of Science, and Scopus were searched from inception to March 2020. STUDY SELECTION Peer-reviewed randomized clinical trials measuring loneliness and social isolation or support in adults aged 65 years or older. Only English language articles were included. DATA EXTRACTION AND SYNTHESIS Two independent reviewers screened studies, extracted data, and assessed risk of bias. Random-effects models were performed to pool the overall effect size by intervention. Statistical heterogeneity was evaluated with the I2 statistic and by estimating prediction intervals. Data were analyzed from November 2021 to September 2022. MAIN OUTCOMES AND MEASURES Quantitative measures of loneliness, social isolation, or social support based on an effect size of standardized mean differences. RESULTS Seventy studies were included in the systematic review (8259 participants); 44 studies were included in the loneliness meta-analysis (33 in the community with 3535 participants; 11 in long-term care with 1057 participants), with participants' ages ranging from 55 to 100 years. Study sizes ranged from 8 to 741 participants. Interventions included animal therapy, psychotherapy or cognitive behavioral therapy, multicomponent, counseling, exercise, music therapy, occupational therapy, reminiscence therapy, social interventions, and technological interventions. Most interventions had a small effect size. Animal therapy in long-term care, when accounting for studies with no active controls, had the largest effect size on loneliness reduction (-1.86; 95% CI, -3.14 to -0.59; I2 = 86%) followed by technological interventions (videoconferencing) in long-term care (-1.40; 95% CI, -2.37 to -0.44; I2 = 70%). CONCLUSIONS AND RELEVANCE In this study, animal therapy and technology in long-term care had large effect sizes, but also high heterogeneity, so the effect size's magnitude should be interpreted with caution. The small number of studies per intervention limits conclusions on sources of heterogeneity. Overall quality of evidence was very low. Future studies should consider measures of social isolation in long-term care and identify the contextual components that are associated with a reduction in loneliness.
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Affiliation(s)
- Peter Hoang
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - James A. King
- Alberta Strategy for Patient Oriented Research Support Unit Data Platform, Calgary, Alberta, Canada
- Data and Analytics, Alberta Health Services, Edmonton, Alberta, Canada
| | - Sarah Moore
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kim Moore
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Krista Reich
- Division of Geriatric Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Harman Sidhu
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Chin Vern Tan
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Colin Whaley
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jacqueline McMillan
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Fu Z, Yan M, Meng C. The effectiveness of remote delivered intervention for loneliness reduction in older adults: A systematic review and meta-analysis. Front Psychol 2022; 13:935544. [PMID: 35967719 PMCID: PMC9372715 DOI: 10.3389/fpsyg.2022.935544] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundRemotely delivered intervention is widely applied to loneliness treatment in older adults, but the effect is controversial. This study aimed to evaluate the effects of remotely delivered intervention on loneliness using a systematic review and meta-analysis.MethodsThe PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, CINAHL (EBSCO), PsycINFO (EBSCO) databases were searched for studies, the search ended on 7 July 2021. Thirteen randomized controlled trials of remotely delivered intervention compared with usual care, brief contact, or no intervention for loneliness were included. A random-effects model measured estimation of loneliness reduction. Furthermore, standardized mean differences (SMDs), 95% confidence intervals (CIs), publication bias, and heterogeneity were calculated. Subgroup analysis was used to explore the factors that might affect the treatment effects.ResultsThe evidence of remotely delivered intervention on loneliness reduction was certain (SMD = −0.41 [95% CI, −0.70 to −0.13]). Media subgroup analysis supported the effectiveness of intervention delivered by video call (SMD = −0.54 [95% CI, −0.83 to −0.25]); treatment strategy subgroup analysis found evidence to support the effectiveness of increasing social support and maladaptive social cognition treatment strategy (SMD = −0.47 [95% CI, −0.77 to −0.18] and SMD = −1.04 [95% CI, −1.98 to −0.10], respectively); participants subgroup analysis shown the effectiveness of intervention for older adults living in LTC and social isolation (SMD = −1.40 [95% CI, −2.43 to −0.36] and SMD = −0.55 [95% CI, −0.74 to −0.36], respectively); group format subgroup analysis testified the effectiveness of intervention carried out in individual format (SMD = −0.39 [95% CI, −0.71 to −0.07]); measurement time points subgroup analysis found the positive effect of intervention at 3 months and 3 to 6 months stage (SMD = −0.33 [95% CI, −0.52 to −0.14] and SMD = −0.32 [95% CI, −0.57 to −0.07], respectively). Significant publication bias was detected (p < 0.05), and the heterogeneity of the studies was substantial.ConclusionThis systematic review and meta-analysis demonstrate that remotely delivered intervention can reduce loneliness in older adults, and it appears to be affected by media type, treatment strategy, participants characteristics, group format, and measurement time points.
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Affiliation(s)
- Zhengke Fu
- Department of Computational Communication, School of Media and Law, Ningbo Tech University, Ningbo, China
- *Correspondence: Zhengke Fu,
| | - Mengsi Yan
- Department of Japanese Language Study, School of Humanity, Ningbo University of Finance and Economics, Ningbo, China
| | - Chao Meng
- Department of Computational Communication, School of Media and Law, Ningbo Tech University, Ningbo, China
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Effects of a Physically Active Lifestyle Modification (PALM) Program for Independent Taiwanese Older Adults. TOPICS IN GERIATRIC REHABILITATION 2022. [DOI: 10.1097/tgr.0000000000000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Todd E, Bidstrup B, Mutch A. Using information and communication technology learnings to alleviate social isolation for older people during periods of mandated isolation: A review. Australas J Ageing 2022; 41:e227-e239. [PMID: 35142013 PMCID: PMC9543732 DOI: 10.1111/ajag.13041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 12/23/2021] [Accepted: 01/03/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine the effectiveness of information and communication technologies (ICTs) in reducing social isolation in older people and draw recommendations from previous literature appropriate for informing ICT use in future mandated periods of isolation. METHODS A systematically conducted review of key databases to identify studies investigating ICT interventions that targeted social isolation or loneliness among older people. RESULTS Fifteen articles were identified. All articles used ICT as an intervention for targeting social isolation with varying results. Most studies reported positive impacts on social isolation, but this was identified more in self-reporting compared to changes in baseline measures. The types of ICT used included videoconferencing, Internet-based applications and purpose-designed applications. A number of factors were also identified throughout the studies that impacted uptake that should be considered when implementing ICT. CONCLUSIONS Overall, we found evidence of ICT improving social connectedness of older people to some extent although more rigorous research in future is needed. Recommendations from previous literature highlight the importance of including older people in purposeful design, engaging families and support networks, and providing ongoing ICT training and support so that systems and skills are in place for future periods of mandated isolation. The literature also warns us not to rely on ICT as the only avenue for social interaction either during or outside periods of social distancing.
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Affiliation(s)
- Emily Todd
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Bronwyn Bidstrup
- Council on the Ageing (COTA) Queensland, Brisbane, Queensland, Australia
| | - Allyson Mutch
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
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Lee C, Kuhn I, McGrath M, Remes O, Cowan A, Duncan F, Baskin C, Oliver EJ, Osborn DPJ, Dykxhoorn J, Kaner E, Walters K, Kirkbride J, Gnani S, Lafortune L. A systematic scoping review of community-based interventions for the prevention of mental ill-health and the promotion of mental health in older adults in the UK. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:27-57. [PMID: 33988281 DOI: 10.1111/hsc.13413] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/24/2021] [Accepted: 03/31/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Mental health concerns in older adults are common, with increasing age-related risks to physical health, mobility and social isolation. Community-based approaches are a key focus of public health strategy in the UK, and may reduce the impact of these risks, protecting mental health and promoting wellbeing. We conducted a review of UK community-based interventions to understand the types of intervention studied and mental health/wellbeing impacts reported. METHOD We conducted a scoping review of the literature, systematically searching six electronic databases (2000-2020) to identify academic studies of any non-clinical community intervention to improve mental health or wellbeing outcomes for older adults. Data were extracted, grouped by population targeted, intervention type, and outcomes reported, and synthesised according to a framework categorising community actions targeting older adults. RESULTS In total, 1,131 full-text articles were assessed for eligibility and 54 included in the final synthesis. Example interventions included: link workers; telephone helplines; befriending; digital support services; group social activities. These were grouped into: connector services, gateway services/approaches, direct interventions and systems approaches. These interventions aimed to address key risk factors: loneliness, social isolation, being a caregiver and living with long-term health conditions. Outcome measurement varied greatly, confounding strong evidence in favour of particular intervention types. CONCLUSION The literature is wide-ranging in focus and methodology. Greater specificity and consistency in outcome measurement are required to evidence effectiveness - no single category of intervention yet stands out as 'promising'. More robust evidence on the active components of interventions to promote older adult's mental health is required.
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Affiliation(s)
- Caroline Lee
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Isla Kuhn
- School of Clinical Medicine, University of Cambridge Medical Library, Cambridge, UK
| | | | - Olivia Remes
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Andy Cowan
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Fiona Duncan
- Department of Sport and Exercise Sciences, Durham University, Durham, England
| | - Cleo Baskin
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Emily J Oliver
- Department of Sport and Exercise Sciences, Durham University, Durham, England
| | | | - Jennifer Dykxhoorn
- Division of Psychiatry, UCL, London, UK
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle-upon-Tyne, UK
| | - Kate Walters
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | | | - Shamini Gnani
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Tong F, Yu C, Wang L, Chi I, Fu F. Systematic Review of Efficacy of Interventions for Social Isolation of Older Adults. Front Psychol 2021; 12:554145. [PMID: 34557122 PMCID: PMC8452930 DOI: 10.3389/fpsyg.2021.554145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/06/2021] [Indexed: 11/14/2022] Open
Abstract
Background: The social isolation of older people is a growing public health concern. The proportion of older people in society has increased in recent decades, and it is estimated that ~40% of the population will be aged 50 or above within the next few decades. This systematic review aims to summarize and renew knowledge of the effectiveness of existing interventions for alleviating social isolation of older adults. Methods: Relevant electronic databases, including Cochrane Library, CINAHL, SCOPUS, and Web of Science, were searched by a systematic evaluation method. Eligible randomized controlled trial (RCT) studies were published between 1978 and 2021 in English or Chinese. The primary and secondary outcomes were social isolation and loneliness. The quality of the included RCTs was scored by the Cochrane risk-of-bias tool to assess their quality. Two independent reviewers extracted data, using a standardized form. Narrative synthesis and vote-counting methods were used to summarize and interpret study data. Results: Twenty-four RCTs were finally included in this review. There was evidence of substantial heterogeneity in the interventions delivered. The overall quality of included studies indicated a low-to-medium risk of bias. Eighteen of 24 RCTs showed at least one dimension effect on reducing social isolation. The interventions with accurate targeting of clients in social and public places had more obvious effect. The interventions in which older people are active participants also appeared more likely to be effective. In addition, group intervention activities and individual intervention interviews were effective in improving structural social support; mixed intervention, and group intervention on training support significantly improved functional social support. Conclusions: This study suggests that group and mixed intervention targeting of older adults could be helpful for alleviating social isolation problems. The use of modern technology for remote services could also present good results. More well-conducted RCTs of the effectiveness of social interventions for alleviating social isolation are needed to improve the evidence base. Especially as the debating results of remote interventions, further research in this field should be conducted.
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Affiliation(s)
- Feng Tong
- School of International Law and Sociology, Sichuan International Studies University, Chongqing, China
| | - ChengLin Yu
- School of International Law and Sociology, Sichuan International Studies University, Chongqing, China
| | - LinSen Wang
- School of Humanities and Management, Southwest Medical University, Sichuan, China
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Fang Fu
- School of Social Development and Public Policy, Fudan University, Shanghai, China
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Fakoya OA, McCorry NK, Donnelly M. How do befriending interventions alleviate loneliness and social isolation among older people? A realist evaluation study. PLoS One 2021; 16:e0256900. [PMID: 34499682 PMCID: PMC8428774 DOI: 10.1371/journal.pone.0256900] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Befriending is a popular way in which to intervene to combat loneliness and social isolation among older people. However, there is a need to improve our understanding about how these interventions work, for whom and in which contexts, to make the best use of the increasing investment in the provision and delivery of befriending services. METHODS A realist evaluation was undertaken as it focuses on uncovering causal processes and interactions between mechanisms and contextual characteristics. Five case studies of befriending programmes in Northern Ireland were studied, reflecting variation in contextual variables, service user and provider characteristics. Data was collected via service documentation and semi-structured interviews (n = 46) with stakeholders involved in the delivery and receipt of befriending interventions. RESULTS Eight initial programme theories were generated, which were 'tested' in the case study analysis to uncover context-mechanism-outcome relationships. Mechanisms identified included reciprocity, empathy, autonomy, and privacy which were triggered in different contexts to support the alleviation of loneliness and social isolation. Reciprocity was 'triggered' in contexts where service users and befrienders shared characteristics, the befriender was a volunteer and befriending took the form of physical companionship. Contexts characterised in terms of shared experiences between befriender and service user triggered empathy. Autonomy was triggered in contexts where befriending relationships were delivered long-term and did not focus on a pre-defined set of priorities. Privacy was triggered in contexts where service users had a cognitive/sensory impairment and received one-to-one delivery. CONCLUSION This study improves understanding about how and why befriending interventions work. Findings indicate that services should be tailored to the needs of service users and take into consideration characteristics including mobility, impairments e.g. physical, sensory and/or cognitive, as well as the influence of service characteristics including payment for befrienders, fixed/long-term befriending relationship, one-to-one support and the impact of non-verbal communication via face-to-face delivery.
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Affiliation(s)
- Olujoke A. Fakoya
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
- Centre of Excellence for Public Health, CoE, Queen’s University Belfast, Belfast, Northern Ireland
| | - Noleen K. McCorry
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
- Centre of Excellence for Public Health, CoE, Queen’s University Belfast, Belfast, Northern Ireland
| | - Michael Donnelly
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
- Centre of Excellence for Public Health, CoE, Queen’s University Belfast, Belfast, Northern Ireland
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Burholt V, Windle G, Gott M, Morgan DJ. Technology-Mediated Communication in Familial Relationships: Moderated-Mediation Models of Isolation and Loneliness. THE GERONTOLOGIST 2021; 60:1202-1212. [PMID: 32369112 PMCID: PMC8059137 DOI: 10.1093/geront/gnaa040] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Indexed: 12/15/2022] Open
Abstract
Background and Objectives We examined whether technology-mediated communication has functional or emotional equivalence to face-to-face (FtF) contact in familial relationships, by scrutinizing the effects of phone, text/e-mail, and video contact on isolation and loneliness. Research Design and Methods We tested whether FtF contact with a relative would mediate the pathway between proximity to family and (i) isolation and (ii) loneliness. We then tested hypotheses that telephone, text/e-mails, and video contact would moderate this mediated pathway. We compared models for younger (<75) and older (≥75) cohorts, expecting to observe moderation effects for text/e-mail and video contact in the younger cohort only. Data were drawn from Wave 2 of CFAS Wales (United Kingdom) study (N = 2,099). Results Proximity to a relative had a significant indirect effect on isolation and loneliness through the mediating variable FtF contact. Phone and text/e-mail contact moderated the effect of FtF contact on isolation for all samples. None of the technologies moderated the impact of FtF contact on loneliness for the full sample. Telephone contact had a moderating influence on loneliness for the younger cohort only. Video calls had no significant moderation effect. Discussion and Implications Telephone and text/e-mail contact have functional equivalence to FtF contact in familial relationships. None of the forms of technological communication have emotional equivalence to the “gold standard” of embodied presence. The study demonstrates the importance of theorizing about the pathways to isolation and loneliness to better understand the likelihood of implementing successful interventions using technology-mediated communication within families.
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Affiliation(s)
- Vanessa Burholt
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.,School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.,Centre for Innovative Ageing, College of Human and Health Sciences, Swansea University, Wales, UK
| | - Gill Windle
- School of Health Sciences, Bangor University, Wales, UK
| | - Merryn Gott
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Deborah Jane Morgan
- Centre for Innovative Ageing, College of Human and Health Sciences, Swansea University, Wales, UK
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Moore A, Motagh S, Sadeghirad B, Begum H, Riva JJ, Gaber J, Dolovich L. Volunteer Impact on Health-Related Outcomes for Seniors: a Systematic Review And Meta-Analysis. Can Geriatr J 2021; 24:44-72. [PMID: 33680263 PMCID: PMC7904324 DOI: 10.5770/cgj.24.434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Volunteers are increasingly promoted to improve health-related outcomes for community-dwelling elderly without synthesized evidence for effectiveness. This systematic review and meta-analysis evaluates the effects of unpaid volunteer interventions on health-related outcomes for such seniors. Methods MEDLINE, EMBASE and Cochrane (CENTRAL) were searched up to November 2018. We included English language, randomized trials. Two reviewers independently identified studies, extracted data, and assessed evidence certainty (using GRADE). Meta-analysis used random-effects models. Univariate meta-regressions investigated the relationship between volunteer intervention effects and trial participant age, percentage females, and risk of bias. Results 28 included studies focussed on seniors with a variety of chronic conditions (e.g., dementia, diabetes) and health states (e.g., frail, palliative). Volunteers provided a range of roles (e.g., counsellors, educators and coaches). Low certainty evidence found that volunteers may improve both physical function (MD = 3.2 points on the 100-point SF-36 physical component score [PCS]; 95% CI: 1.09, 5.27) and physical activity levels (SMD = 0.5, 95% CI: 0.14 to 0.83). Adverse events were not increased. Conclusion Volunteers may increase physical activity levels and subjective ratings of physical function for seniors without apparent harm. These findings support the WHO call to action on evidence-based policies to align health systems in support of older adults.
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Affiliation(s)
- Ainsley Moore
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Shahrzad Motagh
- The Michael G. DeGroote Institute of Pain Research and Care, McMaster University, Hamilton, ON, Canada
| | - Behnam Sadeghirad
- The Michael G. DeGroote Institute of Pain Research and Care, McMaster University, Hamilton, ON, Canada
| | - Housne Begum
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - John J Riva
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,Health Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Jessica Gaber
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,Health Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
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Williams CYK, Townson AT, Kapur M, Ferreira AF, Nunn R, Galante J, Phillips V, Gentry S, Usher-Smith JA. Interventions to reduce social isolation and loneliness during COVID-19 physical distancing measures: A rapid systematic review. PLoS One 2021; 16:e0247139. [PMID: 33596273 PMCID: PMC7888614 DOI: 10.1371/journal.pone.0247139] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/02/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND A significant proportion of the worldwide population is at risk of social isolation and loneliness as a result of the COVID-19 pandemic. We aimed to identify effective interventions to reduce social isolation and loneliness that are compatible with COVID-19 shielding and social distancing measures. METHODS AND FINDINGS In this rapid systematic review, we searched six electronic databases (Medline, Embase, Web of Science, PsycINFO, Cochrane Database of Systematic Reviews and SCOPUS) from inception to April 2020 for systematic reviews appraising interventions for loneliness and/or social isolation. Primary studies from those reviews were eligible if they included: 1) participants in a non-hospital setting; 2) interventions to reduce social isolation and/or loneliness that would be feasible during COVID-19 shielding measures; 3) a relevant control group; and 4) quantitative measures of social isolation, social support or loneliness. At least two authors independently screened studies, extracted data, and assessed risk of bias using the Downs and Black checklist. Study registration: PROSPERO CRD42020178654. We identified 45 RCTs and 13 non-randomised controlled trials; none were conducted during the COVID-19 pandemic. The nature, type, and potential effectiveness of interventions varied greatly. Effective interventions for loneliness include psychological therapies such as mindfulness, lessons on friendship, robotic pets, and social facilitation software. Few interventions improved social isolation. Overall, 37 of 58 studies were of "Fair" quality, as measured by the Downs & Black checklist. The main study limitations identified were the inclusion of studies of variable quality; the applicability of our findings to the entire population; and the current poor understanding of the types of loneliness and isolation experienced by different groups affected by the COVID-19 pandemic. CONCLUSIONS Many effective interventions involved cognitive or educational components, or facilitated communication between peers. These interventions may require minor modifications to align with COVID-19 shielding/social distancing measures. Future high-quality randomised controlled trials conducted under shielding/social distancing constraints are urgently needed.
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Affiliation(s)
| | - Adam T. Townson
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Milan Kapur
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Alice F. Ferreira
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Rebecca Nunn
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Julieta Galante
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Applied Research Collaboration East of England, England, United Kingdom
| | | | - Sarah Gentry
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Juliet A. Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
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15
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Biggs K, Hind D, Gossage-Worrall R, Sprange K, White D, Wright J, Chatters R, Berry K, Papaioannou D, Bradburn M, Walters SJ, Cooper C. Challenges in the design, planning and implementation of trials evaluating group interventions. Trials 2020; 21:116. [PMID: 31996259 PMCID: PMC6990578 DOI: 10.1186/s13063-019-3807-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background Group interventions are interventions delivered to groups of people rather than to individuals and are used in healthcare for mental health recovery, behaviour change, peer support, self-management and/or health education. Evaluating group interventions in randomised controlled trials (RCTs) presents trialists with a set of practical problems, which are not present in RCTs of one-to-one interventions and which may not be immediately obvious. Methods Case-based approach summarising Sheffield trials unit’s experience in the design and implementation of five group interventions. We reviewed participant recruitment and attrition, facilitator training and attrition, attendance at the group sessions, group size and fidelity aspects across five RCTs. Results Median recruitment across the five trials was 3.2 (range 1.7–21.0) participants per site per month. Group intervention trials involve a delay in starting the intervention for some participants, until sufficient numbers are available to start a group. There was no evidence that the timing of consent, relative to randomisation, affected post-randomisation attrition which was a matter of concern for all trial teams. Group facilitator attrition was common in studies where facilitators were employed by the health system rather than the by the grant holder and led to the early closure of one trial; research sites responded by training ‘back-up’ and new facilitators. Trials specified that participants had to attend a median of 62.5% (range 16.7%–80%) of sessions, in order to receive a ‘therapeutic dose’; a median of 76.7% (range 42.9%–97.8%) received a therapeutic dose. Across the five trials, 75.3% of all sessions went ahead without the pre-specified ideal group size. A variety of methods were used to assess the fidelity of group interventions at a group and individual level across the five trials. Conclusion This is the first paper to provide an empirical basis for planning group intervention trials. Investigators should expect delays/difficulties in recruiting groups of the optimal size, plan for both facilitator and participant attrition, and consider how group attendance and group size affects treatment fidelity. Trial registration ISRCTN17993825 registered on 11/10/2016, ISRCTN28645428 registered on 11/04/2012, ISRCTN61215213 registered on 11/05/2011, ISRCTN67209155 registered on 22/03/2012, ISRCTN19447796 registered on 20/03/2014.
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Affiliation(s)
- Katie Biggs
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Daniel Hind
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Rebecca Gossage-Worrall
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Kirsty Sprange
- Nottingham Clinical Trials Unit (NCTU), University of Nottingham, Nottingham, UK
| | - David White
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Jessica Wright
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Robin Chatters
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Katherine Berry
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Diana Papaioannou
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Mike Bradburn
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Stephen J Walters
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Cindy Cooper
- School of Health and Related Research (ScHARR) University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
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16
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Walters SJ, Jacques RM, Dos Anjos Henriques-Cadby IB, Candlish J, Totton N, Xian MTS. Sample size estimation for randomised controlled trials with repeated assessment of patient-reported outcomes: what correlation between baseline and follow-up outcomes should we assume? Trials 2019; 20:566. [PMID: 31519202 PMCID: PMC6743178 DOI: 10.1186/s13063-019-3671-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/20/2019] [Indexed: 12/02/2022] Open
Abstract
Background Patient-reported outcome measures (PROMs) are now frequently used in randomised controlled trials (RCTs) as primary endpoints. RCTs are longitudinal, and many have a baseline (PRE) assessment of the outcome and one or more post-randomisation assessments of outcome (POST). With such pre-test post-test RCT designs there are several ways of estimating the sample size and analysing the outcome data: analysis of post-randomisation treatment means (POST); analysis of mean changes from pre- to post-randomisation (CHANGE); analysis of covariance (ANCOVA). Sample size estimation using the CHANGE and ANCOVA methods requires specification of the correlation between the baseline and follow-up measurements. Other parameters in the sample size estimation method being unchanged, an assumed correlation of 0.70 (between baseline and follow-up outcomes) means that we can halve the required sample size at the study design stage if we used an ANCOVA method compared to a comparison of POST treatment means method. So what correlation (between baseline and follow-up outcomes) should be assumed and used in the sample size calculation? The aim of this paper is to estimate the correlations between baseline and follow-up PROMs in RCTs. Methods The Pearson correlation coefficients between the baseline and repeated PROM assessments from 20 RCTs (with 7173 participants at baseline) were calculated and summarised. Results The 20 reviewed RCTs had sample sizes, at baseline, ranging from 49 to 2659 participants. The time points for the post-randomisation follow-up assessments ranged from 7 days to 24 months; 464 correlations, between baseline and follow-up, were estimated; the mean correlation was 0.50 (median 0.51; standard deviation 0.15; range − 0.13 to 0.91). Conclusions There is a general consistency in the correlations between the repeated PROMs, with the majority being in the range of 0.4 to –0.6. The implications are that we can reduce the sample size in an RCT by 25% if we use an ANCOVA model, with a correlation of 0.50, for the design and analysis. There is a decline in correlation amongst more distant pairs of time points.
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Affiliation(s)
- Stephen J Walters
- School of Health and Related Research (ScHARR), University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Richard M Jacques
- School of Health and Related Research (ScHARR), University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
| | | | - Jane Candlish
- School of Health and Related Research (ScHARR), University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Nikki Totton
- School of Health and Related Research (ScHARR), University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Mica Teo Shu Xian
- School of Health and Related Research (ScHARR), University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
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17
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Zamir S, Hennessy CH, Taylor AH, Jones RB. Video-calls to reduce loneliness and social isolation within care environments for older people: an implementation study using collaborative action research. BMC Geriatr 2018; 18:62. [PMID: 29499659 PMCID: PMC5833092 DOI: 10.1186/s12877-018-0746-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 02/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background Older people in care may be lonely with insufficient contact if families are unable to visit. Face-to-face contact through video-calls may help reduce loneliness, but little is known about the processes of engaging people in care environments in using video-calls. We aimed to identify the barriers to and facilitators of implementing video-calls for older people in care environments. Methods A collaborative action research (CAR) approach was taken to implement a video-call intervention in care environments. We undertook five steps of recruitment, planning, implementation, reflection and re-evaluation, in seven care homes and one hospital in the UK. The video-call intervention ‘Skype on Wheels’ (SoW) comprised a wheeled device that could hold an iPad and handset, and used Skype to provide a free video-call service. Care staff were collaborators who implemented the intervention within the care-setting by agreeing the intervention, recruiting older people and their family, and setting up video-calls. Field notes and reflective diaries on observations and conversations with staff, older people and family were maintained over 15 months, and analysed using thematic analysis. Results Four care homes implemented the intervention. Eight older people with their respective social contacts made use of video-calls. Older people were able to use SoW with assistance from staff, and enjoyed the use of video-calls to stay better connected with family. However five barriers towards implementation included staff turnover, risk averseness, the SoW design, lack of family commitment and staff attitudes regarding technology. Conclusions The SoW intervention, or something similar, could aid older people to stay better connected with their families in care environments, but if implemented as part of a rigorous evaluation, then co-production of the intervention at each recruitment site may be needed to overcome barriers and maximise engagement.
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Affiliation(s)
- Sonam Zamir
- Drake Circus, School of Nursing and Midwifery, University of Plymouth, Plymouth, Devon, PL4 8AA, England.
| | | | - Adrian H Taylor
- University of Plymouth Peninsula Schools of Medicine & Dentistry, ITTC Building, Tamar Science Park, Derriford, Plymouth, Devon, PL6 8BX, England
| | - Ray B Jones
- Drake Circus, School of Nursing and Midwifery, University of Plymouth, Plymouth, Devon, PL4 8AA, England
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18
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Chatters R, Newbould L, Sprange K, Hind D, Mountain G, Shortland K, Powell L, Gossage-Worrall R, Chater T, Keetharuth A, Lee E, Woods B. Recruitment of older adults to three preventative lifestyle improvement studies. Trials 2018; 19:121. [PMID: 29458392 PMCID: PMC5819193 DOI: 10.1186/s13063-018-2482-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 01/18/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Recruiting isolated older adults to clinical trials is complex, time-consuming and difficult. Previous studies have suggested querying existing databases to identify appropriate potential participants. We aim to compare recruitment techniques (general practitioner (GP) mail-outs, community engagement and clinician referrals) used in three randomised controlled trial (RCT) studies assessing the feasibility or effectiveness of two preventative interventions in isolated older adults (the Lifestyle Matters and Putting Life In Years interventions). METHODS During the three studies (the Lifestyle Matters feasibility study, the Lifestyle Matters RCT, the Putting Life In Years RCT) data were collected about how participants were recruited. The number of letters sent by GP surgeries for each study was recorded. In the Lifestyle Matters RCT, we qualitatively interviewed participants and intervention facilitators at 6 months post randomisation to seek their thoughts on the recruitment process. RESULTS Referrals were planned to be the main source of recruitment in the Lifestyle Matters feasibility study, but due to a lack of engagement from district nurses, community engagement was the main source of recruitment. District nurse referrals and community engagement were also utilised in the Lifestyle Matters and Putting Life In Years RCTs; both mechanisms yielded few participants. GP mail-outs were the main source of recruitment in both the RCTs, but of those contacted, recruiting yield was low (< 3%). Facilitators of the Lifestyle Matters intervention questioned whether the most appropriate individuals had been recruited. Participants recommended that direct contact with health professionals would be the most beneficial way to recruit. CONCLUSIONS Recruitment to the Lifestyle Matters RCT did not mirror recruitment to the feasibility study of the same intervention. Direct district nurse referrals were not effective at recruiting participants. The majority of participants were recruited via GP mail-outs, which may have led to isolated individuals not being recruited to the trials. Further research is required into alternative recruitment techniques, including respondent-driven sampling plus mechanisms which will promote health care professionals to recruit vulnerable populations to research. TRIAL REGISTRATION International Standard Randomised Controlled Trial Registry, ID: ISRCTN28645428 (Putting Life In Years RCT). Registered on 11 April 2012; International Standard Randomised Controlled Trial Registry, ID: ISRCTN67209155 (Lifestyle Matters RCT). Registered on 22 March 2012; ClinicalTrials.gov , ID: NCT03054311 (Lifestyle Matters feasibility study). Registered retrospectively on 19 January 2017.
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Affiliation(s)
- Robin Chatters
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Louise Newbould
- Research Fellow Mental Health and Addiction Research Group Department of Health Sciences ARRC Building University of York, Heslington, York YO10 5DD UK
| | - Kirsty Sprange
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, Nottingham, NG7 2UH UK
| | - Daniel Hind
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Gail Mountain
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Katy Shortland
- Sheffield NIHR Clinical Research Facility, O Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF UK
| | - Lauren Powell
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Rebecca Gossage-Worrall
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Tim Chater
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Anju Keetharuth
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Ellen Lee
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Bob Woods
- DSDC Wales, Bangor University, Normal Site, Bangor, LL57 2PZ UK
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Forsman AK, Nordmyr J, Matosevic T, Park AL, Wahlbeck K, McDaid D. Promoting mental wellbeing among older people: technology-based interventions. Health Promot Int 2017; 33:1042-1054. [DOI: 10.1093/heapro/dax047] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Anna K Forsman
- Faculty of Education and Welfare Studies, Developmental Psychology, Åbo Akademi University, Vaasa, Finland
- Faculty of Education and Welfare Studies, Health Sciences, Åbo Akademi University, Vaasa, Finland
| | - Johanna Nordmyr
- Faculty of Education and Welfare Studies, Developmental Psychology, Åbo Akademi University, Vaasa, Finland
| | - Tihana Matosevic
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - A-La Park
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - David McDaid
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London, UK
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Abstract
OBJECTIVE Befriending is an emotional supportive relationship in which one-to-one companionship is provided on a regular basis by a volunteer. It is commonly and increasingly offered by the voluntary sector for individuals with distressing physical and mental conditions. However, the effectiveness of this intervention on health outcomes is largely unknown. We aim to conduct a systematic review of the benefits of befriending. DESIGN Systematic review. METHODS A systematic search of electronic databases was conducted to identify randomised controlled trials and quasi-experimental trials of befriending for a range of physical and mental health indications including depression, anxiety, mental illness, cancer, physical illness and dementia. Main outcomes included patient-relevant and disease-specific outcomes, such as depression, loneliness, quality of life, self-esteem, social support and well-being. RESULTS A total of 14 trials (2411 participants) were included; 7 were judged at low risk of bias. Most trials showed improvement in symptoms associated with befriending but these associations did not reach statistical significance in all trials. Befriending was significantly associated with better patient-reported outcomes across primary measures (standardised mean difference 0.18 (95% CI, -0.002 to 0.36, I2=26%, seven trials)). However, there was no significant benefit on single outcomes, including depression, quality of life, loneliness ratings, self-esteem measures, social support structures and well-being. CONCLUSIONS There was moderate quality evidence to support the use of befriending for the treatment of individuals with different physical and mental health conditions. This evidence refers to an overall improvement benefit in patient-reported primary outcomes, although with a rather small effect size. The current evidence base does not allow for firm conclusions on more specific outcomes. Future trials should hypothesise a model for the precise effects of befriending and use specified inclusion and outcome criteria.
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Affiliation(s)
- Joyce Siette
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Megan Cassidy
- Unit of Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, University of London, London, UK
| | - Stefan Priebe
- Unit of Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, University of London, London, UK
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21
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Avery KNL, Williamson PR, Gamble C, O'Connell Francischetto E, Metcalfe C, Davidson P, Williams H, Blazeby JM. Informing efficient randomised controlled trials: exploration of challenges in developing progression criteria for internal pilot studies. BMJ Open 2017; 7:e013537. [PMID: 28213598 PMCID: PMC5318608 DOI: 10.1136/bmjopen-2016-013537] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 12/19/2016] [Accepted: 01/19/2017] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Designing studies with an internal pilot phase may optimise the use of pilot work to inform more efficient randomised controlled trials (RCTs). Careful selection of preagreed decision or 'progression' criteria at the juncture between the internal pilot and main trial phases provides a valuable opportunity to evaluate the likely success of the main trial and optimise its design or, if necessary, to make the decision not to proceed with the main trial. Guidance on the appropriate selection and application of progression criteria is, however, lacking. This paper outlines the key issues to consider in the optimal development and review of operational progression criteria for RCTs with an internal pilot phase. DESIGN A structured literature review and exploration of stakeholders' opinions at a Medical Research Council (MRC) Hubs for Trials Methodology Research workshop. Key stakeholders included triallists, methodologists, statisticians and funders. RESULTS There is considerable variation in the use of progression criteria for RCTs with an internal pilot phase, although 3 common issues predominate: trial recruitment, protocol adherence and outcome data. Detailed and systematic reporting around the decision-making process for stopping, amending or proceeding to a main trial is uncommon, which may hamper understanding in the research community about the appropriate and optimal use of RCTs with an internal pilot phase. 10 top tips for the development, use and reporting of progression criteria for internal pilot studies are presented. CONCLUSIONS Systematic and transparent reporting of the design, results and evaluation of internal pilot trials in the literature should be encouraged in order to facilitate understanding in the research community and to inform future trials.
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Affiliation(s)
- Kerry N L Avery
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Paula R Williamson
- Medical Research Council North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Carrol Gamble
- Medical Research Council North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Elaine O'Connell Francischetto
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Chris Metcalfe
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Peter Davidson
- National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre, University of Southampton, Southampton, UK
| | - Hywel Williams
- Centre of Evidence-Based Dermatology, University of Nottingham, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jane M Blazeby
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Mountain G, Gossage-Worrall R, Cattan M, Bowling A. Only available to a selected few? Is it feasible to rely on a volunteer workforce for complex intervention delivery? HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:177-184. [PMID: 26445894 DOI: 10.1111/hsc.12285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 06/05/2023]
Abstract
This paper recounts the process of undertaking a randomised controlled trial which was designed to examine the effectiveness of an intervention for socially isolated older people aged 75 years and over. It describes the reasons for early cessation of the study and raises the implications of this outcome for policy, practice and research. The intervention under investigation was designed to alleviate loneliness and foster companionship. It involves participants being linked with a small group of others through a teleconferencing system with each group being facilitated by trained volunteers. There was a requirement to recruit and train a minimum of 30 and a maximum of 60 volunteers over 1 year to facilitate 20 friendship groups to meet the number of older people required to be recruited to the study. Problems with recruiting and retaining the volunteer workforce by the voluntary sector organisation, who were commissioned to do so, led to the study closing even though older people were recruited in sufficient numbers. The paper draws upon analysis of various data sources from the study to identify the potential reasons. The discussion raises considerations regarding the extent of infrastructure required to deliver community services to vulnerable user groups at scale, identifies some of the issues that need to be addressed if such volunteer-initiated services are to be successful and informs future research programmes in this area.
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Affiliation(s)
- Gail Mountain
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Mima Cattan
- Health and Lifestyle/Nursing and Public Health Group, University of Northumbria, Newcastle, UK
| | - Ann Bowling
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Recommendations for the analysis of individually randomised controlled trials with clustering in one arm - a case of continuous outcomes. BMC Med Res Methodol 2016; 16:165. [PMID: 27899073 PMCID: PMC5129671 DOI: 10.1186/s12874-016-0249-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 10/17/2016] [Indexed: 12/05/2022] Open
Abstract
Background In an individually randomised controlled trial where the treatment is delivered by a health professional it seems likely that the effectiveness of the treatment, independent of any treatment effect, could depend on the skill, training or even enthusiasm of the health professional delivering it. This may then lead to a potential clustering of the outcomes for patients treated by the same health professional, but similar clustering may not occur in the control arm. Using four case studies, we aim to provide practical guidance and recommendations for the analysis of trials with some element of clustering in one arm. Methods Five approaches to the analysis of outcomes from an individually randomised controlled trial with clustering in one arm are identified in the literature. Some of these methods are applied to four case studies of completed randomised controlled trials with clustering in one arm with sample sizes ranging from 56 to 539. Results are obtained using the statistical packages R and Stata and summarised using a forest plot. Results The intra-cluster correlation coefficient (ICC) for each of the case studies was small (<0.05) indicating little dependence on the outcomes related to cluster allocations. All models fitted produced similar results, including the simplest approach of ignoring clustering for the case studies considered. Conclusions A partially clustered approach, modelling the clustering in just one arm, most accurately represents the trial design and provides valid results. Modelling homogeneous variances between the clustered and unclustered arm is adequate in scenarios similar to the case studies considered. We recommend treating each participant in the unclustered arm as a single cluster. This approach is simple to implement in R and Stata and is recommended for the analysis of trials with clustering in one arm only. However, the case studies considered had small ICC values, limiting the generalisability of these results. Electronic supplementary material The online version of this article (doi:10.1186/s12874-016-0249-5) contains supplementary material, which is available to authorized users.
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Maintaining older brain functionality: A targeted review. Neurosci Biobehav Rev 2015; 55:453-77. [DOI: 10.1016/j.neubiorev.2015.06.008] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 06/01/2015] [Accepted: 06/03/2015] [Indexed: 12/20/2022]
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