AbstractBackground: This thesis explored community-based responses to the alleviation of loneliness and social isolation among older people. Loneliness and social isolation have been largely identified as problems of old age and research evidence shows strong associations between loneliness and social isolation, and quality of life, mental ill-health and physical health. Hence, there has been increasing policy attention in the UK and implementation of a wide range of services that aim to prevent or alleviate the progression of loneliness. This thesis set out to identify how community-based responses to the alleviation of loneliness and social isolation are described by interrogating previous literature. It aims to evaluate the impact of befriending interventions, which are a predominant direct intervention delivered across NI (and the UK) to reduce loneliness and social isolation; to understand what works, under which circumstances, how and to what extent. This will help service providers to refine and tailor their interventions to fit the profile of the target individuals, as well as the different determinants of loneliness and social isolation.
Methods: Three investigative activities make up the main body of the thesis. Firstly, a scoping review of international literature identified types of interventions that were implemented to alleviate loneliness and social isolation among older populations. Next, a study profiled existing interventions in NI implemented to alleviate loneliness and social isolation, by interviewing key stakeholders about the characteristics of relevant services using the TIDieR checklist. The loneliness framework by the Campaign to End Loneliness informed the sampling frame of the study and interventions were categorised as: (i) foundation services, (ii) direct interventions, (iii) gateway services, and (iv) structural enablers. Finally, a realist evaluation of befriending services (the predominant type of direct intervention in NI to reduce loneliness and social isolation) was conducted using a series of five case studies. The realist evaluation employed multiple methods including semi-structured realist interviews with different stakeholder groups of befriending interventions (e.g. service manager/coordinator, befriender, service user, and family member of service user), as well as reviews of service documentation. This was conducted in order to identify and subsequently refine programme theories explaining how befriending services work.
Findings: Findings from the scoping review highlighted that loneliness and social isolation were often used interchangeably although they are distinct concepts. Review authors of existing literature often did not provide a rationale or theoretical underpinning for the categorisation of interventions designed to alleviate loneliness and/or social isolation. Lack of theoretical underpinning poses difficulties when ascertaining which context(s) a particular category of intervention would be most effective or appropriate, and also by which mechanisms these interventions work to alleviate loneliness and social isolation.
The profile study of interventions in NI identified a broad range and diversity of interventions targeted at alleviating loneliness and social isolation among older people. These interventions did not appear to be based on empirical evidence that demonstrated the effectiveness of the service and how outcomes were achieved. Internal service evaluations were often conducted and comprised of satisfaction surveys completed by staff members and service users. However, this process lacks rigour and does not adhere to the principles of evidence-based practice. Direct interventions, specifically befriending, were identified as the most prevalent type of interventions delivered to alleviate loneliness and social isolation in NI, however, existing literature on befriending are predominantly outcome-focused with aims to answer questions on the effectiveness of these interventions, and whether they work (or not) to produce positive outcomes. However, this approach pays little attention to understanding the underlying mechanisms by which befriending interventions work to produce these outcomes, i.e. alleviation in loneliness and social isolation; and which contextual conditions influence this.
In the realist evaluation of befriending services, eight programme theories describing the context-mechanism-outcome (CMO) configurations were rigorously developed, tested and refined over five case studies. Evidence is provided to demonstrate how befriending interventions work to alleviate loneliness and social isolation. The study’s final findings are multifaceted and focus on the conditions of successful implementation which are presented under these demi-regularities: 1) reciprocity, 2) empathy, 3) autonomy and 4) privacy. Regarding reciprocity, consideration is given to how the matching process between befrienders and service users, face-to-face in-person service delivery, as well as monetisation of befrienders influences the translation from a professional relationship into a type of friendship. Under empathy, the contextual condition of shared experiences between the befriender and service user (i.e. illness) and the utilisation of face-to-face in-person service delivery is crucial to the development of a meaningful and trusting relationship between both parties. Autonomy is facilitated via open-ended befriending relationships with the same befriender whereas privacy is facilitated via one-to-one service delivery and was particularly important for service users with cognitive/sensory impairment due to reduced distractions.
Conclusions: Overall, the findings of the PhD thesis contribute to our understanding about how befriending interventions work in alleviating loneliness and social isolation. Practical implications can be drawn from the theoretical propositions that were uncovered in this thesis, and this may be used to inform the design and implementation of these interventions in different settings. The theoretical propositions indicate some factors that could be used to support future befriending interventions and service providers can make informed decisions based on the findings about what is likely to work in their unique situation.
|Date of Award||Jul 2021|
|Sponsors||Northern Ireland Department for the Economy|
|Supervisor||Michael Donnelly (Supervisor) & Noleen McCorry (Supervisor)|
- social isolation
- older people
- realist evaluation
- scoping review
- mapping study