How do befriending interventions alleviate loneliness and social isolation among older people? A realist evaluation study

PLOS ONE RESEARCH ARTICLE How do befriending interventions alleviate loneliness and social isolation among older people? A realist evaluation study Olujoke A. Fakoya ID1,2*, Noleen K. McCorry1,2, Michael Donnelly1,2 1 Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, 2 Centre of Excellence for Public Health, CoE, Queen’s University Belfast, Belfast, Northern Ireland a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 * Abstract Background OPEN ACCESS Citation: Fakoya OA, McCorry NK, Donnelly M (2021) How do befriending interventions alleviate loneliness and social isolation among older people? A realist evaluation study. PLoS ONE 16(9): e0256900. https://doi.org/10.1371/journal. pone.0256900 Editor: Marcel Pikhart, University of Hradec Kralove: Univerzita Hradec Kralove, CZECH REPUBLIC Received: April 29, 2021 Accepted: August 18, 2021 Published: September 9, 2021 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0256900 Copyright: © 2021 Fakoya et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. 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 longterm 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. PLOS ONE | https://doi.org/10.1371/journal.pone.0256900 September 9, 2021 1 / 21 PLOS ONE Funding: This study is part of a PhD project that was undertaken by the first author, OAF, supervised by NMC and MD. The PhD Studentship Award granted to OAF was funded by the Northern Ireland Government Department of Economics. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. How do befriending interventions alleviate loneliness and social isolation among older people? 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. Introduction There is increasing awareness about the potential harm that loneliness and social isolation can cause [1]. Loneliness can be defined as an undesirable subjective experience, related to ‘unfulfilled intimate and social needs’ [2] whereas social isolation can be understood as an objective concept capturing the absence of relationships, contacts or ties with other people [3]. Although loneliness can occur at all ages, it is a particularly common problem among populations of older people [4] as the opportunities for social contact are limited by various factors such as death of peers, physical limitations such as sensory deficits that limit communication, and/or mobility limitations that restrict their ability to visit family and friends [5]. Loneliness and social isolation have been associated with a range of health conditions and studies have demonstrated how they can lead to adverse physical and mental health consequences, especially among the older population [6, 7]. Across the UK and internationally, a number of initiatives have been deployed by health and social care providers as well as community and voluntary organisations, to address the issue of loneliness and social isolation. Befriending is a popular type of initiative that is mainly implemented to provide relationships and social contact to individuals experiencing loneliness and isolation in community and residential settings [8]. These services are now part of the social landscape in several countries especially the UK, US, Canada, Australia and Europe [9]; and several function at a grassroots level with aims to fill the emotional and social gap that is not being met by existing statutory and social service provision [10]. While befriending services are offered to a diverse range of populations of all ages and needs [11], this study focuses on support for older people. There are various definitions of the age range of ‘older’ populations [12] however most services broadly define older individuals as aged ‘‘50+ or 60+” p.17 [13]. There is no reliable estimate of current befriending provision but Mulvihill [11] identified in 2011 that there were over 3500 different befriending schemes for older people in the UK. Befriending services have also been identified as a common type of intervention delivered in Northern Ireland (NI) to reduce feelings of loneliness among older people. In NI, there are several networks which support befriending services, such as the Befriending Net (...truncated)