Tackling loneliness interventions

Together, the What Works Centre for Wellbeing and the Campaign to End Loneliness have conducted:

1. A rapid systematic review of what interventions work to tackle loneliness;
2. Stakeholder engagement to map current delivery and evaluation practices in the field.

Overall, we found:

• Strong quantitative evidence for multiple effective approaches to alleviating loneliness in the short-term.
• Qualitative evidence on the potential enabling factors and causal pathways in loneliness alleviation, including community-focused connections, building trusting relationships, and the role of group settings.
• Intervention effectiveness is influenced by a blend of ‘key elements’.
• Evidence of holistic systems of support for tackling loneliness being developed.
• Evidence of sectors and settings where interventions target loneliness less explicitly and practice is less established.
• Whilst there is some similarity, the global evaluation literature does not necessarily reflect current UK tackling loneliness practice.

This document brings together the two strands of work, to summarise key insights, implications for research, and recommendations on how to improve evaluation practice.

Commissioned by the Department for Culture, Media and Sport’s Tackling Loneliness Team, the research updates our understanding since we looked in 2018 and can be used to shape further research and policymaking, as well as guide funding decisions and practitioner activity.

Since the Tackling Loneliness Strategy was published in 2018, combating loneliness and promoting social connection have been key priorities for the UK government.

As part of this, loneliness statistics – like those reported as part of the Office for National Statistics’ UK National Wellbeing Framework – are increasingly being used by government and the voluntary sector to inform and evaluate policies effectively and measure societal
progress.

Essential to tackling loneliness and promoting social connection is:

1. consolidating the rapidly growing evidence base;
2. increasing the quality of emerging research;
3. understanding and applying findings on the effectiveness of loneliness interventions to inform policy and programme design.

Charities, in particular, need support to gather robust and consistent loneliness data so that:

• beneficiary needs can be better understood;
• services can be evaluated and targeted effectively;
• the case can be made for investment.

Both funders and charities value evidence that describes how interventions are being delivered in practice and how they help to bring about changes for individuals and communities.

Through our evidence synthesis and knowledge mobilisation we give civil society learning a longer life and wider reach, building in-sector and cross-sector capacity to improve practice and understanding.

This project builds on our previous work to refine the concept of loneliness, identify gaps in the evidence base, and develop tools to improve the evaluation of interventions.

What we did

Between January and June 2023, the What Works Centre for Wellbeing and the Campaign to End Loneliness worked together to explore:

1. the state and consistency of the evidence base on tackling loneliness interventions across the life-course;
2. the landscape of tackling loneliness interventions and factors that enable or limit robust loneliness measurement in evaluation practice.

The rapid systematic review

Systematic reviews provide a comprehensive picture of interventions and detailed information on the value and reliability of their findings. 

We worked with researchers from Kohlrabi Consulting to explore studies across published and grey literature from the last 15 years.

Research questions

• What is the effectiveness of interventions aimed at alleviating loneliness in people of all ages across the life-course?
• Is there an association between setting/intervention type and the direction and size of effect?
• Are there differences in effectiveness across population groups?

We looked at study characteristics and pooled intervention effects by four core themes:

1. Social support
2. Social-interaction
3. Psychological
4. Multiple themes

We used meta-analysis to calculate the effect size of each theme. Findings were explored in relation to intervention aims, core components and mechanisms that lead to loneliness improvements.

Making the cut

Our review included findings from 95 studies and 101 different interventions that:

• were delivered largely in Europe and North America;
• were published from 2008 onward;
• had loneliness as a key outcome;
• used a validated loneliness measure to capture change, such as the UK’s recommended measures that include the UCLA loneliness scales and the De Jong Gierveld scale;
• were aimed at specific population groups: older people (50+) (n=56), young and middle-aged adults (18-50 years) (n=32).

Stakeholder engagement

Stakeholder engagement provides formal evidence about practitioner experiences.

We drew on the knowledge and experience of nearly 100 professionals involved in delivering, funding or researching interventions.

Research questions:

• What kinds of interventions exist and in which contexts?
• What factors influence their design and implementation?
• What makes them effective?
• Are interventions well-established across a variety of contexts?
• How are interventions being evaluated in practice in small and medium organisations?
• Which factors support, and which hinder, the use of loneliness measurement in practice?

Fieldwork took place between January and March 2023 and included:

• interviews with seven ‘key informants’ who each had knowledge of a broad set of interventions;
• six one-to-one interviews and focus groups with 28 professionals with close knowledge of particular interventions;
•  an online survey with 49 respondents;
• two round table discussions with experts in research and evaluation, policy or intervention practice in the field of loneliness to inform recommendations.

Participants were recruited through the Campaign to End Loneliness networks.

Interviews and focus groups were thematically analysed. Simple percentage responses to survey questions and summary points from the round table discussions were included alongside the relevant interview themes in the findings section.

Our full research findings are presented in two separate research reports.

• Loneliness interventions across the life-course: A rapid systematic review (2023)
• Evaluation of interventions to tackle loneliness (2023)

Here we summarise key insights from each:

Key findings – rapid systematic review

Quantitative evidence suggests that there are multiple successful approaches to alleviating loneliness in the short-term, almost all of which target specific age groups or vulnerable populations.

The review identified successful interventions that involve:

• structured therapeutic support and approaches to develop emotional and social skills;
• social support that develops social skills through targeted relationship-building skills and discussion-based activities;
• art and dance activities delivered in community-based settings;
• a range of social interaction-based activities, including facilitated animal/robot interactions, food delivery and social and health promotion activities.

Qualitative data from nearly one quarter of studies (n=25) sheds light on potential enabling factors and causal pathways that lead to improvements in loneliness, including:

• the importance of the emotional bond and caring/trusting relationships built with mentors, befrienders, link workers and home-sharers in social support interventions, who act as connectors to the wider world;
• the role of group settings as a pretext for social contact and meaningful interaction that act as catalysts for larger individual-level changes;
• the importance of community-focused connections and the experience of positive emotions/mood as potential precursors to reductions in loneliness.

Key findings – Stakeholder engagement

What kinds of tackling loneliness interventions exist and in which contexts?

• Interventions types identified include:
  – First engagement work, such as outreach
  – Social prescribing and community connecting
  – Befriending
  – Social groups
  – Social support groups

• Common features or themes include:
  – Tailored, relevant support
  – Developing relationships
  – Bringing people together through shared activity, interests or experiences

• Interventions described were similar to those identified in previous work.
• Clinical interventions involving provision of specialist psychological support were harder to identify and poorly represented in our sample.

Holistic systems of support for tackling loneliness

There is evidence of projects evolving and innovating to incorporate multiple intervention types to meet varied participant needs, both from bottom up by delivery organisations as well as from the top down as happens, for example, when local authorities work to strengthen overall provision in a local area.

Are interventions well-established across a variety of contexts?

• In the voluntary and community sector, a well-established, varied set of direct interventions is being delivered with tackling loneliness as a primary aim.
• In sectors such as universities, private sector organisations, local authorities and public health work, tackling loneliness practice was emergent.
• In the example of youth work, much practice was relevant to tackling loneliness but was often not recognised as such.

What factors make tackling loneliness interventions effective?

• Interviewees identified a blend of key elements important for intervention effectiveness:
  – being responsive to need/person-centred;
  – trust and relationship building;
  – skillful, gentle first engagement;
  – support to unpick problems/identify next steps;
  – providing environments for social engagement;
  – providing opportunities for learning social skills, increasing participation and growth in confidence).

• This ‘blend’ indicates the development of multi-layered support.
• Different ‘types’ of intervention shared many of the same key elements, raising challenges for evaluating the relative impact of different ‘types’ of intervention.

How are interventions being evaluated in practice in small and medium organisations?

• Organisations used a range of evaluation practices.
• Use of measures was partly dependent on organisational size and intervention type.
• Where measures were used:
  – they were always alongside other intervention-specific measures or qualitative methods;
  – there were examples of use pre-/post-intervention, either with or without a comparison group.

Which factors hinder the use of loneliness measurement in practice?

• Lack of evaluation training for staff to support rigorous and unbiased data collection;
• Evaluation requirements perceived as ‘burdensome’ by delivery organisations;
• Stakeholders expressed mixed views about measures:
  – some said measuring loneliness was an effective way to evaluate interventions and that a consistent measure was important for comparing the relative impact of different projects;
  – others saw the measures as of limited use, unsuitable for use with certain participant groups, or at odds with being person-centred and responsive to participant needs.

For a comprehensive list of recommendations from both strands of work, read the full reports.

This briefing accompanies the following reports:

Loneliness interventions across the life-course: A rapid systematic review

Evaluation of interventions to tackle loneliness

Additional resources on loneliness and social connection include:

Trends in social isolation

Loneliness and wellbeing among adolescents and young adults

Promising Approaches Revisited: Effective action on loneliness in later life

Tackling loneliness through the built environment

The Psychology of Loneliness

MacIntyre, H., Musella, M. Tackling Loneliness Interventions:
Insights on the current landscape, evidence and evaluation practice.
September, 2023. What Works Centre for Wellbeing.
Campaign to End Loneliness.