Assessing a facilitated social network intervention on health outcomes for lonely and socially isolated people: the pragmatic, cluster-randomized PALS trial

Abstract

Introduction: loneliness has received attention in recent years as an important public health issue due to the associations with poorer mental and physical health. This study aimed to assess the effectiveness and cost-effectiveness of a facilitated social network intervention for alleviating loneliness and social isolation within community settings.

Methods: a pragmatic, cluster randomized controlled trial comparing participants receiving the intervention to a wait-list control group, with embedded economic evaluation was undertaken in two cities in England, UK. The intervention was a facilitated social network tool. It connects people to local community resources as a way of potentially increasing social involvement. First, participants mapped and reflected on personal social networks. Second, participants completed a questionnaire to ascertain preferred activities, interests and support needs linked to a local resource database. The intervention was delivered by a trained facilitator in person or remotely. Community-based organizations (n=44) identified adults who were at risk of social isolation and/ or loneliness. The control group received the ‘usual care’ from the organization they were recruited through. The primary outcome was the 6-month SF-12 Mental health composite score. Physical health, wellbeing, loneliness, social isolation and collective efficacy were explored as secondary outcomes. The intervention costs, healthcare resource use, quality adjusted life years (QALYs) and net monetary benefit (NMB) were included in the economic analysis.

Results: 469 adults were recruited between November 2018 to November 2021 with an 8-month COVID-19 recruitment pause in 2020 (242 intervention group participants and 227 control group participants). The results show no clinically meaningful treatment effect of the intervention on the primary (0.21; 95% confidence interval: -1.74 to 2.16; p =0.834) or secondary outcomes compared to the usual care control group. The economic evaluation indicated no significant difference in QALYs, and did not lead to demonstrable cost-effectiveness despite being inexpensive to deliver.

Discussion: findings indicate the intervention was not effective under trial conditions. Future interventions implemented to reduce loneliness and social isolation would likely benefit from utilizing a multi-step approach that will include tailored psychological, relational and social components and taking into consideration the structural availability of community assets.

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Identifiers

ORCID for Rebecca Band: orcid.org/0000-0001-5403-1708

ORCID for Jaimie Ellis: orcid.org/0000-0003-0068-3318

ORCID for Elizabeth P. James: orcid.org/0000-0001-9355-0295

ORCID for Sean Ewings: orcid.org/0000-0001-7214-4917

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