Loneliness
Conditions
Keywords
Loneliness, Older Adults, Positive Affect, Behavioral Activation, Randomized Controlled Trials
Brief summary
This study aims to evaluate the effectiveness of two psychosocial interventions-Tele-Positive Affect (Tele-PA) and Tele-Behavioral Activation (Tele-BA)-compared to active control (telephone-delivered friendly visit, Tele-FV) in reducing loneliness among older adults in Hong Kong.
Detailed description
Loneliness in older adults represents a critical public health challenge, associated with detrimental outcomes including depression, cardiovascular risks, cognitive decline, and elevated mortality. Despite existing interventions, significant gaps persist: most approaches neglect the affective dimension of loneliness, fail to address the core mechanism of perceived discrepancies between expected and actual social relationships, and inadequately account for age-related shifts in socioemotional goals. This randomized controlled trial addresses these limitations by evaluating two theoretically distinct telephone-delivered psychosocial interventions against an active comparator. The study employs a three-arm design to compare a 4-week Tele-Positive Affect (Tele-PA) intervention grounded in the broaden-and-build theory of positive emotion, which aims at increasing positive affect through eight evidence-based skills (e.g., gratitude, mindfulness, positive reappraisal), and a Tele-Behavioral Activation (Tele-BA) intervention derived from the behavioral explanations of learning theory, focusing on behavior monitoring and strategies, valued activity scheduling, and social skill enhancement. Both are contrasted with Tele-Friendly Visit (FV)-an active control condition comprising matched-frequency neutral conversations devoid of therapeutic components. Community-dwelling adults aged ≥65 years in Hong Kong with significant loneliness will be randomized to these arms. Using a three-arm, assessor-blinded randomized clinical trial, outcomes will be measured through retrospective surveys and ecological momentary assessments (EMA) at baseline, immediately post-intervention (Week 2), and at 3- and 6-month follow-ups. Primary analyses will examine: 1) the comparative efficacy of Tele-PA and Tele-BA versus the active control in reducing loneliness; 2) differential effectiveness of Tele-PA versus Tele-BA; 3) the mechanisms underlying the effects of Tele-PA and Tele-BA; and 4) the effects of age on the effectiveness. This research pioneers the integration of affective science with loneliness intervention design while employing EMA to capture mechanistic dynamics. Findings will advance precision approaches for alleviating loneliness in aging populations through scalable, theory-informed strategies.
Interventions
BEHAVIORALTele-Positive Affect Intervention
A 4-week intervention consisting of eight skills aimed at enhancing positive affect, delivered via telephone by trained facilitators. Participants will learn skills such as gratitude, mindfulness, and positive reappraisal, with sessions held twice a week.
BEHAVIORALTele-Behavioral Activation Intervention
A 4-week intervention designed to promote engagement in meaningful activities, delivered through telephone by trained facilitators. The intervention will include behavior monitoring, activity planning, and social skills enhancement, with sessions held twice a week.
BEHAVIORALTele-Friendly Visit
An active control condition consisting of telephone-delivered friendly visits. Participants will engage in social conversation and activities to provide companionship without any specific skills training aimed at reducing loneliness. The intervention will be held within 4-week.
Sponsors
University of Texas at Austin
City University of Hong Kong
Education University of Hong Kong
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Subject)
Intervention model description
A three-armed randomized controlled trial
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* aged 65 years or older * proficiency in Cantonese (over telephone) * experiencing loneliness (defined as a score of ≥ 6 on the 3-item UCLA Loneliness Scale)
Exclusion criteria
* cognitive impairments * psychiatric disorders, learning disabilities, or active suicidal ideation * currently participating in other psychotherapy or psychosocial interventions aimed at enhancing well-being
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Loneliness measured by the UCLA Loneliness Scale | Baseline, 3-month, and 6-month | The UCLA Loneliness Scale is a reliable self-assessment tool designed to evaluate feelings of loneliness. Possible scores range from 1 (never) to 4 (always). |
| Real-time Experiences on Ecological Momentary Assessment | Baseline and 2-week | Ecological Momentary Assessment (EMA) is a research method used to collect data in real-time and in the participants' natural environments. It measures momentary loneliness, momentary actual affect examined by the short version of the AVI scale, current and expected locations (e.g., nature, home, public places), as well as details about their current and expected social interactions, including the type (i.e., alone, with spouse, family members), features (e.g., supportiveness, closeness, pleasantness, meaningfulness), and number (i.e., 0, 1, 2, 3, 4, 5, or more than 5). Participants will also report on their current and expected activities, specifying the type (e.g., physical activity, working, cognitive activities) and characteristics (e.g., pleasantness, meaningfulness) of these activities. |
| Loneliness measured by De Jong Gierveld Loneliness Scale | Baseline, 3-month, and 6-month | The De Jong Gierveld Loneliness Scale is a validated, self-reported instrument assessing loneliness. Possible scores range from 1 (yes) to 3 (no). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Perceived Stress on 5-point Chinese Version of the Perceived Stress Scale | Baseline, 3-month, and 6-month | The Chinese version of the Perceived Stress Scale is a validated self-report tool used to measure Perceived Stress levels. Possible scores range from 0 (never) to 4 (very often). |
| Psychological Well-being on 6-point Psychological Well-being Scale | Baseline, 3-month, and 6-month | The Psychological Well-being Scale is a validated, self-reported instrument assessing Psychological Well-being. Possible scores range from 1 (strongly disagree) to 6 (strongly agree). |
| Symptoms of Depression on 4-point Chinese Version of Patient Health Questionnaire-9 (PHQ-9) | Baseline, 3-month, and 6-month | PHQ-9 is a reliable self-report measure designed to evaluate Symptoms of depression. Possible scores range from 0 (not at all) to 3 (nearly everyday). |
| Symptoms of Anxiety on 4-point Chinese Version of the Generalized Anxiety Disorder Scale | Baseline, 3-month, and 6-month | The Chinese version of the Generalized Anxiety Disorder Scale is a validated, self-reported instrument assessing Symptoms of depression. Possible scores range from 0 (not feeling at all) to 3 (most of the time). |
| Cognitive Functioning on the Hong Kong Version of Montreal Cognitive Assessment | Baseline, 3-month, and 6-month | The Hong Kong version of the Montreal Cognitive Assessment (MoCA-HK) is a validated tool administered by clinicians to evaluate cognitive functioning, especially in older adults. Possible scores range from 0 to 30, with higher scores indicating better cognitive performance. |
| Perceived Social Support on 7-point Multidimensional Scale of Perceived Social Support | Baseline, 3-month, and 6-month | The Multidimensional Scale of Perceived Social Support evaluates the social support derived from three key sources: family, friends, and significant others. Respondents rated each item on a 7-point Likert scale, where 1 represents very strongly disagree and 7 indicates very strongly agree. |
| Social Network on Lubben Social Network Scale at Month 3 and Month 6 | Baseline, 3-month, and 6-month | The Lubben Social Network Scale is a validated, self-reported instrument assessing the social networks of participants. This scale comprises six items, with three focused on family connections (family subscale) and three addressing friendships (friend subscale). The overall score ranges from 0 to 30, with each subscale spanning from 0 to 15. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Social Network Characteristics on 10-point Social Network Characteristics Scale | Baseline, 3-month, and 6-month | The Social Network Characteristics Scale will assess the perceived supportiveness, closeness, pleasantness, and meaningfulness of participants' social partners over the past two weeks. Possible scores range from 1 (not at all) to 10 (extremely high). Additionally, participants will report the number of social partners they have engaged with during this same timeframe. |
| Cognitive Reappraisal on 7-point Emotional Regulation Questionnaire (ERQ) | Baseline, 3-month, and 6-month | The ERQ is a validated, self-reported instrument assessing emotional regulation strategies, specifically cognitive reappraisal (6 items) and expressive suppression (4 items). Possible scores range from 1 (strongly disagree) to 7 (strongly agree). |
| Self-Efficacy on 4-point General Self-Efficacy Scale (GSE) | Baseline, 3-month, and 6-month | The GSE is a validated instrument assessing participants' self-reported levels of self-efficacy. This validated instrument consists of 10 items designed to measure individuals' optimistic beliefs regarding their capacity to manage challenging situations. Participants will evaluate each statement using a 4-point Likert scale, where 1 indicates not at all true and 4 represents exactly true. |
| Mindfulness on 5-point Five Facet Mindfulness Questionnaire | Baseline, 3-month, and 6-month | The Five Facet Mindfulness Questionnaire is a validated measure assessing levels of mindfulness. Responses will be scored on a 5-point Likert scale, ranging from 1 (never or very rarely true) to 5 (very often or always true). |
| Gratitude on 7-point Gratitude Scale Questionnaire-Six Item Form (GQ-6) | Baseline, 3-month, and 6-month | The GQ-6 is a validated self-report measure that evaluates inclination to recognize, appreciate, and respond to life events with gratitude. Possible scores range from 1 (strongly disagree) to 7 (strongly agree). |
| Affective Experience over the Past Week on 30-item Affect Valuation Index (actual affect) (AVI) | Baseline, 3-month, and 6-month | The Affect Valuation Index (AVI) is a validated, self-reported instrument assessing affective experiences over the past week. It evaluates both the actual emotions experienced and the ideal emotions valued by the individual. Possible scores for each emotion reflect the frequency of experience, typically ranging from 1 (very slightly or not at all) to 5 (extremely or all the time). |
| Meaning of Life on 7-point Meaning in Life Questionnaire (MLQ) | Baseline, 3-month, and 6-month | The MLQ is a reliable self-assessment tool that evaluates individuals' sense of meaning in life. This instrument comprises two subscales: Presence of Meaning and Search for Meaning, with each subscale containing five items. Each subscale has a minimum score of 5 and a maximum score of 35. |
Countries
Hong Kong
Contacts
Primary ContactDa Jiang, PhD
Backup ContactXinyuan Peng, MSc
Outcome results
None listed