Loneliness
Conditions
Keywords
Loneliness, Social Prescribing, Schools, Pupils
Brief summary
Background: Social Prescribing is a mechanism of connecting patients with non-medical forms of support within the community and has been shown to improve loneliness. Yet update from young people has been lower than for adults. This is thought to be due to accessibility issues as young people are less likely to draw on primary care, where social prescribing is based, for wellbeing support. The INACT pilot sought to test the feasibility and acceptability of a Social Prescribing pathway via schools to support young people who are lonely through a randomised controlled trial. Findings suggested that study procedures, including the measures were appropriate and that Social Prescribing was deemed by young people, social prescribers and school staff as feasible, acceptable and suitable and there was evidence of impact in the social prescribing arm when compared to signposting. Given the positive pilot findings, the aim of the INACT full trial is to build upon the pilot work and conduct a clinical and cost effectiveness trial into the impact of Social Prescribing in schools for loneliness and low community connection, compared to signposting. Methods: A minimum of 215 pupils reporting loneliness will be recruited across 30 mainstream schools in England and be randomly allocated to signposting or Social Prescribing. Pupils in the control group will receive signposting to sources of support from school staff. The co-produced social prescribing intervention includes up to 6 sessions with a Link Worker who will work with individuals to understand 'what matters to them' and connect them with local sources of support. The clinical and cost effectiveness of Social Prescribing for young people with loneliness will be assessed using measures of loneliness, mental health, wellbeing, quality of life, and service use. Data will be collected at baseline and 3, 6, and 12 months later. Qualitative interviews will also be conducted to explore barriers, facilitators, mechanisms of change and impact. Discussion: INACT will provide evidence of the clinical and cost effectiveness of Social Prescribing in schools for supporting young people experiencing loneliness. It will also establish what types of community and social activities young people engage in and what factors affect participation.
Interventions
BEHAVIORALSocial Prescribing
SP is a person-centred approach to wellbeing involving the co-development of a non-clinical prescription, between an individual (i.e. young person) and Link Workers (LWs), based on the perceived difficulties for the referral and the YPs values, needs and preferences. LWs have a good knowledge of their local areas, via community asset mapping and networking, allowing them to connect individuals with different types of available support and activities. Typically, SP ranges from 6-12 sessions (average 8 sessions: unpublished data from sites) with a LW over an 8-week period. Sessions may take place online, via phone call, or in person. As part of this process, LWs draw on psychological skills such as motivational interviewing and behavioural activation as well as employ problem solving and goal setting. Following the identification of issues and preferences, the LW will discuss with the YP what the available local activities and support structures are that best match their preferences.
BEHAVIORALSignposting
Those in the control group will receive signposting to activities and local sources of support in their communities. This will consist of school pastoral staff meeting with YP identified as lonely and providing them with a leaflet detailing the same local sources of support identified by the LW from asset mapping.
Sponsors
University College, London
University of Manchester
National Academy for Social Prescribing
We Do Wellbeing
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
9 Years to 14 Years
Healthy volunteers
No
Inclusion criteria
1. Schools: * A primary or secondary school willing to participate in INACT * In England * Have classes of pupils in eligible year groups to participate (Years 5, 7, 8) 2. Pupils and their parents/guardians: * Score 7 or above on the Good Childhood Index (indicating high loneliness) * Parents/guardians consent, and pupils assent, to get support
Exclusion criteria
1. Schools: * Private schools or sixth form/colleges * Specialist schools * Schools only offering alterative provision * Outside of England * Does not have classes of pupils in eligible year groups to participate (Years 4, 5, 7, 8) 2. Pupils and their parents/guardians: * Score below 7 on the Good Childhood Index (indicating low loneliness) * Parents/guardians do not consent, or pupils do not assent, to get support * Children and young people with severe learning disabilities who are unable to complete questionnaires
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Loneliness | Baseline, 3, 6 and 12 months | Measured using the Good Childhood Index containing 3 questions on a 3-point Likert scale (scoring between 3-9). Higher scores indicate higher reported loneliness. Baseline, 3, 6 and 12 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Wellbeing | Baseline, 3, 6 and 12 months | Measures using the Wellbeing subscale (Kidscreenn-52) which contains 6 questions each on a five-point Likert scale (scoring between 6-30). Higher scores indicate greater well-being. |
| Mental health (emotional difficulties) | Baseline, 3, 6 and 12 months | Measured using the Emotional difficulties subscale (Me and My feelings questionnaire) which contains 10 questions on a 3-point Likert scale (scoring between 0-20). Higher scores indicate higher emotional difficulties. |
| Service use | Baseline, 3, 6 and 12 months | Measures using the Client Service Receipt of Inventory which contains 11 questions on a five-point Likert scale. Scoring can be looked at by individual items (i.e. score between 1-5) or by scoring all items (i.e. scores between 11-55). Higher scores indicate more contact with a service/services. |
| Quality of Life | Baseline, 3, 6 and 12 months | Measured using the CHU-9D which contains 9 questions on a five-point Likert scale (scoring between 1-5). Higher scores indicate higher quality of life. |
| Stress | Baseline, 3, 6 and 12 months | Measured using the Perceived Stress Scale 4 which assesses stress using 4 questions on a five-point Likert scale (scoring between 0-16). Higher scores indicate higher levels of perceived stress (secondary school pupils only) |
| Emotion Regulation | Baseline, 3, 6 and 12 months | Emotion Regulation Index for Children and Adolescents is assessed using 16 items on a five-point Likert scale (scoring between 1-5). Higher scores indicate greater emotion regulation. |
| Intervention Acceptability | 3, 6, and 12 months | Measured using a single item adapted from the NHS Friends and Family Test on a five-point Likert scale . Higher scores indicate higher acceptability. Social prescribing arm only. |
| Intervention Feasibility (School Staff and Link Workers), | Approx 3 months after intervention delivery has begun | Measured using the Feasibility of Intervention Measure (FIM) which contains 4 questions each on a five-point Likert scale (scoring between 4-20). Higher scores indicate higher intervention feasibility. |
| Intervention Acceptability (School Staff and Link Workers) | Approx 3 months after intervention delivery has begun | Measured using the Acceptability of Intervention Measure (AIM) which contains 4 questions each on a five-point Likert scale (scoring between 4-20). Higher scores indicate higher intervention acceptability. |
| Intervention Appropriateness (School Staff and Link Workers) | Approx 3 months after intervention delivery has begun | Measured using the Intervention Appropriateness Measure (IAM) which contains 4 questions each on a five-point Likert scale (scoring between 4-20). Higher scores indicate higher intervention appropriateness. 3 months |
Countries
United Kingdom
Outcome results
None listed