Research and analysis

Evaluation of interventions to tackle loneliness

Published 4 September 2023

© Crown copyright 2023

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This publication is available at https://www.gov.uk/government/publications/exploring-interventions-to-tackle-loneliness/evaluation-of-interventions-to-tackle-loneliness

Author credits: This report was written by Dr Helen MacIntyre and Robin Hewings from The Campaign to End Loneliness

1. Executive summary

1.1 Introduction and methods

A key objective in the government’s 2018 world-first loneliness strategy[footnote 1] was to improve the evidence base on loneliness. The strategy called for organisations tackling loneliness to use a common set of quantitative loneliness measures recommended by ONS (Office for National Statistics), chosen from a range of available validated measures,[footnote 2][footnote 3] in population surveys, research and evaluations. These include one direct question asking how often someone feels lonely and 3 indirect questions asking if someone feels isolated, lacking in companionship or left out. The aim of using consistent measures for evaluation was to enable comparison of the effectiveness of different ways to tackle loneliness. Five years later, there are a rich variety of services, policies and approaches to tackling loneliness for which we use the umbrella term ‘interventions’. The use of consistent measures in population level surveys has led to advances in evidence about when, where and why people are lonely. However, the 2022 Tackling Loneliness Evidence Review[footnote 4] has identified remaining gaps in our understanding of interventions, particularly in terms of how well they work for different groups of people. It also notes that some evaluation work is of poor quality. With this in mind, it is essential to understand what interventions exist to tackle loneliness and any challenges faced by the sector in evaluating them so that there can be continued expansion of the evidence base on what works to tackle loneliness.

Many tackling loneliness (TL) interventions address loneliness among older people[footnote 5] and examples in the UK have often been drawn from work within the voluntary and community sector.[footnote 6] However, there are examples of interventions for other age groups,[footnote 7][footnote 8] and in other contexts. One aim of this engagement was to explore whether provision is becoming well-established in different contexts and for a wide range of age and target groups. Another was to update our understanding of the kind of interventions being delivered. In particular, research reviews of intervention evaluations note that they often do not specify how interventions work.[footnote 9][footnote 10] This report drew on expert knowledge of professionals who have close knowledge of TL interventions to provide practice-based insight into the elements which are key to making them effective.

In relation to evaluation of TL interventions, there continues to be discussion and debate about the use of loneliness measures to evidence impact. Systematic reviews of evidence on intervention effectiveness have highlighted that evaluation evidence is of mixed and sometimes poor quality.[footnote 11] This may be explained in part by reservations of those delivering TL interventions about use of the measures. Prior to this report, concerns have been expressed informally[footnote 12] about how far they provide useful and accurate information; about the demands placed on organisations with limited resources by using measures; and about lack of knowledge around how to use them. Such concerns may act as barriers to use of loneliness measurement as part of the rigorous intervention evaluations which are important for continuing to build understanding of what works to tackle loneliness. However, we do not have formal evidence about practitioner experiences of evaluation. Therefore, another main aim of the report was to collect evidence about the enablers and barriers to use of loneliness measures within TL intervention evaluations and, then, to use this evidence to understand support needed for carrying out high quality evaluations going forward.

Note that throughout this paper ‘loneliness measure’ will refer to a range of available loneliness measures rather than the 2 ONS recommended measures unless specified otherwise.

The team drew on the experiences of nearly 100 people involved in delivering, funding or researching interventions. Participants were recruited through the Campaign to End Loneliness networks. Fieldwork took place between January and March 2023 and included:

  • 7 key informant interviews
  • 34 interviews with professionals with close knowledge of particular interventions
  • An online survey with 49 respondents
  • 2 round table discussions with experts in research and evaluation, policy or intervention practice in the field of loneliness to inform recommendations

The exercise aimed to understand:

Interventions: The different types of interventions and their context, what factors influence their design and implementation, and what makes them effective

Evaluation: The factors that enable or limit robust loneliness measurement and what examples of practice exist for a range of small and medium organisations

Recommendations: What will improve the quality of evaluations and what should be done by government, sector and research bodies, and delivery organisations

1.2 Findings on the landscape of loneliness interventions

Direct TL interventions involve working directly with people experiencing loneliness. Indirect interventions involve making changes to physical, social, organisational or digital environments or to the whole system of interventions. Indirect interventions may support functioning of direct interventions or themselves reduce the likelihood of loneliness.

Sectors for TL interventions

In the voluntary and community sector, a well-established varied set of direct interventions were being delivered with tackling loneliness as a primary aim. By contrast, TL practice in other sectors was emergent.

Types of TL intervention

The loneliness provision identified in this stakeholder engagement exercise included:

  • first engagement activity, which is skillful initial contact and support through helplines or outreach such as street stalls or community door knocks
  • social prescribing and community connecting works with individuals to understand social, emotional or practical needs and to support identification of - and access to - relevant support
  • befriending was focused on developing a supportive relationship between an individual and a volunteer
  • social groups could take the form of social or entertainment events or they could be designed for people to come together to engage in a joint activity or interest
  • social support groups brought together people who faced common challenges because of shared life experiences or needs
  • clinical interventions involved provision of specialist psychological support. These were apparent in the research literature found in the rapid evidence review carried out at the same time as this engagement[footnote 13] (however, this report did not identify any services currently being provided)

Of interest was the fact that projects were evolving and innovating by incorporating more than one type of intervention within single projects to meet varied needs of participants. As such, holistic systems of support for tackling loneliness were being developed from the 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.

Key elements of for TL intervention effectiveness

While some interviewees emphasised particular factors that were central to their intervention, they also talked about a blend of ‘key elements’ which were important for effectiveness suggesting that they were creating multi-layered support systems. These elements included:

  • considered use of the language of loneliness
  • skillful, gentle first engagement to make people feel welcome and overcome hesitancy about joining a group or accessing support
  • support to unpick and address problems contributing to an individual’s loneliness and to identify next steps
  • providing conditions for trust and relationship building
  • providing environments for social engagement to suit individual needs and preferences
  • opportunities for learning social skills, increasing participation and growth in confidence
  • being responsive to need or being person-centred

Different types of interventions shared many of the same key elements. This overlap raises challenges for evaluating the relative impact of different ‘types’ of intervention.

1.3. Findings on the use of loneliness measures to evaluate tackling loneliness interventions

Evaluation practices and use of loneliness measures

Organisations used a range of practices to evaluate their interventions. Some providers of direct interventions used the recommended ONS loneliness measure and others did not. Organisations who did not use any loneliness measures to evaluate their interventions were: smaller, newer organisations; those who carried out light touch first engagement work where use of any formal measures would be inappropriate; as well as some who worked with people over a longer period of time. Where organisations did use loneliness measures, there were examples where these were used pre/post intervention, and either with or without a comparison group. No organisations used the loneliness measure as their only evaluation tool. The measure was used alongside other intervention specific measures or qualitative methods.

Factors enabling use of loneliness measurement

Some organisations and funders said measuring loneliness was an effective way to evaluate the effectiveness of an intervention and that a consistent measure was important for comparing the relative impact of different projects. Others used measures for other reasons such as to support screening conversations for clinical or social prescribing interventions. Local population loneliness data was also used to inform interventions or demonstrate the need for them.

Barriers to loneliness measurement

Some organisations had concerns about using the loneliness measures. One was that asking the questions could alienate individuals from taking part in an intervention or cause them distress. Other concerns included that the measures were: not sensitive to changes in loneliness that could reasonably be achieved by one intervention; not suitable for use with particular participant groups; influenced by factors other than the intervention such as negative life events; or did not provide useful information about project-level impact when data was collected at scale across different projects. These perceived limitations meant that some interviewees saw loneliness measures as being of limited use and at odds with core intervention values of being person-centred and responsive to participant needs.

Funders who were interviewed emphasised the importance of not overburdening funded organisations with demands to use evaluation methods which were not useful and mentioned work they were doing to support organisations in this aspect of their work. However, a number of organisations were using measures despite reservations because they were required to do so by funders. This could mean that use of the measures was regarded as a burdensome imposition. There were also concerns about whether staff - often without evaluation training - could collect data in a rigorous and unbiased way.

1.4. Recommendations

Recommendations based on findings from this engagement with TL professionals are as follows:

  • build better understanding of TL provision across a range of sectors
  • ensure access to psychological approaches to tackling loneliness
  • specify the key elements which explain how TL interventions work when planning and evaluating them
  • develop new guidance on evaluation of TL interventions with involvement of varied stakeholders
  • co-produce evaluations of TL interventions with delivery organisations
  • provide high quality training and support on how to use the recommended loneliness measures and a range of other evaluation methods
  • provide funding to cover evaluation costs and resources
  • review the ONS recommended loneliness measures to reassess their suitability for evaluating TL interventions
  • explore the potential of linking data from evaluation of TL interventions to national healthcare and other datasets

2. Introduction

2.1. Context of the report

In 2018 the UK government set out its world-first tackling loneliness strategy, recognising the substantial negative impacts of loneliness on health and a range of other outcomes and that it is ‘one of our most pressing public health issues’.[footnote 1] The strategy included a commitment to work with local authorities, health bodies, businesses and the voluntary sector to develop initiatives to support social connections particularly for those at risk of loneliness. In addition, the government set a goal to support development of the evidence base to improve understanding of loneliness and of what works to tackle loneliness. Central to this was an intention to encourage charities and other service providers to use a consistent set of recommended loneliness measures to allow comparison of the impact of different interventions.

5 years later, research reviews and work shared by practitioners on the Tackling Loneliness Hub[footnote 14] and elsewhere show that there are a rich variety of services, policies and approaches to tackling loneliness for which we use the umbrella term ‘interventions’. However, there is uncertainty about the extent of innovation in terms of types of intervention being delivered, how they work and how far there is delivery of interventions in new contexts with diverse groups of people. It has also become apparent that professionals organising and delivering interventions face challenges in using loneliness measures to evaluate impact. The current insight work was commissioned by the Department for Culture, Media and Sport (DCMS) to draw on the knowledge of professionals working on loneliness interventions to explore contexts where tackling loneliness (TL) interventions are taking place, what form they take and how they are being evaluated. It sits alongside a rapid evidence review of intervention effectiveness being undertaken by the What Works Centre for Wellbeing.[footnote 15]

2.2. Stakeholder engagement questions

The report had 2 areas of focus. The first was to update our understanding of the landscape of TL interventions in the UK. Questions addressed in this part of the report were

  • In what contexts do TL interventions exist?
  • What types of interventions exist to tackle loneliness?
  • What factors influence the design and implementation of TL interventions?

The second focus was on examining current practice in evaluation of TL interventions. Specifically the aim was to investigate how measures of loneliness were being used to evaluate intervention effectiveness. Questions addressed in this part of the report were:

  • What evaluation practices exist for small to medium organisations (those less likely than large organisations to have an in-house evaluation team)?
  • What are the enabling or limiting factors associated with producing robust loneliness measurement for small to medium organisations working to tackle loneliness?
  • What is required to improve the quality of evaluations for organisations working to tackle loneliness?
  • What should be the respective roles of government, sector[footnote 16] and research bodies, and delivery organisations in collectively building high quality evidence on what works in tackling loneliness?

2.3. The landscape of UK loneliness interventions

The first part of the report was designed to update understanding of the kinds of tackling loneliness interventions which are currently taking place in the UK. Previous research has mainly identified interventions that address loneliness among older people,[footnote 17] and most examples in the UK have been drawn from work within the voluntary and community sector.[footnote 18] However, there have been examples of interventions designed for other age groups, for specific groups,[footnote 19][footnote 20] and in other contexts (workplace, healthcare). One aim of this report was to explore whether provision is becoming well-established in different contexts and for a wide range of age and target groups.

Another focus was to update understanding of the kinds of interventions that are being organised and of how they work to tackle loneliness. Several frameworks have been developed previously to define TL interventions according to broad categories and types[footnote 21][footnote 22] and similar categories have been used to describe interventions in research reviews of their effectiveness. Classifications include division into direct interventions, which involve work with people who may be experiencing loneliness, and indirect interventions, which involve making improvements, for example to physical, social, organisational, digital or whole-system infrastructure, which make loneliness less likely.[footnote 23][footnote 24] In one framework, direct interventions have been divided into community groups, supported socialisation (help from a professional, volunteer, friend or family member to make social connections), social skills training and psychoeducation, and changing maladaptive cognitions.[footnote 25] Another includes connector services (where staff make first contact with an individual and support them to access support and social opportunities), alongside psychological approaches, one-to-one support and groups.[footnote 26] A third framework uses categories which mix delivery mode (e.g. IT intervention), intervention type (e.g. social prescribing) and intervention focus (e.g. mental health).[footnote 27] Some projects incorporate multiple intervention types.[footnote 28] Due to the rapidly expanding loneliness evidence base, this report set out to determine whether UK interventions can still be classified within previous frameworks or whether it is necessary to extend or adjust them.

Some categories used to classify direct TL interventions in existing frameworks:

  • Connector services:[footnote 29] these ‘reach’ lonely individuals, seek to ‘understand’ the nature of their loneliness, personalise the response and ‘support’ individuals to access relevant help and services
  • Supported socialisation:[footnote 30] this involves help from a professional, volunteer, friend or family member to make social connections.
  • Psychological approaches[footnote 31]/Changing maladaptive cognitions:[footnote 32] these support people to overcome ‘maladaptive social cognition’ or unhelpful expectations, thoughts and feelings about their relationships.
  • Social skills training and psychoeducation:[footnote 33] these focus on training/education on social skills (e.g. conversational skills) and on managing mental health problems alongside emphasis on the importance of social support.
  • Groups[footnote 34]/Community groups:[footnote 35] these include a wide range of groups which are either purely social or where members engage in shared interest or activity. Participation may help individuals to develop social confidence and make new social connections.
  • One-to-one approaches:[footnote 36] This refers to various forms of befriending where an individual is matched with a volunteer or peer for companionship, to engage in activities or to support to connect or reconnect an individual to wider social contacts.

Furthermore, the current framework categorisations do not closely define the elements that make a particular intervention effective or ineffective. Research reviews of intervention evaluations highlight that they often do not extend to cover evaluation of how they work, or fail to work,[footnote 37][footnote 38] limiting our understanding of what makes an intervention effective. For this reason, an aim of this report was to gain insight from professionals with close knowledge of interventions about the ‘key elements’ of TL interventions.

2.4. Evaluation of tackling loneliness interventions

Government commitment to improve our understanding of what works to tackle loneliness included an intention to encourage a wide range of organisations working in this area to use consistent measures to evidence the impact of different approaches, thereby enabling comparison of their effectiveness.[footnote 1]

As part of this work, the Office for National Statistics (ONS) assessed the advantages and disadvantages of different validated measures of loneliness and set out recommendations for the consistent use of 2 measures. These were

  • A single, direct question ‘How often do you feel lonely?
  • Three questions known as the University of California, Los Angeles (UCLA) 3-item scale for adults:[footnote 39] ‘How often do you feel that you lack companionship? How often do you feel left out? How often do you feel isolated from others?’

Other loneliness measures include the Campaign to End Loneliness measurement tool, the 20 item UCLA loneliness measure and the De Jong Gierveld scale.[footnote 40] Throughout this paper ‘loneliness measure’ will refer to a range of available measures unless specified otherwise.

Five years later, there has been an acceleration in TL intervention evaluations including in the UK where many have used the recommended ONS measures[footnote 41], or other quantitative loneliness measures. The ONS measures have also been included in a growing number of population level surveys, supporting our understanding of levels of loneliness in the population as a whole and among different sub-groups, as well as risk factors for and impacts of loneliness. Although loneliness measures are an essential resource for understanding the prevalence of loneliness, there continues to be discussion and debate around whether the current available measures are effective when evaluating interventions. This discussion is partly taking place in the academic arena where researchers have examined the properties of different scales, and how far they are valid and reliable measures of different aspects of loneliness for different groups.[footnote 42] It is also taking place among practice focused organisations that are delivering interventions and who have been using measures of loneliness or have contemplated their use.

Presentations and discussions at 2 recent Campaign to End Loneliness research and policy forums on loneliness measurement[footnote 43] showed that there was some overlap in the concerns of these 2 groups. Both were concerned about how far the measures provide useful, accurate information about who is lonely and about the impact of specific interventions in reducing or preventing loneliness. In addition, practitioners raised concerns about the demands on limited resources of using the measures and lack of knowledge about how to use them. In addition, systematic reviews of evidence on intervention effectiveness have highlighted that evaluation evidence is of mixed and sometimes poor quality.[footnote 44] However, we do not have formal evidence on practitioner experiences of evaluation of their TL interventions or on the enablers or barriers to their use of loneliness measures.

3. Methods

3.1 Overview of methods

Engagement methods were designed to collect knowledge and experiences from a wide range of professionals who had involvement with varied TL interventions and their evaluation.

There were 4 stages of data collection:

  1. Interviews with ‘key informants’ who had overview knowledge of a broad set of TL interventions.

  2. Interviews with practitioners, funders, evaluators or researchers who had close knowledge of one or more particular TL interventions.

  3. A survey of professionals involved in the delivery of TL interventions.

  4. Round table discussions with experts in the field of loneliness.

3.2. Key informant interviews

First, the team interviewed 7 key informants. They had roles closely related to one or more of the following areas: policy (2 participants), practice (2 participants), research (2 participants) and/or funding (2 participants). These roles gave them overview knowledge of a broad set of TL interventions and their evaluation.

The aim of these interviews was to gain initial insight into types of intervention being implemented in different sectors or locations which could be followed up in the next round of interviews with TL professionals. Their areas of knowledge included the voluntary and community sector, local area and workplace provision, work on loneliness in clinical settings, digital interventions and work with younger people and older people.

Interviews were semi-structured and were carried out one-to-one, online. See Appendix A for key informant interview questions.

3.3. Interviews with tackling loneliness professionals

In the second stage of the engagement, 34 stakeholders were interviewed via a mixture of 1:1 interviews and focus groups of 3 to 4 people, to fit involvement within the short timeframes of this work. The aim of the interviews was to gain detailed practice-based insight into a wide range of interventions, how they worked to address loneliness, and the use and non-use of loneliness measures as part of evaluation of TL interventions.

Interviewees were identified via extensive Campaign to End Loneliness networks and from research published about specific interventions. The final sample included practitioners involved in organising or delivering interventions, funders, evaluators and researchers. The sample was developed to include professionals with knowledge of a wide range of intervention types and who worked with a range of different groups. See Appendix B for overview of areas of interviewee knowledge and experience. See Appendix C for questions used in interviews with these TL professionals.

3.4. Survey of tackling loneliness professionals

An online questionnaire was used to survey an additional sample of professionals involved in the organisation or delivery of TL interventions. The main purpose of the survey was to gather information from a wider group about use and non-use of loneliness measures within evaluations. Survey questions are listed in Appendix D.

The questionnaire was distributed via Campaign to End Loneliness social media channels and the Tackling Loneliness Hub[footnote 45] and received 49 responses.

3.5. Round table discussions

The final stage involved 2 round table discussions with 4 participants at each session who had high level expertise in research and evaluation, policy or intervention practice in the field of loneliness. The aim of these discussions was to encourage reflection on findings from the interviews about use and non-use of loneliness measures to evaluate intervention impact, whether these findings reflected the experts’ understanding and experience of evaluation practice and to explore how effective measurement of intervention impact should be supported.

3.6. Analysis of data

The main analysis involved the development of themes[footnote 46] from transcripts and notes of both sets of interviews. These were grouped under the key focus areas: intervention type; factors which determined the effectiveness of interventions; use of loneliness measurement within evaluation practice; and factors which supported or acted as barriers to the use of loneliness measures to measure impact. Within these areas, themes were first developed from the data for each intervention type and then elaborated and modified through comparison of themes across intervention types.

Findings from the survey take the form of simple percentage responses to questions or, when fewer than 20 responses to a question, frequency of responses to each option. A summary was made of round table discussions. Findings from both the survey and round table discussions are included alongside relevant interview themes in the findings section below.

3.7. Strengths and limitations of methods used

Existing networks and relationships enabled the team to draw on the substantial expertise of relevant professionals to gain rich insights into a range of current TL interventions and practices. However, drawing on these networks within the short time-frame for the engagement limited recruitment of participants from sectors with less established TL practices. For example, there were challenges in sampling interviewees with knowledge of psychological/clinical interventions where support is often not focused primarily on loneliness.

4. Findings on the landscape of tackling loneliness interventions

Direct TL interventions: These involve working directly with people who may be experiencing loneliness.

Indirect TL interventions: These involve making changes to physical (e.g. built environment), social (e.g. social attitudes), organisational (e.g. manager knowledge), digital or whole-system environments. Indirect interventions may support the functioning of direct interventions or themselves reduce the likelihood of loneliness.

4.1. Sector contexts for tackling loneliness interventions

Voluntary and community sector organisations were delivering many TL interventions involving direct work with people experiencing loneliness. A small number of examples were being delivered by private sector organisations, at universities, and in clinical settings. (It should be noted that some of the intervention types discussed, such as social prescribing, are sometimes delivered in healthcare settings although not in the examples here.) They included provision for a range of ages and were often targeted at specific groups including ethnic or sexual minority groups, disabled people, people who had been bereaved, carers, university students and former military personnel.

In the voluntary and community sector, most of the direct intervention examples had tackling loneliness as a primary aim, although it might be one amongst several. In other sectors this was not the case. For example, in youth work, well-established approaches (outreach work, talking through issues with young people, organising social groups and activities) were recognised as equivalent to different types of TL intervention but did not usually have addressing loneliness as a conscious aim. There were also examples of workplace interventions where loneliness formed a minor part of wider work on mental health and wellbeing.

Local authorities were delivering indirect interventions designed to increase and improve direct provision in the local area, to make local physical infrastructure such as housing and transport more conducive to social connection or to strengthen the area-wide system for addressing loneliness.

4.2. Direct intervention types

Overview

Direct TL intervention types described by interviewees corresponded to ‘Connector’[footnote 47], ‘Supported socialisation’[footnote 48], ‘Community groups’[footnote 49]/‘Groups’[footnote 50], and ‘One-to-one approaches’[footnote 51] categories in existing frameworks for describing intervention types. As such, findings did not indicate the emergence of new types of intervention or the need for additional framework categories. However, the fact that some interventions fell into more than one, reflected the fact that some categories from different frameworks were overlapping (e.g. social prescribing fell into the connector category as well as supported socialisation). However, categories from more than one of the frameworks may be needed. For example, ‘Supported socialisation’ did not well-describe the more focused first engagement ‘Connector’ work being done by outreach services.

‘Connector’ services included first engagement work (outreach, helplines and social prescribing/community connecting).

‘Supported socialisation’ work included one-to-one interventions that provided fuller support over a longer period for people to become less lonely (social prescribing/community connecting also fell into this category, along with befriending and peer support).

‘Groups’ provided opportunities for social engagement and forming connections with peers and took different forms (activity groups, social events, support groups).

‘One to one’ support, as in the original framework, referred to befriending.

Clinical interventions were little represented in the sample and these may have a particular focus on changing cognitions or psychoeducation which aim to address psychological aspects of loneliness. There were digital or online versions or components of these intervention types. Of interest was the fact that projects were evolving to incorporate more than one type of intervention within single projects to meet varied needs of participants. This is in line with previous findings.[footnote 52]

Outreach

Work to make initial contact with people experiencing loneliness was sometimes carried out by skilled workers with a specific first engagement role. This was designed to find people in need of support but who did not necessarily recognise this or for various reasons did not want to do so. Outreach staff actively sought out contact with people experiencing loneliness: interviewees gave examples of this kind of outreach as part of work with older people and as part of youth work. This would involve going out to start conversations and engage people on the street, in housing or elsewhere in the community. In the case of youth work, it could also mean using established community relationships to bring them into contact with young people experiencing loneliness.

Helplines

Helplines might also be a first port of call for individuals with complex problems or in crisis but who had not previously accessed support. An example was given of a helpline where callers might spend a matter of hours on the phone sharing difficulties which had developed over years.

Social prescribing and community connecting

Social prescribing and community connecting were described as involving work to address an individual’s social, emotional or practical (but non-medical) needs which act as a barrier to good health, functioning and wellbeing. It involves a worker giving time and space to engage in an informal 1:1 assessment process to unpick those needs. Loneliness is frequently found to be high on the list of problems. Addressing these issues is likely to involve providing help to navigate different options for support: for example to identify social activities which match needs and interests or to access a befriending service. Depending on the individual, help may simply involve signposting to such services. However, it is often likely to involve the social prescriber or connector in more actively supporting an individual, for example by accompanying them to a new group until they have the confidence to attend independently.

Befriending

Befriending was described as being focused on the relationship between a person and a volunteer. Beyond that there could be a range of different formats. A traditional form of befriending might be for a volunteer to visit their ‘friend’ regularly for a chat or to offer peer support. Alternatively, a befriender might accompany someone to a small social group and support the development of peer relationships between those attending. In other cases, a befriender might work with their friend on an agreed skill or take on a mentoring role: an example was when an adult was a befriender to a young person in need of support, with a range of issues including loneliness. Like a social prescriber, this would involve talking about challenges, needs and interests and providing support to taking next steps to addressing needs. However, the relationship would form a necessary basis for this support since it underpins trust and confidence necessary for the individual to engage with help being offered. The aim would be for this ‘friendship’ to feel genuine but, usually, safeguarding requirements and the fact that this relationship was supported and overseen by an organisation meant that:

It isn’t an equal relationship…[However], at its best, it feels almost as close to a normal, good friendship as you can get. But it isn’t, because it’s always got a sense of rules and boundaries around it.

Activity groups

Activity groups might be open to anyone or were sometimes targeted at particular groups, such as younger or older people or people from a shared community. These were groups where people could engage together in a joint activity or interest - for example, a creative activity, carpentry, a choir, gardening, outdoor gym, to watch a show - or where participants engaged in an activity alongside one another.

Social groups and events

Social groups and events might be open to anyone or provided for particular groups. They provided a convivial atmosphere by providing refreshments or a meal along with opportunities for general socialising and sometimes entertainments or activities.

Support groups

Support groups were aimed at people who had particular shared life experience and faced common challenges: for example, they had been bereaved, served in the military or were part of the same ethnic or sexual minority group. Support groups also provided yet another context for staff to help participants access other support and services relevant for addressing a wider set of needs. In some cases, elements of these different kinds of groups were combined.

Clinical interventions

There was little representation of clinical interventions in the sample. However, interviewees with knowledge of social prescribing and social support groups mentioned that some participants experienced complex psychological problems which contributed to their loneliness and which could not be addressed by non-clinical staff. One said that their support group was often a place where members first talked about their difficulties and then could be encouraged to seek help from a counsellor or therapist.

Digital and online elements

There were digital and online elements or versions of befriending, activity groups and support groups. Examples included befriending which took place online instead of face-to face, an app which was used to set up face-to-face meetings, apps which provided practice in the use of social skills and a button which was pressed when someone felt in need of conversation and linked them by phone to someone else in a group who they could chat to. While there has been speculation about the role that artificial intelligence[footnote 53] can play in addressing loneliness, those we interviewed for this report emphasised the importance of using technology to facilitate rather than replace human interaction and connection:

Technology isn’t the answer. It’s just part of the solution.

4.3. Indirect intervention types

Interviews highlighted indirect intervention work being done particularly by local authority public health teams.

Physical infrastructure

Indirect interventions might involve providing physical infrastructure which could reduce the likelihood of loneliness, for example by providing public spaces where social interaction is likely or transport connections which enable safe, easy travel to local amenities and places where social activities are taking place. Examples came from one local authority where tackling loneliness work was being led by public health staff. This included a focus on reducing loneliness through encouraging improvements to neighbourhood and housing design, natural and sustainable environments and transport. An aspect of this work was that public health staff were working with planners and others who had influence over new developments to incorporate health considerations - including loneliness - into planning requirements.

Organisational infrastructure

Other indirect interventions were aimed at developing social, cultural and organisational conditions to support the development and effectiveness of direct interventions.

This included awareness-raising activity to highlight the prevalence and importance of addressing loneliness. One interviewee described a website, a set of webinars and associated communications activities being developed for local businesses to highlight loneliness alongside other workplace mental health issues. Providing training about how to address the issue was another component of this work and was intended to equip managers to mitigate staff loneliness. In other cases, training or mentoring was offered to public-facing employees or to staff delivering tackling loneliness interventions to enable them to identify individuals who may be lonely and to engage with them supportively.

Whole systems work

County- or local authority-wide work was also being undertaken to improve the provision of direct interventions. This included commissioning and ongoing-support for local organisations to set up and run direct interventions such as social-prescribing services or social groups.

There were also examples of wider systems level work which was being undertaken. This had a number of strands:

  • understanding local factors affecting loneliness such as issues for residents in rural or deprived locations or the challenges faced by particular groups such as young people or minority groups
  • supporting the development of a coherent, interconnected set of loneliness-focused services and approaches so that, for example:
    • local people know about activities on offer
    • transport infrastructure supports access to such activities
    • there are strong networks of local organisations enabling staff to refer someone attending one project onwards to another service that might help address specific barriers to social connection
  • identifying and addressing barriers to bringing about change in the system — this might mean putting appropriate high level leadership structures in place, or it might involve building trust and communication between different organisations (for example, by developing local alliances of organisations and services working to tackle loneliness)

Interviews highlighted the potential complexity of such work:

[They are] based on a complex history, I suppose, of how public and voluntary sector partners have worked together in the past, and power dynamics and commissioning, and procurement and all of those things in the mix around really how we work together to tackle those wider system elements.

4.4. Blending intervention types

One notable point was that several different types of intervention were sometimes merged within a single project. Combining interventions might help to reach a wider range of people.

The project has a mixed model - they are based in volunteer-led befriending … they also run community gatherings - events of around 30 people in the community.

Combining interventions might also contribute to their effectiveness. For example, transport to and from a social activity could become a space for social interaction which was central to the formation of relationships; social activity groups that developed physical infrastructure such as a community garden or space developed strong bonds to one another and to those places. In addition, there was an example of a project which had started as a social group but had expanded to provide support groups for those with particular needs and to develop transport provision so more people could access the group. As such, holistic systems of support for tackling loneliness were being developed from the 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.

4.5. Key elements of intervention effectiveness

Overview

While some interviewees emphasised certain factors that were central to their intervention, they also talked about a blend of ‘key elements’ which were important for effectiveness, suggesting that they were creating multi-layered support systems. Table 1 shows some of these key elements (described next) and how they were referred to across different direct intervention types. It illustrates how interventions with different labels shared many of the same key elements. This overlap raises challenges for evaluating the relative impact of different ‘types’ of intervention.

Table 1: Key elements of interventions mentioned by interviewees with knowledge of different intervention types

Key elements of interventions First engagement Helplines Social prescribing/connectors Befriending Activity and social groups and events Support groups
Using the language of loneliness or not ✔ - ✔ - ✔ -
Gentle and supportive first engagement ✔ ✔ ✔ ✔ ✔ ✔
Support to unpick and address problems; to identify interests and next steps ✔ - ✔ ✔ ✔ -
Working in partnership ✔ - ✔ ✔ ✔ ✔
Trust and relationship building ✔ - ✔ ✔ ✔ ✔
Providing conditions for social engagement - - - ✔ ✔ ✔
Opportunities for learning social skills - - - ✔ ✔ -
Opportunities for participation and growth in confidence - - ✔ ✔ ✔ ✔
Being responsive to need or person-centred ✔ - ✔ ✔ ✔ ✔

Building trusting relationships’ and ‘Being responsive to need or person-centred’ were particularly prominent key elements in interviewee accounts and so are described first.

Building trusting relationships

The development of trusting relationships with staff, volunteers or peers was an aim of TL interventions. It was also described as a necessary precursor to addressing wider challenges which might contribute to loneliness.

It is about that volunteer, in those first few months, getting to know the person … not going in with our set idea of in 6 months’ time as a young person, you’re going to attend this youth club, you’re going to do this and you’re going to do that.

Interviewees mentioned a number of additional factors which could contribute to the development of effective relationships:

Gentle and supportive first engagement discussed below as a starting point for establishing trust and an initial connection.

Shared identity and life experience was mentioned as an important basis for trust and connection between people from a sexual or ethnic minority group or who had particular life experience or needs. This could provide a sense of being understood. Alternatively, for some people there was a benefit to being part of a mixed group which better reflected wider society.

Individuals may have varying needs or preferences for relationships which are more or less reciprocal. For example, some individuals expressed a preference for spending time with peers who had shared experiences; others valued a befriender who was ‘just for them’ and took on a supportive or mentoring role.

Matching was mentioned in relation to befriending. There was some suggestion that this was not essential to making a befriending relationship work. However, there were examples where a great deal of effort was made to get to know both parties and consider their interests and needs in order to make matches which were perceived as resulting in increased numbers of successful relationships. And random matching could be problematic: in the case of a project where an app was used to randomly assign students to meet offline, there were instances where people did not get on well, causing damage to self-esteem.

Proximity. Examples involving sharing of transport illustrated how bringing people into close contact could have a powerful impact on the development of relationships.

“If you have got the same person picking you up, there is a certain intimacy, I think, to somebody who’s coming, knocking on the door, helping you maybe get your coat on, helping you to the car… that’s 40 minutes that day, where it’s just you and that person.”

Time was necessary for allowing relationships to develop. Some interventions were dependent on the development of a relatively short term client-professional relationship that lasted a number of weeks. In other cases, such as befriending, it was often seen as important for fuller relationships to be allowed to develop, which could take many months.

Being responsive to needs of individuals and groups

Running throughout many descriptions of interventions was an emphasis on being responsive to need or being person-centred. This had a number of different meanings.

In some instances, this referred to the development or evolution of a service to meet the needs of participants. It also referred to the process of getting to know someone, unpacking their challenges, identifying necessary support and interesting opportunities for them to pursue, and helping them to access these. In addition, being person-centred was discussed in terms of micro-level interactions. This could be in terms of staff or volunteer responsiveness within a conversation which depended on attentive listening and was described as ‘dance-like’ by one interviewee. Alternatively, it could be about making someone feel comfortable in other ways, for example by allowing someone to just have a quiet cup of tea and be more on the periphery of a social get together:

[It] often helps people, especially the ones that are reluctant to come in or aren’t quite sure, or…you can make little interventions that help people feel engaged without putting them centre stage as it were.

It was also important to make adjustments for different groups:.

  • Places and locations of a particular type — including online spaces — were welcoming for different groups. These were mentioned in relation to younger people, older people, those suffering with anxiety, LGBTQ+ groups and particular cultural groups, for whom ‘culturally competent’ centres were comfortable because they were developed by community members in line with their beliefs and values. In addition, accessibility of places was an important part of creating inclusive places for people with disabilities.
  • Shared community with those offering support. Support offered by staff or volunteers within a community and a shared language could be fundamental to the development of trust and understanding of needs.
  • Content of intervention activities. It might be relevant to address particular issues for some groups, for example safe use of social media by young people. It might also be important to consider whether interventions are developmentally appropriate. For example, children might prefer to take part in practical activities rather than discussion.
  • Language, communication and social skills. This could, for example, be about language of intervention delivery for non-English speakers or about use of sign language for deaf participants. Learning and development of communication skills might also be a focus for intervention activities. This was the case for a befriending project for people with disabilities where participants might choose to focus on developing aspects of their communication. In another example, an intervention for neurodiverse and disabled young adults, there was particular emphasis on encouraging social skills and confidence through enjoyable social events.

Using the language of loneliness or not

Some interviewees emphasised negative aspects of using the term loneliness in relation to their project. Stigma meant that people did not want to be recognised as lonely and would therefore not engage.

And that was something that the guest said was really important to them was that it looked like they were going to a cafe, they weren’t going to a room in a village hall or in a civic centre or something like that, with a sign saying lonely people this way. You know, it was very much just, a normal sort of thing.

However, in other cases those involved in running social groups said that advertising which stated their event was for lonely people had actually increased attendance. It might also be more acceptable to talk directly about loneliness in a one-to-one context such as social prescribing because the participant was attending for help with problems and went with an expectation that difficult issues would be discussed.

Gentle and supportive first engagement

A key concern was to make gentle first contact with a person and to create conditions for them to engage with support they needed. This could mean going to talk to people in their own neighbourhoods or homes where they were comfortable, or creating welcoming places which encouraged them to overcome hesitancy and cross the threshold.

At the centre of everything is making people feel special…it’s about a home from home.

A supportive conversation could help someone to be open minded about accessing activities or help which might be beneficial; a Facebook group or drop-in session could allow an individual to be on the periphery of a group before actually attending; staff and volunteers had an important role to play in welcoming an individual or, as with some social prescribers, accompanying someone to a group or activity at the outset:

Some [people] that are particularly isolated, [they] can start to feel really anxious …taking that step to go out and actually, you know, to try to get involved with something…So we can take a bit of a different approach with our students and go along to the sessions with them. So, for example, I’ve taken students along to yoga classes, volunteering days, and actually done the activity with them.

Understanding needs and helping to access support

A key function of TL interventions was to help participants to unpick and address problems they were experiencing which might be acting as barriers to social connection; and also to help them to navigate and access social opportunities of interest to the individual and other relevant support.

The community worker who went to those people, and they originally thought that they were just going to quickly hand them over to a volunteer for befriending…And they realised when they got there, that those people that they were meeting, by this stage, had lots of other issues. So they’d have other health issues, they’d have access issues, they might have mental health issues as well.

Where loneliness was associated with difficult life experiences or mental health problems, this might mean supporting an individual to access intensive specialist support such as counselling or psychological therapy.

Providing conditions for social engagement

This entailed creating social environments that would provide enjoyable, unpressured social experiences, or encourage social interaction. Different environments could suit people with different preferences. Some might have more focus on social interaction whilst others might involve an activity or event which participants could engage in with less requirement for interaction.

Creative interventions are more valuable if pursued in a group … The sense of achievement is really important to increase self worth. It can be a key to unlocking more resilient behaviours.

Staff members and volunteers played a crucial role in fostering positive interactions, whether by themselves engaging in conversation with participants or by encouraging interactions between them. That might be through planning engaging activities. It might be supporting conversation by introducing interesting topics of conversation, using prompts or by being on hand to keep the conversation flowing.

It’s like an iceberg - the bit above the surface looks normal but below the surface is where the work is.

Development of confidence and skills through participation

Building trusting relationships and accessing engaging activities which an individual found interesting provided foundations for increasing social confidence. Interventions provided contexts for learning and practising social skills, modelled or supported by staff, volunteers and peers, which could be learnt and practised.

Interviewees who talked about befriending and social group interventions gave examples of people who engaged in a very tentative way when they first joined, but had grown in confidence and progressed to being volunteers themselves or adopted a leading role within a group. This had increased their confidence still further. They also talked about people who had developed confidence to such an extent that they no longer needed the support and had left the intervention. However, one social prescriber noted that there were dangers if someone did not enjoy new social contact since that could reinforce their sense of social inadequacy.

4.6. External factors impacting intervention effectiveness

Interviewees also talked about factors external to delivery of direct interventions which could influence their effectiveness. These included:

Funding and organisational capacity.

Skilled staff and volunteers meaning that organisational capacity to support and train staff was crucial.

Leadership and governance that focused on making tackling loneliness a consistent priority.

Theory informing practice. For example, a clear theory of change could help to guide development.

Working in partnership across a system of support. Supporting individuals to access relevant help required the presence of a network of services. Knowledge of other organisations in an area was therefore important and relationships between different providers could make onward referrals smooth.

Physical infrastructure. Appropriate venues were needed for interventions along with travel routes to access them.

5. Findings on the use of loneliness measures to evaluate tackling loneliness interventions

This section includes findings from interviewees on why practitioners and organisations were using loneliness measures and how their use sat within wider evaluation practices. It also presents findings from interviewees and round table discussions on barriers to the use of measures, to their rigorous use and on factors that can help to improve use of measures.

5.1. Reasons for use of loneliness measures

Survey finding

Of the 15 respondents who reported reasons for using loneliness measures:

  • seven said that the primary reason was for assessing participants’ needs or demonstrating progress to them
  • four said it was to provide information to support improvement of the intervention
  • three said it was to meet funder requirements
  • one said it was for research purposes or to contribute to the evidence base

Measuring and demonstrating impact

For several delivery and funder interviewees, data generated by use of loneliness measures was reported as one useful way of showing the effectiveness of an intervention. Consistent use of the recommended measures was also mentioned by some interviewees as a valuable way to compare the impact of different projects. In some cases, this data was included in published evaluation reports.

Funder requirements

However, there was also widespread scepticism about how well current available measures demonstrated impact of an intervention and concern that they might negatively impact project participants. Interviewees both from organisations where the measures were being used and where they were not expressed such doubts. Where they were being used by those with doubts, requirements by their funders were often the motivation for doing so (specific reservations of both those who did and did not use loneliness measures are detailed in Section 5.3 and Section 5.4).

Assessing individual or local need

Interviewees also talked about uses of loneliness measurement other than evidencing the impact of an intervention.

Firstly, they could support one-to-one conversations with intervention participants about their loneliness. This was mentioned, for example, in the context of a clinical intervention and of social prescribing, where loneliness measures were used as part of a screening tool and formed part of a wider conversation with clients about their mental health and tracking of progress.

And it’s really good because they are open questions - they open up the conversation. They tell me how often they feel lonely…It takes me a long time to assess people because they really start people talking. It helps us to better help them. When we close a client, we help them reflect on how they have improved - that can be really powerful… “When I started, I said I was lonely all the time and now I feel lonely some of the time.

Secondly, local population level loneliness data was used to provide context for interventions. This was noted by interviewees working on indirect interventions. For example, local data could be used alongside other indicators to target action by highlighting different levels of loneliness in different parts of a county. Local data was also used to provide context for some small-scale direct loneliness interventions, for example to demonstrate the need for the intervention to funders.

5.2. Evaluation practices

Survey findings

Of 48 who answered:

  • nineteen (40%) said that one or more measures of loneliness had been used to evaluate their loneliness intervention
  • twenty-two (46%) said that a measure of loneliness had not been used
  • seven did not know

Of 19 respondents who reported use of loneliness measures:

  • five reported using the ONS direct measure
  • two the UCLA-3 measure
  • one another UCLA measure
  • two the Campaign to End Loneliness measure

Ten respondents reported use of a different measure. These were mainly unstandardised.

Overview

There was wide variation in the evaluation practices of organisations represented by interviewees. This included differences in the overall extent of evaluation activity as well as in evaluation methods used. There were examples of evaluation led in-house by staff with and without evaluation expertise, and of organisations that used external evaluators and/or were part of a bigger programme where the funder prescribed evaluation requirements.

Varied use of loneliness measures

Organisations not using loneliness measures included those which were very small (with 1 employee or run entirely by volunteers), in their first 2 or 3 years of operating and/or were still developing their evaluation approach. There were also larger, more established organisations where the decision had been made not to use them.

Where loneliness measures were being used to evaluate impact, models of evaluation included the use of pre-/post-test measures either with or without comparison groups. There was one example of a larger organisation with its own evaluation staff who had organised data collection, including of loneliness data, at scale from project participants at 6-monthly intervals. This would enable them to compare different services they delivered and, in the longer term, to build a longitudinal dataset which would allow examination of patterns over time.

There were no examples of organisations using measures of loneliness as their sole evaluation tool.

Use of alternative measures

In some instances, there was use of quantitative measures focused on priority outcomes of an intervention other than loneliness.

Because social prescribing is so wide in terms of the things that it’s addressing…I think we would like to have more in-depth questions around loneliness, and use some of those standardised tools. But because we have to ask about so many different things, we just have to limit the number of questions we’re asking people.

There were also some cases where being person-centred meant project participants were involved in choosing what those measured outcomes should be. Based on what they wanted to get out of participation in a project at the outset, this might, for example, mean measuring whether they had improved their friendships or communication skills rather than whether they had experienced a reduction in loneliness. Several interviewees also described use of ‘tailored’ measures* which referred directly to the impact of their project.

Qualitative methods

Qualitative research and evaluation methods are used to study peoples’ subjective experiences, opinions and attitudes by analysing non-numerical data often collected using interviews and observations. Qualitative methods were widely used to evaluate intervention impact. Some organisations had devised approaches which were minimally intrusive. This could consist of light touch data collection to avoid discouraging people from attending an informal intervention, for example, asking them to indicate on a postcard how they were feeling at the beginning of a session and again at the end. There were also examples of light touch interventions where any collection of data from participants was deemed inappropriate. This was the case for one interviewee involved in first engagement work which involved going out into the community and using a very light touch approach to engage older people who may be experiencing loneliness. This might be a one off meeting where the aim was to make positive contact, establish some trust and signpost/support onwards to other services or social opportunities. In this case, data collection was confined to documenting the type of interactions including indications that a person they had met might be lonely:

We noticed certain kinds of patterns and qualities within interactions…So these were things like…they hold you in conversation, because they’re obviously, you know, they really need that social connection. Or it could be that the person you met, chose to tell you something about their mental health or a bereavement…So we had our own set of indicators, which told us…this person really needed that interaction.

A number of interviewees explained how qualitative data could do more justice to the experiences of project participants than the measures and provide fuller insight into the functioning of an intervention, informing adjustments and improvements.

One of the things that we’re always doing, when we do any consultation, is trying to step back and say, “What is it that matters to people when you just have a conversation with them?…What is it that they emphasise if you just ask them to describe the activity that they’re involved in? Or the relationships that they’re building? …What is it that matters to them?” Because then, eventually, over time, we can have enough evidence to say, “Okay, maybe things that we anticipated as having an impact, aren’t so important”… Over time, I’d like to think that we can be responsive to that.

Another suggested that in contrast to the experience of completing a questionnaire, project participants could find it engaging and enjoyable to share their experiences qualitatively.

So we are using smaller well-being measures, we’re using smaller loneliness measures to try and just get that snapshot. But then it will be backed up, with the qualitative evidence…the case studies, the quotes, the sound bites, the social media posts, all of those, flesh those out. And in that way, people don’t actually think that they’re answering surveys; they’re chatting about their experience.

Round table participants strongly agreed that findings reflected their own experiences of practice in measuring loneliness by organisations. They made additional comments about the growth of valuable evidence which can inform efforts to tackle loneliness. Firstly, they noted that the amount of evidence on loneliness interventions has increased significantly in the last 5 years, which demonstrates that while there may be scope for improvement, there has been real progress. There was also consensus that the use of the ONS measures in a growing number of population level surveys had transformed our ability to understand levels of loneliness in different sub-groups, as well as the drivers and correlates of loneliness. This has been a major addition to the evidence on loneliness.

5.3. Barriers to the use of loneliness measures

Survey finding

Of 46 who answered:

  • eleven respondents (24%) said that there were no barriers to their use of loneliness measures
  • a further 11 cited the fact that loneliness measures are not tailored to their intervention as a barrier to their use

Of 48 who answered:

  • twenty-four respondents (50%) reported that project delivery staff were involved in evaluation of their interventions
  • by contrast only 8% said that an external evaluator was involved and only 4% that an internal evaluation specialist was involved

Capacity of organisations

Lack of capacity and specialist evaluation knowledge presented a barrier to carrying out evaluation work including the use of loneliness measures and to using them well. This was a particular issue for smaller, newer organisations:

It’s something we know, we need to do better, we just don’t really know how to do it.

In some examples, staff who were delivering interventions had responsibility for collecting data and this approach leant itself to being carried out in a relaxed and supportive manner. Participants had a pre-existing relationship with the person requesting completion of the measures who could also provide support with completing questionnaires for people with limited literacy or who had difficulty understanding questions. This approach ensured much better response rates compared to posting or emailing out questionnaires. A downside of this face-to-face data collection was that responses could be biased by the presence of someone involved in project delivery since participants might feel under pressure to report improvement. In addition, sometimes project staff lacked understanding about how to collect data in a rigorous manner. There was one striking example of staff using conversations with participants as a basis for completing the loneliness measure themselves.

Survey finding

Of 48 who answered:

  • twenty-nine (60%) of respondents said that they did not have specific funding for evaluation of their intervention

Of 46 who answered:

  • nineteen (41%) said staff or organisational capacity was a barrier to use of loneliness measures (this was the most frequently cited barrier)

Sensitivities of asking questions on loneliness

As highlighted above (see Section 4.5), person-centredness - being sensitive and responsive to the needs of individuals or the target group - was identified by interviewees as a key aspect of effective tackling loneliness interventions. A number of interviewees felt that use of measures of loneliness was inconsistent with such an approach and with a wish to monitor outcomes ‘*kindly and sensitively’.

The use of any kind of measure was discussed by some interviewees as being incompatible with some very light touch or informal interventions. In other cases, there was a difficult balance to be struck. One concern was that collection of baseline loneliness data could potentially make new participants feel stigmatised and could put them off attending altogether.

‘We don’t ask people to register to attend…you know, people can literally just turn up and leave again without us ever knowing who they are…. So a big piece of work…is figuring out how we collect that data and, therefore, are able to evaluate our work without, I suppose, putting in place some of the barriers that we think are the reason people come to us rather than other groups. So it’s sort of stuck between a rock and a hard place.’

We definitely had pushback from [staff] at the beginning of a project about the fact that when they did the survey with people, they would go, “I’m not lonely” and they’d be off and they’d never see him again…And people didn’t want to be lonely…They thought they were just people.

Similar concerns were expressed by some interviewees in relation to use of questionnaires with established participants, where there was potential for participants to become distressed through answering even positively-worded questions. In the following case, experience of trialling a different wellbeing scale as part of evaluation work meant this organisation leader had strong reservations about the use of loneliness measures.

….but it did more harm than good. And it was really distressing for people and it took away from the fact that actually befriending brings joy and it does make a difference and usually when people come away from a review, the reviewer is like, “Oh, this is amazing. These are the brilliant things that people say.

By contrast, one interviewee cited evidence that project participants did not generally mind answering loneliness scale questions and would say when they did not want to answer them. However, they said that staff often felt awkward about asking the questions and that support and training were needed to help those administering the questionnaires to do so in a rigorous but sensitive way.

Concerns about the limited usefulness of loneliness measures

In addition to concerns outlined above related to the sensitivities of measuring loneliness, some interviewees expressed reservations about the value of data generated by loneliness measures.

Firstly, there was a particular concern about the recommended UCLA-3 measure that it had been validated as a screening measure but was not intended to measure intervention impact and was not sensitive to change.

Secondly, interviewees raised questions about whether available loneliness measures were suitable for use with specific participant groups including children, people with learning difficulties and people from certain minority ethnic groups who might not understand some scale questions or understand them differently.

Thirdly, there was a perception that, when used at the level of a single intervention with a relatively small group of participants, loneliness data would be influenced by other events in participants’ lives or by their state of mind, and so would not be a valid reflection of project impact.

The effects on older people can be so varied by their other circumstances…So, you know, their figures would have, theoretically should have gone up, they were in a better place. But actually, because they’ve been diagnosed with a long-term condition or somebody had died, a friend had died, something has happened, they’ve had to go into a nursing home, you know, all those other life things, then affected their score so much, that it kind of it meant it was really hard to see on paper what had changed.

This had led to discussion within some organisations about whether there could be flexibility in the timing of data collection to avoid moments when individuals were experiencing particularly negative life events that might skew findings. As such, there was potential for staff judgements to bias loneliness data.

At the same time, some organisations had collected measure data at a large scale, from a range of different groups implementing the intervention, which minimised the impact of such external factors on findings. This allowed detection of statistically significant reductions in loneliness. However, such large-scale data collection led to the loss of specific contextual data, which meant that it was hard to gain insight from the data about which aspects of an intervention were or were not impacting on loneliness.

I think there is huge value in the quants [data]. And in those measures, as we build our body of data, to look for patterns, to look for evidence of change and the extent of change…. [But] when I came to the literature and …there was such a drive for, “Everybody needs to be asking the same questions, and we’ll just have a huge big database from all of these different organisations, and that will unlock the secrets of loneliness.” And just, I’m not convinced of that.

As mentioned above, **round table participants noted that use of the recommended measures had helped to significantly advance our understanding of loneliness. However they acknowledged that the recommended loneliness measures were not ideal for measuring the kind of change that could be brought about by interventions since:

  • they were not designed to measure change - they were meant as a screening tool or to understand population levels of loneliness
  • they only focus on frequency of loneliness rather than intensity and duration
  • they may not be sensitive enough - an intervention may only be really trying to affect one aspect of a person’s loneliness and so may not bring about change in measurement scores. For example, befriending is focused mainly on companionship
  • they are negatively worded - although there is some evidence that this may not have the negative impact on participants that project staff sometimes believe it does

Other limiting factors mentioned in relation to these kinds of measures include:

  • many services do not reach enough people to carry out loneliness measurement at a scale which provides data that could show a statistically significant effect of the intervention
  • loneliness measure questions are sometimes included as part of long questionnaires so undermining validity, for example because of response fatigue
  • some services are deliberately informal and without clear end and start dates - this means asking the measure questions can be jarring and the definition of ‘pre- and post-intervention’ becomes complex

Impact of funder requirements to use measures on motivation to evaluate

Funders who were interviewed emphasised the importance of not overburdening funded organisations with demands to use evaluation methods which were not useful and mentioned work they were doing to support organisations in this aspect of their work. This included provision of evaluation resources and guidance. However, other delivery organisations who had to undertake evaluations reported they were not supported when evaluating their interventions. A number of interviewees indicated that the reason their organisations used loneliness measures – or a particular loneliness measure that was not their first choice - was because it was required by funders. An interviewee from one small organisation said,

And in fact, one of the town councillors sort of brushed an idea aside saying, unless it could be measured, they weren’t interested.

This often explained why they were being used despite substantial reservations about their appropriateness or value. Such imposition of evaluation methods could create a sense of burden and disillusionment for organisations with limited capacity and that wanted to focus on delivery.

But it is something that we find it kind of just a necessary evil, that you need to have that kind of stuff on applications…people just want those sort of headline stats.

One evaluation specialist expressed resentment that funders did not actually engage with the data or use it to provide useful feedback which could inform service delivery. As such, time-consuming evaluation work was seen as a waste of time and effort.

I feel like I produce the same report year after year - I’d like to do a deep-dive after a couple of years into specific topics. I don’t think anyone ever reads this at [the funder] - we never get any feedback. I’d be really interested in help to be more thoughtful about the service to inform design: for example, how many hours does it take for someone to become friends? … not just produce the same information over and over again.

5.4. What is needed to improve the use of loneliness measures?

Survey findings

Of 45 who answered:

  • twenty-eight (62%) of respondents said they would welcome additional support for using a measure of loneliness to evaluate their impact
  • twenty (44%) of those who wanted support currently had none
  • twenty-eight respondents specified support which would be helpful:

A smaller number thought that it would be helpful to have advice surgeries (offering advice on planning an evaluation, data analysis and communication of findings)[footnote 57] or trouble shooting drop-in sessions (for sharing evaluation problems and possible ways of addressing them).[footnote 58]

Both round table participants and interviewees suggested actions which could support the use of loneliness measures as well as evaluation more broadly.

Loneliness measures

There was clear agreement that the inclusion of the recommended measures in population level surveys had led to very considerable advances in our understanding of loneliness.

Round table participants suggested exploring whether there are practical ways to supplement or target the recommended loneliness measures to improve their appropriateness/value in measuring the impact of interventions over time. This could ultimately include a review of international evidence on loneliness measurement as well as engaging with leading UK stakeholders - practitioners, academics, funders and policymakers - to produce a more nuanced set of recommendations on intervention evaluation. This could consider which measures are most useful in terms of sensitivity to intervention impact, ease of use and acceptability to organisations who use them. This may also require producing evidence on how well measures work for different groups, for example whether loneliness measures have similar meaning to people who speak different languages. Finally, it should examine at what scale and how established an intervention should be before it is advisable to use loneliness measures to detect statistically significant impacts.

However, while suggesting the need for a review to ensure we are using the optimal measures, round table participants did not say that the current measures should be discarded. There are benefits of the current standardised approach which is contributing to our understanding of what works to tackle loneliness. One interviewee also pointed out there would be transitional costs to a change in measures as it would undermine datasets that have been built up so far.

Provision of training and guidance for staff without evaluation expertise

Both interviewees and round table participants emphasised the need for properly resourced training and guidance for people carrying out evaluation work. They noted that this should cover how to ask measurement questions robustly and sensitively without over-burdening project participants, at what stage in an intervention to ask questions, and how to analyse data.

There was consensus that it would be useful for organisations to have more support on how to understand measures, develop evaluations and engage staff and volunteers in the evaluation process.

An important part of this would be to facilitate learning from organisations carrying out evaluations well. Partnering with skilled evaluation staff would provide less experienced practitioners with opportunities for individualised support with the intention that this would lead to the creation of more impactful evidence.

Guidance to and from funders and commissioners

There was also support from round table participants for providing guidance to funders and commissioners about how they can best support appropriate evaluation practices. This could inform their evaluation work with fundees and include highlighting uses of loneliness measures for different kinds of interventions. For example, some TL interventions work quite indirectly (e.g. provision of transport for accessing social activities): here the role of loneliness measurement would be more about providing population level data on loneliness levels to demonstrate need in an area. Equally, there are some types of service where it should be clear that it is practical and realistic to use loneliness measures and their completion can sometimes be used as part of a conversation which helps build relationships between staff and project participants, for example, in social prescribing.

Interviewees were also concerned that funders should recognise the value of evaluation methods other than measures and scales and, particularly, qualitative approaches. Additionally, both interviewees - including several funders - and round table participants said that funders and other relevant bodies should provide clear guidance and support to make evaluation requirements manageable and to help organisations build their evaluation capacity. They should not be asking for data that would not be used. Funder interviewees talked about their awareness of these issues and efforts they had made to address them.

Exploring ways to lessen the burden on project staff

Interviewees suggested approaches which might help to relieve the evaluation burden for organisations with limited capacity.

Two organisations used volunteers to collect evaluation data. As well as reducing costs, this work was described as providing an interesting volunteer opportunity for individuals who might have considerable, relevant professional experience. However, the need for substantial training to make this role work was also emphasised. This would need to include training on data protection and ethical responsibilities.

Another way to both lessen the load on organisations and remove the possibility of biasing responses was to automate questionnaire completion. In one example, a funder emailed questionnaires directly to project participants. The disadvantage was that response rates were poor, there was potential for excluding participants who needed help to understand questions or respond to them, and those who had limited digital access or proficiency. It might then be that digitally automated approaches might potentially be more suitable for projects with digitally competent participants

Co-production of evaluations

Round table participants stressed the need for people delivering interventions to be involved in the development of evaluations and really understand the reason for methods used.

Existing high quality evidence limits the need for frequent, full-scale evaluation work

Round table participants also suggested that there was not a need for frequent, ongoing use of measures. In one example, an organisation carried out a high quality evaluation with trained researchers to evidence the impact of their intervention model after it had been developed over 5 years. However, having done this they focused their resources on delivering the service and using lighter touch, less burdensome forms of monitoring and feedback. This enabled them to maintain quality and adapt their service in response to need and circumstances.

Round table participants stressed that if organisations adopt this approach, it should not mean stopping all monitoring and evaluation after the initial main piece of work has been done. However, there was agreement that it would be worthwhile to investigate whether this could be a way of collecting evidence in a practical, cost-effective way. Ideas for ongoing quality assurance included checking that services were reaching those most in need and collecting qualitative feedback.

In support of this intermittent high quality kind of evaluation model, several interviewees suggested that there was already enough evidence about the impact of their type of intervention, limiting the need for frequent measurement. One also noted that large-scale loneliness data may itself help to answer the question of when use of the measures was no longer needed. Specifically, longitudinal data might indicate the point at which their intervention had made an impact and was not yielding any additional reductions in loneliness.

Data linking

One round table participant suggested that the ability to link loneliness data to existing administrative datasets (e.g. healthcare data) could support understanding of the impacts of interventions on wider resource use (e.g. GP time) or other longer term outcomes.

6. Recommendations and next steps

The following recommendations were developed in response to findings from this stakeholder engagement and are focused on actions which will continue to build understanding of the landscape of loneliness interventions and support manageable, rigorous evaluation of TL interventions which will increase evidence on what works to tackle loneliness.

6.1 Recommendations relating to the landscape of UK tackling loneliness interventions

Build better understanding of TL provision across sectors:

Government and sector bodies[footnote 59] should build on findings in this report to more fully understand the current landscape of TL interventions and gaps in provision across a range of sectors.

Next steps:

In order to understand where there are gaps in provision, government and sector bodies should seek to engage with particular sectors where TL interventions are beginning to emerge or are, potentially, unrecognised (for example, the workplace, schools and universities, youth work and the criminal justice system).

Ensure access to psychological TL approaches:

Given the effectiveness of psychological approaches for tackling loneliness[footnote 60] and growth in the broader availability of psychological support through the NHS Talking Therapies Programme,[footnote 61] there must be ready access to clinical support which includes a focus on loneliness for those experiencing complex mental health problems. How far psychological approaches are incorporated into non-clinical TL interventions should also be examined.

Next steps:

Government should lead work with the tackling loneliness community, psychologists and other therapists providing psychological support to establish how far there is provision with a focus on loneliness, how well this is connected to the wider system of TL interventions and to address any gaps and barriers to access.

Specify how TL interventions work:

When planning and evaluating interventions, TL organisations and evaluators should specify the combination of key elements — of the kind described in this report — that make them work, as well as how they link to any wider system of provision in a local area or sector.

Next steps:

Stakeholders working on guidance for evaluating loneliness interventions (see 5.2) should consider incorporating advice on specifying the key elements which explain how an intervention works (for example, within a theory of change) so helping to clearly define that intervention for the purposes of evaluation.

6.2. Recommendations relating to evaluation of loneliness interventions

Develop new guidance on evaluation of TL interventions with involvement of varied stakeholders:

Government should lead on work to provide new guidance on evaluation of TL interventions, ensuring that development of this guidance has buy-in from — and involvement of — a range of stakeholders.

Next steps:

Government should work with sector bodies to establish a clear process for developing guidance on evaluation of TL interventions. This will need to involve a range of stakeholders (TL organisations, funders, evaluators, researchers, sector bodies) and should aim to build consensus among them about the content of the guidance. The guidance should:

  • outline the conditions for robust evaluation approaches and inspire organisations to use them including by signposting to relevant support and information

  • outline issues to consider when thinking about the frequency and scale of data collection

  • consider offering advice on the scenarios in which measurement is appropriate, and when it may not be (for example, for newer, smaller organisations and interventions)

Co-produce evaluations of TL interventions with delivery organisations:

Ultimately, the model of evaluation for a particular intervention should be co-produced by the organisation delivering an intervention and funders/commissioners so that they are designed to be useful for both parties, delivery organisations have ownership of the process, understand the data they are collecting and are clear about what its uses will be.

Next steps:

Government and sector bodies should engage with funders to discuss how evaluation can be genuinely co-produced with delivery organisations as part of the process of planning and agreeing the final form of an intervention which will be funded.

Provide high quality training and support on how to use the recommended loneliness measures and a range of other evaluation methods:

Government should work with funders/commissioners and sector bodies to provide high quality support and training for delivery organisations that lack evaluation expertise to encourage rigorous use of loneliness measures and/or a range of alternative evaluation methods.

Next steps:

Government should engage with funders/commissioners and sector bodies to agree how to deliver funding and provision for high quality training and support for use of evaluation methods for TL organisations which lack evaluation expertise.

Provide funding to cover evaluation resourcing:

Funders will need to ensure that funding covers evaluation resourcing which will enable high quality evaluation. Delivery organisations will then be responsible for carrying out evaluation internally or working with outside evaluators to carry out evaluations to the agreed model.

Next steps:

Government and sector bodies need to highlight the necessity for covering costs of evaluation work to funders and commissioners.

Review the ONS recommended loneliness measures to reassess their suitability for evaluating TL interventions:

Government should initiate a review of recommended loneliness measures for evaluating TL interventions to examine latest research on whether alternatives are more sensitive to the impact on loneliness of an intervention.

Next steps:

Government should work with researchers to review available measures and their suitability for measuring the impact of TL interventions. If there is a favourable alternative, the TL community should be involved in considering the pros and cons of a change in the recommended measures and in the final decision about whether and how a change should be implemented.

Explore the potential of linking data from evaluation of TL interventions to national healthcare and other datasets:

Government should explore the possibility of linking data from loneliness evaluations to national datasets to support better understanding of characteristics of intervention populations and the impact of interventions on health outcomes.

Next steps:

Government should identify datasets which contain relevant healthcare data or other relevant information and work with owners of those datasets and data analysts to investigate the possibility and potential of linking data collected as part of loneliness evaluations.

7. Conclusion

This report drew on the knowledge and experience of professionals working in the field of loneliness to improve understanding of whether interventions are well-established across a variety of contexts, what kinds of interventions exist, how they are being evaluated and factors which hinder and support the use of loneliness measurement. This is important for further development of the evidence base on what works to tackle loneliness.

A key finding was about the complex, multi-component nature of TL interventions which illustrated the need for a range of different approaches to address loneliness (already highlighted by intervention frameworks), and for evaluating the effectiveness of interventions. This was not only about the provision of a set of separate intervention types such as outreach, befriending and activity groups. It was also about how these types had to be linked or combined to provide systems of support needed by individuals; and about combining key elements within an intervention to make it effective.

A possible concern is that social skills training and psychological approaches to tackling loneliness which have been identified as effective in evaluations[footnote 62] were little mentioned by practitioners. However, it may be that such approaches were embedded in the interventions described and not recognised by interviewees. On the other hand, they might only be found in clinical or other interventions which were not well-represented in this report.

The report also found that TL work was at different stages in different sectors. In the voluntary and community sector, there were multiple direct intervention types, aimed at a range of different groups, which had a stated aim of tackling loneliness. Indirect interventions were also underway in some local authorities.

However, interviews indicated that in some sectors TL work was emerging but less developed or was a limited priority such as when workplace interventions had a small focus on loneliness as part of wider work on mental health. And, in the case of youth work, it was suggested that TL practice was well-developed but not recognised as such. Those involved in encouraging development of tackling loneliness work in sectors beyond the VCS should identify such practice and develop practitioner understanding of it as relevant to loneliness since this may serve to enhance its effectiveness.

Importantly, the report provided insight into factors influencing the use of loneliness measures by professionals involved in the evaluation of TL interventions. Some interviewees agreed that measurement can be a useful way of showing intervention effectiveness and round table participants highlighted the importance of an increase in the use of ONS measures over the past 5 years for advancing our understanding of risk factors for and impacts of loneliness.

However, for those involved in intervention evaluation, there were concerns that the recommended measures did not provide useful evidence of impact, could risk alienating or causing distress to project participants, and could be difficult for delivery organisations to implement where staff did not necessarily have capacity or evaluation expertise.

As a result, some organisations opted to use alternative evaluation methods which were seen to align better with organisational values and needs. In some cases, external requirements from funders to use the measures, caused resentment.

Round table discussions made the case for the development of a set of tools, guidance and support which could be used by organisations to shape evaluations which responded to their needs and capacity. The general view is that we need to be supporting manageable but rigorous evaluation practices - the right evaluation approach, for the right intervention at the right time - and that this will enable TL organisations to contribute further high quality evidence about what works to tackle loneliness.

Acknowledgements

We would like to warmly thank all the professionals working on loneliness who gave time to share their expertise and experiences which are the basis of this report. Some were happy to be named: they include professionals from Age UK; Befriending Networks; The Centre for Loneliness Studies at Sheffield Hallam University; The Chatty Café Scheme; Coffee Afrik; East Sussex County Council; GoodGym; Ideas to Impact; It Socks to be Lonely Sometimes Limited/The Glamour Club; Kate Jopling, Independent Consultant); The Jo Cox Foundation; Kent Arts & Wellbeing; Lily, Borough Council of King’s Lynn and West Norfolk; the National Association of Social Prescribing; The National Lottery Community Fund; Nesta; Re-engage; Time to Talk Befriending; and The Wolfpack Project. Many others remain anonymous. Thank you to you all.

This report was commissioned by the Department for Culture, Media and Sport (DCMS). We would like to thank staff from the Civil Society and Youth Directorate for their guidance throughout the project. Finally, we are grateful to members of the Campaign to End Loneliness Programme Advisory Group who provided invaluable guidance and comment at various points in the project.

Appendix A: Key informant interview questions

  1. For this review, we’re interested in the variety of interventions that exist to address loneliness and their evaluation. We would like to get information from you which describes some of the interventions you know about. As a starting point we have created the spreadsheet I have shared with you - the headings include some categories used previously to describe interventions.

    Could I begin by asking you to spend 10-15 minutes adding some interventions (perhaps 4-6) to the spreadsheet? It would be good if you can choose quite varied interventions: that could include more or less common examples. 

  2. a) Overall, how adequately did the different headings allow you to classify your set of loneliness interventions? Do the headings capture key elements or not? Are they useful ways to think about the interventions or not?

    b) Pick 2 examples from your list 

    Can you identify and explain what features of the interventions are key to making them work? [Or if missing would mean the intervention wouldn’t work]

    What are the similarities and differences in the features of the 2 interventions which are needed to make them work? 

    Select another – Are key features’ similar or different to those already discussed?

    c) Thinking about each of those interventions in turn:

    Are the form of the intervention and its key features tied to the particular setting/age group/needs or characteristics noted? Or could they be transferred to different settings and beneficiaries? 

  3. Are some of the examples of interventions provided more or less established as tackling loneliness interventions? If so, why is that the case? 

  4. In relation to the examples you have given, do you have any information on the number of people supported through this intervention (NOTE: This could be numbers supported via a specific example of an intervention OR typically supported by an intervention of this type)? 

  5. Looking at your set of tackling loneliness interventions can you identify any which have been evaluated using loneliness measures? 

    a) Are there any which have done this particularly well? For these interventions, can you describe the evaluation that has been undertaken including the use of measures? 

    b) What factors do you think have enabled this effective measurement? 

    c) More generally, what factors enable effective measurement of loneliness for those evaluating interventions? 

  6. And looking at your set of tackling loneliness interventions 

    a) Can you identify where there has been less effective measurement of interventions?

    For these interventions, can you describe in what ways the approach used has been less adequate? 

    b) What factors do you think have posed barriers to effective measurement of loneliness to evaluate this/these intervention(s)? 

    c) More generally what factors do you think present challenges to the effective measurement of loneliness as part of evaluation of tackling loneliness interventions? 

  7. How important do you think it is to measure loneliness as part of an evaluation of an intervention? Please explain your response.

Appendix B: Areas of interviewee knowledge/experience

This table provides an overview of the types of intervention and target groups interviewees had involvement with or knew about.

Intervention types/contexts Specific groups targeted by interventions Age groups targeted by interventions
First engagement/outreach or helplines

Social Prescribing

Befriending

Social or activity groups

Social events

Support group for those with specific need

Digital

Clinical A

Workplace A

Area-wide role/project

Transport		 Students

Carers

People who had been bereaved

People with physical or learning disabilities

Sexual and ethnic minority groups		 Children and young people

Older people

Working age

All ages

Note: A Only one interviewee represented these intervention types and further sampling could extend our knowledge of tackling loneliness work being done in these contexts.

Appendix C: Interview questions for tackling loneliness professionals

  1. Please can you begin by telling us about the intervention or project you work on/have recently been involved with/ or a couple of examples of projects you work with (depending on type of role they have)? 

  2. As a group you’ve mentioned X, Y, Z [Refer back to the types of intervention described so far]. Are there other types of intervention which are different from these? 

  3. Can you describe in detail what makes the different types of interventions X, Y, Z work to address loneliness effectively; or the elements which might be missing which prevent it working effectively? What are the similarities and differences between the different types? 

  4. Do you think the factors described in Q3 specific to the particular contexts mentioned? Or do they apply more widely - to other groups and contexts? Please explain why. 

  5. Have you been involved in the use of measurement of loneliness to measure the impact of any loneliness measures? Can you describe how the measure was used as part of the wider evaluation? And so you know which measure was used?

    If not, do you know why a measure of loneliness was not used? Were other measures or methods used and why were they used in preference? 

  6. Thinking about the use of loneliness measures to evaluate tackling loneliness interventions or projects:  Do you think the use of loneliness measure has been helpful or not? Or could it be helpful or not? In what ways?  Is there any way that use of loneliness measures could be harmful or not? In what ways?  

  7. Are there factors which you think do or could support effective use of loneliness measurement to evaluate tackling loneliness evaluations or projects? 

  8. Are there factors which you think do or could act as barriers to effective use of loneliness measurement to evaluate tackling loneliness evaluations or projects? 

  9. In general, is it important to use a loneliness measure as part of an evaluation of a tackling loneliness intervention or not? Are there any downsides, not already mentioned, to using a loneliness measure as part of an evaluation of a tackling loneliness intervention or not? 

Appendix D: Survey for tackling loneliness professionals: questions with response options

Q1 Please choose the label which best describes the main type of tackling loneliness intervention you work on. [Select one] • Finding, reaching and/or first engagement with people experiencing loneliness

• Befriending

•Transport

• Social Prescribing

• Community Connector / Navigator

• Social group

• Counselling or therapy

• Providing a social space or spaces (real or virtual)

• Awareness, stigma or behaviour change campaign

• Website, directory or other information service

• Creating area- or nation-wide systems of support e.g. loneliness network or alliance

• Improving the built environment or green spaces

• Training about addressing loneliness for staff/managers

• Provision of/or training in use of equipment for participants

• Other (please specify)
Q2 To what extent is this intervention focused on addressing loneliness? [Select one] •Addressing loneliness is the main focus of this intervention

• Addressing loneliness is one of a few key areas addressed by this intervention

• Addressing loneliness is a minor focus of this intervention

• Please specify any other main focus(es) of this intervention
Q3 Please specify any other main areas of focus for this intervention. Open-Ended Response
Q4 Is your intervention delivered [Select all that apply]  • Face-to-face

• Online

• By telephone

• Other (please specify)
Q5 Which of the following best describes the life stage(s) of your participants in this ntervention? [Select all that apply] • Children aged 12 and under

• Young people aged 13 - 15

• Young people aged 16 - 24

• Adults aged 25 - 59

• Older adults aged 60 - 74

• Older adults aged 75+
Q6 Is your intervention specifically designed for any of the following groups? [Select all that apply]  • No specific group

• People from one or more ethnic minority groups

• People with a learning disability

• People with a physical disability

• People with a developmental disability

• People who have been bereaved

• Students

• People who are unemployed

• New parents

• People who are retired

• Other specific group(s) (please specify)
Q7 For how many years has this intervention been running? • Less than 1 year

• 1 to 2 years

• 3 to 4 years

• 5 to 6 years

• 7 to 8 years

• 9 to 10 years

• More than 10 years
Q8 Approximately how many participants does your intervention reach per year? • Less than 25

• 26 to 50

• 51 to 100

• 101 to 500

• 501 - 1000

• 1001 - 2000

• 2001 - 5000

• More than 5000
Q9 What size is the organisation that delivers this intervention? • It is completely run by volunteers and has no employees

• It is a micro organisation (fewer than 10 employees)

• It is a small organisation (10 to 49 employees)

• It is a medium-sized organisation (50 to 249 employees)

• It is a large organisation (250 or more employees)
Q10 How many FTE staff (not volunteers) are employed to deliver this intervention? • 1

• 2 to 5

• 6 to 10

• 11 to 15

• 16 to 20

• 21 to 25

• 26 to 50

• 51 to 100

• 101 to 150

• 151 to 200

• 201 to 500

• More than 500
Q11 Do you have specific funding for evaluation of this intervention? • Yes

• No

• Don’t know

• Other (please specify)
Q12 Evaluation of this intervention is carried out by [Select all that apply] • Project delivery staff

• Project delivery volunteers

• An internal evaluation specialist

• An external evaluator

• Don’t know

• We do not yet carry out any evaluation

• Other (please specify)
Q13 Have you already used a measure of loneliness as part of your evaluation of this intervention?   • Yes

• No

• Don’t know
Q14 Which measure(s) of loneliness have you used? [Select all that apply] • ONS direct measure of loneliness - ‘How often do you feel lonely?’

• UCLA 3 item

• UCLA other

• De Jong Gierveld

• The Campaign to End Loneliness measurement tool

• Other (please specify)
Q15 Please choose your 3 main reasons for using a loneliness scale to evaluate this intervention and rank them 1, 2 and 3 with 1 being the most important reason  • 1 - Providing information to support improvement of your intervention

• 1 - Assessing a participant’s needs and/or demonstrating progress to them

• 1 - For research purposes or to contribute to the evidence base

• 1 - Meeting requirements of funders or commissioners

• 1 - Other A - please specify below

• 1 - Other B - please specify below

• 1 - Other C - please specify below

• 2 - Providing information to support improvement of your intervention

• 2 - Assessing a participant’s needs and/or demonstrating progress to them

• 2 - For research purposes or to contribute to the evidence base

• 2 - Meeting requirements of funders or commissioners

• 2 - Other A - please specify below

• 2 - Other B - please specify below

• 2 - Other C - please specify below

• 3 - Providing information to support improvement of your intervention

• 3 - Assessing a participant’s needs and/or demonstrating progress to them

• 3 - For research purposes or to contribute to the evidence base

• 3 - Meeting requirements of funders or commissioners

• 3 - Other A - please specify below

• 3 - Other B - please specify below

• 3 - Other C - please specify below

• If you have chosen ‘other’ A, B, or C as reasons please specify what they are
Q16 Do you use any other quantitative measures to evaluate this intervention? • Yes

• No

• Don’t know

• If yes, please specify which measures
Q17 Are any of the following barriers to your use of measures of loneliness [Select all that apply]  • There are no barriers to our use of measures of loneliness

• Lack of knowledge of evaluation methods generally

• Lack of knowledge about the measures and how to use them

• Capacity of staff/organisation

• Lack of access to training/support

• Dissatisfaction with how well the measures work

• The measures are not tailored to this intervention

• The measures have a negative impact on the work we are doing

• Don’t know

• Other (please specify)
Q18 Would you welcome support to use a measure of loneliness to evaluate your impact? • Yes - We currently do not receive any support but would like some

• Yes - We currently have some support but would like more

• No - We currently receive sufficient support

• No - We do not need any support as we are already confident in our use of measures of loneliness

• No - We do not intend to use measures of loneliness

• Don’t know
Q19 What kind of support would be helpful? [Select all that apply] • Information on which measure(s) of loneliness to use

• Guidance on how to use measures of loneliness

• Guidance on how to analyse data collected using measures of loneliness

• Guidance on how to communicate findings generated by loneliness measurement

• Advice surgeries (offering advice on planning your evaluation, data analysis and communication of findings)

• Trouble shooting drop-in sessions (for sharing evaluation problems and possible ways for addressing them)

• Peer support from others who have used the measures

• Other (please specify)
Q20 Do you have any other comments or ideas about how tackling loneliness interventions can be best evaluated? Open-Ended Response
Thank you very much for taking the time to complete this survey. If you would like to be kept informed of outcomes of our review of loneliness interventions please enter your email address here. Please refer to the Privacy Notice at the start of this survey for details on how we use your personal data. Open-Ended Response

  1. Department for Digital, Culture, Media and Sport (2018) A Connected Society: A strategy for tackling loneliness, DCMS ↩ ↩2 ↩3

  2. Russell, D., Peplau, L. A., & Cutrona, C. E. (1980). The revised UCLA Loneliness Scale: Concurrent and discriminant validity evidence. Journal of Personality and Social Psychology, 39(3), 472–480. and Campaign to End Loneliness (2015) Measuring your impact in later life..This gives details of the Campaign to End Loneliness measurement tool as well as the De Jong Gierveld and UCLA 3 item scales. ↩

  3. For example, see Maes, M., Qualter, P., Lodder, G. M. A., & Mund, M. (2022). How (Not) to Measure Loneliness: A Review of the Eight Most Commonly Used Scales. International Journal of Environmental Research and Public Health, 19(17) and Panayiotou, M., Badcock, J. C., Lim, M. H., Banissy, M. J., & Qualter, P. (2022). Measuring Loneliness in Different Age Groups: The Measurement Invariance of the UCLA Loneliness Scale.  ↩

  4. Department for Culture Media and Sport. (2022). Tackling loneliness evidence review: Main report. DCMS ↩

  5. Victor, C., Mansfield, L., Kay, T., Daykin, N., Lane, J., Grigsby Duffy, L., Tomlinson, A., & Meads, C. (2018). An overview of reviews: The effectiveness of interventions to address loneliness at all stages of the life-course. What Works Centre for Wellbeing. ↩

  6. Jopling, K. (2020). Promising Approaches Revisited: Effective action on loneliness in later life (p. 104) Campaign to End Loneliness. ↩

  7. Musella, M., Blodgett, J & Harkness, F. (2023) Loneliness interventions across the life-course: A rapid systematic review. What Works Centre for Wellbeing and Kohlrabi Consulting. LINK ↩

  8. Department for Culture Media and Sport. (2022). Tackling loneliness evidence review: Main report. DCMS. ↩

  9. Musella, M., Blodgett, J & Harkness, F. (2023) Loneliness interventions across the life-course: A rapid systematic review. What Works Centre for Wellbeing and Kohlrabi Consulting. LINK ↩

  10. For example, see Hsueh, Y.-C., Batchelor, R., Liebmann, M., Dhanani, A., Vaughan, L., Fett, A.-K., Mann, F., & Pitman, A. (2022). A Systematic Review of Studies Describing the Effectiveness, Acceptability, and Potential Harms of Place-Based Interventions to Address Loneliness and Mental Health Problems. International Journal of Environmental Research and Public Health, 19(8), 4766. ↩

  11. Campaign to End Loneliness (10 October, 2022) Research and policy forum: Future directions in loneliness measurement and (24 November, 2022) Research and policy forum: How can we make measurement work for practitioners? Recordings available at Campaign to end loneliness: evaluation and measurement ↩

  12. For example, see Maes, M., Qualter, P., Lodder, G. M. A., & Mund, M. (2022). How (Not) to Measure Loneliness: A Review of the Eight Most Commonly Used Scales. [International Journal of Environmental Research and Public Health, 19(17). and Panayiotou, M., Badcock, J. C., Lim, M. H., Banissy, M. J., & Qualter, P. (2022). Measuring Loneliness in Different Age Groups: The Measurement Invariance of the UCLA Loneliness Scale. Assessment. ↩

  13. Musella, M., Blodgett, J & Harkness, F. (2023) Loneliness interventions across the life-course: A rapid systematic review. What Works Centre for Wellbeing and Kohlrabi Consulting. LINK ↩

  14. The Tackling Loneliness Hub is an online social media platform which convenes professionals working on loneliness. ↩

  15. Musella, M., Blodgett, J & Harkness, F. (2023) Loneliness interventions across the life-course: A rapid systematic review. What Works Centre for Wellbeing and Kohlrabi Consulting. LINK ↩

  16. Sector bodies could include single organisations, umbrella bodies, organisations with oversight or who convene practitioners from the community and voluntary sector or from other contexts such as the workplace or clinical practice. ↩

  17. Victor, C., Mansfield, L., Kay, T., Daykin, N., Lane, J., Grigsby Duffy, L., Tomlinson, A., & Meads, C. (2018). An overview of reviews: The effectiveness of interventions to address loneliness at all stages of the life-course. What Works Centre for Wellbeing. ↩

  18. Jopling, K. (2020). Promising Approaches Revisited: Effective action on loneliness in later life (p. 104) Campaign to End Loneliness. ↩

  19. Musella, M., Blodgett, J & Harkness, F. (2023) [Loneliness interventions across the life-course: A rapid systematic review. What Works Centre for Wellbeing and Kohlrabi Consulting.] LINK ↩ ↩2

  20. Department for Culture Media and Sport. (2022). Tackling loneliness evidence review: Main report. DCMS. ↩

  21. Jopling, K. (2020). Promising Approaches Revisited: Effective action on loneliness in later life (p. 104) Campaign to End Loneliness. ↩

  22. Mann, F., Bone, J. K., Lloyd-Evans, B., Frerichs, J., Pinfold, V., Ma, R., Wang, J., & Johnson, S. (2017). A life less lonely: The state of the art in interventions to reduce loneliness in people with mental health problems. Social Psychiatry and Psychiatric Epidemiology, 52(6), 627–638. ↩ ↩2

  23. Jopling, K. (2020). Promising Approaches Revisited: Effective action on loneliness in later life (p. 104) Campaign to End Loneliness. ↩

  24. Mann, F., Bone, J. K., Lloyd-Evans, B., Frerichs, J., Pinfold, V., Ma, R., Wang, J., & Johnson, S. (2017). A life less lonely: The state of the art in interventions to reduce loneliness in people with mental health problems. Social Psychiatry and Psychiatric Epidemiology, 52(6), 627–638. ↩

  25. Mann, F., Bone, J. K., Lloyd-Evans, B., Frerichs, J., Pinfold, V., Ma, R., Wang, J., & Johnson, S. (2017). A life less lonely: The state of the art in interventions to reduce loneliness in people with mental health problems. Social Psychiatry and Psychiatric Epidemiology, 52(6), 627–638. ↩

  26. Jopling, K. (2020). Promising Approaches Revisited: Effective action on loneliness in later life (p. 104) Campaign to End Loneliness. ↩

  27. Campbell-Jack, D., Humphreys, A., Whitley, J., Williams, J., & Cox, K. (2021). Ageing Better: Impact Evaluation Report. Ecorys. ↩

  28. Department for Culture Media and Sport. (2022). Tackling loneliness evidence review: Main report. DCMS. ↩

  29. Jopling, K. (2020). Promising Approaches Revisited: Effective action on loneliness in later life (p. 104) Campaign to End Loneliness. ↩

  30. Mann, F., Bone, J. K., Lloyd-Evans, B., Frerichs, J., Pinfold, V., Ma, R., Wang, J., & Johnson, S. (2017). A life less lonely: The state of the art in interventions to reduce loneliness in people with mental health problems. Social Psychiatry and Psychiatric Epidemiology, 52(6), 627–638. ↩

  31. Jopling, K. (2020). Promising Approaches Revisited: Effective action on loneliness in later life (p. 104) Campaign to End Loneliness. ↩

  32. Mann, F., Bone, J. K., Lloyd-Evans, B., Frerichs, J., Pinfold, V., Ma, R., Wang, J., & Johnson, S. (2017). A life less lonely: The state of the art in interventions to reduce loneliness in people with mental health problems. Social Psychiatry and Psychiatric Epidemiology, 52(6), 627–638. ↩

  33. Mann, F., Bone, J. K., Lloyd-Evans, B., Frerichs, J., Pinfold, V., Ma, R., Wang, J., & Johnson, S. (2017). A life less lonely: The state of the art in interventions to reduce loneliness in people with mental health problems. Social Psychiatry and Psychiatric Epidemiology, 52(6), 627–638. ↩

  34. Jopling, K. (2020). Promising Approaches Revisited: Effective action on loneliness in later life (p. 104) Campaign to End Loneliness. ↩

  35. Mann, F., Bone, J. K., Lloyd-Evans, B., Frerichs, J., Pinfold, V., Ma, R., Wang, J., & Johnson, S. (2017). A life less lonely: The state of the art in interventions to reduce loneliness in people with mental health problems. Social Psychiatry and Psychiatric Epidemiology, 52(6), 627–638. ↩

  36. Jopling, K. (2020). Promising Approaches Revisited: Effective action on loneliness in later life (p. 104) Campaign to End Loneliness. ↩

  37. Musella, M., Blodgett, J & Harkness, F. (2023) [Loneliness interventions across the life-course: A rapid systematic review. What Works Centre for Wellbeing and Kohlrabi Consulting.] LINK ↩

  38. For example, see Hsueh, Y.-C., Batchelor, R., Liebmann, M., Dhanani, A., Vaughan, L., Fett, A.-K., Mann, F., & Pitman, A. (2022). A Systematic Review of Studies Describing the Effectiveness, Acceptability, and Potential Harms of Place-Based Interventions to Address Loneliness and Mental Health Problems. International Journal of Environmental Research and Public Health, 19(8), 4766. ↩

  39. Russell, D. W. (1996). UCLA Loneliness Scale (Version 3): Reliability, validity, and factor structure. Journal of Personality Assessment, 66(1), 20–40. ↩

  40. Russell, D., Peplau, L. A., & Cutrona, C. E. (1980). The revised UCLA Loneliness Scale: Concurrent and discriminant validity evidence. Journal of Personality and Social Psychology, 39(3), 472–480. and Campaign to End Loneliness (2015) Measuring your impact in later life.. This gives details of the Campaign to End Loneliness measurement tool as well as the De Jong Gierveld and UCLA 3 item scales. ↩

  41. Musella, M., Blodgett, J & Harkness, F. (2023) [Loneliness interventions across the life-course: A rapid systematic review.* What Works Centre for Wellbeing and Kohlrabi Consulting.] ↩

  42. For example, see Maes, M., Qualter, P., Lodder, G. M. A., & Mund, M. (2022). How (Not) to Measure Loneliness: A Review of the Eight Most Commonly Used Scales. International Journal of Environmental Research and Public Health, 19(17).and Panayiotou, M., Badcock, J. C., Lim, M. H., Banissy, M. J., & Qualter, P. (2022). Measuring Loneliness in Different Age Groups: The Measurement Invariance of the UCLA Loneliness Scale. Assessment. ↩

  43. Campaign to End Loneliness (10 October, 2022) Research and policy forum: Future directions in loneliness measurement and (24 November, 2022) Research and policy forum: How can we make measurement work for practitioners? Recordings available at Campaign to end loneliness: evaluation and measurement ↩

  44. For example, see Day, A., Phelps, K., Maltby, J., Palmer, E., Snell, K., Raine, D., & Conroy, S. (2021). A realist evaluation of loneliness interventions for older people. Age and Ageing, 50(6), 2246–2253. and Eccles, A. M., & Qualter, P. (2021). Review: Alleviating loneliness in young people – a meta-analysis of interventions. Child and Adolescent Mental Health, 26(1), 17–33. ↩

  45. The Tackling Loneliness Hub is an online social media platform which convenes professionals working on loneliness. ↩

  46. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. ↩

  47. Jopling, K. (2020). Promising Approaches Revisited: Effective action on loneliness in later life (p. 104). Campaign to End Loneliness. ↩

  48. Mann, F., Bone, J. K., Lloyd-Evans, B., Frerichs, J., Pinfold, V., Ma, R., Wang, J., & Johnson, S. (2017). A life less lonely: The state of the art in interventions to reduce loneliness in people with mental health problems. Social Psychiatry and Psychiatric Epidemiology, 52(6), 627–638. ↩

  49. Mann, F., Bone, J. K., Lloyd-Evans, B., Frerichs, J., Pinfold, V., Ma, R., Wang, J., & Johnson, S. (2017). A life less lonely: The state of the art in interventions to reduce loneliness in people with mental health problems. Social Psychiatry and Psychiatric Epidemiology, 52(6), 627–638. ↩

  50. Jopling, K. (2020). Promising Approaches Revisited: Effective action on loneliness in later life (p. 104) Campaign to End Loneliness. ↩

  51. Jopling, K. (2020). Promising Approaches Revisited: Effective action on loneliness in later life (p. 104) Campaign to End Loneliness. ↩

  52. Department for Culture Media and Sport. (2022). Tackling loneliness evidence review: Main report. DCMS. ↩

  53. Stupple-Harris, L. (2021). Tech in the Dock: Should AI chatbots be used to address the nation’s loneliness problem? NESTA. ↩

  54. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. ↩

  55. NHS (n.d.) NHS Talking Therapies, for anxiety and depression. ↩

  56. Stupple-Harris, L. (2021). Tech in the Dock: Should AI chatbots be used to address the nation’s loneliness problem? NESTA. ↩

  57. For example, see Hsueh, Y.-C., Batchelor, R., Liebmann, M., Dhanani, A., Vaughan, L., Fett, A.-K., Mann, F., & Pitman, A. (2022). A Systematic Review of Studies Describing the Effectiveness, Acceptability, and Potential Harms of Place-Based Interventions to Address Loneliness and Mental Health Problems. International Journal of Environmental Research and Public Health, 19(8), 4766. ↩

  58. Jopling, K. (2020). Promising Approaches Revisited: Effective action on loneliness in later life (p. 104). Campaign to End Loneliness ↩

  59. Sector bodies could include single organisations, umbrella bodies, organisations with oversight or who convene practitioners from the community and voluntary sector or from other contexts such as the workplace or clinical practice. ↩

  60. Musella, M., Blodgett, J & Harkness, F. (2023) Loneliness interventions across the life-course: A rapid systematic review. What Works Centre for Wellbeing and Kohlrabi Consulting. LINK ↩

  61. NHS (n.d.) NHS Talking Therapies, for anxiety and depression. ↩

  62. Musella, M., Blodgett, J & Harkness, F. (2023) Loneliness interventions across the life-course: A rapid systematic review. What Works Centre for Wellbeing and Kohlrabi Consulting. LINK ↩

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