Research and analysis

Loneliness interventions across the life-course: executive summary

Published 4 September 2023

Executive summary

Since the Tackling Loneliness Strategy was published in 2018, tackling loneliness and promoting social connection have remained key priorities for the government. Understanding the findings and quality of emerging research is essential to consolidate the growing loneliness evidence base and inform policy and programme design.

In 2018, the What Works Centre for Wellbeing (WWCW) reviewed the evidence on interventions designed to alleviate loneliness published between 2008-2018, concluding that:

more large-scale, controlled study designs are required to draw any solid conclusions about what approaches are more effective, for which group of people, in what settings and for how long.^{[footnote 1]}

Since then, loneliness intervention research has grown substantially and loneliness statistics are increasingly used by government and the voluntary sector. Charities in particular need support to gather robust and consistent loneliness data so that beneficiary needs can be better understood, services can be evaluated and targeted effectively, and the case can be made for investment. While government has made recommendations on the measurement of loneliness, the choice of evaluation designs continues to require careful thinking to ensure methods are proportionate and that measures are appropriate for specific contexts and population groups.

1. Review objectives and approach

In January 2023, DCMS commissioned WWCW and the Campaign to End Loneliness to map the landscape and evaluation practices of interventions aimed at alleviating loneliness, and to review recent findings published on their effectiveness.

As part of this programme of work, WWCW and Kohlrabi Consulting conducted a rapid systematic review between January and May 2023. The review aims to update our understanding, given the recent growth of the evidence base on what works to alleviate loneliness. Unlike the previous Review of Reviews, this research focuses on individual studies that report the effectiveness of interventions targeting individuals beyond old age. It therefore includes literature published between 2018 and 2023, to include and expand on the timeframe adopted by the 2018 review.

A comprehensive search of published and grey literature studies was carried out to address the following questions.

Research questions

1. ‘What is the effectiveness of interventions aimed at alleviating loneliness and/or social isolation in people of all ages across the life-course?’

2. ‘Is there an association between intervention core theme/setting/population and direction and size of effect?’

The review brings together findings to explore the state and consistency of the evidence base on loneliness alleviation, including key gaps in research and recommendations for commissioning, future research, and evaluation practice.

2. Summary of study characteristics

The review identified 95 individual studies, published between 2008 and 2023, which present evidence on the effectiveness of 101 loneliness interventions in Organisation for Economic Co-operation and Development (OECD) member countries. Loneliness evaluation research has grown exponentially since 2020 and to date, the field is largely composed of peer-reviewed studies published in Europe and North America. For UK-based interventions, the majority of evidence is from grey literature. The large majority of interventions were aimed at specific population groups, primarily, older people (50+) (n=56), followed by young and middle-aged adults (18-50 years) (n=32).^{[footnote 2]}. Only two studies had samples of children (0-10 years), five of adolescents (11-18 years), and three were made up of individuals across the life course (e.g. age 8+ years).

The UCLA loneliness scale – the UK’s national indicator of indirect loneliness – was the most commonly used measure in included studies, followed by the De Jong Gierveld scale. Overall, the quality of included studies is moderate to high, although the lack of a control group and potentially high attrition rates in evaluations affect the overall reliability of findings. The loneliness interventions identified fall under four core themes, based on their aims, core components and the mechanisms that lead to loneliness improvements.

Social support: Approximately half of studies involved social support, including medium to longer-term and semi-structured to structured social support interventions, or projects that equip individuals with the necessary skills to facilitate social connection. Befriending/mentoring/peer-support programmes, followed by social and emotional skills development were the most common types.

Social interaction-based interventions: Arts/music/culture and social activities with multiple themes were the most common social interaction programmes. They work to reduce loneliness by increasing opportunities for social contact and growing an individual’s social relationships or network.

Psychological interventions: These provide** targeted non-pharmacological therapeutic support/treatment and structured therapy interventions made up the vast majority of interventions.

Multiple Themes: The review includes nine interventions where activities spanned two or more core themes, including multi-component interventions and large-scale national and city-wide programmes delivered following England’s national strategy to tackling loneliness and social isolation in 2018.

3. Findings on effectiveness

Evidence suggests that there are multiple successful approaches to alleviating loneliness in the short-term, almost all of which target specific age groups or vulnerable populations. These include interventions that involve:

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

There is consistent evidence to suggest that interventions that combine social and psychological support, 8-12 week social prescribing link worker schemes, and government-funded programmes that provide social activities and support through voluntary sector organisations, work to alleviate loneliness.

In regards to interventions with multiple components, evidence from the UK Ageing Better programme (2017-2022) suggests that community-focused active participation in a wide range of group and one-to-one activities can alleviate loneliness for over-50s.

4. Insights from qualitative data

Overall, effective loneliness interventions appear to target specific contexts and populations. As a result, contextual factors are likely to play an important role in shaping their success. Qualitative data from approximately one quarter of studies (n=25) sheds light on potential enabling factors and causal pathways that lead to improvements in loneliness and can inform tailored approaches to loneliness services and support. Some of the key factors identified include:

• removing barriers to face-to-face participation in social prescribing interventions, including local infrastructure and health and mobility issues for participants
• the importance of the emotional bond and caring/trusting relationship built with mentors, befrienders, link workers and home-sharers in social support interventions, who act as connectors to the wider world
• the role of group settings as a pretext for social contact and meaningful interaction that act as catalysts for larger individual-level changes
• the importance of community-focused connections and the experience of positive emotions/mood as potential precursors to reductions in loneliness

5. State of the evidence and recommendations for research and practice

For policy-makers and commissioners, systematic reviews provide a comprehensive picture of loneliness interventions and detailed information on the value and reliability of their findings.

Overall, improving the quality of evaluations is likely to generate more solid conclusions about ‘what works’ to tackle loneliness. Using a broader range of evaluation designs may also improve the transferability of evidence across contexts. Below are some specific recommendations to build on the findings of this rapid systematic review, to develop the loneliness evidence base in a comprehensive, relevant, and consistent way.

For evaluation practice:

5.1 Adopt rigorous quantitative designs to evaluate loneliness interventions across populations

Where possible, organisations should aim to use control groups to assess whether changes in loneliness are due specifically to the intervention and not external factors. Wait-list control designs and the use of Propensity Score Matching (PSM) may offer a practical and ethical viable alternative to Randomised Controlled Trials (RCT) to evaluate the effectiveness of social support and psychological interventions.

5.2 Adopt theory-based evaluation to explore the contexts, mechanisms and causal pathways that lead to loneliness improvements

Given the importance of context in the design and effectiveness of loneliness interventions, theory-based and process evaluations provide evidence on how interventions work and in what circumstances. Evaluators should be supported to use qualitative methodologies that build solid hypotheses about the context and implementation of interventions and assess potential mechanisms and pathways of action that underlie successful interventions. The data collected should also include service-led perspectives to shed light on the potential usefulness of interventions and identify causal claims to test in quantitative designs.

For funders and commissioners:

5.3 Ensure there is adequate funding to support the use of robust and appropriate evaluation methodologies

Commissioners should ensure that policy and programme design build in time and funding for organisations to adopt robust qualitative and quantitative evaluations. Providing the chosen evaluation designs are feasible and appropriate, adequate funding will help ensure the integrity and quality of any data collected and strengthen evaluation results and recommendations.

5.4 Commission timely and relevant reviews of the evidence base

Given the rapid growth of loneliness intervention research, reviewers should explore the feasibility of living reviews to allow emerging findings to be rapidly identified and disseminated to decision-makers. The timing of reviews should ideally be aligned with policy development and funding, for example, the government’s Know Your Neighbourhood fund which will pilot approaches to loneliness alleviation through ‘test and learn’.

5.5 Commission primary research to address knowledge gaps for specific intervention types and populations

There are some notable gaps in the evidence identified in this review, including for areas where the evidence base may still be at an early stage, for example, evaluations on connectivity, including digital skills programmes and workplace interventions. In addition, there continues to be a knowledge gap in relation to loneliness alleviation for specific groups, including individuals at different life stages, ethnic minorities and LGBTQ+ individuals.

More evidence is needed on the nature, prevalence and severity of loneliness among recipients of loneliness interventions. In particular, the high prevalence of physical and mental health issues among target populations needs further exploration and can improve our understanding of the specific risk factors for loneliness across age groups.

1. A summary of findings is available in the WWCW Briefing of the loneliness Review of Reviews ↩

2. In this summary the number of studies is reported as (n=). When we say (n=56) this means 56 studies. ↩