Workstream 2

Workstream 2, inclusive of three studies, will identify and evaluate both existing interventions as well as new interventions that can address loneliness and social isolation in high need populations, taking into account information regarding consumer preferences for such interventions. This has never been done before for interventions targeting loneliness and social isolation).

This will involve the development of a national registry of community-based programs and services (Study 4) and the elicitation and weighting of patient preferences for different components of loneliness interventions (Study 5). Finally, the most promising interventions for cost-effectiveness modelling will be selected in partnership with key stakeholders (Study 6).

Study 4: Developing a national registry of community-based programs and services tackling loneliness and social isolation

Recognising that many programs and services currently exist in Australia, the aim of this study is to develop a national registry of services available across sectors and to map those against supporting evidence base in terms of effectiveness. Partnering with Ending Loneliness Together, we will value-add to the tool for health and community service providers, so they can direct individuals at risk to appropriate services in their local area. Recently, Ending Loneliness Together put out a call to providers to add their service to the national service directory. This study will complement this approach by actively identifying existing services and programs. First, our team will undertake a comprehensive search online and contact local government areas to identify existing programs and services. Secondly, an online survey will be circulated to capture existing services, which age or population groups they are targeting, associated fees, and whether an evaluation of the service has been conducted. The survey will be widely distributed across different networks and social media to maximize reach. Identified services and programs will be listed on the Ending Loneliness Together website and kept up-to-date annually. We will also map which services/interventions have evidence of effectiveness and cost-effectiveness as well as overlay these onto the heat map developed in Workstream 1. We will use evidence synthesis methods to update our current knowledge base of the effectiveness of loneliness interventions and map these to what is currently being provided. That way we will know what is being provided, to whom and whether services are being provided to high need areas. Our national registry of community-based services will be published on the Ending Loneliness Together website and will serve as a tool for health and community service providers to direct individuals at risk to services focused on reducing loneliness. A number of services included on the registry will be modelled for cost-effectiveness, which will be informed by Studies 5 and 6.

Study 5: Examining consumer preferences for loneliness and social isolation interventions

Despite the growing evidence of effective interventions to alleviate loneliness or social isolation, there is still a notable hesitation among consumers to use them. The aim of this study is to elicit consumer preferences for different components of loneliness and social isolation interventions to identify which components of interventions are preferred. Our consultations showed that this was a vitally important issue in setting priorities for funding. Discrete Choice Experiments (DCEs), are ideally suited to capture which elements of interventions are important to consumers. A DCE is a preference elicitation tool where respondents are asked to make trade-offs between different hypothetical scenarios, highlighting distinct aspects of programs or services. Initial causes of positive attitudes and scepticism toward interventions will be identified by conducting a literature review and interviewing members of our Community Advisory Group. Tailored to the attributes of interventions identified in Study 4, we will then conduct focus groups with consumers that will be purposively sampled and will include individuals who have experienced a chronic disease for at least 12 months and experience loneliness or social isolation, using screening tools. During the focus groups, a facilitator will ask targeted questions about aspects of services most or least preferred by study participants. An online survey will be developed and piloted. Knowing which characteristics of an intervention are preferred by consumers can help service providers and policy makers understand why people still hesitate to use such interventions and can determine what can be done to increase their acceptability, take-up, adherence, and effectiveness. The results will offer vital information as to which interventions should be modelled for cost-effectiveness based on consumer preferences.

Study 6: Intervention selection

This study will determine which interventions to model for cost-effectiveness in Workstream 3. A Delphi study will be conducted with representative from the Steering Committee and the Community Advisory Group. The Delphi method provides a framework for transforming individual opinions into a group consensus. Prior to engaging with stakeholders, interventions will be identified and mapped to a matrix, which will classify interventions according to those: (i) improving social skills; (ii) enhancing social support; (iii) increasing opportunities for social interaction; and (iv) addressing maladaptive social cognition.The identification of interventions will be based on a literature review and findings from Study 4, reflecting existing programs and services. Existing services and programs will be mapped against published effectiveness evidence if they have not been formally evaluated. The mapping will further consider key implementation considerations such as: (i) population characteristics targeted by the intervention (e.g., age); (ii) the setting for the intervention delivery (e.g., workplace); (iii) feasibility of the intervention by geographical units; (iv) adaptability of the intervention to specific needs; (v) scalability to facilitate roll-out; (vi) availability of effectiveness evidence; and (vii) acceptability of the intervention based on the results from the DCE in Study 5. Once the mapping task is completed, an online survey will be administered to assess the perceptions of stakeholders towards prioritisation of criteria for intervention selection. Stakeholders will then rank a number of interventions based on the highly ranked selection criteria. In the next step, stakeholders will be invited to a workshop where they will be shown the survey results, followed by a group discussion with the aim to reach consensus on the selection criteria and the interventions to be selected for cost-effectiveness modelling. Three rounds of voting will be conducted with discussions occurring in between. This crucial step will ensure that interventions selected meaningfully reflect consumer preferences, are relevant to current policy-making and have the potential to decrease loneliness or social isolation in Australia.