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Social network intervention for loneliness and social isolation in a community setting: the PALS cluster-RCT

Becky Band Orcid Logo, Karina Kinsella Orcid Logo, Jaimie Ellis Orcid Logo, Elizabeth James Orcid Logo, Sandy Ciccognani Orcid Logo, Katie Breheny Orcid Logo, Rebecca Kandiyali Orcid Logo, Sean Ewings Orcid Logo, Anne Rogers Orcid Logo

Public Health Research, Volume: 13, Issue: 1, Pages: 1 - 86

Swansea University Author: Becky Band Orcid Logo

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DOI (Published version): 10.3310/wtjh4379

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BackgroundLoneliness and social isolation are associated with adverse mental and physical health outcomes in adults. However, there is a lack of existing research on effective interventions and the contexts in which these could be implemented.Primary objectiveTo assess the clinical and cost-effectiv...

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Published in: Public Health Research
ISSN: 2050-439X
Published: National Institute for Health and Care Research 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa70019
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However, there is a lack of existing research on effective interventions and the contexts in which these could be implemented.Primary objectiveTo assess the clinical and cost-effectiveness of a social network intervention compared to usual care among at-risk populations.DesignA pragmatic, community-based, cluster randomised controlled trial with embedded health economic evaluation, process evaluation and qualitative study. Outcome assessments were conducted at baseline and at 3 and 6 months.SettingThe study was conducted in collaboration with 44 community-based organisations in two regions in England.ParticipantsAdults aged &#x2265; 18 years at risk of loneliness and social isolation.InterventionA facilitated social network tool (&#x2018;project about loneliness and social networks&#x2019;; PALS) designed to link people to opportunities for social involvement. First, participants map and reflect on personal social networks. Second, identification of local resources based on individual preferences, available support, and health and wellness needs.Main outcome measuresThe primary outcome was mental wellness at 6-month follow-up, measured by the Short Form questionnaire-12 items mental health component score (MCS). Secondary outcomes included the Short Form questionnaire-12 items Physical Health subscale, loneliness, social isolation, well-being and collective efficacy. Economic measures assessed the cost-effectiveness of the intervention in terms of costs, quality-adjusted life-years and net monetary benefits.ResultsWe recruited 469 adults into the study, with 120 withdrawals (25.6%). The main trial results indicate little to no treatment effect of the intervention on either the primary or secondary outcomes compared to usual care. The within-trial economic evaluation found that PALS was inexpensive to deliver but there was no significant difference in quality-adjusted life-years, measures of well-being capability or costs, and the intervention did not lead to demonstrable cost-effectiveness in terms of net monetary benefits. The process evaluation found PALS to be acceptable to all types of community organisations, but low resource availability and capacity to sustain PALS was found across all community organisational contexts. Qualitative interviews (n = 20) highlighted that participants wanted to engage with meaningful social activities but barriers to doing so were psychological (i.e. confidence and competence) and practical (i.e. transport or cost).LimitationsThe timing of COVID-19 and associated restrictions (approximately splitting trial follow-up into thirds of pre-COVID, during the first lockdown, and following the trial reopening) meant its impact on the trial is difficult to assess. There were high levels of missing data (20&#x2013;30% for most outcomes at 6 months), though methods to handle missing data did not change the conclusions of the trial.ConclusionsOur findings do not provide strong evidence of the efficacy of the PALS social network intervention to address the complexities of loneliness and social isolation. Although the intervention was acceptable to participants and community organisations who hold the potential to deliver such an intervention, sustainability would require a networked approach between organisations to mitigate against the challenges found in each organisation.Future workFuture interventions for loneliness would likely benefit from utilising a multistep approach providing tailored psychological, relational and social components.</abstract><type>Journal Article</type><journal>Public Health Research</journal><volume>13</volume><journalNumber>1</journalNumber><paginationStart>1</paginationStart><paginationEnd>86</paginationEnd><publisher>National Institute for Health and Care Research</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>2050-439X</issnElectronic><keywords/><publishedDay>1</publishedDay><publishedMonth>3</publishedMonth><publishedYear>2025</publishedYear><publishedDate>2025-03-01</publishedDate><doi>10.3310/wtjh4379</doi><url/><notes/><college>COLLEGE NANME</college><department>Health and Social Care School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HSOC</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 16/08/41).</funders><projectreference/><lastEdited>2025-09-02T15:52:00.7147204</lastEdited><Created>2025-07-23T09:14:54.7812307</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">School of Health and Social Care - Public Health</level></path><authors><author><firstname>Becky</firstname><surname>Band</surname><orcid>0000-0001-5403-1708</orcid><order>1</order></author><author><firstname>Karina</firstname><surname>Kinsella</surname><orcid>0000-0001-9510-1952</orcid><order>2</order></author><author><firstname>Jaimie</firstname><surname>Ellis</surname><orcid>0000-0003-0068-3318</orcid><order>3</order></author><author><firstname>Elizabeth</firstname><surname>James</surname><orcid>0000-0001-9355-0295</orcid><order>4</order></author><author><firstname>Sandy</firstname><surname>Ciccognani</surname><orcid>0009-0000-8064-5711</orcid><order>5</order></author><author><firstname>Katie</firstname><surname>Breheny</surname><orcid>0000-0001-6886-4049</orcid><order>6</order></author><author><firstname>Rebecca</firstname><surname>Kandiyali</surname><orcid>0000-0001-8566-9536</orcid><order>7</order></author><author><firstname>Sean</firstname><surname>Ewings</surname><orcid>0000-0001-7214-4917</orcid><order>8</order></author><author><firstname>Anne</firstname><surname>Rogers</surname><orcid>0000-0002-7231-790x</orcid><order>9</order></author></authors><documents><document><filename>70019__35014__034290bf94c542d99a94017dd697e83b.pdf</filename><originalFilename>70019.VoR.pdf</originalFilename><uploaded>2025-09-02T15:45:53.1427514</uploaded><type>Output</type><contentLength>1536698</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>Copyright &#xA9; 2025 Band et al. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>https://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling 2025-09-02T15:52:00.7147204 v2 70019 2025-07-23 Social network intervention for loneliness and social isolation in a community setting: the PALS cluster-RCT 06b53a31f254b004de8649a376ce2fbd 0000-0001-5403-1708 Becky Band Becky Band true false 2025-07-23 HSOC BackgroundLoneliness and social isolation are associated with adverse mental and physical health outcomes in adults. However, there is a lack of existing research on effective interventions and the contexts in which these could be implemented.Primary objectiveTo assess the clinical and cost-effectiveness of a social network intervention compared to usual care among at-risk populations.DesignA pragmatic, community-based, cluster randomised controlled trial with embedded health economic evaluation, process evaluation and qualitative study. Outcome assessments were conducted at baseline and at 3 and 6 months.SettingThe study was conducted in collaboration with 44 community-based organisations in two regions in England.ParticipantsAdults aged ≥ 18 years at risk of loneliness and social isolation.InterventionA facilitated social network tool (‘project about loneliness and social networks’; PALS) designed to link people to opportunities for social involvement. First, participants map and reflect on personal social networks. Second, identification of local resources based on individual preferences, available support, and health and wellness needs.Main outcome measuresThe primary outcome was mental wellness at 6-month follow-up, measured by the Short Form questionnaire-12 items mental health component score (MCS). Secondary outcomes included the Short Form questionnaire-12 items Physical Health subscale, loneliness, social isolation, well-being and collective efficacy. Economic measures assessed the cost-effectiveness of the intervention in terms of costs, quality-adjusted life-years and net monetary benefits.ResultsWe recruited 469 adults into the study, with 120 withdrawals (25.6%). The main trial results indicate little to no treatment effect of the intervention on either the primary or secondary outcomes compared to usual care. The within-trial economic evaluation found that PALS was inexpensive to deliver but there was no significant difference in quality-adjusted life-years, measures of well-being capability or costs, and the intervention did not lead to demonstrable cost-effectiveness in terms of net monetary benefits. The process evaluation found PALS to be acceptable to all types of community organisations, but low resource availability and capacity to sustain PALS was found across all community organisational contexts. Qualitative interviews (n = 20) highlighted that participants wanted to engage with meaningful social activities but barriers to doing so were psychological (i.e. confidence and competence) and practical (i.e. transport or cost).LimitationsThe timing of COVID-19 and associated restrictions (approximately splitting trial follow-up into thirds of pre-COVID, during the first lockdown, and following the trial reopening) meant its impact on the trial is difficult to assess. There were high levels of missing data (20–30% for most outcomes at 6 months), though methods to handle missing data did not change the conclusions of the trial.ConclusionsOur findings do not provide strong evidence of the efficacy of the PALS social network intervention to address the complexities of loneliness and social isolation. Although the intervention was acceptable to participants and community organisations who hold the potential to deliver such an intervention, sustainability would require a networked approach between organisations to mitigate against the challenges found in each organisation.Future workFuture interventions for loneliness would likely benefit from utilising a multistep approach providing tailored psychological, relational and social components. Journal Article Public Health Research 13 1 1 86 National Institute for Health and Care Research 2050-439X 1 3 2025 2025-03-01 10.3310/wtjh4379 COLLEGE NANME Health and Social Care School COLLEGE CODE HSOC Swansea University Another institution paid the OA fee This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 16/08/41). 2025-09-02T15:52:00.7147204 2025-07-23T09:14:54.7812307 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Public Health Becky Band 0000-0001-5403-1708 1 Karina Kinsella 0000-0001-9510-1952 2 Jaimie Ellis 0000-0003-0068-3318 3 Elizabeth James 0000-0001-9355-0295 4 Sandy Ciccognani 0009-0000-8064-5711 5 Katie Breheny 0000-0001-6886-4049 6 Rebecca Kandiyali 0000-0001-8566-9536 7 Sean Ewings 0000-0001-7214-4917 8 Anne Rogers 0000-0002-7231-790x 9 70019__35014__034290bf94c542d99a94017dd697e83b.pdf 70019.VoR.pdf 2025-09-02T15:45:53.1427514 Output 1536698 application/pdf Version of Record true Copyright © 2025 Band et al. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence. true eng https://creativecommons.org/licenses/by/4.0/
title Social network intervention for loneliness and social isolation in a community setting: the PALS cluster-RCT
spellingShingle Social network intervention for loneliness and social isolation in a community setting: the PALS cluster-RCT
Becky Band
title_short Social network intervention for loneliness and social isolation in a community setting: the PALS cluster-RCT
title_full Social network intervention for loneliness and social isolation in a community setting: the PALS cluster-RCT
title_fullStr Social network intervention for loneliness and social isolation in a community setting: the PALS cluster-RCT
title_full_unstemmed Social network intervention for loneliness and social isolation in a community setting: the PALS cluster-RCT
title_sort Social network intervention for loneliness and social isolation in a community setting: the PALS cluster-RCT
author_id_str_mv 06b53a31f254b004de8649a376ce2fbd
author_id_fullname_str_mv 06b53a31f254b004de8649a376ce2fbd_***_Becky Band
author Becky Band
author2 Becky Band
Karina Kinsella
Jaimie Ellis
Elizabeth James
Sandy Ciccognani
Katie Breheny
Rebecca Kandiyali
Sean Ewings
Anne Rogers
format Journal article
container_title Public Health Research
container_volume 13
container_issue 1
container_start_page 1
publishDate 2025
institution Swansea University
issn 2050-439X
doi_str_mv 10.3310/wtjh4379
publisher National Institute for Health and Care Research
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Public Health{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Public Health
document_store_str 1
active_str 0
description BackgroundLoneliness and social isolation are associated with adverse mental and physical health outcomes in adults. However, there is a lack of existing research on effective interventions and the contexts in which these could be implemented.Primary objectiveTo assess the clinical and cost-effectiveness of a social network intervention compared to usual care among at-risk populations.DesignA pragmatic, community-based, cluster randomised controlled trial with embedded health economic evaluation, process evaluation and qualitative study. Outcome assessments were conducted at baseline and at 3 and 6 months.SettingThe study was conducted in collaboration with 44 community-based organisations in two regions in England.ParticipantsAdults aged ≥ 18 years at risk of loneliness and social isolation.InterventionA facilitated social network tool (‘project about loneliness and social networks’; PALS) designed to link people to opportunities for social involvement. First, participants map and reflect on personal social networks. Second, identification of local resources based on individual preferences, available support, and health and wellness needs.Main outcome measuresThe primary outcome was mental wellness at 6-month follow-up, measured by the Short Form questionnaire-12 items mental health component score (MCS). Secondary outcomes included the Short Form questionnaire-12 items Physical Health subscale, loneliness, social isolation, well-being and collective efficacy. Economic measures assessed the cost-effectiveness of the intervention in terms of costs, quality-adjusted life-years and net monetary benefits.ResultsWe recruited 469 adults into the study, with 120 withdrawals (25.6%). The main trial results indicate little to no treatment effect of the intervention on either the primary or secondary outcomes compared to usual care. The within-trial economic evaluation found that PALS was inexpensive to deliver but there was no significant difference in quality-adjusted life-years, measures of well-being capability or costs, and the intervention did not lead to demonstrable cost-effectiveness in terms of net monetary benefits. The process evaluation found PALS to be acceptable to all types of community organisations, but low resource availability and capacity to sustain PALS was found across all community organisational contexts. Qualitative interviews (n = 20) highlighted that participants wanted to engage with meaningful social activities but barriers to doing so were psychological (i.e. confidence and competence) and practical (i.e. transport or cost).LimitationsThe timing of COVID-19 and associated restrictions (approximately splitting trial follow-up into thirds of pre-COVID, during the first lockdown, and following the trial reopening) meant its impact on the trial is difficult to assess. There were high levels of missing data (20–30% for most outcomes at 6 months), though methods to handle missing data did not change the conclusions of the trial.ConclusionsOur findings do not provide strong evidence of the efficacy of the PALS social network intervention to address the complexities of loneliness and social isolation. Although the intervention was acceptable to participants and community organisations who hold the potential to deliver such an intervention, sustainability would require a networked approach between organisations to mitigate against the challenges found in each organisation.Future workFuture interventions for loneliness would likely benefit from utilising a multistep approach providing tailored psychological, relational and social components.
published_date 2025-03-01T05:31:24Z
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