Measuring the impact of loneliness interventions Development Workshop

Measuring the impact of loneliness interventions

Development Workshop

www.campaigntoendloneliness.org.uk // @EndLonelinessUK

Welcome and Introductions


Workshop Outcome

To have completed the preparatory stages of developing a tool to measure the impact of various interventions on loneliness.

Specifically, to have:-• Developed an outcome framework• Mapped the most common interventions onto the outcome

framework• To have developed a range of possible questions to be

included in a survey tool(s)


Agenda

• The task – an outline of what the project is seeking to achieve and key issues involved (15mins)

• Developing an outcome framework (45 mins)• Mapping interventions to outcomes (30 mins)• Developing the questions (45 mins)• Next steps (15 mins)


The Task

To develop a new tool, or set of tools, to help service providers to measure the impact of their work on levels of loneliness in older people.


Project Output

Tool should:-• Be simple• Be flexible• Produce comparable results• Be sensitive• Be practical• Be empowering• Be valid


Key Issues

• What is being measured – loneliness / isolation / wellbeing?• For what purpose:-

• Practitioner• Performance management• Commissioner / Funder evaluation (cost and quality)• Academic study

• What context is measurement like to take place?• How are we to measure?

• baseline, when, what type, how asked, how many• How valid will measurement be?• What is our ‘theory of change’?


Outcomes

• Expressed in the positive• As specific as possible• Within area of influence• Able to be measured


Developing outcome framework

1. Identify a realistic and definite goal - the ultimate long term vision

2. Work backwards to develop the intermediate outcomes. Persistently ask the question – “What has to happen in order for this to be achieved?”. Think about the causes and protective factors of loneliness. What things need to be increased / decreased to achieve the desired outcome?

3. Establish the links between outcomes and their order by working out causes and effects. Persistently ask the question – “Does this outcome really lead to the next?”

4. Clarify the assumptions behind each link. What are your beliefs about how change might happen


Example of an outcome framework

Long Term Vision

Outcome

Intermediate Outcome


Outcome



Supported by assumptions about:-- Different types of loneliness- Causes and Protective factors – what needs to be increased or decreased- How people might address their loneliness


Long Term Vision

Older people have the volume and quality of social contact that they want.


Mapping the intervention

• Work out which interventions or activities need to be deployed in order to bring about each outcome - think about intensity and frequency

• Will the intervention change the risk and protective factors and if so, why? Are there circumstances where the intervention might not work. Is there research to back up the assumption?

• Identify what else is needed for the intervention to work – for example, what would completely derail the intervention?

• Develop a narrative which incorporates the outcomes and interventions framework.


Existing survey tool analysis

• Main existing survey tools• Friendship scale• Warwick Edinburgh Mental Wellbeing Scale• UCLA (various versions)• Social Wellbeing Scale• Public Health Outcome Indicator• De Jong Gierveld• ASCOT• Ryff Scale• Older People’s Outcome Star• Abbreviated Duke Social Support Index

• 101 different questions identified


Categorisation of questions

• About competence to make and sustain relationships• About loneliness feeling• About number of social contacts• About change in situation • About quality of social contact• About 'fitting in'• About availability of support in a crisis• About personality type• About engagement in wider community


Types of questionsQuestion Classification

I am no longer close to anyone Change

I find my circle of friends too limited Number

My interests and ideas are not shared by those around me Fitting in

There is no one I can turn to Support

I cannot tolerate being so alone Feeling

I am an outgoing person Personality

I feel like I belong to something I call community Community

It is difficult for me to make friends Competence


Perspectives

Practitioner Manager Commissioner

Simple Group 1 Group 2 Group 3

Complex Group 4 Group 5 Group 6


Views of older people

• 4 focus groups• 36 older people• Semi structured discussions, addressing• Perceptions of lonely people• Language used to talk about loneliness• Type of questions used• How questions should be asked and frequency


Perceptions of lonely people

• Lots of fear:-• I fear of getting into a tied commitment • Some who are desperately lonely cling on• It’s too much for ordinary people, needs professional involvement • When some people say they are lonely other people back off

• Concern about ability to help:-• Some people who are lonely just aren't that friendly and it is

therefore difficult to deal with them • I feel powerless because you cant help them


Perceptions of lonely people

• Some distaste:-• Sometimes people just want others to "do everything for them" -

and you can get a bit tired of that. • Some of them you can see why people don't want to go visit them • Sometimes they are not pleasant people to visit

• Some compassion:-• I feel sorry for them • They have no communication with other people which is sad • They can be frightened of expressing how they feel • Lonely people can worry about being a nuisance • An older person who is lonely still has something to offer


Language

Sometimes when people say they are lonely other people back away - I think it would be different if we could find other language • Other wordsIsolated Forgotten Feeling unhappy

Insecure Abandoned• Talk instead about:-

• ‘wanting more company’ • ‘what would you like to do more of’• Help people understand where they get their energy from - some

people (introverts) get it from internal reflection - others (extroverts) get it from other people - there is no 'shame' attached to this way of framing things


Types of questionsQuestion Score Classification

I am no longer close to anyone 19 Change

I have little social contact with people16 Number

My interests and ideas are not shared by those around me14 Fitting in

There is no one I can turn to14 Support

I cannot tolerate being so alone13 Feeling

I feel as if nobody really understands me10 Fitting in

I am unhappy being so withdrawn 8 Personality

I am unable to reach out and communicate with those around me7 Community

It is difficult for me to make friends7 Competence


Questioning

Type of questioning:-

• Better for questions to be constructed 'positively' - otherwise unlikely to be answered honestly by the person because it is like they would be admitting that there is something wrong with them

• Negative questions can make you feel extremely vulnerable


Questioning

How many:-• Depends on the question• Depends on the person asking and their attitude• It is so important that they are not patronising• You need to allow people to ask quite a few questions if they are then

going to be able to help you• Ask as many as you like – I wouldn’t mind• Being able to give some context to my answer would be important• Have a list and just ‘go with the flow’ until the person asks you to stop


Questioning

How many:-• Depends on the question• Depends on the person asking and their attitude• It is so important that they are not patronising• You need to allow people to ask quite a few questions if they are then

going to be able to help you• Ask as many as you like – I wouldn’t mind• Being able to give some context to my answer would be important• Have a list and just ‘go with the flow’ until the person asks you to stop


Questioning

When to ask:-• Wouldn't ask any questions on the first visit - would need to be 'in the early

stages, which could be several weeks in before it would be appropriate • Ask them to reflect on their experience - how had it gone? Has it made a

difference? • Likely to get the best answers ten or twelve weeks down the line when they are

mote engaged and more confident about the difference in how they are feeling • Not on the first meeting, but in the “early stages”• Maybe after a week or so, but only 3 or 4 questions at this stage• If early on, focus on practical rather than personal questions – try to not be too

threatening• When someone feels that they belong, you could ask around 10-12 questions


Questioning

How to ask-• Use a spectrum of "smiley faces" as a measure that people

can judge themselves against

• Don't expect that you can get someone to fill a form and sign it

• Mustn’t complete the questions as a type of ‘tick box’ approach

Documents

Measuring the impact of loneliness interventions Development Workshop