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| ID | Type | Description | Link |
|---|---|---|---|
| R8002-24 | Other Grant/Funding Number | Research Impact Fund, Research Grants Council |
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| Name | Class |
|---|---|
| University College, London | OTHER |
| The Hong Kong Polytechnic University | OTHER |
| University of Texas at Austin | OTHER |
| Australian National University |
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The study aims to reduce loneliness among Hong Kong Chinese older adults living in poverty with a multi-level intervention involving components at the individual, interpersonal, and community levels.
Loneliness is widespread, with negative impacts on both individuals and society and associated direct and indirect healthcare and long-term care costs. Thus, it is imperative to alleviate loneliness in old age by implementing effective, accessible, affordable, and scalable interventions. Loneliness is often erroneously considered an individual problem due to personal failure. Still, growing evidence indicates that loneliness is caused by factors at multiple levels, including the individual, interpersonal, and community levels. Hence, a multi-level approach is recommended to alleviate loneliness.
However, multi-level interventions for reducing loneliness are in their infancy, and there is yet to be evidence to suggest that they are more effective than single-level interventions. The investigators will conduct an innovative and impactful study to fill this important research gap. This study is a single-blinded cluster, four-arm randomized controlled trial (RCT) designed to test the effect and cost-effectiveness of a multi-level intervention to alleviate loneliness among Hong Kong Chinese older adults living in poverty. The investigators will also adopt the modified biopsychosocial (BPS) model, called the BPS-Pathways model, as the theoretical framework to guide our selection of interventions, mediators, secondary outcomes, long-term outcomes, and impact.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| First Arm | Experimental | Individual-level |
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| Second Arm | Experimental | Individual- and Interpersonal-level |
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| Third Arm | Experimental | Individual-, Interpersonal-, and Community-level |
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| Forth Arm | Active Comparator | Education Control Group |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Individual Level | Behavioral | A 8-weekly, 1hour telephone-delivered sessions using mindfulness and SOLUS-D program. Key contents include: introduction to mindfulness - Body awareness and present moment experiences, emotional awareness and mind-body labeling, relaxation techniques and sensory discrimination, deepening awareness and accepting feelings, personal values, interconnection between thought patterns and emotions, identifying and analyzing of thought traps, and challenging thoughts and future planning. Maintenance sessions which focus on embedding mindfulness practices and SOLUS-D program among older adults as a persistent habit will be conducted. |
| Measure | Description | Time Frame |
|---|---|---|
| UCLA Loneliness Scale | The 20-item UCLA Loneliness Scale is a reliable self-assessment tool designed to evaluate feelings of loneliness. Each item will be rated from 1=Never to 4=Always. Total scores range from 20 to 80. | Baseline, 2-month, 4-month, 6-month, 12-month, 24-month |
| Measure | Description | Time Frame |
|---|---|---|
| Pittsburgh Sleep Quality Index | PSQI evaluates seven components of sleep: sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep medication, and daytime dysfunction. Each item will be rated from 0=No difficulty to 3=Severe difficulty. Total scores range from 0 to 21, | Baseline, 2-month, 4-month, 6-month, 12-month, 24-month |
| Measure | Description | Time Frame |
|---|---|---|
| Mindfulness Attention Awareness Scale | Each item will be rated from 1=Almost always to 6=Almost never. Average score will be calculated. | Baseline, 2-month, 4-month, 6-month, 12-month, 24-month |
| Self-Compassion Scale |
Inclusion Criteria:
Exclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Kee Lee Chou, PhD | The Education University of Hong Kong | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The Education University of Hong Kong | Recruiting | Hong Kong | Hong Kong |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 35140066 | Background | Surkalim DL, Luo M, Eres R, Gebel K, van Buskirk J, Bauman A, Ding D. The prevalence of loneliness across 113 countries: systematic review and meta-analysis. BMJ. 2022 Feb 9;376:e067068. doi: 10.1136/bmj-2021-067068. | |
| 38885446 | Background | Seguin-Fowler RA, Graham ML, Demment M, Uribe ALM, Rethorst CD, Szeszulski J. Multilevel Interventions Targeting Obesity: State of the Science and Future Directions. Annu Rev Nutr. 2024 Aug;44(1):357-381. doi: 10.1146/annurev-nutr-122123-020340. Epub 2024 Aug 12. |
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| OTHER |
| The University of Hong Kong | OTHER |
| Medical School Berlin | OTHER |
| Chinese University of Hong Kong | OTHER |
| University of Bern | OTHER |
| Linkoeping University | OTHER_GOV |
Single Blinded, 4-arm cluster randomized controlled trial
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| Interpersonal Level | Behavioral | A 8 weekly, 1hr sessions through telephone or Zoom using the Group 4 Health. Key contents include: understanding the benefits of social connections, exploring self and community, community and action, support and breakthrough, summary and moving forward. Maintenance sessions which focus on continuous practice of support and community will be conducted. |
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| Community Level | Behavioral | A 4 weekly, 2hour in-person sessions through (1) strengthening collective efficacy via neighbor identification with the community. Key contents include: building neighbourhood connections, getting to know each other, health aging, neighbourhood care, vibrant exploration, thriving community, connecting the dots. |
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| Education Control | Other | Monthly monthly messages via text, graphics or voice recordings will be sent over a period of 6 months. Key content includes: healthy diet tips, recognizing warning signs of health, understanding dementia, fall prevention tips, health message, and anti-fraud tips. |
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| Satisfaction with Life Scale | SWLS measures the subjective well-being and life satisfaction. Each item will be rated from 1=Strongly disagree to 7=Strongly agree. Total scores range from 5 to 35. | Baseline, 2-month, 4-month, 6-month, 12-month, 24-month |
| De Jong Gierveld Loneliness Scale | The De Jong Gierveld Loneliness Scale is known for assessing loneliness with social and emotional loneliness subscale. Each item will be rated from 1=Yes to 3=No. Total scores range from 0 to 6, with subscale score ranging from 0 to 3. | Baseline, 2-month, 4-month, 6-month, 12-month, 24-month |
| Lawton Instrumental Activities of Daily Living | IADL is used to measure participant's ability in performing instrumental activities. Each item will be rated 0=dependent to 1=independent. Total scores range from 0 to 8. | Baseline, 12-month, 24-month |
| Activities of Daily Living | ADL is used to measure participant's independence in completing activities of daily living. Each item will be rate from 0=dependent to 5/10=independent. Total scores range from 0 to 100. | Baseline, 12-month, 24-month |
| Physical Symptoms Inventory | Participants will rate the presence of each physical symptom in the past 30 days from 0=Never to 4=Often. Total scores range from 0 to 72. | Baseline, 2-month, 4-month, 6-month, 12-month, 24-month |
| Charlson Comorbidity Index | Participants will rate the presence a list of 16 comorbid condition. Total scores range from 0 to 37. | Baseline, 12-month, 24-month |
| Perceived Stress Scale | PSS is use to measure perceived stress levels. Each item will be rated from 0=Never to 4=Very often. Total scores range from 0 to 56. | Baseline, 2-month, 4-month, 6-month, 12-month, 24-month |
| 6-Minutes Walking Test | Participants will be asked to walk the furthest distance possible in 6 minutes, rate their level of breathlessness using the Borg scale from 0=No breathlessness to 10=Maximal breathlessness. | Baseline, 12-month, 24-month |
| Hospital Anxiety and Depression Scale | HADS measure the severity of anxiety and depression. Each item will be rated from 0=Not at all to 3=Most of the time. Total score range from 0 to 42. | Baseline, 2-month, 4-month, 6-month, 12-month, 24-month |
| Montreal Cognitive Assessment - Hong Kong | MoCA-HK is a tool to evaluate cognitive functioning in older adults, which compromises of seven cognitive domains. Total score range from 0 to 30. | Baseline, 12-month, 24-month |
SCS-SF measures self-compassion and have 6 subscales. Each item will be rated from 1=Almost never to 5=Almost always. Mean score will be calculated for each subscale and overall scale.
| Baseline, 2-month, 4-month, 6-month, 12-month, 24-month |
| Emotion Regulation Questionnaire | ERQ-CR is used for assessing emotional regulation strategies; cognitive reappraisal (6 items). Each item will be rated from 1=Strongly disagree to 7=Strongly agree. Mean score will be calculated. | Baseline, 2-month, 4-month, 6-month, 12-month, 24-month |
| Multidimensional Scale of Perceived Social Support | MSPSS evaluates the social support derived from three key sources: family, friends, and significant others. Each item will be rated from 1=Strongly disagree to 7=Strongly agree. Total scores range from 12 to 84. | Baseline, 2-month, 4-month, 6-month, 12-month, 24-month |
| Lubben Social Network Scale | LSNS is used to assess the social networks of participants. Each item will be rated 0=None to 5=9 or more. Total scores range from 0 to 30. | Baseline, 2-month, 4-month, 6-month, 12-month, 24-month |
| Neighbourhood Collective Efficacy Scale | NEC assesses the neighborhood collective efficacy and identity of the community. Each item will be rated from from 1=Strongly agree to 5=Strongly disagree. Mean score will be calculated. | Baseline, 2-month, 4-month, 6-month, 12-month, 24-month |
| EuroQol 5-dimension 5-level instrument | EQ-5D-5L assesses descriptive system and visual analogue scale. Participants will rate their health status from 0=No problem to 5=Unable to perform, and their overall health status on the day of assessment from 0=Worst health to 100=Best health. | Baseline, 2-month, 4-month, 6-month, 12-month, 24-month |
| Healthcare Service Usage | Participants will rate their frequency of use of outpatient medical treatment, accident and emergency treatment, and inpatient medical treatment over the past three months at both public and private facilities from 0=None to 3=three times or more. | Baseline, 2-month, 4-month, 6-month, 12-month, 24-month |
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| 32469922 | Background | Lloyd-Evans B, Frerichs J, Stefanidou T, Bone J, Pinfold V, Lewis G, Billings J, Barber N, Chhapia A, Chipp B, Henderson R, Shah P, Shorten A, Giorgalli M, Terhune J, Jones R, Johnson S. The Community Navigator Study: Results from a feasibility randomised controlled trial of a programme to reduce loneliness for people with complex anxiety or depression. PLoS One. 2020 May 29;15(5):e0233535. doi: 10.1371/journal.pone.0233535. eCollection 2020. |
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| 33866082 | Background | Fong P, Cruwys T, Robinson SL, Haslam SA, Haslam C, Mance PL, Fisher CL. Evidence that loneliness can be reduced by a whole-of-community intervention to increase neighbourhood identification. Soc Sci Med. 2021 May;277:113909. doi: 10.1016/j.socscimed.2021.113909. Epub 2021 Apr 6. |
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| 41810289 | Derived | Tang VFY, Jiang D, Kwok JYY, Ho HCY, Jian IY, Choi NG, Cruwys T, You JHS, Warner LM, Seewer N, Bai X, Kall A, Andersson G, Krieger T, Lloyd-Evans B, Chou KL. Study Protocol: Connecting older adults through multi-level programmes for alleviating loneliness in Hong Kong older adults (COMPASS-HOA). Front Public Health. 2026 Feb 23;14:1741422. doi: 10.3389/fpubh.2026.1741422. eCollection 2026. |