Academic journal article American Journal of Health Education

Acceptability of the Components of a Loneliness Intervention among Elderly Dutch People: A Qualitative Study

Academic journal article American Journal of Health Education

Acceptability of the Components of a Loneliness Intervention among Elderly Dutch People: A Qualitative Study

Article excerpt


Data from the Elderly Health Monitor 2005 published by the community health services in the eastern part of The Netherlands showed that 41% of inhabitants aged 65 years and over were mildly to severely lonely. (1) Trend analysis of repeated cross-sectional data suggested an increase from 32% in 1996-1997 to 41% in 2005. (2) Loneliness results in decreased mental and physical health and negatively affects people's quality of life. (3-6) These individual consequences contribute to increased public costs for care and welfare, especially in the context of an aging population. Together, these individual and collective consequences prompted the rural municipality of Epe in the eastern part of The Netherlands, with 32,970 inhabitants, 19% of whom were aged 65 years and over, to give priority to loneliness prevention among elderly people. As a result, in 2007, the municipality, together with the community health service, the mental health service, and the local elderly welfare organization, initiated the intervention Healthy Ageing. The intervention aims to reduce the prevalence of loneliness in the noninstitutionalized elderly population, aged 65 years and over. Elderly people with physical disabilities, a low disposable income, and depressive symptoms and the widowed elderly were targeted as priority groups. (3,5-8)

In the literature, three pathways for the alleviation of loneliness are defined; that is, network development, reduction of personal norms, and coping with feelings of loneliness. (9,10) In line with most loneliness interventions, Healthy Ageing focuses mainly on network development in order to reduce loneliness in the community. (11-14) A logic model was designed to visualize the causal chain between the intervention components and loneliness. (7) Improvement in the network quality is defined as an early marker for loneliness reduction and the long-term outcome of the intervention. Furthermore, frequent involvement in social engagement activities appears to be related to better self-perceived health, better mental health, and better physical functioning (15) and loneliness. (16) Therefore, being socially engaged and searching for professional or informal aid to support social engagement if needed are included as midterm outcomes. Thereafter, improvements in knowledge, attitude, and abilities are formulated as short-term outcomes, according to theoretical behavioral models. (17)

Healthy Ageing intended to become a complex intervention combining multiple strategies in different settings in order to influence a range of outcomes among the older residents and persons in their surroundings. Selection of the intervention components was determined by combining experiences and opportunities of the local project team, interviews with elderly people and professionals with older clients, and analysis of the local Elderly Health Monitor. This integrated approach contrasts with other loneliness interventions in The Netherlands, which are most often single interventions developed for, and tested in, well-defined study populations with a high loneliness prevalence. (13,14)

Three intervention components of Healthy Ageing are discussed in this article, namely, mass media communication materials, including articles in the local newspaper, the municipal information booklet, information brochures and posters, and further information meetings and psychosocial courses (see Table 1). The mass media communication materials aimed to create awareness among elderly people in general about opportunities in the municipality to be involved in social activities, about care and welfare facilities in the municipality, and about personal opportunities to maintain health and quality of life.

The monthly articles in the local newspaper contained advice about how to age healthfully, a calendar with welfare and social activities for elderly people, and references to service providers. The municipal information booklet is provided by the local government and distributed house to house each year. …

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