Six-month outcomes of layperson-delivered, telephone-based behavioural activation and mindfulness interventions on loneliness among older adults during the COVID-19 pandemic: The HEAL-HOA Dual Randomised Controlled Trial

Background Loneliness among older adults during the COVID-19 pandemic constituted a global public health crisis. This study aimed to determine whether layperson- and telephone-delivered behavioural activation (Tele-BA) and mindfulness (Tele-MF) interventions, compared to telephone befriending/support calls (Tele-BF; attention control), could reduce loneliness among older adults who were living alone, socioeconomically deprived and digitally excluded. Methods As part of the ‘Helping Alleviate Loneliness in Hong Kong Older Adults’ dual randomised controlled trial (RCT), 1151 older adults (Mage = 76.6, SD = 7.8) were randomly assigned to Tele-BA, Tele-MF or Tele-BF. Assessments were conducted at baseline (T0), 4-week (T1), 3-month (T2) and 6-month post-intervention (T3). All interventions (eight 30-minute telephone sessions over four weeks) were delivered by 185 trained lay counsellors who were 50–70 years old and reported feeling lonely. Outcomes The primary outcome was loneliness (assessed with the UCLA Loneliness Scale [UCLA-LS] and De Jong Gierveld Loneliness Scale [DJGL]). Secondary outcomes were perceived social support, social network size, perceived stress, life satisfaction, psychological well-being, sleep quality and depressive and anxiety symptoms. The UCLA-LS scores were significantly reduced in Tele-BA at T2 and T3 and in Tele-MF at T2, compared to Tele-BF. No significant difference was observed between Tele-BA and Tele-BF from T1 through T3 in DJGL. The Tele-MF group showed significantly higher DJGL scores at T1 and T3 than the Tele-BF group. Significant positive effects of Tele-BA, compared to Tele-BF, were found in perceived social support, perceived stress, psychological well-being, depression and anxiety. Tele-MF did not significantly differ from Tele-BF on these secondary outcomes. Interpretation The trial demonstrates the effectiveness of telephone-based psychosocial interventions delivered by laypersons in reducing loneliness. It also underscores the potential for training peer lay counsellors to telephone-deliver scalable psychosocial interventions for older adults experiencing loneliness.