Developing a hybrid intervention to reduce loneliness among community-dwelling older adults in China: a multi-method study

Background Loneliness is a prevalent public health and care concern among community-dwelling older adults. While cognitive behavioral therapy (CBT) and social support theory provide useful frameworks for addressing emotional and social loneliness, there remains a gap in translating these theories into structured, culturally tailored interventions within primary care settings. Guided by the Medical Research Council (MRC) framework, this study describes the development of a theory-driven hybrid intervention to reduce loneliness among community-dwelling older adults in China. Methods Intervention development was informed by a systematic review and meta-analysis to identify effective loneliness interventions. Semi-structured interviews were conducted with community-dwelling older adults to explore intervention needs, preferred content, and delivery logistics. An initial draft was refined through formative pilot testing, with feedback informing the modification and finalization of the hybrid intervention for delivery in community healthcare settings. Results Evidence synthesis identified the most effective interventions in terms of content, delivery modes, and contact approaches. In the qualitative findings, participants expressed interest in psychological support alongside physical activities, health education, smartphone skills, and fraud prevention. Perceived participation barriers included time constraints, perceived lack of need or interest, transportation, health concerns, and mistrust and difficulty understanding program content. Perceived facilitators included perceived usefulness, positive group atmosphere, and supportive facilitation and enabling conditions. Pilot feedback led to cultural tailoring, incorporation of locally relevant examples and traditional exercises, and pacing adjustments. The finalized intervention comprised six group sessions integrating psychosocial and practical components, supplemented by home practice and digital support via WeChat. Conclusions This study provides a transparent account of utilizing the MRC framework to develop a culturally tailored, theory-based hybrid intervention for loneliness among older adults. This systematic process integrated evidence synthesis, stakeholder perspectives, and formative pilot feedback to refine the intervention, providing a foundation for subsequent evaluation of its feasibility, acceptability, and effectiveness in community healthcare settings.