Influences on participation in a programme addressing loneliness among people with depression and anxiety: findings from the Community Navigator Study

Abstract

Background Loneliness is associated with negative outcomes, including increased mortality and is common among people with mental health problems. This qualitative study, which was carried out as part of a feasibility trial, aimed to understand what enables and hinders people with severe depression and/or anxiety under the care of secondary mental health services in the United Kingdom to participate in the Community Navigator programme, and make progress with feelings of depression, anxiety and loneliness. The programme consisted of up to ten meetings with a Community Navigator and three optional group sessions. Methods Semi-structured interviews were carried out with participants (n = 19) shortly after programme completion. A co-produced two-stage qualitative approach, involving narrative and reflexive thematic analysis, was undertaken by members of the study’s working group, which included experts by experience, clinicians and researchers. Results The narrative analysis showed that individuals have varied goals, hold mixed feelings about meeting other people and define progress differently. From the thematic analysis, six themes were identified that explained facilitators and challenges to participating in the programme: desire to connect with others; individual social confidence; finding something meaningful to do; the accessibility of resources locally; the timing of the programme; and the participant’s relationship with the Community Navigator. Conclusions We found that people with severe depression and/or anxiety supported by secondary mental health services may want to address feelings of loneliness but find it emotionally effortful to do so and a major personal challenge. This emotional effort, which manifests in individuals differently, can make it hard for participants to engage with a loneliness programme, though it was through facing personal challenges that a significant sense of achievement was felt. Factors at the individual, interpersonal and structural level, that enable or hinder an individual’s participation should be identified early, so that people are able to make the best use out of the Community Navigator or other similar programmes.

Do people perceive benefits in the use of social prescribing to address loneliness and/or social isolation? A qualitative meta-synthesis of the literature

“… 6/10 Y—Clear aims Y—Appropriate qualitative methodology Y—Appropriate research design Y—Appropriate recruitment strategy Y—Appropriate data collection N—Considered reflexivity appropriately N—Ethical considerations addressed N—Rigorous data analysis Y—Clear statement of findings N—Value of research (Fortune et al, 2021) [ 48 ] , Canada 19 (16 female & 3 male) Mostly aged 65 + . People recruited from three art hives (‘public home places’) who differ in terms of cultural background, income levels and health status Exploring the perceptions of belonging and the ways in which the involvement in the intervention contributed to the sense of belonging Focus groups ( n = 3 ) and interviews (face-to-face) Thematic analysis 1)Needing social spaces 2)Being welcomed into a non-judgemental Space 3)Coming for more than just the art 4)Creating a shared space 8/10 Y—Clear aims Y—Appropriate qualitative methodology Y—Appropriate research design N—Appropriate recruitment strategy Y—Appropriate data collection N—Considered reflexivity appropriately Y—Ethical considerations addressed Y—Rigorous data analysis Y—Clear statement of findings Y—Value of research (Frerichs et al, 2020) [ 49 ] , UK 19 (14 female & 5 male) Aged 18–70. People experiencing severe depression and/or anxiety, and loneliness Exploring service users’ experiences to understand what affects people’s ability to embrace loneliness interventions Semi-structured interviews (face-to-face, except one with telephone) Thematic analysis and narrative analysis 1)Desire to connect with others 2)Individual’s social confidence 3)Finding something meaningful 4)Accessible resources locally 5)Relationship with community navigator 7/10 Y—Clear aims Y—Appropriate qualitative methodology N—Appropriate research design Y—Appropriate recruitment strategy Y—Appropriate data collection N—Considered reflexivity appropriately N—Ethical considerations addressed Y—Rigorous data analysis Y—Clear statement of findings Y—Value of research (Giebel et al, 2020) [ 50 ] , UK 13 (9 female & 4 male) Aged 44–84.…”

“…In 12 papers only a proportion of the sample (at least 50% of each) reported feeling lonely or socially isolated, with the remaining participants experiencing long-term physical or mental health conditions but not explicitly reporting that they were lonely/isolated [ 42 , 45 – 49 , 51 – 54 , 59 , 60 ].…”

“…Services provided by Local Authorities and NHS staff include 1:1 session with wellness coaches, group work, smoking cessation, weight management, dietary and healthy eating advice, physical activity pathways, mental health and emotional wellbeing interventions, alcohol brief interventions, signposting and accompanied referral to specialist agencies, such as welfare rights and housing advice (Fortune et al, 2021) [ 48 ] , Canada - Older adults with diverse cultural background, income levels and health status Loneliness and social isolation - Face-to-face delivery - Group activities - Length of intervention: 4 months Art Hives are defined as free inclusive community art spaces and designed as ‘public home places’. In these places, participants were encouraged to make art together (Frerichs et al, 2020) [ 49 ] , UK - People severely anxious and depressed Loneliness - Face-to-face delivery - Individual sessions (up to 10) and group sessions - Length of intervention: 2 years The Community Navigatior programme includes receiving support from a ‘Community Navigator’ based in secondary mental health services who will help service users to increase social contact, participation in social activities and community engagement, with the aim of reducing feelings of loneliness. Besides, group sessions will take place where participants are encouraged to share information about local resources and social groups (Giebel et al, 2020) [ 50 ] , UK - People (aged 18 and above) at risk of feeling lonely and isolated, with low levels mental health needs - People from any socio-economic background Loneliness and social isolation - Face-to-face delivery - Individual sessions and group activities - Length of intervention: 14 weeks The Community Connectors service is a structured support service that enables access to local support through a range of early intervention and prevention services such as luncheon clubs, debt awareness, social activities, befriending, foodbanks, as well as commissioned services (Greaves & Farbus, 2006) [ 51 ] , UK - People from their 50 s onwards, whose lives may have changed or are about to change in some way (perhaps through retirement, moving home, age or illness), or people with time on their hands, or who might find it difficult to keep in touch with the local community - People with no mental or physical health problems Loneliness and social isolation - Face-to-face delivery and telephone contact with the LWs -...…”

“…Overall, being in a community with people facing similar experiences made participants feel more confident to talk about their issues. Link workers seemed to play an important role as they would generally help people to enter social situations and encourage them to raise questions “to gain the confidence needed to do it again by themselves in the future” [ 49 ]: “Well because I’ve been going further afield with [link worker], I feel more empowered to do better things and improve my life. I’ve got more confidence to do things.” (Gender not specified, 44-84 years) [ 50 ] …”

“…To hear about their experiences and what they’d been through. How they were dealing with things.” (Gender not specified, 18-70 years) [ 49 ]…”