Digital Intervention in Loneliness in Older Adults: Qualitative Analysis of User Studies

Background Loneliness is a significant well-being issue that affects older adults. Existing, commonly used social connection platforms do not contain facilities to break the cognitive cycle of loneliness, and loneliness interventions implemented without due processes could have detrimental effects on well-being. There is also a lack of digital technology designed with older adults. Objective We aimed to iteratively design a user-centered smartphone app that can address loneliness in older adults. The aim of this study was to investigate the loneliness-related psychological processes that our conceptual smartphone app promotes. We also identified the emergent needs and concerns that older adults raised regarding the potential benefits and detriments of the app. Methods We used technology probes to elicit older adults’ reflections on the concept of using the app in 2 studies as follows: concept focus groups (n=33) and concept interviews (n=10). We then conducted a prototype trial with 1 week of use and follow-up interviews (n=12). Results Thematic analysis explored the experiences and emergent challenges of our app through the design process. This led to the development of 4 themes as follows occurring in all 3 qualitative data sets: reflection on a digital social map is reassuring; app features encourage socializing; the risk of compounding loneliness; and individuals feel more control with mutual, socially beneficial activities. Conclusions Smartphone apps have the potential to increase older adults’ awareness of the richness of their social connections, which may support loneliness reduction. Our qualitative approach to app design enabled the inclusion of older adults’ experiences in technology design. Thus, we conclude that the older adults in our study most desired functionalities that can support mutual activities and maintain or find new connections rather than enable them to share an emotional state. They were wary of the app replacing their preferred in-person social interaction. Participants also raised concerns about making the user aware of the lack of support in their social network and wanted specific means of addressing their needs. Further user-centered design work could identify how the app can support mutual activities and socializing.

[1]  C. Victor,et al.  Exploring the nature and variation of the stigma associated with loneliness , 2022, Journal of social and personal relationships.

[2]  Catherine V. Talbot,et al.  The use of digital technologies by people with mild-to-moderate dementia during the COVID-19 pandemic: A positive technology perspective , 2021, Dementia.

[3]  Dmitri S. Katz,et al.  Loneliness in older people and COVID-19: Applying the social identity approach to digital intervention design , 2021, Computers in Human Behavior Reports.

[4]  Joel L Larwood,et al.  GROUPS 2 CONNECT: An online activity to maintain social connection and well-being during COVID-19. , 2021, Applied psychology. Health and well-being.

[5]  M. Levine,et al.  'Oh no, not a group!' The factors that lonely or isolated people report as barriers to joining groups for health and well-being. , 2021, British journal of health psychology.

[6]  A. Parks,et al.  Perspectives on the Impact of Digital Interventions on Loneliness: Qualitative Focus Group with Lonely Happify Health Users During COVID-19. , 2021, JMIR mental health.

[7]  J. Holt-Lunstad,et al.  Loneliness and Social Isolation as Risk Factors for Mortality: A Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review Meta-Analytic Review , 2021 .

[8]  Janet Wiles,et al.  “Building the Threads of Connection that We Already Have”: The Nature of Connections via Technology for Older People , 2020, Clinical gerontologist.

[9]  A. Parry-Jones,et al.  Applying agile, iterative co-design principles to the development of a smartphone app for people living with dementia (Preprint) , 2020, JMIR mHealth and uHealth.

[10]  Cayce J. Hook,et al.  Smartphone App to Address Loneliness Among College Students: Pilot Randomized Controlled Trial , 2020, JMIR mental health.

[11]  F. Casati,et al.  A Systematic Review on Technology-Supported Interventions to Improve Old-Age Social Wellbeing: Loneliness, Social Isolation, and Connectedness , 2020, Journal of healthcare engineering.

[12]  P. Kelly,et al.  Reducing loneliness among people with substance use disorders: Feasibility of 'Groups for Belonging'. , 2020, Drug and alcohol review.

[13]  C. Chew‐Graham,et al.  Managing loneliness: a qualitative study of older people’s views , 2020, Aging & mental health.

[14]  B. Nuseibeh,et al.  How are you feeling?: Using Tangibles to Log the Emotions of Older Adults , 2020, TEI.

[15]  S. Vijaykumar,et al.  Barriers to older adults’ uptake of mobile-based mental health interventions , 2020, Digital health.

[16]  Clifford Stevenson,et al.  How can ‘we’ help? Exploring the role of shared social identity in the experiences and benefits of volunteering , 2020 .

[17]  Niklas K. Steffens,et al.  Social identity mapping online. , 2019, Journal of personality and social psychology.

[18]  Ashley A. Knapp,et al.  Clinically Meaningful Use of Mental Health Apps and its Effects on Depression: Mixed Methods Study , 2019, Journal of medical Internet research.

[19]  P. Graf,et al.  Technology, Physical Activity, Loneliness, and Cognitive Functioning in Old Age , 2019, GeroPsych.

[20]  S. Haslam,et al.  Social Scaffolding: Supporting the Development of Positive Social Identities and Agency in Communities , 2019, Social Scaffolding.

[21]  Katrina M. Long,et al.  A pilot digital intervention targeting loneliness in young people with psychosis , 2019, Social Psychiatry and Psychiatric Epidemiology.

[22]  Clifford Stevenson,et al.  When groups help and when groups harm: Origins, developments, and future directions of the “Social Cure” perspective of group dynamics , 2019, Social and Personality Psychology Compass.

[23]  S. Langer.  Interviews in Qualitative Research (2nd Edition) , 2019, QMiP Bulletin.

[24]  C. Shpigelman,et al.  Leveraging Emotional Wellbeing and Social Engagement of the Oldest Old by Using Advanced Communication Technologies: A Pilot Study Using Uniper-Care's Technology , 2019, 3rd IET International Conference on Technologies for Active and Assisted Living (TechAAL 2019).

[25]  Ben C P Lam,et al.  The Importance of Social Groups for Retirement Adjustment: Evidence, Application, and Policy Implications of the Social Identity Model of Identity Change , 2018, Social Issues and Policy Review.

[26]  Wendy A. Rogers,et al.  Designing Health and Fitness Apps with Older Adults: Examining the Value of Experience-Based Co-Design , 2018, PervasiveHealth.

[27]  Anna L. Cox,et al.  Knowing What You're Doing or Knowing what to do: How Stress Management Apps Support Reflection and Behaviour Change , 2018, CHI Extended Abstracts.

[28]  Matthew D. Lieberman,et al.  Putting Feelings Into Words: Affect Labeling as Implicit Emotion Regulation , 2018 .

[29]  C. Gardiner,et al.  Interventions to reduce social isolation and loneliness among older people: an integrative review , 2018, Health & social care in the community.

[30]  Lorraine Hudson,et al.  Amplifying Quiet Voices: Challenges and Opportunities for Participatory Design at an Urban Scale , 2018 .

[31]  Ambuj Tewari,et al.  Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health: Key Components and Design Principles for Ongoing Health Behavior Support , 2017, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[32]  Sharon Shiovitz-Ezra,et al.  Pathways from Ageism to Loneliness , 2018 .

[33]  Thomas A Morton,et al.  Activating and Guiding the Engagement of Seniors With Online Social Networking: Experimental Findings From the AGES 2.0 Project , 2018, Journal of aging and health.

[34]  Susan M. Kaiser,et al.  Harnessing Peer Support in an Online Intervention for Older Adults with Depression. , 2017, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[35]  Rachel L. Franz,et al.  Adoption and feasibility of a communication app to enhance social connectedness amongst frail institutionalized oldest old: an embedded case study , 2017 .

[36]  D. Gooch.  Amplifying Quiet voices Challenges and opportunities for participatory design at an urban scale , 2017 .

[37]  Azadeh Rezvani,et al.  The impact of technology on older adults' social isolation , 2016, Comput. Hum. Behav..

[38]  Jenny Waycott,et al.  Not For Me: Older Adults Choosing Not to Participate in a Social Isolation Intervention , 2016, CHI.

[39]  M. Zyphur,et al.  Loneliness over time: The crucial role of social anxiety. , 2016, Journal of abnormal psychology.

[40]  G. Dingle,et al.  Groups 4 Health: Evidence that a social-identity intervention that builds and strengthens social group membership improves mental health. , 2016, Journal of affective disorders.

[41]  Yi-Ru Regina Chen,et al.  The Effect of Information Communication Technology Interventions on Reducing Social Isolation in the Elderly: A Systematic Review , 2016, Journal of medical Internet research.

[42]  Özkan Çikrikçi,et al.  The effect of internet use on well-being: Meta-analysis , 2016, Comput. Hum. Behav..

[43]  J. Cacioppo,et al.  Loneliness , 2015, Perspectives on psychological science : a journal of the Association for Psychological Science.

[44]  K. Peters,et al.  Interviews in qualitative research. , 2015, Nurse researcher.

[45]  Timothy B. Smith,et al.  Loneliness and Social Isolation as Risk Factors for Mortality , 2015, Perspectives on psychological science : a journal of the Association for Psychological Science.

[46]  George S. Ford,et al.  Internet use and depression among retired older adults in the United States: a longitudinal analysis. , 2014, The journals of gerontology. Series B, Psychological sciences and social sciences.

[47]  G. Dingle,et al.  Feeling connected again: interventions that increase social identification reduce depression symptoms in community and clinical settings. , 2014, Journal of affective disorders.

[48]  B. Schüz,et al.  How do negative self-perceptions of aging become a self-fulfilling prophecy? , 2013, Psychology and aging.

[49]  Predrag V. Klasnja,et al.  Mind the theoretical gap: interpreting, using, and developing behavioral theory in HCI research , 2013, CHI.

[50]  S. Haslam,et al.  "When the age is in, the wit is out": age-related self-categorization and deficit expectations reduce performance on clinical tests used in dementia assessment. , 2012, Psychology and aging.

[51]  Marius Veseth,et al.  Negotiating the coresearcher mandate – service users’ experiences of doing collaborative research on mental health , 2012, Disability and rehabilitation.

[52]  Kaija Saranto,et al.  Impact of computer training courses on reduction of loneliness of older people in Finland and Slovenia , 2012, Comput. Hum. Behav..

[53]  Sidney S. Fels,et al.  Determining the Determinants of Health Behaviour Change through an Online Social Network , 2012, PERSUASIVE.

[54]  Jolanda Jetten,et al.  The social cure : identity, health and well-being , 2012 .

[55]  Joseph A. Cafazzo,et al.  mHealth consumer apps: the case for user-centered design. , 2012, Biomedical instrumentation & technology.

[56]  Jodi Forlizzi,et al.  Understanding my data, myself: supporting self-reflection with ubicomp technologies , 2011, UbiComp '11.

[57]  L. Hawkley,et al.  Loneliness Matters: A Theoretical and Empirical Review of Consequences and Mechanisms , 2010, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[58]  Eileen Cahill,et al.  “You Don't Want to Burden Them” , 2009, Journal of family nursing.

[59]  Owen Johnson,et al.  Digital circles of support: Meeting the information needs of older people , 2009, Comput. Hum. Behav..

[60]  John T. Cacioppo,et al.  Loneliness within a nomological net: An evolutionary perspective , 2006 .

[61]  V. Braun,et al.  Using thematic analysis in psychology , 2006 .

[62]  J. Jetten,et al.  Taking the strain: social identity, social support, and the experience of stress. , 2005, The British journal of social psychology.

[63]  Johannes Siegrist,et al.  Social Productivity and Well-being of Older People: A Sociological Exploration , 2004 .

[64]  Jan Gulliksen,et al.  Key principles for user-centred systems design , 2003, Behav. Inf. Technol..

[65]  Allison Druin,et al.  Technology probes: inspiring design for and with families , 2003, CHI '03.

[66]  T. Tilburg,et al.  Losing and Gaining in Old Age: Changes in Personal Network Size and Social Support in a Four-Year Longitudinal Study , 1998 .

[67]  G. Wenger,et al.  Social networks and the prediction of elderly people at risk , 1997 .

[68]  J. L. Smith,et al.  Semi-Structured Interviewing and Qualitative Analysis , 1995 .

[69]  H Akiyama,et al.  Social networks in adult life and a preliminary examination of the convoy model. , 1987, Journal of gerontology.

[70]  Daniel W. Russell,et al.  Social and emotional loneliness: an examination of Weiss's typology of loneliness. , 1984, Journal of personality and social psychology.

[71]  G J Wentowski,et al.  Reciprocity and the coping strategies of older people: cultural dimensions of network building. , 1981, The Gerontologist.

[72]  Samuel Leinhardt,et al.  Social Networks: A Developing Paradigm , 1977 .

[73]  Mark S. Granovetter.  The Strength of Weak Ties , 1973, American Journal of Sociology.