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HOW-R-U? Implementing a Sustainable Social-Support Program that Promotes Wellbeing for All During and Following COVID-19

Ms Elizabeth Robinson, Dr Marissa Dickins, Ms Lina Lad and Professor Judy Lowthian

Bolton Clarke Research Institute

The public health concern surrounding social isolation and loneliness has been heightened by the COVID-19 pandemic.

Prior to the pandemic one in four Australian adults experienced loneliness, [1] which is associated with negative health outcomes on par with smoking, affecting mental, cognitive and physical health. Infection prevention measures including stay-at-home orders have been effective but have led to increased feelings of loneliness and depression here in Australia [2] and worldwide. [3,4,5,6] HOW-R-U? is a volunteer-delivered social support telephone program that has been shown to effectively reduce feelings of isolation, loneliness, and depression in recently hospitalised older patients. [7]

The HOW-R-U? program was rapidly implemented early in the COVID-19 pandemic across Bolton Clarke, an Australian aged and community care service, and Northern Health, an acute health service. This involved ongoing co-design with both services to ensure the program was fit-for-purpose and met the demands of the ever-changing situation.

Evaluation of implementation involved analysis of (a) program data including referral, program uptake, and call log information; (b) pre- and post- symptoms of isolation, depression, and loneliness; and (c) semi-structured interviews and surveys with patients, volunteers, and front-line staff referrers.

Findings indicate the systems and processes developed effectively supported ongoing implementation and transition into business as usual. Over the 18-month implementation period, (23/6/20-31/12/21), 227 referrals were received. The 156 people enrolled in HOW-R-U? received 1,238 calls (median length 24 mins) from 83 volunteers. A subgroup consented to research participation (median age = 77.5 years (IQR = 11.7), 52.2% female). Reductions in loneliness and risk of social isolation, of 3.3% and 25.3% respectively, were recorded while depressive symptoms increased by 33.3%. These results are likely to have been influenced by various COVID-19 restrictions across the study period.

All referrers, volunteers and participants surveyed indicated they believed that HOW-R-U? should continue with benefits reported by all stakeholders. Participants felt supported, with one telling us ‘It is empowering to talk to someone when you’re down and know that you’re not alone.’ Some participants reported developing deep intergenerational relationships, with one participant saying her HOW-R-U? calls were like ‘talking to a daughter.’ Similarly, volunteers reported ‘There is something in it for the people we ring, but a lot more in it for the volunteers.’

More than 200 clients and residents have now been connected with around 90 volunteers with similar interests, drawn from across the organisation including senior executive management, for a weekly 20–30-minute support phone call. Clients say the weekly call is a highlight and the program continues to deliver strong results and improve wellbeing.

A range of enablers and barriers to implementation have informed successful implementation into business as usual at both services.

The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

1. Lim MH. Australian Loneliness Report: A survey exploring the loneliness levels of Australians and the impact on their health and wellbeing [Internet]. 2018 [cited 2022 Jul 29]. Available from: https://psychweek.org.au/wp/wp-content/uploads/2018/11/Psychology-Week-2018-Australian-Loneliness-Report.pdf.

2. Rossell SL, Neill E, Phillipou A, Tan EJ, Toh WL, Van Rheenen TE, Meyer D. An overview of current mental health in the general population of Australia during the COVID-19 pandemic: Results from the COLLATE project. J. Psychiatr. 2021;296:113660. doi: 10.1016/j.psychres.2020.113660.

3. Office for National Statistics. Mapping loneliness during the coronavirus pandemic [Internet]. 2021 [cited 2022 Jul 29]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/mappinglonelinessduring
thecoronaviruspandemic/2021-04-07

4. Pérez S, Masegoso A, Hernández‐Espeso N. Levels and variables associated with psychological distress during confinement due to the coronavirus pandemic in a community sample of Spanish adults. Clin Psychol Psychother. 2021;28(3):606-14. doi: 10.1002/cpp.2523.

5. Klaiber P, Wen JH, DeLongis A, Sin NL. The ups and downs of daily life during COVID-19: Age differences in affect, stress, and positive events. J Gerontol B Psychol Sci Soc Sci. 2021;76(2):e30-7. doi: 10.1093/geronb/gbaa096.

6. McGinty EE, Presskreischer R, Han H, Barry CL. Psychological distress and loneliness reported by US adults in 2018 and April 2020. JAMA. 2020;324(1):93-4. doi: 10.1001/jama.2020.9740.

7. Lowthian JA, Lennox A, Curtis A, Wilson G, Rosewarne C, Smit De V, O’Brien D, Browning C, Boyd L, Smith C, Cameron PA. HOspitals and patients WoRking in Unity (HOW R U?): Telephone peer support to improve older patients’ quality of life after emergency department discharge – a feasibility study. BMJ Open 2018;8(6):e020321. doi: 10.1136/bmjopen-2017-020321.