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Putting Life in Years (PLINY): a randomised controlled trial and mixed-methods process evaluation of a telephone friendship intervention to improve mental well-being in independently living older people
Hind, D. Mountain, Gail Gossage-Worrall, R. Walters, S.J. Duncan, R. Newbould, L. Rex, S. Jones, C. Bowling, A. Cattan, M.
Hind, D.
Mountain, Gail
Gossage-Worrall, R.
Walters, S.J.
Duncan, R.
Newbould, L.
Rex, S.
Jones, C.
Bowling, A.
Cattan, M.
Publication Date
2014-12
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© Queen's Printer and Controller of HMSO 2014. This work was produced
by Hind et al. under the terms of a commissioning contract issued by the Secretary of State for
Health. This issue may be freely reproduced for the purposes of private research and study and
extracts (or indeed, the full report) may be included in professional journals provided that
suitable acknowledgement is made and the reproduction is not associated with any form of
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Abstract
Social isolation in older adults is associated with morbidity. Evaluating interventions to
promote social engagement is a research priority.
Methods: A parallel-group randomised controlled trial was planned to evaluate whether telephone
friendship (TF) improves the well-being of independently living older people. An internal pilot aimed to
recruit 68 participants by 30 September 2012, with 80% retained at 6 months. Randomisation was web
based and only analysts were blind to allocation. A service provider was contracted to train 10 volunteer
facilitators by 1 April 2012 and 10 more by 1 September 2012. Participants were aged > 74 years with
good cognitive function and living independently in an urban community. The intervention arm of the
trial consisted of manualised TF with standardised training: (1) one-to-one befriending (10- to 20-minute
calls once per week for up to 6 weeks made by volunteer facilitators) followed by (2) TF groups of
six participants (1-hour teleconferences once per week for 12 weeks facilitated by the same volunteer).
Friendship groups aimed to enhance social support and increase opportunities for social interaction
to maintain well-being. This was compared with usual health and social care provision. The primary
clinical outcome was the Short Form questionnaire-36 items (SF-36) mental health dimension score at
6 months post randomisation. Qualitative research assessing intervention acceptability (participants)
and implementation issues (facilitators) and an intervention fidelity assessment were also carried out.
Intervention implementation was documented through e-mails, meeting minutes and field notes.
Acceptability was assessed through framework analysis of semistructured interviews. Two researchers
coded audio recordings of telephone discussions for fidelity using a specially designed checklist.
Results: In total, 157 people were randomised to the TF group (n = 78) or the control group (n = 79).
Pilot recruitment and retention targets were met. Ten volunteers were trained by 1 September 2012; after
volunteer attrition, three out of the 10 volunteers delivered the group intervention. In total, 50 out of the
78 TF participants did not receive the intervention and the trial was closed early. A total of 56 people
contributed primary outcome data from the TF (n = 26) and control (n = 30) arms. The mean difference in SF-36 mental health score was 9.5 (95% confidence interval 4.5 to 14.5) after adjusting for age, sex and
baseline score. Participants who were interviewed (n = 19) generally declared that the intervention was
acceptable. Participant dissatisfaction with closure of the groups was reported (n = 4). Dissatisfaction
focused on lack of face-to-face contact and shared interests or attitudes. Larger groups experienced better
cohesion. Interviewed volunteers (n = 3) expressed a lack of clarity about procedures, anxieties about
managing group dynamics and a lack of confidence in the training and in their management and found
scheduling calls challenging. Training was 91–95% adherent with the checklist (39 items; three groups).
Intervention fidelity ranged from 30.2% to 52.1% (28–41 items; three groups, three time points),
indicating that groups were not facilitated in line with training, namely with regard to the setting of
ground rules, the maintenance of confidentiality and facilitating contact between participants.
Conclusions: Although the trial was unsuccessful for a range of logistical reasons, the experience gained is
of value for the design and conduct of future trials. Participant recruitment and retention were feasible.
Small voluntary sector organisations may be unable to recruit, train and retain adequate numbers of
volunteers to implement new services at scale over a short time scale. Such risks might be mitigated by
multicentre trials using multiple providers and specialists to recruit and manage volunteers.
Version
Published version
Citation
Hind D, Mountain G, Gossage-Worrall R et al (2014) Putting Life in Years (PLINY): a pilot
randomised controlled trial and mixed-methods process evaluation of telephone friendship
groups for community living older adults. Public Health Research. 2(7).
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Report