Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
Centre of Excellence for Public Health, CoE, Queen's University Belfast, Belfast, Northern Ireland.
PLoS One. 2021 Sep 9;16(9):e0256900. doi: 10.1371/journal.pone.0256900. eCollection 2021.
Befriending is a popular way in which to intervene to combat loneliness and social isolation among older people. However, there is a need to improve our understanding about how these interventions work, for whom and in which contexts, to make the best use of the increasing investment in the provision and delivery of befriending services.
A realist evaluation was undertaken as it focuses on uncovering causal processes and interactions between mechanisms and contextual characteristics. Five case studies of befriending programmes in Northern Ireland were studied, reflecting variation in contextual variables, service user and provider characteristics. Data was collected via service documentation and semi-structured interviews (n = 46) with stakeholders involved in the delivery and receipt of befriending interventions.
Eight initial programme theories were generated, which were 'tested' in the case study analysis to uncover context-mechanism-outcome relationships. Mechanisms identified included reciprocity, empathy, autonomy, and privacy which were triggered in different contexts to support the alleviation of loneliness and social isolation. Reciprocity was 'triggered' in contexts where service users and befrienders shared characteristics, the befriender was a volunteer and befriending took the form of physical companionship. Contexts characterised in terms of shared experiences between befriender and service user triggered empathy. Autonomy was triggered in contexts where befriending relationships were delivered long-term and did not focus on a pre-defined set of priorities. Privacy was triggered in contexts where service users had a cognitive/sensory impairment and received one-to-one delivery.
This study improves understanding about how and why befriending interventions work. Findings indicate that services should be tailored to the needs of service users and take into consideration characteristics including mobility, impairments e.g. physical, sensory and/or cognitive, as well as the influence of service characteristics including payment for befrienders, fixed/long-term befriending relationship, one-to-one support and the impact of non-verbal communication via face-to-face delivery.
交友是一种常见的干预方式，可用于缓解老年人的孤独感和社会隔离。然而，我们需要更好地了解这些干预措施的工作原理、针对的人群以及在哪些情况下有效，以便充分利用在提供和实施交友服务方面的日益增长的投入。
本研究采用了现实主义评估方法，因为它侧重于揭示机制和背景特征之间的因果过程和相互作用。对北爱尔兰的五个交友项目进行了案例研究，反映了背景变量、服务使用者和提供者特征的差异。通过服务文件和涉及交友干预的交付和接收的利益相关者的半结构化访谈（n=46）收集数据。
生成了八项初始方案理论，通过案例研究分析对这些理论进行了“检验”，以揭示情境-机制-结果关系。确定的机制包括互惠、同理心、自主性和隐私，这些机制在不同的情境中被触发，以支持缓解孤独感和社会隔离。互惠在服务使用者和交友者具有共同特征、交友者是志愿者且交友形式为身体陪伴的情境中被触发。在交友者和服务使用者之间具有共同经历的情境中触发同理心。在长期的、不关注预先确定的一系列优先事项的交友关系中触发自主性。在服务使用者有认知/感官障碍并接受一对一服务的情境中触发隐私。
本研究增进了对交友干预措施如何以及为何起作用的理解。研究结果表明，服务应根据服务使用者的需求进行定制，并考虑包括机动性、身体、感官和/或认知障碍等特征，以及服务特征的影响，包括交友者的报酬、固定/长期交友关系、一对一支持以及面对面交付中非言语交流的影响。
