Our final sample size at baseline was 452 participants [6 participants did not complete baseline surveys]. We summarize socio-demographic characteristics for the whole sample in Table 2 and for the interview subset in Table 3. As previously reported (37), in the whole sample most participants identified as women (77%), lived in medium to large urban centres (77%), had at least some post-secondary education (75%), no mobility limitations (57%) and identified as white (86%). Specific to these analyses, 58% of participants identified as lonely at baseline (n=261). Those who identified as lonely were more likely to be women and reported lower self-rated health compared to same-age peers (Table 2). Less than 1% of participants (n=4) identified as socially isolated at baseline. Given the low prevalence of socially isolated participants in this group we were unable to explore the combined moderating influence of loneliness and social isolation; therefore, we focused solely on loneliness. Among participants who dropped out of CTM (n=49), withdrew from the evaluation (n=2) or missed an evaluation timepoint (n=51), the proportion who identified as lonely was similar between those who withdrew from, and those who remained in the study (58%).
Results were similar for minimally and fully adjusted models, thus we focus on the fully adjusted model here (Table 4). At baseline, PA levels were similar between participants who identified as lonely and not lonely (mean difference: -0.2 days/week (95% CI, -0.6, 0.3). PA increased significantly during the active intervention phase (baseline to 3 months) in both lonely and not lonely participants. PA decreased significantly from 3-6 months (in the taper phase) in lonely participants only. However, PA at 6 months remained significantly above baseline levels in both groups.
Results were similar for minimally and fully adjusted models, thus we focus on the fully adjusted model here (Table 4). By definition, loneliness scores at baseline were significantly different between participants identifying as lonely and not lonely; this significant between-group difference was maintained at 3 and 6 months. Loneliness decreased significantly from 0-3 months in participants who identified as lonely at baseline; lower loneliness scores were maintained at 6 months (significantly different from baseline). There was no change in loneliness from 0-3 months in the ‘not lonely’ group. However, loneliness increased significantly in this group at 6 months compared to baseline.
Our deductive framework analysis consisted of three CTM intervention components as our categories. Below, we present each category and describe the themes (e.g., factors), within each CTM intervention component, found to promote social connectedness/ reduce loneliness. We highlight the social connectedness indicators of each theme in Table 5. Interview participants were men (n=16) and women (n=27), aged 60-74 (n=33) or 75+ (n=10) who identified as lonely (n = 26), not lonely (n = 16) or did not respond (n = 2). We present participant responses by time point (baseline, 3 months and 6 months), and whether participants identified as lonely or not lonely. Compared with not lonely participants, lonely participants more often discussed social connectedness factors (e.g., social activities, chatting) within each intervention component. Not lonely participants placed more emphasis on education and goal commitment. We focused our analysis on describing factors within CTM intervention components that may promote social connectedness/ reduce loneliness. The following themes were found: activity coach characteristics/personality traits and approaches; opportunities to share information and experiences and learn from others; engage with others who share similar/familiar experiences; increased opportunity for meaningful interaction; and accountability.
Participants deemed the activity coach as essential to influencing social connectedness within all three CTM intervention components. Participants described distinct activity coach characteristics/personality traits and approaches that promote social connectedness/ reduce loneliness.
Activity coach characteristics/personality traits and approaches: being personable (easy to talk to), positive, offering encouragement, accommodating, accepting, observant, careful, motivating, providing accountability, and approachable.
Participants enjoyed being able to connect with an activity coach during the one-on-one consultation, and work with the activity coach to design a personalized action plan. This process enacted feelings of being listened to and cared for and supported development of a meaningful relationship between participants and their activity coach. The activity coach-participant relationship spurred feelings of motivation and encouragement.
(Not lonely, baseline)
Oh, I really like it because it’s designed individually for me and [name of Activity Coach] is really easy to talk to and very personable. And so, yeah, when we had our one-hour session on Thursday where we discussed and made the plan for this coming week. And so when she said would you be interested, she was full of ideas. And she was good at taking my ideas and adjusting them. It’s personalized. So, yeah, which made it very manageable.
(Not lonely, mid-intervention)
Yeah, oh, so for the Choose to Move, yeah, having to be accountable, that’s an important thing for me, I find that once I make the commitment and I just-- really didn’t want to disappoint anyone else, as well as myself.
Motivational Group Meetings
Motivational Group Meetings were overwhelmingly considered of great value to create and sustain social connections. The following factors within the Motivational Group Meetings were found to promote social connectedness/reduce loneliness: activity coach characteristics/personality traits and approaches; opportunities to share information and experiences and learn from others; engage with others who share similar/familiar experiences; and increased opportunity for meaningful interaction.
Activity coach characteristics/personality traits and approaches: being positive, offering encouragement, engaging, accommodating, calls participants by name, accepting, observant, careful, and motivating.
Yeah, ‘cause when I missed one of the classes everybody said, oh, good to see you back. But they didn’t say “[name of participant].” But by the end of-- when (activity coach) said [name of participant], tell us what you’ve done, by the end of the class everybody goes, see you the next month [name of participant], right.
She [activity coach] is so positive and she’s so encouraging. And she really knows her stuff. Because she really tries to engage everybody in-- she knows everybody and she knows everybody’s progress and ability. She is encouraging that way ‘cause she knows when someone is taking it slower ‘cause-- sprained ankle or not feeling well that day. And so she does that in the CTM too where she, you know, like, caters it kind of individually and often as a group. And it’s really hard to explain. But you do feel like you’re getting individual attention even though you’re also in a group getting to know everybody else.
Opportunities to share information and experiences and learn from others promoted interactions between participants, encouraged the exchange of phone numbers, provided personal introductions, and engaged participants in paired and group discussions to share information on community resources.
Participants discussed how they enjoyed activities that offered them the opportunity to share information and experiences with other group members. Being able to learn from others created a sense of bonding, belonging and being cared for, and developed meaningful relationships.
Well, everybody got to share what they did from the last meeting, and then-- like, every time, like, what we did and then if there were problems and what we plan to-- like, exactly what was in the email, but we said it out loud so everybody could hear. And I think everybody-- it was quite helpful, I think. When they had a solution to-- or everybody said, oh yeah, that happened to me. Or-- it was like bonding. So, it was nice, and everybody got to speak, and it was encouraged. And I don’t think anybody was really quiet about it. So, I think everybody enjoyed sharing. Yeah, and it was nice to speak up and see if other people felt the same way sometimes.
I liked the meeting. I liked the fact that other people shared their difficulties. It makes me feel not so alone.
(Not lonely, post-intervention)
There are so many people out there in our age group that would benefit from this if they knew about it. It’s-- so many of us people in, you know, in their 60s feel uncomfortable going to a gym because it’s, you know, full of 20 year olds and you feel like you don’t belong. And this-- with our instructor it just made us feel like we were part of a group like everybody else. It was a good feeling.
Sharing/learning opportunities within Motivational Group Meetings were considered a more fruitful way to promote social connectedness/reduce loneliness than were ‘lecture’ style sessions.
(Not lonely, post-intervention)
But it might be nice to have actually had a-- even if it was just a get together with the group, just to see how everybody else did. I know that one lady was wanting-- she had joined the group with the purpose of, you know, finding someone else to exercise with. Which is a good thing too. But there wasn’t a lot of social opportunity, I think, because we got information. We were given-- there was a video and there was talks and exercises and discussions about things that you did individually. But we really didn’t have a lot of opportunities to sort of talk to one another. And that’s [inaudible] I think everybody’s fairly shy. But it may be something that they could throw in, maybe halfway and again at the end. A little social time, a tea or something. And just everybody could sort of talk about how they’re doing things. ‘Cause we learn from what some of the other people were doing too. So that was a good thing
Engage with others who share similar/familiar experiences promotes emotional and informational support to participants and offers space to share common characteristics or life experiences-- this fosters a sense of belonging and companionship.
There were other people in the class that, when we all introduced ourselves, were having the same kind of struggles I had, the same kind of goals and were people that I thought, hmm, okay. There’s somebody I could probably call; see how they’re doing because they’re like me.
Well, companionship or-- communication and companionship with the other people who are attending. Yeah, these weren’t people that I knew prior. It just-- I think it’s just more supportive when there are other people that you’re hearing are dealing with issues too that are similar, um-hum.
Increased opportunity for meaningful interaction. Participants enjoyed the more frequent interactions during the active phase (first 3 months) of Choose to Move and felt the decline in motivational group meetings over the later months (taper phase) negatively influenced their sense of social connectedness.
Well, I think name (activity coach) did say they were continuing for three more months for checking in on us, right. And I’d assume it’s through email, right, that it wasn’t over. But it would have been nice, I think, to do it one last time, to end the program, just for a goodbye. I guess it’s because I like the group maybe too, yeah.
It was nicer when we met more frequently, I think. I think that was-- yeah, ‘cause we met-- the first while we were meeting once a week, then once every two weeks and then it got to the month. I think the interaction for some people is a good thing. Through the winter that was really nice to have that group to go back to every few weeks, that other group, yeah. I think maybe a little more interaction would be good.
Participants described specific Activity Coach characteristics/personality traits and approaches that promoted a sense of social connectedness/ reduced loneliness during the Check-Ins.
Activity coach characteristics/personality traits and approaches that promoted social connectedness during check-ins included: being personable (easy to talk to), positive, someone who offers encouragement, accommodates, is accepting, motivates, provides accountability, approachable, high energy, makes sure to be available, takes time, listens, and is thoughtful.
Well, I think if they were serious about trying to get more physical in their activity and-- slowly and realistically and with support from the class and the instructor. And also, like, personal checks, either how would they prefer, email, face-to-face or phone call. So, I think it’s a really good follow-up, because a lot of times you get lost in the programs or it doesn’t seem like anybody cares, so you don’t care.
(Not lonely, mid-intervention)
Especially the encouragement. I mean, that’s the main thing anyway for me. ‘Cause I live alone and it’s easy to not do anything. So, it’s very nice when someone phones you up and says, how are you doing and, you know, can I help you in any way, get some ideas together and stuff like that. So that helps a great deal
(Not lonely, mid-intervention)
The phone calls are very encouraging. So that helps a lot. Yeah, she’s [activity Coach] fabulous. Really is a dear friend already so-- wonderful lady, and a very good encourager
Accountability promoted social connectedness by providing participants a sense of responsibility to the Activity Coach and to themselves and the other older adults in their group. The pre-planned check-in offered a consistent point of contact for participants that many looked forward to. Participants were accountable to the Activity Coach, which motivated and encouraged participants to engage in activity.
I mean, she’s right on top of it because she’ll make-- actually make an appointment for you. So that’s a good thing too, right. Because like I said, because I’m so busy doing stuff, that way I already-- it’s sort of pre-planned. I know she’s going to be phoning on that day, approximate time and all that. So, it’s not like I-- you know, so I already know that’s going to take place, and that’s great, yeah
Well, I thought it was good. And she was excellent, and she made sure before she hung up that we had a date set and I had it written in my calendar. A date and time that she would call her next call. So, all the time when you’re-- if you weren’t doing something, in your head you know oh, you-- I’ve got to tell [name of Activity Coach] that I haven’t been doing anything. So, it’s just that little guilt trip there too, I guess