Loneliness and social isolation are well-established health-related risk factors. However, mixed and somewhat weak evidence is available regarding intervention efforts to promote social connection or reduce loneliness and social isolation. Systematic reviews and meta-analyses investigating interventions in clinical settings were able to reduce loneliness and increase survival rates in medical patients. Loneliness and social isolation have negative health consequences, but few services on a large scale could provide effective interventions. This study aims to evaluate whether future good deeds will mitigate loneliness/social isolation, and improve mental health, and neighborhood cohesion.
The Ethics Review Boards of Swinburne University of Technology, Brigham Young University, and the University of Manchester approved the study. The research was reported on following the CONSORT (Consolidated Standards of Reporting Trials) guidelines. Pre-registration for the KIND Challenge was done at ClinicalTrials.gov (Identifier: NCT04398472) before the launch of the study and a protocol paper has been published.
Three randomized controlled trials (RCTs) were conducted in the USA, UK, and Australia, involving a total of 4,284 individuals aged 18-90 randomized to the KIND challenge intervention or a waitlist control group. Participants allocated to the intervention were asked to do at least one act of kindness per week within four weeks. The primary outcome was loneliness and secondary outcomes included measures of social isolation, mental health, and neighborhood social cohesion.
The participants who have been randomly assigned to the intervention arm of the KIND challenge were requested to self-select and conduct their activities of kindness for a period of four weeks as the trial occurred during the COVID-19 pandemic. Following that, participants were required to follow the prescribed health department safety guidelines for their state or country while performing the KIND challenge.
Preliminary screening for normality and the score distribution (e.g., skew and kurtosis) indicated all outcome data in the scales to fall within the permissible limits for parametric analysis (skew ≤ 1). Non-normality robust estimators (Mplus estimator MLR) which take a slight deviation from non-normality in outcomes were used. According to the CONSORT reporting standards, randomization was established and confirmed a successful baseline balance.
Predictors of missingness were identified, and as missing cases exceeded the 5% thresholds and missing at random, multiple imputation procedures were done with FIML in Mplus. This allowed both partially and completely observed cases to be included in the analyses, thus decreasing bias associated with attrition. Descriptive data concerning the outcomes at baseline and follow-up by intervention arm and country.
Findings showed significant intervention effects for reductions in loneliness post-intervention in the USA (B=−0.06, SE=0.02, p=0.003, Cohen’s d=−0.13), UK (B=-0.05, SE=0.02, p=0.026, Cohen’s d=−0.21). No such effects were observed in Australia (B=−0.02, SE=0.02, p=0.331, Cohen’s d=−0.12). These findings were sensitive to the additional explanatory variables, highlighting the robustness of the trial effect in reducing loneliness.
Nonetheless, the effects lasted for only four weeks, measurement concerning how long the impact would last is still unknown. Also, participants could not be kept blind to their assigned condition considering the nature of the intervention. Effectiveness might be affected by much that the pandemic of COVID-19 brought to us. Social restrictions, and their variation across and within countries, have already been controlled in our analyses; it is still possible that, had the restrictions not existed, the range and scope of acts of kindness would have been different.
Promoting the provision of social support through small acts of kindness to neighbors has the potential to reduce loneliness, social isolation, and social anxiety, and promote neighborhood relationships, suggesting a potential strategy for public health campaigns.
Reference: Lim MH, Hennessey A, Qualter P, et al. The KIND Challenge community intervention to reduce loneliness and social isolation, improve mental health, and neighbourhood relationships: an international randomized controlled trial. Soc Psychiatry Psychiatr Epidemiol. Published online August 19, 2024. doi:10.1007/s00127-024-02740-z
