4 How do befriending services impact health? A mixed-methods analysis of potential mechanistic pathways

Abstract

Abstract Background Befriending services do not appear to impact loneliness, but they may have an effect on health. To understand their effect further, we conducted a mixed methods study of the ALONE Befriending and Practical Support Service, using a single case experimental design and supplementary dyadic constructivist grounded theory interviews. Methods To understand the potential mechanistic pathways between befriending services and health outcomes, we integrated qualitative and quantitative findings using a pluralistic triangulation approach. Qualitative and quantitative findings were sequentially paired and described as either in agreement, in partial agreement, dissonant, or silent. Results Qualitative and quantitative findings were in full agreement that befriending had a direct impact on the health of older adults. There was dissonance on the impact of befriending on loneliness; while quantitative findings showed no direct effect of befriending on loneliness, the qualitative findings suggested that befriending reduced loneliness. The quantitative findings supplemented the qualitative by demonstrating that the befriending service is likely to buffer the negative effect of loneliness on health. The qualitative study revealed four other mechanisms through which befriending may impact health (by providing emotional support, lifting mood, opportunities for engagement in health behaviours, and cognitive stimulation) which were not explored in the quantitative study. Conclusion Findings suggest that further research is still required to unpick the nature of the link between befriending and loneliness. It is possible that gratitude for the service mediates this link, which warrants further exploration. Overall we can recommend that befriending services are useful for older adults for protecting health.