The NIHR Public Health Research (PHR) Programme is looking to fund research that evaluates the health and health inequality impacts of community initiatives that aim to address loneliness at a population level.
This is a 2-stage funding opportunity. To apply for the first stage you should submit an outline application. If invited to the second stage, you will then need to complete a full application.
Introduction
The NIHR Public Health Research (PHR) Programme invites applications in response to specific research questions. These have been identified, developed and prioritised for their importance to stakeholders including the Department of Health and Social Care and other relevant government departments, devolved administrations, policy makers, local government, commissioners of public health services, public health practitioners and the general public.
Research question
What are the health and health inequality impacts of community initiatives that aim to address loneliness at a population level?
Background
Tackling the root cause of loneliness requires the full engagement and support from a community-centred and multisectoral approach involving raising public awareness, engaging communities, and providing targeted support services. As with so many health and social inequalities, people in marginalised social groups are disproportionately affected by loneliness, and personal loneliness is associated with community-relevant outcomes such as lower social trust and sense of belonging to the local area. This funding opportunity will focus on the impact the community has on reducing or increasing the experience of loneliness.
Loneliness is a complex phenomenon, related to interpersonal social relationships, social structures, specific life events and an individual’s social environment. Loneliness can be defined as a subjective, unwelcoming feeling of lack or loss of companionship, and evidence of its harmful effects is growing. Chronic loneliness increases the risk of mental and physical ill-health, premature mortality, increased healthcare use and societal costs, including reduced productivity at work and absenteeism. In 2022, nearly 50% of adults in the UK reported feeling lonely occasionally, sometimes or always, and approximately 7% of people in Great Britain experienced chronic loneliness, meaning they feel lonely ‘often or always’. Loneliness is experienced across all ages. Nevertheless, evidence consistently finds higher levels for people aged under 25 years, compared to people who are middle-aged. For people aged over 65 findings are more varied, with some evidence of older people demonstrating the highest levels of loneliness compared to middle-aged people and some evidence of lower levels.
Although anyone can experience loneliness, loneliness is more prevalent in people from marginalised groups including people with disabilities, mobility or physical and mental health problems, single people/people living alone, renters, people whose race or ethnicity is under-represented, LGBTQ+, inclusion health groups or caring responsibilities. The causes of loneliness are often complex, multi-layered, and mutually reinforcing. Loneliness stems from a combination of personal, community, societal and geographic factors rather than being the product of one event or change in circumstances. Triggers for loneliness are also widespread, but are often associated with life course transitions, such as adolescence, leaving home, becoming a parent (particularly young and new mums), retirement, people recently divorced, separated or bereaved. The negative feelings arising from loneliness (such as shame and despair) cause more self-isolating behaviour, which makes loneliness more entrenched, sometimes referred to as the psychological spiral of loneliness.
Although still developing, the evidence has shown a relationship between community identification and reduced loneliness. Community-centred responses may therefore be well placed to support and enhance pre-existing coping strategies in people who are more vulnerable to loneliness. We often refer to the “community” without really taking time to explain what we mean by this. The word itself is a common experience that connects us with each other. Nevertheless, the meaning of community is complex and there is often an insufficient understanding of what a community is and its role in people’s lives. First, community is not a place, a building, or an organisation. Community is both a feeling and a set of relationships among people. People form and maintain communities to meet common needs. When communities function well, members have a sense of trust, belonging, safety and care for each other, and social cohesion within a given community may be one of the most direct determinants of loneliness. For example, lack of accessible and affordable transport can prevent people from building and maintaining social connection. A lack of green and public spaces to meet in or local groups to join can mean there are limited opportunities to socialise and connect with others. Likewise, high crime rates often lead people to feel unsafe within their local community, again limiting the opportunity to connect. There are further inequalities at a society level, financial and other inequalities may lead to people feeling lonely, as they may not be able to take part in paid-for activities. Others may be excluded due to a disability, long-term health problem, their gender, age, race or sexual orientation.
The poor evidence base around what works in tackling loneliness continues to act as a barrier to investment in loneliness interventions. Research into the effectiveness of interventions to reduce loneliness tends to consist of individual level short-term and/or small-scale studies. Other evaluations have addressed social isolation, such as befriending initiatives, but not necessarily loneliness. Although these studies often show evidence for the effectiveness of interventions, systematic reviews consistently call for longer-term, large-scale research into initiatives evaluating more population level community-centred (school, workplace, neighbourhood) interventions to reduce loneliness.
Funding opportunity scope
We would welcome population level research evaluating interventions that impact loneliness in the UK. We recognise that although social isolation and loneliness often come together, they are conceptually and empirically distinct from each other, and this funding opportunity will focus the impact on loneliness.
Research areas of interest could include, but are not limited to:
- community-centred initiatives aiming to prevent loneliness
- community-centred initiatives (including interventions not explicitly set up to target loneliness) which have an impact on alleviating or increasing loneliness (as an unintended consequence)
- interventions utilising community-assets, neighbourhood and place-based approaches to reduce loneliness. This may also include structural initiatives, transportation and lack of access to services
- evaluations of the role of anchor institution’s in addressing loneliness
- evaluations of cross system multi-level interventions to tackle loneliness
- evaluations of interventions designed to gain (social) skills, confidence and build resilience in people to prevent loneliness
- evaluation of interventions aimed at developing and maintaining connections with the local community, for example Community Navigators and community connectors
- the impact of virtual communities on loneliness (positive or negative)
We acknowledge that in researching how interventions impact on loneliness, it would be valuable to understand how the intervention works in a particular area, as well as for whom, and under what circumstances. Making the findings more generalisable will support decision-makers to take evidence-based action to improve population health.
We recognise that for some proposals, underpinning or development work to understand the epidemiology and inform the evaluation of interventions might be beneficial. We are willing to consider applications that include a maximum 6 month period of underpinning or development work. Likewise, we also recognise that researchers at times need to conduct rapid baseline data collection, as well as other feasibility work, within a very tight timeframe. If this is the case, please contact the PHR Programme before applying to discuss further, or read more about the Public Health Research Programme Rapid Funding Scheme on the webpage. You are strongly encouraged to familiarise themselves with the remit of the PHR Programme.
When considering whether to apply, please see the key information below. When developing your application, please consider contacting the Research Support Service Specialist Centre for Public Health, and refer to the application guidance, paying particular attention to the points highlighted below:
Population (P) – While this funding opportunity is broad, you will need to specify and justify your choice of population. We recognise that interventions are likely to impact different (sub)populations in different ways. We would encourage you to pay attention to age groups, and to consider marginalised groups who have higher prevalence of loneliness and recognise where intersectionality may exist.
Intervention (I) – We are predominantly interested in the evaluation of interventions that operate at a population level rather than at an individual level. Our PHR Programme does not fund research into the treatment of disease, but we are interested in research that addresses the wider determinants of health. The description of the intervention may include the setting. We would welcome evaluations of structural initiatives and their impact on loneliness, including unintended consequences. If evaluating smaller scale interventions, you will need to ensure these are generalisable to wider settings and populations.
Comparator (C) – While we recognise that conducting a randomised controlled trial is not necessarily possible or appropriate in many situations, we encourage you to consider including a suitable comparator.
Outcomes (O) – The primary outcome must be a health outcome. You will need to clearly describe and justify your choice of primary and secondary outcomes. You will also need to specify how outcomes will be measured in the short, medium, and long term. Where a primary health outcome is not feasible then intermediary and proxy outcomes are accepted, if appropriately justified.
Health inequalities – Of particular importance to our PHR Programme is an understanding of inequalities in impact of policy and access to services. Evaluations of interventions seeking to reduce health inequalities are also of specific interest.
Study design
A range of study designs can be used. Innovative methodologies are welcomed. You should clearly describe your methodological approach, and the rationale for this approach. We recognise that this funding opportunity is broad and expects you to be targeted in your research. You are expected to be aware of any policy changes that may influence the research as well as other relevant studies. You should identify the gaps in the existing evidence base and articulate why your research is important for decision makers. If relevant, you are encouraged to clearly identify how a wide range of existing evidence outputs can be combined with your study to deliver a whole societal approach.
Health economics: Understanding the value of public health interventions – whether the outcomes justify their use of resources – is integral to the PHR Programme, where resources relating to different economic sectors and budgets are potentially relevant. The main outcomes for economic evaluation are expected to include health (including health-related quality of life) and the impact on health inequalities as a minimum, with consideration of broader outcomes welcomed. Different approaches to economic evaluation are encouraged as long as they assess the value and distributive impact of interventions. Applications that do not include an economic component should provide appropriate justification.
Outputs
Pathways to Impact – we are focused on the impact of the research we fund. You are asked to consider the timing and nature of deliverables in your proposals; and encouraged to maximise the impact of your research by explaining how you will mobilise knowledge and ensure that it is useful and relevant to stakeholders such as policy makers, practitioners (e.g. educators, health and care professionals), public health officers, special interest groups, charities, community audiences and other stakeholders.
Duration and costs
You are advised that we are custodians of public funds and value for money is one of the key criteria that peer reviewers and commissioning committee members will assess applications against.
NIHR Research inclusion
In line with the NIHR principles of inclusion, it is important that you fully consider inclusion throughout the whole research lifecycle and provide information on any associated costs.
This includes (but is not limited to):
- your research design
- the participants you recruit and how you have considered diverse, under-served populations, health inequalities and exclusion criteria
- equalities and exclusion criteria
- research methods
- data and statistical analysis
- knowledge mobilisation and dissemination of findings
Visit funding web page
(https://www.nihr.ac.uk/funding/loneliness-community/2025451)
