Physical activity, social connectedness and healthy ageing: intervention development

Background: Physical activity and social connections support healthy ageing and have been identified as priorities by older people, carers, health-care providers, and the Scottish and UK government. Low levels of physical activity and social isolation are a particular problem among older people living in underserved communities. Physical activity lends itself to connecting people, and support from friends, family and others can help people start and maintain physical activity. Therefore, finding new ways to increase physical activity in combination with social connections may increase the chances of long-term changes in behaviour and better health among older people.

Aim: To work alongside mid-to-older aged people (55+) and other stakeholders to co-design an action plan of interventions that support older people in two communities in Scotland to be more active, but crucially to combine it with strategies to increase social connections.

Our approach: We will work with communities and stakeholders, including people in the target age range, policymakers, health-care practitioners, local community and third sector organisations, to develop a shared understanding of how different factors combine to influence older people's behaviours. We will then co-design interventions to change behaviour. Interventions may include new services or products, or new ways of working or combining existing services.

Research plan:

Our intervention development research will build upon other work currently being done by our research team. This work is underpinned by community engagement and relationship building, and explores physical activity and social connectedness both broadly (e.g. by exploring influential factors for physical activity and social connectedness, using existing data collected in Scotland-specific and UK-wide surveys), and within our two communities. Within these communities, we are currently exploring older people's social networks (e.g., who they connect with, for what, and where), local collaboration between organisations that support physical activity and social connectedness, and the lived experiences of older people through interviews (exploring their physical activity and social connectedness over time, including how this is shaped by the place they live and major life events). As such, we have engagement within the communities and local-level data to bring to this PHIND-funded project.

As part of this PHIND-funded research, we will work within the local communities, and alongside older people and other stakeholders, to identify and design interventions to support social connections and increase physical activity. They will be invited to three workshops during which they will review existing interventions and use these initial ideas alongside findings from the various pieces of ongoing work (as mentioned above), to identify and develop ideas for increasing physical activity and social connections in the areas where they live.

We will also consider literature that has already been published (through a process called a rapid review) to identify potential interventions that the workshop groups may draw upon. After the workshop series, we will facilitate working groups to further refine the intervention ideas prioritised at the workshops. We will also follow-up with individuals in each area to gather their views on the suggested intervention and its potential effects.

We will communicate widely with older people and other stakeholders to develop a network of collaborators to work with us on this project and others. We will develop plans for rolling-out successful interventions to other communities with the ultimate aim that older people maintain their health and independence for longer.

Age-related declines in physical activity (PA) and social connectedness (SC) are public health issues associated with increased mortality, non-communicable disease, multimorbidity, frailty, service burden, poor mental health and wellbeing. Existing PA and SC interventions have typically shown limited effectiveness, and have focused on the individual-level. Drivers of PA and SC are multi-level and multi-sectoral; our research crucially adopts a systems approach, engaging multiple perspectives on the issues and potential solutions.

Through participatory methods, we will co-develop complementary interventions and systems action plans for synergistically increasing physical activity and social connectedness among those aged 55-75, in two Scottish local authority areas. Example participants include older people, carers, local decision-makers, social enterprise representatives, charities and practitioners. The research will be informed by the 6 Steps in Quality Intervention Development Framework:

Step 1: existing research will define issues and their causes.

Step 2: Workshop 1: participatory systems mapping, including consideration of where stakeholders act within the system, will enable identification of modifiable causal factors of PA and SC, and leverage points, for potentially effective and sustainable systems interventions. We will draw upon our existing evidence and conduct a rapid review of relevant intervention literature.

Steps 3-4: Workshop 2 will elicit intervention ideas and identify proposed change mechanisms. Post-workshop, criteria will be applied to select interventions to progress. Workshop 3 will clarify intervention delivery by generating programme theories, examining how interventions, within a whole-systems action plan, effect change.

Step 5: Co-design working groups will refine intervention ideas. Further qualitative work will generate feedback from potential users and peripheral system stakeholders.