Six-month outcomes of layperson-delivered, telephone-based behavioural activation and mindfulness interventions on loneliness among older adults during the COVID-19 pandemic: The HEAL-HOA Dual Randomised Controlled Trial

Background: Loneliness among older adults during the COVID-19 pandemic constituted a global public health crisis. This study aimed to determine whether layperson- and telephone-delivered behavioural activation (Tele-BA) and mindfulness (Tele-MF) interventions, compared to telephone befriending/support calls (Tele-BF; attention control), could reduce loneliness among older adults who were living alone, socioeconomically deprived and digitally excluded. Methods: As part of the 'Helping Alleviate Loneliness in Hong Kong Older Adults' dual randomised controlled trial (RCT), 1151 older adults (M_age = 76.6, SD = 7.8) were randomly assigned to Tele-BA, Tele-MF or Tele-BF. Assessments were conducted at baseline (T0), 4-week (T1), 3-month (T2) and 6-month post-intervention (T3). All interventions (eight 30-minute telephone sessions over four weeks) were delivered by 185 trained lay counsellors who were 50-70 years old and reported feeling lonely. Outcomes: The primary outcome was loneliness (assessed with the UCLA Loneliness Scale [UCLA-LS] and De Jong Gierveld Loneliness Scale [DJGL]). Secondary outcomes were perceived social support, social network size, perceived stress, life satisfaction, psychological well-being, sleep quality and depressive and anxiety symptoms. The UCLA-LS scores were significantly reduced in Tele-BA at T2 and T3 and in Tele-MF at T2, compared to Tele-BF. No significant difference was observed between Tele-BA and Tele-BF from T1 through T3 in DJGL. The Tele-MF group showed significantly higher DJGL scores at T1 and T3 than the Tele-BF group. Significant positive effects of Tele-BA, compared to Tele-BF, were found in perceived social support, perceived stress, psychological well-being, depression and anxiety. Tele-MF did not significantly differ from Tele-BF on these secondary outcomes. Interpretation: The trial demonstrates the effectiveness of telephone-based psychosocial interventions delivered by laypersons in reducing loneliness. It also underscores the potential for training peer lay counsellors to telephone-deliver scalable psychosocial interventions for older adults experiencing loneliness. © 2025 The Author(s). Published by Oxford University Press on behalf of the British Geriatrics Society.