Analysing comfort with primary care discussions and openness to social prescribing as mediators of the associations between loneliness and wellbeing among Canadians aged 55 and older
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Background
Addressing the complex health and wellbeing challenges of older adults is a critical public health priority as populations age. Social Prescribing (SP) represents a promising strategy, connecting patients to non-clinical, community-based resources to enhance physical, mental, and social wellbeing.
Methods
To develop a SP theory of change, this study used cross-sectional data from 2,450 community-dwelling older adults who participated in a population survey. Factor analyses identified four factors of comfort with primary care discussions (general, mental, physical, and social wellness) and three factors of openness to SP (effectiveness, meaningfulness, and supportiveness). Path analysis was conducted for each set of mediators separately.
Results
Path analyses revealed that comfort with primary care discussions about social wellness (β = 0.08**) is associated with better wellbeing. People who report social loneliness are most comfortable with primary care discussions about general wellness (β = − 0.17***) and least comfortable with primary care discussions about mental wellness (β = − 0.24***), whereas people who report emotional loneliness are more likely to have similar levels of comfort to discuss general wellness and mental wellness (β = − 0.18***; − 0.18***). In addition, social loneliness is associated with less comfort with primary care discussions about social wellness (β = − 0.19***) and mental wellness (β = − 0.19***), whereas association is not found for emotional loneliness. These suggest that addressing the SP needs of people who experience emotional loneliness requires a different strategy. Reporting emotional loneliness is associated with expressing support for SP (β = 0.14***), which may be key to improving wellbeing (β = 0.10***) among this population. Overall, social loneliness has a total effect size of β total = − 0.19, whereas emotional loneliness has a total effect size of β total = − 0.45, more than 2.3 times larger.
Conclusions
While SP may be acceptable to those who need it, some may experience greater difficulties accessing SP through primary care providers without interventions tailored to their loneliness status that could elicit buy-in and enrolment. Primary care providers may wish to pay closer attention to people with emotional loneliness. Other considerations, such as trust and motivational interviewing for positive self-beliefs may explain potential changes from loneliness to wellbeing.
