INcreasing Adolescent Social and Community SupporT - Pilot (INACT)

Background: Social prescribing is a mechanism of connecting patients with non-medical forms of support within the community and has been shown to improve loneliness. Yet uptake from young people has been lower than for adults. This is thought to be due to accessibility issues as young people are less likely to draw on primary care, where social prescribing in based, for wellbeing support. INACT will pilot a social prescribing pathway via schools to support young people who are lonely. It will test the feasibility and acceptability of delivering and evaluating it through a randomised controlled trial.

Methods: 78 pupils reporting loneliness will be recruited across 12 mainstream (6 primary and 6 secondary) schools in England and be randomly allocated to signposting or social prescribing. Pupils in the control group will receive signposting to sources of support from school staff. The co-produced social prescribing intervention includes up to 6 sessions with a Link Worker who will work with individuals to understand 'what matters to them' and connect them with local sources of support. Data will be collected at baseline, 3- and 6-months later. Acceptability and feasibility will be assessed via recruitment and retention, as well as via qualitative interviews. Interviews will also explore barriers, facilitators and mechanisms of change. Potential primary and secondary outcomes for a future trial will be completed to assess response and completeness, including measures of loneliness, mental health and wellbeing.

Discussion: INACT will provide preliminary evidence of the feasibility and acceptability of both the research design and social prescribing intervention. Results will inform a potential future randomised trial.

Study Overview

• Status: Active, not recruiting
• Conditions: Loneliness
• Intervention / Treatment: Behavioral: Social Prescribing; Behavioral: Signposting

• Study Type: Interventional
• Enrollment (Estimated): 78
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Kingdom
  • Greater London, United Kingdom, WC1E 7HB
    • University College London

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Children and young people in a participating school and in Years 4, 5 or 7, 8
• Parental consent and young person assent is provided
• A score of 6 or above on the Good Childhood Index loneliness questions

Exclusion Criteria:

• Private schools
• Children and young people with severe learning disabilities

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Signposting; Those in the control group will receive signposting to activities and local sources of support in their communities. This will consist of school pastoral staff meeting with YP identified as lonely and providing them with a leaflet detailing the same local sources of support identified by the LW from asset mapping.	Behavioral: Signposting; Those in the control group will receive signposting to activities and local sources of support in their communities. This will consist of school pastoral staff meeting with YP identified as lonely and providing them with a leaflet detailing the same local sources of support identified by the LW from asset mapping.
Experimental: Social Prescribing; SP is a person-centred approach to wellbeing involving the co-development of a non-clinical prescription, between an individual (i.e. young person) and Link Workers (LWs), based on the perceived difficulties for the referral and the YPs values, needs and preferences. LWs have a good knowledge of their local areas, via community asset mapping and networking, allowing them to connect individuals with different types of available support and activities. Typically, SP ranges from 6-12 sessions (average 8 sessions: unpublished data from sites) with a LW over an 8-week period. Sessions may take place online, via phone call, or in person. As part of this process, LWs draw on psychological skills such as motivational interviewing and behavioural activation as well as employ problem solving and goal setting. Following the identification of issues and preferences, the LW will discuss with the YP what the available local activities and support structures are that best match their preferences.	Behavioral: Social Prescribing; SP is a person-centred approach to wellbeing involving the co-development of a non-clinical prescription, between an individual (i.e. young person) and LW, based on the perceived difficulties for the referral and the YPs values, needs and preferences. LWs have an excellent knowledge of their local areas, via community asset mapping and networking, allowing them to connect individuals with different types of available support and activities. Typically, SP ranges from 6-12 sessions (average 8 sessions: unpublished data from sites) with a LW over an 8-week period. Sessions may take place online, via phone call, or in person. As part of this process, LWs draw on psychological skills such as motivational interviewing and behavioural activation as well as employ problem solving and goal setting. Following the identification of issues and preferences, the LW will discuss with the YP what the available local activities and support structures are that best match their preferences.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Loneliness	Good Childhood Index is assessed using 3 questions on a 3-point Likert scale (scoring between 3-9). Higher scores indicate higher reported loneliness.	3 Months
Intervention Feasibility (School Staff and Link Workers)	Feasibility of Intervention Measure (FIM) is assessed using 4 questions each on a five-point Likert scale (scoring between 4-20). Higher scores indicate higher intervention feasibility	6 months
Intervention Acceptability (School Staff and Link Workers)	Acceptability of Intervention Measure (AIM) is assessed using 4 questions each on a five-point Likert scale (scoring between 4-20). Higher scores indicate higher intervention acceptability	6 months
Intervention Appropriateness (School Staff and Link Workers)	Intervention Appropriateness Measure (IAM) is assessed using 4 questions each on a five-point Likert scale (scoring between 4-20). Higher scores indicate higher intervention appropriateness	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Peer loneliness	LACA - Peer Subscale is assessed using 12 questions each on a four-point Likert scale (scoring between 12-48). Higher scores indicate higher peer loneliness	3 and 6 months
Wellbeing	Kidscreen-52 is assessed using 6 questions each on a five-point Likert scale (scoring between 6-30). Higher scores indicate greater well-being.	3 and 6 months
Mental health (emotional difficulties)	Me and My feelings is assessed using 10 questions on a 3-point Likert scale (scoring between 0-20). Higher scores indicate higher emotional difficulties	3 and 6 months
Service Use	Client Service Receipt of Inventory is assessed using 11 questions on a five-point Likert scale. Scoring can be looked at by individual items (i.e. score between 1-5) or by scoring all items (i.e. scores between 11-55). Higher scores indicate more contact with a service/services.	3 and 6 months
Stress	Perceived Stress Scale 4 is assessed using 4 questions on a five-point Likert scale (scoring between 0-16). Higher scores indicate higher levels of perceived stress	3 and 6 months
Loneliness	Good Childhood Index is assessed using 3 questions on a three-point Likert scale (scoring between 3-9). Higher scores indicate higher reported loneliness.	6 Months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Family Support	Moderator using questions from the Student Resilience Survey which is assessed using 4 questions each on a five-point likert scale (scoring between 4-20). Higher scores indicate higher family support.	Baseline only
School Support	Moderator using questions from the Student Resilience Survey which is assessed using 4 questions each on a five-point Likert scale (scoring between 4-20). Higher scores indicate higher school support.	Baseline only
Social support	Moderator using CYRM-R which is assessed using 4 questions each on a five-point Likert scale (scoring between 4-20). Higher scores indicate higher social support	3 and 6 months
Local Environment	Moderator using questions from the HBSC 2022 assessed using 4 questions each on a five-point Likert scale (scoring between 4-20). Higher scores indicate a more positive view of ones local environment	3 and 6 months
Activity Engagement	Moderator using questions from the BeeWell survey which is assessed using 11 questions each on a six-point Likert scale (scoring between 11-66). Higher scores indicate higher daily engagement with more activities. Each item can also be scored individually and indicates more frequent engagement with that activity.	3 and 6 months
Bullying	Moderator using kidscreen-52 (primary school pupils) which is assessed using 3 questions each on a five-point Likert scale (scoring between 3-15). Higher scores indicate higher levels of bullying	3 and 6 months
Bullying	Moderator using the BeeWell survey (secondary school pupils) which is assessed using 3 questions each on a four-point Likert scale (scoring between 0-9). Higher scores indicate higher levels of bullying.	3 and 6 months
Social structure and quality	Moderator using questions adapted from PISA 2022 and MCS4 which is assessed using five questions. One of which requires an open-ended numerical value and four questions which are rated on a five-point Likert scale (scoring between 0-16). Higher scores indicate a greater social structure and friendship quality.	3 and 6 months
Problem Solving	Mechanism using the Student Resilience Survey which is assessed using 3 questions each on a five-point Likert scale (scoring between 3-15). Higher scores indicate higher problem solving with others	3 and 6 months
Flow	Mechanism using the General Flow Proneness Scale (secondary school pupils only) which is assessed using 13 questions each on a five-point Likert scale (scoring between 13-65). Higher scores indicate higher flow experience	3 and 6 months
Therapeutic Alliance	Mechanism using the Session Feedback Questionnaire which is assessed using 4 questions each on a five-point Likert scale (scoring between 4-20). Higher scores indicate higher therapeutic alliance. This is for individuals in the social prescribing intervention only	3 and 6 months

Collaborators and Investigators

• Sponsor: University College, London
• Collaborators: University of Manchester

Publications and helpful links

Helpful Links

• Study webpage overview

Study record dates

Study Major Dates

• Study Start (Actual): November 12, 2024
• Primary Completion (Estimated): July 1, 2025
• Study Completion (Estimated): August 31, 2025

Study Registration Dates

• First Submitted: October 18, 2024
• First Submitted That Met QC Criteria: October 22, 2024
• First Posted (Actual): October 24, 2024

Study Record Updates

• Last Update Posted (Estimated): December 6, 2024
• Last Update Submitted That Met QC Criteria: December 3, 2024
• Last Verified: December 1, 2024

More Information

Terms related to this study

• Keywords: Loneliness; School; Social Prescribing; Pupils; Link Worker
• Other Study ID Numbers: 6735/017

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: Some IPD data will be shared but we specific data is being currently discussed with the funder. We will update this record when we know more.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No