The GezelschApp

A Dutch Mobile Application to Reduce Social Isolation and Loneliness

Stephanie Jansen-Kosterink

1,2

, Patrick Varenbrink

and Arno Naafs

Cluster Telemedicine, Roessingh Research and Development, Enschede, The Netherlands

Telemedicine Group, University of Twente, Enschede, The Netherlands

Alifa, Enschede, The Netherlands

Present Media, Enschede, The Netherlands

Keywords: Older Adults, Loneliness, Social Isolation, Information Communication Technology, mHealth.

Abstract: The social isolation among older adults is a growing concern, as both social isolation and loneliness have been

associated with ill health. Information communication technology can overcome the social and spatial barriers

of social interaction by enabling easy affordable communication and activities of multiple form between older

adults and others anytime and anywhere. Therefore, technology-supported intervention, such as the

GezelschApp could prevent and ameliorate social isolation and loneliness among older adults. The aim of this

paper is to introduce this new technology, to provide an overview of the current evaluation and to present the

intermediate results concerning the usability of end-user acceptance of this technology. The GezelschApp is

a mobile application to reduce social isolation and loneliness among older adults. This application, also

accessible by PC and tablet, gives older adults access to a homepage with six features (an inbox for messages,

news, activities, information, tips and friends). On beforehand interested older adults are screened by a coach

before they receive a personal access code. During the 3 months evaluation of the GezelschApp the usability,

end-user acceptance, level of experienced loneliness and quality of life are assessed. Although the evaluation

of the GezelschApp is still running, the first focus groups (n=10) with users highlight the need of the current

application to make new friends in a save manner and to participate in social activities.

1 INTRODUCTION

As demographic ageing is a global trend, the social

isolation among older adults is a growing concern.

Compared to the general population the prevalence of

social isolation among older adults (60 years and

older) is high. Often loneliness is referred as a

problem specifically for older adults. This is partial

supported by literature as loneliness is common only

among the very old, that is, those aged 80 and over.

(Dykstra, 2009). It is important to draw the distinction

between social isolation and loneliness (de Jong

Gierveld et al., 2006). Social isolation can be defined

as an objective lack of interactions with others or the

wider community and loneliness can be defined as the

subjective feeling of the absence of a social network

or a companion.

Both social isolation and loneliness have been

associated with ill health. Following a recent review

paper of Leigh-Hunt et al (Leigh-Hunt et al., 2017)

there is a strong evidence that both social isolation

and loneliness are associated with increase all-cause

mortality and social isolation with cardiovascular

disease and depression. However, determining

causality is difficult as much of the research in this

area involves observational studies. Concerning these

association the prevention and amelioration of social

isolation and loneliness of adults is becoming an

important topic of policy-makers in various countries

(Dickens et al., 2011).

There are various interventions to prevent and

ameliorate social isolation and loneliness. Based on

the purpose, mechanisms of action and intended

outcomes these interventions can be categorized.

Gardiner et al. (Gardiner et al., 2016) suggests the

following six categories; social facilitation

interventions, psycho-logical therapies, health and

social care provision, animal interventions,

befriending interventions and leisure/skill

development. As well-conducted studies of the

effectiveness of these social interventions for

alleviating social isolation are rare, the evidence

concerning these interventions are indistinctive.

However, following the results of a review of Dickens

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Jansen-Kosterink, S., Varenbrink, P. and Naafs, A.

The GezelschApp.

DOI: 10.5220/0006732501420147

In Proceedings of the 4th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2018), pages 142-147

ISBN: 978-989-758-299-8

et al (Dickens et al., 2011) it appears there are

common characteristics of effective interventions.

Effective interventions were those developed within

the context of a theoretical basis and those offering

social activity and/or support within a group format.

Next to these two characteristics, interventions in

which older adults are active participants also

appeared more likely to be effective.

In the recent years, there has been an exponential

growth in the use of information communication

technology (ICT) in healthcare. These so called

technology-supported health interventions are widely

evaluated in various target groups (Ekeland et al.,

2010, Kairy et al., 2009) and have the potential to

increase the accessibility to care, to improve the

quality of care and to lower health-care costs

(DeChant et al., 1996). Various papers are published

and addressed the effectiveness of technology-

supported health interventions to reduce social

isolation and loneliness in older adults (Chipps et al.,

2017). ICT can overcome the social and spatial

barriers of social interaction by enabling easy

affordable communication and activities of multiple

form between older adults and others anytime and

anywhere (Chen and Schulz, 2016). Technology-

supported health interventions to reduce social

isolation and loneliness in older adults are divers and

categorized into online activities, interpersonal,

Internet-supported communi-cation and Internet-

supported therapeutics. Older adults can benefit from

technology-supported health interventions and will

use them after proper training (Chen and Schulz,

2016). However, these interventions are not suitable

for all older adults. Therefore, for a positive effect of

these technology-supported health interventions in

reducing social isolation and loneliness tailor-made

interventions and training for the older adult is

necessary.

In the Netherlands a new technology-supported

health intervention to reduce social isolation and

loneliness in older adults is developed and will be

evaluated in the municipality of Enschede. The aim

of this paper is to introduce this new technology, to

provide an overview of the current evaluation and to

present the intermediate results concerning the

usability of end-user acceptance of this technology.

2 METHODS

This paper focusses on a technology supported health

intervention to reduce social isolation and loneliness

in older adults, named GezelschApp. A merge of the

two Dutch words “Gezelschap” (the most suited

Figure 1: Homepage of the GezelschAPP.

English translation is “company”) and Applicatie

(English translation is “application”). This mobile

application, also accessible by PC and tablet, gives

older adults access to a homepage with six features

(Figure 1). The GezelschApp is developed by 8TING.

The six features of the GezelschApp are an inbox

for messages, news, activities, information, tips and

friends.

- Inbox (“Berichten”): In the inbox users

receive messages concerning the current

news, activities, information, tips and friend

requests. With the inbox users also can send

messages to their friends and their personal

coach.

- News (“Nieuws”): This feature provides the

latest news to the users concerning a healthy

and active lifestyle.

- Activities (“Activiteiten”): The activities in

the neighbourhood of the users are listed

here. All activities in the municipality of

Enschede are digitalized and available

online, there are sport activities, social

activities, education activities, cultural

activities, wellbeing activities, culinary

activities, and other activities suitable for

older adults. Based on the interests of the

user (profile information and user data)

appropriated activities are presented.

- Information (“Informatie”): All kind of

information concerning social activities,

healthy and active aging and the use of the

application is saved here.

- Tips (“Tips”): This feature provides tips to

increase the number of social activities and

social interactions.

- Friends (“GezelschAppers”): All users of

the application are showcased here. The full

contact details of a user are only visible for

their friends and their coach. Users can

become friends by sending and accepting

friend requests. Friends can send each other

messages and invite each other for activities.

The GezelschApp

143

Only screened older adults receive a personal access

code (username and password). After older adults

have shown interest in using the application, a face-

to-face appointment is planned. During this

appointment, a social worker of the local welfare and

wellbeing organisation visits the older adults at home.

After the social worker has made an estimation

whether or not the interested older adult is a suitable

user, the application is introduced to the older adult.

Together the social worker and the older adult create

an user account and profile information as a screen

image, interests and hobbies are added to this

account. During this introduction, the social worker

sends a first friend request to the older adult. This

request needs to be accepted by the older adult as this

social worker will during the use of the application,

coach the older adults to participate in activities and

close (online) friendships.

The application gives the coach the opportunity

based on the profile information and user data to send

personal messages and tips focussing on social

activities, healthy and active ageing and the use of the

application to the users. These messages and tips can

be sent to users personal or as batch to a group of

users. Next to these messages and tips, coaches can

activate users by sending them emails to their

personal email account and text messages to their

mobile phone. On behalf of the users, coaches can

create new activities submitted by the users.

Next to the profile information, the application

provides the coach intelligence on the user use of the

application. In a clear overview, the coach can see

whether a user sends friend request, accepts friend

request or participates in activities. With this

information, the coach can provide tailor-made

coaching to the user with the aim to increase the use

of the application and reduce social isolation and

loneliness. This extra information of the user for

coaches, forces the coach to change their way of

working with social isolated older adults.

There are two main reasons for the developers to

develop the GezelschApp and not use an existing

application to reduce social isolation and loneliness in

older adults, such as Facebook. First, to eliminate

unwanted relationships arising such as preys on

vulnerable and lonely older adults. Therefore, a

secure and save (online) environment was requested.

A non-public application was developed with

imbedded an initial screening contact between the

interested older adults and the social worker of the

local welfare and wellbeing organisation. Second, to

ensure the use of the GezelschApp and to help the

users to participate in activities and close (online)

friendships an active coach was requested. In existing

applications, this role of a coach is not foreseen.

2.1 Participants

Users of the application are during the face-to-face

appointment asked to voluntary participate in the

study to assess the added value of this application for

older adults. Older adults are included when they

experience loneliness, are residents of the

municipality of Enschede, have sufficient

understanding of the Dutch language and are aged

above 60 years. All participants give their informed

consent prior to participation. Concerning sample size

the aim of this cross-sectional cohort study is to

include 75 older adults. The participants are asked to

use the application at least three months.

2.2 Measurements

Considering the maturity of the technology and the

aim of the technology the first evaluation of the

GezelschApp focus on the endpoints: Usability,

acceptance and possible working mechanisms

(DeChant et al., 1996)(Jansen-Kosterink et al., 2016).

During the 3 months evaluation of this application the

usability, end-user acceptance, level of experienced

loneliness and quality of life are assessed. Pre- and

post-test participants are asked to complete

questionnaires to assess the level of experienced

loneliness and quality of life. The questionnaires

concerning usability, end-user acceptance are only

competed by the participants post-test.

2.2.1 Usability

The usability of the application is assessed with the

System Usability Scale (Brooke, 1995). The SUS

presented ten statements about the perceived usability

of the application. Participants could indicate on a 0

to 4 scale to what extent the presented statements

were true for them. To obtain the final SUS score, the

sum of the participants’ answers was multiplied by

2.5. The SUS score ranges from 0 to 100 (low and

high usability, respectively). The English version of

the SUS was translated into Dutch, as there was no

validated Dutch version available.

2.2.2 End-user Acceptance

End-user acceptance of this application was assessed

by means of a questionnaire with summated rating

scales, based upon the Technology Acceptance

Model (TAM) (Davis, 1989). TAM originates from

the 1980s and has been used numerous times to assess

and explain the acceptance of new technology. We

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expanded TAM with factors that have been found to

shape the user experience of mHealth technology:

Enjoyment (Crutzen et al., 2011), aesthetics (Baumel

and Muench, 2016), control (Hawkins et al., 2010),

and trust in the technology (Van Velsen et al., 2016).

We hypothesize that these factors affect the core

factors of TAM that explain the intention to use

(perceived usefulness and ease of use).

2.2.3 Loneliness

The De Jong Gierveld loneliness scale (DJGLS) is

frequently used and developed in the mid-1980s in

the Netherlands (de Jong-Gierveld and Kamphuls,

1985). The DJGLS is composed of eleven items, six

negatively formulated and five positively formulated,

with the three response categories (“no,” “more or

less,” and “yes”). The total scale score is the sum of

the item scores, ranging from 0 (not lonely) to 11

(extremely lonely). A score of three or higher is an

indication of loneliness (van Tilburg and de Jong

Gierveld, 1999).

2.2.4 Quality of Life

Quality of life is measured by the 12-item Short Form

questionnaire version 1 (SF-12v1) (Ware et al.,

1996). The SF-12 is a generic instrument including 12

items measuring health related quality of life

(HRQoL). Six items are summed into a physical

component summary (PCS) and six items are

summed into a mental component summary (MCS).

The total score for both scales ranges from 0 to 100,

with a higher number indicating higher quality of life.

2.2.5 Focus Groups

Next to the quantitative data, qualitative data

concerning the added value of this application for

older adults are collected during focus groups. These

focus groups with 6-10 users of the application are

planned at the end of the intervention period of three

months. Next to these focus groups, one focus group

was organized at the beginning of the intervention

period to assess the preliminary experience of the

participants with the application.

2.3 Data Analysis

All outcome measures will be inspected for normal

distribution of data using corresponding histogram

plots including normal curves and normal probability

plots prior to selection of appropriate statistical tests.

Descriptive statistical methods will be applied for

each of the outcome measures (demographic

characteristics, usability, end-user acceptance, level

of experienced loneliness and quality of life).

Presentation of data will be done by calculation of

mean ± standard deviation (SD), or median with

range. To assess the improvement level of

experienced loneliness and quality of life (pre-test

versus post-test) a paired student t-test will be

performed or its non-parametric equivalent. For

statistical analysis, the level for significance will be

set at α < 0.05.

3 RESULTS

The evaluation of the GezelschApp started summer

2017 and is still ongoing. Until the beginning to

December 2017 users of the application will be asked

to participate in this study. Therefore all pre-test

assessed will be finished in the first week of

December. The post-test assessments are planned in

the last week of February 2018. For this reason, the

results that can be present in this paper are limited to

preliminary results and therefore focus on the

demographic of the current participants of the study

and the outcome of the first focus group.

3.1 Participants

At this moment, (November 2017) 23 users (2 male

and 21 female) were willing to participate in this

study. All participants met the predefined inclusion

criteria. The mean age was 72,9 years (range 60-91).

Concerning the living situation, 17% of the

participants are living together with a partner or

spouse and 83% of the participants are living alone.

All participants are community-dwelling older adults

and were retired or un-employed.

3.2 Experienced Loneliness

All participants (n=23) complete the De Jong

Gierveld loneliness scale. The average score on this

scale was 4,9 (SD 3,7). This score correspondents to

moderate loneliness. Focussing on the subscales of

the DJGLS pre-test the participants score on average

3,3 (SD 2,2) on the emotional loneliness subscale

(maximum score is 6) and 1,6 (SD 1,9) on the social

loneliness subscale (maximum score is 5). Focus on

the individual date 30% of the participants experience

no loneliness, 52% of the participants experience

moderate loneliness, 9% of the participants

experience severe loneliness and also 9% experience

very severe loneliness.

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145

3.3 Results of the First Focus Group

At the end of august 2017, a first focus group was

organized. The aim of the focus group was to assess

the first experience of the users with the application

and to see whether redesign of the application or part

of the application was necessary. In total 10 users (5

male and 5 female) of the application participated in

this focus group. The age of these participants was

between 63 and 80 years old.

Table 1 provides an overview of the positive

points and points for improvement of the application

form the first focus group. Overall, the participants

rate the application with a 6+ [range 4-7]. “I am

positive, a seven, the application is good and of

course the application will improve after this

meeting”.

Table 1: Overview of the general experience with the

GezelschApp.

Positive points

- The development of the application; “as

I am looking for company.”

- Nice and safe way to find new friends.

- I like the tips and possibility to find

information about social activities in my

neighborhood.

- The inbox. “I always visit my inbox, to

see i

there are new messa

es”

Points for improvement:

- Various technical improvements are

needed (such as deleting messages) to

increase to level of ease of use of the

application.

- Clear guidelines for the set-up of the user

account, similarity in the information of

every user.

- Openness of the users and willingness to

start new friendship by using the

application. “I am a little bit frustrated

about the users that provided just a little

bit of personal information. Maybe they

are afraid, some resistance to open up.”

- More specific information about the

activities.

- The opportunity to create new activities

by the users, without interference of the

coach.

Overall, the participants like the feature to make new

friends the most. This feature was rated as the most

interested feature. On place two of interested features,

was the ability to send and receive messages and on

place three of interested features, was the feature that

provides tips to increase the number of social

activities and social interactions.

4 CONCLUSIONS

Although the evaluation of the technology-supported

health intervention to reduce social isolation and

loneliness in older adults is still running, the first

focus group with users highlight the need of the

current application to make new friends in a save

manner and to participate in social activities. Based

on the outcome of the focus group the application is

improved. As example, the information feature is

changed in a bulletin board feature. This is a more

dynamic feature were coaches can create new

activities as requested by the users. Next to this, the

role of the coach is improved. As the use of the

application demands to change the social worker’s

working methods. The need to be proactive and send

users messages and tips to increase the use of the

application by the users is unusual.

The GezelschApp divers from existing

applications to reduce social isolation and loneliness

in older adults. The GezelschApp is by the initial

screen of the social worker a secure and save (online)

environment. Next to this, an active coach helps the

users to participate in activities and close (online)

friendships. Based on profile information and user

data this coach sends personal messages and tips

focussing on social activities, healthy and active

ageing and the use of the application.

Considering the maturity of the technology and

the aim of the technology the first evaluation of the

GezelschApp focus on the endpoints: Usability,

acceptance and possible working mechanisms. After

this first evaluation, the added value of the

GezelschApp can be accessed within an evaluation

focussing on effectiveness or social impacts.

Considering the uptake of mobile phones by

older adults, mHealth intervention, such as

GezelfschApp, provide opportunities for increased

uptake of technology-supported health interventions

to address and reduce social isolation and loneliness

in older adults.

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146

ACKNOWLEDGEMENTS

Special thanks go to employees and volunteers of

Alifa and the developers of 8TING. The

GezelschApp is part of the 8TING ICT Platform. This

work was funded by the Municipality of Enschede.

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