Background: Social isolation is a global public health threat and a negative social
determinant of health that affects 1 in 5 adults in the U.S. and contributes to $6.7
billion in annual healthcare spending.
Significance: Affecting roughly 43% of Veterans, social isolation is highly prevalent
among Veterans, particularly those with a history of mental illness. Social isolation
contributes to cardiovascular diseases, dementia, depression, suicidal ideation, and
premature death. To date, social isolation remains largely unaddressed as a negative
social determinant of health in healthcare systems. Current efforts to address social
isolation are limited by lack of diverse participant samples, rigorous methodologies, and
involvement of healthcare systems to systematically assess and reduce social isolation.
Innovation and Impact: To address these gaps, the proposed project will test a novel and
feasible program to intervene on social isolation among diverse Veteran populations in
the Veterans Health Administration healthcare system. The investigators propose to test
the effects of the Increasing Veterans' Social Engagement and Connectedness (CONNECTED)
intervention on social isolation among Veterans. The Increasing Veterans' Social
Engagement and Connectedness (CONNECTED) intervention uses an innovative approach by
integrating two existing evidence-based care models: peer services and patient navigation
to address social isolation among Veterans in Veterans Health Administration primary care
clinics. Increasing Veterans' Social Engagement and Connectedness (CONNECTED)
intervention involves three key services delivered by peer specialists via telehealth
over 8 weeks: 1) peer support, which includes person-centered assessment of factors
driving social isolation; 2) psychosocial interventions to address Veterans' social
isolation (e.g., goal setting, supportive therapy, and group-based social engagement
activities); and 3) navigation (i.e., connecting Veterans to social resources in the
community and the Veterans Health Administration) to help expand their social networks.
Because prior social isolation studies have not prioritized inclusion of younger and
racially/ethnically diverse samples, the investigators will over sample these groups
using stratified random sampling.
Specific Aims: The investigators aim for a randomized controlled clinical trial comparing
Increasing Veterans' Social Engagement and Connectedness (CONNECTED) intervention to an
attention control group. Aim1: Test the effects of Increasing Veterans' Social Engagement
and Connectedness (CONNECTED) intervention on social isolation at 2-, 4-, and 8-months
from baseline compared to the control group; Aim2: Test the effects of CONNECTED on
secondary, health-related outcomes; and Aim 3: Conduct formative and pre-implementation
evaluations to inform future implementation processes.
Methodology: Aims 1 and 2 involve delivering the intervention to (N=264) Veterans in
Veterans Health Administration primary care clinics. Data from Aims 1 and 2 will be
analyzed using general linear models. In Aim 3, the investigators will describe Veterans
(n=20) and providers' experiences (N=10) with the intervention using semi-structured
interviews to identify barriers and facilitators to the Increasing Veterans' Social
Engagement and Connectedness (CONNECTED) intervention's future implementation. The
investigators will also survey peers and peer supervisors (n=20) from VISN10 VA
facilities (n=13) and interview a subgroup of survey completers (n=8) to evaluate factors
that may affect potential adoption of the Increasing Veterans' Social Engagement and
Connectedness (CONNECTED) intervention in Veterans Health Administration and to identify
future implementation strategies. Qualitative data from Aim 3 will be analyzed using an
inductive/deductive approach.
Next Steps & Implementation: Should this trial be successful the investigators will work
with operational partners to implement the Increasing Veterans' Social Engagement and
Connectedness (CONNECTED) intervention in the Veterans Health Administration. The next
step will also involve the evaluation of Increasing Veterans' Social Engagement and
Connectedness (CONNECTED) intervention's core elements and its implementation in diverse
Veterans Health Administration facilities.