“It Made Me Feel Like a Person Again”: Benefits of Meals on Wheels-Based Social Connection Programs

Abstract

Social isolation and loneliness are associated with negative health outcomes, and these outcomes are exacerbated among older adults who are homebound. To address this issue, Meals on Wheels programs increasingly provide social connection services to clients in addition to home-delivered meals. This descriptive qualitative study examines the impact of three types of social connection programs on the well-being of homebound older adult clients, as well as on the volunteers and staff members who deliver the programs. Thematic analysis of semi-structured interviews conducted with 117 clients, volunteers, and staff in six Meals on Wheels social connection programs across the United States indicated that program participation was associated with substantial benefits. Benefits included the development of supportive friendships, reduced feelings of loneliness, and an improved overall sense of well-being. Insights from this study may inform the development, expansion, and sustainability of social connection programs provided by community-based organizations.

Keywords

loneliness qualitative methods social support home and community-based care and services volunteerism and civic engagement

What this paper adds

• Social connection programs meet or exceed the expectations of homebound older adult clients, volunteers, and staff.

• Social connection programs benefit homebound older adults by reducing feelings of isolation and loneliness.

• While programs were designed to provide benefits for clients, volunteers and staff also derived significant benefits.

Applications of study findings

• Recruitment strategies for social connection programs should focus on identifying and responding to individuals’ goals for getting involved.

• Flexibility was described as an important reason why volunteers engaged in social connection programs. Programs should provide as much flexibility as possible and emphasize this flexibility in volunteer recruitment efforts.

• Social connection programs provide substantial value. Findings from this paper add to the evidence base supporting continuation and/or expansion of program funding.

Introduction

The United States Surgeon General recently issued an advisory outlining the severe, negative consequences of social isolation and loneliness on public health (U.S. Department of Health and Human Services, 2023), and put forth a national strategy to promote social connection. This strategy includes strengthening community connection programs, emphasizing volunteer opportunities to foster diverse connections within communities, and training health care providers to recognize the value of social connection and the risks of social isolation and loneliness for all ages. Central to the national strategy is an emphasis on improving the nation’s social infrastructure through the establishment of community connection programs.

The advisory draws on the socio-ecological model and a systems theoretical approach (Centers for Disease Control and Prevention, 2021; Holt-Lunstad, 2018) as organizational tools to describe the interrelated factors—individual, relationship, community, and societal—that contribute to a person’s sense of social connection, and affect social isolation and loneliness. Social isolation is defined as the objective absence of social relationships, limited social network ties, or infrequent social interactions. In contrast, loneliness is defined as the subjective experience felt by an individual due to the lack of social connections (National Academies of Sciences Engineering and Medicine, 2020). Also central is the concept of well-being, defined by the Centers for Disease Control and Prevention as “the presence of positive emotions and moods, the absence of negative emotions, satisfaction with life, fulfillment, and positive functioning” (CDC, 2022).

Within the context of the socio-ecological model and the systems theoretical approach, older adults are at particular risk of social isolation and loneliness, due to reasons including the loss of social connections (relationships), retirement (community), the impact of health conditions prohibiting or severely reducing mobility (individual), and norms around aging (society). Research has shown that these factors impact quality of life for older adults and lead to an increased risk of morbidity and mortality (Bedard-Thomas et al., 2019; Donovan, 2020; Qiu et al., 2010; Sakurai et al., 2019). For older adults who receive services from community-based organizations, studies have found reduced levels of loneliness and depression (Helfand et al., 2020; Millen et al., 2002; Rachasrimuang et al., 2018; Thomas et al., 2020). Building on this success, community-based organizations have increasingly invested in efforts to address social isolation and loneliness among their clients through the expansion of social support programming. However, most existing social connection programs require participation in a community setting and are unable to fully meet the needs of homebound older adults. Homebound older adults represented an estimated 13% of older adults in the United States in 2020 (Ankuda et al., 2021). When placed within the socio-ecological model and systems approach, homebound older adults are especially vulnerable to social isolation and loneliness (Kannan & Veazie, 2022; Xiang et al., 2020), as they may have limited capacity to be out with others (relationships) and reduced access to programs and services (community), for example.

A limited body of research has examined social connection services for homebound older adults. Overall, available research is largely comprised of evaluations of targeted interventions, rather than evaluations of established programs for this population. Interventions that have been found to be effective in improving well-being for homebound older adults include one-on-one in-home technology training, home-delivered therapy, social clubs, and telephone reassurance programs (Bruce et al., 2021; Gadbois et al., 2022; Jesus et al., 2024; Kikuchi et al., 2023; Lee et al., 2021; Pepin et al., 2021), among numerous others. While community-based organizations including Area Agencies on Aging and senior centers often offer social connection programming to homebound older adults, most have not been formally evaluated for their impact on loneliness and isolation. An exception are the services provided by Meals on Wheels programs.

The Meals on Wheels network is made up of more than 5,000 community-based programs across the United States committed to addressing food insecurity and social isolation among older adults (Meals on Wheels, 2023). Meals on Wheels America (MOWA) is the largest leadership organization supporting the Meals on Wheels network. Existing research has documented the benefits of Meals on Wheels to well-being outside of just nutrition (Campbell et al., 2015; Gualtieri et al., 2018; Zhu & An, 2013), and has evaluated the impact of targeted social connection programs on well-being (Gadbois et al., 2022; Helfand et al., 2020; Middleton et al., 2022; Millen et al., 2002). Additionally, several studies have found that Meals on Wheels volunteers and staff reported positive experiences from their role in delivering meals (Dickinson & Wills, 2022; Papadaki et al., 2022; Thomas et al., 2020).

Outside of Meals on Wheels, the benefits of volunteerism among older adults are well-studied (Kim et al., 2020; Population Reference Bureau, 2011; Torres et al., 2023). Research has shown that older adults who volunteer, in general, have improved self-reported health, improved physical and cognitive functioning, reduced depression, and lower mortality rates (Filges et al., 2020; Hood et al., 2018). Within the socio-ecological model and systems approach, volunteers act as an important bridge between the client (individual) and services (community). At the height of the COVID-19 pandemic volunteerism declined, most likely due to measures implemented to decrease viral spread (AmeriCorps, n.d.). Yet, despite social distancing and other mitigation measures during the pandemic, informal helping of others remained constant (AmeriCorps, n.d.). As the U.S. population ages, organizations that provide services to older adults will need to grow their volunteer pool to continue to serve their communities. Understanding the benefits for volunteers and staff who deliver programming is little understood and critically needed.

While no research, to our knowledge, has examined the benefits of social connection programming on staff, existing research evaluating staff outcomes within community-based mental and behavioral health services and home healthcare non-profit organizations found high levels of burnout, compassion fatigue, and poorer health outcomes including higher rates of stroke, diabetes, arthritis, COPD, asthma, high blood pressure, and high cholesterol (Morse & Dell, 2021; Rossi et al., 2012; Sterling et al., 2021). Several of these negative outcomes were exacerbated by the pandemic (Gray et al., 2022; Sterling et al., 2020; Zhang et al., 2021). These outcomes highlight the importance of understanding what motivates individuals to work within this field.

However, research examining the motivational factors driving volunteering and working in social connection programming is limited. Such research has found that pride in the organization, its mission, and accomplishments, as well as having opportunities for both personal and professional growth and development motivate individuals to engage in community-based social services work (Colvin et al., 2021; Harmic, 2022; Houston, 2000; Kerschner & Rousseau, 2008; Wright, 2007). Further research examining the impact of social connection programming on staff and volunteers is a critically needed component of the evidence base to prevent volunteer and staff turnover and support retention.

As the U.S. Surgeon General’s advisory notes, social isolation and loneliness are urgent public health issues. The state of the research on effective interventions for social isolation and loneliness in older adults is still preliminary, with critical gaps in understanding the underlying volunteer and staff motivations to participate in social connection programming, and the applicability of social connection interventions to the homebound older adult population. This paper aims to address these gaps in knowledge, and presents findings from an evaluation of three types of social connection programs offered by MOWA community organizations: telephone reassurance, wellness activity programming, and friendly visitor. Explicitly, this paper presents findings regarding the reasons for participating in social connection programs, the impact of the programs on clients, as well as the unintended benefits for volunteers and staff.

Methods

This research included descriptive case studies (Yin, 2017) of six Meals on Wheels members’ social connection programs. In-depth, semi-structured interviews were conducted with clients, volunteers, and staff in the six social connection programs.

MOWA Network Program Selection and Recruitment

In November 2020, MOWA conducted a survey of 1,062 network programs to understand the impact of COVID-19 (Meals on Wheels America, 2020). Based on the 350 responses from this survey, MOWA identified 194 programs that had an existing, in-house social connection program. Of the 194 programs, 29 indicated their preference to opt out of research projects. The research team, consisting of Brown University staff and MOWA researchers, conducted an extensive review of MOWA network social connection program descriptions provided during the survey and/or available online. Social connection programs were defined as service offerings that aim to reduce social isolation and loneliness, such as friendly visiting, telephone reassurance, volunteer opportunities, pet assistance, and group classes or group activities. The research team chose to evaluate telephone reassurance, friendly visitor, and wellness activity programs, as the programs were commonly occurring but varied greatly in structure and systems of delivery. In addition, programs with diverse characteristics, including budget size, rurality, and client racial/ethnic diversity were selected. Twenty-six potential network programs were identified that had these types of social connection programs, did not opt out of involvement in research projects, and varied in program characteristics. The research team contacted these 26 potential programs and requested additional information including the number of clients served, the impact of the COVID-19 pandemic on social connection programming, and whether the social connection program was still in existence. After reviewing program responses, the research team invited eight programs to participate in this evaluation. Of the eight programs invited, two declined participation, resulting in six programs electing to participate.

Participant Recruitment

Each MOWA network program identified a principal point of contact who worked closely with the Brown University research team, and facilitated interview participant identification and recruitment. To best characterize each program, we sought to interview five staff members and/or program leaders, five volunteers involved in program administration or delivery, and ten client recipients of the program. Contact information for potential participants was shared with the Brown University research team. The research team contacted potential participants via telephone or email, recruited participants, and scheduled interviews. Contact attempts were made once per week and ranged from one to five attempts before the potential participant was removed from the contact list. Interviews were first conducted with program staff, then volunteers, then clients.

Qualitative Interview Procedures

The qualitative team developed interview guides with questions designed to understand the benefits and challenges of social connection programming from multiple perspectives. Questions for program staff were designed to learn specifics about the social connection program including its structure, clientele, and data/metrics collected. In addition, questions focused on assessing program feasibility, with the goal of understanding the most effective and scalable program components, and identifying barriers/challenges for program implementation. Lastly, a primary focus, and the focus of this paper, was on understanding staff perceptions regarding program benefits. Staff responses to interview questions informed the questions developed for volunteers. Volunteer interview questions were designed to understand the program from their perspective: the barriers/challenges, the benefits for volunteers and clients, and their suggestions for improvement. Similarly, client interview questions were informed by previous interviews with staff and volunteers. Client questions were designed to focus on participants’ experiences with the goal of understanding program benefits and challenges.

Participants were recruited from January through September 2022. Staff interviews were conducted from February through March 2022; volunteer interviews from March through May 2022, and client interviews from April through September 2022. Interviews were conducted by telephone or Zoom depending on participant preference. This study was reviewed by the Brown University Institutional Review Board and was determined not to meet the criteria for human subjects research. We did adhere to important ethical standards. Prior to each interview, we used our IRB’s standard informed consent as a guide for obtaining participant verbal consent to participate. At the beginning of each interview, we stated the purpose of the interview, the research objective, that participation was voluntary, that data collected would be de-identified, and that the participant was free to decline answering any questions or stop the interview at any time. After this language, we asked participants if they would like to participate and if the interview could be recorded. Once verbal consent to participate and to audio record was obtained, the interview started. Since our interviews were focused on understanding participant experiences with a social connection program, we did not collect any participant demographic information.

Interviews lasted approximately 1 hour. Two team members participated in each interview for staff and volunteer interviews: one conducted the interview while the other took detailed notes. This approach was also used for five of the ten client interviews at each site. For the remaining five client interviews per site, one interviewer conducted the interview and took notes. Interview summaries were written and reconciled by both interviewers prior to being shared with the entire project team. The approach of having two qualitative team members on each interview ensured adherence to the interview protocol and facilitated team discussions throughout analysis.

Analysis

Transcripts were analyzed using a modified content analysis approach (Strauss & Corbin, 1994). A preliminary coding scheme was first developed based on the interview guide and informed by the interview summaries. This scheme was adjusted iteratively to add and remove codes and refine code definitions. The scheme was then applied to the transcripts by qualitative team members. Three team members individually coded the first three transcripts, meeting weekly for reconciliation, then two team members individually coded eighteen transcripts, meeting weekly for reconciliation. As a high level of agreement was obtained, the remaining transcripts were coded by individual team members. The coded data extracts were then subjected to rigorous examination to identify themes, or patterns of response across the data. In weekly meetings, themes were continually discussed and refined. In addition, a detailed audit trail of developing thoughts and interpretations of the data was maintained (Ritchie et al., 2013).

Results

The six social connection programs included two telephone reassurance, two friendly visitor, and two wellness activity programs. Program characteristics can be found in Table 1. Friendly Visitor 1 was a friendly visitor program in the Northeast, which included in-person visits with clients in their homes made by volunteers who were matched to clients based on interests and availability. Friendly Visitor 2 was a friendly visitor program in the Southwest, which included in-person visits with clients in their home by volunteers. Wellness Activity 1 was a wellness activity program in the Northeast, which included art-based creative kits, and the matching of participants with volunteer companions to engage with in art projects. Wellness Activity 2 was a wellness activity program in the Southeast, which included a range of both in-person and virtual activities at a community center. Telephone Reassurance 1 was a telephone reassurance program in the Southeast, in which clients and volunteers were matched for regular telephone calls. Telephone Reassurance 2 was a telephone reassurance program in the Midwest, in which clients and volunteers were matched for regular telephone calls.

Table 1.

Program Characteristics.

Program Type/ID	Region	Community Type	Budget Size	Percent Non-White Race (%)
Friendly Visitor 1	Northeast	Urban	$250,000–$499,999	44
Friendly Visitor 2	South	Urban	$3,000,000+	54
Wellness Activity 1	Northeast	Rural	$250,000–$499,999	<1
Wellness Activity 2	South	Rural	$250,000–$499,999	40
Telephone Reassurance 1	South	Suburban	$150,000–$249,999	7.5
Telephone Reassurance 2	Midwest	Rural	$500,000–$999,999	33

In total, across the six programs, 116 interviews were conducted with 117 participants (one interview included two staff members). This included 31 staff interviews, 30 volunteer interviews, and 55 client interviews. Across all participant types there were 37 interviews conducted with individuals involved with telephone reassurance programs, 38 interviews conducted with individuals involved with friendly visitor programs, and 41 interviews conducted with individuals involved with wellness activity programs. While participant demographic information was not uniformly gathered as part of this study, many interview participants volunteered such details. Based on demographic information provided by program staff during their interviews, interviewed staff had been associated with their respective organizations ranging from less than a year to over 30 years. Many volunteers shared their employment status during interviews, and volunteers included a number of college students but a majority of individuals who had retired. The client participants who shared their age ranged from 72 to 88 years old. Nearly half of the clients interviewed mentioned living alone and many were widowed.

Analysis of interviews with client participants, volunteers, and staff of social connection programs yielded four themes that were consistent across the six programs and different program structures: 1. Clients discussed their rationale or motivation for joining social connection programs including being isolated or lonely, wanting someone to check in on them, a desire for connection or friendship, and wanting to share their knowledge and life experiences with others. 2. Participation in social connection programs was associated with substantial benefits for clients. Reported benefits included friendship, knowing that someone cares about them, being able to contribute and feeling like a person, participation in activities of interest, and reduced loneliness and improved well-being overall. 3. Volunteers and staff described their rationale for getting involved in social connection programming, and reasons included wanting to give back, share knowledge, and/or contribute in some way, especially during retirement, and knowing their work is meeting a societal need. In discussing their motivation for signing up, volunteers further discussed the importance of flexibility provided by this social connection programming. 4. Volunteers and staff also reported deriving substantial benefits from participating in social connection programs. Benefits experienced by volunteers and staff included positive feelings from helping others and meeting their needs, feeling able to contribute and share their expertise, and the development of genuine connections and friendships.

Theme 1: Clients discussed their rationale or motivation for joining social connection programs.

Clients who participated in social connection programs identified a number of reasons why they signed up. Most clients were motivated to join the program because they described themselves as isolated and lonely. Many clients reported living alone and having the “isolation blues” (Wellness Activity 2 C2). One client eloquently described the challenges of aging:

Aging, taxes, and death, whatever, pretty rotten. And even if you have family and good support, it's still a difficult transition, whether you're still in the workplace part-time or into retirement, and it's sort of like you don't exist. You're invisible. (Wellness Activity 1 C5)

In describing their rationale for joining social connection programs, most participants expressed a desire to be engaged and pursue creative endeavors, build connections, and share experiences and knowledge and otherwise contribute to others. A few clients lived alone with a pet, and wanted a check-in for the simple reason of wanting to know that their pet would not be forgotten if something happened to them. For additional representative quotes, see Table 2.

Table 2.

Theme 1: Clients Discussed Their Rationale or Motivation for Joining Social Connection Programs, Representative Quotes.

Concept	Representative quote, ID
Live alone, “isolation blues,” benefits of keeping busy, learning from/sharing with others	I live alone way out in the country, in the woods. I have been under the influence of the isolation blues and found a quick cure for that, having a new circle of friends to get to know has done wonders for my mental health. Yeah. Keeping your mind busy as well as your body, having things to focus on, learn about and share with others. This has all been very good for me. (Wellness Activity 2 C2)
Lonely, benefits of feeling “worthy,” something to look forward to	I’m a widow. My husband died 26 years ago. Well, I’m 81 years old, and when you reach a certain age, it seems like nobody’s there. You’re lonely. You know, I get very lonely. My kids are scattered. I barely hear from them…I really have something to look forward to now. With [volunteer 1] and [volunteer 2] coming to see me, taking time out of their busy life to come and spend time with me, makes me feel very good, makes me feel worthy. When you get older, you don’t feel so … There’s so much you can no longer do, and that … Now, this program, and with [volunteer 1] and [volunteer 2] coming to … I just love them, and it gives me something during the week to look forward to. (Friendly Visitor 1 C4)
Isolated	I was looking for something to take up some of the time because of the isolation with COVID. I’m 87 years old, or almost 87 years old, and I live alone with a couple of cats, and that seemed to be a great opportunity. (Wellness Activity 1 C4)
Isolated, desire for engagement	I’ve always had a desire to do more art. And I think with aging and aging in place, and being isolated in general because of the pandemic especially, it was a great opportunity to just become more reflective through a different medium and feel more engaged with your creative efforts instead of just servicing whatever else you’re doing in your life. And so I think it was huge for mental health. Huge… Everyone has a support system of some kind, but aging in America is no joke. What do they say? Aging, taxes, and death, whatever, pretty rotten. And even if you have family and good support, it’s still a difficult transition, whether you’re still in the workplace part-time or into retirement, and it’s sort of like you don’t exist. You’re invisible. And because of the internet age, even your children don’t need your advice anymore, right? I don’t need anyone’s advice either. I can just go on the internet and get whatever I want. And so, what is that? That’s not engagement at all. And that’s what we’re missing, that way….[Wellness activity program] at least develops a sort of a relationship with yourself that you may not have had before. And so my son talks about this term, self partnering, which we could all think about more. How are we partnering with ourselves to be more resilient, to stay healthy, to consider what skill level we truly have for self care. (Wellness Activity 1 C5)
Desire for connection	I’m retired and I retired fairly young. I’m single and I live alone. I do have a dog, but other than that my house is pretty quiet… And with COVID, I used to go out and do a lot of volunteering at the local senior center. I was constantly doing trips, and I volunteered there, and I still lead a class there. But with COVID that all imploded in just like, a day. And so, the [program] thing was really perfect for me, because it meant that it gave me an opportunity to connect with other people, that just really wasn’t there during COVID. (Wellness Activity 1 C7)
Desire for connection	COVID had a lot to do with it to begin with and this and that. My poetry and my art is kind of self-contained, so I just wanted to reach out and get different connections with people here in town. (Friendly Visitor 2 C1)
Wanting to give back	It was something for me to give to somebody else in return. (Friendly Visitor 1 C1)
Wanting to share experiences, connection	I like people. I love people. I like to connect. I like to share my 33 years of teaching resources, if they choose. I learn about people. People are interesting, and people are funny. (Telephone Reassurance 1 C3)
Too much time and not enough to do	I talked about having way too much time and very little to do with it after adjusting to dealing with being blind and not able to do what I’ve done in the past. They referred me through their pal, and that’s where I’m at now. (Telephone Reassurance 1 C2)
Regular check-in, concern for pet	I was looking around. There had been for, I don’t know how many years, a program where… I don’t know if it was local or national or what. I would get called each morning at a certain time, whatever. Just say, “Hi, how’re you doing? You’re alive. Okay, bye-bye.” Just to check in. Or we could chat a little bit, but just check in and say hello. And that was great because I live alone and I have a pet. And if something happened to me, I’d hate to think that my pet would… (Telephone Reassurance 1 C1)
Regular check-in, concern for pet	I’m alone. I have nobody. And that made me a little more secure that, I had somebody checking up on me once in a while. All I could see is something happening, and I’m laying in here for weeks, months. And I’ve got an animal, so they have to be taken care of. And that’s the real scare to me, is something happening to me, and my animal’s not being taken care of. (Telephone Reassurance 2 C3)

Theme 2: Participation in social connection programs was associated with substantial benefits for clients.

Many of the reasons clients cited for joining social connection programs were realized as reported benefits. During interviews, clients described that participating in the programs resulted in friendships, and also discussed the importance of being able to help others and knowing that someone else cares about you. Clients said that the program reduced their loneliness, brightened their day, improved physical and mental health, and in some cases “saved [their] life” (Wellness Activity 1 C10, Telephone Reassurance 1 S2). In addition, clients expressed that these programs inspired creativity, facilitated the sharing of interests, and supported feeling like a person, with one client sharing:

I love this program. It makes me feel alive, like someone cares. And I know I'm not the only lonely senior… It made me feel like a person again. It made me feel wanted and loved and cared for, because [volunteer 2] and [volunteer 1] do that. And well, this program would ... I would've never met them. I don't know where I'd be. I did get lonely. I did get depressed. But no, they helped me all through that. (Friendly Visitor 1 C4)

For additional representative quotes, see Table 3.

Table 3.

Theme 2: Participation in Social Connection Programs was Associated With Substantial Benefits for Clients, Representative Quotes.

Concept	Representative quote, ID
Calls just to be helpful	This is a good program. And especially in this world that we’re in right now. It’s so hard for you to find anybody that even cares anymore. What’s happening in your life? And it’s really good to know that somebody is going to be calling you. That’s not doing it for any purpose, but just to help you. (Friendly Visitor 2 C9)
Friendship	They’re a friend if you don’t have a friend. (Telephone Reassurance 2 C1)
Friendship	I look forward to talking to these two women. I anticipate happily them calling. So it’s a win for me, because I know I can just talk to them. And we usually talk for over an hour, sometimes more… I do care about both of them, but it’s having a friend that you talk to on the phone. Friendship’s important. (Telephone Reassurance 1 C6)
Interaction, able to contribute	I think the biggest benefit has been real interaction with another individual that’s not your family and being able to actually interact in positive ways that I’m able to contribute something to them and them to me as well. (Telephone Reassurance 1 C2)
Knowing someone cares	I appreciate, when they call, they always call and check on me all the time. And that means, lets me know that somebody out there cares about me. They care and concern if I need anything, how I’m feeling, how I’m going, how my week is. And I generally let them know that. And I appreciate that. (Telephone Reassurance 2 C9)
Knowing someone cares, personhood	I’m talking from my heart. I love this program. It makes me feel alive, like someone cares. And I know I’m not the only lonely senior… It made me feel like a person again. It made me feel wanted and loved and cared for, because [volunteer 2] and [volunteer 1] do that. And well, this program would … I would’ve never met them. I don’t know where I’d be. I did get lonely. I did get depressed. But no, they helped me all through that, yes. Like, I can talk to [volunteer 1]. She talks to me. I want to say like, she’s like a daughter to me… I can tell she cares about me. Not the program, about me… The friendship, the company, the not being alone all the time. The friendship they offer, not only [volunteer 1], but her husband, her family. When they sang happy birthday to me, I mean, it’s the first time I had it. I never had a birthday cake or nothing, but they sang happy birthday to me at 80 years old. (Friendly Visitor 1 C4)
Reduces loneliness	I think it’s a great thing to have really, when people feel down and lonely and somebody comes here and cheers them up. I think it’s great, because I like to be around people, and where I lived before there was nobody around. I think that’s how come I got so depressed. (Friendly Visitor 1 C5)
Reduces isolation	I love the calls. It feels like you have somebody right with you in the house. You’re not all alone. (Friendly Visitor 2 C6)
“Brightens my day”	Now I get phone calls, and it’s very nice. I use it to help me with my mental health because I can vent about things that bother me to the young lady. It helps me quite a bunch. Brightens my day…It’s become a bright spot in my life, which is not that bright. (Friendly Visitor 2 C8)
Improved mental and physical health	The stimulation is good for mental health and the activity is good for physical health. My life has improved in both categories considerably since I joined up. (Wellness Activity 2 C2)
Improved multiple areas of life	I’m just doing so much better in, I don’t know, all areas of my life. So doing regular exercise and making friends in the class…But now when I go to the center … I see people and say hi and I can chat with them. So in that way, it’s given me a little social aspect since I’m not a very social person. I’m an introvert, so I always feel proud of myself . I’m socializing, I’m doing something, talking to people. Just getting out and doing more is good for you than just sitting at home all the time, just looking at … reading or whatever. [It] gives you a positive mental attitude, the exercise and the fellowship. (Wellness Activity 2 C7)
“Saved my life”	I literally was looking at one of our responses the other day, and the client says this has changed my life. Matter of fact, they said, it actually saved my life. (Telephone reassurance 1 S2)
Restarted activities of interest, helped reduce depression, “save[d] my life”	And it was just that little push that I needed. I think just from being with all the mess with the pandemic, it really made it hard not to be able to do the things we used to do… And so I think this really did save my life… I think it helped with my depression, I was suffering and it just kind of brought back my art muse, which I just needed that little kick in the butt to motivate myself, to get back into my art. And I find it is really, it is a wonderful therapeutic way to… It does really work. I think that it helps people mentally. I really believe that. And I just love it. (Wellness Activity 1 C10)
Inspired creativity	It’s inspired me to do more art, to find more time to devote to that more creative stuff and not feel guilty about it. This is okay. I can do this. And also to just get better at it. And not so much for show, although they have that whole component where they have a big show of everyone’s art, and it used to be on Zoom. This year, they want to do it at a location with drinks and snacks and all that stuff, which is pretty fun. So I feel a little bit like you’re in school, grade school or something, but I think that’s the cycle of life. As you get old, you become young again that way, to be taken care of, and it’s a way to give somebody acknowledgement. And I like that, and I think it’s important. So I would say, the big impact for me was just being inspired to do more creative things. (Wellness Activity 1 C5)
Shared interests, opens up the world	It’s a pleasure to get a phone call from her. It’s not somebody who is advertising windows for that house I no longer own. Life insurance, which I have, or car insurance, which I never owned. It’s a pleasure to get a phone call from her. Truly is….I think it’s lovely for people, other people who have other interests to contact people who have maybe the same interests but can’t go out. Who are shut-in and this opens up a world to them that they used to have and now are physically unable to do. (Friendly Visitor 1 C3)
Personhood	It is treating you as an artist. You may not have been what we normally think of as an artist or define someone as an artist, but it’s defining you as someone who is capable of creating art. And I think oftentimes we see some of the activities that are offered, say in long-term care, that seem childish now that the person’s capabilities may not be what they once were. But they’re still adults and they should still have the equipment and to be treated as an adult and not just given the same materials that a kid in elementary school is being given. (Wellness Activity 1 S3)

Theme 3: Volunteers and staff members identified the reasons they became engaged with social connection programming.

Volunteers and staff members also described the reasons they decided to engage in social connection programs. Many of these individuals expressed awareness of the needs of older adults and a desire to reduce isolation and loneliness. For some, this was about paying it forward or was consistent with a belief in the importance of helping others:

If I'm not part of the solution, I'm part of the problem. And so it's my goal to go out and try to change somebody's life every single day. I don't care what that looks like. I don't care how I do it, but that's my goal to every day make an attempt to make somebody else's life better. And in doing what we do here at Meals on Wheels, we’re no longer just our Meals on Wheels. I had a dream for this center and to change people's lives. My mom was very ill for the last 15 years of her life. I know what she went through and to have somebody be there to put a smile on her face every day changed her livelihood and it takes so much more effort to be negative than it does to bring joy to somebody's life. This is the best thing I've ever done ever. (Telephone Reassurance 1 S1)

Others wanted to share their knowledge and experiences or to “be useful” (Telephone Reassurance 2 V3). This concept of continuing to engage in some way was particularly important to individuals who were retired. Conversely, particularly for those who were still working, participants expressed that a key contributor motivating volunteering for these social connection programs was the flexibility they offered. For additional representative quotes, see Table 4.

Table 4.

Theme 3: Volunteers and Staff Members Identified the Reasons They Became Engaged With Social Connection Programming, Representative Quotes.

Concept	Representative quote, ID
Wanting to meet a need	Took a look at what was going on and saw that isolation and depression was becoming more and more and more prevalent now, and people were paying more attention to what was happening to older adults in their home. And then also was going through it with myself, with my own parents, after my father passed, watching my mother, just her world just started shrinking. And fortunately for my mom, my sisters and I were very active in her life. But working here, I began asking the social workers a lot of questions about how many of our folks are living alone, how many of our folks have family members living nearby? (Friendly Visitor 1 S1)
Wanting to share knowledge	I work in this little kitchen here and this is where we would serve the meals. [Name], who was the Volunteer Coordinator at the time, she was a young lady… I was just playing around with some experiments that I had that I was learning, and she was walking by one day. I said, “[Name] check this out.” I did this one experiment and she just… Her jaw dropped. It was so cool. She goes, “You got to show that to the seniors.” I’m like, “Yeah, I’ll do that in a second. My background is education, I would love to teach them.” So we got that together one time, the seniors loved it, so we started to do it month after month. So once I got my foot in the door that way, I started talking about a lot of the other things that I really liked to do, like woodturning and all of that stuff. I tried to get all these groups together and little by little it happened. (Wellness Activity 2 S6)
Wanting to feel useful	And now that I don’t drive very much, phoning seems to be a good way to relate to people, to be useful, which is what I have to do, I have to feel useful to somebody…. I was going to say if I was alone in an apartment, I would certainly want and welcome people calling me… I mean, after you reach a certain age people are not quite as… They don’t give you a call quite as often as they did when you were active and working, you don’t have that social life. (Telephone Reassurance 2 V3)
Wanting to contribute, help others	If I can’t do something, if I’m not part of the solution, I’m part of the problem. And so it’s my goal to go out and try to change somebody’s life every single day. I don’t care what that looks like. I don’t care how I do it, but that’s my goal to every day make an attempt to make somebody else’s life better. And in doing what we do here at Meals on Wheels, we’re no longer just our Meals on Wheels. I had a dream for this center and to change people’s lives. My mom was very ill for the last 15 years of her life. I know what she went through and to have somebody be there to put a smile on her face every day changed her livelihood and it takes so much more effort to be negative than it does to bring joy to somebody’s life. This is the best thing I’ve ever done ever. (Telephone Reassurance 1 S1)
Wanting to contribute, post-retirement	I’m now semi-retired, I have about six patients throughout my week, and I decided that I wanted to do a little more, I wanted to give back. And because of my love for my grandparents, who were just instilled strength and courage in me and were proud of everything I did moving forward in life, as a child on up, I decided that I wanted to do something with the seniors. (Friendly Visitor 1 V3)
Wanting to contribute, meet a need	I like to volunteer. I mean, I have the time as a retiree and it makes me feel good to be able to help and people that are homebound, but it’s a good way to help, to be able to deliver food to them. And it’s also a social thing I get to say hi and socialize a little bit with them and maybe help make their day a little better. And it’s a really good program. There’s a definite need for it. And I feel good about being able to help fill the need. (Wellness Activity 2 C9)
Wanting to contribute, need for purpose	I wished to do more; after my retirement, I had seen the experience of my father, who after he retired, and he retired at 62 also as I did, and he didn’t really have much to do. And he just, I felt sorry, he’d sit on the couch and he would fall asleep there, and he’d wander around. The poor man would even go to the supermarket and hang around with the cashiers for some company. So I guess, I don’t know if I learned anything, I guess I did; that motivated me at my retirement to do more…I figured I wanted to spend some of my time reaching out, and continuing to do service for others. (Friendly Visitor 1 V5)
Wanting to pay it forward	I started volunteering because during my mother’s last year, she had people help her and it touched my heart. And I wanted to give back to the community. And my heart goes out to the people that are by themselves. Especially since I’ve moved here to Florida. I did not realize how many seniors are by themselves. They outlived their family and friends. (Telephone Reassurance 1 V1)
Importance of flexibility, especially in recruiting volunteers who are working full-time	I think connections are so important in our communities, but I just don’t know. It’s trying to fight that battle of how do you engage people to give their time and talents? …I’ve told so many people that [Program] is attractive, because it’s not like you’re delivering meals between 10:30 and 12:00. That is obviously a time restraint that some people working a full-time job can’t do. But this one, we have people that are making calls on the weekends or in the evening, whenever this client wants it. So it is possible to expand, but it’s trying to continue to plant that seed of, “You could really make a difference and just give 5 minutes of your time.” (Telephone Reassurance 2 S2)
Importance of flexibility, self-direction, in recruiting volunteers	It was the aspect of being able to, on a limited basis, and somewhat under my control since I’m a volunteer, as opposed to an employed person who has restrictions placed upon him or her, I could schedule my time with the person according to my needs, and of course, also to the person’s needs as well. So being able to be kind of free about deciding when to visit and kind of even who was a big direction for me. (Friendly Visitor 1 V5)
Importance of flexibility, remote potential, in recruiting volunteers	I’ve been trying to find something to volunteer with, but we kind of have been traveling around a bit, so I didn’t want to get… And this was perfect because it was through Zoom, so I didn’t have to be in one place all the time. And so, I don’t know, it was just feeling like wanting to do something and trying to figure out. (Wellness Activity 1 V5)
Importance of flexibility	I retired probably about five or six years ago...And in retirement, looking for the balance of volunteering and doing some good in the world without being too scheduled. And that’s what attracted me to this project...It was more the volunteer idea and the flexibility of the idea and I like the idea of it….I took it on as a volunteer thing that I could easily fit in my life. (Wellness Activity 1 V3)

Theme 4: Volunteers and staff reported deriving substantial benefits from participating in social connection programs.

As was the case for clients, volunteers and staff members experienced numerous benefits of their participation in social connection programs, consistent with their reasons for joining. Several expressed the benefits of knowing that they are meeting a need and helping others, including giving “[clients] hope, something to look forward to” (Telephone Reassurance 1 V5). Often, volunteers expressed that the relationships that were built were reciprocal, and “supremely rewarding” (Telephone Reassurance 2 V1). Participants expressed building meaningful relationships and connections, ones which “helped [them] get through the pandemic” (Wellness Activity 2 V1). Volunteers and staff also reported that being a part of these programs provided purpose:

I actually had a little bit of anxiety when I first retired because I didn't know ... I thought, “What is my purpose now?” I thought, “I'm going to go back and do some kind of volunteer work again.” …I think it not only helps the lady that I'm visiting, but it actually helps me. Because I feel like I have a purpose... I like to do for people. That's my personality. I guess I'm a nurturer. I just enjoy doing things for people. I feel like I have a purpose, and it just makes me feel better. (Friendly Visitor 1 V1)

For additional representative quotes, see Table 5.

Table 5.

Theme 4: Volunteers and Staff Reported Deriving Substantial Benefits From Participating in Social Connection Programs, Representative Quotes.

Concept	Representative quote, ID
Meeting a need, helping others	I would’ve never known, like I mentioned that this need, this incredible need is out there and that more people die from loneliness than almost any other disease. I mean, that’s mind-blowing to me. So I think sometimes people look at it, and I mentioned this in a team meeting, like how could a phone call change somebody’s life? It may not change their life, but it gives them hope, something to look forward to, and just knowing that there’s another human being on the planet that actually cares about them. (Telephone Reassurance 1 V5)
Meeting a need, helping others	I’m impressed with the fact that it's fulfilling a need. I found out that there is a need out there for people to be reached that are homebound or don’t get around to see anybody. I mean, that’s not much of a life if that’s all you have, it’s just four walls and nobody to talk to. Even if they have a dog or something like that, it helps, but to be able to talk to another person is important to almost everybody. And so your program is reaching them and I think there’s a big need for it. (Telephone Reassurance 2 V5)
Rewarding, reciprocal	It’s been really good. It’s been a supremely rewarding relationship in a short amount of time. (Telephone Reassurance 2 V1)
Rewarding	We all have personal lives outside of our work obligations. But yet to me, I feel Meals on Wheels knows what they’re doing. I don’t know what secret they have, but maybe it's just that near connection that people feel. If you’re willing to take the time to volunteer, to participate, to reach out to another human soul, it’s so rewarding. (Friendly Visitor 2 V4)
Someone to talk to	It’s helping me. So my children are grown and gone. I have grandchildren. It’s just my husband and I. He works with computers. He’s not a big talker. So I have a person that I can share an afternoon with, and we can talk about flowers for 3 hours. And so it helps me to get everything out that I don’t have anyone to really chat with and talk to. So yeah, just that it's Wednesday and I get to see [client’s name], and let’s see what we’re going to do today. (Friendly Visitor 1 V3)
Someone to talk to, positive interactions	I think for both of us, it’s someone we can talk to every week. Like I said, she doesn’t have a whole lot going on, so I think it’s something for her to look forward to, someone she can connect with and just know that we care for each other with sending mail to every time I send mail, I just say, “I’m thinking about you. I hope you’re doing well, know that people care for you.” And I think, not just with what I’m doing, but anyone, when you reach out to someone and just know that they know that you are thinking of them and care for them, it just feels good and gets them through the day. And also uplifting, we talk about puppies and our dogs and our families and food and going to church and everything. And I think it just adds a positive moment to our week on both ends. (Friendly Visitor 2 V3)
Connection with others	It was really something that helped me get through the pandemic, was being able to make that connection with other people. Even though it was on Zoom, I was still connecting with people. Because at the time…I wasn’t really having much human contact, like most of us, like everybody else. (Wellness Activity 2 V1)
Connection with others	And even though she couldn’t see what the other looked like, she knew you had a smile on your face and she knew she was loved and that’s what made the whole day work. It’s the knowing that we were making their day that made our day. So, we had the people coming in over the phone, I made connections with people that were from the other center but you’d have somebody that was on with you every day and suddenly my Miss [Name], she’s a good friend. (Wellness Activity 2 S3)
Gives purpose	Then, when I retired, I didn’t know what to do with myself because I’m divorced. I too kind of think, “What do I do with myself?” Because I actually had a little bit of anxiety when I first retired because I didn’t know … I thought, “What is my purpose now?” I thought, “I’m going to go back and do some kind of volunteer work again.“…I think it not only helps the lady that I’m visiting, but it actually helps me. Because I feel like I have a purpose… I like to do for people. That’s my personality. I guess I’m a nurturer. I just enjoy doing things for people. I feel like I have a purpose, and it just makes me feel better. (Friendly Visitor 1 V1)
“Fulfilling my purpose”	I’m the kind of person that wants to be able to be of support to others… And so to know that this person is feeling emotional support, I feel like I’m fulfilling my purpose. Yeah. Because when I retired, for a while I was falling off a cliff because I was able to help people literally every day in my job. Then all of a sudden, I’m not able, I’m not in that position to help make a difference for people. (Friendly Visitor 1 V4)

Discussion

Findings from this qualitative study illustrate that social connection programs are sought after and meet a wide range of needs. For clients, irrespective of the social connection program they participated in (telephone reassurance, wellness activities, or friendly visitor), similar motivations for and perceived benefits from participating in the social connection program were described. Similarly, volunteer and staff interviews highlighted the numerous motivational factors for committing time and effort towards providing and delivering social connection programs in their communities. The U.S. Surgeon General’s advisory on social isolation and loneliness draws on the socio-ecological framework and systems approach as tools with which to describe social connection in American society. We use this model to contextualize our findings below.

Existing research has demonstrated that socially connected individuals live longer (Gronewold et al., 2020; Holt-Lunstad et al., 2015; Shor & Roelfs, 2015). Within this context, the social connection programs provided by community-based organizations fill a critically needed role in the lives of older adults. As our findings indicated, clients, volunteers, and staff reported a variety of reasons that motivated participation in social connection programs. Reasons to participate included factors we consider individually focused, such as reducing loneliness and providing purpose. Often, these individual motivational factors are closely tied to relationships with others. As our interviews revealed, motivational factors to participate in social connection programming also included building relationships with other people: clients, volunteers, and staff reported that they were motivated to participate by a hope to reduce social isolation for themselves and others, a wish to build friendships, and a desire to engage and connect with others. Individual and relationship factors are intricately linked to one’s community and society. For volunteers and staff in particular, community-focused motivational factors such as a desire to give back to their communities and help others were reported. These tiered findings illustrate the intersections and interconnections throughout a community, from an individual client to the overarching community, and by extension society, which create a vast network of critically important social connections for older adults.

Existing social connection programming provides a successful model for addressing social isolation and loneliness in older adults. As our findings showed, clients reported the benefits of participating in social connection programs. These benefits included improved mental and physical health, decreased loneliness, and the opportunity to be creative, physically active, or engaged in other activities. These findings are consistent with prior literature, which found that receiving services from community-based organizations was associated with improved well-being (Helfand et al., 2020; Millen et al., 2002; Rachasrimuang et al., 2018; Thomas et al., 2020). Additionally, these findings add to the evidence base that Meals on Wheels programming is beneficial outside of nutrition (Campbell et al., 2015; Gualtieri et al., 2018; Zhu & An, 2013). For staff and volunteers in our sample, benefits of participation in program delivery were also identified and included personal satisfaction of meeting a need identified in the community, helping others, and a sense of connection and purpose. These benefits are also consistent with prior research on volunteers, which reports that volunteers derive meaningful benefits from their engagement (Filges et al., 2020; Hood et al., 2018; Kim et al., 2020; Population Reference Bureau, 2011; Torres et al., 2023). Existing research has yet, to our knowledge, to examine benefits specifically received by staff of social connection programs.

Findings from this study have important implications. First, our research expands on the existing literature and provides depth regarding the underlying motivational factors that drive people to join or deliver a social connection program. These findings are important as understanding motivation at the individual and relationship level ensures that new programming can meet not only individual goals, but also those of the surrounding community and society: to reduce social isolation and loneliness. Second, to our knowledge, our research is the first to examine the benefits of social connection programs for staff. As community-based organizations recruit new staff and volunteers, it is critically important to be able to demonstrate the benefits of participation, especially in light of declines in volunteerism and workforce challenges. Third, our findings expand the evidence base exploring what motivates individuals to volunteer and work in social connection programming. Previous research has found that people are motivated to do community-based social services work because of pride in the organization and its accomplishments (Colvin et al., 2021; Harmic, 2022; Houston, 2000; Kerschner & Rousseau, 2008; Wright, 2007). Our findings add to this body of work as volunteers and staff from our sample also expressed an explicit desire to connect with others, share knowledge, and feel useful. Lastly, the data provided through these interviews highlight the importance of time and commitment flexibility as a critical component volunteers and staff take into consideration when deciding to engage.

Although this research included a large sample by the standards of qualitative research, results are not intended to be generalizable. Further, our study included participants from six social connection programs representing three program types. Additionally, in order to recruit volunteers and clients to participate in our interviews, we relied on assistance from staff members. This may have meant that we heard from those who had the most positive experiences to report and is consistent with the largely positive information shared by participants and reported in this paper. However, in interviews, we also heard constructive feedback and areas for program improvement, which will be the focus of a subsequent paper. Future research would benefit from recruitment of interview participants with little to no assistance from staff to prevent possible biases, and interviews among more programs in order to encapsulate a broader understanding of how different programs impact outcomes for clients, volunteers, and staff.

Findings of the current study provide critical insights to community-based organizations that operate social connection or other programs seeking to recruit clients, volunteers, and staff. In an effort to develop and support programs that enable social connection, it is imperative to understand the driving factors that motivate individuals to join programs, as well as the resulting benefits that individuals experience. Findings also have implications for organizations that deliver social connection programs: insights into the benefits allow programs to expand or tailor their services to build on those strengths and minimize program weaknesses. Consistent with the Surgeon General’s national strategy to promote social connection through strengthening the infrastructure for social connection in local communities (U.S. Department of Health and Human Services, 2023), our research adds to the evidence base demonstrating the value of community-based social connection programs for homebound older adult clients, as well as volunteers and staff involved in program delivery, which may lend support for continuation and/or increases of funding.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by Meals on Wheels America.

Authors Note

Study materials and the interview protocol were sent to the Brown University Institutional Review Board for review and determined to not be human subjects’ research.

ORCID iDs

Emily A. Gadbois

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