The Effectiveness of the ‘Friendship Program’ in Enhancing Perceived Social Support and Psychological Resilience among the Elderly: A Quasi-Experimental Study

Abstract

This study assessed the effectiveness of the “Friendship Program,” a psychosocial intervention designed to increase perceived social support and psychological resilience among elderly individuals in institutional settings in Jordan. Using a quasi-experimental pretest–posttest–follow-up design with a single experimental group, the study involved 27 elderly participants and 27 student volunteers trained in basic counseling and communication skills. The six-week program featured structured sessions based on social learning and cognitive-behavioral principles, designed to promote emotional expression, cognitive engagement, and interpersonal bonds. To evaluate changes in social support and psychological resilience, the Social Support Scale and the Connor-Davidson Resilience Scale were administered at three different time points. The results indicated that participants experienced enhanced perceived social support and improved psychological resilience, supporting the program's effectiveness in fostering emotional well-being and resilience in older adults. The findings underscore the importance of integrating structured psychosocial interventions into geriatric care settings.

Keywords

friendship program social support psychological resilience mental health elderly

Introduction

Aging is a natural and complex part of life characterized by changes in physiology, psychology, and social interactions (World Health Organization [WHO], 2022). As people grow older, they encounter various challenges, such as declining health, loneliness, the loss of loved ones, and reduced financial independence. The elderly are particularly susceptible to psychological distress, anxiety, and depression due to these issues (Liu et al., 2021; Yu et al., 2023). Social support is one of the most effective defenses against these problems and is essential for maintaining the mental health and overall well-being of older adults (Schulz & Eden, 2016).

In this context, social support is broadly defined as feeling cared for, having people you can rely on, and being appreciated within a social network (Cohen & Wills, 1985). Research consistently shows that older adults with greater social support have better coping skills, a higher quality of life, and less psychological distress (Antonucci et al., 2014; Litwin & Stoeckel, 2016). Specifically, older individuals who receive both instrumental and emotional support are significantly less affected by adverse life experiences (Wang et al., 2020).

In the field of gerontological psychology, psychological resilience—a system of cognitive, emotional, and behavioral skills that protect individuals from mental decline—has become a key concept alongside social support (Oláh et al., 2010; Seery, 2011). Psychological resilience enables adaptive coping, calmness, and flexibility in the face of adversity (Barbanell, 2009; Kagan, 2021). Higher psychological resilience in the elderly is linked to lower levels of anxiety, despair, and self-reported stress, as well as greater optimism and life satisfaction (Fonken et al., 2018; Tan et al., 2020).

Unfortunately, as people age, their social support and psychological resilience decline due to role loss, physical limitations, and shrinking social networks (Charles & Carstensen, 2010). Recent research clearly shows that older adults without social support networks have very low psychological resilience, making them more vulnerable to mental illnesses and even suicidal thoughts (Maier et al., 1994; Saini et al., 2020). Moreover, these vulnerabilities worsened during the COVID-19 pandemic, which increased psychological distress and social isolation among older populations worldwide (Kagan, 2021; Yu et al., 2023).

More global attention has been directed toward developing psychosocial therapies to enhance psychological resilience and social support among older adults facing adversity (Reynolds et al., 2022). One possible solution is promoting real-life interpersonal engagement through structured social programs, such as friendship or mentorship initiatives. These programs have been demonstrated to improve social integration, prevent loneliness, and boost emotional resilience (Leff et al., 2016; Tajbakhsh & Rousta, 2012).

In line with this global trend, the “Friendship Program” is a structured initiative that encourages regular social interaction between young volunteers and senior citizens. These activities help build long-term psychological resilience and provide direct emotional support by fostering friendship, emotional expression, and intergenerational communication (Gilbert et al., 1998; Oláh et al., 2010). Moreover, these interventions address behavioral, cognitive, and emotional factors that enhance adaptive coping strategies (Folkman & Moskowitz, 2004).

However, even though data from around the world support such interventions, there are no empirical research studies from Arab or Middle Eastern settings evaluating the impact of these programs on the psychological well-being of the elderly. Current research does not directly examine the relationship between psychological resilience and perceived social support; instead, it focuses on overall mental health outcomes (Badawy & Shaban, 2025).

To address this important gap, this study will empirically examine how a culturally tailored “Friendship Program” influences perceptions of psychological resilience and social support among older adults living in Jordanian care facilities. Based on solid psychological theories and cross-national data, this research aims to create effective psychosocial interventions for aging populations in Arab societies.

Study Importance

This study is important because it tackles the urgent need to improve mental health among institutionalized elderly individuals, a group often affected by social isolation and emotional decline. As global populations age, there is a pressing need to develop sustainable, evidence-based psychosocial interventions that can boost emotional well-being, reduce loneliness, and build resilience among older adults. This research aims to fill existing gaps by testing a new intervention designed to meet the psychological and social needs of elderly individuals. The study's results are expected to add to academic research and help improve eldercare practices. By providing scalable, cost-effective solutions, the study could influence public health policies, guide mental health professionals, and assist institutions in developing effective aging support frameworks. Ultimately, the findings will promote healthier, more connected aging experiences for elderly individuals in different settings.

Literature Review

Social Support and its Impact on Elderly Mental Health

Social support significantly affects mental health and quality of life, especially among older adults. It helps reduce the adverse effects of stressors associated with aging. Social support is defined as the feeling or experience of being loved, respected, and part of a caring, supportive social network (Cohen & Wills, 1985). Research shows that older adults with strong social support networks are less likely to suffer from psychological discomfort, anxiety, and depression compared to those who are socially isolated (Antonucci et al., 2014; Litwin & Stoeckel, 2016).

Generally, the age-related challenges of widowhood, retirement, and chronic illnesses reduce social interaction and increase feelings of powerlessness and isolation. According to Schulz and Eden (2016), these pressures make older people more vulnerable to mental health issues. However, perceived social support helps buffer these effects, strengthening the person's sense of belonging and offering emotional stability. During the COVID-19 pandemic, a study by Yu et al. (2023) showed that social support was crucial for reducing symptoms of depression and loneliness and for enhancing psychological well-being in older adults.

Based on additional research, social support helps older adults handle daily challenges by providing informational, practical, and emotional assistance (Saini et al., 2020; Wang et al., 2020).

As Upasen and his colleagues (2024) note, perceived social support enhances resilience and self-worth, enabling seniors to better manage health issues and life changes. Given these findings, improving social support systems is becoming increasingly important for comprehensive senior care.

Psychological Resilience and its Relevance in Aging

The concept of psychological resilience has become more significant in current discussions, especially in conversations about aging. Psychological resilience refers to the collection of internal cognitive, emotional, and behavioral resources that help individuals endure difficulties, maintain emotional balance, and recover from stress (Oláh et al., 2010). According to Barbanell (2009), the concept is sometimes viewed as the psychological equivalent of the physical immune system, protecting against threats to one's emotional and mental health.

Psychological resilience is a key factor in reducing vulnerability to mental disorders such as depression, anxiety, and emotional exhaustion in older adults. Research shows that older individuals with strong psychological resilience are more adaptable, manage emotions more effectively, and are better able to handle life's challenges (Kagan, 2021; Seery, 2011). According to Tan et al. (2020), psychological resilience improves life satisfaction during extreme adversity and significantly lessens the effects of stress-related illnesses. One example of the physiological benefits of psychological resilience is its role in reducing neuroinflammatory responses after chronic stress, as noted in a study by Fonken et al. (2018). In later life, when individuals are more vulnerable to loss, physical decline, and existential struggles, psychological resilience fosters optimism and elasticity, which are essential (Gilbert et al., 1998). Overall, these studies emphasize the importance of building psychological resilience as a key part of therapies aimed at improving mental health in older adults.

Structured Social Interventions and Friendship Programs as Protective Mechanisms

Many systematic psychosocial therapies have been implemented worldwide to meet the mental health needs of older adults, recognizing the importance of social support and psychological resilience. Programs designed to enhance social engagement and emotional bonds have decreased loneliness, boosted mood, and strengthened resilience among the elderly population (Coppola et al., 2025).

Friendship programs are among the most effective types of intervention. By fostering frequent and meaningful relationships between young participants and older volunteers, these programs provide opportunities for companionship, emotional support, and communication. According to Leff et al. (2016), who evaluated the “Friend to Friend” program, participants showed significant improvements in social skills, emotional adjustment, and reductions in aggressive or maladaptive behaviors. The findings highlight the remarkable potential of structured social interventions to boost social integration and strengthen psychological resources.

Additionally, research has shown that interventions involving intergenerational relationships enhance older adults’ sense of purpose and self-worth (Tajbakhsh & Rousta, 2012). Furthermore, according to Gooding et al. (2012), these connections help people develop coping strategies that support long-term mental health as well as ease temporary emotional distress. These therapies offer emotional regulation, cognitive stimulation, and renewed social connections, all of which are important indicators of maintaining mental health as people age.

Despite mounting evidence supporting these initiatives, research on their implementation in Arab and Middle Eastern contexts remains notably scarce. Few studies have investigated culturally adapted friendship programs and their effects on older people's perceptions of psychological resilience and social support in Arab communities (Badawy & Shaban, 2025). This strongly justifies the need for empirical research on the effectiveness of these interventions within these cultural settings.

Although social support and psychological resilience have been shown to positively influence the mental health of older adults in international research, many questions remain, especially in Arab societies. Culturally sensitive research is needed to better understand how formal interventions, such as friendship programs, can improve older adults’ perceptions of social support and resilience. This study aims to address these issues by evaluating the effectiveness of a “Friendship Program” in senior care facilities in Jordan.

Study Hypothesis

Accordingly, this study aims to assess the impact of the intervention program on enhancing social support and psychological resilience among the elderly, as measured by pre-test and post-test evaluations.

There are statistically significant differences between the mean scores of the pre-test and post-test measurements of the elderly on the social support scale in favor of the post-test measurement.

There are statistically significant differences between the mean scores of the pre-test and post-test measurements of the elderly on the ‘friends’ dimension of the social support scale in favor of the post-test.

There are statistically significant differences between the mean scores of the pre-test and post-test measurements of the elderly on the Psychological Resilience Scale in favor of the post-test.

There are no statistically significant differences between the post-test and follow-up scores of the elderly on the Social Support Scale (family and friends’ dimensions).

There are no statistically significant differences between the post-test and follow-up scores of the elderly on the Psychological Resilience Scale.

Methodology

Research Design

This study used a quasi-experimental pretest-posttest-follow-up design with a single experimental group to evaluate the effectiveness of the “Friendship Program” in changing perceived social support and psychological resilience among the elderly. This design allows the researcher to observe changes over time while controlling for individual differences (Creswell & Creswell, 2018). It is considered a strong design for intervention studies where random assignment is not possible but controlled conditions are available (Creswell & Creswell, 2018).

Participants and Sampling

The sample included 27 older adults (14 males and 13 females) aged 60–85 living in Jordanian elderly care facilities. Participants were chosen through purposive sampling to ensure they met specific inclusion criteria aligned with the study's goals. Eligible participants had to be at least 60 years old, live in an institutional care setting, have limited family contact or be more vulnerable to social isolation, and be medically stable with enough cognitive ability to participate in conversations and structured activities. Those with acute medical conditions, severe cognitive impairments, or psychiatric disorders that could hinder participation were excluded. To support the intervention, 27 student volunteers from a Jordanian university were recruited, each paired with one older adult to ensure continuity and foster a stable social relationship during the program.

Ethical Considerations

All participants provided informed consent, including signing, after clear explanations regarding confidentiality, voluntary participation, and the right to withdraw at any time. Measures to ensure psychological safety were put in place and monitored by elderly care centers. Sessions were conducted in private, comfortable settings, with reminders that participants could pause or terminate at any moment. The research team monitored signs of emotional distress and halted interviews if needed to safeguard participants’ well-being. To address potential cognitive limitations, consent forms were simplified, printed in large font, and supported by brief capacity assessments and ongoing assent during the interview. Confidentiality was maintained through anonymization and secure, encrypted data storage. Physical comfort was promoted by keeping sessions short, providing breaks, accessible seating, and scheduling at convenient times. After each session, participants received a brief, reassuring debriefing and information on psychological support options, with elderly care centers ensuring adherence to ethical standards.

Research Instruments

To accurately evaluate the intervention's effect on social support and psychological resilience, the study used two scales to measure these constructs among the elderly.

Social Support Scale (Al-Samadouni, 1997). This scale assesses perceived social support using 30 items, evenly distributed across two subscales: family support and friend support. Responses are given on a 5-point Likert scale from 1 (Not at all) to 5 (Very much). The total score ranges from 30 to 150, with lower scores indicating less perceived social support and higher scores indicating more. The scale shows high internal consistency (Cronbach's alpha = 0.89) and has established content validity through expert review. Some example questions are, “I have friends I can rely on when I face difficult situations,” “I have at least one friend I can tell everything to,” and “I feel comfortable when I am alone, away from my family members.”

Psychological Immunity Scale: Adapted from the Connor-Davidson Resilience Scale (2003) by Al-Najjar (2023). This scale consists of 25 items covering seven areas of psychological resilience: hardiness, coping, adaptability, meaningfulness or purpose, emotional regulation, self-efficacy, and optimism. Items are rated on a 5-point Likert scale from 1 (Strongly Disagree) to 5 (Strongly Agree). The total score ranges from 25 to 125, with lower scores indicating lower psychological immunity and higher scores indicating higher psychological immunity. The scale demonstrates high reliability (α = 0.92) and strong content validity, confirmed by expert panel evaluations. Some example questions include, “I can adapt when changes occur.” “I am capable of dealing with unpleasant or painful emotions, such as sadness, fear, and anger.” “My success in previous experiences gives me confidence in handling new challenges and difficulties.”

Demographic Data Form: Participants filled out a short demographic survey gathering details on age, gender, education level, health condition, and length of stay at the care center.

The Intervention

The Friendship Program. The Friendship Program is a structured psychosocial intervention grounded in social learning theory and cognitive-behavioral techniques. It aims to enhance participants’ social skills, emotional expression, and psychological coping abilities. The program lasted six weeks and consisted of 17 sessions, each lasting 30–60 min, held three times a week. The sessions adopted a thematic approach that integrated emotional, cognitive, and relational elements.

The first type of sessions focused on guided discussions and emotional support activities designed to build trust and rapport between participants and volunteers. Each session included open-ended conversations that encouraged older adults to share their thoughts and feelings openly. Activities involved emotional check-ins, inviting participants to reflect on their daily experiences, guided storytelling to trigger autobiographical memory, and supportive dialogue centered on validation, empathy, and reflective listening. The psychological goals of these sessions were to promote emotional expression, strengthen participants’ sense of interpersonal support, and create a relational “safe space” that fosters meaningful emotional connections.

The second type of sessions included cognitive and recreational games specifically chosen to boost memory, storytelling, and problem-solving skills. These organized activities encouraged mental engagement and social interaction through memory games such as recall challenges and card-matching tasks, cooperative puzzles that required teamwork, story-completion and sequencing exercises, and simple problem-solving tasks grounded in cognitive-behavioral principles. The psychological goals of this session were to enhance attention, working memory, and executive functions, and to promote a positive mood through enjoyable activities. Additionally, the session aimed to reinforce adaptive thinking patterns and increase participants’ confidence in their abilities.

The third type of sessions involved reflective discussions aimed at fostering emotional connections and psychological reinforcement. These semi-structured conversations gave participants a chance to reflect on the week's activities, strengthen emotional bonds with volunteers, and notice positive changes in mood or coping skills. Activities included sharing insights from the cognitive games, identifying personal strengths and effective coping strategies, and setting goals for the upcoming week. The psychological goals of this session were to bolster resilience and emotional stability, consolidate learning, and reinforce adaptive behaviors developed throughout the program.

Before starting the program, student volunteers underwent structured training that provided them with essential interpersonal and supportive communication skills. The training initially covered basic counseling techniques, including active listening, paraphrasing, summarizing, asking open-ended questions, and maintaining appropriate boundaries. Volunteers also learned about empathy and emotional responsiveness, focusing on understanding age-related psychosocial needs and responding sensitively to emotional disclosures. Additionally, they received guidance on practical communication methods, including managing conversations with older adults, observing emotional cues, and maintaining a nonjudgmental attitude during interactions. Throughout the six-week intervention, volunteers were responsible for maintaining daily phone contact to offer consistency and reassurance, conducting weekly face-to-face visits to strengthen relationships, and recording brief notes after each interaction to ensure adherence to the program's structure and support ongoing monitoring of participant progress.

The intervention was carefully tailored to fit the Jordanian cultural and social context to ensure it was appropriate and accepted by older adults. Content and communication were aligned with values such as family cohesion, respect for elders, and intergenerational connectedness. Activities included familiar cultural practices, such as mutual support and storytelling. All materials were delivered in culturally sensitive spoken Arabic. Volunteers received training on cultural expectations regarding modesty, emotional expression, and proper interaction between younger and older individuals. The frequency of phone calls and visits was also adjusted to match Jordanian norms, where regular contact with older adults is seen as a sign of respect. These adaptations enhanced the intervention's cultural relevance and increased participant engagement.

Data Collection Procedure

Data collection was conducted in three phases to evaluate the intervention's immediate and long-term effects. The pre-test, or baseline phase, took place right before the program began. During this time, participants completed standardized assessments, including the Psychological Resilience Scale and the Perceived Social Support Scale, to establish initial levels of psychological resilience and perceived social support. These baseline scores served as a foundation for measuring subsequent changes caused by the intervention.

The post-test phase was carried out immediately after completing the six-week program. During this phase, the same standardized scales were used to assess changes in participants’ psychological functioning. The purpose of this assessment was to measure the immediate effects of the intervention on participants’ emotional well-being, social connectedness, and coping skills. By comparing post-test scores with baseline data, the research team was able to evaluate the improvements linked to participation in the Friendship Program.

One month after the intervention, a follow-up assessment was conducted to evaluate the stability and durability of the program's effects over time. This third round of data collection enabled researchers to determine whether improvements in psychological resiliency and social support were maintained beyond the immediate post-intervention period. The follow-up phase thus offered valuable insights into the program's long-term advantages.

To ensure data accuracy and reliability, all assessments were conducted in person by trained research assistants. These assistants were specifically trained to standardize instructions across participants, record responses accurately, and provide appropriate support to individuals with limited literacy or comprehension. This careful attention to data collection procedures helped maintain consistency and boost the overall credibility of the study's findings.

The Friendship Program concluded with a closure that prioritized participants’ emotional health and reinforced the skills they had acquired. The final sessions encouraged reflection on personal development, favorite activities, and enhancements in emotional, social, and cognitive abilities. Group discussions provided a platform for sharing meaningful memories, while volunteers emphasized individual strengths to enhance self-esteem and coping mechanisms. Farewell activities included culturally meaningful gestures of appreciation, reinforcing emotional bonds. This gradual, supportive closing process ensured participants felt valued, empowered, and emotionally secure as the program came to an end.

Data Analysis

The data were analyzed using SPSS 26. Descriptive statistics, including means and standard deviations, were calculated for each study variable. Paired-samples t-tests assessed changes in scores for family support, friend support, and psychological immunity before and after the intervention. Effect sizes were measured using Eta squared (η²) due to the small sample size. All tests were two-tailed, with a significance level set at p < .05. Normality of the data and homogeneity of variance were checked before analysis.

The first hypothesis states that there are statistically significant differences between the pre-test and post-test mean scores for the elderly on the social support scale, favoring the post-test. Analysis revealed statistically significant improvements in perceptions of social support after the implementation of the Friend Program. Family social support increased from a pre-test mean of 8.18 (SD = 2.33) to a post-test mean of 18.92 (SD = 1.07). The paired t-test showed a highly significant improvement, t(26) = 21.25, p < .001, with an effect size of η² = 0.901. As shown in Table 1.

Table 1.

Family Dimension of the Social Support Scale (Pre vs. Post Test).

Measurement	N	Mean	SD	t-Value	df	p-Value	Effect Size (η²)
Pre-test	27	8.18	2.33	21.25	26	0.01	0.901
Post-test	27	18.92	1.07

These results show that the program successfully improved the elderly's perception of the social support they get from their families. This progress might be due to the program's role in enhancing communication and interaction between the elderly and their family members or in raising the elderly's awareness of the importance of the family support available to them. This finding supports previous research that highlights the crucial role of family social support in improving the mental health of older adults.

The second hypothesis states: “There are statistically significant differences between the mean scores of the pre-test and post-test measurements of the elderly on the ‘friends’ dimension of the social support scale in favor of the post-test.” A paired samples t-test was used to determine the statistical significance of the differences between the means of related samples, as follows:

Similarly, for friend support, scores increased from a pre-test mean of 9.70 (SD = 2.31) to 26.70 (SD = 1.40) after the intervention. The results were statistically significant, t(26) = 33.38, p < .001, with a large effect size (η² = 0.953). As shown in Table 2.

Table 2.

Social Support Scale – Friends Dimension (Pre-Test vs. Post-Test).

Measurement	N	Mean	SD	t-Value	df	p-Value	Effect Size (η²)
Pre-test	27	9.70	2.31	33.38	26	0.01	0.953
Post-test	27	26.70	1.40

The third hypothesis states that there are statistically significant differences between the pre-test and post-test mean scores of the elderly on the Psychological Resilience Scale, favoring the post-test. The results show a significant improvement in participants’ psychological resilience scores following the implementation of the Friendship Program. The average score increased from 33.51 in the pre-test to 70.92 in the post-test, indicating a substantial positive change. This difference was statistically significant (t = 27.56, df = 26, p = 0.01), suggesting it was unlikely to have occurred by chance. The effect size (η² = 0.940) is substantial, indicating that the Friendship Program significantly affected the measured outcome, most likely through social support or psychological well-being. These findings highlight the program's effectiveness in enhancing the mental health of elderly participants, as shown in Table 3.

Table 3.

t-Value and its Significance for the Differences in Mean Scores of the Experimental Group on the Psychological Resilience Scale (Total Score) between Pre-Test and Post-Test Measurements.

Dimension	Measurement	N	Mean	Standard Deviation	t-Value	Degrees of Freedom	Significance Level (p)	Effect Size (η²)
Psychological Resilience	Pre-test	27	33.51	6.06	27.56	26	0.01	0.940
Psychological Resilience	Post-test	27	70.92	3.12

These findings indicate that the program positively affected the elderly's psychological resilience. This improvement may be linked to the program's role in boosting self-esteem, a sense of competence, and optimism among the elderly. These results align with previous research showing that social support is vital in strengthening psychological resilience and helping people cope with life's challenges.

Follow-up Measurement Results

To assess the lasting impact of the training program on participants’ perceived social support, a follow-up measurement was conducted after the post-test. The goal is to see if levels of social support from both family and friends were maintained over time. Table 4 displays the follow-up results, compares them with the post-test scores, and indicates whether perceptions of social support remained stable or changed after the intervention.

Table 4.

Follow-up Results on the Social Support Scale (Family and Friends).

Dimension	Measurement	N	Mean	Standard Deviation	t-Value	Degrees of Freedom	Significance Level (p)	Effect Size
Family	Post-test	27	18.92	1.91	0.41	26	0.68	0.08
Family	Follow-up	27	18.85	1.89
Friends	Post-test	27	19.85	1.78	0.32	26	0.75	0.06
Friends	Follow-up	27	19.81	1.80

The t-values are small and not statistically significant (p > 0.05), indicating no significant differences between the post-test and follow-up measurements. This suggests that there are no meaningful differences in the mean scores of the experimental group on the social support scale across its two dimensions (family and friends) between these two time points. The t-values were low and not statistically significant (p > 0.05), and the effect sizes were also small. These results imply that the improvement in the experimental group's perceived social support after the training program was maintained throughout the follow-up period, demonstrating the program's effectiveness and the lasting nature of its impact.

Regarding the follow-up results on the Psychological Resilience Scale, the data show no statistically significant differences in mean scores between the post-test and follow-up assessments. The t-value was low (0.41), the p-value was high (0.68 > 0.05), and the effect size was small (η² = 0.08). This indicates stability and consistency in participants’ psychological resilience levels across both measurement points (Table 5).

Table 5.

Differences Between Post-Test and Follow-up Scores on the Psychological Resilience Scale.

Dimension	Measurement	N	Mean	Standard Deviation	t-Value	Degrees of Freedom	Significance Level (p)	Effect Size (η²)
Psychological Resilience	Post-test	27	132.4	7.12	0.41	26	0.68	0.08
Psychological Resilience	Follow-up	27	132.1	7.19

The lack of significant differences indicates that the participants’ psychological resilience levels remained stable between the post-test and follow-up. This suggests that psychological resilience is a relatively enduring trait among older adults. Additionally, the absence of change in the follow-up measurement may imply that the intervention had a lasting impact, with resilience levels not declining over time, thus supporting the program's medium-term effectiveness. These findings also demonstrate the high reliability of the Psychological Resilience Scale, as scores remained consistent over time, indicating that the scale can accurately measure this psychological trait. Lastly, the absence of significant differences may indicate that external factors or situational variables did not significantly influence participants’ psychological resilience during the follow-up period.

Discussion

The findings of the present study offer strong evidence for the effectiveness of the Friendship Program in enhancing perceived social support and psychological resilience among older adults. Participants showed significant improvements in familial support, peer support, and psychological resiliency after the intervention. These results align with a substantial body of research highlighting the important role of social interventions in fostering psychological adaptation and emotional well-being in elderly populations.

Social support is widely acknowledged as a protective factor for mental health, especially for older adults experiencing loneliness, social isolation, or chronic health conditions (Saini et al., 2020). Consistent with this, the current study found a significant increase in self-reported support from both family and friends after participating in the program. This result aligns with previous research showing that structured social interactions and community-based interventions can effectively reduce feelings of loneliness and promote a sense of belonging and resilience (Skalski et al., 2025). Socially engaging interventions have also been proven to decrease symptoms of depression and improve overall psychological well-being among older adults (Tibubos et al., 2025).

A key outcome of the intervention was a notable increase in resilience, an individual's ability to handle stress, adapt to change, and maintain psychological stability. This boost indicates that the program effectively promoted internal coping skills, including emotional regulation, optimism, self-efficacy, and adaptive strategies. These results align with existing research demonstrating that social support is a significant factor in building resilience (Tragantzopoulou & Giannouli, 2025). As Bosco and Lopez (2025) emphasize, enhancing perceived support not only helps prevent distress but also develops internal psychological resources, further strengthening psychological immunity.

Furthermore, the large effect sizes observed (η² > 0.90) emphasize the program's practical importance. These results indicate that consistent emotional and social support, whether from family members or peer-like relationships, can be deeply transformative for older adults. Previous studies have similarly reported that group-based or peer-facilitated programs are especially effective in boosting cognitive and emotional resilience (Giannouli et al., 2025; Skalski et al., 2025). These findings strengthen the idea that fostering meaningful social engagement is not just beneficial but crucial for maintaining mental health in later years.

Although the results are encouraging, several limitations must be recognized. The small sample size restricts how much the findings can be applied to a larger population. Additionally, the lack of a control group hampers the ability to draw definitive causal conclusions about the intervention's effectiveness. Future studies should use more rigorous approaches, such as randomized controlled trials (RCTs) and long-term follow-up, to validate and expand upon these results. It would also be beneficial to examine potential moderating factors—such as gender, education level, or prior mental health status—since previous research has indicated that these variables can affect the outcomes of resilience-based interventions (Hussain et al., 2025).

Notably, the lack of a decrease in perceived social support after the intervention suggests that the program's benefits persisted over time. Participants retained the higher levels of perceived support they gained during the intervention, demonstrating long-term retention of its psychological and emotional advantages. This durability further endorses the program's design and implementation, emphasizing that the positive effects of structured psychosocial support can last well beyond the immediate treatment period.

Finally, these findings support the growing body of positive psychology literature, which emphasizes the lasting effects of well-designed interventions that improve interpersonal connections and emotional resilience. When implemented effectively, programs that bolster family and peer support networks can lead to long-term improvements in mental health, life satisfaction, and overall quality of life among older adults.

Cultural Relevance in the Arab-Muslim Context

The results are especially significant when viewed within the Arab-Muslim cultural and social context. In traditional Arab-Muslim societies, strong bonds across generations, family unity, and community support are highly valued and act as informal systems of help for the elderly. However, changing family dynamics, urban migration, and the growing institutionalization of elder care have weakened these traditional support networks.

In this cultural context, the Friendship Program serves as a culturally sensitive intervention that reinforces community values such as rahma (compassion), birr al-walidayn (duty to parents), and silat ar-rahim (maintaining family ties). The structured, consistent interactions provided by the program align with Islamic ethical principles, highlighting empathy, social responsibility, and care for vulnerable individuals. Therefore, the intervention does not simply duplicate Western psychosocial models but instead adapts to the sociocultural expectations of Arab-Muslim aging populations, making it more acceptable and effective.

Conclusion

The current study provides strong evidence that implementing a structured Friendship Program significantly improves older adults’ perceptions of social support and psychological resilience. The intervention resulted in notable improvements in both family and friend support and psychological immunity, key factors in promoting mental well-being and successful aging. The large effect sizes observed confirm the program's practical importance and potential for broader use. These findings align with current research highlighting the vital role of social support systems in enhancing resilience, alleviating emotional distress, and improving the quality of life among older adults (Saini et al., 2020; Skalski et al., 2025). The program successfully reduced risks often associated with aging, such as social isolation, loneliness, and mental health vulnerability, by encouraging consistent, meaningful social interactions.

Importantly, the program's benefits go beyond external social support, indicating that it also boosts psychological resilience. It further strengthens internal coping mechanisms such as self-efficacy, emotional regulation, and optimism, which are crucial for managing the psychological stressors of aging. This dual effect suggests that similar psychosocial programs should be incorporated into eldercare models to support overall well-being.

In conclusion, the Friendship Program offers a low-cost, culturally congruent, and highly effective model for improving the lives of older adults in Arab-Muslim societies. It strengthens both external support networks and internal psychological resilience, paving the way for healthier, more dignified aging across diverse communities.

Recommendations

Based on the findings, the following recommendations are suggested for practice, policy, and future research.

Institutional Integration of the Friendship Program: Aged care centers, nursing homes, and community organizations should incorporate the Friendship Program as a fundamental part of eldercare services. Embedding it into daily operations can greatly enhance older adults’ well-being, diminish isolation, and promote social inclusion.

Training for Volunteers and Family Members: To ensure effectiveness, volunteers, especially students and family caregivers, should receive training in empathy, active listening, and communication techniques. Cultural sensitivity training should also be provided to align with the values and expectations of older individuals in Arab-Muslim societies, where caring for the elderly is deeply rooted in religious and cultural traditions.

Culturally Inclusive and Longitudinal Research: Future studies should use randomized controlled trials (RCTs) with larger and more diverse samples, including participants from various regions, genders, and socioeconomic backgrounds. Long-term studies are also needed to assess the program's ongoing impact on psychological immunity and overall well-being.

Digital Accessibility and Outreach: The use of digital communication tools (such as video calls and mobile apps) should be considered to broaden the program's reach, especially to older adults who are homebound or geographically isolated. This strategy would also support the growing digital literacy among seniors.

Policy Development and Support: Policymakers in Arab and Muslim-majority countries should incorporate social support interventions into national aging strategies. These programs can help reduce the psychological strain on healthcare systems by preventing mental health decline and improving life satisfaction among older adults.

Paying attention to demographic and cultural differences: Researchers should examine how factors like gender, education level, health status, and religiosity affect the outcomes of social support interventions. Customizing programs to address the unique needs of various subgroups within the elderly population will boost their effectiveness and cultural relevance.

Footnotes

Ethics Approval

The study was conducted following ethical principles and received approval from the Research Ethics Committee at the University of Jordan.

Patient Consent Statement

Written informed consent was obtained from study participants.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

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

Data Availability Statement

The study materials and data that support the findings of this study are available at .

ORCID iDs

Somaya Abdel-Hameed Al-Ja’afreh

Ashraf Faris Alqudah

Dhaval Vinodkumar Patel

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