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Promoting Communication Strategies for Seniors during Pandemics
Sandikonda E. Tambala
Edson College of Nursing and Health Innovation, Arizona State University

Author Note
Sandikonda Tambala is now at Edson College of Nursing and Health Innovation, Arizona
State University
He has no conflict of interest to disclose.
Correspondence concerning this paper should be addressed to Sandikonda Tambala,
Health North Suite 301, PO Box 873020, Tempe, AZ 85287-3020. Email: tambala@asu.edu

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Promoting Communication Strategies for Seniors during Pandemics
Abstract
Purpose: The COVID-19 pandemic government regulations and mandates have caused feelings
of overload, isolation, anxiety, depression, and loneliness. This project aimed to evaluate the
level of impact of social distancing and homestay mandates on seniors during the COVID-19
pandemic. The knowledge from the data guided the implementation of Information
Communication Technology (ICT) as a focused intervention to address loneliness, social
isolation, and depression among seniors.
Methods: Quantitative reviews were employed to assess the impact of ICT on lonely seniors. A
convenience sample of 5 seniors aged 65 and up from a local church congregating in worship
center located in southwestern United States enrolled in this voluntary pre-and post-educational
intervention project. Participants were informed of the confidentiality of the study and that the
study had no known risks on participants. The participants willingly signed a consent for the
study. The attendees received two one-hour education sessions on how to use WhatsApp and
Zoom as communication strategies. The pre-and post-loneliness scale scores were collected
using the Revised UCLA Loneliness Scale as a tool. Results were compared before and after the
educational intervention using a paired Wilcoxon signed-rank test.
Results: The results indicate significant reductions in reported loneliness from pre to post
intervention (z = -2.02, p = 0.043). These results indicate that using ICT can help address
loneliness in the seniors.
Conclusion: Implementing communication strategies such as WhatsApp and Zoom effectively
addresses social isolation and loneliness in seniors. The data reveals that integrating electronic

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communication in the life of the seniors can manage the social isolation problem. Future nursing
practices may benefit from the project's data to address loneliness in the seniors.
Keywords: Seniors, COVID-19 pandemic, Information Communication Technology (ICT),
Revised UCLA Loneliness Scale.

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Promoting Communication Strategies for Seniors during Pandemics
Background and Significance
Description of the problem
The COVID-19 pandemic has had a significant impact on people's lives. Feelings of
overload, isolation, tension, and anxiety have all been linked to depression and loneliness.
Quarantine and homestay requirements have caused social and living patterns to be disrupted.
This disruption has been having unanticipated consequences for people's physical and emotional
health all over the world. Nwachukwu, 2020 states that the government homestay mandates
programs have protected the seniors from the coronavirus. It has also become known that
interventions are needed to promote mental wellbeing in seniors while practicing social isolation
mandates during pandemics.
Purpose & rationale statement
The purpose of this project was to evaluate the impact of social distancing and homestay
orders on the seniors during COVID-19 pandemic. Senior people are at risk for anxiety,
depression, and suicide when not socializing with family and friends. Previously, religious
support has been an ally for dealing with daily stresses but with the COVID-19 pandemic, these
religious institution-based resources have been restricted leaving most older church members
experiencing isolation and loneliness and at increased risk for anxiety, depression, and suicides
(Dutra & Rocha, 2021). Therefore, the knowledge from the evaluation of the impact of social
distancing and homestay orders guided the implementation of focused interventions to address
loneliness, isolation, and depression among the seniors.
Epidemiological data to support the significance

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According to the Centers for Disease Control and Prevention (CDC) (2021), social
isolation raises a person's risk of dying young. It is linked to a 50 percent higher risk of dementia
and a 29% increased risk of heart disease, and a 32% increased stroke risk. Loneliness was found
to be related to a 29% increase in the risk of heart disease and a 32% increase in stroke risk.
Consequently, action to fix the problem was needed to promote social cohesion and the seniors'
mental wellbeing.
Internal evidence to support the project
The worship center located in southwestern United States and has been there for a long
time; about 75% of the congregation are seniors. Most of them do not have families, while others
have few family members remaining. Many have turned to this church and its members as part of
the family to cope with loss and grief. The church assembles on Saturdays and Wednesday
evenings for bible study. This type of gathering has been a tradition until the covid-19 pandemic
came into play. In following the state's rules and regulations on how to conform to the pandemic
guidelines, the church had to close until the pandemic was under control. This act affected the
members who have always taken church gatherings to socialize and entertainment; they found
themselves staying at home alone without anybody visiting or interacting with them.
The church pastor indicated that the closure has led to many senior members becoming
lonely and depressed and that some have thoughts of ending their lives. Currently, there are no
interventions to address the issue. The suggested interventions include virtual visitations through
video calls, periodic phone calls, prayer time by phone, getting involved in exercises, and eating
a balanced diet. Sepulveda-Loyola (2020) states that social distancing measure set to prevent the
spread of the COVID-19 pandemic affects the seniors, as many places where activities for the
seniors were held have closed and that older adults are having restrictions on how family

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members can visit them. Therefore, this has led to decreased social interaction that could cause
an adverse effect on mental and physical health in older people.
PICOT question
Therefore, this inquiry has led to the PICOT question, among seniors 65 or older who are
lonely due to social isolation caused by avoiding contracting COVID-19 and not socially
interacting with other church members in worship centers, does the online educational
intervention on how to use the information and communications technologies (ICT) to
communicate with fellow church members, family, and friends reduce the risk of loneliness?

Evidence Synthesis:
The search strategy and narrative literature review
To answer the PICOT question, three electronic databases: CINAHL, PsycINFO, and
PubMed, were systematically searched using a single approach for quantitative and qualitative
studies published in English between 2016 and 2021 on the efficacy of ICT-mediated social
isolation approaches for older adults. The results of the established studies were interpreted using
narrative synthesis. Suicide risk factors for adults, treatments for seniors with isolation, and
obstacles to adopting interventions for seniors with depression, loneliness, suicidal thinking, or
attempt were among the keywords used in the database searches.
PsychINFO Search Strategy
In PyschINFO's initial search, the phrases "barriers to ICT," "implementation of ICT," and
"loneliness Referral Rates" were used. The following electronic search technique has been used
for papers published in the PsychINFO database since 2016: (Isolation's impact) [All Fields] OR
(Isolation Prevention) [All Fields] OR (Loneliness Interventions) [All Fields] OR (Loneliness

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Referral Rates) [All Fields] AND (ICT Barriers) [All Fields]. A total of 72 observations were
found. Other filters, such as English language, peer-reviewed, qualitative, systematic study, and
meta-analysis, were used to reduce articles to 12.
PubMed Search Strategy
The keywords used in the PubMed database search were risk factors for depression and
suicide, prevention of depression in the seniors, and prevention of loneliness and depression in
the seniors. An electronic search strategy for published studies in the PubMed database since
2016 is as follows: (senior isolation) AND (risk of suicide) OR (isolation) [Includes all fields]
For the search, there were 82 results. Additional filters such as English language, meta-analysis,
qualitative, systematic review, and peer-reviewed articles limited the search to 12 results.
CINAHL Search Strategy
The original CINAHL search included key terms like suicide prevention, systematic
analysis, and suicide intervention education. [All Fields] (elderly) OR (senior) AND [All Fields]
(elderly) OR (senior) AND [All Fields] (Elderly) OR (senior) AND [All Fields] (Elderly) OR
(senior) AND [All Fields] (El (suicide risk assessment). Publication dates from 2016 to 2021,
English language, and peer-reviewed journal publication filters were used to narrow down the
findings. This yielded a total of 15 results. The search terms risk factors of loneliness, and daily
exercise were also added, reducing the number of publications on the subject to seven.
A grey literature review was conducted using a combination of search terms and meanings
extracted from a Google Scholar search of electronic reference databases to look for unpublished
research. The top 30 results were reviewed for articles that met the inclusion criteria. The
websites of the Centers for Disease Control and Prevention (CDC) were also searched and
reviewed. The findings of peer-reviewed publications published in English with people aged 65

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and up from 2016 to 2021 were also included and this yielded a total of 11 results seven with
LOE= 1 while the rest were LOE =II
Critical Appraisal and Synthesis
Melnyk and Fineout-Overholt's (2019) rapid critical appraisal was used to evaluate the
quality and strength of the ten articles selected for this literature review. All ten studies presented
high-level evidence and were carried out in an outpatient setting. The systematic review
conducted by Chen & Schulz (2016) included twenty-five publications studied in an outpatient
setting. Four of the studies were deemed to be analyzed thoroughly. Most research looked at
individual dimensions of ICT rather than social isolation to determine its efficacy.
ICT use has been shown to consistently impact social support and positive relationships
with social isolation in people in a positive way. Four of the ten articles reported their funding
source, and two possible bias was recognized in the studies. All the ten studies had an adequate
sample size, and the number of articles was more significant than or equal to ten in their
systematic reviews. The literature review included an intercontinental sampling with all ten
studies originating globally. Age and social isolation were listed as risk factors for loneliness in
all ten studies. One of the ten studies identified the female gender as a risk factor for loneliness.
This inconsistency in whether the female gender is a risk factor may be due to an interaction
between sex and age. Only one of the ten studies conducted in a systematic literature search
proved that physical exercise could improve outcomes for social isolation and promote the
seniors' well-being.
Most of the interventions across the studies included recognizing social isolation as a risk
factor for depression, anxiety, and suicide. Measurement tools and intervention designs were
heterogeneous across all ten studies. However, ICT has shown to be a valuable tool for

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addressing social isolation amongst the elderly. Thus, leading to decreased rates of depression,
anxiety, and suicide. Also, 8 of 10 studies were helpful to the PICOT since similar concepts were
discussed during educating the elderly on the risk factors for depression and how to increase the
implementation rate of ICT, thereby decreasing mortality and morbidity associated with social
isolation. Strong reliability and validity can be assumed for all the ten studies due to the priori
research designs, comprehensive search of electronic databases, duplicate study selection, quality
assessment of measurement tools, methodology, and statistically significant results.

Theoretical Framework & Implementation Framework:
Theoretical Framework
The Chronic Care Model (CCM) was selected as the project's conceptual structure. Even
though loneliness has no physical symptoms and is diagnosed solely based on the patient's
history and mental status assessment, recent research has shown that therapies can successfully
treat loneliness in people. As a result, it is fair to think of loneliness as a condition that
necessitates long-term treatment or intervention. Given the persistent nature of loneliness and its
high medical and psychological comorbidity, it is critical to have ongoing treatment that includes
screening, early intervention, support, and supervision.
When coping with chronic disease treatment, the CCM model of care can be beneficial
by providing proactive, patient-centered, multidisciplinary care, community resource use, and
evidence-based approaches to structurally improve the way people with chronic illnesses and
loneliness are cared for, as well as encouraging healthcare providers and patients to participate in
their care. The six main elements that interact to facilitate quality treatment for patients with
chronic disease are included within this model. A health system or community groups,

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association, clinical data analytics, decision support, execution system design, self-management
support, and patient care are only a few services available in six components. Patient protection,
cultural competency, care planning, regional policy, and case management are other topics
covered in the current CCM (Grover & Joshi, 2014). Through offering tools for collaboration
and integration of treatment for patients with loneliness, CCM will ensure a multidisciplinary
and team-based approach. The CCM tends to be a valuable method for achieving evidence-based
therapy for loneliness with the same care team and how other chronic diseases are managed.
Implementation Framework
The project's implementation was likewise guided by the Iowa model. The Iowa Model
assists nurses in utilizing research findings to improve patient care, identifying concerns through
research, developing solutions, and implementing Evidence-Based Practice (EBP) adjustments to
promote health care excellence. An evidence-based paradigm, according to a recent study by
Moullin et al. (2017), increases the depth and breadth of application, produces aligned measures,
and broadens user networks.
Implementing evidence-based practice (EBP) adjustments is a necessary but difficult
stage in the EBP approach. The Iowa Model guided the project through the steps of identifying a
clinical issue, studying literature, evaluating evidence, analyzing, and addressing the existing
problem, and reviewing results using EBP. The model was appropriate for the project because it
enhanced people's happiness. The project site also decided to use EBP to solve problems and
make changes in their organization.
Methods:
Ethical considerations and human subject protection

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The Institutional Review Board (IRB) approval was obtained through the Arizona State
University on October 30, 2022. All willing participants enrolled to participate in the study for 46 weeks if they matched the eligibility requirements. Participants had no foreseeable risks to
participating in the study other than completing the education and discomfort from learning how
to use modern technology. After obtaining consent the participants received a conference call
invitation and the student provided two Zoom presentation sessions, each lasting one hour on
ICT. Thereafter the data collection process started using the UCLA Loneliness Scale screening
tool as a first-line loneliness screening tool. Those individuals with potential loneliness were
asked to complete pre-and post-intervention survey questionnaires to measure their level of
loneliness.
Participants completed and returned the survey within seven days of receiving it.
Students obtained permission from Dr. D. Russell, the author of loneliness scale to use it as a
tool for pre-and post-intervention surveys instruments to run statistics and validate the results.
The outcome measurement was based on a statistical significance comparison of pre-and postintervention on those who showed loneliness symptoms. The collected documents, such as
recruitment papers, signed consent forms, pre, and post-intervention questionnaires, and
participant replies, were filed and labeled separately.
The data obtained was saved on a Dropbox server, with just the student and the student's
mentor having access connection to the data. To identify participants, an identity code was
established and used on all questions. Participants created their IDs by combining their birth year
and the last four digits of their phone number. The data was preserved in a lockable filing cabinet
folder then will be destroyed in May 2022 after the project was completed.
Description of population and setting

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The project took place in a church in southwestern of the United States. Many of the
church's core beliefs are of Early Christianity, including acknowledging the Bible's authority,
confessing the human sin of the need for redemption, and confidence in Christ's atoning work.
The broader church, Congregation, congregant families, community, staff, staff families,
volunteers, volunteer families, ministries, and outreach recipients were all church stakeholders
that benefited from the project.
The expected impact of the project and the relationship to the system
When applied to the project site, data collection partnerships between the seniors and the
church were crucial, and individuals who required intervention were addressed individually. The
collection of data necessitated the assistance of church staff's involvement in all stages of the
project to ensure the completion promptly. After collecting all the essential data, the student
performed data analysis. Data on barriers to ICT implementation, including the resources
required and how barriers differ depending on the environment, was also collected.
Identify the body of knowledge that will be impacted by this project
This organization was working on researching, developing, and implementing sustainable
health intervention programs for their community and the members of the church to address the
issue. In collaboration with the community, the organization planned to implement and evaluate
Information and Communications Technology (ICT) at their facility. The project aimed to equip
church staff, and direct support professionals with the knowledge and resources to confidently
deliver inclusive health education and interventions to prevent social isolation to socially
isolated, lonely, and depressed people.
Instrumentation, data collection, and data analysis plan

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People consented to participate in the study for an approximate time of 4-6weeks once
they matched the eligibility requirements. After potential participants accepted the invitation, a
consent form was issued to them along with a request for a phone conversation to discuss the
project and go through the permission form to ensure they understood the objective of the
research and what was expected of them. The phone conversation also allowed the student and
participants to review the consent form and address any questions or concerns. What was
expected of the participants was explained. The student provided pre-intervention surveys to
participants to measure ICT knowledge and attitudes. Pre-intervention questionnaires took 15
minutes to complete. Participants returned the survey within 7 days of receipt. The student sent
an invite to two Zoom sessions, each lasting one hour. The first session covered how to use
Zoom. And in the second session, covered how to use Skype and WhatsApp. All was in
PowerPoint form. Participants who could not join the Zoom meeting were provided a recording
of the meeting. Participants who received the recorded presentation were contacted to see if they
watched it. Those participants received a follow-up email after a week after receiving the
recorded presentation. The student then conducted a post-intervention survey one week later to
measure participants' knowledge and attitudes towards social isolation and loneliness
management. The student also collected subjective data about their educational experience. Postintervention questionnaires took about 15 minutes to complete.
Budget and any funding received
The following items budgeted for this project: Designing and printing informed consent
forms, information on social information, and depression scales; Flash drive to store participants
private information and all documentation related to the research was stored in a secured locked
cabinet; A Projector for PowerPoint presentation on how the screening, brief intervention,

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referral, and treatment tools were used; Gas purchase to drive to and from the project site; Pens
were provided for participants to complete the depression assessment scales and Intellectus
software was used to run the data analysis and statistician was hired to help in data review. No
funding from the outside source was received, personal funding was used for the project.

Results:
Five seniors participated in the project. All participants were 65 years or older. The
PICOT question was tested using a paired Wilcoxon signed rank test to compare the participants’
responses on the Revised UCLA Loneliness Scale prior to and after the educational intervention.
The results shown in Table 1 indicate that there were significant reductions in reported loneliness
from before to after the intervention (z = -2.02, p = 0.043). These results are further illustrated in
Figure 1.
Comparison of pre- versus post-intervention Loneliness Scale scores
Loneliness Score
Pre-intervention
Post-intervention
Paired Differences
95% CI of the Difference
•
•

Mean
43.80
33.60
-10.20
-13.16 to -7.24

SD
6.94
5.18
2.39

z*
-2.02

p
0.043

* z = standardized Wilcoxon signed rank test
* p = 0.043 which indicated statistically significant.

43.8
45
40

33.6

35
30
25
20
15
10
5
0
Pre-Intervention

Post-Intervention

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Outcomes:
Seniors’ mental and physical well-being benefitted from education on loneliness and ICT
strategies and loneliness in seniors were reduced by adopting ICTs in clinical and social settings
where people are likely to feel lonely. The project intervention was sustained by facility adoption
of quarterly reminders on how to use ZOOM and WhatsApp via the already prepared PowerPoint
presentation.
Discussion:
The sample size of five participants, convenience sampling, singular site location, no
variation, and limited to a specific population are all limitations of this study. As a result, the
results may not apply to other situations. Despite these shortcomings, the study points to
important research directions for the future, including evaluating the impact of educating elders
on loneliness and the effects of ICT interventions in reducing loneliness using larger sample
sizes from multiple locations with diverse populations.
The study results back up previous studies by Talmage et al. (2021), who found in their
research that ICT use decreases loneliness and social disconnectedness in older adults. And
Casanova et al. (2021) indicated that the analysis of the studies they reviewed confirms the

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existence of a beneficial effect of ICT use on the well-being of older people in terms of reduced
loneliness.
In conclusion, this project has demonstrated the efficacy of educational initiatives in
enhancing seniors mental and physical well-being in this project. Educating seniors about
loneliness and adopting ICTs have shown to be effective in reducing loneliness. The literature
review has also demonstrated that ICT education reduces loneliness. And this project adds to the
evidence for making this a part of care for those with loneliness.

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health and wellbeing of interventions that foster respect and social inclusion in
community-residing older adults? A systematic review of quantitative and qualitative
studies. Systematic reviews, 7(1), 26. https://doi.org/10.1186/s13643-018-0680-2
Vetrovsky, T., Frybova, T., Gant, I., Semerad, M., Cimler, R., Bunc, V., Siranec, M., Miklikova,
M., Vesely, J., Griva, M., Precek, J., Pelouch, R., Parenica, J., & Belohlavek, J. (2020).
The detrimental effect of COVID‐19 nationwide quarantine on accelerometer‐assessed
physical activity of heart failure patients. ESC Heart Failure, 7(5), 2093–2097.
https://doi.org/10.1002/ehf2.12916
Wand, A., Zhong, B., Chiu, H., Draper, B., & De Leo, D. (2020). COVID-19: The implications
for suicide in older adults. International Psychogeriatrics, 32(10), 1225–1226.
https://doi.org/10.1017/S1041610220000770
Weaver, R., Jackson, A., Lanigan, J., Power, T., Anderson, A., Cox, A., Eddy, L., Parker, L.,
Sano, Y., & Weybright, E. (2021). Health behaviors at the onset of the covid-19
pandemic. American Journal of Health Behavior, 45(1), 44–61.
https://doi.org/10.5993/AJHB.45.1.4

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS

22

Williams, C., Townson, A. T., Kapur, M., Ferreira, A. F., Nunn, R., Galante, J., Phillips, V.,
Gentry, S., & Usher-Smith, J. A. (2021). Interventions to reduce social isolation and
loneliness during COVID-19 physical distancing measures: A rapid systematic
review. PloS one, 16(2), e0247139. https://doi.org/10.1371/journal.pone.0247139
Yetmar, Z., Issa, M., Munawar, S., Burton, M., Pureza, V., Sohail, M., & Mehmood, T. (2020).
Inpatient care of patients with COVID-19: A guide for hospitalists. The American
Journal of Medicine, 133(9), 1019–1024. https://doi.org/10.1016/j.amjmed

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS

23

Appendix A
Table 1
Budget

Phase
Preparation

Activities
Design and print
assessment tools and
handouts
Creating a PowerPoint
presentation, the church
staff on how to assess for
depression and how to
apply Information and
communications
technology intervention
(ICT) for those isolated
and depressed
1 flash drive 16 GB

Quantity
needed

Cost per item

50

$0.50

1

$0.00
(Self)

1

$14.99

Subtotal

$25.00

$0.00

$14.99

Pencils
6 boxes
of 12
each

Delivery

Delivery

Gas for travel to and from
the project site.
Hall for Information and
communications
technology intervention
(ICT) implementation
training
Drinks and snacks
Lunch (30 people)
Projector for PowerPoint
presentation

Evaluation

Time spent to email call 50
church members
reminding them to
complete surveys post

15gallons

3 days

$0.80
(Per box)
$3.25

$4.80

$48.75

3 days

$0.00
(Church
will
provide)
$30.00

$90.00

3 days

$15.00

$1350.00

$0.00
(Church
will
provide)

$0.00

3 days

$30

$0.00

$180.00

Total

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS

24

Appendix B
Table 1
Quantitative Studies Evaluation Table
Citation

Theory/
Conceptual
Framework

Author: Chen &
Schulz

Inferred to be
the CognitiveBehavioral
Frame of
Reference

Year: 2016
Title:
The Effect of
Information
Communication
Technology
Interventions on
Reducing Social
Isolation in the
Elderly: A
Systematic
Review.
Countries: The
reviewed studies
were conducted
in Austria,

Design/
Method

Design:
Systematic
review of
literature.
Purpose: The
objective of the
systematic
review was to
gain a synthesis
of the evident
effects of ICT
interventions on
social isolation
in the seniors.

Sample/
Setting

N= 424 records
identified from
database search.
235 abstracts
assess for
eligibility.
Final sample n= 25
articles included in
quantitative
synthesis.
Demographics:
Studies of humans
aged 55years of
age or older.
Setting: Articles
were accessed from
PsycINFO,
PubMed,
MEDLINE,

Major
Variables &
Definitions

IV1: Age
IV2: Gender
IV3: Nationality
DV1: The effect
of ICT on social
isolation.
DV2: The
impact of ICT on
social support
DV3: The
impact of ICT on
social
connectedness

Measurement/
Instrumentati
on

Data
Analysis

Findings/
Results

Tools used to
Measure
variables: Two
independent
researchers
screened abstracts
and titles for
eligibility. If the
information
provided by a title
or abstract was
insufficient for
determination, the
full paper was
screened by two
researchers who
documented the
reasons leading to
the exclusion of
full texts.

Statistical Tests
used to analyze
data.

IV1: ICT
studies show
decreases social
isolation.

LOE:

IV2: ICT
increases social
support.

The
comprehensive
search strategy
and the
inclusion of
studies of all
designs
increased the
likelihood of
including all
relevant studies
in the field.

(ANOVA,
Fisher Exact,
Chi Sq):
I-squared
statistic-Data
coding and
quality appraisal
were conducted
by the first
author and a
research
assistant,
reaching an
intercoder
reliability of .91.
Any
inconsistencies

IV3: ICT
increases social
connectedness
ICT was found
to alleviate the
seniors’ social
isolation
through four
mechanisms:
connecting to
the outside
world, gaining
social support,
engaging in

Level/Qualit
y of
Evidence;
Decision for
practice/
application
to practice.
Level 1
Strengths:

Weakness:
The
heterogeneity of
studies included

Key: CI-Confidence Interval; ICT- Information and Communication Technology; IV-Independent Variable; DV-Dependent Variable; LOE-Level of Evidence; RCTs- Random
Control Trials N=number of studies; n- number of participants; NOS: Newcastle-Ottawa Scale; GRADE (Grades of Recommendation; ES-effect sizes; DAS=Depression, Anxiety
and Stress; SCORARE GA= Assessment tools for geriatric population; HADS=Hospital Anxiety and Depression Scale; HAI=Health Anxiety Inventory; EPHPP= Effective Public
Health Practice Project; SR=Systematic Review; UK-United Kingdom USA-United States of America; NG-Not Given; ↑=increased; ↓=Decreased; UAE= United Arab Emirates

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS
Canada, Finland,
Israel,
Netherlands,
New Zealand,
Norway,
Slovenia,
Sweden, Taiwan,
United Kingdom,
and United
States.

EBSCO, and SSCI
databases

The EPHPP tool
was used because
of its suitability
for assessing such
research with
various study
designs.

Inclusion criteria:
(1) publications
must be in English.
(2) studies must
empirically
investigate the
effects of ICTs on
one or more
attributes of social
isolation among the
seniors; and

Funding: No
funding
Bias: None

25
between the
reviewers were
discussed
between the 2
authors to
achieve
agreement.

activities of
interests, and
boosting selfconfidence.

Feasibility:

The criteria
proposed by
Salmon were used
to evaluate the
qualitative
research:
theoretical
framework, the
value of study,
data collection,
participant
description, data
analysis, and data
interpretations.

(3) study
participants must
be aged 55 years or
older.
Exclusion criteria:
Any study that did
not meet the
inclusion criteria.

in the review
limits the
comparability
and
generalizability
of the study
results.

Results of such
research can
facilitate
innovative and
effective
practice of ICTbased social
isolation
interventions
for senior
people.

Attrition: None
Author:
Hidalgo et al,
Date: 2020
Title:
The
Psychological
Consequences of

Conceptual/
Theoretical
framework:
Grounded
Theory

Design/Method.
Mixed research
methodologycombining
qualitative
and quantitative
methods to
approach
complex

Sample
N=167
n=40
Demographic:
adult population
(18 years or over)
Setting:
Inclusion criteria:

IV1: Gender
IV2: Age
IV1: Social
Economic
DV1:
General

Instruments
used:
Questionnaires
and online
surveys.

Statistics used:
Percentages of
change and Chisquare statistical
tests

Findings/Resul
ts:
Showed
relevantly
changes in
attitudes and
mood swings
compared to the
period prior to

LOE: II
Strengths:
It allows for
people’s
experiences to
be transferred to
the panel
survey.

Key: CI-Confidence Interval; ICT- Information and Communication Technology; IV-Independent Variable; DV-Dependent Variable; LOE-Level of Evidence; RCTs- Random
Control Trials N=number of studies; n- number of participants; NOS: Newcastle-Ottawa Scale; GRADE (Grades of Recommendation; ES-effect sizes; DAS=Depression, Anxiety
and Stress; SCORARE GA= Assessment tools for geriatric population; HADS=Hospital Anxiety and Depression Scale; HAI=Health Anxiety Inventory; EPHPP= Effective Public
Health Practice Project; SR=Systematic Review; UK-United Kingdom USA-United States of America; NG-Not Given; ↑=increased; ↓=Decreased; UAE= United Arab Emirates

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS
COVID-19 and
Lockdown in the
Spanish
Population: An
Exploratory
Sequential
Design
Funding:
No external
funding.
Conflicts/bias:
No bias reported
Country: Spain

phenomena
Purpose of the
study:
To analyze the
psychological
impact of the
COVID-19
pandemic and of
lockdown in the
Spanish
population and to
identify what
population
profiles were
most affected.

Exclusion
Criteria:
Because the quota
for the autonomous
community has
already been met,
because they
accessed the survey
after the deadline
and due to surveys
being incomplete.
Attrition:
Not reported

psychological
distress
DV2:
Difficulty
concentrating
DV3 Panic
attacks

26
lockdown.
Report: %
ES: Not known
CI: Not known
p-value: <
0.001

Furthermore,
the data come
from a large
sample
collected with
international
quality criteria
to be
representative
of the Spanish
population.
Weaknesses:
Does not allow
for establishing
causal or
predictive
relationships
based on the
data found and
the data
collection
procedure was
based on
subjective selfreported
measures based
on subjects’
assessment of
their own
condition
Feasibility:
The findings of
the study may
serve as a basis
for detecting
needs and
providing
psychological

Key: CI-Confidence Interval; ICT- Information and Communication Technology; IV-Independent Variable; DV-Dependent Variable; LOE-Level of Evidence; RCTs- Random
Control Trials N=number of studies; n- number of participants; NOS: Newcastle-Ottawa Scale; GRADE (Grades of Recommendation; ES-effect sizes; DAS=Depression, Anxiety
and Stress; SCORARE GA= Assessment tools for geriatric population; HADS=Hospital Anxiety and Depression Scale; HAI=Health Anxiety Inventory; EPHPP= Effective Public
Health Practice Project; SR=Systematic Review; UK-United Kingdom USA-United States of America; NG-Not Given; ↑=increased; ↓=Decreased; UAE= United Arab Emirates

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS

Author: Kelly et
al.
Date: 2017
Title:
The impact of
social activities,
social
networks, social
support and
social
relationships on
the cognitive
functioning
of healthy older
adults: a
systematic
review
Funding:
No funding
Conflicts/bias:
High Risk of
Bias
Country:
Ireland

Conceptual/
Theoretical
framework:
Inferred
Health
Promotion

Design/Method.
Systematic
Reviews and
Meta-Analysis
Purpose of the
study:
The impact of
social activities,
social networks,
and social
support on the
cognitive
functioning of
healthy older
adults (50+) and
examine the
differential
effects of aspects
of social
relationships on
various cognitive
domains.

Sample
N=17959
n=107
Description:
Healthy older
adults 50yrs and up

IV1:
Social activities
IV2:
Social Networks
IV1:
Social support
DV1:
Cognitive
functioning
DV2: Reasoning
DV3:
Attention

27

Instruments
used:
The STROBE
assessment tool
was used to assess
the quality of
reporting in
cohort studies

Statistics used:
literature reviews
were used to
provide a
comprehensive
overview of
research on
social
relationships and
cognitive
function in older
adults.

Findings/Resul
ts
The results
support prior
conclusions that
there is an
association
between social
relationships
and cognitive
function, but
the exact nature
of this
association
remains
unclear.
Report: %
Not Provided
ES:
Not Provided
CI:
Not Provided
p value:
Not Provided

support, as the
symptoms
detected as the
most common
are key for the
processes of
screening atrisk individuals.
LOE: I
Strengths:
It set up a
foundation for
future research
to consider the
impact of
technology,
internet and
social media on
social
relationships,
particularly
feelings of
social support.
Weaknesses:
It was difficult
to identify
RCTs that
included social
relationships as
either
intervention or
active control
components and
Loneliness was
not considered
in the current
review. While
previous meta-

Key: CI-Confidence Interval; ICT- Information and Communication Technology; IV-Independent Variable; DV-Dependent Variable; LOE-Level of Evidence; RCTs- Random
Control Trials N=number of studies; n- number of participants; NOS: Newcastle-Ottawa Scale; GRADE (Grades of Recommendation; ES-effect sizes; DAS=Depression, Anxiety
and Stress; SCORARE GA= Assessment tools for geriatric population; HADS=Hospital Anxiety and Depression Scale; HAI=Health Anxiety Inventory; EPHPP= Effective Public
Health Practice Project; SR=Systematic Review; UK-United Kingdom USA-United States of America; NG-Not Given; ↑=increased; ↓=Decreased; UAE= United Arab Emirates

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS

28
analyses and
reviews have
investigated
loneliness and
social isolation
together

Author:
Malcolm et al.
Year: 2019
Title:
Loneliness and
social isolation
causal
association with

Inferred to be
a discursive
Theoretical.
approach

Design:
Systematic
Reviews

Demographics:
Older adult aged 50
and older.

IV1:
Seniors

Purpose:

Setting:
Collections
electronic studies
relevant to the

IV2:

Tools used to
Measure
variables:
Bradford-Hill
criteria and
Newcastle-Ottawa
Scale

Statistical Tests
used to analyze
data:
narrative
synthesis

IV1: lower
physical
activity
IV2: alcohol
misuse

Feasibility:
The study
shows us that
loneliness is
often
experienced as
a psychological
phenomenon
which is not
entirely
contingent on
social
engagement but
instead at
least partly
attributable to
factors such as
maladaptive
social
cognitions [96]
and feelings of
physical
security
LOE: Level I
Strengths:
Clear
definitions and
inclusion
criteria,
transparent
systematic
approach to

Social Isolation
To assess the
IV3:) Smoking
extent and causal
IV3:
Loneliness
nature of
Findings/Resul
associations
Key: CI-Confidence Interval; ICT- Information and Communication Technology; IV-Independent Variable; DV-Dependent Variable; LOE-Level of Evidence; RCTs- Random
Control Trials N=number of studies; n- number of participants; NOS: Newcastle-Ottawa Scale; GRADE (Grades of Recommendation; ES-effect sizes; DAS=Depression, Anxiety
and Stress; SCORARE GA= Assessment tools for geriatric population; HADS=Hospital Anxiety and Depression Scale; HAI=Health Anxiety Inventory; EPHPP= Effective Public
Health Practice Project; SR=Systematic Review; UK-United Kingdom USA-United States of America; NG-Not Given; ↑=increased; ↓=Decreased; UAE= United Arab Emirates

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS
health-related
lifestyle risk in
older adults: a
systematic
review and metaanalysis protocol
Country: United
Kingdom
Funding:
The study was
funded as part of
principal
author’s
doctorate
research study
by University of
Stirling.
Bias: Not
Known
.

between
loneliness/social
isolation
and healthrelated behaviors
among older
adults.

publication.
Inclusion criteria:
any interventional
or observational
study that
quantitatively
assesses the
associations of
loneliness/social
isolation and
selected healthrelated behaviors
and the evidence of
causation
Exclusion criteria:
Any interventional
or observational
study that
quantitatively
assesses the
associations of
loneliness/social
isolation and
selected healthrelated behaviors
and the evidence of
causation and nonEnglish language
studies. Also,
studies that do not
test for empirical
associations
between loneliness
or social isolation
and the specified
health-related

29
ts
Sociodemographic
trends fueling
loneliness and
social isolation
among older
adults to
the extent it has
become an
acknowledged
public health
challenge.

searching,
screening,
assessing and
extracting
which utilizes
standardized
forms and
independent
review
wherever
possible.
Weakness:
Lacked
statistical
information of
the significance
of the study.
Feasibility:
It helps in
understanding
the association
and causal
pathways
between
loneliness/socia
l isolation and
ill-health will
be important for
developing
interventions
and strategies to
combat
loneliness and
social isolation
with 95%
confidence

Key: CI-Confidence Interval; ICT- Information and Communication Technology; IV-Independent Variable; DV-Dependent Variable; LOE-Level of Evidence; RCTs- Random
Control Trials N=number of studies; n- number of participants; NOS: Newcastle-Ottawa Scale; GRADE (Grades of Recommendation; ES-effect sizes; DAS=Depression, Anxiety
and Stress; SCORARE GA= Assessment tools for geriatric population; HADS=Hospital Anxiety and Depression Scale; HAI=Health Anxiety Inventory; EPHPP= Effective Public
Health Practice Project; SR=Systematic Review; UK-United Kingdom USA-United States of America; NG-Not Given; ↑=increased; ↓=Decreased; UAE= United Arab Emirates

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS

30

lifestyle behaviors
will be excluded.

Author:
Noone et al.,
Year: 2020
Title:
Video calls for
reducing social
isolation and
loneliness in
older people: a
rapid review
Country:
Taiwan
Funding:
Not Known
Bias:
not enough data
to assess
reporting biases.

Inferred to the
Social
Engagement
and
Attachment
Theory

Design:
Randomized
controlled trials
(RCTs) and
quasi‐RCTs
Purpose:
to assess the
effectiveness of
video calls for
reducing social
isolation and
loneliness in
older adults and
to address the
effectiveness of
video calls on
reducing
symptoms of
depression and
improving
quality of life.

Attrition: not
specified
Demographics:
Older Adults over
the age of 65
years.
N=201
Participants.
Setting:
Comparison
between studies
conducted in
nursing homes and
studies conducted
in home
settings.
Inclusion criteria:
Mean age of at
least 65 years
whether they were
experiencing
symptoms of
loneliness or social
isolation.
Exclusion criteria:
Articles in
non‐English
languages, studies
where the mean
age of the
participants was
under the age of 65

intervals (CIs).

IV1:
Loneliness
IV2:
Social Isolation

Tools used to
Measure
variables:
UCLA Loneliness
Scale and
Geriatric
Depression Scale

Statistical Tests
used to analyze
data:
Chi-Squared test
for
heterogeneity

IV1:
Symptoms
of depression
(95% CI −0.90
to 1.72)
IV2: Quality of
life emotional
role (MD −7.18,
95% CI −16.23
to 1.87)
IV3: Quality of
life emotional
role mental
health (MD
9.19, 95% CI
0.36 to 18.02)
Findings/Resul
ts
Videoconferenc
ing
interventions
compared with
usual care for
reducing
loneliness

LOE: Level 1
Strengths:
Set foundation
for future
studies in the
investigation of
the
effectiveness of
video calls for
reducing social
isolation and
loneliness in
older adults.
Weakness:
The study
lacked precision
and was very
indirect. Also,
the study had
high possibility
of publication
bias
Feasibility:
The study is
truly relevant as
it focuses in
finding
solutions to

Key: CI-Confidence Interval; ICT- Information and Communication Technology; IV-Independent Variable; DV-Dependent Variable; LOE-Level of Evidence; RCTs- Random
Control Trials N=number of studies; n- number of participants; NOS: Newcastle-Ottawa Scale; GRADE (Grades of Recommendation; ES-effect sizes; DAS=Depression, Anxiety
and Stress; SCORARE GA= Assessment tools for geriatric population; HADS=Hospital Anxiety and Depression Scale; HAI=Health Anxiety Inventory; EPHPP= Effective Public
Health Practice Project; SR=Systematic Review; UK-United Kingdom USA-United States of America; NG-Not Given; ↑=increased; ↓=Decreased; UAE= United Arab Emirates

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS

31

years, studies that
included
participants with
major
neurocognitive
disorders, or sight
and hearing
impairments.
interventions that
did not use video
calls or used video
calls to deliver
telemedicine.
Author: Omari
Date: 2020
Title:
Stress among
Youth at the
Time of COVID19: Online
Cross-Sectional
Multicountry
Study
Funding:
The Omani
Research
Council
Conflicts/bias:
Potential
selection
bias in terms of
recruiting.

Conceptual/
Theoretical
framework:
Inferred to the
linear
regression
model.

Design/Method:
A crosssectional,
descriptive
design
Purpose of the
study:
The purpose of
this study was to
explore the
prevalence of
DAS among
youth from six
Middle Eastern
countries and to
identify the
extent to which
some COVID19-related
variables could
predict DAS
among them.

Attrition: None
Sample
N= 1,057

reduce social
isolation and
loneliness in
older people

IV1: Age
IV2: Gender

Demographics
Middle and late
adolescence of age
15 to 24 years,
Setting:
WhatsApp and
Facebook were the
main social media
platforms used in
the study settings.
Inclusion criteria:
Those willing to
Participate, being
15 to 24 years old
at the time of the
study, ability to
read and type in
Arabic and residing
in one of the
countries included

IV1: Country
DV1:
Depression
DV2: Anxiety
DV3: Stress

Instruments
used:
Structured
Questionnaire,
Anxiety scale,
Stress scale.

Statistics used:
One-way
ANOVA and
independent
t-test

Findings/Resul
ts
The results
show that
COVID-19 is
an
epidemiological
crisis that is
casting a
shadow on
youths’ DAS.
The restrictions
and prolonged
lockdowns
imposed by
COVID-19 are
negatively
impacting their
level of DAS.
Report:
Statistical
power is 80%
ES:
Not provided

LOE: II
Strengths:
It set foundation
for future
studies and
recommends to
a larger sample
and include
youth who do
not have access
to the internet.
Weaknesses:
The sample
composition
restricts the
potential
generalisability
of the findings.
Feasibility:
It shows
Healthcare

Key: CI-Confidence Interval; ICT- Information and Communication Technology; IV-Independent Variable; DV-Dependent Variable; LOE-Level of Evidence; RCTs- Random
Control Trials N=number of studies; n- number of participants; NOS: Newcastle-Ottawa Scale; GRADE (Grades of Recommendation; ES-effect sizes; DAS=Depression, Anxiety
and Stress; SCORARE GA= Assessment tools for geriatric population; HADS=Hospital Anxiety and Depression Scale; HAI=Health Anxiety Inventory; EPHPP= Effective Public
Health Practice Project; SR=Systematic Review; UK-United Kingdom USA-United States of America; NG-Not Given; ↑=increased; ↓=Decreased; UAE= United Arab Emirates

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS
Country:
Oman
Jordan
Saudi Arabia
Iraq
Egypt
UAE

32

in the study at the
time of the survey.

CI:
Not Provided
p value=0.05

organizations,
in collaboration
with various
sectors, are
recommended
to apply
psychological
first aid and
design
appropriate
educational
programs to
improve the
mental health of
youth.

Findings/Resul
ts
Found that
women, and
individuals
living
in urban areas,
with a COVID+
patient among
friends or
relatives,
previously or
currently in
receipt of
psychiatric
treatment and
with at least one
accompanying
chronic disease,
were more
severely
affected.
Report: %
ES:

LOE: II

Exclusion
Criteria:
Explanatory
variables which
were not
significant were
excluded.
Attrition:
Not provided

Author:
Ozdin & Ozdin
Date: 2020
Title:
Levels and
predictors of
anxiety,
depression and
health anxiety
during
COVID-19
pandemic in
Turkish
society: The
importance of
gender
Funding:
No financial
support for the
research

Conceptual/
Theoretical
framework:
Inferred to the
Social
Engagement
and
Attachment
Theory

Design/Method.
Online
questionnaire
Purpose of the
study:
To investigate
the levels of
depression,
anxiety
and health
anxiety in
Turkish society
during the
COVID19 pandemics.

Sample
N= 343
Demographic:
Individuals aged
above 18
Setting:
Individuals living
in various
provinces
of Turkey.
Inclusion criteria:
Individuals with
Internet and able or
willing to use
smartphones or
email were
included in the
study.
Exclusion
Criteria:
Individuals without

IV1: age
IV2: gender
IV1: place of
residence
DV1:
Working after
pandemic
DV2: Living
with an
individual
aged above 65
DV3:
Friends or
relatives with
COVID

Instruments
used:
HADS and HAI

Statistics used:
Mann–Whitney
U-test and
Kolmogorov–
Smirnov test

Strengths:
The study
measured
the public
psychological
state during the
pandemic.
Weaknesses:
It is difficult to
draw any
conclusions
regarding its
long-term effect
Feasibility:
It suggests
priorities for
future
psychiatric
planning.

Key: CI-Confidence Interval; ICT- Information and Communication Technology; IV-Independent Variable; DV-Dependent Variable; LOE-Level of Evidence; RCTs- Random
Control Trials N=number of studies; n- number of participants; NOS: Newcastle-Ottawa Scale; GRADE (Grades of Recommendation; ES-effect sizes; DAS=Depression, Anxiety
and Stress; SCORARE GA= Assessment tools for geriatric population; HADS=Hospital Anxiety and Depression Scale; HAI=Health Anxiety Inventory; EPHPP= Effective Public
Health Practice Project; SR=Systematic Review; UK-United Kingdom USA-United States of America; NG-Not Given; ↑=increased; ↓=Decreased; UAE= United Arab Emirates

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS
Conflicts/bias:
Possibility of
selection bias
since the study
was performed
with an
online
questionnaire.

33

Internet and unable
or unwilling to use
smartphones or
email could not
be included in the
study.

Not Provided
CI: 95%
p value: < .05

Attrition:
Not Provided

Country:
Turkey
Author:
SepulvedaLoyola et al.
Date: 2020
Title:
To review the
impact of social
isolation during
COVID-19
pandemic on
mental and
physical health
of older people
and the
recommendation
s for patients,
caregivers, and
health
professionals

Conceptual/
Theoretical
framework:
Inferred to the
social signal
transduction
theory of
depression

Design/Method.
Narrative review
Purpose of the
study:
To review the
impact of social
isolation during
COVID-19
pandemic on
mental and
physical health
of older people
and the
recommendation
s for patients,
caregivers, and
health
professionals

Sample:
N=605
n=41
Demographic:
People over 65

IV1:
Age
IV2:
Social Isolation
IV3:
Depression

Setting:
Noninstitutionalized
community-living
people.

DV1:
Irritability
DV2:
Stress
DV3: Depression

Inclusion criteria:
Studies with people
sixty and older
were included.
Exclusion
Criteria: Studies
with people
younger than 65
were excluded.

Instruments
used:
SCORARE GA

Statistics used:
Summary data

Findings/Resul
ts
The study
reports
increased
anxiety,
depression,
poor sleep
quality and
physical
inactivity
during the
isolation period.
Report:
ES:
Not provided
CI:
Not Provided
p value:
Not Provided

LOE: II
Strengths:
It sets
foundation for
future
investigations
should in a
longitudinal or
cross-sectional
design in older
individuals,
with
larger sample
size and
different
outcomes
related to
mental and
physical health.

Weaknesses:
Studies
included in this
review were
Attrition:
cross-sectional
None reported
design
and not specific
Key: CI-Confidence Interval; ICT- Information and Communication Technology; IV-Independent Variable; DV-Dependent Variable; LOE-Level of Evidence; RCTs- Random
Control Trials N=number of studies; n- number of participants; NOS: Newcastle-Ottawa Scale; GRADE (Grades of Recommendation; ES-effect sizes; DAS=Depression, Anxiety
and Stress; SCORARE GA= Assessment tools for geriatric population; HADS=Hospital Anxiety and Depression Scale; HAI=Health Anxiety Inventory; EPHPP= Effective Public
Health Practice Project; SR=Systematic Review; UK-United Kingdom USA-United States of America; NG-Not Given; ↑=increased; ↓=Decreased; UAE= United Arab Emirates
Funding:
European
Regional
Development
Funds

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS

34

Conflicts/bias:
None Reported

in senior
population and
there is a lack
of evidence
regarding the
most
appropriate
psychological
and physical
recommendatio
ns and most of
the
interventions
suggested are
based on expert
opinions and
not on high
evidence
studies.

Country:
China, Italy,
Spain, Paraguay,
and France

Author: Taylor
Date: 2019
Title:

Conceptual/
Theoretical
framework:
The
Evolutionary

Design/Method:
Rotational
study design
Purpose of the
study:

Sample
N = 6962
Description:
Adults aged 50 and
above living in the

IV1:
Social isolation
(n = 367)

Instruments
used:

IV2: Gender

The Hughes
loneliness scale

Statistics used:
Multivariate
regression
model

Findings/Resul
ts
Report: %
Not Provided

Feasibility:
It provides
recommendatio
n that keeping
quarantine as
short as
possible, and
giving as much
information as
possible and
providing
adequate
supplies
reduces stress
LOE: III
Strengths:
It provides
results showing

Key: CI-Confidence Interval; ICT- Information and Communication Technology; IV-Independent Variable; DV-Dependent Variable; LOE-Level of Evidence; RCTs- Random
Control Trials N=number of studies; n- number of participants; NOS: Newcastle-Ottawa Scale; GRADE (Grades of Recommendation; ES-effect sizes; DAS=Depression, Anxiety
and Stress; SCORARE GA= Assessment tools for geriatric population; HADS=Hospital Anxiety and Depression Scale; HAI=Health Anxiety Inventory; EPHPP= Effective Public
Health Practice Project; SR=Systematic Review; UK-United Kingdom USA-United States of America; NG-Not Given; ↑=increased; ↓=Decreased; UAE= United Arab Emirates

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS
Social Isolation’s
Influence on
Loneliness
Among Older
Adults
Funding:
Provided by
National Institute
on Aging
Conflicts/bias:
Social
desirability
bias
Country:
USA

Theory of
Loneliness

To examine
social isolation’s
overall influence
on loneliness and
how specific
social isolation
indicators
influence
loneliness.

United States of
America
Setting: clinical
settings
Attrion

IV1: Race
DV1: Loneliness
(n = 231)
DV2:
Employment
status
DV3:
Education

35
ES: Not
Provided
CI:
Not Provided
p value:
Not Provided
The study
illustrates the
effects social
isolation has on
loneliness, and
showing these
conditions,
while often
correlated with
each other, are
unique
constructs.

that there is
high
prevalence rate
of both
loneliness (57%
had experienced
at least
moderate or
severe
loneliness) and
several types of
social isolation
(ranging from
19 to 39%)
throughout the
older adult
population.
Weaknesses:
The current
study is crosssectional;
therefore,
causality
between social
isolation and
loneliness
cannot be
assessed and
the
Evolutionary
Theory of
Loneliness
was not able to
determine how
social isolation
and loneliness
affect each
other over time.

Key: CI-Confidence Interval; ICT- Information and Communication Technology; IV-Independent Variable; DV-Dependent Variable; LOE-Level of Evidence; RCTs- Random
Control Trials N=number of studies; n- number of participants; NOS: Newcastle-Ottawa Scale; GRADE (Grades of Recommendation; ES-effect sizes; DAS=Depression, Anxiety
and Stress; SCORARE GA= Assessment tools for geriatric population; HADS=Hospital Anxiety and Depression Scale; HAI=Health Anxiety Inventory; EPHPP= Effective Public
Health Practice Project; SR=Systematic Review; UK-United Kingdom USA-United States of America; NG-Not Given; ↑=increased; ↓=Decreased; UAE= United Arab Emirates

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS

36
Feasibility:
It sets stage for
future studies to
utilize a
longitudinal
study design
which would
allow for
disentangling
temporal
precedence
between social
isolation and
loneliness.

Author:
Williams et al.

Conceptual/
Theoretical
framework:

Design/Method.
Systematic
reviews

Date: 2021
Title:
Interventions to
reduce social
isolation and
loneliness during
COVID-19
physical
distancing
measures: A
rapid systematic
review
Funding:
No funding
Conflicts/bias:
low risk of bias
Country:
United Kingdom

Inferred
Theories of
loneliness and
social
integration

Purpose of the
study:
To identify
effective
interventions to
reduce social
isolation and
loneliness that
are compatible
with COVID-19
shielding and
social distancing
measures.

Sample:
n-159
Description:
Participants
of any age in a
non-hospital setting
Setting:
Non-hospital
setting

IV1: Age
IV2: Gender
IV1: Race
DV1:
Social isolation
DV2:
Social isolation
DV3:
Social Support.

Instruments
used:
Downs and
Black tool for
Quality
assessment and
Questionnaires
when assessing
loneliness; and
Loneliness scale
and the De Jong
Gierveld
Loneliness scale;

Statistics used:
Narrative
synthesis of
evidence and
Morris’ 2008, Eq
8

Findings/Resul
ts
Report: %
Not Provided
ES: Not
Provided
CI:
Not Provided
p value:
Not Provided
The review
presents the
current
evidence for
interventions
targeting social
isolation or
loneliness that
may be
compatible with

LOE: 1
Strengths:
The use of
official March
2020 UK
government
guidance on
shielding. And
many
interventions
could also be
delivered
without
modification as
restrictions are
eased.
Weaknesses:
many studies
were found to
be of “Fair”
quality when
assessing risk of

Key: CI-Confidence Interval; ICT- Information and Communication Technology; IV-Independent Variable; DV-Dependent Variable; LOE-Level of Evidence; RCTs- Random
Control Trials N=number of studies; n- number of participants; NOS: Newcastle-Ottawa Scale; GRADE (Grades of Recommendation; ES-effect sizes; DAS=Depression, Anxiety
and Stress; SCORARE GA= Assessment tools for geriatric population; HADS=Hospital Anxiety and Depression Scale; HAI=Health Anxiety Inventory; EPHPP= Effective Public
Health Practice Project; SR=Systematic Review; UK-United Kingdom USA-United States of America; NG-Not Given; ↑=increased; ↓=Decreased; UAE= United Arab Emirates

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS

37
social
distancing
measures. Most
effective
interventions
for loneliness
either involved
cognitive or
educational
components, or
facilitated
communication,
and networking
between peers.

bias and the
extent to which
our findings can
be applied to
the
entire
population is
unclear.
Feasibility:
This review
presents the
current
evidence for
interventions
targeting social
isolation
or loneliness
that may be
compatible with
shielding/social
distancing
measures.

Key: CI-Confidence Interval; ICT- Information and Communication Technology; IV-Independent Variable; DV-Dependent Variable; LOE-Level of Evidence; RCTs- Random
Control Trials N=number of studies; n- number of participants; NOS: Newcastle-Ottawa Scale; GRADE (Grades of Recommendation; ES-effect sizes; DAS=Depression, Anxiety
and Stress; SCORARE GA= Assessment tools for geriatric population; HADS=Hospital Anxiety and Depression Scale; HAI=Health Anxiety Inventory; EPHPP= Effective Public
Health Practice Project; SR=Systematic Review; UK-United Kingdom USA-United States of America; NG-Not Given; ↑=increased; ↓=Decreased; UAE= United Arab Emirates

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS

38

Appendix C
Table 1
Synthesis Table
Author

Year
Design
LOE
CognitiveBehavioral
Frame of
Reference
Grounded
Theory
Theory of
Health
Promotion
Discursive
Theoretical.
approach
Social
Engagement and
Attachment
Theory

Chen
&
Schu
ltz.
2016
SR
I

Hida
lgo
et al.

Kelly et
al.

Malcol
m et al.

Noone
et al.

2020
SR
II

2017
SR
I

2019
SR
I

2020
SR
I

Omari

Ozdin
&
Ozdin

2020
2020
SR
SR
II
II
Theory/Conceptual
Framework

SepulvedaLoyola et al

Taylor

Williams et al.

2020
SR
I

2019
SR
III

2021
SR
I

X
x
X
X

X

x

Key: CI-Confidence Interval; ICT- Information and Communication Technology; IV-Independent Variable; DV-Dependent Variable; LOE-Level of Evidence; RCTs- Random
Control Trials N=number of studies; n- number of participants; NOS: Newcastle-Ottawa Scale; GRADE (Grades of Recommendation; ES-effect sizes; DAS=Depression, Anxiety
and Stress; SCORARE GA= Assessment tools for geriatric population; HADS=Hospital Anxiety and Depression Scale; HAI=Health Anxiety Inventory; EPHPP= Effective Public
Health Practice Project; SR=Systematic Review; UK-United Kingdom USA-United States of America; NG-Not Given; ↑=increased; ↓=Decreased; UAE= United Arab Emirates

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS
Linear
regression
model
The
Evolutionary
Theory of
Loneliness
Theory of
loneliness and
social
integration
Social signal
transduction
theory of
depression
Outpatient
SR of adults
only
Number of
studies included
in the SR

39

X

X

X

X

X
X

X
X

X
X

X
X

X
X

25

40

107

NG

201

Reliability of
Instruments

X

Austria
Canada
Finland
Israel
Netherlands
Norway
Slovenia

X
X
X
X
X
X
X

X

X

X

X

Study Characteristics
X
X
X
X
1057

343

Validity & Reliability
X
X

X
X

X
X

X
X

41

6962

159

X

X

X

Setting

Key: CI-Confidence Interval; ICT- Information and Communication Technology; IV-Independent Variable; DV-Dependent Variable; LOE-Level of Evidence; RCTs- Random
Control Trials N=number of studies; n- number of participants; NOS: Newcastle-Ottawa Scale; GRADE (Grades of Recommendation; ES-effect sizes; DAS=Depression, Anxiety
and Stress; SCORARE GA= Assessment tools for geriatric population; HADS=Hospital Anxiety and Depression Scale; HAI=Health Anxiety Inventory; EPHPP= Effective Public
Health Practice Project; SR=Systematic Review; UK-United Kingdom USA-United States of America; NG-Not Given; ↑=increased; ↓=Decreased; UAE= United Arab Emirates

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS
Sweden
Taiwan
United Kingdom
United States.
Spain
Ireland
UAE
Oman
Jordan
Saudi Arabia
Iraq
Egypt
Turkey
China
Italy
Paraguay
France

X
X
X
X

Any current or
previous anxiety
and depression
Social Isolation
Age greater than
18

X

X

X

X

X

X
X

X
X

X
X

X
X

X
X

40

X
X

X
X

X

X
X
X
X
X
X
X
X
X
X
X
X
X
Independent Variables
X
X
X
X

X
X

X

X

X

X
X

X
X

X
X

Dependent Variables
Effect of ICT on
Social Isolation
Effect of ICT on
Social Support

X
X

Key: CI-Confidence Interval; ICT- Information and Communication Technology; IV-Independent Variable; DV-Dependent Variable; LOE-Level of Evidence; RCTs- Random
Control Trials N=number of studies; n- number of participants; NOS: Newcastle-Ottawa Scale; GRADE (Grades of Recommendation; ES-effect sizes; DAS=Depression, Anxiety
and Stress; SCORARE GA= Assessment tools for geriatric population; HADS=Hospital Anxiety and Depression Scale; HAI=Health Anxiety Inventory; EPHPP= Effective Public
Health Practice Project; SR=Systematic Review; UK-United Kingdom USA-United States of America; NG-Not Given; ↑=increased; ↓=Decreased; UAE= United Arab Emirates

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS
General
Psychological
distress
Cognitive
Functioning
Depression &
Anxiety
Living with an
seniors person
Friends or
Relatives with
COVID-19
Irritability and
stress
Education
Loneliness
Social Support
Social Isolation

41

X
X
X
X
X
X
X
X
X
X
Findings

Communication
and networking
between peers
Anxiety,
depression, poor
sleep quality and
physical
inactivity during
the isolation
period.
Engagement in
↑
social activities
Social loneliness

↑

↓

↑

↓

Key: CI-Confidence Interval; ICT- Information and Communication Technology; IV-Independent Variable; DV-Dependent Variable; LOE-Level of Evidence; RCTs- Random
Control Trials N=number of studies; n- number of participants; NOS: Newcastle-Ottawa Scale; GRADE (Grades of Recommendation; ES-effect sizes; DAS=Depression, Anxiety
and Stress; SCORARE GA= Assessment tools for geriatric population; HADS=Hospital Anxiety and Depression Scale; HAI=Health Anxiety Inventory; EPHPP= Effective Public
Health Practice Project; SR=Systematic Review; UK-United Kingdom USA-United States of America; NG-Not Given; ↑=increased; ↓=Decreased; UAE= United Arab Emirates

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS
Impact of
COVID-19 on
DAS
Effect of
COVID-19 on
those with other
Chronic
Diseases
Attentional bias
Funding

42

↑

↑

↑

↑
X

X

X

X

Key: CI-Confidence Interval; ICT- Information and Communication Technology; IV-Independent Variable; DV-Dependent Variable; LOE-Level of Evidence; RCTs- Random
Control Trials N=number of studies; n- number of participants; NOS: Newcastle-Ottawa Scale; GRADE (Grades of Recommendation; ES-effect sizes; DAS=Depression, Anxiety
and Stress; SCORARE GA= Assessment tools for geriatric population; HADS=Hospital Anxiety and Depression Scale; HAI=Health Anxiety Inventory; EPHPP= Effective Public
Health Practice Project; SR=Systematic Review; UK-United Kingdom USA-United States of America; NG-Not Given; ↑=increased; ↓=Decreased; UAE= United Arab Emirates

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS

43

Appendix D
Models and Frameworks
Figure 1
The Chronic Care Model

Key: CI-Confidence Interval; ICT- Information and Communication Technology; IV-Independent Variable; DV-Dependent Variable; LOE-Level of Evidence; RCTs- Random
Control Trials N=number of studies; n- number of participants; NOS: Newcastle-Ottawa Scale; GRADE (Grades of Recommendation; ES-effect sizes; DAS=Depression, Anxiety
and Stress; SCORARE GA= Assessment tools for geriatric population; HADS=Hospital Anxiety and Depression Scale; HAI=Health Anxiety Inventory; EPHPP= Effective Public
Health Practice Project; SR=Systematic Review; UK-United Kingdom USA-United States of America; NG-Not Given; ↑=increased; ↓=Decreased; UAE= United Arab Emirates

COMMUNICATION IN WORSHIP CENTERS DURING PANDEMICS

44

Figure 2
Hubs and Spokes Model

 High intensity ICT-mediated social
isolation interventions: Telephone
befriending programs, computer, and
Internet, communication programs (using
landline phones, smartphones, iPads,
emailing, and online chat rooms or forums).
 If depression is worse, patient will be
receiving inpatient treatment.

 Maintenance ICT-mediated social isolation
interventions: Telephone befriending
programs, computer, and Internet,
communication programs (using landline
phones, smartphones, iPads, emailing, and
online chat rooms or forums).
 In community setting. Maintenance of
depression treatment by local providers

Department of Vermont Health (2021)

Key: CI-Confidence Interval; ICT- Information and Communication Technology; IV-Independent Variable; DV-Dependent Variable; LOE-Level of Evidence; RCTs- Random
Control Trials N=number of studies; n- number of participants; NOS: Newcastle-Ottawa Scale; GRADE (Grades of Recommendation; ES-effect sizes; DAS=Depression, Anxiety
and Stress; SCORARE GA= Assessment tools for geriatric population; HADS=Hospital Anxiety and Depression Scale; HAI=Health Anxiety Inventory; EPHPP= Effective Public
Health Practice Project; SR=Systematic Review; UK-United Kingdom USA-United States of America; NG-Not Given; ↑=increased; ↓=Decreased; UAE= United Arab Emirates