Professionals and volunteers observed changes in participants that they attributed to the intervention. The benefits were more intensive among those participants who adhered more, suggesting a dose–response effect.
3.2.1. Perceived Benefits on Social Support
Professionals and participants expressed that the program was especially successful at promoting mutual support. Living in the same area gave them a feeling of familiarity, and participants often met each other on the street, and sometimes walked back to their homes together.
According to participants, the group provided companionship, a feeling of social integration and sense of belonging to the group. The group was perceived as a space of attention, respect and affection to give and receive emotional support. When a participant suffered an injurious fall, was in low mood or had a new illness, support relationships could be observed.
Many participants were part of a group for the first time and for some participants, the group was the only place they had to socialize.
Participants discovered that peer relationships, as opposed to relationships within the family, provided a way of communicating shared worries and interests by sharing a similar age.
“We are the same age, you can talk about the same things… youth, depending on the topic… you talk but…, I don’t know, youth is very different. (…) For me, the company of one or the other is different. With the group companions there …, I don’t know, maybe it’s another freedom, another thing because since we all speak about the same thing, pretty much, about what happens to us and about what we do not have…” Participant 29, Woman, 78 years old, Zone B.
Participants identified others as a model to follow or, on the contrary, as a model to avoid, evoking positive changes.
Some participants became friends and started visiting and calling each other. While some people were previously aware of missing having friends, others made friends for the first time.
“(...) because I don’t tend to go out with friends here and there. But now it’s different, since I’ve been coming here (…) Look, I get on very well with Maria, she’s a lovely and good woman and we get on great together. For her it’s the same; she says “I’ve found a shoe for my foot, because I don’t trust anybody but you”.” Participant 37, Woman, 77 years old, Zone B.
In some cases, new friends generated subgroups that integrated other participants, including those who were more socially isolated. In other cases, friendships were closed, and some participants felt excluded.
“... and they seem to have become very united to go out on walks together (…), but I go by and they are sitting there and never say “do you want to come with us”, so I go home....” Participant 2, Woman, 74 years old, Zone C.
The group comprised different profiles regarding educational levels, age-related disability and health problems, which unified but also divided the group. Some participants expressed having felt united and treated without differences. In some cases, participants and volunteers developed support relationships with more vulnerable participants, moved by compassion. Telephone contact was especially relevant between participants with mobility limitations or living apart, and also for volunteers to support participants.
“The one I see who needs to cheer up is Margalida, she is very down... (...) For me it’s no effort because it’s something I’ve done all my life, listen to people and be at their side and support them. Let them tell you things, especially that… I’ll go and see her this week, because she called me the other day and I went to her house and now I want her to come to my house”. Volunteer 2, Woman, 77 years old, Zone A.
However, those participants with mobility limitations and hearing impairment were at higher risk of not establishing friendships and dropping out, thus losing the opportunity to benefit of the program at any level.
The few participants with a higher educational level expressed not sharing interests with the rest. For them, feeling valued and helpful for more vulnerable participants was key to remain in the program. In one group, there was a conflict with one participant. She felt more skillful and was jealous of those who participated more in the group.
“You can see that she doesn’t stop talking, she always wants to speak… and from the first day there has been a conflict, and everybody saw there was a conflict. Even Jose said he didn’t feel comfortable because of her. And of course, this has restricted the dynamic a bit, hasn’t it? It hasn’t been easy…” Social care professional 1, Woman, Zone C.
3.2.2. Perceived Benefits on Loneliness
Most of the participants reported that their loneliness decreased after the program by feeling accompanied by peers and professionals, and thanks to the bonds established and to having become aware of and engaged in local activities of their interest. While some people said they no longer felt lonely because of new friendships, others continued to suffer from loneliness, but with less intensity. The awareness that loneliness was a common matter helped them to cope with it by realizing they were not alone in their loneliness.
“I don’t feel lonely, now I have friends”. Participant 28, Woman, 71 years old, Zone B.
“Like bread and butter: loneliness is easier to digest when in company”. Participant 4, Woman, 78 years old, Zone C.
Some participants expressed a transitory benefit on loneliness. For them, home was the space of loneliness, while the group and the street were relational spaces. Likewise, some participants said that the improvement would vanish once the group finished. Nevertheless, thinking and talking about the program with others also helped them to feel less lonely.
“I am happy to join the group, but then, when I get back home, I fall apart, I need to be on the street with someone… at home, alone, is bad…” Participant 35, Woman, 81 years old, Zone B.
Some widows who attributed loneliness to widowhood reported no decrease in loneliness after the program. Accordingly, in these cases the main effect desired of the intervention was not achieved. However, these participants reported other benefits such as an increase in social relationships, well-being and empowerment.
“Since my loneliness is due to missing my husband, it cannot be replaced, at the moment, or ever.” Participant 13, Woman, 75 years old, Zone A.
3.2.3. Perceived Benefits on Social Participation
According to all types of informants, the program was generally successful at helping participants to discover and sometimes engage in local activities.
Visiting community assets allowed participants to get a sense of what was available and to remove prejudices. Moreover, some people returned to community resources where they used to go with their husbands.
“The satisfaction of seeing things I had never seen before, although you imagine them, you’ve seen them on TV, but being there inside, you see it, you touch it, it is a big satisfaction…” Participant 5, Woman, 78 years old, Zone C.
The visits included testing local activities and triggered participation in a wide range of activities. Some participants started participating in activities immediately and others started later during the program. They became engaged in activities that suited their interests, abilities or worries (e.g., memory training). Belonging to the group facilitated becoming engaged with other peers. Thus, new friends easily did new activities together, accompanying each other and reinforcing their friendship.
“Carme and Teresa meet up to go to the cinema, since they live near each other, and Carme does not like going out on the street on her own at night. They meet up to see the film that the parish puts on in the cinema and has been recommended to them, but it’s not a planned activity; it’s an extra outing.” Field note, researcher LCP, referring to participants 10 and 13, Women, 75 and 80 years old, Zone A.
Other participants made specific plans to start activities the following year and some exclusively connected with their wish to participate. For some participants, socializing was very important but participating in activities was not. Some participants, especially those who had been caregivers over the past years, discovered the value of doing activities with other people.
“Everything we did there was new to me. Everything…” Participant 12, Woman, 79 years old, Zone A
Low self-confidence and low communication ability, often related with low education, limited the benefits on participation to the extent of feeling they were not up to join community assets.
“She tells me she’s odd and that she thinks everything is very nice and would like to get involved but she doesn’t feel capable because she is silly, she doesn’t express herself well, she talks poorly...” Field note, researcher LCP, referring to the participant 30, Woman, 84 years old, Zone B.
3.2.4. Perceived Benefits on Health
Participants, professionals, and volunteers agreed on the improvement in mental health. The program was seen as a strategy to prevent or alleviate depressive symptoms. Many participants took antidepressive drugs and/or tranquillizers and explained feeling better after the program. Some women expressed that the program was a salvation to them. One participant explained having solved her sleep problems.
“For me, beforehand, I wasn’t able to go anywhere on my own. Now, I’ve changed! If I had to go for an X-ray, I had to be accompanied, and, since I have claustrophobia, in a lift and things like that… but now, I go alone wherever it may be, an X-ray, Sant Pau (Hospital)… I’m a different woman!” Participant 5, Woman, 78 years old, Zone C.
According to the professionals, some participants were initially trapped in a loop linked to loneliness with an obsessive focus on illnesses and woes, but the intervention successfully broke it by connecting them with others, awakening the wish to remain connected and helping them to forget about their worries.
Sharing their woes and coping strategies among peers during the sessions was generally relieving and helped them to deal with them, although specific people needed to feel their suffering was greater.
“By participating, you don’t feel lonely, with everything you are experiencing.” Participant 18, Woman, 65 years old, Zone A.
Specifically, sharing the way in which they talked with their deceased husbands to overcome loneliness helped them to feel better instead of “crazy”, as they said.
In terms of positive mental health, participants reported an improved subjective well-being, becoming aware of worse circumstances and valuing their situation more. They reported being more understanding and empathic, and having more trust in other people; particularly those who were more closed and socially isolated. Others explained being more compassionate, respectful and having learned not to judge others. Likewise, they also reported feeling less worried and more able to deal with economic, family and health problems. Those living with family members expressed having learned to be more tolerant in cohabitation with other household members.
An empowerment process was observed that contributed to alleviating their loneliness. According to the three groups of informants, the program contributed to the development of personal potential and autonomy to participate and to live their life as they wanted, with less dependency on their children. They had a feeling of strength and of power to decide.
“My daughter wanted me to spend every Sunday with them, but I didn’t like it and I used to say: “but why do I have to be here every Sunday?” and she’d say “so that you’re not on your own” (…) And now, if one day I don’t want to go for lunch I say “today, I won’t come for lunch, don’t wait for me because I’ll be with Maria”, now it’s different.” Participant 37, Woman, 77 years old, Zone B.
Participants attributed their empowerment to the attention and value received. Additionally, realizing they had helped peers was very satisfying and increased their self-esteem, since it gave value to their life experience. Accordingly, feeling useful and able instead of useless meant that their life was not ending and was worth living.
“(With the program) you have another stimulus, you feel like living, you feel like someone needs you for something. You feel that you, life, or God or whatever, needs you for something. Do you know what that feels like?” Participant 29, Woman, 78 years old, Zone C.
In particular, those participants with a life trajectory that was family-oriented, said that they reached a new sense of freedom in their lives. Those participants with severe physical conditions felt connected with their wish to live by becoming aware that others do care about them. They were aware of their own empowerment process and participants mutually reinforced each other. It was strange for them having lived until then without these satisfying aspects of life. However, participants did not see themselves able to lead the continuity of the group and wanted someone as a leader to tell them where to go.
Empowerment was also enhanced by discovering new interests. Becoming engaged in local activities like physical activity and memory training especially promoted healthy ageing, but their physical activity also increased by starting to participate.
The program had some benefits on self-care and healthy lifestyles. Participants were motivated to dress smartly, some of them rediscovering the desire to get dressed up after widowhood by identifying some participants as a model to follow.
Two participants with hearing impairment felt motivated to wear the hearing aid that they had not used before because they wanted to feel connected to others in the group.
Through the program, they became aware of the relevance of taking care of their own health, especially those who had cared for a spouse and whose own health and self-care had not been a priority before.
Nevertheless, participants reported limited benefits on physical health, since many participants reported suffering from chronic conditions with aches that were difficult to alleviate.
summarizes the results on the benefits of the program attributed to the intervention on social support, loneliness, participation and health. In each category, no effect, adverse effects, facilitators and mediators are specified when identified. Mediators are factors interpreted to be necessary in the pathway to reach benefits, while facilitators are factors considered as enhancing that area.