Interventions to reduce involuntary loneliness

Involuntary loneliness is a significant social issue that can lead to severe consequences, including mental and physical health problems that place a substantial burden on healthcare resources. In Sweden, approximately one in four people experience involuntary loneliness and social isolation. The sense of involuntary loneliness is most prevalent among children, young adults, and the elderly. There is a need for societal efforts to address and reduce the effects of involuntary loneliness.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut202414 Registration no: SBU 2024/236

Question

What systematic reviews have been published regarding interventions to reduce involuntary loneliness?

Method

A systematic literature search was performed using the following databases: Medline (Ovid), Scopus and PsycINFO.
Two authors independently assessed the abstracts of all identified studies.
Risk of bias in relevant systematic reviews was assessed using an assessment tool based on AMSTAR.

Identified literature

Twelve relevant systematic reviews with low to moderate risk of bias were identified [1-12]. The results and conclusions are presented in Table 1. In 40 relevant systematic reviews, the risk of bias was considered to be high, therefore the results and conclusions are not reported [13-52].

Table 1 Systematic reviews with low/moderate risk of bias.
Included studies Population, Intervention, Control Outcome and Results
Chua et al, 2023 [1]
Effectiveness of home-based interventions in improving loneliness and social connectedness among older adults: a systematic review and meta-analysis.
Included studies:
14 RCTs

Setting:
USA (7), Sweden (3), United Kingdom (1), Canada (2), Netherlands (1).		 Population:
Older people (over 50) living at home

Intervention:
Four different types of home-based interventions:
befriending interventions, psychological therapies, skill development, and health and social care provision

Control:
Telephone support calls, friendly visits, standard care, or waitlist		 Loneliness (continuous data)
(8 studies, n=1356)
SMD= −0.27 (95% CI, −0.51 to −0.03, p=0.03)
It showed a statistically significant small effect size favoring the intervention group.

Loneliness (dichotomous data)
(2 studies, n=219)
RR=0.60 (95% CI, 0.27 to 1.34)
No significant difference compared to control group.
Authors' conclusion:
“Overall, this review found that home-based interventions were able to significantly increase older adults’ social connectedness (social support and social engagement) and reduce their loneliness and depressive symptoms. […] Considering the low-quality rating by the GRADE approach, future research is needed to confirm current findings.”
Foettinger et al, 2022 [2]
The Role of Community-Based Men's Sheds in Health Promotion for Older Men: A Mixed-Methods Systematic Review. American journal of men's health.
Included studies:
52 studies (35 qualitative, 9 quantitative, 8 mixed-methods studies)

Setting:
Australia (28), United Kingdom (8), Ireland (5), New Zealand (3), Canada (3), Denmark (1), cross-country comparisons (4)		 Population:
Men aged 50 years and older

Intervention:
Men’s sheds (set up in communal spaces where men can get together to engage in joint activities and work on projects)

Control (intervention)/Comparison/:
Men who do not participate in Men’s Sheds or no control		 Social isolation
No separate analysis of quantitative results. Synthesis of the complete material found 4 themes, where social isolation was one.

The code social isolation was described (with sub-codes in italics):

The shed environment facilitates social interaction between the participating men which can counteract social isolation in retirement.

Social interaction is characterized by communicating “shoulder to shoulder.”
Thereby, men develop a sense of belonging.

The companionship and new connections both expand and strengthen the social network.
Authors' conclusion:
“The results indicate that older men can benefit from shed participation in regard to mental health, well-being, and social isolation. […] This mixed-methods systematic review provides a comprehensive overview of the evidence base concerning Men’s Sheds and highlights the needfor longitudinal studies investigating causal relationships and gathering sufficient information on how to successfully transfer and implement the concept of Men’s Sheds in other countries.”
Fu et al, 2022 [3]
The effectiveness of remote delivered intervention for loneliness reduction in older adults: A systematic review and meta-analysis.
Included studies:
13 RCTs

Setting:
USA (6), Israel (2), South Africa (1), Canada (1), Taiwan (1), United Kingdom (1), China (1)		 Population:
Older adults (above 65)

Intervention:
Remotely delivered (telephone call, video call, computer or internet-based) treatment of loneliness

Control:
Brief contact, social activity, usual care, or no intervention.		 Loneliness
All delivery types compared to all control groups:
(13 studies, n=1045)
SMD= –0.41 (95% CI, –0.70 to –0.13)

Analyses based on specific interventions

Video call compared to all control groups:
(3 studies, n=211)
SMD= –0.54 (95% CI, –0.83 to –0.25, p=0.0003)

Media subgroup analysis supported the effectiveness of intervention delivered by video call.

Telephone-based compared to all control groups:
(6 studies, n=591)
SMD= –0.20 (95% CI, –0.56 to 0.15, p=0.27)

Computer and internet-based compared to all control groups:
(4 studies, n=243)
SMD= –0.85 (95% CI, –1.8 to 0.1, p=0.08)

No evidence was found to support the effectiveness of telephone call and computer and internet- delivered intervention.

Note: This is a selection of relevant results. For complete results, see reference in full.
Authors' conclusion:
“In conclusion, we believe that remotely delivered intervention can provide superior loneliness relief than brief intervention, usual care, and no intervention. The effect on loneliness reduction appears to be affected by intervention technology, strategy, participants’ characteristic, group format, and effect measurement time point.”
Hoang et al, 2022 [4]
Interventions Associated With Reduced Loneliness and Social Isolation in Older Adults: A Systematic Review and Meta-analysis.
Included studies:
70 RCT (56 RCT included in meta-analysis)

Setting:
USA (25), China (7), United Kingdom (5), Netherlands (4), Taiwan (3), Australia (3), Sweden (3), Canada (3), Finland (3), Iran (2), Italy (2), New Zealand (1), South Africa (1), Norway (1), Austria (1), Russia (1), Singapore (1), Japan (1), Hong Kong (1), Israel (1), multi (1)		 Population:
Older adults (over 65), living in community or long-term care.

Intervention:
Interventions to prevent or reduce loneliness, for example animal therapy, cognitive behavioural therapy, exercise, or technological interventions.

Control:Waitlist control, standard care, no intervention		 Loneliness
Combined or multicomponent interventions, long term care compared to control
(3 studies, n=675)
SMD= -0.53 (95% CI, –0.86 to –0.20)

Animal therapy, long term care compared to control (one study comparing individual animal therapy to group animal therapy excluded)
(3 studies, n=111) SMD= −1.86
(95% CI, −3.14 to −0.59)

Note: This is a selection of results. For results of all interventions, see the reference in full.
Authors' conclusion:
“In this study, animal therapy and technology in long-term care had large effect sizes, but also high heterogeneity, so the effect size’s magnitude should be interpreted with caution. The small number of studies per intervention limits conclusions on sources of heterogeneity. Overall quality of evidence was very low.”
Laermans et al, 2023 [5]
Friendly visiting by a volunteer for reducing loneliness or social isolation in older adults: A systematic review.
Included studies:
13 studies (9 RCTs, 4 non-RCTs)

Setting:USA (9), Canada (2), Germany (1), Ireland (1)		 Population:
Community‐dwelling or institutionalized older adults (over 60)

Intervention:
Friendly visitors

ControlNo friendly visitors		 Loneliness
(2 studies, n=123)
No synthesis provided.

Social isolation
(2 studies, n=134)
Synthesizing the results of two non‐randomized controlled trials by vote counting based on the direction of effect, three of the four effects (75%) favoured the friendly visiting intervention.
Authors' conclusion:
“At the moment, the evidence is very uncertain about the effect of friendly face‐to‐face visiting by a volunteer on improving loneliness, social isolation, and wellbeing in older adults. Overall, the identified evidence is scarce and of very low certainty, which precludes any conclusions about the added value of friendly face to‐face visiting by a volunteer.”
Ma et al, 2020 [6]The effectiveness of interventions for reducing subjective and objective social isolation among people with mental health problems: a systematic review.
Included studies:
30 RCTs; n=3080

Setting:
USA (13), Europe including Sweden and Norway (11), Israel (3), China (2), Canada (1).		 Population:
People diagnosed with mental health conditions.

Intervention:
Interventions which were designed to alleviate subjective or/and objective social isolation for people with mental health problems. For example, psychoeducation and social skills programs.

Control:
Treatment as usual, no treatment, two or more active treatments		 Subjective social isolation
(15 studies)
Active intervention vs control (10 studies)

No significant differences between groupsStudies comparing two active interventions (5 studies)1 case of significant between-group difference

Objective social isolation (11 studies)
Active intervention vs control (6 studies)4/6 studies suggest superior outcomes compared to control group.

Studies comparing two active interventions (5 studies)
2 studies present positive findings.

Interventions targeting subjective and objective social isolation
(4 studies)

Active intervention vs control
(4 studies)

2 of 4 report significant between-group difference for both subjective and objective social isolation.

3 reported significant difference for only subjective social isolation.
Authors' conclusion:
“The evidence is not yet strong enough to make specific recommendations for practice. Preliminary evidence suggests that promising interventions may include cognitive modification for subjective social isolation, and interventions with mixed strategies and supported socialisation for objective social isolation. We highlight the need for more thorough, theory-driven intervention development and for well-designed and adequately powered RCTs.”
McElfresh et al, 2021 [7]
Interventions for Loneliness Among Adult Cancer Survivors: A Systematic Review and Meta-Analysis.
Included studies:
8 studies (7 RCTs, 1 pre-post evaluation study design)

Setting:
USA (6), Iran (1), and Japan (1).		 Population:
Cancer survivors (lung cancer, breast cancer, and other cancers)

Intervention:
Interventions to reduce loneliness in cancer survivors. Interventions include for example social skills training and support discussion groups.Group-based (4), telephone-based (3) and web-based (1).

Control:
Standard care, waitlist, or other version of an education program.		 Loneliness
(6 studies, n=465)
SMD= –0.32 (95% CI, –0.50 to –0.14, p<0.001)
indicating interventions overall had a significant effect on reducing loneliness.
Authors' conclusion:
“There are limited interventions addressing loneliness in cancer survivors. Development and testing of culturally-relevant programs are warranted.”
Orr et al, 2023 [8]
What are the effects of animals on the health and wellbeing of residents in care homes? A systematic review of the qualitative and quantitative evidence.
Included studies:
34 studies (18 qualitative and 16 quantitative)

Setting:
USA (17), United Kingdom (4), Canada (2), Norway (2), Spain (2), New Zealand (1), Japan (1), Sweden (1), Italy (1), South Africa (1), Australia (1), Denmark (1)		 Population:
Elderly in care homes or long-term care facilities. 5 qualitative and 9 quantitative studies included patients with dementia.

Intervention:
Animal assisted interventions, for example animal-assisted therapy with a dog or robotic animals

Control:
Usual care (no control in qualitative studies)		 Loneliness
Visits from a dog (real or robotic) compared to usual care
Or
Visits from a dog 1 or 3 times a week compared to usual care
(2 studies, n=unclear)

Significantly less loneliness in both dog intervention groups compared to control (2 studies).

Respite from loneliness was identified (based on 14 studies) as an aspect of one of 7 themes in the qualitative synthesis.
Authors' conclusion:
“There was, however, limited evidence of a positive effect of pet/animal interaction on outcomes of loneliness […]”
Osborn et al, 2021 [9]
Interventions to address loneliness and social isolation in young people: A systematic review of the evidence on acceptability and effectiveness.
Included studies:
16 studies (presented in 28 articles)
5 RCTs, 7 pre-post designs, 1 quasi-experimental, 1 non-randomised group comparison study, and 2 repeated measure design (qualitative).

Setting:
Portugal (1), USA (4), Canada (3), Israel (1), China (1), Australia (5)		 Population:
Teenagers and adolescents at risk of loneliness (for example with mental illness, autistic spectrum disorders or chronic health conditions)

Intervention:
Interventions seeking to prevent or reduce loneliness and/or social isolation in young people (16 different social and emotional learning programs)

Comparison:
Brief advice and other various comparisons.		 Loneliness
Meta-analysis or thematic synthesis were not possible due to the significant heterogeneity of the material. Narrative synthesis of the results shows 14 of the 16 programs found reduction in prevalence of loneliness (measured by 8 different scales) over the study period. For complete descriptions of interventions and results, see reference in full.
Authors' conclusion
“Interventions that appeared successful were targeted at the specific needs of the population and the determinants of loneliness or social isolation specific to the context and implemented in more institutional settings. However, the interventions were mostly intensive, individual, or small group approaches that were often poorly described. Given loneliness and social isolation are common and pervasive issues it is unlikely these approaches could be scaled to the wider population”.
Shah et al, 2021 [10]
Evaluation of the Effectiveness of Digital Technology Interventions to Reduce Loneliness in Older Adults: Systematic Review and Meta-analysis.
Included studies:
6 studies: 1 quasi-experimentalstudy, 1 beforeand afterstudy, 4 RCTs

Setting:
Taiwan (1), Netherlands (1), Sweden (1), USA (1), United Kingdom (1), South Africa (1).		 Population:
Older people, in nursing home or independent living

Intervention:
Digital technology interventions, for example videoconferencing

Control:
Regular care, no comparator, care as usual plus regular carervisits		 Loneliness
(Digital technology interventions compared to control, 3 studies, n=106)

SMD=0.02 (95% CI, −0.36 to 0.40, p=0.92)

Narrative synthesis showed that there was a reduction in loneliness in the intervention groups at the follow-ups compared with baseline.
Authors' conclusion:
“Our meta-analysis showed no evidence supporting the effectiveness of DTIs in reducing loneliness in older adults. Therefore, there is a need for further research involving RCTs with larger sample sizes and longer duration of interventions and follow-up measurement periods.”
Yeo et al, 2023 [11]
Unpacking older adults’ experiences using mobile telepresence robots: A systematic mixed-studies review.
Included studies:
43 studies, 13 qualitative, 17 quantitative and 13 mixed-methods studies

Setting:
Australia (2), Austria (2), Belgium (1), Canada (3), Finland (2), France (4), Germany (3), Greece (1), Hungary (2), Italy (8), Japan (2), Macedonia (1), Netherlands (1), New Zealand (5), Poland (1), Spain (1), Sweden (2), United Kingdom (2), USA (6)		 Population:
Older adults, with or without cognitive impairment

Intervention:
Mobile telepresence robots

Control:
Not clearly stated, or no control		 Loneliness
No separate reporting of quantitative data on loneliness. A mixed methods synthesis, pooling results from both the qualitative and quantitative findings, produced four themes:
-Enjoyable experiences-Willingness and acceptance
-Promoting social connectedness
-Improved psychosocial and physiological well-being

“Alleviated loneliness” was a component of the theme Enjoyable experience. “Promote social connectivity” was a component of the theme Promoting social connectedness.
Authors' conclusion:
“[…] it recognised the value of increasing access to quality care as well as overcoming social isolation and loneliness through the engagement, enjoyment, and connection brought about by mobile telepresence robots”
Yu et al, 2023 [12]
Effects of non-pharmacological interventions on loneliness among community-dwelling older adults: A systematic review, network meta-analysis, and meta-regression.
Included studies:
60 studies (37 included in meta-analysis)
RCT (49 studies),
Non-randomized studies (11 studies)

Setting:
USA (13), United Kingdom (7), Netherlands (7), Finland (4), Sweden (4), Spain (3), Israel (3), China (3), Taiwan (2), India (2), Iran (2), Canada (2), Philippines (1), Japan (1), Singapore (1), Egypt (1), Brazil (1), Denmark (1), Italy (1), Portugal (1)		 Population:
Community-dwelling older adults
(aged 60 years or above)

Intervention:
Non-pharmacological interventions to prevent loneliness (for example behavioural activation, individual-based or group-based exercise, health promotion)

Control:
Active control, usual care or no-treatment control.		 Loneliness
Psychological interventions vs control group (6 studies, n=1171)
SMD= −2.33 (95% CI, −4.40 to −0.25, p=0.003)

Non-digital social support interventions vs control group
(14 studies, n=2439)
SMD =−0.63 (95% CI, −1.16 to −0.10, p= 0.02)

Multi-component interventions vs control group
(7 studies, n=1317)
SMD= −0.28 (95% CI, −0.54 to −0.03, p=0.03)

Behavioural activation, digital social support, exercise with social engagementNo significant differences
Authors' conclusion:
“In conclusion, this is the first review to offer a comparison between different interventions to combat loneliness among community dwelling older adults. The findings reinforce the complexity of late-life loneliness and emphasize the need for integrative interventions to increase the emotional adaptation of older adults, optimize their social connection skills and enhance the accessibility to social networks. Gender and health-related risk factors loneliness also need to be considered in identifying the optimal intervention.”

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Search strategies

Medline via OvidSP 22 November 2023

Title: Interventions for reducing loneliness
Search terms Items found
1. exp Social Isolation/ or exp Loneliness/ or ("social* isolat*" OR lonel* OR "social* disconnect*" OR "Social* Exclu*" OR "social* depriv*" OR "social* estrange*" OR "social* alienat*" OR "societal alienat*" OR "societal isolat*" OR "societal disconnect*" OR "societal Exclu*" OR "societal depriv*" OR "societal estrange*").ab,bt,kf,ti 47 465
Intervention:
2. exp Social Participation/ OR exp Social Interaction/ OR exp Exercise/ OR exp Social support/ OR Social capital/ OR exp Animal Assisted Therapy/ OR exp Community Networks/ OR (interv* OR support* OR program* OR treatment* OR prevent* OR therap* OR activation OR "Social access" OR "Neighbourhood identification" OR engage* OR "social* prescri*" OR Multicomponent OR intergeneration* OR "Active aging" OR "Active ageing" OR "social* particip*" OR "peer relationship*" OR "social relationship*" OR "Physical activity" OR exercise OR "Animal assisted" OR "Animal Facilitated" OR "Pet assisted" OR "Pet Facilitated" OR promot* OR "social* interact*" OR integr* OR reduc* OR "community centre*" OR "community center*" OR "community hub*" OR "meeting point*" OR "open centre*" OR "open center*" OR "open meet*" OR "open space*" OR "health connector*" OR "social* connect*" OR befriend* OR "social capital").ab,bt,kf,ti 15 699 991
Study types: systematic reviews and meta-analysis
3. ((Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or ((systematic adj4 review) or "meta analys*" or metaanalys*).ti,bt,ab.) not (editorial/ or letter/ or case reports/)) 45 8520
Combined sets:
4. 1 AND 2 31 280
5. 3 AND 4 1027
Final result
6.   1027
/ = Term from the MeSH controlled vocabulary.sh = Term from the MeSH controlled vocabulary; exp = Term from MeSH including terms found below this term in the MeSH hierarchy;.ti,ab = Title or abstract; .tw = Title or abstract; .kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase
Population:

Scopus via scopus.com 22 November 23

Title: Interventions for reducing loneliness
TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords); ALL = All fields; W/n = Within. Proximity operator retrieving terms within n words from each other; PRE/n = Precedes by. Proximity operator, the first term in the search must precede the second by n words; LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range; DOCTYPE = Publication type; “re” = review; “le” = letter; “ed” = editorial; “ch” = book chapter; “cp” = conference proceedings; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. TITLE-ABS-KEY ("social* isolat*" OR lonel* OR "social* disconnect*" OR "Social* Exclu*" OR "social* depriv*" OR "social* estrange*" OR "social* alienat*" OR "societal alienat*" OR "societal isolat*" OR "societal disconnect*" OR "societal Exclu*" OR "societal depriv*" OR "societal estrange*") 91 674
Intervention:  
2. TITLE-ABS-KEY (interv* OR support* OR program* OR treatment* OR prevent* OR therap* OR activation OR "Social access" OR "Neighbourhood identification" OR engage* OR "social* prescri*" OR Multicomponent OR intergeneration* OR "Active aging" OR "Active ageing" OR "social* particip*" OR "peer relationship*" OR "social relationship*" OR "Physical activity" OR exercise OR "Animal assisted" OR "Animal Facilitated" OR "Pet assisted" OR "Pet Facilitated" OR promot* OR "social* interact*" OR integr* OR reduc* OR "community centre*" OR "community center*" OR "community hub*" OR "meeting point*" OR "open centre*" OR "open center*" OR "open meet*" OR "open space*" OR "health connector*" OR "social* connect*" OR befriend* OR "social capital") 37 733 349
Study types: systematic reviews and meta-analysis / randomized controlled trials
3. TITLE-ABS-KEY ((systematic W/2 review) OR "meta analy*" OR metaanaly* ) AND (EXCLUDE (DOCTYPE, “le”) OR EXCLUDE (DOCTYPE, “ed”) OR EXCLUDE (DOCTYPE, “ch”) OR EXCLUDE (DOCTYPE, “cp”)) 672 655
Combined sets:
4. 1 AND 2 62 769
5. 3 AND 4 1938
Final result
6.   1938

PSYCINFO via EBSCO 22 November 2023

Title: Interventions for reducing loneliness
TI = Title; AB = Abstract; SU = Keyword, exact or part (including all other fields for indexed and author keywords); DE = Exact keyword; TX = All text; MR = Methodology; Nn = Near. Proximity operator retrieving terms within n words from each other; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. SU ("social* isolat*" OR lonel* OR "social* disconnect*" OR "Social* Exclu*" OR "social* depriv*" OR "social* estrange*" OR "social* alienat*" OR "societal alienat*" OR "societal isolat*" OR "societal disconnect*" OR "societal Exclu*" OR "societal depriv*" OR "societal estrange*") OR TI ("social* isolat*" OR lonel* OR "social* disconnect*" OR "Social* Exclu*" OR "social* depriv*" OR "social* estrange*" OR "social* alienat*" OR "societal alienat*" OR "societal isolat*" OR "societal disconnect*" OR "societal Exclu*" OR "societal depriv*" OR "societal estrange*") OR AB ("social* isolat*" OR lonel* OR "social* disconnect*" OR "Social* Exclu*" OR "social* depriv*" OR "social* estrange*" OR "social* alienat*" OR "societal alienat*" OR "societal isolat*" OR "societal disconnect*" OR "societal Exclu*" OR "societal depriv*" OR "societal estrange*") 39 954
Intervention:
2. SU (interv* OR support* OR program* OR treatment* OR prevent* OR therap* OR activation OR "Social access" OR "Neighbourhood identification" OR engage* OR "social* prescri*" OR Multicomponent OR intergeneration* OR "Active aging" OR "Active ageing" OR "social* particip*" OR "peer relationship*" OR "social relationship*" OR "Physical activity" OR exercise OR "Animal assisted" OR "Animal Facilitated" OR "Pet assisted" OR "Pet Facilitated" OR promot* OR "social* interact*" OR integr* OR reduc* OR "community centre*" OR "community center*" OR "community hub*" OR "meeting point*" OR "open centre*" OR "open center*" OR "open meet*" OR "open space*" OR "health connector*" OR "social* connect*" OR befriend* OR "social capital") OR TI (interv* OR support* OR program* OR treatment* OR prevent* OR therap* OR activation OR "Social access" OR "Neighbourhood identification" OR engage* OR "social* prescri*" OR Multicomponent OR intergeneration* OR "Active aging" OR "Active ageing" OR "social* particip*" OR "peer relationship*" OR "social relationship*" OR "Physical activity" OR exercise OR "Animal assisted" OR "Animal Facilitated" OR "Pet assisted" OR "Pet Facilitated" OR promot* OR "social* interact*" OR integr* OR reduc* OR "community centre*" OR "community center*" OR "community hub*" OR "meeting point*" OR "open centre*" OR "open center*" OR "open meet*" OR "open space*" OR "health connector*" OR "social* connect*" OR befriend* OR "social capital") OR AB (interv* OR support* OR program* OR treatment* OR prevent* OR therap* OR activation OR "Social access" OR "Neighbourhood identification" OR engage* OR "social* prescri*" OR Multicomponent OR intergeneration* OR "Active aging" OR "Active ageing" OR "social* particip*" OR "peer relationship*" OR "social relationship*" OR "Physical activity" OR exercise OR "Animal assisted" OR "Animal Facilitated" OR "Pet assisted" OR "Pet Facilitated" OR promot* OR "social* interact*" OR integr* OR reduc* OR "community centre*" OR "community center*" OR "community hub*" OR "meeting point*" OR "open centre*" OR "open center*" OR "open meet*" OR "open space*" OR "health connector*" OR "social* connect*" OR befriend* OR "social capital") 3 022 750
Study types: systematic reviews and meta-analysis
3. TI((systematic n3 review) OR "meta analys*" OR metaanalys*) OR AB((systematic n3 review) OR "meta analys*" OR metaanalys*) OR SU((systematic n3 review) OR "meta analys*" OR metaanalys*) OR (MR "Systematic Review" OR MR "meta analysis") 96 133
Combined sets:
4. 1 AND 2 27 514
5. 3 AND 4 621
Final result
6.   621
Page published
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