Can remote healthcare interventions mitigate the psychological impact of COVID-19 related restrictions in older adults?

In a recent study published on medRxiv* preprint server, researchers assessed whether a health care intervention delivered remotely could help reduce depression and loneliness in older adults with long-term illnesses (LTCs) during the coronavirus disease pandemic 2019 (COVID-19).

Study: Acceptability of a behavioral intervention to mitigate the psychological impacts of COVID-19-related restrictions in older adults with long-term illnesses: a qualitative study. Image Credit: fizkes/Shutterstock


Over the next 25 years, England will see a 60% spike in the number of people over 60. It is well known that aging leads to reduced social contact, isolation and loneliness, increasing the risk of cognitive impairment, depression and mortality in older people. The COVID-19 pandemic has further worsened the mental health of older people in England. As a result, the government has made improving the well-being of older people in England a public health priority.

About the study

In the present study, researchers first familiarized themselves with Behavioral Activation in Social Isolation (BASIL) data using thematic analysis (TA). Later, they presented the data analysis using the Theoretical Acceptability Framework (TFA).

The study population consisted of 16 older adults with two or more LTCs and nine BASIL Support Workers (BSW) who participated in the BASIL pilot trial organized by the National Health Service (NHS) in England between June and October 2020. elderly participants consented to participate in an interview during the BASIL trial only; however, they contacted the BSWs by telephone after completing their BASIL response training.

The team used semi-structured interviews conducted between September and November 2020 to assess the acceptability and feasibility of the behavioral activation (BA) intervention. BA, a brief psychological intervention, works on the principle that inactivity leads to low mood and loss of positivity in the absence of pleasurable activities.

The researchers recorded the interviews digitally using an encrypted dictaphone and transcribed them with the help of a professional. The BSW interviews lasted between 39 and 60 minutes, while the other interviews lasted between 30 and 56 minutes. These interviews explored three main areas, the delivery context of the BA intervention, study processes, and reflections around the content of the intervention, all sensitized by the seven concepts of EFA.

Notably, the TFA had seven domains, burden, affective attitude, ethics, consistency of intervention, opportunity costs, perceived efficacy, and self-efficacy. The researchers derived the meaning of each TFA domain and then indexed the relevant data for those domains.

Study results

The TA suggested that the recruitment procedures for the BASIL pilot trial and the BA intervention, including the self-help booklet, were acceptable. Additionally, study participants found the self-help booklet engaging and relevant. Similarly, most study participants readily accepted remote delivery of the BA intervention.

In other words, older adults and BSWs had a positive affective attitude towards the BASIL intervention. Some BSWs were positive about how the study has adapted in response to the COVID-19 pandemic. However, the positive affective attitude waned due to challenges in planning activities amid COVID-19 induced restrictions.

Older adults seemed to have a good understanding of the correlation between mood, activity, and physical health, indicating that the BA intervention was understandable. Interestingly, the BSWs found that when people weren’t in a bad mood, BA intervention made less sense to them.

The TFA ethics domain was difficult to interpret and sometimes overlapped with the affective attitude domain. Self-efficacy increased over time for older adults and BSWs, with greater self-efficacy in older adults as they experienced positive effects from participating in the BASIL trial. BSW self-efficacy increased with experience delivering the intervention. However, it decreased as the gap between training and delivery of BA interventions increased.

Seniors and BSWs appreciated the opportunity to show altruism during the COVID-19 pandemic, but seniors also appreciated the help in obtaining health care. Additionally, the BA intervention had a low opportunity cost for BSWs and older adults. The BSWs described how the delivery of the interventions fitted into their work routine. Similarly, older adults described how the BA intervention was flexible and could be planned around their other activities.


The initial technical assistance was invaluable in assessing the psychological impact of COVID-19. However, despite being a relatively new method, the TFA examined the acceptability of BA as a healthcare intervention in older adults with LTC across seven dimensions and ensured the identification of all factors to inform a future trial.

Overall, the study analysis shed light on all aspects of health care intervention acceptability while evaluating brief psychological interventions that may help prevent depression in older populations during the pandemic. of COVID-19.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice/health-related behaviors, or treated as established information.

Journal reference:

  • Acceptability of a Behavioral Intervention to Mitigate the Psychological Impacts of COVID-19-Related Restrictions in Older People with Long-Term Illnesses: A Qualitative Study, Leanne Shearsmith, Peter Coventry, Claire Sloan, Andrew Henry, Lauren Burke, Eloise Ryde , Elizabeth Newbronner, Della Bailey, Samantha Gascoyne, Rebecca Woodhouse, Dean McMillan, David Ekers, Simon Gilbody, Carolyn A. Chew-Graham, preprint medRxiv 2022, DOI:, https ://