Bridging Culture and Technology: Developing a Culturally Sensitive intervention to Alleviate Loneliness and Social Isolation among Older Chinese Immigrants

Abstract

Background: Older adults are often considered particularly vulnerable to loneliness and social isolation, primarily due to functional declines associated with aging, an increased risk of facing multiple losses, and diminished resilience during their later years. Loneliness is the subjective feeling of lacking support and companionship, while social isolation is its objective counterpart, indicating a genuine lack of social connections. Despite having apparent definitional differences, loneliness and social isolation often co-occur, exacerbating their negative impacts on older adults. A recent report by the U.S. federal government highlights that loneliness is a critical public health issue, severely affecting the health and well-being of older adults. Addressing this issue and ensuring the mental health of the aging population have become urgent health challenges in a rapidly aging global population. With the advancement of technology and the push from the pandemic, Information and Communication Technology (ICT) is a potential strategy to promote social connections and reduce feelings of loneliness. However, there remains a lack of solid evidence supporting the effectiveness of existing interventions, including those involving ICT. The failure of these interventions can be attributed to the complexity of loneliness experience and the diversity of subjects' backgrounds, including racial and cultural differences. International migration is considered a significant risk factor for loneliness and social isolation, especially in older adults. The population of older Chinese immigrants is rapidly expanding and has become one of the largest groups in Western societies. Despite their numbers, older Chinese immigrants have received limited attention in the research literature, even though they exhibit a higher prevalence of loneliness compared to other age and ethnic groups. This not only troubles older adults and their families but also negatively affects the healthcare system and even the stability of society.Objectives: This dissertation attempts to develop an effective strategy to address this critical issue more precisely, bridging the gap in knowledge and application. The objective of this research is to gain a comprehensive understanding of the experiences of loneliness and social isolation among older Chinese immigrants and to design, develop, and evaluate a culturally sensitive ICT intervention aimed at mitigating these conditions. Specifically, the study aims to: 1) explore the lived experiences and challenges related to loneliness, social isolation, and technology use among older Chinese immigrants; 2) assess the effectiveness of existing ICT interventions in addressing loneliness and social isolation, with a focus on culturally sensitive approaches; 3) design and preliminarily test a web-based discussion platform, Virtual Online Communities for Aging Life Experience–Older Chinese Immigrants (VOCALE-OCI), tailored to the specific needs and preferences of older Chinese immigrants. Methods: This dissertation is divided into three parts. The first study includes results from in-depth interviews with older Chinese immigrants in the United States to explore their experiences of loneliness and social isolation and engagement with ICT. Thematic analysis reveals vital themes related to the multifaceted nature of loneliness, the impact of cultural and social factors, and the challenges and motivations behind ICT use. The second study includes a review of the literature on ICT interventions for loneliness and social isolation among older adults, focusing on culturally sensitive approaches. The third study involves designing, developing, and preliminary evaluating VOCALE-OCI through participants' feedback and usability testing by the think-aloud method, applying Human-Centered Design principles, and emphasizing cultural sensitivity. Main findings: The qualitative study identified four core themes related to the subjective experiences of loneliness and social isolation among 18 older Chinese immigrants (mean age: 72.09 years; standard deviation: ±10.27 years; age range: 60-89 years old), highlighting the importance of cultural influences, life transitions, and overcoming technological barriers. The review included 13 reviews comprising various types of review articles published within the last five years. This research emphasized the potential of ICT interventions in reducing loneliness among older adults but also pointed out the limited research on minority racial/ethnic groups and the necessity for culturally sensitive designs. Building on the first two, the third study combined Bronfenbrenner's Ecological Systems Theory to develop a prototype of VOCALE-OCI. This study involved 8 older Chinese immigrants, with a mean age of 65.88 years (SD = 5.94) and an age range from 60 to 78 years. Preliminary usability showed positive participant feedback, indicating its potential to foster a sense of belonging and community. Participants noted that the online community platform was culturally resonant, accessible, and inclusive, aligning with their cultural values and preferences. Conclusions: The findings from this dissertation contributes to a deeper understanding of loneliness and social isolation among older Chinese immigrants and demonstrates the potential of a culturally sensitive ICT solution, VOCALE-OCI, to address these challenges. The research underscores the critical role of cultural sensitivity in designing effective interventions and the importance of involving users in the design process. The findings highlight the value of advocating for the expansion of research to include diverse older immigrant populations and the exploration of long-term effects and broader applicability of such interventions. Future work should focus on refining ICT solutions based on continuous feedback, integrating advanced technologies like AI for personalization, and developing scalable interventions that can be adapted to other vulnerable groups.