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LonelinessRECETASNCT05507684

Effects of Nature-based Group Intervention on Quality-of-life in Lonely Older People Living in Assisted Living Facities

A study testing Nature-based social prescribing group intervention in people with Loneliness, run by University of Helsinki at 1 site in Finland.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

RECETAS (Re-imagining Environments for Connection and Engagement: Testing Actions for Social Prescribing in Natural Spaces) is a worldwide project (H2020 No 945095) that addresses loneliness and the role of nature-based social intervention (NBSI) to alleviate it. Read more about this study

Who is it for?
Ages 65 years and older
Conditions the study is for
Loneliness
What is being tested?
Nature-based social prescribing group intervention
Could I receive a placebo?
No, everyone receives an active treatment
How many people
316 participants
Where
1 siteFinland
Study dates
21 Feb 2023to 28 Feb 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 65 years and older
  • All sexes
  • No healthy volunteers
  • Older adult

Who may be able to join

  • Age at least 55 years
  • Suffers from loneliness at least sometimes
  • lives permanently in assisted living facility
  • is voluntary to participate
  • has Minimental Examination at least 15 points or CPS <5 (not being moderately-severly cognitively impaired)
  • is able to move independently or dependently with or without assisting devices
  • sufficient sight and hearing to participate in group activities

Who cannot join

  • having a serious illness with a prognosis less than 6 months.

Trial locations and contacts

1 site in 1 country.

Finland1 site
  • Helsinki City assisted living facilities

    Helsinki

Other trials in Finland

About this study

Official title: RECETAS (Re-Imagining Environments for Connection and Engagement: Testing Actions for Social Prescribing in Natural Spaces) in Helsinki

RECETAS (Re-imagining Environments for Connection and Engagement:

Testing Actions for Social Prescribing in Natural Spaces) is a worldwide project (H2020 No 945095) that addresses loneliness and the role of nature-based social intervention (NBSI) to alleviate it. Definitions: Loneliness is the perception of feeling alone, even if surrounded by people. Social prescription is a non-medical community referral approach to connect individuals with community resources to support wellbeing. Nature-based social intervention (NBSI) is a structured therapeutic groupbased social intervention that specifically include access to nature as a main component. Nature-based experiences may facilitate dynamic processes of social interactions and it can reduce feelings of loneliness.

Read more

Hypothesis: NBSI in vulnerable people suffering from loneliness is more effective than usual social and health care on improving their health-related quality of life and alleviating loneliness during 3-,6- and 12-months follow up.

Objectives: This trial aims to assess the effectiveness and to explore the processes and perceived impacts of NBSI in vulnerable people suffering from loneliness in the assisted living facilities in Helsinki. In Helsinki, the main objective is to assess the effectiveness of a 10-week NBSI (RCT) in vulnerable people suffering from loneliness on changes of their health-related quality of life (HRQOL) and loneliness compared to usual social and health care at end of intervention, and at 6-,and 12- months post-randomization.

Methods: The study design is a randomized controlled trial (RCT). The RCT will include also a process evaluation, a qualitative study and a Health Economics evaluation. Therefore, the RCT will use a mixed-method approach collecting quantitative information to assess the main outcomes and qualitative methods to explore lived experiences of participants and professionals.

The recruitment will be performed screening residents in Helsinki assisted living facilities by a survey. A total of 316 participants will be randomly allocated in two groups (c.158 each) after baseline assessments: intervention and control. Participants will sign the informed consent. The intervention is a group-based, multicomponent, behaviorally based complex intervention that requires a specific training to prepare professionals as facilitators. It is based on the "Circle of Friends" methodology.

Read the detailed description

RECETAS (Re-imagining Environments for Connection and Engagement:

Testing Actions for Social Prescribing in Natural Spaces) is a worldwide project that addresses loneliness and the role of nature-based social intervention (NBSI) to alleviate it. This project has received funding from tte European Union's Horizon 2020 research and innovation under grant agreement No 945094. more information at: https://recetasproject.eu Background: Loneliness is the perception of feeling alone, even if surrounded by people. It is a growing public health concern due to its impact on morbidity and mortality even in old age, being as dangerous as smoking or obesity: it reduces people's lifespan, and it is associated with increased use of health and social services and it impairs people's quality-of-life. In Europe, 30 million European adults frequently felt lonely. Social prescription is a non-medical community referral approach to connect individuals with community resources to support wellbeing. Nature-based social intervention (NBSI) is a structured therapeutic group-based social intervention that specifically include access to nature as a main component. Nature-based experiences can facilitate dynamic processes of social interactions and it can reduce feelings of loneliness.

Justification: NBSI in urban areas may improve health and mental well-being and reduce loneliness. Investments in nature-based solutions and green infrastructure can be harnessed for health and wellbeing even in times of health emergencies (covid-19). NBSI offers a novel socio-environmental innovation to reduce loneliness by creating the social and technological infrastructure needed to support social and community cohesion.

Hypothesis: NBSI in vulnerable older people in assisted living facilities suffering from loneliness is more effective than usual social and health care on improving their quality of life and alleviating loneliness during 3-,6- and 12-months follow up.

Objectives: The study aims to assess the effectiveness and to explore the processes and perceived impacts of NBSI in vulnerable older people in assisted living facilities suffering from loneliness in the area of Helsinki. The main objective is to assess the effectiveness of a 10-week NBSI (RCT) in vulnerable people suffering from loneliness on the changes of loneliness and health-related quality of life compared to usual social and health care at 3-, 6-, and 12- months post-randomization.

Methods: The study design is a randomized controlled trial (RCT). The RCT will also include a process evaluation, a qualitative study and a health economics evaluation.

Therefore, overall, the RCT will use a mixed-method approach collecting quantitative information to assess the main outcomes and qualitative methods to explore lived experiences of participants and professionals. The recruitment will be performed by screening residents in Helsinki assisted living facilities by a survey inclusing 1500 residents. Inclusion criteria will be age 65+ years, suffering from loneliness, living permanently in assisted living facility, being voluntary to participate, having Minimental Examination at least 15 point (not being moderately-severly cognitively impaired), being able to move independently with or without assisting devices, sufficient sight and hearing and not having a seirous illnes with a prognosis than 6 months. A total of 316 participants will be randomly allocated in two groups (c.158 each) after baseline assessments: intervention and control. Participants will sign the informed consent. The intervention is a group-based, multicomponent, behaviorally based complex intervention that requires a specific training to prepare professionals as facilitators. It is based on the "Circle of Friends" methodology developed in Helsinki University. Participants in the intervention arm meet in closed groups including 5-12 participants once a week for 9 times. The group activities include nature-based activities and discussions on them and participants' loneliness. The groups facilitators will use group dynamics to facilitate participants' mutual interaction and to support their self-efficacy. Control group participants will receive usual care, and a list of nature-based resources available in their area.

Main outcome measures will be changes in loneliness by De Jong Gierveld Loneliness scale and health-related quality-of-life by 15D measure. Secondary measures will be changes in wellbeing (Psychological Wellbeing scale), EuroQual 5D-5L, cognition (Minimental State examination, Clock-drawing test, verbal fluency), walking speed and frailty (Physical frailty), self efficacy (Generalized Self-Efficacy scale), sleep quality, attachment ot neighbourhood (12 Neighborhood Assessment Scale), and relationship with nature (NR-6). THe use of health and social services will be collected from central records and health economic analyses performed.

Conditions
Loneliness
Being tested
Nature-based social prescribing group intervention
Keywords
Loneliness, nature activities, group intervention, socialization

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Nature-based social prescribing group interventionOther

    Groups of 5-12 persons will formed from one assisted living facility. All of them will undergo an individual interview to assess their wishes for the nature-based activities.

    Participants meet in a closed group for 9 times once a week for 10 weeks. All 2-4 hour sessions will include nature-based activities and mutual discussions about the experiences of nature and loneliness.

    2 professionals will facilitate and observe the group more thoroughly, give feedback to each other, and make use of group dynamics. They write diaries on each session and receive feedback from their trainers. The groups are objective oriented (aiming to alleviate loneliness, to improve participants' self-efficacy), client oriented and aim with favorable group dynamics to mature, self-directing group in which the participants have made friends with each other and want meet with each other without the facilitators after the official group intervention is over.

Study groups in NCT05507684
Study groupRoleWhat they receive
Nature-based social prescribing group interventionExperimentalGroups of 5-12 persons will formed from one assisted living facility. All of them will undergo an individual interview to assess their wishes for the nature-based activities. Participants meet in a closed group 9 times for once a week for 10 weeks. All 2-4 hour sessions will include nature-based activities and mutual discussions about the experiences of nature and loneliness. 2 professionals will facilitate and observe the group more thoroughly, give feedback to each other, and make use of group dynamics. They write diaries on each session and receive feedback from their trainers. The groups are objective oriented (aiming to alleviate loneliness, to improve participants' self-efficacy), client oriented and aim with favorable group dynamics to mature, self-directing group in which the participants have made friends with each other and want meet with each other without the facilitators after the official group intervention is over.
Receives: Other: Nature-based social prescribing group intervention
ControlNo interventionThe control arm will receive individually usual care in assisted living facility (e.g. the existing social prescription as available) Usual care is the appropriate comparison rather than a placebo for complex interventions.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in health related quality of life

    15D health-related quality of life instrument. Minimum 0 (worst) and maximum 1 (best). 15D will be used as an index ( 0 to 1) and the changes in various 15 dimensions will also be explored.

    Measured: From baseline to 3months, 6months, 12 months

  2. Change in loneliness

    Modified De Jong Gierveld Loneliness Scale as a continuous scale (minimum 11 (best) and maximum 55 (worst))

    Measured: From baseline to 3months, 6months, 12 months

Secondary outcomes (17)
  1. Change in Psychological Wellbeing

    Psychological Wellbeing Scale by Routasalo et al. 2009 (Minimum 0 (worst) and maximum 1 (best).

    Measured: From baseline to 3months, 6months, 12 months

  2. Change in executive function

    Clock Drawing test (Minimum 0 (worst) and maximum 6 (best).

    Measured: From baseline to 3months, 6months, 12 months

  3. Change in cognition

    Verbal Fluency (Minimum 0 (worst) and maximum >30 (best)).

    Measured: From baseline to 3months, 6months, 12 months

  4. Minimental State Examination

    Measured: Only baseline

  5. Change in self Efficacy

    Generalized Self-Efficacy scale by Schwarzer \& Jerusalem 1995

    Measured: From baseline to 3months

  6. Change in frailty phenotype

    Physical frailty

    Measured: Only baseline

  7. Change in blood pressure

    Blood pressure

    Measured: From baseline to 3months and 12 months

  8. Change in sleep quality

    One item questions

    Measured: From baseline to 3months, 6months, 12 months

  9. Change in attachment to neighbourhood

    Neighborhood Assessment Scale

    Measured: From baseline to 3months

  10. Change in relationship with nature

    Questions related to nature attitudes

    Measured: From baseline to 3months

  11. Use of health and social services

    Use of health and social services retrieved from registers

    Measured: during 12 months from baseline

  12. Health economic analyses (costs of health services with EQ5D-5L)

    EuroQOL 5D-5L

    Measured: During 12 months (3mo, 6mo, 12mo)

  13. Change in social relationships

    Number of new friends, continuation of group activity, satisfaction with relationships

    Measured: From baseline to 3months, 6months, 12 months

  14. Repeated wellbeing before, during and after the intervention

    4 items related to psychological and physical wellbeing

    Measured: Baseline, during the intervention and at 3 months

  15. Repeated short measure of wellbeing

    4 items related to psychological and physical wellbeing

    Measured: Baseline, during the intervention and at 3 months

  16. Satisfaction with social relationships

    Items on social relationships and social activity

    Measured: Baseline, 3 months

  17. Number and time spent on outdoor activities

    Number of outdoor activities and time spent there during the intervention

    Measured: 3 months from baseline

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Aug 2022
  2. Study start21 Feb 2023
  3. Primary completion28 Jan 2025
  4. Study completion28 Feb 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Investigator, Outcomes assessor
Enrolment
316 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05507684
Sponsor's protocol ID
945095 HEL
Acronym
RECETAS
Status last verified
Feb 2025
First submitted
12 Aug 2022
Last updated
28 Feb 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes

Publications

  • Papon V, Puntscher S, Arvandi M, Jahn B, Litt JS, Coll-Planas L, Maso-Aguado M, Pitkala KH, Laakkonen ML, Roitto HM, Holmerova I, Bartova A, Jones M, Drummond M, Siebert U, Rochau U. Protocol for the health economic evaluation of nature-based social prescribing against loneliness alongside the RECETAS trials. BMC Public Health. 2026 May 9;26(1):2001. doi: 10.1186/s12889-026-27698-2.

    PubMed 42106778
  • Pitkala KH, Rautiainen L, Kautiainen H, Aalto UL, Kolster A, Laakkonen ML, Partonen T, Roitto HM, Puntscher S, Rochau U, Siebert U, Bartova A, Holmerova I, Coll-Planas L, Litt JS, Strandberg T, Jansson AH. Effectiveness of nature-based group intervention in loneliness and health-related quality-of-life in lonely older adults living in assisted living facilities-a randomised controlled trial. Age Ageing. 2026 Feb 1;55(2):afag009. doi: 10.1093/ageing/afag009.

    PubMed 41638234
  • Vert C, Litt JS, Gascon M, Roque M, Maso-Aguado M, Opacin N, Garcia G, Jansson A, Cattaneo L, Bartova A, Briones-Buixassa L, Carbo A, Rautiainen LJ, Hidalgo L, Sachs A, Domenech S, Blancafort-Alias S, Holmerova I, Pitkala KH, Coll-Planas L. Evaluating the feasibility of "Friends in Nature," a complex nature-based social intervention to address loneliness and quality of life in six cities worldwide. Pilot Feasibility Stud. 2024 Nov 30;10(1):146. doi: 10.1186/s40814-024-01575-4.

    PubMed 39616375
  • Pitkala KH, Rautiainen L, Aalto UL, Kautiainen H, Kolster A, Laakkonen ML, Partonen T, Roitto HM, Strandberg TE, Opacin N, Puntscher S, Siebert U, Coll-Planas L, Sachs AL, Litt JS, Jansson AH; RECETAS project. Participants' baseline characteristics and feedback of the nature-based social intervention "friends in nature" among lonely older adults in assisted living facilities in finland: a randomised controlled trial of the RECETAS EU-project. BMC Geriatr. 2024 Oct 7;24(1):812. doi: 10.1186/s12877-024-05408-0.

    PubMed 39375627
  • Coll-Planas L, Carbo-Cardena A, Jansson A, Dostalova V, Bartova A, Rautiainen L, Kolster A, Maso-Aguado M, Briones-Buixassa L, Blancafort-Alias S, Roque-Figuls M, Sachs AL, Casajuana C, Siebert U, Rochau U, Puntscher S, Holmerova I, Pitkala KH, Litt JS. Nature-based social interventions to address loneliness among vulnerable populations: a common study protocol for three related randomized controlled trials in Barcelona, Helsinki, and Prague within the RECETAS European project. BMC Public Health. 2024 Jan 13;24(1):172. doi: 10.1186/s12889-023-17547-x.

    PubMed 38218784

Questions about this trial

What is this clinical trial studying?

A study testing Nature-based social prescribing group intervention in people with Loneliness, run by University of Helsinki at 1 site in Finland.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 28 Feb 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Finland. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in health related quality of life (time frame: From baseline to 3months, 6months, 12 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05507684, which also lists 5 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Feb 2025.

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