Befriending Services for Culturally Diverse Older People

Journal of Gerontological Social Work ISSN: 0163-4372 (Print) 1540-4048 (Online) Journal homepage: https://www.tandfonline.com/loi/wger20 Befriending Services for Culturally Diverse Older People Janine Wiles, Tessa Morgan, Tess Moeke-Maxwell, Stella Black, Hong-Jae Park, Ofa Dewes, Lisa Ann Williams & Merryn Gott To cite this article: Janine Wiles, Tessa Morgan, Tess Moeke-Maxwell, Stella Black, HongJae Park, Ofa Dewes, Lisa Ann Williams & Merryn Gott (2019) Befriending Services for Culturally Diverse Older People, Journal of Gerontological Social Work, 62:7, 776-793, DOI: 10.1080/01634372.2019.1640333 To link to this article: https://doi.org/10.1080/01634372.2019.1640333 Published online: 11 Jul 2019. Submit your article to this journal Article views: 447 View related articles View Crossmark data Citing articles: 1 View citing articles Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=wger20 JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2019, VOL. 62, NO. 7, 776–793 https://doi.org/10.1080/01634372.2019.1640333 Befriending Services for Culturally Diverse Older People Janine Wilesa, Tessa Morganb, Tess Moeke-Maxwellb, Stella Blackb, Hong-Jae Park Ofa Dewesb, Lisa Ann Williamsb, and Merryn Gott b c , a School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; bSchool of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; cSchool of Social Sciences and Psychology, Western Sydney University, Penrith, NSW, Australia ABSTRACT ARTICLE HISTORY Befriending services may address loneliness and social isolation amongst older people. However social diversity is rarely reported in investigations of befriending services. The views of non-users are also rarely explored. In this research, we explored older adults’ experiences of, and attitudes towards, a befriending service, among service users and non-service users, drawing on interviews and focus groups with 76 older adults, 10 volunteer visitors, and 20 service providers. Participants agreed that the befriending service helped alleviate social isolation and loneliness and that supportive services to foster connection are needed. Barriers to engagement included lack of knowledge, appropriateness of services and feeling undeserving. The befriending service was most successful when a match went beyond a transactional ‘professional-client’ relationship to resemble genuine friendship, underpinned by mutual interests and norms of reciprocity and reliability. We also identified five clear ideas about what characterizes an ideal supportive service; supported opportunities for getting out, genuine and reciprocal relationships, reliability, visitor characteristics, and connecting people to their culture. Befriending adds to social networks, and enhances connectedness to the community. Loneliness is alleviated when mutually beneficial and genuinely reciprocal relationships develop. However, group interventions or connections to community groups may be more appropriate for some. Received 13 November 2018 Revised 1 July 2019 Accepted 1 July 2019 KEYWORDS Social connectedness; volunteer; loneliness; social isolation; diversity Introduction Befriending has received increased interest internationally as a low-cost way to increase older people’s social networks (Moriarty & Manthorpe, 2017) and alleviate social isolation and loneliness which are costly to both individuals and society (Mann et al., 2017; World Health Organisation, 2015; Poscia et al., 2018). Befriending is ‘a relationship between two or more individuals which is initiated, supported and monitored by an agency that has defined one or more parties as likely to benefit’ (Joseph Rowntree Foundation, 1998). It is a ‘direct’ form of formalized and targeted intervention to alleviate loneliness through CONTACT Janine Wiles [email protected] School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, New Zealand © 2019 Taylor & Francis Group, LLC JOURNAL OF GERONTOLOGICAL SOCIAL WORK 777 supported socialization (Mann et al., 2017). Befriending can be conducted oneto-one or in groups, over the phone or in person, at home or through ‘going out’ (Moriarty & Manthorpe, 2017). Befriending differs from other forms of peer support, such as mentoring, as it develops more informally, often over a longer period of time (Moriarty & Manthorpe, 2017). There is little consensus about whether befriending services influence older peoples’ experiences of social isolation and loneliness, and if so, how. Some quantitatively-focused systematic reviews have concluded one-to-one interventions may be less effective than either groups with activities or support (Cattan, White, Bond, & Learmouth, 2005; Dickens, Richards, Greaves, & Campbell, 2011). However recent qualitative reviews suggest befriending services can alleviate social isolation and loneliness (Cattan, Kime, & Bagnall, 2011; Gardiner & Barnes, 2016; Poscia et al., 2017). While some of this research has included older service-users’ perspectives, key evidence gaps remain. Notably, little is known about the views of older people who are lonely but do not engage with befriending services; or about the accessibility, acceptability and efficacy of interventions which support culturally diverse communities of older people (Gardiner, Geldenhuys, & Gott, 2018). A recent review of why some groups are over- or underrepresented among service-users (Moriarty & Manthorpe, 2017), observes that diversity of all kinds (e.g., age, gender, disability, sexuality, ethnicity), are rarely reported in research on befriending. In this paper, we address these gaps by exploring culturally diverse older adults’ attitudes towards and experiences of a befriending service in Aotearoa New Zealand. Our study included current befriending service-users, and eligible non-users. To further ‘crystallize’ our understanding, we also include the perspectives of volunteer visitors, and other key informant stakeholders and service providers. Methods This qualitative study was conceptually framed by attention to individual factors and socio-environmental contexts, as well as the synergies between them (McLeroy, Norton, Kegler, Burdine, & Sumay, 2003). Ethics approval was granted by the University of Auckland Human Participants Ethics Committee (016593). The service we investigated was the Age Concern New Zealand ‘Accredited Visiting Service’ (AVS) program, referred to here as a ‘befriending service’. Age Concern NZ is a charitable organization consisting of a network of 33 Member Councils, two affiliated services, and a national office, with a core of paid staff supported by around 4,500 volunteers. It is reliant on funding from government agencies, philanthropic trust grants, contributions from clients, and donations. Along with providing information and services for older people’s needs including advocacy, public awareness, health promotion, and prevention of elder abuse and 778 J. WILES ET AL. neglect, Age Concern NZ have run the AVS program to enhance social connection for almost thirty years. The AVS befriending service is run by a core of 30 paid staff (most part time) and supported by around 2,500 volunteers supporting 2600 clients. The befriending service consists of a volunteer visiting an older person who has expressed a desire for more company (and is able to contribute to a mutually beneficial relationship). Visits are for about an hour weekly ‘to enjoy conversation and shared interests and activities’ (Age Concern NZ, 2019). The purpose is to provide supportive contact, and improve health and wellbeing. Age Concern NZ supported the research design and facilitated recruitment of older people receiving the AVS befriending service, but did not play a role in the data collection, analysis, or interpretation. Recruitment: participants and settings Recruitment was from three areas of Aotearoa, New Zealand which each had socio-economically and culturally diverse populations and an established Age Concern NZ befriending service. We recruited at least 10 people aged over 65 from each of four broad cultural groups: Māori (indigenous New Zealanders); New Zealanders of European descent (NZE); Pacific living in NZ (including Samoan, Tongan, Fijian); and Asian living in NZ (Chinese and Korean). Few current Age Concern NZ befriending service clients are Māori, Pacific, or Asian and the organization is interested to understand how best to use their limited resources to engage a more culturally diverse population. Our original research design centred on individual interviews but some older people preferred to be interviewed in groups, so we included three additional group interviews. Age Concern NZ service coordinators supported recruitment of serviceusers, identifying and presenting potential participants who met our criteria with information about the study. Those who indicated interest were then contacted by a researcher. We also deliberately recruited non-service users. In NZ, older people access ‘packages of care’ after assessment by a Needs Assessment and Service Coordination (NASC) service; this includes assessment using the widely-validated interRAI measure (Morris, 2009). For this study, people not using the befriending service, but experiencing social isolation and loneliness according to a single-item interRAI screening question, were verbally invited to participate in the research by a NASC provider known to them. Those who expressed interest received a letter of information and a follow-up phone call from a researcher. To ensure appropriate representation, additional Māori, Pacific, Chinese and Korean participants who were not using the befriending service were recruited in a similar way, through culturally-specific services known to them, with a culturally matched member of the research team following up on expressions of interest. We had all information and consent materials translated into Mandarin and Korean. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 779 Prior to the interview, interested individuals received at least two calls to discuss the research and build rapport with the interviewer. This rapport-building process included a separate visit prior to interview for Chinese participants, and at the beginning of the interview visit for Māori and Pacific participants in a process of whanaungatanga [establishing relationships and relating well to each other]. Volunteer visitors who had been in that role longer than six months (n = 10) and other stakeholders supporting older people in the community (n = 20) were recruited as key informants via purposive, snowball sampling techniques (Table 1). Other stakeholders included Age Concern NZ managers and coordinators, NASC team members, social workers and nurses, and other social and cultural support workers from relevant third-sector groups supporting older people in the community. Data collection Data collection took place in 2016, and all participants provided consent to participate. The interview guide addressed experiences and understandings of social isolation and loneliness, and of the befriending service. We conducted individual interviews with 44 older people, 22 who received the befriending service and 22 who did not (Table 2). Forty interviews were conducted in the participant’s home, two (both Chinese participants) in a café selected by the participant, and two (both Pacific participants) at a known healthcare provider’s office. Interviews with older people ranged from 16 to 93 minutes; most averaged one hour. Ten participants had a support person with them (in four cases this was their volunteer visitor, one was a manager at an office, and five were family members). All supporters willingly left on request when questions specifically about the befriending service were asked. Group interview discussions were also undertaken with 32 older adults in the community. One of the three group discussions with older people took place in a participant’s home (four Korean participants). The other two were at community centers; one with six Chinese participants, and one with twenty-two people attending an Age Concern NZ-hosted fortnightly coffee group, most of whom were Māori. These discussions ranged from 31 to 44 minutes. Key informants participated in one of 16 individual or small group interviews (from two to five people), lasting between 32 and 105 minutes. These also took place in organization offices, community centers, and a residential care home. Table 1. Characteristics of interview participants. Cultural group Total Female (Male) Age range (Average age) Befriending service (yes/no) Māori 10 9 (1) 55–90 (77.6) 5/5 Pacific 10 9 (1) 61–90 (72.3) 3/7 Asian 10 10 63–89 (77.9) 5/5 New Zealand European 14 8 (6) 70–92 (82.5) 9/5 780 J. WILES ET AL. Table 2. Characteristics of key informants. Total Ethnicity: NZE Māori Pacific Asian Other Gender Female Male Age group 20–29 30–39 40–49 50–59 60–69 70–79 80–89 Volunteer visitors 10 Other stakeholders 20 5 2 1 1 1 9 5 3 2 1 7 3 16 4 2 3 1 3 1 1 2 2 11 4 - Interviewers and interviewees were matched by ethnicity and language (eight interviewers participated). Customs of hospitality and reciprocity were followed, e.g., offering appropriate koha [reciprocal gifts] to older participants, and kai [food] and karakia [prayers] with Māori participants. All participants gave written informed consent to participate prior to beginning the interview, with the exception of the large interview group where participants ‘opted in’ by staying to participate in a spontaneous interview held immediately after an Age Concern coffee morning where the project had been presented. This group interview began with a conversation about informed consent All interviews and group discussions were digitally recorded and transcribed. Korean data were collected, transcribed and translated by the same researcher, and Chinese data transcribed and then translated by a researcher who was not the interviewer. Data analysis We analyzed our data using a thematic approach (Braun & Clarke, 2006), influenced by the socio-ecological framework to be attentive to the interaction between context and individual experience. To familiarize, the lead researcher for each of the cultural groups chose two transcripts for the group to read together and discuss initial observations and categories. Then we developed higher-level codes, using NVivo 11 for support. We then coded our data into descriptive and latent themes (Braun & Clarke, 2006), looking for similarities and differences across the transcripts, as well as coherence and context within each transcript (Maxwell & Chmiel, 2014). At least two people coded each transcript, including at least one researcher leading the culturally specific data set. Key informant data were read multiple times to interrogate how their JOURNAL OF GERONTOLOGICAL SOCIAL WORK 781 responses ‘fitted’ against the older people’s data. For the purposes of this paper, we have focused on analysis of data related to a ‘befriending service’, including any discussions about not using the service, and ‘wished for’ services. Interview participants are identified by ethnicity (E: NZ European, M: Māori, P: Pacific, or A: Asian), gender (M:F), and a unique number. Those not participating in the befriending service are also identified as ‘non-service user.’ Interviewer questions are presented in bold. Findings Participants agreed some kind of supportive service to foster social connection for isolated older people is needed. The key to the befriending service alleviating loneliness was that it went beyond a transactional ‘professional/ client’ relationship to resemble genuine friendship, underpinned by mutual interests and norms of reciprocity and reliability (see also Lilburn, Breheny, & Pond, 2018). Many older people perceived these characteristics as more important than the socio-demographic characteristics of the visitor; for some older people, the belief that a genuine connection could not be achieved was a barrier to engaging in the service. Another function of the befriender was supporting connection to the wider community. For Māori, Pacific, Chinese and Korean older people, the visitor could also provide connection to culture. Therefore, cultural matching was more important for non-NZ European older people, and group activities with others of the same cultural background were often preferred. In the remainder of this paper, we first explore reasons participants who were ‘non-service users’ and did not use the befriending service, followed by what participants in general (both service users and not) felt was (or could be) particularly valuable about such services. Reasons for not using services Not knowing about the befriending service Older people not using the service either lacked knowledge about it but expressed interest in participating, or felt that it was not appropriate for them to use. Seven had not heard of the befriending service; of these, at least three expressed enthusiasm for finding out more, ‘it will help me out to know more people, and I would be out of the house. I won’t feel lonely’ (PF08, non-service user). Older service users also suggested the need for greater promotion of the service and service providers highlighted the importance of reflecting the cultural diversity of the volunteers in recruitment material: 782 J. WILES ET AL. if you’re just looking at the service, at the beginning, like just looking at the pamphlet or meeting the coordinator, or the website, you might not realize that you’re going to get that connection with, either if you’re a migrant, or from a diverse or marginalized group (SP16). Uncertainty if it would work ‘for me’ There was also a perception amongst non-service users that the befriending service was for people who were ‘really’ lonely or isolated; ‘really I shouldn’t be on it, people who really need it should get it … right into my 80s is maybe a better time’ (EF09, non-service user). Asian participants in particular thought the voluntary service had limited funding and ought to go to people they perceived as ‘the worst-off’: ‘No need to use them now, so no need to waste Government money’ (AF05, non-service user). Such views were underpinned by their pervasive experiences of racism and a related sense they did not want to ‘fuel’ further racism by being perceived as using more services than they ‘deserved’. Although no-one explicitly suggested the service would not be valuable, at least two NZE men did say they themselves did not want a visitor, in one case because he was uncertain of whether there could be shared interest: But what I’m hesitant about … have they got a genuine interest in things that I’m interested in? And if they haven’t, then there’s nothing, a visit to talk to you about nothing, no interest in common, is just as good as no visitors at all for me you know? (EM08, non-service user) Another woman viewed the service’s guideline of a one-hour, weekly time slot as a barrier: ‘an hour’s not long. I mean what can you talk about?’ (EF10, non-service user). These responses highlight anxiety about the difficulty of reciprocating adequately, or developing a meaningful relationship. Service providers felt this kind of ‘opting out’ was associated with the stigma attached to loneliness and that it presented a significant barrier to older people accessing the service. What participants valued about the befriending service We identified five clear ideas about what characterizes an ideal supportive service: supported opportunities to get out and about, genuine and reciprocal relationships, reliability, characteristics of the visitor, and the role of a service in enabling connection to their culture. The latter was discussed in particular by Māori, Pacific and Chinese/Korean older people. Getting out and about Although participants varied as to where they would like to meet their visitor, all expressed a desire to have some role in determining the place. For those JOURNAL OF GERONTOLOGICAL SOCIAL WORK 783 using the befriending service, the way it enabled opportunities to get out of the house was one of the most frequently mentioned benefits. Even for those not using the service, support to get out of the house was also a potentially attractive benefit: I think … it’s somebody with me to go out. The activities out there, I loved to be with people. Because as we grow older I’m sure, it’s what’s happening around, you need somebody to go out. Or just to be there. Company, that’s the word, yeah. (PF07, non-service user) People organizing things for people to go to … . But if we go, the thing is, if we go … And being able to go. (MF08, non-service user) This need for support to get out, and the value of doing so was echoed by volunteer visitors, who emphasized the connecting role they played for the person they visited with their community and the sense of esteem this engendered: VV1: … taking them out for a drive is fine, that stimulates them with their sights and sounds and all that, but a café visit does amazing things I think … . And what is it about the café, having the coffee, what else is in that, do you think? VV1: I think it stimulates them intellectually. We have some good conversations when we’re at the café. VV2: Could it be a feeling that they’re in with the community. VV1: Yep, yep. ‘I’m not so bad after all.’ VV2: There is a world out there. (Volunteer visitor focus group 01) Some participants suggested having support from someone familiar would be helpful in overcoming the initial hurdle of joining established group activities in the community: People coming to pick you up, and take you out … . sometimes you feel a bit shy about walking into a group that’s already there … [and] everyone’s going to turn around and look at you … so to take someone along to something would be fantastic … It’s difficult doing things on your own, you really need a companion to take you. (EF06) Getting out of the house was also important for participants who felt their homes were not appropriate for socializing. Those living in social housing or with family often pointed out their homes were too small to have people over. Some of our participants were housebound or had limited mobility. Visitors could help such participants ‘get out’ metaphorically by providing news or ‘a bit of scandal’ (EF06) about the wider community. The 784 J. WILES ET AL. importance of being able to talk about the wider world, rather than being focused on themselves, was emphasized by several older people as well as visitors. Genuine, reciprocal relationships A key aspect of good visits was when the relationship was perceived as being genuine, in the sense that it was caring and meaningful. A degree of informality seemed to underpin the most successful matches: I like someone who treats me like a family and she does … . I wanted the person who comes to visit me to mix it, like she’s part of me and I’m part of the family, she knows me for a long time. She can come anytime and say, ‘Oh we’ll have a cup of tea, let’s go out somewhere, yeah’ (PF02) Volunteers also wanted genuine relationships, in addition to wanting to give back they often also wanted to establish new relationships (sometimes as a result of their own families living away). Service-users were near unanimous in their desire for a volunteer with mutual interests. Although some expressed anxiety about whether they could reciprocate, the sense of mutual exchange was an important aspect of a genuine, meaningful relationship for both service users and volunteers: She’s easy for me to spend time with, but I wonder whether I’m a bit boring, you know, for her. (EF03) And we talk about world events … yeah, we get on well. He tells me that he enjoys coming so I take him at face value there So what do you think is your favorite part about spending time with your visitor? Talking … Exchange of ideas. (EM05) In addition to social reciprocity, there were also powerful cultural dimensions of exchange and recognition. For example, most of our Māori participants viewed the sharing of kai [food] as important to underpinning manaakitanga [hospitality and caring]: … so whenever she can, she comes, yeah. But other than that, well they don’t come every day but every time she comes she brings me a cake [or a sandwich]. Every time, she never misses (laughter) … Yeah she always does, she never comes without anything. (MF03) The mutual exchange of refreshments (e.g., offering a cup of tea), spending time together, and sharing kai builds and confirms the respect within, and ‘extraordinary everydayness’ of the relationship. For Māori and Pacific people, such hospitality and reciprocity is an important part of whanaungatanga. Manaakitanga is about caring, and often includes freely sharing whakapapa [genealogies] or personal stories and looking for ways to whakamana [acknowledge and uplift the status of] the other person. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 785 On the other hand, multiple NZE and Asian participants did not want their visitor to buy them coffee, as their perception that they could not reciprocate made them feel uncomfortable: I get Age Concern lady comes round – Every week. She’s lovely. But I don’t like her shouting [paying for] me coffee, you know. She’s [working], but we’re all in this tough times together, aren’t we? Rates, mortgages, car payments, maintenance, you know, the whole lot of us are. And if I can’t afford $3.80 or $4.00 for a cup of coffee, I don’t deserve the trip out. You know what I mean? … But she did shout [pay for] me at the start, you know, and I just felt, second rate. … Do you do anything to prepare for her visit? You mean like food or something like that? … No, I just stop her from buying my coffees, because we’re all in this rowboat, New Zealand, together. And everything’s dear [expensive]. (EF03) Reliability and frequency of the visit Reliability was the most frequently mentioned characteristic of a ‘good’ visitor. Older participants felt satisfied when they knew what day and time their visitor would arrive and that their visits would occur every week. For many, their visitor was one of only a handful of people they saw regularly: But they were so good because they’re my only, only time I can talk to someone when they come to visit me. (PF03) Being reliable signaled respect for the physical and emotional effort participants put into receiving their visitor. They were understanding when their visitors could not visit, but wanted to be told in advance: [my visitor is] easy to talk to, but the only one complaint I’ve got is I don’t know when she’s coming … . I wouldn’t mind seeing her again, yeah,. … if she could give me a ring [phone call] and say she’s coming, that’s the only thing I want, yeah. Because, you know we said Thursday at about 11 there and yeah a couple of weeks passed and she never turned up, and I’d tidied up the house and bloody get dolled up and have a shower and God knows what, you know (laughter) … anticipating a bloody visitor, you know, yeah. (EM04) Participants reported visits ranged from half an hour to four hours every week. Overall, service-users wanted visits to be more frequent and to last longer. Of the volunteer visitors we interviewed, almost all spent more than an hour each week with the person they visited and indicated they also provided emotional support outside of the weekly visit. Service-users and volunteer visitors also stressed reliability in relation to the confidential nature of conversation and the ability of visitors to support people with a variety of serious issues, including agoraphobia, depression, and suicidal feelings. 786 J. WILES ET AL. Characteristics of visitor Other characteristics of the visitor, such as age, gender and ethnicity, were often discussed but infrequently flagged as important or specific considerations. Many participants explicitly stated they were more interested in the authenticity of the relationship: Anyone else? And I’ve got [befriending visitor’s name]. [repeats name]. Is she Māori or Pakeha? She’s lovely. [smiling] She’s lovely. That’s a good answer. She’s, no, she’s lovely, she’s a Scots or … Yeah, some foreign, but ka pai [that’s okay, good] … .Yes. She comes in and … puts a jug on and makes a cup of tea, and then she sits down (laughing). … you get that wairua [soul, feeling, connection] amongst yourselves (MF02) Yet there were some participants who expressed explicit preferences for visitors similar to themselves, whether of their own cultural background, perceived ‘class’, age or gender. Others were also keen that their visitors have specific characteristics, although often it was that they would be different from them in some particular way. Some expressed interest in having a visitor of a different gender. Some also felt that being from different cultures enhanced the visit: She’s really, really good, and really nice … She’s from another country … . She’s lovely. She’s like me, not a great talker. And sometimes there’s little bits of silence … But I’ve gotten to know her pretty well … It’s a little bit, educational, you know, for me. And for her, I guess. (EF03) There were also numerous, more implicit suggestions that cultural matching for Māori, Pacific and Asian participants mattered because of language, and cultural understandings of reciprocity. For those who had migrated in later life and did not speak English, which was the case for all of our Asian participants, having a shared language to converse in was essential. This view was shared by one of our Pacific key informant participants: Because language is the main thing, if you have a language barrier, what do you do? So I feel it’s important for that person to be from that culture, or at least know the language. (SP19) Connection to culture A number of Pacific, Asian, and Māori participants mentioned group activities hosted by Age Concern, as valuable opportunities to get out and have social contact: JOURNAL OF GERONTOLOGICAL SOCIAL WORK 787 Like the Age Concern in [location], I go there and learn English, I go home when I finish the class. They do have some activities, like singing, dancing, painting, vegetable growing, I didn’t join them. I wanted to join the singing group, but it wasn’t really arranged. (AF03) [My neighbor] says, ‘I go to a program called the Kaumātua Program. Would you like to come?’ And I went, ‘No’. And she goes, ‘Oh, but it’s just old people, like us.’ She made it sound really interesting and that it’d be really up my alley. … .I think the service is excellent. I recommend it to anybody who, who is a little bit, like myself, I was at the time, only within my four walls, to draw them out. To get them interested in something outside the home. (MF05) For some of the participants not currently using the befriending services, group activities, rather than one-on-one arrangements, were also preferred. This was especially so if they drew on cultural ways of connecting. For example, some expressed their preference for the Kaumātua Program [a day service for older Māori], which is embedded in Māori tikanga [custom]: Well, we start off with a karakia [prayer] and then we have lunch. And after lunch we go into, some play Connect Five, some play cards over there, and some play socializing over there. And it’s massive (laugh), just to be with them. (MF06, nonservice user) If the elderly people can have more contacts with each other, I think that would be enough [to solve the problem of loneliness]. We’d have more activities, we would have more chance to meet up, and talk about the things; you say your news, and I say mine. Everyone talks a bit, the time will go fast, and playing mahjong can also kill the time. (AF06, non-service user) Activities that drew on cultural values were also appealing to many of those currently using the services, often in addition to the visitor: That would be wonderful, like a whakawhanaungatanga [building relationships], a gathering Everyone getting together? Yeah, and take a plate [bring food] and have a shared lunch or something. (MF02) Discussion The befriending service was highly valued amongst those participants who used it, especially where genuine and reciprocal relationships were enabled, and participants were supported to make meaningful connections to their wider communities of interest. While Māori, Asian and Pacific adults are underrepresented in befriending services in a similar way to other minoritised groups (Moriarty & Manthorpe, 2017), we found many were interested to know about the service. The major barrier for not engaging was not knowing about the service, which 788 J. WILES ET AL. may suggest a need for more extensive marketing and clearer referral pathways to be inclusive of diverse groups and of less ‘active lonely’ people (Cattan, Newell, Bond, & White, 2003). Many Māori, Asian and Pacific participants, however, described ideal services as those that connected them with wider community groups, rather than operating individually (see also Kharicha, Iliffe, Manthorpe, et al., 2017). In conjunction with findings about perceptions of befriending services being ‘not for me’, and the emphasis on mutuality, getting out of the house and reliability, these proposals suggest there is a need to explore ways in which current befriending services can work with existing culturally-specific organizations to ensure a greater degree of cultural alignment; this is likely to be most effective from a communitydevelopment basis with the active involvement of older people (Dickens et al., 2011; Gardiner & Barnes, 2016) and investment in collaborative relationships with organizations representing diverse cultural interests. It is, nevertheless, important to acknowledge the cultural heterogeneity within cultural groups, and thus the need to offer all participants a wide range of choices including group and individual interactions, more formal and less, and at home or outside home. Another barrier of entry was that some participants did not view themselves as ‘old enough’, or as worse off than others, or were reluctant to somehow ‘take advantage’ of services they perceived as being in scarce supply. This aligns with other findings that descriptions of support as being for loneliness or specific to older people discouraged engagement (Kharicha et al., 2017) and that non-targeted interventions tend to be more effective than those explicitly aimed at older or lonely people (Dickens et al., 2011). Discourses of limited resources in the volunteer sector, while designed to promote further donations, might limit engagement with the service by people who need it most. This study supports evidence (Cattan et al., 2011; Lester, Mead, Graham, Gask, & Reilly, 2012; Moriarty & Manthorpe, 2017) that befriending services can alleviate social isolation by adding a regular and reliable contact into diminished social networks. Even when the visitor was not physically present, the service gave participants something to look forward to and a sense someone cared about them (Gardiner & Barnes, 2016). Service-users and visitors enjoyed being valued companions, and this appeared to enhance the social confidence of both parties, which may be a mechanism through which befriending services can alleviate social isolation (Bradshaw & Haddock, 1998; Gardiner & Barnes, 2016). We also found the befriending service alleviated social isolation by enhancing participants’ feelings of connection to their community (Cattan et al., 2011). Volunteers brought news of the outside world in, which was especially important for participants whose health and mobility issues made it difficult to leave home. All participants who were physically able, however, wanted JOURNAL OF GERONTOLOGICAL SOCIAL WORK 789 the opportunity to get out, particularly to ‘third spaces’ like coffee shops (Gardner, 2011). For some, this sense of ‘doing extra’ sealed the relationship with the befriender, making it less formal and enhancing a sense of reciprocity (Andrews, Gavin, Begley, & Brodie, 2003). However it is notable that was not experienced in the same way by all cultural groups, and that there are complex cultural, social, and economic dimensions to reciprocity. Reciprocity was also fundamentally underscored by the visitor’s reliability, which was seen by participants as a mark of respect, further instilling feelings of being a worthy companion (see also Andrews et al., 2003). While befriending visits might be more structured and less spontaneous than other relationships they may also be more reliable and regular contacts (Lilburn et al., 2018). The befriending service alleviated participants’ loneliness when mutually beneficial relationships transformed into meaningful friendships (Gardiner & Barnes, 2016; Lester et al., 2012). This helps to make sense of why participants saw mutual interests as the most important aspect in underpinning a ‘good’ match (Lester et al., 2012), and supports previous research stressing the importance of older people wanting to maintain their former identity, either from their previous roles or centered on a beloved hobby (Cattan et al., 2011). Other aspects contributed positively to feelings of reciprocity and were essential to building friendship. As with previous research, we found that the ability to have ‘safe’, confiding relationships with someone who was perceived as a peer rather than a service provider enabled participants to discuss sensitive topics, including their feelings of loneliness (Andrews et al., 2003; Lester et al., 2012). The face-to-face aspect of the service was seen as central to fostering strong connection and allowing friendships to develop, as well as widening social networks (Cattan et al., 2011). The voluntary nature of the service further enhanced reciprocity, indicating to participants their visitor wanted to be there and countering feelings of inadequacy (Andrews et al., 2003; Cattan et al., 2011). Volunteers felt their acts of volunteering made the experience very satisfying as it enabled them to fulfil their sense of duty to give back to the community, while also giving them an enjoyable and educational time (Stephens, Breheny, & Mansvelt, 2015) and helping them establish relationships too. Strengths and limitations Our paper draws on diverse cultural perspectives from older people themselves, as well as a range of relevant stakeholders, and the research team included people with a variety of attributes and skills pertinent to achieving this. Working with our community-collaborative partners including Age Concern AVS and hospital partners enabled us to recruit from groups that have often been excluded from research participation because of their social isolation. We were able to glean 790 J. WILES ET AL. more nuances by comparing samples of older people who were involved in AVS and not involved in AVS. There was a need to build rapport with participants given the sensitive nature of this research. A potential limitation of the study is that we did not conduct multiple in-depth interviews with participants. Nevertheless, we went to significant lengths to ensure participants were familiar and comfortable with interviewers before the interview, for example, by making multiple phone calls, or visiting or meeting prior to interviews. A slightly higher proportion of NZE participants were befriending service users. It is unlikely however that positive statements about the befriending service relate to a NZE perspective: all those engaged with the service valued it highly regardless of their cultural background; and many non-users from other cultural backgrounds were interested to learn about and potentially engage with the befriending service as well as other services supportive of connection such as groups. Another potential limitation was that, in some cases, a support person or volunteer visitor was present during the interview. Usually this was at the request of the participant and in all cases these visitors were asked to step outside when any questions that might be sensitive (such as perceptions of the visitor) were asked; all were very happy to do so. Implications for policy and practice Addressing the need for culturally sensitive and flexible models of individual and group-based befriending can be difficult within the constraints of current funding models, but must be prioritized, given the rapidly growing numbers of older people worldwide experiencing social isolation and loneliness. The complexity of problems related to isolation and loneliness such as poor mental health means that volunteers may need ongoing support and training to do their work. Given that success in alleviating loneliness revolved around genuine feelings of reciprocity, befriending service providers’ attention should focus on supporting such bonds to flourish in culturally tailored ways. Actions could include recruiting befrienders who speak languages other than English and communicating this in wellconsidered material in a variety of languages, and engaging advisors from cultural groups. Conveying the benefits to volunteers (including establishing new relationships) in advertising may also be helpful. To neutralize cultural barriers around reciprocity, providers could consider introducing ‘coffee/tea’ or petrol allowances to enable both parties to take turns at hosting and support older people to feel they are a contributing member of the relationship. Investing resources in a variety of models, including traditional one-on-one befriending services and larger group gatherings, structured activities or informal spaces for gathering, or even services not necessarily targeted at older people or specifically for social isolation and loneliness would also be worthwhile. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 791 Conclusion In illustrating how a face-to-face, peer-led befriending service can be effective in ameliorating feelings of social isolation and loneliness in a culturally diverse group of older people, this paper contributes to the literature on interventions for loneliness and social isolation. We demonstrate that this service combats social isolation by increasing older adults’ social networks, their ability to connect with others, and their sense of belonging to the wider community. A befriending service lessens loneliness when mutually enhancing friendships, based on principles of reciprocity and reliability, are facilitated. Further practice and policy must focus on tailoring befriending services to meet the needs of increasingly culturally diverse populations; which may require certain modifications of the current individualized focus, offering a greater diversity of opportunities for social interaction, and greater cooperation and collaboration with pre-existing, culturally specific services. Acknowledgments We would like to thank our participants for their generosity, time and insights. We are grateful for funding from the New Zealand Ministry of Business, Innovation and Employment’s National Science Challenge Aging Well Fund (Social Isolation, 12815/1, SUB1302). We thank Louise Rees, Clare Gardiner, Judith Davey, and Robyn Dixon for their support. We thank the various organisations who supported this research including: Age Concern NZ, Salvation Army, Treasuring Older Adults, Waitemata and Counties Manukau NASC teams. 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