Understanding Group Processes to Maximise the Potential of Group Interventions

Abstract

Group interventions are often used to help people manage health and psychosocial wellbeing, including loneliness. However, systematic reviews show inconsistent evidence of their effectiveness, and few studies examine mechanisms shaping their outcomes. Evidence suggests that group processes enabled by social identification may provide a basis by which group interventions can enhance group experience and promote improvements in psychosocial outcomes, but further work is needed to optimise its practical application. The thesis aims to guide delivery and evaluation of groups, focusing particularly on those targeting loneliness, to understand how group processes are enacted, how they influence the experience of group participation, and how they shape intervention outcomes.

Four studies were conducted, informed by the social identity approach to health. A scoping review of 43 group-based interventions for loneliness in older people revealed little evidence that group processes were managed in a deliberate or systematic way, suggesting that group processes that underpin effectiveness are left to chance. Next, a cross-sectional survey of 579 stroke survivors from 84 community-based support groups found that support group identification was associated with reduced loneliness, while social support, having clear group goals, and member continuity were associated with greater group identification. Interviews with 14 stroke group members (12 stroke survivors; two carers) supported survey conclusions, further highlighting that shared experiences were important, but not sufficient, for fully accessing the benefits of stroke support group membership.

Finally, a generalisable framework was developed from literature review, expert consultation, and iterative coding of video data from two group interventions. It identified positive and negative behaviours indicative of group processes being enacted, to support researchers and facilitators to interpret group function.

This thesis advances theorising and practical application of the social identity approach to health and demonstrates the importance of understanding group processes as mechanisms shaping psychosocial intervention outcomes and participant experience. Findings inform practical recommendations for facilitators delivering groups that aim to develop shared identification.