Evaluating and Implementing The CONNECT Program - a Group-Based Telehealth Intervention to Reduce Social Isolation, Loneliness, and Mental Health Symptoms in Adults Ages 55+, Compared to Routine Community-Based Programming

Psychological flexibility will be measured using the Acceptance and Action Questionnaire-II, a 7-item self-report scale. Scores range from 7 to 49, with higher scores indicating greater psychological inflexibility, and lower scores indicating greater psychological flexibility. Psychological flexibility is a core target of Acceptance and Commitment Therapy and has been shown to be a transdiagnostic mechanism of change in psychotherapy outcomes.

Loneliness will be assessed using the De Jong Gierveld Loneliness Scale, a validated 6-item self-report instrument designed to measure emotional and social dimensions of loneliness. Total scores range from 0 to 6, with higher scores indicating greater loneliness and lower scores indicating less loneliness. Loneliness is a key risk factor for late-life depression and anxiety and is associated with negative physical and cognitive health outcomes.

Social isolation will be assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Social Isolation 8a short form, an 8-item standardized measure of perceived disconnection from others. Scores range from 8 to 40, with higher scores indicating greater social isolation. Social isolation is an objective risk factor for poor mental and physical health and is closely linked to late-life depression, anxiety, and cognitive decline.

Emotional support will be assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Emotional Support Short Form, a standardized self-report measure evaluating the perceived availability of caring and understanding individuals in one's life. Scores range from 4 to 20, with higher scores indicating greater emotional support. Greater emotional support is associated with reduced risk of depression, better coping with stress, and improved quality of life in older adults.

Anxiety symptoms will be assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety Short Form 4a, a validated 4-item self-report scale capturing core features of anxiety such as fear, worry, and nervousness. Scores range from 4 to 20, with higher scores indicating greater severity of anxiety symptoms. Anxiety is prevalent among older adults and is strongly linked to social isolation and reduced quality of life.

Depressive symptoms will be assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression Short Form 4a, a 4-item self-report measure capturing core features such as sadness, hopelessness, and lack of interest in activities. Scores range from 4 to 20, with higher scores indicating greater severity of depressive symptoms. Subsyndromal depressive symptoms are common in late life and are associated with lower quality of life and increased health risk.

Mental health literacy will be assessed using the Brief Mental Health Literacy Scale. This 4-item self-report measure evaluates perceived knowledge about signs and symptoms, possible causes, types of professional help available, and how to seek help for common mental health problems (e.g., anxiety, depression). Respondents rate their knowledge on a 5-point Likert scale (1=not at all, to 5=extremely). Composite scores range from 4 to 20, with higher scores indicating greater perceived mental health literacy. Older adults typically have lower mental health literacy than younger groups, which may hinder service use and self-identification of mental health problems.

Acceptability is defined as the perception among implementation stakeholders that a given treatment, service, practice, or innovation is agreeable, palatable, or satisfactory. Acceptability of the CONNECT Program will be assessed using a post-program survey that includes both Likert-scale items (1=not at all acceptable to 5=completely acceptable, with higher scores indicating greater acceptability) and open-ended questions. Survey items were developed based on the Proctor implementation outcomes framework.

Participant ratings of the CONNECT program intervention content acceptability will be assessed using the Intervention Content Evaluation survey adapted from McCracken et al., 2014. This survey includes Likert ratings of key aspects of the intervention. Items are rated on a 3-point scale: satisfied, neither satisfied nor not satisfied, or not satisfied. Higher satisfaction across items reflects greater acceptability of the CONNECT program content.

Qualitative exit interviews assessing participants' perceptions and overall satisfaction with the CONNECT Program. Data will be analyzed thematically to identify patterns in participant experience.

Weekly participant ratings of the quality and acceptability of group sessions will be assessed using the Group Session Rating Scale. This brief self-report measure captures participants' perceptions of four key aspects of each session: relationship, goals and topics, approach or method, and overall experience. Each item is rated on a 10-point visual analog scale, with higher scores indicating greater session acceptability.

Participant ratings of CONNECT program intervention delivery mode satisfaction and usability will be assessed using the Intervention Delivery Type Evaluation adapted from McCracken et al., 2014. Responses are provided using a 3-point Likert scale: satisfied, neither satisfied nor not satisfied, and not satisfied. Higher ratings reflect greater delivery acceptability; lower ratings reflect challenges or dissatisfaction with the delivery mode.

Acceptability will be evaluated through weekly facilitator-reported tracking of acceptability indicators such as attendance, dropout rates, reasons for missing sessions or discontinuing participation using the weekly facilitator check-in questionnaire (developed for this trial).

Adoption is defined as the intention, initial decision, or action to employ or continue using the CONNECT Program. Adoption will be assessed using a post-program survey, each item rated on a 5-point Likert scale (1=Not at all 5=Extremely), and open-ended questions (items developed based on Proctor implementation framework).

Adoption will be evaluated through weekly facilitator-reported tracking of adoption indicators such as attendance, dropout rates, reasons for missing sessions or discontinuing participation using the weekly facilitator check-in questionnaire (developed for this trial).

Appropriateness is the perceived fit, relevance, or compatibility of the innovation or evidence-based practice for a given setting, provider, or consumer, and/or the perceived fit of the innovation to address a particular issue or problem. Data will be collected through the post-program survey item, rated on a 5-point Likert scale (1=Not at all a good fit to 5=Excellent fit). Higher scores reflect greater perceived appropriateness. Participants will also respond to the open-ended question.

Qualitative assessment of participants' perceptions of the CONNECT Program's appropriateness using open-ended interview questions. Data will be analyzed thematically to identify patterns in participant experience.

Participants' evaluation of intervention content appropriateness using the Intervention Content Evaluation adapted from McCracken et al. (2014). Participants will rate satisfaction with specific components of the CONNECT Program using a 3-point scale (satisfied, neither satisfied nor not satisfied, not satisfied). Higher ratings across items indicate greater perceived appropriateness of the intervention content; lower ratings reflect poorer perceived fit or relevance.

Participants' perceptions of the appropriateness of the CONNECT Program's delivery mode will be assessed using the Intervention Delivery Type Evaluation Survey, adapted from McCracken et al. (2014). The survey includes participant ratings of specific delivery-related aspects using a 3-point scale (satisfied, neither satisfied nor not satisfied, not satisfied). Higher ratings indicate greater perceived appropriateness and fit of the delivery format.

Appropriateness will be evaluated through weekly facilitator-reported tracking of appropriateness indicators such as attendance, dropout rates, reasons for missing sessions or discontinuing participation using the weekly facilitator check-in questionnaire (developed for this trial).

Feasibility is defined as the extent to which an innovation can be successfully used or carried out within a given agency or setting. Feasibility will be assessed using the post-program survey item, rated on a 5-point Likert scale (1=Not at all manageable to 5=Very manageable). Higher scores indicate greater perceived feasibility. Participants will also respond to the open-ended question.

Qualitative assessment of participants' perceptions of the CONNECT Program's feasibility using open-ended interview questions. Data will be analyzed thematically to identify patterns in participant experience.

Participants' evaluation of intervention content feasibility using the Intervention Content Evaluation adapted from McCracken et al. (2014). Participants will rate satisfaction with specific components of the CONNECT Program using a 3-point scale (satisfied, neither satisfied nor not satisfied, not satisfied). Higher ratings across items indicate greater perceived feasibility of the intervention content; lower ratings reflect poorer perceived feasilibity.

Participants' perceptions of the feasibility of the CONNECT Program's delivery mode will be assessed using the Intervention Delivery Type Evaluation Survey, adapted from McCracken et al. (2014). The survey includes participant ratings of specific delivery-related aspects using a 3-point scale (satisfied, neither satisfied nor not satisfied, not satisfied). Higher ratings indicate greater perceived feasibility of the delivery format.

Feasibility will be evaluated through weekly facilitator-reported tracking of feasibility indicators such as attendance, dropout rates, reasons for missing sessions or discontinuing participation using the weekly facilitator check-in questionnaire (developed for this trial).

Penetration refers to the integration of an innovation within a service setting and its reach among intended users. At the recipient level, it is defined as the number of eligible individuals who use a service, divided by the total eligible population. At the setting level, it is the number of providers delivering the service, divided by the total number trained or expected to deliver it. Penetration will be assessed using the post-program survey item, rated on a 5-point Likert scale (1=almost none of them to 5=almost all of them). Higher scores indicate greater perceived program reach among eligible individuals. Participants will also respond to an open-ended question.

Cost (incremental or implementation cost) is defined as the cost impact of an implementation effort. Implementation cost will be assessed using the post-program survey item, rated on a 5-point Likert scale (1=It was no burden at all to 5=A very big burden). Higher scores indicate greater perceived cost or burden. Participants will also respond to an open-ended question.

Sustainability is defined as the extent to which a newly implemented treatment is maintained or institutionalized within a service setting's ongoing, stable operations. Sustainability will be assessed using the post-program survey item, rated on a 5-point Likert scale (1=Not at all sure to 5=Very sure). Higher scores indicate greater perceived sustainability. Participants will also respond to the open-ended question.

Sustainability will be evaluated through weekly facilitator-reported tracking of sustainability indicators such as attendance, dropout rates, reasons for missing sessions or discontinuing participation using the weekly facilitator check-in questionnaire (developed for this trial).