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Background <p>Loneliness is recognized by the World Health Organization as a major global public health concern, with well-documented consequences for mental and physical health. Yet it remains under-prioritized in public health programs, particularly in low- and middle-income countries (LMICs). In rural India, intersecting vulnerabilities—caste, gender, and widowhood—exacerbate risks of social isolation and loneliness in later life. Despite commitments under the National Programme for Health Care of the Elderly (NPHCE), validated screening tools are lacking in primary care.</p> Objective <p>To evaluate the psychometric properties of the 8-item UCLA Loneliness Scale (UCLA-8) among community-dwelling older adults in rural Tamil Nadu, using Classical Test Theory (CTT) and Item Response Theory (IRT).</p> Methods <p>A cross-sectional survey of 413 older adults (≥ 60 years) was conducted across five villages. CTT analyses assessed internal consistency, item–total correlations, and factorial structure via exploratory and confirmatory factor analyses. IRT analyses applied a graded response model to estimate item discrimination, threshold parameters, and test information. Known-groups validity was examined by gender, age cohort, and living arrangement.</p> Results <p>The UCLA-8 demonstrated acceptable internal consistency (α = 0.74) and a two-factor structure distinguishing emotional from social loneliness. Emotionally salient items (e.g., “I feel alone”) showed high discrimination and strong factor loadings, whereas reverse-coded relational items (e.g., “I feel part of a group”) underperformed. IRT findings indicated optimal precision for detecting moderate-to-high loneliness but weaker sensitivity at lower levels. Loneliness scores were significantly higher among widowed women, Scheduled Caste/Scheduled Tribe (SC/ST) elders, and those living alone.</p> Conclusions <p>The UCLA-8 shows robust psychometric validity and feasibility as a brief, equity-sensitive screening tool for rural Indian primary care. Cultural adaptation of weaker items and integration into NPHCE and Health and Wellness Centres could enable earlier detection and support for loneliness among structurally marginalized older adults.</p>

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Psychometric evaluation of the UCLA-8 loneliness scale among structurally vulnerable older adults in rural India: implications for equity-oriented screening in primary health care

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月25日

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  • Suman Kanougiya,
  • M. Dhanush,
  • R. Dharani,
  • S. Baskarpandi,
  • A. Surendhar,
  • B. Vishali,
  • R. Swetha,
  • V. Oviya

摘要

Background

Loneliness is recognized by the World Health Organization as a major global public health concern, with well-documented consequences for mental and physical health. Yet it remains under-prioritized in public health programs, particularly in low- and middle-income countries (LMICs). In rural India, intersecting vulnerabilities—caste, gender, and widowhood—exacerbate risks of social isolation and loneliness in later life. Despite commitments under the National Programme for Health Care of the Elderly (NPHCE), validated screening tools are lacking in primary care.

Objective

To evaluate the psychometric properties of the 8-item UCLA Loneliness Scale (UCLA-8) among community-dwelling older adults in rural Tamil Nadu, using Classical Test Theory (CTT) and Item Response Theory (IRT).

Methods

A cross-sectional survey of 413 older adults (≥ 60 years) was conducted across five villages. CTT analyses assessed internal consistency, item–total correlations, and factorial structure via exploratory and confirmatory factor analyses. IRT analyses applied a graded response model to estimate item discrimination, threshold parameters, and test information. Known-groups validity was examined by gender, age cohort, and living arrangement.

Results

The UCLA-8 demonstrated acceptable internal consistency (α = 0.74) and a two-factor structure distinguishing emotional from social loneliness. Emotionally salient items (e.g., “I feel alone”) showed high discrimination and strong factor loadings, whereas reverse-coded relational items (e.g., “I feel part of a group”) underperformed. IRT findings indicated optimal precision for detecting moderate-to-high loneliness but weaker sensitivity at lower levels. Loneliness scores were significantly higher among widowed women, Scheduled Caste/Scheduled Tribe (SC/ST) elders, and those living alone.

Conclusions

The UCLA-8 shows robust psychometric validity and feasibility as a brief, equity-sensitive screening tool for rural Indian primary care. Cultural adaptation of weaker items and integration into NPHCE and Health and Wellness Centres could enable earlier detection and support for loneliness among structurally marginalized older adults.