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Laughter and humour interventions for well-being in older adults: A systematic review and intervention classification.Objectives To assess the potential of laughter and humour interventions to increase well-being in a general population of adults aged 60 plus; and to develop a classification to compare approaches and potential benefits of different intervention types. Design A systematic search of Web of Science, PubMed/MEDLINE, PsychInfo, AMED, and PsychArticles used inclusive terms relating to laughter and humour interventions. A realist synthesis approach enabled heterogeneous interventions to be compared pragmatically. Setting Five laughter interventions, and one humour intervention, using one or more outcome related to well-being, were considered for inclusion after screening 178 primary research papers. The five laughter interventions, representing a sample of 369 participants, were retained. Main outcome measures Well-being related outcome measures reported in each intervention informed efficacy; Joanna Briggs Institute tools appraised design; and a realist approach enabled heterogeneous interventions to be measured on their overall potential to provide an evidence base. Results Well-being related measures demonstrated at least one significant positive effect in all interventions. Confounding factors inherent in the intervention types were observed. Individual participant laughter was not reported. Conclusions Laughter and humour interventions appear to enhance well-being. There is insufficient evidence for the potential of laughter itself to increase well-being as interventions contained a range of confounding factors and did not measure participant laughter. Interventions that isolate, track, and measure the parameters of individual laughter are recommended to build evidence for these potentially attractive and low-risk interventions. The classification proposed may guide the development of both evidence-oriented and population-appropriate intervention designs.
Prescribing laughter to increase well-being in healthy adults: an exploratory mixed methods feasibility study of the LaughieCalls for a practical laughter prescription have been made by the medical community. This research developed the Laughie and evaluated its impact to elicit laughter and increase well-being in healthy adults. The Laughie is a user-created one minute recording of the user’s laughter, operated by re-playing it while laughing simultaneously. A mixed methods preliminary feasibility study was conducted between March and May 2018. Twenty-one participants aged 25–93 (x = 51, SD = 20) created a Laughie and were instructed to laugh with it three times a day for seven days, documenting each trial. Well-being was measured prior to and post-intervention using the World Health Organization (WHO five-item) well-being index. Interviews were analysed using thematic analysis. Evaluation considered the Feasibility, Reach-out, Acceptability, Maintenance, Efficacy, Implementation and Tailorability (FRAME-IT) of the Laughie. The Laughie elicited laughter for most of the one minute in 89% of 420 Laughie trials; immediate well-being increased in 70% of them. Absolute overall WHO well-being scores increased post-intervention by 16%. Laughie evaluation using FRAME-IT showed the Laughie was feasible, acceptable, and tailorable. Four smart laughter techniques that facilitated maintenance/usage were identified. The Laughie was feasible, enjoyable, and effective as a laughter prescription in eliciting laughter. Fourteen participants reported absolute well-being increases of 10% or more. Ten participants found their laughter self-contagious. Smart laughter (laughing in a smart way for a smart reason on a smartphone) is a convenient way to harness the benefits of laughter. FRAME-IT is proposed as a practical planning and evaluation framework.