Does domiciliary welfare rights advice improve health-related quality of life in independent-living, socio-economically disadvantaged people aged ≥60 years? Randomised controlled trial, economic and process evaluations in the North East of England.
Milne, Eugene MG
Public Library of Science (PLoS)
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Howel, D., Moffatt, S., Haighton, C., Bryant, A., Becker, F., Steer, M., Lawson, S., et al. (2019). Does domiciliary welfare rights advice improve health-related quality of life in independent-living, socio-economically disadvantaged people aged ≥60 years? Randomised controlled trial, economic and process evaluations in the North East of England.. PloS one, 14 (1), e0209560. https://doi.org/10.1371/journal.pone.0209560
Abstract Background There are major socio-economic gradients in health that could be influenced by increasing personal resources. Welfare rights advice can enhance resources but has not been rigorously evaluated for health-related impacts. Methods Randomised, wait-list controlled trial with individual allocation, stratified by general practice, of welfare rights advice and assistance with benefit entitlements, delivered in participants’ homes by trained advisors. Control was usual care. Participants were volunteers sampled from among all those aged ≥60 years registered with general practices in socio-economically deprived areas of north east England. Outcomes at 24 months were: CASP-19 score (primary), a measure of health-related quality of life; changes in income, social and physical function, and cost-effectiveness (secondary). Intention to treat analysis compared outcomes using multiple regression, with adjustment for stratification and key covariates. Qualitative interviews with purposive samples from both trial arms were thematically analysed. Findings Of 3912 individuals approached, 755 consented and were randomised (381 Intervention, 374 Control). Results refer to outcomes at 24 months, with data available on 562 (74.4%) participants. Intervention was received as intended by 335 (88%), with 84 (22%) awarded additional benefit entitlements; 46 did not receive any welfare rights advice, and none of these were awarded additional benefits. Mean CASP-19 scores were 42.9 (Intervention) and 42.4 (Control) (adjusted mean difference 0.3 [95%CI -0.8, 1.5]). There were no significant differences in secondary outcomes except Intervention participants reported receiving more care at home at 24m (53.7 (Intervention) vs 42.0 (Control) hours/week (adjusted mean difference 26.3 [95%CIs 0.8, 56.1]). Exploratory analyses did not support an intervention effect and economic evaluation suggested the intervention was unlikely to be cost-effective. Qualitative data from 50 interviews suggested there were improvements in quality of life among those receiving additional benefits. Conclusions We found no effects on health outcomes; fewer participants than anticipated received additional benefit entitlements, and participants were more affluent than expected. Our findings do not support delivery of domiciliary welfare rights advice to achieve the health outcomes assessed in this population. However, better intervention targeting may reveal worthwhile health impacts.
Humans, Qualitative Research, Quality of Life, Social Class, Poverty, Social Welfare, Socioeconomic Factors, Aged, Aged, 80 and over, Middle Aged, Vulnerable Populations, Cost-Benefit Analysis, State Medicine, Waiting Lists, Primary Health Care, England, Female, Male, Independent Living
All authors received a grant of £798,884 from the UK National Institute of Health Research, Public Health Research Programme (No. 09/3009/ 02). www.nihr.ac.uk. All authors received a grant of £28,000 from the North East Strategic Health Authority in 2012 to cover the costs of delivering the intervention, associated training and other nonresearch costs of this study. North East SHA no longer exists. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Wellcome Trust (087636/Z/08/Z)
External DOI: https://doi.org/10.1371/journal.pone.0209560
This record's URL: https://www.repository.cam.ac.uk/handle/1810/288846
Attribution 4.0 International
Licence URL: https://creativecommons.org/licenses/by/4.0/