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Reece S, Moss RH, Tanveer Z, Hammad M, Pickett KE, Dickerson J. Exploring the feasibility of evaluating a community alliance welfare advice programme co-located in primary care in Bradford: an uncontrolled before and after study. BMC Public Health 2024; 24:300. [PMID: 38273264 PMCID: PMC10811861 DOI: 10.1186/s12889-024-17773-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Welfare advice services co-located in health settings are known to improve financial security. However, little is known on how to effectively evaluate these services. This study aims to explore the feasibility of evaluating a welfare advice service co-located in a primary care setting in a deprived and ethnically diverse population. It seeks to investigate whether the proposed evaluation tools and processes are acceptable and feasible to implement and whether they are able to detect any evidence of promise for this intervention on the mental health, wellbeing and financial security of participants. METHODS An uncontrolled before and after study design was utilised. Data on mental health, wellbeing, quality of life and financial outcomes were collected at baseline prior to receiving welfare advice and at three months follow-up. Multiple logistic and linear regression models were used to explore individual differences in self-reported financial security and changes to mental health, wellbeing and quality of life scores before and after the provision of welfare advice. RESULTS Overall, the majority of key outcome measures were well completed, indicating participant acceptability of the mental health, wellbeing, quality of life and financial outcome measures used in this population. There was evidence suggestive of an improvement in participant financial security and evidence of promise for improvements in measured wellbeing and health-related quality of life for participants accessing services in a highly ethnically diverse population. Overall, the VCS Alliance welfare advice programme generated a total of £21,823.05 for all participants, with participants gaining an average of £389.70 per participant for participants with complete financial outcome data. CONCLUSIONS This research demonstrates the feasibility of evaluating a welfare advice service co-located in primary care in a deprived and ethnically diverse setting utilising the ascribed mental health, wellbeing and quality of life and financial outcome tools. It provides evidence of promise to support the hypothesis that the implementation of a welfare advice service co-located in a health setting can improve health and wellbeing and reduce health inequalities.
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Affiliation(s)
- Sian Reece
- Hull York Medical School, York, North Yorkshire, UK.
| | - Rachael H Moss
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, West Yorkshire, UK
| | - Zahrah Tanveer
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, West Yorkshire, UK
| | - Mohammed Hammad
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, West Yorkshire, UK
| | - Kate E Pickett
- Department of Health Sciences, University of York, Heslington Road, York, North Yorkshire, UK
| | - Josie Dickerson
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, West Yorkshire, UK
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Baskin C, Duncan F, Adams EA, Oliver EJ, Samuel G, Gnani S. How co-locating public mental health interventions in community settings impacts mental health and health inequalities: a multi-site realist evaluation. BMC Public Health 2023; 23:2445. [PMID: 38062427 PMCID: PMC10702025 DOI: 10.1186/s12889-023-17404-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Public mental health interventions are non-clinical services that aim to promote wellbeing and prevent mental ill health at the population level. In England, the health, social and community system is characterised by complex and fragmented inter-sectoral relationships. To overcome this, there has been an expansion in co-locating public mental health services within clinical settings, the focus of prior research. This study evaluates how co-location in community-based settings can support adult mental health and reduce health inequalities. METHODS A qualitative multi-site case study design using a realist evaluation approach was employed. Data collection took place in three phases: theory gleaning, parallel testing and refining of theories, and theory consolidation. We collected data from service users (n = 32), service providers (n = 32), funders, commissioners, and policy makers (n = 11), and members of the public (n = 10). We conducted in-depth interviews (n = 65) and four focus group discussions (n = 20) at six case study sites across England, UK, and two online multi-stakeholder workshops (n = 20). Interview guides followed realist-informed open-ended questions, adapted for each phase. The realist analysis used an iterative, inductive, and deductive data analysis approach to identify the underlying mechanisms for how community co-location affects public mental health outcomes, who this works best for, and understand the contexts in which co-location operates. RESULTS Five overarching co-location theories were elicited and supported. Co-located services: (1) improved provision of holistic and person-centred support; (2) reduced stigma by creating non-judgemental environments that were not associated with clinical or mental health services; (3) delivered services in psychologically safe environments by creating a culture of empathy, friendliness and trust where people felt they were being treated with dignity and respect; (4) helped to overcome barriers to accessibility by making service access less costly and more time efficient, and (5) enhance the sustainability of services through better pooling of resources. CONCLUSION Co-locating public mental health services within communities impacts multiple social determinants of poor mental health. It has a role in reducing mental health inequalities by helping those least likely to access services. Operating practices that engender inter-service trust and resource-sharing are likely to support sustainability.
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Affiliation(s)
- Cleo Baskin
- Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London, W6 8RP, UK
| | - Fiona Duncan
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle, NE2 4AX, UK.
| | - Emma A Adams
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle, NE2 4AX, UK
| | - Emily J Oliver
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle, NE2 4AX, UK
| | - Gillian Samuel
- The McPin Foundation, 7-14 Great Dover Street, London, SE1 4YR, UK
| | - Shamini Gnani
- Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London, W6 8RP, UK
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Meisters R, Putrik P, Westra D, Bosma H, Ruwaard D, Jansen M. Two sides of the same coin? Absolute income and perceived income inadequacy as social determinants of health. Int J Equity Health 2023; 22:128. [PMID: 37408001 DOI: 10.1186/s12939-023-01945-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/27/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Absolute income is commonly used in studies of health inequalities, however it does not reflect spending patterns, debts, or expectations. These aspects are reflected in measures concerning perceived income inadequacy. While health inequities by absolute income or perceived income inadequacy are well established, few studies have explored the interplay of absolute income and perceived income inadequacy in relation to health. METHODS Multiple data sources were linked into a nationally representative dataset (n = 445,748) of Dutch adults (18 +). The association between absolute income, perceived income inadequacy and health (self-reported health, chronic disease and psychological distress) was tested using logistic and Poisson regressions, controlling for various potential confounders (demographics, education) and mastery. Interactions were tested to check the association between perceived income inadequacy and health for different absolute income groups. RESULTS Perceived income inadequacy was reported at every absolute income group (with 42% of individuals in the lowest income group and 5% of individuals in the highest income group). Both absolute income and perceived income inadequacy were independently associated with health. The adjusted relative risk (RR) for lowest absolute income group is 1.11 (1.08-1.1.14) and 1.28 (1.24-1.32) for chronic disease and self-reported health respectively, and the Odds Ratio (OR) for psychological distress is 1.28 (1.16-1.42). For perceived income inadequacy the RR's were 1.41 (1.37-1.46) and 1.49 (1.44-1.54) and the OR for psychological distress is 3.14 (2.81-3.51). Mastery appeared to be an important mediator for the relationship between perceived income inadequacy, poor self-rated health and psychological distress. CONCLUSIONS Absolute income and perceived income inadequacy reflect conceptually different aspects of income and are independently associated with health outcomes. Perceived income inadequacy may be accounted for in health inequality studies, alongside measures of absolute income. In policy-making, targeting perceived income inadequacy might have potential to reduce health inequalities.
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Affiliation(s)
- Rachelle Meisters
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, the Netherlands.
| | - Polina Putrik
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, the Netherlands
- GGD Zuid Limburg, Academic Collaborative Centre for Public Health Limburg, Heerlen, the Netherlands
| | - Daan Westra
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, the Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, the Netherlands
| | - Maria Jansen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, the Netherlands
- GGD Zuid Limburg, Academic Collaborative Centre for Public Health Limburg, Heerlen, the Netherlands
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Interprofessional collaboration to support patients with social problems in general practice—a qualitative focus group study. BMC PRIMARY CARE 2022; 23:169. [PMID: 35788186 PMCID: PMC9251943 DOI: 10.1186/s12875-022-01782-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 06/23/2022] [Indexed: 11/10/2022]
Abstract
Background Social problems of patients such as family or work-related conflicts as well as financial difficulties affect the individual health situation and the treatment of diseases in general practice. General practitioners (GPs) would like to have direct access to professionals in social care services. In Germany, there are many different social care facilities for people with a wide range of social problems. As the social and health care systems hardly interact collaborations between social professionals (SPs) and GPs are rare exceptions. This study explored perspectives of GPs regarding their patients with social problems in combination with the perspectives of SPs. Aim of this study was to explore how a systematic interprofessional collaboration between GPs and SPs could be realised. Methods We carried out a participatory sequential qualitative study design consisting of two focus groups with GPs, two with SPs and two mixed-professional focus groups with GPs and SPs. The focus groups were conducted with semi-structured moderating guidelines and analysed with a qualitative content analysis approach using inductive and deductive categories. Results GPs view themselves as the first point of contact for their patients' social problems. For persistent social problems, they expressed a desire for support and SPs were willing to provide this. We developed a stepped care implementation model for a systematic cooperation consisting of nine collaboration strategies. These strategies included: index or website of social care services, referrals to the social care system, using flyers and posters of social care services, direct contact/hotline to local social care services, participation in meetings of social care facilities, involving physician assistants, external social care advice service in GP rooms, implementation in education and training and access to volunteers. Conclusions Our stepped care implementation model for a systematic cooperation of GPs and SPs could be a feasible need- and resource-oriented approach for the collaborative care of patients with social problems to improve their medical treatment in most western healthcare systems. GPs and SPs are ready to generate the necessary evidence for policy makers in high quality RCTs.
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Young D, Bates G. Maximising the health impacts of free advice services in the UK: A mixed methods systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1713-1725. [PMID: 35307896 PMCID: PMC9545623 DOI: 10.1111/hsc.13777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/28/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
After a decade of austerity spending cuts and welfare reform, the COVID-19 pandemic has posed further challenges to the finances, health and wellbeing of working-age, low-income people. While advice services have been widely seen (and funded) as an income maximisation intervention, their health and well-being impact is less clear. Previous systematic reviews investigating the link between advice services and health outcomes have found a weak evidence base and cover the period up until 2010. This mixed methods review examined up to date evidence to help understand the health impacts of free and independent welfare rights advice services. We included evaluations of free to access advice services on social welfare issues for members of the public that included health outcomes. Through comprehensive searches of two bibliographic databases and websites of relevant organisations we identified 15 articles based on a mixture of study designs. The advice interventions evaluated were based in a range of settings and only limited information was available on the delivery and nature of advice offered. We undertook a convergent synthesis to analyse data on the effectiveness of advice services on health outcomes and to explain variation in these outcomes. Our synthesis suggested that improvements in mental health and well-being measures are commonly attributed to advice service interventions. However, there is little insight to explain these impacts or to inform the delivery of services that maximise health benefits. Co-locating services in health settings appears promising and embracing models of delivery that promote collaboration between organisations tackling the social determinants of health may help to address the inherent complexities in the delivery of advice services and client needs. We make recommendations to improve routine monitoring and reporting by advice services, and methods of evaluation that will better account for complexity and context.
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Affiliation(s)
- David Young
- Sustainable Housing and Urban Studies Unit (SHUSU)University of SalfordSalfordUK
| | - Geoff Bates
- Institute for Policy ResearchUniversity of BathBathUK
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Reece S, Sheldon TA, Dickerson J, Pickett KE. A review of the effectiveness and experiences of welfare advice services co-located in health settings: A critical narrative systematic review. Soc Sci Med 2022; 296:114746. [PMID: 35123370 DOI: 10.1016/j.socscimed.2022.114746] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 10/19/2022]
Abstract
We conducted a narrative systematic review to assess the health, social and financial impacts of co-located welfare services in the UK and to explore the effectiveness of and facilitators and barriers to successful implementation of these services, in order to guide future policy and practice. We searched Medline, EMBASE and other literature sources, from January 2010 to November 2020, for literature examining the impact of co-located welfare services in the UK on any outcome. The review identified 14 studies employing a range of study designs, including: one non-randomised controlled trial; one pilot randomised controlled trial; one before-and-after-study; three qualitative studies; and eight case studies. A theory of change model, developed a priori, was used as an analytical framework against which to map the evidence on how the services work, why and for whom. All studies demonstrated improved financial security for participants, generating an average of £27 of social, economic and environmental return per £1 invested. Some studies reported improved mental health for individuals accessing services. Several studies attributed subjective improvements in physical health to the service addressing key social determinants of health. Benefits to the health service were also demonstrated through reduced workload for healthcare professionals. Key components of a successful service included co-production during service development and ongoing enhanced multi-disciplinary collaboration. Overall, this review demonstrates improved financial security for participants and for the first time models the wider health and welfare benefits for participants and for health service from these services. However, given the generally poor scientific quality of the studies, care must be taken in drawing firm conclusions. There remains a need for more high quality research, using experimental methods and larger sample sizes, to further build upon this evidence base and to measure the strength of the proposed theoretical pathways in this area.
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Affiliation(s)
| | - Trevor A Sheldon
- Wolfson Institute for Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK.
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7
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Beardon S, Woodhead C, Cooper S, Ingram E, Genn H, Raine R. International Evidence on the Impact of Health-Justice Partnerships: A Systematic Scoping Review. Public Health Rev 2021; 42:1603976. [PMID: 34168897 PMCID: PMC8113986 DOI: 10.3389/phrs.2021.1603976] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Health-justice partnerships (HJPs) are collaborations between healthcare and legal services which support patients with social welfare issues such as welfare benefits, debt, housing, education and employment. HJPs exist across the world in a variety of forms and with diverse objectives. This review synthesizes the international evidence on the impacts of HJPs. Methods: A systematic scoping review of international literature was undertaken. A wide-ranging search was conducted across academic databases and grey literature sources, covering OECD countries from January 1995 to December 2018. Data from included publications were extracted and research quality was assessed. A narrative synthesis approach was used to analyze and present the results. Results: Reported objectives of HJPs related to: prevention of health and legal problems; access to legal assistance; health improvement; resolution of legal problems; improvement of patient care; support for healthcare services; addressing inequalities; and catalyzing systemic change. There is strong evidence that HJPs: improve access to legal assistance for people at risk of social and health disadvantage; positively influence material and social circumstances through resolution of legal problems; and improve mental wellbeing. A wide range of other positive impacts were identified for individuals, services and communities; the strength of evidence for each is summarized and discussed. Conclusion: HJPs are effective in tackling social welfare issues that affect the health of disadvantaged groups in society and can therefore form a key part of public health strategies to address inequalities.
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Affiliation(s)
- Sarah Beardon
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Charlotte Woodhead
- Department of Psychological Medicine, King's College London, London, United Kingdom
| | - Silvie Cooper
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Elizabeth Ingram
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Hazel Genn
- Faculty of Laws, University College London, London, United Kingdom
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, United Kingdom
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8
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Pinto AD, Da Ponte M, Bondy M, Craig-Neil A, Murphy K, Ahmed S, Nair P, Swartz A, Green S. Addressing financial strain through a peer-to-peer intervention in primary care. Fam Pract 2020; 37:815-820. [PMID: 32537646 DOI: 10.1093/fampra/cmaa046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Financial strain is a key social determinant of health. As primary care organizations begin to explore ways to address social determinants, peer-to-peer interventions hold promise. OBJECTIVE Our objective was to evaluate a peer-to-peer intervention focussed on financial empowerment delivered in primary care, in partnership with a social enterprise. METHODS This intervention was hosted by a large primary care organization in Toronto, Canada. Participants were recruited within the organization and from local services. We organized three separate groups who met over 10 weekly in-person, facilitated sessions: millennials (age 19-29) no longer in school, precariously employed adults (age 30-55) and older adults near retirement (age 55-64). We applied principles of adult education and peer-to-peer learning. We administered surveys at intake, at exit and at 3 months after the intervention, and conducted three focus groups. RESULTS Fifty-nine people took part. At 3 months, participants had sustained higher rates of optimism about their financial situation (54% improved from baseline), their degree of control (55% improved) and stress around finances (50% improved). In focus groups, participants reported greater understanding of their finances, that they were not alone in struggling with finances, and that it was useful to meet with others. One group continued to meet for several months after the intervention. CONCLUSIONS In this study, a peer-to-peer intervention helped address a key social determinant of health, likely through reducing stigma, providing group support and creating a space to discuss solutions. Primary care can host these interventions and help engage potential participants.
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Affiliation(s)
- Andrew D Pinto
- The Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,University of Toronto Practice-Based Research Network (UTOPIAN), Toronto, ON, Canada
| | - Monica Da Ponte
- Strive, Toronto, ON, Canada.,Shift & Build, Toronto, ON, Canada
| | - Madeleine Bondy
- The Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Undergraduate Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Amy Craig-Neil
- The Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | | | - Suhal Ahmed
- Shelter, Support, and Housing Administration, City of Toronto, ON, Canada
| | | | - Alyssa Swartz
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Samantha Green
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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9
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Beardon S, Woodhead C, Cooper S, Raine R, Genn H. Health-justice partnerships: innovation in service delivery to support mental health. JOURNAL OF PUBLIC MENTAL HEALTH 2020. [DOI: 10.1108/jpmh-03-2020-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to introduce the concept of “health-justice partnership” (HJP), the provision of legal assistance for social welfare issues in health-care settings. It discusses the role of these partnerships in supporting health and care for people with mental health issues.
Design/methodology/approach
The authors describe an example of an HJP; discuss the rationale and evidence for this approach in relation to mental health; and reflect on implementation challenges and future directions in the UK. The authors draw on both health and legal literature to frame the discussion.
Findings
Social welfare legal needs have negative impacts on mental well-being and are more likely to occur among people with mental health conditions. Integrating legal assistance with healthcare services can improve access to support for those with unmet need. High-quality research has demonstrated positive impacts for mental health and well-being as a result of HJP interventions. Both further research and wider strategies are required to support implementation of HJPs in practice.
Originality/value
Legal assistance is rarely positioned as a health intervention, yet it is an effective tool to address social welfare issues that are harmful to mental health and to which people experiencing mental health are at greater risk. This paper highlights the importance of the HJP movement as an approach for supporting people with mental health issues.
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10
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Pinto AD, Bondy M, Rucchetto A, Ihnat J, Kaufman A. Screening for poverty and intervening in a primary care setting: an acceptability and feasibility study. Fam Pract 2019; 36:634-638. [PMID: 30649280 PMCID: PMC6781937 DOI: 10.1093/fampra/cmy129] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND A movement is emerging to encourage health providers and health organizations to take action on the social determinants of health. However, few evidence-based interventions exist. Digital tools have not been examined in depth. OBJECTIVE To assess the acceptability and feasibility of integrating, within routine primary care, screening for poverty and an online tool that helps identify financial benefits. METHODS The setting was a Community Health Centre serving a large number of low-income individuals in Toronto, Canada. Physicians were encouraged to use the tool at every possible encounter during a 1-month period. A link to the tool was easily accessible, and reminder emails were circulated regularly. This mixed-methods study used a combination of pre-intervention and post-intervention surveys, focus groups and interviews. RESULTS Thirteen physicians participated (81.25% of all) and represented a range of genders and years in practice. Physicians reported a strong awareness of the importance of identifying poverty as a health concern, but low confidence in their ability to address poverty. The tool was used with 63 patients over a 1-month period. Although screening and intervening on poverty is logistically challenging in regular workflows, online tools could assist patients and health providers identify financial benefits quickly. Future interventions should include more robust follow-up. CONCLUSIONS Our study contributes to the evidence based on addressing the social determinants of health in clinical settings. Future approaches could involve routine screening, engaging other members of the team in intervening and following up, and better integration with the electronic health record.
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Affiliation(s)
- Andrew D Pinto
- The Upstream Lab, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Madeleine Bondy
- The Upstream Lab, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Anne Rucchetto
- The Upstream Lab, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - John Ihnat
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.,Health Access Thorncliffe Park, Toronto, Canada.,Flemingdon Health Centre, Toronto, Canada
| | - Adam Kaufman
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.,Health Access Thorncliffe Park, Toronto, Canada.,Department of Family Medicine, Toronto East Health Network, Toronto, Canada.,Department of Emergency Medicine, Toronto East Health Network, Toronto, Canada
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11
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Dalkin SM, Forster N, Hodgson P, Lhussier M, Philipson P, Carr SM. Exposing the impact of intensive advice services on health: A realist evaluation. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:767-776. [PMID: 30556191 DOI: 10.1111/hsc.12695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 11/05/2018] [Accepted: 11/08/2018] [Indexed: 06/09/2023]
Abstract
Attention has turned to welfare advice as a potential health and social care intervention. However, establishing direct evidence of health impact has proven difficult. This is compounded by the need to understand both the facilitative contexts and mechanisms through which this impact occurs. This study investigated if, how and in which circumstances an intensive advice service had an impact on stress and well-being (as precursors to health impacts), for clients attending a branch of Citizens Advice, located in the North East of England. A mixed methods realist evaluation of three intensive advice services offered by Citizens Advice (CA) was operationalised in five phases: (a) Building programme theories, (b) refining programme theories, (c) Development of a data recording tool, (d) Testing programme theories with empirical data, (e) Impact interviews. This paper focuses on phase 4. The Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) and Perceived Stress Scale (PSS) were completed by 191 clients, with a 91% follow-up rate (data collected: February 2016 to March 2017). Twenty-two CA clients participated in interviews (data collected: October 2015 to November 2016). The PSS indicated a significant decrease in stress from initial consultation to approximately 4-6 weeks post advice from 31.4 to 10.3 (p < 0.001) and the WEMWBS indicated a significant increase in client well-being from a mean of 26.9 to 46.5 (p < 0.001). Nine refined programme theories are presented which combine the qualitative and quantitative analysis; they are underpinned by three abstract theories: Capabilities model, The Decision to Trust Model, and Third Space. An explanatory framework is presented covering the micro, meso, and macro levels of CA. Use of a stress and well-being lens has allowed insight into the precursors of health in those receiving intensive advice. Using these measures whilst explaining contextual and mechanistic properties, begins to build a complex and real picture of how advice services impact on health.
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Affiliation(s)
- Sonia Michelle Dalkin
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Benton, Newcastle Upon Tyne, UK
- Fuse (The Centre for Translational Research in Public Health), Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Natalie Forster
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Benton, Newcastle Upon Tyne, UK
- Fuse (The Centre for Translational Research in Public Health), Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Philip Hodgson
- Department of Nursing, Midwifery and Health, Northumbria University, Benton, Newcastle Upon Tyne, UK
| | - Monique Lhussier
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Benton, Newcastle Upon Tyne, UK
- Fuse (The Centre for Translational Research in Public Health), Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Pete Philipson
- Department of Mathematics, Physics and Electrical Engineering, Northumbria University, Newcastle upon Tyne, UK
| | - Susan Mary Carr
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Benton, Newcastle Upon Tyne, UK
- Fuse (The Centre for Translational Research in Public Health), Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
- Department of Education and Training, Federation University Australia, Mount Helen, Victoria, Australia
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Woodhead C, Collins H, Lomas R, Raine R. Co-located welfare advice in general practice: A realist qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:1794-1804. [PMID: 28569395 DOI: 10.1111/hsc.12453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 06/07/2023]
Abstract
General practitioners (GPs) engage with patients about a variety of social issues distinct from direct clinical work ("non-health" issues), such as health-related benefits and debt. Co-located welfare advice services could provide support to practices but have usually been considered in terms of patient rather than practice outcomes. We aimed to develop an initial programme theory for how the provision of co-located advice supports specific practice outcomes, and to identify salient barriers and enabling factors. Twenty-four semi-structured interviews with general practice staff, advice staff and service funders in two UK urban localities were conducted between January and July 2016. Data were thematically analysed and a modified Realist Evaluation approach informed the topic guide, thematic analysis and interpretation. Two outcomes are described linked to participant accounts of the impact of such non-health work on practices: reduction of GP consultations linked to non-health issues and reduced practice time spent on non-health issues. We found that individual responses and actions influencing service awareness were key facilitators to each of the practice outcomes, including proactive engagement, communication, regular reminders and feedback between advice staff, practice managers and funders. Facilitating implementation factors were: not limiting access to GP referral, and offering booked appointments and advice on a broader range of issues responsive to local need. Key barriers included pre-existing sociocultural and organisational rules and norms largely outside of the control of service implementers, which maintained perceptions of the GP as the "go-to-location". We conclude that co-location of welfare advice services alone is unlikely to enable positive outcomes for practices and suggest several factors amenable to intervention that could enhance the potential for co-location to meet desired objectives.
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Affiliation(s)
- Charlotte Woodhead
- Department of Applied Health Research, University College London, London, UK
| | - Hillliary Collins
- Department of Applied Health Research, University College London, London, UK
| | | | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
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13
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Health promotion and disease prevention in general practice and primary care: a scoping study. Prim Health Care Res Dev 2017; 18:529-540. [DOI: 10.1017/s1463423617000494] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This paper reports the findings of a scoping review on the organisation and delivery of health improvement activities in general practice and the primary healthcare team. The project was designed to examine who delivers these interventions, where they are located, what approaches are developed in practices and how individual practices and the primary healthcare team organise such public health activities and how these contribute to health improvement. Our focus was on health promotion and prevention activities and aimed to identify the current extent of knowledge about the health improvement activities in general practice and the wider primary healthcare team. Many of the research studies reviewed had some details about the type, process, location or who provided the intervention. Little attention is paid in the literature to examining the impact of the organisational context on the way services are delivered or how this affects the effectiveness of health improvement interventions in general practice. We found that the focus of attention is mainly on individual prevention approaches with practices engaging in both primary and secondary prevention. Although many GPs do not take a population approach and focus on individual patients some do see health promotion as an integral part of practice – whether as individual approaches to primary or secondary health improvement or as a practice-based approach to improving the health of their patients. Based on our analysis we conclude that there is insufficient good evidence to support many of the health improvement interventions undertaken in general practice and primary care.
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Barnes MC, Donovan JL, Wilson C, Chatwin J, Davies R, Potokar J, Kapur N, Hawton K, O’Connor R, Gunnell D. Seeking help in times of economic hardship: access, experiences of services and unmet need. BMC Psychiatry 2017; 17:84. [PMID: 28253879 PMCID: PMC5335839 DOI: 10.1186/s12888-017-1235-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 02/10/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Economic recessions are often accompanied by increased levels of psychological distress and suicidal behaviour in affected populations. Little is known about the experiences of people seeking help for employment, financial and benefit-related difficulties during recessions. We investigated the experiences of people struggling financially in the aftermath of the Great Recession (2008-9) - including some who had self-harmed - and of the frontline support staff providing assistance. METHODS Interviews were conducted with three groups of people in two cities: i) people who had self-harmed due to employment, financial or benefit concerns (n = 19) ('self-harm'); ii) people who were struggling financially drawn from the community (n = 22), including one focus group) ('community'); iii) and frontline staff from voluntary and statutory sector organisations (e.g., Job Centres, Debt Advice and counselling agencies) providing support services to the groups (n = 25, including 2 focus groups) ('service providers'). Data were analysed using the constant comparison method. RESULTS Service provision was described by people as confusing and difficult to access. The community sample reported considerably more knowledge and access to debt advice than the participants who had self-harmed - although both groups sought similar types of help. The self-harm group exhibited greater expectation that they should be self-reliant and also reported lower levels of informal networks and support from friends and relatives. They had also experienced more difficult circumstances such as benefit sanctions, and most had pre-existing mental health problems. Both self-harm and community groups indicated that practical help for debt and benefit issues would be the most useful - a view supported by service providers - and would have particularly helped those who self-harmed. CONCLUSION Interventions to identify those in need and aid them to access practical, reliable and free advice from support agencies could help mitigate the impact on mental health of benefit, debt and employment difficulties for vulnerable sections of society.
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Affiliation(s)
- M. C. Barnes
- 0000 0004 1936 7603grid.5337.2School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS UK
| | - J. L. Donovan
- 0000 0004 1936 7603grid.5337.2School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS UK
| | - C. Wilson
- 0000 0004 1936 7603grid.5337.2School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS UK
| | - J. Chatwin
- 0000 0004 0460 5971grid.8752.8University of Salford, Salford, UK
| | - R. Davies
- 0000 0004 1936 7603grid.5337.2School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS UK
| | - J. Potokar
- 0000 0004 1936 7603grid.5337.2School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS UK
| | - N. Kapur
- 0000000121662407grid.5379.8Centre for Suicide Prevention, University of Manchester, Manchester, UK
| | - K. Hawton
- 0000 0004 1936 8948grid.4991.5Centre for Suicide Research, University of Oxford, Oxford, UK
| | - R. O’Connor
- 0000 0001 2193 314Xgrid.8756.cSuicidal Behaviour Research Laboratory, University of Glasgow, Glasgow, UK
| | - D. Gunnell
- 0000 0004 1936 7603grid.5337.2School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS UK
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Forster N, Dalkin SM, Lhussier M, Hodgson P, Carr SM. Exposing the impact of Citizens Advice Bureau services on health: a realist evaluation protocol. BMJ Open 2016; 6:e009887. [PMID: 26792219 PMCID: PMC4735145 DOI: 10.1136/bmjopen-2015-009887] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Welfare advice services can be used to address health inequalities, for example, through Citizens Advice Bureau (CAB). Recent reviews highlight evidence for the impact of advice services in improving people's financial position and improving mental health and well-being, daily living and social relationships. There is also some evidence for the impact of advice services in increasing accessibility of health services, and reducing general practitioner appointments and prescriptions. However, direct evidence for the impact of advice services on lifestyle behaviour and physical health is currently much less well established. There is a need for greater empirical testing of theories around the specific mechanisms through which advice services and associated financial or non-financial benefits may generate health improvements. METHODS AND ANALYSIS A realist evaluation will be conducted, operationalised in 5 phases: building the explanatory framework; refining the explanatory framework; testing the explanatory framework through empirical data (mixed methods); development of a bespoke data recording template to capture longer term impact; and verification of findings with a range of CAB services. This research will therefore aim to build, refine and test an explanatory framework about how CAB services can be optimally implemented to achieve health improvement. ETHICS AND DISSEMINATION The study was approved by the ethics committee at Northumbria University, UK. Project-related ethical issues are described and quality control aspects of the study are considered. A stakeholder mapping exercise will inform the dissemination of results in order to ensure all relevant institutions and organisations are targeted.
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Affiliation(s)
- N Forster
- Department of Public Health and Wellbeing, Northumbria University, Newcastle Upon Tyne, UK
- Fuse (The Centre for Translational Research in Public Health), Newcastle University, Newcastle Upon Tyne, UK
| | - S M Dalkin
- Department of Public Health and Wellbeing, Northumbria University, Newcastle Upon Tyne, UK
- Fuse (The Centre for Translational Research in Public Health), Newcastle University, Newcastle Upon Tyne, UK
| | - M Lhussier
- Department of Public Health and Wellbeing, Northumbria University, Newcastle Upon Tyne, UK
- Fuse (The Centre for Translational Research in Public Health), Newcastle University, Newcastle Upon Tyne, UK
| | - P Hodgson
- Department of Public Health and Wellbeing, Northumbria University, Newcastle Upon Tyne, UK
| | - S M Carr
- Department of Public Health and Wellbeing, Northumbria University, Newcastle Upon Tyne, UK
- Fuse (The Centre for Translational Research in Public Health), Newcastle University, Newcastle Upon Tyne, UK
- Federation University, Australia
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Peckham S, Falconer J, Gillam S, Hann A, Kendall S, Nanchahal K, Ritchie B, Rogers R, Wallace A. The organisation and delivery of health improvement in general practice and primary care: a scoping study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03290] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThis project examines the organisation and delivery of health improvement activities by and within general practice and the primary health-care team. The project was designed to examine who delivers these interventions, where they are located, what approaches are developed in practices, how individual practices and the primary health-care team organise such public health activities, and how these contribute to health improvement. Our focus was on health promotion and ill-health prevention activities.AimsThe aim of this scoping exercise was to identify the current extent of knowledge about the health improvement activities in general practice and the wider primary health-care team. The key objectives were to provide an overview of the range and type of health improvement activities, identify gaps in knowledge and areas for further empirical research. Our specific research objectives were to map the range and type of health improvement activity undertaken by general practice staff and the primary health-care team based within general practice; to scope the literature on health improvement in general practice or undertaken by health-care staff based in general practice and identify gaps in the evidence base; to synthesise the literature and identify effective approaches to the delivery and organisation of health improvement interventions in a general practice setting; and to identify the priority areas for research as defined by those working in general practice.MethodsWe undertook a comprehensive search of the literature. We followed a staged selection process involving reviews of titles and abstracts. This resulted in the identification of 1140 papers for data extraction, with 658 of these papers selected for inclusion in the review, of which 347 were included in the evidence synthesis. We also undertook 45 individual and two group interviews with primary health-care staff.FindingsMany of the research studies reviewed had some details about the type, process or location, or who provided the intervention. Generally, however, little attention is paid in the literature to examining the impact of the organisational context on the way services are delivered or how this affects the effectiveness of health improvement interventions in general practice. We found that the focus of attention is mainly on individual prevention approaches, with practices engaging in both primary and secondary prevention. The range of activities suggests that general practitioners do not take a population approach but focus on individual patients. However, it is clear that many general practitioners see health promotion as an integral part of practice, whether as individual approaches to primary or secondary health improvement or as a practice-based approach to improving the health of their patients. Our key conclusion is that there is currently insufficient good evidence to support many of the health improvement interventions undertaken in general practice and primary care more widely.Future ResearchFuture research on health improvement in general practice and by the primary health-care team needs to move beyond clinical research to include delivery systems and be conducted in a primary care setting. More research needs to examine areas where there are chronic disease burdens – cancer, dementia and other disabilities of old age. Reviews should be commissioned that examine the whole prevention pathway for health problems that are managed within primary care drawing together research from general practice, pharmacy, community engagement, etc.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Stephen Peckham
- Centre for Health Services Studies, University of Kent, Kent, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jane Falconer
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Steve Gillam
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alison Hann
- Public Health and Policy Studies, Swansea University, Swansea, UK
| | - Sally Kendall
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Kiran Nanchahal
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Benjamin Ritchie
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Rogers
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Wallace
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Social Policy, University of Lincoln, Lincoln, UK
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