Mackintosh Joan, White Martin, Howel Denise, Chadwick Tom, Moffatt Suzanne, Deverill Mark, Sandell Adam
Public Health Research Group, School of Population & Health Sciences, Faculty of Medical Sciences, University of Newcastle upon Tyne, NE2 4HH, UK.
BMC Public Health. 2006 Jun 21;6:162. doi: 10.1186/1471-2458-6-162.
Little research has directly evaluated the impact of increasing financial or material resources on health. One way of assessing this lies with assisting people to obtain full welfare benefit entitlements. In 2000-1, 2.3 million pensioners were living in poverty in the UK and estimates suggest that around one million do not claim the financial support to which they are entitled. The effectiveness of welfare rights advice services delivered via primary health care to promote health and reduce health inequalities is unknown.
The main objectives of this study were to assess the feasibility and acceptability of a randomised controlled trial of welfare rights advice in a community setting and identify appropriate health and social outcome measures in order to plan a definitive trial. This was a single blind, community-based, pilot randomised controlled trial. 126 men and women aged 60 years and over, recruited from 4 general practices in Newcastle upon Tyne, UK, participated. The intervention comprised a structured welfare rights assessment followed by active assistance with welfare benefit claims over the following 24 months. The control group received the intervention after a six month delay. A range of socio-economic, health, behavioural and psycho-social outcomes were measured.
126 out of 400 people invited agreed to participate and 109 were followed up at 24 months. Both the intervention and research procedures were feasible and acceptable to participants and professionals involved. 68 (58%) of all participants received a welfare benefit award (31 financial, 16 non-financial and 21 both). Median time to receipt of benefits from initial assessment was 14 (range 1 to 78) weeks and median financial award was pounds 55 (Euro 81, dollar 98) per household per week. There was little evidence of health-related differences between groups or over time, which could be due to limitations of the study design.
Modification of the study design, including selection of study participants, timing of interventions and length of follow up are recommended for a definitive trial. More appropriate health and psycho-social outcome measures relevant to the elderly population should be sought, particularly focussing on those issues highlighted in the accompanying qualitative study.
很少有研究直接评估增加资金或物质资源对健康的影响。评估这一影响的一种方法是帮助人们获得全额福利津贴。2000 - 2001年，英国有230万养老金领取者生活在贫困中，据估计约有100万人未申领他们有权获得的经济支持。通过初级卫生保健提供的福利权利咨询服务在促进健康和减少健康不平等方面的有效性尚不清楚。
本研究的主要目的是评估在社区环境中进行福利权利咨询随机对照试验的可行性和可接受性，并确定适当的健康和社会结果指标，以便规划一项确定性试验。这是一项单盲、基于社区的试点随机对照试验。从英国泰恩河畔纽卡斯尔的4家全科诊所招募了126名60岁及以上的男性和女性参与。干预措施包括进行结构化的福利权利评估，随后在接下来的24个月里积极协助申领福利津贴。对照组在延迟6个月后接受干预。测量了一系列社会经济、健康、行为和心理社会结果。
400名被邀请者中有126人同意参与，109人在24个月时接受了随访。干预措施和研究程序对参与的受试者和专业人员来说都是可行且可接受的。所有参与者中有68人（58%）获得了福利津贴（31人获得经济津贴，16人获得非经济津贴，21人两者都获得）。从初次评估到获得津贴的中位时间为14周（范围为1至78周），每户每周获得的经济津贴中位数为55英镑（81欧元，98美元）。几乎没有证据表明两组之间或随时间推移存在与健康相关的差异，这可能是由于研究设计的局限性。
建议对研究设计进行修改，包括研究参与者的选择、干预时间和随访时长，以进行确定性试验。应寻求与老年人群体更相关的适当健康和心理社会结果指标，尤其要关注随附定性研究中突出的那些问题。
