Moffatt Suzanne, Mackintosh Joan, White Martin, Howel Denise, Sandell Adam
Public Health Research Group, School of Population and Health Sciences, Faculty of Medical Sciences, University of Newcastle upon Tyne, NE2 4HH, UK.
BMC Public Health. 2006 Jun 21;6:163. doi: 10.1186/1471-2458-6-163.
Qualitative research is increasingly used alongside randomised controlled trials (RCTs) to study a range of factors including participants' experiences of a trial. The need for a sound evidence base within public health will increase the need for RCTs of non-clinical interventions. Welfare rights advice has been proposed as an intervention with potential to reduce health inequalities. This qualitative study, nested within an RCT of the impact of welfare rights advice, examined the acceptability of the intervention, the acceptability of the research process and the perceived impact of the intervention.
25 men and women aged 60 years or over were recruited from four general practices in Newcastle upon Tyne (UK), a sub-sample of those who consented to be contacted (n = 96) during the RCT baseline interview. Semi-structured interviews were undertaken and analysed using the Framework Method.
Participants viewed the trial positively although, despite agreeing that the information leaflet was clear, some had agreed to participate without being fully aware of what was involved. Some participants were unaware of the implications of randomisation. Most thought it fair, but a few concerns were raised about the control condition. The intervention was acceptable and made participants feel confident about applying for benefit entitlements. 14 out of 25 participants received some financial award; median weekly income gain was pounds 57 (Euro 84, dollar 101). The perceived impact of additional finances was considerable and included: increased affordability of necessities and occasional expenses; increased capacity to deal with emergencies; and a reduction in stress related to financial worries. Overall, perceived independence and ability to participate in society increased. Most participants perceived benefits to their mental well-being, but no-one reported an improvement in physical health. The RCT showed little or no effect on a wide range of outcome measures.
Participation in the trial and the intervention was acceptable to participants. Welfare rights advice targeted at people aged 60 years or over and accessed via primary care had a positive impact on quality of life and resulted in increased social participation. The divergence of qualitative and quantitative findings suggests that both methods make important contributions to the evaluation of complex social interventions.
定性研究越来越多地与随机对照试验（RCT）一起用于研究一系列因素，包括参与者对试验的体验。公共卫生领域对可靠证据基础的需求将增加对非临床干预措施进行随机对照试验的需求。福利权利咨询已被提议作为一种有可能减少健康不平等的干预措施。这项定性研究嵌套在一项关于福利权利咨询影响的随机对照试验中，考察了该干预措施的可接受性、研究过程的可接受性以及该干预措施的感知影响。
从英国泰恩河畔纽卡斯尔的四家全科诊所招募了25名60岁及以上的男性和女性，他们是在随机对照试验基线访谈期间同意被联系的人群（n = 96）的一个子样本。进行了半结构化访谈，并使用框架法进行分析。
参与者对试验持积极看法，尽管他们同意信息手册清晰易懂，但一些人在不完全了解所涉及内容的情况下就同意参与。一些参与者没有意识到随机分组的影响。大多数人认为这是公平的，但对对照条件提出了一些担忧。该干预措施是可接受的，并且让参与者对申请应享福利充满信心。25名参与者中有14人获得了一些经济奖励；每周收入增加的中位数为57英镑（84欧元，101美元）。额外资金的感知影响相当大，包括：必需品和偶尔开支的可承受性增加；应对紧急情况的能力增强；以及与经济担忧相关的压力减轻。总体而言，感知到的独立性和参与社会的能力有所提高。大多数参与者认为这对他们的心理健康有益，但没有人报告身体健康有所改善。随机对照试验对一系列结果指标几乎没有影响。
参与者对参与试验和干预措施是可接受的。针对60岁及以上人群并通过初级保健获得的福利权利咨询对生活质量有积极影响，并导致社会参与增加。定性和定量研究结果的差异表明，这两种方法对复杂社会干预措施的评估都做出了重要贡献。
