Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle, NE2 4AX, UK.
BMC Public Health. 2012 May 28;12:382. doi: 10.1186/1471-2458-12-382.
Older people in poor health are more likely to need extra money, aids and adaptations to allow them to remain independent and cope with ill health, yet in the UK many do not claim the welfare benefits to which they are entitled. Welfare rights advice interventions lead to greater welfare income, but have not been rigorously evaluated for health benefits. This study will evaluate the effects on health and well-being of a domiciliary welfare rights advice service provided by local government or voluntary organisations in North East England for independent living, socio-economically disadvantaged older people (aged ≥60 yrs), recruited from general (primary care) practices.
METHODS/DESIGN: The study is a pragmatic, individually randomised, single blinded, wait-list controlled trial of welfare rights advice versus usual care, with embedded economic and qualitative process evaluations. The qualitative study will examine whether the intervention is delivered as intended; explore responses to the intervention and examine reasons for the trial findings; and explore the potential for translation of the intervention into routine policy and practice. The primary outcome is the effect on health-related quality of life, measured using the CASP 19 questionnaire. Volunteer men and women aged ≥60 years (1/household) will be identified from general practice patient registers. Patients in nursing homes or hospitals at the time of recruitment will be excluded. General practice populations will be recruited from disadvantaged areas of North East England, including urban, rural and semi-rural areas, with no previous access to targeted welfare rights advice services delivered to primary care patients. A minimum of 750 participants will be randomised to intervention and control arms in a 1:1 ratio.
Achieving a trial design that is both ethical and acceptable to potential participants, required methodological compromises. The choice of follow-up length required a trade-off between sufficient time to demonstrate health impact and the need to allow the control group access to the intervention as early as possible. The study will have implications for fundamental understanding of social inequalities and how to tackle them, and provides a model for similar evaluations of health-orientated social interventions. If the health benefits of this intervention are proven, targeted welfare rights advice services should be extended to ensure widespread provision for older people and other vulnerable groups. CURRENT CONTROLLED TRIALS ISRCTN NUMBER: ISRCTN37380518.
身体欠佳的老年人更有可能需要额外的资金、辅助器具和改造，以帮助他们保持独立并应对健康问题，但在英国，许多老年人没有申领到他们有权享受的福利。福利权益咨询干预措施会带来更多的福利收入，但尚未经过严格评估以确定其对健康的益处。本研究将评估为英格兰东北部独立生活的社会经济弱势群体（年龄≥60 岁）提供的由地方政府或志愿组织提供的上门福利权益咨询服务对健康和福祉的影响，这些老年人是从一般（初级保健）实践中招募的。
方法/设计：该研究是一项务实的、个体随机、单盲、等待名单对照试验，比较了福利权益咨询与常规护理，同时嵌入了经济和定性过程评估。定性研究将检查干预措施是否按计划实施；探索对干预措施的反应，并探讨试验结果的原因；探索将干预措施转化为常规政策和实践的可能性。主要结局是使用 CASP19 问卷测量的健康相关生活质量的影响。从一般实践患者登记册中确定年龄≥60 岁的志愿男女（每户 1 人）。在招募时在疗养院或医院的患者将被排除在外。一般实践人群将从英格兰东北部弱势地区招募，包括城市、农村和半农村地区，他们以前没有接受过针对初级保健患者的定向福利权益咨询服务。将按照 1:1 的比例将至少 750 名参与者随机分配到干预组和对照组。
为了使潜在参与者能够接受和符合伦理要求，实现试验设计的目标需要做出方法上的妥协。随访时间的选择需要在足够的时间展示健康影响和需要让对照组尽早获得干预措施之间进行权衡。该研究将对社会不平等问题的基本理解以及如何解决这些问题产生影响，并为类似的健康导向社会干预措施的评估提供了模型。如果该干预措施对健康有益，那么应该扩大有针对性的福利权益咨询服务，以确保为老年人和其他弱势群体提供广泛的服务。当前的对照试验注册号为 ISRCTN37380518。
