Randomised controlled trial of welfare rights advice accessed via primary health care: pilot study [ISRCTN61522618].
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Mackintosh
Joan
J
Public Health Research Group, School of Population & Health Sciences, Faculty of Medical Sciences, University of Newcastle upon Tyne, NE2 4HH, UK. j.e.mackintosh@newcastle.ac.uk
White
Martin
M
Howel
Denise
D
Chadwick
Tom
T
Moffatt
Suzanne
S
Deverill
Mark
M
Sandell
Adam
A
D000368:Aged; D000369:Aged, 80 and over; D003253:Consultants; D003254:Consumer Advocacy; D004608:Eligibility Determination / Q000458:organization & administration*; D005240:Feasibility Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D010865:Pilot Projects; D011320:Primary Health Care; D011632:Public Assistance / Q000458:organization & administration* / Q000706:statistics & numerical data; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D006113:United Kingdom