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Does domiciliary welfare rights advice improve health-related quality of life in independent-living, socio-economically disadvantaged people aged ≥60 years? Randomised controlled trial, economic and process evaluations in the North East of England

Author

Listed:
  • Denise Howel
  • Suzanne Moffatt
  • Catherine Haighton
  • Andrew Bryant
  • Frauke Becker
  • Melanie Steer
  • Sarah Lawson
  • Terry Aspray
  • Eugene M G Milne
  • Luke Vale
  • Elaine McColl
  • Martin White

Abstract

Background: There are major socio-economic gradients in health that could be influenced by increasing personal resources. Welfare rights advice can enhance resources but has not been rigorously evaluated for health-related impacts. Methods: Randomised, wait-list controlled trial with individual allocation, stratified by general practice, of welfare rights advice and assistance with benefit entitlements, delivered in participants’ homes by trained advisors. Control was usual care. Participants were volunteers sampled from among all those aged ≥60 years registered with general practices in socio-economically deprived areas of north east England. Outcomes at 24 months were: CASP-19 score (primary), a measure of health-related quality of life; changes in income, social and physical function, and cost-effectiveness (secondary). Intention to treat analysis compared outcomes using multiple regression, with adjustment for stratification and key covariates. Qualitative interviews with purposive samples from both trial arms were thematically analysed. Findings: Of 3912 individuals approached, 755 consented and were randomised (381 Intervention, 374 Control). Results refer to outcomes at 24 months, with data available on 562 (74.4%) participants. Intervention was received as intended by 335 (88%), with 84 (22%) awarded additional benefit entitlements; 46 did not receive any welfare rights advice, and none of these were awarded additional benefits. Mean CASP-19 scores were 42.9 (Intervention) and 42.4 (Control) (adjusted mean difference 0.3 [95%CI -0.8, 1.5]). There were no significant differences in secondary outcomes except Intervention participants reported receiving more care at home at 24m (53.7 (Intervention) vs 42.0 (Control) hours/week (adjusted mean difference 26.3 [95%CIs 0.8, 56.1]). Exploratory analyses did not support an intervention effect and economic evaluation suggested the intervention was unlikely to be cost-effective. Qualitative data from 50 interviews suggested there were improvements in quality of life among those receiving additional benefits. Conclusions: We found no effects on health outcomes; fewer participants than anticipated received additional benefit entitlements, and participants were more affluent than expected. Our findings do not support delivery of domiciliary welfare rights advice to achieve the health outcomes assessed in this population. However, better intervention targeting may reveal worthwhile health impacts.

Suggested Citation

  • Denise Howel & Suzanne Moffatt & Catherine Haighton & Andrew Bryant & Frauke Becker & Melanie Steer & Sarah Lawson & Terry Aspray & Eugene M G Milne & Luke Vale & Elaine McColl & Martin White, 2019. "Does domiciliary welfare rights advice improve health-related quality of life in independent-living, socio-economically disadvantaged people aged ≥60 years? Randomised controlled trial, economic and p," PLOS ONE, Public Library of Science, vol. 14(1), pages 1-31, January.
    • Handle: RePEc:plo:pone00:0209560
    DOI: 10.1371/journal.pone.0209560
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    References listed on IDEAS

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    1. R. Wiggins & G. Netuveli & M. Hyde & P. Higgs & D. Blane, 2008. "The Evaluation of a Self-enumerated Scale of Quality of Life (CASP-19) in the Context of Research on Ageing: A Combination of Exploratory and Confirmatory Approaches," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 89(1), pages 61-77, October.
    2. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
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    4. Rembrandt D. Scholz & Heiner Maier, 2003. "German unification and the plasticity of mortality at older ages," MPIDR Working Papers WP-2003-031, Max Planck Institute for Demographic Research, Rostock, Germany.
    5. Suzanne Moffatt & Emma Noble & Martin White, 2012. "Addressing the Financial Consequences of Cancer: Qualitative Evaluation of a Welfare Rights Advice Service," PLOS ONE, Public Library of Science, vol. 7(8), pages 1-10, August.
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