The impact of welfare advice in primary care: a qualitative study

Abstract

This qualitative study documents the perceived impact of welfare advice on the health and circumstances of people living on low incomes; assesses the acceptability of a primary care based welfare advice service provided by the Citizen's Advice Bureaux; identifies a range of relevant and appropriate health and social outcome measures for evaluating primary care welfare advice services; and builds theory concerning socio-economic position and health. Findings are based on semi-structured interviews with eleven recipients of welfare advice whose resources increased following consultation with a welfare advice worker. Respondents reported positive effects on financial, material and social circumstances and health, in particular reduced stress and anxiety, better sleeping patterns; reversal of weight loss; changes in medication; reduced contact with the primary care team; reduction or cessation of smoking, improved diet and physical activity. Participants characterised the effects of welfare advice in terms of releasing them from a burden or pressure and giving greater choice and control over circumstances. We hypothesise that improvements in health-related quality of life may be mediated by reduced stress, the adoption of more advantageous social arrangements and healthier behaviours. These changes seem to enable greater choice and control over circumstances. The study has enabled the development of an empirically testable theoretical model; adds to evidence suggesting that welfare advice has an important impact on health; and confirms that primary health care provides an important route for potential claimants. The study has formed the basis for a formal outcome evaluation using an appropriate trail design in order to establish the evidence base for welfare advice as a health intervention in primary care.

Acknowledgements

We wish to thank all interview participants, the Primary Health Care Teams of South Grange Medical Centre, Thornaby Health Care Practice and Tennant Street Practice, Ian Bartlett, of Stockton CAB, Carol Jenkin and Jane Carter-Jones of Redcar & Cleveland CAB, Susanne Young and Carole Frazer for administrative support, Joe Kai for useful comments on an earlier draft and David Player for stimulating us to do the research. This research was funded by the NHS R&D Northern and Yorkshire small grants committee.