Open Access
Open Peer Review

This article has Open Peer Review reports available.

How does Open Peer Review work?

A systematic review of the health, social and financial impacts of welfare rights advice delivered in healthcare settings

  • Jean Adams1Email author,
  • Martin White1,
  • Suzanne Moffatt1,
  • Denise Howel1 and
  • Joan Mackintosh1
BMC Public Health20066:81

DOI: 10.1186/1471-2458-6-81

Received: 31 January 2006

Accepted: 29 March 2006

Published: 29 March 2006

Abstract

Background

Socio-economic variations in health, including variations in health according to wealth and income, have been widely reported. A potential method of improving the health of the most deprived groups is to increase their income. State funded welfare programmes of financial benefits and benefits in kind are common in developed countries. However, there is evidence of widespread under claiming of welfare benefits by those eligible for them. One method of exploring the health effects of income supplementation is, therefore, to measure the health effects of welfare benefit maximisation programmes. We conducted a systematic review of the health, social and financial impacts of welfare rights advice delivered in healthcare settings.

Methods

Published and unpublished literature was accessed through searches of electronic databases, websites and an internet search engine; hand searches of journals; suggestions from experts; and reference lists of relevant publications. Data on the intervention delivered, evaluation performed, and outcome data on health, social and economic measures were abstracted and assessed by pairs of independent reviewers. Results are reported in narrative form.

Results

55 studies were included in the review. Only seven studies included a comparison or control group. There was evidence that welfare rights advice delivered in healthcare settings results in financial benefits. There was little evidence that the advice resulted in measurable health or social benefits. This is primarily due to lack of good quality evidence, rather than evidence of an absence of effect.

Conclusion

There are good theoretical reasons why income supplementation should improve health, but currently little evidence of adequate robustness and quality to indicate that the impact goes beyond increasing income.

Background

Socio-economic variations in health, including variations in health according to wealth and income, have been widely reported [14]. However, interventions to overcome socio-economic variations in health have achieved little success[5, 6]. One potential method of improving the health of the most deprived groups is to increase their income. Despite a number of income supplementation experiments – particularly in the USA in the 1960s and 1970s – little investigation of the impact of these experiments on health has been performed[7].

State funded welfare programmes of financial benefits and benefits in kind for, amongst others, the unemployed, the elderly and the sick are common in developed countries. However, there is evidence of widespread under claiming of welfare benefits by those eligible for them, with take up of income related benefits in the UK around 80% in 2002[8]. Take up rates in the rest of Europe are around 40–80% with generally lower rates in the USA[9]. One method of exploring the health effects of income supplementation is, therefore, to measure the health effects of welfare benefit maximisation programmes[7].

Efforts to provide advice on claiming welfare benefits are increasingly being made in the UK[10]. In general, 'welfare rights advice' involves review of eligibility for welfare benefits and active assistance with claims for any benefits to which the client is found to be entitled. Active assistance includes help with completing forms, telephone calls, obtaining letters of support and references, and attendance in person at benefit tribunals. Welfare rights advisors are also often able to offer debt counselling and legal advice, or refer to other appropriate agencies. In the UK, where the majority of welfare rights advice programmes are based, advice is primarily offered through local government, Citizens Advice Bureaux (CAB – a voluntary organisation that "helps people resolve their legal, money and other problems by providing free information and advice"[11] from community locations) or primary care, with clients accessing the services either through self referral, referral from another agency, or a combination of both.

Welfare rights advice services delivered at, or through, primary care premises work within a holistic model of primary health care that "involves continuity of care, health promotion and education, integration of prevention with sick care, a concern for population as well as individual health, community involvement and the use of appropriate technology"[12]. In the UK, all individuals who have been legally resident for at least six months are entitled to be registered with a local primary care practice and receive free treatment there. As over 98% of the population is registered with a primary care practice[13], primary care provides a setting in which the great majority of the population can be accessed.

Given the increasing interest in this area, particularly in the UK, the funding that is now being committed to it by primary care organisations and local authorities, and the opportunity it offers to assess the impact of income supplementation on health, it is timely to bring together the available evidence on the impacts of welfare rights advice delivered in healthcare settings. Two previous reviews have focused on welfare rights advice in healthcare settings[14, 15]. However, neither of these took a systematic approach to literature searching and were primarily descriptions of the different programmes on offer, rather than an assessment of the impacts of these.

We performed a systematic review in order to answer the question: what are the health, social and financial impacts of welfare rights advice delivered in healthcare settings?

Methods

Search strategy

The following strategies were used (by JA) to find and access potentially relevant studies for consideration for inclusion in the review:

1. Searches of electronic databases: the keyword search "(welfare OR benefit OR social welfare OR citizen OR money OR assistance) AND (advice OR right OR prescrip$ OR counsel$)" was used to search the electronic databases listed in Box 1 (see Figure 1) (where $ = wildcard symbol). All available years of all databases were searched up to and including October 2004.

https://static-content.springer.com/image/art%3A10.1186%2F1471-2458-6-81/MediaObjects/12889_2006_Article_378_Fig1_HTML.jpg
Figure 1

Box 1. Electronic databases searched.

2. Hand searches of specific journals: the electronic contents pages of Health and Social Care in the Community (volumes 6–12, 1998–2004), and the Journal of Social Policy (volumes 26–33, 1997–2004) were scanned to identify relevant publications[16]. These journals were chosen because of their relevance to the subject area and the perception that substantial relevant work had been published in them.

3. Searches of internet search engine: searches were made of the internet search engine Google http://www.google.com using the same strategies as above. The first 100 results returned by each search strategy were scanned for relevance and those judged to be potentially relevant followed up.

4. Suggestions from experts and those working in the field: requests for help with accessing relevant literature were sent to relevant e-mail distribution lists (listed in Box 2 – see Figure 2), posted on the rightsnet.org.uk discussion forum and published in the 'trade magazines' Poverty and Welfare Rights Bulletin. 'Experts' – identified as such either by frequent publication in the area, or through personal contacts of the research team – were also contacted directly and asked for help with identifying relevant literature or providing further contacts[17].

https://static-content.springer.com/image/art%3A10.1186%2F1471-2458-6-81/MediaObjects/12889_2006_Article_378_Fig2_HTML.jpg
Figure 2

Box 2. Email distribution lists sent requests for information.

5. Searches of specific websites: the websites of a number of specific organisations that sponsor and conduct social policy research (listed in Box 3 – see Figure 3) were searched to identify publications of interest.

https://static-content.springer.com/image/art%3A10.1186%2F1471-2458-6-81/MediaObjects/12889_2006_Article_378_Fig3_HTML.jpg
Figure 3

Box 3. Websites hand searched for relevant publications.

6. Reference lists from relevant studies: the reference lists of all studies assessed to be relevant were scanned to identify other relevant work, as were the reference lists of previous reviews in this area[14, 15].

7. Science Citation Index and Social Science Citation Index: citation searches of the Science Citation Index and Social Science Citation Index were performed to identify all citations of studies identified as relevant.

8. Author searches: searches for other articles by all authors of articles included in the review were performed in Medline and Health Management Information Consortium (the two databases that provided the greatest number of relevant hits) for all available years up to and including October 2004.

Inclusion and exclusion criteria for studies included in the review

Studies were considered relevant and included in the review if they reported an evaluation of welfare rights advice in a healthcare setting in terms of health, social or financial outcomes. We defined 'welfare rights advice' as expert advice concerning entitlement to and claims for welfare benefits. 'Healthcare settings' were defined as health related buildings – including primary, secondary or tertiary care centres – or where clients were identified through primary, secondary or tertiary care patient lists.

A preliminary scoping review revealed that: there is substantial 'grey literature' in this area; the main study design used is uncontrolled before and after studies; and outcome variables studied vary widely. In order to provide an overview of the wide variety of impacts of welfare rights advice delivered in healthcare settings, we did not restrict our review to any particular outcomes, study design, methods, study population or place of publication (i.e. studies not published in peer reviewed journals were not necessarily excluded). Although searches were conducted in English, no a priori exclusions were made based on the language of publication. However, we did not identify any potentially relevant studies that were not written in English.

The process of determining whether studies should be included in the review was made by one reviewer (JA) in the majority of cases. The review team discussed any cases where doubt concerning inclusion remained after retrieval of reports.

Data abstraction

Data were abstracted from reports and papers ("studies") in the review using a structured proforma. Data collected included: descriptive details of interventions delivered and evaluations performed, and outcome data on all financial, social and health outcomes measured. Data abstraction from each report was performed independently by pairs of reviewers with information entered onto a Microsoft Access database for recording and analysis. In cases where reviewers were found to disagree about the data abstracted, reviewers met to discuss disagreements. If agreement could not be reached, the whole review team was asked to consider the issue and reach a consensus.

Where investigators reported data on the same outcome at a number of different follow up times, information from all follow ups was abstracted and reported. Where information on a number of different outcomes was reported from the same project, information on all outcomes reported was abstracted and the results presented to highlight that these are not independent findings. When we retrieved both an internal report and peer reviewed paper on the same project, both documents were scrutinised and if discrepancies were found, results reported in peer-reviewed journals were used in our assessment.

Assessment of study quality

As the majority of quantitative evaluations of welfare rights advice delivered in healthcare settings use a simple before and after design (6 of 8 studies that reported data on health and social outcomes employed a before and after design, all 29 studies that reported data on financial outcomes employed a before and after design), we felt it inappropriate to assess the quality of studies reported in terms of a formal scoring framework. Instead, we collected information on various aspects of methodology and report this in a descriptive analysis.

As with the quantitative evaluative work in this area, few qualitative studies, or components of studies, identified in the scoping review appeared to meet many of the quality standards for qualitative research that have been proposed[18, 19]. As before, we did not apply any formal framework for determining quality in qualitative work. Instead, information on various aspects of methodology were recorded and are reported descriptively

Analyses and reporting

Given the wide variety of studies that we anticipated including in the review, a formal meta-analysis was not planned and results are reported primarily in a narrative form according, as far as possible, to the schema proposed by Stroup et al (2000) – a checklist of topics that should be covered in meta-analyses of observational studies under the general headings of background, search strategy, methods, results, discussion and conclusions devised by an expert working group (The Meta-analysis Of Observational Studies in Epidemiology (MOOSE) Group)[20].

Ethics and research governance

This review of published and publicly available literature did not require ethical approval.

Results

Search results

Results of electronic database searches for articles, citation searches and author searches are reported in Table 1, Table 2 and Table 3 respectively. Numerous reports were identified by responders to the requests for information. Overall, 55 different studies, considered to meet the inclusion criteria, were included in the review and are summarised in Table 4. Where single reports contained data on two or more projects that differed substantially in design[21, 22], these different projects are reported as separate studies in the results. Table 5 lists those papers and reports retrieved but not included in the review with reasons for exclusion. Only one study included in the review was not UK based[23].
Table 1

results of electronic database searches

Database

Hits

Of some relevance

Included in review

Ageinfo

5

1[34]

1[34]

British Humanities Index

67

0

0

CINAHL

99

6[35–40]

1[40]

Embase

141

7[25, 37, 41–45]

4[25, 42–44]

Health Management Information Consortium

38

14[14, 36–38, 40, 42, 43, 45–47]

4[14, 40, 42, 43]

Health Financials Evaluations Database

0

0

0

International Bibliography of the Social Sciences

113

0

0

MDX health

0

0

0

Medline

286

15[25, 34, 36, 38, 41–45, 48–53]

5[25, 34, 42–44]

PAISArchive

82

0

0

PAISInternational

83

2[54, 55]

0

PsycINFO

686

3[41, 53, 56]

0

Science citation index

150

8[25, 37, 41–45, 57]

5[25, 42–44, 57]

SIRS researcher

5

0

0

Social science citation index

237

7[36–38, 41–43, 45]

2[42, 43]

Social Services Abstracts

147

3[36, 38, 58]

0

Sociological Abstracts

293

2[59, 60]

0

Zetoc

0

0

0

Table 2

results of citation searches

Article

Hits

Of some relevance

Included in review

Abbott and Hobby (2000)[42]

3

3[36, 37, 61]

1[61]

Coppel et al (1999)[43]

7

7[36, 37, 42, 61–64]

3[42, 61, 63]

Cornwallis and O'Neil (1998)[65]

Journal (Hoolet) not listed

Dow and Boaz (1994)[23]

4

1[66]

1[66]

Frost-Gaskin et al (2003)[66]

0

0

0

Galvin et al (2000)[67]

4

4[25, 36, 37, 61]

2[25, 61]

Greasley and Small (2005)

0

0

0

Hoskins and Smith (2002)[63]

2

1[68]

1[68]

Langley et al (2004)[25]

1

1[68]

1[68]

Memel and Gubbay (1999)[57]

2

2[24, 61]

2[24, 61]

Memel et al (2002)[24]

3

2[25, 68]

2[25, 68]

Middleton et al (1993)[69]

4

4[36, 37, 63, 64]

1[63]

Moffatt et al (2004)[70]

Journal (Critical Public Health) not listed

Paris and Player (1993)[71]

21

14[36, 37, 43, 44, 61, 63, 64, 67, 68, 72–76]

7[43, 44, 61, 63, 67, 68, 72]

Powell et al (2004)[68]

0

0

0

Reading et al (2002)[72]

1

1[61]

1[61]

Sherratt et al (2000)[77]

Journal (Primary Healthcare Research and Development) not listed

Toeg et al (2003)[61]

1

0

0

Veitch and Terry (1993)[44]

0

0

0

Table 3

results of author searches

 

Medline

Health Management Information Consortium

Author

Hits

Of some relevance

Included in review

Hits

Of some relevance

Included in review

Abbott, S

38

4[36, 37, 42, 78]

1[42]

3

1[42]

1[42]

Boaz, TL

9

1[23]

1[23]

0

0

0

Coppel, DH

1

1[43]

1[43]

3

0

0

Cornwallis, E

0

0

0

0

0

0

Dow, MG

17

1[23]

1[23]

0

0

0

Downey, D

45

0

0

1

0

0

Frost-Gaskin, M

1

1[66]

1[66]

0

0

0

Galvin, K

35

0

0

12

1[67]

1[67]

Greasley, P

8

0

0

6

0

0

Gubbay, D

3

2[25, 68]

2[25, 68]

0

0

0

Hehir, M

34

1[24]

1[24]

1

0

0

Henderson, C

147

1[66]

1[66]

17

0

0

Hewlett, S

21

3[24, 25, 68]

3[24, 25, 68]

3

0

0

Hobby, L

5

3

 

10

6[34, 36, 40, 42, 78, 79]

4[34, 40, 42, 79]

Hoskins, RA

12

1[63]

1[63]

5

2[63, 64]

1[63]

Hudson, E

42

0

0

2

0

0

Illife, S

85

1[61]

1[61]

2

0

0

Jackson, D

501

0

0

19

1[67]

1[67]

Jones, K

581

0

0

90

1[77]

1[77]

Kirwan, J

47

1[68]

1[68]

6

0

0

Langley, C

25

3[24, 25, 68]

3[24, 25, 68]

6

0

0

Lenihan, P

13

1[61]

1[61]

10

1[61]

1[61]

Means, R

13

1[68]

1[68]

63

0

0

Memel, D

6

1[68]

1[68]

5

0

0

Mercer, L

16

1[61]

1[61]

1

1[61]

1[61]

Middleton, P

51

0

0

7

1[77]

1[77]

Moffatt, S

29

0

0

2

0

0

O'Kelly, R

6

1[66]

1[66]

8

0

0

O'Neil, J

101

0

0

6

0

0

Packham, CK

11

1[43]

1[43]

1

0

0

Paris, JA

14

1[71]

1[71]

2

1[71]

1[71]

Player, D

11

1[71]

1[71]

13

1[71]

1[71]

Pollock, J

86

2[25, 68]

2[25, 68]

2

0

0

Powell, JE

57

1[68]

1[68]

22

0

0

Reading, R

28

1[80]

1[80]

14

0

0

Reynolds, S

106

1[72]

1[72]

13

0

0

Sharples, A

25

0

0

2

1[67]

1[67]

Sherratt, M

4

0

0

2

1[77]

1[77]

Small, P

15

0

0

25

0

0

Smith, LN

40

1[63]

1[63]

26

0

0

Stacy, R

21

0

0

5

0

0

Steel, S

18

1[72]

1[72]

5

0

0

Toeg, D

6

1[61]

1[61]

1

1[61]

1[61]

Varnam, MA

13

1[43]

1[43]

7

1[43]

1[43]

White, M

579

0

0

0

0

0

Table 4

summary of interventions delivered and evaluations performed (studies included in the review)

Authors (date)

Intervention delivered

Evaluation performed

 

Who gave advice?

Where was advice given?

Referral system

Eligibility criteria (size of eligible population)

Financial

Non-financial, before-and-after design

Non-financial comp./control group

Qualitative

Abbott & Hobby (1999)[79]

CAB worker

primary care or client's home

PHCT, self

all registered at 7 practices

No

Yes

Yes

Yes

Abbott & Hobby (2002)[34]

CAB worker and city council welfare rights officer

primary care

variable

(94+ practices)

No

Yes

Yes

Yes

Actions (2004)[81]

welfare rights advisers

primary care, clients' homes, telephone

self, medical staff, friends and family, voluntary and community _rganizations, social services, various other services

not reported

Yes

No

No

Yes

Bennett (1997)[82]

CAB worker

CAB office

PHCT

all registered at 3 practices

Yes

No

No

No

Borland (2004)[83, 84]

CAB worker

primary care, community hospitals, CAB offices, client's home

PHCT, self, any other agency

(Wales wide)

No

No

No

Yes

Bowran (1997)[85]

CAB worker

primary care

not reported

(n = 12500)

No

No

No

Yes

Broseley Health and Advice Partnership (2004)[86]

CAB worker

Primar care

self and all those registered at practice aged over 75 invited to take part

those registered at health centre

Yes

No

No

Yes

Bundy (2002)[87, 88]

city council welfare rights officer and CAB worker

primary care

PHCT, self

(9 practices)

Yes

No

No

No

Bundy (2003)[88]

city council welfare rights officer and CAB worker

primary care

PHCT, self, any other agency

all registered at practices covering 1/3 of those registered in Salford

Yes

No

No

No

Coppell et al (1999)[43]

welfare rights officer

primary care

PHCT, self

anyone (n = 4057)

Yes

No

No

Yes

Cornwallis & O'Neil (1998)[65]

Money advice worker

primary care

PHCT, self

all registered at practice(s) (n = 7600)

No

No

No

Yes

Derbyshire CC WRS (1997)[89]

welfare rights officer

primary care

PHCT, self

all registered at practice(s) (n = 23 039)

Yes

No

No

No

Derbyshire CC WRS (1998a)[22]

welfare rights officer

primary care

not reported

all registered at 2 practices

Yes

No

No

No

Derbyshire CC WRS (1998b)[22]

Welfare rights service worker

primary care

PHCT and targeted mailshots

(4 practices)

Yes

No

No

No

Dow & Boaz (1994)[23]

Linkage worker trained to assist in application for benefit

Clients' home or treatment facility

All individuals registered at 2 community mental health centres over 18 not currently claiming benefits, random sample of those meeting criteria at third centre, possibly eligible for benefits at screening

Screening form used – US citizen or resident alien, income <$600/month ($900 if married), one of: HIV+, 65+, blind, deaf, disabled

No

No

Yes

No

Emanuel & Begum (2000)[90]

CAB worker

primary care

PHCT, self

anyone (n = 12 601)

No

Yes

Yes

Yes

Farmer & Kennedy (2001)[91]

CAB worker

primary care, hospital

at hospitals – from ward staff to social work staff to CAB worker

not reported

No

No

No

Yes

Fleming & Golding (1997)[92]

CAB worker

primary care

not reported

all registered at 21 practices

No

No

No

Yes

Frost-Gaskin et al (2003)[66]

Mind benefit advisor

Mental health resource and day centres (primary care)

None – advisors approached as many regular attendees as possible

all regular attendees (population of those eleigible to attend = 313 510)

Yes

No

No

No

Ferguson & Simmons[93]

Community Links workers (local advice provider)

primary care

Mailshot to registered patients, GP referral

(50% of surgeries in London Borough of Newham)

No

No

Mp

Yes

Galvin et al (2000)[67, 94]

CAB worker

primary care

PHCT

(7 practices)

No

No

No

Yes

Greasley (2003)[95] and Greasley & Small (2005)[96]

12 advisors from 6 agencies

primary care

PHCT, self, any other agency

(n = 106 707)

Yes

Yes

No

Yes

Griffiths (1992)[97]

city council welfare rights officer

primary care

PHCT, self, any other agency

(2 health centres)

Yes

No

No

No

Hastie (2003)[98]

CAB worker

primary care, 2 other local locations

GP, self

not reported

Yes

No

No

Yes

High Peak CAB (1995)[99]

CAB worker

primary care

not reported

all those in town (n = 2500)

No

No

No

No

High Peak CAB (2001)[100]

CAB workers

not reported

not reported

not reported

Yes

No

No

No

High Peak CAB (2003)[101]

CAB workers

primary care

PHCT, self, other agencies

all registered at practices involved

Yes

No

No

No

Hoskins & Smith (2002)[63]

welfare rights officer

client's home

community nurses screened for attendance allowance eligibility opportunistically from their client list and referred screen positive

those >64 who in community nurses opinion were physically/mentally frail (population>64 = 1690)

Yes

No

No

Yes

Hoskins et al (in press)[102]

money advice workers

clients' homes

community nurses screened for attendance allowance eligibility from their client list and referred screen positive

those over 64 who appeared to have unmet clinical needs

Yes

No

No

No

Knight (2002)[103]

welfare benefits advisor

primary care and client's home

all aged 75+ identified through GP and sent invitation to take part

all aged 75+ in central Liverpool PCT area (n = 31 000)

No

No

No

Yes

Lancashire CC WRS (2001)[104]

welfare rights officer

client's home

all patients aged 80+ invited to take part

all registered at 3 practices 80+

No

No

No

No

Langley et al (2004)[25]

Welfare benefits advice worker

primary care, hospital, client's home, local CAB

after consent obtained, sent health assessment questionnaire. Those with score >1/5 contacted by advisor and offered advice session

over 16 with rheumatoid arthritis or osteoarthritis of knee or hip for >1 yr plus NSAID recruited from 20 practices. If >100 eligible from any practice, random sample of 100

No

No

No

No

Lishman-Peat & Brown (2002)[105]

not reported

primary care and client's home

PHCT, self

(5 practices)

Yes

No

No

Yes

MacMillan & CAB Partnership (2004)[106]

CAB workers

clients' homes, "acute and primary care locations" and cancer information centres

from nursing staff at 3 hospitals and community MacMillan nurses

cancer patients and their families

Yes

No

No

Yes

Memel & Gubbay (1999)[57]

welfare rights advisor

primary care

not reported

not reported

No

No

No

No

Memel et al (2002)[24]

CAB worker

primary care or hospital

those with RA or OA from follow up patients at rheumatology outpatients at a teaching hospital and those from two GP surgeries who had take part in other research project

diagnosis of OA or RA, being seen at outpatients or registered at participating GP, health assessment questionnaire score of 2 or more, not currently claiming attendant's allowance or disability living allowance

No

No

No

No

Middlesbrough WRU (1999)[107]

city council welfare rights officer

primary care and client's home where necessary

PHCT

all registered at practice(s) (n = 90 500)

No

No

No

No

Middlesbrough WRU (2004)[108]

welfare rights officers

primary care and clients' homes

GPs, practice receptionists, district nurses, health visitors, health and social care assessors, Macmillan nurses, social workers, age concern

those registered at practice aged over 50

Yes

No

No

No

Middleton et al (1993a)[69]

housing department welfare rights advisor

primary care

not reported

(n = 15 000)

Yes

No

No

No

Middleton et al (1993b)[69]

CAB worker

primary care

not reported

(4 practices)

Yes

No

No

No

Moffatt (2004)[109]

Welfare rights worker

client's home

invitation to take part sent to random sample of those aged 65+

random sample (n = 400+) of those aged 65+ registered at 4 practices

Yes

No

No

Yes

Moffatt et al (2004)[110, 111]

CAB worker

primary care

PHCT, self

all registered at practice

No

No

No

Yes

Paris & Player (1993)[71]

CAB worker

primary care

PHCT

(n = 64 779)

Yes

No

No

No

Reading et al (2002)[72, 80]

CAB worker

primary care

letter to all eligible families

all families registered at 3 health centres with child under 1 year

Yes

No

Yes

Yes

Roberts (1999)[112]

CAB worker

primary care, client's home, letter, telephone

PHCT, self

(5 practices)

No

No

No

Yes

Sedgefield and district AIS (2004)[113]

CAB worker

primary care

PHCT

all registered at practice(s)

No

No

No

Yes

Sherratt et al (2000)[77]

CAB worker

3 models – primary care, telephone, client's home

PHCT (GP surgery, telephone) or targeted at housebound (home visits only)

all registered at 7 or 4 practices (in-surgery and telephone advice), all housebound patients registered with GP in Gateshead (home visits)

No

No

No

Yes

Southwark CC MAS (1998)[114]

welfare rights officer

primary care

not reported

(n = 76 417)

Yes

No

No

Yes

Toeg et al (2003)[61]

CAB worker

primary care, client's home or telephone

all those eligible invited by letter from GP

registered at practice, 80 years +, living in own home (n = 12 000)

Yes

No

No

No

Vaccarello (2004)[115]

HABIT officer

client's home

invitation letters from GPs to those aged 75+

all aged 75 in Liverpool (n = 31 000)

No

No

No

Yes

Veitch (1995) GP[21]

CAB worker

primary care

not reported

(21 practices)

Yes

Yes

No

No

Veitch (1995) mental health[21]

CAB worker

health and social services sites (mental health centres)

not reported

not reported

Yes

Yes

No

No

Veitch & Terry (1993)[44]

CAB worker

primary care

PHCT

(n = 64 779)

No

No

No

No

Widdowfield & Rickard (1996)[116]

CAB worker

primary care

PHCT, self

all registered at practice(s)

No

No

No

Yes

Woodcock (2004)[117]

city council welfare rights officer

primary care

PHCT

not reported

No

No

No

Yes

CAB = Citizen's Advice Bureau; PHCT = any member of primary healthcare team; GP = general practitioner; OA = osteoarthritis; RA = rheumatoid arthritis

Table 5

Papers, reports and book chapters retrieved but not included in the review with reasons for exclusion

Author (date)

Description of content and reason for exclusion

Abbot & Hobby (2003)[36]

Description of service users rather than evaluation of impacts of service.

Abbott (2000)[118]

Multi-disciplinary support service for patients with mixed social and health needs with small welfare rights component but no evaluation of welfare rights component in isolation.

Abbott (2002)[37]

Discussion of where welfare rights advice fits in terms of health interventions. No evaluation of any specific intervention programme.

Alcock (1994)[119]

Discussion of potential benefits of welfare advice in primary healthcare settings and recommendations for development of such services, not evaluation of single/multiple project(s)

Barnes (2000)[120]

Citizens advice service for patients at a long stay psychiatric hospital – including a limited amount of welfare rights advice. No specific evaluation of welfare rights advice component.

Barnsley Community Legal Service Partnership (2003)[121]

Very brief mention of a welfare rights advice project in primary care within a larger report – no evaluation of service.

Bebbington & Unell (2003)[122]

Description of a multidisciplinary telephone advice line for older people with some evaluation of use. No evaluation of welfare rights advice component.

Bebbington et al (?year)[123]

Description of a multidisciplinary telephone advice line for older people with some evaluation of use. No evaluation of welfare rights advice component.

Bird (1998)[124]

Audit of CAB services for those with mental illness – not evaluation of any specific intervention programme delivered in a healthcare setting.

Buckle (1986)[125]

Discussion of eligibility for various benefits. No evaluation of specific intervention.

Bundy (2001)[39]

Brief description of 'The Health and Advice Project' – full evaluation report included in review

Burton & Diaz de Leon (2002)[126]

Review of a number of welfare advice services but only service for which any outcomes are report does not appear to have been delivered in a healthcare setting.

Clarke et al (2001)[127]

Multidisciplinary service to provide advice and support to individuals and families with complex social and health problems – including welfare rights advice. No specific evaluation of welfare rights advice component.

Craig et al (2003)[128]

Review and primary research on the impact of addition welfare benefit income in older people – not specifically of welfare rights advice delivered in a healthcare setting.

Dowling et al (2003)[129]

Systematic review of effectiveness of financial benefits in reducing inequalities in child health with limitation to randomised controlled trials. Not evaluation of welfare rights advice.

Emanuel (2002)[130]

Description of service rather than evaluation of impacts of service.

Ennals (1990)[131]

Discussion of importance of welfare benefits in relation to health and eligibility for benefits.

Ennals (1993)[74]

Editorial relating to article (Paris and Player, 1993) included in review

Evans (1998)[132]

Report of client profile, sources of referrals and problems raised at a welfare rights advice service in primary care. No evaluation of effect on clients.

Forrest (2003)[133]

Very brief mention of a welfare rights advice project in primary care within a larger report – no evaluation of service.

Gask et al (2000)[134]

Very brief mention of a welfare rights advice project in primary care within a larger report – no evaluation of service.

Greasley & Small (2002)[135]

A review of previously published work on welfare rights advice delivered in primary care. Not an evaluation of a specific intervention.

Greasley (2005)[136]

Discussion of the process of videoing interviews that happened to be with users of a welfare rights advice service in primary healthcare. No evaluation of the impact of the intervention service itself.

Green (1998)[137]

Description of eligibility for benefits whilst an in-patient.

Green et al (2004)[138]

Review of health impact assessments in a variety of areas with very limited mention of Longworth et al (2003)

Harding et al (2002)[38]

Audit of provision of welfare rights advisors in general practices and perceived impact of these facilities on the primary healthcare team. No evaluation of any specific programme on clients.

Hobby & Abbott (1999)[78]

Brief description of 'The Health and Advice Project' – full evaluation report included in review

Hobby et al (1998)[15]

A survey of CAB offering outreach in primary care settings with collation of some information. Limited data on impacts of advice not included in other, primary, reports.

Hoskins et al (2000)[64]

Discussion of potential importance of welfare benefits advice for health with proposal that nurses could become involved in giving advice. No actual intervention described or evaluated.

Jarman (1985)[45]

Description of computer programme to help determine eligibility for various welfare benefits. No evaluation of impact of programme.

Kalra et al (2003)[48]

Methods of family planning _ounseling, not welfare rights advice related.

Longworth et al (2003)[139]

Discussion of potential, rather than actual, impact of service

NACAB (1999)[10]

Magazine type articles on various different studies with case studies, not evaluation of single/multiple project(s)

Norowska (2004)[62]

Description of delayed application for and provision of attendance allowance. No intervention to improve take-up discussed.

Okpaku (1985)[140]

Audit of mentally ill people applying for benefit and problems they encounter. No intervention programme to provide advice with claiming.

Pacitti & Dimmick (1996)[56]

Descriptive study of extend and correlates of underclaiming of welfare benefits amongst individuals with mental illness.

Powell et al (2004)[68]

Financial evaluation of welfare rights advice programme with repetition of financial impacts for clients of data in Langley et al (2004) and Memel et al (2004)

Reid et al (1998)[141]

Assessment of staff awareness and involvement in an ongoing welfare rights advice project in primary care. No evaluation of impact of service on users.

Riverside Advice Ltd (2004)[142]

Report of welfare rights project for those with mental illnesses. No evaluation of impact of service on users.

Scully (1999)[143]

Report of training programme for welfare rights advisors working within primary care settings, not evaluation of a specific service.

Searle (2001)[144]

Description of a multidisciplinary telephone advice line for older people. No evaluation of welfare rights advice component.

Sherr et al (2002)[145]

Audit of current practice in three London boroughs with exploration of attitudes to potential services, not evaluation of service in place.

Stenger (2003)[35]

Discussion of moving from welfare to work, not of advice to help claim welfare benefits.

Strachan (1995)[146]

Proceedings of a conference with descriptions but no evaluations of welfare rights advice services in healthcare settings.

Tameside MBC [33, 147]

Description of rationale for service and recommendations for the future, not evaluation of service

Thomson et al (2004)[95]

Discussion of problems involved in rigorous scientific evaluation of social interventions – including welfare rights advice – but no evaluation of specific intervention.

Venables (2004)[148]

Annual report of welfare rights service not based in a healthcare setting.

Watson (2000)[149]

Multidisciplinary intervention project with small welfare rights component but no evaluation of welfare rights component in isolation.

Waterhouse (1996)[150]

Profile of users of a welfare rights advice service in primary care, along with advice sought, service provided and discussion of logistic issues. No evaluation of effect on clients.

Waterhouse (2003)[151]

Report on logistical problems and solutions to setting up welfare advice service in primary care. No evaluation of effect on clients.

Waterhouse and Benson (2002)[152]

Background paper proposing establishment of a welfare rights service within a PCT. No evaluation of new project.

West Berkshire CAB (2004)[153]

Report of service activity and financial statement – no evaluation of service.

Williams (1982)[154]

Description of a hospital based services. Evaluation limited to type of contacts and activity engaged in by welfare advisor.

Interventions delivered

Interventions delivered took a number of different forms. Some identification of who delivered the intervention was reported in 54 (98%) cases. In 30 (55%) instances all or some of the advice was delivered by employees of, or volunteers for, the CAB. In a further 22 (40%) studies all or some of the advice was delivered by welfare rights workers, officers and advisers – sometimes, but not always, explicitly identified as employees of local government.

The location where advice was delivered was reported in 54 (98%) cases. In 31 (57%) instances advice was delivered only in primary care premises such as general practice surgeries or health centres. In a further 16 (29%) cases advice was delivered in primary care premises along with one or more other locations, including clients' homes, hospitals and local CAB. Overall, 18 (33%) studies offered advice within clients' own homes – either exclusively or as an available option.

The referral system by which individuals gained access to the welfare rights advice was reported in 44 (80%) studies. In 32 (73%) studies referral could be from any member of the primary care team, a member of another relevant agency, via self referral from clients or via a combination of these modes. In 11 (25%) studies there were more formal eligibility criteria and invitational processes.

Criteria for who was eligible to receive the welfare rights advice given were reported in 31 (56%) studies. In 14 (45%) studies all patients registered at the general practice or practices participating in the project were eligible to receive advice. In a further 15 (48%) studies some sort of screening or sampling procedure was used to restrict eligibility to certain subgroups of the population – often those suffering from particular conditions or over a certain age. In two cases it was explicitly stated that welfare rights advice was only offered for a limited number of specified benefits (Attendance Allowance and Disability Living Allowance in both cases)[24, 25].

The size of the population eligible to receive the advice given was reported in 17 (31%) studies. Eligible populations ranged in size from 1690 to 313 510 with a median of 23 039.

Health and social outcomes – studies with a comparison or control group

Results from studies that reported the use of a comparison or control group are summarised in Table 6. Of the seven studies with a control or comparison group that reported non-financial outcomes, only one[23] randomly assigned individuals to the intervention or control group.
Table 6

health and social outcomes (validated measurement instruments), studies with a control or comparison group (studies included in the review)

Authors (date)

Outcome measure

Nature of control/comparison group

Random allocation?

Control group N at baseline

Intervention group N at baseline

Control group mean score at baseline

Intervention group mean score at baseline

Follow up period

Control N at follow up

Intervention N at follow up

Control group mean score at follow up

Intervention group man score at follow up

p-value*

Abbott & Hobby (1999)[79]

SF36 physical functioning (change in score)

Those whose income didn't increase following advice allocated to comparison group

No

20

48

NR

NR

6 months

20

48

0

2.4

p > 0.05

 

SF36 role functioning physical (change in score)

 

No

20

48

NR

NR

6 months

20

48

-2.5

2.1

p > 0.05

 

SF36 bodily pain (change in score)

 

No

20

48

NR

NR

6 months

20

48

1

-0.5

p > 0.05

 

SF36 general health (change in score)

 

No

20

48

NR

NR

6 months

20

48

2.5

3.3

p > 0.05

 

SF36 vitality (change in score)

 

No

20

48

NR

NR

6 months

20

48

-7

7.7

p = 0.001

 

SF36 social functioning (change in score)

 

No

20

48

NR

NR

6 months

20

48

-1.3

2.9

p > 0.05

 

SF36 role functioning emotional (change in score)

 

No

20

48

NR

NR

6 months

20

48

8.3

14.6

p > 0.05

 

SF36 mental health (change in score)

 

No

20

48

NR

NR

6 months

20

48

-4.8

7.2

p = 0.019

Abbott & Hobby (2002)[34]

SF36 physical functioning

Those whose income didn't increase following advice allocated to comparison group

No

50

150

34

29.5

6 months

50

150

34.2

30.6

p = 0.65

 

SF36 physical functioning

 

No

50

150

34

29.5

12 months

50

150

37.7

28.9

p = 0.17

 

SF36 role functioning physical

 

No

50

150

15.5

18.9

6 months

50

150

24.5

28.1

p = 0.5

 

SF36 role functioning physical

 

No

50

150

15.5

18.9

12 months

50

150

27

26

p = 0.74

 

SF36 bodily pain

 

No

50

150

29.2

34.8

6 months

50

150

30

43.1

p = 0.013

 

SF36 bodily pain

 

No

50

150

29.2

34.8

12 months

50

150

36.4

39.4

p = 0.71

 

SF36 general health

 

No

50

150

35.6

31.7

6 months

50

150

34

32.3

p = 0.59

 

SF36 general health

 

No

50

150

35.6

31.7

12 months

50

150

32.3

32.1

p = 0.35

 

SF36 vitality

 

No

50

150

33.2

28.7

6 months

50

150

28.4

32.3

p = 0.13

 

SF36 vitality

 

No

50

150

33.2

28.7

12 months

50

150

29.2

28.4

p = 0.26

 

SF36 social functioning

 

No

50

150

45.8

42.3

6 months

50

150

52.5

50.2

p = 0.58

 

SF36 social functioning

 

No

50

150

45.8

42.3

12 months

50

150

54.6

49.2

p = 0.58

 

SF36 role functioning emotional

 

No

50

150

48.7

40.8

6 months

50

150

36.7

51.7

p = 0.17

 

SF36 role functioning emotional

 

No

50

150

48.7

40.8

12 months

50

150

42.7

52.2

p = 0.02

 

SF36 mental health

 

No

50

150

57.1

53

6 months

50

150

56

55.9

p = 0.84

 

SF36 mental health

 

No

50

150

57.1

53

12 months

50

150

56

58.3

p = 0.03

Emanuel & Begum (2000)[90]

HADS anxiety

Those whose income didn't increase following advice allocated to comparison group

No

28

12

12.03

12

9 months

28

13

11.14

12.58

p > 0.05

 

HADS depression

 

No

28

12

8.21

9.75

9 months

28

13

7.86

9.33

p > 0.05

 

MYMOP symptom 1

 

No

28

12

4.48

4.64

9 months

28

13

3.86

4.36

p > 0.05

 

MYMOP symptom 2

 

No

28

12

3.59

4.67

9 months

28

13

2.41

5.33

p > 0.05

 

MYMOP activity

 

No

28

12

4.17

5.7

9 months

28

13

3.83

5

p > 0.05

 

MYMOP wellbeing

 

No

28

12

3.86

4.55

9 months

28

13

3.14

4.65

p > 0.05

 

MYMOP profile

 

No

28

12

4.53

4.28

9 months

28

13

3.44

4.79

p > 0.05

 

GP consultations in last 9 months

Control identified as next in individual on practice register matched for age and sex.

No

39

39

70

187

9 months

39

39

111

165

p > 0.05

 

prescriptions in last 9 months

 

No

39

39

122

239

9 months

39

39

146

278

p > 0.05

 

referrals to secondary care in last 9 months

 

No

39

39

3

21

9 months

39

39

5

18

p > 0.05

 

Visits to A&E in last 9 months

 

No

39

39

0

1

9 months

39

39

2

0

p > 0.05

 

practice nurse contacts in last 9 months

 

No

39

39

13

12

9 months

39

39

6

11

p > 0.05

 

home visits in last 9 months

 

No

39

39

5

3

9 months

39

39

1

3

p > 0.05

 

out of hours calls in last 9 months

 

No

39

39

2

3

9 months

39

39

3

5

p > 0.05

 

social service referrals in last 9 months

 

No

39

39

0

0

9 months

39

39

0

0

p > 0.05

 

cervical cancer screening in last 9 months

 

No

39

39

1

1

9 months

39

39

5

7

p > 0.05

Reading et al (2002)[72]

Edinburgh postnatal depression scale

Six practices recruited – three allocated to intervention group, three to control group.

Yes

173

88

7.7

9.7

NR

153

66

7.1

8.1

p > 0.05

 

Prevalence of maternal smoking

 

Yes

173

88

25

34

NR

153

66

20

36

p > 0.05

 

Maternal non-routine GP visits per year

 

Yes

173

88

NR

NR

NR

153

66

3.1

3.5

p > 0.05

 

Maternal prescriptions

 

Yes

173

88

NR

NR

NR

153

66

2.4

2.1

p > 0.05

 

Child general health "very good"

 

Yes

173

88

NR

NR

NR

153

66

51

44

p > 0.05

 

Child more than 2 minor illnesses in last 3 months

 

Yes

173

88

NR

NR

NR

153

66

18

22

p > 0.05

 

Child accident requiring attention in last year

 

Yes

173

88

NR

NR

NR

153

66

10

6

p > 0.05

 

Child behaviour problems

 

Yes

173

88

NR

NR

NR

153

66

5

10

p > 0.05

 

Child sleeping problems

 

Yes

173

88

12

13

NR

153

66

12

14

p > 0.05

 

Child currently breast fed or stopped aged >4 months

 

Yes

173

88

31

31

NR

153

66

23

17

p > 0.05

 

Child non-routine GP visits per year

 

Yes

173

88

NR

NR

NR

153

66

4.2

4.2

p > 0.05

 

Child prescriptions

 

Yes

173

88

NR

NR

NR

153

66

2.4

2

p > 0.05

Veitch (1995) GP[21]

NHP total score

Those identified by control practices who would have been referred had service been available.

No

5

5

NR

NR

NR

5

5

NR

NR

p > 0.05

 

NHP energy

 

No

5

5

NR

NR

NR

5

5

NR

NR

p > 0.05

 

NHP pain

 

No

5

5

NR

NR

NR

5

5

NR

NR

p > 0.05

 

NHP emotional reaction

 

No

5

5

NR

NR

NR

5

5

NR

NR

p > 0.05

 

NHP sleep

 

No

5

5

NR

NR

NR

5

5

NR

NR

p > 0.05

 

NHP social isolation

 

No

5

5

NR

NR

NR

5

5

NR

NR

p > 0.05

 

NHP physical mobility

 

No

5

5

NR

NR

NR

5

5

NR

NR

p = 0.09

Veitch (1995) mental health[21]

NHP total score

Those identified by control mental health centres who would have been referred had service been available.

No

12

36

NR

NR

NR

12

18

NR

NR

p = 0.4588

 

NHP energy

 

No

12

36

NR

NR

NR

12

18

NR

NR

p = 0.2312

 

NHP pain

 

No

12

36

NR

NR

NR

12

18

NR

NR

p = 0.0700

 

NHP emotional reaction

 

No

12

36

NR

NR

NR

12

18

NR

NR

p = 0.0466

 

NHP sleep

 

No

12

36

NR

NR

NR

12

18

NR

NR

p = 0.3095

 

NHP social isolation

 

No

12

36

NR

NR

NR

12

18

NR

NR

p = 0.4872

 

NHP physical mobility

 

No

12

36

NR

NR

NR

12

18

NR

NR

p = 0.1312

Dow & Boaz (1994)[23]

applied for award

Random allocation to intervention/control group

Yes

389

387

0

0

6 months

311

303

20

63

p < 0.001

 

applied for award

 

Yes

389

387

0

0

8 months

311

303

26

67

p < 0.05

 

applied for award

 

Yes

389

387

0

0

11 months

311

303

26

67

p < 0.05

 

received award

 

Yes

389

387

0

0

6 months

311

303

8

17

p < 0.05

 

received award

 

Yes

389

387

0

0

8 months

311

303

12

22

p < 0.05

 

received award

 

Yes

389

387

0

0

11 months

311

303

13

23

p < 0.051

*comparison of change in score in intervention group with change in score in control or comparison group; SF36 = short form 36; MYMOP = Measure Yourself Medical Outcome Profile scale; GP = general practitioner; A&E = accident and emergency; NHP = Nottingham Health Profile; NR = not reported

Outcome measures used included the Short Form 36 (SF-36 – a general health scale)[26, 27], the Hospital Anxiety and Depression Scale (HADS – a questionnaire commonly used to screen for anxiety or depression)[28], the Measure Yourself Medical Outcome Profile scale (MYMOP – a patient generated wellbeing scale)[29], the Nottingham Health Profile (NHP – a quality of life scale)[30], and the Edinburgh Post-natal Depression Scale[31], as well as whether or not benefits had been applied for or received, and a variety of measures of use of health services. The size of intervention groups at follow up ranged from 13 to 303 with five studies reporting intervention group sizes at follow up of less than 70. Control or comparison group sizes at follow up ranged from 12 to 311 with five studies having control or comparison group sizes at follow up of less than 51. Follow up periods ranged from six to 12 months.

The majority of studies assessed the effect of the advice by comparing change in scores between baseline and follow up in the control or comparison group with the intervention group. Out of 72 separate comparisons reported, 11 (15%) were statistically significant at the 5% level including comparisons relating to SF36 vitality, SF36 mental health, SF36 bodily pain, SF36 role functioning emotional, SF36 mental health, NHP emotional reactions and the proportion of participants who had both applied for and received an award.

Health and social outcomes – before-and-after study design

The six studies that reported non-financial results using recognised measurement scales and a before-and-after study design are summarised in Table 7. These studies used four different outcome measures – the SF36, HADS, MYMOP and NHP. Sample sizes included in follow up ranged from 22 to 244 with five out of six studies completing follow up on less than 55 individuals. Reported follow up periods ranged from six to 12 months. Out of 59 separate statistical comparisons reported, 6 (10%) were found to be significant – SF36 vitality, SF36 role functioning emotional, SF36 mental health, SF36 general health, NHP pain and NHP emotional reactions. Three studies, including one with a follow up sample size of 244 at six months and 200 at 12 months, reported no statistically significant comparisons at all.
Table 7

Quantitative scalar health outcomes, before and after studies (studies included in the review)

Authors (date)

Outcome measure

Baseline N

Baseline mean score

Follow up period

Follow up N

Follow up mean score

p-value*

Abbott & Hobby (1999)[79]

SF36 physical functioning

48

20.8

before vs after income increase

48

23.1

p > 0.05

 

SF36 role functioning physical

48

12.5

before vs after income increase

48

14.6

p > 0.05

 

SF36 bodily pain

48

25.5

before vs after income increase

48

24.9

p > 0.05

 

SF36 general health

48

26.7

before vs after income increase

48

30

p > 0.05

 

SF36 vitality

48

20.8

before vs after income increase

48

28.5

p = 0.002

 

SF36 social functioning

48

29.4

before vs after income increase

48

32

p > 0.05

 

SF 36 role functioning emotional

48

36.8

before vs after income increase

48

51.4

p = 0.037

 

SF36 mental health

48

45.9

before vs after income increase

48

53.1

p = 0.005

Abbott & Hobby (2002)[34]

SF36 physical functioning

345

35.8

6 months

244

31.5

p > 0.05

 

SF36 physical functioning

345

35.8

12 months

200

30.6

p > 0.05

 

SF36 role functioning physical

345

22.8

6 months

244

18.9

p > 0.05

 

SF36 role functioning physical

345

22.8

12 months

200

18

p > 0.05

 

SF36 bodily pain

345

35.7

6 months

244

33.2

p > 0.05

 

SF36 bodily pain

345

35.7

12 months

200

33.4

p > 0.05

 

SF36 general health

345

34.8

6 months

244

32.9

p > 0.05

 

SF36 general health

345

34.8

12 months

200

32.6

p > 0.05

 

SF36 vitality

345

31.3

6 months

244

29.9

p > 0.05

 

SF36 vitality

345

31.3

12 months

200

29.8

p > 0.05

 

SF36 social functioning

345

40.9

6 months

244

42.5

p > 0.05

 

SF36 social functioning

345

40.9

12 months

200

43.2

p > 0.05

 

SF36 role functioning emotional

345

40.9

6 months

244

40.4

p > 0.05

 

SF36 role functioning emotional

345

40.9

12 months

200

42.8

p > 0.05

 

SF36 mental health

345

51.7

6 months

244

53.1

p > 0.05

 

SF36 mental health

345

51.7

12 months

200

54

p > 0.05

Emanuel & Begum (2000)[90]

HADS anxiety

40

12.03

9 months

40

11.58

p > 0.05

 

HADS depression

40

8.68

9 months

40

8.3

p > 0.05

 

MYMOP symptom 1

31

4.58

9 months

31

4.1

p > 0.05

 

MYMOP symptom 2

25

3.92

9 months

25

3.48

p > 0.05

 

MYMOP activity 1

27

4.67

9 months

27

4.26

p > 0.05

 

MYMOP wellbeing

31

4.13

9 months

31

3.71

p > 0.05

 

MYMOP profile

31

4.45

9 months

31

3.94

p > 0.05

Greasley (2003)[95]

SF36 physical functioning

22

39.09

6 months

22

48.64

p > 0.05

 

SF36 physical functioning

22

39.09

12 months

22

57.50

p > 0.05

 

SF36 role functioning physical

22

30.11

6 months

22

36.36

p > 0.05

 

SF36 role functioning physical

22

30.11

12 months

22

40.34

p > 0.05

 

SF36 bodily pain

22

30.45

6 months

22

25.91

p > 0.05

 

SF36 bodily pain

22

30.45

12 months

22

29.18

p > 0.05

 

SF36 general health

22

22.90

6 months

22

31.09

p < 0.002

 

SF36 general health

22

22.90

12 months

22

33.59

p < 0.076

 

SF36 vitality

22

25.28

6 months

22

26.98

ANOVA across 3 time points, p < 0.079

 

SF36 vitality

22

25.28

12 months

22

33.52

 
 

SF36 social functioning

22

34.09

6 months

22

43.75

ANOVA across 3 time points, p < 0.077

 

SF36 social functioning

22

34.09

12 months

22

43.75

 
 

SF36 role functioning emotional

22

34.85

6 months

22

47.72

p > 0.05

 

SF36 role functioning emotional

22

34.85

12 months

22

39.77

p > 0.05

 

SF36 mental health

22

37.14

6 months

22

42.85

p > 0.05

 

SF36 mental health

22

37.14

12 months

22

47.86

p < 0.076

Greasley (2003)[95] cont.

HADS anxiety

22

13.31

6 months

22

11.73

ANOVA across 3 time points, p < 0.051

 

HADS anxiety

22

13.31

12 months

22

11.36

 
 

HADS depression

22

10.59

6 months

22

10.41

p > 0.05

 

HADS depression

22

10.59

12 months

22

9.59

p > 0.05

Veitch (1995) – GP[21]

NHP total score

52

Not reported

6 months

52

Not reported

p-0.6344

 

NHP energy

52

Not reported

6 months

52

Not reported

p = 0.3970

 

NHP pain

52

Not reported

6 months

52

Not reported

p = 0.8368

 

NHP emotional reactions

52

Not reported

6 months

52

Not reported

p = 0.4249

 

NHP sleep

52

Not reported

6 months

52

Not reported

p = 0.3138

 

NHP social isolation

52

Not reported

6 months

52

Not reported

p = 0.9011

 

NHP physical mobility

52

Not reported

6 months

52

Not reported

p = 0.8489

Veitch (1995) – mental health[21]

NHP total score

52

Not reported

6 months

52

Not reported

p = 0.1084

 

NHP energy

52

Not reported

6 months

52

Not reported

p = 0.3359

 

NHP pain

52

Not reported

6 months

52

Not reported

p = 0.0127

 

NHP emotional reactions

52

Not reported

6 months

52

Not reported

p = 0.0333

 

NHP sleep

52

Not reported

6 months

52

Not reported

p = 0.1309

 

NHP social isolation

52

Not reported

6 months

52

Not reported

p = 0.8928

 

NHP physical mobility

52

Not reported

6 months

52

Not reported

p = 0.2061

*comparison of follow up versus baseline score; SF36 = short form 36; MYMOP = Measure Yourself Medical Outcome Profile scale; HADS = Hospital Anxiety and Depression Scale; NHP = Nottingham Health Profile

Seven studies reported health and social results using in-house questionnaires with little evidence of validation. These are summarised in Table 8. These studies found consistently high levels of clients agreeing with statements concerning the positive impact of the advice on their health, quality of life and living situations.
Table 8

Quantitative non-scalar health and social outcomes, studies without a control or comparison group (studies included in the review)

Authors (date)

Sample size and composition

Sample selection strategy

Data collection method

Summary of results

Abbott & Hobby (1999)[79]

48 clients

all clients whose income increased as a result of the advice

structured interview

69% felt increase in income "affected how they felt about life and/or that their health had improved"

Borland (2004)[83, 84]

1088 clients

all clients asked to complete questionnaire

postal questionnaire

88% felt better after seeing the advice worker

Broseley Health and Advice Partnership (2004)[86]

unspecified number of clients

not reported

postal questionnaire

100% "felt less worried or stressed" following the advice 75% "had more money to buy food or provide heating" following the advice 75% "felt better in themselves" following the advice

Hastie (2003)[98]

86 clients

not reported

postal questionnaire

87% thought the service "made a positive difference to them" 83% "felt less worried, calmer and supported" following the advice 60% "felt their health had improved" following the advice 53% "felt that their housing situation had improved" following the advice

Lishman-Peat & Brown (2002)[105]

34 clients

not reported

structured interview

73% "felt happier having been helped by ad advisor, even if that help did not result in extra income"

Sedgefield and district AIS (2004)[113]

33 clients

not reported

postal questionnaire

73% felt advice had "improved quality of life"

Vaccarello (2004)[115]

unspecified number of clients

10% random sample of clients invited to take part

postal questionnaire

98% felt service "had improved their quality of life" 91% said the service "had helped them to keep independent and remain in their own home" 83% "felt they were able to manage more safely in their homes" following the advice 77% felt they "cope better with their day-to-day living" following the advice

Ferguson & Simmons[93]

unspecified number of clients

not reported

not reported

46% felt "less anxious or worried" after seeing the advisor 11% "reported an improvement in their health" 13% "reported that they could now afford a better diet" 13% "stated that they could afford increased heating" as a result of the advice

Health and social outcomes – qualitative studies

Aspects of the qualitative investigations within studies included in the review are summarised in Table 9. The 14 studies that reported qualitative data collected information from a variety of individuals including those who received advice, advice givers and primary care staff. Sample sizes ranged from six to 41. In 12 of the 14 (86%) studies, data were collected via interviews with participants whilst questionnaires were relied on in two (14%) cases. Six of 12 (50%) studies that reported a rationale for participant selection, gave a theoretical reason for participant selection, rather than reporting that selection was random, opportunistic or just those who responded to a postal questionnaire. The analytical approach used for drawing results from the data was reported in 10 (71%) cases.
Table 9

Quality of qualitative studies (studies included in the review)

Authors (date)

Sample Size

Sample composition

Sample selection strategy

Data collection method

Analytical method

Abbott & Hobby (2002)[34]

6

clients

illustrative of "complex interactions between social situation, income and health"

interviews

development of case studies

Actions (2004)[81]

Not stated

clients

Not stated

questionnaire with free text

non stated – verbatim reporting of free text comments

Bowran (1997)[85]

25

17 successful claimants, 7 unsuccessful claimants

all those seen in 1996 invited to take part, 43 consented, purposefully sampled

unstructured interviews

grounded theory

Emanuel & Begum (2000)[90]

10

10 clients

5 users whose HADS/MYMOP improved, 5 users whose HADS/MYMOP didn't improve/worsened

semi-structured interviews

thematic analysis

Farmer & Kennedy (2001)[91]

8

4 clients after advice given, 4 clients before and after advice given

clients seen after chosen by random selection, clients seen before and after approached in waiting room and asked to take part

semi-structured interviews

development of case studies and inductive thematic analysis

Fleming & Golding (1997)[92]

27

clients

all clients who gave consent

semi-structured interviews

not stated – description of apparently important areas reported

Galvin et al (2000)[67, 94]

10

clients

service users those with multiple and complex needs

"focused interviews"

illuminative evaluation, thematic content analysis

Knight (2002)[103]

28

service users

not stated

focus groups and telephone unstructured interviews

thematic analysis

MacMillan & CAB Partnership (2004)[106]

38

clients

Those clients who gave permission to be contacted for research

telephone interview

not stated – verbatim reporting of comments given

Moffatt et al (2004)[70]

11

all white, 7 women, age range 46–76 years, all unemployed/retired/unable to work, all chronic health problems, 8 never used welfare advice before

purposeful of those who benefited financially

semi-structured interviews

establish analytical categories, grouping into overarching key themes

Moffatt (2004)[109]

25

14 in intervention arm, 14 female, mean age 75

purposeful to get those who did and didn't receive intervention and those who did and didn't benefit financially

semi-structured interviews

development of conceptual framework and thematic charting

Reading et al (2002)[72]

10

5 service users and 5 non-service users who were eligible and expressed debt concerns at start of project

random selection of two groups represented

semi-structure interviews

modified grounded theory with more descriptive approach

Sherratt et al (2000)[77]

41

13 patients

4 patients randomly chosen per month and invited to take part

semi-structured interviews with clients, focus groups with staff

thematic analysis

Woodcock (2004)[117]

Not stated

clients

all clients seen sent satisfaction questionnaire

postal questionnaire with free text

not stated – verbatim reporting of few text comments

Some of the common themes identified in the qualitative results are listed in Box 4 (see Figure 4). Money gained as a result of the advice was commonly reported as being spent on healthier food, avoidance of debt, household bills, transport and socialising. A number of negative issues concerning the advice were raised, primarily by general practitioners. These included the suggestion that the health benefits of increased welfare benefits may be temporary or offset by ongoing, irreversible, health deterioration.
https://static-content.springer.com/image/art%3A10.1186%2F1471-2458-6-81/MediaObjects/12889_2006_Article_378_Fig4_HTML.jpg
Figure 4

Box 4. Common areas identified in qualitative work.

Financial outcomes

Data on either lump sums (generally back dated payments and arrears for the period between claim submission and claim approval) or recurring benefits or both gained as a result of the advice were reported in 28 cases (51%). Financial data from these studies are summarised in Table 10. Although a number of other studies reported some information on financial outcomes, this was often given as a combined figure of both lump sum payments and recurring benefits – making comparisons difficult. Furthermore, the specific benefits gained for clients was inconsistently reported and are not, therefore, reported here. The studies reporting analysable financial data gained a mean of £194 (US$353, €283) lump sum plus £832 (US$1514, €1215) per year in recurring benefits per client seen – a total of £1026 (US$1867, €1498) in the first year following the advice per client seen. As, the number of successful claimants was only reported in 17 (59%) cases where all other financial data were reported, we have not reported gains per successful claimant. As the number of successful claimants is likely to be less than the total number of clients seen, the actual financial benefit to those who successfully claimed is likely to be greater than the figures summarised here. Furthermore, a number of authors stated that their data did not include the outcomes of claims or appeals still pending at the time of reporting, making the definitive amount gained as a result of advice likely to be greater still.
Table 10

Quantitative financial outcomes (studies included in review where data provided)

Authors (date)

Number of clients seen

Total lump sum/one off payments gained

Mean lump sum/one off payments per client seen

Recurring benefits gained (per year)

Mean recurring benefits (per year) per client seen

Bennett (1997)[82]

49

£28 121.00

£573.898

£41 860.00

£854.29

Bundy (2002)[87]

561

£183 147.00

£326.47

£762 042.00

£1358.36

Bundy (2003)[88]

818

£261 231.00

£319.35

£474 587.00

£580.18

Coppell et al (1999)[43]

270

£15 863.00

£58.75

£28 028.00

£103.81

Cornwallis & O;Neill (1997)[65]

102

£66 785.00

£654.75

not reported

not reported

Derbyshire CC WRS (1997)[89]

428

£73 643.07

£172.06

£527 352.90

£1232.13

Derbyshire CC WRS (1998a)[22]

480

£117 405.20

£244.59

£573 995.20

£1195.82

Derbyshire CC WRS (1998b)[22]

290

£56 967.87

£196.44

£374 630.40

£1291.83

Frost-Gaskin et al (2003)[66]

153

£60 323.34

£394.27

£281 805.80

£1841.87

Greasley (2003)[95] & Greasley and Small (2005)[96]

2484

£431 198.00

£173.59

£1 940 543.00

£781.22

Griffiths (1992)[97]

157

£32 708.00

£208.33

£87 131.20

£554.98

Hastie (2003)[98]

492

£39 688.00

£80.67

£173 108.00

£351.85

High Peak CAB (1995)[99]

39

not reported

not reported

£38 646.40

£990.93

High Peak CAB (2001)[100]

236

£9 069.74

£38.43

£24 934.52

£105.65

High Peak CAB (2003)[101]

156

£4765.63

£30.55

£60 201.96

£385.91

Hoskins et al (in press)[102]

630

£119 515.44

£189.71

£1 016 908.70

£1 614.14

Memel & Gubbay (1999)[57]

46

not reported

not reported

£73 872.00

£1605.91

Memel et al (2002)[24]

19

not reported

not reported

£38 725.00

£2038.16

Middlesbrough WR (1999)[107]

272

not reported

not reported

£473 053.00

£1739.17

Middleton et al (1993a)[69]

52

£10 393.00

£199.87

£14 359.00

£276.13

Middleton et al (1993b)[69]

583

£12 559.80

£21.54

£8 373.20

£14.36

Moffatt (2004)[109]

25

£5 766.00

£230.64

£37 442.08

£1497.68

Paris & Player (1993)[71]

150

£3 371.00

£22.47

£54 929.58

£366.20

Reading et al (2002)[72]

23

£4 389.00

£190.83

£6 480.00

£281.74

Southwark CC MAC (1998)[114]

621

£160 593.00

£258.60

£390 500.00

£628.82

Vaccarello (2004)[115]

206

£11 433.00

£55.50

£137 819.00

£669.02

Veitch (1995)[21] – mental health

35

£16 122.90

£460.65

£25 581.40

£730.90

Veitch (1995)[21] – GP

37

£28 783.69

£777.94

£74 025.64

£2000.69

Widdowfield & Rickard (1996)[116]

106

not reported

not reported

£183 790.20

£1733.87

Totals

 

£1 753 843 and 9038 clients, mean = £194 per client

£7 864 910 and 9418 clients, mean = £832 per year per client

CAB = Citizen's Advice Bureau

Discussion

Summary of results

We found 55 studies reporting on the health, social and economic impact of welfare advice delivered in healthcare settings. The majority of these studies were grey literature, not published in peer reviewed journals, and were of limited scientific quality: full financial data were only reported in 50% of cases, less than 10% of studies used a control or comparison group to assess the impact of the advice, and qualitative approaches did not always reflect best practice. Only one study – based in the USA – included in the review was not UK based.

Amongst those studies included in the review, most welfare rights advice was delivered by CAB workers or local government welfare rights officers, most advice was delivered in primary care with around a third of studies offering advice in clients' homes. Few studies had restrictive eligibility criteria or referral procedures.

There was evidence that welfare rights advice delivered in healthcare settings leads to worthwhile financial benefits with a mean financial gain of £1026 per client seen in the year following advice amongst those studies reporting full financial data. This equates to around 9% of average individual gross income in the UK in 1999–2001[32]. However, this is by no means a precise estimate of typical gains: there was considerable variation in the gains reported and many studies identified that their data were incomplete with a number of claims still 'pending'.

Studies that included control or comparison groups tended to use non-specific measures of general health (e.g. SF36, NHP and HADS) and found few statistically significant differences between intervention and control or comparison groups. However, sample sizes were often small and follow up limited to a maximum of 12 months – likely to be too short a period to detect changes in health following changes in financial circumstances. Where statistically significant results were found, these tended to be in relation to measures of psychological or social, rather than physical, health. Qualitative methods were commonly used to assess both clients' and staff's perceptions of the impact of the advice. The advice was generally welcomed with extra money gained as a result of the advice commonly reported as being spent on household necessities and social activities.

Limitations of review methods

The majority of the studies included in this review were grey literature not published in peer reviewed journals and were accessed via requests for information sent to email distribution lists. Although often of limited scientific quality, we included these studies in our review as they often included legitimate data on financial benefits of the intervention and let us describe the current scope of welfare rights advice as far as possible. Because grey literature is not comprehensively indexed, it is hard to be sure that we accessed all that is available, despite our use of a systematic approach to both literature searching and data abstraction[17]. In particular, we collected very little information from non-UK settings, despite sending requests for information to a number of international distribution lists. Whilst welfare rights advice may be rare outside the UK, it is also possible that it is described differently in different contexts and that the vocabulary used in our requests for information had little meaning for those outside the UK. We did not conduct searches of non-English language electronic databases or place posts in other languages to international email distribution lists. These additional techniques may have revealed additional relevant work from outside the UK.

The variations and limitations of methods used by the studies included in this review meant that it was inappropriate to perform formal meta-analysis. Similarly, limitations in data availability prevented us from performing potentially interesting comparisons of the cost of providing welfare rights advice versus the financial benefits gained for clients. The interpretation of our findings and conclusions that can be drawn are, therefore, more subjective than might be the case in other systematic reviews. In order to confirm that we were using the best possible methods, we considered performing our review under the umbrella of one of the evidence and review collaborations. However, there was no obvious appropriate review group within the Cochrane Collaboration for this sort of work. The Campbell Collaboration supports systematic reviews of behavioural, social and educational interventions but were unwilling to consider inclusion of any uncontrolled studies in our review. Although this would undoubtedly have increased the overall quality of studies included, we felt it would have led to a review that was not representative of the evidence base – which is largely of poor scientific quality, as described here. This problem has been previously described[12].

Interpretation of results

Our review supports previous findings that the provision of welfare rights advice in healthcare settings is increasingly common in the UK[14, 15] – although as these are non-statutory services, coverage is inevitable patchy. However, there was also some evidence that similar programmes can be provided in other settings with one study from the USA included in the review[23]. Whilst we have found substantial evidence that welfare rights advice in healthcare settings leads to financial benefits, there is little evidence that the advice leads to measurable health and social benefits. This is primarily due to absence of good quality evidence, rather than evidence of absence of an effect.

Whilst some sort of evaluation of welfare rights advice programmes is commonplace, the scientific rigour of these evaluations appears to be limited. Many of these advice services appear to operate in conditions of limited resources. Although performing some sort of evaluation of their service is frequently a requirement of funding, additional resources to support such evaluation and the skills to conduct it rigorously are scarce.

Implications for policy, practice and research

There is now substantial evidence that welfare rights advice delivered in healthcare settings leads to financial benefits for clients – although typical levels cannot be precisely estimated. There is little need to conduct additional work to determine whether such advice has a financial effect, although further work is required to explore the characteristics of those most likely to benefit financially in order that such advice can be effectively targeted.

As there is little evidence either that welfare rights advice in healthcare settings does or does not have health and social effects, and this remains an intervention with theoretical potential to improve health, there is a need for further studies to examine these effects using robust methods. In particular, future work should: use randomised and controlled approaches; put careful consideration into the outcome measures to be used – general measures of health such as the SF36 may not be able to pick up subtle changes in psychological and social aspects of health; and make efforts to follow up participants over an appropriate time period – as the health and social effects of increased financial resources may take years, rather than months, to become apparent. There has been some discussion concerning the ethics of conducting randomised controlled trials of welfare rights advice interventions as it may be considered unethical to randomise some participants to a control group when there is good reason to believe that the intervention will lead to financial benefit for many participants[33]. However, if the control condition comprises 'usual care' and control group participants are free to seek out welfare rights advice from routine sources should they wish, it is not clear why such trials should necessarily be unethical.

There is also a need for evaluations of the effects of welfare rights advice in healthcare settings outside the UK. All welfare benefits systems are country specific and it can not be assumed that results for one country – such as the majority of those included in this review – are necessarily generalisable internationally. However, many of the conclusions of this review, in terms of how interventions are evaluated, will be applicable internationally.

Conclusion

This review has revealed the poor quality of many evaluations of welfare rights advice in healthcare settings. If firm conclusions about the health and social effects of such advice are to be drawn, future evaluative work should be well resourced and carried out by those with appropriate skills. Those funding such programmes should think carefully about the benefits of requiring evaluations to be performed without providing additional resources and skills – poor quality evaluations could be argued to be a waste of money.

This review confirms that there is a substantial under claiming of welfare benefits amongst those referred to welfare rights advice services and that such services can go some way to resolving under claiming. However, there is currently little evidence of adequate robustness and quality to indicate that such services lead to health improvements.

Declarations

Acknowledgements

Many thanks to all those who responded to the requests for help with finding literature. This review was not supported by any specific funding. JA was supported by a Wellcome Trust Value in People award from Newcastle University when this review was conducted.

Authors’ Affiliations

(1)
Public Health Research Group, School of Population and Health Sciences, University of Newcastle upon Tyne

References

  1. Townsend P, Phillimore P, Beattie A: Health and deprivation: inequality and the North. 1988, Bristol, Croom HelmGoogle Scholar
  2. Townsend P, Davidson N: Inequalities in health: The Black Report. 1982, Suffolk, Penguin BooksGoogle Scholar
  3. Whitehead M: Inequalities in health: The health divide. 1992, Suffolk, Penguin Books, 3rdGoogle Scholar
  4. Acheson D: Report of the independent enquiry into inequalities in health. 1998, London, Stationary OfficeGoogle Scholar
  5. Gunning-Schepers LJ, Gepkens A: Reviews of interventions to reduce social inequalities in health: research and policy implications. Health Educ Res. 1996, 55: 226-238.Google Scholar
  6. Arblaster L, Lambert M, Entwistle V, Forster M, Fullerton D, Sheldon T, Watt I: A systematic review of the effectiveness of health service interventions aimed at reducing inequalities in health. Journal of Health Service Research Policy. 1996, 1: 93-103.Google Scholar
  7. Connor J, Rodgers A, Priest P: Randomised studies of income supplementation: a lost opportunity to assess health outcomes. J Epidemiol Community Health. 1999, 53: 725-730.PubMedPubMed CentralGoogle Scholar
  8. Jutla S, Ladva S, Majumdar R, Nowak J: Income related benefits estimates of take-up in 2001/2002. 2004, London, Department of Work and Pensions and National StatisticsGoogle Scholar
  9. Hernanz V, Malherbet F, Pellizzari M: Take-up of welfare benefits in OECD countries: a review of the evidence. 2004, Paris, OECD, Directorate of Employment, Labour and Social AffairsGoogle Scholar
  10. NACAB (National Association of Citizens Advice Bureau): Prescribing advice: health and inequality. 1999, London, NACABGoogle Scholar
  11. Citizens Advice Bureau: About us. [http://www.citizensadvice.org.uk/index/aboutus.htm]
  12. Ogilvie D, Egan M, Hamilton V, Petticrew M: Systematic reviews of health effets of social interventions: 2. Best available evidence: how low should you go?. Journal of Epidemiology and Community Health. 2005, 59: 886-892. 10.1136/jech.2005.034199.PubMedPubMed CentralGoogle Scholar
  13. Hippisley-Cox J, Hammersley V, Pringle M, Coupland C, Crown N, Wright L: Methodology for assessing the usefulness of general practice data for research in one research network. Health Informatics Journal. 2004, 10: 91-109. 10.1177/1460458204042230.Google Scholar
  14. Greasley P, Small N: Welfare advice in primary care. 2001, Bradford, University of Bradford, School of Health StudiesGoogle Scholar
  15. Hobby L, Enmanuel J, Abbott S: Citizen's Advice Bureau in primary care in England and Wales: a review of available information. 1998, Liverpool, Health and Community Care Research UnitGoogle Scholar
  16. Armstrong R, Jackson N, Doyle J, Waters E, Howes F: It's in your hands: the value of handsearching in conducting systematic review of public health interventions. J Public Health. 2005, 27: 388-391. 10.1093/pubmed/fdi056.Google Scholar
  17. Ogilvie D, Hamilton V, Egan M, Petticrew M: Systematic reviews of health effects of social interventions: 1. finding the evidence: how low should you go?. J Epidemiol Community Health. 2005, 59: 804-808. 10.1136/jech.2005.034181.PubMedPubMed CentralGoogle Scholar
  18. Barbour RS: Checklists for improving rigor in qualitative research: a case of the tail wagging the dog?. BMJ. 2001, 322: 1115-1117. 10.1136/bmj.322.7294.1115.PubMedPubMed CentralGoogle Scholar
  19. Spencer E, Ritchie J, Lewis J, Dillon L: Quality in qualitative evaluation: a framework for assessing research evidence. 2003, London, The Cabinet OfficeGoogle Scholar
  20. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB: Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000, 283: 2008-2012. 10.1001/jama.283.15.2008.PubMedGoogle Scholar
  21. Veitch D: Prescribing citizens advice: an evaluation of the work of the citizens advice bureau with Health and Social Services in Birmingham. 1995, Birmingham, District Citizens Advice BureauGoogle Scholar
  22. Derbyshire County Council Welfare Rights Service: Welfare rights in primary care (Shirebrook and Bolsover practices, Derbyshire) second annual report. 1998, , Derbyshire County Council Welfare Rights ServiceGoogle Scholar
  23. Dow MG, Boaz TL: Assisting clients of community mental health centers to secure SSI benefits: a controlled evaluation. Community Ment Health J. 1994, 30: 429-440. 10.1007/BF02189061.PubMedGoogle Scholar
  24. Memel D, Kirwan JR, Langley C, Hewlett S, Hehir M: Prediction of successful application for disability benefits for people with arthritis using the Health Assessment Questionnaire. Rheumatology. 2002, 41: 100-102. 10.1093/rheumatology/41.1.100.PubMedGoogle Scholar
  25. Langley C, Memel DS, Kirwan JR, Pollock J, Hewlett S, Gubbay D, Powell J: Using the health assessment questionnaire and welfare benefits advice to help people disabled through arthritis to access financial support. Rheumatology. 2004, 43: 863-868. 10.1093/rheumatology/keh184.PubMedGoogle Scholar
  26. McHorney CA, Ware JE, Raczek AE: The MOS 36-Item Short-Form Health Survey (SF-36®): II. psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993, 31: 247-263.PubMedGoogle Scholar
  27. Ware JE, Sherbourne CD: The MOS 36-Item Short-Form Health Survey (SF-36®): I. conceptual framework and item selection. Med Care. 1992, 30: 473-483.PubMedGoogle Scholar
  28. Zigmond AS, Snaith RP: The Hospital Anxiety And Depression Scale. Acta Psychiatr Scand. 1983, 67: 361-370.PubMedGoogle Scholar
  29. Paterson C: Measuring outcome in primary care: a patient-generated measure, MYMOP, compared to the SF-36 health survey. BMJ. 1996, 312: 1016-1020.PubMedPubMed CentralGoogle Scholar
  30. Hunt SM, McEwen J, McKenna SP: Measuring health stats: a new tool for clinicians and epidemiologists. J R Coll Gen Pract. 1985, 35: 185-188.PubMedPubMed CentralGoogle Scholar
  31. Cox JL, Holden JM, Sagovsky R: Detection of postnatal depression: development of the 10- item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987, 150: 782-786.PubMedGoogle Scholar
  32. Causer P, Virdee D: Regional Trends, No. 38. 2004, London, The Stationery OfficeGoogle Scholar
  33. Thomson H, Hoskins R, Petticrew M, Ogilvie D, Craig N, Quinn T, Lindsay G: Evaluating the health effects of social interventions. BMJ. 2004, 328: 282-285. 10.1136/bmj.328.7434.282.PubMedPubMed CentralGoogle Scholar
  34. Abbott S, Hobby L: What is the impact on individual health of services in primary health care settings which offer welfare benefits advice. 2002, Liverpool, Health and Community Care Research Unit, University of LiverpoolGoogle Scholar
  35. Stenger J: Welfare writes. Don't even consider moving into work, without getting independent advice first. Ment Health Today. 2003, 17-Google Scholar
  36. Abbott S, Hobby L: Who uses welfare benefits advice services in primary care?. Health Soc Care Community. 2003, 11: 168-174. 10.1046/j.1365-2524.2003.00414.x.PubMedGoogle Scholar
  37. Abbott S: Prescribing welfare benefits advice in primary care: is it a health intervention, and if so, what sort?. J Public Health Med. 2002, 24: 307-312. 10.1093/pubmed/24.4.307.PubMedGoogle Scholar
  38. Harding R, Sherr L, Singh S, Sherr A, Moorhead R: Evaluation of welfare rights advice in primary care: the general practice perspective. Health Soc Care Community. 2002, 10: 417-422. 10.1046/j.1365-2524.2002.00393.x.PubMedGoogle Scholar
  39. Bundy R: Mutual benefits. Health Serv J. 2001, 15 Feb: 34-Google Scholar
  40. Abbott S, Hobby L: Impact on individual health of the provision of welfare advice in primary health care. Ment Health Learn Disabil Care. 2000, 3: 260-262.Google Scholar
  41. Harding R, Sherr L, Sherr A, Moorhead R, Singh S: Welfare rights advice in primary care: prevalence, processes and specialist provision. Fam Pract. 2003, 20: 48-53. 10.1093/fampra/20.1.48.PubMedGoogle Scholar
  42. Abbott S, Hobby L: Welfare benefits advice in primary care: evidence of improvements in health. Public Health. 2000, 114: 324-327.PubMedGoogle Scholar
  43. Coppel DH, Packham CJ, Varnam MA: Providing welfare rights advice in primary care. Public Health. 1999, 113: 131-135. 10.1016/S0033-3506(99)00137-7.PubMedGoogle Scholar
  44. Veitch D, Terry A: Citizens' advice in general practice: patients benefit from advice. BMJ. 1993, 307: 262-262.Google Scholar
  45. Jarman B: Giving advice about welfare benefits in general practice. BMJ. 1985, 290: 522-524.PubMedGoogle Scholar
  46. Millar B: Welfare rights on prescription. Healthlines. 1997, 48:Google Scholar
  47. Kempson E: Money advice and debt counseling. 1995, London, Policy Studies InstituteGoogle Scholar
  48. Kalra RC, Kapoor N, Das M: Counseling in family welfare. Nurs J India. 2003, 94: 114-116.PubMedGoogle Scholar
  49. Mochizuki H: The establishment of licensed social welfare counselors: background for the development of the system and education of personnel. A view by the nursing profession of the new system (Japanese). Kango Kyoiku. 1988, 29: 135-141.PubMedGoogle Scholar
  50. Anonymous: The establishment of licensed social welfare and nursing welfare counselors. Supplement 1. Outline of the bill introducing the systems of social welfare and nursing welfare counselors (Japanese). Kango Kyoiku. 1988, 29: 141-143.Google Scholar
  51. Anonymous: The establishment of licensed social welfare and nursing welfare counselors. Supplement 2. Qualifications for social welfare and nursing welfare counselors (Japanese). Kango Kyoiku. 1988, 29: 144-150.Google Scholar
  52. Anonymous: The establishment of social welfare and nursing welfare counselors. Supplement 3. Report by the committee evaluating facilities training social welfare and nursing welfare counselors and their qualifying examinations (Japanese). Kango Kyoiku. 1988, 29: 151-157.Google Scholar
  53. Lansky MR, Rudnick A: Right on the money: disability forms and the hospitalized borderline patient. Hillside J Clin Psychiatry. 1986, 8: 132-143.PubMedGoogle Scholar
  54. Blacksell M: Citizens Advice Bureaux: problems of an emerging service in rural areas. Social Policy and Administration. 1990, 24: 212-225.Google Scholar
  55. Brooke R: Advice services in welfare rights. 1976, London, Fabian SocietyGoogle Scholar
  56. Pacitti R, Dimmick J: Poverty and mental health: underclaiming of welfare benefits. J Community Appl Soc Psychol. 1998, 6: 395-402. 10.1002/(SICI)1099-1298(199612)6:5<395::AID-CASP390>3.0.CO;2-2.Google Scholar
  57. Memel D, Gubbay D: Welfare benefits advice in primary care. Br J Gen Pract. 1999, 49: 1032-1033.Google Scholar
  58. Alcock P, Shepherd J, Stewart G, Stewart J: Welfare rights work in the 1990s - A changing agenda. J Soc Policy. 1991, 20: 41-63.Google Scholar
  59. Placek PJ: Welfare workers as family planning change agents and the perennial problem of heterophily with welfare clients. J Appl Behav Sci. 1975, 11: 298-316. 10.1177/002188637501100304.Google Scholar
  60. Blaxter M: Health 'on the welfare' - a case study. J Soc Policy. 1974, 3: 39-51.Google Scholar
  61. Toeg D, Mercer L, Iliffe S, Lenihan P: Proactive, targeted benefits advice for older people in general practice: a feasibility study. Health Soc Care Community. 2003, 11: 124-128. 10.1046/j.1365-2524.2003.00412.x.PubMedGoogle Scholar
  62. Nosowska G: A delay they can ill afford: delays in obtaining Attendance Allowance for older, terminally ill cancer patients, and the role of health and social care professionals. Health Soc Care Community. 2004, 12: 283-287. 10.1111/j.1365-2524.2004.00496.x.PubMedGoogle Scholar
  63. Hoskins RAJ, Smith LN: Nurse-led welfare benefits screening in a general practice located in a deprived area. Public Health. 2002, 116: 214-220.PubMedGoogle Scholar
  64. Hoskins R, Carter DE: Welfare benefits' screening and referral: a new direction for community nurses?. Health Soc Care Community. 2000, 8: 390-397. 10.1046/j.1365-2524.2000.00264.x.PubMedGoogle Scholar
  65. Cornwallis E, O'Neil J: Promoting health by tackling poverty. hoolet. 1998, 8-9.Google Scholar
  66. Frost-Gaskin M, O'Kelly R, Henderson C, Pacitti R: A welfare benefits outreach project to users of community mental health services. Int J Soc Psychiatry. 2003, 49: 251-263. 10.1177/0020764003494003.PubMedGoogle Scholar
  67. Galvin K, Sharples A, Jackson D: Citizens Advice Bureaux in general practice: an illuminative evaluation. Health Soc Care Community. 2000, 8: 277-282. 10.1046/j.1365-2524.2000.00249.x.PubMedGoogle Scholar
  68. Powell JE, Langley C, Kirwan J, Gubbay D, Memel D, Pollock J, Means R, Hewlett S: Welfare rights services for people disabled with arthritis integrated in primary care and hospital settings: set-up costs and monetary benefits. Rheumatology. 2004, 43: 1167-1172. 10.1093/rheumatology/keh278.PubMedGoogle Scholar
  69. Middleton J, Spearey H, Maunder B, Vanes J, Little V, Norman A, Bentley D, Lucas G, Bone B: Citizen's advice in general practice. BMJ. 1993, 307: 504-PubMedPubMed CentralGoogle Scholar
  70. Moffat S, White M, Stacey R, Downey D, Hudson E: The impact of welfare advice in primary care: a qualitative study. Critical Public Health. 2004, 14: 295-309. 10.1080/09581590400007959.Google Scholar
  71. Reading R, Steel S, Reynolds S: Citizen's advice in primary care for families with young children. Child Care Health Dev. 2002, 28: 39-10.1046/j.1365-2214.2002.00241.x.PubMedGoogle Scholar
  72. Chaggar JS: Citizens' advice in general practice. A burden GPs could do without. BMJ. 1993, 307: 261-PubMedPubMed CentralGoogle Scholar
  73. Ennals S: Providing citizen's advice in general practice. BMJ. 1993, 306:Google Scholar
  74. McLeod E: Social work in health care settings. Br J Soc Work. 2002, 32: 121-127. 10.1093/bjsw/32.1.121.Google Scholar
  75. Finch J, Patel B, Nacra AS: Citizens advice bureaus. Br J Gen Pract. 1993, 43: 481-482.PubMed CentralGoogle Scholar
  76. Sherratt M, Jones K, Middleton P: A citizens' advice service in primary care: improving patient access to benefits. Primary Health Care Research and Development. 2000, 1: 139-146. 10.1191/146342300672823063.Google Scholar
  77. Hobby L, Abbott S: More lolly, more jolly. Health Serv J. 1999, 109: 26-PubMedGoogle Scholar
  78. Abbott S, Hobby L: An evaluation of the Health and Advice Project: its impact on the health of those using the service. Report no. 99/63. 1999, Liverpool, Health and Community Care Research Unit, University of LiverpoolGoogle Scholar
  79. Reading R, Reynolds S, Appleby J: Citizens advice bureau and family health: report of a pilot study. 2000, Norwich, University of East Anglia, School of Health Policy and PracticeGoogle Scholar
  80. Actions: Actions annual report April 2003 to March 2004 with updates to December 04. 2004, Nottingham, Nottingham City Primary Care TrustGoogle Scholar
  81. Bennett J: Inverness Citizens Advice Bureau, Doctor's Surgery Project. 1997, Inverness, Inverness Citizens Advice BureauGoogle Scholar
  82. Borland J, Owens D: Welfare Advice in General Practice - The Better Advice, Better Health Project in Wales. 2004, , University of BangorGoogle Scholar
  83. Borland J: Better advice, better health. Final evaluation report. 2004, Gwynedd, University of Wales - BangorGoogle Scholar
  84. Bowran C: Evaluation of the in-surgery Citizens Advice Bureau advice service for patients of the Auckland Medical Group. 1997, Wear Valley, Wear Valley Citizen's Advice BureauGoogle Scholar
  85. Brosely Health and Advice Partnership: Annual report: the first year. 2004, Brosely, Brosely Health and Advice PartnershipGoogle Scholar
  86. Bundy R: Primary health care welfare rights & CAB advice services, service report April 2001-March 2002. 2002, Salford, City of Salford Community and Social Services, Citizens Advice Bureau and Salford PCTGoogle Scholar
  87. Bundy R: Primary health care welfare rights & CAB advice services, service report April 2002-March 2003. 2003, Salford, Salford City Council Welfare Rights Service, Citizens Advice Bureau and Salford PCTGoogle Scholar
  88. Derbyshire County Council Welfare Rights Service: Welfare rights in primary care (Shirebrook and Bolsover practices, Derbyshire) first annual report. 1997, , Derbyshire County Council Welfare Rights ServiceGoogle Scholar
  89. Emanuel J, Begum S: What do you advice doc? A citizens advice bureau in primary care in the West Midlands. 2000, Manchester, Centre for Higher and Adult Education, Faculty of Education, University of ManchesterGoogle Scholar
  90. Farmer J, Kennedy L: CAB outreach services evaluation: a report on the impact of Citizen's Advice Bureau outreach services at Aberdeen Royal Infirmary and Banff & Buchan on client health and professional workload. 2001, Aberdeen, University of Aberdeen, Department of Management StudiesGoogle Scholar
  91. Fleming B, Golding L: Evaluation of 4 CAT-funded Citizens' Advice Bureaus units. 1997, Birmingham, Birmingham Soundings ResearchGoogle Scholar
  92. Ferguson S, Simmons J: London Borough of Newham GP Advice Project. London, London Borough of Newham Social Regeneration Unit
  93. Galvin K, Sharples A, Jackson D: Citizens Advice Bureaux in general practice: a pilot project evaluation. 1996, Bournemouth, Institute of Health and Community Studies, Bournemouth UniversityGoogle Scholar
  94. Greasley P: The Health Plus Project: advice workers in primary care in inner city Bradford. 2003, Bradford, Department of Community & Primary Care, School of Health Studies, University of BradfordGoogle Scholar
  95. Greasley P, Small N: Providing welfare advice in general practice: referrals, issues and outcomes. Health and Social Care in the Community. 2005, 13: 249-258. 10.1111/j.1365-2524.2005.00557.x.PubMedGoogle Scholar
  96. Griffiths S: Through health workers to welfare rights - a report on the Health and Benefits Project in Goodinge and Finsbury Health Centers, Islington. 1992, London, Camden and Islington FHSAGoogle Scholar
  97. Hastie A: Good advice, better health. 2003, Haddington, Haddington CABGoogle Scholar
  98. High Peak CAB: Advice in primary healthcare settings: report of a pilot project. 1995, , High Peak CABGoogle Scholar
  99. High Peak CAB: GP project report (four-site). Results for 2000/01 half year. 2001Google Scholar
  100. High Peak CAB: Healthy living network GP project report for surgeries at Sett Valley Medical Centre, Buxton Medical Practice and Hartington, Results for half year: 1st July 2003-31st Dec 2003. 2003, , High Peak CABGoogle Scholar
  101. Hoskins R, Tobin J, McMaster K, Quinn T: The roll out of a nurse led welfare benefits screening service throughout the largest Local Health Care Cooperative in Glasgow. An evaluation study. Public Health. 2005, 119: 853-861. 10.1016/j.puhe.2005.03.012.PubMedGoogle Scholar
  102. Knight L: Someone to turn to...someone who cares: evaluation of the HABIT project. 2002, Liverpool, North Mersey Community TrustGoogle Scholar
  103. Lancashire County Council Welfare Rights Service: Pensioners benefits check pilot project. 2001, , Lancashire County Council Welfare Rights ServiceGoogle Scholar
  104. Lishman-Peat J, Brown G: Welfare benefits take up project in primary care. Benefits. 2002, 10: 45-48.Google Scholar
  105. Macmillan & CAB Partnership: Provision of advice on benefits, housing, employment and debt for people affected by cancer; Annual report 2003/2004. 2004, Airdrie, Macmillan Cancer Relief & Citizens Advice BureauGoogle Scholar
  106. Middlesbrough Welfare Rights Unit: Welfare rights advice in general practice. 1999, Middlesbrough, Middlesbrough Welfare Rights UnitGoogle Scholar
  107. Middlesbrough Welfare Rights Unit: Annual Report April 2003 - March 2004. 2004, Middlesbrough, Middlesbrough Council Welfare Rights UnitGoogle Scholar
  108. Moffatt S: "All the difference in the world". A qualitative study of the perceived impact of a welfare rights service provided in primary care. 2004, London, University College LondonGoogle Scholar
  109. Moffatt S, White M, Stacey R, Hudson E, Downey D: "If we had not got referred and got the advice, I don't know where we'd be, it doesn't bear thinking about" The impact of welfare advice provided in general practice: a qualitative study. 1999, Newcastle upon Tyne, Department of Epidemiology and Public Health and Department of Primary Health Care, University of Newcastle upon TyneGoogle Scholar
  110. Roberts C: Practice advice service - Blackpool. 1999, , University of Central LancashireGoogle Scholar
  111. Sedgefield & District Advice & Information Service: Health advice service 2003/2004. 2004, Sedgefield, Sedgefield Citizens Advice Bureau and Sedgefield Primary Care TrustGoogle Scholar
  112. Southwark Council Consumer and Money Advice Centre: Benefits and health project: annual report, 1st April 1997-31st March 1998. 1998, London, Southwark Council Consumer and Money Advice CentreGoogle Scholar
  113. Vaccarello M: HABIT...at work in CENTRAL Liverpool Primary Care Trust. 2004, Liverpool, Age Concern LiverpoolGoogle Scholar
  114. Widdowfield H, Rickard P: Wear Valley Citizens Advice Bureau: Health centre advice service report: April to October 1996. 1996, , North House and Braeside Medical GroupGoogle Scholar
  115. Woodcock J: PCT advice project: Manchester City Council. 2004, Manchester, Manchester AdviceGoogle Scholar
  116. Abbott S, Davidson L: Easing the burden on primary care in deprived urban areas: a service model. Primary Health Care Research and Development. 2000, 1: 201-206. 10.1191/146342300127205.Google Scholar
  117. Alcock P: Welfare rights in primary health care. 1994, Sheffield, Centre for Regional Economic and Social Research, Sheffield Hallam University School of Urban and Regional StudiesGoogle Scholar
  118. Barnes D: Advocacy from the outside in: a review of the patients' advocacy service at Ashworth Hospital. 2000, Durham, Centre for Applied Social Sciences, University of DurhamGoogle Scholar
  119. Barnsley Community Legal Partnership: Progress report, June 2003. 2003, Barnsley,Google Scholar
  120. Bebbington AC, Unell J: Care Direct: an integrated route to help for older people. Generations Review. 2003, 18:Google Scholar
  121. Bebbington A, Unell J, Downey S: Evaluating the Care Direct programme. PSSRU Bulletin. 14: 26-
  122. Bird L: Independent advice services for people with mental health problems: needs and provision. Ment Health Care. 1998, 2: 135-Google Scholar
  123. Buckle J: Informing participants about attendance and mobility allowances. BMJ. 1986, 293: 1077-1078.PubMedPubMed CentralGoogle Scholar
  124. Burton S, Diaz de Leon D: An evaluation of benefits advice in primary care - Camden and Islington HAZ. Learning from Health Action Zones: findings from local and national evaluation. Edited by: Bauld L and Judge K. 2002, Chichester, AeneasGoogle Scholar
  125. Clarke K, Sarre S, Glendinning C, Data J: FWA's WellFamily Service: evaluation report. 2001, London, Family Welfare AssociationGoogle Scholar
  126. Craig G, Dornan P, Bradshaw J, Garbutt R, Mumtaz S, Syed A, Ward A: Underwriting citizenship for older people: the impact of additional benefit income for older people. 2003, Hull, University of Hull and University of YorkGoogle Scholar
  127. Dowling S, Joughin C, Logan S, Laing G, Roberts H: Financial benefits and child health. 2003, London, City University London, Peninsula Medical School, and City and Hackney Teaching Primary Care TrustGoogle Scholar
  128. Emanuel J: Citizen's advice bureaux in primary care: a tool to address social and economic inequalities. Promoting health: politics and practice. Edited by: Adams L, Amos M and Munro J. 2002, London, SageGoogle Scholar
  129. Ennals S: Doctors and benefits. BMJ. 1990, 301: 1321-1322.PubMedPubMed CentralGoogle Scholar
  130. Evans C: GP surgery project: final report, June to December 1998. 1998, York, York Citizens Advice BureauGoogle Scholar
  131. Forrest D: KNOWing health in Knowsley: the report of the Director of Public Health 2003. 2003, Knowsley, Knowsley PCTGoogle Scholar
  132. Gask L, Rogers A, Roland M, Morris D: Improving quality in primary care: a practical guide to the national service framework for mental health. 2000, Manchester, University of Manchester, National Primary Care Research and Development CentreGoogle Scholar
  133. Greasley P, Small N: Take it from here. Health Serv J. 2002, 112: 28-29.PubMedGoogle Scholar
  134. Greasley P: Filming patient interviews to demonstrate the value of welfare advice in general practice: a strategy for the dissemination of project outcomes. International Journal of Social Research Methodology. In press:
  135. Green J: Benefits in hospital. Ment Health Care. 1998, 1: 417-Google Scholar
  136. Green G, Cromar P, Whittle S, Greif S: Health impact assessment in Yorkshire and the Humber region. 2004, Sheffield, Sheffield Halam UniversityGoogle Scholar
  137. Longworth P, Hughes M, Harrison R: Citizen's advice in South Kirklees a health impact assessment. 2003, , South and Central Huddersfield PCTGoogle Scholar
  138. Okpaku S: A profile of clients referred for psychiatric evaluation for Social Security Disability Income and Supplemental Security Income: implications for psychiatry. Am J Psychiatry. 1985, 142: 1037-1043.PubMedGoogle Scholar
  139. Reid A, Nixon A, Whitter M: Working together: welfare rights in primary care an audit of its progress. 1998, , Wigan and Leigh Health Services NHS TrustGoogle Scholar
  140. Riverside Advice Ltd: Welfare rights project for clients experiencing mental health difficulties: end of year report 01.04.03 - 31.03.04 and report for review of voluntary service by local health board. 2004, Cardiff, Riverside Advice LtdGoogle Scholar
  141. Scully T: SACG primary health care project. 1999, , Sheffield Advice Centers GroupGoogle Scholar
  142. Searle P: Care Direct: what is it and how is it being developed?. Managing Community Care. 2001, 9: 37-41.Google Scholar
  143. Sherr L, Sherr A, Harding R, Moorhead R, Singh S: A stitch in time - accessing and funding welfare rights through health service primary care. 2002, London, University College Royal Free School of Medicine and University of LondonGoogle Scholar
  144. Strachan P: Health and advice services - working together. 1995, , NACAB Southern Area OfficeGoogle Scholar
  145. Tameside MBC welfare rights and money advice project: ; Harrogate. 2004,
  146. Venables W: Annual Report 2003/4. 2004, Bristol, Bristol Child Poverty Action GroupGoogle Scholar
  147. Watson HE: Multi-agency work in practice: the evaluation of a primary care-based mental health promotion project. International Journal of Mental Health Promotion. 2000, 2: 18-26.Google Scholar
  148. Waterhouse P: Welfare rights and health project: stage two evaluation report. 1996, London, Haringey community advice servicesGoogle Scholar
  149. Waterhouse P: The health links project, advice in primary care and other health care settings: Interim evaluation for Hackney Information and Advice Consortium (HIAC). 2003, London, Health Links Advice ProjectGoogle Scholar
  150. Waterhouse P, Benson A: Health links advice project: taking advice into the community, background paper. 2002, London, Hackney Health Links Advice ProjectGoogle Scholar
  151. West Berkshire CAB: Advice in outreaches project. 2004, West Berkshire, West Berkshire CABGoogle Scholar
  152. Williams A: Benefits advice for patients. 1982, Manchester, City of Manchester Social Services DepartmentGoogle Scholar
  153. Pre-publication history

    1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/6/81/prepub

Copyright

© Adams et al; licensee BioMed Central Ltd. 2006

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Advertisement