Impact on public health practice & policy

How do Citizens Advice services improve people’s health?

While it is established that welfare advice services improve people’s financial position, understanding their potential health impact has proved more difficult. Fuse researchers are undertaking an innovative evaluation exploring if, how, when and in which circumstances Citizens Advice (CA) services improve client’s health.

Citizens Advice services provide people with independent, impartial, confidential, and free advice on issues related to debt, benefits, employment, housing and discrimination. CA are therefore one example of a service that addresses the social determinants of health, which can affect health inequalities.

CA deliver complex services, providing support that is highly tailored to the needs of individuals and potentially leading to very different health impacts depending on the individual circumstances of the client. Due to this variation, establishing evidence on the effectiveness of CA services in improving health has been challenging. Further work is needed to unpick the different kinds of support offered by CA, how this may trigger changes in health, and the contexts in which health improvements are most likely to happen.

Researchers from Fuse are undertaking a realist evaluation to explore the potential health impacts of CA services in Gateshead, Tyne and Wear, England. Realist evaluation is an approach that seeks to generate theories about how an intervention is supposed to work from the outset of the evaluation before going on to test these theories in later phases. This approach is well suited to the evaluation of complex interventions such as CA services as it explores how interventions may have different effects for different people, and in different circumstances.

Researchers carried out interviews with Citizen Advice Gateshead (CAG) staff, clients and used client questionnaire to enable researchers to build a framework to explain how CAG leads to health outcomes for clients. Researchers used The Perceived Stress Scale, the Warwick Edinburgh Mental Well Being Scale and lifestyle questions to measure impact.

The questionnaire data showed a very significant increase in wellbeing and significant decrease in stress as a result of contact with CAG. Interviews with staff and clients were used to understand how CAG contributed to this positive outcome. They highlighted that CAG clients often have complex needs, and feel alienated by the state systems. CAG advice changed the resources people had, meeting their basic needs, preventing mental health exacerbations, reducing stress and decreasing social isolation. Clients trusted CAG advisors due to their expertise, benevolent style and similarities. As a result of this, CAG acted as a buffer between the client and the state, allowing the two to talk to one another and for example, progress claims.

Last modified: Wed, 24 Mar 2021 13:18:21 GMT