Service-integration approaches for families with low income: a Families First Edmonton, community-based, randomized, controlled trial.
Trials
; 17: 343, 2016 07 22.
Article
in En
| MEDLINE
| ID: mdl-27449358
ABSTRACT
BACKGROUND:
Increasing access to health and social services through service-integration approaches may provide a direct and sustainable way to improve health and social outcomes in low-income families.METHODS:
We did a community-based randomized trial evaluating the effects of two service-integration practices (healthy family lifestyle and recreational activities for children) among low-income families in Alberta, Canada. These two practices in combination formed four groups Self-Directed (no intervention), Family Healthy Lifestyle, Family Recreation, and Comprehensive (Family Healthy Lifestyle plus Family Recreation programs). The primary outcome was the total number of service linkages.RESULTS:
We randomized 1168 families, 50 % of which were retained through the last follow-up visit. The number of service linkages for all three intervention groups was not significantly different from the number of linkages in the Self-Directed group (Comprehensive 1.15 (95 % CI 0.98-1.35), Family Healthy Lifestyle 1.17 (0.99-1.38), and Family Recreation 1.12 (0.95-1.32) rate ratios). However, when we explored the number of linkages by the categories of linkages, we found significantly more healthcare service linkages in the Comprehensive group compared to the Self-Directed group (1.27 (1.06-1.51)) and significantly more linkages with child-development services in the Family Healthy Lifestyle group compared to the Self-Directed group (3.27 (1.59-6.74)). The monthly hours of direct intervention was much lower than the assigned number of hours (ranging from 5 to 32 % of the assigned hours).CONCLUSIONS:
Our findings are relevant to two challenges faced by policymakers and funders. First, if funds are to be expended on service-integration approaches, then, given the lack of intervention fidelity found in this study, policymakers need to insist, and therefore fund a) a well-described practice, b) auditing of that practice, c) retention of family participants, and d) examination of family use and outcomes. Second, if child-development services are widely required and are difficult for low-income families to access, then current policy needs to be examined. TRIAL REGISTRATION ClinicalTrials.gov, NCT00705328 . Registered on 24 June 2008.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Primary Health Care
/
Child Health Services
/
Family Health
/
Delivery of Health Care, Integrated
/
Healthy Lifestyle
Type of study:
Clinical_trials
Aspects:
Determinantes_sociais_saude
Limits:
Adult
/
Child
/
Child, preschool
/
Female
/
Humans
/
Male
Country/Region as subject:
America do norte
Language:
En
Journal:
Trials
Journal subject:
MEDICINA
/
TERAPEUTICA
Year:
2016
Document type:
Article
Affiliation country: