Title: Co-locating welfare advice in maternity services and its potential to improve maternal and child health and wellbeing and reduce health inequalities
Funder: Department of Health and Social Care

Abstract: Background Early childhood deprivation is associated with poor physical and mental health and social outcomes, limiting childhood development with long lasting effects into adulthood. Addressing financial hardship can reduce inequalities across the life course and have significant impacts upon lifelong health and opportunity.Welfare advice services can help support people to improve their living circumstances and so potentially improve health and reduce inequalities. Because uptake of advice and benefits is often low, these services have sometimes been located in healthcare settings. Little is known on how to do this effectively to reach the populations most in need.Pregnancy provides a rare opportunity for contact with women; nearly all pregnant women regularly attend maternity services. Maternity clinics may provide suitable settings in which to offer welfare advice, particularly for people from some ethnic minorities that have low uptake of eligible benefits. A welfare advice service located as part of routine maternity health care might increase uptake of benefits and advice and so positively affect maternal and child health. Aim To determine whether the provision of co-located welfare and benefits advice in maternity services is feasible to deliver, acceptable to families and has the potential to improve maternal mental health and wellbeing and reduce health inequalities.Methods The research will be adopted as part of the recently funded ActEarly research programme, one of three recently funded by the UK Prevention Research Partnership, and the Better Start Bradford Innovation Hub, funded by the Big Lottery Community Fund. It will be organised into four linked workstreams:Workstream 1: I will conduct a systematic review to assess the evidence base for the provision of co-located welfare advice in healthcare settings. I will use international standards for searching and analysing the data. The review will focus particularly on factors influencing acceptability, uptake and impact on health and inequalities. Workstream 2: I will co-produce a co-located welfare advice services within a maternity service setting in Bradford using a theory of change model. To ensure true engagement throughout, the public, practitioners and policy leaders will be involved in a service design group. Workstream 3: I will undertake an implementation evaluation of the new service. Data will be collected to assess uptake of the service and benefits received. I will conduct in-depth interviews with women and their partners, and staff, to assess factors influencing uptake and potential effects on living standards. Thematic analysis will be conducted using the Theoretical Domains Framework. Workstream 4: I will explore the appropriateness and feasibility of different evaluation methods and outcome measures for an effectiveness and economic evaluation of this intervention. I will then write a full protocol for a feasible definitive evaluation.Anticipated impact and dissemination This project will produce new knowledge about the co-location of welfare advice in maternity services. We will gain insights into factors affecting the uptake of benefits advice, including within and between ethnic minority groups. The output will be fed back to participants and the wider community and, through conferences and papers, to the academic and policy communities.

Lay abstract: Background People we consulted in Bradford felt that programmes to promote the health of new families should focus on providing support for pregnant women aimed at improving financial security in preparation for a new baby. Poverty and deprivation experienced by mothers and babies is associated with poor physical and mental health and can have long lasting effects. Financial difficulties for parents can cause mental health problems and chronic physical illness which affect parenting.Welfare agencies sometimes offer services in community healthcare settings to help increase uptake of support and financial benefits, but we don't know what impact they have. Pregnancy provides a rare opportunity for contact with women; nearly all pregnant women attend maternity services. Maternity clinics therefore, may provide suitable settings in which to offer welfare advice, particularly for under-served populations such as some ethnic minority groups that have low uptake of eligible benefits. A culturally sensitive welfare advice service, located as part of routine maternity health care, might increase uptake of benefits and advice and so positively affect family living standards and maternal and child health. My aims I aim to develop a welfare advice service located within maternity clinics in Bradford, to explore the acceptability of this scheme and uptake of support and to design a rigorous evaluation of its effect on health and inequalities and its costs.What I will do First, I will review all of the existing research on locating welfare services in any healthcare setting. In particular, I am interested to find out what factors make such services successful. I will conduct the review in a rigorous way to ensure I find all the relevant literature, and analyse and interpret the studies that I find in a clear and unbiased fashion. In collaboration with a group of representatives from the local community, scientists, policy leaders and service providers, I will develop a model of the welfare advice service informed by my review and relevant theories. This group will provide strategic direction for the research throughout.The next step will be to commission and implement the service model we have developed. This will be funded by Bradford Metropolitan District Council and implemented in maternity clinics in Bradford. Once in place I will conduct a study to evaluate how well it is being implemented. This will involve collecting data on the uptake of the service and benefits received. I will also conduct interviews with a sample of pregnant women who were eligible for the support and their partners, as well as staff who delivered the service, midwives and other staff from the maternity clinics and those who commissioned the service. This will provide information on the acceptability of the service and what influences uptake of benefits and some early insight into the potential value to service users. This information will be used to refine the welfare advice intervention. We cannot assume that this intervention will be beneficial and represent value for money. So in the final stage of the fellowship I will explore how best to evaluate its impact using the rich data available from a Bradford birth cohort and write an evaluation proposal. This should assess the effect of the welfare service on: uptake of advice and support, benefits and living standards, mental and physical health of the mother and the family, its longer-term impact on inequalities in health and overall value for money. Dissemination I will feedback the results of this work directly to the participants of the study and the local community and disseminate knowledge gained nationally and internationally through public health research and policy networks, conferences and publications in scientific journals.

Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH