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Feasibility of linking universal child and family healthcare and financial counselling: findings from the Australian Healthier Wealthier Families (HWF) mixed-methods study
OBJECTIVES: ‘Healthier Wealthier Families’ (HWF) seeks to reduce financial hardship in the early years by embedding a referral pathway between Australia’s universal child and family health (CFH) services and financial counselling. This pilot study investigated the feasibility and short-term impacts...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BMJ Publishing Group
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10668198/ https://www.ncbi.nlm.nih.gov/pubmed/37993153 http://dx.doi.org/10.1136/bmjopen-2023-075651 |
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author | Price, Anna M H White, Natalie Burley, Jade Zhu, Anna Contreras-Suarez, Diana Wang, Si Stone, Melissa Trotter, Kellie Mrad, Mona Caldwell, Jane Bishop, Rebecca Chota, Sumayya Bui, Lien Sanger, Debbie Roles, Rob Watts, Amy Samir, Nora Grace, Rebekah Raman, Shanti Kemp, Lynn Lingam, Raghu Eapen, Valsamma Woolfenden, Susan Goldfeld, Sharon |
author_facet | Price, Anna M H White, Natalie Burley, Jade Zhu, Anna Contreras-Suarez, Diana Wang, Si Stone, Melissa Trotter, Kellie Mrad, Mona Caldwell, Jane Bishop, Rebecca Chota, Sumayya Bui, Lien Sanger, Debbie Roles, Rob Watts, Amy Samir, Nora Grace, Rebekah Raman, Shanti Kemp, Lynn Lingam, Raghu Eapen, Valsamma Woolfenden, Susan Goldfeld, Sharon |
author_sort | Price, Anna M H |
collection | PubMed |
description | OBJECTIVES: ‘Healthier Wealthier Families’ (HWF) seeks to reduce financial hardship in the early years by embedding a referral pathway between Australia’s universal child and family health (CFH) services and financial counselling. This pilot study investigated the feasibility and short-term impacts of HWF, adapted from a successful Scottish initiative. METHODS: Setting: CFH services in five sites across two states, coinciding with the COVID-19 pandemic. Participants: Caregivers of children aged 0–5 years experiencing financial hardship (study-designed screen). Design: Mixed methods. With limited progress using a randomised trial (RCT) design in sites 1–3 (March 2020–November 2021), qualitative interviews with service providers identified implementation barriers including stigma, lack of knowledge of financial counselling, low financial literacy, research burden and pandemic disruption. This informed a simplified RCT protocol (site 4) and direct referral model (no randomisation, pre–post evaluation, site 5) (June 2021–May 2022). Intervention: financial counselling; comparator: usual care (sites 1–4). Feasibility measures: proportions of caregivers screened, enrolled, followed up and who accessed financial counselling. Impact measures: finances (quantitative) and other (qualitative) to 6 months post-enrolment. RESULTS: 355/434 caregivers completed the screen (60%–100% across sites). In RCT sites (1–4), 79/365 (19%–41%) reported hardship but less than one-quarter enrolled. In site 5, n=66/69 (96%) caregivers reported hardship and 44/66 (67%) engaged with financial counselling; common issues were utility debts (73%), and obtaining entitlements (43%) or material aid/emergency relief (27%). Per family, financial counselling increased income from government entitlements by an average $A6504 annually plus $A784 from concessions, grants, brokerage and debt waivers. Caregivers described benefits (qualitative) including reduced stress, practical help, increased knowledge and empowerment. CONCLUSIONS: Financial hardship screening via CFH was acceptable to caregivers, direct referral was feasible, but individual randomisation was infeasible. Larger-scale implementation will require careful, staged adaptations where CFH populations and the intervention are well matched and low burden evaluation. TRIAL REGISTRATION NUMBER: ACTRN12620000154909. |
format | Online Article Text |
id | pubmed-10668198 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-106681982023-11-22 Feasibility of linking universal child and family healthcare and financial counselling: findings from the Australian Healthier Wealthier Families (HWF) mixed-methods study Price, Anna M H White, Natalie Burley, Jade Zhu, Anna Contreras-Suarez, Diana Wang, Si Stone, Melissa Trotter, Kellie Mrad, Mona Caldwell, Jane Bishop, Rebecca Chota, Sumayya Bui, Lien Sanger, Debbie Roles, Rob Watts, Amy Samir, Nora Grace, Rebekah Raman, Shanti Kemp, Lynn Lingam, Raghu Eapen, Valsamma Woolfenden, Susan Goldfeld, Sharon BMJ Open Health Services Research OBJECTIVES: ‘Healthier Wealthier Families’ (HWF) seeks to reduce financial hardship in the early years by embedding a referral pathway between Australia’s universal child and family health (CFH) services and financial counselling. This pilot study investigated the feasibility and short-term impacts of HWF, adapted from a successful Scottish initiative. METHODS: Setting: CFH services in five sites across two states, coinciding with the COVID-19 pandemic. Participants: Caregivers of children aged 0–5 years experiencing financial hardship (study-designed screen). Design: Mixed methods. With limited progress using a randomised trial (RCT) design in sites 1–3 (March 2020–November 2021), qualitative interviews with service providers identified implementation barriers including stigma, lack of knowledge of financial counselling, low financial literacy, research burden and pandemic disruption. This informed a simplified RCT protocol (site 4) and direct referral model (no randomisation, pre–post evaluation, site 5) (June 2021–May 2022). Intervention: financial counselling; comparator: usual care (sites 1–4). Feasibility measures: proportions of caregivers screened, enrolled, followed up and who accessed financial counselling. Impact measures: finances (quantitative) and other (qualitative) to 6 months post-enrolment. RESULTS: 355/434 caregivers completed the screen (60%–100% across sites). In RCT sites (1–4), 79/365 (19%–41%) reported hardship but less than one-quarter enrolled. In site 5, n=66/69 (96%) caregivers reported hardship and 44/66 (67%) engaged with financial counselling; common issues were utility debts (73%), and obtaining entitlements (43%) or material aid/emergency relief (27%). Per family, financial counselling increased income from government entitlements by an average $A6504 annually plus $A784 from concessions, grants, brokerage and debt waivers. Caregivers described benefits (qualitative) including reduced stress, practical help, increased knowledge and empowerment. CONCLUSIONS: Financial hardship screening via CFH was acceptable to caregivers, direct referral was feasible, but individual randomisation was infeasible. Larger-scale implementation will require careful, staged adaptations where CFH populations and the intervention are well matched and low burden evaluation. TRIAL REGISTRATION NUMBER: ACTRN12620000154909. BMJ Publishing Group 2023-11-22 /pmc/articles/PMC10668198/ /pubmed/37993153 http://dx.doi.org/10.1136/bmjopen-2023-075651 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Health Services Research Price, Anna M H White, Natalie Burley, Jade Zhu, Anna Contreras-Suarez, Diana Wang, Si Stone, Melissa Trotter, Kellie Mrad, Mona Caldwell, Jane Bishop, Rebecca Chota, Sumayya Bui, Lien Sanger, Debbie Roles, Rob Watts, Amy Samir, Nora Grace, Rebekah Raman, Shanti Kemp, Lynn Lingam, Raghu Eapen, Valsamma Woolfenden, Susan Goldfeld, Sharon Feasibility of linking universal child and family healthcare and financial counselling: findings from the Australian Healthier Wealthier Families (HWF) mixed-methods study |
title | Feasibility of linking universal child and family healthcare and financial counselling: findings from the Australian Healthier Wealthier Families (HWF) mixed-methods study |
title_full | Feasibility of linking universal child and family healthcare and financial counselling: findings from the Australian Healthier Wealthier Families (HWF) mixed-methods study |
title_fullStr | Feasibility of linking universal child and family healthcare and financial counselling: findings from the Australian Healthier Wealthier Families (HWF) mixed-methods study |
title_full_unstemmed | Feasibility of linking universal child and family healthcare and financial counselling: findings from the Australian Healthier Wealthier Families (HWF) mixed-methods study |
title_short | Feasibility of linking universal child and family healthcare and financial counselling: findings from the Australian Healthier Wealthier Families (HWF) mixed-methods study |
title_sort | feasibility of linking universal child and family healthcare and financial counselling: findings from the australian healthier wealthier families (hwf) mixed-methods study |
topic | Health Services Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10668198/ https://www.ncbi.nlm.nih.gov/pubmed/37993153 http://dx.doi.org/10.1136/bmjopen-2023-075651 |
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