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- Title
Service-integration approaches for families with low income: a Families First Edmonton, community-based, randomized, controlled trial.
- Authors
Drummond, Jane; Wiebe, Natash; So, Sylvia; Schnirner, Laurie; Bisanz, Jeffrey; Williamson, Deanna L.; Mayan, Maria; Templeton, Laura; Fassbender, Konrad; Wiebe, Natasha; Community-University Partnership for the Study of Children, Youth, and Families
- Abstract
<bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusions: </bold>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.<bold>Trial Registration: </bold>ClinicalTrials.gov, NCT00705328 . Registered on 24 June 2008.
- Subjects
ALBERTA; CLINICAL trials; HEALTH outcome assessment; POOR people; LIFESTYLES &; health; FAMILY health; CHILD health services; COMPARATIVE studies; INTEGRATED health care delivery; RESEARCH methodology; MEDICAL cooperation; POVERTY; PRIMARY health care; RECREATION; RESEARCH; RESEARCH funding; SOCIAL case work; SAMPLE size (Statistics); PROFESSIONAL practice; RESIDENTIAL patterns; EVALUATION research; RANDOMIZED controlled trials
- Publication
Trials, 2016, Vol 17, p1
- ISSN
1745-6215
- Publication type
journal article
- DOI
10.1186/s13063-016-1444-8