Co-locating universal welfare advice in health settings for mothers and their families

Childhood deprivation is associated with poor health and social outcomes, limiting childhood development with long-lasting effects into adulthood. Welfare advice services improve financial security but access is often unequal for the most vulnerable. Maternity care offers a unique opportunity to access most pregnant women and may provide a suitable setting to host a universal welfare advice service to improve advice uptake. However, little is known on how to effectively design, implement and evaluate these services to reach those most in need.

This thesis aims to understand whether co-location of universal welfare advice in health settings for mothers and their families, as a cost-effective measure to improve health and wellbeing, is acceptable and feasible to deliver and evaluate.

The thesis adopts a complex intervention research framework as a methodological approach to the development, implementation and evaluation of this intervention. First, I conducted a narrative systematic review to explore the effectiveness and implementation of co-located welfare services. Secondly, I conducted an analysis of a longitudinal study to explore how financial security changed and impacted the health, wellbeing and socioeconomic security of mothers in Bradford during the COVID-19 pandemic. Third, I conducted a before and after study, exploring the feasibility of evaluating a co-located welfare service in primary care. Finally, I explored the feasibility of utilising financial data linkage to improve evaluations of co-located welfare services.

This research presents a theory of change model, depicting how universal welfare services co-located in maternity settings improves health and wellbeing and cost savings to the National Health Service, and demonstrates evidence of promise to support this theory of change. I demonstrate the most appropriate effectiveness and implementation outcomes and report the utility of routine financial data linkage for such evaluations. The thesis culminates with a methodological approach to investigate the effectiveness and implementation of a welfare service co-located in maternity settings.