Health and Social Care in the Community. 2004;12, 3:221-232.
The objective of the present study was to assess the effectiveness of a health advocate's
casework with homeless people in a primary care setting in terms of improvements in
health-related quality of life (QoL). The impact of the health advocacy intervention
was assessed in a quasi-experimental, three-armed controlled trial. Homeless people
moving into hostels or other temporary accommodation in the Liverpool 8 area of the
UK and patients registering at an inner-city health centre as temporary residents
were allocated in alternating periods to health advocacy (with or without outreach
registration) or 'usual care' over a total intake period of 3 years. Health-related
QoL outcomes were assessed using three independent self-report measures: the Life
Fulfilment Scale; the Delighted-Terrible Faces Scale; and the Nottingham Health Profile.
Out of the 326 homeless people who were given baseline questionnaires at registration,
222 (68%) returned usable questionnaires. Out of these individuals, 171 (77.0%) were
traceable at follow-up, and 117 (68.4%) follow-up questionnaires were returned. The
majority of respondents (n = 117) were women (72%) who were under 30 years of age
(74%), white British (91%), and single (63%) or separated (23%), many of whom were
living with their children (41%) in either women's refuges (30%) or family hostels
(25%). Improvements in health- related QoL were greatest in people recruited and supported
by a health advocate early in their stay in temporary housing, in comparison with
those in the control group given 'usual care' at the health centre. The model of streamlined
care for patients with complex psycho-social needs is shown to be a worthwhile and
effective option for primary healthcare providers.