addressInG iNcome securITy in Primary carE

Not Applicable

• Conditions: Poverty; Social Determinants of Health; Income
• Interventions: Other: Income Security Health Promotion

• Registration Number: NCT02459184
• Lead Sponsor: Unity Health Toronto

Brief Summary

Social processes that impact the health of individuals have been labeled the social determinants of health (SDOH). These are "the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels". Perhaps the most important SDOH is income security, a person's actual, perceived and expected income. Our objective is to carry out a pragmatic randomized controlled trial that evaluates the impact of an income-focused health promoter.

Detailed Description

This study aims to answer the question: What is the impact of an income security health promotion service based in a primary care setting on the income security of people living in poverty? We hypothesize that an income security health promotion service for adults living in poverty will increase monthly income relative to usual care. We will carry out a pragmatic randomized controlled trial that evaluates the impact of such a new service focused on income security health promotion. The St. Michael's Hospital Academic Family Health Team has received ongoing funding from the Ministry of Health and Long-Term Care (MOHLTC) to support this service. The primary outcome is income security, and secondary outcomes include quality of life, financial literacy and community integration.

Population - Adults living in poverty Intervention - Income security health promotion Control - Usual care Outcome - Primary: Improvement in income per month in the intervention group at 6 months (post-intervention) compared to income in control group at 6 months (pre-intervention). Secondary: quality of life, self-rated health, community engagement.

Study Timeline

• Study First Submitted: 2015-05-28
• Study First Submitted QC: 2015-05-29
• Study First Posted: 2015-06-01
• Study Start: 2017-09-01
• Primary Completion: 2021-07-09
• Status Verified: 2021-09
• Last Update Submitted: 2021-09-27
• Last Update Posted: 2021-09-28
• Study Completion: 2022-01-31

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 284

Inclusion Criteria

• Age ≥18
• Lives within the Metropolitan catchment areas
• Lives in a postal code that is in the lowest income quintile, or has had a billing code specific to social assistance forms billed ever billed, or has been identified as low income based on reported family income and number of people supported by income on the "Health Equity Data"
• Patient of the Family Health team including those that are: rostered, non-rostered, refugee claimants (IFH) or uninsured seen in the FHT.
• Verified by the patient's family physician as living in poverty, a good candidate for the intervention, and the patient's family physician agrees to have a letter submitted with his/her name attached.

Exclusion Criteria

• Patients who have previously worked with the Income Security Health Promoter, or are part of households of people who have previously worked with the Income Security Health Promoter.
• Patients who have no available contact information for mailing.
• Patients of any member of the investigative team.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: CROSSOVER

Arm && Interventions

Group	Intervention	Description
Late intervention	Income Security Health Promotion	Participants will meet with the Income Security Health Promoter at 6 months.
Early intervention	Income Security Health Promotion	Participants will meet with the Income Security Health Promoter immediately.

Primary Outcome Measures

Name	Time	Method
Change in monthly income from baseline to 6 months after intervention	6 months	Change in monthly income from baseline to 6 months after intervention

Secondary Outcome Measures

Name	Time	Method
financial literacy: Change in scores on the Canadian Centre for Financial Literacy Personal Financial Literacy Quiz	12 months	Change in scores on the Canadian Centre for Financial Literacy Personal Financial Literacy Quiz
food security	12 months	changes in scores on Health Canada food security module
quality of life (overall health, mental health, physical health): change in units on a measured scale of EQ VAS	12 months	changes in units on a measured scale
community integration: Change in scores on the Community Integration Scale	12 months	Change in scores on the Community Integration Scale
quality of life: Change in scores on the WHO QoL-BREF and EQ-5D-5L	12 months	Change in scores on the WHO QoL-BREF and EQ-5D-5L
other social determinants	12 months	changes scores relating to housing and employment
co-morbidities and medication access	12 months	changes to scores relating to comorbidities and medication access

Trial Locations

Locations (1)

St. Michael's Hospital; 🇨🇦 Toronto, Ontario, Canada