Addressing financial strain through a peer-to-peer intervention in primary care

Abstract

Background Financial strain is a key social determinant of health. As primary care organizations begin to explore ways to address social determinants, peer-to-peer interventions hold promise. Objective Our objective was to evaluate a peer-to-peer intervention focussed on financial empowerment delivered in primary care, in partnership with a social enterprise. Methods This intervention was hosted by a large primary care organization in Toronto, Canada. Participants were recruited within the organization and from local services. We organized three separate groups who met over 10 weekly in-person, facilitated sessions: millennials (age 19–29) no longer in school, precariously employed adults (age 30–55) and older adults near retirement (age 55–64). We applied principles of adult education and peer-to-peer learning. We administered surveys at intake, at exit and at 3 months after the intervention, and conducted three focus groups. Results Fifty-nine people took part. At 3 months, participants had sustained higher rates of optimism about their financial situation (54% improved from baseline), their degree of control (55% improved) and stress around finances (50% improved). In focus groups, participants reported greater understanding of their finances, that they were not alone in struggling with finances, and that it was useful to meet with others. One group continued to meet for several months after the intervention. Conclusions In this study, a peer-to-peer intervention helped address a key social determinant of health, likely through reducing stigma, providing group support and creating a space to discuss solutions. Primary care can host these interventions and help engage potential participants.

Screening and Interventions for Social Risk Factors

“…130 Of the 68 studies with a comparator, 38 studies (n = 111 102) reported health care utilization outcomes (eg, emergency department visits and inpatient admissions), followed by physiological and behavioral health outcomes (eg, mental health status and changes in substance use), reported in in 32 studies (n = 34 058). 11,13,17,18,30,35,37,42,44,49,54,72,74,75,78,80,81,84,89,92,96,101-103,105,106,108, 109,[114][115][116]125 Twenty-seven studies (n = 27 255) [11][12][13]16,17,29,30,40,42,49,54,56,72,78,80,81,84,91,96,101,103,106,108,111,114,115,121 reported social risk outcomes (eg, resolution of food insecurity), 21 studies (n = 14 120) 12,13,18,21,22,25,27,29,35,37,39,40,42,46,68,69,72,91,101,104,…”

“…Fifty-two studies 13,15,22,25,26,[32][33][34]38,39,44,48,56,68,71,74,76,78,84,98,99,101,107,112,115,116,119,121,123,124,[126][127][128]132,136,[150][151][152][153][154][155][156][157][158][159][160][161][162][163][164][165][166] provided data on patient-or clinician-reported satisfaction or challenges after imple-mentation of social risk screening or interventions (eTable 4 in the Supplement).…”

Implementing social interventions in primary care

“…Evaluations have shown a positive impact on well-being, as well as a strong return on investment. [39][40][41] The establishment of income support programs requires funding for embedded specialists or partnership with community organizations that have the expertise and capacity to carry out this work. Practices with fewer resources can establish and maintain lists of income benefits programs and local, free tax clinics to which patients may be referred.…”

Mise en œuvre d’interventions sociales en soins de santé primaires

“…Parmi les autres approches prometteuses, on compte du mentorat financier mené par les pairs, des partenariats entre des organismes médicaux et financiers et l'offre de services de production de déclarations de revenus dans l'enceinte des cliniques. Les évaluations ont montré un effet positif sur le bien-être, de même qu'un important rendement de l'investissement [39][40][41] .…”