Assessing the health benefits of advice services: using research evidence and logic model methods to explore complex pathways

Abstract

Poverty is positively associated with poor health; thus, some healthcare commissioners in the UK have pioneered the introduction of advice services in health service locations. Previous systematic reviews have found little direct evidence for a causal relationship between the provision of advice and physical health and limited evidence for mental health improvement. This paper reports a study using a broader range of types of research evidence to construct a conceptual (logic) model of the wider evidence underpinning potential (rather than only proven) causal pathways between the provision of advice services and improvements in health. Data and discussion from 87 documents were used to construct a model describing interventions, primary outcomes, secondary and tertiary outcomes following advice interventions. The model portrays complex causal pathways between the intervention and various health outcomes; it also indicates the level of evidence for each pathway. It can be used to inform the development of research designed to evaluate the pathways between interventions and health outcomes, which will determine the impact on health outcomes and may explain inconsistencies in previous research findings. It may also be useful to commissioners and practitioners in making decisions regarding development and commissioning of advice services.

Exposing the impact of intensive advice services on health: A realist evaluation

“…The findings from this research support existing literature highlighting the impact of advice services on mental health and well‐being (Abbott, ; Burrows et al, ; Citizens Advice Bureau, ; Holkar & Mackenzie, ), although the service evaluated here was an intensive service where clients had longer term contact, which may have led to slightly enhanced outcomes. Research has also highlighted the complexity of identifying links between advice services and health (Allmark et al, ). This research begins to map the pathways of impact from advice to reduced stress and increased well‐being, which are recognised as improving more distal, long term health outcomes, such as cardiovascular disease (Dimsdale, ), diabetes control (Faulenbach et al, ), and rheumatoid arthritis (Straub, Dhabhar, Dhabhar, Bijlsma, & Cutolo, ).…”

“…Research has also highlighted the complexity of identifying links between advice services and health (Allmark et al, 2013). This research begins to map the pathways of impact from advice to reduced stress and increased well-being, which are recognised as improving more distal, long term health outcomes, such as cardiovascular disease (Dimsdale, 2008), diabetes control (Faulenbach et al, 2012), and rheumatoid arthritis (Straub, Dhabhar, Dhabhar, Bijlsma, & Cutolo, 2005).…”

Cochrane Qualitative and Implementation Methods Group guidance series—paper 2: methods for question formulation, searching, and protocol development for qualitative evidence synthesis

“…Theoretical frameworks explain the possible relationships between concepts in general terms; logic models are usually more pragmatic illustrations of how the components of a specific programme or intervention work together to produce the desired outcomes for a particular population in a given context [25][26][27] The protocol for a mixed method review on WASH Promotion Programmes [28] presents a logic model based on the RANAS theoretical model [29], the PROGRESS framework [30] and the Checklist for Implementation (Chimp) [31]. It was refined by inviting keystakeholders to comment on the different components and the overall structure of the logic framework.…”

“…15 models and frameworks [26,45,78] which are discussed in paper 2 of the series; and checklists to assess implementation [31] which are described in paper 3. Qualitative reviews that are commissioned to enable policy making could use the SURE framework for implementing policy, which enables teams to identify where further information is needed before deciding to pursue a particular policy option [78].…”

Cochrane Qualitative and Implementation Methods Group guidance series—paper 3: methods for assessing methodological limitations, data extraction and synthesis, and confidence in synthesized qualitative findings

“…The initial logic model is developed and/or refined from the reports of completed studies. However, published studies (and the logic models built on them) may not capture the nonlinearity of complex interventions [45][46]. Several authors have noted that it is difficult to derive adequate descriptions of programme theory or the operation of programmes in practice from published research [47][48][49].…”