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Appendix B. Argyll & Clyde Health Board - Health Advocacy Research Project
Topics: Hard to Reach Groups; Primary Care
Background
The health needs of people with learning disabilities are characteristically different to that of the general population and there is strong evidence of a higher level of unmet need. For example, the learning disabled population show a higher prevalence of sensory deficit, epilepsy and behavioural and psychological disturbance. In addition, health professionals lack adequate knowledge of the complex factors involved and services designed for the general population present access difficulties.
The Health Advocacy Research Project ( HARP) was designed to investigate the effects of using the health assessment "C21st Health Check" and the employment of a health advocate.
Adults living in Inverclyde and Renfrewshire areas who had been diagnosed as having a moderate to severe learning disability were identified for potential participation in the study.
Funding allocation
The pilot was allocated £262,998
Aim(s)
To improve access and uptake of health services, specifically dental, ophthalmic and breast screening (where appropriate) to people with learning disabilities and to investigate barriers to uptake of these services by people with learning disabilities.
Methodology
An intervention group of 116 adults with learning disabilities living in a relatively deprived area was taken from the Inverclyde area. The control group of 102 adults with learning disabilities living in a relatively deprived area was taken from the Renfrewshire area.
All participants firstly received a face to face interview that focussed on their experience of the three stated health service areas of dental, ophthalmic and breast screening. All participants then received a health check using the "C21st Health Check".
Following this, the intervention group were offered the services of the advocate worker who facilitated access to appropriate services. The control group was only offered the interview and the health assessment.
All participants were then interviewed 12 months after the initial interview.
Key results
There was a general improvement in service use after the intervention. However, given that similar effects were seen across the intervention and control locations on most issues, it is likely that the effect was due to the impact of the health assessment, which may have served as a reminder and a spur to patients and carers, rather than the advocacy work with service providers. There may also have been some carry-over advocacy effects as professionals in the intervention condition may have been in contact with professionals in the control condition.
The only exception to the general finding of improvement in service use for both intervention and control groups came when looking at the pattern of eyesight tests. This showed a notable shift in the intervention area only which saw a higher number of participants reporting recent testing and fewer people whose most recent eyesight test was more than one year ago. Therefore, it is possible that advocacy work with ophthalmologists in the invention area helped encourage opticians to invite more people with learning disabilities for regular check-ups.
Conclusions
Results suggest that the project helped people with learning disabilities to access routine services appropriately but it is difficult to attribute this to advocacy intervention. The use of the health assessment is more likely to have operated as a reminder to participants rather than the advocacy work providers in Inverclyde.
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