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Managing Finances and Multiple Long-Term Conditions: Eliciting the Perspectives of Individuals Living on Low Incomes

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Managing Finances and Multiple Long-Term Conditions: Eliciting the Perspectives of Individuals Living on Low Incomes Managing finances and multiple long-term conditions: eliciting the perspectives of individuals living on low incomes Final Report Principal investigator: Olga Biosca, PhD2 Co-investigators: Rachel Baker, PhD1 Cam Donaldson, PhD1 Neil McHugh, PhD1 Antony Morgan, PhD2 Research team: Ahalya Bala, PhD2 Enrico Bellazzecca1 Marta Mojarrieta2 Gregory White, PhD2 External advisor: Jonathan Morduch, PhD3 1 Yunus Centre for Social Business and Health, Glasgow Caledonian University 2 Yunus Centre for Social Business and Health, GCU London 3 Wagner Graduate School of Public Service, New York University Page 1 of 106 Table of contents Managing finances and multiple long-term conditions: eliciting the perspectives of individuals living on low incomes .............................................................................................................. 1 Table of contents .................................................................................................................... 2 List of figures ........................................................................................................................... 4 List of tables ............................................................................................................................ 4 1 Executive summary ......................................................................................................... 5 2 Introduction .................................................................................................................... 13 3 Methodology .................................................................................................................. 14 3.1 Financial Diaries ..................................................................................................... 14 3.1.1 The sample ...................................................................................................... 14 3.1.2 Data collection ................................................................................................. 16 3.1.3 Analysis ........................................................................................................... 17 3.2 In-depth qualitative interviews ................................................................................ 17 3.2.1 Recruitment of sample .................................................................................... 17 3.2.2 Analysis of data ............................................................................................... 18 3.3 Q Methodology ....................................................................................................... 18 3.3.1 Generation of statement sets .......................................................................... 18 3.3.2 Recruitment of sample .................................................................................... 20 3.3.3 Data Collection ................................................................................................ 20 3.3.4 Analysis ........................................................................................................... 21 3.4 Ethics ...................................................................................................................... 21 4 Results: Finances, health and social determinants ....................................................... 22 4.1 Financial lives and health ....................................................................................... 22 4.2 Income .................................................................................................................... 25 4.2.1 Case study: Anya ............................................................................................ 27 4.2.2 Case study: Daliya .......................................................................................... 28 4.3 Finance ................................................................................................................... 30 4.3.1 Case study: Sofia ............................................................................................ 34 4.3.2 Case study: Charles ........................................................................................ 36 4.4 Employment ............................................................................................................ 38 4.4.1 Case study: Luisa’s household ........................................................................ 39 4.5 Housing .................................................................................................................. 45 Page 2 of 106 4.5.1 Case study: Andrea ......................................................................................... 46 4.6 Making services and support accessible for people with long-term conditions ...... 49 4.7 Q Methodology ....................................................................................................... 50 5 Discussion and Conclusion ............................................................................................ 54 6 Recommendations ......................................................................................................... 56 7 References .................................................................................................................... 58 8 Appendices .................................................................................................................... 61 8.1 Appendix 1 Tool given to diarists for self-reported transactions ............................. 61 8.2 Appendix 2 Baseline questionnaires ...................................................................... 65 8.3 Appendix 3 Final questionnaire .............................................................................. 94 8.4 Appendix 4 Topic guide for the interviews ............................................................ 100 8.5 Appendix 5 ‘Causes’ and ‘Solutions’ statement sets and factor scores................ 103 8.6 Appendix 6 Factor solutions ................................................................................. 105 Page 3 of 106 List of figures Figure 1 Data collection schedule Figure 2 ‘Causes’ sorting-grid Figure 3 ‘Solutions’ sorting-grid Figure 4 Example card-sort Figure 5 Anya’s monthly trends in expenditure and mental health Figure 6 Daliya’s income trend and mental health during the study Figure 7 Sofia’s household weekly income and expenditure (£) Figure 8 Charles’ monthly income and expenditure (£) Figure 9 Luisa's household monthly income by type (in £; after rent) Figure 10 Luisa’s household monthly income and expenditure (£) Figure 11 Andrea’s first accommodation during the study period List of tables Table 1 Sample of diarists Table 2 Socio-demographic characteristics of the sample Table 3 Demographic characteristics of interviewed diarists Table 4 Examples of ‘Causes’ statements Table 5 Examples of ‘Solutions’ statements Table 6 Professional Stakeholders (PS) Expertise/Background Table 7 Diarists’ perceptions on the effect of health on finances and vice versa Table 8 Main characteristics of the financial diarists Table 9 Anya's monthly budget for month 2 (August 10 - September 9, 2019) Table 10 Financial instruments used Table 11 Sofia’s monthly budget for month 6 (21 November - 20 December, 2019) Table 12 Charles’ monthly budget for month 4 (15 October - 14 November, 2019) Table 13 Luisa’ monthly budget for month 4 (19 October - 18 November, 2019) Table 14 Luisa’ monthly budget for month 5 (19 November - 18 December, 2019) Table 15 Luisa’ monthly budget for month 6 (19 December 2019 - 18 January 2020) Table 16 Andrea’s monthly budget for month 1 (July 5 - August 4, 2019) Table 17 Andrea’s monthly budget for month 3 (September 5 - October 4, 2019) Page 4 of 106 1 Executive summary Introduction Despite an established link between income and health, limited evidence exists on how the struggle to make ends meet impacts on aspects of health and vice versa. Low income and worse health interact and often reinforce each other. However, little is known about the nature of this relationship and, thus, what can be done to alleviate the challenges faced by people in difficult financial situations whilst also trying to manage multiple long-term conditions. It is to this knowledge gap which the study reported here responds. We aimed to establish whether there is a perceived link between people’s financial lives (including the use of microcredit initiatives) and their health (focusing on the progression of long-term conditions), and the mediating mechanisms that might facilitate this association. Methodology To explore these issues, we used intensive and innovative research methods (financial diaries, in-depth interviews and Q methodology), closely following the lives of our participants over a 6-month period. Financial diary studies have the ability to provide unique insights into the lived experiences of our participants as the methodology enables longitudinal, in-depth data to be collected on how individuals cope with (un)expected changes to their income and expenditure in a way that cannot be captured through traditional surveys. Our participants were a diverse and hard-to-reach group of people living on low incomes in Lambeth and Southwark and with at least one long-term condition. We aimed to observe and analyse the widest possible range of experiences and identify both the events and patterns that most affected their finances and health. Our participants also experienced different levels of participation in fair microcredit
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