Using realist evaluation to explore the impact of Citizens Advice Bureau activities on improving health

Welfare advice is theorised as able to improve health through, for example, tackling poverty and reducing stress and anxiety. However, little empirical evidence is available in support of these links. Citizens Advice Bureau (CAB) interventions are prime examples of complex interventions, with huge variation in individual client circumstances, the forms of advice delivered, the financial and non-financial benefits clients receive, and the health impacts that may be set in chain. Such heterogeneity poses significant challenges for evaluation. In addition, as advice services are delivered in conjunction with other services, the attribution of health outcomes to CAB interventions is difficult. This presentation reports on a realist evaluation to understand how, for whom and in what circumstances CAB interventions improve people’s health. It describes the approaches taken to managing intervention complexity. This included using clients as opposed to particular CAB interventions as the locus for the evaluation, and drawing boundaries around the chains of potential outcomes that can realistically be observed within the evaluation timescale, focusing mainly on reductions in stress and anxiety. An illustration is provided of the development and refinement of initial programme theories about how CAB interventions are expected to improve health.