Fair Start Scotland evaluation report 2: participant phone survey - November 2019

7. Health and wellbeing

In the first half of this section we examine the incidences of both single and multiple long-term health conditions among FSS participants, the profile of participants with different types of conditions and the impacts that health conditions have on participants ability to carry out day-to-day activities. The second part of this section looks at participants' mental wellbeing and how levels of wellbeing vary by different factors.

7.1 Health conditions reported by participants

As described briefly in section 2.1 above, 72% of FSS participants had at least one long term health condition or disability, and for 60% of participants their condition limited their ability to carry out day-to-day activities.

The majority of Fair Start Scotland participants had just one health condition. As shown in Figure 6.1, a total of 56% of participants had one health condition while 16% had multiple conditions. This means that just under a quarter (23%) of participants with a health condition had more than one.

Figure 6.1 Number of health conditions reported by FSS participants

Source: Sample, H4i: Do you have any of the following conditions which have lasted, or are expected to last, at least 12 months? Base: All participants (1,005)

As discussed in chapter 2.1, three in ten (31%) participants with any health condition reported that they had a mental health condition, just under a quarter said they had another type of long-term illness, disease or condition, and 16% had a physical disability (see Figure 2.4 in chapter 2.1).

Figure 6.2 looks specifically at those who had more than one health condition or disability, showing that of those with multiple conditions, three quarters (74%) has a long term illness, disease or condition and one quarter (25%) said this was their main condition. Sixty-five per cent had a mental health condition and 22% said that this was their main condition.

Figure 6.2 Incidence of health conditions amongst participants with multiple conditions

Source: Sample and H4i: Do you have any of the following conditions which have lasted, or are expected to last, at least 12 months? Base: All participants with more than one health condition (166)

7.2 The profile of respondents by health condition

There were, perhaps surprisingly, few differences in both current working status and work history by health condition status. Participants with and without health conditions were equally likely to be in work at the time of the survey (28% of those with a condition that limited their day-to-day activities were in work compared with 30% of those without a condition). Furthermore, those with a limiting health condition were not more likely to have been out of work for 5 or more years before taking part in the service (36% compared with 35%).

There were however some demographic differences between individuals who reported having different health conditions:

• Participants with learning difficulties such as dyslexia were likely to be younger and to have no or lower level qualifications. Nineteen per cent of 16-34 year olds had a learning difficulty compared to 7% of those aged over 50, and 13% of respondents overall, while 21% of those with no qualifications and 15% of those with National 1-5 level qualifications had a learning difficulty, compared to 13% of respondents overall.
• Participants with developmental disorders such as autism were more prevalent among males, younger age groups and those with higher qualifications. Six per cent of men had autism compared with three per cent of women, and 10% of 16-34 year olds compared to just three per cent of those between 35 and 49, and one per cent of over fifty year olds. 10% of those with a degree and 8% of those with Highers / Advanced Highers or equivalent had a developmental disorder, compared to five per cent of all participants.
• As might be expected, the proportion of participants with a physical disability increased with age (9% of 16 to 34 year olds compared to 27% of over fifty year olds). They were also more likely to be white than BAME (18% compared to 7%).
• Participants with a long term illness, disease or condition were similar to those with a physical disability. Those who were over fifty were twice as likely to have a long-term condition than 16-34 year olds (33% compared with 16%).
• Mental health conditions were more prevalent among women than men (44% compared to 28%) and those with higher level qualifications (40% of those with Highers / Advanced Highers; 43% of those with a degree or above; compared with 33% overall). As with physical and long-term illnesses, mental health conditions were also more prevalent among white respondents than BAME (35% compared to 17%).

7.3 Impact of health conditions on daily lives

We asked all respondents who had a health condition or disability what impact their condition had on their ability to carry out day-to-day activities. Responses, illustrated below in Figure 6.3, showed that 81% of all participants who reported having a health condition said that their condition limited their ability to carry out day-to-day activities. Three in ten (29%) felt they were affected 'a lot', while over half were affected a little (52%). Seventeen per cent said their condition did not affect their ability to carry out day to day tasks at all.

Figure 6.3: Extent to which health conditions / disabilities limit participants' ability to carry out day-to-day tasks

Source: H4n. Does your health or disability limit your ability to carry out day-to-day activities? Base: All participants with a health condition (753)

The impact of conditions also increased in participants over 50 years old, who were much more likely to say they were limited 'a lot' by their condition than the average across other groups (38% compared to 29%).

Glasgow and Forth Valley (Lots 1 and 4) had the highest proportions of participants severely affected by their disability (39% and 48% respectively, compared to an average of 29%). Conversely, Lot 9, the West, had the highest proportion of participants who were not at all affected by their disability (32% compared to an average of 17%).

7.4 Mental wellbeing

In order to measure participants' wellbeing we used the Short Warwick-Edinburgh Mental Wellbeing Scale, an established measure used to monitor the mental wellbeing in the general population and in the evaluation of projects^[7]. The scale comprises of the following seven statements:

• I've been feeling optimistic about the future
• I've been feeling useful
• I've been feeling relaxed
• I've been dealing with problems well
• I've been thinking clearly
• I've been feeling close to other people
• I've been able to make up my own mind about things

The respondent is asked how often each sentence describes their experience over the last two weeks, on a five point scale from none of the time to all of the time. Responses are coded from one (none of the time) to five (all of the time) and scores are then summed to produce a single wellbeing score for each respondent.

The scores of FSS participants based on our survey responses were compared with the population norms based on the Health Survey for England 2011^[8], when data was last published. FSS participants had a lower mean score of 23.1 than the population norm of 23.6. As Figure 6.4 shows, FSS participants were considerably more likely to have a score in the lower quartile of the population norm by 14 percentage points (39% of FSS participants scored less than 21.5 compared to the norm of 25%). FSS participants were less likely to score within the interquartile range (39% scored between 21.5 and 26.0 compared to the norm of 50%) and the upper quartile range (23% scored above 26.0 compared to the norm of 25%).

Figure 6.4: SWEMBS Wellbeing Scores, FSS participants and population norms

Source: F3: How often would you say each of the following describes your experience over the last 2 weeks? Base: All providing a valid response to all SWEMWBS statements (907)

The average score of participants varied considerably by employment status, age and the impact of health conditions on individuals.

7.5 Mental wellbeing and employment

Participants who were receiving In-work support from FSS scored the highest wellbeing score of any demographic group at 25.5, which was considerably higher than both the FSS participant average (23.1) and the population average (23.6). Those who were in work (a slightly higher proportion than those recorded as receiving In-work support) also had a higher average score of 25.4, while those who had been in work in the last five years had a scored more highly than those who have not worked in this period (23.4 compared with 22.6).

There was also some variation among different FSS Lots. The East (Lot 5) were more likely to have scores in the lower quartile of the population norm (42% had a score of below 21.5 compared to the norm of 25%). Lot 4, Forth Valley had the lowest average score of 21.6%, with only 11% of participants in this region recording a score in the population top quartile.

7.6 Mental wellbeing and age

Participants aged between 16 and 24 had the highest wellbeing score of 24.2, while those aged between 16 and 34 still had a higher than average score of 23.6. Participants aged between 35 and 49 scored lower than average, at 22.4. Over fifty year olds were very close to the average and the difference was not statistically significant.

7.7 Mental wellbeing and the impact of health conditions

As described above, we asked participants who had a health condition to what extent their condition impacted on their ability to carry out day-to-day activities. As might be expected, participants who were limited by their health condition (either a lot or a little) had a lower than average mental wellbeing score (22.4), while those who had a health condition which did not limit their abilities were in line with the average (23.1). FSS participants who did not have a health condition scored 24.8 which is above the average for both FSS participants and the population norm.

Participants who did not have any qualifications had the lowest mental wellbeing score of any demographic group (22.0 compared to 23.1 average across all FSS participants), although there were no significant differences across those who had qualifications.