Addressing Health Needs Helps Women Move from Welfare to Work

Assisting women receiving welfare with their health needs can help them to more quickly gain employment, according to a new study from the University of North Carolina Chapel Hill School of Nursing. The study also offers insight into how the recession affected employment for these women.

Shawn M. Kneipp, Ph.D., R.N., an associate professor at the School of Nursing, led the study, which appears online in Social Science & Medicine, an international and interdisciplinary journal that publishes social science research on health issues.

Welfare reform legislation in 1996 created the Temporary Assistance for Needy Families (TANF) program, which requires participants to immediately search for a job or take part in job training or education. When trying to secure a job, women in the TANF program face various challenges, and health problems are one of the most significant.

“Our study is the first randomized control trial to test an intervention aimed at reducing the health-related barriers to employment,” said Kneipp. “The findings show that health is an area where we can intervene to achieve positive results, and this knowledge could be used to shape future policy.”

The study included 432 women who had at least one chronic health condition and participated in the TANF program. The women receiving the intervention met with a public health nurse four times over nine months. The nurse conducted a comprehensive health assessment and helped the women with access and coordination of care, disease management through a health care provider, health education, and disease prevention. Women in the control group received usual care.

The researchers found that by the third month, women who saw the public health nurse gained employment 35 days earlier than other women receiving TANF. For the intervention group, 73.4 percent secured jobs, compared to 64.4 percent of those in the control group. The intervention improved the ability of the study participants to get a job regardless of their age, education level or functional status at study entry. The results were not affected by the recession or whether a woman had received TANF before.

The public health nursing intervention did not affect long-term employment measures such as length of employment or employment rate — the proportion of time a woman spent working relative to the number of days she was observed in the study. In the future, the researchers will conduct further analyses to better understand the factors effecting long-term employment. They also plan to build problem-solving skills into the intervention with an aim of improving long-term employment.

The study’s authors include John A. Kairalla, Ph.D., from the University of Florida and Amanda L. Sheely, Ph.D., from the UNC Chapel Hill School of Social Work. This research was supported by National Institute of Nursing Research grant R01NR009406.