Left Behind: How Women Manage Life and Health after Welfare

In this study we focused on the health of women in poverty who have participated in the U.S. welfare system. The current work-based welfare program, Temporary Assistance for Needy Families (TANF), presents community health and public health challenges that have been largely ignored. The study aim was to analyze assets and constraints that impoverished, community dwelling women perceive in themselves and their environments, which influence their capacity to care for and support themselves and their children. This longitudinal study used a narrative interview design as the dominant research method. The setting was a large urban county in the Midwest, and participants were 41 women who were terminated from TANF after using up their 5-year lifetime limit of cash support.  Instruments were a semi-structured interview guide, and the HANES General Well-Being Schedule. Participants were interviewed up to four times over the course of a year; 157 interviews were collected between 2007 and 2009. Interviews were transcribed verbatim, and entered into qualitative data management software to facilitate data management. Coded data were analyzed using multi-stage narrative analysis. Data were also analyzed from a self management perspective to understand health issues that persist during and after the TANF intervention. Findings suggest:  1) health deficits, marginalization, and socioeconomic instability put disproportionate burdens on impoverished families and limit their ability to self manage, 2) a measure of the responsibility for failures lies with the social policy itself, and 3) the Individual and Family Self-management Theory is a tool that would be useful in structuring effective self management interventions. The study provides policy makers and health care decision makers with information about the health impact of welfare reform policy, and suggests innovative nursing solutions that are health protective of low income women with children.