Enduring Resilience: Being a Woman, Uninsured, and Living in a Rural County

Purpose:

The purpose of this research was threefold: a) to explore the experiences of near elderly women who are uninsured or underinsured, b) to identify ways women managed health care needs, c) to develop a conceptual understanding of this experience grounded in the participants perspectives. 

There is limited research analyzing or exploring the experiences of near elderly women who are uninsured.   There is a many studies determining the numbers of uninsured and underinsured but none describing the difficulties these women face on a day-to-day basis. This study offers a new view of how these women manage their health care needs in a challenging socioeconomic environment.  Grounded theory is useful in research situations where there are major gaps in current knowledge.

Near elderly women, ages 50-64 years of age are at a higher risk for worsening of chronic diseases than women in younger age groups.  The uninsured have limited access to care, and are likely to delay care. Without medical insurance, women are less likely to seek care or to follow up with prescribed tests, treatments and appointments.  When they do seek care, they are often sicker than insured peers of a similar age. Access to primary care and consistent face-to-face contact with a regular care provider are associated with better health outcomes and enhanced chronic disease management and health outcomes in general.

Methods:

 A grounded theory approach was used.  Eleven participants responded to advertisements in local newspaper seeking women between 50-64 years old who are uninsured.  All were interviewed and the interview digitally recorded. Transcripts were analyzed word for word and coded using the constant comparison method.  During the analysis codes, categories and Enduring Resilience is the basic social process employed by near-elderly women who face myriad economic and social challenges.

Results:

 The lack of financial protection from unexpected health care expenses that increase with age can have devastating effects on health and finances. The participants were a resolute group of women who offered numerous examples of how the loss or the lack of health insurance had impacted their lives and their ability to manage on a day-to-day basis.  Several had medical debt ranging from several hundred dollars to more than $90, 000.  Study participants described the many barriers to health they encountered and the strategies they used for managing their health.  Enduring Resilience is the basic social process employed by near-elderly women who face myriad economic and social challenges.  The Basic Social Process, enduring resilience occurs in a non-linear manner and has 2 sub-processes Downward Spiralling and Keeping it all together.   The phrase “downward spiral” evokes a picture of a loss of control which concludes in a momentous crash.  Following the “crash,” these women found their way back to a state of balance.  Keeping it all together refers to the participants’ determination to move forward despite the obstacles.  The term describes the ability of these women to modify, adapt to, and/or accept circumstances which could constrain their progress.

Conclusion:

Without health insurance, women are less likely to seek care or to follow through with prescribed medications, tests, treatments and appointments.  Uninsured women in this age group have a barrier to routine primary care placing them at increased risk for worsening any chronic disease.  These women are also likely to skip, discontinue or decrease prescribed medications often destabilizing any chronic disease.  In order to provide apropriate care nurses and nurse practitioners must understand the difficulties uninsured women encounter in managing their health care needs. Once the difficulties have been indentified nurses may help mitigate some of the barriers these women must overcome.