why “change matters”: building economic self-sufficiency among people living with and at-risk...
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Why “Change Matters”: Building Economic Self-Sufficiency
among People living with and at-risk for HIV Infection
Paula M. Frew, MA, MPH, PhDEmory University
Co-Investigators
Carlos del Rio, MDEmily McCollum, MPH
Takeia Horton, MPHMarcus Bolton, MA
Jeffery RomanMary Helen Borck, RN
Garcelia BurchellMichael Banner
Epidemiology of HIV Infection in Georgia and Louisiana
•Louisiana: 4th in nation AIDS cases of large metro area•Baton Rouge: highest rate of AIDS cases in state •African Americans: 72% of newly diagnosed HIV cases (2007)
•Georgia: 8th in nation AIDS cases•Atlanta: 60% of prevalent HIV cases •African Americans: 78% newly diagnosed HIV/AIDS cases (2008)
Theorized Socioecological Factors Influencing HIV Risk
•Housing issues•Economic policies•Health disparities•Healthcare access
Structural/Policy
• Socioeconomic challenges
• Educational access
• Environmental issues
• Access to resources
Community
• Financial dependency
• Concurrency
• Domestic violence
• Condom negotiation
Relational
•Financial insecurity
•Self-esteem issuesIndividual
Denning et al., 2011; Gillies et al., 1996; Schwartz et al., 2011; Behrer, 2007;
Sumartojo et al., 2000; Gilbert, 2003; Adimora et al., 2006; Greene et al., 2010; Ezzy et al., 1999
Program Aims
• Increase opportunities for participants to become financially self-sufficient and improve well-being.
• Increase knowledge and skills to negotiate many socioecological factors associated with HIV risk (housing instability , educational attainment, financial dependency, self-esteem issues).
Building the “Change Matters” Program
Curricular Examples:
• “Hope and Power” (National Coalition against Domestic Violence)
• “Moving On” (Sudie Pollack)
• “Will the Dollars Stretch? Teen Parents Living on Their Own” (Sudie Pollack)
Curricular Aims:
• Basic financial management
• Setting achievable goals
• Self-sufficiency
“Change Matters” Topics
• Taking a financial inventory
• Finding a job
• Paying bills
• Managing a household
• Building a financial base
• Saving for emergencies
• Helping with big problems
• Looking toward the future
Intervention Sites
• Baton Rouge, LA (N=48), 2008 - 2009
– Recruited at Family Services of Greater Baton Rouge
– Program: 8 week one-hour sessions plus facilitator follow up at 1-, 3-, 6-months
• Atlanta, GA (N=15), 2009
– Recruited at Stand, Inc
– Program: 1 day class
Inclusion Criteria
• Persons ≥18 years
• Able to read and write English
• Reside in designated areas of Baton Rouge or Atlanta with high HIV prevalence and poverty
• Clients of designated partner CBOs
Data Collection
Quantitative variables:
• Gender
• Age
• Race and ethnicity
• Education
• Income
• Employment status
• General well-being
• Self-efficacy
• Attitudes towards money
Qualitative topics:
• Knowledge gains related to program topics
• Attitudes towards topics
• Behavioral impact
• Engagement with topic
• Program pedagogical approach
• Program impressions
• Program design feedback
Analytic Approach
Conclusions
Quantitative Data
•Baseline and Follow-up
Surveys
•Session Questionnaires
Qualitative Data
•In-depth interviews with staff
•Client narratives
•Field observations
Content Analysis
•Interim Reports
•Final Reports
Group Characteristics*
Atlanta (N=15)
Baton Rouge(N=48)
Black/African American 14 (93%) 48 (100%)
Gender (Male) 15(100%) 15 (31%)
Heterosexual 13 (87%) 40 (83%)
Unemployed 15 (100%) 31 (66%)
Annual Family Income <$20K 12 (86%) 38 (84%)
Educational Attainment (HS/GED)
12 (80%) 32 (67%)
Results Improved
Navigation of Structural
issues
Opened Access to Resources
Greater Financial
Independence
Improved Self-Efficacy &
Self-Esteem
Navigating Structural
issues
Financial Skills
Question Pairs Mean–Pre
(0=No;1=Yes)
Mean –Post
(0=No;1=Yes)
t df P-value
Credit Report Assessment (Baton Rouge) 0.58 1.02 -3.57 47 .001
Net Worth Calculation (Baton Rouge) 0.31 0.90 -5.27 47 <.001
Personal Spending Plan (Baton Rouge) 0.43 0.91 -5.21 45 <.001
Addressing Economic Challenges
“About the 7 years statute of limitation for Louisiana. Deal with the original creditor instead of collection people. ‘Don’t Settle.’”
“That there programs to help me get work. That I don’t need to stop living, because its help out there.”
Navigating Structural
issues
Opening Access to Resources
Accessing Educational Resources
Navigating Structural
issues
Question Pairs Mean Baseline(1=Fair;
3=Excellent)
MeanFollow Up
(1=Fair;3=Excellent)
t df P value
Overall Impression of the Change Matters Program (Baton Rouge)
2.32 2.79 -3.64 46 .001
Overall Impression of Change Matters (Atlanta)
2.07 2.73 -3.57 14 .003
Accessing Educational Resources
“They need many more like this class”
“I like to come back to see or talk about using what I learned. And how it better my living arrangements.”
“This is such a helpful experience”
Navigating Structural
issues
Opening Access to Resources
Fostering Economic Empowerment
Question Pairs Mean Baseline
(1=SA;6=SD)
MeanFollow-Up (1=SA;6=SD)
t df P value
I am skilled at money management (Baton Rouge)
3.74 2.76 3.72 41 .001
I am skilled at money management (Atlanta)
4.00 3.27 2.58 14 .022
I am skilled at keeping my family’s money records (Baton Rouge)
4.07 2.49 5.96 44 <.001
I feel that I lack education to manage my money
3.85 4.79 -3.35 46 .002
Navigating Structural
issues
Opening Access to Resources
Greater Financial
Independence
Question Pairs Mean Baseline
MeanFollow
-Up
t df P value
Feelings in general over the past month (Baton Rouge)
2.94 2.36 2.99 46 .004
My major accomplishments are entirely due to hard work and intelligence (BatonRouge)
2.05 1.52 2.56 43 .014
Happy, satisfied, or pleased with personal life (Atlanta)
3.33 2.73 3.67 14 .003
Anxious, worried, or upset during the past month (Baton Rouge)
3.91 4.45 -3.15 46 .003
Improving Self-Worth
Navigating Structural
issues
Opening Access to Resources
Greater Financial
Independence
Improved Self-Esteem
and Self-Efficacy
Self-Empowerment and Self-Efficacy
“I’ve learned not to just settle less & continue to strive for higher goals.”
“I learned that it is good idea if go back to school”
“I can accomplish anything I put my mind to”
Navigating Structural
issues
Opening Access to Resources
Greater Financial
Independence
Improved Self-Esteem
and Self-Efficacy
“Know that What You Do Can & Does Change Lives”
• -Barry reentered the workforce and has a monthly savings plan
• -Ary enrolled in community college and saved $500 for emergencies
• Norman saved up enough money to purchase a weed eater and provides lawn services
Study & Programmatic Considerations
• Small samples
• Selection bias
• Social desirability bias
• Format length
• Additional content needs
What Did We Learn?
• Participants recognize their need for improvement in financial areas
• Improved financial skills corresponded with improved emotional well-being
• Future economic interventions could be paired with HIV prevention programs
Thanks!
Program Participants
AIDS United (Formerly National AIDS Fund)
Emory University Office of University Community Partnerships(OUCP)
Emory Center for AIDS Research (P30AI050409)