Financial Insecurity Research Articles

Resilience among Rural South Indian Families during Covid-19 Pandemic: A Pilot Study

Pandemics have been in the history of mankind wiping out large number of people. COVID-19 pandemic in the 21st century has also taken a heavy toll on lives and has impacted every aspect of life. There have been several short-term and long-term implications on the families. Many families are still experiencing an ongoing negative impacts viz., loss of job, loss and threatened loss of loved ones, financial insecurity etc. Families were unable to meet the demands of children and elderly at home while being grateful for the quality time spent with family members. Material and Method: A comparative cross-sectional study was carried out to measure the level of resilience among families faced with and without COVID-19 infection during the pandemic in selected rural areas of Tamil Nadu, South India. FRS-16 was used to measure the resilience. Results: The study findings regarding the overall resilience revealed that 53% of the families had moderate resilience and 47% had high resilience. However, there was no statistical difference observed in the different domains of resilience such as Family Communication and Connectedness, Positive Framing and External Resources/Support between the families faced with and without COVID-19 infection. Discussion: The findings of this study corresponded to the findings of a study done in Indonesia with 68.9% of the families having moderate resilience during the COVID-19 pandemic. It has also been observed that a positive framing, family communication and connectedness have a positive influence on the family resilience. Conclusion: Family Resilience is a complex process; hence it is of high importance that adaptive strategies are enhanced in families to strengthen them in rising from adversities.

Correlation of Patient-Reported Social Determinants of Health With Census Tract Measures of Socioeconomic Disadvantage in Patients With GI Cancers in Eastern North Carolina.

Investigating the impact of social determinants of health (SDOHs) on cancer care in large populations relies on census estimates. Routine clinic SDOH screening provides timely patient-level information which could inform best practices. This study evaluated the correlation between patient-reported SDOH needs and population-level census tract measures. This was a retrospective cross-sectional study of a cohort of adult patients with GI malignancy screened for SDOHs such as financial insecurity, transportation, and food insecurity during initial outpatient evaluation at East Carolina University (formerly Vidant) Health Medical Center in Greenville, NC (November 2020-July 2021). Primary outcomes included number and severity of identified SDOH needs and area deprivation index (ADI) and census tract measures for each patient. Spearman rank correlations were calculated among patient-level needs and between patient-level needs and similar census tract measures. Of 112 patients screened, 58.9% self-identified as White (n = 66) and 41.1% as Black (n = 46). A total of 50.5% (n = 54) resided in a rural county. The collective median state ADI rank was 7 (IQR, 5-9). The median household income was $38,125 in US dollars (USD) (IQR, $31,436-$48,934 [USD]). Only 12.5% (n = 14) reported a moderate or severe financial need. Among reported needs, financial need moderately correlated with food insecurity (coefficient, 0.46; P < .001) and transportation (coefficient, 0.45; P < .001). Overall, census tract measures and reported needs poorly correlated. Lack of transportation correlated with percentage of households without a vehicle (coefficient, 0.18; P = .03) and limited access to healthy foods (coefficient, 0.18; P = .04). Given the poor correlation between reported and census needs, population-level measures may not accurately predict patient-reported needs. These findings highlight the importance of SDOH screening in the clinical setting to reduce health disparities and identify opportunities to improve care delivery.

The mediating effect of maturity on anxiety and the motives for postponing parenthood

Postponed parenthood is considered one of the most extensive changes in the process of family formation. Among the many reasons for deferred parenthood, those related to greater feelings of incompetence as a potential parent, self-focus, perceiving parenthood as a burden, fearing the changes that the birth of a child may bring to a person’s life, financial insecurity, and worrying about the child’s future seem particularly important. Since little is known about the motives for delayed parenthood in relation to anxiety and psychological maturity, the main goal of our study was to verify how these variables may be related to each other and whether maturity for parenthood mediates the direct association between anxiety and the motives for delayed parenthood. The sample consisted of 223 Polish adults (the age range of the participants was 18–44 years). The respondents completed the State-Trait Anxiety Inventory (STAI), the Maturity to Parenthood Scale (MPS), and the Multidimensional Scale of Motives for Postponing Parenthood (MSMPP-18). The results showed positive correlations between anxiety and four (uncertainty, burden, change, and finance) of the six motives for postponing parenthood and postponed parenthood overall. Maturity for parenting and all its dimensions correlated negatively with anxiety and all factors of postponed parenthood, except worry about the child’s future. In all six of the seven models (except “worry”), at least one of the factors of maturity to parenthood mediated the relationship between trait anxiety and motives for postponing parenthood/total score. Based on the results it can be assumed that a tendency to direct attention to a threat related to the context of child-bearing and child-rearing may lead to lower maturity to parenthood, which in turn may result in various motives for postponing parenthood.

Living with financial insecurity: Analysing the impact of the cost‐of‐living crisis on older ethnic minority people

Living with financial insecurity: Analysing the impact of the cost‐of‐living crisis on older ethnic minority people

Effects of social determinants on the health outcomes and academic success of international college students in Georgia, United States

Objective: Although there are many international college students in the state of Georgia, few studies have been conducted on how social determinants affect their health outcomes and academic success. This study examined the effects of social determinants on the health outcomes and academic success of international college students in Georgia. Participants: Participants were international college students (n = 136) in Georgia. Methods: A mixed methods cross-sectional design was used for the study. Results: The lack of access to sufficient funds caused study participants to experience anxiety (39.0%), depression (20.6%), and stress (52.9%). Cultural differences (16.9%), lack of access to health care (15.4%), transportation (14.7%), poor housing (7.4%), and financial insecurity (54.5%) affected study participant health outcomes and academic success. Conclusion: Addressing financial insecurity, the lack of access to health care, poor housing, transportation issues, and cultural differences experienced by international college students in Georgia, is crucial to their health outcomes and academic success.

Social determinants of health as barriers to care for vasculitis: perspectives of patients and healthcare providers.

This study examined patient and healthcare provider (HCP) perspectives on the impact of unmet social needs on healthcare barriers for patients with vasculitis. Two surveys were developed to gather perspectives from patients with vasculitis, and HCPs specializing in vasculitis care. The patient survey also included a 20-question social needs assessment. The data were analyzed using descriptive statistics. One hundred patients and 31 HCPs completed the surveys between September 2022 and June 2023. Fifty-six percent of patients reported unmet social needs, with poor social and mental health (30%) being the most common. Sixty-three percent of patients with vasculitis perceived unmet social need(s) as barriers to healthcare access. Financial insecurity (30%), poor mental health (29%), and poor health knowledge (25%) were the most common barriers identified. Overall, HCPs perceived SDOH have a greater impact on healthcare access than the patients surveyed. Most patients (82%) and HCPs (90%) believed rheumatologists should help in the management of SDOH, specifically health knowledge and mental health. Few HCPs (10%) felt well-positioned to address patients' mental health. Suggested interventions that address social needs and improve healthcare access included referrals to community-based resources, providing educational materials, and virtual visits. Through patient and HCP perspectives, the impact of SDOH on healthcare access for patients with vasculitis was explored. Understanding the positive experiences and challenges faced by patients is crucial for developing targeted interventions to enhance healthcare access. These findings underscore the importance of ongoing efforts to improve the healthcare experience for patients with vasculitis. Key Points • The impact of unmet social needs on healthcare access for patients with vasculitis, illustrates the complex relationship between SDOH and healthcare outcomes. • Unmet social needs among patients with vasculitis, included poor social and mental health, financial and food insecurity, and a lack of health literacy, which may exacerbate challenges leading to poor health outcomes. • The differences in perspectives between patients and healthcare providers regarding the impact of certain SDOH on healthcare access, necessitates the importance of co-production in the development of interventions to improve healthcare delivery. • The importance of patient-centered care and tailored solutions was highlighted by the need for various interventions to address social needs and improve healthcare access, such as referrals to community-based resources, educational materials, and interprofessional collaboration.

Breaking the Silence on Food Risks for Elderly People Living Alone.

(1) Background: Currently, numerous qualitative research studies on food and its influence on health are being conducted. In qualitative research, data are obtained by analyzing participants' responses. However, silence during conversation has been little studied. The aim of this study was to interpret the silences in the narratives of elderly people living alone about the potential risks of not keeping a healthy diet. (2) Methods: This is a descriptive and interpretative observational study under the qualitative research paradigm following a phenomenological and ethnographic perspective. The study was developed in two phases with people over 65 years old. In the first phase, from June 2021 to January 2022, 90 interviews, 12 life history analyses, 58 food diaries and 51 free listings (cultural domain technique) were conducted. In the second phase, from March to June 2022, 3 participatory workshops and 24 pile sorts (cultural domain technique) were conducted, as well as 3 focus groups. Only data from participants over 65 years old living alone are analyzed in this paper. The ATLAS-ti (Version 22) qualitative analysis software was used for coding and data analysis. (3) Results: The results show that elderly people living alone would sometimes remain silent during the various conversations conducted within the research. This silence reflects their desire to downplay the risks to their health from not eating well due to their unwanted loneliness. The people participating in our research had chronic health problems, financial insecurity and emotional problems. (4) Conclusions: We concluded that elderly people living alone are unable to maintain a healthy diet because they downplay their risk of malnutrition. This mindset is caused by their loneliness and bolstered by a situation of learned helplessness and social injustice.

Barriers to Engagement with Gastrointestinal Health Management

BackgroundAlthough behavioral interventions have been effective in gastrointestinal (GI) conditions, barriers exist in implementing these interventions into clinical practice. The majority of previously published studies have focused on workforce limitations and have not considered individual and social determinants of health (SDoH) factors that can impact engagement in GI behavioral healthcare.AimsTo characterize barriers to engagement in appointment attendance and health management, explore individual and SDoH factors impacting GI behavioral healthcare engagement, and identify barriers that occur more often for patients with SDoH-related vulnerability (low health literacy and/or financial insecurity).MethodsA survey was distributed to adult patients who had been seen in Gastroenterology at the Dartmouth-Hitchcock Medical Center from June 2022 to December 2022.ResultsOne hundred participants [mean age = 58 years, 57.1% women] completed the survey. SDoH vulnerability was present in 32.3% of the population. For the entire sample, 73% reported at least one barrier to accessing care and 75% reported at least one factor which impacted health management. Those with SDoH vulnerability reported significantly more barriers to attending appointments and to managing health. In addition, they were significantly more likely to endorse physical health problems, difficulty affording medical bills, pain, mobility issues, trauma experiences, significant stress, and difficulty with concentration.ConclusionsPatients in a GI clinic reported multiple barriers to accessing care and participating in health management. Innovative, multi-level strategies are needed to address barriers to ensure that all patients are able to obtain quality GI behavioral health services.

Ethnoracial Differences in Social Determinants of Health and Acute Mental Health Symptoms Among Adults Hospitalized After Emergency Care

Abstract: Research has established relationships between social determinants of health (SDOH) and mental health, with mixed findings on which ethnoracial groups are most vulnerable to deleterious outcomes. The current study examines ethnoracial differences in SDOH and their associations with acute mental health symptoms among patients hospitalized after emergency care. Using data collected in a multi-site study of 1,318 diverse adults admitted to inpatient units, we performed analyses using linear regression models. Findings show that Multiracial/Indigenous and Black adults had significantly higher discrimination and financial stress scores. However, compared with White adults, the positive association between extreme discrimination and acute mental health symptoms was diminished among Latinx (B=–2.3; p=.02) and Black individuals (B=–1.6; p=.05) as was the positive association between financial insecurity and acute mental health symptoms for Black adults (B=–2.3; p=.04). This study provides evidence of differential experiences of SDOH and mental health challenges that may warrant tailored interventions.

Shame and Hostility as Mediators Between Financial Insecurity and Work Outcomes

Shame and Hostility as Mediators Between Financial Insecurity and Work Outcomes

More Costs of Insecurity: Turnover as a Consequence of Worker Financial Insecurity

More Costs of Insecurity: Turnover as a Consequence of Worker Financial Insecurity

A Mixed Methods Exploration of Young Women's Agency and Mental Health during COVID-19 in Low-Income Communities in Mumbai, India.

Adolescent girls and young women (AGYW) in India face additional health inequities compared to their male peers, as gender norms constrain agency for prevention and self-care. The onset of the COVID-19 pandemic and associated lockdowns deepened health inequities and often worsened mental health, but the impacts on agency are unclear. This exploratory sequential mixed methods paper examined mental health and COVID-19 elements that exacerbated or mitigated adverse consequences for AGYW in low-income communities in Mumbai. We conducted semi-structured interviews with AGYW (aged 15-25 years; N = 60) and adults (parents, healthcare providers, community-based organization representative; N = 30). We administered a structured survey to AGYW (N = 150) to assess health concerns, depression and anxiety symptoms (using the PHQ-8 and GAD-7 scales), and experiences during COVID-19. We analyzed qualitative data using the constant comparative approach in Atlas.ti, and quantitative data using R and SPSS. Qualitative data revealed that AGYW faced stressors and had limited agency during lockdowns due to limited access to education, financial insecurity, and community violence. Quantitative data indicated that limited agency in the context of COVID-19 was significantly associated with depression and anxiety. Financial resources to address COVID-19 created new employment and leadership opportunities for AGYW to become COVID educators and preschool teachers; participation in these opportunities was associated with less anxiety. Pandemic stress was difficult for low-income AGYW in Mumbai. Mitigating programs for COVID-19 control helped address acute needs and enable capabilities. Exploring similar themes among a broader population of youth can help design strategies and opportunities for young people in low-income communities during health emergencies.

Households' Debts Among Rural and Agriculture-based Households in Indonesia

Household debts reflect financial insecurity for households to maintain their standard of living because it reflects the financial commitment that must be paid to other parties. However, the share of debts among different household classes, especially among agriculture and rural households in Indonesia still needs to be discovered. This research investigates the distribution of households’ debts in rural areas in Indonesia by utilizing data from the Indonesian Family Life Survey (IFLS) Wave 5 (2014). This research shows that households in rural areas have lower average debts than those in urban areas. At the same time, households in rural areas outside Java Island have higher average debts than their counterparts in Java Island. Two significant contributors to households’ debts are household size and household head educational attainment, where both variables show a positive and significant effect. The government must focus on rural development, including agricultural-based households, creating small but financially strong households, and increasing food self-sufficiency. Keywords: agriculture, debts, households, rural

A qualitative exploration of the reasons and influencing factors for pregnancy termination among young women in Soweto, South Africa: a Socio-ecological perspective

BackgroundPregnancy termination is an essential component of reproductive healthcare. In Southern Africa, an estimated 23% of all pregnancies end in termination of pregnancy, against a backdrop of high rates of unintended pregnancies and unsafe pregnancy terminations, which contributes to maternal morbidity and mortality. Understanding the reasons for pregnancy termination may remain incomplete if seen in isolation of interpersonal (including family, peer, and partner), community, institutional, and public policy factors. This study therefore aimed to use a socio-ecological framework to qualitatively explore, in Soweto, South Africa, i) reasons for pregnancy termination amongst women aged 18–28 years, and ii) factors characterising the decision to terminate.MethodsIn-depth interviews were conducted between February to March 2022 with ten participants of varying parity, who underwent a termination of pregnancy since being enrolled in the Bukhali trial, set in Soweto, South Africa. A semi-structured, in-depth interview guide, based on the socioecological domains, was used. The data was analysed using reflexive thematic analysis, and a deductive approach.ResultsAn application of the socio-ecological framework indicated that the direct reasons to terminate a pregnancy fell into the individual and interpersonal domains of the socioecological framework. Key reasons included financial dependence and insecurity, feeling unready to have a child (again), and a lack of support from family and partners for the participant and their pregnancy. In addition to these reasons, Factors that characterised the participants’ decision experience were identified across all socio-ecological domains and included the availability of social support and (lack of) accessibility to termination services. The COVID-19 pandemic and resultant lockdown policies also indirectly impacted participants’ decisions through detrimental changes in interpersonal support and financial situation.ConclusionsAmongst the South African women included in this study, the decision to terminate a pregnancy was made within a complex structural and social context. Insight into the reasons why women choose to terminate helps to better align legal termination services with women’s needs across multiple sectors, for example by reducing judgement within healthcare settings and improving access to social and mental health support.

Sociodemographic and clinical indicators of children and young people with cerebral palsy and reported unmet social needs.

To determine the frequency, type, clinical, and sociodemographic associations of unmet social needs in children with cerebral palsy (CP). We conducted a cross-sectional study of parents and carers of children with CP attending a specialist hospital clinic between July and September 2022. Unmet social needs were self-identified using a survey, guided by the WE CARE survey instrument and adapted to the local context. Sociodemographic and clinical data were obtained from medical records. We performed descriptive analysis of participants' unmet social needs, sociodemographic factors, and clinical factors, and examined for associations using a χ2 test and logistic regression. A total of 105 parents and carers completed the survey. Of these, 68 (64.8%) reported one or more unmet social need, with 24 (22.9%) reporting three or more unmet needs. A higher number (three or more) of unmet needs was associated with Gross Motor Function Classification System levels IV and V (odds ratio [OR] = 3.77, 95% confidence interval [CI] = 1.44-9.86) and intellectual disability (OR = 4.63, 95% CI = 1.61-13.31), but were not significant when corrected for neighbourhood socioeconomic disadvantage. The greatest socioeconomic disadvantage was associated with housing concerns (p = 0.002), food (p = 0.026), and financial insecurity (p = 0.02). Unmet social needs are experienced by most families of children with CP. This study highlights the importance of systematic pathways to identify and address unmet social needs.

‘Life became harder with COVID-19’: exploring the experiences of the COVID-19 pandemic among youth living in eThekwini district, South Africa

BackgroundIn South Africa, pervasive age and gender inequities have been exacerbated by the COVID-19 pandemic and public health response. We aimed to explore experiences of the COVID-19 pandemic among youth in eThekwini district, South Africa.MethodsBetween December 2021-May 2022 we explored experiences of the COVID-19 pandemic on youth aged 16–24 residing in eThekwini, South Africa. We collated responses to the open-ended question “Has the COVID-19 pandemic affected you in any other way you want to tell us about?” in an online survey focused on understanding the pandemic’s multi-levelled health and social effects. We used a thematic analysis to summarise the responses.ResultsOf 2,068 respondents, 256 (12.4%, median age = 22, 60.9% women) completed the open-ended survey question (11% in isiZulu). Results were organized into three main themes encompassing (1) COVID-19-related loss, fear, grief, and exacerbated mental and physical health concerns; (2) COVID-19-related intensified hardships, which contributed to financial, employment, food, education, and relationship insecurities for individuals and households; and (3) positive effects of the pandemic response, including the benefits of government policies and silver linings to government restrictions.ConclusionsWe found that South African youth experienced significant grief and multiple losses (e.g., death, income, job, and educational) during the COVID-19 pandemic. Trauma-aware interventions that provide economic and educational opportunities must be included in post-COVID recovery efforts.

Navigating the gig economy in Romania: unveiling perceptions of working on on-demand platforms

Purpose This paper aims to explore the realm of gig work and the gig economy in Romania in an attempt to shed light on the mechanisms of this type of work and the reasons and benefits of engaging in gig-related activities.Considering the low conceptual consensus on gig work, the authors aim to explore how participants in this study define and refer to gig work, thus helping to contribute to the current conceptualization and characterizations of gig work and the gig economy. Among the wide range of services encountered within the gig economy, this research focuses on three categories of tasks, as defined within COLLEEM 2018 questionnaire (see Pesole et al., 2018), namely, online creative and multimedia work, online sales and marketing support and online software development and technology work. Design/methodology/approach Based on semistructured interviews with people working in the gig economy in Romania, the authors look to understand the meaning given to gig work and its features. The authors tackle how participants in this study perceive themselves and their work. The authors also look into perceived similarities and differences with other types of independent work. Findings In this paper, findings are organized into two main sections. The first section showcases perceptions about working in the gig economy, including how people involved with this type of work are describing them and their activity and exploring financial insecurities in connection with the independent/gig work. The second section highlights the mechanisms of gig work on digital labor platforms, developing means and ways of reputation-building and their impact on financial earnings. Originality/value This research aims to contribute to a better understanding of the environment and needs of gig workers. Although gig economy and online work are widely covered by field literature, knowledge about the experiences and perceptions of gig workers in emerging markets has more to gain by exploring European Union developing markets.

A Study on Economic Stressors During the COVID-19 Pandemic Among Intimate Partner and Sexual Violence Survivors in the United States.

Systemic racism and racialized poverty are socially produced structural determinants that shape health outcomes during infectious disease outbreaks. Public health emergencies compound vulnerabilities for survivors of intimate partner violence (IPV) and sexual violence (SV) and those who self-identify as people from racial and ethnic minority groups. We describe findings from an online survey designed to collect data on financial conditions faced by survivors of IPV and SV to understand these conditions during the COVID-19 pandemic. Our analyses were limited to a sample of women in the United States (91.4%, n = 523) who reported IPV or SV to whom we refer as survivors. We characterize the differences of economic stressors across White and aggregated categories of self-identified race, i.e., Black and Brown Latinx women and non-Black or non-Brown Latinx women of color, to highlight disparities between White and non-White populations in our sample. Logistic regressions were used to examine the relationships among racial categories, food insecurity, housing insecurity, and economic insecurity during the COVID-19 pandemic. Black and Brown Latinx women survivors were twice as likely as White women to report housing, financial, and economic insecurity during the COVID-19 pandemic. Approximately one-third of all survivors anticipated taking on more debt than they would want to cover their expenses due to COVID-19. The results of this study have implications for public health responses that involve coordinating economic relief measures among populations disparately affected by public health crises and disasters to ensure that the economic needs of the most impacted are addressed.

Socio-Economic Implications of Domestic Violence in Thenmaradchi Divisional Secretariat in Jaffna District

Domestic violence against women is one of the most contemporary social issues in Sri Lanka. This study aimed to identify the socioeconomic implications of domestic violence experienced by women. All 107 women were selected in Thenmaradchi Divisional Secretariat. The mixed method research design was undertaken with the help of a questionnaire survey and interviews. The Chi-square for univariate analysis was employed to analyze quantitative data with the usage of SPSS version 21 and qualitative data were analyzed thematically using the thematic analysis. According to the results, Hinduism (98.1%) was the predominant religion and 24.3% of the respondents’ age range was 26-30 years. The majority of the victims (54.2%) were educated up to secondary educational level. Wage labour was the primary livelihood of many women and most of the respondents’ monthly income was less than 20,000 Sri Lankan Rupees. There was a significantly high status between economic domestic violence and the variables including education (p&lt;0.000); occupation (p&lt;0.000) and income (p&lt;0.000). Further, financial instability, low income, financial insecurity, unemployment, debt, poverty, low level of living standards, helplessness, lack of social recognition, and lack of social support were the significant economic and social impacts on women. In addition, stress, fear, tension, low self-esteem, and eating and sleeping disorders were the major psychological impacts on women. Additionally, cultural norms, fear, and stigma often cause women to stay silent about their experiences with abuse. Most of the women used coping mechanisms to cope with their implications. The research concludes that psychological implications were the most severe implication among the participants. This study suggests that vulnerable communities should be identified and services such as counselling and legal aid should be made easily accessible.

Masculinities in Immigration Detention Centres

A great tool to grow an empire, detention camps have been historically used and abused as a subordination tactic by all of the most powerful empires, most notably by Germany’s Nazi Regime in the Second World War. Commonly thought to have been born and died in history, they are a mostly forgotten piece of the past. Many would be shocked to discover that there is a secret world of institutions that disregard international human rights law in order to prioritize their national goals, where refugees, asylum seekers and migrants are the primary victims. Systems for migrancy and immigration detention have emerged in the wake of globalization, seeking asylum from conflicts, natural disasters or financial insecurity, or simply searching for better economic opportunities, education or reunion with family. Multicultural liberal democracies use detention centres to enforce their racialized and gendered penal power and establish a national hierarchy where poor, young men of colour are the most marginalized. This paper critically examines the victimization of male refugees, asylum seekers and migrants by neo-colonial masculinities in Canadian, American and British immigration detention centres and how these experiences create offenders through the victim-offender overlap.