why “change matters”: building economic self-sufficiency among people living with and at-risk...

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.”


issues

Opening Access to Resources

Accessing Educational Resources


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”


issues


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


issues


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


issues


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”


issues


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)

why “change matters”: building economic self-sufficiency among people living with and at-risk...

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