CBPR to Reduce Women's Health Disparities thru TANF

描述（由申请人提供）：自1996年以来，美国福利制度发生了重大变化，导致对贫困家庭的临时援助（TANF）或“福利”援助大幅减少，主要是通过“福利到工作”或福利过渡计划（WTPs）将她们转移到低薪工作岗位。研究表明，30%的人由于难以维持就业而在退出后一年内重新进入该项目，推动他们重新进入的一个因素是这一群体中慢性疾病的患病率极高。我们的数据和其他方面的数据表明，目前解决世界粮食计划署妇女保健问题的办法严重不足，既不能缩小保健差距，也不能提高她们实现自给自足目标的能力。尽管有明确和令人信服的证据表明，她们的健康问题发生率高于一般人口中的妇女和其他低收入妇女，但没有开展研究，以改善接受药物辅助治疗妇女的健康状况，而且在药物辅助治疗方案中几乎没有采取任何措施来满足她们的健康需要。因此，这项研究对改善这一群体的健康状况是必要的；它也很简陋，因为干预是基于WTP参与者自己的需求和偏好。

DESCRIPTION (provided by applicant): Major changes to the U.S. welfare system since 1996 have resulted in significant reductions in Temporary Assistance to Needy Families (TANF, or 'welfare') assistance to predominantly poor, minority women by moving them into low-wage jobs through 'welfare-to-work', or welfare transition programs (WTPs). Studies have documented that 30% re-enter the program within one year of exit due to difficulty maintaining employment, and one factor driving 're-entry1 is the extremely high prevalence of chronic health conditions in this group. Our data, and data from others, suggests current approaches for addressing health problems among women in WTPs are woefully inadequate, and will result in neither reducing health disparities nor improve their ability to meet self-sufficiency goals. Studies to improve the health of women receiving TANF are absent, despite clear and compelling evidence they suffer from higher rates of health problems than women in both the general population and other low-income women, and that little is being done in WTPs to meet their health needs. Thus, this study is necessary to improve the health of this group; it is also hovel, in that the intervention is based on the needs and preferences of WTP participants themselves. The specific aims of this research are: 1. To redesign the current WTP clinical health screening tool so that it is culturally relevant, sensitive, and acceptable for use in testing the efficacy of a Welfare Participant-Centered Health Program (WPCHP) using a participatory research methodology. 2. To test the efficacy of a WPCHP in: a) increasing rates of voluntary screening, identification, and treatment for chronic health conditions, b) increasing the knowledge and skills necessary to navigate the Medicaid system, c) improving functional and health status over time, and d) increasing employment duration among women enrolled in WTPs with chronic health conditions using a participatory research methodology.