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A randomized controlled trial to improve health among women receiving welfare in the U.S.: The relationship between employment outcomes and the economic recession. (Kneipp et al. 2013)

Citation

Kneipp, S., Kairalla, J. & Sheely, A. (2013). A randomized controlled trial to improve health among women receiving welfare in the U.S.: The relationship between employment outcomes and the economic recession. Social Science & Medicine, 80, 130-140.

Highlights

  • The study’s objective was to examine the impact of the Public Health Nurse (PHN) intervention on employment outcomes.
  • The authors conducted a randomized controlled trial. Researchers used self-reported job beginning and ending dates to determine whether a participant was employed over a nine-month period.
  • The authors found no statistically significant effect of PHN on any employment in the first nine months after random assignment.
  • The quality of causal evidence presented in this study is high because it was based on a well-implemented randomized controlled trial. This means we would be confident that any estimated effects would be attributable to PHN and not to other factors. However, the study did not find statistically significant effects.

Intervention Examined

Public Health Nurse Intervention

Features of the Intervention

The PHN program aimed to address the chronic health needs of Temporary Assistance for Needy Families (TANF) clients so those clients’ health concerns would not be a barrier to employment. People in the treatment group met with a public health nurse for a comprehensive health assessment after entering the program. The nurse was a case manager who supported and coordinated access to care and helped clients manage and prevent diseases through both primary care or referrals and health education. Participants in the treatment group could also attend a two-hour information session about Medicaid. In addition, treatment group participants followed up with the nurse three, six, and nine months later to check in about their health and case management needs.

Features of the Study

The authors conducted a randomized controlled trial, randomly assigning 432 unemployed female TANF recipients ages 18 to 60 with at least one chronic health condition to either the treatment or control groups. Participation in the study was denied to pregnant women and those receiving disability income. Using self-reported job beginning and ending dates, the authors used estimated regression models comparing the outcomes of treatment and control group members on whether a participant was employed over a nine-month period. Participants were recruited from one rural and one urban welfare transition program in north-central Florida.

Findings

  • The authors found no statistically significant effect of PHN on any employment in the first nine months after random assignment.

Considerations for Interpreting the Findings

For the outcome of interest to this review, the authors used data from the three-, six-, and nine-month surveys, so later outcomes are missing for sample members who completed the six-month follow-up but not the nine-month follow-up, for example. The estimates may therefore underestimate employment because non-respondents at nine months may have found work by that time. However, the authors accounted for days of participation in the study to mitigate this concern.

Causal Evidence Rating

The quality of causal evidence presented in this study is high because it was based on a well-implemented randomized controlled trial. This means we would be confident that any estimated effects would be attributable to PHN and not to other factors. However, the study did not find statistically significant effects.

Reviewed by CLEAR

November 2016

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