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Women, low income, and health : an ethnography of a housing co-operative Wasylishyn, Christine 1996

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WOMEN, LOW INCOME, AND HEALTH: AN ETHNOGRAPHY OF A HOUSING CO-OPERATIVE by CHRISTINE WASYLISHYN BScN., L a u r e n t i a n U n i v e r s i t y ,  198 0  THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTERS OF SCIENCE IN NURSING in FACULTY OF GRADUATE STUDIES School of Nursing  We accept t h i s t h e s i s as conforming t o t h e r e q u i r e d standard  THE UNIVERSITY OF BRITISH COLUMBIA A p r i l 1996 Wasylishyn, 1996  In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree, that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of. my department  or by his  or her representatives.  It is  understood  that  copying or  publication of this thesis for financial gain shall not be allowed without my written permission.  Department  of  MuCRSirffr  The University of British Columbia Vancouver, Canada Date  DE-6 (2/88)  11  Abstract The  purpose of t h i s study was t o d e s c r i b e t h e h e a l t h  b e l i e f s , v a l u e s , concerns,  and h e a l t h p r a c t i c e s o f women  l i v i n g on low income i n a s p e c i f i c housing The  co-operative.  c h o i c e o f t h i s context c o n t r o l l e d f o r some o f t h e  d i v e r s i t y which e x i s t s amongst poor women. c o - o p e r a t i v e housing  The e f f e c t o f a  environment on t h e h e a l t h o f these  women was a l s o examined. Initially, access was  an ethnographic  method was proposed.  f o r p a r t i c i p a n t - o b s e r v a t i o n was denied,  When  t h e method  modified t o include intensive interviews only.  Ten  v o l u n t e e r s were r e c r u i t e d out of t h e t o t a l p o p u l a t i o n o f t h i r t y - s i x women.  These women were i n t e r v i e w e d  (with one e x c e p t i o n ) , u s i n g an u n s t r u c t u r e d i n t e r v i e w s were audio-taped,  individually  format.  The  t r a n s c r i b e d , and a n a l y z e d  for  common themes. At t h e time of t h e study,  t h e p a r t i c i p a n t s saw  themselves as a d i v e r s e group l a c k i n g a common i d e n t i t y . They d i d acknowledge, however, t h a t they shared h i s t o r y o f "hard experiences."  The f i n d i n g s r e v e a l e d t h a t ,  f o r these women, inherent i n t h e experience low  income i s a sense of a l a c k o f c o n t r o l .  o f l i v i n g on a Limited  f i n a n c e s r e s u l t i n fewer c h o i c e s and decreased c o n t r o l over one's l i f e .  a common  feelings of  Consequently, h e a l t h was d e f i n e d  f o r these women i n terms of meeting b a s i c needs such as s a f e t y and s e c u r i t y .  Ill  The having  p a r t i c i p a n t s i d e n t i f i e d t h e i r new environment as  both p o s i t i v e and negative h e a l t h consequences.  A c q u i r i n g s t a b l e , s u b s i d i z e d housing had reduced, a l t h o u g h not e l i m i n a t e d , t h e s t r e s s of coping with Initially,  limited  finances.  however, t h e new r e s p o n s i b i l i t i e s a s s o c i a t e d  managing t h e c o - o p e r a t i v e , community l i f e s t y l e ,  with  combined with a d j u s t i n g t o a  provided  enough added s t r e s s t h a t  s e v e r a l women i d e n t i f i e d a s i g n i f i c a n t d e t e r i o r a t i o n i n t h e i r h e a l t h f o l l o w i n g t h e move. Since no r e s e a r c h c o u l d be found which addresses t h e h e a l t h o f mature, unattached, low income women, t h i s d e s c r i p t i v e study r e p r e s e n t s research.  a starting point for further  iv TABLE  OF CONTENTS  Abstract  i i  T a b l e o f Contents  iv  Acknowledgement  viii  CHAPTER ONE: INTRODUCTION  1  Background o f t h e Study  1  Research  5  Questions and Purpose  Statement o f t h e Problem  5  Purpose  5  Research CHAPTER TWO:  Questions  6  LITERATURE REVIEW  7  Introduction  7  Poverty and H e a l t h  9  Conceptual  and M e t h o d o l o g i c a l Issues  10  Women, Poverty, and H e a l t h  11  Housing,  20  Poverty, and H e a l t h  Gaps i n the Research Conclusions CHAPTER THREE:  on Women and Poverty  22 25  METHOD  28  Introduction  28  D e f i n i t i o n o f Terms  29  Assumptions  29  Limitations  30  Sample  30  Setting  30  G a i n i n g Access  31  V  Sampling  32  Data C o l l e c t i o n  34  Procedures  34  Recording o f t h e Data  35  Length o f Fieldwork  36  Analysis  37  Protection  of Human R i g h t s  Summary  39 40  CHAPTER FOUR:  FINDINGS  42  Introduction The Housing  42 Co-operative  43  The Concept o f Co-operative Housing  43  The P h y s i c a l  44  Space  Administrative Structure The Women of t h e Housing  Co-operative  Common Backgrounds  48 50 50  Dysfunctional/Abusive H i s t o r i e s  51  P r e v i o u s Housing  54  Experiences  Experiences L i v i n g on a Low Income  57  D i v e r s i t y o f Poorness  57  Coping S t r a t e g i e s  60  Emotions and Low Income as I d e n t i t y  64  Definitions  68  Building  of Poverty  a Co-operative L i v i n g Environment  69  Diversity  70  The Move  72  vi Boundary Issues  74  B u i l d i n g Support Networks  80  What i s H e a l t h f o r These Women?  86  Summary  91  CHAPTER FIVE:  DISCUSSION  94  Introduction  94  D i s c u s s i o n of the F i n d i n g s  94  I d e n t i t y and Self-Concept The Environment  96 101  The Neighbourhood  102  The Housing  103  Co-operative  S o c i a l Support Control I m p l i c a t i o n s f o r Nursing  105 108 113  Nursing P r a c t i c e  113  Nursing Education  115  N u r s i n g Research  116  D i s c u s s i o n of Method  117  Rigor  118  S i g n i f i c a n c e o f the Study  12 3  Summary o f the Study  12 3  References  125  Appendix A  13 2  Appendix B  134  Appendix C  13 6  vii Acknowledgement F i r s t and foremost, I would l i k e t o express my deep a p p r e c i a t i o n t o my t h e s i s committee, Dr. J o y Johnson, Dr. Joan B o t t o r f f , and Dr. S a l l y Thorne. They have g e n e r o u s l y shared i d e a s , r e s o u r c e s , c r i t i c a l feedback, and encouragement. Joy and Joan have impressed upon me t h a t m a i n t a i n i n g a sense of f u n i s e s s e n t i a l , and t h a t even w r i t i n g a t h e s i s can be enjoyable. Without Joy's a s s i s t a n c e i n p r e p a r i n g t h e many d r a f t s o f "the o f f i c i a l s h e d u l e , " I am not sure i f I would have ever reached t h e end. To my p a r e n t s , P a t r i c i a and Joseph, f o r h a v i n g impressed upon me t h e v a l u e o f an education and s u p p o r t i n g a l l t h e endeavours I have ever undertaken, I express my l o v e and appreciation. Many f r i e n d s and c o l l e a g u e s p r o v i d e d support d u r i n g t h e course o f my graduate s t u d i e s . I am e s p e c i a l l y g r a t e f u l t o G a i l Gleason and Lona Lonergan whose p r a c t i c a l a s s i s t a n c e and encouragement were always a v a i l a b l e . S p e c i a l mention needs t o be made o f Murphy who stood by me through i t a l l without ever complaining. To t h e Langara C o l l e g e Research Committee, I am g r a t e f u l f o r the generous f i n a n c i a l support p r o v i d e d f o r t h i s study. F i n a l l y , I thank t h e women who p a r t i c i p a t e d i n t h i s study. Not o n l y d i d they generously share o f themselves and t h e i r e x p e r i e n c e s , but they a l s o p r o v i d e d a tremendous amount support and encouragement f o r t h i s p r o j e c t . Of s p e c i a l note i s C l e o Pawson's a s s i s t a n c e and i n s p i r a t i o n . Without i t , the i d e a f o r t h i s study never would have been born.  1  CHAPTER ONE INTRODUCTION Background of t h e Study H e a l t h promotion  i s a major focus i n h e a l t h c a r e today.  I t has been d e f i n e d by the World H e a l t h O r g a n i z a t i o n (1984) as "the p r o c e s s of e n a b l i n g people t o i n c r e a s e c o n t r o l over, and t o improve,  their health"  (p. 3 ) . H e a l t h promotion has  been o p e r a t i o n a l i z e d p r i m a r i l y through e f f o r t s t o change t h e h e a l t h - r e l a t e d behaviours of i n d i v i d u a l s v i a e d u c a t i o n .  An  emphasis on h e a l t h education alone, however, f a i l s t o take i n t o account the s o c i a l and economic b a r r i e r s t o behaviour change (Nelson,  1994).  The determinants o f h e a l t h a r e emphasized promotion approach. encourages  For example, B u t t e r f i e l d  nurses t o " t h i n k upstream"  i n a health (1990)  which means  c o n s i d e r i n g and a d d r e s s i n g t h e economic, p o l i t i c a l ,  and  environmental f a c t o r s t h a t a r e the p r e c u r s o r s o f poor health.  Many of these f a c t o r s a r e beyond t h e c o n t r o l o f t h e  individual.  Research has shown t h a t t h e r e l a t i o n s h i p  between t h e determinants of h e a l t h and h e a l t h i t s e l f complex ( W i l l i a m s , 1990). Furthermore,  i s very  the m o d i f i c a t i o n of  environmental r i s k f a c t o r s i s extremely d i f f i c u l t (Epp, 1986). Of t h e many determinants o f h e a l t h , status  socioeconomic  (SES) i s t h e s i n g l e most r e l i a b l e p r e d i c t o r o f h e a l t h  2 status  (Nelson, 1994).  H e a l t h i s c l e a r l y r e l a t e d t o wealth  (Health & Welfare Canada, 1992) and c o n v e r s e l y , p o v e r t y e x e r t s a d e v a s t a t i n g e f f e c t on one's w e l l - b e i n g ( N a t i o n a l C o u n c i l o f Welfare,  1987).  While t h e r e i s ample evidence o f a d i r e c t  relationship  between SES and h e a l t h , t h i s r e l a t i o n s h i p i s not w e l l understood  (Williams, 1990).  Due t o t h e complexity o f t h e  r e l a t i o n s h i p between poverty and h e a l t h , r e s e a r c h i s f r a u g h t w i t h many confounding  variables.  Even d e f i n i n g SES by  i n d i c a t o r s such as income, occupation, s o c i a l c l a s s or  education i s problematic  e f f e c t i v e h e a l t h promotion  (Nelson, 1994). s t r a t e g i e s cannot  levels,  Development o f be accomplished  u n t i l t h e r e l a t i o n s h i p between poverty and h e a l t h i s b e t t e r understood. W i t h i n t h e body o f l i t e r a t u r e t h a t addresses t h e r e l a t i o n s h i p between h e a l t h and poverty, women's h e a l t h needs have r e c e i v e d very l i t t l e a t t e n t i o n  (Doyal, 1991).  Indeed, a major c r i t i c i s m of t h e r e s e a r c h on p o v e r t y and h e a l t h i s t h e absence of an a n a l y s i s o f t h e confounding e f f e c t s o f gender.  I t i s very important t o i n c l u d e women i n  t h i s a n a l y s i s s i n c e they a r e e s p e c i a l l y v u l n e r a b l e t o p o v e r t y and i t s e f f e c t s .  For example, women comprise t h e  m a j o r i t y o f t h e poor i n Canada ( N a t i o n a l C o u n c i l o f Welfare, 1990)  and some evidence e x i s t s t o i n d i c a t e t h a t women, by  p l a c i n g t h e needs of others ahead of t h e i r own, a r e more l i k e l y t o experience d e p r i v a t i o n and i t s n e g a t i v e  consequences w h i l e l i v i n g i n poverty  (Payne, 1991).  I t was not u n t i l 1970 t h a t t h e d i f f e r e n t i a l e f f e c t o f p o v e r t y f o r women was i d e n t i f i e d i n Canada ( N a t i o n a l C o u n c i l of Welfare,  1979).  Many m o r t a l i t y and m o r b i d i t y s t u d i e s  i n c l u d e d men o n l y o r f a i l e d t o analyze gender d i f f e r e n c e s (McElmurray e t a l . ,  1987).  Women who do not work o u t s i d e  the home a r e excluded from s t a t i s t i c s on employee absenteeism  and workers' compensation  (Doyal, 1991), and  when i n c l u d e d i n s t a t i s t i c a l data a r e o f t e n c l a s s e d a c c o r d i n g t o t h e i r husband's occupation & Elston,  (Marmot,  Kogevinas,  1987).  S i n c e 1970, some r e s e a r c h has been completed  specific  t o women's experience i n poverty, but many gaps remain.  The  m a j o r i t y o f t h i s r e s e a r c h has focused on r e p r o d u c t i v e i s s u e s such as p r e n a t a l care, b r e a s t - f e e d i n g , and c e r v i c a l and b r e a s t cancer.  Very l i t t l e r e s e a r c h has addressed t h e  i s s u e s o f poverty f o r s i n g l e parents o r e l d e r l y women, and unattached poor women seem t o have been completely  ignored.  T h i s omission i s p u z z l i n g when one c o n s i d e r s t h a t t h e m a j o r i t y o f poor Canadian women l i v e alone o r w i t h nonrelatives  ( N a t i o n a l C o u n c i l of Welfare,  1990).  There i s a need f o r r e s e a r c h t h a t addresses  both  women's concerns as they r e l a t e t o h e a l t h and p o v e r t y and t h a t e x p l a i n s t h e r e l a t i o n s h i p of poverty t o h e a l t h .  To  date, a few s t u d i e s have demonstrated l i n k s between SES and stress  (Williams & House, 1991), h i e r a r c h i c a l  position  4 (regardless  o f income) and h e a l t h , and m e a n i n g f u l  r e l a t i o n s h i p s and h e a l t h a simple and  social  ( L i n d h e i m & Syme, 1983) .  However,  r e l a t i o n s h i p between o n l y one o f t h e s e v a r i a b l e s  h e a l t h seems u n l i k e l y . Inadequate h o u s i n g i s an e s p e c i a l l y i m p o r t a n t  associated with poverty 1991;  Payne, 1991).  a n d p o o r h e a l t h f o r women.  (Doyal,  Payne s t a t e s t h a t h o u s i n g s e r v e s a s an  i n d i c a t o r o f b o t h d e p r i v a t i o n and h e a l t h s t a t u s women.  factor  f o r poor  P u b l i c housing projects a r e often associated  s t i g m a t i z a t i o n which has negative Syme, 1 9 8 3 ) .  with  health e f f e c t s (Lindheim &  Housing co-operatives,  however, have been  i d e n t i f i e d a s a means o f e n h a n c i n g women's h e a l t h v i a a supportive  community e n v i r o n m e n t  ( W e k e r l e , 1988) w h i c h  f o s t e r s t h e d e v e l o p m e n t o f new s k i l l s c o n t r o l over t h e environment Nurses a r e confronted poverty  and an sense o f  (Morisette,  1987).  w i t h t h e h e a l t h consequences o f  i n a l m o s t e v e r y work s e t t i n g .  Furthermore,  s t a t i s t i c a l p r o j e c t i o n s i n d i c a t e t h a t t h e number o f p o o r people w i l l order  continue  t o increase  ( M o c c i a & Mason, 1 9 8 6 ) .  t o serve t h i s growing c l i e n t e l e ,  n u r s e s c a n no  t r e a t economic impoverishment as an u n m o d i f i a b l e factor. the  Instead,  In  longer  risk  n u r s e s need t o enhance t h e i r awareness o f  r e l a t i o n s h i p between p o v e r t y  and h e a l t h ,  increase  understanding of people's experiences with poverty  their  and  h e a l t h , and i n c r e a s e knowledge o f s t r a t e g i e s w h i c h c a n be used t o a s s i s t t h e poor t o improve t h e i r  health.  Q u a l i t a t i v e r e s e a r c h methods seek a depth o f data t h a t e n l a r g e s our view by attempting t o see human e x p e r i e n c e " i n the complexity of i t s context" (Munhall & O i l e r , 57).  1986, p.  There a r e numerous r e f e r e n c e s i n t h e l i t e r a t u r e on  p o v e r t y and h e a l t h t h a t c a l l f o r q u a l i t a t i v e s t u d i e s t h a t address t h e h e a l t h p r a c t i c e s and h e a l t h needs o f t h e poor. Nelson  (1994),  f o r example, concluded t h a t " n u r s i n g  i n v e s t i g a t i o n s d e s c r i b i n g the processes through which t h e h e a l t h p r a c t i c e s o f t h e s o c i o e c o n o m i c a l l y disadvantaged a r e shaped by t h e l a r g e r s o c i a l environment a r e u r g e n t l y needed" (pp. 8-9). Research  Questions and Purpose  Statement o f t h e Problem E f f e c t i v e h e a l t h promotion  s t r a t e g i e s a r e l i m i t e d by  the l a c k o f knowledge r e g a r d i n g how f a c t o r s such as SES affect health.  There a r e l a r g e gaps i n our knowledge o f t h e  r e l a t i o n s h i p between t h e environment, poverty, and h e a l t h , e s p e c i a l l y concerning women and t h e i r  experiences.  V i r t u a l l y no r e s e a r c h has been conducted unattached,  low income women.  on t h e h e a l t h o f  S p e c i f i c aspects of l i v i n g i n  p o v e r t y , such as inadequate housing, and t h e r e l a t i o n s h i p w i t h h e a l t h need t o be addressed. Purpose The purpose o f t h i s study was t o develop an understanding  o f how l i v i n g on a l i m i t e d income a f f e c t s t h e  h e a l t h o f women.  Women l i v i n g i n poverty, however, a r e a  v e r y d i v e r s e group.  In order t o narrow t h e f o c u s o f t h e  r e s e a r c h and t o examine t h e p o s s i b l e h e a l t h - e n h a n c i n g e f f e c t s o f one proposed s o c i a l i n t e r v e n t i o n , t h e r e s i d e n t s of a housing c o - o p e r a t i v e b u i l t e x c l u s i v e l y f o r unattached, low income women were s e l e c t e d f o r study.  The c h o i c e o f  t h i s subgroup o f poor women allows f o r t h e study o f t h e i n f l u e n c e of t h i s environment  on t h e i r h e a l t h and h e l p s t o  c o n t r o l f o r some o f the d i v e r s i t y  amongst poor women by  e l i m i n a t i n g v a r i a t i o n s i n housing. Research  Questions  The main q u e s t i o n addressed was: How does l i v i n g i n a housing c o - o p e r a t i v e i n f l u e n c e t h e h e a l t h and h e a l t h p r a c t i c e s of women l i v i n g on low income? S u b s i d a r y q u e s t i o n s were: (a)  How do t h e women l i v i n g i n a s p e c i f i c housing c o operative construct health i n t h e i r  (b)  lives?  What a r e t h e b e l i e f s , v a l u e s , concerns, and p r a c t i c e s of low income women i n r e l a t i o n t o t h e i r health?  7 CHAPTER TWO LITERATURE REVIEW Introduction No w r i t t e n account can even come c l o s e t o p o r t r a y i n g t h e damage t o p h y s i c a l h e a l t h and t h e scars t o psychological well-being  t h a t can come  from l i v i n g a t standards below those deemed a b s o l u t e l y minimal f o r b a s i c s u b s i s t e n c e .  What  can be s a i d of a l i f e which c o n s i s t s o f a d a i l y s t r u g g l e merely t o s u r v i v e ?  (National Council of  Welfare, 1987, p. 82). Despite  t h e f a c t t h a t socioeconomic s t a t u s  (SES) i s t h e  s i n g l e most r e l i a b l e p r e d i c t o r o f h e a l t h s t a t u s  (Nelson,  1994) , t h e a c t u a l mechanisms of t h e r e l a t i o n s h i p between p o v e r t y and poor h e a l t h a r e not w e l l understood 1990).  (Williams,  Although these c a u s a l mechanisms have not been  c l e a r l y demonstrated, t h e r e i s arguably l i t t l e doubt t h a t the m a n i f e s t a t i o n s and  of poverty, i n c l u d i n g inadequate housing  n u t r i t i o n , a r e a s s o c i a t e d with poor h e a l t h .  Payne  (1991), f o r example, contends t h a t "poor housing, an inadequate or e r r a t i c income and poor n u t r i t i o n a l l suggest l e v e l s o f s t r e s s which may r e s u l t i n a t h r e a t t o mental as w e l l as p h y s i c a l h e a l t h " observations  (p. 155). S i m i l a r l y , based on h e r  of women i n I n d i a , B e c k t e l l (1994) concluded  t h a t women's s h o r t e r l i f e s p a n s and poorer h e a l t h were a r e s u l t o f endemic s t r e s s , t h a t i s , t h e consequences o f  8 d e p r i v a t i o n , inadequate  resources, l i m i t e d  o p p o r t u n i t i e s , and o p p r e s s i v e c u l t u r a l  role  forces.  While t h e connection between t h e n e g a t i v e f o r c e s o f p o v e r t y and poor h e a l t h seems i n t u i t i v e l y l o g i c a l , t h e a c t u a l study o f these mechanisms i s very  difficult.  Research on poverty and h e a l t h i s complicated by many confounding  variables.  socioeconomic  For example, those i n lower  groups tend t o have h i g h e r r a t e s o f smoking  ( W i l l i a m s , 1990), and i t i s c h a l l e n g i n g , a t t h e v e r y t o s e p a r a t e out t h e e f f e c t s of poverty p e r se.  least,  As t h e  f o l l o w i n g l i t e r a t u r e review i l l u s t r a t e s , t h e r e a r e a t l e a s t t h r e e reasons f o r t h e gaps i n our knowledge o f p o v e r t y and h e a l t h : t h e nature of t h e r e l a t i o n s h i p between p o v e r t y and h e a l t h i s very complex, the e m p i r i c a l evidence  i s limited  p r i m a r i l y t o m o r b i d i t y and m o r t a l i t y s t a t i s t i c s ,  and t h e r e  has been a f a i l u r e among r e s e a r c h e r s t o adequately  address  gender i n r e l a t i o n t o poverty and h e a l t h . In t h a t t h e r e a r e a l i m i t e d number of e m p i r i c a l s t u d i e s a v a i l a b l e on women, poverty, and h e a l t h , t h e f o l l o w i n g review o f t h e l i t e r a t u r e i n c l u d e s o p i n i o n papers and review papers.  The l i t e r a t u r e reviewed a r i s e s from t h e d i s c i p l i n e s  of n u r s i n g , medicine,  and t h e s o c i a l s c i e n c e s .  A brief  review o f s e l e c t e d , c l a s s i c s t u d i e s on p o v e r t y and h e a l t h p l a c e s t h e l i t e r a t u r e on women, poverty, and h e a l t h i n t o context.  The l i t e r a t u r e review has been o r g a n i z e d i n t o f o u r  s e c t i o n s : poverty and h e a l t h ; women, poverty, and  9 h e a l t h ; housing,  poverty, and h e a l t h ; and gaps i n the  r e s e a r c h on women, poverty, and h e a l t h . Poverty and Williams  (1990) conducted an e x t e n s i v e review  l i t e r a t u r e on socioeconomic concluded  Health of the  d i f f e r e n t i a l s and h e a l t h .  He  t h a t w h i l e t h e r e i s " c l e a r abundant evidence  s t r o n g c a u s a l r e l a t i o n s h i p between socioeconomic and h e a l t h s t a t u s " (p. 81), t h e r e i s l i t t l e explain this association.  for a  position  information to  Many s t u d i e s have examined the  r e l a t i o n s h i p of SES t o m o r t a l i t y and m o r b i d i t y .  For  example, Marmot e t a l . (1987) reviewed the n a t i o n a l m o r t a l i t y and m o r b i d i t y s t a t i s t i c s f o r England and between 1922  and  c l a s s and gender.  1971  and analyzed them a c c o r d i n g t o  They found  s o c i a l c l a s s t o be a  p r e d i c t o r of m o r t a l i t y and suggested  They concluded,  social  "robust"  that s o c i a l  i n e q u a l i t i e s i n m o r t a l i t y have probably years.  Wales  increased i n recent  however, t h a t the l i n k s between  s o c i a l c l a s s and d i s e a s e and death are not  understood.  The Alameda County Study (Haan, Kaplan, & Camacho, 1987)  attempted t o examine the reasons  of low SES with poor h e a l t h . age  f o r the a s s o c i a t i o n  A sample of 1,811  35 were f o l l o w e d f o r nine y e a r s .  a d u l t s over  The r e s e a r c h e r s  t h a t r e s i d e n t s of a designated poverty area had  found  higher  m o r t a l i t y r a t e s than a s i m i l a r group l i v i n g i n non-poverty areas d e s p i t e adjustment f o r m u l t i p l e v a r i a b l e s i n c l u d i n g employment, income, education, age,  race, gender,  and  10 a l c o h o l and tobacco use.  T h i s study proves t o be v e r y  important as t h e r e s u l t s suggest t h a t environmental  factors  i n a d e s i g n a t e d poverty area c o n t r i b u t e t o m o r t a l i t y . U n f o r t u n a t e l y , a s i g n i f i c a n t gap remains i n our understanding  of how the f a c t o r s a s s o c i a t e d w i t h p o v e r t y  affect health. Conceptual  and M e t h o d o l o g i c a l  Issues  Much o f the r e c e n t l i t e r a t u r e on p o v e r t y and h e a l t h addresses t h e conceptual and methodologic d i f f i c u l t y f o r researchers.  issues that create  For example, merely  defining  the l e v e l o f economic adequacy becomes p r o b l e m a t i c . "Education, occupation, and income a r e commonly used i n d i c a t o r s o f SES, and each of these has p a r t i c u l a r s t r e n g t h s and weaknesses" (Nelson, 1994, p. 4 ) .  Statistics  Canada r e p o r t s r e v e a l t h a t 16-24 year o l d s e x p e r i e n c e t h e g r e a t e s t depth o f poverty among a l l age groups, t h e s e f i g u r e s should be viewed with c a u t i o n .  although  Many people i n  t h i s age group a r e l i k e l y t o be students who r e c e i v e money from p a r e n t s not r e p o r t e d as income ( N a t i o n a l C o u n c i l o f Welfare,  1990).  As another example, o c c u p a t i o n i s a b e t t e r  measure o f s o c i a l c l a s s f o r men, while type o f housing and access t o c a r s seems t o be a b e t t e r measure o f s o c i a l f o r women (Marmot e t a l . ,  class  1987).  The way i n which poverty i s d e f i n e d i s an important i s s u e because i t a f f e c t s how poverty i s measured, who i s c o n s i d e r e d poor, and has i m p l i c a t i o n s f o r i d e n t i f y i n g t h e  11 u n d e r l y i n g causes of poverty  (Payne, 1991).  Payne r a i s e s  the i s s u e of d e p r i v a t i o n and notes t h a t one cannot assume t h a t r e s o u r c e s a r e a l l o c a t e d e q u a l l y w i t h i n a household. Women may do with l e s s t o ensure t h a t the needs o f other f a m i l y members are met or may be denied access t o " f a m i l y " r e s o u r c e s such as an  automobile.  Women, Poverty,  and H e a l t h  There i s very l i t t l e known about women's h e a l t h i n general  (Doyal, 1991), and even l e s s about t h e e f f e c t s o f  p o v e r t y on women's h e a l t h . for t h i s "oversight."  There are a number o f reasons  Women, and e s p e c i a l l y poor women,  tend t o be a f f o r d e d lower s t a t u s and importance i n s o c i e t y . Zambrana (1988) i n d i c a t e s t h a t the h e a l t h o f poor and m i n o r i t y women remains a low r e s e a r c h p r i o r i t y .  In many  s t u d i e s concerning poverty, the p o p u l a t i o n has been c o n s i d e r e d homogeneous and r e s e a r c h e r s have not analyzed t h e i r r e s u l t s i n ways t h a t would emphasize t h e "gender factor" review  (World H e a l t h O r g a n i z a t i o n , 1992).  Based on t h e i r  o f t h e l i t e r a t u r e , McElmurray e t a l . (1987) a s s e r t  t h a t t h e r e a r e gender d i f f e r e n c e s i n h e a l t h .  These  d i f f e r e n c e s need t o be explored. Most o f t h e l i t e r a t u r e reviewed i n t h i s s e c t i o n c o n s i s t s o f t h e o r e t i c a l and o p i n i o n papers due t o t h e d e a r t h of e m p i r i c a l r e s e a r c h on women, poverty,  and h e a l t h .  Much  of t h e i n f o r m a t i o n t h a t i s a v a i l a b l e i s i n t h e form o f demographic data.  T h i s i n f o r m a t i o n has been very h e l p f u l i n  12 i l l u m i n a t i n g women's s i t u a t i o n i n regards  t o poverty.  For  example, i t was not u n t i l t h e 197 0 r e p o r t by t h e S t a t u s of Women Commission t h a t t h e extent of poverty  among women was  brought t o n a t i o n a l a t t e n t i o n ( N a t i o n a l C o u n c i l o f Welfare, 1979).  The f a c t t h a t a n a t i o n a l study o f p o v e r t y  conducted  a t t h e same time f a i l e d t o i d e n t i f y women's predominance among t h e poor  ( N a t i o n a l C o u n c i l o f Welfare, 1979)  h i g h l i g h t s how r e s e a r c h e r s '  l a c k o f a t t e n t i o n t o gender may  influence results. Many o p i n i o n s have been put forward t o e x p l a i n t h e l a c k of a t t e n t i o n t o women's h e a l t h needs.  Thomas (1988)  e x p l a i n s t h e i n s e n s i t i v i t y t o women's needs as a b i a s w i t h i n the m e d i c a l system t h a t c o n s i d e r s men as normal and female d i f f e r e n c e s a r e abberrant.  Daly (1989) blames t h e  " m e d i c a l i z a t i o n " o f h e a l t h care f o r producing  a p i c t u r e of  women's h e a l t h dominated by a s p e c i f i c view o f r e p r o d u c t i v e h e a l t h and under-estimating  other aspects.  McBarnette  (1988) seems t o agree t h a t women a r e viewed as important p r i m a r i l y f o r t h e i r reproductive value.  Based on a review  of t h e l i t e r a t u r e and American s t a t i s t i c a l data  (mostly  from  New York s t a t e ) , she concluded t h a t poor women a r e a t h i g h e r r i s k f o r unplanned pregnancy, s e x u a l l y t r a n s m i t t e d maternal m o r t a l i t y , and c e r v i c a l cancer.  diseases,  McBarnette a s s e r t s  t h a t "the h e a l t h gap f o r poor women i s s i g n i f i c a n t t o t h e l a r g e r s o c i e t y s i n c e t h e h e a l t h s t a t u s of women d i r e c t l y a f f e c t s t h e h e a l t h s t a t u s of f u t u r e g e n e r a t i o n s "  (p. 76) .  A  13 computer search A l l i e d Health regarding  of t h e Cumulative Index o f Nursing and  L i t e r a t u r e (CINAHL) and Medline f o r  references  women, poverty, and h e a l t h supports t h e view t h a t  women's r e p r o d u c t i v e a r t i c l e s concerning  h e a l t h i s emphasized.  The m a j o r i t y o f  women's h e a l t h , e s p e c i a l l y e m p i r i c a l  s t u d i e s , p r i m a r i l y d e a l with t h e t o p i c s o f p r e n a t a l breast-feeding,  and b r e a s t and c e r v i c a l cancer  While r e p r o d u c t i v e  care,  screening.  i s s u e s have been t h e major  focus,  Payne (1991) i d e n t i f i e s " r o l e s t r a i n " as t h e second obsession  of r e s e a r c h e r s  studying women and h e a l t h .  Recent  s t u d i e s have i n d i c a t e d , however, t h a t r o l e s t r a i n i s n o t t h e h e a l t h hazard i t was a n t i c i p a t e d t o be. and  Lavery  well-being  In one study, Aston  (1993) measured t h e p h y s i c a l and p s y c h o l o g i c a l o f women i n p a i d employment.  Studying 12 0 women  i n t h e work f o r c e , they used t h r e e s c a l e s t o measure psychological well-being, inventory and  including a self-reported  of p h y s i c a l symptomology, a s o c i a l support s c a l e ,  a cynicism  scale.  T h e i r f i n d i n g s support t h e view t h a t  p a i d employment i s g e n e r a l l y rewarding f o r women.  Given t h e  a d d i t i o n a l r e s p o n s i b i l i t i e s and exposure t o hazards i n t h e workplace, however, i t i s s u r p r i s i n g t o f i n d t h a t t h e h e a l t h of working women i s b e t t e r  (Payne, 1991).  "The f a c t  that  the h e a l t h o f women i n p a i d work i s b e t t e r than women who are f u l l - t i m e housewives i n d i c a t e s perhaps t h e disadvantages i n terms of s t a y i n g a t home, i n a job which i s unpaid, i s o l a t e d , and undervalued" (Payne, p.  128).  14 While p a i d employment seems t o be good f o r women, i t i s not an easy answer t o t h e problems of poor women. U n f o r t u n a t e l y , t h e jobs a v a i l a b l e t o t h e m a j o r i t y o f women do n o t pay a wage s u f f i c i e n t t o overcome women's v u l n e r a b i l i t y t o poverty.  Smith (1986) examined t h e  r e l a t i o n s h i p between t h e i n c r e a s e i n t h e number o f women i n p a i d employment and growth i n the s e r v i c e s e c t o r i n t h e United States  (US).  p o v e r t y as t w o f o l d .  She e x p l a i n e d t h e cause o f women's First,  i n c r e a s i n g numbers o f women a r e  s e l f - s u p p o r t i n g o r dependent on s o c i a l a s s i s t a n c e and t h e low wages p r o v i d e d by most new jobs a v a i l a b l e t o women o f f e r little is  o p p o r t u n i t y t o "climb out of p o v e r t y . "  Second, t h e r e  an assumption i n our s o c i e t y t h a t women w i l l be supported  f i n a n c i a l l y by men d e s p i t e growing numbers o f women who a r e not. Few of  r e s e a r c h e r s have examined poor women's p e r c e p t i o n s  their situations.  Calnan and Johnson (1985) e x p l o r e d t h e  r e l a t i o n s h i p of E n g l i s h women's s o c i a l c l a s s t o two dimensions o f h e a l t h b e l i e f s .  A trained interviewer  conducted two s e t s of u n s t r u c t u r e d i n t e r v i e w s w i t h 60 women from two s o c i a l c l a s s e s . analyzed  f o r concepts  Interview t r a n s c r i p t s were  of h e a l t h and p e r c e p t i o n s o f  v u l n e r a b i l i t y t o disease..  The r e s e a r c h e r s found  little  c l a s s d i f f e r e n c e and questioned whether t h e importance o f p e r s o n a l h e a l t h b e l i e f s i n p a t t e r n s o f h e a l t h behaviour been overestimated.  They a l s o suggest  that the s o c i a l  have  15 context  a c t s as a b a r r i e r t o p r e f e r r e d c h o i c e s  Williams  of action.  (1990) l a b e l s the f a i l u r e t o address t h e s t r u c t u r a l  elements o f i n e q u a l i t y , w h i l e f o c u s i n g on h e a l t h  education,  as "blaming t h e v i c t i m " f o r f a i l u r e t o f o l l o w h e a l t h i e r lifestyles. In one of t h e few e m p i r i c a l s t u d i e s o f p o v e r t y and women's h e a l t h , S c h r i j v e r s e t a l . (1995) analyzed  t h e data  from a cancer r e g i s t r y i n southeast England i n order t o examine t h e a s s o c i a t i o n between d e p r i v a t i o n and b r e a s t cancer.  D e p r i v a t i o n was d e f i n e d by r a t i n g t h e e l e c t o r a l  d i s t r i c t s where t h e women l i v e d a t t h e time o f d i a g n o s i s according  t o f o u r v a r i a b l e s : overcrowding, male  unemployment, s o c i a l c l a s s , and car ownership.  The  C a r s t a i r s Index gave a s i n g l e score f o r these f o u r variables.  A m u l t i v a r i a t e a n a l y s i s was used t o compare t h e  r e l a t i v e s u r v i v a l r a t e , expressed as a r a t i o , w i t h t h e d e p r i v a t i o n score.  Findings  showed a b e t t e r s u r v i v a l r a t e  f o r women from more a f f l u e n t areas,  even a f t e r adjustments  were made f o r stage a t d i a g n o s i s , morphology, and treatment category.  The i n v e s t i g a t o r s speculated  that the possible  causes o f t h i s g r a d i e n t were e a r l i e r d e t e c t i o n , and  referral,  treatment f o r t h e more a f f l u e n t women, and decreased  n u t r i t i o n a l s t a t u s , l e s s s o c i a l support,  negative  p s y c h o l o g i c a l f a c t o r s , and decreased a b i l i t y t o cope w i t h a diagnosis groups.  of cancer f o r the women i n t h e lower income Once again,  support f o r the a s s o c i a t i o n between SES  16 and h e a l t h has been demonstrated, without this  any e x p l a n a t i o n o f  relationship. The  g e n e r a l l a c k of understanding  which p o v e r t y consequences.  o f t h e mechanisms by  leads t o poor h e a l t h has many n e g a t i v e From a h e a l t h care p e r s p e c t i v e , economic  impoverishment o f t e n i s t r e a t e d as an u n m o d i f i a b l e f a c t o r , such as age o r h e r e d i t y (Nelson,  risk  1994); o r t h e  s t r u c t u r a l elements of i n e q u a l i t y a r e ignored w h i l e h e a l t h education  i s emphasized  (Williams, 1990).  This attitude  impedes t h e development of e f f e c t i v e i n t e r v e n t i o n s o r h e a l t h promotion s t r a t e g i e s .  For example, Makuc, F r e i d , and  Kleinman (1989) analyzed changes i n US n a t i o n a l t r e n d s i n the use o f p r e v e n t i v e h e a l t h care by women between 1973 and 1985.  E x i s t i n g data from the N a t i o n a l H e a l t h  Survey were c a t e g o r i z e d a c c o r d i n g t o age, year o f t h e i n t e r v i e w .  Interview  r a c e , income, and  They found t h a t , with t h e e x c e p t i o n  of b l o o d p r e s s u r e t e s t i n g among o l d e r women, t h e poor remained l e s s l i k e l y t o have r e c e n t p r e v e n t i v e c a r e .  The  r e s e a r c h e r s recommended i n c r e a s e d e f f o r t s t o encourage preventive care.  However, one must q u e s t i o n t h e  e f f e c t i v e n e s s of "encouragement" when p o t e n t i a l  barriers,  such as a l a c k of t r a n s p o r t a t i o n , t h e absence o f c h i l d  care,  or other concerns e x i s t i n the l i v e s of poor women. In McBarnette's (1988) p r e v i o u s l y c i t e d r e p o r t o f p o v e r t y and r e p r o d u c t i v e h e a l t h , her f i r s t  recommendation  c a l l s f o r more h e a l t h education s t a t i n g t h a t "much o f t h e  17 observed  h e a l t h gap i s r e l a t e d t o l i f e s t y l e and knowledge"  (p. 77).  Rowe and M i l e s (1994), however, i n t h e i r  experience w i t h poor s i n g l e mothers i n a B r i t i s h h e a l t h p r o j e c t , found t h a t t h e women were a l r e a d y  daily  preventive familiar  w i t h t h e h e a l t h i n f o r m a t i o n they had t o o f f e r . McElmurray e t a l . (1987) s t u d i e d t h e e f f e c t i v e n e s s o f t r a i n e d i n n e r - c i t y v o l u n t e e r s as community h e a l t h advocates i n an e i g h t week program.  The 3 0 t r a i n e e s , a l l except two  of whom were women, were between 16 and 21 years o f age. They r e c e i v e d h e a l t h i n f o r m a t i o n and advocacy t r a i n i n g , which i n c l u d e d developing t h e i r communication s k i l l s and conflict resolution s k i l l s .  The advocates were expected t o  a c t as l i a i s o n s between h e a l t h care experts and women i n t h e community.  Although  t h e time l i m i t a t i o n imposed by t h e  f u n d i n g source was a major drawback t o t h e study,  both  t r a i n e e s and p r o j e c t s t a f f evaluated t h e program p o s i t i v e l y . The  s t a f f found, however, t h a t t h e advocates had repeated  q u e s t i o n s r e g a r d i n g how t o apply t h e h e a l t h i n f o r m a t i o n t o t h e i r s p e c i f i c c u l t u r a l contexts.  Providing information  t h a t women a l r e a d y have o r cannot use i s o b v i o u s l y an i n e f f e c t i v e h e a l t h promotion s t r a t e g y .  Nurses and o t h e r  h e a l t h c a r e p r o f e s s i o n a l s need t o l e a r n more about t h e barriers to utilizing this  information.  Edwards (1993) conducted a q u a l i t a t i v e study o f A f r i c a n American women l i v i n g i n poverty  i n order t o e x p l o r e  h e a l t h problems and h e a l t h management behaviours.  their  Each o f  18 22 women, r e c r u i t e d from an urban low income housing p r o j e c t , were interviewed  t h r e e times.  by c o n s t a n t comparative a n a l y s i s .  Data were a n a l y z e d  Coping w i t h  emerged as t h e b a s i c h e a l t h problem.  stress  The main sources of  s t r e s s were i d e n t i f i e d as r a i s i n g c h i l d r e n alone, l a c k o f money, and t r a n s p o r t a t i o n .  A c t i v e mastery was i d e n t i f i e d as  the p r o c e s s these women used t o s u c c e s s f u l l y manage t h e i r daily stressors.  Many o f t h e women who were a b l e t o manage  s t r e s s s u c c e s s f u l l y had a strong i d e n t i f i e d goals, neighbours.  and networked with church members and  While these f i n d i n g s a r e not w i d e l y  generalizable,  they do suggest the importance o f s o c i a l  support f o r s u c c e s s f u l low  b e l i e f i n God, c l e a r l y  s t r e s s management f o r t h i s group o f  income women. The  p l i g h t o f homeless women i s b e g i n n i n g t o r e c e i v e  some r e c o g n i t i o n Saperstein  i n t h e nursing  (1992) d e s c r i b e  literature.  K l i n e and  a s h e l t e r f o r homeless women r u n  by nurses i n order t o draw a t t e n t i o n t o t h e i s s u e s t o women's homelessness.  They d e s c r i b e  related  homelessness as t h e  r e s u l t o f "a complex s e r i e s of s o c i a l , economic, and i n t e r a c t i o n a l issues"  (p. 887). K l i n e and S a p e r s t e i n  emphasize t h e d e a r t h of research A few r e c e n t  also  on t h i s t o p i c .  s t u d i e s have addressed homeless women.  Nyamathi and Flaskerud  (1992) conducted a s e r i e s o f s t u d i e s  t o r e f i n e and e v a l u a t e a t o o l t o measure t h e concerns o f minority  women who were homeless and/or d r u g - a d d i c t e d .  A  19 comprehensive l i t e r a t u r e review and q u a l i t a t i v e f o c u s groups were used t o r e f i n e t h e t o o l , which c o n s i s t s o f an i n v e n t o r y of c u r r e n t concerns. 978  The i n v e n t o r y was then a d m i n i s t e r e d t o  American Black and H i s p a n i c women who were i n drug  r e c o v e r y programs o r who were homeless.  The r e s e a r c h e r s  found t h e concerns of these women t o be "complex and m u l t i d i m e n s i o n a l " with competency (the a b i l i t y t o f u n c t i o n o p t i m a l l y i n t h e p e r s o n a l , s o c i a l , o r r e l i g i o u s domains) as a major concern.  The instrument,  however, r e q u i r e s f u r t h e r  assessment o f i t s r e l i a b i l i t y and v a l i d i t y . Montgomery (1994) i n t e r v i e w e d seven women i d e n t i f i e d by a s h e l t e r ' s s t a f f as having overcome homelessness.  Her  i n t e n t was t o study t h e s t r e n g t h s and p e r s o n a l r e s o u r c e s o f these women.  She a l s o v o l u n t e e r e d f o r two t o s i x hours p e r  week a t t h e s h e l t e r d u r i n g t h i s time.  The m a j o r i t y o f t h e  women ( s i x o f t h e seven) had grown up i n " d e p l o r a b l e " conditions.  Using grounded theory t o analyze h e r data,  Montgomery found t h a t homelessness, a t l e a s t i n t h i s i n s t a n c e , was a "temporary s t a t e of d i s r u p t i o n " i n an attempt t o break away from an abusive and o p p r e s s i v e s i t u a t i o n i n order t o s t a r t a b e t t e r l i f e . r e p r e s e n t only a beginning  These s t u d i e s  i n our e f f o r t s t o understand t h e  causes and e f f e c t s o f homelessness. A l l t h e e m p i r i c a l s t u d i e s c i t e d t o t h i s p o i n t have been American o r B r i t i s h .  The a p p l i c a b i l i t y of t h e i r r e s u l t s t o  the Canadian environment must be viewed c a u t i o u s l y ,  20  p a r t i c u l a r y because of t h e major d i f f e r e n c e s i n t h e h e a l t h c a r e systems. women, poverty,  The p a u c i t y of e m p i r i c a l s t u d i e s on Canadian and h e a l t h h i g h l i g h t s t h e need f o r them.  In  the o n l y i d e n t i f i e d Canadian work, Thomas (1988) r e p o r t s t h e r e s u l t s o f a key informant  survey.  Unfortunately, the  r e p o r t o f t h i s survey c o n t a i n s very l i t t l e regarding with  i t s method.  Structured  information  i n t e r v i e w s were conducted  55 p a r t i c i p a n t s r e s i d i n g i n the f i v e r e g i o n s o f Canada.  Mental h e a l t h was t h e c h i e f concern a f f e c t i n g a l l women, but of s p e c i a l concern f o r r u r a l , women.  i s o l a t e d , d i s a b l e d , o r poor  Thomas a s s e r t e d t h a t economics i s probably  t h e most  important f a c t o r a f f e c t i n g women's h e a l t h and suggests t h a t t h e r e a r e f i n a n c i a l b a r r i e r s t o h e a l t h care f o r poor women d e s p i t e t h e p r i n c i p l e o f u n i v e r s a l access Canada.  While t h i s survey i s important, t h e sample  c o n s i s t e d o f persons considered  experts  (from community, academic, medical, and  t o h e a l t h care i n  on women's h e a l t h  and government s e t t i n g s )  t h e r e f o r e t h e f i n d i n g s may not r e p r e s e n t  poor women's  concerns. Housing, Poverty,  and H e a l t h  Housing i s a p a r t i c u l a r l y important i s s u e f o r poor women.  For example, Payne (1991) c i t e d a survey o f l i v i n g  standards i n London, England t h a t showed environmental f a c t o r s , i n c l u d i n g dampness i n t h e house, t o be l i n k e d t o poorer h e a l t h .  In a d d i t i o n , Payne suggested t h a t t h e  q u a l i t y o f housing i s both an i n d i c a t o r o f a woman's o v e r a l l  21 l e v e l o f d e p r i v a t i o n and an i n d i c a t o r o f her h e a l t h s t a t u s . Because t h e r e a r e d i f f e r e n c e s i n t h e c l i m a t e and i n t h e c e n t r a l h e a t i n g systems between Canada and B r i t a i n ,  these  r e s u l t s may not be d i r e c t l y g e n e r a l i z a b l e t o a Canadian population. In t h e i r l i t e r a t u r e review, Lindheim and Syme (198 3) discuss the stigmatization associated with p u b l i c projects.  They suggest t h a t constant reminders  housing  o f one's  lower rank may cause anger and lowered s e l f - e s t e e m , which may r e s u l t i n h i g h e r r a t e s of d i s e a s e . d i s c u s s t h e importance  Other  authors  of housing i n r e l a t i o n t o SES.  Doyal  (1991) s t a t e s t h a t the c o s t , design, and l o c a t i o n o f housing a l l a f f e c t women's h e a l t h . C o - o p e r a t i v e housing environments,  however, p r o v i d e  a f f o r d a b l e , secure housing with s t a b l e r e n t ( M o r i s s e t t e , 1987) .  Wekerle (1988) conducted  in-depth case s t u d i e s of  t e n women's housing c o - o p e r a t i v e s i n e i g h t Canadian  cities.  She noted t h a t c o - o p e r a t i v e housing i s more than j u s t an affordable place to l i v e . community environment,  I t can p r o v i d e a s u p p o r t i v e  and experience on committees can  p r o v i d e c o - o p e r a t i v e housing r e s i d e n t s an o p p o r t u n i t y t o improve s k i l l s such as decision-making. reviewed  M o r i s s e t t e , who  s t a t i s t i c s on t h e Canadian housing s i t u a t i o n ,  also  acknowledges t h e p o s i t i v e b e n e f i t s of c o - o p e r a t i v e housing f o r r e s i d e n t s , i n c l u d i n g t h e p r o v i s i o n of g r e a t e r c o n t r o l over t h e environment.  22 Nairne  (1991), based on a review o f t h e l i t e r a t u r e on  women's housing needs and i n f o r m a t i o n from  Statistics  Canada, concluded t h a t women o f t e n must spend more on housing than t h e i r male c o u n t e r p a r t s because o f t h e i r concerns about neighbourhood  safety.  Women as r e n t e r s a l s o  pay a l a r g e r p r o p o r t i o n of t h e i r t o t a l income on housing. For example, i n 1986,  approximately 46% o f Canadian  one-person  spent 3 0% o r more o f t h e i r income on  households  women i n  housing, and 23% of t h e women spent 50% o r more (Nairne, p.43).  These s t a t i s t i c s have i m p l i c a t i o n s f o r d e f i n i n g  p o v e r t y because a woman spending a h i g h p r o p o r t i o n o f h e r income on r e n t has l e s s remaining f o r t h e o t h e r n e c e s s i t i e s of  life. Gaps i n t h e Research on Women and Poverty Zambrana (1988) i d e n t i f i e d s e v e r a l gaps i n t h e r e s e a r c h  on women, poverty, and h e a l t h .  "The q u a l i t y o f l i f e of poor  and m i n o r i t y women, with s p e c i f i c r e f e r e n c e t o t h e i r h e a l t h , mental h e a l t h , and f a m i l y r o l e s , has been a low r e s e a r c h priority"  (p. 138).  understood,  C l a s s and c u l t u r a l v a r i a b l e s a r e p o o r l y  d e s p i t e evidence t h a t "poor and r a c i a l / e t h n i c  women a r e a t a disadvantage (p.  142).  There i s even l i m i t e d data on low-income  Caucasian women. of  i n terms of t h e i r h e a l t h s t a t u s "  Zambrana c a l l s f o r r e s e a r c h on t h e e f f e c t s  aging, on c h r o n i c l i f e s t r e s s and i t s e f f e c t s , and t h a t  addresses t h e q u a l i t a t i v e experiences o f poor and m i n o r i t y women.  23 In h e r demographic overview of American women i n p o v e r t y , Wilson (1988) advocates f o r r e c o g n i z i n g and e x p l o r i n g t h e d i v e r s i t y amongst poor women.  "By i g n o r i n g  the d i v e r s i t y i n t h e p o p u l a t i o n of poor women and t h e changes i n t h i s p o p u l a t i o n over time, p o l i c y makers and o t h e r s f a i l t o develop and advocate f o r p o l i c i e s  that  address t h e needs o f a l l types of poor women" (p. 21) . W i l s o n s t a t e s t h a t "by 1984,  almost one i n f i v e poor people  l i v e d alone o r i n a household where they were u n r e l a t e d t o o t h e r i n d i v i d u a l s , and more than h a l f of these poor were women" (p. 25).  In her d i s c u s s i o n of t h e d i v e r s e groups o f  poor women, Wilson devotes s e v e r a l pages each t o poor m a r r i e d women, female heads of households, and teenage mothers,  but o n l y t h r e e paragraphs t o unattached poor women.  She does i n d i c a t e t h a t poor women who l i v e alone o r w i t h n o n - r e l a t i v e s a r e a d i v e r s e group t h a t c o n s t i t u t e an i n c r e a s i n g percentage of the "poverty p o p u l a t i o n . " A s i m i l a r " o v e r s i g h t " i s observed i n Women and P o v e r t y R e v i s i t e d , a r e p o r t by t h e N a t i o n a l C o u n c i l o f Welfare (1990).  I n t h i s document, the f o l l o w i n g f a c t s a r e p r o v i d e d .  The l a r g e s t group of poor Canadian women (40%) l i v e alone o r with non-relatives. the unattached.  The f a s t e s t growing group o f women a r e  In terms of depth of poverty, t h e second  p o o r e s t group i s unattached men and women between t h e ages of 25 and 64 with an average income a t o n l y 58% o f t h e poverty l i n e .  [Women c o n s i s t e n t l y have lower incomes than  24 men  i n any category.  For example, t h e average annual  for  unattached  for  women (Lindsay & Devereaux, 1991, p. 35).]  income  men 45-54 years i s $27,654 and o n l y $21,881 In contrast,  the income o f poor s e n i o r s averages 82% o f t h e p o v e r t y  line.  D e s p i t e t h e evidence above, d e t a i l e d a n a l y s i s f o c u s e s on o n l y t h r e e age groups: 16-24, 55-64, and t h e e l d e r l y . The reasons  f o r unattached  poor women between 25 and 54  b e i n g v i r t u a l l y i n v i s i b l e , even i n d i s c u s s i o n s c o n c e r n i n g women and poverty, a r e not e x p l i c i t .  As mentioned a l r e a d y ,  women a r e v a l u e d l a r g e l y f o r t h e i r r e p r o d u c t i v e p o t e n t i a l . A woman who i s n e i t h e r w i f e nor mother, i n a d d i t i o n t o b e i n g e c o n o m i c a l l y disadvantaged, our s o c i e t y .  i s a f f o r d e d v e r y low s t a t u s i n  The World Health O r g a n i z a t i o n (1992),  however,  a s s e r t s t h a t "the enjoyment of t h e h i g h e s t a t t a i n a b l e s t a n d a r d o f h e a l t h i s one o f t h e fundamental r i g h t s o f every human b e i n g without d i s t i n c t i o n of r a c e , r e l i g i o n ,  political  b e l i e f , economic o r s o c i a l c o n d i t i o n (p. v ) " . It  i s a n t i c i p a t e d t h a t mature, unattached,  women, l i k e o t h e r s who a r e economically  low-income  disadvantaged,  s u f f e r n e g a t i v e h e a l t h consequences as a r e s u l t o f t h e i r poverty.  These women f a l l w i t h i n a category t h a t has been  v i r t u a l l y ignored i n t h e l i t e r a t u r e , t h a t i s , unattached, low income women below r e t i r e m e n t age. (1994) observed  Rowe and M i l e s  t h a t poor, s i n g l e mothers have l i t t l e  social  support due t o t h e emotional and f i n a n c i a l c o s t s o f a s o c i a l life.  T h i s o b s e r v a t i o n r a i s e s t h e q u e s t i o n o f whether o t h e r  25  groups o f low income women s u f f e r from a l a c k o f s o c i a l support.  Unattached poor women may be prone t o s o c i a l  i s o l a t i o n due t o a l a c k of f a m i l y supports. and  "The economic  s o c i a l consequences of l i v i n g alone must not be  underestimated" (Nairne,  1991, p.38).  Mature, unattached, low-income women have a b a s i c r i g h t t o have t h e i r s p e c i f i c h e a l t h needs i d e n t i f i e d and addressed. was  In t h i s search  found suggesting  of t h e l i t e r a t u r e , no evidence  t h a t any work i n t h i s area has been  done. Conclusions Poverty r e s u l t s i n poor h e a l t h .  T h i s r e l a t i o n s h i p has  been f i r m l y e s t a b l i s h e d by e m p i r i c a l r e s e a r c h . of e m p i r i c a l s t u d i e s concerning seems s m a l l when one c o n s i d e r s  SES and h e a l t h , however, t h a t SES i s t h e s i n g l e most  r e l i a b l e p r e d i c t o r of h e a l t h s t a t u s . conceptual  The number  A l a r g e number o f  and methodological i s s u e s make s t u d y i n g  this  r e l a t i o n s h i p d i f f i c u l t , which may dissuade i n v e s t i g a t o r s from a d d r e s s i n g  t h i s important t o p i c .  "poverty" may be problematic,  and t h e number of confounding  v a r i a b l e s may be overwhelming. a v a i l a b l e research morbidity  regarding  Merely d e f i n i n g  As a r e s u l t , t h e m a j o r i t y o f  poverty and h e a l t h c o n s i s t s o f  and m o r t a l i t y s t u d i e s .  These s t u d i e s c o n f i r m t h e  r e l a t i o n s h i p between SES and h e a l t h , but t h e mechanisms o f how  SES and h e a l t h i n t e r a c t remain p o o r l y In t h e g e n e r a l  understood.  l i t e r a t u r e on poverty and h e a l t h , t h e  26  gender f a c t o r has been l a r g e l y ignored.  In r e g a r d s t o  women, poverty, and h e a l t h , demographic i n f o r m a t i o n has r e v e a l e d t h a t t h e m a j o r i t y of the poor a r e women, t h e female gender e x p e r i e n c e s a g r e a t e r v u l n e r a b i l i t y t o p o v e r t y , and women, once e c o n o m i c a l l y disadvantaged, tend t o s t a y poor f o r l o n g e r p e r i o d s of time. are a d i v e r s e group  We a l s o know t h a t poor women  i n terms of age, m a r i t a l s t a t u s ,  and e t h n i c backgrounds,  and l i v i n g s i t u a t i o n s .  racial  Despite  women's predominance among the poor, v e r y few e m p i r i c a l s t u d i e s have addressed t h i s  topic.  Nurses need a b e t t e r understanding of t h e e f f e c t s o f p o v e r t y on h e a l t h from t h e i n d i v i d u a l ' s p e r s p e c t i v e , as w e l l as how t h e e f f e c t s may be moderated by l i v i n g i n a housing co-operative. implementing  T h i s understanding i s e s s e n t i a l f o r e f f e c t i v e h e a l t h promotion s t r a t e g i e s , t h a t i s ,  measures t h a t address t h e needs i d e n t i f i e d by those who a r e poor. Authors of t h e o p i n i o n papers reviewed a l l advocate f o r the use o f q u a l i t a t i v e methods t o study women, p o v e r t y , and health.  Q u a l i t a t i v e methods can be used t o study people  w i t h i n t h e r i c h c o n t e x t s of t h e i r l i v e s , thus p r o v i d i n g a l a r g e amount o f d e s c r i p t i v e data r e g a r d i n g a s m a l l sample. T h i s approach,  t o an extent, overcomes t h e problem o f  confounding v a r i a b l e s as the c o n t r o l l e d environment  o f an  e x p e r i m e n t a l study i s not r e q u i r e d . The  i n v e s t i g a t o r chose a q u a l i t a t i v e method t o study a  27  s m a l l , d i s c r e t e group o f low income women l i v i n g i n a s p e c i f i c housing c o - o p e r a t i v e .  Unattached,  low income women  below r e t i r e m e n t age i s a group t h a t has been o v e r l o o k e d i n the l i t e r a t u r e , even i n d i s c u s s i o n s r e g a r d i n g women and poverty.  Knowledge o f these women's b e l i e f s , v a l u e s ,  concerns, and h e a l t h p r a c t i c e s and how they a r e a f f e c t e d by l i v i n g on a low income w i t h i n t h i s s p e c i f i c environment  housing  w i l l be a s t a r t i n g p o i n t i n understanding t h e  complex r e l a t i o n s h i p of poverty and h e a l t h f o r women.  28 CHAPTER THREE METHOD Introduction Moccia and Mason (1986) recommend t h a t  qualitative  r e s e a r c h methods be employed t o examine t h e e f f e c t s o f p o v e r t y on h e a l t h . Nursing's knowledge base c o u l d be extended and enhanced tremendously  by q u a l i t a t i v e ,  descriptive  s t u d i e s u s i n g such methods as ethnography and phenomenology t o study the l i v e s o f t h e poor, t h e i r experiences i n r e l a t i o n t o t h e i r h e a l t h s t a t u s , t h e s u c c e s s f u l and u n s u c c e s s f u l ways they have attempted  t o i n f l u e n c e t h e i r communities and  the h e a l t h care system  (p. 22).  In o r d e r t o d i s c o v e r what h e a l t h means f o r low income women, and t o determine how they c o n s t r u c t h e a l t h i n t h e i r an ethnographic study o f t h e women i n a s p e c i f i c  lives,  housing  c o - o p e r a t i v e was undertaken. Ethnography  i s t h e study of c u l t u r e , which i s d e f i n e d  as "the a c q u i r e d knowledge t h a t people use t o i n t e r p r e t e x p e r i e n c e and generate s o c i a l behaviour" p. 5 ) . The g o a l of ethnography knowledge. customary  "Ethnographers  (Spradley, 1979,  i s t o d i s c o v e r such  cultural  seek understanding o f t h e  a c t i o n s , b e l i e f s , knowledge, and a t t i t u d e s o f a  s o c i a l group as r e f l e c t e d i n the ways o f engaging i n everyday  life"  ( Z a h a r l i c k & Green,  1991, p. 207).  In t h i s  29 study, t h e everyday  l i f e of a group o f low income women i n a  c o - o p e r a t i v e housing u n i t was examined i n order t o a c q u i r e an understanding of t h e i r knowledge, b e l i e f s , and p r a c t i c e s related to health. perspective oriented  Although ethnography  (Munhall & O i l e r ,  provides a h o l i s t i c  1986), i t may be t o p i c -  ( Z a h a r l i c k & Green, 1991), and i n t h i s i n s t a n c e ,  h e a l t h i s the c e n t r a l focus. D e f i n i t i o n of Terms A d e f i n i t i o n of h e a l t h was not be predetermined  for  t h i s study as t h e women's own d e f i n i t i o n s o f h e a l t h were e x p l o r e d by l o o k i n g a t t h e i r b e l i e f s , v a l u e s , concerns, and health practices. problematic  D e f i n i n g socioeconomic  (Nelson, 1994).  status i s often  For t h e purposes  of t h i s  study,  however, i t i s p r a c t i c a l and a p p r o p r i a t e t o use t h e d e f i n i t i o n o f t h e c o - o p e r a t i v e housing s o c i e t y .  Low income,  t h e r e f o r e , i s d e f i n e d as an annual income of $2 5,500 o r less.  Unattached  unrelated adults.  i s d e f i n e d as l i v i n g alone o r w i t h During t h e course o f t h e study, a l l  r e s i d e n t s o f t h e c o - o p e r a t i v e housing development  lived  alone. Assumptions T h i s study i s based on t h e f o l l o w i n g  assumptions:  1.  Women l i v i n g i n poverty have a shared  culture.  2.  The women l i v i n g i n t h i s housing c o - o p e r a t i v e have a shared c u l t u r e which i s not s t a t i c but continually evolving.  30 3.  The women have concerns r e g a r d i n g h e a l t h which a r e r e l a t e d t o t h e i r income l e v e l .  4.  The c o - o p e r a t i v e housing  environment has a e f f e c t  on t h e women's h e a l t h and h e a l t h  concerns.  Limitations T h i s study  i s l i m i t e d p r i m a r i l y by i t s s i z e and scope.  The women s t u d i e d r e p r e s e n t only one s m a l l sample o f poor women who l i v e i n c o - o p e r a t i v e housing  complexes.  Since  t h e r e i s g r e a t d i v e r s i t y amongst poor women and t h e i r needs, the r e s u l t s cannot be g e n e r a l i z e d t o other groups o f women l i v i n g on low incomes. The women s e l e c t e d f o r t h i s c o - o p e r a t i v e  housing  p r o j e c t r e q u i r e s p e c i a l a b i l i t i e s i n order t o f u l f i l d u t i e s as members of t h e c o - o p e r a t i v e .  An i n t e r v i e w and  s e l e c t i o n process was used t o b r i n g t o g e t h e r t h i s group o f women.  their  Therefore, c a u t i o n i s suggested  particular i n looking  a t these p a r t i c u l a r women as r e p r e s e n t a t i v e o f unattached low  income women as they may possess  a higher l e v e l of  s k i l l s and a b i l i t i e s than the average woman who f i n d s h e r s e l f economically  disadvantaged. Sample  Setting The  s e t t i n g f o r t h i s study was a newly-opened  c o - o p e r a t i v e f o r mature, low income women.  housing  While t h e c o -  o p e r a t i v e ' s t a r g e t range f o r the women i s 40-64 y e a r s o f age,  younger women with d i s a b i l i t i e s a r e e l i g i b l e .  The c o -  31 o p e r a t i v e ' s r e g u l a t i o n s do not s t i p u l a t e t h a t t h e women must be s i n g l e .  The small s i z e of t h e s u i t e s , however, and t h e  c r i t e r i o n t h a t t h e combined income o f a l l occupants must be l e s s than $25,500 a n n u a l l y make i t u n l i k e l y t h a t any women w i l l choose t o share t h e i r accommodation. of  t h i s study,  a l l residents lived  T h i s housing  During t h e course  alone.  co-operative i s the f i r s t  one i n t h e c i t y  b u i l t e x c l u s i v e l y f o r low income women 40-64 y e a r s . study,  The  i n a sense, has been " o p p o r t u n i s t i c r e s e a r c h , "  because t h e r e c e n t opening of t h e c o - o p e r a t i v e p r e s e n t e d a unique o p p o r t u n i t y t o study a c l e a r l y d e f i n e d group o f women l i v i n g on low income. G a i n i n g Access Access f o r t h i s p r o j e c t was f a c i l i t a t e d by one o f t h e r e s i d e n t s o f t h e housing made i n i t i a l l y  c o - o p e r a t i v e . Informal c o n t a c t was  with t h e s o c i e t y r e s p o n s i b l e f o r t h e c o -  o p e r a t i v e ' s development.  In a d d i t i o n t o t h e members o f t h e  s o c i e t y , t h i s group i n c l u d e d t h r e e o r i g i n a l members o f t h e board  o f d i r e c t o r s f o r the c o - o p e r a t i v e and a number o f  r e s i d e n t s of t h e c o - o p e r a t i v e . and  (Membership i n t h e s o c i e t y  i n t h e c o - o p e r a t i v e a r e not mutually  i n c l u s i v e . ) The  e n t i r e group's i n i t i a l response t o the proposed study was very  positive. The  t h r e e board members agreed  t o d i s t r i b u t e a one and  o n e - h a l f page o u t l i n e of t h e proposed study a l l members o f t h e c o - o p e r a t i v e .  (Appendix A) t o  The members were asked t o  32 review t h e o u t l i n e and d i s c u s s i t amongst themselves.  The  i n v e s t i g a t o r had hoped t o attend a g e n e r a l meeting o f t h e membership t o d i s c u s s t h e p r o p o s a l and t o answer any questions.  The d i r e c t o r s , however, r e p o r t e d t h a t due t o t h e  l a r g e volume of business t o be d i s c u s s e d a t t h e meeting, p e r m i s s i o n c o u l d not be granted  f o r the i n v e s t i g a t o r t o  attend. Upon t h e advice o f one board member, a w r i t t e n r e q u e s t was sent t o t h e board  of d i r e c t o r s o u t l i n i n g t h e access  r e q u i r e d f o r t h e study.  F o l l o w i n g a g e n e r a l membership  meeting, one woman r e p o r t e d t o the i n v e s t i g a t o r t h a t some o f the r e s i d e n t s had s e r i o u s r e s e r v a t i o n s about t h e o b s e r v a t i o n p o r t i o n o f t h e study.  Since consensus c o u l d not be reached  by t h e membership, permission f o r o b s e r v a t i o n and p a r t i c i p a n t - o b s e r v a t i o n was denied. As an a l t e r n a t e p l a n , women were r e c r u i t e d t o p a r t i c i p a t e on an i n d i v i d u a l b a s i s .  One e n t h u s i a s t i c  member, d i s a p p o i n t e d t h a t f u l l access had not been approved, r e c r u i t e d nine v o l u n t e e r s and s u p p l i e d t h e i n v e s t i g a t o r with t h e i r names and telephone  numbers.  Sampling In an ethnographic  study,  sampling  must take p l a c e on  t h r e e l e v e l s a c c o r d i n g t o time, people,  and v a r i a t i o n s i n  context  i n order t o p r o v i d e a f u l l and r e p r e s e n t a t i v e  picture  (Hammersley & Atkinson,  1983).  Sampling time was no  longer p o s s i b l e once p a r t i c i p a n t - o b s e r v a t i o n was denied.  33  The  sampling  of persons was s i m p l i f i e d by t h e  r e c r u i t m e n t of v o l u n t e e r s .  Women were s e l e c t e d mainly a t  random from t h e v o l u n t e e r l i s t and i n t e r v i e w e d a c c o r d i n g t o their availability.  For example, one woman had expressed  i n t e r e s t i n being i n t e r v i e w e d as soon as p o s s i b l e , and two women were not a v a i l a b l e when contacted and were i n t e r v i e w e d i n t h e l a t t e r p a r t of t h e study.  One o f t h e v o l u n t e e r s d i d  not r e t u r n any o f t h e i n v e s t i g a t o r ' s c a l l s and was, t h e r e f o r e , not i n t e r v i e w e d .  One p a r t i c i p a n t i n v i t e d a  second woman t o her i n t e r v i e w , and one a d d i t i o n a l p a r t i c i p a n t was r e c r u i t e d , f o r a t o t a l sample o f t e n women.  As t h e study proceeded, i t became apparent t h a t  the women o f t h e c o - o p e r a t i v e were not as homogeneous a group as a n t i c i p a t e d .  Instead, t h e p a r t i c i p a n t s were  c h a r a c t e r i z e d by a great d e a l of d i v e r s i t y .  F o r example,  the women v a r i e d c o n s i d e r a b l y i n age, r a n g i n g from those i n t h e i r t h i r t i e s t o those i n t h e i r s i x t i e s .  Many o f t h e  sub-groups i d e n t i f i e d by the women were w e l l - r e p r e s e n t e d i n the v o l u n t e e r sample.  When i t became apparent, however,  t h a t some sub-groups, such as working women, were not w e l l represented,  attempts were made t o r e c r u i t more v o l u n t e e r s .  One woman advised a g a i n s t o b t a i n i n g t h e names o f a l l t h e working women and c o n t a c t i n g them d i r e c t l y as she b e l i e v e d they might c o n s i d e r t h i s a c t i o n t o be an i n v a s i o n o f privacy.  Instead, a n o t i c e was posted  i n t h e laundry room  s p e c i f i c a l l y r e q u e s t i n g working women t o v o l u n t e e r f o r t h e  34  study.  There was no response  to this  request.  The women i n t e r v i e w e d were a l s o asked t o suggest who would be v a l u a b l e p a r t i c i p a n t s .  others  I t i s encouraging t o  note t h a t some of t h e suggestions i n c l u d e d women who had a l r e a d y been i n t e r v i e w e d . o p e r a t i v e a r e Caucasian,  Most of t h e women of t h e c o and t h e name o f one "woman o f  c o l o u r " was p u t forward as p o s s i b l y having a d i f f e r e n t perspective.  A note was l e f t under her door, but she d i d  not respond.  As Hammersley and A t k i n s o n  sampling  i s always s u b j e c t t o access.  want t o share t h e i r thoughts  (1986) i n d i c a t e ,  Some people do not  and t h e r i g h t t o r e f u s e t o  p a r t i c i p a t e must be r e s p e c t e d always. Data C o l l e c t i o n Initially,  t h e i n t e n t was t o gather data v i a  observation, participant-observation, intensive, interviews, and  focus groups.  Due t o l a c k of p e r m i s s i o n f o r g e n e r a l  a c c e s s , data c o l l e c t i o n was l i m i t e d t o i n t e n s i v e open-ended, unstructured interviews. Procedures A t o t a l of eleven i n t e r v i e w s were completed.  Two o f  the women were i n t e r v i e w e d twice.  A t t h e b e g i n n i n g o f each  s e s s i o n , t h e i n v e s t i g a t o r reviewed  t h e purpose o f t h e study,  encouraged and answered any q u e s t i o n s , and o b t a i n e d w r i t t e n consent  (Appendix B).  A l i s t of proposed q u e s t i o n s  (Appendix C) p r o v i d e d a s t a r t i n g p o i n t f o r t h e i n i t i a l interviews.  35 For t h e e a r l y i n t e r v i e w s , t h e women were asked t o describe l i f e  i n the co-operative.  both v e r b a l and non-verbal,  Questions and prompts,  were used t o encourage t h e women  t o expand on p o i n t s of i n t e r e s t .  The s u b j e c t s o f h e a l t h and  l i v i n g on a low income were introduced as a p p r o p r i a t e t o t h e flow o f t h e i n t e r v i e w . In l a t e r i n t e r v i e w s , t h e p a r t i c i p a n t s were asked t o imagine t h e i n v e s t i g a t o r as a new member of t h e c o - o p e r a t i v e i n o r d e r t o determine what procedures and i n f o r m a t i o n would be g i v e n t o h e l p a new member " f i t proceeded, q u e s t i o n s  As data  collection  a r i s i n g from t h e review o f t h e  t r a n s c r i p t s were i n c l u d e d .  As t h e study progressed,  and more o f t h e data from p r e v i o u s for  in."  more  i n t e r v i e w s was i n t r o d u c e d  validation. The  i n t e r v i e w s were completed i n t h r e e  t h r e e i n t e r v i e w s a t t h e beginning, midpoint,  and f i v e i n t e r v i e w s  "clusters":  three interviews a t the  ( i n c l u d i n g t h e two r e p e a t  i n t e r v i e w s ) towards t h e end of t h e data c o l l e c t i o n phase. Each taped Recording Ten  i n t e r v i e w l a s t e d s i x t y t o n i n e t y minutes. o f t h e Data  i n t e r v i e w s were audio-taped,  but o n l y n i n e were  t r a n s c r i b e d due t o t e c h n i c a l problems which r e s u l t e d i n one "blank"  tape.  One of the repeat  over t h e telephone were taken.  i n t e r v i e w s was conducted  so i t was not taped,  The audio-tapes  but d e t a i l e d notes  were t r a n s c r i b e d verbatim t o  p r o v i d e an a c c u r a t e r e c o r d of t h e d i a l o g u e .  Each t r a n s c r i p t  36 was  reviewed with t h e tape t o ensure F i e l d notes were recorded  accuracy.  following the interviews.  They i n c l u d e d a b r i e f d e s c r i p t i o n of t h e p a r t i c i p a n t and t h e s e t t i n g , and t h e i n v e s t i g a t o r ' s thoughts, i d e a s , and r e a c t i o n s t o the interview.  U s u a l l y t h r e e separate  types of  f i e l d n o t e s a r e used: a condensed account o f d e s c r i p t i v e data made d u r i n g or immediately f o l l o w i n g t h e p e r i o d o f observation,  an expanded account made l a t e r which f i l l s i n  d e t a i l , and a j o u r n a l of the ethnographer's  experiences,  f e e l i n g s , r e a c t i o n s , problems, i n s i g h t s , and d e c i s i o n s (Spradley,  1979).  observation  Due t o t h e absence o f p a r t i c i p a n t -  s e s s i o n s , these three types of r e c o r d s were  condensed i n t o one. Length o f Fieldwork I d e a l l y , a c t i v e f i e l d w o r k continues  until  data  s a t u r a t i o n i s reached, or no new data, p a t t e r n s , themes, dimensions, o r i n s i g h t s a r e r e v e a l e d 1986).  (Munhall & O i l e r ,  I n t h i s i n s t a n c e , data c o l l e c t i o n spanned a p e r i o d  of seven and one h a l f months.  The f i r s t  i n t e r v i e w took  p l a c e n e a r l y e i g h t months a f t e r t h e women moved i n t o t h e c o operative.  When t h e f i n a l i n t e r v i e w was conducted, t h e  women had been l i v i n g i n the c o - o p e r a t i v e months.  for fifteen  S e v e r a l themes were r e v e a l e d d u r i n g t h e course o f  t h i s study and were v a l i d a t e d by t h e p a r t i c i p a n t s . suspected continued,  It is  t h a t new themes may have emerged i f t h e study had as t h e c u l t u r e of t h e c o - o p e r a t i v e  i s i n the  37 process of evolution.  As many ethnographers  however, no ethnography  i s ever complete  emphasize,  (Spradley, 1979).  Analysis Data c o l l e c t i o n and a n a l y s i s proceeded T h i s p r o c e s s i s e s s e n t i a l i n ethnography  concurrently.  as t h e on-going  a n a l y s i s d i r e c t s f u r t h e r data c o l l e c t i o n by r a i s i n g new questions  (Spradley, 1979).  A f t e r each i n t e r v i e w , f i e l d  notes were w r i t t e n , t h e  audiotape was reviewed, and notes were made from t h e tape before t r a n s c r i p t i o n .  Each t r a n s c r i p t was reviewed a  minimum o f s i x times.  T r a n s c r i p t s were examined f o r any  i n f o r m a t i o n which r e l a t e d t o t h e concepts o f h e a l t h and poverty.  N o t a t i o n s were made i n t h e margins.  Sections or  phrases which seemed e s p e c i a l l y s i g n i f i c a n t were u n d e r l i n e d or  highlighted. Following the f i r s t  in  t h r e e i n t e r v i e w s , themes a p p e a r i n g  a l l t h r e e t r a n s c r i p t s were i d e n t i f i e d .  Some o f t h e  t o p i c s t h a t began t o r e c u r even a t t h i s e a r l y stage were c o n f l i c t s within the co-operative, boundary-setting, concerns f o r s a f e t y , and s t r a t e g i e s f o r l i v i n g on a low income.  A c h a r t was made t o o u t l i n e how t h e t h r e e d i f f e r e n t  women had commented on t h e common t o p i c s .  New q u e s t i o n s  arose from an examination of these a s s o c i a t i o n s . of  Examples  some o f these q u e s t i o n s a r e as f o l l o w s : What do t h e s e  women have i n common?, What are p o s i t i v e a s p e c t s o f l i f e i n the  c o - o p e r a t i v e ? , and What does t h e word "poor" mean t o t h e  38  women? A f t e r t h e completion of s i x i n t e r v i e w s , a l l s i x t r a n s c r i p t s were colour-coded l i n e by l i n e f o r t h e f o l l o w i n g categories:  h e a l t h , h e a l t h problems, poverty, co-op  life,  p r e v i o u s housing s i t u a t i o n , f a m i l y , and w o r k / l i f e ' s purpose. Some l i n e s had m u l t i p l e c o l o u r codes i f more than one c a t e g o r y was a p p l i c a b l e .  The data were then  completely  r e o r g a n i z e d i n order t o compile a l l r e f e r e n c e s from category.  These c a t e g o r i e s of data were reviewed  a g a i n , a l l o w i n g new themes t o emerge.  each  and coded  For example, w i t h i n  the c a t e g o r y of h e a l t h , s u b - c a t e g o r i e s such as s a f e t y , boundaries,  c o n t r o l , self-esteem, support, s k i l l s ,  work,  absence o f symptoms, pets, and environment were i d e n t i f i e d . Each main category was s u b - d i v i d e d i n t h i s manner. r e o r g a n i z a t i o n was completed.  A final  The data were l i t e r a l l y c u t  and p a s t e d one more time and new c a t e g o r i e s were established. The b e n e f i t of o r g a n i z i n g and r e o r g a n i z i n g t h e data i s the promotion  of data a n a l y s i s .  As one t r i e s t o r e o r g a n i z e  p i e c e s o f data, q u e s t i o n s a r i s e as t o where t h i s segment best f i t s ,  such as, "Does comparing o n e s e l f t o o t h e r s  less  f o r t u n a t e c o n s t i t u t e a s t r a t e g y f o r coping w i t h a low income, o r does i t f i t b e t t e r under s e l f - e s t e e m ? "  Notations  were made o f these q u e s t i o n s and i d e a s . Major themes, key ideas, and q u e s t i o n s were shared w i t h the p a r t i c i p a n t s i n t h e l a t t e r i n t e r v i e w s , p a r t i c u l a r l y  39  those women being i n t e r v i e w e d f o r a second time.  This  s h a r i n g of i n f o r m a t i o n r e s u l t e d i n v a l i d a t i o n o f t h e themes, or t h e g e n e r a t i o n of new data.  Two p a r t i c i p a n t s were asked  t o review t h e second d r a f t of t h e f i n d i n g s chapter and they provided  feedback.  A n a l y s i s continued throughout the f i n d i n g s .  Attempting  t h e process o f w r i t i n g  t o communicate t h e data i n a  l o g i c a l sequence continued t o r a i s e ideas and q u e s t i o n s as t o how t h e data f i t t o g e t h e r . P r o t e c t i o n of Human R i g h t s The r i g h t s of t h e p a r t i c i p a n t s were ensured ways.  The p r o p o s a l f o r t h i s study was reviewed  i n several and approved  by t h e U n i v e r s i t y of B r i t i s h Columbia B e h a v i o u r a l  Sciences  S c r e e n i n g Committee f o r Research and Other S t u d i e s I n v o l v i n g Human S u b j e c t s . were addressed  The i s s u e s of consent  and c o n f i d e n t i a l i t y  as f o l l o w s .  Consent f o r each taped i n t e r v i e w was o b t a i n e d and a consent  form  (Appendix B) was signed by each p a r t i c i p a n t .  P r i o r t o each i n t e r v i e w , i t was emphasized t h a t t h e p a r t i c i p a n t was under no o b l i g a t i o n t o answer any s p e c i f i c q u e s t i o n s o r t o d i s c u s s any p a r t i c u l a r t o p i c s . two  On a t l e a s t  occasions, p a r t i c i p a n t s exercised t h i s r i g h t t o refuse  to discuss a s p e c i f i c subject. The anonymity of t h e housing maintained.  c o - o p e r a t i v e has been  Although members of t h e s o c i e t y f o r t h e c o -  o p e r a t i v e ' s development expressed  an i n t e r e s t i n and a need  40  t o document t h e b e n e f i t s of t h i s type o f housing  f o r low  income women, t h e women who a c t u a l l y l i v e t h e r e t h a t they d i d not want the c o - o p e r a t i v e named.  specified The  d e s c r i p t i o n s o f t h e b u i l d i n g and the p a r t i c i p a n t s has been done w i t h t h e i n t e n t of p r e v e n t i n g i d e n t i f i c a t i o n o f e i t h e r the c o - o p e r a t i v e o r t h e i n d i v i d u a l s who p a r t i c i p a t e d . Data w i l l be made a v a i l a b l e f o r secondary a n a l y s i s . T h i s i n t e n t i o n i s made c l e a r i n t h e consent B).  form  (Appendix  A l l data, however, w i l l have a l l i n f o r m a t i o n which may  i d e n t i f y t h e p a r t i c i p a n t s removed.  Pseudonyms  f o r the  p a r t i c i p a n t s have been used i n a l l f i e l d notes,  transcripts,  and  f i n d i n g s t o maintain c o n f i d e n t i a l i t y .  for  t h e pseudonyms has been seen by t h e i n v e s t i g a t o r o n l y  and w i l l be destroyed upon completion  A l i s t o f codes  of the p r o j e c t .  Summary Due t o t h e complexity  of the r e l a t i o n s h i p between  p o v e r t y and h e a l t h , t h e l i t t l e t h a t i s known r e g a r d i n g t h e experience  of l i v i n g  i n poverty, and t h e d i v e r s i t y amongst  poor women, a q u a l i t a t i v e r e s e a r c h method was deemed t o be most a p p r o p r i a t e f o r t h i s t o p i c .  An ethnographic  approach  has p r o v i d e d d e t a i l e d i n f o r m a t i o n on one s m a l l , c l e a r l y d e f i n e d group of low income women l i v i n g housing  in a specific  c o - o p e r a t i v e and has explored t h e i r b e l i e f s ,  concerns,  and p r a c t i c e s r e l a t e d t o h e a l t h .  This  values,  study  p r o v i d e s a s t a r t i n g p o i n t f o r r e s e a r c h i n t h i s area and has uncovered q u e s t i o n s f o r f u r t h e r study.  The d e t a i l s o f these  41 f i n d i n g s are presented i n the next  chapter.  42 CHAPTER FOUR FINDINGS Introduction In t h i s study, t h e experiences o f a d i s c r e t e group o f women l i v i n g on a low income a r e e x p l o r e d .  The f i n d i n g s  p r o v i d e a glimpse i n t o t h e women's d a i l y s t r u g g l e t o cope w i t h l i m i t e d means, and the s t r e s s and f r u s t r a t i o n which accompanies t h i s c h a l l e n g e .  The women's s t r e n g t h , courage,  and c r e a t i v i t y a r e a l s o captured. A new housing c o - o p e r a t i v e f o r mature, low income women was  t h e s e t t i n g f o r t h e study.  Due t o t h e r e c e n t nature o f  the women's move i n t o the housing c o - o p e r a t i v e , t h e adjustment  t o t h i s new way of l i f e was found t o e x e r t a f a r  g r e a t e r e f f e c t on t h e women's h e a l t h concerns o r i g i n a l l y anticipated.  than  The i n i t i a l d i f f i c u l t i e s o f  c r e a t i n g a community out of a group o f t h i r t y - s i x s t r a n g e r s was  c e n t r a l t o many of t h e i n t e r v i e w s .  living  i n a c o - o p e r a t i v e environment  The b e n e f i t s o f  a r e h i g h l i g h t e d , and  out o f t h e i r d e s c r i p t i o n s of d a i l y l i f e ,  an u n d e r s t a n d i n g o f  what h e a l t h means f o r these women emerges. The f i n d i n g s have been organized i n t h e f o l l o w i n g manner.  To p r o v i d e t h e reader with context, t h e c h a p t e r  begins w i t h a d e s c r i p t i o n of t h e p h y s i c a l space, t h e a d m i n i s t r a t i v e s t r u c t u r e , and some g e n e r a l d e s c r i p t i o n s o f the women themselves.  In t h e next s e c t i o n , t h e women's  e x p e r i e n c e s of l i v i n g on a low income, i n c l u d i n g p r e v i o u s housing s i t u a t i o n s , a r e d e s c r i b e d .  Subsequently,  t h e major  43  themes o f "co-op l i f e " a r e o u t l i n e d : boundary i s s u e s and b u i l d i n g support networks.  In t h e f i n a l s e c t i o n , h e a l t h as  d e f i n e d by these women i s d e s c r i b e d .  As much as p o s s i b l e ,  the women's own words have been used t o convey meaning. The Housino: Co-operative The housing c o - o p e r a t i v e which p r o v i d e d t h e c o n t e x t f o r t h i s study i s unique i n t h a t i t i s t h e f i r s t designed  i n the province  and c o n s t r u c t e d s p e c i f i c a l l y f o r unattached, low  income women.  I t e x i s t s l a r g e l y as a r e s u l t o f t h e e f f o r t s  of an o r g a n i z e d group o f women committed t o t h e development of a f f o r d a b l e housing  f o r mature, s i n g l e women.  r e a s o n a b l e r e n t i s extremely  important  Stable,  f o r low income women.  In a d d i t i o n , housing c o - o p e r a t i v e s have t h e p o t e n t i a l t o p r o v i d e many other b e n e f i t s f o r t h e i r r e s i d e n t s , i n c l u d i n g a sense o f community. The  Concept of Co-operative  Housing  A sense o f community i s , i n many i n s t a n c e s , absent i n today's  l a r g e urban c e n t r e s .  Current Canadian c u l t u r e  emphasizes i n d i v i d u a l achievement over c o - o p e r a t i v e  efforts.  In a d d i t i o n , t h e average urban d w e l l e r o f t e n l i v e s , works, shops, and p l a y s i n d i f f e r e n t p a r t s of t h e c i t y , and may not have any a s s o c i a t i o n s with neighbours.  These two f a c t o r s  combine t o c r e a t e an environment which may become fragmented and  impersonal. Many e f f o r t s a r e being made t o r e c a p t u r e t h i s  sense o f community.  lost  Governments and c i t i z e n groups a r e  undertaking  p r o j e c t s such as neighbourhood houses, community  crime p r e v e n t i o n o f f i c e s , Block Watch, community a r t p r o j e c t s , f e s t i v a l s , and others t o t r y t o r e - e s t a b l i s h community i d e n t i t i e s and the b e n e f i t s of community The  life.  " c r e a t i o n o f community" w i t h i n t h e urban  environment i s one o f t h e main g o a l s of c o - o p e r a t i v e (Cooper & Rodman, 1994).  housing  Members of a c o - o p e r a t i v e purchase  shares, p r o v i d i n g them with j o i n t ownership and shared c o n t r o l over t h e i r l i v i n g space.  The r e s i d e n t s o f t h e  b u i l d i n g a r e not merely neighbours due t o g e o g r a p h i c a l p r o x i m i t y , but they a r e p a r t n e r s i n t h e o p e r a t i o n o f t h e i r home.  I n t h i s p a r t i c u l a r c o - o p e r a t i v e and d u r i n g t h e p e r i o d  of t h e study, t h e r e s i d e n t s were not only r e q u i r e d t o p a r t i c i p a t e i n t h e f u n c t i o n i n g of t h e c o - o p e r a t i v e , but shared t h e a d d i t i o n a l c h a l l e n g e of s e t t i n g up t h e i n i t i a l s t r u c t u r e s and l a y i n g t h e foundation f o r f u t u r e o p e r a t i o n . In order t o understand  t h e experiences,  c h a l l e n g e s , and  accomplishments of t h i s group of women, some background i n f o r m a t i o n i s needed.  There a r e t h r e e elements o f t h i s c o -  o p e r a t i v e : t h e p h y s i c a l space, t h e a d m i n i s t r a t i v e s t r u c t u r e s , and t h e women who l i v e t h e r e .  These t h r e e  elements a r e d e s c r i b e d i n t h e f o l l o w i n g s e c t i o n s w i t h t h e i n t e n t i o n o f p l a c i n g t h e f i n d i n g s of t h e study w i t h i n t h e i r context. The  P h y s i c a l Space The housing  c o - o p e r a t i v e i s based i n a new, f o u r -  45  s t o r e y b u i l d i n g l o c a t e d i n a major Canadian c i t y . building i t s e l f  The  i s s i t u a t e d i n an upper middle c l a s s  neighbourhood between a f a s t food r e s t a u r a n t and a f i n a n c i a l institution. the a r e a .  I t s pink stucco e x t e r i o r i s commonly found  in  There i s a s i g n above the f r o n t entrance w i t h  the  name of the c o - o p e r a t i v e on i t . The  s t r e e t i s a busy thoroughfare,  and the bus  stops  almost a t the door. Along the s t r e e t are many s m a l l r e s t a u r a n t s , produce s t o r e s , and a mix  of s m a l l  For many of the women, t h i s new  businesses  and  shops.  neighbourhood  was  a d r a s t i c change from the ones t o which they had become  accustomed. The  c o - o p e r a t i v e ' s main f l o o r space houses the  lobby,  the laundry room, and the main common area, or "community room."  There i s a c o n t r o l l e d entrance  t o the  co-operative  and o p p o s i t e most of the s u i t e numbers on the panel "occupied."  Very few of the women have requested  reads  t o have  t h e i r names d i s p l a y e d . Behind the c l e a r g l a s s of the double doors i s the lobby.  I t i s open and spacious, f u r n i s h e d o n l y w i t h  an  u p h o l s t e r e d couch, one p a i n t i n g , a small s c u l p t u r e , and plant.  These items have been donated.  The  w i t h l a r g e brown and white l i n o l e u m squares. are on the w a l l f a c i n g the door.  a  floor i s tiled The  mailboxes  Below the mailboxes are  neat p i l e s of f r e e community newspapers and magazines. As one moves through the lobby,  i t narrows t o a  46  hallway.  To t h e l e f t a r e t h e e l e v a t o r , t h e laundry room,  and t h e common room. the r i g h t .  The stairway t o t h e upper f l o o r s i s on  There i s a l a r g e b u l l e t i n board o p p o s i t e t h e  e l e v a t o r and two more b u l l e t i n boards i n t h e laundry room. They a r e o r g a n i z e d i n t o s e c t i o n s f o r s p e c i f i c types o f i n f o r m a t i o n and have always appeared very neat and t i d y . A p p a r e n t l y t h e r e has been a problem w i t h n o t i c e s b e i n g down  taken  prematurely. The  community room has k i t c h e n f a c i l i t i e s  (cupboards,  s i n k , and a dishwasher) a t one end and windows a t t h e o t h e r . Next t o t h e windows, a door opens onto t h e p a t i o .  When no  events a r e i n progress, the room i s s p a r s e l y f u r n i s h e d w i t h a beige u p h o l s t e r e d couch, and metal against the wall.  During events, t h i s room can be  d r a m a t i c a l l y transformed. was  stacking c h a i r s lean  For example, a c a f e atmosphere  c r e a t e d f o r one of t h e p a r t i e s . The hallway runs a l o n g s i d e t h e common room and l e a d s t o  the p a t i o , adjacent t o the back lane.  The s m a l l p a t i o i s a  v e r y p l e a s a n t spot with r a i s e d flower beds c o n t a i n i n g s m a l l t r e e s and shrubs, and i n summer, f l o w e r s and v e g e t a b l e s .  A  white p a t i o t a b l e with an umbrella and c h a i r s p r o v i d e s a place to s i t . The t h i r t y - s i x women l i v e i n one-bedroom s u i t e s on t h e second, t h i r d , and f o u r t h f l o o r s . Access t o t h e upper i s v i a t h e e l e v a t o r or s t a i r w e l l .  floors  The i n n e r w a l l o f t h e  s t a i r w e l l i s c l e a r g l a s s which c r e a t e s a f e e l i n g o f  47  openness.  The e l e v a t o r has l a r g e buttons mounted low on t h e  w a l l f o r easy access by those i n w h e e l c h a i r s . s m a l l b u l l e t i n board  There i s a  i n the e l e v a t o r with n o t i c e s f o r t h i n g s  such as t h e change o f a meeting time. The h a l l s a r e p a i n t e d throughout i n o f f - w h i t e w i t h a h i n t o f pink and t h e t r i m i s a dark "dusty r o s e " p i n k . c a r p e t s i n t h e hallways  and s t a i r w e l l s a r e an i n d u s t r i a l  q u a l i t y and a r e a l s o of a "dusty r o s e " hue. questioned  The  One woman  t h e a r c h i t e c t ' s view of low income women g i v e n  the overwhelming "pinkness" The hallways  of t h e decor.  give a perception of brightness,  c l e a n l i n e s s , and newness.  One p a r t i c i p a n t , however,  i n d i c a t e d where t h e hallway show s i g n s o f wear.  carpets are already beginning t o  S e v e r a l women have p e r s o n a l i z e d t h e  doors t o t h e i r s u i t e s with small d e c o r a t i o n s , p i c t u r e s o f p e t s t o be rescued  i n case of a f i r e , r e c e p t a c l e s f o r  " i n s i d e " m a i l , and s m a l l c a r p e t s .  One "welcome mat" reads  "go away." In approximately office.  t h e middle of t h e second f l o o r i s an  The c o - o p e r a t i v e ' s manager/book-keeper works i n t h e  o f f i c e one day p e r week.  On t h e t h i r d and f o u r t h f l o o r s ,  t h i s space i s a common area.  To date, t h e r e i s l i t t l e  f u r n i t u r e i n these s m a l l , bare rooms.  On t h e f o u r t h f l o o r ,  t h i s common room opens onto a garden p a t i o .  There i s a l s o  common space i n t h e basement with l o c k e r s f o r s t o r a g e . The one-bedroom s u i t e s a r e not l a r g e , r a n g i n g from 54 6  48  t o 712 square f e e t .  They a r e b r i g h t w i t h p a t i o doors  l e a d i n g onto s m a l l b a l c o n i e s .  When windows a r e open, t h e  t r a f f i c n o i s e i s c o n s i d e r a b l e , e s p e c i a l l y i n those which f a c e t h e s t r e e t .  suites  Despite t h i s f a c t , two women  commented on how much q u i e t e r i t i s than t h e i r p r e v i o u s neighbourhood. The k i t c h e n s and bathrooms a r e t i l e d , f l o o r space hallways.  and t h e remaining  i s covered with hard t w i s t c a r p e t s i m i l a r t o t h e The s u i t e s come i n f o u r l e v e l s o f a d a p t a b i l i t y  for the disabled.  Features i n c l u d e wide doorways f o r  w h e e l c h a i r access and low c l o s e t r a i l i n g s . s u i t e s a r e p a i n t e d i n a n e u t r a l tone.  The w a l l s o f t h e  A t t h e end o f one  year, t h e women a r e allowed t o decorate w i t h p a i n t and w a l l p a p e r , p r o v i d i n g they r e t u r n t h e s u i t e t o i t s o r i g i n a l c o n d i t i o n when they move. Administrative Structure P r i o r t o acceptance,  q u a l i f i e d a p p l i c a n t s were  i n t e r v i e w e d by a panel and g i v e n i n f o r m a t i o n about c o operative l i v i n g .  A f t e r being asked a s e r i e s o f standard  i n t e r v i e w q u e s t i o n s , women were recommended t o t h e board o f d i r e c t o r s f o r acceptance  based on t h e i r apparent w i l l i n g n e s s  and a b i l i t y t o l i v e and work i n a community.  (Nine u n i t s ,  however, a r e s e t a s i d e f o r B r i t i s h Columbia Housing, and a l t h o u g h these candidates were a l s o i n t e r v i e w e d , they c o u l d not be r e j e c t e d u n l e s s f r a u d c o u l d be proven.) acceptance,  t h e women were informed t h a t t h e i r  Upon participation  49  i n t h e o p e r a t i o n of t h e c o - o p e r a t i v e was a c o n d i t i o n o f acceptance,  and they signed an agreement t o t h a t e f f e c t .  They were t o l d t o expect p a r t i c i p a t i o n t o be approximately t e n hours p e r month, which i s a standard co-operatives.  f o r most  housing  Very few of the women knew each other  before  they moved i n , although a few long term f r i e n d s h i p s d i d exist. The women a r e r e s p o n s i b l e f o r t h e o p e r a t i o n and maintenance o f t h e c o - o p e r a t i v e , and a number o f committees have been s e t up t o achieve these ends. board  Members o f t h e  o f d i r e c t o r s a r e e l e c t e d f o r a one year term, but h a l f  of t h e board  changes every s i x months t o p r o v i d e c o n t i n u i t y .  Other committees address s a f e t y , and p e t s .  f i n a n c e s , maintenance, membership,  Consensus decision-making  i s used by a l l  committees and has been d e s c r i b e d by some of t h e women as time-consuming, and a t times,  frustrating.  The amount o f  work r e q u i r e d i n t h e e a r l y phase of t h e c o - o p e r a t i v e ' s development has g r e a t l y exceeded everyone's e x p e c t a t i o n s . A s s i s t a n c e i n l e a r n i n g t o run t h e c o - o p e r a t i v e has been p r o v i d e d by an o r g a n i z a t i o n t h a t a s s i s t s w i t h t h e establishment  of new c o - o p e r a t i v e s , t h e management company's  p a i d , p a r t - t i m e employee, and t h e Co-operative British  Columbia.  Federation of  The c o n s u l t a n t from t h e former has  f a c i l i t a t e d t h i s process by s e t t i n g up workshops t o h e l p t h e women develop  administrative s k i l l s .  F o r example, she has  l e d workshops on t o p i c s such as t a k i n g minutes a t a meeting.  50 A l l t h e women who have mentioned these support  personnel  speak v e r y h i g h l y of them and t h e a s s i s t a n c e they have provided. The Women of t h e Housing  Co-operative  To q u a l i f y f o r the c o - o p e r a t i v e , women must have annual incomes below $25,500, be r e s i d e n t s of t h e p r o v i n c e , be paying more than 3 0% o f t h e i r income f o r r e n t o r l i v e i n poor o r i n a c c e s s i b l e accommodation, and be a t l e a s t y e a r s o l d o r have a permanent d i s a b i l i t y .  forty  The women's  a c t u a l ages range from m i d - t h i r t i e s t o s e v e n t i e s .  A l l the  women i n t e r v i e w e d have some l e v e l of d i s a b i l i t y , whether i t be p h y s i c a l , mental, o r emotional.  The women have d i v e r s e  backgrounds i n terms o f education and work experience,  and a  m i n o r i t y a r e c u r r e n t l y employed. The 28%  t e n women who p a r t i c i p a t e d i n t h e study  comprise  o f t h e t o t a l p o p u l a t i o n of t h e c o - o p e r a t i v e .  In many  ways, they a r e r e p r e s e n t a t i v e of the women i n g e n e r a l .  For  example, t h e i r ages span t h e complete age range w i t h i n t h e co-operative.  The study p a r t i c i p a n t s were a l l h i g h l y  i n v o l v e d i n t h e work of the c o - o p e r a t i v e .  I t i s impossible  t o say, however, i f t h i s sample i s t r u l y r e p r e s e n t a t i v e . Common Backgrounds There was complete consensus amongst those  interviewed  t h a t t h e women of t h e c o - o p e r a t i v e share a common h i s t o r y . Although  each woman's experience was acknowledged as unique,  i t contained  "hard experiences" t h a t t h e women had endured.  51  T h e i r common backgrounds i n c l u d e d t h r e e elements: a d y s f u n c t i o n a l or abusive past, d i f f i c u l t i e s w i t h housing,  previous  and t h e experience o f l i v i n g on a low income.  This  common h i s t o r y , p a r t i c u l a r l y a d y s f u n c t i o n a l o r abusive p a s t , was i d e n t i f i e d as t h e i r reason f o r being i n t h e c o operative. "Dysfunctional"/Abusive The  Histories  "hard experiences" or "rough u p b r i n g i n g s " shared by  the women were, f o r many of them, c h i l d h o o d s spent i n d y s f u n c t i o n a l o r abusive f a m i l i e s .  For women w i t h  s u p p o r t i v e f a m i l i e s , "hard experiences" i n c l u d e d s e x u a l a s s a u l t , c h r o n i c h e a l t h problems, or permanent d i s a b i l i t i e s . These common p a s t s were r e f e r r e d t o by s e v e r a l women as " f e a r - b a s e d backgrounds" and were c h a r a c t e r i z e d by a l a c k o f trusting  relationships.  These p a s t hardships have made " s u r v i v o r s " of t h e women.  While they b e l i e v e d t h a t i t i s t h e i r common  backgrounds t h a t brought them together, t h e p e r s o n a l q u a l i t i e s t h a t have allowed them t o s u r v i v e a r e a l s o shared. T h e i r h i s t o r i e s , and t h e coping mechanisms they have developed  t o d e a l with them, were i d e n t i f i e d by some o f t h e  women as n e g a t i v e l y a f f e c t i n g t h e i r day-to-day l i v e s i n t h e c o - o p e r a t i v e , s p e c i f i c a l l y i n t h e ways i n which they communicated w i t h one another. D o r i s d e s c r i b e d how she c o u l d "sense" other women's abusive p a s t s by t h e i r " o v e r - s e n s i t i v i t y t o f l i p p a n t  52  remarks": Maybe I'm making assumptions. the people I meet.  I t ' s j u s t my sense o f  I f e e l I have t o be c a r e f u l what I  say. T h i s need t o be c a r e f u l was c h a r a c t e r i z e d by another woman as "walking on t i p p y - t o e s . "  L y d i a a l s o "sensed" t h a t many  of t h e women had lacked t r u s t i n g r e l a t i o n s h i p s by t h e i r c o n f r o n t a t i o n a l and demanding behaviour. "fear-based  A l i c e stated the  backgrounds r e s u l t e d i n a l o t o f p a r a n o i a . "  S e v e r a l women commented t h a t some of t h e o t h e r s p r o g r e s s e d beyond t h e i r p a s t s .  had not  A l i c e believes that i t i s  unhealthy t o dwell on one's d y s f u n c t i o n a l  past:  A l o t of people t o me here want t o g e t i n t o t h i s  real  depth o f problems and past h i s t o r y , what your p a r e n t s were l i k e and a l l .  That's okay, but come on,  doesn't have t o be a l l doomsday e i t h e r .  i t  That's what I  was  f e e l i n g . . . a l l of these women have a l l these  and  problems and t h a t ' s why we l i v e i n t h i s co-op and,  oh,  we've g o t t o have a committee and f i n d out how we  can b e t t e r o u r s e l v e s . was  issues  I t j u s t g o t t o be t o o much,  j u s t t o o [much] a n a l y z i n g  i t  everything.  From h e r comments, i t i s c l e a r t h a t b e l i e f s about a common h i s t o r y a r e not based on an i n t u i t i v e sense alone,  but a l s o  r e s u l t from open d i s c u s s i o n s of these matters. D o r i s drew a connection  between these  "dysfunctional"  backgrounds and t h e high percentage of h e a l t h problems  53  amongst t h e women. A l o t of them have emotional problems and someone t o l d me t h e other day 97 o r 96% of women have p h y s i c a l problems and o r b o t h . . . i t ' s probably as a consequence of  [coming] from d y s f u n c t i o n a l f a m i l i e s and...they were  abused as c h i l d r e n o r [by] husbands. Her  comments p o i n t t o t h e p o s s i b i l i t y of a c y c l e i n r e g a r d s  t o abusive h i s t o r i e s , h e a l t h problems, and p o v e r t y .  One  woman a c t u a l l y a r t i c u l a t e d a d e s i r e t o "break out o f t h i s pattern." Despite  the current d i f f i c u l t i e s r e l a t e d t o t h e i r  d y s f u n c t i o n a l h i s t o r i e s , t h e women d i d b e l i e v e t h a t they had achieved Eve  some p o s i t i v e outcomes i n regards t o t h e i r  health.  b e l i e v e s t h a t t h e women have progressed beyond t h e s e  "hard experiences"  and have learned t o take care o f  themselves: I t h i n k t h a t a l o t of the women here have had quote, unquote, hard experiences i n t h e i r l i v e s and have done some amount of work i n g e t t i n g t o here because I t h i n k g e t t i n g t o here has meant t h a t we're t a k i n g care o f ourselves  somehow.  S e v e r a l women confirmed t h i s p e r s p e c t i v e  by commenting on  the courage d i s p l a y e d by many of t h e women i n t h e f a c e o f various challenges.  One p a r t i c i p a n t i n d i c a t e d t h a t a l l t h e  women o f t h e c o - o p e r a t i v e  have learned t o advocate f o r  themselves, and even those who say they do not v a l u e  54  themselves do, a t l e a s t enough t o seek out good q u a l i t y , affordable  housing.  Observations  c o n f i r m t h i s view.  The women were seen as  a s s e r t i v e and a r t i c u l a t e i n p r e s e n t i n g t h e i r  viewpoints,  p o l i t i c a l l y a s t u t e , and d i d show evidence o f v a l u i n g themselves.  For example, one woman r e c o g n i z e d t h e l a c k o f  r e s p e c t she has r e c e i v e d from her f a m i l y i n t h e p a s t and t h e age d i s c r i m i n a t i o n she c u r r e n t l y f a c e s from s o c i e t y a t large.  She showed s e l f - r e s p e c t and an awareness o f s e l f -  worth by d e s c r i b i n g h e r s e l f as a more i n t e r e s t i n g person now than she has ever been. S e v e r a l o f t h e women i n t e r v i e w e d b e l i e v e they share a common p a s t d e s c r i b e d as "fear-based backgrounds" and now l i v e i n t h e c o - o p e r a t i v e as a r e s u l t .  These  experiences  have had n e g a t i v e consequences f o r t h e i r h e a l t h , r a n g i n g from a l a c k of t r u s t i n g r e l a t i o n s h i p s and d i f f i c u l t i e s communicating t o p h y s i c a l and emotional  disabilities.  D e s p i t e these hard experiences, t h e women have l e a r n e d t o v a l u e and take care o f themselves,  a t l e a s t enough t o make  improvements i n t h e i r p r e v i o u s l y u n s a t i s f a c t o r y housing accommodations. P r e v i o u s Housing  Experiences  In terms o f t h e more r e c e n t past, t h e women a l s o shared some common d i f f i c u l t i e s with t h e i r housing t o moving i n t o t h e c o - o p e r a t i v e . v a r i e t y o f housing  situations  prior  The women have come from a  situations including  individually-rented  55 apartments, shared accommodation with one or more roommates, l i v i n g i n someone's home i n exchange f o r c a r e g i v i n g s e r v i c e s , and one woman had even l i v e d i n a c o - o p e r a t i v e . The  i n s t a b i l i t y of these housing arrangements i s b e s t  e x e m p l i f i e d by one woman who  had moved f o u r times  i n the  p r e v i o u s year. The d i f f i c u l t i e s with p r e v i o u s housing  identified  by  the m a j o r i t y of women r e l a t e d t o f i n a n c e s , p e r s o n a l s a f e t y , and s o c i a l i s o l a t i o n .  The most obvious p o s i t i v e outcome  r e s u l t i n g from these shared experiences genuine a p p r e c i a t i o n f o r how their living  i s the women's  the c o - o p e r a t i v e has  improved  situations.  Finances represented the most f r e q u e n t l y mentioned concern.  The women d i s c u s s e d how  r e n t had consumed a  d i s p r o p o r t i o n a t e amount of t h e i r t o t a l income; i n some i n s t a n c e s , as much as t h r e e - q u a r t e r s of i t . left  f o r other expenses.  tremendous d i f f i c u l t y  Although  i n and of themselves,  she f e l t  little  was  these h i g h r e n t s posed  accompanied by f e e l i n g s of i n s e c u r i t y and woman d e s c r i b e d how  Very  they were a l s o  instability.  "trapped" by her  previous  l a n d l o r d due t o her p h y s i c a l d i s a b i l i t y and the f i n d i n g accommodation which accepted p e t s .  One  difficulty  Several others  a l s o d e s c r i b e d the f e a r of sudden, u n a f f o r d a b l e r e n t increases. Doris:  . . . L i v i n g i n rented apartments, they can go  anytime.  You don't f e e l secure.  I was  i n one  very  up  56 reasonable, q u i t e n i c e apartment and, phew, t h e r e n t s went sky h i g h . A l l but two o f t h e women mentioned f i n a n c i a l  difficulties  a s s o c i a t e d w i t h p r e v i o u s housing, and these two women have f a m i l i a l f i n a n c i a l resources upon which t o draw. S i n g l e women a r e b e l i e v e d t o spend a l a r g e r p o r t i o n o f income on r e n t due t o a g r e a t e r need f o r a s a f e environment (Nairne, 1991).  Amongst these women, however, concern f o r  p e r s o n a l s a f e t y i n t h e former neighbourhoods was f r e q u e n t l y mentioned d e s p i t e them spending a s u b s t a n t i a l percentage o f income f o r r e n t . Kathryn: When I walked down t h e s t r e e t , I would  look  behind me and around me...not d u r i n g t h e day b u t i n t h e evening when I was walking home so t h e r e was a sense o f insecurity. Not " f e e l i n g s a f e " was l i n k e d not only t o a f e a r o f crime i n the neighbourhood a t l a r g e , but a l s o t o s o c i a l  isolation.  For B e t t y , l i v i n g alone meant an absence o f s o c i a l support, no one t o c a l l on i n times of need: B e t t y : You're l i v i n g i n s i t u a t i o n s where i t ' s o n l y you t h a t ' s going t o do i t and nobody e l s e , nobody around t o c a r e i f you f a l l .  There's nobody around t o come and  knock on your door and see i f you're okay. Another woman, s e l f - s u f f i c i e n t i n most r e s p e c t s , d i d n o t r e q u i r e p r a c t i c a l a s s i s t a n c e , but was i n g r e a t need o f social  contact.  57  D o r i s : I c e r t a i n l y wouldn't go back t o my r e n t e d apartment a f t e r l i v i n g here, d e f i n i t e l y not, no, I was very  lonely.  Conversely,  f o r some women l i v i n g alone was not an o p t i o n as  shared accommodation was a l l they c o u l d a f f o r d . Out o f t h i s shared experience o f d i f f i c u l t i e s i n p r e v i o u s housing  s i t u a t i o n s comes an a p p r e c i a t i o n f o r what  the c o - o p e r a t i v e has t o o f f e r : Kathryn: was  I t ' s not home, but i t ' s b e t t e r than where I  b e f o r e , i n many ways.  I mean, i t ' s b e t t e r than  where I c o u l d be. These women d i d not choose t o l i v e i n t h e c o - o p e r a t i v e p r i m a r i l y f o r t h e b e n e f i t s of an a l t e r n a t i v e l i f e s t y l e ;  they  chose i t out of a p r e s s i n g need f o r s t a b l e , a f f o r d a b l e housing.  S e v e r a l of t h e women d i d not view t h e c o - o p e r a t i v e  as a permanent home, but r a t h e r as a " s t e p p i n g stone" t o something b e t t e r .  When they do leave t h e c o - o p e r a t i v e ,  however, i t w i l l be by t h e i r c h o i c e . While i t does not completely  e l i m i n a t e the problems these women f a c e d i n t h e i r  p r e v i o u s l i v i n g s i t u a t i o n s , the c o - o p e r a t i v e c e r t a i n l y does reduce some o f t h e s t r e s s of l i v i n g on a low income. I t g i v e s these women a sense of c o n t r o l , something s e v e r e l y l a c k i n g when one l i v e s on a low income. Experiences L i v i n g on Low Income D i v e r s i t y of Poorness Some d i v e r s i t y was apparent  i n regards t o t h e women's  58 e x p e r i e n c e s o f l i v i n g on a low income and t h e i r  perceptions  of t h a t experience, but t h e r e were a l s o common themes. all  o f t h e women d e s c r i b e d themselves as "poor."  Not  In order  t o t r y t o d e s c r i b e t h e experience, however, a l l t h e women began by d e s c r i b i n g coping s t r a t e g i e s they used t o manage on a low income, and two main types of coping emerged.  strategies  The women shared many s i m i l a r emotions i n t h e  s t r u g g l e t o g e t by on a low income, and some agreement on the d e f i n i t i o n of poverty emerged. I n t e r e s t i n g l y , the women d i d not i d e n t i f y s t r o n g l y w i t h one  another  d e s p i t e t h e i r common socioeconomic  status.  In  f a c t , t h e low income s t a t u s may have been a d e t e r r e n t t o i d e n t i f y i n g w i t h one another.  While they were v e r y open t o  d i s c u s s i n g p e r s o n a l f i n a n c e s i n t h e i n t e r v i e w s , t h e women s t a t e d t h a t g e n e r a l l y they do not t a l k t o each o t h e r about these matters.  Lydia attributed t h i s fact t o the values of  the l a r g e r s o c i e t y .  Money equals success, and t o  acknowledge one's low income i s , i n a sense,  t o admit t o  failure. Although  a l l t h e women must have an annual  income of  $25,500 o r l e s s t o be e l i g i b l e f o r t h e c o - o p e r a t i v e , t h e r e e x i s t s a range of "poorness"  and d i f f e r i n g p e r c e p t i o n s o f  poorness amongst t h e women. There were women who do not i d e n t i f y themselves as poor: A l i c e : I'm not r e a l l y poor, no, I don't see myself as poor a t a l l .  I j u s t need more money.  59  Others d e s c r i b e d g r a p h i c accounts of l i v i n g i n p o v e r t y . woman b e l i e v e s t h a t " q u i t e a few of t h e people" o p e r a t i v e a r e "poor." poor a t present,  One  i n the co-  She does not c o n s i d e r h e r s e l f t o be  but d e s c r i b e d her experience  as a c h i l d t o  i l l u s t r a t e t h a t she knows what i t i s l i k e t o be poor: D o r i s : I have been poor as a c h i l d , we were on w e l f a r e , and we hated  i t . We j u s t l i v e d f o r t h e day and she  [mother] would t a l k about when we g o t o f f w e l f a r e .  It  was t e r r i b l e t o be on welfare, and we had t o wear welfare clothes.  You know, they gave you t h e c l o t h e s  you had t o wear and your shoes, and gaudy, h o r r i b l e colours...So  I know what i t ' s l i k e t o be poor.  Another woman r e a d i l y d e s c r i b e d h e r s e l f as "poor," s t a t i n g she had been poor a l l her l i f e .  She i d e n t i f i e d t h i s f a c t o r  as making h e r d i f f e r e n t from some of t h e women i n t h e c o o p e r a t i v e , although  she s t a t e d , "I would imagine t h a t some  of t h e women here have a l s o been poor t h e i r e n t i r e l i v e s . " On s e v e r a l occasions, t h e women gave c l u e s t h a t t h e v a l u e s , b i a s e s , and assumptions of s o c i e t y towards t h e poor a l s o operate w i t h i n t h e c o - o p e r a t i v e .  For example, some o f  the women with hidden d i s a b i l i t i e s b e l i e v e d t h a t o t h e r women looked a t them and wondered why they were not working.  In  another i n s t a n c e , someone put f o r t h a s t r o n g argument t h a t poor women deserve a n i c e p l a c e t o l i v e , then proceeded t o defend h e r r i g h t t o be there, s t a t i n g she had worked hard for i t .  60 Copincr S t r a t e g i e s When asked what i t was l i k e t o l i v e on a low income, the women t y p i c a l l y began by d e s c r i b i n g t h e c o p i n g s t r a t e g i e s they used t o manage with l i m i t e d f i n a n c e s . Out of t h i s s m a l l sample of women, g e n e r a l coping s t r a t e g i e s f o r d e a l i n g w i t h a low income seemed t o vary between two d r a s t i c a l l y d i f f e r e n t methods. c a r e f u l budgeting,  S e v e r a l women t a l k e d about  "counting pennies," and "having t o  scrimp," and t h e s t r e s s and f r u s t r a t i o n t h a t accompanied those measures. A v e r y d i f f e r e n t coping s t y l e was d e s c r i b e d by one woman who spends r e l a t i v e t o what she has a t t h e moment and d e a l s w i t h t h e consequences l a t e r : Eve:  I ' l l go out and spend money because I don't want  t o s o r t o f spend f i v e d o l l a r s here and t h e r e a l o n g t h e way and not, and deny myself something.  I'll  f o r d i n n e r and spend t o o much money, even j u s t d o l l a r s i s t o o much money and then I ' l l  go out fifteen  j u s t go, okay,  w e l l I d e a l with t h a t on t h e other end o f i t and I ' l l do without  something.  T h i s woman's experience of growing up poor was one o f c o n t i n u a l l y running out of b a s i c n e c e s s i t i e s such as food and h o t water.  She e x p l a i n e d her behaviour  f a t h e r ' s r o l e modelling.  i n terms o f h e r  "My f a t h e r has been t h e same  way...he s o r t o f spends r e l a t i v e t o what he has i n h i s pocket and then h e ' l l do without."  She a l s o r e l a t e d i t t o a  61 need t o a v o i d a constant Eve:  sense of d e p r i v a t i o n :  Always around food I don't r e a l l y want t o deny  myself t h a t much because i t ' s always been an i s s u e i n my  l i f e having enough food.  T r y i n g t o budget with an inadequate income i s an impossible  task,  as evidenced by Nancy who  received a welfare  previously  cheque of $550 per month and  d o l l a r s l e f t a f t e r b a s i c expenses were met.  had  five  Perhaps, f o r  t h i s depth of poverty, spending r e l a t i v e t o what i s i n your pocket, r a t h e r than h o p e l e s s l y t r y i n g t o budget, i s a means of r e d u c i n g  s t r e s s , at l e a s t  temporarily.  Coping s t r a t e g i e s centred of food and  clothing.  around the b a s i c n e c e s s i t i e s  Recreational  activities,  or  l i m i t a t i o n s on them, were a l s o mentioned f r e q u e n t l y .  An  i n a b i l i t y t o a f f o r d s o c i a l a c t i v i t i e s such as " e a t i n g  out"  seemed t o be a measure of "poorness." D o r i s : A l o t of them j u s t don't have the money t o out f o r One  woman who  coping budget.  dinners. d i d not consider h e r s e l f "poor" had  mechanisms f o r being Her  several  able t o eat out on her l i m i t e d  s t r a t e g i e s i n c l u d e d s h a r i n g a b o t t l e of wine  w i t h f r i e n d s before going out and her meal as even n o n - a l c o h o l i c p r i c e of the  go  d r i n k i n g o n l y water w i t h  beverages c o u l d equal  the  food.  E a t i n g at home a l s o i n v o l v e d measures t o reduce c o s t s , such as "watching p r i c e s " and  "buying whatever they have on  62  special."  One woman, on a p a r t i a l v e g e t a r i a n  diet for  h e a l t h reasons, acknowledged t h a t " i t ' s cheap." women mentioned food a l l e r g i e s and d e s c r i b e d of buying more expensive s p e c i a l t y foods,  Several  the challenge  necessary f o r  h e a l t h , on a l i m i t e d budget. C l o t h i n g was f r e q u e n t l y mentioned i n r e g a r d s t o managing on a low income.  S e v e r a l women d e s c r i b e d  a t "second hand s t o r e s " most o r a l l of t h e time.  shopping F o r other  women, however, even second hand s t o r e s were not an o p t i o n . Instead,  they coped by not buying any c l o t h e s a t a l l f o r  long p e r i o d s Eve:  of time.  I w i l l j u s t go without f o r so long, you know,  for  y e a r s without new c l o t h i n g . These d e s c r i p t i o n s of d e p r i v a t i o n stand  i n stark contrast t o  the consumerism o f our s o c i e t y . Recreational  a c t i v i t i e s a r e l i m i t e d f o r these women due  t o income, although not a l l of them i d e n t i f i e d t h i s as stressful.  One woman s a i d she c o u l d not a f f o r d t o go t o  movies, but d i d not mind watching t e l e v i s i o n a t home instead.  "Window shopping" i s a popular a c t i v i t y .  expressed any resentment r e g a r d i n g  No one  t h e c o n t r a s t between t h e  v i s i b l e a f f l u e n c e of the neighbourhood and t h e i r l i m i t e d incomes.  Instead,  many expressed enjoyment o f t h e p l e a s a n t  ambiance. There were s t r a t e g i e s such as walking o r b i c y c l i n g i n s t e a d o f t a k i n g t h e bus,  exchanging s e r v i c e s v e r s u s p a y i n g  63  f o r them (such as peer c o u n s e l l i n g ) , and making one's own furniture.  Some of t h e women have been very c r e a t i v e i n  d e c o r a t i n g t h e i r s u i t e s with inexpensive items.  One woman  d e s c r i b e d t h e p l e a s u r e she obtained from " c r e a t i n g something out o f n o t h i n g . "  Overall, the residents of the co-operative  seemed t o have a h i g h percentage people.  of c r e a t i v e o r a r t i s t i c  A t f i r s t t h i s c r e a t i v i t y seems born o f n e c e s s i t y .  Or, perhaps, i t i s these women's i n n a t e c r e a t i v i t y t h a t s e t s them a p a r t from other poor women who have not f a r e d so w e l l . The m a j o r i t y of women i n t e r v i e w e d compared themselves t o o t h e r s l e s s f o r t u n a t e , i n c l u d i n g t h e homeless. I d e n t i f y i n g o t h e r s i n worse circumstances  can be a mechanism  f o r making one's own s i t u a t i o n appear b e t t e r .  These women,  however, acknowledged t h e r e a l p o s s i b i l i t y o f ending up on the s t r e e t Eve:  themselves. I've always been, up u n t i l now, a s t e p away from  l i v i n g i n the street. The r e c o g n i t i o n of t h i s p o s s i b i l i t y was accompanied by f e a r : A l i c e : I would be p e t r i f i e d t o be out t h e r e t r y i n g t o l i v e i n Stanley Park o r on t h e s t r e e t , no one s h o u l d have t o l i v e l i k e t h a t . I r o n i c a l l y , a "bag lady" had been s l e e p i n g i n t h e doorway o f the c o - o p e r a t i v e .  In r e f e r e n c e t o her, B e t t y commented:  Without t h i s p l a c e we c o u l d a l l be her, although some people don't want t o be helped. O v e r a l l , t h e s t r a t e g i e s used t o cope w i t h a l i m i t e d  64  income were not c a r e f u l p l a n s .  Instead, they were a means  of working w i t h i n very l i m i t e d o p t i o n s . have no money f o r t h e bus, you walk.  F o r example, i f you  Comparison t o o t h e r s  l e s s f o r t u n a t e , although thought t o be a coping s t r a t e g y , seemed t o engender more f e a r than comfort.  In a d d i t i o n t o  f e a r , many other emotions were d e s c r i b e d as i n t e g r a l t o t h e i r experiences of l i v i n g on a low income. Emotions and Low Income as I d e n t i t y The emotions a s s o c i a t e d with l i f e on a low income i n c l u d e d f e a r , anger, f r u s t r a t i o n , g u i l t , despair.  shame, and  They g i v e some p e r s p e c t i v e o f what i t " f e e l s "  t o s t r u g g l e i n t h i s way.  like  The word " f r u s t r a t i n g " and o t h e r s  such as " s t r e s s f u l " o r " s t r a i n " were used r e p e a t e d l y . F r u s t r a t i o n was r e l a t e d t o not having enough. Eve:  I t ' s very f r u s t r a t i n g and i t ' s always s o r t o f f e l t  l i k e i t ' s j u s t over t h e r e t h a t t h e access t o these t h i n g s i s j u s t over t h e r e , somewhere, j u s t out o f my reach, but c l o s e . S e v e r a l o f t h e women expressed  f r u s t r a t i o n a t being  limited  s o c i a l l y by t h e i r incomes. Kathryn: There i s n ' t a s l u s h fund t o j u s t p l a y . A l i c e : That's t o o bad t h a t money i s such a problem sometimes, when you want t o go out t o d i n n e r o r go r e n t a boat o r do some fun t h i n g s , but i t takes money so I t r y t o f i n d other t h i n g s t h a t don't take i t . The women emphasized t h a t they were not t a l k i n g about  65  l u x u r i e s o r extravagances, but t h i n g s t h a t a r e necessary f o r health.  S e v e r a l women used the e x p r e s s i o n  "basic  comforts,"  t h i n g s t h a t more a f f l u e n t Canadians take f o r granted.  For  example, one woman mentioned such a b a s i c , but i n a c c e s s i b l e , t h i n g as a rack f o r d r y i n g  clothes.  Anger and f r u s t r a t i o n were a l s o c l o s e l y l i n k e d t o t h e s t r u c t u r e and a d m i n i s t r a t i o n  of s o c i a l s e r v i c e s .  Some o f  the p a r t i c i p a n t s r a i s e d t h e i r v o i c e s , one becoming v e r y f l u s h e d i n t h e face, when d i s c u s s i n g how they wanted "the b a s i c s , " but asking  only  f o r e x t r a money from S o c i a l  S e r v i c e s was a dehumanizing experience. Nancy: The f i n a n c i a l a i d worker made me f e e l so vulnerable  because you're a t t h e i r mercy i n a way...  ( l a t e r ) You a r e not human when you a r e i n t h e s o c i a l service. puppet.  You're j u s t a number, o r j u s t l i k e a l i t t l e I t ' s very demeaning, i t ' s very c r u e l t o me.  T h i s woman compared her r e l a t i o n s h i p with S o c i a l S e r v i c e s t o a p a r e n t - c h i l d s i t u a t i o n where she had t o "get for everything." "I've  permission  Eve used a s i m i l a r analogy when she s a i d ,  never r e a l l y l i v e d i n an a d u l t world, t h e world o f  money."  I t i s no wonder the women d e s c r i b e d  t h i s dependent  p o s i t i o n w i t h l i m i t e d c o n t r o l over t h e i r own l i v e s as frustrating. The  women were s e n s i t i v e t o the d i s c r i m i n a t i o n which  e x i s t s towards those of lower income l e v e l s . "I'm  n o t a l a z y bum."  One a f f i r m e d ,  On a c o l l e c t i v e l e v e l , t h e women  66  disagreed  as t o whether or not the c o - o p e r a t i v e  d i s c r i m i n a t i o n w i t h i n t h e neighbourhood.  itself  faced  Betty b e l i e v e s i t  does: We a l l know what housing co-op means.  It's a  stigmatism t h a t has been put on s o c i a l housing f o r decades. Others d i s a g r e e  t h a t "co-op" i s e q u i v a l e n t  to social  housing, and b e l i e v e t h e neighbourhood t o be g e n e r a l l y supportive  o f t h i s type of housing p r o j e c t .  the name of t h e c o - o p e r a t i v e  became t h e focus  The s i g n w i t h for this  disagreement as some of t h e women b e l i e v e d i t a d v e r t i s e s t h e presence o f s o c i a l housing and they wanted i t removed.  The  s i g n , however, remains. The  women a r e a l s o d i v i d e d i n t h e i r o p i n i o n s  the q u a l i t y of t h e b u i l d i n g . the c o - o p e r a t i v e  regarding  One p a r t i c i p a n t b e l i e v e s  i s under s o c i a l pressure  that  t o conform t o a  p a r t i c u l a r image: D o r i s : I t h i n k i t was t h e a r c h i t e c t t h a t t o l d us o r i g i n a l l y t h a t we have t o keep i t modest. people s a i d , "Well,  A l o t of  t h a t ' s s o c i a l housing, how come  they got such a n i c e l o o k i n g b u i l d i n g ? " Another woman d e s c r i b e s t h e c o n s t r u c t i o n o f t h e b u i l d i n g as "a p i e c e o f s h i t . "  These p e r c e p t i o n s  understand i n l i g h t of the i n f o r m a t i o n  are d i f f i c u l t t o that the b u i l d i n g  meets earthquake standards and was r a t e d h i g h l y by a b u i l d i n g i n s p e c t o r a t t h e end of t h e f i r s t y e a r .  Are the  views o f some of t h e women clouded they w i l l never have anything perceptions The  by t h e e x p e c t a t i o n  nice?  that  Or, a r e these  r e l a t e d t o the shame of l i v i n g on a low income?  shame of l i v i n g on a low income was acknowledged  s e v e r a l times.  P a r t of one woman's s t r a t e g y f o r a v o i d i n g  the d i s c r i m i n a t i o n t h a t e x i s t s towards t h e poor was t o a v o i d s p e c i f i c aspects  of stereotypes.  She makes a  conscious  e f f o r t t o speak and appear i n a manner which p r e v e n t s  others  from r e c o g n i z i n g t h a t she i s someone who has been poor a l l her  life. It  was r e v e a l i n g t o hear the women t a l k about t h e i r  " r e l a t i o n s h i p t o money" very e x p l i c i t l y . described confusion. current  Some o f them  i t i n v a r y i n g degrees of shame, g u i l t , and One woman o b v i o u s l y blames h e r s e l f f o r h e r  situation:  A l i c e : I wanted money. was wrong with me. being  I was greedy.  That's what  I p a i d the p r i c e , I ' l l t e l l  you, o f  so i n t o money.  T h i s r e l a t i o n s h i p t o money was a l s o t i e d t o some o f t h e women's i d e n t i t i e s : Eve:  I wasn't a l l o w i n g myself t o b e l i e v e t h a t I c o u l d  make money because a l o t of t h a t i s i n g r a i n e d ,  [that]  t o make money i s t o t r y and be something you're n o t . The  p o i n t was r e i n f o r c e d by a member of t h e f i n a n c e  committee who s a i d i t " f e l t very strange all  t o suddenly have  t h i s money," even though i t was not p e r s o n a l l y  hers.  68 D e f i n i t i o n s o f Poverty One p a r t i c i p a n t very c l e a r l y d e f i n e d "having no o p t i o n s . "  being poor as  C e r t a i n l y t h e women's d e s c r i p t i o n s of  c o p i n g s t r a t e g i e s show they are working w i t h l i m i t e d r e s o u r c e s and have fewer o p t i o n s . the  This  idea  i s supported by  o b s e r v a t i o n t h a t t h e women who f i n d t h e i r income l e v e l  l e s s o f a s t r a i n , o r do not c o n s i d e r themselves "poor," have o u t s i d e r e s o u r c e s upon which t o draw.  For example, some of  the women have been a b l e t o a f f o r d e x t r a comforts due t o g i f t s o f money from f a m i l y  o r the a b i l i t y t o o b t a i n  credit.  Compared t o those who c o n s i d e r themselves poor, t h e s e women do have o p t i o n s . In d e s c r i b i n g  t h e experience of l i f e on a low income,  the women i n v a r i a b l y d i s c u s s e d coping s t r a t e g i e s they use t o manage f i n a n c i a l l y .  These s t r a t e g i e s  c l o t h i n g , and r e c r e a t i o n a l a c t i v i t i e s .  involve  food,  The two main types  of c o p i n g methods were "counting pennies" and "spend now, do without l a t e r . " by  Both types o f s t r a t e g i e s were accompanied  f e e l i n g s o f f e a r , anger, and f r u s t r a t i o n . Out  o f these d e s c r i p t i o n s  d e f i n i t i o n s of poverty.  of coping s t r a t e g i e s  emerged  For some of t h e women, poorness i s  measured by t h e i n a b i l i t y t o a f f o r d b a s i c comforts which go beyond t h e n e c e s s i t i e s of s u r v i v a l such as food and s h e l t e r , y e t do not c o n s t i t u t e a r t i c u l a t e l y defined options.  luxuries.  Poverty was a l s o  by one p a r t i c i p a n t as h a v i n g no  69  B u i l d i n g a Co-operative L i v i n g Environment For these women, the journey t o a c o - o p e r a t i v e l i v i n g environment  has been along a very bumpy road.  mentioned, urban Canadian people f o r l i v i n g  c u l t u r e does not p r o p e r l y prepare  i n a community.  The women were f a c e d w i t h  the c h a l l e n g e o f b u i l d i n g a c o - o p e r a t i v e l i v i n g from an a l l - f e m a l e group.  As p r e v i o u s l y  environment  According t o the p a r t i c i p a n t s ,  the women have s u r v i v e d abusive o r d y s f u n c t i o n a l p a s t s and some o f them a r e s t i l l  s t r u g g l i n g t o overcome them.  group o f women from d i v e r s e backgrounds have l i v e d the i n i t i a l  This through  d i f f i c u l t i e s and a r e beginning t o enjoy some o f  the b e n e f i t s of community e x i s t e n c e , although they have not reached t h e freeway y e t . These women a l l share t h e experience o f l i v i n g b u i l d i n g and t h i s neighbourhood,  i n this  and, w i t h a few e x c e p t i o n s ,  p a r t i c i p a t e i n t h e o p e r a t i o n of t h e c o - o p e r a t i v e .  Creating  a community i n a new b u i l d i n g with t h i r t y - s i x s t r a n g e r s has been v e r y c h a l l e n g i n g and "a l o t of work."  In t h e i n i t i a l  i n t e r v i e w s , t h e women focused on t h e tremendous amount o f work i n v o l v e d i n l e a r n i n g t o run t h e c o - o p e r a t i v e . Consensus d e c i s i o n - m a k i n g i s used by a l l committees which i s t i m e consuming and, a t times, f r u s t r a t i n g .  As time p r o g r e s s e d ,  however, t h e women acknowledged t h e growth o f support networks and a sense of community. they have accomplished  One woman d e s c r i b e s what  i n t h e f i r s t year as a " m i r a c l e . "  P a r t o f t h e " m i r a c l e " has been the development o f a sense o f  70  community from such a d i v e r s e group of women. Diversity One might a n t i c i p a t e t h a t a group of mature, low  income women i n t e r e s t e d i n a c o - o p e r a t i v e  would have much i n common.  single,  lifestyle  The women, however, have  r e p e a t e d l y emphasized t h e i r d i f f e r e n c e s r a t h e r than t h e i r similarities.  A t approximately  i n t e r v i e w process,  t h e midpoint of t h e  one woman was emphatic t h a t t h e women o f  the c o - o p e r a t i v e have only two t h i n g s i n common: l i v i n g i n the same b u i l d i n g , and l i v i n g on a low income,  "nothing  else." Throughout t h e i n t e r v i e w s , the women have i d e n t i f i e d many c a t e g o r i e s which h i g h l i g h t t h e i r d i v e r s i t y .  For  example, t h e r e a r e working and non-working women, d i s a b l e d (with t h e s u b - c a t e g o r i e s and n o n - d i s a b l e d years,  of v i s i b l e and hidden  women, age c a t e g o r i e s  disabilities)  ( l e s s than  forty  f o r t y t o s i x t y years, and g r e a t e r than s i x t y y e a r s ) ,  those who i d e n t i f y themselves as poor and those who do not, always poor versus newly poor, p r e v i o u s l y married married,  and gay and heterosexual  women.  and never  One woman even  c h a r a c t e r i z e d women i n terms of t h e i r involvement i n t h e c o operative: over-involved,  i n v o l v e d , and those who have  "stepped back." The  p a r t i c i p a n t s frequently pointed t o t h e i r  as a source  of actual or p o t e n t i a l c o n f l i c t .  diversity  One woman,  when asked i f t h e r e i s a d i v i s i o n between working and non-  71  working women w i t h i n t h e c o - o p e r a t i v e , responded w i t h an emphatic "yes."  She s t a t e d she b e l i e v e s t h e working women  are l e s s i n v o l v e d i n the running  of t h e c o - o p e r a t i v e and  expect t h e non-working women t o "take care of e v e r y t h i n g . " The  one working woman interviewed, however, d i d not see t h i s  difference.  She d i d imply, however, t h a t she b e l i e v e s t h e  non-working women t o be g e n e r a l l y l e s s p r o d u c t i v e by h e r statement, " I couldn't stand t o j u s t do n o t h i n g . " another example, one woman i d e n t i f i e d p r e v i o u s l y  In married  women as having g r e a t e r d i f f i c u l t y a d j u s t i n g t o l i f e  i n the  co-operative. B e t t y : There a r e a few l i k e t h a t , widowed o r d i v o r c e d , used t o male i n f l u e n c e t o h e l p take care o f them, not used t o s t a n d i n g on t h e i r own two f e e t , but t h e y ' l l a d j u s t t o l o o k i n g a f t e r themselves. The women a l s o d i f f e r i n o p i n i o n s which has l e d t o c o n f l i c t d u r i n g committee work: D o r i s : Sometimes t h e meetings i n p a r t i c u l a r g e t very v o l a t i l e and we a l l have d i f f e r e n t view p o i n t s . Another p a r t i c i p a n t d e s c r i b e d her r e s i g n a t i o n from one o f the committees.  While she enjoyed t h e work very much, a  " p e r s o n a l i t y c o n f l i c t " with another member made i t impossible  f o r her t o continue.  To an o u t s i d e observer,  t h e women do not appear  d r a m a t i c a l l y d i f f e r e n t from one another.  L y d i a used t h i s  analogy t o e x p l a i n t h e c o n t r a s t between apparent  72  s i m i l a r i t i e s and t h e v a s t d i v e r s i t y d e s c r i b e d by those interviewed. Perhaps i t ' s l i k e an a r t i s t ' s monochrome p a l e t t e . a d i s t a n c e , i t a l l looks l i k e one c o l o u r . get  From  But when you  up c l o s e , you can see a l l t h e d i f f e r e n t shades and  tones. For whatever reason, these women see t h e i r first.  differences  The women o f t h e c o - o p e r a t i v e a r e d e m o g r a p h i c a l l y  v e r y s i m i l a r , and t o t h e c a s u a l observer would appear t o have much i n common.  The women themselves,  however, have  r e p e a t e d l y focused on t h e d i v e r s i t y which e x i s t s w i t h i n t h e group. As h y p o t h e s i z e d e a r l i e r , t h e women may be r e s i s t i n g i d e n t i f i c a t i o n w i t h one another due t o t h e low s t a t u s a s s o c i a t e d w i t h being on a low income.  Perhaps,  too, the  emphasis on d i f f e r e n c e s i s a means of r e t a i n i n g one's uniqueness  i n t h e f a c e of a c o l l e c t i v e i d e n t i t y as t h e women  move i n t o g e t h e r and begin b u i l d i n g a community. The Move The f i r s t  aspect of l i f e  i n the co-operative that the  women shared was t h e experience of t h e move.  Moving t o new  accommodation can be both e x c i t i n g and s t r e s s f u l . P a r t i c i p a n t s d e s c r i b e d t h e i r a n t i c i p a t i o n upon moving i n t o a brand new b u i l d i n g , each of them with an i n d i v i d u a l  suite.  There was r e l i e f i n having s e c u r i t y and s t a b i l i t y r e l a t e d t o housing, and excitement r e g a r d i n g meeting  new people.  One  73  woman d e s c r i b e d how she was so g r a t e f u l f o r t h e c o - o p e r a t i v e t h a t she " k i s s e d t h e c a r p e t s and the w a l l s . "  Unfortunately,  f o r many o f t h e women, the problems o f t h e f i r s t seemed t o overshadow the p o s i t i v e a s p e c t s . d e s c r i b e s t h e " h o r r o r s " of the move very  few months  One woman  articulately:  D o r i s : I t was very traumatic moving i n here. absolutely h e l l .  I t was  We were l i k e l o s t sheep and i t took a  long time t o g e t over t h a t , months, and I can't  really  e x p l a i n why. Another woman d e s c r i b e d t h e move as a " d i s a s t e r . " the problem seemed t i e d t o u n f u l f i l l e d Kathryn:  Some o f  expectations:  I hated t h e co-op as soon as I moved i n . I  mean I was ready t o move out.  I absolutely despised i t  because i t wasn't what I wanted i n terms o f p h y s i c a l space.  I t ' s an a b s o l u t e p i e c e of s h i t  i n terms o f t h e  d e s i g n , i n terms of the c o n s t r u c t i o n . The  l i m i t e d p h y s i c a l space was a concern  members i n t e r v i e w e d .  f o r many o f t h e  One woman p o i n t e d t o her d r e s s e r which  i s i n t h e l i v i n g room because t h e r e i s not enough space f o r it  i n t h e bedroom.  She considered h e r s e l f b e t t e r o f f than  o t h e r s whose beds would not f i t and they had t o "send them out" and g e t s i n g l e beds. Another f a c t o r which a f f e c t e d t h e move was t h e number of problems which occurred i n the f i r s t  few months.  Kathryn  describes i t well: When I moved i n t h e r e was one t h i n g a f t e r another  that  74 happened. I s l i p p e d and f e l l .  The power was blowing  out i n t h e neighbourhood, two, t h r e e t i m e s . We were h a v i n g f a l s e alarms. The p i p e s blew. I t was l i k e  there  was a l l t h i s s t u f f happening and I thought, you know, I don't t h i n k t h i s i s a very good move. A l l t h e s e problems seemed t o c r e a t e an atmosphere  of c r i s i s  f o r t h e women who were a l r e a d y f u l l y o c c u p i e d s e t t i n g up an a d m i n i s t r a t i v e s t r u c t u r e and l e a r n i n g how t o r u n t h e c o operative.  F o r some women, however, s u c c e s s f u l l y managing  the c r i s e s strengthened a l l i a n c e s and c o n t r i b u t e d t o a sense of accomplishment.  One woman d e s c r i b e d h e r involvement i n  one emergency s i t u a t i o n w i t h p r i d e . The move t o a more a f f l u e n t neighbourhood r e q u i r e d an adjustment i n one's  identity.  Eve: When I f i r s t moved i n here I f e l t r e a l l y out o f p l a c e i n t h e neighbourhood because i t ' s a p r e t t y a f f l u e n t neighbourhood and I've never r e a l l y  lived i n  t h a t k i n d of a community. The move was f r a u g h t with many problems, and r e q u i r e d t h e women t o make adjustments on many l e v e l s .  Setting  boundaries was t h e next c h a l l e n g e f o l l o w i n g t h e move. Boundary Issues L i v i n g together, working together, and p o s s i b l y s o c i a l i z i n g t o g e t h e r make i t e s s e n t i a l t o be c l e a r boundaries.  A l l women interviewed mentioned  about  "boundary  i s s u e s " and, f o r most of them, i t was a major concern.  The  75 boundary  i s s u e s r e l a t e d t o three main problem  reaching  agreement  areas:  about t h e use of common areas,  the work o f t h e c o - o p e r a t i v e  from one's p e r s o n a l  separating l i f e , and  s e t t i n g l i m i t s on i n t e r p e r s o n a l r e l a t i o n s h i p s w i t h t h e other women. The problems r e l a t e d t o common space seem t o be t h e l e a s t complex,  and a c t i o n s a r e being taken t o r e s o l v e them.  The i s s u e s have r e v o l v e d around n o i s e , use o f a l c o h o l , and competing i n t e r e s t s f o r the a v a i l a b l e space. p a r t i c u l a r boundary  This  i s s u e was d e s c r i b e d by a woman who  t h i n k s o f her s u i t e as her "room" and b e l i e v e s many o t h e r women t h i n k of t h e e n t i r e b u i l d i n g as "home." D o r i s : I t h i n k we a l l t h i n k of t h i s , t h e whole p l a c e as our home and i t ' s j u s t , as you would i n your own home, you don't l i k e somebody e l s e mucking around.  around, messing  Somebody takes i t upon themselves t o p u t  something somewhere and you don't l i k e t h a t . Not everyone agrees with t h i s view.  One woman suggested  t h a t c o n s i d e r i n g t h e e n t i r e b u i l d i n g one's home may be i n d i c a t i v e o f boundary  problems.  Task f o r c e s have been s e t up t o examine t h e i s s u e s o f common space and t o s e t up p o l i c i e s f o r use o f them.  When a  t a s k f o r c e i s s t r u c k , however, " t h i n g s j u s t slow r i g h t down," so t h e problems have not y e t been s o l v e d , but t h e women seemed s a t i s f i e d t h a t they a r e being addressed. Separating  t h e work of the c o - o p e r a t i v e  from  one's  76  personal  l i f e begins by making d i s t i n c t i o n s between  i n t e r a c t i o n s t h a t occur as p a r t of t h e work o f t h e c o o p e r a t i v e from o r d i n a r y i n t e r p e r s o n a l r e l a t i o n s h i p s o f a s o c i a l o r neighbourly  nature:  D o r i s : Sometimes you might have d i f f e r e n t o p i n i o n s and then i f you're s o c i a l i z i n g as f r i e n d s i t c o u l d conflict.  [cause]  What I t r y t o do i s i f I l o s e my temper o r I  have a disagreement with someone t h a t ' s g o t a d i f f e r e n t o p i n i o n , I leave i t behind The  a t t h e meeting.  problem o f drawing a l i n e between t h e work o f t h e c o -  o p e r a t i v e and one's p e r s o n a l l i f e  i s compounded by t h e  amount o f work i n v o l v e d which exceeded everyone's expectations.  One woman s a i d t h e amount of work f e l t more  l i k e t e n hours p e r week i n s t e a d of t e n hours p e r month. d e s c r i b e s t h e overflow and  life  space t h i s way: Alice:  Not  of t h e work i n t o her p e r s o n a l  She  T h i s p l a c e became an o f f i c e .  I mean, I had  paperwork [everywhere].  I was l i k e committee here o r  committee t h e r e .  l i k e I d i d n ' t have a l i f e .  I felt  o n l y i s t h e r e a huge volume of work, but i t s  d i s t r i b u t i o n has been uneven.  While some women have "worked  t h e i r b u t t s o f f , " others have c o n t r i b u t e d much l e s s . women b e l i e v e they have done "too much," w i t h  Some  detrimental  consequences attached t o becoming " o v e r - i n v o l v e d "  i n the  work o f t h e c o - o p e r a t i v e : Eve: A l o t o f people got c l o s e t o being very s i c k here  77  i n t h e b e g i n n i n g because they j u s t thought they had t o keep g i v i n g and g i v i n g because no one e l s e was going t o do i t . In a t r i a l and e r r o r f a s h i o n , t h e women l e a r n e d t e c h n i q u e s t o s e p a r a t e t h e work from the r e s t of t h e i r l i v e s , w i t h a c c e p t a b l e standards o f behaviour emerging.  F o r example, i t  i s g e n e r a l l y unacceptable t o knock on someone's door t o discuss co-operative business.  Any complaints o r problems,  u n l e s s emergencies, a r e t o be addressed i n w r i t t e n form t o the c h a i r p e r s o n of t h e a p p r o p r i a t e  committee.  A few members have responded t o t h e c o n f l i c t and boundary  i s s u e s by withdrawing completely from co-op  and n o n - p a r t i c i p a t i o n has become another major i s s u e .  life, When  asked what form t h i s withdrawal takes, one woman d e s c r i b e d o t h e r s who have not attended any meetings f o r months and a r e seldom seen around t h e b u i l d i n g as they "sneak i n t h e back door."  While temporary withdrawal i s a c c e p t a b l e when one  "needs a break," t o withdraw t o t a l l y i s not.  One woman  blames those, h e r s e l f i n c l u d e d , who have made i t easy f o r some not t o c o n t r i b u t e by doing e v e r y t h i n g f o r them.  In any  case, a t a s k f o r c e has been s e t up t o t r y t o "get back" these n o n - p a r t i c i p a t i n g members. S e v e r a l of t h e women t a l k e d about t h e need t o s e t l i m i t s on t h e i r i n t e r p e r s o n a l r e l a t i o n s h i p s t o m a i n t a i n p e r s o n a l space, p r i v a c y , and mental h e a l t h : A l i c e : T h i s i s probably my own p e r c e p t i o n t h a t I had t o  78  almost b e f r i e n d these 35 other women and i t ' s j u s t unrealistic. D o r i s : Some people have found t h a t t h e y . . . g e t t o o f r i e n d l y w i t h somebody and t h e y ' r e t a p p i n g on t h e i r door a l l t h e time and l o s i n g t h e i r  privacy.  One p a r t i c i p a n t i d e n t i f i e d t h e women's " d y s f u n c t i o n a l " backgrounds as c o n t r i b u t i n g t o t h e c h a l l e n g e o f n e g o t i a t i n g i n t e r p e r s o n a l boundary i s s u e s . L y d i a : You can g e t r e a l l y entangled i n each o t h e r s ' l i v e s here i f you don't have good boundary s k i l l s . can be s c a r y because huge amount o f need.  It  some people here r e a l l y have a I f e e l l i k e i f I took t h a t upon  myself t o s t a r t t r y i n g t o f u l f i l a l l t h e t h i n g s I see they need then maybe I wouldn't have any more time f o r myself ever again. Another woman concurred t h a t i t i s both u n h e l p f u l and unhealthy t o respond t o t h e " t e l l  me what t o do" a s p e c t o f  another's neediness, hence f a l l i n g i n t o o l d p a t t e r n s o f c o dependency. Over t h e course of the f i r s t  year, t h e women began t o  come t o terms with t h e boundary i s s u e s .  Sometimes a move  towards t h e o p p o s i t e extreme was needed t o a c h i e v e b a l a n c e . The words "stepped back," "stayed back," o r "backed  away"  were used r e p e a t e d l y , i n regards t o t h e i r involvement i n t h e operation of the co-operative: Eve: I guess my s t r a t e g y here has been a l i t t l e  b i tto  79 s t a y back, j u s t t o be i n v o l v e d jeopardize  t o a degree t h a t  doesn't  those boundaries but a l s o keeps up w i t h  my  commitment t o the co-op; and i n r e g a r d s t o i n t e r p e r s o n a l Alice:  ...And then I was  relationships:  l i k e too much, too many, too  much company, so I j u s t back away and I back away. Although the women i n d i c a t e they are making p r o g r e s s w i t h the boundary i s s u e s ,  i t remains a very d i f f i c u l t t a s k .  of the women expressed f e e l i n g s of g u i l t or concern  Some  that  o t h e r s would be offended by t h i s s e t t i n g of l i m i t s on interpersonal  relationships:  A l i c e : I've got t h i s t h i n g t h a t they won't l i k e me  or  t h a t t h e y ' l l t h i n k t h a t I don't want t o have a n y t h i n g t o do with them. There i s , however, s a t i s f a c t i o n i n s e t t i n g l i m i t s and f i n d i n g the consequences A l i c e : I'm  more p o s i t i v e than  q u i t e content and now  anticipated:  t h a t I've s e t these  boundaries f o r myself, i t ' s much b e t t e r . S e t t i n g a p p r o p r i a t e boundaries means "drawing the  lines"  between f r i e n d s , acquaintances, c o l l e a g u e s i n committee work, and those w i t h whom one does not a s s o c i a t e Determining who  i s s i m i l a r t o and d i f f e r e n t from h e r s e l f  a s s i s t s each woman t o f i n d where she " f i t s  i n , " the  s t e p i n the development of a support network. s e t t i n g also requires first,  at a l l .  first  Boundary-  t h a t each member takes c a r e of h e r s e l f  and f i n d s a balance i n honouring her commitment t o  80  the c o - o p e r a t i v e without doing t o o much. B u i l d i n g Support Networks B u i l d i n g support networks r e q u i r e s a number o f s t e p s for  these women.  F i r s t , the women found they need t o accept  the f a c t t h a t you cannot be "best f r i e n d s " w i t h a l l t h i r t y f i v e o t h e r women.  Since t h a t i s not p o s s i b l e , one needs t o  seek out o t h e r s , sometimes by t r i a l and e r r o r , w i t h whom you are compatible and can " f i t i n . " W i t h i n these s m a l l e r groups o f like-minded i n d i v i d u a l s ,  "support happens."  N e g o t i a t i n g boundary i s s u e s seems c l o s e l y t i e d t o t h e tasks of " f i t t i n g the c o - o p e r a t i v e . "fitting  i n " and b u i l d i n g support networks w i t h i n Participants discussed the issue of  i n " within the co-operative's structures,  f o r m a l and i n f o r m a l . be a new concern.  both  For many o f them, i t d i d not seem t o  For example, one woman d e s c r i b e d h e r s e l f  as h a v i n g always f e l t " d i f f e r e n t . " o p e r a t i v e , not " f i t t i n g  In regards t o t h e c o -  i n " was o f t e n d e s c r i b e d w i t h i n t h e  c o n t e x t o f t h e d i v e r s i t y of t h e members.  F a c t o r s such as  age d i f f e r e n c e s were an i s s u e : Eve: There's always t h a t sense of I'm younger than most of  t h e people here so I do have t h a t sense o f not q u i t e  fitting  i n t h e way others f i t i n .  None o f t h e women i n t e r v i e w e d a c t u a l l y expressed a sense of "fitting  i n , " i n s t e a d many emphasized f e e l i n g s o f  separateness w i t h phrases such as " I don't f e e l i n v o l v e d " o r "the co-op i s n ' t my l i f e . "  fully  There were  81 i n d i c a t i o n s , however, t h a t some r e s o l u t i o n of t h e " f i t t i n g in"  issue i s occurring: B e t t y : I've always been t h a t h a l f - a - s t e p out o f step a l l my l i f e .  I t h i n k now i t ' s not so odd but now I  stand a s i d e from people and I'm not t h e o n l y one t h a t ' s h a l f out of step.  I've got company now, e s p e c i a l l y i n  here. B e t t y ' s comments i n d i c a t e t h a t t h e women o f t h e c o - o p e r a t i v e are d i s c o v e r i n g some common ground, even i f i t i s i n terms of them a l l being  " d i f f e r e n t " i n some way.  S e v e r a l women have made a c l e a r d i s t i n c t i o n between t h e formal and i n f o r m a l s t r u c t u r e s w i t h i n t h e c o - o p e r a t i v e . . The c o n f l i c t , work overload, and "burnout" a s s o c i a t e d committee work has, connotation  with  f o r some women, r e s u l t e d i n a n e g a t i v e  t o t h e word "co-op."  The word has come t o be  a s s o c i a t e d with t h e formal s t r u c t u r e s .  While many p o s i t i v e  a s p e c t s were a s s o c i a t e d with the i n f o r m a l r e l a t i o n s h i p s t h e women had developed, they were c o n s i d e r e d by many as separate  from t h e co-op.  I t i s i n t e r e s t i n g t o note t h a t  some o f t h e women denied a sense of community o r downplayed t h e i r involvement i n t h e c o - o p e r a t i v e , y e t t h e i r c o n t r a d i c t e d t h e i r statements.  actions  One woman d e s c r i b e d h e r s e l f  as "not r e a l l y i n v o l v e d i n t h e co-op," y e t she i s both t h e a c t i n g c h a i r p e r s o n and r e c o r d e r f o r a major committee and an a c t i v e p a r t i c i p a n t on a new task f o r c e .  When asked, another  woman s t a t e d t h e r e was no sense of community, .yet  later  82  d e s c r i b e d how much she enjoys " c h a t t i n g " t o t h e o t h e r women when she meets them i n t h e h a l l ,  i n t h e laundry room, o r on  the bus. There a r e i n d i c a t i o n s t h a t a sense of community does e x i s t d e s p i t e some p a r t i c i p a n t s ' statements  t o the contrary.  Many p a r t i c i p a n t s r e f e r r e d t o t h e " o u t s i d e world" o r t h e " l a r g e r community."  Mary d e s c r i b e s how t h e concepts o f  " i n s i d e r " and " o u t s i d e r " were c l e a r l y i l l u s t r a t e d a t a r e c e n t g e n e r a l meeting.  A v i s i t o r was p r e s e n t a t t h e  meeting and Mary d e s c r i b e d how one c o u l d "sense a r i p p l e pass through  t h e group" as people r e c o g n i z e d t h e presence o f  an o u t s i d e r and questioned why she was t h e r e . In l a t e r i n t e r v i e w s , t h e women r e a d i l y acknowledged t h e presence  of support systems w i t h i n t h e c o - o p e r a t i v e .  p a r t i c i p a n t s defined the f i r s t  Some  step towards b u i l d i n g a  support system as i d e n t i f y i n g others who a r e s i m i l a r t o you or share common i n t e r e s t s . L y d i a : People can u s u a l l y t e l l through  i n s t i n c t who  t h e y ' r e going t o be s i m i l a r t o and comfortable  with.  One p a r t i c i p a n t s a i d " i t i s a matter of not f o r c i n g connections."  Another woman d e s c r i b e d i t as a p r o c e s s o f  " c l i c k i n g o r not c l i c k i n g " with o t h e r s .  She d e s c r i b e d how  she has s a t i s f y i n g c o n v e r s a t i o n s with some women and y e t does not speak t o others a t a l l . The  support networks developing w i t h i n t h e c o - o p e r a t i v e  are mostly  of an i n f o r m a l nature.  Efforts to formalize  83  support networks have been u n s u c c e s s f u l .  In one i n s t a n c e ,  an attempt was made t o i n s t i t u t e a formal "buddy system" f o r women w i t h d i s a b i l i t i e s .  The p l a n was met w i t h  complete  resistance. L y d i a : Someone had t h i s p l a n . neighbour  You'd be a s s i g n e d t o a  t o go t o [ f o r help] and so many o f us  r e s i s t e d t h a t and s a i d , "No way, we want t o go t o whoever we've e s t a b l i s h e d t r u s t w i t h . " In  another example, a support group f o r women w i t h  disabilities,  initiated  hidden  by one woman, d i s s o l v e d due t o  d e c r e a s i n g p a r t i c i p a t i o n and l a c k of a c l e a r  purpose.  A l l other support d e s c r i b e d i n t h e i n t e r v i e w s was of an i n f o r m a l nature. L y d i a : I've seen a l o t o f support happen here and i t ' s not u s u a l l y organized. of  I t ' s j u s t t h e neighbours  t a k i n g i t on themselves  sort  t o reach out t o t h e person.  T h i s i n f o r m a l support takes a v a r i e t y o f forms and seems t o fall  into the following categories: concrete or m a t e r i a l  support, i n f o r m a t i o n a l support, i n s p i r a t i o n a l support, and emotional  support.  Concrete support, d e s c r i b e d by one o f t h e women as "a t h i n g support" encompasses money, m a t e r i a l goods, and physical assistance.  Cards of sympathy o r support a r e  c i r c u l a t e d f o r s i g n a t u r e s and g i v e n t o women who a r e i l l o r have experienced a r e c e n t l o s s of a f a m i l y member.  One  woman emphasized t h a t no one i n the c o - o p e r a t i v e i s i n a  84  p o s i t i o n t o p r o v i d e monetary support t o another  i n need.  She d e s c r i b e d an agreement she has w i t h a neighbour  for a  $2 0 l o a n a t t h e end of the month when one o f them i s "caught short,"  a t e n t a t i v e arrangement a t best, as n e i t h e r o f them  can depend on t h e other t o have an e x t r a $2 0 when i t i s needed. Kathryn  spoke e n t h u s i a s t i c a l l y about t h e " f r e e b i e box"  i n t h e laundry room.  In t h i s box,  insiders or outsiders  d i s c a r d c l o t h i n g and other items which can be c l a i m e d by o t h e r s on a " f i r s t - c o m e , f i r s t - s e r v e d " b a s i s . Kathryn  Not o n l y has  found s e v e r a l d e s i r a b l e items o f new c l o t h i n g f o r  h e r s e l f , but a neighbour  has claimed a number o f items f o r  her which she has g r e a t l y a p p r e c i a t e d . I n f o r m a t i o n a l support was d e s c r i b e d by s e v e r a l participants.  For example, one person mentioned a n o t i c e  f o r a food bank posted on the b u l l e t i n board as b e i n g a b e t t e r way t o h e l p someone than a c t u a l l y g i v i n g them food. Another woman d e s c r i b e d " h e a l i n g i n f o r m a t i o n " which has been extremely  h e l p f u l t o her, such as t h e name o f an e x c e p t i o n a l  p h y s i o t h e r a p i s t t h a t s e v e r a l of t h e women a r e now v i s i t i n g . I n f o r m a t i o n on n u t r i t i o n , food a l l e r g i e s , and r e c i p e s i s a l s o exchanged. I n s p i r a t i o n a l support takes a number o f forms.  Some  women d e s c r i b e d how the courage seen i n o t h e r s as they struggle with various challenges i s i n s p i r i n g . another woman d e s c r i b e d how she f e l t  Conversely,  "sorry for h e r s e l f "  85  when she l i v e d alone, but seeing t h e d i f f i c u l t i e s f a c e d by o t h e r s i n t h e c o - o p e r a t i v e , she has r e c o g n i z e d h e r own s t r e n g t h s and a b i l i t i e s ,  and has seen her work p r o g r e s s as a  result. While organized s o c i a l events a r e enjoyed wonderful  parties"),  ("We have  they do have t h e i r awkward "moments.  L y d i a : Everyone i s k i n d of shy so maybe o n l y one person i s speaking and you're aware o f t h i r t y o t h e r  people  p a y i n g a t t e n t i o n t o your every word so i t ' s k i n d o f inhibiting. Even many o f t h e "organized" events a r e r e l a t i v e l y i n f o r m a l , such as t h e v i d e o n i g h t s where a group gets t o g e t h e r t o watch a movie. The g r e a t e s t s o c i a l and emotional  support develops as  the women d i s c o v e r others with whom they " c l i c k " and friendships are established.  Dyads o r s m a l l groups o f women  "get t o g e t h e r f o r c o f f e e " o r go out t o g e t h e r .  I t i s within  these i n f o r m a l s t r u c t u r e s t h a t the women l i s t e n t o one another,  o f f e r emotional  support, and share i n f o r m a t i o n .  B e t t y ' s comments best i l l u s t r a t e the type o f support available: I r e l y on t h e people talk to.  i n here as f r i e n d s ,  They help me a l o t .  j u s t people t o  I have a f r i e n d .  s t o p s always before she goes o u t s i d e .  She  She says do you  need anything, she always stops t o see i f I'm okay. The  support w i t h i n t h e c o - o p e r a t i v e i s mainly a r e s u l t o f  86  i n f o r m a l networks, and i t i s growing. Kathyrn:  I can see t h a t t h e r e i s a community  building  and d e v e l o p i n g , t h a t some people a r e r e a l l y t h e r e f o r o t h e r people,  and t h e r e i s a support system c r e a t e d  which i s very n i c e t o see and t o be around. The  energy expended by the women i n seeking out c o n n e c t i o n s  and e s t a b l i s h i n g t r u s t i n g r e l a t i o n s h i p s w i t h  select  i n d i v i d u a l s o r groups i s beginning t o reap tremendous b e n e f i t s i n terms of the support  gained.  What i s Health f o r these Women? The women d i s c u s s e d t h e i r many and v a r i e d h e a l t h problems, from food a l l e r g i e s t o c a r d i a c a r r e s t .  I t was  not, however, from t h e i r i n d i v i d u a l s t o r i e s o f i l l n e s s t h a t the meaning o f h e a l t h f o r these women emerged. shared b e l i e f s , v a l u e s , and concerns from t h e i r d e s c r i p t i o n s of d a i l y  Instead, t h e  r e g a r d i n g h e a l t h arose  life.  S a f e t y and s e c u r i t y f i g u r e l a r g e l y i n t h e d e f i n i t i o n o f h e a l t h f o r these women, and were mentioned by everyone interviewed.  When asked t o d e f i n e h e a l t h , one woman  d e s c r i b e s h e a l t h as contentment, then d i r e c t l y l i n k s i t t o safety: Alice:  [Health i s ] a l o t of peace o f mind...being  content q u i t e a b i t , f e e l i n g s a f e i n your environment. " F e e l i n g s a f e " seems t o encompass t h r e e areas, which a r e p h y s i c a l s a f e t y , f i n a n c i a l s e c u r i t y , and emotional Although  security.  t h e trauma of "the move" and t h e d i f f i c u l t i e s  87  r e l a t i n g t o the operation  of t h e c o - o p e r a t i v e ,  setting  boundaries, and f i t t i n g i n have taken a t o l l on t h e women t o some extent,  o v e r a l l t h i s measure o f h e a l t h ,  " f e e l i n g safe",  seems t o be enhanced by l i v i n g i n t h e c o - o p e r a t i v e . the  i s s u e s of p h y s i c a l s a f e t y a r e examined. A f t e r a sexual a s s a u l t a t a young age,  she  First,  still  increased  one woman says  never goes out a t n i g h t , but d i s c u s s e d t h e f e e l i n g o f s a f e t y i n t h i s new neighbourhood due t o  the number o f shops and s t o r e s .  Her former neighbourhood  l a c k e d these amenities and was comprised o f h o t e l s , pubs, and  l a r g e b u s i n e s s e s such as an automobile d e a l e r s h i p , a l l  on a very busy thoroughfare: Julia:  I f someone f o l l o w s you,  food r e s t a u r a n t ] ordering  you j u s t go i n t o a [ f a s t  and stay t h e r e and p r e t e n d you're  something.  Another woman d e s c r i b e d  a f e e l i n g of s a f e t y i n h a v i n g  neighbours c l o s e a t hand.  " I l i k e l i v i n g alone i n t h i s  s u i t e but I l i k e knowing t h a t I have t h e neighbours here." T h i s same woman c a l l e d me s h o r t l y a f t e r her i n t e r v i e w t o r e p o r t t h a t d u r i n g t h e n i g h t someone had climbed up t h e s i d e of t h e b u i l d i n g t o t h e f o u r t h f l o o r , and she been v e r y r e l i e v e d t h a t others,  i n a d d i t i o n t o h e r s e l f , heard t h e  i n t r u d e r and c a l l e d t h e p o l i c e . Connections were drawn between income and h e a l t h . Nancy expressed her wish t o r e t u r n t o t h e work f o r c e , b u t due  t o her food a l l e r g i e s , g r o c e r i e s consumed a l a r g e  88  p o r t i o n of her income.  Without s u f f i c i e n t income t o buy t h e  s p e c i a l foods, however, she says she w i l l not be s t r o n g enough t o go back t o work. H e a l t h p r a c t i c e s were d i r e c t l y i n f l u e n c e d , i n many i n s t a n c e s , by t h e women's f i n a n c i a l s i t u a t i o n s .  Several  p a r t i c i p a n t s d e s c r i b e d f r u s t r a t i o n a t being l i m i t e d i n t h e i r p r e f e r r e d h e a l t h p r a c t i c e s by a l a c k o f money. suggested  These women  t h a t v i t a m i n s and a l t e r n a t i v e t h e r a p i e s such as  acupuncture should be covered  by medical  insurance  plans.  Another l i m i t a t i o n t o h e a l t h y c h o i c e s was t h e h i g h c o s t o f o r g a n i c foods.  One p a r t i c i p a n t questioned whether t h e  s t r e s s o f being a b l e t o a f f o r d only produce which might be h i g h i n chemicals itself.  a d v e r s e l y a f f e c t e d h e a l t h i n and o f  A l l o f t h e women interviewed have s p e c i a l h e a l t h  concerns ranging from food a l l e r g i e s t o emotional  problems.  I t i s u n f o r t u n a t e t h a t , f o r many of them, a l i m i t e d i n t e r f e r e s with t h e i r a b i l i t y t o address  income  these concerns i n  the manner they would p r e f e r . In terms of f i n a n c i a l s e c u r i t y , some o f t h e women were q u i c k t o emphasize t h a t t h e i r l i v e s a r e not easy now, but t h a t f i n a n c i a l l y t h i n g s have improved c o n s i d e r a b l y . Kathryn:  I don't have t o worry about t h e f i n a n c e s so  much because of being on subsidy and t h a t ' s a g r e a t relief.  There's a sense of being a b l e t o have a b i t  more and t h e r e ' s a sense of s e c u r i t y . A l l o f t h e women seemed t o make a c l e a r  distinction  89  between p h y s i c a l and emotional emotional  health.  Emotional  s e c u r i t y ) f o r these women encompasses  h e a l t h y boundaries,  and f e e l i n g s of c o n t r o l .  h e a l t h (or self-esteem,  In terms of  s e l f - e s t e e m , t h e r e were many r e f e r e n c e s t o ways i n which t h e c o - o p e r a t i v e improved t h e women's s e l f - e s t e e m .  Enhanced  s e l f - w o r t h accompanied merely l i v i n g i n a " n i c e " b u i l d i n g i n a good neighbourhood. D o r i s : I t h i n k i t [the co-op] would g i v e them a f e e l i n g t h a t t h e y ' r e worthwhile, t h a t they do deserve nice.  I t h i n k i t helps t h e i r  self-esteem.  O p p o r t u n i t i e s t o l e a r n new s k i l l s a l s o promoted One  woman admitted  self-esteem.  t h a t she had not known how t o w r i t e a  cheque u n t i l a year ago. committees, although positive  something  P a r t i c i p a t i n g on t h e v a r i o u s  s t r e s s f u l a t times, p r o v i d e d many  experiences:  B e t t y : I was very s u r p r i s e d when I got voted Board of D i r e c t o r s ] .  i n [to the  I was dumbfounded. I never  thought t h a t I was t h a t popular.  I was v e r y  Kathryn:  of one o f t h e  I'm now t h e minute-taker  committees.  shocked.  The c h a i r p e r s o n acknowledged how good t h e  minutes were and I thought, ooh, I f e l t good, I f e e l r e a l l y good about t h a t acknowledgment. In a d d i t i o n t o t h e i n d i v i d u a l s k i l l s and accomplishments, t h e r e i s an o v e r a l l sense of achievement i n being a b l e t o operate  the co-operative:  Eve:  The f a c t t h a t we're a l l women, I mean t h a t ' s g r e a t  90  in  i t s e l f because t h a t b u i l d s s e l f - e s t e e m , too, because  we're not depending on anybody from the male gender t o come and save our co-op or make our co-op f u n c t i o n or rescue us from anything happening here.  We  have t o do  i t o u r s e l v e s and when we do t h a t , i t b u i l d s esteem. Inherent  i n t h i s d e s c r i p t i o n of enhanced s e l f - e s t e e m i s an  element of c o n t r o l . co-op l i f e , of  In d i s c u s s i n g the p o s i t i v e a s p e c t s of  many of the women used phrases such as "a  sense  c o n t r o l " or "being empowered": Kathryn: There's more a sense of being i n c o n t r o l of life  and I l i k e t h a t .  Eve:  I t ' s the f i r s t time I've ever l i v e d i n a p l a c e  my  t h a t e v e r y t h i n g works, and a l s o t h a t I have some c o n t r o l over, t h a t I don't have t o go look t o somebody e l s e , you know, t o f i x t h i n g s or t o o r g a n i z e t h i n g s , so in  t h a t sense i t ' s r e a l l y good.  T h i s sense of c o n t r o l c o n t r a s t s s h a r p l y w i t h the women's e x p e r i e n c e s of l i v i n g on a low income where they s t r u g g l e w i t h l i m i t e d o p t i o n s and f e e l a t the mercy of s o c i a l services. H e a l t h was  even d e f i n e d i n terms of community.  Nancy, "a h e a l t h f u l environment i s one where people l e a r n i n g t o l i v e with one another."  For are  She q u e s t i o n e d whether  many of our s o c i e t y ' s problems are a r e s u l t of t h i s i n a b i l i t y t o l i v e together i n community. The c h a l l e n g e with boundaries,  gaining control,  and  91 e s t a b l i s h i n g h e l p f u l r e l a t i o n s h i p s a l s o seems t o i n v o l v e gaining  perspective:  Eve:  People are f i n d i n g out where they f i t and what  t h e i r r o l e can be, and not everybody i s p a n i c k i n g  about  the s m a l l t h i n g s anymore because I t h i n k we've stepped back and seen t h e o v e r a l l p i c t u r e . Summary The  p a r t i c i p a n t s of t h i s study b e l i e v e t h a t t h e women  of t h i s housing c o - o p e r a t i v e ,  although d i v e r s e i n many ways,  share s i g n i f i c a n t common experiences. i n c l u d e d y s f u n c t i o n a l or abusive  These  experiences  backgrounds, l i v i n g on low  income, and t h e d i f f i c u l t y of f i n d i n g adequate, a f f o r d a b l e housing. They a r e engaged i n t h e c h a l l e n g e  of b u i l d i n g a  community out o f t h i r t y - s i x women who were strangers.  This challenge  not had experiences  initially  i s i n t e n s i f i e d i n t h a t many have  c o n t r o l l i n g t h e i r own environments.  While they have i d e n t i f i e d many s t r e s s e s a s s o c i a t e d w i t h t h e t a s k s o f l e a r n i n g t o operate the c o - o p e r a t i v e ,  setting  boundaries, and f i t t i n g i n , they a r e a l s o beginning t o i d e n t i f y p o s i t i v e aspects  of c o - o p e r a t i v e  life.  S u b s i d i z e d r e n t i n a permanent home has i n c r e a s e d f e e l i n g s o f s e c u r i t y and reduced some of t h e s t r a i n o f l i v i n g on a low income. and  The b e t t e r q u a l i t y neighbourhood  l i v i n g i n community have i n c r e a s e d f e e l i n g s o f p h y s i c a l  safety.  As boundaries a r e n e g o t i a t e d  and support  networks  92 emerge, t h e women i d e n t i f y the p o t e n t i a l f o r a h e a l t h i e r way of  life. The women i n t h i s study a r e seen t o c o n s t r u c t h e a l t h i n  terms o f b a s i c needs.  They d e f i n e h e a l t h i n terms o f  s a f e t y , s e c u r i t y , adequate s h e l t e r , and having comforts.  basic  The women's b e l i e f s and values r e g a r d i n g h e a l t h  m i r r o r those of t h e l a r g e r s o c i e t y .  U n l i k e women i n h i g h e r  income b r a c k e t s , t h e i r incomes r e s t r i c t t h e i r o p t i o n s f o r health practices.  Some of t h e women, however, have  developed c r e a t i v e s t r a t e g i e s f o r c a r r y i n g out these h e a l t h p r a c t i c e s w i t h i n t h e c o n s t r a i n t s of t h e i r income. The housing  c o - o p e r a t i v e , even f o r those women who a r e  committed t o t h e i d e a l s of community l i f e ,  i s f i r s t and  foremost a p l a c e o f secure, a f f o r d a b l e housing.  The women  v a r y g r e a t l y i n t h e i r a t t i t u d e s towards t h e c o - o p e r a t i v e as a home.  Some of t h e women view i t as a long term r e s i d e n c e ,  w h i l e o t h e r s see i t as a "stepping stone," a l l o w i n g them an o p p o r t u n i t y t o strengthen t h e i r h e a l t h and develop new s k i l l s , with t h e u l t i m a t e g o a l of r e t u r n i n g t o t h e workforce. refuge.  In t h i s regard, the c o - o p e r a t i v e i s a temporary  I t p r o v i d e s t h e women with hope f o r a b e t t e r  future. The  c o - o p e r a t i v e i s somewhat of a "mixed b l e s s i n g " f o r  the women i n terms of t h e i r h e a l t h .  While l i v i n g t h e r e has  reduced t h e f i n a n c i a l s t r e s s and p r o v i d e d a sense o f s t a b i l i t y , t h e demands of p a r t i c i p a t i n g i n i t s o p e r a t i o n has  93  created  new  stresses.  Sadly, s e v e r a l of the  b e l i e v e t h e i r h e a l t h has co-operative.  d e t e r i o r a t e d s i n c e moving i n t o  Perhaps, i n time, as the  a s p e c t s of the c o - o p e r a t i v e the new  evident.  way  the  administrative  s t a b i l i z e , and  s k i l l s needed f o r t h i s new  b e n e f i t s w i l l become  participants  the women develop  of l i f e ,  health  94  CHAPTER 5 DISCUSSION Introduction To date, v i r t u a l l y no r e s e a r c h has been completed on the h e a l t h o f unattached women l i v i n g on a low income.  This  study p r o v i d e s d e s c r i p t i v e i n f o r m a t i o n on t h e everyday experiences  o f t h i s d i s c r e t e group o f women l i v i n g on low  income i n one c o - o p e r a t i v e housing  p r o j e c t . The purpose o f  t h i s study was t o develop a beginning  understanding  o f how  l i v i n g on a low income i n t h i s context a f f e c t s t h e h e a l t h o f these women, by e x p l o r i n g how they c o n s t r u c t h e a l t h i n t h e i r lives. low  The r e s u l t s a r e not g e n e r a l i z a b l e t o other groups o f  income women, but they do r a i s e q u e s t i o n s  f o r further  research. In t h i s chapter,  t h e most s i g n i f i c a n t a s p e c t s o f t h e  f i n d i n g s a r e d i s c u s s e d i n l i g h t of r e l e v a n t r e s e a r c h .  Due  t o t h e d e a r t h o f s t u d i e s on unattached low income women, references t o the l i t e r a t u r e include references t o opinion papers and r e l a t e d r e s e a r c h .  The i m p l i c a t i o n s o f t h e  f i n d i n g s f o r n u r s i n g p r a c t i c e , n u r s i n g education, and n u r s i n g r e s e a r c h a r e contained  i n the f o l l o w i n g s e c t i o n .  Subsequently, t h e method of the study and i t s l i m i t a t i o n s are d i s c u s s e d .  A summary of t h e study concludes  this  chapter. D i s c u s s i o n of t h e F i n d i n g s Initially,  t h e e f f e c t s of l i v i n g i n a housing c o -  95  o p e r a t i v e was not a n t i c i p a t e d t o be t h e major f o c u s o f t h i s study.  As t h e i n t e r v i e w s proceeded,  however, a d j u s t i n g t o  t h i s new way o f l i f e was found t o be t h e most p r e s s i n g h e a l t h concern f o r t h e m a j o r i t y of t h e p a r t i c i p a n t s .  For  t h i s reason, t h e most s i g n i f i c a n t f i n d i n g s o f t h e study a r e r e l a t e d d i r e c t l y or i n d i r e c t l y to l i f e  i n t h i s housing c o -  operative. Three of t h e most i n t e r e s t i n g aspects o f t h e f i n d i n g s of  t h i s study a r e d i s c u s s e d i n t h i s chapter.  The f i r s t  a s p e c t i s t h a t t h e women were found t o p e r c e i v e themselves as a d i v e r s e group without a common i d e n t i t y .  This lack of  a common i d e n t i t y seemed t o i n t e r f e r e w i t h t h e i n t e r p e r s o n a l i n t e r a c t i o n s t h e women had with one another t o t h e e x t e n t t h a t t h e s o c i a l environment of  stress.  was i d e n t i f i e d as a major source  The second s i g n i f i c a n t aspect of t h e f i n d i n g s i s  t h a t t h e environment  exerted both p o s i t i v e and n e g a t i v e  e f f e c t s on t h e women's h e a l t h , with t h e p h y s i c a l h a v i n g many p o s i t i v e consequences.  environment  The f i n a l a s p e c t o f t h e  f i n d i n g s t o be d i s c u s s e d i s the women's c o n s t r u c t i o n o f health.  H e a l t h was d e f i n e d as " f e e l i n g s a f e " and was  u n d e r l i n e d by a theme of c o n t r o l .  These f i n d i n g s have been  o r g a n i z e d around t h e f o l l o w i n g concepts: the environment  (1)  identity  (2)  ( i n c l u d i n g both t h e p h y s i c a l and s o c i a l  c o n t e x t s ) and (3)  control.  An examination o f t h e f i n d i n g s  i n r e l a t i o n t o these concepts demonstrates  they a r e c l o s e l y  i n t e r - r e l a t e d and a l l a f f e c t t h e women's h e a l t h .  96 I d e n t i t y and Self-Concept I d e n t i t y , or a coherent sense of s e l f , health.  Without  i s important f o r  " t h a t sense of s e l f h o o d , o n l y r e t r e a t and  entrenchment a r e t h e v i a b l e a l t e r n a t i v e s t o a s c h i z o p h r e n i c and d i s t u r b e d e x i s t e n c e " (Rutherford, 1990, p. 24). While i d e n t i t y p r o v i d e s a s t a b l e core t o a person's it  individuality,  i s about belonging, as w e l l as being d i f f e r e n t  others  (Weeks, 1990).  identifying  Nozick  from  (1992) d e s c r i b e s how  w i t h one's peers leads t o self-knowledge by  p r o v i d i n g a " m i r r o r " t h a t r e f l e c t s back t o us who we a r e and what we might be. One  o f t h e most s t r i k i n g and unexpected  findings of  t h i s study was t h e women's l a c k of a sense o f b e l o n g i n g t o one another.  The women i n t e r v i e w e d p e r c e i v e d themselves as  a d i v e r s e group without a common i d e n t i t y .  Although t h e  l i t e r a t u r e supports the view t h a t low income women a r e a d i v e r s e group w i t h v a r y i n g needs ( N a t i o n a l C o u n c i l o f Welfare, 1990; Wilson, 1988), t h e women o f t h i s sample a r e d e m o g r a p h i c a l l y very s i m i l a r , their  y e t they r e p e a t e d l y  emphasized  differences. The women's r e l u c t a n c e t o i d e n t i f y w i t h t h e c o -  o p e r a t i v e as a whole was e x p l a i n e d by t h e p a r t i c i p a n t s . They gave reasons f o r t h i s outlook as having been a l l their their  different  l i v e s , o r suggesting they d i d not want t o l o s e  i n d i v i d u a l i t y w i t h i n t h e c o l l e c t i v e whole.  The  l i t e r a t u r e r e g a r d i n g c o - o p e r a t i v e housing supports t h e i d e a  97 of t h i s t e n s i o n between community i d e n t i t y and i n d i v i d u a l i s m (Cooper  & Rodman, 1994; Ley,  1993).  W i t h i n our s o c i e t y ,  w i t h i t s emphasis on i n d i v i d u a l growth and achievement,  i t  i s n o t s u r p r i s i n g t h a t members o f any group would have d i f f i c u l t y d e v e l o p i n g a group i d e n t i t y . (1986) suggest,  As Moccia  and Mason  an outlook focused on community w e l f a r e  r a t h e r than rugged i n d i v i d u a l i s m r e q u i r e s a major philosophical  shift.  While a sense of community o r b e l o n g i n g i s l a c k i n g i n s o c i e t y a t l a r g e , t h e r e seem t o be other reasons t h e women have not been a b l e t o r e a d i l y i d e n t i f y w i t h one another. The women i n t e r v i e w e d agreed t h a t they share a common h i s t o r y o f abuse, d y s f u n c t i o n , o r other "hard  experiences."  N e v e r t h e l e s s , some of them p o i n t e d t o t h i s commonality as the source o f t h e i r d i f f e r e n c e s . t h a t h o l d i n g onto uniqueness  One p a r t i c i p a n t  suggested  c o u l d be a s t r a t e g y f o r  m a i n t a i n i n g s e l f - w o r t h and s u r v i v i n g abusive o r dysfunctional relationships.  Justice  (1992) c o n f i r m s t h a t  f a m i l y v i o l e n c e , whether p h y s i c a l o r emotional, damages one's sense o f i d e n t i t y o r separateness.  McEvoy (1990), a  f e m i n i s t c o u n s e l l o r working with v i c t i m s o f abuse, t h a t c h i l d h o o d abuse c r e a t e s "a sense of i s o l a t i o n , freakishly different"  (p.  concurs o f being  63).  R e c o l l e c t i o n s of the q u a l i t y of c h i l d h o o d e x p e r i e n c e s have been p o s i t i v e l y c o r r e l a t e d with p s y c h o l o g i c a l adjustment  and coping, and negative c h i l d h o o d e x p e r i e n c e s  98 have been c o r r e l a t e d with distress,  i n c r e a s e d symptoms o f emotional  i n c r e a s e d s o c i a l i n t r o v e r s i o n , and decreased ego  s t r e n g t h i n low income s i n g l e mothers (Olson, Banyard, & C e b a l l o , 1994). c r o s s a l l income l e v e l s  Kiechnick,  Although abuse has been shown t o  ( J u s t i c e , 1992), t h e f i n d i n g s o f  t h i s study a r e c o n s i s t e n t with r e p o r t s i n t h e l i t e r a t u r e t h a t those i n low income brackets more f r e q u e n t l y r e p o r t l i v i n g i n d y s f u n c t i o n a l f a m i l i e s (Cohen, 1994). Montogomery's (1994) study of homeless women a l s o found t h e m a j o r i t y o f p a r t i c i p a n t s ( s i x of seven) had grown up i n "deplorable"  conditions.  The h i s t o r i e s of abuse and/or d y s f u n c t i o n have most l i k e l y a f f e c t e d t h e i d e n t i t i e s of the women i n t h i s  study.  There a r e , however, other p o s s i b i l i t i e s as t o why t h e women do not r e a d i l y i d e n t i f y with one another. h o l d very coping  l i t t l e s t a t u s and power i n s o c i e t y , and as a  s t r a t e g y , these women may have chosen not t o i d e n t i f y  with t h i s undesirable  image.  As one p a r t i c i p a n t s t a t e d so  s u c c i n c t l y , t o i d e n t i f y with other equivalent t o admitting how,  Low income women  failure.  low income women i s Cohen  i n our s o c i e t y , women's s e l f - e s t e e m  (1994) d i s c u s s e s i s often linked t o  appearance which i n c l u d e s wearing t h e r i g h t c l o t h e s , t h e r i g h t makeup, and " p a r t i c i p a t i n g i n a l i f e s t y l e t h a t i s beyond t h e reach of those who l i v e i n poverty"  (p. 952) .  There i s an absence of p o s i t i v e r o l e models and p o s i t i v e media images t o which poor women can r e l a t e .  According t o  99 H a l l , Stevens, and M e l e i s (1994), " d i f f e r e n t i a t i o n " i s one of t h e p r o p e r t i e s of m a r g i n a l i z a t i o n .  "The edge i s thus an  e x p e r i e n t i a l p l a c e i n which p e r i p h e r a l i z e d persons a r e d i s t i n c t and i s o l a t e d not only from t h e c e n t r e , but a l s o from one another"  (p. 26) .  A s t r o n g sense of s e l f , combined w i t h a sense o f connectedness,  i s important f o r h e a l t h .  In a study o f o l d e r  women's images of h e a l t h , P e r r y and Woods (1995) found t h a t a "core i n n e r s e l f " t h a t grows and adapts i s one a s p e c t o f being healthy.  Developing t h a t i n n e r core r e q u i r e s  i d e n t i f i c a t i o n with others.  Nozick  (1992) concurs  stating  t h a t p e r s o n a l empowerment begins with self-knowledge which does not develop i n i s o l a t i o n ,  "but i s u s u a l l y sparked by an  i n t e r a c t i v e process of i d e n t i f y i n g with o t h e r people i n a common s t r u g g l e "  (p. 101).  Similarly,  i n h e r study o f  women's experiences of empowerment, S h i e l d s  (1995) found  t h a t two o f t h e themes of empowerment a r e a c o r e sense o f s e l f and one of connectedness.  Saltonstall  (1993) , i n a  study o f conceptions of h e a l t h , a l s o found a sense o f s e l f t o be one aspect of being h e a l t h y . Conversely, l a c k i n g a sense of connectedness f e e l i n g s of i s o l a t i o n .  results i n  This perception of being d i f f e r e n t  can l e a d t o s t i g m a t i z a t i o n , low s e l f - e s t e e m , and decreased p e r s o n a l power ( H a l l e t a l . ,  1994).  In a review o f twenty-  t h r e e s t u d i e s o f t h e determinants of h e a l t h - p r o m o t i n g behaviour, G i l l i s  (1993) found s e l f - e f f i c a c y and s e l f -  100 concept t o be among t h e s t r o n g e s t p r e d i c t o r s o f h e a l t h promoting behaviour. personal  Lacking  a s t r o n g s e l f - c o n c e p t and  power may n e g a t i v e l y a f f e c t one's h e a l t h p r a c t i c e s .  In summary, i d e n t i f y i n g with peers i s important t o t h e development of a h e a l t h y  sense of s e l f .  The women who  p a r t i c i p a t e d i n t h i s study l a c k a common i d e n t i t y f o r a number o f p o s s i b l e reasons. and  dysfunction  "different."  The women's h i s t o r i e s o f abuse  have r e s u l t e d i n f e e l i n g s o f being  L i v i n g i n a low income bracket  r e i n f o r c e s the  sense o f i s o l a t i o n because i t i s one of t h e p r o p e r t i e s of marginalization.  F i n a l l y , our s o c i e t y ' s emphasis on  i n d i v i d u a l i s m i s a b a r r i e r t o the development o f a sense o f community and b e l o n g i n e s s .  Whatever t h e causes, however,  the absence of a common i d e n t i t y has p o t e n t i a l l y n e g a t i v e consequences f o r h e a l t h , increased  i n c l u d i n g low s e l f - e s t e e m ,  f e e l i n g s of powerlessness, reduced o r absent  health-promoting behaviours, and i n c r e a s e d v u l n e r a b i l i t y t o illness. L i v i n g on t h e p e r i p h e r y ,  however, does c a r r y t h e  p o t e n t i a l f o r some p o s i t i v e outcomes.  They a r e worth  mentioning because these p o s i t i v e c h a r a c t e r i s t i c s were evident  i n some o f the women interviewed.  Marginalization  almost f o r c e s one t o r e f l e c t on t h e s i t u a t i o n , and q u a l i t i e s of r e s i l i e n c e may be promoted ( H a l l e t a l . , 1994). the women d i s c u s s e d  the amount of "personal  Many o f  work" they have  done i n terms of c o u n s e l l i n g and group work, evidence o f  101 reflection.  Several of the participants  themselves as " s u r v i v o r s , "  indicating  i n n e r s t r e n g t h and r e s i l i e n c e .  identified  an awareness  of t h e i r  Furthermore, s o c i e t y  looks  t o t h e margins f o r i n n o v a t i o n and c r e a t i v i t y r e l a t i v e t o c u l t u r a l change ( H a l l e t a l . , 1994).  I t i s not l i k e l y a  c o i n c i d e n c e t h a t many of the p a r t i c i p a n t s  referred to  themselves as a r t i s t s o r d i s c u s s e d t h e i r need t o express themselves  creatively.  Despite the p o t e n t i a l  for positive  outcomes,  m a r g i n a l i z e d persons do have an i n c r e a s e d v u l n e r a b i l i t y t o n e g a t i v e h e a l t h consequences. not  i s related  o n l y t o t h e i r p e r c e p t i o n s of themselves and t h e i r  situations, the  This v u l n e r a b i l i t y  but i s a l s o dependent on t h e c o n t i n g e n c i e s o f  environment  ( H a l l e t a l . , 1994).  For t h i s reason, t h e  elements of t h e environment i d e n t i f i e d by t h e women as a f f e c t i n g t h e i r health are discussed i n the following section. The  Environment Kieffel  (1991) has encouraged nurses t o broaden  their  concept o f t h e environment and t o pursue r e s e a r c h which addresses t h e p r e c u r s o r s of h e a l t h problems. h e a l t h problems o f i n d i v i d u a l s effects findings  Treating the  without c o n s i d e r a t i o n o f t h e  o f t h e environment i s doomed t o f a i l u r e .  The  o f t h i s study p e r t i n e n t t o t h e concept o f t h e  environment a r e i n t e r e s t i n g  f o r s e v e r a l reasons.  The women  f r e q u e n t l y mentioned a s p e c t s of the environment i n r e g a r d s  102 to t h e i r health.  Due t o the r e c e n t nature o f t h e i r move  i n t o t h e housing c o - o p e r a t i v e , the women were a b l e t o make comparisons w i t h t h e i r p r e v i o u s housing i n c l u d i n g t h e e f f e c t s o f changing operative i t s e l f  situations,  neighbourhoods.  The c o -  i s an i n t e r e s t i n g environment which h o l d s  the p o t e n t i a l t o reduce the women's sense o f i s o l a t i o n . The s o c i a l c o n t e x t of t h e c o - o p e r a t i v e , however, was o f t e n c i t e d as a source of s t r e s s r a t h e r than a support.  In t h e next  s e c t i o n s , both t h e p h y s i c a l and t h e s o c i a l environments a r e discussed i n r e l a t i o n t o the l i t e r a t u r e . .  The d i s c u s s i o n has  been o r g a n i z e d i n t o t h r e e s e c t i o n s : t h e neighbourhood, t h e housing c o - o p e r a t i v e , and s o c i a l support networks. The  Neighbourhood  L i v i n g i n a designated poverty area has a n e g a t i v e e f f e c t on h e a l t h as shown by t h e Almeda County Study et a l . ,  1987).  (Haan  The m a j o r i t y of the women i n t e r v i e w e d  i d e n t i f i e d n e g a t i v e aspects of t h e i r p r e v i o u s housing situations,  i n c l u d i n g crime, s a f e t y concerns,  and s o c i a l  isolation.  These concerns do not address t h e i n v i s i b l e  h e a l t h r i s k s i n h e r e n t i n poorer neighbourhoods such as i n c r e a s e d exposure t o p o l l u t a n t s and g r e a t e r s t r e s s  related  t o s t i g m a t i z a t i o n (Lindheim & Syme, 1983). Not o n l y a r e poor neighbourhoods d e t r i m e n t a l t o h e a l t h , but Anderson and Armstead (1995) suggest t h e "the r e s i d e n t i a l environments of t h e a f f l u e n t may even be h e a l t h enhancing"  (p. 222) .  S c h r i j v e r s e t a l . (1995) found  103 i n c r e a s e d s u r v i v a l r a t e s f o l l o w i n g t h e d i a g n o s i s o f cancer f o r women from more a f f l u e n t neighbourhoods.  S t u d i e s have  shown t h a t merely being able t o look upon p l e a s i n g , n a t u r a l scenes can speed h e a l i n g a f t e r surgery S e v e r a l p a r t i c i p a n t s of t h i s study  (Ulrich,  1984) .  i d e n t i f i e d the p o s i t i v e  a s p e c t s o f t h e i r new neighbourhood, s p e c i f y i n g such t h i n g s as parks,  p r o x i m i t y t o t h e beach, i n t e r e s t i n g shops, and  i n c r e a s e d f e e l i n g s o f s a f e t y as c o n t r i b u t i n g t o enhanced well-being. The women o f t h i s study t h e i r p r e v i o u s housing  i d e n t i f i e d several aspects of  s i t u a t i o n s which may have had  n e g a t i v e h e a l t h consequences.  In a d d i t i o n , many o f them  mentioned f a c t o r s i n t h e new neighbourhood c o n s i d e r e d t o be health-enhancing.  Their reports are consistent with  those  i n t h e l i t e r a t u r e and emphasize the importance o f t h e environment t o h e a l t h . The  Housing  Co-operative  Housing c o - o p e r a t i v e s a f f o r d a b l e housing,  a r e designed  and b u i l t t o p r o v i d e  t o allow r e s i d e n t s g r e a t e r c o n t r o l over  t h e i r environments, and t o p r o v i d e a sense o f community (Cooper & Rodman, 1994; Ley, 1993).  While a l l o f t h e women  i n t e r v i e w e d acknowledged f e e l i n g s o f i n c r e a s e d s e c u r i t y and reduced f i n a n c i a l s t r a i n s i n c e moving i n t o t h e c o - o p e r a t i v e , the i n c r e a s e d sense of c o n t r o l and s o c i a l support  inherent  i n community l i f e were not immediately apparent. I r o n i c a l l y , almost a l l p a r t i c i p a n t s r e p o r t e d  increased  104 stress l e v e l s associated  with l i v i n g i n the  p a r t i c i p a t i n g i n i t s operation.  In f a c t ,  co-operative  several  p a r t i c i p a n t s reported a s i g n i f i c a n t d e t e r i o r a t i o n p h y s i c a l and/or mental h e a l t h  following  and  in their  the move i n t o  the  co-operative. The  adjustment t o a new  way  of l i f e may  have  created  a d d i t i o n a l s t r e s s , r e s u l t i n g i n t h i s negative e f f e c t health.  Previously,  major l i f e change events, such  change i n p l a c e of r e s i d e n c e , were thought t o s t r e s s and i s the  p r e c i p i t a t e h e a l t h problems.  element of l o s s w i t h i n  considered to create 1991).  as  increase  More r e c e n t l y ,  these changes t h a t  pathogenic s t r e s s  on  it  is  (Williams & House,  C u l t u r a l change t o an extent t h a t a l t e r s c u l t u r a l  v a l u e s and  r u l e s of behaviour, and  impacts on t r a d i t i o n a l  ways of coping w i t h s t r e s s , i s a l s o p o t e n t i a l l y damaging t o health  (Corin,  o p e r a t i v e has  1994). resulted  former l i f e s t y l e s , successful  The  women's move i n t o the  i n several  including,  c u l t u r a l "vacuum" u n t i l new established,  and  new  losses r e l a t e d to t h e i r  i n some i n s t a n c e s ,  coping s t r a t e g i e s .  co-  previously  They moved i n t o somewhat of a  r u l e s and  values could  become  methods of coping developed.  S t u d i e s of housing c o - o p e r a t i v e s i l l u s t r a t e t h e i r p o t e n t i a l t o p r o v i d e increased for  women (Wekerle, 1988).  and  the  The  s o c i a l support, e s p e c i a l l y development of  community,  s o c i a l support t h a t accompanies i t , i s not  p r o c e s s due  t o d i f f e r i n g views on the d e f i n i t i o n of  a smooth  105 community and t h e c h a l l e n g e of a c h i e v i n g a balance between s o c i a l support and p r i v a c y (Cooper & Rodman, 1994).  These  problems a r e c o n s i s t e n t with those i d e n t i f i e d by t h e women i n t h i s study. the f o l l o w i n g  The t o p i c of s o c i a l support i s d i s c u s s e d i n section.  Social  Support  Social  support, l i k e poverty, i s a complex and m u l t i -  d i m e n s i o n a l concept and, u n t i l r e c e n t l y , i t has been r e p o r t e d as having o n l y a b e n e f i c i a l health  role  (Ducharme, Stevens, & Rowat, 1994).  i n regards t o Social  has a l s o been c o n s i d e r e d synonymous w i t h s o c i a l (Malone,  1988).  support  networks  One of the problems f a c e d by low income  women i s t h e absence o f adequate support networks.  Two o f  the women i n t h i s study r e p o r t e d s o c i a l i s o l a t i o n as a problem  prior  t o moving i n t o t h e c o - o p e r a t i v e .  limited  l i t e r a t u r e on women, poverty, and h e a l t h , t h e  absence of s o c i a l support has been noted.  In the  Nairne  (1991)  suggests t h a t unattached poor women may be prone t o s o c i a l i s o l a t i o n due t o l a c k o f f a m i l y supports.  Family members,  however, a r e not n e c e s s a r i l y a person's main support (Lackner, Goldenberg,  Arrizza,  system  & T j o s v o l d , 1994).  Although s o c i a l support i s a c q u i r e d through  one's  s o c i a l network, t h e presence of s o c i a l r e l a t i o n s h i p s does not guarantee  support.  Rowe and M i l e s (1994) observed  that  poor, s i n g l e mothers a r e l a c k i n g i n s o c i a l support due t o the f i n a n c i a l and emotional c o s t s of a s o c i a l l i f e .  Other  106 s t u d i e s have shown t h a t f o r low income women, s o c i a l r e l a t i o n s h i p s may be a source of g r e a t e r women w i t h more resources  s t r e s s than f o r  (Peznecker, 1984).  Most  i n t h i s study i s t h a t t h e women interviewed,  notable  i n c l u d i n g those  p r e v i o u s l y i s o l a t e d , i d e n t i f i e d s o c i a l r e l a t i o n s h i p s as a major source of s t r e s s , p a r t i c u l a r l y i n t h e e a r l y phase o f e s t a b l i s h i n g t h e housing c o - o p e r a t i v e .  Almost everyone  mentioned n e g o t i a t i n g boundary i s s u e s as c h a l l e n g i n g and problematic. has  T h i s negative  aspect  of s o c i a l r e l a t i o n s h i p s  r e c e n t l y been acknowledged and l a b e l l e d  "dissupport"  (Malone, 1988). In oppressed groups, i t has been observed t h a t those who f e e l powerless tend t o i d e n t i f y with t h e oppressor and respond n e g a t i v e l y towards peers, r e s u l t i n g i n what has been called "horizontal violence"  (Heide, 1988).  p a r t i c i p a n t s o f t e n l i n k e d t h e problems w i t h  The interpersonal  r e l a t i o n s h i p s t o communication d i f f i c u l t i e s and boundary i s s u e s t h a t were rooted interviewed  discussed  their interactions.  i n t h e i r common p a s t s .  t h e l a c k of t r u s t e v i d e n t  i n some o f  M i s t r u s t i s the one l e s s o n l e a r n e d by  almost a l l s u r v i v o r s of f a m i l y v i o l e n c e Some o f t h e women d e s c r i b e d "paranoia"  The women  ( J u s t i c e , 1992).  the b a r r i e r s t o communication as  and " o v e r - s e n s i t i v i t y . " McEvoy (1990) says t h a t  s u r v i v o r s of childhood  abuse a r e h y p e r s e n s i t i v e t o t h e i r  environment and t h e people i n i t . White (1992) maintains t h a t boundaries a r e c o n s t r u c t e d ,  107 n e g o t i a t e d , and maintained t o g i v e some sense of o r d e r l i n e s s t o human i n t e r a c t i o n .  An i n t e r p e r s o n a l boundary i s d e f i n e d  as "a dynamic l i n e of demarcation  s e p a r a t i n g an  i n t e r n a l and e x t e r n a l environments, p e r m e a b i l i t y and f l e x i b i l i t y " Boundaries  individual's  and v a r y i n g i n  (Scott, 1988,  p.  26).  are an important p a r t of c u l t u r a l norms,  r e g u l a t i n g our i n t e r a c t i o n s with others  (McEvoy, 1990).  McEvoy (1990) s u b s t a n t i a t e s t h a t c h i l d h o o d abuse c o n s t i t u t e s r e p e a t e d i n v a s i o n of boundaries,  l e a v i n g the i n d i v i d u a l w i t h  boundaries t h a t are too permeable, r e s u l t i n g i n a b l u r r e d sense of s e l f and decreased p e r s o n a l power.  Women, i n  g e n e r a l , tend t o have more permeable boundaries g r e a t e r r i s k of "over-commitment" i n s o c i a l (Stewart, 1993;  W i l l i a m s & House, 1991).  and are a t  relationships  In t h i s  study,  problems w i t h boundary i s s u e s were e v i d e n t i n the women's d i f f i c u l t y s e t t i n g l i m i t s on i n t e r p e r s o n a l r e l a t i o n s h i p s , t h e i r degree of involvement  i n the c o - o p e r a t i v e , and  f e a r of becoming "entangled" i n one another's  their  lives.  Over the course of data c o l l e c t i o n , the women i n t e r v i e w e d p r o v i d e d more and more examples of how support was  developing, and how  t h i s support was  v e r y p o s i t i v e aspect of l i f e i n the c o - o p e r a t i v e . concepts of i d e n t i t y and  social  viewed as a The  boundaries are important t o the  development of s o c i a l support.  One  needs s u f f i c i e n t  boundaries t o g a i n a c l e a r sense of s e l f , and one needs t o take c a r e of o n e s e l f f i r s t .  Next, one needs t o f i n d  others  108 s i m i l a r t o o n e s e l f with whom t o i d e n t i f y . d e s c r i b e d t h i s step as " f i t t i n g i n . "  The p a r t i c i p a n t s  Once a woman f i n d s  o t h e r s w i t h whom she " f i t s i n , " t h e stage i s s e t f o r these l i k e - m i n d e d i n d i v i d u a l s t o p r o v i d e support t o one another. The women's d e s c r i p t i o n s of t h i s process a r e c o n s i s t e n t w i t h t h e f i n d i n g s o f S h i e l d s (1995) whose study o f empowerment found a l l of these aspects  (a sense o f s e l f ,  commitment t o s e l f , and a sense of connectedness) as necessary  i n g r e d i e n t s f o r empowerment.  The m i s s i n g  of empowerment, a sense of c h o i c e o r c o n t r o l ,  aspect  i s discussed  in the following section. Control In a d d i t i o n t o s o c i a l r e l a t i o n s h i p s and s o c i a l  support,  a sense o f p e r s o n a l c o n t r o l can a f f e c t h e a l t h ( W i l l i a m s & House, 1991).  C o n t r o l has been p o s i t i v e l y c o r r e l a t e d  with  s o c i a l s t a t u s , and t h e accompanying s e l f - e s t e e m and sense o f mastery can b u f f e r the impact ( W i l l i a m s & House, 1991).  of s t r e s s f u l l i f e  Conversely,  events  chronic poverty  t o t h e p e r c e p t i o n t h a t much of t h e world has c o n t r o l the i n d i v i d u a l  (Humphry, 1995).  In t h i s study,  leads over  control  emerged as a major theme u n d e r l i n i n g t h e women's p e r c e p t i o n s of h e a l t h .  When asked t o d e s c r i b e t h e i r l i v e s , t h e women  i n v a r i a b l y began d i s c u s s i n g coping s t r a t e g i e s they used t o manage on a low income. pennies," lives.  These s t r a t e g i e s , such as " c o u n t i n g  can be seen as attempts t o g a i n c o n t r o l over  One woman a c t u a l l y made t h e c o n n e c t i o n between  their  109 p o v e r t y and  c o n t r o l by d e f i n i n g poverty as "having  no  options." The  f i n d i n g s of t h i s study i n d i c a t e t h a t l i v i n g on  low  income, and  has  had  health,  the a s s o c i a t e d  decreased sense of c o n t r o l ,  a s i g n i f i c a n t impact on the women's d e f i n i t i o n s of concerns r e g a r d i n g  an e x p l o r a t o r y  health,  study, Calnan and  and  health practices.  circumstances.  and  They d i d f i n d , however, t h a t  lower c l a s s women interviewed  had  In  Johnson (1985) found t h a t  h e a l t h b e l i e f s have l i t t l e r e l a t i o n s h i p t o s o c i a l material  a  the  more f u n c t i o n a l  d e f i n i t i o n s of h e a l t h such as " g e t t i n g through the day." t h i s study, the women's d e f i n i t i o n s of h e a l t h and  In  associated  concerns focused on meeting b a s i c needs on a day-to-day b a s i s , hence i l l u s t r a t i n g a more f u n c t i o n a l and p r a c t i c a l view of h e a l t h .  C o n t r o l over b a s i c needs i s l e s s l i k e l y  to  be r e f l e c t e d i n the h e a l t h concerns of women i n h i g h e r economic s t r a t a .  More r e s o u r c e s mean more c h o i c e s ,  and  hence, more c o n t r o l . Safety  and  s e c u r i t y featured  l a r g e l y i n the women's  d e f i n i t i o n s of h e a l t h and were mentioned by a l l participants.  The  focus on s a f e t y and  important component of h e a l t h may "hard e x p e r i e n c e s " and personal  safety.  sexually assaulted  s e c u r i t y as  an  be r e l a t e d t o the  shared  p r e v i o u s l o s s of c o n t r o l over  For example, the women who at an e a r l y age were s t i l l  concerned with p h y s i c a l s a f e t y .  had  been  v e r y much  S a l t o n s t a l l (1993)  reported  110 t h a t d e f i n i t i o n s of h e a l t h were guided and c o n s t r a i n e d by s o c i a l norms and s i t u a t i o n s , and t h a t gender was i n t e g r a l t o one's concept of h e a l t h .  In p a r t , t h i s was r e f l e c t e d i n t h e  frequency w i t h which i s s u e s of s a f e t y and danger were evident  i n t h e women's n a r r a t i v e s .  I n t e r e s t i n g l y , t h e women  i n S a l t o n s t a l l ' s study were white, m i d d l e - c l a s s , 3 5 and 55 y e a r s .  Considering  and between  t h a t s a f e t y concerns were a l s o  prominent f o r t h e women who l i v e d i n t h e c o - o p e r a t i v e , p o s s i b l e t h a t t h i s i s s u e i s r e l a t e d more t o being  it is  female  than t o income l e v e l . I t has been observed t h a t women attempt t o g a i n some c o n t r o l over s a f e t y by spending a l a r g e r p r o p o r t i o n  of t h e i r  income on r e n t i n order t o l i v e i n b e t t e r neighbourhoods (Nairne,  1991).  For low income women, t h i s s t r a t e g y r e s u l t s  i n fewer resources  remaining t o meet other b a s i c needs,  thereby r e s u l t i n g i n reduced c o n t r o l over other their lives.  aspects of  While t h e theme of s a f e t y and s e c u r i t y d i d not  a r i s e i n a study of o l d e r women's images o f h e a l t h  (Perry &  Woods, 1995), t h e themes of independence and energy, both necessary f o r c o n t r o l , d i d . L i m i t e d f i n a n c e s and reduced c o n t r o l over one's can  l e a d t o f e e l i n g s of i n s e c u r i t y .  described  the increased  inadequate income.  life  The women i n t h i s  study  s t r e s s of s t r u g g l i n g t o manage on an  T h i s f i n d i n g concurs w i t h those o f  Edwards (1993) whose p a r t i c i p a n t s , A f r i c a n American s i n g l e mothers l i v i n g on low income, d e s c r i b e d  coping  with s t r e s s  Ill as t h e i r primary c h a l l e n g e .  Many of these women l i s t e d  r a i s i n g t h e i r c h i l d r e n alone as the g r e a t e s t source o f s t r e s s , f o l l o w e d by l a c k of money and t r a n s p o r t a t i o n difficulties.  These two groups d i f f e r s i g n i f i c a n t l y i n  terms o f n a t i o n a l i t y , race, and p a r e n t a l s t a t u s .  The  r e s u l t s do suggest, however, t h a t t h e g r e a t e s t t h r e a t t o h e a l t h f o r low income women i s l i v i n g under c o n s t a n t  stress.  These r e s u l t s a r e c o n s i s t e n t with B e c k t e l l ' s (1993) observations  o f endemic s t r e s s f o r women i n I n d i a and t h e  subsequent e f f e c t s on t h e i r  health.  S e v e r a l p a r t i c i p a n t s c l e a r l y a r t i c u l a t e d how a l a c k o f money d i r e c t l y a f f e c t e d t h e i r a b i l i t y t o c a r r y out p r e f e r r e d health practices.  T h i s f i n d i n g i s c o n s i s t e n t w i t h a growing  body o f l i t e r a t u r e which supports the idea t h a t s o c i a l and economic b a r r i e r s , and not a l a c k o f i n f o r m a t i o n , i n f l u e n c e on h e a l t h behaviour (Nelson, Williams,  1990).  e x e r t most  1994; G i l l i s , 1993;  T h i s idea i s c o n t r a r y t o t h e h e a l t h - b e l i e f  model (Rosenstock, 1974) where b e l i e f s , v a l u e s , and knowledge a r e considered  t o form t h e b a s i s o f behaviour  change.  i s i n d i r e c t l y supported by G i l l i s  This conclusion  (1993) who found t h a t one of t h e most f r e q u e n t l y determinants of a h e a l t h y as an i n c o n s e q u e n t i a l It  studied  l i f e s t y l e , health value,  determinant of h e a l t h  emerged  behaviour.  i s noteworthy t h a t the women i n t h i s study b e l i e v e d  t h e i r h e a l t h p r a c t i c e s were l i m i t e d by income, d e s p i t e a p o l i c y o f u n i v e r s a l access t o h e a l t h s e r v i c e s i n Canada.  112 S e v e r a l women v o i c e d f r u s t r a t i o n over t h e i r i n a b i l i t y t o c a r r y out p r e f e r r e d h e a l t h p r a c t i c e s such as buying v i t a m i n s , purchasing  o r g a n i c f r u i t s and v e g e t a b l e s , o r  s e e k i n g t h e r a p i e s such as c o u n s e l l i n g which a r e not covered by h e a l t h insurance.  In K e i t h ' s  (1987) study o f  postponement of h e a l t h care by o l d e r unmarried women, f i n a n c i a l concerns were found t o be t h e prime reason f o r d e l a y s i n seeking medical treatment.  Although  t h i s study i s  American and d i f f e r e n c e s i n t h e h e a l t h care systems need t o be taken  i n t o account,  overlooked.  these r e s u l t s should not be  In one Canadian study, Thomas (1988) a l s o  i d e n t i f i e d economics as a b a r r i e r t o h e a l t h c a r e . In a d d i t i o n t o t h e d i r e c t e f f e c t o f l i m i t i n g h e a l t h p r a c t i c e s , f i n a n c i a l s t a t u s a l s o i n c r e a s e s s t r e s s due t o f e e l i n g s o f l o s s of c o n t r o l over p e r s o n a l h e a l t h .  Living i n  the c o - o p e r a t i v e has, however, p r o v i d e d t h e women w i t h o p p o r t u n i t i e s t o l e a r n t o new s k i l l s and g a i n more c o n t r o l over t h e i r environment. p o s i t i v e experience,  For many, t h i s has been a v e r y  i d e n t i f i e d by some o f t h e women  themselves as empowerment. While r e s e a r c h has shown t h a t a sense o f c o n t r o l enhances h e a l t h (Williams & House, 1991), Jones and M e l e i s (1993) have a c t u a l l y d e f i n e d h e a l t h as empowerment.  In  t h e i r model, h e a l t h i s c o n c e p t u a l i z e d as t h e i n t e r a c t i o n o f t h r e e v a r i a b l e s : s t r e s s o r s , resources e x t e r n a l ) , and energy (or power).  ( i n t e r n a l and  When t h e f i n d i n g s o f t h i s  113 study a r e examined i n terms of t h i s model, t h e c h a l l e n g e s t o h e a l t h f o r low income women become r e a d i l y apparent.  These  women have many s t r e s s o r s and p o t e n t i a l l y fewer  resources  (both i n t e r n a l and e x t e r n a l ) t o cope with them.  A  considerable needs.  amount of energy i s r e q u i r e d t o meet b a s i c  T h i s d r a i n i n g of energy d e p l e t e s one's power, thus  r e s u l t i n g i n a sense of decreased c o n t r o l . C o n t r o l has emerged as an important theme i n t h i s of low income women's c o n s t r u c t i o n o f h e a l t h . resources  l e s s e n one's choices i n a l l aspects  including health practices.  study  Limited of l i f e ,  Fewer c h o i c e s r e s u l t i n a l a c k  of a sense of c o n t r o l , i n c r e a s e d s t r e s s , and n e g a t i v e e f f e c t s on h e a l t h . the c o - o p e r a t i v e  When t h e women of t h i s study  identify  as p r o v i d i n g them with a sense o f g r e a t e r  c o n t r o l over t h e i r l i v e s , they are, i n essence, d e s c r i b i n g an improved s t a t e of h e a l t h . Implications for The  f i n d i n g s of t h i s study have i m p l i c a t i o n s f o r  n u r s i n g p r a c t i c e , n u r s i n g education, The  Nursing  and n u r s i n g  research.  i m p l i c a t i o n s f o r each of these areas i s d i s c u s s e d  separately i n the sections that follow. Nursing The  Practice women's l a c k of a common i d e n t i t y has i m p l i c a t i o n s  f o r t h e nurse working with c l i e n t s l i v i n g on a low income. The  nurse cannot assume t h a t demographic s i m i l a r i t i e s mean  women w i l l r e l a t e t o one another, and t h i s has i m p l i c a t i o n s  114 f o r s t r a t e g i e s such as support groups.  When attempting t o  b r i n g women t o g e t h e r f o r mutual support, nurses need t o look a t f a c t o r s such as age, employment s t a t u s , and m a r i t a l s t a t u s as i n f l u e n c i n g group cohesiveness. When working with c l i e n t s l i v i n g i n housing c o o p e r a t i v e s , t h e nurse needs t o r e c o g n i z e both t h e b e n e f i t s and s t r e s s o r s i n h e r e n t i n t h i s type of l i f e s t y l e . may  The nurse  a s s i s t t h e c l i e n t t o i d e n t i f y sources o f s t r e s s and t h e  s k i l l s needed t o manage them.  R e f e r r a l s t o community  r e s o u r c e s where these s k i l l s can be developed might be made. I d e n t i f y i n g and s u p p o r t i n g e f f e c t i v e coping mechanisms already i n place i s also b e n e f i c i a l .  In g e n e r a l , nurses  a l s o need t o take measures t o support and f o s t e r i n c r e a s e d s e l f - e s t e e m i n low income c l i e n t s . p r o v i d e p o s i t i v e feedback  One way t o do so i s t o  on t h e e f f e c t i v e c o p i n g s t r a t e g i e s  the c l i e n t i s u s i n g t o manage s t r e s s o r s s u c c e s s f u l l y  (Rowe &  M i l e s , 1994) . P r o v i d i n g p o s i t i v e r o l e models f o r women l i v i n g on a low income may present a c h a l l e n g e .  There are, however,  o r g a n i z a t i o n s whose l e a d e r s and members have s t r i v e d t o improve t h e s i t u a t i o n f o r those l i v i n g on low income. I n t r o d u c i n g c l i e n t s t o these o r g a n i z a t i o n s a c h i e v e s two purposes.  I t provides the c l i e n t with a d d i t i o n a l resources,  and a l s o i n t r o d u c e s t h e woman t o persons who may s e r v e as p o s i t i v e r o l e models. F i n a l l y , nurses must have an i n c r e a s e d community f o c u s .  115 A t t e n t i o n t o the environmental determinants of h e a l t h i s crucial.  I t i s no longer a c c e p t a b l e t o use the n u r s i n g  d i a g n o s i s "knowledge d e f i c i t " without c o n s i d e r i n g the b a r r i e r s t o c a r r y i n g out p r e f e r r e d h e a l t h p r a c t i c e s .  When  working w i t h c l i e n t s l i v i n g on a low income, nurses need t o a s s e s s the b a r r i e r s t o h e a l t h t h a t e x i s t f o r each  client,  and work w i t h t h i s person t o develop measures t o overcome them. Nurses a l s o have an important r o l e beyond t h e i r immediate p r a c t i c e .  Nurses are i n an e x c e l l e n t p o s i t i o n t o  i d e n t i f y the s o c i a l and environmental p r e c u r s o r s t o poor health.  Once socially-embedded h e a l t h r i s k s have been  found, nurses must work both i n d i v i d u a l l y and  collectively,  v i a t h e i r p r o f e s s i o n a l a s s o c i a t i o n s , t o i n f l u e n c e changes i n social  policy.  N u r s i n g Education The f i n d i n g s of t h i s study underscore the need f o r n u r s i n g e d u c a t i o n t o address the f a c t t h a t b a r r i e r s t o h e a l t h p r a c t i c e s are a focus f o r n u r s i n g i n t e r v e n t i o n . e d u c a t i o n needs t o be c a r r i e d out a t a l l l e v e l s  This  including  b a s i c e d u c a t i o n programs, graduate programs, and c o n t i n u i n g e d u c a t i o n f o r a l l p r a c t i s i n g nurses. need t o l e a r n assessment  Students a t a l l l e v e l s  s k i l l s t h a t enable nurses t o a s s e s s  e n t i r e communities and which l e a d t o the i d e n t i f i c a t i o n of environmental determinants of h e a l t h problems.  Students  nurses a l i k e need encouragement t o become p o l i t i c a l l y  and  active  116 and t o lobby f o r s o c i a l changes t h a t w i l l have p o s i t i v e health benefits. Nursing  Research  The r e s u l t s of t h i s study r a i s e many q u e s t i o n s f o r f u r t h e r study.  For example, what i s t h e i n c i d e n c e o f abuse  and d y s f u n c t i o n a l f a m i l y experiences f o r women l i v i n g on low income?  What i s t h e r e l a t i o n s h i p between these  experiences  and both t h e women's income l e v e l s and h e a l t h l a t e r i n l i f e ? Most i m p o r t a n t l y , what a r e t h e mechanisms which enable an i n d i v i d u a l t o overcome these  experiences?  Nursing r e s e a r c h needs t o encompass a broader c o n c e p t i o n o f t h e e n v i r o n m e n t , ( K i e f f e l , 1991).  In  p a r t i c u l a r , more r e s e a r c h on t h e s u b j e c t o f s a f e t y as a h e a l t h concern f o r women i s needed.  Housing  i s 'another  a s p e c t o f t h e environment a p p r o p r i a t e f o r n u r s i n g r e s e a r c h . For example, s o c i a l housing has t y p i c a l l y been developed i n low income areas  (Ley, 1993).  The e v a l u a t i o n o f s o c i a l  housing p r o j e c t s i n " b e t t e r " neighbourhoods may r e v e a l l o n g term h e a l t h and s o c i a l b e n e f i t s .  T h i s change might h e l p  decrease t h e s t i g m a t i z a t i o n t h a t Lindheim  and Syme (1983)  i d e n t i f y as being a s s o c i a t e d with p u b l i c housing.  They  suggest t h a t i t i s the s t i g m a t i z a t i o n t h a t l e a d s t o anger, decreased outcomes.  s e l f - e s t e e m , and consequently n e g a t i v e h e a l t h More r e s e a r c h i s needed before any f i r m  c o n c l u s i o n s can be made. The  study p a r t i c i p a n t s have been a b l e t o improve t h e i r  117 s i t u a t i o n by g a i n i n g access t o a housing c o - o p e r a t i v e .  What  q u a l i t i e s s e t them apart from other low income women who have not f a r e d so w e l l ?  Can these q u a l i t i e s be f o s t e r e d i n  o t h e r s , and i f so, how?  Anderson and Armstead  (1995) a l s o  q u e s t i o n e d whether t h e r e a r e coping s k i l l s t h a t can be taught t o t h e poor t o enable them t o b e t t e r manage t h e i r many s t r e s s o r s .  Of p a r t i c u l a r importance  i s the evaluation  of measures t h a t may h e l p t o support t h e coping measures o f these women o r reduce some of the s t r e s s .  Furthermore,  what  are t h e long term h e a l t h b e n e f i t s o f l i v i n g i n a c o o p e r a t i v e s t y l e o f housing?  Can these p r i n c i p l e s be a p p l i e d  t o o t h e r aspects o f s o c i e t y f o r health-enhancing Given t h a t very l i t t l e r e s e a r c h has been  effects?  conducted  r e g a r d i n g women, poverty, and h e a l t h , and v i r t u a l l y none p e r t a i n i n g t o mature, unattached,  low income women, t h e r e  are numerous p o s s i b i l i t i e s f o r i n v e s t i g a t i o n .  T h i s study,  however, has i n d i c a t e d t h a t t h e concepts o f i d e n t i t y , t h e environment, and c o n t r o l a r e s u i t a b l e p l a c e s t o b e g i n . D i s c u s s i o n of Method The method proposed  f o r t h i s study was ethnography.  U n f o r t u n a t e l y , p e r m i s s i o n f o r p a r t i c i p a n t - o b s e r v a t i o n was denied and t h i s has l i m i t e d t h e data c o l l e c t i o n f o r t h e study.  In t h e next s e c t i o n s , the measures taken t o ensure  r i g o r a r e d e s c r i b e d , t h e l i m i t a t i o n s t o t h e study a r e d i s c u s s e d , and t h e s i g n i f i c a n c e of t h e f i n d i n g s , the study's l i m i t a t i o n s , a r e reviewed.  i n l i g h t of  118 Rigor The e s s e n t i a l d i f f e r e n c e s between q u a l i t a t i v e and q u a n t i t a t i v e r e s e a r c h methods make i t i n a p p r o p r i a t e t o use the c r i t e r i a of r e l i a b i l i t y and v a l i d i t y , a s s o c i a t e d w i t h a q u a n t i t a t i v e approach, (Sandelowski,  1986).  when e v a l u a t i n g q u a l i t a t i v e r e s e a r c h For t h i s reason, s t r a t e g i e s t o achieve  r i g o r i n q u a l i t a t i v e r e s e a r c h were used. A u d i t a b i l i t y has been i d e n t i f i e d as an important s t r a t e g y t o achieve r i g o r i n q u a l i t a t i v e r e s e a r c h 1989;  Sandelowski,  "decision t r a i l "  1986).  (Burns,  I t requires that a clear  i s documented, which means r e p o r t i n g a l l  d e c i s i o n s t h a t were made and the r a t i o n a l e f o r them. t h i s study, a u d i t a b i l i t y has been ensured  i n two ways.  mentioned e a r l i e r , the i n v e s t i g a t o r maintained r e c o r d o f thoughts, decisions.  As  a journal  f e e l i n g s , r e a c t i o n s , i n s i g h t s , and  In combination with the w r i t t e n a n a l y s e s t h a t  f o c u s e s on the data, t h i s r e c o r d p r o v i d e s a c l e a r trail.  In  In a d d i t i o n , the f a c u l t y committee members  decision reviewed  the data and analyses on a r e g u l a r b a s i s and p r o v i d e d s u g g e s t i o n s as necessary. A second fittingness  aspect of r i g o r i s a c h i e v i n g c r e d i b i l i t y and  (Sandelowski,  1986).  The f i r s t  strategy to  a c h i e v e t h i s c r i t e r i o n i s t o ensure f o r r e p r e s e n t a t i v e n e s s of  the data.  The procedures  d i r e c t e d towards t h i s aim.  l i s t e d under sampling For example,  were  selecting  p a r t i c i p a n t s that hold d i f f e r e n t roles within the co-  119 o p e r a t i v e prevents view.  t h e p r e s e n t a t i o n o f o n l y one p a r t i c u l a r  " E l i t e b i a s " can occur when only t h e most v i s i b l e and  a r t i c u l a t e members of a group a r e i n t e r v i e w e d o r observed (Burns,  1989).  I t i s a l i m i t a t i o n o f t h i s study  p a r t i c i p a n t - o b s e r v a t i o n d i d not take p l a c e .  that  Nevertheless,  i n t e n s i v e i n t e r v i e w s were conducted with a sample o f volunteers.  These women comprise 28% of t h e r e s i d e n t s o f  the c o - o p e r a t i v e , and were seen t o r e p r e s e n t t h e d i v e r s i t y of t h e membership i n many ways.  For example, t h e v o l u n t e e r s  i n c l u d e d women from a l l age groups, newly poor and always poor, and those who c o n s i d e r themselves poor and those who do not.  I t i s l i k e l y , however, t h a t t h e i r w i l l i n g n e s s t o  participate  may s e t them apart i n some way.  In a d d i t i o n ,  some groups were known t o be under-represented,  such as t h e  working women and those women not a c t i v e l y p a r t i c i p a t i n g i n the o p e r a t i o n of t h e c o - o p e r a t i v e .  Measures were taken t o  r e c r u i t some of these women, but they were u n s u c c e s s f u l .  To  compensate f o r t h i s l i m i t a t i o n i n data c o l l e c t i o n , women participating  i n t h e study were asked t o compare themselves  w i t h women who were not w e l l represented.  In a d d i t i o n ,  through t h e i r s t o r i e s of l i f e i n t h e c o - o p e r a t i v e , p o s s i b l e t o g a i n a t l e a s t some understanding  i t was  of t h e dynamics  that affected a l l residents. I t must be kept i n mind t h a t accounts o f one's behaviour do not always c o i n c i d e e x a c t l y with one's a c t u a l behaviour.  Jarrett  (1993), i n d i s c u s s i n g t h e use o f focus  120 groups w i t h  low income m i n o r i t y p o p u l a t i o n s ,  acknowledges  the p o t e n t i a l f o r " i d e a l i z e d " accounts of one's l i f e .  This  p o t e n t i a l a r i s e s from t h e poor's acceptance o f mainstream v a l u e s w h i l e r e c o g n i z i n g t h a t t h e i r behaviour d i v e r g e s that of the larger population.  from  T h i s type o f "impression  management" i s , however, not l i m i t e d t o low income groups but  i s seen as a f a c t o r a f f e c t i n g t h e data c o l l e c t e d by an  ethnographer i n any context  (Hammersley & A t k i n s o n ,  1986).  Even i n t h e absence o f p a r t i c i p a n t - o b s e r v a t i o n , t h e women were seen, a t times,  t o c o n t r a d i c t themselves.  For  example, s e v e r a l women d e s c r i b e d themselves as not very i n v o l v e d i n t h e c o - o p e r a t i v e , when, i n f a c t , they were p a r t i c i p a t i n g on more than one committee.  There were a l s o  a s p e c t s o f t h e i r l i v e s t h a t t h e women were r e l u c t a n t t o t a l k about.  In one i n s t a n c e , a p a r t i c i p a n t mentioned a "major  c o n f l i c t " occurring within the co-operative,  but d e c l i n e d an  i n v i t a t i o n t o d i s c u s s i t . T h i s obvious r e l u c t a n c e t o t a l k about c e r t a i n circumstances have been evidence  l i m i t e d data c o l l e c t i o n ,  of t r u s t i s s u e s .  and may  P a r t i c i p a n t s from  v u l n e r a b l e groups, such as these women, may f i n d i t d i f f i c u l t t o t r u s t the i n v e s t i g a t o r (Abbott, Duncan, 1993).  Blair, &  P a r t i c i p a n t - o b s e r v a t i o n would have p r o v i d e d  an added dimension t o t h e data, and t h e d e n i a l of t h i s aspect o f t h e study perhaps s i g n a l s t h e concerns o f some o f the women r e g a r d i n g t r u s t .  Measures were taken t o f o s t e r  t r u s t and a sense o f c o n t r o l on t h e p a r t of t h e  121 participants.  For example, t h e i n v e s t i g a t o r ensured  d i s c u s s i o n s w i t h t h e women remained  that  c o n f i d e n t i a l and was  r e s p e c t f u l o f women who e x e r c i s e d t h e i r r i g h t t o n o t answer any s p e c i f i c q u e s t i o n s o r d i s c u s s p a r t i c u l a r  topics.  Another s t r a t e g y t o ensure r i g o r i n v o l v e s l o o k i n g a t the data from d i f f e r e n t viewpoints, known as t r i a n g u l a t i o n . Respondent v a l i d a t i o n and sampling from  different  p a r t i c i p a n t s and a t d i f f e r e n t p o i n t s i n time a r e forms o f triangulation  (Hammersley & A t k i n s o n , 1986).  One way  sampling i n time was accomplished was by completing t h e i n t e r v i e w s i n t h r e e c l u s t e r s over a p e r i o d o f s e v e r a l months.  Another example of sampling i n time  involved  i n t e r v i e w i n g two of the e a r l i e r p a r t i c i p a n t s f o r a second time l a t e r i n t h e study.  T h i s procedure showed a decrease  i n r e p o r t s o f s t r e s s and c o n f l i c t as t h e study p r o g r e s s e d , a l t h o u g h these themes d i d not disappear e n t i r e l y , and an i n c r e a s e i n r e p o r t s of p o s i t i v e aspects of co-op l i f e was observed.  The time l i m i t s on t h i s study were a drawback  because an on-going e v o l u t i o n of t h e c u l t u r e i n t h e c o o p e r a t i v e i s t o be expected.  The completion o f a  l o n g i t u d i n a l study, however, was not t h e o r i g i n a l i n t e n t o f t h i s study. R i g o r i s a l s o maintained by checking f o r t y p i c a l and a t y p i c a l elements.  When a c o n c l u s i o n has been reached, t h e  researcher d e l i b e r a t e l y t r i e s t o disprove i t t o strengthen its validity.  For example, when t h e data were o r g a n i z e d and  122 seemed t o f i t i n a p a r t i c u l a r way, they were r e o r g a n i z e d a g a i n t o see i f a b e t t e r f i t c o u l d be found.  Finally,  o b t a i n i n g v a l i d a t i o n from t h e s u b j e c t s themselves was b u i l t i n t o t h e data c o l l e c t i o n process by p r e s e n t i n g i d e a s from e a r l i e r i n t e r v i e w s t o new p a r t i c i p a n t s .  Participants  i n d i c a t e d v a l i d a t i o n by comments such as "Yes, t h a t ' s i t exactly."  While v a l i d a t i o n by p a r t i c i p a n t s i s g e n e r a l l y  c o n s i d e r e d a measure of r i g o r i n q u a l i t a t i v e r e s e a r c h (Sandelowski,  1986), t h i s technique does not n e c e s s a r i l y  apply t o ethnography.  While respondent  u s e f u l due t o t h e respondent's  v a l i d a t i o n may be  g r e a t e r knowledge o f t h e  c o n t e x t , t h e i n v e s t i g a t o r cannot be assured t h a t t h e p a r t i c i p a n t s have conscious access t o t h e b e l i e f s , and c u l t u r a l norms t h a t i n f l u e n c e behaviour Atkinson,  values,  (Hammersley &  1986).  A c l e a r example of how respondent  v a l i d a t i o n i s not  always s u c c e s s f u l with ethnography o c c u r r e d when two p a r t i c i p a n t s were g i v e n a r e p o r t of t h e r e s u l t s o f t h i s study t o review.  One p a r t i c i p a n t s t r o n g l y d i s a g r e e d w i t h  some o f t h e f i n d i n g s , i n c l u d i n g some quotes from h e r own interview. expressed  When t h i s d i s c r e p a n c y was i d e n t i f i e d t o her, she h e r concerns  t h a t t h e f i n d i n g s presented t h e women  and t h e c o - o p e r a t i v e i n a negative l i g h t .  I t i s possible  t h a t both h e r c l o s e n e s s t o l i f e i n t h e c o - o p e r a t i v e . a n d h e r own needs i n f l u e n c e d t h i s p a r t i c i p a n t ' s e v a l u a t i o n o f t h e results.  123 S i g n i f i c a n c e of t h e Study I t was never t h e i n t e n t f o r t h e r e s u l t s of t h i s t o be g e n e r a l i z a b l e t o any other p o p u l a t i o n .  study  The study  does, however, p r o v i d e d e s c r i p t i v e i n f o r m a t i o n on t h e e x p e r i e n c e s o f one group of women l i v i n g on a low income, and g i v e s some i n s i g h t s i n t o the c o n s t r u c t i o n o f h e a l t h f o r these women. I t e x p l o r e s the h e a l t h b e l i e f s , concerns,  values,  and p r a c t i c e s of these women, and how l i v i n g on a  low income i n t h i s p a r t i c u l a r environment a f f e c t s them. S i n c e t h e women have only r e c e n t l y moved i n t o t h i s  housing  environment, they were a b l e t o p r o v i d e comparisons w i t h t h e i r p r e v i o u s l i v i n g arrangements.  The concepts o f  i d e n t i t y , environment, and c o n t r o l have been shown t o have particular significance.  The p r o j e c t has generated  several  q u e s t i o n s f o r f u r t h e r study. Summary of the Study Economic impoverishment has been c l e a r l y l i n k e d t o poor h e a l t h , although t h e mechanisms of t h i s r e l a t i o n s h i p i s not w e l l understood.  T h i s study has been an i n i t i a l attempt t o  address t h e gaps i n t h e l i t e r a t u r e on women, p o v e r t y , and health.  The purpose of t h i s study has been t o examine how  low income women c o n s t r u c t h e a l t h i n t h e i r l i v e s w i t h i n t h e c o n t e x t o f a s p e c i f i c housing c o - o p e r a t i v e . the women's b e l i e f s , v a l u e s , concerns, by s t u d y i n g t h e i r everyday An ethnographic  I t has e x p l o r e d  and h e a l t h p r a c t i c e s  lives.  approach was chosen t o p r o v i d e  124  d e s c r i p t i v e data on the d a i l y l i v e s of these women. U n f o r t u n a t e l y , access f o r p a r t i c i p a n t - o b s e r v a t i o n was denied.  As an a l t e r n a t i v e , i n t e n s i v e i n t e r v i e w s were  conducted w i t h a sample of t e n v o l u n t e e r s .  The i n t e r v i e w s  were audio-taped, t r a n s c r i b e d , and analyzed f o r common themes. There were s e v e r a l i n t e r e s t i n g f i n d i n g s . p e r c e i v e d themselves identity.  The women  t o be a d i v e r s e group without a common  They d i d , however, see themselves  as s h a r i n g a  number o f common experiences which i n c l u d e d a h i s t o r y o f abuse, d y s f u n c t i o n , o r other "hard e x p e r i e n c e s . " L i v i n g i n t h e housing c o - o p e r a t i v e was i d e n t i f i e d i n i t i a l l y as a major source of s t r e s s by t h e m a j o r i t y o f t h e participants.  The reasons g i v e n i n c l u d e d l e a r n i n g new  s k i l l s r e q u i r e d i n the o p e r a t i o n of t h e c o - o p e r a t i v e and n e g o t i a t i n g boundary i s s u e s .  As time progressed, t h e women  i d e n t i f i e d more success i n managing i n t e r p e r s o n a l relationships.  As each woman l e a r n e d t o " f i t  support systems developed.  i n , " social  The most s i g n i f i c a n t f i n d i n g s o f  the study r e l a t e t o the concepts of i d e n t i t y , t h e environment,  and c o n t r o l .  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I d e n t i t y and c o n t r o l : A s t r u c t u r a l t h e o r y o f s o c i a l a c t i o n . P r i n c e t o n , New J e r s e y : Princeton U n i v e r s i t y Press. W i l l i a m s , D. R. (1990). Socioeconomic d i f f e r e n t i a l s i n h e a l t h : A review and r e d i r e c t i o n . S o c i a l Psychology Q u a r t e r l y . 51(2), 81-99. W i l l i a m s , D. R., & House, J . (1991). S t r e s s , s o c i a l support, c o n t r o l and coping: a s o c i a l e p i d e m i o l o g i c a l view. In B. Badura & I . Kickbusch (Eds.), H e a l t h promotion r e s e a r c h : Towards a new s o c i a l epidemiology (pp. 147-172). Copenhagen: World H e a l t h O r g a n i z a t i o n .  131 Wilson, J . (1988). Women and poverty: A demographic overview. Women and Health, 12(3/4), 21-40. World H e a l t h O r g a n i z a t i o n . (1984). H e a l t h promotion: A d i s c u s s i o n document o f the concept and p r i n c i p l e s . Copenhagen: World Health O r g a n i z a t i o n . World H e a l t h O r g a n i z a t i o n . (1992). Women's h e a l t h : A c r o s s acre and f r o n t i e r . Geneva: World H e a l t h Organization. Z a h a r l i c k , A., & Green, J . (1991). Ethnographic r e s e a r c h . In J . Flood, J . Jensen, D. Lapp, & J . S q u i r e (Eds.), Handbook o f r e s e a r c h on t e a c h i n g t h e E n g l i s h language a r t s (pp. 205-225). New York: Macmillan P u b l i s h i n g Co. Zambrana, R. E. (1988). A r e s e a r c h agenda on i s s u e s a f f e c t i n g poor and m i n o r i t y women: A model f o r under-standing t h e i r h e a l t h needs. Women and H e a l t h , 12.(3/4), 137-160.  132 Appendix A Research P r o p o s a l O u t l i n e f o r XXXXXXXXXX by C h r i s Wasylishyn. MSN Student, UBC October 26, Research  1994.  Questions:  1. What i s i t l i k e t o l i v e i n a housing co-op f o r low income women? a) How do low-income women c o n s t r u c t h e a l t h i n t h e i r lives? b) What a r e t h e b e l i e f s , v a l u e s , concerns, and p r a c t i c e s o f low income women i n r e l a t i o n t o t h e i r health? c) How does l i v i n g i n a co-op i n f l u e n c e a woman's h e a l t h and h e a l t h p r a c t i c e s ? Purpose: The purpose of t h i s study i s t o l e a r n about how l i v i n g on a l i m i t e d income a f f e c t s the h e a l t h o f women. I a l s o expect t o l e a r n something about how l i v i n g i n a housing co-op a f f e c t s health. To date, v i r t u a l l y no r e s e a r c h has been done on t h e h e a l t h o f unattached, low-income women. T h i s study i s a n t i c i p a t e d t o be a s t a r t i n g p o i n t f o r r e s e a r c h i n t h i s area and w i l l l i k e l y generate q u e s t i o n s f o r f u r t h e r study. Method: The method I p l a n t o use i s c a l l e d ethnography. Using i t , the r e s e a r c h e r l e a r n s about shared b e l i e f s among a p a r t i c u l a r group. The main technique f o r ethnography i s p a r t i c i p a n t - o b s e r v a t i o n . Using t h i s approach, I hope t o observe and i n t e r a c t with members o f t h e co-op a t meetings, s o c i a l events, and w h i l e j u s t spending time around t h e building. Other techniques I propose t o use a r e i n d i v i d u a l taped i n t e r v i e w s and focus ( d i s c u s s i o n ) groups o f two t o three participants. E t h i c a l Issues: The study must be approved by t h e U n i v e r s i t y o f B r i t i s h Columbia e t h i c s committee b e f o r e I begin. A l l i n f o r m a t i o n p r o v i d e d by i n d i v i d u a l s w i l l be kept c o n f i d e n t i a l . I will c o n t i n u e t o n e g o t i a t e p e r m i s s i o n on an on-going b a s i s . For example, I w i l l o b t a i n p e r m i s s i o n t o a t t e n d each s o c i a l  133 event and p r i o r t o each taped i n t e r v i e w . Anyone who does not want t o p a r t i c i p a t e i n a taped i n t e r v i e w w i l l be under no o b l i g a t i o n t o do so. (I expect I w i l l need t o do o n l y s i x t o t e n i n d i v i d u a l interviews.) I w i l l be working under the d i r e c t s u p e r v i s i o n of two experienced r e s e a r c h e r s . Consequences of P a r t i c i p a t i n g i n t h e Study: Many people f i n d t h e o p p o r t u n i t y t o p a r t i c i p a t e i n a study rewarding and enjoy e x p r e s s i n g t h e i r concerns. The p e r s o n a l consequences o f p a r t i c i p a t i n g a r e minimal. A t times, you may f e e l t h e e f f e c t s of having an " o u t s i d e r " p r e s e n t . I f , however, a t any time you f e e l your p r i v a c y i f being invaded, you w i l l be a b l e t o ask me t o leave. There has not been enough r e s e a r c h on women's h e a l t h i n g e n e r a l and e s p e c i a l l y on t h e h e a l t h of low-income women. T h i s study w i l l c o n t r i b u t e i n a s m a l l way towards c o r r e c t i n g t h a t d e f i c i e n c y . I am committed t o having t h e r e s u l t s o f the study p u b l i s h e d so they w i l l be a c c e s s i b l e t o o t h e r s .  134 Appendix B (UBC  LETTERHEAD) Page 1 of 2  CONSENT FORM: Interviews Project T i t l e : Women, Low Income & H e a l t h : An Ethnography Student I n v e s t i g a t o r : C h r i s Wasylishyn Master of Science i n Nursing Student U n i v e r s i t y of B r i t i s h Columbia  Telephone: XXX-XXXX  Graduate T h e s i s S u p e r v i s o r : Dr. Joy Johnson  Telephone: 82 2-XXXX  The f o l l o w i n g aspects of t h i s r e s e a r c h study have been e x p l a i n e d t o me t o my s a t i s f a c t i o n : 1.  The purpose of t h i s r e s e a r c h p r o j e c t i s t o e x p l o r e the b e l i e f s , v a l u e s , concerns, and h e a l t h p r a c t i c e s of low income women.  2.  A maximum of t h r e e i n t e r v i e w s w i l l be conducted w i t h me.  3.  Each i n t e r v i e w w i l l  4.  Each i n t e r v i e w w i l l be audiotaped by the i n v e s t i g a t o r and t r a n s c r i b e d by a t y p i s t .  5.  A summary of the r e s e a r c h r e p o r t w i l l be a v a i l a b l e t o me upon request.  l a s t approximately  60 minutes.  I understand t h a t t h e r e may be no d i r e c t b e n e f i t s t o me f o r p a r t i c i p a t i n g i n t h i s study, but i t i s hoped t h a t the knowledge gained w i l l help t o improve h e a l t h c a r e f o r low income women. I hereby g i v e p e r m i s s i o n t o be i n t e r v i e w e d and f o r those i n t e r v i e w s t o be audiotaped and t r a n s c r i b e d . I understand t h a t the tapes and t r a n s c r i p t i o n s w i l l be i d e n t i f i e d o n l y by code numbers, t h a t my name and address w i l l be kept i n a s e p a r a t e locked f i l e , and t h a t t h i s f i l e w i l l be d e s t r o y e d upon the completion of t h i s i n v e s t i g a t i o n . I understand t h a t any i d e n t i f y i n g i n f o r m a t i o n w i l l be d e l e t e d from the transcriptions.  135 Page 2 of 2 I understand t h a t a f t e r the p r o j e c t i s f i n i s h e d , the i n f o r m a t i o n c o l l e c t e d may be used by t h i s or another i n v e s t i g a t o r t o answer another r e s e a r c h q u e s t i o n . T h i s i n v e s t i g a t o r w i l l o b t a i n e t h i c a l approval a c c o r d i n g t o s t a n d a r d procedures b e f o r e beginning such r e s e a r c h . The audiotapes are the p r o p e r t y of the i n v e s t i g a t o r and by consenting t o p a r t i c i p a t e i n t h i s p r o j e c t , any r i g h t s t o these tapes are waived. I understand t h a t I am f r e e t o r e f u s e t o p a r t i c i p a t e i n t h i s study, t o r e f u s e t o answer any q u e s t i o n s , and t o withdraw from the study a t any time without consequences t o myself. I have had o p p o r t u n i t y t o ask q u e s t i o n s and these q u e s t i o n s have been answered t o my s a t i s f a c t i o n . T h i s i s t o c e r t i f y t h a t I, , hereby v o l u n t a r i l y agree t o p a r t i c i p a t e i n the above named project. I have r e c e i v e d a copy of t h i s consent form.  Participant Date:  Investigator  136 Appendix C  SAMPLE INTERVIEW QUESTIONS Both t h e i n d i v i d u a l i n t e r v i e w s and the f o c u s groups w i l l address t h e f o l l o w i n g q u e s t i o n s . Broad, openended q u e s t i o n s a r e used t o e l i c i t the p a r t i c i p a n t s ' perspectives. I am i n t e r e s t e d i n the e f f e c t s of l i v i n g on a low income on your l i f e s t y l e c h o i c e s and h e a l t h . T e l l me about your day t o day l i f e . What does i t mean t o you t o be h e a l t h y ? What i s important t o you i n regards t o your health? What a r e the t h i n g s you do t o f o r your h e a l t h ? How does l i v i n g on a l i m i t e d incomed a f f e c t your health? How does i t a f f e c t those t h i n g s you do or would l i k e t o do t o be h e a l t h y ? In what ways has l i v i n g i n t h i s housing c o - o p e r a t i v e a f f e c t e d your l i f e i n g e n e r a l , and s p e c i f i c a l l y , your h e a l t h ?  

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