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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S c h r i j v e r s , C., Mackenback, J . , Lutz, J . , Quinn, M., & Coleman, M. (1995). D e p r i v a t i o n and s u r v i v a l from b r e a s t cancer. B r i t i s h J o u r n a l o f Cancer. 72(3) , 738-743. S c o t t , A. (1998). Human i n t e r a c t i o n and p e r s o n a l boundaries. J o u r n a l of P s y c h o s o c i a l Nursing, 26(8) , 130 23-27. S h i e l d s , L. (1995). Women's experiences o f t h e meaning of empowerment. Q u a l i t a t i v e H e a l t h Research. 5 ( 1 ) , 15-35. Smith, J . (1986). The paradox o f women's p o v e r t y : Wagee a r n i n g women and economic t r a n s f o r m a t i o n . In B. G e l p i , N. Hartsock, C. Novak, & M. S t r o b e r (Eds.), Women i n Poverty (pp. 121-140). Chicago: The U n i v e r s i t y of Chicago P r e s s . Spradley, J . (1979). The ethnographic i n t e r v i e w . New York: H o l t , R i n e h a r t , & Winston. Stewart, M. (1993). I n t e g r a t i n g s o c i a l support i n n u r s i n g . Newbury Park: Sage. Thomas, E. (1988). R e s u l t s of a key informant survey. In Proceedings of the N a t i o n a l Symposium on Changing P a t t e r n s of H e a l t h & Disease i n Canadian Women (pp. 31-3 5). Ottawa: M i n i s t e r of Supply and S e r v i c e s Canada. U l r i c h , R. (1984). View through a window may i n f l u e n c e r e c o v e r y from surgery. Science, 224, 420-421. Weeks, J . (1990). The v a l u e of d i f f e r e n c e . In J . R u t h e r f o r d (Ed.), I d e n t i t y : Community, c u l t u r e , d i f f e r e n c e (pp. 88-100). London: Lawrence & W i s h a r t . Wekerle, G. (1988). Canadian women's housing c o o p e r a t i v e s : Case s t u d i e s i n p h y s i c a l and s o c i a l i n n o v a t i o n . In C. Andrew & B. M i l r o y (Eds.), L i f e spaces: Gender, household, employment (pp. 102140). Vancouver: The U n i v e r s i t y of B r i t i s h Columbia Press. White, H. (1992). 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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Women, low income, and health : an ethnography of a housing co-operative Wasylishyn, Christine 1996
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