For Love, Not Money! A study of health-related decision making in a group of female healthcare assistants who work in residential aged care and who live in low-income households

Abstract

Issues of social inequality have increasingly featured in public debate in New Zealand and around the world, as the widening gap between rich and poor, both within and across countries, is highlighted and becomes more unacceptable. In New Zealand there has been considerable debate around issues of social inequality and a call to lift the minimum wage has been part of that. Concern about hardship experienced by low-wage employees in New Zealand was highlighted with the recent Pay-Equity Settlement affecting health-support workers and caregivers; and the very recent announcement of an increase in the minimum wage rate. This thesis was initiated prior to these changes and sought to explore the impact of low income on health-related decision-making among healthcare assistants (i.e. caregivers) working in residential aged-care. The primary research question for this study was: How do female healthcare assistants employed in residential aged-care and who live in low-income households, think about and attend to their personal health concerns? The literature review provided the contextual framework for this, drawing on literature regarding social determinants of health, particularly low-income and gender, and individually-focussed theories of health decision-making and behaviour change. To ground this theoretical context in lived experience eight semi-structured interviews were conducted with women who were employed as healthcare assistants in residential aged-care facilities in Dunedin, New Zealand. Participants were obtained using a purposive sampling strategy and they represented a range of ages and worked in different aged-care facilities. One participant was born outside of New Zealand. Thematic analysis of the interviews revealed two overarching themes which were: “It’s a struggle” and “It’s good to work and it’s good work”. These themes reflect findings from previous studies with this workforce. Mediating these two aspects of the women’s experience were key health beliefs that deeply influenced the women’s confidence and ability to achieve and maintain good health. The study’s findings are further explicated using the Constrained Choices framework and the Health Capability Model.

The main recommendations to emerge from this research are: - That mechanisms be adopted to support HCAs constructing themselves as professional carers rather than pseudo-family members - That adequate staffing levels be maintained to protect the health and wellbeing of HCAs - That a cohesive team culture be fostered in the workplace that includes all staff - That appropriate and targeted support be offered to migrant workers - That a health capability framework be adopted to inform policy and practice in RAC