Health and wellbeing of lone parents in welfare to work: a systematic review of qualitative studies

BackgroundLone parents have worse health than couple parents, which is largely explained by higher levels of poverty. Many high income countries have attempted to address poverty by introducing mandatory requirements to actively seek employment or participate in training for welfare recipients, including lone parents. However, employment might not reduce poverty or improve the health of lone parents. To assess experiences of welfare to work and gain insight into possible mechanisms linking interventions with health and wellbeing, this study systematically reviewed qualitative data from studies of lone parents’ experiences of mandatory welfare to work.Methods21 bibliographic databases were searched (appendix) for articles published between July 16, 2009, and July 6, 2013, with no language restrictions; search-term sets were used for the topics, lone parent and welfare to work. Studies that met the criteria of focusing on lone parents, mandatory welfare to work interventions, and health or wellbeing were imported into NVivo (version 10) for coding. Two reviewers independently screened references, assessed study quality for clarity and appropriateness of methods, and developed the coding framework. Thematic synthesis, a method to facilitate transparency when identifying analytical themes between studies, was used to guide line-by-line coding of the data.FindingsFrom 4703 papers identified, 16 studies (724 participants) from five high income countries were included. Although the balance of evidence was on negative findings—ie, linking welfare to work to negative health effects, such as stress, fatigue, and depression—there were some positive reports of improved self-worth. Available employment was often precarious and poorly paid. The demands of parenting were frequently in direct conflict with employment and welfare to work obligations, and affected parents’ control over major life decisions and everyday routines. Therefore, the concepts of conflict and control seemed to encapsulate how welfare to work affected health. Social support allowed some parents to manage these conflicts, allowing greater control over their circumstances, and for some mediating the adverse health effects of welfare to work.InterpretationParticipation in mandatory welfare to work can result in increased conflict and reduced control for lone parents, leading to negative effects on mental health. The potential benefits of welfare to work are dependent on access to adequate social support and suitable employment opportunities; however these are often unavailable to lone parents in welfare to work.FundingUK Medical Research Council and Scottish Government Chief Scientist Office Informing Healthy Public Policy programme (MC_UU_12017/4).