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Case Study of Organizational and Community Health Changes Under New Jersey State Welfare Reform

Nursing research has predominantly examined the environment at the micro level; however, nurse scholars are increasingly calling for studies that examine macro-level environmental factors on population health. This comparative case study examined changes made by health-related organizations and in community health during the 1st years of New Jersey welfare reform policy implementation (1992-1998). The boundaries of these case descriptions were directed by Milio's ecological framework for policy studies. Throughout these years, county welfare agencies made organizational changes that shifted their focus from supporting family well-being to encouraging work as a means to achieving independence from welfare. Health care provider organizations are just now beginning to make organizational changes in response to the ripple effects of welfare reform. Beyond providing insight into the possible health consequences of welfare reform policy, this study may prove useful as a methodological guide for nurse researchers confronting the challenges inherent in process-oriented policy research.

Key Words: health promotion • policy process • health policy • welfare reform • community health • organizational change • uninsured

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