The Ecosystem of Women’s Health Social Enterprises Based in the United States
Entrepreneurship for Social Change
ISBN: 978-1-80071-211-9, eISBN: 978-1-80071-210-2
Publication date: 2 August 2021
Abstract
The overall objective of this research was to elucidate the ecosystem of women’s health social enterprises (WHSEs) based in the United States. The Aim I was to conduct a secondary data analysis of a random national sample of non-profit WHSEs based in the United States regarding their characteristics and areas of intervention. Aim II was to conduct a qualitative assessment of a sample of WHSEs based in the United States regarding their perspectives on the ecosystem of WHSEs. Aim I utilized the GuideStar database and assessed enterprise size, geographic location, financial distress, health intervention area, and health activity category using descriptive statistics, statistical tests, and multivariable regression analysis via SPSS. Aim II utilized in-depth interviewing and grounded theory analysis via MAXQDA 2018 to identify novel themes and core categories while using an established framework for mapping social enterprise ecosystems as a scaffold.
Aim I findings suggest that WHSE activity is more predominant in the south region of the United States but not geographically concentrated around cities previously identified as social enterprise hubs. WHSEs take a comprehensive approach to women’s health, often simultaneously focusing on multiple areas of health interventions. Although most WHSEs demonstrate a risk for financial distress, very few exhibited severe risk. Risk for financial distress was not significantly associated with any of the measured enterprise characteristics. Aim II generated four core categories of findings that describe the ecosystem of WHSE: (1) comprehensive, community-based, and culturally adaptive care; (2) interdependent innovation in systems, finances, and communication; (3) interdisciplinary, cross-enterprise collaboration; and (4) women’s health as the foundation for family and population health. These findings are consistent with the three-failures theory for non-profit organizations, particularly that WHSEs address government failure by focusing on the unmet women’s health needs of the underserved populations (in contrast to the supply of services supported by the median voter) and address the market failure of over exclusion through strategies such as cross-subsidization and price discrimination. While WHSEs operate with levels of financial risk and are subject to the voluntary sector failure of philanthropic insufficiency, the data also show that they act to remediate other threats of voluntary failure.
Aim I findings highlight the importance of understanding financial performance of WHSEs. Also, lack of significant associations between our assessed enterprise characteristics and their financial risk suggests need for additional research to identify factors that influence financial performance of WHSE. Aim II findings show that WHSEs are currently engaged in complex care coordination and comprehensive biopsychosocial care for women and their families, suggesting that these enterprises may serve as a model for improving women’s health and health care. The community-oriented and interdisciplinary nature of WHSE as highlighted by our study may also serve as a unique approach for research and education purposes. Additional research on the ecosystem of WHSE is needed in order to better inform generalizability of our findings and to elucidate how WHSE interventions may be integrated into policies and practices to improve women’s health.
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Acknowledgements
Acknowledgments
I thank Yale School of Medicine for the opportunity to engage in research throughout my student career, culminating in this thesis work. More specifically, I thank the Office of Student Research for continued research funding and support. I thank Dr Xiao Xu for mentorship that exceeded expectations and Dr Kate Cooney for co-mentorship that provided the invaluable asset of expert guidance. I thank the Department of Obstetrics and Gynecology, especially Thesis Chair, Dr Seth Guller, for their sponsorship and support. I also thank Dr Marcella Nunez-Smith for her mentorship, support, and inspiration throughout not only the thesis revision process, but also my entire medical student career.
With regard to technical research support, I thank Belinda Nhundu for serving as my qualitative research assistant, especially maintaining flexibility and dedicating a significant amount of time and care to help produce a robust coding system. I also thank the StatLab at Yale University, the Equity Research and Innovation Center (ERIC) at Yale University (notably Arian Schulze), and the Harvey Cushing/John Hay Whitney Medical Library at Yale University (notably Holly Grossetta Nardini) for strategic consultation on biostatistics, qualitative research methods, and literature review, respectively. I also extend my sincerest gratitude to the GuideStar staff (notably Ashley Early; visit www.guidestar.org for more information) as well as enterprises who assisted with data collection for this study, especially the entrepreneurs who generously participated in the qualitative arm of this study.
Last, but certainly not least, I thank my husband, family, and friends for always being there any time I need you; my thesis research was no exception. Thank you.
Citation
Kilgore-Nolan, M. (2021), "The Ecosystem of Women’s Health Social Enterprises Based in the United States", Sergi, B.S., Scanlon, C.C. and Heine, L.R.I. (Ed.) Entrepreneurship for Social Change (Lab for Entrepreneurship and Development), Emerald Publishing Limited, Leeds, pp. 37-94. https://doi.org/10.1108/978-1-80071-210-220211003
Publisher
:Emerald Publishing Limited
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