Exploratory Study of a Financial Education Intervention to Promote Financial Well-Being in Low-Income Mothers

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Financial well-being has only recently been acknowledged as a social determinant of health. This study explored a framework for delivering financial education to low-income, primarily Hispanic mothers. Methods. A financial education intervention was developed for low-income mothers of infants based on formative data gathered from focus groups, cognitive interviews, and a pilot survey. Participants attended five weekly 30-minute classes taught in small groups using a virtual format. Self-reported surveys were administered at baseline and post-intervention to explore associations between financial well-being and baseline demographic and financial characteristics, examine factors that influenced financial education class attendance, and evaluate the impact of financial education on mothers’ financial outcomes and well-being. Results. Of the 56 participants enrolled in the study from March 2021 to February 2022, 18 attended at least one class and 15 completed the post-intervention survey. Financial confidence and behavior were positively associated with financial well-being (p = .00). Attitude toward saving predicted financial behavior (p = .00). Common barriers to attendance included lack of time and the need for childcare. Following financial education, participants reported feeling more comfortable going to a bank to inquire about a product or service (p = .0001) and greater ability to make financial decisions new to them (p = .03). While overall financial well-being did not change, the ability to handle a major expense improved (p = .004). Discussion. Given the limited time that new mothers can dedicate to financial education, the goals of such programs should focus on building confidence in making informed financial decisions and fostering a positive attitude toward saving. financial literacy financial knowledge financial health social determinants of health minority women Figures Figure 1 Introduction The Great Recession of 2008 and the economic downturn caused by the COVID-19 pandemic highlighted the importance of financial literacy among large segments of the U.S. population (Dinwoodle, 2011 ). The crushing economic impact of the pandemic further deepened existing financial inequality among vulnerable groups such as Hispanics, low-income households, families with children, and those with limited financial literacy (Clark et al., 2020 ). Financial literacy, defined as the knowledge and skills to manage money effectively, is essential for building financial capability, practicing positive financial behaviors, and achieving overall financial well-being (Fan & Henager, 2022 ; Sherraden, 2013 ). Despite increased attention to financial literacy over the past decade, financial well-being is only recently recognized as a social determinant of health (Weida et al., 2020 ). Social determinants of health are the circumstances in which people are born, grow, live, work, and age, including the social, economic, cultural, and political conditions contributing to disparities (World Health Organization, 2008 ). Economic hardship can lead to both immediate and long-term consequences for the health and well-being of individuals, families, and communities (Chilton et al., 2017 ; Sandel et al., 2018; Whitehead et al., 2017). Financial stress can adversely affect children’s physical health, academic performance, and social-emotional development (Huang & Sherraden, 2016 ; Kiernan & Huerta, 2008 ). Conversely, efforts to enhance financial well-being can have a positive impact on health, happiness, and overall life satisfaction (Brüggen et al., 2017 ). Addressing social determinants of health requires screening for economic hardship, connecting families with financial resources, and implementing interventions to promote financial well-being (Chung et al., 2016). The Consumer Financial Protection Bureau (CFPB, 2015) identifies financial well-being as an essential outcome of financial literacy efforts. Financial well-being includes having a sense of control over finances; having the ability to absorb a financial shock; staying on track to meet financial goals; and making financial decisions that enhance life satisfaction. However, there is a paucity of research on financial well-being among minority women, and existing financial education programs often fail to meet the needs of this vulnerable population (Clark et al., 2021 ). To address these gaps, a financial education intervention was developed for mothers of infants enrolled in a program called Developmental Understanding and Legal Collaboration for Everyone (DULCE). DULCE is an innovative approach that promotes healthy child development by addressing social determinants of health during routine pediatric visits from birth to six months (Sege et al., 2015). This age group was selected for DULCE intervention because: 1) nearly all infants are seen in primary care, offering opportunities for screening; 2) the birth of a child can alter family dynamics and increase financial stress; and 3) the first six months of life are associated with a heightened risk of child maltreatment (Sege et al., 2015; U.S. Department of Health and Human Services, 2022). A DULCE Family Specialist partners with each family to strengthen caregiver skills, connect them to resources, and help to alleviate challenges that arise with a new child, including financial stressors (Sege et al., 2015). This nationally recognized, evidence-based model serves a predominantly low-income, minority population (Sege et al., 2014). The current study engaged participants from three DULCE clinics in a county facing economic hardship, where nearly 25% of children live in poverty, and one in three families struggle to meet their basic needs (Manzo et al., 2021 ). The purpose of this study was to develop and evaluate an evidence-based financial literacy curriculum and assessment methods to be integrated into DULCE's constellation of resources and, more broadly, into pediatric healthcare services. The specific aims were to: 1) create a financial education program and evaluation tools for low-income mothers of infants based on data gathered from formative research; 2) examine associations between mothers’ financial well-being and their baseline demographic and financial characteristics; 3) explore factors influencing financial education class attendance; and 4) evaluate the impact of a financial education intervention on mothers’ financial outcomes and well-being. Methods This mixed methods exploratory study was conducted from November 2020 to February 2022 in two phases: formative research and an intervention study. Formative research methods included focus groups, cognitive interviews, and a pilot survey conducted from November 2020 to January 2021. The goal of the formative phase was to develop a financial education curriculum that addressed the specific needs and circumstances of the target population, predominantly Hispanic low-income mothers. The intervention consisted of five weekly 30-minute financial education classes delivered to small groups via Zoom videoconferencing technology in two enrollment waves from April to October 2021. Approval for this study was obtained from the Institutional Review Boards at California State University, Fullerton and Children’s Hospital of Orange County. Informed consent was obtained from participants to participate in the study. All procedures performed involving human participants were in accordance with the U.S. Department of Health and Human Services 45 Code of Federal Regulations Part 46. Participants and Setting Using convenience sampling methods, participants were recruited from three DULCE clinics in southern California. Eligible participants were mothers of infants younger than six months of age who received care at a DULCE clinic from November 2020 to September 2021. Mothers were excluded if they were younger than 18 years of age and/or received medical care in a language other than English or Spanish. Family Specialists screened mothers for eligibility and notified the study coordinator, who recruited participants via telephone and email. Study participation was incentivized with gift cards. Phase 1 group assignment was based on convenience; the first few participants were assigned to focus groups, the next few were invited to participate in cognitive interviews, and the last several participants were asked to complete the pilot survey. Formative data were analyzed, and participants who were not part of Phase 1 were invited to enroll in the intervention for Phase 2. Phase 1: Formative Research First, two virtual 45-minute focus groups were led by a bilingual moderator who guided discussions on topics relevant to the participants’ financial needs and circumstances. Most of the discussions were held in Spanish. Two trained observers documented field notes during each session (Appendix Table 1). Following the focus groups, cognitive interviews were conducted virtually to determine: 1) if the survey items were clearly articulated; 2) if participants understood the survey items in the way they were intended; and 3) how to locally adapt and contextualize survey items developed at the national level (e.g., the National Financial Capability Study). These interviews were conducted in English or Spanish and documented by a trained observer (Appendix Table 2). Finally, a pilot survey was administered to estimate survey completion time and to evaluate the user interface when accessed on participants’ mobile phones. Phase 2: Intervention Study The intervention study evaluated the impact of financial education classes on various aspects of financial health, including financial access, literacy, attitude, confidence, behavior, and well-being in low-income mothers of infants. Upon enrollment, participants completed a baseline survey and were invited to attend a series of five weekly 30-minute live online classes, available in English or Spanish, taught by a financial education specialist. After completing the classes, participants responded to a post-intervention survey. The curriculum used for the classes was developed based on principles outlined in the University of Chicago’s Financial Education Initiative (n.d.; Appendix Table 3). During the formative phase of the study, participants expressed concern for everyday money management issues rather than investing or saving for retirement. This finding guided the selection of the following curriculum topics: 1) money values and influences; 2) banking and credit; 3) income, expenses, and budgeting; 4) borrowing and debt management; and 5) credit cards and credit card safety (Appendix Table 3). Measures Findings from the formative phase of the study were used to refine the evaluation surveys. The baseline survey consisted of 64 items, including 11 demographic questions, 6 financial access items, 14 financial literacy items, 5 financial attitude items, 7 financial confidence items, 3 financial behavior items, 12 financial well-being items, and 6 items related to the impact of the COVID-19 pandemic on family finances (Appendix Table 4). Baseline financial literacy was measured as the Pre-Score. Financial access was assessed by participants’ bank account ownership, comfort level with visiting a bank for information, methods of cashing checks and paying utility bills, number of credit cards, and use of a payday loan or pawn shop. Financial attitudes were measured by participants’ attitudes toward saving, borrowing, risk-taking, and present bias. Financial confidence was measured with questions assessing participants’ confidence in making financial decisions, progress toward financial goals, and financial knowledge. Financial confidence was quantified as a factor score derived from a principal-component factor (PCF) analysis of seven questions. Financial behavior was evaluated based on whether participants incurred fees for late payments or exceeding their credit limits. Financial well-being was measured using the code and methodology provided by CFPB (2017) described in Table 4 of the Appendix. Statistical Approach First, the relationships between financial well-being and demographic characteristics, banking status, financial literacy, confidence, and behavior were examined using p-values. To further explore the factors influencing baseline financial well-being, the following regression equation was specified, controlling for demographic variables and preexisting financial literacy. Y i = α 0 + α 1 Married i + α 2 PreScore i + α 3 College i + α 4 Fin Behavior i + α 5 Fin Confidence i + ε i where Y i is the financial well-being index calculated for individual i . Next, the following binary probit model was used to estimate the probability of attending financial education classes: Si * = β 0 + β 1 PreScore i + β 2 Language i + β 3 FWB Control i + β 4 FWBMoneyleftover i + ε i where S * was a latent variable representing a respondent's perceived difference between the marginal benefit and cost of attending the financial education class. As per Marlowe et al. ( 2019 ) it was posited that the probability of attending financial education classes would depend on the following financial well-being item: “ My finances control my life and I have money left over at the end of the month .” The baseline financial literacy score, “PreScore,” was included to determine if having high preexisting scores would reduce the probability of attending financial education classes. Participants’ preferred language (English or Spanish) was used to determine if different demographic groups were more or less likely to attend financial education classes. Finally, paired t tests were used to evaluate the effect of the financial education intervention on financial outcomes and well-being in mothers who attended at least one class. Results Descriptive Characteristics of Our Participants Of the 26 eligible and interested candidates, 17 mothers (65%) enrolled in the formative phase of the study. Among them, six mothers were assigned to focus groups, six participated in cognitive interviews, and five completed the pilot survey. For the intervention study, 56 mothers out of 166 eligible candidates enrolled (34%) and 46 completed the baseline survey (Fig. 1 ). Eighteen mothers attended at least one financial education class, of which 15 completed the post-intervention survey. Of the 46 mothers who completed the baseline survey, more than a third (35%) responded in Spanish (Table 1). Most participants (67%) had at least a high school education and some (39%) had attended college. The majority were either homemakers (39%) or unemployed (24%). Half of the participants reported that their spouses or partners had a high school education, with 12% having attended college. Spouses and partners were employed full-time (55%), part-time (12%), or were self-employed (24%). Fifty percent of households had a monthly income of $ 2,000 or less and 39% had six or more members in their households. All of the families were renters. At baseline, the average financial literacy score was approximately 40% or 5.6 correct answers out of 14 questions. Fewer than half of mothers (48%) correctly answered the interest rate question and about a quarter (26%) correctly answered the inflation question. Table 2 summarizes the financial access of the participants. At baseline, most mothers reported that they (or their spouse or partner) had a bank account (76%), felt comfortable going to a bank to ask a question about a product or service (72%), and/or had a credit card (61%). A smaller proportion had used a payday loan or pawn shop (26%) and/or cashed checks at a grocery or liquor store (9%). Table 3 summarizes the financial attitudes of the participants. At baseline, most mothers expressed positive attitudes toward saving and borrowing, with 81% agreeing with the statement “ I try not to spend all the money that I have saved” and 91% disagreeing with the statement “ It is OK to borrow money to buy things I want but do not need.” Additionally, 67% indicated that they would save an extra $ 200 rather than spend it. Regarding financial risk, 70% would prefer to keep $ 100 in winnings rather than take a 50% chance to double their money or lose it all. Nearly half of the mothers (46%) would choose $ 100 now rather than wait for twice the amount next month, indicating strong present bias. At baseline, most mothers lacked confidence in their ability to manage finances (56%) and struggled to make progress toward their financial goals (70%) (Table 4). However, a majority responded that they knew how to save money (89%), avoid overspending (83%), make new financial decisions (76%), and seek financial advice (54%). Table 5 describes the financial behavior of the 28 participants with a credit card. At baseline, 36% were charged a late fee, 15% had exceeded their credit limit, and the majority (57%) had not compared credit card offers when opening a new account. Associations Between Financial Well-being and Baseline Variables None of the demographic variables were associated with mothers’ financial well-being at baseline, including language, marital status, education, employment, and income (Table 6). Financial well-being was associated with financial confidence (p = .00) and financial behavior (p = .00), but not financial literacy or banking status. Table 7 confirms that financial confidence and financial behavior were key predicators of final well-being (p < .05), after controlling for demographic variables. Baseline financial literacy was higher for those with higher levels of education, income, and mothers’ employment. Another important finding was that financial behavior was influenced by attitude toward saving (p < .05). Factors Influencing Financial Education Class Attendance None of the three hypothesized predictor variables (i.e., financial well-being: control, financial well-being: money left, and language preference) were associated with attendance at financial education sessions (Table 7). The post-intervention survey revealed barriers to attendance including lack of childcare and work responsibilities. When asked if they would have attended in-person classes, 8 participants responded “ Yes ,” 10 were “ Unsure ,” and 3 said “ No .” The large proportion of “ Unsure” responses may have been influenced by the ongoing uncertainties surrounding the evolving COVID-19 pandemic. Financial Education Outcomes Financial education outcomes are presented in Table 8 and summarized below. Financial Access Mothers who attended at least one financial education class (n = 15) reported feeling more comfortable going to a bank to ask a question about a product or service (p = .0001). No change was observed in the other financial access variables. Financial Literacy No improvement was observed in financial literacy post-intervention. Financial Attitude Financial education did not have an impact on mothers’ financial attitudes. Financial Confidence After receiving financial education, mothers reported that they had a greater ability to make good financial decisions that were new to them (p = .03). No change was observed in other aspects of financial confidence. Financial Behavior Financial education did not have an impact on mothers’ credit card behavior. Financial Well-Being After attending at least one financial education class, mothers felt that they could handle a major unexpected expense (p = .004) (Table 9). Effect of the COVID-19 Pandemic on Household Finances At baseline, 30% of mothers and 26% of their spouses or partners had lost their jobs due to the pandemic (Table 10). Nearly three-quarters of households (72%) experienced income loss and 43% of mothers reported feeling more stressed about paying bills and rent as a result of the pandemic. Discussion This study found that low-income mothers of infants from a predominantly Hispanic community had relatively low levels of financial access. In this study, 13.0% of households were unbanked, compared to a national sample where 8.4% of Hispanic households, 8.0% of Black households, and 1.7% of White households with annual incomes ranging from $ 30,000 to $ 50,000 were unbanked (Federal Deposit Insurance Corporation, 2022 ). Notably, one aspect of financial access improved after the intervention, where participants reported feeling more comfortable going to a bank to inquire about a product or service. This is an important finding, given that financial access can help reduce material hardship among low-income mothers (Huang & Sherraden, 2016 ). Since minority women are often excluded from financial products and services, one potential solution is to provide financial education while simultaneously facilitating access to financial tools (Atkinson & Messy, 2013 ). Financial education can help mothers understand the risks associated with alternative banking services and teach strategies to avoid predatory lending practices. Another important approach is to address the perceived barriers that minority women face when accessing mainstream financial services, such as banking fees, unexpected charges, uncertainty about interest rates, lack of a social security number, discriminatory treatment, and fear of deportation (Bullock et al., 2020 ). By empowering minority women with access to bank accounts, savings mechanisms, and other financial services, they can gain greater control over their earnings and make informed decisions about how they manage their money, ultimately helping to reduce social and economic inequality (Gammage et al., 2017 ). Participants in this study exhibited low levels of financial literacy and were predominantly homemakers or unemployed, which limited their earning potential and financial security. Less than half (48%) correctly answered the interest rate question and only about a quarter (26%) correctly answered the inflation question. These figures are lower than the national averages of U.S. Hispanic women, where 65% and 40% answered these questions correctly (Clark et al., 2021 ). Despite low financial literacy, individuals often overestimate their financial knowledge (Lusardi & Mitchell, 2013 ). In the U.S. Financial Capability Study, 70% of respondents rated their financial knowledge as above average, yet only 30% answered the knowledge questions correctly (Lusardi, 2011 ). Enhancing financial literacy in low-income mothers is crucial, as it can positively impact the entire family by enabling mothers to share financial knowledge and tools with their children and older relatives. In this study, financial education did not lead to improvement in mothers’ financial literacy. While one meta-analysis found that education had a favorable impact on financial literacy, its effectiveness was less pronounced in low-income populations (Kaiser & Menkhoff, 2017 ). However, another review indicated that financial education was most effective in promoting financial literacy among low-income groups (Wagner, 2019 ). Given that higher financial literacy is linked to positive financial behavior and improved financial well-being, further research is needed to develop interventions that improve financial literacy in low-income minority women (Mitchell & Lusardi, 2011 ). For immigrant women, in particular, learning new financial concepts involves not only understanding the content but also navigating a new financial system and overcoming sociocultural barriers. Offering financial education courses taught by a native Spanish speaker who is culturally sensitive to the needs of Hispanic women could address some of these challenges, including low literacy and numeracy. While participants demonstrated favorable attitudes toward saving, spending, and borrowing, they also exhibited a high degree of present bias; 46% preferred to receive $ 100 now rather than wait and take twice the amount next month, compared to 38% of middle school parents from a California county (Gill & Bhattacharya, 2017 ). Present bias can lead to overuse of debt financing and interfere with the ability to pay down debt, including credit card balances (Bar-Gill & Hayashi, 2021 ). Of the 28 participants with a credit card, 36% were charged a late fee and 14% had overspent their credit limit, higher than the 23% and 11% reported by Clark et al. ( 2021 ). Financial education should focus on raising mothers’ awareness of present bias in addition to creating realistic repayment plans and reducing unnecessary expenses (Kuchler & Pagel, 2021 ). At baseline, fewer than half (45%) of mothers were confident in their ability to manage their finances and less than a third (30%) felt that they were making progress in reaching their goals, indicating low levels of financial confidence (Table 4). This contrasts with the 2018 U.S. Financial Wellness Census report that found that most Hispanics were confident in reaching their financial goals, such as leaving a large inheritance, purchasing a home, helping their children with a down payment, and paying for their children’s college tuition despite limited participation in retirement savings plans (16%) due to current expenses (Prudential, 2018 ). While Hispanic women may have an optimistic outlook, financial overconfidence has been associated with a range of negative financial behaviors and outcomes (Atlas et al., 2019 ). However, in this study, financial confidence was positively associated with financial well-being. The CFPB (2015) also noted that financial well-being is not strictly tied to income level, a finding that aligns with ours. In this study, the mean financial well-being index was 54.8 (sd = 11.06) on a scale of 0 to 100, which is higher than the national average of 50 for Hispanic adults and 52 for all U.S. adults in 2018 (CFPB, 2021). This is similar to a sample in Los Angeles wherein Blanco et al. ( 2022 ) found a financial well-being index of 54 (Blanco et al., 2022 ). In the current study, financial well-being was higher among participants with “above-average” financial behavior, supporting Burke and Francisco Perez's (2019) finding that protective behavior correlates with financial well-being. This finding is consistent with previous studies (Castro-González et al., 2020 ). Intuitively, good financial behavior allows individuals to feel satisfied with their financial situation. Nearly three-quarters of the households surveyed (72%) experienced income loss and 43% of mothers reported feeling more stressed about paying bills and rent due to the COVID-19 pandemic. These findings are consistent with Blanco et al. ( 2022 ), who studied the impact of the pandemic on financial stress among Hispanic adults in California who were primarily English-speaking and employed. Their study, which collected data during the pandemic in October 2020 and compared it with prior data from August to October 2018, revealed that participants faced significant stressors related to labor market experiences and family circumstances. Similar to our findings, more women than men lost their jobs during the pandemic. Conducting this research during the pandemic necessitated a distance-mediated intervention, which likely impacted recruitment, retention, and participation. The low attendance and high attrition observed in this study are consistent with findings from other studies. For example, Marlowe et al. ( 2019 ) reported that participation in financial coaching through Oakland’s Brilliant Baby Program varied widely, with attendance ranging from 30–80% across different sites. Another study found that 44–63% of participants enrolled in financial coaching did not attend a single session (Theodos et al., 2015 ). In our study, infant caregiving needs were a common barrier to attendance, suggesting that financial education programs should provide childcare support, involve the entire family, and offer various delivery options, including live virtual classes, in person-instruction, and on-demand modules to accommodate the needs and preferences of new mothers. Limitations Despite the low birth rates during the pandemic (Schneider & Wedge, 2022 ), we engaged with 166 DULCE families. However, pandemic-related stressors may have contributed to new mothers prioritizing other concerns over participating in and continuing with our study, leading to a small sample size and lack of a control group. These factors limit the conclusions that can be drawn from this study. Nonetheless, this research lays the groundwork for integrating financial wellness into pediatric healthcare as a way to address social determinants of health, and it is hoped that similar interventions can be replicated to benefit DULCE families nationwide. This study contributes to the existing literature in three ways. First, it examines the factors associated with financial well-being calculated as the financial well-being index as defined by the CFPB. Second, the focus on families enrolled in DULCE program offers an existing channel to increase new mothers' financial well-being through nine clinics nationwide, including three clinics at the study site. Third, despite recognition of the need for intervention, there is an absence of systematic approaches embedded into the health care system to mitigate the impact of financial stress as a social determinant of health. This study addresses this gap by developing a framework wherein low-income households with infants up to six months can receive financial education delivered through the DULCE program. These results confirm the notion that financial education efforts should focus on those who need it the most. Additionally, since caring for infants is a primary barrier to attending financial education classes, these programs should offer childcare and involve the entire family, ideally through in-person sessions. Another potential strategy may be to offer financial education programs to expectant mothers during the prenatal period. This study also supports the idea that financial education should not only impart factual knowledge but also empower individuals with the confidence to make financial decisions and foster positive attitudes toward saving. Conclusions A financial education program for low-income mothers has the potential to improve a range of financial outcomes and well-being, an underrecognized social determinant of health. Programs must be adapted to meet the needs of new mothers, such as assisting with childcare, inviting the entire family, and offering flexibility through virtual and in-person class options. Declarations Competing Interests: None Funding: This project was sponsored with a grant from U.S. Bank. Author Contribution Radha Bhattacharya: PI; designed formative study and main study collaboratively with CHOC; designed the estimation methods, interpretation of results and context, manuscript preparationJennifer Barrows: study design and manuscript preparation Rachel Lobo: Research Assistant; conducted the statistical analysis based on codes written by Andrew GillJennifer Hayakawa: IRB Protocol and contributed collaboratively to the overall framework and study, manuscript review and editingMichelle Lubahn: Participant recruitment, contributed to study design, manuscript review and editing Author Note Correspondence concerning this article should be addressed to Radha Bhattacharya, Department of Economics, California State University at Fullerton, 800 N. State College Blvd, Fullerton, CA 92831. Phone: (657) 278-3652, Email: [email protected] Data Availability Statement The data that support the findings of this study are not openly available due to reasons of sensitivity (i.e., the small sample size could mean that individual patients/participants are easily identifiable) and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at California State University, Fullerton. Acknowledgments We thank Andrew Gill for writing the code; Francisco Fuentes for contacting participants, conducting the formative study, and administering the surveys; and Norma Serrato, Jessica Canizal, and Mayra Moreno for recruiting participants. References Atkinson, A. & Messy, F. (2013). Promoting financial inclusion through financial education: OECD/INFE evidence, policies, and practice. OECD Working Papers on Finance, Insurance and Private Pensions, 34, 1-55. Atlas, S. A., Lu, J., Michu, P. D., & Porto, N. (2019). 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The economic importance of financial literacy: Theory and evidence. National Bureau of Economic Research, Working Paper 18952. Manzo, P., Gascon, H., Block, B. B., & Beeby, D. (2021). Struggling to move up: The real cost measures in California 2021. UW-RCM Exec Summary July 2021 v15.indd (unitedwaysca.org) Marlowe, T., Hedberg, E., Gabouer, A., et al. (2019). The relationship between financial well-being, life stress, and the uptake of financial coaching. NORC at the University of Chicago. November 2019. https://files.consumerfinance.gov/f/documents/cfpb_financial-well-being_marlowe_brief.pdf Mitchell, O. S. & Lusardi, A. (2011). Financial literacy: Implications for retirement security and the financial marketplace. New York: Oxford University Press. National Financial Capability Study. (2018). NCFS state-by-state survey instrument. https://www.usfinancialcapability.org/downloads/NFCS_2018_State_by_State_Qre.pdf Prudential. (2018). The cut: Exploring financial wellness within diverse populations. The Cut (prudential.com). Sandel, M., Sheward, R., Ettinger de Cuba, S., Coleman, S., Heeren, T., Black, M. M., Casey, P. H., Chilton, M., Cooks, J., Cutts, D. B., Rose-Jacobs, R., & Grank, D. A. (2018). Timing and duration of pre- and postnatal homelessness and the health of young children. Pediatrics, 142(4), 1-8. Schneider, E. B., & Wedge, R. (2022). The Impact of COVID-19 on Birth Rates in the United States (NBER Working Paper No. 30000). National Bureau of Economic Research. https://www.nber.org/system/files/working_papers/w30000/w30000.pdf Sege, R., Kaplan-Sanoff, M., Morton, S. J., Velasco-Hodgson, M. C., Preer, G., Morakinyo, G., DeVos, E., & Krathen, J. (2014). Project DULCE: Strengthening families through enhanced primary care. Zero to Three, 35(1), 10-18. Sege, R., Preer, G., Morton, S. J., Cabral, H., Morakinyo, O., Lee, V., Abreu, C., DeVos, E., & Kaplan-Sanoff, M. (2015). Medical-legal strategies to improve infant health care: A randomized trial. Pediatrics, 136(1), 97-106. Sherraden, M. S. (2013). Building blocks of financial capability. In J. M. Birkenmaier, M. S. Sherraden, & J. C. Curley (Eds.), Financial capability and asset building: Research, education, policy, and practice (pp. 1-43). New York: Oxford University Press. Theodos, B., Simms, M., Treskon, M., et al. (2015). An evaluation of the impacts and implementation approaches of financial coaching programs. The Urban Institute. University of Chicago. (n.d). Characteristics of a High-Quality Financial Education Curriculum. University of Chicago Financial Education Initiative. https://www.nefe.org/_images/convenings/UChicagoFinEd-Curriculum-Checklist.pdf U.S. Department of Health & Human Services. (2022). Child maltreatment 2020. https://www.acf.hhs.gov/cb/data-research/child-maltreatment Wagner, J. (2019). Financial education and financial literacy by income and education groups. Journal of Financial Counseling and Planning, 30(1), 132-141. Weida, E. B., Phojanakong, P., Patel, F., & Chilton, M. (2020). Financial health as a measurable social determinant of health. PloS One, 15(5), e0233359. https://doi.org/10.1371/journal.pone.0233359 Whitehead, B. R. & Bergeman, C. S. (2017). The effect of the financial crisis on physical health: Perceived impact matters. Journal of Health Psychology, 22(7), 864-873. World Health Organization. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. untitled (who.int) Tables Table 1 to 10 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files FinancialWellBeingAppendix.docx FinancialWellBeingTables.pdf Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 03 Jan, 2025 Reviews received at journal 12 Dec, 2024 Reviewers agreed at journal 12 Dec, 2024 Reviews received at journal 01 Dec, 2024 Reviewers agreed at journal 22 Nov, 2024 Reviewers invited by journal 21 Nov, 2024 Editor assigned by journal 18 Nov, 2024 Submission checks completed at journal 14 Nov, 2024 First submitted to journal 22 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5313835","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":384025243,"identity":"4cbbe969-3f8c-483e-b289-8f606460fce4","order_by":0,"name":"Radha Bhattacharya","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEElEQVRIiWNgGAWjYDACCR4IbQAiPtgwyPDBpQ7g0XIgAaKFcUYaAw8bkG4gWgszDzFazGf3Hvz88YedvDn72WfSNgmHedjYe58/+LiDQY7vRgJWLTJ3ziVLHEhINtzZk24mnQPSwnPcsHHmGQZjSRxaJCRyDIBamBMMDqSxSef+AGqRSGNs5m1jSNyAW4vxjwMJ9QkG55+xSVuAbJF/BtZSj0eLGdCWwwkGN4C2MIC0SLCBtQBFcGiROWNmcSbtuOGGG8+YLXsS0oF+SWOcObNNwnDmmQfYtUj3GN+osKmWNzifxnjjR4K1HD/7MYYPH9ts5PmOY7cFGbBIIJtFUDkIMH8gStkoGAWjYBSMOAAA81tbrb8mAxAAAAAASUVORK5CYII=","orcid":"","institution":"California State University, Fullerton","correspondingAuthor":true,"prefix":"","firstName":"Radha","middleName":"","lastName":"Bhattacharya","suffix":""},{"id":384025244,"identity":"81ca52f6-9a3a-4208-8390-704accfa3573","order_by":1,"name":"Jennifer Barrows","email":"","orcid":"","institution":"Children's Hospital of Orange County","correspondingAuthor":false,"prefix":"","firstName":"Jennifer","middleName":"","lastName":"Barrows","suffix":""},{"id":384025245,"identity":"82b4ae8c-40b9-48cc-bc95-6d0b4b7d66c5","order_by":2,"name":"Jennifer Hayakawa","email":"","orcid":"","institution":"Children's Hospital of Orange County","correspondingAuthor":false,"prefix":"","firstName":"Jennifer","middleName":"","lastName":"Hayakawa","suffix":""},{"id":384025246,"identity":"358d1e0f-c635-4309-826a-c558cc5190d2","order_by":3,"name":"Rachel Lobo","email":"","orcid":"","institution":"California State University, Fullerton","correspondingAuthor":false,"prefix":"","firstName":"Rachel","middleName":"","lastName":"Lobo","suffix":""},{"id":384025247,"identity":"7df85da8-511e-4821-89ae-f780a077af74","order_by":4,"name":"Michelle Lubahn","email":"","orcid":"","institution":"Children's Hospital of Orange County","correspondingAuthor":false,"prefix":"","firstName":"Michelle","middleName":"","lastName":"Lubahn","suffix":""}],"badges":[],"createdAt":"2024-10-22 18:08:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5313835/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5313835/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":71735994,"identity":"2d6ee3f7-7e4f-4746-92d8-b2f9116f030d","added_by":"auto","created_at":"2024-12-18 07:31:57","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":59513,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eSee image above for figure legend\u003c/em\u003e\u003c/p\u003e","description":"","filename":"FinancialWellBeingFigure.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5313835/v1/d7bc5cb22666cd37333c68d1.jpg"},{"id":71735996,"identity":"ffa1151e-8955-459d-95cf-7efd5772c29b","added_by":"auto","created_at":"2024-12-18 07:32:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":536006,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5313835/v1/d5728cf5-8c46-4eb2-a309-1484e2bc2f1d.pdf"},{"id":71735993,"identity":"100ae242-b029-45b3-929e-d6b98b6f354e","added_by":"auto","created_at":"2024-12-18 07:31:57","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":30282,"visible":true,"origin":"","legend":"","description":"","filename":"FinancialWellBeingAppendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-5313835/v1/c9a0936508e5956c089fd3e3.docx"},{"id":71735995,"identity":"e52c4803-56d0-4a0a-89d5-e210c62dca87","added_by":"auto","created_at":"2024-12-18 07:31:57","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":317313,"visible":true,"origin":"","legend":"","description":"","filename":"FinancialWellBeingTables.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5313835/v1/9ced0afd0a2f9c585a4d71bb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploratory Study of a Financial Education Intervention to Promote Financial Well-Being in Low-Income Mothers","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe Great Recession of 2008 and the economic downturn caused by the COVID-19 pandemic highlighted the importance of financial literacy among large segments of the U.S. population (Dinwoodle, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). The crushing economic impact of the pandemic further deepened existing financial inequality among vulnerable groups such as Hispanics, low-income households, families with children, and those with limited financial literacy (Clark et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Financial literacy, defined as the knowledge and skills to manage money effectively, is essential for building financial capability, practicing positive financial behaviors, and achieving overall financial well-being (Fan \u0026amp; Henager, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Sherraden, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite increased attention to financial literacy over the past decade, financial well-being is only recently recognized as a social determinant of health (Weida et al., \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Social determinants of health are the circumstances in which people are born, grow, live, work, and age, including the social, economic, cultural, and political conditions contributing to disparities (World Health Organization, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Economic hardship can lead to both immediate and long-term consequences for the health and well-being of individuals, families, and communities (Chilton et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Sandel et al., 2018; Whitehead et al., 2017). Financial stress can adversely affect children\u0026rsquo;s physical health, academic performance, and social-emotional development (Huang \u0026amp; Sherraden, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Kiernan \u0026amp; Huerta, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Conversely, efforts to enhance financial well-being can have a positive impact on health, happiness, and overall life satisfaction (Br\u0026uuml;ggen et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAddressing social determinants of health requires screening for economic hardship, connecting families with financial resources, and implementing interventions to promote financial well-being (Chung et al., 2016). The Consumer Financial Protection Bureau (CFPB, 2015) identifies financial well-being as an essential outcome of financial literacy efforts. Financial well-being includes having a sense of control over finances; having the ability to absorb a financial shock; staying on track to meet financial goals; and making financial decisions that enhance life satisfaction. However, there is a paucity of research on financial well-being among minority women, and existing financial education programs often fail to meet the needs of this vulnerable population (Clark et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo address these gaps, a financial education intervention was developed for mothers of infants enrolled in a program called Developmental Understanding and Legal Collaboration for Everyone (DULCE). DULCE is an innovative approach that promotes healthy child development by addressing social determinants of health during routine pediatric visits from birth to six months (Sege et al., 2015). This age group was selected for DULCE intervention because: 1) nearly all infants are seen in primary care, offering opportunities for screening; 2) the birth of a child can alter family dynamics and increase financial stress; and 3) the first six months of life are associated with a heightened risk of child maltreatment (Sege et al., 2015; U.S. Department of Health and Human Services, 2022). A DULCE Family Specialist partners with each family to strengthen caregiver skills, connect them to resources, and help to alleviate challenges that arise with a new child, including financial stressors (Sege et al., 2015). This nationally recognized, evidence-based model serves a predominantly low-income, minority population (Sege et al., 2014). The current study engaged participants from three DULCE clinics in a county facing economic hardship, where nearly 25% of children live in poverty, and one in three families struggle to meet their basic needs (Manzo et al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe purpose of this study was to develop and evaluate an evidence-based financial literacy curriculum and assessment methods to be integrated into DULCE's constellation of resources and, more broadly, into pediatric healthcare services. The specific aims were to: 1) create a financial education program and evaluation tools for low-income mothers of infants based on data gathered from formative research; 2) examine associations between mothers\u0026rsquo; financial well-being and their baseline demographic and financial characteristics; 3) explore factors influencing financial education class attendance; and 4) evaluate the impact of a financial education intervention on mothers\u0026rsquo; financial outcomes and well-being.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis mixed methods exploratory study was conducted from November 2020 to February 2022 in two phases: formative research and an intervention study. Formative research methods included focus groups, cognitive interviews, and a pilot survey conducted from November 2020 to January 2021. The goal of the formative phase was to develop a financial education curriculum that addressed the specific needs and circumstances of the target population, predominantly Hispanic low-income mothers. The intervention consisted of five weekly 30-minute financial education classes delivered to small groups via Zoom videoconferencing technology in two enrollment waves from April to October 2021. Approval for this study was obtained from the Institutional Review Boards at California State University, Fullerton and Children\u0026rsquo;s Hospital of Orange County. Informed consent was obtained from participants to participate in the study. All procedures performed involving human participants were in accordance with the U.S. Department of Health and Human Services 45 Code of Federal Regulations Part 46.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants and Setting\u003c/h2\u003e \u003cp\u003eUsing convenience sampling methods, participants were recruited from three DULCE clinics in southern California. Eligible participants were mothers of infants younger than six months of age who received care at a DULCE clinic from November 2020 to September 2021. Mothers were excluded if they were younger than 18 years of age and/or received medical care in a language other than English or Spanish. Family Specialists screened mothers for eligibility and notified the study coordinator, who recruited participants via telephone and email. Study participation was incentivized with gift cards. Phase 1 group assignment was based on convenience; the first few participants were assigned to focus groups, the next few were invited to participate in cognitive interviews, and the last several participants were asked to complete the pilot survey. Formative data were analyzed, and participants who were not part of Phase 1 were invited to enroll in the intervention for Phase 2.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePhase 1: Formative Research\u003c/h3\u003e\n\u003cp\u003eFirst, two virtual 45-minute focus groups were led by a bilingual moderator who guided discussions on topics relevant to the participants\u0026rsquo; financial needs and circumstances. Most of the discussions were held in Spanish. Two trained observers documented field notes during each session (Appendix Table\u0026nbsp;1). Following the focus groups, cognitive interviews were conducted virtually to determine: 1) if the survey items were clearly articulated; 2) if participants understood the survey items in the way they were intended; and 3) how to locally adapt and contextualize survey items developed at the national level (e.g., the National Financial Capability Study). These interviews were conducted in English or Spanish and documented by a trained observer (Appendix Table\u0026nbsp;2). Finally, a pilot survey was administered to estimate survey completion time and to evaluate the user interface when accessed on participants\u0026rsquo; mobile phones.\u003c/p\u003e\n\u003ch3\u003ePhase 2: Intervention Study\u003c/h3\u003e\n\u003cp\u003eThe intervention study evaluated the impact of financial education classes on various aspects of financial health, including financial access, literacy, attitude, confidence, behavior, and well-being in low-income mothers of infants. Upon enrollment, participants completed a baseline survey and were invited to attend a series of five weekly 30-minute live online classes, available in English or Spanish, taught by a financial education specialist. After completing the classes, participants responded to a post-intervention survey. The curriculum used for the classes was developed based on principles outlined in the University of Chicago\u0026rsquo;s Financial Education Initiative (n.d.; Appendix Table\u0026nbsp;3). During the formative phase of the study, participants expressed concern for everyday money management issues rather than investing or saving for retirement. This finding guided the selection of the following curriculum topics: 1) money values and influences; 2) banking and credit; 3) income, expenses, and budgeting; 4) borrowing and debt management; and 5) credit cards and credit card safety (Appendix Table\u0026nbsp;3).\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eFindings from the formative phase of the study were used to refine the evaluation surveys. The baseline survey consisted of 64 items, including 11 demographic questions, 6 financial access items, 14 financial literacy items, 5 financial attitude items, 7 financial confidence items, 3 financial behavior items, 12 financial well-being items, and 6 items related to the impact of the COVID-19 pandemic on family finances (Appendix Table\u0026nbsp;4).\u003c/p\u003e \u003cp\u003eBaseline financial literacy was measured as the Pre-Score. Financial access was assessed by participants\u0026rsquo; bank account ownership, comfort level with visiting a bank for information, methods of cashing checks and paying utility bills, number of credit cards, and use of a payday loan or pawn shop. Financial attitudes were measured by participants\u0026rsquo; attitudes toward saving, borrowing, risk-taking, and present bias. Financial confidence was measured with questions assessing participants\u0026rsquo; confidence in making financial decisions, progress toward financial goals, and financial knowledge. Financial confidence was quantified as a factor score derived from a principal-component factor (PCF) analysis of seven questions. Financial behavior was evaluated based on whether participants incurred fees for late payments or exceeding their credit limits. Financial well-being was measured using the code and methodology provided by CFPB (2017) described in Table\u0026nbsp;4 of the Appendix.\u003c/p\u003e\n\u003ch3\u003eStatistical Approach\u003c/h3\u003e\n\u003cp\u003eFirst, the relationships between financial well-being and demographic characteristics, banking status, financial literacy, confidence, and behavior were examined using p-values. To further explore the factors influencing baseline financial well-being, the following regression equation was specified, controlling for demographic variables and preexisting financial literacy.\u003c/p\u003e \u003cp\u003e \u003cem\u003eY\u003c/em\u003e \u003csub\u003e \u003cem\u003ei\u003c/em\u003e \u003c/sub\u003e\u0026thinsp;=\u0026thinsp;\u003cem\u003eα\u003c/em\u003e\u003csub\u003e\u003cem\u003e0\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;+\u0026thinsp;\u003cem\u003eα\u003c/em\u003e \u003csub\u003e1\u003c/sub\u003eMarried\u003csub\u003e\u003cem\u003ei\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;+\u0026thinsp;\u003cem\u003eα\u003c/em\u003e \u003csub\u003e2\u003c/sub\u003e PreScore\u003csub\u003e\u003cem\u003ei\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;+\u0026thinsp;\u003cem\u003eα\u003c/em\u003e \u003csub\u003e3\u003c/sub\u003e College\u003csub\u003e\u003cem\u003ei\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;+\u0026thinsp;\u003cem\u003eα\u003c/em\u003e\u003csub\u003e4\u003c/sub\u003e Fin Behavior\u003cem\u003ei\u003c/em\u003e\u0026thinsp;+\u0026thinsp;\u003cem\u003eα\u003c/em\u003e \u003csub\u003e5\u003c/sub\u003e Fin Confidence\u003cem\u003ei\u003c/em\u003e\u0026thinsp;+\u0026thinsp;\u003cem\u003eε\u003c/em\u003e\u003csub\u003e\u003cem\u003ei\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e \u003cp\u003ewhere \u003cem\u003eY\u003c/em\u003e\u003csub\u003e\u003cem\u003ei\u003c/em\u003e\u003c/sub\u003e is the financial well-being index calculated for individual \u003cem\u003ei\u003c/em\u003e.\u003c/p\u003e \u003cp\u003eNext, the following binary probit model was used to estimate the probability of attending financial education classes:\u003c/p\u003e \u003cp\u003eSi\u003csup\u003e*\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;\u003cem\u003eβ\u003c/em\u003e\u003csub\u003e0\u003c/sub\u003e\u0026thinsp;+\u0026thinsp;\u003cem\u003eβ\u003c/em\u003e\u003csub\u003e1\u003c/sub\u003ePreScore\u003csub\u003ei\u003c/sub\u003e\u0026thinsp;+\u0026thinsp;\u003cem\u003eβ\u003c/em\u003e\u003csub\u003e2\u003c/sub\u003eLanguage\u003csub\u003ei\u003c/sub\u003e\u0026thinsp;+\u0026thinsp;\u003cem\u003eβ\u003c/em\u003e\u003csub\u003e3\u003c/sub\u003eFWB Control\u003csub\u003ei\u003c/sub\u003e\u0026thinsp;+\u0026thinsp;\u003cem\u003eβ\u003c/em\u003e\u003csub\u003e4\u003c/sub\u003eFWBMoneyleftover\u003csub\u003ei\u003c/sub\u003e\u0026thinsp;+\u0026thinsp;ε\u003csub\u003ei\u003c/sub\u003e\u003c/p\u003e \u003cp\u003ewhere S\u003csup\u003e*\u003c/sup\u003e was a latent variable representing a respondent's perceived difference between the marginal benefit and cost of attending the financial education class. As per Marlowe et al. (\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) it was posited that the probability of attending financial education classes would depend on the following financial well-being item: \u0026ldquo;\u003cem\u003eMy finances control my life\u003c/em\u003e and \u003cem\u003eI have money left over at the end of the month\u003c/em\u003e.\u0026rdquo; The baseline financial literacy score, \u0026ldquo;PreScore,\u0026rdquo; was included to determine if having high preexisting scores would reduce the probability of attending financial education classes. Participants\u0026rsquo; preferred language (English or Spanish) was used to determine if different demographic groups were more or less likely to attend financial education classes.\u003c/p\u003e \u003cp\u003eFinally, paired t tests were used to evaluate the effect of the financial education intervention on financial outcomes and well-being in mothers who attended at least one class.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eDescriptive Characteristics of Our Participants\u003c/h2\u003e \u003cp\u003eOf the 26 eligible and interested candidates, 17 mothers (65%) enrolled in the formative phase of the study. Among them, six mothers were assigned to focus groups, six participated in cognitive interviews, and five completed the pilot survey. For the intervention study, 56 mothers out of 166 eligible candidates enrolled (34%) and 46 completed the baseline survey (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Eighteen mothers attended at least one financial education class, of which 15 completed the post-intervention survey.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eOf the 46 mothers who completed the baseline survey, more than a third (35%) responded in Spanish (Table\u0026nbsp;1). Most participants (67%) had at least a high school education and some (39%) had attended college. The majority were either homemakers (39%) or unemployed (24%). Half of the participants reported that their spouses or partners had a high school education, with 12% having attended college. Spouses and partners were employed full-time (55%), part-time (12%), or were self-employed (24%). Fifty percent of households had a monthly income of \u003cspan\u003e$\u003c/span\u003e2,000 or less and 39% had six or more members in their households. All of the families were renters. At baseline, the average financial literacy score was approximately 40% or 5.6 correct answers out of 14 questions. Fewer than half of mothers (48%) correctly answered the interest rate question and about a quarter (26%) correctly answered the inflation question.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;2 summarizes the financial access of the participants. At baseline, most mothers reported that they (or their spouse or partner) had a bank account (76%), felt comfortable going to a bank to ask a question about a product or service (72%), and/or had a credit card (61%). A smaller proportion had used a payday loan or pawn shop (26%) and/or cashed checks at a grocery or liquor store (9%).\u003c/p\u003e \u003cp\u003e Table\u0026nbsp;3 summarizes the financial attitudes of the participants. At baseline, most mothers expressed positive attitudes toward saving and borrowing, with 81% agreeing with the statement \u0026ldquo;\u003cem\u003eI try not to spend all the money that I have saved\u0026rdquo;\u003c/em\u003e and 91% disagreeing with the statement \u0026ldquo;\u003cem\u003eIt is OK to borrow money to buy things I want but do not need.\u0026rdquo;\u003c/em\u003e Additionally, 67% indicated that they would save an extra \u003cspan\u003e$\u003c/span\u003e200 rather than spend it. Regarding financial risk, 70% would prefer to keep \u003cspan\u003e$\u003c/span\u003e100 in winnings rather than take a 50% chance to double their money or lose it all. Nearly half of the mothers (46%) would choose \u003cspan\u003e$\u003c/span\u003e100 now rather than wait for twice the amount next month, indicating strong present bias.\u003c/p\u003e \u003cp\u003eAt baseline, most mothers lacked confidence in their ability to manage finances (56%) and struggled to make progress toward their financial goals (70%) (Table\u0026nbsp;4). However, a majority responded that they knew how to save money (89%), avoid overspending (83%), make new financial decisions (76%), and seek financial advice (54%).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;5 describes the financial behavior of the 28 participants with a credit card. At baseline, 36% were charged a late fee, 15% had exceeded their credit limit, and the majority (57%) had not compared credit card offers when opening a new account.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAssociations Between Financial Well-being and Baseline Variables\u003c/h3\u003e\n\u003cp\u003eNone of the demographic variables were associated with mothers\u0026rsquo; financial well-being at baseline, including language, marital status, education, employment, and income (Table\u0026nbsp;6). Financial well-being was associated with financial confidence (p\u0026thinsp;=\u0026thinsp;.00) and financial behavior (p\u0026thinsp;=\u0026thinsp;.00), but not financial literacy or banking status.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;7 confirms that financial confidence and financial behavior were key predicators of final well-being (p\u0026thinsp;\u0026lt;\u0026thinsp;.05), after controlling for demographic variables. Baseline financial literacy was higher for those with higher levels of education, income, and mothers\u0026rsquo; employment. Another important finding was that financial behavior was influenced by attitude toward saving (p\u0026thinsp;\u0026lt;\u0026thinsp;.05).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFactors Influencing Financial Education Class Attendance\u003c/h2\u003e \u003cp\u003eNone of the three hypothesized predictor variables (i.e., financial well-being: control, financial well-being: money left, and language preference) were associated with attendance at financial education sessions (Table\u0026nbsp;7). The post-intervention survey revealed barriers to attendance including lack of childcare and work responsibilities. When asked if they would have attended in-person classes, 8 participants responded \u0026ldquo;\u003cem\u003eYes\u003c/em\u003e,\u0026rdquo; 10 were \u0026ldquo;\u003cem\u003eUnsure\u003c/em\u003e,\u0026rdquo; and 3 said \u0026ldquo;\u003cem\u003eNo\u003c/em\u003e.\u0026rdquo; The large proportion of \u0026ldquo;\u003cem\u003eUnsure\u0026rdquo;\u003c/em\u003e responses may have been influenced by the ongoing uncertainties surrounding the evolving COVID-19 pandemic.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eFinancial Education Outcomes\u003c/h2\u003e \u003cp\u003eFinancial education outcomes are presented in Table\u0026nbsp;8 and summarized below.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eFinancial Access\u003c/h2\u003e \u003cp\u003eMothers who attended at least one financial education class (n\u0026thinsp;=\u0026thinsp;15) reported feeling more comfortable going to a bank to ask a question about a product or service (p\u0026thinsp;=\u0026thinsp;.0001). No change was observed in the other financial access variables.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eFinancial Literacy\u003c/h2\u003e \u003cp\u003eNo improvement was observed in financial literacy post-intervention.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eFinancial Attitude\u003c/h2\u003e \u003cp\u003eFinancial education did not have an impact on mothers\u0026rsquo; financial attitudes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eFinancial Confidence\u003c/h2\u003e \u003cp\u003eAfter receiving financial education, mothers reported that they had a greater ability to make good financial decisions that were new to them (p\u0026thinsp;=\u0026thinsp;.03). No change was observed in other aspects of financial confidence.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eFinancial Behavior\u003c/h2\u003e \u003cp\u003eFinancial education did not have an impact on mothers\u0026rsquo; credit card behavior.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eFinancial Well-Being\u003c/h2\u003e \u003cp\u003eAfter attending at least one financial education class, mothers felt that they could handle a major unexpected expense (p\u0026thinsp;=\u0026thinsp;.004) (Table\u0026nbsp;9).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eEffect of the COVID-19 Pandemic on Household Finances\u003c/h2\u003e \u003cp\u003eAt baseline, 30% of mothers and 26% of their spouses or partners had lost their jobs due to the pandemic (Table\u0026nbsp;10). Nearly three-quarters of households (72%) experienced income loss and 43% of mothers reported feeling more stressed about paying bills and rent as a result of the pandemic.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study found that low-income mothers of infants from a predominantly Hispanic community had relatively low levels of financial access. In this study, 13.0% of households were unbanked, compared to a national sample where 8.4% of Hispanic households, 8.0% of Black households, and 1.7% of White households with annual incomes ranging from \u003cspan\u003e$\u003c/span\u003e30,000 to \u003cspan\u003e$\u003c/span\u003e50,000 were unbanked (Federal Deposit Insurance Corporation, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Notably, one aspect of financial access improved after the intervention, where participants reported feeling more comfortable going to a bank to inquire about a product or service. This is an important finding, given that financial access can help reduce material hardship among low-income mothers (Huang \u0026amp; Sherraden, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSince minority women are often excluded from financial products and services, one potential solution is to provide financial education while simultaneously facilitating access to financial tools (Atkinson \u0026amp; Messy, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Financial education can help mothers understand the risks associated with alternative banking services and teach strategies to avoid predatory lending practices. Another important approach is to address the perceived barriers that minority women face when accessing mainstream financial services, such as banking fees, unexpected charges, uncertainty about interest rates, lack of a social security number, discriminatory treatment, and fear of deportation (Bullock et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). By empowering minority women with access to bank accounts, savings mechanisms, and other financial services, they can gain greater control over their earnings and make informed decisions about how they manage their money, ultimately helping to reduce social and economic inequality (Gammage et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eParticipants in this study exhibited low levels of financial literacy and were predominantly homemakers or unemployed, which limited their earning potential and financial security. Less than half (48%) correctly answered the interest rate question and only about a quarter (26%) correctly answered the inflation question. These figures are lower than the national averages of U.S. Hispanic women, where 65% and 40% answered these questions correctly (Clark et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Despite low financial literacy, individuals often overestimate their financial knowledge (Lusardi \u0026amp; Mitchell, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). In the U.S. Financial Capability Study, 70% of respondents rated their financial knowledge as above average, yet only 30% answered the knowledge questions correctly (Lusardi, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Enhancing financial literacy in low-income mothers is crucial, as it can positively impact the entire family by enabling mothers to share financial knowledge and tools with their children and older relatives.\u003c/p\u003e \u003cp\u003eIn this study, financial education did not lead to improvement in mothers\u0026rsquo; financial literacy. While one meta-analysis found that education had a favorable impact on financial literacy, its effectiveness was less pronounced in low-income populations (Kaiser \u0026amp; Menkhoff, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). However, another review indicated that financial education was most effective in promoting financial literacy among low-income groups (Wagner, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Given that higher financial literacy is linked to positive financial behavior and improved financial well-being, further research is needed to develop interventions that improve financial literacy in low-income minority women (Mitchell \u0026amp; Lusardi, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). For immigrant women, in particular, learning new financial concepts involves not only understanding the content but also navigating a new financial system and overcoming sociocultural barriers. Offering financial education courses taught by a native Spanish speaker who is culturally sensitive to the needs of Hispanic women could address some of these challenges, including low literacy and numeracy.\u003c/p\u003e \u003cp\u003eWhile participants demonstrated favorable attitudes toward saving, spending, and borrowing, they also exhibited a high degree of present bias; 46% preferred to receive \u003cspan\u003e$\u003c/span\u003e100 now rather than wait and take twice the amount next month, compared to 38% of middle school parents from a California county (Gill \u0026amp; Bhattacharya, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Present bias can lead to overuse of debt financing and interfere with the ability to pay down debt, including credit card balances (Bar-Gill \u0026amp; Hayashi, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Of the 28 participants with a credit card, 36% were charged a late fee and 14% had overspent their credit limit, higher than the 23% and 11% reported by Clark et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Financial education should focus on raising mothers\u0026rsquo; awareness of present bias in addition to creating realistic repayment plans and reducing unnecessary expenses (Kuchler \u0026amp; Pagel, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAt baseline, fewer than half (45%) of mothers were confident in their ability to manage their finances and less than a third (30%) felt that they were making progress in reaching their goals, indicating low levels of financial confidence (Table\u0026nbsp;4). This contrasts with the 2018 U.S. Financial Wellness Census report that found that most Hispanics were confident in reaching their financial goals, such as leaving a large inheritance, purchasing a home, helping their children with a down payment, and paying for their children\u0026rsquo;s college tuition despite limited participation in retirement savings plans (16%) due to current expenses (Prudential, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). While Hispanic women may have an optimistic outlook, financial overconfidence has been associated with a range of negative financial behaviors and outcomes (Atlas et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). However, in this study, financial confidence was positively associated with financial well-being. The CFPB (2015) also noted that financial well-being is not strictly tied to income level, a finding that aligns with ours.\u003c/p\u003e \u003cp\u003eIn this study, the mean financial well-being index was 54.8 (sd\u0026thinsp;=\u0026thinsp;11.06) on a scale of 0 to 100, which is higher than the national average of 50 for Hispanic adults and 52 for all U.S. adults in 2018 (CFPB, 2021). This is similar to a sample in Los Angeles wherein Blanco et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) found a financial well-being index of 54 (Blanco et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). In the current study, financial well-being was higher among participants with \u0026ldquo;above-average\u0026rdquo; financial behavior, supporting Burke and Francisco Perez's (2019) finding that protective behavior correlates with financial well-being. This finding is consistent with previous studies (Castro-Gonz\u0026aacute;lez et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Intuitively, good financial behavior allows individuals to feel satisfied with their financial situation.\u003c/p\u003e \u003cp\u003eNearly three-quarters of the households surveyed (72%) experienced income loss and 43% of mothers reported feeling more stressed about paying bills and rent due to the COVID-19 pandemic. These findings are consistent with Blanco et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), who studied the impact of the pandemic on financial stress among Hispanic adults in California who were primarily English-speaking and employed. Their study, which collected data during the pandemic in October 2020 and compared it with prior data from August to October 2018, revealed that participants faced significant stressors related to labor market experiences and family circumstances. Similar to our findings, more women than men lost their jobs during the pandemic.\u003c/p\u003e \u003cp\u003eConducting this research during the pandemic necessitated a distance-mediated intervention, which likely impacted recruitment, retention, and participation. The low attendance and high attrition observed in this study are consistent with findings from other studies. For example, Marlowe et al. (\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) reported that participation in financial coaching through Oakland\u0026rsquo;s Brilliant Baby Program varied widely, with attendance ranging from 30\u0026ndash;80% across different sites. Another study found that 44\u0026ndash;63% of participants enrolled in financial coaching did not attend a single session (Theodos et al., \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). In our study, infant caregiving needs were a common barrier to attendance, suggesting that financial education programs should provide childcare support, involve the entire family, and offer various delivery options, including live virtual classes, in person-instruction, and on-demand modules to accommodate the needs and preferences of new mothers.\u003c/p\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eDespite the low birth rates during the pandemic (Schneider \u0026amp; Wedge, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), we engaged with 166 DULCE families. However, pandemic-related stressors may have contributed to new mothers prioritizing other concerns over participating in and continuing with our study, leading to a small sample size and lack of a control group. These factors limit the conclusions that can be drawn from this study. Nonetheless, this research lays the groundwork for integrating financial wellness into pediatric healthcare as a way to address social determinants of health, and it is hoped that similar interventions can be replicated to benefit DULCE families nationwide.\u003c/p\u003e \u003cp\u003eThis study contributes to the existing literature in three ways. First, it examines the factors associated with financial well-being calculated as the financial well-being index as defined by the CFPB. Second, the focus on families enrolled in DULCE program offers an existing channel to increase new mothers' financial well-being through nine clinics nationwide, including three clinics at the study site. Third, despite recognition of the need for intervention, there is an absence of systematic approaches embedded into the health care system to mitigate the impact of financial stress as a social determinant of health. This study addresses this gap by developing a framework wherein low-income households with infants up to six months can receive financial education delivered through the DULCE program.\u003c/p\u003e \u003cp\u003eThese results confirm the notion that financial education efforts should focus on those who need it the most. Additionally, since caring for infants is a primary barrier to attending financial education classes, these programs should offer childcare and involve the entire family, ideally through in-person sessions. Another potential strategy may be to offer financial education programs to expectant mothers during the prenatal period. This study also supports the idea that financial education should not only impart factual knowledge but also empower individuals with the confidence to make financial decisions and foster positive attitudes toward saving.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eA financial education program for low-income mothers has the potential to improve a range of financial outcomes and well-being, an underrecognized social determinant of health. Programs must be adapted to meet the needs of new mothers, such as assisting with childcare, inviting the entire family, and offering flexibility through virtual and in-person class options.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eCompeting Interests: None\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis project was sponsored with a grant from U.S. Bank.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eRadha Bhattacharya: PI; designed formative study and main study collaboratively with CHOC; designed the estimation methods, interpretation of results and context, manuscript preparationJennifer Barrows: study design and manuscript preparation Rachel Lobo: Research Assistant; conducted the statistical analysis based on codes written by Andrew GillJennifer Hayakawa: IRB Protocol and contributed collaboratively to the overall framework and study, manuscript review and editingMichelle Lubahn: Participant recruitment, contributed to study design, manuscript review and editing\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAuthor Note\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence concerning this article should be addressed to Radha Bhattacharya, Department of Economics, California State University at Fullerton, 800 N. State College Blvd, Fullerton, CA 92831. Phone: (657) 278-3652, Email: [email protected]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are not openly available due to reasons of sensitivity (i.e., the small sample size could mean that individual patients/participants are easily identifiable) and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at California State University, Fullerton.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Andrew Gill for writing the code; Francisco Fuentes for contacting participants, conducting the formative study, and administering the surveys; and Norma Serrato, Jessica Canizal, and Mayra Moreno for recruiting participants.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAtkinson, A. \u0026amp; Messy, F. (2013). Promoting financial inclusion through financial education: OECD/INFE evidence, policies, and practice. OECD Working Papers on Finance, Insurance and Private Pensions, 34, 1-55.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAtlas, S. A., Lu, J., Michu, P. D., \u0026amp; Porto, N. (2019). Financial knowledge, confidence, credit card use, and financial satisfaction. Journal of Financial Counseling and Planning, 30(2), 175-190.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBar-Gill, O. \u0026amp; Hayashi, A. (2021). Present bias and debt-financed durable goods. Cambridge: Harvard Law School.\u003c/li\u003e\n \u003cli\u003eBlanco, L., Cruz, V., Frederick, D., \u0026amp; Herrera, S. (2022). Financial stress among Latino adults in California during COVID-19.\u0026rdquo; Journal of Economics, Race, and Policy, 5(2), 134\u0026ndash;148. https://doi.org/10.1007/s41996-021-00087-0\u003c/li\u003e\n \u003cli\u003eBr\u0026uuml;ggen, E. C., Hogreve, J., Holmlund, M., Kabadayi, S., \u0026amp; L\u0026ouml;fgren, M. (2017). Financial well-being: A conceptualization and research agenda. Journal of Business Research, 79, 228-237.\u003c/li\u003e\n \u003cli\u003eBullock, H. E., Toolis, E. E., Sencion, B., \u0026amp; Caldenas, M. T. (2020). 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Pediatrics, 142(4), 1-8.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSchneider, E. B., \u0026amp; Wedge, R. (2022). The Impact of COVID-19 on Birth Rates in the United States (NBER Working Paper No. 30000). National Bureau of Economic Research. https://www.nber.org/system/files/working_papers/w30000/w30000.pdf\u003c/li\u003e\n \u003cli\u003eSege, R., Kaplan-Sanoff, M., Morton, S. J., Velasco-Hodgson, M. C., Preer, G., Morakinyo, G., DeVos, E., \u0026amp; Krathen, J. (2014). Project DULCE: Strengthening families through enhanced primary care. Zero to Three, 35(1), 10-18.\u003c/li\u003e\n \u003cli\u003eSege, R., Preer, G., Morton, S. J., Cabral, H., Morakinyo, O., Lee, V., Abreu, C., DeVos, E., \u0026amp; Kaplan-Sanoff, M. (2015). Medical-legal strategies to improve infant health care: A randomized trial. Pediatrics, 136(1), 97-106.\u003c/li\u003e\n \u003cli\u003eSherraden, M. S. (2013). Building blocks of financial capability. In J. M. Birkenmaier, M. S. Sherraden, \u0026amp; J. C. Curley (Eds.), Financial capability and asset building: Research, education, policy, and practice (pp. 1-43). New York: Oxford University Press.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTheodos, B., Simms, M., Treskon, M., et al. (2015). An evaluation of the impacts and implementation approaches of financial coaching programs. The Urban Institute.\u003c/li\u003e\n \u003cli\u003eUniversity of Chicago. (n.d). Characteristics of a High-Quality Financial Education Curriculum. University of Chicago Financial Education Initiative. https://www.nefe.org/_images/convenings/UChicagoFinEd-Curriculum-Checklist.pdf\u003c/li\u003e\n \u003cli\u003eU.S. Department of Health \u0026amp; Human Services. (2022). Child maltreatment 2020. https://www.acf.hhs.gov/cb/data-research/child-maltreatment\u003c/li\u003e\n \u003cli\u003eWagner, J. (2019). Financial education and financial literacy by income and education groups. Journal of Financial Counseling and Planning, 30(1), 132-141.\u003c/li\u003e\n \u003cli\u003eWeida, E. B., Phojanakong, P., Patel, F., \u0026amp; Chilton, M. (2020). Financial health as a measurable social determinant of health. PloS One, 15(5), e0233359. https://doi.org/10.1371/journal.pone.0233359\u003c/li\u003e\n \u003cli\u003eWhitehead, B. R. \u0026amp; Bergeman, C. S. (2017). The effect of the financial crisis on physical health: Perceived impact matters. Journal of Health Psychology, 22(7), 864-873.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. untitled (who.int)\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 10 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"diedu","sideBox":"Learn more about [Discover Education](https://www.springer.com/journal/44217)","snPcode":"44217","submissionUrl":"https://submission.nature.com/new-submission/44217/3","title":"Discover Education","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"financial literacy, financial knowledge, financial health, social determinants of health, minority women","lastPublishedDoi":"10.21203/rs.3.rs-5313835/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5313835/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground.\u003c/h2\u003e \u003cp\u003eFinancial well-being has only recently been acknowledged as a social determinant of health. This study explored a framework for delivering financial education to low-income, primarily Hispanic mothers.\u003c/p\u003e\u003ch2\u003eMethods.\u003c/h2\u003e \u003cp\u003eA financial education intervention was developed for low-income mothers of infants based on formative data gathered from focus groups, cognitive interviews, and a pilot survey. Participants attended five weekly 30-minute classes taught in small groups using a virtual format. Self-reported surveys were administered at baseline and post-intervention to explore associations between financial well-being and baseline demographic and financial characteristics, examine factors that influenced financial education class attendance, and evaluate the impact of financial education on mothers\u0026rsquo; financial outcomes and well-being.\u003c/p\u003e\u003ch2\u003eResults.\u003c/h2\u003e \u003cp\u003eOf the 56 participants enrolled in the study from March 2021 to February 2022, 18 attended at least one class and 15 completed the post-intervention survey. Financial confidence and behavior were positively associated with financial well-being (p\u0026thinsp;=\u0026thinsp;.00). Attitude toward saving predicted financial behavior (p\u0026thinsp;=\u0026thinsp;.00). Common barriers to attendance included lack of time and the need for childcare. Following financial education, participants reported feeling more comfortable going to a bank to inquire about a product or service (p\u0026thinsp;=\u0026thinsp;.0001) and greater ability to make financial decisions new to them (p\u0026thinsp;=\u0026thinsp;.03). While overall financial well-being did not change, the ability to handle a major expense improved (p\u0026thinsp;=\u0026thinsp;.004).\u003c/p\u003e\u003ch2\u003eDiscussion.\u003c/h2\u003e \u003cp\u003eGiven the limited time that new mothers can dedicate to financial education, the goals of such programs should focus on building confidence in making informed financial decisions and fostering a positive attitude toward saving.\u003c/p\u003e","manuscriptTitle":"Exploratory Study of a Financial Education Intervention to Promote Financial Well-Being in Low-Income Mothers","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-18 07:31:52","doi":"10.21203/rs.3.rs-5313835/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-01-03T20:05:03+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-13T04:48:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"224433579862779126325719163517916678631","date":"2024-12-12T15:55:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-02T03:50:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"134918436399716081464479424964737861448","date":"2024-11-22T08:54:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-21T12:59:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-18T05:33:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-14T13:59:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Education","date":"2024-10-22T17:59:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"diedu","sideBox":"Learn more about [Discover Education](https://www.springer.com/journal/44217)","snPcode":"44217","submissionUrl":"https://submission.nature.com/new-submission/44217/3","title":"Discover Education","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e1342566-b479-4999-8884-82284688373b","owner":[],"postedDate":"December 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-03-26T07:38:33+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-18 07:31:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5313835","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5313835","identity":"rs-5313835","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}