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Understanding Mothers’ Efforts to Safeguard Children
in the Home Environment
A Qualitative Approach
L.L. Olsen, J.L. Bottorff, P. Raina, & C.J. Frankish
Acknowledgments
Canadian Institutes for Health ResearchIPals (Injury Prevention Across the Life Span)ICE Team Grant
Michael Smith Foundation for Health Research & B.C.Medical Services Foundation
B.C. Injury Research and Prevention Unit
NEXUS, University of British Columbia
Medical Health Officer’s Council of B.C.
Injuries in Childhood
• Leading causes of injury mortality among children in B.C. 0-4 years
1. Motor vehicle traffic 2. Drowning 3. Suffocation4. Fire (flames/hot substances)
Unintentional Injuries in B.C. Trends and Patterns among Children and Youth, Unintentional Injuries in B.C. Trends and Patterns among Children and Youth, 1987-2000, BCIRPU1987-2000, BCIRPU
Injuries in Childhood
• Leading causes of injury hospitalizations among children in B.C. 0-4 years
1. Falls 2. Poisoning3. Foreign body4. Fire (flames/hot substances)
Unintentional Injuries in B.C. Trends and Patterns among Children and Youth, Unintentional Injuries in B.C. Trends and Patterns among Children and Youth, 1987-2000, BCIRPU1987-2000, BCIRPU
Injuries in Childhood
• 50 % - 70% of unintentional injuries to children < 5 years take place in the home environment
• Poverty is associated with higher rates of childhood injury for both frequency and severity
Methods
Strengths of Qualitative Approach:
• Emphasis on meanings people place on events in their lives
• Data focus on naturally occurring events in natural settings
• Influence of local contexts taken into account• Richness and holism of data• Strategy for developing hypotheses
Institutional Ethnography
• Participants:• Mother and primary
caregiver of child 1-5 years
• Living in study community but not on a working farm
• Living in low-income household (LICO cutoff)
Research Questions
• What are the everyday experiences of mothers living in low-income households with safeguarding young children?
• How are these experiences situated in and linked to broader physical and social contexts?
Recruitment
• Control arm of intervention study
• Public health unit – advertisements posted
• Drop-in centre for single moms at community church
• Family resource centre -health and nutrition program for pregnant and new mothers
Data Collection Methods
• Multiple methods of data collection: • In-home audiotaped 60 minute interviews• In-home 2 hour observation sessions:
• physical features of the home• self-reported home safety actions• mother-child safety related interactions
Interviews
• In-home audiotaped interview lasting approximately 60 minutes addressing:
• Top priority safety concerns• Changes in concerns over time• Typical daily things the mother does to keep child
safe• Care by others• Injury experiences and close calls
Interviews Cont’d.
• Use of safety information and community resources• Family health issues that may impact (mother, child,
others)• How living on a low-income impacts safety efforts• Supports and challenges related to physical and
social environment
• Member checking in later interviews
Analytic Approaches
• Institutional ethnography
• Discourse analysis of injury and close call events
• Gender-based analysis - safeguarding and household division of labor
Theoretical Framework
• Institutional ethnography using theories of social relations and social organization (Smith 1987, 2004)
• Theories of mothering
• Frameworks for injury prevention, health promotion, child development
• Concept of safeguarding- broad frame of reference to understand safety concerns and efforts
Data Analysis
• Safeguarding Work: Coding to develop a ‘generous account’ of this work (what it consists of, actions, steps, time, difficulties, knowledge and skills)
• Contextual Conditions: Coding to identify elements that are implicated or linked with the safeguarding work
Findings
• Participants• 17 mothers participated in study• Mothers’ age range: 19- 37 years• Children’s age range: 16 months - 5 years• Number of children in house: range 1-7
Mothers’ Pre-tax Family Income(N=17)
0
1
2
3
4
5
6
<10K $10-20K $20-30K $30-40K
Background InfluencesMother’s
Safeguarding WorkChild Safety Outcomes
• Parenting style/skills
• Safety knowledge, beliefs & values
• Past experiences with injury
Cognitive Work
• Risk appraisal
• Emotional work
Child-Directed Work
• Teaching and communicating
• Supervision and monitoring
• Intervening with child
• Balancing child needs
Social Environment
• Partner communication
• Negotiations with others for repairs, child safety issues
Physical Environment
• Altering physical structures
• Using devices
• Making repairs
• Arranging space & objects
• Safe/unsafe behaviors
• Injury events
• Close call events
Mothers’ most frequently mentioned top safety concerns in and around the home.
0
2
4
6
8
10
12
14
Falls Traffic Burns Abduction Choking
Findings: Contextual Factorsin the Physical Environment
• Design/quality of indoor space• Housing maintenance/repair• Stability of housing
– frequent moves– lack of affordable options
• Availability of playspace• Outdoor concerns
Findings: Contextual Factors in the Social Environment
• Family level– Mother-partner relationship– Family health issues– Sibling interactions
• Neighborhood/community level– Relationships with neighbors– Care by others– Community norms (fears, values)
Findings: Institutional Contexts Linked to Safeguarding Work
• Housing • Child care system• Child welfare system• Expert safety knowledge• Gendered disadvantages
– Employment opportunities– Lack of authority over space
Conclusion
• Concept of safeguarding useful for understanding the scope of mothers’ efforts to keep young children safe:• Positive frame• Recognizes hidden aspects of safety work• Recognizes emotional impacts (fear/stress)• Privileges women’s own perspectives
Study Limitations
• Social desirability• Sources of
participant recruitment
Implications: Practice
Need for design and evaluationof interventions that:• Acknowledge mothers’ experiences• Address barriers in social and physical environments• Address institutional practices that undermine
safeguarding work• Avoid blame and deficit focus
Implications: Research
• Does mothers’ early use of child directed strategies increase injury risks?
• What are the links between psychological issues, effective parenting and child injury risks?
• What risks might be associated with use of low-cost home modification strategies?
• How do mothers’ perceptions of indoor safety risks compare with perceptions of outdoor risks?
Implications: Research
• Gender differences: How do values held about child safety and safeguarding strategies differ between mothers and fathers? How are they similar?
• Evaluation of women-centered strategies that address disadvantages faced by low-income mothers of young children.
Implications: Policy
• Availability of affordable child care• Availability of safe, stable housing options• Residential and road design • Safety as a value at community level