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Single Mothers' Views of Young Children'sEveryday Routines: A Focus Group StudyChristina Koulouglioti a , Robert Cole a & Marian Moskow aa University of Rochester School of Nursing , Rochester, New York,USAPublished online: 02 Aug 2011.

To cite this article: Christina Koulouglioti , Robert Cole & Marian Moskow (2011) Single Mothers' Viewsof Young Children's Everyday Routines: A Focus Group Study, Journal of Community Health Nursing,28:3, 144-155, DOI: 10.1080/07370016.2011.589236

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Journal of Community Health Nursing, 28:144–155, 2011Copyright © Taylor & Francis Group, LLCISSN: 0737-0016 print / 1532-7655 onlineDOI: 10.1080/07370016.2011.589236

Single Mothers’ Views of Young Children’s EverydayRoutines: A Focus Group Study

Christina Koulouglioti, Robert Cole, and Marian MoskowUniversity of Rochester School of Nursing, Rochester, New York

Consistent daily routines have been associated with children’s well-being, but children of single par-ents are less likely to engage in regular family meals or bedtime routines. This study explored routinesand the challenges of maintaining routines as experienced by single mothers with a preschool age(3–5) child. Four focus groups (N = 12) were conducted and qualitative content analysis was used.Mothers described routines as an integral part of their parenting role and a reflection of successfulparenting but maintaining routines around bedtimes and mealtimes were major concerns. Difficultiesmanaging their child’s behavior and their own fatigue were major challenges but mothers describeda wide range of helpful strategies as well.

Recent reports indicate that children, and especially minority children, engage in fewer homeroutines, such as regular family meals, than in the past (Flores, Tomany-Korman, & Olson, 2005).In the United States during 2000, only 58% of mothers with a young child (ages 4 months to3 years old) reported their children having both the same bedtime and mealtime every day, and thepercentage was even lower for children living in single-mother homes (45%; Child Trends, 2003).Single-parent families are less likely to maintain daily routines for meals, naps, and bedtimes fortheir young children when compared to two-parent families (Koulouglioti, 2005; Young, Davis,Schoen, & Parker, 1998). Children living in low-income, single-parent families and childrenliving in poverty are less likely to have a bedtime routine, less likely to be part of a parent–child interactive routine (Hale, Berger, LeBourgeois, & Brooks-Gunn, 2009), and less likely tobe read to every day (43%), compared to children living with two parents (62%; Child Trends,2010).

Family routines have been defined as observable, patterned, predictable interactions that arerepeated over time (Fiese et al., 2002). In our work with families with young children, we focuson a more narrowly defined set of routines that, in addition to their predictability, involve lowconflict parent–child interaction structure to provide an appropriate environment for health pro-motion and cognitive development. These include routines surrounding mealtimes, bedtimes andreading.

This research was supported by a Faculty Research Support Grant awarded to Dr. Christina Koulouglioti.Address correspondence to Christina Koulouglioti, School of Nursing, University of Rochester, 601 Elmwood

Avenue, BOX SON, Rochester, NY 14642. E-mail: Christina_Koulouglioti@urmc.rochester.edu

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SINGLE MOTHERS AND CHILDREN’S ROUTINES 145

The absence of such health-promoting routines places children at risk for a host of physicalproblems. For example, lack of bedtime and mealtime routines places children at greater risk forsleep problems (Morgenthaler et al., 2006), poor quality of food consumption (Gillman et al.,2000), overweight and associated diseases like hypertension and diabetes (Mellin, Neumark-Sztainer, Patterson, & Sockalosky, 2004; Patrick & Nicklas, 2005) and unintentional injuries(Koulouglioti, Cole, & Kitzman, 2009).

Furthermore, young children living in disorganized home environments characterized by anabsence of predictable routines (Gregory, Eley, O’Connor, Rijsdijk, & Plomin, 2005) or byincreased noise levels, crowding, and family instability (Brown & Low, 2008) are less likelyto have regular sleep routines and to experience more frequent sleep problems. Among youngchildren with asthma, disruptive bedtime routines were associated with an increased probabil-ity of night awakenings (Fiese, Winter, Sliwinski, & Anbar, 2007). Similarly, in adolescents,lack of family routines related to less regular bedtimes and wake-up times are linked to daytimesleepiness and sleep onset latency (Billows, Gradisar, Dohnt, Johnston, & McCappin, 2009).

Children and adolescents who regularly have dinner with other family members tend to con-sume healthier foods and are less likely to be overweight (Lee, Murry, Brody, & Parker, 2002;Rollins, Francis, & BeLue, 2007; Videon & Manning, 2003). Eating dinner with the family mostdays of the week is associated with a healthier diet among school-age children (Gillman et al.,2000), and mealtime routines undisrupted by television or other distractions have been linkedto low rates of obesity (Dennison, Erb, & Jenkins, 2002; Dennison, Russo, Burdick, & Jenkins,2004). Children who watch TV during their meals are less likely to eat fruits and vegetables andmore likely to consume pizza, snack foods, and soda (Coon, Goldberg, Rogers, & Tucker, 2001).

Preschool children living in less routinized home conditions also have been found to sus-tain more injuries, probably because fewer routines result in children’s inadequate sleep andsubsequently increase the probability for an injury (Koulouglioti et al., 2009).

Despite the established associations between everyday routines and children’s health out-comes, researchers do not know enough about the factors that contribute to lower rates of routinesin single-parent families. As the number of single-parent families increases, rising to 32% in theUnited States (Annie E. Casey Foundation, 2009), so does the need to better understand the par-enting processes unique to single mothers (Murry, Bynum, Brody, Willert, & Stephens, 2001).Single mothers cite difficulties with child-rearing and report child care as a major stressor ofdaily living (Wijnberg & Reding, 1999). Improved understanding of mothers’ views and chal-lenges of everyday routines will facilitate the development of effective intervention programsto assist single mothers in cultivating and maintaining an optimal degree of predictable dailyroutines.

METHODS

Aim

The purpose of this study was to explore the experiences and perspectives of single mothers of3- to 5-year-old children about daily routines and the challenges related to the establishment andmaintenance of everyday routines.

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Design

The study employed a qualitative research design using focus groups. Four focus groups wereconducted during December 2007 and January of 2008.

Sample

A total of 12 mothers of preschool-age children were recruited from the greater Rochester, NY,area. Each participant was (a) at least 18 years of age, (b) self-identified as a single mother, (c)English-speaking, (d) the child’s primary caregiver, and had (e) a preschool child between ages3 and 5 with no identified disabilities. Our sample consisted of seven African American andfive Caucasian mothers. The majority of mothers (11 of 12) had more than one child. Motherswere recruited with flyers placed in local community centers, public libraries, hospitals, andinner-city and suburban YWCAs and YMCAs. The flyers invited mothers to share their viewsregarding their young child’s everyday activities. Mothers who called our project office to expresstheir interest in participation were screened for eligibility by the principal investigator. Mothersfrom two-adult families, single-fathers, and teenage mothers were excluded because their familystructure presents different challenges that need to be addressed separately.

Data Collection

All focus groups took place in two local public library conference rooms. Each focus group lastedapproximately 60 to 90 min. Participants were encouraged to share their views without focusingon agreement between the group members. Each mother received an honorarium of $20 at theend of the discussion as token of appreciation for her participation.

A detailed interview guide was developed and used consistently with each group. The dis-cussion started with open-ended questions and moved from general to more specific topics. Allfamilies have routines, but routines are unique and have a special meaning to each family, and,as a result, interview questions were purposively broad in nature in an effort to be less direc-tive, allowing mothers to talk about their family’s unique routines. We chose not to use the wordroutine in our initial questions because we felt that some mothers might not use this term indescribing their family. For example, they may simply enjoy eating together with their childevery night or reading to him or her without any thought that they may have established a rou-tine. Instead, we chose to open with questions about activities the mothers regularly do with theirchildren.

Examples of the initial questions are: (a) Tell me about the things that you do with your childevery day. Are there certain activities that take place every day or almost every day? (b) Whydo you do these activities? (c) How helpful are they for you or your child? If so, in what way?(d) What is the biggest challenge in doing these activities every day? (e) What helps you? (f)What interferes with your efforts to maintain these activities every day? Prompts were given tofacilitate the discussion and reorient it to the main topic. The moderator rephrased what she heardand asked the mothers to verify their responses by use of a phrase such as: “What I’m hearingyou say is that . . . is that correct?”

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A moderator and a comoderator with previous experience in focus group methodology con-ducted all focus groups. Group discussions were audio taped and transcribed verbatim by aresearch assistant soon after the completion of each focus group. All audiotapes were erasedafter the completion of the transcriptions and participants’ names were not used in the transcrip-tions. Audiotapes (during the transcription period) and transcriptions were stored in a locked filecabinet in the principal investigator’s office.

Ethical Considerations

The study was approved by the University of Rochester Medical Center Research SubjectsReview Board. No personal information was gathered from the participants during the focusgroups and mothers were encouraged not to use their real first names if they desired not to do so.Participants provided verbal consent and received an information letter describing the purpose ofthe study, description of procedures, and contact information for answering questions related tothis project and their rights as research participants.

Data Analysis

Qualitative content analysis was used for analyzing the transcripts and involved four major steps(Hsieh & Shannon, 2005). Initially, each member of the research team (the moderator, the comod-erator, and a research assistant who was not involved in the data collection) independently reada transcript (different for everyone) and identified major ideas/topics discussed by the mothers.After comparing their findings, they identified shared topic categories. Second, each memberindependently coded a new transcript (coders switched transcripts) using the identified cate-gories. After discussing their results, they created definitions for the categories. For the third step,each member coded the same transcript using the set of identified topics and definitions, to cal-culate reliability. This step was repeated, clarifying and refining the categories every time, untilan acceptable interrater agreement of 80% was achieved. Finally, after agreement on the codeswas achieved, all transcripts were recoded using a final set of codes. The results are organizedunder six major themes to cluster common topics.

Rigour

Trustworthiness of the analysis was optimized by steps taken to achieve (a) credibility, (b)dependability, (c) transferability, and (d) confirmability (Lincoln & Guba, 1985). Credibilityof the findings was established by conducting multiple focus groups, using a consistent inter-view guide, asking participants to verify their ideas, and encouraging participants to share theirviews without expecting or soliciting agreement between the group members. Dependability ofthe analysis was increased by establishing acceptable intercoder agreement during the codingprocess. Transferability of the findings was established by providing a detailed description of thesampling strategy and research methods. Finally, confirmability of the analytic process was estab-lished by keeping detailed notes about the study procedures, by reporting information regardingthe agreement among the researchers on emerging codes, and by verifying the described findingswith the raw data.

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RESULTS

Six major themes were identified:

Mothers’ Desires for Their Children’s Health

When mothers were asked to describe the things they try to do with their child everyday, theymainly focused on health related activities. In part, they talked about wanting their children toeat more and healthier foods:

• “You want them to eat their vegetables. . . . This is like building blocks for your brain. . . .What about health concerns down the line . . . how is this going to affect everything whenhe’s 30, 40, 50, you know?”

• “I like to try to keep the meat, potato, and veggie that I learned from my mother and father.”• “I like her to eat all her food. . . . I cook proportions for kids . . . and I can give her a small

amount and an hour later that small amount is just still sitting at her plate looking at her.”

They also talked about dental hygiene: “I would like . . . for him to brush his teeth everyday; he’s not really consistent with it,” and about being concerned regarding physical activityand overweight: “He plays video games all day. . . . He’s 85 pounds (son, age 5). . . . We watchTV . . . go shopping. . . . I take him places . . . Chuck E. Cheese.”

One mother talked specifically about her desire for her child to spend less time with electronicentertainment: “I would like him to do less things that are involved with electronics and stuff likethat. . . . My goal this year . . . to remove all electronics and batteries.”

Mothers’ Perceived Challenges With the Establishment of Everyday Routines

Mothers talked about the things that hinder the establishment and maintenance of their everydayroutines, focusing mainly on the child’s personality and reactions, their own lack of knowledge,time constraints, fatigue, lack of family support, and the disruption to schedules created by thetransition of the child between two homes. Having a “difficult” and uncooperative child createdstressful situations and had an effect on the child’s eating and consequently going to bed andfalling asleep.

He’s very picky and if he doesn’t want to eat, he’s not going to eat, and if he wants to eat at 9:00 atnight before bed, that’s when he’s hungry, and he’ll start crying about eating. . . . I’m like, “Oh, man,here are some crackers; take them to your bed; eat your dinner next time!”

Sometimes you would think that she was the parent sometimes because she try and boss mearound and I’ll be like, “No it’s not happening; you got to go to bed or you got to clean up your messbehind you or something.” It’s always something with her attitude and we get into a little argument.Arguing with a 3-year-old is pathetic.

A mother spoke explicitly about her lack of knowledge:

Because, like . . . umm . . . I really don’t know what’s right and wrong, a lot of people say that, well,it’s not a written book on how to raise a child, but I really don’t know, so I’m just. . . . I mean, like,I take parenting classes and whatever right now, so like I get it from them and then like my momand older people in my family and things like that, but it’s like I seen things that goes on in my mom

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family that I, definitely, I’m not going to let happen in my daughter life, so, you know, I try to go bythe book. But I don’t know what I’m doing right now.

Other mothers talked about how financial pressure and lack of family support limit their timeand exacerbate their everyday pressures.

I had to go back to work full-time. It’s not an option to work part-time in my situation. I don’t havea man at home; I don’t have family with a lot of money. Sure, they gave me all the support theycould in the beginning, but I can’t keep taking, and I wouldn’t. . . . There was the father and going tocourt and that whole drama, so finally I can say 3, almost 4 years later. . . . I’ve got a good job. . . .Unfortunately, it just feels like every day I don’t have enough time with him. . . . I want him more; Iwant to see him more, and I have to live with that. I can’t. You just can’t.

Another major challenge for mothers was the lack of time and the need to use time wisely.Mothers felt that there was neither enough time to be with their children nor to have quality timewith them, or even participate in a family meal.

I’m like, during the meal time when they’re sitting there, I’m trying to take care of everything else andget stuff straightened up, because when they’re around, it’s like so hectic and stuff. So (at) mealtime,they’re sitting there, so it’s hardly ever do I feed him. But sometimes when I sit down, but I don’t sitdown with them. Everybody else sits down and I’ll be doing other things. . . . I’m right in the kitchenso I can see them and stuff.

Mothers also described how their own fatigue level interfered with their ability to maintainregular routines: “Sometimes we eat at 4 o’clock; sometimes it’s 8 o’clock, because if I don’tfeel good or something or if I’m tired, I’ll take a nap and then wake up and cook.”

They also talked about giving in to their child’s demands and how that affected their mealtimeand bedtime.

• I’m trying to maintain a family meal around the table, and it’s really hard to keep himengaged in that and sitting at the table when there’s more interesting things. . . . ‘Fine, let’seat in the living room.”’

• “Well, umm, 8:30 lights out but . . . sometimes like somewhere around 9:30, she’ll get backup to try again to sleep with me and I’ll send her back in her room, or I’ll let her sleep withme you know, depends on how I feel pretty much.”

Transitioning between two households and different parenting styles (child’s mother vs.child’s father) created confusing inconsistencies for the children:

The father, because once he goes over to his father’s house he has . . . it’s like his rules are totallydifferent rules from mine rules so it’s like he’ll be like, “I want to go to daddy’s house because daddylets me do this,” and “Daddy lets me eat this for dinner and this and that” so it’s like. . . . And his dadlike has no rules, no structure, no nothing. So it’s like when he goes over there on the weekends andhe comes back home it’s like I have to retrain him all over again.

Distress and Difficulties Around Mealtimes and Bedtime

Mothers consistently isolated mealtime and bedtime as areas of concern. A common theme wasa child who doesn’t sit at the dinner table and resists going to bed:

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• “I would like for him to sit at the table more often and eat his food and not wander around.”• “Mealtime is treacherous. . . . He gets down at the table and runs out back to these

computers and electronic gadgets that he wants to play with”• “As soon as I say it’s time for her to go to bed, ‘Mommy it’s scary; no. it’s scary.’ It’s a

hassle to get her to go to sleep.”• “He doesn’t eat too good either; he wants to play; he’ll sit; he might sit at the table for a

minute and then he’s kicking his brother across the table or he’s this across it or gettingdown; he’s all over the place, so it’s like hard to even get him to sit down.”

TV as Competition With Meal Time and Sleep Time

Along with the difficulties expressed about mealtime and bedtime, the presence of TV and TVviewing were a common theme. On the one hand, mothers felt that the TV can be helpful inmanaging the child’s resistance: “I use the TV like it’s a father; it helps me out a lot. By mehaving the demand channel, I can just pick what I think she’s interested in; that’s going to keepher there (in the bed).”

On the other hand, the TV posed a major distraction and prevented the child from fallingasleep:

He doesn’t like to sleep in his room; he likes to sleep downstairs on the couch with me and have theTV on to fall asleep. So then it takes up to an hour for him to fall asleep because the TV is on.

She’s usually the one that’s up all night long. . . . She goes in; she be asleep and then she wantsto watch TV. . . . About 2 or 3 o’clock in the morning she up, now the TV’s on ‘cause they got cablein their room, so now she’s usually asleep, and the middle child is the one that’s up so now she be upand usually back to sleep by 4:30.

A similar picture was presented during dinner time with children eating in front of the TV,instead of the dinner table:

For dinner, they eat because they will start in the kitchen . . . that’s where all the plates will beprepared . . . they start at the table, but cartoons usually be coming on that time, and they’ll end upsitting there . . . right in the middle of the floor.

Mothers’ Strategies for Achieving Routines

Mothers described different strategies they use to try to establish, implement, and maintainroutines. Some of their strategies were responses to the challenges posed by their children’sbehaviors. For example, they used rewards for doing an activity: “He doesn’t want to brush histeeth, so there’s a lot of bribery going on for that.”

Some mothers mentioned that exercise was helpful: “I take her out to calm her down youknow. Either every day we go to the community center or we are going to go for a walk becauseher walking is her exercise.”

They also talked about how their presence was critical in preventing their child fromovereating or in helping their child to finish his/her meal:

• “He eats a lot, you know. If I’m not with him, he’ll just go back and keep getting more andmore.”

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• “He’ll hardly eat any meal, but if I sit down and feed it to him he’ll eat it; he’ll eat a wholeplate or two plates if I sit down and feed it to him.”

• “I eat with them so they have some kind of order, because they would not finish their foodor eat their food if I’m not in there.”

Other strategies focused on creating the conditions for more enjoyable everyday interactions.They talked about planning ahead of time: “I make sure all of his stuff is in his book bag thenight before so that our morning is more relaxed . . . because morning is all about business.”

They found it helpful not to purchase food products that are considered unhealthy: “I don’thave a lot of bad things available . . . don’t have pop in the house.”

One mother mentioned that thinking about what she would also enjoy doing with her childwas helpful: “I have to make sure it’s something I like so we can play together.”

Another mother mentioned how having the help of older siblings made a difference in achiev-ing everyday activities: “I have two other children. . . . They do a lot to help me around the houseso that I have more time to spend with them.”

Routines as a Sign of Good Parenting

When mothers were asked to describe the main reasons for striving (motivators) for routines andthe rationale for their actions, they talked about the satisfaction they felt knowing they fulfilledtheir role as a parent:

• “Makes me feel as a good mother.”• “I sacrifice for my kids so one day, even if they don’t grow up to be rich people, they’ll

know the sacrifices . . . and so. if nothing else, it boils down to the love I give them and Iexpect from them.”

• “It’s a bond, it helps us bond together, I really like the spending time thing.”

DISCUSSION

The goal of this study was to explore single mothers’ views related to routines and to gain a bet-ter understanding of the challenges involved in establishing and maintaining everyday routines.Without prompting, mothers in our study quickly focused their attention on children’s activitiesrelated to eating and sleeping. It was evident that mothers devoted considerable energy to whatand where the child is eating and where and how much the child is sleeping. Mothers’ main con-centration on sleep and mealtime routines is developmentally appropriate and similar to knownparental concerns for preschool age children (Parlakian & Lerner, 2009).

An interesting finding is that mothers focused mainly on health promotion, such as eatinghealthier foods, being more active and brushing their teeth. Mothers viewed routines as an inte-gral part of the parenting role and a reflection of their successful parenting. They thought thatroutines were a vehicle to teach their young children life skills and a few mothers expressedthe bonding possibilities that routines could present but were frustrated with their inability totransform these opportunities into reality.

Knowing single mothers’ positive views on routines, their concentration on health promotionand struggles with mealtimes and bedtimes could be relevant to the increasing obesity threat

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in childhood. It was recently reported that preschool children who have regular family dinners,obtain adequate sleep, and spend less than 2 hr per day watching TV have about 40% lower preva-lence of obesity, compared to those who don’t have regular family dinners, don’t sleep enoughduring the night, and spend more than 2 hr every day watching TV (Anderson & Whitaker, 2010).In addition, lack of sleep has been found to relate to childhood overweight (Beebe et al., 2006;Lumeng et al., 2007). Mothers could be very responsive to a health promotion intervention thatuses routines as the intervening venue.

Mothers described several specific challenges they faced in their efforts to accomplish rou-tines. Mothers pointed to “being alone,” “kids’ own personality and attitude,” “not knowing whatis right and wrong,” “time constraints,” and “everyone’s exhaustion” as the main barriers forestablishing and implementing routines. Maternal fatigue has been linked to fewer everyday rou-tines (Koulouglioti et al., 2009) and time constraints have been cited among minority parents asa major factor influencing their decisions related to appropriate food choices for their children(Sealy, 2010). Establishment and sustainability of routines depends on the individuals’ ability tobe consistent and continue to engage in the activities that form the family routine over time. Inthe case of young children that responsibility falls mainly on the mother, so her lack of energyand/or lack of time to maintain routines cannot be overlooked.

Managing their child’s demands and difficult behavior was another reported challenge. This isconsistent with previous reports on low-income single mothers who express inadequate parent-ing competence as a personal barrier to success (Campbell-Grossman, Hudson, Keating-Lefler,& Fleck, 2005). Helping mothers develop problem-solving skills and understand normal devel-opmental expressions of child behavior, such as resistance to try new foods, which is particularlycommon among preschoolers, could be an important way to intervene. Helping mothers to havemore control of their family situation, understand their personal needs along with their child’s,and develop a plan to achieve their goals through routines could be another focus for intervention.

Mothers in our study talked explicitly about TV viewing and how it interfered with sharinga meal or obstructed the child’s sleep, but also how TV was perceived to be helpful in man-aging challenging situations. About 25% to 40% of preschool children report difficulty fallingasleep and night-wakings (Mindell & Owens, 2003), and many of these problems arise from poorsleep hygiene practices, including the absence of a regular bedtime routine, inconsistent bed andwake-up times, poor quality sleep environments, and activities that either interfere with sleep(TV in a bedroom, consumption of caffeinate drinks) or reduce exercise (extensive TV view-ing; LeBourgeois, Giannotti, Cortesi, Wolfson, & Harsh, 2005; Mindell, Meltzer, Carskadon, &Chervin, 2009; Paavonen, Pennonen, Roine, Valkonen, & Lahikainen, 2006). Knowing single-mothers’ views about TV viewing is very informative when considering interventions related tochildren’s mealtime and bedtime routines.

Mothers also described strategies that they have found helpful. Mothers reported a wide rangeof options including specific rewards but also exercise as a way to manage the children’s highenergy levels. Some mothers also were aware of the importance of their own presence on theirchildren’s behavior. This is supportive of our focus on health-promoting routines characterizedby high frequency, low conflict interaction between parents and children. Other mothers empha-sized planning and problem solving and the involvement of the entire family. This suggests thatmothers would find assistance in planning and problem solving helpful.

There are several limitations in this study, such as the small sample and the lack of detaileddemographic information of participating mothers. However all mothers are single parents with

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a preschool age child and are the primary caregiver of the child, enhancing the trustworthiness ofthe data in relation to study aims. Other limitations are inherent to the focus group methodologyitself. Introverted participants may be more likely to keep quiet or not to state a different opinionduring the group discussion.

These findings speak to the challenges faced by single mothers in relation to everyday rou-tines. Routines offer a unique opportunity for mothers to promote health even under significanttime constraints and knowing that single mothers struggle most with meal time and sleep time isclinically important, especially for community nurses. Nurses can intervene by helping mothersfirst recognize, acknowledge, and address their own needs, such as fatigue and time constraints,which could interfere with implementation of routines. They can also help by improving mothers’efficacy level and parenting skills. Mothers could benefit from health promotion interventionsfocusing on children’s everyday mealtime and sleep routines. These interventions could play asignificant role in many problems experienced by young children such as childhood obesity.

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