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