Understanding Mothers Efforts to Safeguard Children in the

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 Research IPals (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. 2. 3. 4. Motor vehicle traffic Drowning Suffocation Fire (flames/hot substances) Unintentional Injuries in B. C. Trends and Patterns among Children and Youth, 1987 -2000, BCIRPU

Injuries in Childhood • Leading causes of injury hospitalizations among children in B. C. 0 -4 years 1. 2. 3. 4. Falls Poisoning Foreign body Fire (flames/hot substances) Unintentional Injuries in B. C. Trends and Patterns among Children and Youth, 1987 -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)

Background Influences Mother’s Safeguarding Work Child Safety Outcomes • Parenting style/skills Cognitive Work • Safe/unsafe behaviors • Safety knowledge, beliefs & values • Risk appraisal • Injury events • Emotional work • Close call events • Past experiences with injury 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

Mothers’ most frequently mentioned top safety concerns in and around the home.

Findings: Contextual Factors in 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 evaluation of 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