Understanding Mothers’ Efforts to Safeguard Children in the Home Environment

1. Understanding Mothers’ Efforts to Safeguard Children in the Home Environment A Qualitative Approach L.L. Olsen, J.L. Bottorff, P. Raina, & C.J. Frankish

2. 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.

3. Injuries in Childhood • Leading causes of injury mortality among children in B.C. 0-4 years 1. Motor vehicle traffic 2. Drowning 3. Suffocation 4. Fire (flames/hot substances) Unintentional Injuries in B.C. Trends and Patterns among Children and Youth, 1987-2000, BCIRPU

4. Injuries in Childhood • Leading causes of injury hospitalizations among children in B.C. 0-4 years 1. Falls 2. Poisoning 3. Foreign body 4. Fire (flames/hot substances) Unintentional Injuries in B.C. Trends and Patterns among Children and Youth, 1987-2000, BCIRPU

5. 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

6. 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

7. 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)

8. 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?

9. 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

10. 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

11. 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

12. 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

13. Analytic Approaches • Institutional ethnography • Discourse analysis of injury and close call events • Gender-based analysis - safeguarding and household division of labor

14. 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

15. 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

16. 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

17. Mothers’ Pre-tax Family Income(N=17)

18. Mother’s Safeguarding Work Background Influences Child 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

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

20. 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

21. 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)

22. 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

23. 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

24. Study Limitations • Social desirability • Sources of participant recruitment

25. 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

26. 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?

27. 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.

28. Implications: Policy • Availability of affordable child care • Availability of safe, stable housing options • Residential and road design • Safety as a value at community level