Constructing health and sickness in the context of motherhood and paid work

Facilitators and barriers to implementing successful exclusion among children with shiga toxin-producing Escherichia coli: a qualitative analysis of public health case management records

BACKGROUND

Shiga toxin-producing Escherichia coli (STEC) infections are a significant public health concern as they can cause serious illness and outbreaks. In England, STEC incidence is highest among children and guidance recommends that children under six diagnosed with STEC are excluded from childcare until two consecutive stool cultures are negative. We aimed to describe the barriers and facilitators to implementing exclusion and the impact of exclusion policies on young children and their families.

METHODS

Individual level data was obtained from a wider study focusing on shedding duration among STEC cases aged < 6 years between March 2018 - March 2022. Data was extracted from England's public health case management system. The case management system includes notes on telephone conversations, email correspondence and meeting minutes relating to the case. Collected data consisted of free text in three forms: (1) quotes from parents, either direct or indirect, (2) direct quotes from the case record by health protection practitioners or environmental health officers, and (3) summaries by the data collector after reviewing the entire case record. We analysed free text comments linked to 136 cases using thematic analysis with a framework approach.

RESULTS

The median age of included cases was 3 years (IQR 1.5-5), with males accounting for 49%. Nine key themes were identified. Five themes focused on barriers to managing exclusion, including (i) financial losses, (ii) challenges with communication, engagement and collaboration, (iii) issues with sampling, processing, and results, (iv) adverse impact on children and their families and (v) conflicting exclusion advice. Four themes related to facilitators to exclusion, including (i) good communication with parents and childcare settings, (ii) support with childcare, (iii) improvements to sampling, testing, and reporting of results, and (iv) provision of supervised control measures.

CONCLUSIONS

Qualitative analysis of public health case records can provide evidence-based insights around complex health protection issues to inform public health guidelines. Our analysis highlights the importance of considering wider social and economic consequences of exclusion when developing policies and practices for the management of STEC in children.

Women Agro-Entrepreneurship Promoting Vegetables at a Family Level: A Healthcare Approach towards Non-Communicable Disease Risk Reduction

The role of women in promoting the production and consumption of vegetables at a family level towards mitigating the risk of non-communicable diseases (NCDs) is crucial. Women not only select and prepare food items consumed by their families but care about the health issues of family members. As research examining this critical role of women is scant, we attempted to understand how women as agro-entrepreneurs can promote vegetables to enhance healthcare situations. A field study was conducted in a northeastern district of Bangladesh from January to June 2019, adopting qualitative-participatory approaches that involved interviews, focus groups, and workshops. The study revealed that women play a vital role in taking care of the health of the family members, while their role in planning the family diet is exclusive. However, they have limited decision-making authority in the production and consumption of vegetables, and their knowledge and perception of NCDs are limited. The results imply that with enhanced capacity of vegetable production and better knowledge of nutrition and NCDs, women can improve family dietary habits by increasing the consumption of vegetables. Therefore, building the agro-entrepreneurial capacities of women in terms of knowledge, skills, access to finance, and decision-making authority at the family level would be a significant interventional approach for increased production and consumption of vegetables. We argue that public health strategies and policies addressing NCDs should incorporate this family-centric approach by promoting agro-entrepreneurship by women who would promote the production and consumption of vegetables.

ADVERSE EFFECT OF WORK ROLE STRESS ON FAMILY ROLE CONFLICT AMONG MARRIED IT PROFESSIONALS IN INDIA

Work role stress is one of the major problems that influence family role conflict of Information Technology (IT) professionals. The purpose of the paper is to examine the relationship between work role stress and family role conflict among married employees in IT sector. The data is collected from 227 married IT professionals employed in different IT companies across India. The data is analysed with the help of descriptive statistics, correlation, factor analysis and multiple regression through SPSS 21.0 software, AMOS for Structural Equation Model (SEM) analysis. The results of the study revealed that all the determinants of work role stress does not effect on family role conflict of married IT professionals. Determinants such as work load and work schedules influence on family role conflict. In addition, the study findings bring out the relation between the determinants of work role stress and family role conflict. This study is important to IT companies as it helps to provide useful insights in managing family role conflict of married IT professionals.

Disgusting disruptions: Capturing the everyday experience and burden of managing gastrointestinal infections in the home

Gastrointestinal (GI) infections exert a significant public health burden in the United Kingdom and the numbers of episodes are increasing. Younger children are considered particularly vulnerable to infection, and can experience 2-3 GI infections episodes per year, with consequences being more severe for more disadvantaged children, who are much more likely to be admitted to hospital. Few qualitative studies have explored the lived experience of GI infection in the community in the UK. The aim of the study reported here was to contribute to addressing this evidence gap, by examining the consequences of GI infection for 'normal' family life. Eighteen mothers with young children who had recently experienced a gastrointestinal infection were recruited from two socioeconomically contrasting neighbourhoods in North West of England. The findings demonstrated that GI infections were particularly disruptive: experienced as disgusting, laborious and stressful and significantly impacted normal family routines. Women felt burdened by the heavy physical and emotional demands of caring for a GI infection, resulting in feelings of isolation and insufficient support in their caring role from male partners. Tensions also arose from interactions with external community organisations, particularly in complying with their regulations on infection which often undermined caregivers knowledge and expertise of what was best for their children. This study challenges assumptions that managing GI infections in the home is unproblematic and experienced by caregivers as a 'minor ailment.' Infection control measures need to incorporate insights gleaned from the day-to-day realities of caring for sick children in the community.

From 'neurotic' to 'managing' mother: The 'medical career' experienced by mothers of a child diagnosed with Juvenile Idiopathic Arthritis

Objective Despite increased research into how caring for a child diagnosed with juvenile idiopathic arthritis (JIA) affects mothers, more needs to be known about ways in which such experiences transform their lives. Insight into the experiences of such mothers was sought through analysis of interviews with eight mothers and one father caring for a child with JIA. Design The study is situated within a larger project involving families with a child with JIA. A social constructionist approach was adopted and grounded theory including a 'negative case,' guided gathering and analysing data. Individual, semi-structured interviews were conducted based on the research question: 'What is it like to be the mother of a child with juvenile idiopathic arthritis?' Results Findings suggest that mothers find difficulty living up to the 'ideal mother' expected within Western society when forced to provide competing demands of age-related, yet illness-relevant care. The unpredictable nature of JIA means mothers face a lack of understanding from professionals so become hyper-vigilant, 'battling' on behalf of their ill child. A self-perpetuating loop develops if this is misperceived as being overprotective, leaving mothers vulnerable to being judged 'neurotic'. However, with experience, often at an emotional cost, such mothers' confidence in managing the competing demands of caring for their ill child increases such they can navigate a positive journey from 'neurotic' to 'managing' mother. Conclusions Understanding this process could help health care professionals reduce stressful experiences faced by mothers when caring for a chronically ill child. Statement of contribution What is already known on this subject? Mothers of chronically ill children are often diagnosed with anxiety and depression. Such mothers will have taken over managing their child's condition, and this can include negative experiences within the health care system. Qualitative methods enable deeper understanding of the experiences of mothers of chronically ill children. What does the study add? Potentially gendered position of mothers of children with chronic conditions. Taken for granted assumptions implicitly underpin interactions between mothers and some professionals. Greater partnership between mothers and professionals ultimately improves the care of the ill child.

Double Exposure to Adverse Psychosocial Work Factors and High Family Responsibilities as Related to Ambulatory Blood Pressure at Work: A 5-Year Prospective Study in Women With White-Collar Jobs

OBJECTIVE

Accumulating evidence shows that psychosocial work factors of the demand-control and effort-reward imbalance models may contribute to increase blood pressure (BP). Women are more likely to be exposed to these psychosocial factors than men. Moreover, women spend twice as much time per week performing family responsibilities than men. This study aimed to evaluate the longitudinal association of the double exposure to psychosocial work factors and high family responsibilities in women with BP for a 5-year follow-up.

METHODS

At baseline, the study sample was composed of 1215 working women. Psychosocial work factors were measured using validated scales. Family responsibilities were measured using items related to "the number of children and their age" and "housework and children care." Ambulatory BP measures were taken every 15 minutes during a working day. Associations between psychosocial measures and BP were examined using analyses of covariance.

RESULTS

Women with a double exposure to effort-reward imbalance and high family responsibilities had significantly higher BP means than women not exposed to these factors at baseline (diastolic: +2.75 mm Hg), at 3-year follow-up (systolic: +2.22 mm Hg and diastolic: +2.55 mm Hg), and at 5-year follow-up (systolic: +2.94 mm Hg and diastolic: + 3.10 mm Hg). No adverse effect on BP was observed for the double exposure to the psychosocial work factors of the demand-control model and high family responsibilities.

CONCLUSIONS

A double exposure to effort-reward imbalance at work and high family responsibilities might contribute to elevated ambulatory BP at work among women. BP elevations related to this double exposure may persist for several years.

Caregivers reflecting on the early days of childhood cancer

Much research examining primary caregivers of children with cancer has focused on their distress levels and coping strategies. Drawing on qualitative data from semi-structured interviews with 38 Australian primary caregivers, this article examines their experiences through their child's cancer diagnosis and early treatment period. However, it does so retrospectively with their child in remission (a minimum of 5 years post diagnosis). This methodology gave caregivers the time to evaluate and reflect on their experiences through their child's cancer. Interviews with caregivers were recorded, transcribed verbatim and analysed using a grounded constant comparison approach. The concept of neo-normal was developed to represent caregivers' responses to having a child with cancer - characterised by the existential threat of cancer, the shattering of notions of control and certainty in their capacity to protect their child's well-being and reliance on medical intervention. Paradoxically, conceding to this disempowered position facilitated new ways to be a caregiver of a child with cancer. The findings illustrate the social processes and cultural context in which caregivers construct new normalising strategies as they transition through their child's illness. The study also gives recognition to the vital care, advocacy and pseudo-nursing contributions that caregivers bring to the paediatric oncology setting.

"I have surly passed a limit, it is simply too much": women's and men's experiences of stress and wellbeing when living within a process of housework resignation

BACKGROUND

Gender inequality within paid and unpaid work exposes women and men to different environments and responsibilities. These gender patterns shape living conditions for women and men, either negatively or positively, by affecting the prospect of good health. Most public health studies of gender and housework are quantitative, and knowledge about the relationship between housework experiences and health for women and men is limited. The aim of this study was to explore the housework experiences and practices of women and men and their experiences of stress and perceived wellbeing from a gender perspective.

METHODS

We conducted thematic interviews with four women and four men living in Sweden, and performed an analysis using the Grounded Theory method.

FINDINGS

We found that stereotypical gender practices in housework influenced experiences of stress and perceived wellbeing among women and men. Despite proposing gender equality in housework as a means of improving wellbeing, inequality was amplified by the way women and men handle the gendered division of housework. We call this recurring theme "The process of housework resignation", which also constitute the core category in our analysis. "The process of housework resignation" was theorised from the categories "Gender practices in housework", "Experiencing stress and wellbeing" and "Managing daily life".

CONCLUSIONS

Stereotypical gender practices in housework can increase experiences of stress among women and men. Challenging stereotypical masculinities can be a key for breaking the process of resignation in housework and for facilitating improved health among both women and men in heterosexual couple relationships within a Swedish context.

What happens to work if you're unwell? Beliefs and attitudes of managers and employees with musculoskeletal pain in a public sector setting

INTRODUCTION

Musculoskeletal complaints can impact on work in terms of productivity, sickness absence and long term incapacity for work. While employee attitudes and knowledge can drive absenteeism and presenteeism behaviour, managers also play an important role in influencing this via the quality of their relationships with employees and their role in implementing organisational policies and procedures. The aims of this study were to investigate the beliefs and attitudes of managers and employees with musculoskeletal pain about sickness absence, presenteeism, and return to work and to identify areas of consensus and conflict.

METHODS

18 employees with musculoskeletal pain and 20 managers from two large public sector organisations in South Wales, UK, took part in individual face-to-face interviews. Data were analysed thematically using NVivo.

RESULTS

Employees' and managers' reports indicated that there was a strong culture of presenteeism in these organisations. Establishing the legitimacy of complaints was a salient theme for both managers and employees, although their views were in conflict. Employees reported feeling that contact with employers was intrusive when sickness absence was legitimate. Managers were supportive of those who they felt were 'genuinely' unwell, but also cited examples of people 'working the system' and not reporting absences appropriately.

CONCLUSIONS

These issues require careful consideration of the rights and responsibilities of both employees and employers, where strategies for improving communication, trust, and creating an environment conducive to successful return to work need to be investigated.

Containing acute childhood illness within family life: a substantive grounded theory

Acute childhood illness is a universal experience for children and families. This paper presents the central process of a Glaserian grounded theory study which explored family management of acute childhood illness at home. Twenty-nine interviews were conducted with 15 families of children 0-9 years of age. Constant comparative analysis generated the substantive grounded theory 'Containing acute childhood illness within family life'. This informal social rule was identified from families' persistent desire to do the right thing, for their child and in the eyes of others in social life. Families perceived that they were expected to contain illnesses which are defined as minor and to seek medical help for 'real' illnesses. Considerable uncertainty was evident around defining the illness and the legitimacy of seeking medical help. Their concern with the latter indicates doctors' role as moral agents for parents' behaviour, directing the containment of acute childhood illness.

Beliefs about common health problems and work: a qualitative study

Common health problems (CHPs) such as pain, depressed mood and fatigue are often cited as causes of disability and incapacity for work. The aim of this qualitative study was to investigate beliefs about CHPs in relation to work. Focus groups (n=16) were undertaken with 79 people aged 17-83 in South Wales, UK, where there is a high prevalence of limiting long-term illnesses in a number of areas. The findings indicated that depression and stress were consistently reported to have a high impact on life and work relative to other CHPs, with work being perceived as a primary cause of these complaints. The social, moral and economic pressures involved in work and sickness absence emerged as a major theme. Differences were identified in beliefs about CHPs and work according to gender, age and socio-economic status. Beliefs were relatively consistent across geographical locations, although changes in forms of work and social structure of communities were more salient issues within the ex-coalfield areas. Care needs to be taken that initiatives aimed at reducing incapacity for work due to CHPs do not simply add to the pressure to 'be well'.

Masculinities fathering and health: The experiences of African-Caribbean and white working class fathers

There is a developing body of research that investigates the links between masculinities and men's health experiences, but the links between masculinities and the health of fathers has been a neglected focus for research in the UK. This paper presents some of the findings drawn from a parent study which investigated African-Caribbean and white working class fathers' experiences of fathering, health and social connectedness. Data are drawn from interviews with 13 men (6 African-Caribbean and 7 White working class) living in a city in the West Midlands area of the UK. In this paper, I analyse and discuss African-Caribbean and white working class fathers' stories about the meaning of health, the influences upon their health, and their health practices. It was found that for the African-Caribbean fathers specifically, anticipated or perceived racist prejudice, abuse or discrimination influenced their health experiences. However, the meaning of health for both ethnic groups of fathers was as functional capacity, that is health was an asset that allowed fathers to meet the obligations of paid work and fathering. These obligations were also associated with a restricted sense of personal agency for the men interviewed, and the associated constraints were linked to transgressive consumption of alcohol, food and tobacco. In addition, fathers were also involved in solitary ways of dealing with their vulnerability, vulnerability that was associated with fathers' health concerns, and other difficult life experiences. Fathers' solitary experiences of vulnerability were also mediated by hegemonic forms of masculinity. Nevertheless, the experience of fathering within the lifecourse influenced men's health experiences: reflexivity and challenges to both transgressive consumption and solitary experiences were linked to fathers' perceived obligations to children. The significance of gender, ethnicity and social class for theory and future research with working class fathers and boys is identified, and the need for gender-sensitive public health and health promotion interventions regarding the 'work-family balance' and working class fathers' personal and social skills is also discussed.