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. Background Influences Mother’s Safeguarding Work 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 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

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