Selecting a Child Care Center: What Really Matters to Parents?

Previous research on parents' decision making concerning child care centers has attempted to evaluate the importance of various characteristics of the centers by having parents evaluate them one at a time. In an effort to better understand how parents evaluate centers when they must consider all the characteristics of the center simultaneously as is done in real life, 235 parents who were in the process of finding child care for their children were surveyed. Utilizing conjoint analysis, parents were presented with profiles of child care centers in which eight center characteristics were varied. Parents evaluated all eight characteristics simultaneously and then indicated how likely they were to select each center. Results indicated that the characteristics of child care centers that most significantly affect parents' decision-making vary based on demographic characteristics of the parents. Single mothers attend most strongly to cost in their decision making, while married mothers attend to the child/staff ratio and married fathers give relatively equal attention to four factors; cost, convenience, child/staff ratio and hours of operation. Further differences in parents' decision-making strategies were found based on parents' education and family income. These findings are discussed in light of the importance of developing child care programs which meets the needs of parents as well as children.     

Clinical decision making and the provision of information in PEG feeding: an exploration of patients and their carers' perceptions

Background:  Government health care policy encourages a culture of patient choice and involvement in decision making, although the complexities and challenges involved in fully engaging patients in clinical decision making can be perceived as barriers to effective communication between the professional and patient. The present study aimed to explore the patients and their carers perceptions of the adequacy of the information provided and their subsequent involvement in the decision making process for percutaneous endoscopic gastrostomy (PEG) tube insertion.
Methods:  The study used purposive sampling. A cross-sectional qualitative design was utilised using semi-structured interviews, which were tape recorded. Sixteen patients and 27 carers were interviewed. The interviews were then transcribed verbatim and data analysis was undertaken using thematic analysis.
Results:  Only four patients and 11 carers reported having a choice in the decision for PEG placement, with only four patients and 10 carers, respectively, reporting they received sufficient information regarding the PEG. Poor communication, lack of information and inappropriate information, attitudes of health care professionals and exclusion were key themes for patients.
Conclusions:  Clinicians should develop interdisciplinary and participative practices to agree shared treatment goals and evaluate patient experiences. Consideration should also be given to the use of decision making models; in our opinion, the development of such a model, which supports interdisciplinary and participative approaches to decision making, is urgently required.     

Accounting for risk and responsibility associated with smoking among mothers of children with respiratory illness

Contemporary public health discourses construct individuals as rational, responsible and knowledgeable, and thus promote a self-controlled prudent response to risk. In the context of evidence emphasising risks to children's health associated with passive smoking, mothers of children with respiratory illness may knowingly place their children at increased risk should they continue to smoke in their presence. Drawing on an analysis of depth qualitative interview accounts with mothers who smoke and whose young child was recently admitted to hospital with respiratory illness, this study describes mothers' constructions of risk and responsibility associated with their smoking. Three forms of accounting style were identified: 'stories of acceptability'; 'denial of agency'; and 'reflections of guilt'. 'Stories of acceptability' either positioned the risk of passive smoking as contained and controlled to an acceptable level, or disputed the level of risk that passive smoke posed. 'Denial of agency' drew on discourses of addiction and shared responsibility to exonerate the mother of responsibility or blame. 'Reflections of guilt' were presented when contradictions arose within accounts, particularly in relation to discussions of agency and rationality in decision-making. The study illustrates how constructions of moral responsibility, especially in relation to being a 'good mother', framed mothers' accounts of smoking in the face of risk. The study concludes that far greater consideration be given to the way in which mothers rationalise their smoking to others if paediatric doctors are to foster risk reduction practices associated with passive smoking more effectively.     

Getting out of the house: the challenges mothers face when their children have long-term care needs

In most industrialised countries, the care needs of those who are sick, disabled and frail are increasingly met in peoples' homes. One of the implications of this shift in the site of care is that individuals with long-term care needs and their family care providers experience social and spatial isolation. Many are housebound and most face considerable challenges in getting out of the house. This paper illuminates these challenges as they are experienced by mothers of children with long-term care needs, and the resulting isolation and disconnection that they experience. Eleven semistructured interviews were conducted in two regions of Ontario, Canada. Grounded theory informed the analysis of the mothers' accounts of their experiences of getting out of the house. The present findings are derived from a larger investigation of the meanings and experiences of the home as a place of caring for families with children who have long-term care needs. Secondary analysis of the data found that three main challenges restricted the mothers' abilities to leave their houses. Mothers experienced difficulties getting out of the house when they attempted to leave with the child, and when the child was left with an alternative care provider. Physical challenges were associated with the work and planning required in moving the child's equipment and supplies, meticulous planning of the outing within the daily schedule, and navigating barriers in the built and natural environments. Social challenges reflected the lack of people within the mothers' social network of family and friends who have the knowledge and expertise to care for the child. Service challenges resulted from the gaps between the policies and practices of paid respite, and the conditions that must be satisfied in order for mothers to be able and/or willing to leave the house. The authors also examined the reasons why some of the mothers worked from home, and the strategies that they used to get out of the house for employment. In this paper, the authors discuss each challenge, and how it contributes to the mothers' social and spatial isolation. The mothers' experiences elucidate the differences between living in a community and being part of a community. The consequences of the isolation on mothers' daily lives are not recognised in home and community care policy. The suggestions that are put forward concerning paid respite have relevance for home and community care policy and practice.     

Fathers' Involvement in Child Health Care: Associations with Prenatal Involvement,Parents' Beliefs,and Maternal Gatekeeping

Using data from 182 dual‐earner couples experiencing the transition to parenthood, this study examined associations between prenatal involvement, gender‐role beliefs, and maternal gatekeeping and new fathers' involvement in child health care. Results indicated that prenatal father involvement was associated with fathers' direct engagement in child health care and perceived influence in child health‐related decision making. Fathers also demonstrated greater direct engagement in child health care when mothers held more nontraditional beliefs about gender roles. Moreover, when mothers were more encouraging of fathers' involvement in childrearing, fathers felt more influential in child health‐related decision making, whereas when mothers engaged in greater gate‐closing behavior, fathers with more traditional gender‐role beliefs felt less influential in child health‐related decision making. This study suggests that fathers' prenatal involvement, mothers' beliefs, and maternal gatekeeping may play a role in the development of new fathers' involvement in child health care at the transition to parenthood.     

Parenting Stress and Its Relationship to Child Health Care

This study examined the relationship between the level of parental stress (Parenting Stress lndex) experienced by mothers of children during their child s second vear of life and the frequency, and appropriateness of the health care they obtained for their child No systematic relationships were found between the amount or medical necessity of the pediatric health care obtained in relation to maternal stress for this largely middle class population Contrary to clinical folklore, these mothers were able to appropriately separate their decision making regarding seeking health care for their children from their stress level.     

Embodied context: social institutional influences on employed mothers' health decision making

The purpose of this critical ethnographic study was to explicate the ways that employed mothers' personal and family health decision making were socially organized through the institutions of motherhood, the family, the workplace, and the health care, education, and social systems in Canada. Data were analyzed from individual interviews, a focus group, workplace policy documents, and popular media articles. Twenty women participated over 2 years. Family, workplace, and social contexts were external influences on women's choices and were embodied through internal influences such as personal expectations that framed decision making. Strategies are suggested to promote the health and well-being of employed mothers and their families.     

The mothers' participation in the child malnutrition program

This study aims to show mothers' and health professionals' conceptions and perceptions related to their participation in the Child Malnutrition Program. Thus, we particularly explore the mothers' participation, as a means of making them aware of the individual and social reality and their decisions about it. Our analysis of the maternal participation process is guided by Imogene King's conceptual framework. This study was conducted in Crato, Ceará State, Brazil. Study participants were mothers and professionals. We used semi-structured interviews and adopted Bardin's Content Analysis for organizing and analyzing the collected data. This study did not find evidence of strategies for the conscious participation of social actors in the child malnutrition program.     

Home enteral tube feeding in children following percutaneous endoscopic gastrostomy: perceptions of parents, paediatric dietitians and paediatric nurses

BACKGROUND: The perceptions of parents and professionals are important in deciding to feed children by gastrostomy, yet there are few published studies in this field. This study explored and compared the perceptions of parents to those of paediatric outreach nurses and paediatric dietitians. METHODS: A cross-sectional mixed-method study with purposive sampling was undertaken using structured interviews and questionnaires to explore perceptions of percutaneous endoscopic gastrostomy (PEG) placement and feeding. Binomial regression was used to investigate differences in perceptions across the groups of participants. RESULTS: Parents, paediatric outreach nurses and dietitians shared similar perceptions regarding success of feeding, support for gastrostomy reinsertion and the acceptability of the child's quality of life. Much greater differences in perceptions were evident regarding the parents' involvement in the decision-making process for PEG placement and the adequacy of the support received from healthcare professionals. CONCLUSIONS: A high level of support for feeding was demonstrated together with strong perceptions across all groups that feeding was successful. It is important for healthcare professionals to consider the perceptions of the parents throughout decision making and provision of care following PEG placement because it is highly likely there will be differences in the perceptions between parents and healthcare professionals.     

Living with lifting: mothers' perceptions of lifting and back strain in childcare

The methods a mother selects to physically care for her young children may subject her to back strain or injury depending on the methods she selects. Little is known about what motivates mothers to select particular child‐care methods and equipment. The aim of this qualitative study was to explore the choices mothers of young children make in this area and their experiences using the methods they select. Nine mothers completed a brief questionnaire and participated in a semi‐structured interview. Analysis of the data revealed a number of motivating factors that were considered before making a final decision on what method to use. Rarely were issues related to posture and back care considered. Primarily, mothers chose methods based on what was best for the child, without consideration of their own needs. Consideration of the effect of a method on their back was given only when they experienced back strain. Further research is required to investigate the best methods for lifting and handling young children while providing maximum protection for the mothers' backs. Copyright © 2000 Whurr Publishers Ltd.     

The role of narrative in discussing end-of-life care: eliciting values and goals from text, context, and subtext

This article reports a qualitative study of elderly veterans' perceptions of and preferences for end-of-life care. At a large urban Veterans Affairs (VA) hospital, we asked 30 veterans and 30 health care providers to define 4 terms in the VA form of the advance directive: life-sustaining treatment, terminal condition, state of permanent unconsciousness, and decision-making capacity. The veterans commonly used narratives to construct meaning, and analysis showed that the resulting texts had both a subtext (the values and goals driving the narrative) and a context (life experiences that filter and shape the current interpretation). We found that all 3 components--text, subtext, and context--are crucial to understanding the central theme of an individual's narrative and the decision-making processes associated with it. In this article we examine 1 lengthy narrative using Chafe's (1994) notion of intonation units. We then present a series of short narratives to demonstrate 3 subthemes that emerged from the data: quality of life versus quantity of life, benefit of treatment versus cost of treatment, and, most common, control versus lack of control. Our goal was to demonstrate the centrality and usefulness of storytelling in the patient-provider interaction when listeners are willing to consider the subtext and context of the story and its role in the decision-making process. As demonstrated in this study, deciphering people's stories gives us insight into their values, the mental constructs that drive their decision making, and the goals that they have for their own health care.     

Maternal Health-Related Coping Patterns and Health and Adjustment Outcomes in Children With Type 1 Diabetes

Parental coping patterns can influence health outcomes of a child with a chronic illness. As part of a longitudinal study of 8- to 13-year-old children with newly diagnosed diabetes, we examined the relation between maternal health-related coping strategies and rehospitalizations and psychopathology in the child with diabetes. Forty-two pairs of children and their mothers were evaluated separately by means of a comprehensive assessment battery including a semistructured psychiatric interview, self-rated questionnaires, and overall diabetes course and management. Although results of this study suggest that mothers' coping patterns have no detectable impact on short-term health outcomes of children with diabetes, mothers considered maintaining family integration and understanding the medical situation as very helpful coping strategies. Suggestions for research using a longer follow-up period and implications for health care providers are discussed.     

Social gradients in dental health among low-income mothers and their young children

For low-income mothers of children aged 3-6 years, we estimate whether social gradients exist between mothers' income, education, and employment status and mothers' perceptions of self and child dental and general health, and whether these relationships differ by racial/ethnic group. Disproportionate stratified sampling by racial/ethnic group selected 10,909 eligible children aged 3 to 6 in Medicaid in Washington State. Mothers (n=4,373) completed a mixed-mode (web, mail, telephone) survey. Mothers' education had a strong, gradient relationship with mother ratings of self and child dental health that was not explained by other measures. Similar gradients were found for mothers' employment status and income, but some associations were no longer significant (p>.05) after adjusting for oral health beliefs and behaviors, dental insurance, and regular dental care. Associations did not differ significantly by racial/ethnic group.     

Australian mothers’ notions of risk and uncertainty in relation to their pre-teen children

In this article we examine the ways discourses of risk manifested and played out within and across two groups of Australian mothers living in two large urban centres in Australia: the first comprised of mothers who had a pre-teen child diagnosed with an eating disorder (n = 13); the second of mothers who had a pre-teen child without the symptoms or diagnosis of an eating disorder (n = 13). In 2011 and 2012, we conducted in-depth interviews with the mothers in their homes on their ideas about health and their relationships with their children. An analysis of the data collected from these interviews indicated that having a pre-teen child diagnosed with an eating disorder had a decisive impact on how the mothers constituted and responded to risk. For mothers, who had a pre-teen child with an eating disorder, risk was intensified by bio-medical discourses. The particular intensifications of risk limited the ways in which mothers could act and often threatened to undermine their abilities as competent carers. By contrast, the mothers who did not have a pre-teen child with an eating disorder spoke about risk less directly, and with less sense of immediacy. Where these mothers acknowledged risk discourses particularly in regard to health, they were in a stronger position to negotiate them. Our analysis indicates that the ways in which mothers responded to risk is contingent on circumstances and contexts. Mothers’ responses to risk were related to the calculability of the risk and their perceived capacity to manage it.     

Engaging Caregivers in the Treatment of Youth with Complex Developmental and Mental Health Needs

Caregivers of youth with coexisting cognitive and mental health problems face difficult treatment decisions for their child and have unique challenges engaging in shared decision-making. Many stakeholders can influence care management decisions, and the child’s cognitive impairment often prohibits their inclusion in the shared decision-making process. In-depth interviews and focus groups with 37 caregivers elicited their experiences with care management related to their child’s educational, mental health, and other care needs. Four themes that describe the process of engagement were awareness, activation, formulating a strategy, and action. Findings show psychoeducation, and peer-to-peer support could enhance caregivers’ awareness of the condition and encourage activation, which would help in navigating complex service sectors. Coordinated services could enhance capabilities for formulating a strategy jointly with multiple providers and stakeholders. Ultimately, this would contribute to shared decision-making around a common treatment goal that hopefully leads to better quality of care in the least restrictive setting.     

Young adolescent mothers-how they and their children fare

This paper presents selected findings for a three-year, U.S. study of adolescent mothers who were under 16 at the time of their first live births and were keeping their infants rather than relinquishing them for adoption. The young mothers' child care arrangements, knowledge of child development, assessments of child care competency, and sources and needs for child development information during the first two years of their babies' lives are discussed. In addition, an assessment of the children's physical, cognitive and social development is included. The help provided by the mothers' families in child care, information about parenting, and emotional support, as well as housing and financial assistance, is comprehensive and not easily duplicated. While the infants experienced an inordinately high number of health problems during the first two years, they appear to be developing well in all areas, and may, in fact, be somewhat advanced in their self-help and social abilities.     

Mothers' psychological distress 1 year after very preterm childbirth. Results of the EPIPAGE qualitative study

BACKGROUND: The objectives of this study were to assess qualitatively mothers' physical and psychological health, their perception of their child's health and development, and their difficulties with childcare from 2 months post discharge to 1 year after a very preterm delivery. METHODS: The study population included all mothers who delivered before 33 weeks of amenorrhea between November 1998 and November 1999 in a Parisian maternity unit and between February 2000 and February 2001 in a maternity unit located in Rouen (France). Twenty-one of the 38 mothers contacted agreed to participate (55%). Semi-structured interviews were conducted by a clinical psychologist at the woman's home. They were taped, fully transcribed and subjected to content analysis. RESULTS: The main difficulties reported by mothers at 1 year were fatigue, depressive mood, anxiety and physical symptoms. Depressive mood was associated with social isolation, post-traumatic symptoms, withdrawal and feelings of guilt. Most mothers also described their child as being difficult and tiring. Mothers' reports about their own health and difficult behaviour of their child were more negative at 1 year than at 2 months post discharge. CONCLUSIONS: The mothers' psychological distress following a very preterm birth did not improve between 2 months post discharge and 1 year after delivery. Comprehensive follow-up care programmes should take into account this consequence of a very preterm birth and provide access to adequate psychological support, care or treatment.