Health Promotion in Single-parent Families
Marilyn Ford-Gilboe, RN, PhD
This program of research aims to contribute to nursing science by developing the extremely limited body of theoretical, empirical and clinical knowledge related to health promotion processes in single-parent families. Approximately 1 in 4 Canadian families with children are single-parent families, the majority of which are headed by women. The literature is replete with studies addressing the problems of single-parent families, some of which include persistent economic difficulties, shortages of time and energy, parental role strain and social stigma. While acknowledging these problems, this program of research focuses on identifying the strength and potential within these families as a basis for increasing personal control over health matters. This empowerment orientation stems from: a) the World Health Organization definition of health promotion, b) a feminist research agenda of improving the quality of life for women and their families by providing an alternative view of women's needs and experiences in context, and, c) the nursing perspective of the Developmental Health Model.
The Developmental Health Model
This program of research evolves from key concepts in the Developmental Health Model, a theoretical extension of the McGill Model of Nursing. A critical assumption in this theory is that all families possess capabilities (i.e. health potential- strengths, motivation, resources) that serve as the basis for health promotion behaviour (i.e. health work). Health work, the degree to which a family engages in health-related problem-solving and goal attainment, reflects the process of family health promotion, the outcomes of which are competence in health behaviour and improved health status. Nursing interventions may be aimed at improving the health of individuals and families directly by assisting families to participate in health work or, indirectly, by building the strengths, motivation and resources needed by families to support health work. Family health promotion processes may be influenced by a variety of contextual factors, such as the types of health situations facing the family, structural, developmental or cultural aspects family life, and broader social and political forces which affect families.
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Preparatory Work
Single-parent families possess both common and unique characteristics which influence how they engage in health promotion processes. The current research program builds on my PhD dissertation in which the influence of health potential on health work was examined in 68 single-parent and 70 two-parent families with pre-adolescent children (Ford-Gilboe, 1994, 1997, 2000). Consistent with the Developmental Health Model (DHM), measures of health potential (i.e. family cohesion, family pride, mothers' sex role orientation, mother's self-efficacy, network and community support) were found to be significant predictors of health work in both types of families. Family types did not differ significantly on degree of health work or five of the seven indicators of health potential. Single-parent families reported significantly less community support and had lower incomes than two-parent families. Qualitative interview data obtained from a subsample of 16 families confirmed and enriched the quantitative study findings. Only female-headed single-parent families created by separation or divorce took part in this study.
In preparation for my dissertation, I was intensively involved in clarifying selected concepts and relationships proposed in the Developmental Health Model. Although formulations of this model have been used to guide clinical nursing practice for more than 25 years, few published accounts of the theoretical premises underlying this method of nursing are available. By synthesizing published and unpublished work with my clinical experience working with this model, definitions of the concepts of health potential and health work were developed as a basis for their use in the dissertation. Results of ongoing studies are being used to continue theory refinement and elaboration.
A related project involved the development and initial testing of the Health Options Scale (HOS), a measure of health work. Initial evidence of internal consistency, content and construct validity was provided using data from 30 mothers of school-aged children (pilot study) and by 138 mothers and their pre-adolescent children (10-14 years) who took part in the dissertation study.
Phase I Studies
In phase 1 of the research plan, descriptive work aimed at identifying factors which influence health work in single-parent families as well as the outcomes of this process has been undertaken. Several aspects of this phase are completed or in progress:
1.Analysis and Refinement of the Concept of Health Work.
Qualitative data provided by families in my dissertation research were used to refine the concept of health work using the Hybrid Method described by Schwartz-Barcott & Kim (1994).The process consisted of identifying a working definition of the concept of health work, followed by a period of analyzing related empirical and theoretical literature and family interview data. Themes identified from the literature and interviews were synthesized to produce a reformulation of the concept of health work. A description of the refined concept of health work was integrated into the description of the model.
2. Further Testing of the Health Options Scale (HOS).
Following the concept analysis work, the Health Options Scale, a measure of health work, was revised to reflect the refined conceptualization of health work. Twenty new items were generated to reflect aspects of health work not tapped by the original instrument and added to the 18 original items. A methodological study was undertaken to determine the reliability and validity of the 38-item HOS in community-dwelling parents and children. This work has been conducted in several phases.
3. Testing and Refinement of the Developmental Health Model
As an extension of my dissertation research, a number of studies are being undertaken to examine the validity of Developmental Health Model in understanding health promotion processes of single-parent families who vary in potentially important ways (i.e. in terms of social class, route to single-parenthood, abuse history, health status of members, etc). A range of quantitative and qualitative methods are being used in these studies:
Study #1: Testing a Causal model of Health Promotion Behaviour in Mother-Headed Single-Parent Families
The purpose of this study was to examine relationships among variables in a causal model derived from the Developmental Health Model (Allen, 1986) examining: a) the effects of selected family strengths, motivation, and resources (health potential) on family health promotion behaviour (health work), and subsequently, health outcomes (problem-solving and goal attainment effectiveness, lifestyle practices, family functioning) in a community sample of 236 female-headed single-parent families with school-age children and, b) the influence of selected contextual factors (e.g. length of time as a SPF, mothers' employment status and education, abuse history) on health potential, health work and health outcomes. This study partially replicates and extends my dissertation by adding selected outcomes of health work to the model and testing it a more diverse sample of SPFs (separated, divorced, never married, widowed). Consistent with the previous study, a combination of quantitative data generated from written questionnaires completed by mothers and qualitative data derived from 13 families was used to address the study purposes.
Study #2: The impact of woman abuse on health promotion processes of single mothers and their children
This study provides an opportunity to more fully
explore the health promotion processes used by single mothers and their children and the
impact of woman abuse on these processes. The high incidence of a history of woman that
was documented in the community sample of single mothers who took part in study #1 lead to
the development of this project. The methodology used in this study, feminist grounded
theory, is qualitative in nature, and will allow more indepth description both of health
promotion processes and enable us to better understand the complex mechanisms by which
violence affects health promotion efforts of single-parent families. The type of
understanding gained is quite different from but complementary to the use of more
traditional quantitative approaches and is a precursor to developing and testing health
promoting interventions for this group of families. Further, while grounded theory
methodology is ideally suited to theory-building, the understanding gained will also be
useful in refining selected aspects of the theory that is being used to guide my research
program.
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Study #3: The Impact of Public Policy on Health Promotion Processes of Single-Parent Families with a History of Woman Abuse
This study explores the impact of public policy both as written and enacted on health promotion processes of single-parent families who have experienced woman abuse. Prior research conducted by the research team has documented the control exerted by the broader social system on the lives of both single mothers and there children and on women who have left abusive relationships. Frequent ongoing contact with legal, social, health and other systems has not always been viewed as supportive of the family's needs and goals. An indepth analysis of the impact of public policies on health promotion processes of these families has not been conducted. As a parallel to study #2, the two studies emphasize different influences (abuse history, policy) on health promotion process of single-parent families using consistent methodology. This will provide an opportunity to easily integrate findings from these two studies. The study is participatory in orientation and uses both focus groups and interviews with single-parent families and key policy informants to raise awareness about the supportiveness of particular policies and programs and to develop ways of overcoming these problems from within the system. The ultimate aim is empowerment of single-mother and their children to make changes that will improve the quality of their lives.
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Marilyn Ford-Gilboe.
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