Category Archives: Journal Articles

Swedish Child Health Centers’ Built Environment: Do They Include Fathers?

Swedish child health centers have historically been a place for new mothers and children. We assessed 31 child health centers’ waiting rooms to see the extent to which they included images of mothers, fathers, and children. 75% did not include fathers…at all. Read the full article here.

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Background: Sweden is trying to create a gender equal country and around 97% of all families in Sweden visit the child health centers for routine check-ups, vaccinations, to monitor their child’s growth and development, and to receive parenting advice, either for their specific child’s problems or via parenting groups.

Study Design:Prior to the study, we defined what constituted a mother, father, and/or child environment (or any combination thereof).

 

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Note: None of the environments were father-mother, father-child, or father centered, so those definitions have been removed.

I then visited and took pictures of 31 child health centers throughout Sweden. I visited centers in rich and poor neighborhoods, urban and rural areas, and private and public child health centers.

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Pictures were taken of everything in their waiting room, magazine titles were written down, and all pamphlets that could be handed out to parents were collected.

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I then met up with two co-researchers, where we independently viewed the waiting room via the pictures and samples to determine if that space included the mother, father, and/or child.

The waiting room was determined to be mother, father, and/or child centered as long as at least 25% of the space consisted of that individual; leaving the last 25% to be aimed at any or all of these types of individuals (neutral items [e.g. abstract art, pictures of nature] did not count for or against any individual family member).

The messages on the bulletin boards were broken down using manifest and latent analysis using semiotic visual analysis.

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The magazine readership was sought out

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Results

31 Child Health Centers

  • 12 = Mother-Child Centered
  • 8  = Family-Centered
  • 6  = Child-Centered
  • 2  = Women-Centered
  • 3  = Neutral

The most common waiting room had lots of items for mothers (e.g. images of mothers, magazines that mothers typically read) and toys and books for children, as well as images of children, but very little or nothing for fathers.

In fact, only one category, family-centered, included fathers, while the rest were composed of mothers and/or children.

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Observations

We also observed parents, mothers and fathers, visiting the child health centers to see what they did while in the waiting room–read books, talk on their cell phone, interact with their child, talk with each other….just sit in their chair.

Mothers’ behavior did not change between environments, but fathers were more likely to play with their child and read the brochures/pamphlets if they were in a non-women centered environment (e.g. either family centered or child centered).

Conclusions: People are affected by their environments–people read in libraries, party at concerts, act posh at fine dining establishments. They don’t typically do the reverse (read at concerts and party in libraries).

The child health centers are no different. Their built environment sends messages on who’s welcomed and how they should act.

To further promote involved fathering in child health, the child health centers should rebuild their environments to be more inclusive of fathers.

To help ensure an inclusive waiting room (for all types of people), we created (in Swedish) a checklist they can use!!!

Click here or on the picture to see the full checklist.

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Swedish Child Health Nurses’ Attitude Toward Fathers

We published a qualitative article in Acta Paediatrica on how Swedish child health nurses felt about fathers coming into the child health centers. While child health nurses accepted and welcomed fathers, they did little to invite, include, or further support fathers (click here to read the full article).

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I interviewed 17 child health nurses from various places in Sweden: north, south, east, west; urban and rural; experienced and inexperienced; young and old. All child health nurses were women–Not uncommon since there are only a handful of men that are child health nurses in the whole country.

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Four themes were discussed in this article.

While child health nurses are experts on children’s health and believe that fathers are attending the child health centers more than ever; they seem to be attending in spite of rather than because of support they receive from the child health nurses.

Child health nurses say that they value mothers to a much greater extent than fathers and provide more support to mothers.

However, child health nurses are in various stages of providing more support to fathers: while some have never thought about actively involving fathers, others have tried to, but feel their hands are tied when it comes to making changes, while others have even tried to make changes (e.g. discuss with their boss about having evening and weekend hours, magazines for fathers, pictures emphasizing fathers). However, no child health nurses that were interviewed had yet made any real changes.

downloadConclusion: If we want mothers and fathers to be equal parents, fathers will need to be accepted and encouraged to participate, just like mothers.

The Swedish child health centers provide great child development advice, host parenting groups, are seen as parenting experts, and are appreciated throughout Sweden.

For example, their services benefit parents…mothers.

The extra support mothers receive aides mothers in continuing to raise their child, at least as far as their child’s health in concerned, since she is the parenting expert because she receives the most support and is the most welcome at the child health centers.

Changing routine practices at the child health centers to further promote and support fathers will aid Sweden’s goal of becoming a gender equal country.

Head Start Preschool Teacher Retention

I recently published an article in Early Childhood Research Quarterly (the best early childhood education journal) showing the factors that can predict Head Start preschool teachers quitting their employment across the first half of the school year (click here to read the published article).

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Study Design: Ten Head Start centers in one major Midwest city were recruited to participate (170 total preschool teachers). Head Start preschool teachers with two years or less of experience, were asked to complete a 16-item questionnaire, as well as a demographics questionnaire at the beginning of the school year (n = 65 participating preschool teachers).

In January, half-way through the school year, I learned from the Center Directors who had continued teaching and who had quit. I then compared the scores of those who stayed and those who quit for any differences.

Results:
Preschool teachers came from a variety of backgrounds, according to the demographic questionnaire–different races, ages, work experiences, education, etc. There were also some differences between lead and assistant preschool teachers (see full article). However, all but one of the participants were female.

Huge Turnover Rates:

  • 48% of all Head Start teachers were newly hired (within the last two years)!
  • 36% of newly hired teachers quit during the first half of the school year!

Salary:
The preschool teachers’ salary was not a contributing factor to their quitting their job. In fact, on a one-to-seven scale, preschool teachers who stayed rated their salary as a 3.9, while those who quit rated theirs as a 3.7 (statistically identical)–and both are just above the middle (3.5 out of 7), suggesting that both stayers and quitters think their salary is adequate.

Five factors differed between those who stayed and those who quit:

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Preschool teachers were more likely to quit if they:

  1. did not want to stay teaching in the early childhood education (ECE) field
  2. were not happy
  3. had a bad relationship with their supervisor
  4. did not like their work environment
  5. had a lower education

In addition, the more factors that an individual teacher possessed the more likely they were to quit (e.g. if they did not want to stay in ECE AND were not happy AND did not like their supervisor AND did not like their work environment AND had a low education).

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While those preschool teachers who kept teaching, either did not have any or had only one of these five risk factors.

Conclusion: Preschool teacher turnover affects child outcomes, the quality of the preschool program, the teachers who continue teaching, and those who feel they need to quit their job.

Interventions should use this information to tailor their programs, so that fewer preschool teachers quit their job; yielding positive outcomes for children, parents, the school, and the teachers.

Father & Mother Attendance at a Parent Support Program

We recently published a paper that looks at why mothers and fathers attend a parent support program–in this case, Triple P – Positive Parenting Program in the Scandinavian Journal of Public Health (Click here to read the published article).

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Most research on this topic looks at parents in general, and some only on mothers. Fathers however come much less often to parent support programs compared to mothers–so we wondered why that might be?

The intervention: The program was offered free-of-charge to all parents in one community in Sweden. We then looked at the background factors of mothers and fathers who attended compared to those who did not attend to see if there were any differences.

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Results: Turns out that mothers are much more likely to attend the program if they perceive their child as having behavior problems, while fathers were approaching significance of attending if they perceived their child as having emotional problems.

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Future research should look further into various background factors to see how to increase rates of other minority groups, such as those who are not native to the country the program is held in or those parents with less education.

Marketing Strategies:
Since it is the goal of public health ventures, like parent support programs, to reach as much of the population as possible, direct and specific marketing methods should be employed, rather than marketing to parents–since parents, based on their gender, have different needs.

Future research can better target parents via marketing/advertising strategies that appeal to the parents’ needs. In other words, if you only market for improving children’s behavior problems, you can expect more mothers to come to the program than father, since they are more likely to perceive that as an issue.

 

Child behaviour problems, parenting behaviours and parental adjustment in mothers and fathers in Sweden

Publishing aScreen Shot 2014-07-09 at 1.59.00 PM peer-reviewed article is always important in the academic world. Not only do you get to promote yourself and your abilities, but more importantly, you get to promote your findings. Better still would be for someone to pick up your work and institute change based on your findings.

It is our hope that Swedish politicians and bureaucrats take heed of the messages within this article, and further help in providing needed support to parents who struggle with child behavior problems.

Raziye Salari was the lead author on a paper entitled Child behaviour problems, parenting behaviours and parental adjustment in mothers and fathers in Sweden. Anna Sarkadi and myself were co-authors.

The article is published in the Scandinavian Journal of Public Health.

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The abstract and link to the full article can also be found on my researchgate page.

Main message:

Although Sweden is seen as a country that promotes parenting and has lots of family policies to encourage strong parent-child relationships, parents in Sweden still may struggle with child behavioral issues. Therefore, support for these parents is still needed and warranted.

To see the abstract, click here (or read below):

Aims: We aim to examine the relationship between child behavioural problems and several parental factors, particularly parental behaviours as reported by both mothers and fathers in a sample of preschool children in Sweden.

Methods: Participants were mothers and fathers of 504 3- to 5-year-olds that were recruited through preschools. They completed a set of questionnaires including the Eyberg Child Behavior Inventory, Parenting Sense of Competence Scale, Parenting
Scale, Parent Problem Checklist, Dyadic Adjustment Scale and Depression Anxiety Stress Scale.

Results: Correlational analyses showed that parent-reported child behaviour problems were positively associated with ineffective parenting practices and interparental conflicts and negatively related to parental competence. Regression analyses showed that, for both mothers and fathers, higher levels of parental over-reactivity and interparental conflict over child-rearing issues and lower levels of parental satisfaction were the most salient factors in predicting their reports of disruptive child behaviour.

Conclusions: This study revealed that Swedish parents’ perceptions of their parenting is related to their ratings of child behaviour problems which therefore implies that parent training programs can be useful in addressing behavioural problems in Swedish children.

 

Now I can officially call myself a public health researcher!

 

Swedish Parent’s Views on Sweden’s Food Temptations and their Effect on Parenting Young Children

‘Children are exposed to temptation all the time’– parents’ lifestyle-related discussions in focus groups was published in Acta Paediatrica (2012), Christina Stenhammar and myself (Michael Wells) headed up this peer reviewed journal article along with A. Åhman, B. Wettergren, B. Edlund, and our advisor, Anna Sarkadi. The article focuses on Swedish parents’ needs, obstacles, and solutions to providing their young children with a healthy lifestyle.

Aim:  To explore parents’ perspectives on providing their preschool child with a healthy lifestyle, including obstacles and resources.

Methods:  Five semi-structured focus group interviews were conducted, with 30 parents of 4-year-olds in Sweden. Interviews were transcribed verbatim and analysed using Systematic Text Condensation.

Results:  Four themes emerged from the qualitative analysis: Lifestyle –‘The way you live is parents’ responsibility’, Challenges to promote children’s healthy lifestyle, Support from professionals, and peers might facilitate, and Request for an overall responsibility from society. Parents felt that they were role models for their child’s lifestyle, a concept including many factors. Attractive and tempting sedentary activities and unhealthy foods were perceived as obstacles, and parents were frustrated by the media’s contradictory lifestyle messages. Child health services were expected to more actively invite parents to discuss their child’s lifestyle issues. Parents desired some collective responsibility for children’s lifestyles through agencies, services and media messages that support and promote healthy choices.

Conclusion:  Parents struggled to give their children a healthy lifestyle and the ‘temptations’ of daily unhealthy choices were causing hassles and conflicts. Parents desired professional support from preschools, Child Health Centers and a collective responsibility from society to create uniform guidelines about healthy eating and exercise. Parents groups were mentioned as peer support.

Literature Review on Parental Leave in Sweden and Their Child Health Centers

‘Do Father-Friendly Policies Promote Father-Friendly Child-Rearing Practices? A Review of Swedish Parental Leave and Child Health Centers’ was published in the Journal of Child and Family Studies (2012). We reviewed the literature on how parental leave policies in Sweden have influenced two well-defined areas of early father involvement: participating in parental leave and at visits/activities at the Child Health Centers.

Sweden has one of the most comprehensive and egalitarian parental leave policies in the world, permitting parents to take 480 days off of work, receive 80% of their pay for the first 15 months, and divide their leave however they see fit, barring that both parents receive 2 months of parental leave that is exclusive to them. Additionally, fathers are permitted to take the first ten working days off to be at home with his family.

Most parents, especially mothers, use parental leave throughout their infant’s first year. During the parents’ time off from work, nearly all Swedish parents (95–99%) utilize the Child Health Centers between 11 and 13 times during the infant’s first year of life. The Child Health Centers help to monitor a child’s growth and development, provide parenting support, immunizations, health education, health screenings, and provide referral sources if the child has any special needs. However, fathers only use 22% of all parental leave days.

Studies have pointed out that fathers may not use parental leave because of corporate, maternal, and financial attitudes. Despite the Child Health Centers’ policy of including both parents, fathers do not utilize the Child Health Centers to the same extent as mothers, because they are mainly only open during normal working hours, they are dominated by females (staff and mothers), and many conversations during the child’s first year are directed towards mothers (i.e. breastfeeding).

Swedish fathers have barriers to utilizing parental leave and have barriers at the Child Health Centers; therefore, fathers may not learn about their child’s health (i.e. growth and development) during the most formative years. This empowers mothers, since they are learning about their child’s health, and therefore become the child’s health expert and have formed relationships with the Swedish child health nurses. This may discourage fathers from taking an active role in their child’s health care; thus barriers need to be removed so that fathers can participate more in their young child’s health, if the Swedish health care system is to be more egalitarian.