Category Archives: Research Projects

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.

 

Dissertation (Avhandling) Cover Photo

I’m often asked by fellow PhD students–what should I have on the cover of my dissertation (avhandling) book?

To me, the answer was very clear–I wanted the overall message, the theme, of my dissertation to be front and center on the cover.

If a picture is worth a thousand words, then I should shorten my dissertation 😉

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I had a childhood friend, Kirb Brimstone (also found on Facebook here), do the artwork. I advised him what I wanted and he drew it.

Here’s the significance of my cover art:

Since my dissertation is about how fathers are not provided with an equal chance to parent, both through the Swedish family policies and through the institutions, like the child health field, I had this represented on the cover.

There’s an illustration of Sweden in the background, with a father, presumably from Uppsala University, holding his daughter’s hand as he walks towards a nurse and a preschool teacher.

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The nurse and preschool teacher are both women, signifying the gender difference men/fathers face at the outset of garnering parenting advice from these individuals.

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However, he is stopped at a fence, with a lock, signifying the gatekeeping that is happening as those who have knowledge about young children’s health hold the keys (and therefore the power) to inform or not inform others about young children’s health.

In this case, fathers feel like the gate is closed, and that they have several barriers to break down before they can be fully accepted into the child health world.

Even my own institution highlights the lack of the importance of fathers, as it is aptly named “Women’s and Children’s Health“.

Mainly people in Sweden and around the world believe that Sweden is a very gender equal country. And to its credit, it most certainly is, especially relative to other countries. But that doesn’t mean that there isn’t a vast amount of work still needed before achieving gender equality. While many people work with the struggle for equal rights for women, few pose the argument on ways men/fathers are discriminated against, not the least of which is through the Swedish child health field.

With that in mind, the sign on the gatekeeping fence has a sign saying “Nullius in Verba” which is Latin for “take nobody’s word for it”. In other words, just because people believe Sweden is a gender equal country, and that men/fathers hold all of the power–do not take societies word for it.

Seek out the truth…..by reading my dissertation.

You can find a copy of my dissertation by clicking here.

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One last thing–I gave a tip of my hat to the father-figures in my life: my father (JSW), my two grandfathers (KFE & CRW), and my best childhood friends dad (SP) by having their initials “carved” into the fence on the right-hand side. This was also intended as a symbolic gesture, suggesting that these fathers had reached the gate, but were stopped and couldn’t be as involved in all aspects of childrearing as they might have liked due to the various levels of gatekeeping that they encountered.

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!

 

First (book chapter) publication: Using Semiotics to Research Father Involvement in Sweden Child Health Care Centers

In the summer of 2008, I flew over to Sweden for the first time. In fact, I flew the day I graduated from Ohio State University with my master’s degree in Human Development and Family Science.

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I was offered a 3 month summer job doing fatherhood research for Dr Anna Sarkadi (see her blog here), Uppsala University.

I was quickly assigned to travel around Sweden in order to see why fathers weren’t visiting the Child Health Centers (Barnavårdscentral [BVC] in Swedish) as often as mothers. I went to 6 different counties; heading into cities like Stockholm, Gothenburg and Uppsala to rural areas like Tanumshede and in between places like Mora and Leksand.

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I set off to find out what some of the barriers and obstacles might be by interviewing nurse from the Child Health Centers on how they involve fathers, as well as assessed the waiting room environment.

Assessing the waiting room was quite novel and unique. We used a process called semiotics, which helps people to understand a picture at both its manifest and latent level. The manifest level tells exactly what’s seen in a picture, while the latent analysis tells what is meant by that picture.

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So for example, when looking at gender differences:  At the manifest level, these pictures on the bulletin board shows a woman running (physical activity), while a man is smoking (tobacco habits). The other two pictures are not of people, and therefore are excluded from this analysis. Latent: These pictures convey a positive health message about women and a negative health message about men.

Before this analysis, semiotics was just used to describe one picture. What we’ve since done was to say that an entire environment can be assessed using this technique. So we (Jonas Engman, Anna Sarkadi, and myself) analyzed each picture of men, women, and children (differentiating men from fathers and women from mothers if there were or were not children in that picture) and then tallied them up to see how many messages on the manifest level were there related to men/fathers, women/mothers, and children and then how many of those were positive or negative.

If the room was mostly equal between these three groups, then it was termed Family Oriented, meaning that all members of the family were welcome. However, if one of the family members was missing, then different terms were used such as, mother-child oriented, woman oriented, and child oriented. A fifth group was termed neutral, as there were no pictures of people on the wall within the waiting room.

My first book chapter was published with co-author Jonas Engman in the Swedish-written book Föräldrastöd i Sverige idag – Vad, När, och Hur? (Parental Support in Sweden today – What, When and How?

The book chapter is linked in here: BVC Book Chapter

My chapter

The English article is published in the journal Semiotica.

If you analyzed this picture, what would be the manifest and latent analysis (viewing only the picture, not the words):

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