Adult Daughters’ Influence on Mothers’ Health-Related Decision Making: An Expansion of the Subjective Norms Construct

Abstract

This study of mother-adult daughter communication uses qualitative methods to explore the appropriateness of including adult daughters as referents in the measurement of subjective norms (a behavioral theory construct) related to the use of mammography and other health-related tests and services. The methods were chosen to approximate as closely as possible the mother-adult daughter relationship in the context of daily life. This inductive approach contrasts with the deductive origins of the construct. A sample of nine Mexican and Filipina immigrant and U.S.-born mothers and their adult daughters was recruited. Data were collected in two phases: (a) videotaped observations of mother-daughter dyads discussing health-related topics and (b) follow-up interviews designed to obtain an emic (insider) perspective of the videotaped interaction. Results show that adult daughters influence their mothers' ability to navigate the health care system and contribute to health-related decision making and behavior, suggesting that it may be appropriate to include adult daughters in the assessment of subjective norms.Keywords mother-daughter relationship; breast cancer screening; subjective norms Breast cancer is the most commonly diagnosed type of cancer among Mexican and Filipina immigrant and U.S.-born women in California (California Cancer Registry, 2007). Compared to Whites, these women are more likely to be diagnosed at later stages and are more likely to die from this disease (American Cancer Society, 2008; California Cancer Registry, 2007). Latestage diagnosis is attributed in part to lack of participation in early detection behaviors such as mammography screening, access to salient information and education necessary for optimal health choices, and successful navigation of the medical care system (Borrayo & Jenkins, © 2009 by SOPHE Address correspondence to Pamela K. Washington, University of California, San Francisco, 1450 3rd Street, MC 0128, PO Box 589001, San Francisco, phone: (415) 385-6862; pamela.k.washington@gmail.com.. 2001). Health behavior research has developed a body of theory designed to explain and to predict practices such as the use of screening mammography and to inform interventions to increase screening (Rakowski & Breslau, 2004). However, concerns are frequently raised about the lack of attention to culture and social context in these theories and the extent to which the theories are meaningful among diverse communities (Kagawa-Singer, 2000). NIH Public AccessThe current research arose from our study titled Behavioral Constructs and Culture in Cancer Screening (3Cs), a mixed-method (inductive qualitative and deductive quantitative) intensive assessment of the cultural appropriateness of the five behavioral theory constructs most commonly used to explain breast cancer screening and to inform interventions to promote mammography: perceived threat, perceived benefits, intention, self-efficacy, and subjective norms. This analysis explores the specific case of mother-adult daughter comm...

Mother-Daughter Communication About Mammography in an Australian Sample

“…Table 2 outlines the marital status and highest level of education achieved for each participant. Consistent with data from culturally diverse samples (Mosavel et al, 2006;Mosavel & Thomas, 2009;Washington et al, 2009), daughters in our sample were more highly educated than their mothers.…”

“…In Anglo-Australian culture, an individualistic worldview dominates (Bornstein et al, 2007), in contrast to the collectivist worldview that prevails in the Latino and Filipino samples used by Mosavel andcolleagues (2006, 2009), and by Washington et al (2009).…”

“…The studies reviewed in the previous section were conducted in cultural contexts that are notably dissimilar to the dominant Australian culture. The studies by Mosavel et al (2006), Mosavel and Thomas (2009) and Washington et al (2009) targeted ethnic minorities or migrant groups in English-speaking Western settings, where daughters were often more educated and more acculturated than their mothers. Thus, the educational and economic gaps between generations were particularly apparent in these previous studies, perhaps enhancing the daughters' perceived status and trustworthiness in the eyes of their mothers.…”

“…Furthermore, participants reported that their mothers often heeded their advice. Convergent evidence for the daughters' self-reports was provided in a related focus group study with mothers of the same demographic (Mosavel, 2009 As part of a separate program of research, Washington, Burke, Joseph, Guerra, and Pasick (2009) conducted observations of interactions between Filipino and Mexican mothers and their adult daughters (over 30 years of age), as well as follow-up interviews with each woman separately. They reported evidence of mothers consulting their adult daughters for health advice, as well as evidence of daughters facilitating the health care of their mothers, even if they were not in need of assisted care.…”

Risk, Activism, and Empowerment

“…Family also plays a role in how patients seek out and interpret information. Women often receive information about breast cancer from their loved ones (Washington et al, 2009). Women tend to feel as though they, not the physician, bear the responsibility to inform family members of their genetic cancer risk, which may also increase anxiety about a diagnosis (Macdonald et al, 2008).…”