Embodied Context: Social Institutional Influences on Employed Mothers' Health Decision Making

Abstract

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.

Maternal Predictors of Toddler Health Status

“…findings from these studies may provide additional insight into maternal psychosocial characteristics that may affect child health. Furthermore, engaging in health-promoting behaviors is often difficult for women as they attempt to meet the multiple demands of employment, childcare, and family responsibilities (Kushner, 2005). The negative relationship between levels of stress and health promotion behaviors in postpartum women is consistent with Jesse and Reed's (2004) findings that women with high levels of stress during pregnancy were more likely to engage in risky health behaviors and less likely to engage in health-promotion behaviors.…”

“…Furthermore, engaging in health-promoting behaviors is often difficult for women as they attempt to meet the multiple demands of employment, childcare, and family responsibilities (Kushner, 2005). Furthermore, engaging in health-promoting behaviors is often difficult for women as they attempt to meet the multiple demands of employment, childcare, and family responsibilities (Kushner, 2005).…”

Meaning and Action in Employed Mothers' Health Work

“…This discourse also reinforces women's relative acceptance of "women last" in setting priorities to take care of personal and family health. Women's embodiment, in this study, of motherhood and family ideology and of their family and workplace circumstances increases the potential for self-care neglect (Kushner, 2005). It is important, however, to acknowledge women's comparative success in supporting personal and family health in everyday life as they negotiated their multiple responsibilities and the constraints imposed by social ideals.…”

“…Diana contended, "In order for me to keep my family healthy, I need to be healthy and if I'm not, I don't know what's going to happen." Regardless of their acceptance or rejection of the dominant self-sacrificial "good mother" ideal (Kushner, 2005), women expressed a need to give priority, at least, to an adequate level of self-care that prevented threat to their ability to fulfill everyday responsibilities.…”

The meta-volition model: Organizational leadership is the key ingredient in getting society moving, literally!

“…Social control (formal and informal sanctions) and influence (Cohen et al, 2006;Meier, 1982;Mittelmark, 1999;Valente and Pumpuang, 2007) Social capital and collective efficacy Social exchange and opinion leaders Women's studies Embodied context (values/ideals embodied or embraced through internal influences) (Brazy and Shah, 2006;Christakis and Fowler, 2007;Kushner, 2005;Tavares and Plotnikoff, 2008) Gender roles Behavioral economics Individual and societal (dis)incentives (Cohen and Farley, 2008;Day, 2006;Gordon-Larsen et al,;Green et al, 2009;Halpern et al, 2007;Pratt et al, 2004;Sturm, 2004;Wansink and Chandon, 2006; Market failure Availability bias (default decisions) Framing and priming Herd instinct (crowd influence) Social marketing and communications 4 P's: product, price, place, promotion (Andreasen, 1995;Borgatti et al, 2009;Brodie et al, 2001;Gantz and Wang, 2009;Grier and Bryant, 2005;Luke and Harris, 2007;Maibach et al, 2007;Gladwell, 2000) Communication channels and messengers Message packaging (e.g., entertainment value) Social networks Critical mass/tipping point (to spread practice beyond minority, must be promoted by 3 types: connectors, mavens and sales people) Social ecology and health policy Upstream-downstream approaches (Glasgow et al, 1999;Green et al, 2009;Katan, 2006;Kersh and Morone, 2002;Kumanyika and Ewart, 1990;Kumanyika et al, 2008;Smedley et al, 2000;Stokols et al, 2003) Population-level intervention (reach and exposure), multi-level intervention Implementation and dissemination science, including push-pull design principles (e.g., lowering the bar to make adoption of a behavior less costly financially and psychologically by developin...…”