The Effect of Parental Stresses on Childhood Obesity in Head Start Children: A Photovoice Inquiry

The Effect of Parental Stresses on Childhood Obesity in Head Start Children: A Photovoice

Inquiry Juliana Svistova, SUNY at Albany,

Kirsten K. Davison, Harvard University,

Janine M. Jurkowski, SUNY at Albany

Funded by the National Institute on Minority Health and Health Disparities (R24MD004865). Supported by: 1P20MD003373

About CHL• Family-centered childhood obesity prevention intervention project

• Family Ecological Model and Empowerment Theory

• Parent –centered CBPR approach

Participatory Community Assessment

• One of 9 data collection methods for participatory community assessment

• Goal of assessment- identify locally relevant social, cultural and environmental factors that influence low-income families’ ability to prevent childhood obesity and related risk factors

• Conducted Spring 2010 in Rensselaer County, NY

Photovoice: “a process by which people identify, represent, and enhance their community through a specific photographic technique” in which participants,

1) take pictures that are meaningful to them;

2) reflect on meaning of the images and critically discuss strengths and weakness of their social or physical environment represented in the photographs;

3) advocate for change by communicating what pictures revealed to those who influence program development and policy.

Photovoice as Research Method

• After developing photos, bring participants together in a focus group

• Have them select their most important pictures to reflect upon

• Develop probing questions as a guide for fostering critical discussion (e.g. SHOWED technique)

• Record or somehow document this discussion

Methods• Eligibility- parents of children participating in Head Start or Early Head Start

• Recruited by flier, word of mouth or directly by IRB certified parents or research staff

• Recruited through Head Start Centers

• 17 participants recruited

Methods• 12 parents received training and were given disposable cameras• Asked to document through photographs:

– Stressor or assets in their home and community that helped or hinder family activities;

– Identify factors that made it difficult (or easy) to support their family health and well-being.

• N=8 participated in the follow up focus group– given printed copies of their photographs– select the five most salient pictures to share with the group

– Explain their rationale for taking each picture in context of study purpose and participate in a group reflection of identified stressors or assets

• Photovoice discussion was audio recorded, transcribed, and de-identified for analysis.• Data was analyzed in Nvivo.

Ethics and Camera Training: Capacity

Building• Teach responsibility when using camera – Obtain permission from people prior to taking their picture.

– Understand potential risks of taking pictures in community

– Teach about how photography is documentation

– Train on the use of throwaway cameras- flash, etc.

– Prints can be given back to those photographed in addition to being used in project

Findings

• I had to do so much running around. I got home at 9:00. My daughter is screaming eat, eat, eat, eat, eat, eat, eat. So at this moment, what am supposed to do?.. Am I supposed to sit there and make pasta, get everything prepared, have my vegetables and everything that’s in my pasta that I usually do, or do I go in the freezer and get out the frozen French fries and the cheese sticks that we had last weekend? I’m going to go in the freezer. And that’s quick to me. I had put that in the oven. I have a picture, too. I put it in the oven for about 15 to 25 minutes, and dinner is served.

• If I do frozen food, like I’ll take frozen vegetables out of the freezer and put it in the oven. And French-fries with it. Something like that, but it is crazy trying to handle all of that and then get home and feed them a five-course meal. That’s not happening.

• Usually, if I have things that I have to finish up from work, we’re doing the quickest thing possible like a frozen pizza, or we’re doing Kid’s Cuisine or something because I just don’t have enough time to make a decent meal.

• So I don’t finish my work here, I take

work home with me. So sometimes if I’ve got a lot going on, I’ve got to kind of put what’s going on with my kids on the back burner so that I can get my job done, so that I can spend just a little bit of time with them before they go to bed at night.

We were in the middle of apartments. Um, and having just moved out of one into this one, but moving out of this one into another one, which we are now, where we are now. So this was a really bad time, a really bad time with working full time and – not having much help and four kids and moving. So this was pretty much my living room, um, for like three or four months.

My dishes from last night’s dinner are still sitting in the sink waiting for me to come home tonight.

Findings: Non-Stressors• Personal vehicle as a stressor and a “non-stressor”

• The importance of social support

• Joys of parenthood

The Good Enough Mother Dilemma

• I can’t pick her up. I can’t give her piggyback rides. It contributes a lot to being tired. I mean, I’m in school full time, so I’m already tired. Being a mother, I’m already tired. But being handi-capped makes it a lot harder. And, uh, it definitely wears on my, um, how I feel on a daily basis… I’m frustrated often, and I feel that – I battle with myself at night in bed because I feel like a piece of junk for being – for showing my child my frustrations…I beat myself up a lot for that.

Family Responsibilities versus Time and Space for

Self• That made me crazy. I didn’t sleep. I cursed everybody out. I was – she came over one day, and I was so pissed off.

•  Yeah, because it’s always me and them, so I really don’t have – I didn’t have an outlet. So it’s always, if they did something, you know, that wasn’t – wouldn’t be bad on any other day or that bad, I’d probably take it overboard. That was harsh.

Family Responsibilities versus Time and Space

for SelfI am a full time student. Believe it or not, you can’t see it, but there’s about 40 books in that box that I have to read for my senior seminar, which is basically my thesis that’s due in two weeks. And I haven’t started writing it yet. And I have three kids. And I’m a single mother. And I’m going crazy.

Oppressive Structures/Environmental

Stressors• She treated me like well, you’re on Medicaid, and you don’t know anything, and you’re not smart enough to deal with this. So I’ll just do it for you.

• And they treat you horribly. They treat you like you’re a total scumbag. They don’t appreciate people that come in there that are working, that are going to school or trying to do something to better their lives. They’re horrible.

Oppressive Structures/Environmental

StressorsThey think that because you’re coming to Social Services, you’re ignorant…I do research on everything that I do. So I went on the internet and printed out one of their handbooks on the rules and regulations and laws, so that every time that I go down there and they tell me I can’t have what I’m demanding, I show it to them…And it’s crazy that you have to go through this. And it’s not like, you know, they don’t know that you’re supposed to get it. But they just don’t want you to advance at any point.

CHL Photovoice Outcomes• High participation as a part of a broader CBPR process

• Enhanced understanding of community needs and assets: Parent Program created, expanded FEM (“social disparities and chronic stress”)

• Capacity building: Ethics and photography training

• Parents as experts and consciousness raising• Awareness raising: Town Hall presentation• Empowerment due to Photovoice not measured• Action and advocacy to affect policy: organizational practices on parent involvement

PV as Participatory Empowerment Intervention

In the focus group discussion parents: - acknowledge that stresses influence choices - show awareness and reflect on how stress affects family dynamics, mental health and breeds further stress-share strategies how to manage and overcome stress

PV as Participatory Empowerment Intervention

- explore the root of the problem as both individual and structural/systematic and how it plays out in their families - discuss oppressive intersections of economic instability, gender and disability and parental roles-express the need for advocacy and share stories of how they advocate for themselves and resist the system

Photovoice as Empowerment Intervention

• Against the notion that “they don’t know”; instead show that are very well aware of how stresses affect health

• Support the need to consult and engage parents as experts in program and policy inception that will directly affect them

• Create an empowering setting and a space for raising and sharing awareness; social networking and social support. E.g. a counterspace for oppressive social services