Enhancing low-income parents' capacities to promote their children's health: education is not enough

The effect of poverty and income disparity on the psychological well-being of Hong Kong children

OBJECTIVE

This study explored the impact of poverty and income disparity on the psychological well-being of Hong Kong Chinese children.

DESIGN AND SAMPLE

A cross-sectional study was conducted in 12 elementary schools from the three highest and three lowest median household income districts. A total of 1,725 pupils were recruited with 898 pupils came from low-income and 827 from high-income families.

MEASURES

Participants were asked to respond to the Chinese version of the Center for Epidemiologic Studies Depression Scale for Children, the Rosenberg self-esteem scale, and the Pediatric Quality of Life Inventory. The data were collected from 2012 to 2013.

RESULTS

Children from low-income families reported statistically significant lower scores in self-esteem and quality of life, but higher scores in depressive symptoms than those from high-income families. Income disparity had their greatest impact on children's self-esteem.

CONCLUSION

This study has addressed a gap in the literature by comparing the self-esteem, depressive symptoms, and quality of life among children living in low- and high-income families. The results add further evidence to the literature that poverty and income disparity may have a negative impact on the psychological well-being of children.

The role of public health agencies in addressing child and family poverty: public health nurses' perspectives

Poverty rates among child-bearing families in industrialised countries remain unacceptably high and have significant implications for population health. Both today and in the past, public health nurses have observed the impact of poverty on family health and well-being every day in their practice; yet, their perspectives on their role in addressing child and family poverty are currently absent from the literature. This paper presents findings of a qualitative descriptive study that explored perspectives of public health nurses in an urban Canadian setting about the impact of poverty on the well-being of children and families, and the potential roles of health organisations and public health nurses in addressing this issue. A key finding is the large gap between the role that nurses believe they can potentially play, and their current role. Barriers that public health nurses encounter when attempting to address poverty are identified, and implications of the findings for public health policy, practice, and research are discussed.

Development of the role of public health nurses in addressing child and family poverty: a framework for action

AIM

The purpose of this paper is to invite dialogue about how public health nurses could best address child and family poverty. Their current role is reviewed and a framework for expanding this role is presented.

BACKGROUND

The negative health consequences of poverty for children are well-documented worldwide. The high levels of children living in poverty in wealthy industrialized countries such as Canada should be of concern to the health sector. What role(s) can public health nurses play in addressing child and family poverty?

METHOD

A review of scholarly literature from Canada, the United States of America and the United Kingdom was conducted to ascertain support for public health nurses' roles in reducing poverty and its effects. We then reviewed professional standards and competencies for nursing practice in Canada. The data were collected between 2005 and 2006.

FINDINGS

Numerous nursing scholars have called for public health nurses to address the causes and consequences of poverty through policy advocacy. However, this role was less likely to be identified in professional standards and competencies, and we found little empirical evidence documenting Canadian public health nurses' efforts to engage in this role. Public health nurses' roles in relation to poverty focus primarily on assisting families living in poverty to access appropriate services rather than directing efforts at the policy level. Factors associated with this limited involvement are identified. We suggest that the conceptual framework developed by Blackburn in the United Kingdom offers direction for a more fully developed public health nursing role. Prerequisites to engaging in the strategies articulated in the framework are discussed.

CONCLUSION

Given more organizational support and enhanced knowledge and skills, public health nurses could be playing a greater role in working with others to make child and family poverty history.

Toward a critical theoretical interpretation of social justice discourses in nursing

Despite widespread appeals to social justice, nursing conceptions of this ideal have been critiqued as incomplete and inconsistent. With the aim of contributing to a critical dialogue on discourses of social justice in nursing, we explore contemporary theories of social justice and their move beyond a distributive paradigm, employing techniques of replication and critique of social justice discourses in nursing. We consider how postcolonial feminist theory can help us understand the relevance of more recent critical interpretations of social justice, particularly in reinterpreting and broadening nursing's individualistic focus on social justice so that due consideration and actions are directed toward the intersecting impact of historically and socially mediated conditions on health and human suffering.

Low-income Canadians’ experiences with health-related services: Implications for health care reform

This study investigated the use of health-related services by low-income Canadians living in two large cities, Edmonton and Toronto. Interview data collected from low-income people, service providers and managers, advocacy group representatives, and senior-level public servants were analyzed using thematic content analysis. Findings indicate that, in addition to health care policies and programs, a broad range of policies, programs, and services relating to income security, recreation, and housing influence the ability of low-income Canadians to attain, maintain, and enhance their health. Furthermore, the manner in which health-related services are delivered plays a key role in low-income people's service-use decisions. We conclude the paper with a discussion of the health and social policy implications of the findings, which are particularly relevant within the context of recent health care reform discussions in Canada.

Assessing the policy environment

This article proposes a basic framework for assessing the policy environment. Environment is a key concept in nursing's much-discussed "metaparadigm," but the policy environment is rarely considered. Too often, bedside nurses do not recognize the policy dimensions of clinical practice issues. Yet nursing assessment involves identifying and appraising aspects of patients' situations that are salient to their responses to actual or potential health problems. Policy may be such a salient factor, as it shapes the physical aspects of patients' surroundings; the relationships possible between practitioners and patients; the institutions in which health care is offered; and, on a broader scale, the prospects for global survival. This article proposes a question-based framework for clinical practice nurses to use in assessing the policy environment.

Randomized controlled trial of a family problem-solving intervention

Adaptive problem solving contributes to individual and family health and development. In this article, the effect of the cooperative family learning approach (CFLA) on group family problem solving and on cooperative parenting communication is described. A pretest or posttest experimental design was used. Participant families were recruited from Head Start programs and exhibited two or more risk factors. Participant preschool children were screened to have two or more developmental delays. Direct behavioral observation measures were used to determine group family problem solving and cooperative parenting communication outcomes. Few group family problem-solving behaviors were coded, and they displayed little variability. However, intervention parents increased the length of time they played and extended the cooperative parent-child interactions. The evidence shows that CFLA has the potential to enhance parental-modeling of cooperative behavior while engaged in play activities with preschoolers. Direct measurement of group family problem solving was difficult. Solutions are suggested.

Nursing students' beliefs about poverty and health

PURPOSE

This paper examines baccalaureate nursing students' beliefs about the relationship between poverty and health, and the factors that influence these beliefs.

BACKGROUND

The relationship between poverty and health is well established, and poverty remains a persistent problem in many industrialized nations. Nurses' understanding of how poverty influences health will affect how they interact with individual clients as well as the strategies they employ to address poverty-related issues. No studies have examined nursing students' understandings of how poverty influences health and the factors that influence that understanding.

METHODS

A cross-sectional survey of a random sample (n = 740) of basic baccalaureate nursing students was conducted in three Canadian universities in 2000. Students completed a 59-item questionnaire eliciting data on demographic variables, personal and educational exposure to poverty, beliefs about the relationship between poverty and health (myth, drift, behavioural, structural), and attitudes to poverty.

RESULTS

Students were most likely to adhere to a structural explanation of the relationship between poverty and health. Very little of the variance in myth and drift explanations was accounted for by course or personal exposure, programme level, age, and attitudes toward poverty. Greater course exposure and more positive attitudes toward the poor predicted support for the structural explanation. Support for the behavioural explanation was influenced by attitudes toward the poor and, to a lesser extent, by course exposure, age, and programme level.

CONCLUSION

Students would benefit from greater exposure to poverty through coursework that emphasizes the structural factors contributing to poverty and its negative health consequences. Classroom experience should be complemented with clinical placements that provide students with opportunities to interact with families living in poverty and to work collaboratively with others to address the causes and consequences of poverty at community and policy levels.

Pediatricians advocating for children: an annotated bibliography

PURPOSE OF REVIEW

Pediatricians have for many years been strong advocates for the health and safety of children. This article reviews the health literature to provide a historical perspective of advocacy efforts of pediatricians and examples of advocacy for patients at the bedside, in the community, and through local, state, and federal legislation, as well as policymaking. Studying these advocacy activities and incorporating them into pediatric practice and education of residents will surely result in stronger, healthier, safer, and happier children and families.

RECENT FINDINGS

Some of the cited works relate to pediatric advocacy in general, and some relate to advocacy for specific pediatric topics. Also, articles relating to the education of medical students and pediatric residents are reviewed; they may be of benefit to educators who develop advocacy curriculum.

SUMMARY

A review of the MEDLINE literature database from 1966 through October 2003 was performed looking for the terms advocacy (child advocacy, consumer advocacy, legislative advocacy, patient advocacy), as well as advocacy education and training, and was limited to children from birth through 18 years. The titles and many of the abstracts of 4580 articles were reviewed, and 104 articles were read in full. From these, 68 were selected for review here; they were thought to be of particular interest to practicing pediatricians and pediatric educators.

The role of the health sector in addressing poverty

PURPOSE

To explore Canadian health sector initiatives addressing poverty.

METHODS

Information about 224 health sector initiatives addressing poverty was collected from Health Canada, provincial/territorial health ministries, and health regions.

RESULTS

Health Canada, 12 provincial/territorial health ministries, and at least one third of health regions have been undertaking poverty-related initiatives. Almost two thirds (64.7%) of initiatives focused on the consequences of poverty. Much less frequent were initiatives that aim to: raise awareness about poverty; prevent people from becoming poor; enhance skills and education of people in poverty; and alter social and economic conditions contributing to poverty.

DISCUSSION AND CONCLUSIONS

While strategies that focus on the consequences of poverty likely enhance the health of Canadians in poverty, these strategies do little to reduce poverty rates. Efforts to improve the health of both individual Canadians in poverty and society as a whole will be limited until the health sector uses more strategies that challenge fundamental structural conditions contributing to poverty.

Healthy eating for rural low-income toddlers: caregivers' perceptions

Caregivers exert a powerful influence on young children's eating habits. This qualitative study used focus groups to assess nutritional needs and barriers in establishing healthy eating habits in toddlers. Three focus groups were conducted with rural, low-income caregivers, 2 with men and 1 with women, in 3 rural Michigan counties. Four major themes emerged: (a) barriers to providing healthy meals, (b) division of responsibility, (c) mealtime behavior, and (d) desired nutrition education. The major barriers identified were work schedules; cost of food; inadequate time to shop, plan, and prepare nutritious meals; or a combination thereof. Caregivers expressed concern for the nutritional well-being of their toddlers. The perceived needs and perceptions of low-income caregivers need to be considered when providing nutrition education. Findings from this study provided the basis for developing a nutrition education intervention for low-income parents of young children.