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Walsh, A., Meagher-Stewart, D. & Macdonald, M. (2015). Persistent optimizing: How
mothers make food choices for their preschool children. Qualitative Health Research,
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-data collection methods
-plan for data analysis
-strength (2)-provide support for your explanation with citations from additional sources. apa format. last 5 years
-weakness (2) -provide support for your explanation with citations from additional sources. apa format. last 5 years
Qualitative research methods have 5 categories Phenomenological looks at life experiences and then interpreted by the researcher. Grounded Theory examines social situations to be able to formulate new theories. Ethnographic research focuses on different cultures to better understand the impact of that culture on their overall behavior and health. Exploratory Descriptive research is done to get a result or solution to a problem. Historical research studies the past to help steer future developments. Once the information is obtained, the researcher analyzes, interprets, and develops themes and subthemes.
The nature itself of qualitative research leads to bias in both the research and the subjects. The results of any of the methods used require the researcher to take the information and analyze it. There is nothing to compare this information to and does not take different variable into account. The information the researcher is analyzing could be biased itself due to the way the information is obtained; personal experience from subject, historical ‘facts’, or researchers observations. It would be challenging, if not imposible, to have a control group to compare when analyzing a persons feelings, actions, thoughts, or events that have already occured. There is also no interventions in qualitative research.
My patient safety problem from week 1 was the relationship between the readmission rates of patients with chronic diseases and medication adherence following a hospitalization. I do not feel qualitative research method would be a viable option for this research problem. The readmission rate itself deals with a number or amount which automatically uses quantitative research methods.
Gray, J. R, Grove, S. K., & Sutherland, S. (2017). The practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis, MO: Elsevier.
Persistent Optimizing: How Mothers Make Food Choices for Their Preschool Children
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Cape Breton University, Sydney, Nova Scotia, Canada See all articles by this author
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, Donna Meagher-Stewart2
Dalhousie University, Halifax, Nova Scotia, Canada See all articles by this author
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, Marilyn Macdonald2
Dalhousie University, Halifax, Nova Scotia, Canada See all articles by this author
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First Published September 25, 2014 Research Article Find in PubMed
Volume: 25 issue: 4, page(s): 527-539
Article first published online: September 25, 2014; Issue published: April 1, 2015
1Cape Breton University, Sydney, Nova Scotia, Canada
2Dalhousie University, Halifax, Nova Scotia, Canada
Corresponding Author: Audrey Walsh, Cape Breton University, 1250 Grand Lake Rd., Sydney, Nova Scotia, Canada B1P 6L2. Email: [email protected]
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Mothers’ ability to provide healthy food choices for their children has become more complex in our current obesogenic environment. We conducted a total of 35 interviews with 18 mothers of preschool children. Using constructivist grounded theory methods, we developed a substantive theory of how mothers make food choices for their preschoolers. Our substantive theory, persistent optimizing, consists of three main integrated conceptual categories: (a) acknowledging contextual constraints, (b) stretching boundaries, and (c) strategic positioning. Implications to improve mothers’ ability to make healthy food choices that reduce their children’s risk of becoming overweight or obese are discussed.
Mothers play a vital role in providing healthy food choices for their young children. The complexity of this role has increased over the last few decades. Mothers are now making food choices in an environment that is considered obesogenic or obesity-producing. This environment has contributed to a rapid increase in the number of Canadian children becoming overweight and obese (Canadian Population Health Initiative [CPHI], 2004), constituting a critical public health issue in Canada.
Since the late 1970s the prevalence of childhood overweight and obesity in Canada has risen (Shields, 2006). Using the 2004 age-/sex-specific body mass index (BMI) classification cut-offs established by the International Obesity Task Force (IOTF), 26% of Canadian children and youth are overweight or obese (Statistics Canada, 2004). This prevalence rate increases when using the more recent 2007 World Health Organization (WHO) age-/sex-specific BMI classification cut-offs for children and adolescents (de Onis et al., 2007). The WHO growth charts estimate that 31.5% of Canadian children aged 5 to 17 years are overweight or obese (Statistics Canada, 2012).
Compared with their normal-weight peers, overweight and obese children suffer disproportionately from a number of chronic conditions such as type 2 diabetes, heart disease, bone and joint problems, and sleep apnea (Lobstein, Baur & Uauy, 2004; Public Health Agency of Canada [PHAC], 2011). These children report poorer health-related quality of life, intense stigmatization, lower self-esteem, and increased loneliness as their ability to move freely, play sports, and engage with peers is affected (Institute of Medicine [IOM], 2004; Lobstein et al., 2004). In addition, obesity-related health problems place a tremendous strain on present and long-term Canadian health care costs (Kuhle et al., 2011; PHAC, 2011). Kuhle et al. found that obese children living in Nova Scotia had significantly higher health care costs, more physician visits, and more specialist referrals than their normal-weight peers.
Feeding one’s family is work taken on primarily by mothers. Its gendered nature is well noted in the literature (Attree, 2005; Spitzer, 2005; Travers, 1996). On a daily basis, mothers generally make their young children’s food choices (Lindsay, Sussner, Kim, & Gortmaker, 2006; Statistics Canada, 2010a). Although seemingly simple, because much of the work involved is not visible to others (DeVault, 1991), making food choices is a complex social practice determined by many factors and their interactions (Delormier, Frohlich, & Potvin, 2009; Furst, Connors, Bisogni, Sobal, & Falk, 1996). Contextual factors such as social, economic, political, and environmental conditions can limit one’s agency and consequent capacity to make healthy choices. Therefore, it is important to examine the role that personal and environmental circumstances play when exploring how mothers make food choices for their children.
In this article, we report on a research project in which we explored the individual, interpersonal, and socioenvironmental factors and conditions that constrained mothers’ ability to make preferred food choices for their preschool-aged children, and the strategies that mothers used to push back against these constraints. We present a theoretical understanding of the process in which mothers engaged while making food choices for their preschool-aged children. This research was carried out by the first author as part of her PhD work and was guided by her supervisors, who are the coauthors.
A complex and interacting set of social, economic, cultural, technological, and environmental factors and conditions contributes to the problem of childhood overweight and obesity (Eriksen, Lyn, & Moore, 2010; PHAC, 2011). Combined, many of these factors and conditions create an environment that is obesogenic. An obesogenic or obesity-producing environment was defined by Swinburn, Egger, and Raza (1999) as “the sum of influences that the surroundings, opportunities or conditions of life have on promoting obesity in individuals or populations” (p. 564). This obesity-producing environment is the backdrop against which mothers are expected to make food choices that promote and protect their children’s health.
The literature contains descriptions of the many factors at different levels of influence that affect mothers’ ability to make healthy food choices for their children. On an individual level, a child’s food preferences might pose a barrier. Mothers are frequently challenged to promote nutritious food choices because children’s preferences are often for energy-dense foods and drinks that are high in sugar (Dwyer, Needham, Simpson, & Heeney, 2008; Holsten, Deatrick, Kumanyika, Pinto-Martin, & Compher, 2012).
A mother’s income, race, and education play a significant role. In Canada, single mothers with children and individuals living on social assistance are among the groups that experience the highest rates of food insecurity (Health Canada, 2006; McIntyre & Rondeau, 2009). Aboriginal women experience greater levels of poverty and therefore endure higher levels of food insecurity than non-Aboriginals (Health Canada; Power, 2008). Single-parent households, low-income households, and those with two working parents more often report having less time to prepare nutritious meals made from whole foods. They consequently rely on convenience foods that are less costly, quicker, and easier to prepare, but higher in fat and sodium (Broughton, Janssen, Hertzman, Innis, & Frankish, 2006; Raine, 2005). Homes of parents with higher levels of education tend to purchase healthy food on a more frequent basis (Cribb, Jones, Rogers, Ness, & Emmett, 2011; Ricciuto, Tarasuk & Yatchew, 2006).
At the interpersonal level, the mother–child relationship is an important factor in determining the foods that mothers select for their children. Although most studies indicate that mothers’ food choices are motivated mainly by their concern for their children’s health, many of these studies highlight inconsistencies between motivation and behavior as mothers engage in practices such as offering unhealthy foods to motivate their children’s eating behaviors (Slater, Sevenhuysen, Edginton, & O’Neil, 2012; Tucker, Irwin, He, Bouck, & Pollett, 2006). Brewis and Gartin (2006) found that although parents wanted their children to eat low-sugar, low-fat foods, many children were consuming calorie-dense foods even when directly supervised by parents. In addition, children often vetoed their mother’s healthier food choices for foods that were lower in nutritional value and higher in calories, fat, and salt (Colapinto, Fitzgerald, Taper, & Veugelers, 2007; Slater et al., 2012).
On a community level, features of the physical environment influence mothers’ food choices. Families that live in rural or deprived communities in North America often have less access to large supermarkets that provide variety and lower-priced healthy foods. Williams (2009) reported that the average monthly cost of a basic nutritious diet in rural Nova Scotia was greater compared to those in urban areas. In addition, rural and less-affluent communities are less conducive to maintaining a healthy weight (Oliver & Hayes, 2005) because they often lack resources such as safe and attractive trails, parks, and recreational facilities for indoor sports and activities (Dehghan, Akhtar-Danesh, & Merchant, 2005).
Finally, societal and political factors influence mothers’ food choices. Invasive marketing practices and campaigns strongly sway the decisions made by the uncritical consumer (Nestle, 2006; Winson, 2004). According to Winson, the foods most heavily promoted, marketed, and prominently placed in grocery stores were those that yielded the greatest margin of profit. In particular, these products included “pseudo foods,” or foods that were highly processed and high in sugar and/or fat and calories, and low in nutrients. The types of foods that were made available, marketed, and advertised influenced individuals’ preferences, purchases, and children’s requests (Gantz Schwartz, Angelini, & Rideout, 2007; Hastings et al., 2003; Taylor, Evers, & McKenna, 2005; Winson).
This overview of the literature provides valuable insight into the constraining factors from different levels of influence that challenge mothers in their attempts to make healthy food choices for their children. Notably absent in the literature were findings on the process mothers use to make their food choices in the face of all these factors. This gap in the research was the focus of our study.
We used a constructivist grounded theory methodology (Charmaz, 2002, 2006) to better understand the actions, interactions, or the process in which mothers engage when making food choices for their preschool-aged children. According to Charmaz (2005), a constructivist grounded theory demands going deeper into the phenomenon itself and its situated location in the world. In constructivist grounded theory, the researcher creates the data and ensuing analysis with the participants and reality arises from the interactive process and its temporal, cultural, and structural contexts (Charmaz, 2002, 2006).
Constructivist grounded theorists enter the field with a set of guideposts or sensitizing concepts based on extant literature or past experiences (Blumer, 1969; Charmaz, 2006). Consistent with the literature and our public health nursing backgrounds and beliefs, we used sensitizing concepts from the multifactoral socioen-vironmental health promotion (SEHP) perspective (Cohen, 2012; Labonte, 1993). Our knowledge of the SEHP perspective sensitized us to be alert to multiple-level factors and underlying conditions that perpetuate differences between people and limit their ability to make healthy choices (Charmaz, 2006; Labonte). It is important to stress that sensitizing concepts were used to assist us in asking questions and approaching the data with greater consideration of the background issues. Sensitizing concepts were not used to force a preconceived framework onto the data.
Recruitment and Sampling
Mothers with children between the ages of 3 and 5 were invited to take part in this study. Study participants were recruited from a variety of settings that provided services to preschool-aged children in a large municipality in eastern Canada. Upon receiving required research ethics board approval, mothers were recruited from settings that included public health services, family place resource centers, and early childhood centers.
Participants included 18 mothers with children between the ages of 3 and 5, who did not have any dietary restrictions and represented a range of economic, educational, cultural, and geographical backgrounds. Mothers ranged in age from 23 to 48 years, with an average age of 30 years. All mothers except one with twins had one preschooler at home. Eleven mothers were married or living in common-law marriages. Fourteen had a high school education or higher, 12 were unemployed, 10 had incomes below the Statistics Canada Low Income Cut-Off (LICO) rate (Statistics Canada, 2010b), and 8 had incomes above the LICO rate. Fourteen mothers resided in a city or town and 4 resided in a rural setting. Sixteen mothers were White, and 2 were Mi’kmaq (First Nations people indigenous to Canada).
In keeping with Morse’s (2007) recommendation to begin with a demographically homogeneous sample, we started with a sample of participants whose estimated before-tax yearly family income was below Statistics Canada’s LICO rate (Statistics Canada, 2010b). To add dimension to our emerging theory, once we heard the same central concerns from these mothers we expanded our sample to include mothers whose incomes were above the LICO rate.
The primary source of data collection was an initial face–to–face, semistructured interview followed by a second telephone or face-to-face interview. In addition, over the 16- month period of data collection, mothers brought to our attention issues such as child-focused product placement in grocery stores and increased pricing for products with cartoon or celebrity figures on the package. To obtain a clearer picture of the settings and situations described by mothers in their interviews, we made observations in local grocery stores and restaurants. These observations allowed us to create additional question probes to add to our interviews. All field notes were considered data and were analyzed using grounded theory methods.
All interviews followed a semistructured approach to allow each participant greater control over the inquiry process. Initial questions were broad and open-ended; as we interacted with the data and as categories were coconstructed, we adjusted the range of topics to gather more specific data to develop our theoretical framework. For example, each time a mother introduced a new topic or idea such as money, time, interpersonal conflict, or unique strategies, we added this insight to future interviews to see if it was common for other mothers. Data analysis began with the first interview.
Typed transcripts of the initial interviews were prepared and mailed to participants to read and verify. Following receipt of the transcript, we conducted a follow-up recorded interview with 17 of the 18 original participants. In the follow-up interviews, mothers were invited to discuss and provide further examples of findings that could be used to modify and saturate categories. Data collected during follow-up interviews were used to supplement those gathered from the initial narrative accounts.
The question of how mothers make food choices for their children was a clear and obvious one. The mothers who participated in this study were willing to share their stories and provide extensive and detailed data. For this study, 35 interviews with 18 participants was a sufficient number to build robust theoretical categories and thus reach saturation.
Consistent with grounded theory methodology, data collection, coding, and analysis occurred concurrently (Glaser & Strauss, 1967). We used QSR International’s (2008) NVivo 8 qualitative software to sort and code data. We followed the two main grounded theory coding phases described by Charmaz (2002, 2006) that consist of an initial phase and a focused, selective phase. Theoretical coding followed the selective phase.
In the initial or open coding phase, we read each transcript and asked questions of the data to identify pieces of data such as words, lines, or incidents to determine their analytical significance. In the second or focused selective coding phase, we took the most significant or frequently appearing initial codes to use in sorting and synthesizing larger segments of data. We used focused coding to develop categories, and like codes were subsumed into categories. For example, a number of initial codes pertained to a variety of strategies that some mothers used to better afford healthier foods; these were grouped together as a focused code, economizing. Other codes referred to strategies that mothers used to gain more time and to be better prepared to make healthier food choices; these were grouped together under enhancing time and effort. Both of these focused codes were subsumed under the category, managing resources.
Theoretical coding, as described by Charmaz (2006), is a sophisticated level of coding that suggests relationships between the categories developed during the selective phase of analysis. It is a process of coding that yields the conceptual relationship between categories and their properties (Glaser, 1978). For example, the managing resources category referred to a previously described set of strategies that mothers used to counteract contextual constraints. Two other categories, namely advancing healthy food choices and minimizing societal d
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